When it came to deciding what to include and what not to include on this page, I had to set some criteria. The biggest problem I see in the Alternative or Complementary Medicine field, is lack of substantiation and documentation. With herbal medications, much of the literature produced by companies and literature is based on anecdotal stories. Things that people have reported this or that herbal has done for them. There is very few scientific double-blinded studies that compare the herbal to a placebo. While some may feel that it is not necessary to put herbals through this, citing the fact that herbals have been used for hundreds, possibly thousands of years, I believe herbals should be put through the same standards as any other drug. Just because something has been used for years, doesn't mean that it is appropriate for use. For years, we use to imprison the mentally ill or used treatments that killed patients for non-life threatening illnesses.
Just like any medication, herbals have both good and bad effects. These effects must be measured and balanced against the benefits that a person will derive from using the herbal. This goes for vitamins, supplements, health care practitioners, and health vendors.
For purposes of this web site, I will attempt to stick to only scientifically substantiated claims. If the claims are supported by a double blinded study, like with Cordyceps sinensis, I will mention that. If the only support is through anecdotal evidence and it is important enough to include in the item, then I will mention that.
If a specific product has met all of the criteria and a specific manufacturer has documented that their product has and does what they say it does, I will recommend a specific brand. Otherwise, no brand recommendations will be provided. One of the main items I look for in a brand name is that their product has been independently shown to deliver the precise, standardized dosage that appears on the label. Every capsule. Every bottle. Every time. This has been one of my greatest problems. Of the few companies that responded to my request for substantiation of their claims, most repied that their product was tested and met my requirements, but they would not provide details or support. Therefore, if your brand is not listed, that may be the reason. If you have a particular brand that has provided you the proof, please forward it to me. In my research to date, I have found that there is a university study underway comparing ten of the most used national brands. It is expected to be published later this year and you can be assured that I will have it here as soon as it is out. I found that there are several national brands, that while containing the herbal plant, they do not contain any of the active ingredients. Moreover, others have additional chemicals and drugs added, so beware. If you have not had the expected response from an herbal, it could be the brand that you are taking.
General Herbal and Supplement Criteria
To identify specific herbal remedies and brands to recommend, I have utilized some of the following criteria:
> Is there scientific data to identify unique and differentiated activities for the specific herbal?
> Is there a quality-control in place to ensure that the active ingredients are present and are not destroyed in the production process?
> Has the herbal been chemically analyzed to identify the specific active ingredient? This is important as some companies will use the whole plant, which may not provide enough of the active ingredient or may provide harmful ingredients.
> Are the active ingredients standardized to guarantee consistent levels and predictable health benefits?
> Are there sufficient safety studies and toxin analysis?
> Are the efficacy claims substantiated by documented scientific studies? This requires the herbal to provide a measurable effect on the body. It is not enough for a person to say that they "feel better" on a specific herbal.
For brand name multi-vitamins, I felt the following criteria were important:
> Preferably uses exclusively natural vitamin E because of its documented higher bioavailability.
Recent well-designed human pharmacokinetic studies demonstrate clearly that natural vitamin E has significantly higher bioavailability than synthetic vitamin E, even on an IU-for-IU basis (1;2). In fact a recent study by Kiose et al. (3) indicated that 100 mg of the natural RRR-a-tocopherol results in the same serum and lipoprotein uptake as 300 mg of the synthetic all-rac-a-tocopherol.
> Provides at least 50 % of the most recently established nutrient intake recommendations of the National Research Council (NRC) for adult men and women of all essential vitamins and minerals, except electrolytes, phosphorus, fluoride and iron.
The multi-vitamin should act as a supplement to the diet. Most people should be able to provide some of their needs in their diet.
> For those with antioxidant claims they should provide optimum amounts of antioxidant nutrients: 100-400 IU vitamin E, 200-500 mg vitamin C, 5,000-10,000 IU beta-carotene, and 70-200 mcg selenium.
> Uses optimum amounts of B-vitamins involved in homocysteine metabolism: at least 200 mcg folic acid, 1.5 mg vitamin B6 and 2.4 mcg vitamin B12.
The B-vitamins B6, B12 and folic acid are necessary to maintain normal, low blood levels of homocysteine. Homocysteine is an amino acid derived from methionine metabolism that can adversely affect lipid deposition and inflammation of the vascular wall.
> Uses optimum amounts of bone nutrients: 500-1,500 mg calcium, 210-700 mg magnesium, 200-800 IU vitamin D, at least 40 mcg vitamin K, and at least 1 mg boron.
> Provides significant amounts of carotenoids from multiple sources. Must provide at least 6 mg carotenoids which must include at least 3 out of the 5 most important dietary carotenoids: beta-carotene, alpha-carotene, lutein, lycopene and cryptoxanthin. Amounts must be specified.
Carotenoids are a major class of phytonutrients with many well-documented health benefits.
> Provides significant amounts of flavonoids from multiple sources. Must provide at least 20 mg of dietary flavonoids from at least 3 different, well-characterized sources. Amounts must be specified.
Flavonoids are recognized as an important group of phytonutrients with many health benefits. It is estimated that there are over 600 different flavonoids present in foods and beverages. Large epidemiological studies suggest that dietary flavonoid intake from fruits, vegetables, tea, grape juice and red wine is positively associated with cardiovascular health.
> Uses well-absorbable, bioavailable sources of trace minerals zinc, iron, copper, and chromium, such as organic acid salts and amino acid chelates.
Bioavailability and intestinal absorption efficiency for the divalent trace minerals iron, zinc, and copper, as well as for trivalent chromium is variable and depends to a great extent on solubility and the type of chemical ligand of these trace minerals.
> Free of potentially unsafe amounts of vitamins and minerals.
The recently published No-Observed Adverse Effect Levels (NOAEL) by the Council for Responsible Nutrition (CRN) serve as a credible guideline for all essential vitamins and minerals. The NOAEL are the highest daily amounts used as supplements in clinical studies without any significant adverse effects.
> Free of artificial fillers, binders, colors, flavors and preservatives.
This is largely a philosophical issue. The artificial ingredients typically used as excipients in capsules, tablets, softgels etc. are Generally Recognized as Safe (GRAS) by the Food and Drug Administration (FDA). However, in a few cases, safety concerns did surface even though the compounds were listed as GRAS. For example, among others, the artificial colors FD&C Reds #1 and #2, Yellows #3 and #4 were banned by the FDA for use in foods, drugs and cosmetics, and the safety of FD&C Red #3 (erythrosine) is currently an issue due to its high iodine content. Even though the FDA-required toxicity data may indicate no concerns at the time of approval, subsequent research may identify safety problems. Typically, many natural inert substances do not have these safety concerns, since they are and have always been present in natural foods with a long safety record. As a result, it may be wise to avoid the use of artificial fillers, binders, colors, flavors, preservatives and other artificial substances whenever possible.
> Meets USP XXIII disintegration guidelines: 30 minutes for capsules and uncoated tablets, 45 minutes for coated tablets.
The United States Pharmacopeia (USP) XXIII disintegration test methods and guidelines for vitamin capsules and tablets are widely recognized standards in the industry to ensure that the nutrients in capsules and tablets are made available for digestion and intestinal absorption in a timely manner.
I felt that the last three requirements were some of the most important, so in some cases, such as TwinLab, I made recommendations based on the fact that they had met the last three criteria, provided at least 50 % of the most recently established nutrient intake recommendations, and documented that their product delivered what it said it did. In the case of TwinLab, I overlooked the fact that many of their sources are synthetic. There is still a great deal of debate over the difference natural sources vs. synthetic sources in their effect on the body.
I thought this one would be a little bit easier. I was just looking for documentation that a manufacturer put in the bottle what they said they put in the bottle without any additives. Unfortunately what I found was that many manufacturers were unwilling to provide that documentation or independent studies were found showing that their product had additional ingredients that were unwanted.
So far, the only companies fitting my criteria for some or all of their products have been Pharmanex, Schiff, TwinLabs, and Upsher-Smith.
For product sources, I primarily relied on personal experiences and consumer reports. Does the company provide the products in a timely fashion? Have there been any reported complaints?
So far the only online sources fitting my criteria have been:
Pharmanex products are only available through the company. For more information on the products or for ordering productsplease e-mail me at Aquadoc@pol.net
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Health Provider Criteria
In seeking the services of any health care practitioner, the same criteria are used regardless if the practitioner is "mainstream" or "alternative".
> Are they licensed by the state?
> Do they work with your other health care providers? Be very careful with a practitioner that tries to steer you away from any traditional medical source. (in the same vein, be careful with a traditional source that tries to steer you away from an alternative therapy, without substantiation. It is a two-way street.) Alternative therapies need to be used in combination with traditional medicine. No one source offers all of the answers.
> Have you been thoroughly medically evaluated? You need to know what your problem is before you can seek appropriate treatment.
> Check their references. Ask others about the provider or the type of therapies offered.
> Check their training and background. If I were seeing you in person, I would expect that you would check into my training. Even on this site, I have included the information necessary for you to verify my background as a physician. Many of the "alternative medicine" sites do not.
> Keep abreast of the scientific literature on the therapies. If there is a risk of harm, weigh the benefits. If the only risk will be monetary and you are willing to risk that, then give it a shot. There are still therapies that we do not scientifically understand. Just make sure that the therapy will not make you worse or delay appropriate care.
> One very telling piece of information is to ask about liability coverage. If the provider tells you that there is no risk or that they do not need liability (malpractice) coverage, be very wary. There is always risk and if the provider says otherwise, then they are either a fool or a quack and I would not want either one to treat me.
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