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ANTIDEPRESSANTS

LIFESTYLE

NUTRITIONAL SUPPLEMENTS: ARE THEY FOR EVERYBODY?


For some age groups, nutrients gotten from mere diet might not be sufficient to keep the body running at a normal pace, hence the advent of nutritional supplements.

The sole reason for supplements is to help individuals achieve their daily nutrient intake and also help improve their health status as the case may be. Supplements are there to augment whatever lapses possible as diet alone might not be able to provide adequate amounts of a particular nutrient.

Nutritional supplements are consumables and the come either as capsules, pills or tablets. They are either the combination of a different nutrients (protein, fat, vitamins and minerals, carbohydrates, fiber) and compounds or just one nutrient that is produced by the body.

A supplement is mostly needed to help balance a particular nutrient in the body especially if there is a condition that requires more amount of that nutrient than the body can produce or mere diet can provide. It is not intended to substitute a healthy diet.

Research has it that the global market for nutritional and dietary supplements recorded over US$104 billion sales as at 2013. These sales was cut across globally among geriatric populations, pregnant women and the rising urban population.

The major types of supplements used are multivitamins, calcium supplements, fatty acids or fish oils, and mineral supplements.

CLASSES OF SUPPLEMENTS
The National Agency of Medicines suggests that dietary supplements be grouped according to their intended uses:
1. Food supplements as products which supplements the usual diet
2. Food stuff for particular uses which due to their special composition are targeted at certain groups e.g for special people with disordered metabolism, for infants from 2-5 months, for special sets of people with special physiological condition
Supplements also, can be classified according to their origin, texture, or in the form in which they are available. They could also be grouped as follows
i. Vitamins and minerals; in a combination form as multivitamin or multiminerals.
ii. Protein supplements; in form of liquid or tablets and not combined with other macronutrients.
iii. Different compositions of amino acids
iv. Meal surrogates in form of wafers, biscuits or powder
v. Carbohydrate supplement with/without electrolytes
vi. Supplements with natural anabolic effects
vii. Activator supplements of growth and other hormones
viii. Herbs etc.

Class Example Contents
Activator Amino acids Growth hormones and other hormones
Carbohydrate Dextrose Some vitamins and electrolytes
Herbs Ginseng, saw palmetto Amino acid and other plant sources
Minerals Selenium, zinc, multimineral tablets Contains only minerals
Multivitamins and minerals Vitamin D, calcium supplement Contains a mixture of vitamins and minerals
Oil supplements Cod liver oil, primrose oil Oil base with vitamins and minerals
Vitamins B complex, vitamin C (high doses) Contains only vitamins

Examples of Botanical supplements and their uses

Common Name Uses
1. Gingko biloba -Memory improvement, lowering blood pressure
2. Ginseng -overall health, anti-stress
3. Saw palmetto- Treating of bening prostatic hypertrophy
4. St Johns wort- Antidepressant
5. Valerian- Reducing anxiety
6. Green tea extract-  Antioxidant

Dietary Reference Intakes for Nutrients
The Dietary Reference Intakes (DRIs) are developed to help define nutrient requirements for healthy populations. These references are derivatives from scientific studies and researches to provide ranges for optimum to maximum indicators for good health, reduce the risk of chronic diseases and even the outcome of excessive intake on the health status of individuals.

RDA (recommended dietary allowance) simply is the average amount of a nutrient for a particular age/gender group that is thought to be sufficient to meet their nutrient requirement and bodily functionality in a day to about (97%-98%).

For an individual to be deficient of a nutrient, it means he/she is getting an inadequate supply of a particular nutrient(s). this would normally happen as a result of impaired digestion, absorption, transport or metabolism of nutrients. When these occurs, illness or diseases arises; then comes in nutritional supplements to the rescue.

WHEN IS THE BEST TIME TO SUPPLEMENT?

Consuming whole grains, vegetables, fruits, legumes, nuts and fishes might not just be sufficient for particular groups. Certain amounts of extra nutrients are needed to ensure they have reduced risk of disease and mortality rates.
Most times, these supplements are more effective when used for as preventive measures.

Groups with increased requirements:

1. Pregnancy and breastfeeding
– folic acid: pregnant and breastfeeding women would require a folic acid supplement in order to help their infants brain and spinal cords develop adequately. Their bodily supply wont be enough to sustain both mother and child, so supplementation is key at this period. In addition to a diet of folate-rich food sources which include okro, liver, cabbage, spinach, beans etc, a pregnant woman should take at least 400mcg of folate every day.
– calcium: (intake from dietary sources like milk, yoghurt, cheese, leafy vegetables, almonds is recommended) 1300 mg/day for women of 18 years; 1000 mg/day for those of 19 years and above. This is to help babies build healthy bones and teeth.
– vitamin D: 600 units/day; consider 2000mg for women in very extreme weather conditions (especially northerners )
– iron: . Iron is important in pregnancy to help create red blood cells and prevent anemia for both mother and child.
Recommended dosage is 27 mg/day. To prevent gestational anemia in non-anemic women, monitored supplementation at 120mg weekly is adviced ; given at the 1st day of the week in 2 divided doses
2. Aged people
• people from 60 and above always struggle with poor oral health, depression, dementia and social isolation. This might deter the intake of nutrient by this group and so supplementation is needed. Especially for nutrients like Vitamin B12 to avoid malabsorption and deficiency.

Conditions with risk of malabsorption:

• People that has undergone bariatric surgery: vitamins A, D, K, B1, B12, vitamin C and folic acid; calcium, copper, iron, selenium and zinc. Patients require routine supplementation with vitamins and minerals for 2 years or more, with doses higher than those provided by nonprescription supplements

• People diagnosed with several types of gastrointestinal diseases known to cause malabsorption or maldigestion (e.g., lactose intolerance, gluten-sensitive enteropathy, food allergies): fat-soluble vitamins, vitamin B12, vitamin K, zinc, iron, calcium

• People who might have swallowing, chewing or dental problems.

ADVANTAGES AND LIMITATIONS
There are quite a number of advantages attached to supplements as provide large content of nutrients in small volumes, specialized sporting needs, absence of unnecessary accompanying substances as fats, cholesterol and purines.

But for some reasons, some individuals tend to abuse these supplements by increasing the dosage or frequency which could result in a drop in the effectiveness of supplements. When this occurs frequently, the human body is forced to work harder to eliminate excesses.

An overdose of these supplements could lead to organ failure, hypervitaminosis, and endocrine disorders.

There are factors that lead to the appearance of side effects due to the toxicity of dietary supplements and they include: (i) dosage (ii) duration of intake (iii)special chemical properties found in supplements and their interactions with other foods (iv) the individuals weight (v) individual capacity.

SAFETY AND RISK LEVELS
These supplements have active ingredients that might be harmful to the body if not taken as prescribed by a physician, you should look out for reactions on your body as soon as possible and report to a healthcare center.
Some supplements can increase bleeding time if taken before surgery, while some can alter your response to anesthesia. Supplements have a tendency of reacting with some drugs in very detrimental ways and they include:
• Vitamin K can reduce the ability of the blood thinner warfarin to prevent blood from clotting.
• St. John’s wort can speed the breakdown of many medicines and reduce their effectiveness (including some antidepressants, birth control pills, heart medications, anti-HIV medications, and transplant drugs).
• Antioxidant supplements, such as vitamins C and E, might reduce the effectiveness of some types of cancer chemotherapy.
Metformin used by diabetics can reduce the absorption of vitamin B12

SOURCES:

1. McCormick DB. Vitamin/mineral supplements: of questionable benefit for the general population. Nutr Rev 2010;68(4):207-13.
2. Maher LK, Escott-Stump S. Krause’s Food, Nutrition, and Diet Therapy. 11th ed. USA: Elsevier, 2004. Vitamins. In: Kleinman RE, editor. Pediatric Nutrition Handbook. 5th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2004.

3. Fraga CG (2009) Plant phenolics and human health: biochemistry, nutrition and pharmacology, vol 1. Wiley, Hoboken

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DIET THERAPY OF DISEASES

GASTROPARESIS

GASTROPARESIS

As a saying goes thus : “ to eat is human, to digest is divine; a number of people find it difficult to utilize their digestive tracts after enjoying a sumptuous meal. Really, it’s saddening to be afraid to eat that very delicious meal because you know you would probably be bloated or even constipated. So, what to do? 

Let’s take a look at this exciting digestive disorder called gastroparesis, shall we?

Gastroparesis (abbreviated as GP) represents a clinical syndrome characterized by sluggish emptying of solid food (and more rarely, liquid nutrients) from the stomach, which causes persistent digestive symptoms especially nausea and primarily affects young to middle-aged women, but is also known to affect younger children and males.

It’s thought to be the result of a problem with the nerves (vagus) and muscles that control how the stomach empties.

Sadly, If these nerves are damaged, the muscles of your stomach might become dysfunctional and the motility of food can slow down.

“While delayed emptying of the stomach is the clinical feature of gastroparesis, the relationship between the degree of delay in emptying and the intensity of digestive symptoms does not always match”. For instance, some diabetics may exhibit pronounced gastric stasis yet suffer very little from the classical gastroparetic symptoms of: nausea, vomiting, reflux, abdominal pain, bloating, fullness, and loss of appetite. “Rather, erratic blood-glucose control and life-threatening hypoglycemic episodes may be the only indication of diabetic gastroparesis. In another subset of patients (diabetic and non-diabetic) who suffer from disabling nausea that is to the degree that their ability to eat, sleep or carry out activities of daily living is disrupted gastric emptying may be normal, near normal, or intermittently delayed”. In such cases, a gastric neuro-electrical dysfunction, or gastric dysrhythmia (commonly found associated with gastroparesis syndrome), may be at fault.

DIABETES AND GASTROPARESIS 

Over time, diabetes can affect many parts of your body (especially nerves). One of those is the vagus nerve, which controls how quickly your stomach empties. “When it’s damaged, your digestion slows down and food stays in your body longer than it should”.

Although it’s more common in people with type 1 diabetes, people with type 2 can also get it.

From a study carried out by Phillips LK et al., 2015 : 

Glucose and gastric emptying: bidirectional relationship. The rate of gastric emptying is a critical determinant of postprandial glycemia. Glucose entry into the small intestine induces a feedback loop via CCK, peptide YY (PYY) and glucagon-like peptide 1 (GLP-1), which are secreted from the intestine in response to nutrient exposure. GLP-1 and gastric inhibitory polypeptide (GIP) induce the release of insulin, and GLP-1 inhibits glucagon secretion, which attenuates postprandial glycemic excursions. Amylin, which is co-secreted with insulin, also slows gastric emptying. At the same time, the blood glucose concentration modulates gastric emptying, such that acute elevations of blood glucose levels slow gastric emptying (effects are evident even within the physiological range) and emptying is accelerated during hypoglycemia.

DIAGNOSIS

Diagnosis of gastroparesis begins with a doctor asking about symptoms and past medical and health experiences (history), and then performing a physical exam. Any medications that are being taken need to be disclosed.

Tests will likely be performed as part of the examination. These help to identify or rule out other conditions that might be causing symptoms. Tests also check for anything that may be blocking or obstructing stomach emptying. Examples of these tests include:

  • a blood test,
  • an upper endoscopy, which uses a flexible scope to look into the stomach,
  • an upper GI series that looks at the stomach on an x-ray, or
  • an ultrasound, which uses sound waves that create images to look for disease in the pancreas or gallbladder that may be causing symptoms.

SYMPTOMS 

The digestive symptom profile of nausea, vomiting, abdominal pain, reflux, bloating, early satiety, and anorexia can vary in patients both in combination and severity.

Others may include weight loss/weight gain, constipation and/or diarrhea, wide glycemic fluctuations in diabetics, belching and bloating-again, developing soon after meal ingestion and lasting for hours-along with visible abdominal distention. The distention and bloating may push up against the diaphragm making breathing uncomfortable.

“A poorly emptying stomach additionally predisposes patients to regurgitation of solid food, as well as gastroesophageal reflux disease (GERD)”. The reflux may range from mild through to severe. GERD complications can create esophageal spasm (also called non-cardiac chest pain) and can add to the burden of chronic pain. In severe cases, reflux aspiration pneumonitis compounds the clinical picture.

CAUSES

Reports from one tertiary referral center found that out of their 146 patients with gastroparesis: 36% were idiopathic (unknown causes), 29% were diabetic, 13% were post-surgical, 7.5% had Parkinson’s disease and 4.8% had collagen diseases. Any disease of metabolic, neurological (psychiatric, brainstem, autonomic including sympathetic and parasympathetic or enteric), or connective tissue (autoimmune) origin has the potential to disrupt gastric neural circuitry.

Apparently, diabetes is the most common known cause of gastroparesis. It can damage nerves — including the vagus nerve, which regulates your digestive system — and certain cells in your stomach.

Other causes of gastroparesis include:

Related Disorders

A stomach motor disturbance known as “dumping syndrome” whereby food or liquids empty too quickly from the stomach can present with similar symptoms as are found in gastroparesis. Other disorders that may clinically present as gastroparesis (gastritis, gastric ulcers, pyloric stenosis, celiac disease, and GI obstructions) need to be ruled out.

TREATMENT 

You may find these tips helpful:

  • instead of 3 meals a day, try smaller, more frequent meals – this means there’s less food in your stomach and it will be easier to pass through your system
  • try soft and liquid foods, or even semi solid foods which are easier to digest. In severe cases, broths might be advisable. 
  • Masticate well before swallowing ( i tried to check how long it’ll take to carefully grind a spoon of rice and i got 21seconds; you should try eating slowly. winks).
  • drink non-fizzy liquids with each meal

It may also help to avoid certain foods that are hard to digest, such as apples with their skin on or high-fibre foods like oranges and broccoli, plus foods that are high in fat, which can also slow down digestion.

MEDICATIONS 

Use of drugs like domperidone, erythromycin, anti-emetics. Also note that these drugs might have side effects so it’s important to discuss with your doctor before using them. 

Domperidone should only be taken at the lowest effective dose for the shortest possible time because of the small risk of potentially serious heart-related side effects.

Other options like electric stimulation, botulinum toxin injections, a feeding tube, surgery

FOOTNOTE FOR DIABETICS

The nerves to the stomach can be damaged by high levels of blood glucose, so it’s important to keep your blood glucose levels under control if you have diabetes.

Your doctor alongside a dietitian can advise you about any changes you may need to make to your diet or medicine. For example, if you’re taking insulin, you may need to divide your dose before and after meals and inject insulin into areas where absorption is typically slower, such as into your thigh.

SOURCES: https://www.nhs.uk/conditions/gastroparesis/

https://rarediseases.org/rare-diseases/gastroparesis
https://aboutgastroparesis.org/signs-symptoms.html/diagnosis-tests.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6028327
https://www.webmd.com/diabetes/type-1-diabetes-guide/diabetes-and-gastroparesis#1
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