Fiber

Overview

Dietary fiber, found in all plant-based foods, plays an essential role in human health. There are two types of fiber -- soluble and insoluble -- and most whole foods contain a combination of the two types. Both types of fiber help maintain the health of your digestive system and promote regular bowel movements.

Soluble fiber pulls in water to form a gel in the digestive tract. This slows digestion, so that your stomach and intestine don’t absorb as much of some nutrients, like starch and sugar. As a result, cholesterol levels go down over time, which may help prevent heart disease and stroke. Consuming soluble fiber may also improve glucose tolerance in people with diabetes. This type of fiber is a common ingredient in many over-the-counter laxatives. Psyllium husk, pectin, and the soft parts of fruits, dried beans, and peas are examples of soluble fiber.

Insoluble fiber, on the other hand, can be found in the peels of fruit, such as apples, blueberries, and grapes. It acts as a natural laxative that speeds the passage of foods through the stomach. It also gives stool its bulk and helps it move quickly through the gastrointestinal tract.

Getting more fiber in your diet has been shown to play a role in the treatment of conditions such as gastrointestinal disease, constipation, hemorrhoids, high cholesterol, heart disease, and diabetes. Most Americans don’t get anywhere near the amount of fiber -- 25 to 30 grams per day -- recommended in their daily diet.

 

 

 

Uses

Constipation

Many well-designed clinical studies have shown that fiber relieves constipation. Most clinical studies have used wheat bran and psyllium. Researchers think fiber relieves constipation by adding bulk to stool and helping it move faster through the intestines.

Diarrhea

Fiber can be used to relieve mild-to-moderate diarrhea. Soluble fiber soaks up water in the digestive tract, which makes stool firmer and slower to pass.

Irritable bowel syndrome (IBS)

Several well-designed clinical studies have found that soluble fiber helps regulate stool frequency and consistency in people with IBS.

Hemorrhoids

Your doctor may recommend soluble fiber to help soften stool and reduce the pain associated with hemorrhoids.

Inflammatory bowel disease (IBD)

A clinical study of people with ulcerative colitis (a type of IBD) found that psyllium seeds were as effective as the prescription drug mesalamine (Rowasa) in reducing recurrences of the disease.

Diverticulosis

Patients with diverticulosis are often given fiber supplements to prevent constipation and stop the condition from progressing. The American Dietetic Association (ADA) recommends 25 - 30 grams of fiber per day; your doctor may recommend more. Some researchers think that people with diverticulosis should avoid foods such as nuts, pumpkin, caraway, and sesame seeds. It is thought that these small particles may get lodged in the diverticula (pouches in the colon) and cause infection and irritation.

High cholesterol

Soluble fibers, such as those in psyllium husk (which contains both soluble and insoluble fiber), guar gum, flax seed, and oat bran, can help lower cholesterol when added to a low-saturated-fat, low-cholesterol diet. Clinical studies have shown psyllium, in particular, is effective in lowering total cholesterol levels as well as LDL (or “bad”) cholesterol levels.

Diabetes

Clinical studies suggest that a high-fiber diet may help prevent type 2 diabetes, lower insulin and blood sugar levels, and improve cholesterol and triglyceride (fats in the blood) levels in people with diabetes. In addition, one well-designed clinical study suggests that pregnant women with type 1 diabetes may be able to reduce the amount of insulin they use if they eat a high-fiber diet.

A clinical study compared people with type 2 diabetes who were eating 50 grams of fiber daily with people getting the American Diabetes Association’s recommended 24 grams of fiber daily. After 6 weeks, people on the higher fiber diet had better control of blood glucose, insulin, and blood lipids. In another clinical study, a group of men with type 2 diabetes who took psyllium twice daily lowered blood glucose and lipid values compared to a control group taking a placebo.

Obesity

Clinical studies and human case reports suggest that soluble fiber (such as psyllium, pectin, and guar gum) may make you feel full and less hungry, so that you eat less and lose weight.

Heart disease

Eating more high-fiber foods (such as oatmeal, oat bran, psyllium, and legumes) may help lower heart disease risk.

Coloncancer

There are conflicting results from studies examining whether a high-fiber diet can help prevent colon cancer. Some studies have suggested that fiber protects against the development of colorectal cancer. But most large, better-designed clinical studies have found only a small association between how much fiber people eat and their risk of colorectal cancer. In addition, fiber does not seem to protect against the recurrence of colorectal cancer in people who have already been treated for the condition.

Other types of cancer

Preliminary clinical evidence suggests that a diet high in fiber (in conjunction with lifestyle changes and conventional medication) may help protect against certain types of cancer such as prostate, breast, and lining of the uterus. Further studies are needed to be sure, however.

 

 

 

Dietary Sources

Soluble fiber is found in dried beans and peas, oats, barley, fruits, and psyllium seed husks.

Insoluble fiber is found primarily in fruits and vegetables, whole-grain products, whole grain cereals, and wheat and corn bran.

 

 

 

Available Forms

Fiber is available as a supplement in several forms, including fiber tablets, capsules, and powders. Fiber is also available as bulk fiber laxatives, including psyllium.

 

 

 

How to Take It

The following are daily fiber recommendations from the National Academy of Sciences' Institute of Medicine:

Pediatric

Infants and children under 18 years of age: There is no daily fiber recommendation for children. Children with specific fiber needs should increase the amount of foods with fiber they eat slowly over a period of days. Do not give fiber supplements to a child without first asking your doctor.

Adults

Males ages 19 - 50: 38 grams per day

Females ages 19 - 50: 25 grams per day

Males ages 51 and older: 30 grams per day

Females ages 51 and older: 21 grams per day

If you are not getting enough fiber, you may need to add more fiber-rich foods to your diet. Choose whole-grain products, raw or cooked fruits and vegetables, dried beans, and dried peas. Refined or processed foods, including fruit juices, white breads, pastas, and rice, and non-whole-grain cereals, are lower in fiber. The grain-refining process removes the outer coat (bran) from the grain, which lowers its fiber content. Peeling fruits and vegetables also decreases their fiber content.

 

 

 

Precautions

Because supplements may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable health care provider.

In general, fiber supplements may reduce or delay your body's absorption of certain medications. Try to take medications at least 1 hour before or 2 - 4 hours after taking fiber.

You should always drink an 8 oz. glass of water with fiber supplements. It is also important to drink at least 6 - 8 full glasses of water throughout the day to avoid constipation. Taking fiber supplements without enough water may cause the supplement to swell and could cause choking. Do not take this product if you have difficulty swallowing. People with esophageal stricture (narrowing of the esophagus) or any other narrowing or obstruction of the gastrointestinal tract should not take fiber supplements.

If you have chest pain, vomiting, or difficulty swallowing or breathing after taking fiber supplements, seek immediate medical attention.

Fiber can cause gas and bloating.

It is rare, but people who take soluble fiber supplements for a long time may develop allergic reactions (even anaphylaxis).

 

 

 

Possible Interactions

If you are currently being treated with any of the following medications, you should not use fiber supplements without first talking to your health care provider.

Antidepressant medications (Tricyclic antidepressants) -- Dietary fiber may lower the blood levels and effectiveness of tricyclic antidepressant medications. If you take tricyclic medications, talk to your doctor before taking fiber supplements or adding more fiber to your diet. Tricyclic antidepressants include:

Amitriptyline (Elavil)

Doxepin (Sinequan)

Imipramine (Tofranil)

Diabetes medications -- Fiber supplements may help to regulate blood sugar levels, but they can also reduce the absorption of some medications, such as glyburide (Diabeta) and metformin (Glucophage). Talk to your doctor before taking fiber supplements if you have diabetes, and don’t take fiber supplements at the same time as your medications. Wait a few hours in between.

Carbamazepine -- Taking soluble fiber such as psyllium with carbamazepine (Tegretol), a medication used to treat seizures, may decrease the absorption and effectiveness of carbamazepine. A doctor should monitor blood levels of anyone taking both soluble fiber and carbamazepine.

Cholesterol-lowering medications -- Combining psyllium or other soluble fibers with cholesterol-lowering medications known as bile acid sequestrants, may help lower cholesterol levels. If you take these medications, talk to your doctor to see whether psylium is safe and right for you. These drugs include:

Cholestyramine (Questran)

Colestipol (Colestid)

One study also found that when people taking simvastatin (Zocor) added psyllium supplements to their regimen, they lowered cholesterol levels as much as if they had been taking a double dose of simvastatin.

Digoxin -- Fiber supplements may reduce the body's ability to absorb digoxin (Lanoxin), a medication used to regulate heart function. Do not take fiber supplements at the same time as digoxin.

Lithium -- Clinical reports suggest that psyllium or other soluble fibers may lower lithium levels in the blood, making lithium less effective. Lithium levels should be monitored very closely by a health care provider, especially if there is any big change in fiber intake.

Melatonin

 

Overview

Melatonin is a hormone secreted by the pineal gland in the brain. It helps regulate other hormones and maintains the body's circadian rhythm. The circadian rhythm is an internal 24-hour “clock” that plays a critical role in when we fall asleep and when we wake up. When it is dark, your body produces more melatonin; when it is light, the production of melatonin drops. Being exposed to bright lights in the evening or too little light during the day can disrupt the body’s normal melatonin cycles. For example, jet lag, shift work, and poor vision can disrupt melatonin cycles.

Melatonin also helps control the timing and release of female reproductive hormones. It helps determine when a woman starts to menstruate, the frequency and duration of menstrual cycles, and when a woman stops menstruating (menopause).

Some researchers also believe that melatonin levels may be related to aging. For example, young children have the highest levels of nighttime melatonin. Researchers believe these levels drop as we age. Some people think lower levels of melatonin may explain why some older adults have sleep problems and tend to go to bed and wake up earlier than when they were younger. However, newer research calls this theory into question.

Melatonin has strong antioxidant effects. Preliminary evidence suggests that it may help strengthen the immune system.

If you are considering using melatonin supplements, talk to your doctor first.

 

 

 

Uses

Insomnia

Studies suggest that melatonin supplements may help people with disrupted circadian rhythms (such as people with jet lag or those who work the night shift) and those with low melatonin levels (such as some seniors and people with schizophrenia) to sleep better. A review of clinical studies suggests that melatonin supplements may help prevent jet lag, particularly in people who cross five or more time zones.

A few clinical studies suggest that when taken for short periods of time (days to weeks) melatonin is more effective than a placebo in reducing the time it takes to fall asleep, increasing the number of sleeping hours, and boosting daytime alertness. It’s not clear how well melatonin works, however – some studies suggest that it only reduces the amount of time to fall asleep by a few minutes.

A number of human studies have measured the effects of melatonin supplements on sleep in healthy people. A wide range of doses has been used, often taken by mouth 30 - 60 minutes prior to sleep time. Results have been mixed. Some evidence suggests that melatonin may work best for people over 55 who have insomnia. One study of 334 people aged 55 and older found that sustained-release melatonin seemed to help people fall asleep faster, sleep better, be more alert in the morning, and improve quality of life in people with primary insomnia.

Menopause

Melatonin supplements may help with sleep problems associated with menopause. However, it does not appear to relieve other symptoms of menopause, such as hot flashes. Peri- or postmenopausal women who use melatonin supplements should do so only for a short period of time since long term effects are not known.

Benzodiazepine Withdrawal

Some clinical research has found that melatonin may help elderly people with insomnia who are tapering off or stopping benzodiazepines such as diazepam (Valium), alprazolam (Xanax), or lorazepam (Ativan). Taking controlled-release melatonin improved sleep quality in those stopping benzodiazepine use. More study is needed.

Breast Cancer

Several studies suggest that melatonin levels may be associated with breast cancer risk. For example, women with breast cancer tend to have lower levels of melatonin than those without the disease. Laboratory experiments have found that low levels of melatonin stimulate the growth of certain types of breast cancer cells, while adding melatonin to these cells slows their growth. Preliminary evidence also suggests that melatonin may strengthen the effects of some chemotherapy drugs used to treat breast cancer. In a study that included a small number of women with breast cancer, melatonin (given 7 days before beginning chemotherapy) prevented the lowering of platelets in the blood. This is a common complication of chemotherapy that can lead to bleeding.

In another small study of women who were taking tamoxifen for breast cancer but seeing no improvement, adding melatonin caused tumors to modestly shrink in more 28% of the women. Women with breast cancer should ask their doctors before taking melatonin.

Prostate Cancer

Studies show that people with prostate cancer have lower melatonin levels than men without the disease. In test tube studies, melatonin blocks the growth of prostate cancer cells. In one small-scale study, melatonin -- combined with conventional medical treatment -- improved survival rates in 9 out of 14 men with metastatic prostate cancer. Interestingly, since meditation may cause melatonin levels to rise it appears to be a valuable addition to the treatment of prostate cancer. More research is needed before doctors can make recommendations in this area.

Attention Deficit Hyperactivity Disorder (ADHD)

Some evidence suggests that melatonin may help promote sleep in children in ADHD, although it does not seem to improve the behavioral symptoms of ADHD.

Other Uses

Sunburn -- A few small clinical studies suggest that gels, lotions, or ointments containing melatonin may protect against sunburn and other skin damage. Studies examined using melatonin alone or combined with topical vitamin E prior to UV light exposure from the sun.

Irritable Bowel Syndrome -- Some preliminary studies suggest that people with IBS who take melatonin reduce some symptoms of IBS, such as abdominal pain. But results are mixed as to whether melatonin may help improve other symptoms, such as bloating and frequency of bowel movements.

Epilepsy -- Some studies suggest melatonin may reduce the frequency and duration of seizures in children with epilepsy. But other studies suggest melatonin may increase the frequency of seizures. Do not take melatonin for epilepsy or give it to a child without talking to your doctor first.

 

 

 

Available Forms

Melatonin is available as tablets, capsules, cream, and lozenges that dissolve under the tongue.

 

 

 

How to Take It

There is currently no recommended dose for melatonin supplements. Different people will have different responses to its effects. Lower doses appear to work better in people who are especially sensitive. Higher doses may cause anxiety and irritability.

The best approach for any condition is to begin with very low doses of melatonin. Keep the dose close to the amount that our bodies normally produce (< 0.3 mg per day). You should only use the lowest amount possible to achieve the desired effect. Your doctor can help you determine the most appropriate dose for your situation, including how to increase the amount, if needed.

Pediatric

Always ask your doctor before giving melatonin to a child. Keep doses to less than 0.3 mg/day. There is not enough information to say that doses greater than 0.3 mg per day are safe in children under age 15. In fact, doses between 1 - 5 mg may cause seizures in this age group.

Adult

Insomnia: 1 to 3 mg 1 hour before bedtime is usually effective, although doses as low as 0.1 -0.3 mg may improve sleep for some people. If 3 mg per night does not work after 3 days, try 5 - 6 mg 1 hour before bedtime. You should work with your doctor to find the safest and most effective dose for you. The right dose for you should produce restful sleep with no daytime irritability or fatigue.

Jet lag: 0.5 - 5 mg of melatonin 1 hour prior to bedtime at final destination has been used in several studies. Another approach that has been used is 1 - 5 mg 1 hour before bedtime for 2 days prior to departure and for 2 - 3 days upon arrival at final destination.

 

 

 

Precautions

Because of the potential for side effects and interactions with medications, people should take dietary supplements only under the supervision of a knowledgeable health care provider.

Some people may have vivid dreams or nightmares when they take melatonin. Taking too much melatonin may disrupt circadian rhythms (your “body clock”).

Melatonin can cause drowsiness if taken during the day. If you are drowsy the morning after taking melatonin, try taking a lower dose.

Additional side effects include stomach cramps, dizziness, headache, irritability, decreased libido, breast enlargement in men (called gynecomastia), and decreased sperm count.

Pregnant or nursing women should not take melatonin because it could interfere with fertility.

Some studies show that melatonin supplements worsened symptoms of depression. For this reason, people with depression should consult their doctor before using melatonin supplements.

Although many researchers believe that melatonin levels go down with age, newer evidence has brought this theory into question. People older than 65 should ask their doctor before taking melatonin supplements, so blood levels of this hormone can be monitored.

 

 

 

Possible Interactions

If you are being treated with any of the following medications, you should not use melatonin without first discussing it with your health care provider.

Antidepressant medications -- In an animal study, melatonin supplements reduced the antidepressant effects of desipramine and fluoxetine (Prozac). More research is needed to know if the same thing would happen in people. In addition, fluoxetine (a member of a class of drugs called selective serotonin reuptake inhibitors, or SSRIs) can cause low levels of melatonin in people.

Antipsychotic medications -- A common side effect of antipsychotic medications used to treat schizophrenia is a condition called tardive dyskinesia, which causes involuntary movements. In a study of 22 people with schizophrenia and tardive dyskinesia caused by antipsychotic medications, those who took melatonin supplements had fewer symptoms compared to those who did not take the supplements.

Benzodiazepines -- The combination of melatonin and triazolam (Halcion) improved sleep quality in one study. In addition, a few reports have suggested that melatonin supplements may help people stop using long-term benzodiazepine therapy. (Benzodiazepines are habit-forming.)

Blood pressure medications -- Melatonin may make blood pressure medications like methoxamine (Vasoxyl) and clonidine (Catopres) less effective. In addition, medications in a class called calcium channel blockers may lower melatonin levels. Calcium channel blockers include:

Nifedipine (Procardia)

Amlodipine (Norvasc)

Verapamil (Calan, Isoptin)

Diltiazem (Cardizem)

Felodipine (Plendil)

Nisoldipine (Sular)

Bepridil (Vascor)

Beta-blockers -- Use of beta-blockers may lower melatonin levels in the body. Beta-blockers include:

Acebutolol (Sectral)

Atenolol (Tenormin)

Bisoprolol (Zebeta)

Carteolol (Cartrol)

Metoprolol (Lopressor, Toprol XL)

Nadolol (Corgard)

Propranolol (Inderal)

Blood-thinning medications (anticoagulants) -- Melatonin may increase the risk of bleeding from anticoagulant medications such as warfarin (Coumadin).

Interleukin-2 -- In one study of 80 cancer patients, use of melatonin along with interleukin-2 led to more tumor regression and better survival rates than treatment with interleukin-2 alone.

Nonsteroidal anti-inflammatory drugs (NSAIDs) -- NSAIDs such as ibuprofen (Advil, Motrin) may lower levels of melatonin in the blood.

Steroids and immunosuppressant medications -- Melatonin may cause these medication to lose their effectiveness. Do not take melatonin with corticosteroids or other medications used to suppress the immune system.

Tamoxifen -- Preliminary research suggests that the combination of tamoxifen (a chemotherapy drug) and melatonin may benefit some people with breast and other cancers. More research is needed to confirm these results.

Other -- Caffeine, tobacco, and alcohol can all lower levels of melatonin in the body.

Oligomeric Proanthocyanidins (OPCs) Grapes

 

Overview

Grapes (Vitis vinifera) have been heralded for their medicinal and nutritional value for thousands of years. Egyptians ate grapes at least 6,000 years ago, and several ancient Greek philosophers praised the healing power of grapes -- usually in the form of wine. European folk healers made an ointment from the sap of grapevines to treat skin and eye diseases. Grape leaves were used to stop bleeding, inflammation, and pain, such as the kind brought on by hemorrhoids. Unripe grapes were used to treat sore throats and dried grapes (raisins) were used for constipation and thirst. Round, ripe, sweet grapes were used to treat a range of health problems including cancer, cholera, smallpox, nausea, eye infections, and skin, kidney, and liver diseases.

But grapes -- or the chemicals within them, especially oligomeric proanthocyanidin complexes (OPCs) -- have been touted as powerful antioxidants. Some people believe they could help treat a number of conditions, from heart disease to cancer to aging skin, although scientific evidence is mostly lacking for those conditions. However, there is good evidence that grape seed extract can help treat chronic venous insufficiency and edema.

A study of healthy volunteers found that taking grape seed extract did substantially increase levels of antioxidants in their blood. Antioxidants are substances that destroy free radicals -- harmful compounds in the body that damage DNA (genetic material) and even cause cell death. Free radicals are believed to contribute to aging as well as the development of a number of health problems, including heart disease and cancer.

 

 

 

Plant Description

Grapes are native to Asia near the Caspian Sea, but they were brought to North America and Europe around the 1600s. This plant's climbing vine has large, jagged leaves, and its stem bark tends to peel. The grapes may be green, red, or purple.

 

 

 

What's It Made Of?

Vitamin E, flavonoids, linoleic acid, and OPCs are highly concentrated in grape seeds. These compounds can also be found in lower concentrations in the skin of the grape. OPCs are also found in grape juice and wine, but in lower concentrations. Resveratrol is another of grape's compounds which is related to OPCs and found mainly in the skins. Resveratrol has become very popular as an antioxidant and is being studied in connection with a variety of diseases.

 

 

 

Medicinal Uses and Indications

Today, standardized extracts of grape seed may be used to treat a range of health problems related to free radical damage, including heart disease, diabetes, and cancer. Some studies -- mostly in animals -- support these uses.

Flavonoids found in red wine may help to protect the heart by lowering "bad" LDL cholesterol. The so-called "French paradox" is the belief that drinking wine protects people living in France from developing heart disease at the high rates seen in people living in the United States. So far, however, there is no clear evidence that taking grape seed extract helps reduce heart disease. Some researchers speculate that it may the alcohol in the wine, and not the flavonoids, that could be responsible for any healthful effects. Others think it could be the combination of alcohol and flavonoids.

Drinking alcohol to protect against heart disease is not advocated by the American Heart Association and other organizations because of the potential for addiction and other serious problems, such as car accidents and the increased risk of hypertension, liver disease, breast cancer, and weight gain. If you do drink red wine, you should have no more than 2 glasses (20 g ethanol) per day if you are a man, and no more than one if you are a woman.

Chronic venous insufficiency

In chronic venous insufficiency, blood pools in the legs, causing pain, swelling, fatigue, and visible veins. A number of high-quality studies have shown that OPCs from grape seed can reduce symptoms.

Edema

Edema -- swelling caused by surgery or an injury -- seems to go away faster when people take grape seed extract. Edema is common after breast cancer surgery, and one double-blind, placebo-controlled study found that breast cancer patients who took 600 mg of grape seed extract daily after surgery for six months had less edema and pain than those who took placebo. Another study found that people who took grape seed extract after experiencing a sports injury had less swelling than those who took placebo.

High cholesterol

There isn't enough evidence to say whether taking grape seed extract can lower cholesterol, although two preliminary studies showed promising results. A study of 40 people with high cholesterol looked at whether taking grape seed extract, chromium, a combination of both, or placebo for 2 months would lower cholesterol. The combination of grape seed extract and chromium was more effective than either grape seed alone or placebo in lowering total and LDL ("bad") cholesterol.

Another study looked at the effects of a proprietary grape seed extract on lipid peroxidation (the breakdown of fats in the blood) in a group of heavy smokers. Twenty-four healthy male smokers, (aged 50 years or greater) took either placebo or 2 capsules (75 mg of a grape procyanidin extracts and soy-phosphatidalcholine), twice daily for 4 weeks. "Bad" LDL cholesterol levels were lower in those taking the grape seed supplement than those taking placebo.

High blood pressure

Theoretically, grape seed extract might help treat hypertension or high blood pressure. Antioxidants, like the ones found in grape seed, help protect blood vessels from damage. Damaged blood vessels can lead to higher blood pressure. In several animal studies, a grape seed extract substantially reduced blood pressure. But human studies are needed to see whether grape seed extract helps people with high blood pressure.

Cancer

Studies have found that grape seed extracts may prevent the growth of breast, stomach, colon, prostate, and lung cancer cells in test tubes. However, there is no clear evidence yet whether it works in humans. Antioxidants, such as those found in grape seed extract, are thought to reduce the risk of developing cancer. Grape seed extract may also help prevent damage to human liver cells caused by chemotherapy medications. Talk to your doctor or pharmacist before combining antioxidants with any chemotherapy drugs to make sure they interact safely together.

Other conditions

Grape seed extract is sometimes suggested for the following, although evidence is slight:

Diabetes (improving blood sugar control)

Improving night vision

Protecting collagen and elastin in skin (anti-aging)

Treating hemorrhoids

 

 

 

Available Forms

Grape seed is available as a dietary supplement in capsules, tablets, and liquid extracts. Look for products that are standardized to 40 - 80% proanthocyanidins or an OPC content of not less than 95%.

 

 

 

How to Take It

Pediatric

Grape seed extracts are not recommended for children. Whole grapes, however, make a healthy and safe snack for children.

Adult

To protect against free radical damage (oxidation), take 25 - 150 mg of a standardized extract (40 - 80% proanthocyanidins or 95% OPC value), 1 - 3 times daily.

Chronic venous insufficiency: 150 - 300 mg daily

Edema: 200 - 400 mg daily for 10 - 30 days

 

 

 

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider qualified in the field of botanical medicine.

At the recommended dosage, grape seed is considered safe for up to 12 weeks. However, pregnant or breastfeeding women should not take grape seed supplements.

 

 

 

Possible Interactions

There are no known scientific reports of interactions between grape seed and conventional medications. However, the OPCs in grape seed extract may interact with the following:

Anticoagulants (blood thinners) -- Grape seed extract may act as a blood-thinner, and could increase the risk of bleeding if taken with other blood-thinners such as warfarin (Coumadin). If you are taking blood thinning medications or have bleeding disorders, ask your doctor before taking grape seed extract.

Probiotics

Overview

Lactobacillusacidophilus (L. acidophilus) is the most commonly used probiotic, or "friendly" bacteria. Many healthy bacteria live in the intestines and vagina, where they protect against "bad" bacteria that can cause disease. They do this is a couple of ways: for example, when L. acidophilus breaks down food in the intestine, several substances are formed (such as lactic acid and hydrogen peroxide) that create an unfriendly environment for “bad” bacteria. Probiotics are often suggested as a supplement when you take antibiotics. Antibiotics kill bacteria, but don’t discriminate between “friendly” and “unfriendly” organisms, so the balance between good and bad bacteria in the intestines can be upset. It is thought that taking probiotics helps restore the healthy balance of bacteria.

Other probiotics include several Lactobacillus species (spp.), such as L. bulgaricus, L. casei, and L. reuteri, Lactobacillus GG,Bifidobacterium longum, Bifidobacterium bifidum, Streptococcus thermophilus, and Saccharaomyces boulardii (a kind of yeast).

In addition to probiotics, some health care providers suggest taking “prebiotics.” These are the soluble fiber found in some foods or supplements that help prebiotics thrive in the intestine. Examples include fructooligosaccharides (FOS), the carbohydrates found in fruit.

 

 

 

Uses

Probiotics may be used for the following:

Vaginal infections

Several clinical studies suggest that using L. acidophilus vaginal suppositories can help treat bacterial vaginosis. A small number of clinical studies suggests that eating yogurt with L. acidophilus cultures may also help. Some people also use L. acidophilus to treat or prevent vaginal yeast infections, although the evidence about whether it is effective is mixed. Additional clinical research is needed.

Diarrhea prevention

The evidence for using Lactobacillus to prevent diarrhea is mixed. Some clinical research suggests Lactobacillus acidophilus may be effective when used to prevent traveler’s diarrhea (caused by eating contaminated food). Other studies have found that Lactoabcillus GG was effective. A mix of probiotics (Saccharomyces boulardii and a mixture of Lactobacillus acidophilus and Bifidobacterium bifidum) helped people with treat traveler’s diarrhea in one study.

Probiotics, especially Lactobacillus GG, may help prevent or treat infectious diarrhea in children and adults, although the evidence is mixed. Studies seem to show probiotics are most effective in treating rotavirus in children. Diarrhea in children can be serious, and you should call your doctor if it lasts more than a day or your child seems dehydrated.

Other studies have found that probiotics, taken regularly, may help prevent gastrointestinal infections in adults.

Several studies -- though not all -- suggest that probiotics, especially Lactobacillus GG and S. boulardi, may help prevent diarrhea associated with taking antibiotics. Antibiotic-related diarrhea can be serious, so you should tell your doctor about it.

Other uses

Lactobacillus and other probiotics have been suggested for a number of conditions, although evidence in most cases is preliminary or mixed:

Replacing the "friendly" intestinal bacteria destroyed by antibiotics

Helping digestion and suppressing disease-causing bacteria

Treating chronic constipation

Treating symptoms of irritable bowel syndrome and inflammatory bowel disease (such as Crohn's disease and ulcerative colitis)

Improving lactose tolerance in people who are lactose intolerant

Enhancing the immune system. Studies have suggested that consuming yogurt or milk that contains specific strains of Lactobacillus or taking supplements with Lactobacillus or Bifidobacterium may improve the body’s natural immune response.

Lowering risk of pollen allergies

Reducing the risk of childhood eczema

Helping to treat high cholesterol

 

 

 

Dietary Sources

The primary dietary sources of L. acidophilus include milk enriched with acidophilus, yogurt containing live L. acidophilus cultures, miso, and tempeh.

Prebiotics are found in breast milk, onions, tomatoes, bananas, honey, barley, garlic, and wheat.

 

 

 

Available Forms

L.acidophilus preparations consist of dried or liquid cultures of living bacteria. These cultures are usually grown in milk but can sometimes be grown in milk-free cultures. L. acidophilus is available in the following forms:

Freeze-dried granules

Freeze-dried powders

Freeze-dried capsules

Liquid L. acidophilus preparations

Yogurt enhanced with probiotics

L. acidophilus supplements should be refrigerated for best quality. Some preparations are in a form that does not break down under normal temperatures and may be convenient for travelers who can’t refrigerate their supplements. Check the package label for storage instructions.

Prebiotics occur naturally in foods, but supplements provide a more concentrated source. Prebiotics are oligosaccharides -- chains of sugar units linked together -- and include inulin and fructooligosaccharides (FOS). Fructoligosaccarhides (FOS) are the most commonly used.

 

 

 

How to Take It

Pediatric

Newborns and Infants (0 - 1 year): Always check with your pediatrician before giving dietary supplements to an infant or child. Liquid preparations may be used as a lotion and applied topically to diaper area for yeast infections and diaper rashes. If the child is on antibiotic therapy, ¼ tsp or ¼ capsule can be taken orally, 2 hours after each dose of antibiotics, to replace beneficial bacteria. Make sure you use products specifically formulated for infants.

Add ¼ tsp or ¼ capsule to water for the treatment of mouth infections.

Adult

Recommended doses of L. acidophilus vary depending on the health condition being treated. Check the specific dosage recommendations on the product label. The following lists guidelines for the most common uses:

For prevention or treatment of diarrhea: Take 1 -2 billion colony-forming units or CFUs per day. Some health care providers may recommend up to 10 - 15 billion cells per day.

For vaginal infections: Lactobacillus capsules or tablets may be inserted directly into the vagina. Orally, eat 8 ounces of yogurt (with live active cultures containing one of the Lactobacillus or Bifidobacterium strains listed above) daily or take a daily supplement containing at least 1 - 2 billion live organisms.

For maintaining intestinal health: Take 1 - 15 billion CFUs daily. If for prevention of antibiotic related diarrhea, some health care providers recommend taking it 2 - 3 hours after the antibiotic.

If diarrhea occurs, decrease the dosage or stop taking the product and talk with your health care provider.

 

 

 

Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable health care provider.

Lactobacillus acidophilus is generally considered safe for most people. Gas, upset stomach, and diarrhea are potential side effects in some people (not on antibiotic therapy) who take more than 1 - 2 billion L. acidophilus cells daily.

There has been one report of anaphylaxis (a serious allergic reaction accompanied by shortness of breath and loss of consciousness) in a person taking inulin, a type of prebiotic.

People with weakened immune systems (such as those receiving chemotherapy or drugs that suppress their immune systems) should ask their doctor before taking probiotics.

People with artificial heart valves should not take L. acidophilus because of the rare chance of bacterial infection.

 

 

 

Possible Interactions

If you are currently being treated with any of the following medications, you should not use Lactobacillus or other probiotics without first talking to your health care provider.

Sulfasalazine -- A laboratory study suggests that L. acidophilus speeds up metabolism of sulfasalazine, a medication used to treat ulcerative colitis.