The use of dietary supplements occurs in the majority of American adults >20 years old and has been reported to be on the rise by the National Health and Nutrition Examination Survey. People are not only taking more dietary supplements, but taking them without the advice of a health care provider. With the lack of education time and focus on this topic, physicians need to know some evidence regarding the most common supplements used, how to understand dietary supplement labels, and where to find reputable information about dietary supplements. Vitamin D, Omega-3, and Glucosamine/ Chondroitin are reviewed here. Also, a description of the various components of a dietary supplement label is explained. Finally, a brief description of independent companies (Consumerlabs.com®, US Pharmacopedial Convention, Natural Medicine Comprehensive Database, and Natural Standard) as well as the federally run Office of Dietary Supplements are presented.

Background: Research suggests that a low omega-3 index may contribute to the low heart rate variability and the increased risk of cardiovascular morbidity and mortality in bipolar disorders. However, so far, no intervention trial with EPA and DHA has been conducted in bipolar patients attempting to increase their heart rate variability. - Methods: 119 patients with bipolar disorder according to DSM-IV were screened, with 55 euthymic bipolar patients—owing to inclusion criteria (e.g. low omega-3 index (< 6%), SDNN < 60 ms.)—being enrolled in a randomized, double-blind, 12-week parallel study design with omega-3 fatty acids (4 capsules of 530 mg EPA, 150 mg DHA) or corn oil as a placebo, in addition to usual treatment. Heart rate variability as well as the omega-3 index were measured at baseline and at the endpoint of the study. - Results: A total of 42 patients (omega-3: n = 23, corn oil: n = 19) successfully completed the study after 12 weeks. There was a significant increase in the omega-3 index (value at endpoint minus value at baseline) in the omega-3 group compared to the corn oil group (p < 0.0001). However, there was no significant difference in the change of the SDNN (value at endpoint minus value at baseline) between the treatment groups (p = 0.22). In addition, no correlation between changes in SDNN and change in the omega-3 index could be detected in the omega-3 group (correlation coefficient = 0.02, p = 0.94) or the corn oil group (correlation coefficient = − 0.11, p = 0.91). Similarly, no significant differences between corn oil and omega-3 group regarding the change of LF (p = 0.19), HF (p = 0.34) and LF/HF ratio (p = 0.84) could be demonstrated. - Conclusions: In our randomized, controlled intervention trial in euthymic bipolar patients with a low omega-3 index and reduced heart rate variability no significant effect of omega-3 fatty acids on SDNN or frequency-domain measures HF, LF and LF/HF ratio could be detected. Possible reasons include, among others, the effect of psychotropic medication present in our trial and/or the genetics of bipolar disorder itself. Further research is needed to test these hypotheses.

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Inappropriate sinus tachycardia (IST) is a common disease of the autonomic nervous system in children and adults. Diagnosis and treatment of IST in adolescents is not well defined. In this retrospective study, we tested our hypothesis regarding autonomic dysfunction in childhood by analyzing 24-h heart rate variability (HRV) in 479 children, with a mean age of 13.7 ± 2.1 years, who were referred to the outpatient clinic in the Pediatrics Department within the last 15 years. Seventy-four adolescents with a mean 24-h heart rate ≥ 95 bpm (our cut-off for an IST based upon 66 healthy controls) were deemed to have IST. We found the risk of IST to be high in adolescents with attention deficit disorder (OR = 3.5,p<0.001), pre-hypertension (OR = 2.5, p = 0.043) and hypertension (OR = 2.1,p = 0.02); insignificantly enhanced in children with short stature (OR = 1.9,p = 0.19), surgically-treated congenital heart disease (OR = 1.4,p = 0.51) and obesity without hypertension (OR = 1.4;p = 0.25); and negligible in adolescents with anorexia nervosa (OR = 0.3, p = 0.26) and constitutional thinness (OR = 0.9,p = 0.89). IST was associated with a significant decrease in global HRV and elevated blood pressures, indicating an enhanced cardiovascular risk. Methylphenidate did not increase 24-h heart rates, whereas omega-3 fatty acid supplementation significantly decreased elevated heart rates and increased HRV in adolescents with IST. In this retrospective analysis, 15.4% of adolescents suffered from IST with a 24-h heart rate ≥ 95 bpm, predominately due to attention deficit disorder and hypertension. / Die Inadäquate Sinustachykardie (IST) ist eine häufige Erkrankung des autonomen Nervensystems bei Kindern und Erwachsenen. Die Diagnose und Therapie einer IST bei Jugendlichen ist bisher nicht genau definiert. In dieser retrospektiven Studie haben wir unsere Hypothese bezüglich autonomer Dysfunktion im Kindesalter durch die Analyse von 24-h Herzfrequenzvariabilität (HRV) bei 479 Kindern mit einem Durchschnittsalter von 13,7 ± 2,1 Jahren, die innerhalb der letzten 15 Jahre an die pädiatrische Ambulanz überwiesen wurden, untersucht. 74 Jugendliche hatten eine mittlere Herzfrequenz ≥95/min (Cut-off Werte für eine IST basieren auf der gesunden Kontrollgruppe) und hatten damit eine IST. Wir stellten fest, dass das Risiko einer IST bei Jugendlichen mit einer Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) (OR = 3,5, p < 0,001), Prä-Hypertonie (OR = 2,5, p = 0,043) und Hypertonie (OR = 2,1, p = 0,02) hoch ist; nicht signifikant erhöht bei Kindern mit Kleinwuchs (OR = 1,9, p = 0,19), chirurgisch behandelte angeborene Herzkrankheit (OR = 1,4). ,p = 0,51) und Adipositas ohne Bluthochdruck (OR = 1,4; p = 0,25); und unbedeutsam bei Jugendlichen mit Anorexia nervosa (OR = 0,3, p = 0,26) und konstitutioneller Dünnheit (OR = 0,9, p = 0,89). Eine IST war mit signifikant reduzierten HRV-Werten und erhöhten Blutdrücken assoziiert, was auf ein erhöhtes kardiovaskuläres Risiko hindeutet. In dieser retrospektiven Analyse litten 15,4 % der Jugendlichen an einer IST mit einer 24h HF ≥ 95 bpm hauptsächlich aufgrund einer ADHS und Hypertonie.

Consumer interest in supplementation with healthy omega-3 fatty acids (Ï 3 FA) has led to increased research in fortification of popular foods with these healthy fats. Yogurt, which is already popular, offers a functional food matrix to fortify with Ï 3 FA. Fish oil, a major source of two important long chain Ï 3 FA eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) is an excellent source of Ï 3 FA enrichment into foods but brings problems of oxidation and off-flavors or odors when added to foods. Encapsulation, deodorized fish oil, and flavoring have been investigated to reduce these off-flavors and odors in food products while producing a fish oil-fortified yogurt. Discrimination of butter, fish or oxidized fish oil at 0.5% (wt/wt) levels was investigated in unflavored low-fat (1%) yogurt using untrained panelists (n=31) and sensory triangle tests. Five sensory attributes (lime, sweet, heat, acid, oxidized) were analyzed by experienced sensory panelists (n=12) in chile-lime flavored yogurts with butter, fish or oxidized fish oils added at low (0.43%) and high (1% wt/wt) levels. Analytical analysis for composition, fatty acid profile, and volatile chemistry of the yogurts was conducted. Consumer acceptance of a low-fat (1.5%) chile-lime flavored yogurt enriched with fish oil was investigated using a 9-point hedonic scale (1="dislike extremely", 9="like extremely"). Untrained panelists (n=31) were unable to differentiate 0.5% (wt/wt) levels of fish and butter oils in unflavored yogurts but were able to detect oxidized fish oil compared to butter or fish oil under in the same conditions. Experienced panelists (n=12) found significant differences (p<0.05) in lime and acid attributes in chile-lime flavored yogurts containing 1% (wt/wt) oxidized fish oil compared with 0.43 and 1% (wt/wt) butter and fish oil yogurts and 0.43% (wt/wt) oxidized fish oil yogurts. Oxidized attributes were determined as significantly different (p<0.05) by experienced panelists in chile-lime yogurts with 1% (wt/wt) fish oil, 0.43 and 1% (wt/wt) oxidized fish oil added. The acceptance of a fish oil-enriched chile-lime flavored yogurt was neutral ("neither liked nor disliked") by consumers (n=100) but 44% rated the product "like slightly" (6 of 9) or greater. A successful chile-lime flavored yogurt offering a novel savory flavor was formulated from pre-pasteurization addition of fish oil to deliver more than 145 mg DHA+EPA/170 g serving of yogurt. / Master of Science

Milk is often packaged in translucent containers providing little protection against flavor degradation from light. Addition of omega-3 fatty acid sources into milk increases the risk of light-initiated degradation of nutrients and sensory quality. The effectiveness of iridescent film materials in reducing light-induced oxidation of extended shelf-life omega-3 fatty acid enriched milk (2% total fat) was studied. Film selections were targeted to provide product visibility and control product exposure at targeted riboflavin excitation wavelength regions. Effectiveness was determined by sensory evaluation and measuring changes in volatile compounds on days 1, 7, 14, and 21 when stored under fluorescent light at 4°C. Five packaging treatments (films overwrapped on glass bottles) were evaluated: 446nm block, 570 nm block, broad spectrum block with 4% transmission (BS4T), light-protected (foil overwrap) control, and light-exposed (no overwrap) control. Experienced panelists (n=12) rated oxidized flavor intensity (0-9; 9=extreme) for milk samples. Light-protected milk was lower in oxidized flavor (mean score less than 3) throughout the storage period. Oxidized flavor in milk with BS4T film overwraps was not different compared to light-protected milk (p>.05) at the later stage (21 days), suggesting some level of protection to milk flavor. Milk without fish oil (milk fat only) shows relatively larger peak areas for 2-butanone on day 14, compared to other milk samples, suggesting antioxidants in the fish oil can prevent light oxidation. Overall, packaging that provides a complete light block is still the best way to prevent light-oxidized flavor in milk. / Master of Science in Life Sciences

Yes / We investigated red blood cell (RBC) PUFA profiles, and the predictive value of RBC EPA content for tumour EPA exposure and clinical outcomes, in the EMT study, a randomised trial of EPA in patients awaiting colorectal cancer (CRC) liver metastasis surgery (A.J. Cockbain et al., 2014). There was a significant increase in RBC EPA in the EPA group (n=43; median intervention 30 days; mean absolute 1.26 [±0.14]% increase; P<0.001), but not in the placebo arm (n=45). EPA incorporation varied widely in EPA users and was not explained by treatment duration or compliance. There was little evidence of ‘contamination’ in the placebo group. The EPA level predicted tumour EPA content (r=0.36; P=0.03). Participants with post-treatment EPA ≥1.22% (n=49) had improved OS compared with EPA <1.22% (n=29; HR 0.42[95%CI 0.16–0.95]). RBC EPA content should be evaluated as a biomarker of tumour exposure and clinical outcomes in future EPA trials in CRC patients.

Yes / As pre-clinical and clinical research interest in ω-3 polyunsaturated fatty acids (PUFA) increases, so does the need for a fast, accurate and reproducible analytical method to measure fatty acids (FA) in biological samples in order to validate potential prognostic and predictive biomarkers, as well as establishing compliance in ω-3 PUFA intervention trials. We developed a LC-ESI-MS/MS method suitable for high throughput development to measure FAs and validated it in the context of treatment with the ω-3 PUFA eicosapentaenoic acid (EPA). Uniquely we directly compared the LC-ESI-MS/MS method to a GC-MS protocol. We demonstrated the LC-ESI-MS/MS method is accurate and reproducible, with coefficients of variation consistently below 15% for each PUFA analysed. The relative FA content values correlated well with those obtained by GC-MS (r2 = 0.94, p<0.001 for EPA) in vitro. The data obtained following analysis of FA content of liver tissues from mice fed an eicosapentaenoic acid enriched diet showed similar results to that of published studies in which GC-MS was used. The LC-ESI-MS/MS method allows concomitant analysis of unesterified (free, unbound) and esterified (bound) FAs in biological samples, allowing investigation of different PUFA pools in cells and tissues. / Yorkshire Cancer Research, MRC/NIHR