What over the counter (OTC) products have been evaluated for anxiety in adults aged 18-60? A scoping review.

BACKGROUND: Anxiety symptoms and disorders are common in the UK. Whilst waiting for, or alongside, treatments such as anxiolytics or psychological therapies, people often self-manage anxiety symptoms with products purchased over-the-counter (OTC), such as herbal medicines or dietary supplements. However, the evidence for these products is often presented across different reviews and is not easy for patients or healthcare professionals to compare and understand. AIMS: To determine the nature and size of the evidence base available for these products. METHODS: A scoping review. CENTRAL, MEDLINE, EMBASE, PsycInfo, and AMED (inception-Dec 2022) were searched for RCTs assessing OTC products in people aged 18-60 with symptoms or a diagnosis of anxiety. RESULTS: In total 69 papers assessing a range of products were found, which mostly focussed on kava, lavender, saffron, probiotics, Galphimia glauca and valerian. Studies used varying dosages. Compared to herbal medicine studies, there were much fewer dietary supplement studies and homeopathic remedy studies, despite some of use of these by the general public. CONCLUSION: Future research needs to investigate commonly used but less evaluated products (e.g. chamomile, St John's Wort) and to evaluate products against or alongside conventional treatments to better reflect patient decision making.

A post-pandemic trend in the consumption of dietary supplements among residents of Lithuania.

OBJECTIVES: The consumption of dietary supplements might prevent the deficiency of necessary nutrients. On the other hand, in cases of overconsumption, adverse effects might occur. In Lithuania, the COVID-19 pandemic provoked an increase in the consumption of dietary supplements. The aim of this study was to reveal the post-pandemic trend of the consumption of dietary supplements among the working-age residents of Lithuania with respect to social and demographic factors and food selection criteria. METHODS: A cross-sectional observational study was performed. In total, using the same methods, 3,200 residents were surveyed: 1,600 in 2021 and 1,600 in 2022. Both samples were representative for Lithuania and included residents of Lithuania aged from 18 to 64 years. According to socio-demographic factors (sex, age, level of education, type of place of residence, marital status, number of family members, presence of children under 18 years old in the household, employment status, level of income), COVID-19 experience (presence of COVID-19 cases among friends or relatives, severeness of COVID-19) and food selection criteria (health strengthening, other) the prevalence of the consumption of dietary supplements was compared between the samples. RESULTS: The consumption of dietary supplements accounted for 78.1% and 71.6% of the respondents in 2021 and 2022, respectively (p < 0.001). After the COVID-19 pandemic, the prevalence of the consumption of dietary supplements decreased in the majority of social and demographic groups analysed in this article (p < 0.05). The consumption of dietary supplements remained unchanged among those who selected foods for health strengthening (p = 0.098). CONCLUSIONS: The prevalence of the consumption of dietary supplements decreased after the COVID-19 pandemic in most social and demographic groups except those who selected foods for health strengthening.

Curcumin extract improves beta cell functions in obese patients with type 2 diabetes: a randomized controlled trial.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic condition characterized by insulin resistance and impaired insulin production, leading to elevated blood glucose levels. Curcumin, a polyphenolic compound from Curcuma longa, has shown potential in improving insulin sensitivity and reducing blood glucose levels, which may help mitigate type 2 diabetes progression. OBJECTIVE: To assess the efficacy of improving type 2 diabetes (T2DM). STUDY DESIGN: This randomized, double-blind, placebo-controlled trial included subjects (n = 272) with criteria for type 2 diabetes. METHODS: All subjects were randomly assigned to receive curcumin (1500 mg/day) or placebo with blind labels for 12 months. To assess the improvement of T2DM after curcumin treatments body weight and body mass index, fasting plasma glucose, glycosylated hemoglobin A1c, ß-cell function (homeostasis model assessment [HOMA-ß]), insulin resistance (HOMA-IR), insulin, adiponectin, and leptin were monitored at the baseline and at 3-, 6-, 9-, and 12-month visits during the course of intervention. RESULTS: After 12 months of treatment, the curcumin-treated group showed a significant decrease in fasting blood glucose (115.49 vs.130.71; P < 0.05), HbA1c (6.12 vs. 6.47; P < 0.05). In addition, the curcumin-treated group showed a better overall function of ß-cells, with higher HOMA-ß (136.20 vs. 105.19; P < 0.01) The curcumin-treated group showed a lower level of HOMA-IR (4.86 vs. 6.04; P < 0.001) and higher adiponectin (14.51 vs. 10.36; P < 0.001) when compared to the placebo group. The curcumin-treated group also showed a lower level of leptin (9.42 vs. 20.66; P < 0.001). Additionally, body mass index was lowered (25.9 4 vs.29.34), with a P value of 0.001. CONCLUSIONS: A 12-month curcumin intervention in type 2 diabetes patients shows a significant glucose-lowering effect. Curcumin treatment appeared to improve the overall function of ß-cells and reduce both insulin resistance and body weight, with very minor adverse effects. Curcumin intervention in obese patients with type 2 diabetes may be beneficial. TRIAL REGISTRATION: Thai clinical trials regentrify no.20140303003.

Exploring GP and patient attitudes towards the use and deprescribing of dietary supplements: a survey study in Switzerland.

BACKGROUND: Dietary supplements are commonly used by older adults, but their inappropriate use may lead to adverse events. To optimise medication use, general practitioners (GPs) ideally are aware of all substances that patients use, including supplements. This cross-sectional study explored the use of dietary supplements by older patients with polypharmacy, the rate at which they disclosed this use to their GPs, and compared patients' and GPs' attitudes towards discontinuing dietary supplements. METHODS: Ten GPs in Swiss primary care recruited five to ten of their older patients taking ≥ 5 regular medications. Both GPs and their patients completed a survey on patients' use of dietary supplements and attitudes towards deprescribing those. We described and compared their responses. We assessed the association of supplement disclosure with patient characteristics using multilevel logistic regression analysis. RESULTS: Three out of ten GPs (30%) were female, and GPs' average age was 52 years (SD = 8). 45% of patients were female (29/65). Most patients (n = 45, 70%) were taking ≥ 1 supplement. On average, patients reported to be using three supplements (SD = 2). In 60% (n = 39) of patients, GPs were unaware of ≥ 1 supplement used. We did not find evidence for an association between supplement disclosure to GPs and patient characteristics. Only 8% (n = 5) of patients and 60% (n = 6) of GPs reported ≥ 1 supplement they would be willing to deprescribe and none of the supplements reported by GPs and patients to deprescribe matched. CONCLUSION: Swiss GPs were unaware of many dietary supplements used by their older patients, which may affect medication optimisation efforts.

Understanding the complexity of barriers and facilitators to adherence to oral nutritional supplements among patients with malnutrition: a systematic mixed-studies review.

The aim of this systematic mixed-studies review is to summarise barriers/facilitators to adherence to and/or consumption of oral nutritional supplements (ONS) among patients with disease-related malnutrition. In March 2022, the Cochrane CENTRAL, PUBMED, PsycINFO (Ovid) and CINAHL were searched for articles with various study designs, published since 2000. Articles were identified on the basis of 'population' (patients ≥18 years with malnutrition/at nutritional risk), 'intervention' (ONS with ≥2 macronutrients and micronutrients), 'comparison' (any comparator/no comparator) and 'outcome' (factors affecting adherence or consumption) criteria. A sequential exploratory synthesis was conducted: first, a thematic synthesis was performed identifying barriers/facilitators; and second, the randomised controlled trials (RCTs) were used to support these findings. The five WHO dimensions of adherence guided the analysis. Study inclusion, data extraction, analysis and risk-of-bias assessment (MMAT 2018) were carried out independently by two researchers. From 21 835 screened articles, 171 were included with 42% RCTs and 20% qualitative studies. The two major populations were patients with malignancies (34%) and older adults (35%). In total, fifty-nine barriers/facilitators were identified. Patients' health status, motivation, product tolerance and satisfaction as well as well-functioning healthcare routines and support were factors impacting ONS consumption. Few barriers/facilitators (n = 13) were investigated in RCTs. Two of those were serving a small ONS volume and integrating ONS into ward routines. Given the complexity of ONS adherence, non-adherence to ONS should be addressed using a holistic approach. More studies are needed to investigate the effect of different approaches to increase adherence to ONS.

The National Center for Natural Products Research (NCNPR) at 30: A Legacy of Pioneering Research in Natural Products and Dietary Supplements.

Since its establishment in 1994, the National Center for Natural Products Research (NCNPR) at the University of Mississippi has made notable contributions to the field of natural product research, coinciding with the passage of the Dietary Supplement Health and Education Act. Over the past three decades, the Center has focused on studying plants, herbs, and other natural materials for applications in medicine, agriculture, and nutraceuticals, particularly in the area of botanical dietary supplements. NCNPR scientists have been actively engaged in developing and improving quality control measures to help ensure the safety of dietary supplements in response to a growing market. The Center's research efforts have led to its designation as a U.S. Food and Drug Administration Center of Excellence, reflecting its role in advancing scientific understanding of natural products. Through collaborations with various stakeholders and regulators, NCNPR has contributed to shaping the regulatory landscape for botanical dietary supplements, highlighting both their potential health benefits and associated risks, such as product adulteration. The Center's influence is also evident internationally, as demonstrated by its annual International Conference on the Science of Botanicals, which will mark its 26th year in April 2025. This overview outlines NCNPR's role in supporting research, regulation, and safety in the natural products field.

Recommendations for India-specific multiple micronutrient supplement through expert consultation.

Background & objectives Reducing maternal anaemia and enhancing feto-maternal health to achieve desired birth outcomes is a major health concern in India. Micronutrient deficiencies during pregnancy may impact fetal growth and neonatal outcomes. There is increasing interest in using multiple micronutrient supplement (MMS) during pregnancy. However, the World Health Organization (WHO) recommends use of MMS containing Iron and Folic Acid (IFA) in the context of "rigorous research". Against this backdrop, an Indian Council of Medical Research (ICMR)-led MMS design expert group met over six months to review the evidence and decide on the formulation of an India-specific MMS supplement for pregnant mothers for potential use in a research setting. Methods The India-MMS design expert group conducted a series of meetings to assess the available evidence regarding the prevalence of micronutrient deficiencies in pregnant women in India, the health benefits of supplementing with different micronutrients during pregnancy, as well as nutrient interactions within the MMS formulation. Based on these considerations, the expert group reached a consensus on the composition of the MMS tailored for pregnant women in India. Results The India-specific MMS formulation includes five minerals and 10 vitamins, similar to the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) composition. However, the quantities of all vitamins and minerals except Zinc, Vitamin E, and Vitamin B6 differ. Interpretation & conclusions This report provides an overview of the process adopted, the evidence evaluated, and the conclusions from the expert working group meetings to finalize an MMS supplement in pregnancy for the Indian context to be used in a research setting.

Results of the Italian cross-sectional web-based survey "Nutrition and breast cancer, what would you like to know?" An attempt to collect and respond to patients' information needs, through social media.

Introduction: Several studies have demonstrated that, following a breast cancer (BC) diagnosis, patients are eager to obtain information on cancer and nutrition, in order to ameliorate both their quality of life (QoL) and disease outcome. To avoid BC survivors to get wrong information from unreliable sources, healthcare providers need to be aware of patients' needs, to guide them toward optimal nutrition recommendations, aimed at preventing tumor recurrence and increasing survival rates. Material and methods: The cross-sectional web-based survey "Nutrition and breast cancer, what would you like to know?" has been conceived and conducted, in Italy, between the 2nd and the 25th of June 2023. The link to the 19-items questionnaire, structured in 6 sections, was distributed via social media (Facebook and Instagram), newsletter, institutional websites, and printed flyers. Patients' responses were collected and analyzed, reporting absolute and relative frequencies. Results: A total of 1616 participants (98.9% female and 1.1% male), with an average age of 47.5 years, answered the survey. Only subjects who declared having previously received a BC diagnosis (N=1159, 71.7%) were included in the present analysis. Overall, the respondents showed a wide interest in understanding whether nutrition might help to manage therapy side effects, as well as knowing how specific diets, foods, nutrients, and supplements could affect disease onset, progression and prognosis. Importantly, the need to receive evidence-based information from the "referring physician/specialist" and "nutritionist/dietitian" was expressed by 95.8% and 88.8% of them, respectively. Discussion: In this study, we primarily aimed at intercepting nutrition information needs and sources of an Italian BC survivors' group. Based on that, we first organized a proactive digital intervention, to respond via Instagram live broadcasts to patients' "cancer and nutrition"-related questions. Secondly, we arranged a healthcare providers dedicated-workshop focused on the latest evidence-based knowledge on nutrition and BC. It is crucial, in fact, that once healthcare professionals capture patients' information needs, they can respond with appropriate nutritional guidance, counseling and education programs, while counteracting misleading and incorrect messages.

Recent advancements in the role of phytochemicals and medicinal plants in prophylaxis and management of Alzheimer's disease.

Medicinal plants and phytochemicals are some of the major sources in the treatment of various neurodegenerative disorders including Alzheimer's disease (AD). There is no FDA-approved drug to target AD pathology directly. Full cognitive restoration and management of psychosis-like symptoms are still to be achieved. Being comparatively safer with fewer side effects, medicinal plants have been among the major areas of interest to be researched. Several mechanistic pathways are involved in AD including anticholinesterase activity, glutamate toxicity, free radicals generation, Amyloid ß (Aß) toxicity, inflammation, and mitochondrial dysfunction. Various phytochemicals such as paenol, andrographolide, isoquercitrin, flavonoids, and saponins obtained from different plant sources, various medicinal plants like Spirulina maxima, Salicornia europaea, Curcuma longa, Citrus Junos Tanaka, Cassiae semen, Centella asiatica as well as various traditional medicinal plants of China, Asia, Europe, Turkey, and Iran have been found effective against one or more of these targets. Large numbers of clinical trials are under process to evaluate the role of different phytoconstituents in AD management. Out of 143 agents under clinical trials, 119 have been categorized as disease-modifying agents. The present review extensively covers the recent advancements in the usage of phytochemicals and medicinal plants in various experimental AD models. It involves clinical trials and other research works divided into three sections, including those performed in vitro, in vivo, and in humans mainly from the last five years along with disease markers and mechanistic pathways involved. However, phytochemicals should be explored further in order to achieve neurorestoration in AD.

Junior athletes' nutritional demands: a narrative review of consumption and prevalence of eating disorders.

Information regarding the dietary requirements and consumption of young athletes is limited. Hence, the aim of this narrative review is to provide a comprehensive combination of research and review papers on the nutritional status of young athletes aged 5-18 years old, as well as quantitative, qualitative, wholesome foods, food choices, and eating disordered data concerning the dietary requirements for growing young athletes. This study involved systematic searches of electronic databases, including Google Scholar, PubMed, Science Direct, Scopus, and Web of Science. The specific criteria for identifying research papers published in English from July 1980 until May 2024 were included. Only 48 studies out of 1,262 were included in this narrative review. The findings of this study suggest that, compared with adults, junior athletes need a unique approach to meet their dietary needs. Growth, development, and general athletic performance depend on macronutrients, as they are vital nutrients for young active athletes. However, research on enhancing junior athletes' performance is still in progress, and studies on hydration status, and eating disorders are limited.

Knowledge, Prevalence, and Consequences of Dietary Supplements Intake among Iranian Bodybuilders.

Background: This study investigated the nutritional knowledge and prevalence of dietary supplements (DSs) among Iranian bodybuilders. Methods: This cross-sectional research study involved sampling 648 bodybuilding clubs in Iran. A researcher distributed questionnaires among clubs in various regions and analyzed categorical variables, DS, nutritional knowledge, and sports nutrition data from 160 bodybuilders aged 18 and above in Iran. The analysis was conducted using the results obtained from a quantitative questionnaire. Results: There was a significant relationship between DS use and gender (P = 0.001, r = 0.330, males > females), bodybuilding history (P = 0.045; r = 0.158), and exercise sessions/wk (P = 0.050, r = 0.156). Whey protein (45.6%) and branched-chain amino acid (33.7%), vitamin D (50%), caffeine (34.3%), and generally vitamin C (56.2%) were the most common DS used. The most information sources for bodybuilders regarding DS were fitness coaches (35.6%) and registered dietitians/nutritionists (34.3%). Drug stores (36.7%) and fitness coaches (19.3%) were the most prominent sources for purchasing DS. Increasing performance (54.3%), increasing the need for DS through exercise (53.6%), preventing injury, and improving recovery (36.2%) were the most important reasons to consume DS. Skin problems (21.0%), increased liver enzymes (10.8%), and hair loss (9.4%) were the most common side effects of DS use. Total nutritional knowledge (macronutrients, micronutrients, and sports nutrition) was 58.6%. Conclusions: This study concluded that fitness coaches and registered dietitians/nutritionists were the most common information sources for bodybuilders. It also revealed a moderate level of nutrition knowledge among bodybuilders. The most commonly used DS were vitamins C, D, and whey protein. Also, gender, bodybuilding history, and exercise sessions had a significant relationship with the prevalence of DS. However, the study also revealed some concerning findings; bodybuilders commonly experienced adverse side effects such as skin rashes, increased liver enzymes, and hair loss.

Heptaminol hair testing to highlight octodrine contamination in supplements, responsible for a doping adverse analytical finding.

Octodrine, also known as dimethylhexylamine (DMHA), is a central nervous stimulant. When ingested by humans, octodrine is rapidly metabolized to heptaminol, the main compound present in the blood. Due to their stimulant activities, octodrine and its metabolite are specified substances in section S6b "specified stimulants" of the World Anti-Doping Agency (WADA) Prohibited List, prohibited in competition. But in some cases, they can be responsible for an adverse analytical finding (AAF) following contamination, with a low concentration in the urine. In such cases, a hair test can distinguish doping from contamination according to the concentration measured, or the absence of the target drug. However, no data are available in the literature. The aim of this study was to develop a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the quantification of octodrine and heptaminol in hair, and to apply it to an athlete with an AAF with heptaminol (141 and 136 ng/mL in urine samples A and B after correction for specific gravity) and octodrine (16 ng/mL, not given by the WADA laboratory in sample A as being below the minimum request level of 50 ng/mL). All the supplements taken by the athlete were analysed, and pubic hair (black, 1.5-2 cm long, no head hair available) and toenail clippings (0.1 cm) were sampled two months after AAF. A supplement was identified as the source of contamination, containing octodrine at a concentration range 16-34 µg/g. The athlete had taken 13 g daily (0.2-0.4 mg octodrine) for 20 days prior to the AAF (total dose 4-8 mg). His pubic hair and toenail clippings contained only heptaminol (30 pg/mg and 3 pg/mg, respectively). A controlled study was carried out on a volunteer who took a single 13 g dose of the contaminated supplement (single dose of octodrine 0.2-0.4 mg). His urine was positive for both compounds, with concentrations very close to those of the athlete on the day of the AAF after the same delay between intake and sampling (around 4 h). One month later, his head hair and pubic hair showed only heptaminol at 2 and 3 pg/mg, respectively, and toenail clippings were totally negative for both compounds. The contamination was accepted by the WADA commission, but the athlete was still banned for 9 months for having consumed supplements purchased on the internet.

Effects of selected dietary supplements on migraine prophylaxis: A systematic review and dose-response meta-analysis of randomized controlled trials.

BACKGROUND: The existing evidence on the effect of dietary supplements for preventing migraines has generated conflicting results. METHODS: We assessed alterations in migraine clinical features corresponding to the intake of dietary supplements. Our main outcomes included the frequency (number of attacks), duration (in hours), the severity (intensity) and the monthly migraine days. Using a dose-response meta-analysis, we estimated the dose-dependent impact. The certainty of evidence was evaluated using the GRADE tool. RESULTS: Finally, twenty-two trials were included in the systematic review and meta-analysis. Magnesium supplementation reduced migraine attacks (mean difference (MD) = -2.51), severity (MD = -0.88), and the monthly migraine days (MD = -1.66) compared with the control group. CoQ10 decreased the frequency (MD = -1.73), severity (MD = -1.35), and duration of migraine (MD = -1.72). Riboflavin decreased attack frequency (MD = -1.34). Alpha-lipoic acid decreased attack frequency (MD = -1.24) and severity (MD = -0.38). Probiotics decreased the frequency (MD = -1.16), severity (MD = -1.07) and the monthly migraine days (MD = -3.02). Vitamin D reduced migraine frequency (MD = -1.69) and the monthly migraine days (MD = -2.41). In adults, compared with placebo, these supplements did not significantly affect other outcomes, and omega-3 supplementation did not yield a statistically significant reduction in any of these outcomes. CONCLUSION: The use of certain dietary supplements has resulted in a significant decrease in migraine prophylaxis. Further clinical trials of high quality appear to be beneficial.

Acute Liver Failure Induced by Provitalize: A Menopause Supplement Concocted From Herbs & Probiotics.

Drug-induced liver injury is one of the most common causes of acute liver failure in the Western world. Despite discontinuation of the offending agent, it can still tax a grim prognosis. We describe a case of a menopausal woman taking a herbal supplement called "Provitalize" to relieve hot flashes and bloating. This is the first case report of liver injury from this supplement. She initially presented with mild jaundice and elevated transaminases. Unfortunately, she rapidly progressed to encephalopathy, experienced multiorgan failure, and then died.

Experiences, acceptability and barriers to calcium supplementation during pregnancy in Dar es Salaam, Tanzania.

Calcium supplementation in pregnancy is recommended in contexts with low dietary calcium intake to reduce the risk of pre-eclampsia and its complications. The World Health Organisation suggested high-dose calcium supplementation (1500-2000 mg/day), divided into three doses and taken at different times from daily iron-folic supplements. We conducted a mixed methods evaluation study to assess experiences, acceptability and barriers to high-dose calcium supplementation from the perspectives of pregnant women and antenatal health care providers at two public health facilities in Dar es Salaam, Tanzania. Descriptive statistics and thematic analysis were used to characterise acceptability, barriers and overall experiences of using high-dose calcium supplementation. Pregnant women in the cohort were aged 19-41 years, with 32.4% being primiparous. The proportion of pregnant women who liked calcium supplements 'a lot' decreased from 50.2% at the first visit to 31.8% at the last antenatal follow-up visit. Adherence was 71.3% (interquartile range: 50.5%, 89.3%), with only 24.0% of the participants taking 90% or more of the required supplements. Although participants expressed positive attitudes towards using calcium supplements, they also voiced concerns about the large size, side effects, the potential to forget and the burden of taking calcium supplements three times per day. Antenatal health care providers also affirmed the high burden of taking calcium supplements in addition to iron-folic acid supplements. Participants expressed the acceptability of using calcium supplements during pregnancy, but adherence to three doses per day posed challenges to pregnant women. Reducing the number of calcium supplement doses per day may improve adherence.

Determination of objective taste perception among Iranian medical sciences students during COVID­19 pandemic in Yazd, Eastern Iran: a case-control pilot study.

BACKGROUND: Taste disorders in patients suffering from COVID-19 were popular. Some people even after recovery report residual effects of loss of smell and taste. This study aimed to investigate the taste Perception of Iranian Medical Sciences students during the COVID-19 pandemic. METHODS: The case-control study evaluated 50 Medical Sciences students with a history of COVID-19 infection, as confirmed by the Novel Coronavirus (2019-nCOV) CFX96™ Real-Time PCR Detection System. The other participants consisted of 50 volunteer students with COVID-19 negative. The taste perception was measured with 4 different concentrations of the basic tastes. The stimuli were applied to the protruded tongue. Subjects were asked to identify the researcher when they felt the taste. Data are expressed as frequency distribution and analyzed with the Chi-Square test (P < 0.05). RESULTS: In this survey, 54% of participants were male and 46% were female, the mean age of participants was 22.96 ± 5 years. The results showed a significant difference in the sweet and bitter taste perception score according to the history of dietary supplement use. The bitter taste perception score declared a considerable difference since COVID-19 infection. There was no significant difference between the taste perception in the two studied groups for all 4 basic tastes according to gender, COVID-19 infection status, history of taste and smell disorders, and the elapsed time since COVID-19 infection. CONCLUSION: Our findings could provide important insights into taste perception. The history of dietary supplementation may influence how sweetness and saltiness are perceived. There was a noticeable difference in bitter taste perception depending on the time that had elapsed since the most recent COVID-19 infection.

Review of Integrative Medical Therapies for Psoriasis: The Microbiome, Probiotics, Diet, and Mindfulness.

Background: Psoriasis is a chronic inflammatory condition with cutaneous and systemic involvement. Although many efficacious treatment options are available, concerns regarding costs and duration of treatment have expanded interest in the role of integrative medical therapies for psoriasis. Objective: In this review, we aim to provide evidence for the use of integrative medical approaches in the management of psoriasis, namely approaches utilizing the microbiome, probiotics, diet, and mindfulness. Methods: PubMed/Medline and Google Scholar databases were searched from inception up to 16 August 2023 to identify clinical studies that evaluated how integrative medical therapies affect psoriasis severity. Search terms combined "psoriasis" or "psoriatic arthritis" with terms related to the microbiome, diet, and lifestyle. Results: Multiple clinical studies have shown that integrative approaches can reduce psoriasis severity. Probiotic supplementation in psoriatic patients decreased PASI scores, decreased inflammatory markers, increased quality of life, and reduced the risk of disease relapse. Intermittent fasting, in the context of Ramadan, decreased PASI scores and plasma CRP levels. Low-calorie diets and low-calorie ketogenic diets have been shown to reduce psoriasis severity. Notably, combining low-calorie diets with biologics and cyclosporine synergistically improved psoriasis to a greater extent than pharmaceutical therapy alone. A gluten-free diet improved psoriasis and reduced antigliadin antibodies in those with hypersensitivity. Mindfulness therapies also improved psoriasis severity with and without phototherapy. Conclusion: Several studies show that integrative medicine can be used to manage psoriasis. Specifically, probiotic supplementation, diets that promote weight loss or modulate antigliadin antibodies, and mindfulness therapies may improve disease severity.

Efficacy and safety of an oral complementary medicine combination in people with symptomatic knee osteoarthritis: Protocol for the double-blind, randomized, placebo-controlled ATLAS trial.

Objective: To investigate the efficacy and safety of an oral complementary medicine combination formulation relative to placebo, on changes in pain intensity from baseline to week 12, in people with knee osteoarthritis (OA). Design: A placebo-controlled, double-blind, two-arm, superiority, phase II, Randomized Controlled Trial (RCT) (ACTRN12623000380695). We will recruit 82 participants (∼41 per arm), aged ≥40 years, with a clinical diagnosis of symptomatic knee OA and radiographic change on x-ray (Kellgren-Lawrence Grade ≥2). Participants will be randomly allocated to receive either a complementary medicine formulation containing a daily dose of Boswellia serrata extract (Boswellin® Super, 250 â€‹mg/day), pine bark extract (Fenoprolic™ 70 Organic 100 â€‹mg/day), curcumin (500 â€‹mg/day), piperine (5 â€‹mg/day), and methylsulfonylmethane (MSM, 1500 â€‹mg/day), or placebo, for 12-weeks. The primary endpoint will be change from baseline in average knee pain intensity at 12-weeks (visual analogue scale). Secondary endpoints will include change in knee pain from baseline to 12-weeks in the Knee Injury and Osteoarthritis Outcome Score (KOOS), global assessment of disease activity, global rating of change, and health-related quality of life (AQoL-8D). Ethics and dissemination: This protocol has been approved by the University of Sydney Human Research Ethics Committee (#2021/877). Dissemination will occur through lay summaries, infographics, conference abstracts, oral presentations, theses, and scientific publications. Conclusion: This RCT will provide credible evidence about the efficacy and safety of this complementary medicine combination and inform updates to international clinical practice standards on the use of complementary medicines in the management of symptomatic knee OA.

Selenium supplementation in chronic kidney disease patients undergoing haemodialysis: a systematic review of the effects on plasma selenium, antioxidant and inflammatory markers, immunological parameters and thyroid hormones.

Selenium (Se) is a mineral with several biological functions, and studies have shown that its deficiency can be linked to many complications in patients with chronic kidney disease (CKD). This study aims to systematically review the effects of Se supplementation in patients with CKD undergoing haemodialysis (HD). This systematic review was carried out according to the PRISMA statement. Clinical trials were searched in PubMed, Lilacs, Embase, Scopus and Cochrane Library databases from inception to July 2021 and updated in July 2024. The protocol was registered on PROSPERO (CRD42021231444). Two independent reviewers performed the study screening and data extraction, and the risk of bias was evaluated using the Cochrane Collaboration tool. Thirteen studies were included in this review. Only nine studies showed results on Se levels; in all, reduced Se levels were observed before supplementation. A positive effect of supplementation on plasma Se level was demonstrated. Of the ten studies analysed, six demonstrated positive effects on antioxidant and inflammatory markers. Only one study analysed immunological parameters, showing a positive impact. From two studies that analysed thyroid hormones, only one showed positive results. All studies were classified as high risk of bias. The findings suggest that Se supplementation significantly increases plasma Se levels in these patients; however, there are still not enough studies to clarify the effects of Se supplementation on the antioxidant and inflammatory markers, immune system and thyroid hormones. Further studies are needed to elucidate the effects of Se supplementation and to provide a recommendation for patients with CKD undergoing HD.