Complementary Medicine

Transcription

1 Complementary Medicine Technical Document Developed by INDI/SNIG for the Irish Sports Council 2014

2 Complementary Medicines Pubmed (Medline), SPORTDiscus and the Cochrane Library were searched for all human studies published in peer reviewed journals in the last 5 years. The terms: Bee Pollen, Echinacea and Ginseng and Guarana were used as key terms in all databases. Inclusion criteria Human studies published in English Original investigations assessing the use of bee pollen, Echinacea, ginseng and guarana and exercise Incorporated the use of an indistinguishable placebo Exclusion Criteria Studies assessing all the use of the above complementary medicines in diseased populations Studies assessing the use of the above complementary medicines for illness Qualitative studies assessing supplement use in both the general and athletic population After title and abstract review, there was one original article assessing bee pollen and exercise, no original articles assessing the use of Echinacea, ginseng and guarana that met the above inclusion/exclusion criteria. Complementary medicines (CM) are a diverse set of medical and health care systems, practices and products which are not considered part of conventional medicine (Barnes et al. 2002, Cuzzolin et al. 2006). CMs are often referred to as "traditional" or "alternative" medicines. Examples include vitamins, minerals, nutritional supplements and herbal, aromatherapy and homoeopathic products (Therapautic Goods Administration Australia, 2009). In clinical medicine, nutritional supplements are generally intended to supply nutrients (vitamins, minerals, fatty acids or amino acids) that are missing from or not consumed in sufficient quantities through a person s diet. There are, however, some clinical situations where these agents are accepted as useful for therapeutic purposes. CM, including nutritional supplements, have become increasingly popular within the athletic population, who perceive them as being useful for enhancing performance. Their efficacy may be through compensation for less than adequate diets or lifestyles, satisfaction of unusual nutrient demands induced by heavy exercise, or by the production of a direct ergogenic effect (Crowley and Wall, 2004).

3 This brief review will highlight some of the CM reportedly consumed by Irish athletes from the initial phase of this project, conducted in Due to the limited or non existence of scientific literature demonstrating any positive performance benefits in athletes with these products, this technical document aims to inform the reader of the product, and the proposed benefits. Four CM, Bee Pollen, Ginseng, Gurana and Echinacea, will be explored. Following the previous search on CM s and their therapeutic use within the athletic population, no new pertinent studies assessing the use of Bee Pollen and Guarana have been found in this most recent literature search.

4 Bee Pollen Bee pollen is a popular sport supplement which claims to increase energy and to boost red blood cell production and therefore VO2max. There is no scientific evidence to support any of these claims. It was only in 2001 that a detailed chemical analysis of honeybee pollen was carried out, which identified 15 key compounds, the most prevalent being flavonoid glycosides, which act like antioxidants. Other constituents included the phenols rutin and quercetin (Bonvehi et al. 2001). Quercetin is one of bee pollen s key components, and has been claimed to have antihistamine properties, though there is no scientific evidence to confirm this claim (Anderson, 2001). When searching literature regarding bee pollen and exercise, limited human studies were found. One study assessed the effects of bee pollen on treadmill running time to exhaustion and rate of perceived exhaustion, and another assessed the use of a pollen extract on maximal oxygen uptake and upper respiratory tract infections in adolescent swimmers. No significant differences were identified between the athletes consuming bee pollen and the athletes consuming the placebo in both studies. Therefore bee pollen did not demonstrate any performance benefit. (Maughan and Evans 1982, Woodhouse et al. 1987). Possible side effects The main concern with bee pollen supplements has been anaphylaxis. Other reported adverse effects include: Headaches Nausea Diarrhoea Abdominal pain (Anderson, 2001) Summary At present there is no supporting literature that bee pollen provides any performance benefits, therefore cannot be recommended as an ergogenic aid.

5 Echinacea Echinacea Echinacea has traditionally been used topically and orally for a diverse range of conditions including wound healing, abcesses, burns, eczema, and leg ulcers (Ernst, 2002). Echinacea preparations contain many potentially active ingredients, such as polysaccharides, glycoproteins, alkamides, and flavonoids (Ernst, 2002). One of the more commonly researched CMS Echinacea has demonstrated positive outcomes, predominantly in vitro, as an antiinflammatory and antiviral agent (Sharma et al. 2009, Pleschka et al, 2009), immunostimulant and immunomodulator (Schoop et al. 2006), antioxidant and mild anaesthetic (Braun and Cohen, 2007). Whether these effects that are demonstrated on isolated cells in the test tube apply to humans is not altogether clear. The majority of published human clinical trials have investigated the use of Echinacea in the prevention and treatment of upper respiratory tract infections. One systematic review assessed several Meta analyses and noted that despite including fairly well structured studies, there were different doses, product formulations and time frames used, making results difficult to interpret (Woelkart et al. 2008). Regardless of these concerns, previous meta-analyses found that Echinacea decreased the odds of developing a cold by 58% and the duration of a cold by 1.4 days (Shah et al. 2007). A Cochrane analysis of randomized blinded trials (2006) and a recent review by Nahas and Balla (2011) highlighted evidence supporting the use of Echinacea purpurea as an effective treatment of colds in adults as opposed to Echinacea angustifolia or Echinacea pallida; the results, however, are not fully consistent. Echinacea appears to be one of the most popular herbal extracts used within the athletic population for the purpose of preventing exercise-induced immunosuppression (Petróczi A et al. 2007), despite little evidence to support such usage (Gleeson et al. 2004; 2006, Senchina et al ). One study observed a low rate of sickness in athletes using Enhinacea (Snoop et al. 2006). Another study, by Hall and colleagues (2007), noted that reductions in salivary s-iga (considered an indication of immunity suppression from exercise when reduced) were attenuated with supplementation of Echinacea; however, there were no significant differences in sickness rates between Echinacea and placebo group over the 4 week trial.

6 Studies have also validated (Whitehead et al. 2007; 2012) and discredited (Baumann et al. 2013) the use of Echinacea on improving maximum oxygen consumption (Vo2 max) and aerobic capacity in persons who are physically active. As a result, more robust studies are warranted to support such claims. Possible side effects Minimal side effects have been reported after Echinacea ingestion. Reported side effects include: Allergic reactions Rash (Braun and Cohen, 2007) Summary There is some moderate evidence to support the use of Echinacea Purpera for the treatment of colds in adults but this is subjected to a degree of variability. At this moment in time, there is not enough evidence to recommend Echinacea as a supplement for preventing sickness from exercise-induced immunosuppression in athletes. Due to conflicting results on the use of Echinacea on improving VO2max in active persons, it cannot be, at present, recommended as a nutritional supplement to aid cardiovascular performance.

7 Ginseng There are several species of ginseng: American, Chinese, Korean, Japanese and Siberian, however only three medicinal species of ginseng are currently recognised: Panax Ginseng C.A. Meyer, Panax japonicus C.A. Meyer, and Panax quinquefolius. The main active constituents of the Panax species are saponins, which have been isolated through chromatographic methods and used to differentiate the various ginseng species (Bahrke and Morgan, 2000) Ginseng has been credited with the ability to enhance stamina, decrease blood pressure, aid in recuperation from physical stress and if used topically as an ointment, improve microcirculation in muscles, dissipate bruises, act as an antiinflammatory agent and have a positive effect on coronary heart disease and angina pectoris (Liu and Xie, 2003, Yang and Du, 2002). Though many of the above claims are made by numerous nutritional companies, there is a lack of rigorous scientific trials providing convincing results that ginseng is effective for all of the above mentioned musculoskeletal conditions. A study, by Jung and Kwak (2011), reported a reduction in muscle damage and inflammatory response induced by uphill running after consumption of Red Ginseng in young athletes. However, a recent similar study, by Pumpa and Colleagues (2013), failed to provide evidence to support the use of ginseng as a preventive option for muscle damage and inflammation in athletes; small sample size may have impacted the statistical significance of these findings. A recent review by Shergis et al. (2012) explores the use of Ginseng as an ergogenic aid and concludes that enhanced performance after ginseng ingestion is yet to be demonstrated. The majority of evidence for ginseng is based on association, anecdote or traditional Chinese use. Further studies with stronger methodological quality and larger sample sizes are warranted to produce more conclusive results. Possible side effects The most commonly experienced adverse effects include headache, sleep disturbances and gastrointestinal disorders. However, several recent reports on

8 the adverse effects of ginseng indicate that more severe outcomes can occur. These include ginseng-induced mania, transient ischemic attack, photosensitivity reaction, anaphylactic reaction, and menstrual dysfunction (Bahrke et al. 2009). Summary There are no well-designed, scientifically rigorous trials demonstrating ginseng will enhance athletic performance. Therefore, should not be used as an ergogenic aid. Guarana Guarana has traditionally been used by the Amazonian Indians of South America to enhance energy levels, suppress appetite, increase libido and protect them from malaria (Braun and Cohen, 2007). Guarana seeds are rich sources of caffeine, containing 3-6% on a dry weight basis (Saldana et al. 2002). Guarana has only recently been clinically studied, and at present there are no published studies assessing the use of guarana in sport. One study relating to exercise was found, which assessed the effect of guarana on metabolic rate and substrate utilization in over weight males at rest and during 60 minutes of treadmill walking. This study found no significant effects of guarana ingestion on total adenosine triphosphate (ATP) utilisation during 6 h rest or during 60 min treadmill walking (Sale et al. 2006), therefore no clinical effect for enhancing energy metabolism. Guarana today is most commonly consumed as a constituent in energy drinks. Due to controversy surrounding the consumption of energy drinks in the media, such as excess consumption causing adverse cardiac events, questions around the safety of energy drinks has been debated. One study assessing the safety of consuming energy drinks found the amounts of guarana, taurine, and ginseng found in popular energy drinks were far below the amounts expected to deliver either therapeutic benefits or adverse events (Clauson et al. 2008). Possible side effects Due to the lack of clinical studies available, possible adverse effects can only be hypothesized. Due to the caffeine content, the following adverse effects may be experienced (Braun and Cohen, 2007):

9 Agitation Tremor Anxiety Restlessness Headache Seizures Tachycardia Premature ventricular contractions Diarrhea Gastrointestinal cramping Nausea and vomiting Diuresis Summary Currently there is no evidence for the use of guarana as an ergogenic aid to enhance athletic performance.

10 References Andersen O. Sports supplements: experts determine what s really in bee pollen but does the stuff actually work? Peak Performance 2001; 155: 7-8. Bahrke MS, Morgan WP, Stegner A. Is Ginseng and Ergogenic Aid? Int J Sports Nut Ex Metab. 2009; 19: Bahrke MS, Morgan WR. Evaluation of the ergogenic properties of ginseng: an update. Sports Med. 2000; 29(2): Barnes PM, Powell-Griner E, McFann K, Nahin R. Complementary and alternative medicine use among adults: United Statues, Online: Advance Data Report #343. Accessed 22 nd November Baumann CW, Bond KL, Rupp JC, Ingalls CP, Doyle J. A Echinacea Purpurea Supplementation does not Enhance VO2max in Distance Runners.. Strength Cond Res Sep 14 (ahead of print). Bonvehi JS, Torrento MS, Lorente EC. Evaluation of polyphenolic and flavonoid compounds in honeybee-collected pollen produced in Spain. J Agric Food Chem. 2001; 49(4): Braun L, Cohen M. (2007) Herbs and Natural Supplements. An Evidenced-based Guide, 2 nd Ed. Elsevier Australia. Clauson KA, Shields KM, McQueen CE, Persad N. Safety issues associated with commercially available energy drinks. J Am Pharm Assoc (2003). 2008; 48(3): Crowley JJ, Wall C. The use of dietary supplements in a group of potentially elite secondary school athletes. Asia Pac J Clin Nutr, (Suppl): S39. Cuzzolin, L., S. Zaffani, and G. Benoni, Safety implications regarding use of phytomedicines. Eur J Clin Pharmacol, 2006; 62(1): Ernst E. The risk-benefit profile of commonly used herbal therapies: Gingo, St. John s Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. Ann Intern Med. 2002; 136: Gleeson M, Nieman DC, Pedersen BK Exercise, nutrition and immune function. J Sports Sci. 2004

11 Gleeson M. Can Nutrition Limit Exercise-Induced Immunodepression. Nutrition Reviews. 2006; 64(3): Hall H, Fahlman MM, Engels HJ. Echinacea purpurea and mucosal immunity. Int J Sports Med Jung HL, Kwak HE, Kim SS, Kim YC, Lee CD, Byurn HK, Kang HY (2011). Effects Of Panax ginseng supplementation on muscle damage and inflammation after uphill treadmill running in humans.. Am J Chin Med.;39(3): Liang, M.T., T.D. Podolka, and W.J. Chuang, Panax notoginseng supplementation enhances physical performance during endurance exercise. J Strength Cond Res. 2005; 19(1): Liu Y, Xie M. Studies on the interaction of total saponins of panax notoginseng and human serum albumin by Fourier transform infrared spectroscopy. Spectrochim Acta A Mol Biomol Spectrosc. 2003; 59(12): Maughan RJ, Evans SP. Effects of pollen extract upon adolescent swimmers. Br J Sports Med. 1982; 16: Petróczi A, et al. Limited agreement exists between rationale and practice in athletes' supplement use for maintenance of health: a retrospective study. Nutr J Pumpa KL, Fallon KE, Bensoussan A, Papalia S The effects of Panax notoginseng on delayed onset muscle soreness and muscle damage in well.-trained males: a double blind randomised controlled trial. Complement Ther Med. 2013; 21(3): Jun;. doi: /j.ctim Nahas R, Balla G. Complementary and alternative medicine for prevention and treatment of the common cold. Can Fam Physician, 2011; 57:31-6 Saldana MD, Zetzl C, Mohamed RS, Brunner G. Extraction of methylxanthines from guarana seeds, mate leaves, and cocoa beans using supercritical carbon dioxide and ethanol. J Agri Food Chem. 2002; 50(17): Sale C, Harris RC, Delves S, Corbett J. Metabolic and physiological effects of ingesting extracts of bitter orange, green tea and guarana at rest and during treadmill walking in overweight males. Int J Obes (Lond). 2006;30(5):

12 Schoop R, Buechi S, Suter A. Open, Multicentre Study to evaluate the tolerability and efficacy of Echinaforce Forte Tablets in Athletes. Adv Ther. 2006; 23(5): Senchina DS, Shah NB, Doty DM, Sanderson CR, Hallam JE Herbal supplements and athlete immune function what's proven, disproven, and unproven?. Exercise immunology review, 2009; 15, 66 Shah SA, Sander S, White CM, Rinaldi M, Coleman CI Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis. Lancet Infect Dis 2007; 7 (7): Shergis et al. Panax ginseng in randomized controlled trials: a systematic review BMC Complement Altern Med. 2012; 12(Suppl 1): P297 Linde K, Barrett B, Bauer R, Melchart D, Woelkart K.. The Cochrane Collaboration Echinacea for preventing and treating the common cold (Review). 2006,JohnWiley & Sons Ltd. Therapeuric Goods Administration Australia. Complementary Medicines, Available from: Accessed 22nd November Whitehead, MT, Martin, TD, Scheett, TP, and Webster, MJ. (2012)Running economy and maximal oxygen consumption after 4 weeks of oral Echinacea supplementation. J Strength Cond Res 26(7): Whitehead, MT, Martin, TD, Webster, MJ, and Scheett, TP. Improved Running Economy and Maximal Oxygen Consumption After 4Weeks of Oral Echinacea Supplementation: 908 Medicine and Science in Sports and Exercise - Med Sci Sports Exercise. 2007; 01/; 39 DOI: /01.mss c Woelkart K, Linde K, Bauer R. Echinacea for preventing and treating the common cold. Planta Med, 2008, 74(6): doi: /s Woodhouse ML, Williams M, Jackson C. The effects of varying doses of orally ingested bee pollen extract upon selected performance variables. Athletic Training. 1987; 22(1):

13 Yang F, Du Y. Synthesis of oligosaccharide derivatives related to those from sanqi, a Chinese herbal medicine from Panax notoginseng. Carbohydr Res. 2002; 337(6):