Feature

Hot Stock

by Ben Babal, C.N.

This past year saw many store managers concerned with competition and a flattening market. Now they are watching and waiting to see which dietary supplements will emerge as the year's super sellers. Numerous factors are necessary for consumer awareness and acceptance of supplements. These include the coordinated forces of media attention and scientific backing as well as effective marketing and advertising strategies.

Anti-aging products appear to have all four factors going for them. Demographics—namely, the aging baby boomers—are big contributors to their popularity as well. Every eight seconds a baby boomer turns 50. This year, some 75 million Americans will be more than 50 years old. The anti-aging products category refers to supplements including hormones, antioxidants, vitamins, minerals and other nutrients. These products, marketed for a variety of conditions likely to be of concern to an aging populace, promise to whiten teeth, smooth wrinkles, restore hair, increase bust size, reduce the waistline and overall add life to one's years.

According to Ronald Klatz, M.D., president of the American Academy of Anti-Aging Medicine in Chicago, "Anti-aging medicine is no longer alternative medicine—it's cutting-edge." The organization has grown from 12 physicians in 1993 to 1,300 today. The academy plans to board-certify physicians who want to specialize in anti-aging medicine.

While not necessarily new, the products showcased here command attention because they promise to capture store shelf space and increase sales in the coming year. Retailers and practitioners would do well to educate themselves and prepare for the inevitable queries from their customers.

1. Growth Hormone Enhancer
One current aging theory involves the gradual decline of growth hormone secretion. Human growth hormone (hGH) is responsible for growth spurts in teenagers; it also restores lost muscle mass and redistributes fat cells in the elderly.¹ After age 30, humans experience a decline in circulating growth hormone levels. Consequently, body composition shifts from muscle to fat.

Once retrieved from the pituitary glands of cadavers, hGH is now a genetically engineered protein derived from bacteria. Until recently, the only approved use of prescription hGH was to treat dwarfism in children. But in 1996, the U.S. Food and Drug Administration approved hGH for long-term replacement therapy in growth hormone-deficient adults. An estimated 75,000 adult Americans suffer growth hormone deficiencies, symptoms of which principally include fatigue coupled with a number of the following symptoms: decreased lean body mass, muscle mass or physical strength; abdominal obesity and weight gain; reduced cardiac performance; impaired sense of well being; and poor sleep.² Many of these people received hGH when they were children or had their pituitary glands damaged by cancer, radiation or trauma.

However, increasing numbers of anti-aging enthusiasts are receiving daily injections for reasons not approved by the FDA. One study showed that 21 men aged 61-80 years old who injected 50 mg recombinant hGH three times a week for six months raised their lean mass 8 percent, decreased fat 14 percent, increased spleen and liver sizes by 18 percent, and increased bone density by 1.6 percent.³ Anecdotal reports cite enhanced libido, improved immunity and wrinkle removal. At $12,000 to $20,000 a year, though, the treatment is out of reach for most people. Plus, adverse effects are documented in those taking 0.15-5 mg/day of injectable hGH. Side effects run the gamut from headaches to cardiovascular and heart diseases.^4-6 Those taking injections must be monitored by a health care practitioner.

Human growth hormone is also growing in popularity as a performance-enhancing drug in professional sports. One double- blind, placebo-controlled study of 35 growth hormone-deficient adults found favorable changes in body composition after six months. The researchers concluded that training in addition to supplementing with growth hormone may be necessary to significantly increase physical performance in people with hGH deficiencies.⁷ Other studies conclude the ergogenic benefits of growth hormone doping among athletes remain unproven.⁸ Unlike steroids, there is no test for hGH use.

Another approach to increasing hGH levels is amino acid precursor therapy. A precursor, by definition, converts into another substance along the biochemical pathway. These amino acids convert to growth hormone, which in turn increases the burning of fat as well as muscle growth.

Arginine and ornithine, amino acid precursors for hGH stimulation, first received acclaim in 1987 with Durk Pearson and Sandy Shaw's best-selling book, Life Extension—A Practical, Scientific Approach (Warner Books, 1987). The two growth hormone precursors were touted as body-building and fat-loss products and sales increased. However, this is an expensive proposition since rather large doses of the amino acids—at least 6 g arginine or 3 g ornithine—are sometimes required for a detectable increase of hGH in the bloodstream, according to the authors. Plus, those dosage recommendations can cause stomach upset and diarrhea. Finally, no studies indicate this increase translates to increased performance. When the book faded from the best-seller lists, so did consumer interest in hGH precursors. However, new published studies and new products targeting hGH enhancement may swing the pendulum back in favor of these amino acids.

Glutamine, the most abundant amino acid in the body, is invaluable in influencing hGH. A clinical trial demonstrated that glutamine affects muscular protein synthesis and circulating growth hormone levels.⁹ In this study, only 2 g/day oral glutamine caused a significant release (more than 400 percent) of circulating growth hormone in nine healthy adult men. Although growth hormone levels increased, the study did not measure muscle mass changes or exercise enhancement. An in vitro study did show glutamine's anabolic and anticatabolic effects as it increased protein synthesis and inhibited protein breakdown.¹⁰ Physiologically, this could translate to enhanced muscle growth and improved athletic performance.

Research on amino acids such as glutamine is still in its infancy; some studies show positive effects of glutamine supplementation on overtraining, others do not.¹¹

Homeopathic growth hormone is another product marketed for hGH enhancement. Three double-blind, placebo-controlled clinical studies published in the December 1999 issue of Alternative and Complementary Therapies found chewable tablets of homeopathic recombinant human growth hormone promoted significant physical, physiological and self-perceived quality-of-life benefits compared to placebo in 162 healthy adults. The three trials, lasting between 21 and 42 days, found statistically significant decreases in weight and fat storage, lowered systolic blood pressure, relief from fatigue and dry skin, and improvements in sleep quality and libido.¹²

2. Medicinal Mushrooms
A new category of nutritional supplements is neither vitamin, mineral nor herbal. These are mycological products— medicinal mushrooms. Although considered part of traditional Chinese medicine (TCM) and Japanese herbology, medicinal mushrooms are not herbs but fungi, a biological kingdom unto themselves.

There are about 100,000 different types of fungi, including the penicillin mold. Also in this group are 38,000 species of mushrooms, about 500 of which are thought to possess medicinal properties.

Most of the immune activation provided by medicinal mushrooms is attributed to a polysaccharide called beta glucan. Beta glucan is a complex carbohydrate composed of glucose molecules strung together. Receptors for beta glucans are found on macrophages, large white blood cells that destroy harmful microorganisms and tumor cells.

More mainstream practitioners are using medicinal mushrooms to treat a variety of clinical conditions including heart disease, cancer, depressed immunity, hypertension and elevated triglyceride levels. In fact, the all-time, best-selling cancer drug sold in Europe and Japan is a mushroom derivative called PSK. Among the better-known mushrooms used throughout Asia for millennia are reishi, shiitake and maitake.

Reishi (Ganoderma lucidum), perhaps the most renowned of all medicinal mushrooms, is called the "elixir of immortality." In TCM, reishi is considered in the highest class of tonics to promote longevity. The emperor responsible for the Great Wall of China is said to have dispatched 3,000 soldiers to search for this rare mushroom. Many human clinical trials in China during the last 20 years show reishi to be an effective treatment for a wide range of disorders including coronary heart disease and chronic bronchitis.¹³

Shiitake (Lentinus edodes) is used as both food and medicine. It is Japan's top agricultural export and the most cultivated exotic mushroom in the world. A shiitake polysaccharide component called lentinan, is recognized as an immunostimulant and is an approved drug in Japan for treating gastric cancer.¹⁴

Maitake (Grifola frondosa) is the latest mycologic superstar. Used for centuries in Japanese herbal medicine, recent re-search seems to confirm maitake's ability to stimulate immunity. At least 30 studies have looked at its anti-tumor action. One study compared maitake D-fraction, an extract of the mushroom that contains a concentration of the immune-stimulating polysaccharides, with mitomycin-C (MMC), a widely-used chemotherapeutic drug. A small dose of the maitake extract produced an 85 percent tumor shrinkage in mice compared to 30 percent with MMC. When half-doses of MMC and maitake D-fraction were combined, they achieved 99 percent tumor shrinkage in 14 days.¹⁵

At Georgetown University Medical Center in Washington, Harry Preuss, M.D., is studying the effects of various maitake extracts in different rat breeds. Preuss and colleagues have concluded that both extracts and whole mushroom powder have significant hypotensive and triglyceride-lowering effects when given orally.¹⁶ The fractions are different from D-fraction, and Preuss' work will likely lead to new products. Meanwhile, whole, dried maitake mushroom supplements contain all fractions.

3. Ribose
Another carbohydrate to stock is D-ribose. Ribose is the sugar backbone of ribonucleic acid (RNA) and deoxyribonucleic acid (DNA). Found in all living cells, ribose is the starting point for adenosine triphosphate (ATP), the energy "currency."

Although recognized as an important nutrient since the 1970s, it is only recently that improved and more economical manufacturing procedures have made ribose supplements available. Recent research shows that giving ribose to people suffering from myocardial ischemia, or inadequate blood flow to the heart, greatly increases energy in the heart muscle. In one placebo-controlled study of 20 men with documented severe coronary artery disease, the heart's tolerance to ischemia improved after three days treatment with 60 g ribose daily.¹⁷

Since the body produces ribose from glucose slowly, supplementing can benefit not only heart patients but athletes who exercise intensely. Under normal conditions, it takes several days to replace energy lost to ischemia or heavy exercise. In heart patients, low blood flow and ATP deficiency can cause chest pain after light activity such as walking. It is estimated, however, that ribose supplementation could quickly restore energy to muscle cells. A rat study found intravenous administration of ribose fully restored ATP levels in 12 hours vs. 72 hours without supplementation.¹⁸ In athletes, a day off between exercising to exhaustion three or four times per week may not provide enough time for recovery. To keep cellular ATP levels at their highest, 3-5 g of ribose are recommended daily before and/or after exercise.¹⁹

It is conceivable that ribose will become as popular as creatine since the supplements appear to be complementary. Ribose is part of the metabolic pathway leading to ATP production in the presence of oxygen. It is part of adenosine, the "A" in ATP. During exercise, cells generally use creatine phosphate as a source of a phosphate ("P") molecule for reforming ATP. It is theorized that ribose and creatine together may produce a benefit that exceeds that of creatine alone.

4. Systemic Enzymes

Systemic enzyme supplements are used to instigate various chemical reactions within cells and not necessarily for food digestion. The clinical use of enzymes is most widely practiced in Germany, where they are commonly used for their anti-fibrotic, anti-inflammatory, immune-supportive and blood- thinning properties. More than 50 studies have confirmed their use in treating rheumatoid arthritis and osteoarthritis, sports injuries and maintaining good heart health and immune function. One systemic oral enzyme preparation is the No. 1 non-aspirin, over-the-counter medicine for pain and inflammation and the ninth-leading natural medicine among all medical drugs in Germany. In the United States, systemic oral enzymes have been overlooked by most physicians and consumers, but this trend is changing.

Proteolytic systemic enzymes (proteases), such as those found in bromelain, papain and pancreatin, cleave protein compounds by hydrolysis. That is, they split their substrate by incorporating water. These enzymes are absorbed from the gastrointestinal tract into the bloodstream and travel to specific sites where they break down cell debris, fibrin and toxins. They also stimulate phagocytosis within the immune system and accelerate elimination by way of the lymphatic system and blood vessels.²⁰ This translates into improved circulation and reduced inflammation.

In contrast to chemical inhibitors of inflammation such as nonsteroidal anti-inflammatory drugs (NSAIDs), enzyme preparations support and accelerate the natural inflammatory process without contributing to pain, redness and swelling. This is accomplished by helping degrade and remove plasma proteins and fibrin that invade the interstitial space within tissues at the site of inflammation. Improved microcirculation and removal of inflammatory products results in an analgesic effect and complaint relief.^21,22

Unlike digestive enzymes, which are taken with food, systemic enzyme supplements are taken on an empty stomach, 45 minutes to one hour before meals, to digest proteinaceous or fibrous waste material including the outer coating of bacteria, cysts, tumors, necrotic tissue and immune complexes. The only negative effects are for people with rare cases of protein allergies.²³

The dawn of the new year—and millennium—promises to be an exciting one as more consumers turn to natural products for their healthcare needs. Let's prepare for these products to take off in the coming year.

Ken Babal, C.N., is a consulting nutritionist and a member of the Society of Certified Nutritionists. He is staff nutritionist for Erewhon Natural Foods Market in Los Angeles.

References

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2. Ho Ky, Veldhuis JD. Diagnosis of growth hormone deficiency in adults. Endocrinol Metab 1994;1(Suppl A):61-3.

3. Rudman D, et al. Effects of human growth hormone in men over sixty years old. New Engl J Med 1990;323:1-6.

4. Toagood AA, Shalet SM. Growth hormone replacement therapy in the elderly with hypothalamic-pituitary disease: a dose-finding study. J Clin Endocrinol Metab 1999;84:131-6.

5. Mason P, et al. Growth hormone as a risk for premature mortality in healthy subjects: data from the Paris prospective study. BMJ 1998;316:1132-3.

6. Lombardi G, et al. Cardiovascular aspects in acromegaly: effects of treatment. Metabolism 1996;45 (Suppl 1):57-60.

7. Rodriguez-Arnao J, et al. Effects of growth hormone replacement on physical performance and body composition in GH deficient adults. Clin Endocrinol 1999 Jul;51(1):53-60.

8. Jenkins PJ. Growth hormone and exercise. Clin Endocrinol 1999 Jun;50(6):683-9.

9. Welbourne TC. Increased plasma bicarbonate and growth hormone after an oral glutamine load. Am J Clin Nutr 1995;61:1058-61.

10. Wu Gy, Thompson JR. The effect of glutamine on protein turnover in chicken skeletal muscle in vitro. Biochem J 1990;265(2):593-8.

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12. Brewitt B. Physiological and psychological benefits from homeopathic growth hormone in healthy subjects: three types of double-blind, placebo-controlled studies. Alt Compl Therapies 1999 Dec;5(5). In press.

13. Hobbs C. Medicinal mushrooms: an exploration of tradition, healing and culture. Botanica Press, Santa Cruz, Calif. 1996. P. 101.

14. T, Kaneko Y. Lentinan: an overview of experimental and clinical studies of its action against cancer. In: Proceedings of the seventh symposium of host defense mechanisms against cancer. Hakone, Japan. Nov. 8-10, 1985.

15. Nanba H. Maitake D-fraction: healing and preventive potential for cancer. J Orthomolecular Med 1997;12(1):43-9.

16. Preuss HG, et al. Effects of maitake mushroom and two extracts on blood pressure (BP) and other CVD parameters in 2 rat strains. J Am Coll Nutr 1998;17:507.

17. Pliml W, et al. Effects of ribose on exercise-induced ischaemia in stable coronary artery disease. Lancet 1992;340:507-10.18.

18. Hellsten-Westing Y, et al. Decreased resting levels of adenine nucleotides in human skeletal muscle after high-intensity training. J Appl Physiol 1993;74(5):2523-8.

19. Zimmer HG, Ibel H. Ribose accelerates the repletion of the ATP pool during recovery from reversible ischemia of the rat myocardium. J Mol Cell Cardiol 1984 Sep;16(9):863-6.

20. Klaschka F. Oral enzymes: new approach to cancer treatment. Munich, Germany: Forum-Medizin,(1996) 121.

21. Kleine M, Pabst H. The study of an oral enzyme therapy on an experimental erzeugre hamatome. Forum of practical and general practitioners 1988;27:42.

22. Kleine M et al. Kinetic of proteolytic enzyme activity of serum in a controlled randomized double blind study, Abstr. 2nd International Congress on Biological Response Modifiers, San Diego, California, Jan. (1993), 29-31.

23. Kimber I, et al. Toxicology of protein allergenicity: prediction and characterization. Toxical Sci 1999 Apr;48(2):157-62.