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Glucosamine Supplements Linked to Lower CVD Event Risks – Medscape



People who regularly take glucosamine supplements appear to have a moderately lower risk for cardiovascular disease (CVD) events, results from 22 centers participating in the UK Biobank suggest.

Glucosamine use was associated with a 15% lower risk for total CVD events and a 9% to 22% lower risk for stroke, coronary heart disease (CHD), and CVD death after adjustment for age, sex, body mass index, race, lifestyle factors, diet, medications, and other supplements.

“Even though the use of glucosamine is related to only 15% reduced risk, the effect size is similar to most of the protective dietary factors,” senior author Lu Qi, MD, PhD, from Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, told | Medscape Cardiology.

“Another thing that really convinced me about the relationship was that glucosamine use showed a highly consistent association with the various events,” he said.

A few other cohort studies have raised this question including the Vitamins and Lifestyle (VITAL) cohort study, in which high glucosamine use (at least 4 days per week for at least 3 years) was associated with a 17% lower adjusted total mortality risk.

Animal studies suggest the associations may be driven by the anti-inflammatory properties of glucosamine or that the popular supplement may mimic a low carbohydrate diet by decreasing glycolysis and increasing amino acid catabolism, the authors write in their article published online May 14 in BMJ.

Qi and colleagues used data from 466,039 UK Biobank participants without baseline CVD who completed a questionnaire on regular supplement use, including glucosamine. In all, 19.3% reported glucosamine use at baseline.

After a median follow-up of 7 years, there were 10,204 incident CVD events, 3060 CVD deaths, 5745 CHD events, and 3263 strokes.

In multivariate analyses, the hazard ratios (HRs) associated with glucosamine use were:

  • 0.85 for total CVD events (95% confidence interval [CI], 0.80 – 0.90; P < .001)

  • 0.78 for CVD death (95% CI, 0.70 – 0.87; P < .001)

  • 0.82 for CHD (95% CI, 0.76 – 0.88; P < .001)

  • 0.91 for stroke (95% CI, 0.83 – 1.00; P = .04)

Glucosamine was associated with significantly lower risks for nonfatal and fatal CHD (HRs, 0.84 and 0.70; P for both < .001), but only a marginally lower risk for nonfatal stroke (HR, 0.91; P = .08), and had no association with fatal stroke risk (HR, 0.87; P = .30).

It is unclear why the association was weaker with stroke, but “coronary heart disease is a macrovascular disease, whereas stroke is microvascular,” Qi observed. “They affect different size blood vessels. So I think the etiology of stroke and coronary heart disease is totally different, even though there are some similarities.”

Of note, the association between glucosamine use and CHD was stronger in current smokers (37% lower risk) than in former (18%) or never smokers (12%; P = .004). This may reflect the anti-inflammatory effects of glucosamine, as smokers have more inflammation and a higher risk for CVD, he said.

There was no significant association between glucosamine use and stroke based on smoking status. The investigators also calculated genetic risk scores for CHD and stroke using previously reported single nucleotide polymorphisms and found no significant interactions between glucosamine use and either risk score on CHD or stroke risk.

“Really Provocative Data”

“This is interesting, really provocative data,” Laurence Sperling, MD, director of the Emory Heart Disease Prevention Center in Atlanta, Georgia, told | Medscape Cardiology. “It’s hypothesis-generating but it’s a large cohort of long duration with a lot of events that at least adds some credence to this association.”

“But I would not recommend right now routine use of glucosamine for cardiovascular reduction until we have a critical mass of excellent cohort studies or the gold standard of a randomized controlled trial,” he said.

Although atherosclerosis is very clearly an inflammatory disease state, Sperling noted that the inflammatory pathways are complex and that there can be a downside when inflammation in suppressed biologically. Recent cardiovascular trials of anti-inflammatory drugs such as canakinumab (Ilaris, Novartis) in CANTOS and low-dose methotrexate in CIRT have produced mixed results.

Although some studies have suggested methotrexate may worsen glucose tolerance in persons at high risk for diabetes, subsequent clinical trials in healthy participants and patients with diabetes have shown this to be unfounded, Qi noted.

A cross-sectional Australian study, in which glucosamine use reached 22%, suggests that its finding of lower use in patients with cardiac conditions than in those with osteoporosis may be related to patients’ concerns or professional advice regarding the potential for drug interactions with prescription antiplatelets or anticoagulants.

Neither Sperling nor Qi were unaware of this potential interaction but Qi agreed that further investigation is needed before starting glucosamine for CVD reduction.

“For patients, I think at this stage we would not give any strong recommendation because the data is observation,” Qi said. “The most important thing is for not only epidemiologists, but people doing the basic science, to investigate why glucosamine affects cardiovascular disease. The second thing is test the casual relationship in clinical trials, which would not be very difficult.”

Although the authors note that glucosamine has been rated as the safest supplement for osteoarthritis, the study was limited by a lack of information in the UK Biobank on the side effects of glucosamine, the dosage and duration of glucosamine use, and the specific form of glucosamine in the supplements.

“If you have a patient with heart disease or cardiovascular risk, you should always be cautious about adding a supplement to the mix never knowing the impact of that until it’s very well studied,” Sperling said.

Patients also need to be forthright with their physicians if they are taking some type of supplement or herbal because “unless you specifically ask, you often don’t get those answers,” he said.

Qi was supported by grants from the National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases. Sperling reported no relevant financial relationships.

BMJ. Published online May 14, 2019. Full text

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Collagen supplement use growing in popularity, improves skin, hair and nails – WXYZ




There are so many options when a person goes into a supplement store, from vitamins to minerals and protein powders and more.

The latest one to grow in popularity? Collagen.

At Supplement Giant, owner Adam Watts says collagen powder is a popular product.

“Collagen is actually the most abundant amount of protein in our body,” Watts said.

Collagen represents 30 percent of a human body’s protein content.

“It’s found in animal bones ligaments and tendons again not traditionally part of our diet anymore,” he said.

Most brands sell collagen as a great supplement to take to improve a person’s hair, skin, fingernails, and bone and joint health.

“If you have a deficiency of collagen in your skin it can decrease you skin health which can cause stretch marks, dark spots, infections,” Watts said.

He suggests people age 30 and older take a collagen supplement.

“After the age of 30, collagen decreases by 1 percent, so by the time you’re 50, you’ve lost 20 percent of your collagen,” he said. “If you have injuries, collagen is going to help and repair tissue.”

Registered Dietician Jessica Crandall Snyder said she recommends food as medicine, not supplements.

“Being active on a daily basis you are actually helping to re-synthesize your collagen,” she said, “So supplemental sources from protein powders may not be the way for you to get adequate nutrition.”

While Adam Watts sells collagen powder at whole sale, other stores start the product at $25 per container.

But eggs, wild salmon, tomatoes, pumpkin and chia seeds are affordable foods that aid in collagen production.

The experts say collagen powder works, but make sure it’s not your main source of protein.

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CA Permit Sale of Hemp-Derived CBD in Foods & Supplements – The National Law Review




California Assembly Bill 228 would expressly permit the retail sale of hemp-derived CBD in foods and supplements in California, notwithstanding the Food and Drug Administration’s position to the contrary. On Thursday, May 16, 2019, AB-228 passed through the State Assembly’s Appropriations Committee with a unanimous 18-0 approval. The Bill, sponsored by Assembly Member Cecilia Aguiar-Curry (District 4), moves to the House floor where a two thirds vote is required for it to continue on to the Senate for approval. 

AB-228 is intended to address the guidance offered by the California Department of Public Health (CDPH) in July 2018, which prohibits hemp-derived CBD from being added to foods. The CDPH’s release provides: 

California incorporates federal law regarding food additives, dietary use products, food labeling, and good manufacturing practices for food… Currently, the United States Food and Drug Administration (FDA) has concluded that it is a prohibited act to introduce or deliver for introduction into interstate commerce any food (including any animal food or feed) to which tetrahydrocannabinol (THC) or CBD has been added. This is regardless of the source of CBD – derived from industrial hemp or cannabis. 

While manufacturing and retail sales of marijuana-derived CBD products are permitted in accordance with California’s cannabis regulations, hemp-derived CBD remains unapproved for use as a food ingredient, food additive or dietary supplement. 

The City of Los Angeles took a similar position when its Department of Public Health, Environmental Health, which regulates food operators, issued the following guidance: “use of industrial hemp derived products in food will be considered adulterated and cited by DPH-EH as a violation resulting in a deduction of two (2) points on the official inspection report.” The Los Angeles guidance becomes effective on July 1, 2019. 

In response to the FDA’s position, California would join multiple states, including Colorado and Illinois, that have released policies allowing hemp-derived CBD in foods. AB-228 provides that “the sale of food or beverages that include hemp or cannabinoids, extracts, or derivatives from industrial hemp shall not be restricted or prohibited based solely on the inclusion of industrial hemp or cannabinoids, extracts, or derivatives from industrial hemp. 

Though legalization at the state level does not preclude FDA enforcement, AB-228 would provide California defendants with an affirmative defense in civil court to unlawful adulterant allegations regarding CBD products. AB-228 also would allow hemp-derived CBD product sales by licensed cannabis businesses and declare that industrial hemp and its derivatives are an agricultural product. 

If the California House of Representatives passes AB-228, it will move on to the Senate where it must receive support by an assigned Senate committee before being placed on the Senate floor for a vote. If approved by the Senate, AB-228 will be delivered to Governor Newsom for final approval.

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Warning: Avoid dietary supplements from these 12 companies –




In the quest to be healthy, dietary supplements continue to be a popular option with some people but the U.S. Food and Drug Administration’s recent warnings to companies hawking such products should cause potential customers to proceed with caution.

The agency recently sent out warnings to several companies that it said did not adhere to government guidelines on dietary supplement claims and their purported benefits.

FDA warns 12 companies over dietary supplement claims

Three of the companies ran afoul of the law by making claims about phenibut, which is sometimes marketed as a sleep aid. According to the FDA, phenibut does not meet the statutory definition of a dietary ingredient.

The FDA also issued nine warning letters to companies marketing DMHA (Dimethylhexylamine or 2-aminoisoheptane) as an ingredient in numerous dietary supplements.

In April 2019, the FDA determined that DMHA, which is often marketed for weight loss and sports performance, is either a “new dietary ingredient” for which the agency has yet to receive the mandatory New Dietary Ingredient notification or is “an unsafe food additive.”

The violations ultimately mean that American consumers may be buying and using products that are not approved for consumption. It also means the remedial claims of the products are as of yet unproven.

On the FDA’s website, a dietary supplement is defined as “a dietary ingredient as a vitamin; mineral; herb or other botanical; amino acid; dietary substance for use by man to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of the preceding substances.”

But then there is this major distinction: “Unlike drugs, supplements are not intended to treat, diagnose, prevent, or cure diseases. That means supplements should not make claims, such as ‘reduces pain’ or ‘treats heart disease.’ Claims like these can only legitimately be made for drugs, not dietary supplements.”

Here are the FDA warning letters to the 12 companies

Warning Letters (DMHA):

Warning Letters (Phenibut):

Do you use dietary supplements? If so, do these warnings concern you at all? Let us know in the comments below!

The post Warning: Avoid dietary supplements from these 12 companies appeared first on Clark Howard.

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