The Role of Herbs and Probiotics in GI Wellness for Older Adults
Herbal therapy (botanical products) and probiotics are two forms of complementary and alternative medicine (CAM). Primary care providers and geriatricians should know about CAM therapies as their patients may well be using it--an estimated 50% or more of the Western population take some form of supplement. Herbals and probiotics are often used for both functional and organic gastrointestinal diseases, with some limited evidence by randomized controlled trials demonstrating occasional efficacy. Issues of toxicity and lack of regulation are major limitations surrounding herbal and probiotic therapies.
Complementary and alternative medical (CAM) therapies are often used by individuals with gastrointestinal symptoms and/or disease. The reasons these therapies are used vary, but often involve patients' frustrations with their inability to control or alleviate gastrointestinal symptoms with available conventional therapies. CAM therapies involve heterogeneous modalities, and CAM has been difficult to define. "Interventions neither taught widely in medical schools nor generally available in U.S. hospitals," is somewhat unsatisfactory, as one, many forms of CAM are increasingly taught; two, the U.S. National Institutes of Health has a division devoted to CAM; and three, CAM therapies are increasingly integrated into Western health care facilities. Others talk of "traditional," meaning ancient, therapies as opposed to more contemporary Western therapy. These therapies have been defined as both alternative, when they are used instead of, and complementary, when they are applied as an adjunct to, standard management.
Primary care providers and geriatricians should know about CAM as their patients may well be using it. Estimates vary, but it is suggested that 50% or more of the Western population take some form of supplement. About 26% of patients in gastrointestinal outpatient clinics and 50% of subjects with inflammatory bowel disease and irritable bowel syndrome in the United Kingdom were found to use some form of CAM therapy, with over half thinking that such therapy alleviated symptoms. Over 50% of supplement takers do not report this use to their physicians.
A recent U.S. National Institutes of Health Conference on Dietary Supplement Use in the Elderly has been summarized. The conference was convened for several reasons, including concern regarding prevalence of supplement use in individuals over the age of 50 (>50% overall; 40% of older adults reporting use of some type of herbal; 12% of those >age 65 reporting herbal supplement use). This drew attention because of perceived inadequate scientific evidence supporting the safety and benefits of supplement use among these individuals, meaning that older adults may be spending money on products that are ineffective and potentially harmful.
In Canada, dietary supplements (including herbal products and probiotics discussed in this paper) are regulated by the Natural Health Products Regulations, which became effective January 1, 2004. Supplements are classified as "natural health products," not foods. All natural health products are required to undergo mandatory premarket review, ensuring that what is on the label is in the bottle and that health claims are supported by an appropriate level of evidence. Unlike foods, "natural health products" can make a full range of health claims, including "risk reduction, structure-function and treatment-prevention claims, where sufficient evidence exists."
Individuals may consume supplements for various reasons. They may perceive that "natural" products are healthier than manufactured drugs. There is significant dissatisfaction with "conventional" medicine and beliefs that doctors do not listen and do not respect cultural traditions. Another charge made is that doctors focus on curing disease rather than treating the "whole patient." Other patients opt to use complementary and alternative therapies as a means to maintain "control" over their own health. Further, patients may receive recommendations from family, friends, sales persons, TV infomercials, and/or a "nutritionist;" to use CAM therapies to prevent chronic diseases, including cardiac illness, dementia, and cancer, or even to slow aging.
This paper reviews data on two forms of supplements: herbals and probiotics. An "herbal" may be defined as a substance derived from any plant source, such as roots, bark, leaves, seeds, flowers, and/or fruits. Herbal products may consist of a number of constituents, none of which are defined at the biochemical level. Probiotics are ingested living microorganisms purported to have health benefits.
Herbal therapy (botanical products) and probiotics are two forms of complementary and alternative medicine (CAM). Primary care providers and geriatricians should know about CAM therapies as their patients may well be using it--an estimated 50% or more of the Western population take some form of supplement. Herbals and probiotics are often used for both functional and organic gastrointestinal diseases, with some limited evidence by randomized controlled trials demonstrating occasional efficacy. Issues of toxicity and lack of regulation are major limitations surrounding herbal and probiotic therapies.
Complementary and alternative medical (CAM) therapies are often used by individuals with gastrointestinal symptoms and/or disease. The reasons these therapies are used vary, but often involve patients' frustrations with their inability to control or alleviate gastrointestinal symptoms with available conventional therapies. CAM therapies involve heterogeneous modalities, and CAM has been difficult to define. "Interventions neither taught widely in medical schools nor generally available in U.S. hospitals," is somewhat unsatisfactory, as one, many forms of CAM are increasingly taught; two, the U.S. National Institutes of Health has a division devoted to CAM; and three, CAM therapies are increasingly integrated into Western health care facilities. Others talk of "traditional," meaning ancient, therapies as opposed to more contemporary Western therapy. These therapies have been defined as both alternative, when they are used instead of, and complementary, when they are applied as an adjunct to, standard management.
Primary care providers and geriatricians should know about CAM as their patients may well be using it. Estimates vary, but it is suggested that 50% or more of the Western population take some form of supplement. About 26% of patients in gastrointestinal outpatient clinics and 50% of subjects with inflammatory bowel disease and irritable bowel syndrome in the United Kingdom were found to use some form of CAM therapy, with over half thinking that such therapy alleviated symptoms. Over 50% of supplement takers do not report this use to their physicians.
A recent U.S. National Institutes of Health Conference on Dietary Supplement Use in the Elderly has been summarized. The conference was convened for several reasons, including concern regarding prevalence of supplement use in individuals over the age of 50 (>50% overall; 40% of older adults reporting use of some type of herbal; 12% of those >age 65 reporting herbal supplement use). This drew attention because of perceived inadequate scientific evidence supporting the safety and benefits of supplement use among these individuals, meaning that older adults may be spending money on products that are ineffective and potentially harmful.
In Canada, dietary supplements (including herbal products and probiotics discussed in this paper) are regulated by the Natural Health Products Regulations, which became effective January 1, 2004. Supplements are classified as "natural health products," not foods. All natural health products are required to undergo mandatory premarket review, ensuring that what is on the label is in the bottle and that health claims are supported by an appropriate level of evidence. Unlike foods, "natural health products" can make a full range of health claims, including "risk reduction, structure-function and treatment-prevention claims, where sufficient evidence exists."
Individuals may consume supplements for various reasons. They may perceive that "natural" products are healthier than manufactured drugs. There is significant dissatisfaction with "conventional" medicine and beliefs that doctors do not listen and do not respect cultural traditions. Another charge made is that doctors focus on curing disease rather than treating the "whole patient." Other patients opt to use complementary and alternative therapies as a means to maintain "control" over their own health. Further, patients may receive recommendations from family, friends, sales persons, TV infomercials, and/or a "nutritionist;" to use CAM therapies to prevent chronic diseases, including cardiac illness, dementia, and cancer, or even to slow aging.
This paper reviews data on two forms of supplements: herbals and probiotics. An "herbal" may be defined as a substance derived from any plant source, such as roots, bark, leaves, seeds, flowers, and/or fruits. Herbal products may consist of a number of constituents, none of which are defined at the biochemical level. Probiotics are ingested living microorganisms purported to have health benefits.