A historical, evidence-based, and narrative review on commonly used dietary supplements in lipid-lowering

Effects of aged garlic extract on experimental periodontitis in mice

Aged garlic extract (AGE) has been reported to exert anti-inflammatory effects. AGE has been recently found to reduce the inflammatory symptoms of periodontitis, a widespread chronic inflammatory disease caused by oral bacterial infection. However, the mechanisms underlying these effects remain unclear. In the present study, it was aimed to determine the effects of AGE on experimental periodontitis and the related inflammatory factors. AGE (2 g/kg/day) was orally administered to 15 mice during the experimental period, while a control group consisted of 15 mice that received pure water. A total of 3 days after initiation of administration, the left maxillary second molar was ligated with a 5-0 silk thread for 7 days. Blood biochemical tests were performed to monitor the systemic effects of AGE. Alveolar bone loss was measured morphometrically using a stereomicroscope, and reverse transcription-quantitative PCR was performed to assay mRNAs of proinflammatory cytokines in gingival tissues. A histological survey was also performed to identify osteoclasts in periodontitis lesions (five mice per group). The total protein and albumin levels showed no significant differences between the AGE and control groups. However, ligation-induced bone resorption was lower in the AGE group than in the control group (P=0.01). Additionally, ligature increased the mRNA expression of inflammatory cytokines, whereas AGE administration tended to suppress them. Remarkably, tumor necrosis factor gene expression was significantly suppressed (P=0.04). The number of osteoclasts in periodontitis lesions was reduced in the AGE-treated group. These results indicate that AGE prevents alveolar bone loss by suppressing the inflammatory responses related to osteoclast differentiation in the periodontal tissue. Further research is needed to elucidate the role of AGE in reducing inflammatory bone resorption.

Nutraceuticals: a promising, yet unregulated Frontier in Healthcare

Nutraceuticals, with their potential health benefits, are increasingly being used to manage a variety of health conditions. The global market for nutraceuticals, valued at USD 540 billion in 2022, is projected to reach USD 1025 billion by 2030. This paper delves into the beneficial impacts of emerging nutraceuticals on a spectrum of medical disorders, drawing from credible sources from the National Library of Medicine. We have scrutinized studies on the application of nutraceuticals in treating conditions like sleep disorders, migraines, oxidative stress, mental health issues, pain disorders, obesity, gastrointestinal disorders, and even COVID-19. Our analysis indicates that nutraceuticals hold promise for addressing various health issues. However, this paper also sheds light on the health risks associated with nutraceuticals. Despite their widespread use, the safety and efficacy of nutraceuticals are still uncertain due to the lack of stringent regulations, unlike pharmaceutical drugs. This raises concerns about potential health risks and misleading claims. Research indicates that some supplements can cause adverse effects and interact with medications. Therefore, to ensure safe usage, it is imperative to implement stricter regulations, enhance reporting systems, and boost consumer awareness.

Extraction and Processing of Bioactive Phytoconstituents from Widely Used South African Medicinal Plants for the Preparation of Effective Traditional Herbal Medicine Products: A Narrative Review

Medicinal plants are sources of crude traditional herbal medicines that are utilized to reduce the risk of, treat, or manage diseases in most indigenous communities. This is due to their potent antioxidant and anti-inflammatory effects. It is estimated that about 80% of the population in developing countries rely on herbal traditional medicines for healthcare. This signifies the need for traditional herbal medicines, which are polyherbal formulations prepared by traditional health practitioners. This review examines preparatory steps to extract bioactive phytoconstituents and post-extraction processes to increase the potency of the extracted bioactive phytoconstituents. Achieving this will allow for the reduced use of plant materials and promote the sustainable use of the limited resource of medicinal plants, especially in our South African context. Electronic ethnobotanical books and online databases were used to find studies that focus on phytoconstituent extraction and post-extraction processing to enhance the potency of the extracted bioactive phytoconstituents. Modification of the extracted bioactive phytoconstituents to synthesize daughter compounds facilitates an enhancement in their potency and bioavailability. Based on the data collected through this review, the importance of understanding the properties of the targeted phytoconstituents is essential in selecting the required extraction method. This determines the quality and yield of extracted bioactive phytoconstituents.

Effects of β-hydroxy-β-methylbutyrate (HMB) supplementation on lipid profile in adults: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials

Background and aim

The regulation of lipid metabolism is crucial for preventing cardiovascular diseases, which are among the leading causes of mortality worldwide. β-hydroxy-β-methylbutyrate (HMB) has garnered attention for its potential role in modulating lipid profiles. However, the magnitude of these effects are unclear due to the heterogeneity of the studies. This study aimed to provide a comprehensive overview of the randomized controlled trials (RCTs) that have examined the effects of HMB on lipid profiles in adults.

Methods

Databases including PubMed, Web of Science, and Scopus, were searched for relevant studies through January 2024. The study protocol was also registered at Prospero (no. CRD42024528549). Based on a random-effects model, we calculated WMDs and 95% confidence intervals (CIs). The outcomes assessed included total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). Sensitivity, subgroup and meta-regression analyses were also conducted.

Results

Our analysis included a total of 10 RCTs comprising 421 participants. The pooled data revealed no significant effect of HMB supplementation on TC (WMD: -2.26 mg/dL; 95%CI: -6.11 to 1.58; p = 0.25), TG (WMD: -2.83 mg/dL 95% CI: -12.93 to 7.27; p = 0.58), LDL-C (WMD: 0.13 mg/dL; 95%CI: -3.02 to 3.28; mg; p = 0.94), and HDL-C (WMD: -0.78 mg/dL; 95%CI: -2.04 to 0.48; p = 0.22). The quality of evidence was rated as moderate to low for all outcomes.

Conclusion

The current evidence from RCTs suggests that HMB supplementation does not significantly alter lipid profiles, including TC, TG, LDL-C, and HDL-C. Further research is warranted to confirm these results and explore the potential mechanisms of action of HMB.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=528549, CRD42024528549.

The importance of LDL-C lowering in atherosclerotic cardiovascular disease prevention: Lower for longer is better

Cumulative exposure to low-density lipoprotein cholesterol (LDL-C) is a key driver of atherosclerotic cardiovascular disease (ASCVD) risk. An armamentarium of therapies to achieve robust and sustained reduction in LDL-C can reduce ASCVD risk. The gold standard for LDL-C assessment is ultracentrifugation but in routine clinical practice LDL-C is usually calculated and the most accurate calculation is the Martin/Hopkins equation. For primary prevention, consideration of estimated ASCVD risk frames decision making regarding use of statins and other therapies, and tools such as risk enhancing factors and coronary artery calcium enable tailoring of risk assessment and decision making. In patients with diabetes, lipid lowering therapy is recommended in most patients to reduce ASCVD risk with an opportunity to tailor therapy based on other risk factors. Patients with primary hypercholesterolemia and familial hypercholesterolemia (FH) with baseline LDL-C greater than or equal to 190 mg/dL are at elevated risk, and LDL-C lowering with high-intensity statin therapy is often combined with non-statin therapies to prevent ASCVD. Secondary prevention of ASCVD, including in patients with prior myocardial infarction or stroke, requires intensive lipid lowering therapy and lifestyle modification approaches. There is no established LDL-C level below which benefit ceases or safety concerns arise. When further LDL-C lowering is required beyond lifestyle modifications and statin therapy, additional medications include oral ezetimibe and bempedoic acid, or injectables such as PCSK9 monoclonal antibodies or siRNA therapy. A novel agent that acts independently of hepatic LDL receptors is evinacumab, which is approved for patients with homozygous FH. Other emerging agents are targeted at Lp(a) and CETP. In light of the expanding lipid treatment landscape, this manuscript reviews the importance of early, intensive, and sustained LDL-C-lowering for primary and secondary prevention of ASCVD.