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Herbal product use by older adults  
Maturitas
In the past two decades, there has been an exponential increase in the use of medicinal herbal products around the world. In various countries, these products are classified and promoted as foods, not pharmaceuticals, which facilitate their availability on the international market without requiring a medical prescription.
Since older adults (OAs) are an important and growing sector of the population in many countries, it is important to know the prevalence of their herbal product use, since many OA take herbs along with diverse quantities of prescription and over the counter medications. For this reason, it is important to be aware of the possibilities of health complications due to the concomitant use of diverse medications and herbs. OA are an especially vulnerable population, since many of the human body's physiological activities, such as renal and hepatic detoxification and clearance usually decrease with age.
Additionally, information on certain herbal products is either misleading, or simply unavailable. These products may indeed be a therapeutic option, but some can be used properly only under the guidance of a health professional. Those OA taking combinations of various medications and herbal supplements are also more at risk to experience some sort of herb–drug interactions.
This publication reviews selected articles related to the use of herbal products by OAs and mentions the various patterns of use and health implications of the concomitant use of herbal products and prescription medications. This topic is currently not fully understood and further research is warranted.
Article Outline
1. Introduction: The surge of complementary and alternative medicine (CAM) therapies
2. Methods
3. Defining older adults
4. Complementary and alternative medicine (CAM) – definition and prevalence
5. Ethnic background determines the use of herbal products by OA
6. Use of herbal products by older adults in the United States (US)
7. Use of herbal products by older adults in the United Kingdom (UK)
8. Use of herbal products by older adults in Canada
9. Conclusions and further directions
Contributor
Competing interests
Funding
Provenance and peer review
References

Foods and natural health products: Gaps and ambiguities in the Canadian regulatory regime  
Food Policy
Canadian regulations have different rules for foods and natural health products (NHPs) regarding allowable health claims, requirements for use in clinical trials and good manufacturing standards and labeling requirements. How these rules apply to products at the food–NHP interface is often unclear. This paper describes the regulatory environment and explores two product examples – probiotic yogurt and green tea – to illustrate the issue. In addition, results from a qualitative study of NHP/food researchers highlights the confusion and frustration of those working in the field. Interim agreements between the NHP and Foods Directorate of Health Canada regarding products reviews provide a temporary response but regulatory amendments, accompanied by clear guidance to stakeholders, are needed.
Article Outline
Introduction
The Canadian regulatory environment
Product categorization issues
Clinical trials
Pre-market approval
Health claims
Two case examples: probiotic yogurt and green tea
Probiotic yogurt
Green tea
Confusion among researchers in Canada
Conclusions – moving toward regulatory reform
Acknowledgements
References

Herbal products and their association with substance use in adolescents  
Journal of Adolescent Health
Purpose
To describe the prevalence of herbal product use in adolescents and the association between herbal product use and tobacco, alcohol, and other drug use.
Methods
The 1999 Monroe County, New York Youth Risk Behavior Survey provided data on a random sample of 2,006 high school students. Herbal product use was defined by lifetime use of “herbal or other natural products—to feel better, or perform better in sports or school.” Bivariate analyses using χ2 tests and logistic regressions were used to describe the independent associations between herbal product use and substance use.
Results
Overall, 28.6% reported using herbal products. Herbal product use increased with age (24.5% of 9th graders to 29.9% of 12th graders; p < .04) and varied by ethnicity (33% of Hispanics, 30.9% of Caucasians, 28.8% of Asians, Native Americans, or Pacific Islanders, and 12.1% of African Americans; p < .001), but not by gender. After controlling for gender, grade, and ethnicity, logistic regression models showed herbal product use to be associated with lifetime use of: cigarettes (OR = 2.2; 95% CI = 1.8–2.8), alcohol (OR = 3.5; 2.5–4.9), marijuana (OR = 2.2; 1.8–2.7), and other drugs (odds ratios from 4.4 to 14.5). All p values were < .001.
Conclusions
Over one-quarter of high school students report herbal product use, and this use is associated with drug use. Health care providers should inquire about adolescents’ herbal product use, and disclosure should prompt an in-depth substance use history.
Article Outline
Methods
Results
Demographics (Table 1)
Herbal Product Use
Herbal Product Use and Demographics (Table 1)
Substance Use
Association Between Herbal Product Use and Substance Use
Discussion
Conclusions
References

Plant composition, pharmacological properties and mutagenic evaluation of a commercial Zulu herbal mixture: Imbiza ephuzwato  
Journal of Ethnopharmacology
Graphical abstract
Extracts of 21 plant species used to make Imbiza ephuzwato, a Zulu herbal mixture were each investigated for their pharmacological properties. Several plant species demonstrated good activities which, if supported by other confirmatory tests, justify their inclusion in the makeup of Imbiza ephuzwato herbal mixture as well as their use in traditional medicine.

Pharmacological and neurochemical evidence for antidepressant-like effects of the herbal product Catuama 

A Clinical Trial Evaluating Prophylactic and Therapeutic Antibiotic Use on Health and Performance of Preweaned Calves 

Lack of herbal supplement characterization in published randomized controlled trials 

Complementary and alternative medicine for the allergist-immunologist: Where do I start?  
Journal of Allergy and Clinical Immunology

Genotoxicity assessment of Pyungwi-san (PWS), a traditional herbal prescription 
Graphical abstract

10,455 articles found for: pub-date > 2003 and tak(((Health food R&D projects ) or (Cooperation projects in research institutions ) or (Herbal health products ) or (Applied Research and Evaluation ) or (Small test) or test or (trial production )) and ((Industry Seminar ) or (Management and intelligence ) or Medicine or drugs or (Analytical Chemistry) or (Food Specialty)))

18 articles found for: pub-date > 1999 and tak(((Health food R&D projects ) or (Cooperation projects in research institutions ) or (Herbal health products ) or (Applied Research and Evaluation )) and ((Small test) or test or (trial production )) and ((Industry Seminar ) or (Management and intelligence ) or Medicine or drugs or (Analytical Chemistry) or (Food Specialty)))

Safety and nutritional assessment of GM plants and derived food and feed: The role of animal feeding trials 
Food and Chemical Toxicology
In this report the various elements of the safety and nutritional assessment procedure for genetically modified (GM) plant derived food and feed are discussed, in particular the potential and limitations of animal feeding trials for the safety and nutritional testing of whole GM food and feed. The general principles for the risk assessment of GM plants and derived food and feed are followed, as described in the EFSA guidance document of the EFSA Scientific Panel on Genetically Modified Organisms.
In Section 1 the mandate, scope and general principles for risk assessment of GM plant derived food and feed are discussed. Products under consideration are food and feed derived from GM plants, such as maize, soybeans, oilseed rape and cotton, modified through the introduction of one or more genes coding for agronomic input traits like herbicide tolerance and/or insect resistance. Furthermore GM plant derived food and feed, which have been obtained through extensive genetic modifications targeted at specific alterations of metabolic pathways leading to improved nutritional and/or health characteristics, such as rice containing β-carotene, soybeans with enhanced oleic acid content, or tomato with increased concentration of flavonoids, are considered.
The safety assessment of GM plants and derived food and feed follows a comparative approach, i.e. the food and feed are compared with their non-GM counterparts in order to identify intended and unintended (unexpected) differences which subsequently are assessed with respect to their potential impact on the environment, safety for humans and animals, and nutritional quality. Key elements of the assessment procedure are the molecular, compositional, phenotypic and agronomic analysis in order to identify similarities and differences between the GM plant and its near isogenic counterpart.
The safety assessment is focussed on (i) the presence and characteristics of newly expressed proteins and other new constituents and possible changes in the level of natural constituents beyond normal variation, and on the characteristics of the GM food and feed, and (ii) the possible occurrence of unintended (unexpected) effects in GM plants due to genetic modification. In order to identify these effects a comparative phenotypic and molecular analysis of the GM plant and its near isogenic counterpart is carried out, in parallel with a targeted analysis of single specific compounds, which represent important metabolic pathways in the plant like macro and micro nutrients, known anti-nutrients and toxins. Significant differences may be indicative of the occurrence of unintended effects, which require further investigation.
Section 2 provides an overview of studies performed for the safety and nutritional assessment of whole food and feed. Extensive experience has been built up in recent decades from the safety and nutritional testing in animals of irradiated foods, novel foods and fruit and vegetables. These approaches are also relevant for the safety and nutritional testing of whole GM food and feed.
Many feeding trials have been reported in which GM foods like maize, potatoes, rice, soybeans and tomatoes have been fed to rats or mice for prolonged periods, and parameters such as body weight, feed consumption, blood chemistry, organ weights, histopathology etc have been measured. The food and feed under investigation were derived from GM plants with improved agronomic characteristics like herbicide tolerance and/or insect resistance. The majority of these experiments did not indicate clinical effects or histopathological abnormalities in organs or tissues of exposed animals. In some cases adverse effects were noted, which were difficult to interpret due to shortcomings in the studies.
Many studies have also been carried out with feed derived from GM plants with agronomic input traits in target animal species to assess the nutritive value of the feed and their performance potential. Studies in sheep, pigs, broilers, lactating dairy cows, and fish, comparing the in vivo bioavailability of nutrients from a range of GM plants with their near isogenic counterpart and commercial varieties, showed that they were comparable with those for near isogenic non-GM lines and commercial varieties.
In Section 3 toxicological in vivo, in silico, and in vitro test methods are discussed which may be applied for the safety and nutritional assessment of specific compounds present in food and feed or of whole food and feed derived from GM plants. Moreover the purpose, potential and limitations of the 90-day rodent feeding trial for the safety and nutritional testing of whole food and feed have been examined.
Methods for single and repeated dose toxicity testing, reproductive and developmental toxicity testing and immunotoxicity testing, as described in OECD guideline tests for single well-defined chemicals are discussed and considered to be adequate for the safety testing of single substances including new products in GM food and feed.
Various in silico and in vitro methods may contribute to the safety assessment of GM plant derived food and feed and components thereof, like (i) in silico searches for sequence homology and/or structural similarity of novel proteins or their degradation products to known toxic or allergenic proteins, (ii) simulated gastric and intestinal fluids in order to study the digestive stability of newly expressed proteins and in vitro systems for analysis of the stability of the novel protein under heat or other processing conditions, and (iii) in vitro genotoxicity test methods that screen for point mutations, chromosomal aberrations and DNA damage/repair.
The current performance of the safety assessment of whole foods is mainly based on the protocols for low-molecular-weight chemicals such as pharmaceuticals, industrial chemicals, pesticides, food additives and contaminants. However without adaptation, these protocols have limitations for testing of whole food and feed. This primarily results from the fact that defined single substances can be dosed to laboratory animals at very large multiples of the expected human exposure, thus giving a large margin of safety. In contrast foodstuffs are bulky, lead to satiation and can only be included in the diet at much lower multiples of expected human intakes. When testing whole foods, the possible highest concentration of the GM food and feed in the laboratory animal diet may be limited because of nutritional imbalance of the diet, or by the presence of compounds with a known toxicological profile.
The aim of the 90-days rodent feeding study with the whole GM food and feed is to assess potential unintended effects of toxicological and/or nutritional relevance and to establish whether the GM food and feed is as safe and nutritious as its traditional comparator rather than determining qualitative and quantitative intrinsic toxicity of defined food constituents. The design of the study should be adapted from the OECD 90-day rodent toxicity study. The precise study design has to take into account the nature of the food and feed and the characteristics of the new trait(s) and their intended role in the GM food and feed.
A 90-day animal feeding trial has a large capacity (sensitivity and specificity) to detect potential toxicological effects of single well defined compounds. This can be concluded from data reported on the toxicology of a wide range of industrial chemicals, pharmaceuticals, food substances, environmental, and agricultural chemicals. I