Astragalus

This post was motivated by a patient who chose to take astragalus supplements instead of receiving steroid-based medication to treat a flare up of their inflammatory bowel disease. Whatever treatment you choose, the choice is yours in the end. But you deserve to have all the information you need to make an educated decision.
Since I hadn't heard much about this supplement, I decided to conduct a bit of research to assess the scientific evidence behind the use of this product.
Astragalus can be found as a supplement from the plant Astragalus membranaceus. It has been used in traditional Chinese medicine for immune system support; In China it has been used for chronic hepatitis, colds, upper respiratory tract infections, cancer therapy, and heart disease. The root of plant is often used in soups, teas, extracts, or capsules.

The National Center for Complementary and Alternative medicine suggests that the evidence to support health claims for this product is lacking. They also state that the supplement is safe for most adults, but certain species that are not usually in supplement, can be toxic. There is a possibility that astragalus may interact with medications that suppress the immune system and may affect blood sugar and blood pressure.

Some studies (not on humans) have found astragalus to inhibit human gastric cancer cell growth in lab. Another study on humans suggested it could have potential in treatment of cancer-related fatigue. While a 2011 study of 90 participants suggested that daily astragalus + perindopril improved heart contraction. However, this study did not include a control group which was not receiving astragalus (to compare results to). In addition, it is not clear if positive results obtained could also be related to the medication perindopril (medication used to manage blood pressure and promote blood to flow more smoothly).

The American Cancer Society suggests that "the ability of astragalus to enhance the immune system and fight diseases, including cancer and heart disease, comes mostly from lab and animal studies."
It is important to understand that it cannot be assumed that effects seen in a test tube in a lab or in animals would be the same as in humans. The Cancer Society concludes that "available scientific evidence does not support claims that astragalus can prevent or cure cancer in humans or decrease the toxic effects of chemotherapy or other cancer treatments." More experiments in humans are needed to determine if there are benefits to the use of astralagus.

If you're still interested in using astragalus, speak with your physician and pharmacist first to ensure its safety. Doses found to be safe by Health Canada can be found on their 2010 Astragalus Monograph.

Information Sources:
http://nccam.nih.gov/health/astragalus
http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/herbsvitaminsandminerals/astragalus
http://webprod.hc-sc.gc.ca/nhpid-bdipsn/monoReq.do?id=36&lang=eng
http://www.ncbi.nlm.nih.gov/pubmed/24152941
http://www.ncbi.nlm.nih.gov/pubmed/22309959
http://www.ncbi.nlm.nih.gov/pubmed/21390582
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a602017.html

Pumpkin Spice Latte

As the days get a bit cooler and we get closer and closer to winter, I notice an increase in advertising for the beloved pumpkin spice latte. The latte is available not only at Starbucks now, but at many other cafes such as Second Cup. Today I thought to break things down and let you know what is really in your pumpkin spice latte, and how a few, small, changes could make a big difference!

A grande, 16oz Pumpkin Spice Latte, made with 2% milk and whipped cream contains:

• 380 calories (average person is recommended to have 2000 calories/day)
• 49 grams sugar (more than 12 tsp sugar)
• 220 mg sodium (sodium should be limited to 2300mg/day)
• 50 mg cholesterol (American Heart Association suggests that people with high LDL ("bad" cholesterol) to limit intake to 200mg/day)
• 8 grams saturated fat (recommendations from the American Heart Association are to limit saturated fat to less than 14g/day)
• 14g protein

If we take replace 2% milk with skim milk, remove the whipped cream, and switch to a tall 12oz pumpkin spice latte, the drink contains:

• 200 calories
• 37 grams sugar (more than 9 tsp sugar)
• 170 mg sodium
• 5 mg cholesterol
• 0 grams saturated fat
• 11 grams protein

Approximately 16 grams of the sugar in this 12oz beverage comes from natural lactose in milk while the remainder comes from the pumpkin spice syrup.
Each pump of syrup contains approximately 5 grams of sugar. If you are interested in managing your sugar intake, asking for 1 or 2 less pumps would decrease the sugar content another 5-10 grams.

There are many ways to control what goes into your body. Choosing a smaller beverage size, opting for skim milk, requesting less pumps of syrup, trying a flavorful full leaf tea, having a plain latte with a small amount of honey or adding cinnamon and/or nutmeg for flavor are all steps in direction of making sure your comforting drinks aren't packed with calories, sugar, and fat.
You can even play around with the cafe's websites, searching for nutritional information in order to make more informed choices the next time you're in that cafe!

Nutritional Information for Starbucks beverages and food can be found at:
http://www.starbucks.com/menu/catalog/nutrition?food=all#view_control=nutrition

Nutritional Information for Second Cup Lattes can be found at:
http://www.secondcup.com/best-latte/?nutcat=5

Information Sources:
http://www.mayoclinic.com/health/heart-healthy-diet/NU00196
http://www.starbucks.com/menu/drinks/espresso/pumpkin-spice-latte

Will PGX Solve My Problems?

I don't know how many commercials I've seen for the weight loss product PGX. So today I thought to take a look into what is in PGX and if the product itself has evidence to support its claims of weight loss and feeling full for longer.
PGX or PolyGlycoplex states that it will "change your life." It technically is a viscous fiber (polysaccharide) supplement.

One study including 10 subjects found that small quantities of this supplement before meals can decrease glycemic index of common foods (meaning that it can limit blood sugar spikes).
Another study of 64 subjects involved 32 obese Japanese participants taking 15g of PGX per day for 14 weeks, and another 32 participants taking an placebo. After 14 weeks, the PGX group showed a greater decrease in LDL (bad cholesterol) and waist circumference. However, it is difficult to say that 32 Japanese people could represent the entire population.
Finally, a third study of 35 participants was conducted over 3 days. Women were on a strict 1000calorie/day diet; one group received 5g of PGX at breakfast, lunch, and supper, while another group received a placebo. The PGX group reported decreased appetite, hunger, and desire to eat. However, the study didn't assess what would happen with this strict decrease in calories over a long period of time.

An adverse affect of overloading your body with a high quantity of fiber supplements may be symptoms of bloating, abdominal discomfort, gas, diarrhea, and/or constipation. On the other hand, if you were to use a small quantity of this supplement between meals, or before meals you may be likely to eat less because you feel more full from the fiber.

From a dietitian's perspective, I wouldn't openly recommend this product to my patients due to the lack of enough studies with large amounts of participants. However, if you really want to try PGX, your could double check with a member of your healthcare team and trial small quantities to see how you tolerate it. If you are unsure about the product, my personal recommendation would be utilize high fiber grains, vegetables, and plant sources of protein (beans, peas and legumes) to make you feel full for longer. These foods also provide additional antioxidants, vitamins, and minerals that cannot be found in a pill. If this is combined with exercise, your odds of losing weight and keeping it off go higher.

Remember, a powder, a pill, a magic drug, or a sports drink shouldn't be responsible for changing your life, you are! If you lose weight, it is because of your efforts; so be sure to recognize small, healthy, changes as successes along your path and use your healthcare team of dietitians, doctors, and friends for education and support.

Information Sources:
http://www.ncbi.nlm.nih.gov/pubmed/22017917
http://www.ncbi.nlm.nih.gov/pubmed/23512917
http://www.theglobeandmail.com/life/health-and-fitness/ask-a-health-expert/will-fibre-capsules-help-me-lose-weight/article4182609/