Osteoarthritis : Supplements

In the past several years, a combination of glucosamine and chondroitin sulfate has been proposed as a dietary supplement that helps the body maintain and repair cartilage. Studies conducted in Europe have shown the effectiveness of this treatment...

In the past several years, a combination of glucosamine and chondroitin sulfate has been proposed as a dietary supplement that helps the body maintain and repair cartilage. Studies conducted in Europe have shown the effectiveness of this treatment...

Chondroitin was first extracted and purified in the 1960s. It is currently manufactured from natural sources (shark/beef cartilage or bovine trachea) or by synthetic means. The consensus of expert and industry opinions support the use of chondroitin and its common partner agent, glucosamine, for improving symptoms and arresting (or possibly reversing) the degenerative process of osteoarthritis.

Chondroitin is a substance found in human and animal cartilage that is used to treat several physical disorders, most importantly arthritis, psoriasis , and cancer . It is the most plentiful type of glycosaminoglycan (GAG) found in cartilage. Glycosaminoglycans (GAGs) are complex carbohydrates that are found in the various types of connective tissue in the body. GAGs account for 5-20% of cartilage tissue. Chondroitin occurs in connective tissue as a sulfate composed of repeating disaccharide units; the first unit is either glucosamine or galactosamine; the other unit is glucuronic acid.

In the United States, willow bark is used by herbalists as an antipyretic (fever reducer), a mild analgesic (pain reliever), and an anti-inflammatory. There is currently strong scientific evidence that willow bark is effective for osteoarthritis and lower back pain. Early study suggests that willow bark extracts may not be helpful for rheumatoid arthritis, but further study is warranted to confirm these recommendations. Taking willow bark may increase the risk of bleeding; however, this risk may be less than taking aspirin. Several countries in Europe have approved willow bark for pain and inflammatory disorders. The German Commission E has approved willow bark for fever, rheumatic ailments, and headaches. The British Herbal Compendium indicates that willow bark can be used for rheumatic and arthritic conditions, and fever associated with cold and influenza. In France, willow bark has been approved as an analgesic to treat headache and toothache pain, as well as painful articular (joint) conditions, tendonitis, and sprains. The European Scientific Cooperative on Phytotherapy (ESCOP) has approved willow bark extract for the treatment of fever, pain, and mild rheumatic complaints.

Glucosamine is a natural compound that is found in healthy cartilage. Glucosamine sulfate is a normal constituent of glycoaminoglycans in cartilage matrix and synovial fluid. Available evidence from randomized controlled trials supports the use of glucosamine sulfate in the treatment of osteoarthritis, particularly of the knee. It is believed that the sulfate moiety provides clinical benefit in the synovial fluid by strengthening cartilage and aiding glycosaminoglycan synthesis. If this hypothesis is confirmed, it would mean that only the glucosamine sulfate form is effective and non-sulfated glucosamine forms are not effective. Glucosamine is commonly taken in combination with chondroitin, a glycosaminoglycan derived from articular cartilage. Use of complementary therapies, including glucosamine, is common in patients with osteoarthritis, and may allow for reduced doses of non-steroidal anti-inflammatory agents.

Glucosamine is an amino sugar that occurs naturally in the body. This one-molecule substance consists of glucose and a hydrogen and nitrogen amine. Amino sugars are different from other body sugars, as they form part of carbohydrates. Their function is also different as they are not a source of energy, but rather are included in body tissue structure. Therefore, glucosamine plays a role in forming and maintaining the body's tissues—for example, constructing nails, skin, eyes, bones, ligaments, tendons, heart valves, discharging mucus from the respiratory system, digestive system, and urinary tract. Glucosamine helps blend sulfur into the cartilage. When people grow older, their bodies may lose the capacity to make enough glucosamine, so the cartilage in such weight-bearing joints as the hips, knees, and hands is destroyed. The remaining cartilage then hardens and forms bone spurs , causing pain , deformed joints, and limited joint movement. Glucosamine is not readily available from any primary food source. Commercial preparations of glucosamine are derived from chitin, which is a substance found in the outer covering of such shellfish as lobster, crab, and shrimp, as well as in such animal connective tissues as the marrow of chicken bones. Commercially prepared glucosamine comes in three formats: glucosamine sulfate, glucosamine hydrochloride, and N-acetyl-glucosamine (NAG).

Avocados are fruits that contain 60% more potassium than bananas; they are also sodium and cholesterol-free. An avocado has a higher fat content (5 grams per serving) than other fruit, but the fat is monounsaturated fat, which is considered healthy when consumed in moderation. Diets rich in monounsaturated fatty acids can reduce total cholesterol levels in the blood and increase the ratio of high-density lipoprotein (HDL, "good" cholesterol) to low-density lipoprotein (LDL, "bad" cholesterol). In addition to high cholesterol, avocado has been taken by mouth to treat osteoarthritis. Its oils have been used topically to treat wounds, infections, arthritis, and to stimulate hair growth. The seeds, leaves, and bark have been used for dysentery and diarrhea. It is also used in topical creams for regular skincare. Historically the Amazonian natives used avocado to treat gout, and the Mayan people believed it could keep joints and muscles in good condition, avoiding arthritis and rheumatism. The most promising use for avocado is in a combination product, avocado/soybean unsaponifiables (ASU), which is a combination of avocado oil and soybean oil. Caution is advised when taking Mexican avocado due to the constituents, estragole and anethole, which may be liver damaging and cancer causing.

Devil's claw ( Harpagophytum procumbens ) originates from the Kalahari and Savannah desert regions of South and Southeast Africa. In these parts of the world, devil's claw has historically been used to treat a wide range of conditions including fever, malaria and indigestion. The medicinal ingredient of the devil's claw plant is extracted from the dried out roots. Currently, the major uses of devil's claw are as an anti-inflammatory and pain reliever for joint diseases, back pain and headache. There is currently widespread use of standardized devil's claw for mild joint pain in Europe. Potential side effects include gastrointestinal upset, low blood pressure, or abnormal heart rhythms (increased heart rate or increased heart squeezing effects). Traditionally, it has been recommended to avoid using devil's claw in patients with stomach ulcers, or in people using blood thinners (anticoagulants such as warfarin/Coumadin®).

Devil's claw ( Harpagophytum procumbens ) is an African plant whose fruit looks like a giant claw. The plant grows in an arid climate and is found in Namibia, Madagascar, the Kalahari Desert, and other areas on the African continent. The tuberous roots are used in traditional medicine. The root is collected when the rainy season ends. The root is chopped and dried in the sun for three days. Devil's claw is also known as grapple plant and wood spider.

SAMe was first discovered in 1953 by a researcher named Cantoni. It is formed in the body from methionine and adenosine triphosphate in a reaction catalyzed by methionine adenosyltransferase. SAMe functions as a primary methyl group donor in a variety of reactions in the body. After donating a methyl group, SAMe is converted to S-adenosyl-homocysteine. SAMe is used for psychiatric illnesses, infertility, liver concerns, premenstrual disorders and musculoskeletal disorders, among others. SAMe has been studied extensively in the treatment of osteoarthritis and depression. Many trials provide evidence that SAMe reduces the pain associated with osteoarthritis and is well tolerated in this patient population. Some evidence is available for the use of SAMe for intrahepatic cholestasis of pregnancy although additional study is needed in this area. Anti-inflammatory and analgesic (pain relieving) activity has also been attributed to SAMe. Future well-designed clinical trials are required in the areas of depression, fibromyalgia and liver cholestasis before a strong recommendation can be made in these areas.

Ademetionine, also known as SAMe, is a specific form of the amino acid methionine known as S-adenosyl-methionine. The body manufactures it, and it is found in most tissues of the body. Ademetionine is essential for the formation of glutathione , a water-soluble peptide that helps the body fight free radicals. SAMe also helps the liver to process fats (protecting against a fatty liver) and is believed to play a role in protecting the body from heart disease . SAMe is a methyl donor, which means that it provides other molecules with methyl groups that are critical to their metabolism. In general, ademetionine raises the level of functioning of other amino acids in the body. Severe deficiencies of SAMe can cause problems with other important body functions, such as secretion of important hormones like melatonin , which plays a key role in regulating sleep and circadian rhythms.

SAD see Seasonal affective disorder Sadism see Sexual sadism

The rhizomes (underground stem) and stems of ginger have assumed significant roles in Chinese, Japanese and Indian medicine since the 1500s. The oleoresin of ginger is often contained in digestive, antitussive, antiflatulent, laxative, and antacid compounds. There is supportive evidence from one randomized controlled trial and an open-label study that ginger reduces the severity and duration of chemotherapy-induced nausea/emesis. Effects appear to be additive to prochlorperazine (Compazine®). The optimal dose remains unclear. Ginger's effects on other types of nausea/emesis, such as postoperative nausea or motion sickness remain indeterminate. Ginger is used orally, topically, and intramuscularly for a wide array of other conditions, without scientific evidence of benefit. Ginger may inhibit platelet aggregation/decrease platelet thromboxane production, thus theoretically increasing bleeding risk.

Water-soluble, B complex vitamin. Prescription-only preparations are FDA-labeled for use as antilipemic agents. Do not use dietary supplement preparations and prescription-only preparations interchangeably. (See Substitution of Different Niacin Preparations under Cautions.)

Niacin is a type of B vitamin. It is water-soluble, which means it is not stored in the body. Water-soluble vitamins dissolve in water. Leftover amounts of the vitamin leave the body through the urine. That means you need a continuous supply of such vitamins in your diet.

Niacin, also known as Vitamin B 3 , is important for the normal function of many bodily processes. Like other B vitamins, it is water-soluble and plays a role in turning food into energy, as well as in the metabolism of fats and carbohydrates. Niacin can also act as an antioxidant within cells, which means it can destroy cell-dam-aging free radicals. In conjunction with riboflavin and pyridoxine , it helps to keep the skin, intestinal tract and nervous system functioning smoothly.

The rhizome (root) of turmeric ( Curcuma longa Linn.) has long been used in traditional Asian medicine to treat gastrointestinal upset, arthritic pain, and "low energy." Laboratory and animal research has demonstrated anti-inflammatory, antioxidant, and anti-cancer properties of turmeric and its constituent curcumin. Preliminary human evidence, albeit poor quality, suggests possible efficacy in the management of dyspepsia (heartburn), hyperlipidemia (high cholesterol), and scabies (when used on the skin).

Turmeric is a member of the Curcuma botanical group, which is part of the ginger family of herbs, the Zingiberaceae. Its botanical name is Curcuma longa . Turmeric is widely grown both as a kitchen spice and for its medicinal uses. Two closely related plants, Curcuma petolata and Curcuma roscoeana , are natives of Cambodia and are grown for their decorative foliage and blossoms. All curcumas are perennial plants native to southern Asia. They grow in warm, humid climates and thrive only in temperatures above 60°F (29.8°C). India, Sri Lanka, the East Indies, Fiji, and Queensland (Australia) all have climates that are conducive to growing turmeric. The turmeric plant is identifiable by both its characteristic tuberous root and the leaves that extend upward from erect, thick stems arising from the root. Turmeric root is actually a fleshy oblong tuber 2–3 in (5–10 cm) in length, and close to 1 in (2.54 cm) wide. It is tapered at each end, and its exterior can be yellow, tan, or olive-green in color. The interior of the root is hard, firm, and either orange-brown or deeply rust-colored, with transverse resinous parallel rings. M. Grieve, in A Modern Herbal , states that the root is dense and breaks into a powder that is lemon yellow in color. Turmeric root has a fragrant aroma and a somewhat bitter, peppery, biting taste reminiscent of ginger. When eaten, it colors the saliva yellow and leaves a warm sensation in the mouth. The root contains a bitter volatile oil, brown coloring matter, gum, starch, calcium chloride, woody fiber and a yellowish coloring material that is known as cucurmin. In addition to the root, the turmeric plant produces rhizomes, which are underground stems growing parallel to the ground that produce roots below and new shoots from their upper surface. Turmeric rhizomes have also been used for medicinal purposes. The plant's leaves are divided, lance-shaped and narrower at each end. They are close to 2 ft (61 cm), lustrous and deep green. The flowers arise from those leaves, and are a pale yellow color, growing in groupings of three to five.

Black cohosh is popular as an alternative to hormonal therapy in the treatment of menopausal (climacteric) symptoms such as hot flashes, mood disturbances, diaphoresis, palpitations, and vaginal dryness. Several studies have reported black cohosh to improve menopausal symptoms for up to six months, although the current evidence is mixed. The mechanism of action of black cohosh remains unclear and the effects on estrogen receptors or hormonal levels (if any) are not definitively known. Recent publications suggest that there may be no direct effects on estrogen receptors, although this is an area of active controversy. Safety and efficacy beyond six months have not been proven, although recent reports suggest safety of short-term use, including in women experiencing menopausal symptoms for whom estrogen replacement therapy is contraindicated. Nonetheless, caution is advisable until better-quality safety data are available. Use of black cohosh in high-risk populations (such as in women with a history of breast cancer) should be under the supervision of a licensed healthcare professional.

Black cohosh ( Cimicufuga racemosa ) is a member of the Ranunculaceae family. Its nicknames of squawroot and snakeroot denote its Algonquian heritage and differentiate it from the common snake root plant ( Aristolochia serpentaria ). It should also not be confused Black cohosh plants. (© PlantaPhile , Germany. Reproduced by permission. ) with blue cohosh ( Caulophyllum thalictroides ); their only similarity is that both are roots. Black cohosh grows from a gnarled black root, hence its name; it has a smooth stem and big multiple leaves with jagged edges. In summer, white flowers develop from what are called racemes. These flowers emit a stinky odor. The plant, which can grow to 9 ft (1 m) tall, is a native North American plant found on hills and in forests located at high levels. It is found from Ontario, Canada to Maine to the southern states of Georgia and Missouri. Black cohosh contains several components, as outlined by James F. Balch, MD and Phyllis A. Balch, CNC in their book Prescription for Nutritional Healing, Second Edition : actaeine cimicifugin estrogenic substances isoferulic acid oleic acid palmitic acid pantothenic acid phosphorus racemosin tannins triterpenes vitamin A

Boron is a trace element, which is found throughout the global environment. It has been suggested for numerous medicinal purposes, but there is not strong evidence for any specific use. Preliminary studies report that boron may not be helpful for enhancing bodybuilding, reducing menopausal symptoms, or treating psoriasis.

Boron is a trace mineral that has gained popularity in recent years due to claims that it can strengthen bones, build muscle mass, and boost brain activity. While such macrominerals as calcium, magnesium , and potassium have become household names because they make up over 98% of the body's mineral content, certain trace minerals are also considered essential in very tiny amounts to maintain health and ensure proper functioning of the body. They usually act as coenzymes, working as a team with proteins to facilitate important chemical reactions. While boron is considered essential for plants, it is not known if the mineral is necessary for humans. Evidence has been mounting in the last two decades, however, that suggests boron may be an important micronutrient. Studies indicate that boron may contribute to the way that calcium, a vital building block of bone, and other minerals are processed by the body. Boron appears to increase the amount of calcium absorbed from food and lower the amount excreted by the body. These effects may help to keep bones strong. Boron may also improve mental functioning, strengthen the immune system, boost energy utilization, and affect cholesterol production. While the effects of a boron-free diet have not been observed in people, animal studies suggest that a lack of boron can be unhealthy. In one investigation, for example, a boron-deficient diet fed to animals seemed to increase the amount of calcium they lost. It also appeared to have a negative effect on bone development and energy utilization. It is not certain, however, that study results such as this confirm the nutritional importance of boron for human beings. As of 2000, research is still necessary to determine if boron can produce significant health benefits safely and effectively. The proper dosage of the mineral has not yet been established.

The name "carotene" was first coined in the early 19th Century by the scientist Wachenroder after he crystallized this compound from carrot roots. Beta-carotene is a member of the carotenoids, which are highly pigmented (red, orange, yellow), fat-soluble compounds naturally present in many fruits, grains, oil and vegetables (green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers). Alpha, beta, and gamma carotene are considered provitamins because they can be converted to active vitamin A. The carotenes possess antioxidant properties. Vitamin A serves several biological functions including involvement in the synthesis of certain glycoproteins. Vitamin A deficiency leads to abnormal bone development, disorders of the reproductive system, xerophthalmia (a drying condition of the cornea of the eye), and ultimately death. Commercially available beta-carotene is produced synthetically or from palm oil, algae, or fungi. Beta-carotene is converted to retinol, which is essential for vision and is subsequently converted to retinoic acid, which is used for processes involving growth and cell differentiation.

Weak antioxidant; precursor of vitamin A.

Beta carotene is one of the most important naturally occurring antioxidants . It is a fat-soluble pigment found in plants (notably carrots and many colorful vegetables and fruits) and in the sea alga Dunaleilla salina and D. bardawil . Naturalbeta carotene supplements are derived primarily from D. salina . Beta carotene is one of the major dietary carotenoids and one of the most biologically active of approximately 800 carotenes and more than 1,000 carotenoids present in food. It is responsible for the orange or yellow colors of many fruits and vegetables. In the human body, beta carotene is found in lipids and in fat tissues. Sometimes beta carotene is called provitamin A because it is more easily converted to vitamin A (retinol) in the liver than other carotenoids. Beta carotene is considered to be a conditionally essential nutrient because it becomes essential when vitamin A intake is low. Beta carotene consists of a chain of 40 carbon atoms, with conjugated double bonds and a ring structure at each end of the chain. Depending on the positions of the molecular groups attached to the carbon chain, naturally occurring beta carotene may be: All- trans beta-carotene 9- cis beta-carotene 13- cis beta-carotene, in smaller amounts Synthetic beta carotene is primarily all- trans . In plants and alga, beta carotene and other carotenoids attract light for photosynthesis and provide protection from toxic forms of oxygen. Beta carotene is a powerful antioxidant because it destroys toxic free radicals, including singlet oxygen—an oxygen atom that is missing an electron and is very damaging to human tissue if not taken up quickly and "deactivated."

Beta-carotene is the most active of the deeply colored pigments called carotenoids . After consumption, beta-carotene converts to retinol, a readily usable form of vitamin A. Beta-carotene's beneficial effects include protecting the skin from sunlight damage, fighting early cancer cells, boosting immunity, and preventing cataract formation. It also stops the creation of free radicals (oxidants), which are DNA-damaging molecular fragments in the body. Food sources of beta-carotene include carrots, spinach, kale, and broccoli, as well as animal sources such as liver, whole eggs, and whole milk. Since beta-carotene is fat-soluble, most fat-free milk has been fortified with vitamin A to replace what is lost when the fat is removed. Vitamin A is stored in the body, and an excess amount can lead to acute symptoms, such as vomiting and muscle weakness, as well as chronic problems such as liver abnormalities, birth defects, and osteoporosis . In addition, beta-carotene supplements have been found in some studies to actually increase the risk of cancer in smokers. (Excess beta-carotene is not stored in the body, however.) Because of these dangers, the Institute of Medicine recommends that beta-carotene supplements are not to be used by the general public. The institute does advocate the use of such supplements for populations with inadequate vitamin A intake. SEE ALSO A NTIOXIDANTS ; C AROTENOIDS ; V ITAMINS , F AT -S OLUBLE . Chandak Ghosh

Guggul (gum guggul) is a resin produced by the mukul mirth tree. Guggulipid is extracted from guggul, and contains plant sterols (guggulsterones E and Z), which are believed to be its bioactive compounds. Prior to 2003, the majority of scientific evidence suggested that guggulipid elicits significant reductions in serum total cholesterol, low-density lipoprotein (LDL), and triglycerides, as well as elevations in high-density lipoprotein (HDL). Although recent evidence provides preliminary evidence against the efficacy of guggul for hypercholesterolemia, and thus, further study is necessary before a definitive conclusion can be reached. Initial research reports that guggulsterones are antagonists of the farsenoid X receptor (FXR) and the bile acid receptor (BAR), nuclear hormones that are involved with cholesterol metabolism and bile acid regulation.

The mukul myrrh tree, or Commiphora mukul , is small, thorny, and usually devoid of foliage. It grows naturally throughout India and Arabia. Guggul is the gum resin that comes from this tree, which belongs to the same genus as myrrh and has some similar components and actions. Guggul resin contains steroids, diterpenoids, alipathic esters, and carbohydrates. These factors appear to work together to exert the beneficial effects of this botanical. Guggul has been traditionally used in Ayurvedic medicine to treat arthritis, inflammation, bone fractures , overweight, and disorders of lipid metabolism. One ancient Ayurvedic reference describes the power of guggul to treat "coating and obstruction of channels." This description stimulated further research into the properties of this botanical medicine for preventing and treating atherosclerosis , as well as other conditions resulting from high levels of lipids in the body.

Methylsulfonylmethane, or MSM, is a form of organic sulfur that occurs naturally in a variety of fruits, vegetables, grains, and animals. MSM is a normal oxidation product of dimethyl sulfoxide (DMSO). It arises from a series of reactions that begin on the surface waters of the ocean. MSM is a white, odorless, crystalline substance that is water-soluble and contains 34% element sulfur. No evidence suggests that MSM is a necessary part of a normal diet. Sulfur is considered an essential mineral, but no dietary requirement has been established for it. MSM as a vital source of dietary sulfur is unsupported by published research. The nutrient is generally well tolerated, but long-term effects of supplementation with MSM have not been examined. MSM seemed to improve symptoms of allergic rhinitis and osteoarthritis. However, more high quality research using MSM is necessary to define its role in treating these conditions. Although the Arthritis Foundation reports that MSM is used for pain and inflammation, they do not recommend its use due to lack of clinical trials.

Methylsulfonylmethane, or MSM, is also known as methyl sulfone and dimethylsulfone (DMSO 2 ). It is a sulfur-bearing compound that exists naturally in many fruits, vegetables, grains, and animals, including humans. Its presence and activity was discovered while working with its parent compound, DMSO, of which it is an oxidized metabolite (hence the O 2 designation). Although 55,000 papers have been written on DMSO, research on MSM has been more limited. A wide range of therapeutic benefits are attributed to it, along with a high degree of safety, and a low degree of toxicity. Actor James Coburn, crippled by rheumatoid arthritis , praised MSM's pain relieving benefits. The history of MSM, as derived from DMSO, includes the following highlights: DMSO was first synthesized in a nineteenth century Russian lab, and was investigated for its usefulness as a solvent (a dissolver of other substances). British scientist Lovelock, working with red blood cells and cryogenics—the science of "alive freezing," reported DMSO as a uniquely helpful agent. Stanley Jacob, M.D., an American working in the 1950s to perfect kidney transplants, found Lovelock's report on cryogenic uses of DMSO, and met with DMSO chemist researcher, Robert Herschler, Ph.D. Drs. Jacob and Herschler discovered that DMSO, in addition to being useful in transplant surgery, facilitated delivery of other medications through the skin into the body, and that it had significant pain relieving and anti-inflammatory properties. They also discovered an undesirable effect of DMSO—a fishy taste and body odor. DMSO was approved for veterinary use (1970) in the treatment of joint and muscle related problems. In Russia (1973), prescription DMSO began use for the treatment of pain related to autoimmune disorders, arthritis, and diabetic ulcers. (One source reports as of 1999, more than 125 countries are using DMSO more safely and less expensively than drugs used for the same conditions in the United States.) In 1978, DMSO was approved by the United States Food and Drug Administration (FDA) for human use in the treatment of interstitial cystitis only, a painful inflammatory condition affecting many women. With lagging FDA approval, Herschler continued research and discovered that approximately 15% of DMSO turns into MSM in the body, and that the MSM metabolite produced the pain-relieving and anti-inflammatory benefits without the unpleasant odor side effect. Since that time, Drs. Jacob and Herschler, and others by anecdote, have found MSM to be clinically helpful in treating many more conditions, and that it is extremely safe, and has no known toxicity. MSM occurs naturally in some foods including cow's milk (its highest source). One source specifies the presence of MSM—in descending order—in unpasteurized cow's milk, coffee, tomatoes, tea, Swiss chard, beer, corn, and alfalfa . Some reports say that natural levels of MSM decline with age. Dr. Herschler believes that the average diet is deficient in MSM because of the foods that are eaten or the way in which they are prepared. However, other sources refute the need for supplementing sulfur in the form of MSM, claiming that dietary sources of sulfur are sufficient. Sulfur-containing foods include cabbage, Brussels sprouts, broccoli, cauliflower (these are all known as cruciferous vegetables), sunflower seeds, garlic , onions, asparagus, avocados, beans, peas, mustard, horse-radish, lentils, soybeans, and yogurt. Dietary sources of the three sulfur-containing amino acids—methionine, cystine, and cysteine—include meat, fish, poultry, eggs, milk, cheeses, and nuts, The cruciferous vegetables are reported to contain other sulfur compounds in addition to the sulfur-bearing amino acids . Nevertheless, many anecdotes cite the benefit of supplementing the diet with MSM.

Pantothenic acid (vitamin B5) is essential to all life, and is a component of coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Pantothenic acid is essential to the metabolism of carbohydrates, proteins, and fats, as well as for the synthesis of hormones and cholesterol. The name pantothenic acid comes from the Greek word pantos, meaning "everywhere," referring to its wide distribution in most plants and animals. Rich food sources include meats, liver, kidney, fish/shellfish, chicken, vegetables, legumes, yeast, eggs, and milk. However, freezing and canning may lead to a loss of much of the pantothenic acid content. Whole grains are also a good source, although refining may degrade much of the pantothenic acid content. In commercial supplement products, vitamin B5 is available as D-pantothenic acid and as the synthetic products dexpanthenol (converted in the body to pantothenic acid) or calcium pantothenate. Pantothenic acid is frequently used in combination with other B vitamins in vitamin B complex formulations. Only the dextrorotatory (D) isomer of pantothenic acid possesses biologic activity. Pantothenic acid deficiency is exceedingly rare, and likely only occurs only in cases of the most severe life-threatening malnutrition. Most individuals likely obtain sufficient amounts from dietary sources. Pantothenic acid has been used or studied for numerous health conditions, but has not been clearly demonstrated as beneficial for any. Oral, topical (on the skin), or injected forms have been used.

Pantothenic acid and biotin are types of B vitamins. They are water-soluble, which means that the body can't store them. If the body can't use all of the vitamin, the extra leaves the body through the urine. Therefore, these vitamins must be replaced every day.

Pantothenic acid, also known as vitamin B 5 , is a member of the water-soluble B vitamin family. It is an essential ingredient of two substances, coenzyme A and acyl carrier protein, which are needed to metabolize carbohydrates and fats. The same coenzymes play a part in production of certain hormones, vitamin D , red blood cells, and the neurotransmitter acetylcholine. Pantothenic acid is necessary for proper growth and development. Studies of Mexican infants whose diets are deficient in micronutrients have shown that those who receive dietary supplements containing pantothenic acid do not show the growth retardation that appears in control groups.

Vitamin B3 is made up of niacin (nicotinic acid) and its amide, niacinamide, and can be found in many foods, including yeast, meat, fish, milk, eggs, green vegetables, and cereal grains. Dietary tryptophan is also converted to niacin in the body. Vitamin B3 is often found in combination with other B vitamins including thiamine, riboflavin, pantothenic acid, pyridoxine, cyanocobalamin, and folic acid.

Niacin, also known as Vitamin B 3 , is important for the normal function of many bodily processes. Like other B vitamins , it is water-soluble and plays a role in turning food into energy, as well as in the metabolism of fats and carbohydrates . Niacin can also act as an antioxidant within cells, which means it can destroy cell-damaging free radicals. In conjunction with riboflavin and pyridoxine, it helps to keep the skin, intestinal tract and nervous system functioning smoothly.

Ashwaganda, also spelled ashwagandha, is a member of the pepper family known as Withania somnifera . The small evergreen grows in the frost-free drier parts of western India, northern Africa, the Mediterranean, and the Middle East. Ashwaganda grows to a height of 2–3 ft (about 1 m) and has oval leaves, showy yellow flowers, and red, raisin-sized fruits. All parts of the plant, including the root, are used medicinally. Ashwaganda is also called winter cherry, withania, asgandh, and Indian ginseng.

Resin extracts from the Boswellia serrata tree have been found to have anti-inflammatory effects. Animal and laboratory studies suggest possible efficacy for inflammatory conditions such as inflammatory bowel disease, rheumatoid arthritis, and osteoarthritis, although high-quality human data are lacking. Initial human evidence suggests the efficacy of boswellia as a chronic therapy for asthma (but not for the relief of acute asthma exacerbations). Further studies are warranted in this area. As opposed to non-steroidal anti-inflammatory drugs (NSAIDs), long-term use of boswellia has not been shown to cause gastrointestinal irritation or ulceration, although adverse effects have not been well studied in humans.

Arnica montana is commonly used in herbal ointments and oils applied on the skin as an anti-inflammatory and pain-relieving agent for aches, bruises and sprains on unbroken skin. Highly diluted homeopathic preparations are considered safe and are widely used for the treatment of injuries. However, full doses of arnica may be toxic when taken by mouth. Arnica may also be damaging to the heart, resulting in high blood pressure. Currently, the U.S. Food and Drug Administration (FDA) has declared arnica an unsafe herb due to adverse effects associated when ingested orally. In contrast, the German market offers over 100 preparations of arnica to its consumers. In Canada, arnica is not allowed for use as a non-medicinal ingredient for oral (by mouth) use products.

Arnica ( Arnica montana L. ), known also as leopards-bane, wolfsbane, and European arnica, is a member of the Compositae (Asteraceae) family. This attractive herb is native to the mountains of Siberia and central Europe, where the leaves were smoked as a substitute for tobacco. This practice led to a common name for the herb: mountain tobacco. There are several North American species of arnica, including A. fulgens, A. sororia , and A. cordifolia . Arnica thrives in the northern mountains of the United States and Canada, in high pastures and woodlands. Arnica grows from a cylindrical, hairy rhizome with a creeping underground stem. First year leaves are downy and grow in a flat rosette at the base of the stem. In the second year, arnica sends up a round, hairy stem with smaller, sessile leaves growing in one to three opposite pairs. This central stem may branch into three or more stems each with a terminal composite blossom. Arnica's aromatic, daisy-like flowers have 10–14 bright yellow rays, each with three notches at the end. Flower rays are irregularly bent back. The central disk is composed of tubular florets. Arnica blooms from June to August. The flowerheads, when crushed and sniffed, may cause sneezing , resulting in another of arnica's common names: sneezewort.

Selenium is a trace mineral found in soil, water, and some foods. It is an essential element in several metabolic pathways. Selenium deficiency can occur in areas where soil content of selenium is low, and may affect thyroid function and cause conditions such as Keshan disease. Selenium deficiency is also commonly seen in patients on total parenteral nutrition (TPN) as their sole source of nutrition. Gastrointestinal disorders may decrease the absorption of selenium resulting in depletion or deficiency. Selenium may be destroyed when foods are refined or processed. Specific dietary sources of selenium include brewer's yeast, wheat germ, butter, garlic, grains, sunflower seeds, Brazil nuts, walnuts, raisins, liver, kidney, shellfish (lobster, oyster, shrimp, scallops), fresh-water and salt-water fish (red snapper, salmon, swordfish, tuna, mackerel, halibut, flounder, herring, smelts). Selenium is also found in alfalfa, burdock root, catnip, fennel seed, ginseng, raspberry leaf, radish, horseradish, onion, chives, medicinal mushrooms (reishi, shiitake), and yarrow. The role of selenium in cancer prevention has been the subject of recent study and debate. Initial evidence from the Nutritional Prevention of Cancer (NPC) trial suggests that selenium supplementation reduces the risk of prostate cancer among men with normal baseline PSA (prostate specific antigen) levels, and low selenium blood levels. However, in this study selenium did not reduce the risk of lung, colorectal, or basal cell carcinoma of the skin, and actually increased the risk of squamous cell skin carcinoma. The ongoing Selenium and Vitamin E Cancer Prevention Trial (SELECT) aims to definitively address the role of selenium in prostate cancer prevention.

Selenium is an essential trace mineral. Small amounts of selenium are good for your health.

Selenium is a nonmetallic element with an atomic number of 34 and an atomic weight of 78.96. Its chemical symbol is Se. Selenium is most commonly found in nature in its inorganic form, sodium selenite. An organic form of selenium, selenomethionine, is found in foods.