“Let food be thy medicine and NUTRACEUTICALS: Eat to Treat “Let food be thy medicine and medicine be thy food” “Hippocrates, father of Medicine”

According to DeFelice, a nutraceutical can be defined as: The term “Nutraceutical” is a portmanteau (a linguistic blend) of “Nutrition” & Pharmaceutical” introduced in 1989 by Stephen DeFelice According to DeFelice, a nutraceutical can be defined as: “A food (or part of a food) that provides medical or health benefits, including the prevention and/or treatment of a disease”. Stephen L. DeFelice is the founder and chairman of FIM, the Foundation for Innovation in Medicine

However, the term nutraceuticals as commonly used in marketing has no regulatory definition. Nutraceuticals can be regarded as: “A pharmaceutical-grade and standardized nutrient”

Other words used in this context include: Dietary supplementation, Functional, Multi-functional Foods. Pharmaconutrients.

International sources Canada Under Canadian law, a nutraceutical can either be marketed as a food or as a drug; the terms "nutraceutical" and "functional food" have no legal distinction, referring to "a product isolated or purified from foods that is generally sold in medicinal forms not usually associated with food, and is demonstrated to have a physiological benefit or provide protection against chronic disease." United States The term "nutraceutical" is not defined by US law. Depending on its ingredients and the claims with which it is marketed, a product is regulated as a drug, dietary supplement, food ingredient, or food. International sources In the global market, there are significant product quality issues. Nutraceuticals from the international market aspect may claim to use organic or exotic ingredients, yet the lack of regulation may compromise the safety and effectiveness of products. Companies looking to create a wide profit margin may create unregulated products overseas with low-quality or obscure ingredients. wikipedia

Drugs Nutraceuticals Dietary supplements Definition of drugs, nutraceuticals, and dietary supplements in USA, Europe and Egypt Region Drugs Nutraceuticals Dietary supplements USA Material that is intended for use in diagnosis, cure, mitigation, treatment, or prevention of disease Materials (other than food) intended to affect the structure or any function of the body of man or other animals (U.S. Food and Drug Administration) Nutraceuticals have no strict definition in the American law Any food or part thereof with medicinal or health benefits, which includes vitamins and herbal products (Mosby’s medical dictionary)

Drugs Nutraceuticals Dietary supplements Definition of drugs, nutraceuticals, and dietary supplements in USA, Europe and Egypt Region Drugs Nutraceuticals Dietary supplements Europe “Any substance or combination of substances presented as having properties for treating or preventing disease in human beings” (Medicines and Healthcare Products Regulatory Agency -MHRA) or Any substance or combination of substances which may be used in or administered to human beings either with a view to restoring, correcting or modifying physiological functions by exerting a pharmacological, immunological or metabolic action, or used for medical diagnosis” No strict definition for nutraceuticals in the European regulation. If the product modifies the physiological function it is recognized as medicine and if it is merely for health maintenance it is recognized as food. Concentrated sources of nutrients or other substances with a nutritional or physiological effect whose purpose is to supplement the normal diet. They are marketed “in dose” form i.e. as pills, tablets, capsules, liquids in measured doses etc. (European Commission 2014) Supplements may be used to correct nutritional deficiencies or maintain an adequate intake of certain nutrients”

Drugs Nutraceuticals Dietary supplements Definition of drugs, nutraceuticals, and dietary supplements in USA, Europe and Egypt Region Drugs Nutraceuticals Dietary supplements Egypt Egyptian pharmacopeia (1984) states that drug is a substance or preparation used for alleviation of or protection against a disease affecting man or animal (Arab Republic of Egypt, 2005) Nutraceuticals have no strict definition in the Egyptian law A product to be taken orally that improves the human diet in order to improve body functions and performance. The dietary supplement is not considered a drug or an alternative for food and is not used alone to treat, diagnose or prevent diseases. It May contain vitamins, minerals, amino acids, fatty acids, herbs, and extracts (Egyptian Drug Authorities, 2009)

Why are nutraceuticals gaining global growing recognition? In recent years, a new diet health paradigm is evolving which places more emphasis on the positive aspects of diet. Consumers being frustrated with the expensive, high-tech, disease- treatment approach in the modern medicines are seeking complementary or alternative beneficial products. Nutraceuticals help in combating some of the major health problems of the century such as obesity, cardiovascular diseases, cancer, osteoporosis, arthritis, diabetes, cholesterol…. etc Conclusively, ‘nutraceutical’ has lead to the new era of medicine and health, in which the food industry has become a research oriented sector.

Nutraceutical may range from: Dietary supplements (Probiotics, Prebiotics, Antioxidants, Enzymes). Isolated nutrients (Vitamins, Minerals, Amino Acids, Fatty acids). Herbal products (fresh or dried herbs or botanical products). Processed products (cereals, soups, and beverages). Genetically engineered “designer” food.

Dietary Supplements According to the Dietary Supplement Health and Education Act (DSHEA -1994): A dietary supplement is a product (other than tobacco) that: Is intended to supplement (reinforce) diet. Contains one or more dietary ingredients intended to supplement the diet (including vitamins, minerals, herbs or other botanics, amino acids, enzymes ….etc) or their constituents. Is intended to be taken by mouth as pills, capsules, tablets, soft gels, powders or liquid drinks. Is labeled on the front panel as being a dietary supplement.

Dietary Supplements Dietary supplements are sold in grocery, health food and drug stores. Also available through mail-order catalogs, TV programs, the Internet and direct sales. The manufacturer does not have to prove that the supplement is effective. The manufacturer can say that the product addresses a nutrient deficiency, supports health, or reduces the risk of developing a health problem. If the manufacturer does make a claim, it should be stated that "This product has not been evaluated by the Food and Drug Administration, and is not intended to diagnose, treat, cure, or prevent any disease."

Intended to affect structure and function of body Drug Dietary supplement Article intended to diagnose, cure, mitigate, treat, or prevent disease A product intended to supplement diet…etc Intended to affect structure and function of body Must undergo FDA approval after clinical studies to determine effectiveness and safety No FDA approval, just labelling as dietary supplement Pre-marketing approval and post marking monitoring (pharmacovigilance) None, only manufacturer is responsible for safety evaluation

Intended to affect structure and function of body Dietary supplement Functional Foods Intended to affect structure and function of body Not intended for this purpose Not intended as sole item of a meal or a diet & does not substitute conventional food Can be intended as a sole item, however they don’t substitute conventional food Must be Labeled with: Name of each ingredient Quantity of each ingredient Total weight of all ingredient if a blend Identity of part of plant derived from Term “Dietary Supplement” None, only may/not contain nutritional labeling information as : Calories, fat, sodium

Risks of Dietary Supplements A Dietary supplement might: Not contain the ingredient that is listed on the label (such as plant species). For example, one study that analyzed 59 preparations of Echinacea found that about half did not contain the species listed on the label. Contain higher or lower amounts of the active ingredient. Use the term “Standardized" to describe efforts to make the product consistent. However, U.S. law does not define standardization. Therefore, the use of this term (or similar terms such as "verified" or "certified") does not guarantee product quality or consistency. Be contaminated.

Examples of Dietary Supplements Sports Drinks Glucose Sodium + Electrolytes Carbohydrates Water Multivitamins Vitamin a-H Calcium Zinc Potassium …etc. *Content Varies Protein Powders Protein Amino Acids

NUTRIENTS Health Benefits of some common nutrients 1-Vitamins Fat Soluble Vitamins Vitamin A: Acts as antioxidant, essential for growth and development, maintains healthy vision, skin and mucous membranes, may aid in the prevention and treatment of certain cancers and in the treatment of certain skin disorders. Vitamin D: Essential for formation of bones and teeth, helps the body to absorb and use calcium. Vitamin E: Antioxidant, helps to form blood cells, boosts immune system. Vitamin K: Essential for blood clotting.

Water Soluble Vitamins: Vitamin C: Antioxidant, necessary for healthy bones, gums, teeth and skin. Helps in wound healing, prevent from common cold Vitamin B 1: Helps in carbohydrate metabolism, essential for neurological function. Vitamin B 2: Energy metabolism, maintain healthy eye, skin and nerve function. Vitamin B 3: Energy metabolism, brain function Vitamin B 6: Helps to produce essential proteins, convert proteins to energy Vitamin B 12: Help in producing genetic material, formation of RBC, maintenance of CNS, synthesis of amino acids, involved in metabolism of protein, fat and carbohydrate. Folic acid: Helps in RBC formation, formation of genetic material of cell, very much essential during pregnancy Pantothenic acid: Aids in synthesis of cholesterol, steroids, and fatty acids, crucial for intraneuronal synthesis of acetylcholine

Vitamin like Compounds L- Carnitine: Helps in oxidation of fatty acids, role in oxidative phosphorylation, Choline: Lipotropic agent, used to treat fatty liver and disturbed fat metabolism, Inositol: For amino acid transport and movement of Potassium and sodium, Taurine: Helps in retinal photoreceptor activity, bile acid conjugation, WBC antioxidant activity, CNS neuromodulation, platelet aggregation, cardiac contractibility, sperm motility, insuline activity,

2- Minerals Calcium: essential for bone and teeth, maintaining bone strength, nerve, muscle and glandular function, blood clotting. Iron: energy production, Haemoglobin, oxygen transport. Magnesium: for healthy nerve and muscle function, bone formation. Phosphorous: energy production, phosphorylation process, bone and teeth, for genetic material. Cobalt: component of Vit. B 12 and B 12 coenzymes. Copper: Haemoglobin and collagen production, function of heart, energy production, absorption of Iron. Iodine: proper function of Thyroid gland. Chromium: with insulin it helps in conversion of carbohydrate and fat into energy, treatment of diabetes. Selenium: Antioxidant, functioning of heart muscle, part of Glutathione peroxidase enzyme. Zinc: Essential for cell reproduction, for development in Neonates, wound healing, production of sperm and testosterone hormone.

Herbal Products (Phytochemicals) Phytochemicals provide health benefits being: Substrate for biochemical reactions Cofactors of enzymatic reactions Inhibitors of enzymatic reactions Absorbents that bind to & eliminate undesirable constituent in the intestine Scavengers of reactive or toxic chemicals Enhance the absorption and / or stability of essential nutrients Selective growth factor for beneficial bacteria Fermentation substrate for beneficial bacteria Selective inhibitors of deleterious intestinal bacteria

Health benefit PREVENTION Treatment DRUG NUTRACEUTICALS

Examples of Phytochemicals Source Role Tocotrienols & tocopherols Grains Suppress the growth of diverse tumors cell lines via initiation of apoptosis and concomitant arrest of cells in the G1 phase of the cell cycle Carotenoids Carrots, Fruits & vegetables Antioxidants, protects against uterine, prostate, colorectal, lung and digestive tract cancers, and protection to other antioxidants. Limonoids Citrus fruits Inhibiting phase I enzymes & inducing phase II detoxification enzymes in liver, provide protection to lung tissue.

Examples of Phytochemicals (contin.) Source Role Phytosterols Various plants Exhibit anti-inflammatory, anti-neoplastic, anti-pyretic & immune- modulating activity, decrease cholesterol Phenolic constituents Various plants, wholegrain Antioxidants, lowers the risk of CHD, diabetes, hypertension etc. Flavonoids Grapes, apples, tea & citrus plants Action against free radicals, free radicals mediated cellular signaling, inflammation, allergies, platelet aggregation & hepatotoxicity

Examples of Phytochemicals (contin.) Source Role Catechin & gallic acids Grapes, berries, cocoa, green tea, acacia spp. Antioxidants, free radical scavenging ability, inhibition of eicosanoid synthesis, reduces CHD Isoflavonoids Soybeans Treating cancers & osteoporosis Anthocyanidins Fruits & flowers Antioxidants & anti-mutagenic properties Lycopene Tomatoes May contribute to maintenance of prostate

Examples of Phytochemicals (contin.) Source Role Mono saturated fatty acids Nuts May reduce risk of coronary heart disease Glucosinolates Cruciferous vegetables Activators of liver detoxification enzymes, inhibit the neoplastic effect of various carcinogens Indoles Cruciferous vegetables Reduces estrogen-dependent cancer risk Fiber Various vegetables, fruits Protects against colorectal diseases

How to gain maximum benefit /active components from food?? Manipulating the diet to get maximum level of active components Combination of food ingredients rich in nutraceuticals Fortifying food with active ingredients, by fermentation of food products Changing food habits to natural type of diet

Risks associated with nutraceuticals consumption They are not subjected to same testing and regulations required for approval of pharmaceuticals. No strict regulatory rules and the majority are not regulated by FDA in USA. Companies creating unregulated products to gain a wide profit margin. Bioavailability of nutrients is low.

CONCLUSION Nutraceuticals are present in most of the food ingredients with varying concentration Concentration, time and duration of supply of nutraceuticals influence human health Manipulating the foods, the concentration of active ingredients can be increased Diet rich in nutraceuticals along with regular exercise, stress reduction and maintenance of healthy body weight will maximise health and reduce disease risk