Sports Medicine: Do We Need Vitamins, Minerals, and Nutritional Supplements?

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The Doc Is In

In this part and the following articles in this series about Vitamins, Minerals, and Nutritional Supplements, we will explore dietary supplements used less often by athletes to improve performance. In addition, many non-athletes use these as well.  We will also begin looking at supplements many of us may use, or have thought about trying.  This information will be very useful in aiding us to choose wisely and take carefully.  You will find that some supplements that we may be urged to take are not useful.  Others have a low toxicity level (i.e., the difference between a safe dose and a toxic dose is small), and should be used very carefully.  Others may be useful for some things and not for others.  At any rate, the information to make these differences is in the article.

We include a great deal of well-researched up-to-date medical information about some of the supplements you may take, so that you can use it to get the most out of them while using them safely.

‘Buyer Beware’ Information about Supplementation

Most supplements are not tested adequately for efficacy, purity, or safety.

Be careful of misleading product information.

‘Natural’ does not mean safe!

‘More’ is seldom better!

Nothing replaces a well-balanced diet that includes a variety of high-quality foods with plenty of nutrients.

Athletes, and others, use supplements at their own risk!



Ginseng: Panax (Chinese or Korean) ginseng is a plant. People use the root to make medicine. Do not confuse Panax ginseng with American ginseng, Siberian ginseng, or Panax pseudoginseng.

Claims: The Chinese, and the Koreans, have used ginseng, for thousands of years as a stimulant, a diuretic, to promote menstruation, and to fight infection. Other claims concern treatment of adrenal and thyroid dysfunction, and aphrodisiac qualities. Athletes use ginseng to enhance aerobic performance and energy level, and to help the body with stress.

Mechanism: It is hypothesized that ginseng stimulates the hypothalamic-pituitary-adrenal axis – HPA (specialized system for response to stress; it produces adrenaline for short-term stress, and cortisol for more long-term stressors), which may result in increased resistance to numerous kinds of stress. It may enhance myocardial metabolism, increase oxygen extraction by muscles, and optimize mitochondrial metabolism in muscle.  During strenuous exercise, ginseng may increase cortisol response (see above-mentioned HPA axis) and enhance the body’s ability to sustain muscle creatine phosphate levels, thus decreasing lactic acid production (which may length of time before muscles begin to ache from use).

Efficacy: No quality evidence or studies support the claim that ginseng supplementation enhances physical performance.

Possibly Effective for:

Thinking and memory: Taking Panax ginseng by mouth might improve abstract thinking, mental arithmetic skills, and reaction times in healthy, middle-aged people. Panax ginseng alone does not seem to improve memory, but there is some evidence that a combination of Panax ginseng and ginkgo leaf extract (see gingko section below) can improve memory in otherwise healthy people between the ages of 38 and 66.

Diabetes: There is some evidence that Panax ginseng might lower fasting blood sugar in people with type 2 diabetes.

Male impotence (erectile dysfunction, ED): Taking Panax ginseng by mouth seems to improve sexual function in men with ED.

Chronic obstructive pulmonary disease (COPD): Taking Panax ginseng by mouth seems to improve lung function and improve some symptoms of COPD.

Premature ejaculation (reaching orgasm too early): when a cream containing ginseng and other ingredients is applied directly to the skin of the penis.

Possibly Ineffective for:  Improving athletic performance; Improving mood and sense of well-being; Hot flashes associated with menopause: Taking Panax ginseng by mouth does not seem to help hot flashes but it might improve other menopausal symptoms such as fatigue, insomnia, and depression.

Insufficient Evidence for:

Breast cancer.  Infection of the airways in the lung (bronchitis): Panax ginseng, combined with treatment with antibiotics, might be more effective in killing bacteria that antibiotic treatment alone.

Common cold and influenza: There is some evidence that taking a specific Panax ginseng extract (G115) by mouth can decrease the chance of catching a cold. There is some evidence that taking a specific Panax ginseng extract (G115) by mouth four weeks before a flu shot and continued for eight more weeks can decrease the risk of getting the flu. It is likely however, that the flu shot itself is doing most, if not all, the heavy lifting here.

Cancer (stomach, lung, liver, ovarian, skin). Population studies suggest that taking ginseng by mouth might decrease the occurrence of cancer, specifically stomach cancer, lung cancer, liver cancer, ovarian cancer, skin cancer, Depression, Anemia, Fluid retention, Stomach inflammation and other digestive problems, Chronic fatigue syndrome (CFS), Fibromyalgia, and Fever.

Athletic performance.  Taking 1600 mg of American ginseng by mouth for 4 weeks does not seem to improve athletic performance, even though lab tests confirm it may decrease muscle damage during exercise.

Be aware that Panax ginseng products are not always what they claim.  The contents of products labeled as containing Panax ginseng can vary greatly.  Many contain little or no Panax ginseng.

Panax ginseng interacts with many prescription drugs.  If you take medications, talk to your healthcare provider before taking Panax ginseng

The effectiveness ratings for American ginseng are as follows:

Possibly effective for:

Lowering blood sugar after a meal in people with type 2 diabetes. Taking 3 grams of American ginseng by mouth, up to two hours before a meal, can significantly lower blood sugar after a meal in patients with type 2 diabetes. Interestingly, larger doses do not seem to lower blood sugar more. Different American ginseng products may have different effects. Researchers think that is because they contain different amounts of the active chemicals called ginsenosides.

Preventing respiratory tract infections such as the common cold or influenza in adults. Some evidence suggests that taking a specific American ginseng extract called CVT-E002; 200 mg twice daily over a 3-4 month period during influenza season, might help slightly to prevent cold or flu symptoms in adults between the ages of 18 and 65. People older than 65 seem to need a flu shot at month 2 along with this treatment in order to decrease their risk of getting the flu or colds. This extract also seems to help make symptoms milder and last a shorter length of time when infections do occur. Some evidence suggests that the extract might not reduce the chance of getting the first cold of a season, but it seems to reduce the risk of getting repeat colds in a season.

Insufficient evidence to rate effectiveness for:

Side Effects: The most common side effects are nervousness and excitability that decrease after several days (the body habituates to it). Many people find the taste unpleasant. Hypoglycemia and difficulty concentrating have been reported. Because of ginseng’s estrogen-like effect, women who are pregnant or breastfeeding should not take it. Occasionally, there have been reports of more serious adverse reactions, such as asthma attacks, increased blood pressure, palpitations, and in postmenopausal women, uterine bleeding.

Dosage: Doses of 100-300 mg three times/day have been studied. A study of fifty commercial products revealed a level of active ingredient ranging from 1.9% to 9%, with six showing no evidence of ginseng.



Claims: During exercise, free radicals are produced, and the stimulation effects of glutathione may counteract the results of extreme physical training.

Mechanism: Hepatic (liver) glutathione production increases as exercise duration increases. The liver used glutathione to remove vitamin E radicals and to replenish vitamin C from radicals.

Efficacy: The effectiveness of aerolized, intramuscular, or intravenous glutathione has not been well established. Glutamine and N-acytylcysteine are under study to determine if they increase glutathione levels.

Side Effects: No known side effects. However, this supplement is not well studied.

Dosage: Oral glutathione is not bioavailable (no ability to be absorbed by a living organism).  A typical recommended dose of oral glutathione is said by manufacturers to be 50 mg twice daily. However, as noted above, when glutathione is taken by mouth it is destroyed.  Therefore, no matter what the dose (with the possible exception of megadoses), it will not make any difference. However, by giving an extremely high enough dose, some may be absorbed.

IV injection is the most effective route still.  This idea that glutathione cannot cross the cell “wall” is not relevant as animal cells do not have cell walls, but have membranes.  Whether exogenous glutathione can effect cells is highly debatable, however clinical studies seem to show a skin lightening effect even with oral doses.  This implies that glutathione is doing something and must be affecting the cells.  It is definitely possible that glutathione receptors or carriers exist on the cell membrane.  This has not really been studied. For most purposes, however, the purchase of oral glutathione (pills) is a waste of time and money.



Claims: Oral ingestion of glycerol may induce a state of ‘hyperhydration’ (water intoxication), which may result in superior athletic performance.

Mechanism: Oral glycerol acts as an osmotic agent (pertaining to the diffusion of molecules through a semipermeable membrane from a place of higher concentration to a place of lower concentration until the concentration on both sides is equal) and increases water retention.

Efficacy: Results are equivocal regarding benefits of glycerol-induced hyperhydration on core temperature, plasma volume, and exercise tolerance.  Hyperhydration does not appear to offer benefit compared with euhydration (normal state of body water content).  Hyperhydrated athletes may be less likely to become dehydrated, especially during exercise in extreme environmental conditions of high heat and humidity.  Adverse effects of hyperhydration remain concerning (electrolyte shifts – electrolytes are important because they are what cells [especially nerve, heart, muscle] use to maintain voltages across their cell membranes and to carry electrical impulses (nerve impulses, muscle contractions) across themselves and to other cells).  Kidneys work to keep the electrolyte concentrations in blood constant despite changes in the body.  For example, during heavy exercise, electrolytes are lost in sweat, particularly sodium and potassium (shifts).  These electrolytes must be replaced to keep the electrolyte concentrations of the body fluids constant.  Practice should be never to replace proper oral hydration with water, proper acclimatization, and good sense during exercise in extreme conditions.

Side Effects: Isolated reports of headache, bloating, and nausea after oral ingestion. Other than that, data about side effects are limited.

Dosage: Typically, 1-1.2 g/kg mixed with 1.5 L of fluid one to two hours before competition.



Claims: Lysine is used for prevention and treatment of herpes simplex labialis and improved athletic performance.

Mechanisms: Lysine inhibits the growth of herpes simplex virus (HSV) in vitro (in an artificial environment outside the living organism, e.g., petri dish). It is important in collagen growth and bone formation.  It has been proposed that lysine, arginine, and ornithine (amino acids) increase human growth hormone (HGH).

Efficacy: Lysine reduces healing time, severity, and recurrence of HSV labialis. Lysine, arginine, and ornithine benefit in resistance or aerobic exercise.  Intravenous arginine before endurance activity has been insufficiently studied.

Side Effects: Lysine is contraindicated in people with kidney disease or liver impairment, as they may not be able to eliminate large amounts of nitrogen produced from supplemented amino acid breakdown.  Hypercalcemia (the presence of an unusually high concentration of calcium in the blood) may develop from increased gastric absorption and decreased excretion (may lead to kidney stones and renal damage).  No data supports the use in children or pregnant/breastfeeding women.

Dosage: For recurrent herpes: 1000mg/day for one year, or 1000mg 3 times daily for six months.  No ergogenic (enhances physical performance) dose has been established. However, be aware of the possible dangers of larger doses (e.g., kidney stones and renal damage).



Claims: Pyruvate is said to increase exercise endurance, help with weight loss, and reduce body fat content.

Mechanism: The body produces pyruvate when it breaks down sugar (glucose). BCAAs (remember them from Part 3?) transfer an amine group to pyruvate to form alanine. Alanine has the role of increasing fat oxidation and decreasing carbohydrate oxidation.  This means that fat will be broken down more readily and more slowly for carbohydrates.  Pyruvate may also reduce free radical.  It enhances leg-exercise endurance capacity by increasing glucose extraction by muscles.

Efficacy: Studies are limited.  Reports of oral pyruvate supplementation used for weight loss are promising.  Increases in time to exhaustion with endurance exercise have been noted in untrained people.

Insufficient Evidence for: 

Improving athletic performance. Some research suggests that taking pyruvate along with high-dose dihydroxyacetone (used primarily in sun tanning products) from the diet increases arm and leg exercise endurance. However, other research suggests that pyruvate, alone or in combination with creatine does not improve athletic performance.

Other conditions:

More evidence is needed to rate the effectiveness of pyruvate for any other uses.

Side Effects: GI upset including gas, bloating, and diarrhea. One death reported after intravenous (into a vein with a syringe) administration.  Pyruvate seems to be safe when taken by mouth short-term (up to six weeks).

Dosage: Typically, 22 to 32 g/day.


Sodium Bicarbonate:

Claims: It is said that sodium bicarbonate increases time to exhaustion, and decreases time in sprinting in races of 400 to 1500 meters.

Mechanisms: Sodium bicarbonate causes buffering (a buffer is a molecule that tends to either bind or release hydrogen ions in order to maintain a particular pH of blood), which leads to metabolic alkalosis (abnormally high alkalinity [low hydrogen-ion concentration of the blood and other body tissues]), thereby decreasing the effects of lactic acid.

Efficacy: Mixed reviews have been published.  Although it has been found to be effective in horses, it is illegal for horse racing.  The positive effects in humans are seen in events lasting more than one minute and less than seven.

Side Effects: Nausea, bloating, or gas may occur.  If any of these effects persist or worsen, contact your doctor or pharmacist promptly.

If your doctor has directed you to use this medication, remember that he or she has judged that the benefit to you is greater than the risk of side effects. Most people using this medication do not have serious side effects.

Tell your doctor immediately if any of these unlikely but serious side effects occur: swelling hands/ankles/feet, unusual weight gain.

When taken with sodium bicarbonate, large doses of calcium from your diet, medications, or supplements can only rarely cause a serious problem called milk-alkali syndrome.  Ask your doctor or pharmacist about using calcium products safely while you are using this medication.

Tell your doctor immediately if any of these rare but very serious side effects occur:

muscle aches/spasms, change in the amount of urine
vomitingmental/mood changes (e.g., confusion, irritability, memory problems)

Tell your doctor if these symptoms occur.

Seek immediate medical attention if any of these rare but very serious side effects occur: rash
chest painitching/swelling (especially of the face/tongue/throat)
seizuressevere dizziness
serious allergic reactiontrouble breathing

Seek immediate medical attention, including going to an emergency room, if these symptoms occur.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Dosage: Dosage used in studies is 300 mg/kg before exercise.


For general population use and for aging athletes in their later years (e.g., many of us).

Coenzyme Q-10 (ubiquinone or ubiquinal forms):

Claims: Coenzyme Q10 (CoQ10) is produced by the human body and is necessary for the basic functioning of cells.  Coenzyme Q-10 (CoQ-10) is a vitamin-like substance found throughout the body, but especially in the heart, liver, kidney, and pancreas.  It is ingested in small amounts in meats and seafood. Coenzyme Q-10 can also be made in a laboratory and it is used as medicine.  CoQ10 levels are reported to decrease with age and to be low in patients with some chronic diseases such as heart conditions, angina, diabetes, metabolic myopathies (myopathies are neuromuscular disorders in which the primary symptom is muscle weakness due to dysfunction of muscle fiber; myopathy as a result of disordered metabolism, usually caused by genetic defects or hormonal dysfunction). Additionally, other disorders connected to low CoQ-10 include muscular dystrophies, Parkinson’s disease, cancer, diabetes, hypertension, and HIV/AIDS. Some prescription drugs may also lower CoQ10 levels.  It is also is used to prevent drug toxicity, to increase exercise tolerance, and to stimulate the immune system in AIDS patients.

Mechanism: CoQ-10 is an essential cofactor in ATP production (for energy). It has antioxidant effects and prolongs the antioxidant effects of vitamin E.

Efficacy: Likely effective for:

Coenzyme Q-10 deficiency: This is a very rare condition. The symptoms include weakness, fatigue, and seizures.

Inherited or acquired disorders that limit energy production in the cells of the body (mitochondrial disorders): Improvement in symptoms is slow. Some people have to take coenzyme Q-10 for six months to get the most benefit.

Possibly effective for…

Congestive heart failure (CHF): There is no evidence that taking coenzyme Q-10 alone can help heart failure.  Nevertheless, there is some evidence (though controversial) that it might be helpful when taken in combination with other heart failure medications and treatments.

Decreasing the risk of additional heart problems in people who have had a recent heart attack (myocardial infarction, MI): When started within 72 hours of MI and taken for one year, coenzyme Q-10 appears to lower significantly the risk of heart-related events including non-fatal MI.

Huntington’s disease (a rare genetic neurological disorder).  Ubiquinal, an altered (and more absorbable form of coenzyme Q-10), has been granted “Orphan Drug Status” by the Federal Food and Drug Administration (FDA).  This gives the makers of ubiquinal some financial incentives to study its effectiveness for Huntington’s, a condition that is so rare (affecting less than 200,000 individuals) that pharmaceutical companies might not otherwise invest in developing a drug for it.  However, taking coenzyme Q-10 by mouth in doses of 600 mg per day or less does not seem to be effective for slowing the progression of Huntington’s disease.

Preventing blood vessel complications caused by heart bypass surgery: There is some evidence that taking coenzyme Q-10 by mouth for a week before surgery might help to reduce blood vessel damage. However, not all research agrees with this finding.

High blood pressure (hypertension): Taking coenzyme Q-10 by itself or along with other medications for treating high blood pressure seems to help lower blood pressure even more.

Preventing migraine headache: Taking coenzyme Q-10 by mouth seems to help prevent migraine headaches. Studies show it can decrease the frequency of headaches by about 30% and the number of days with headache-related nausea by about 45% in adults. Taking coenzyme Q-10 also appears to reduce migraine frequency in children who have low levels of coenzyme Q-10. It can take up to 3 months for significant benefit. Unfortunately, coenzyme Q-10 does not seem to be effective in treating migraines, once they have developed.

Parkinson’s disease: Some research shows that taking coenzyme Q-10 supplements might slow decline in people with early Parkinson’s disease.  However, taking a coenzyme Q-10 supplement in people with mid-stage Parkinson’s disease does not seem to improve symptoms.

Improving the immune system of people with HIV/AIDS.

Muscular dystrophy, an inherited disorder involving muscle wasting: Taking coenzyme Q-10 by mouth seems to improve physical performance in some patients with muscular dystrophy.

Possibly ineffective for:

High cholesterol: Taking coenzyme Q-does not seem to decrease high cholesterol or triglycerides.

Likely ineffective for:

Improving athletic performance: Apparently, there are no athletic performance effects from CoQ-10. However, any improvements to overall health cannot be discounted for athletes.

Dental (periodontal – gums) disease may be ameliorated when applied directly to the teeth and gums.  However, there is some early evidence that coenzyme Q-10 taken by mouth might be helpful in treating periodontal disease, but more evidence is needed.

Insufficient evidence to rate effectiveness for:

Cyclic vomiting syndrome (characterized by episodes of severe vomiting that have no apparent cause): Some preliminary research suggests that taking coenzyme Q-10 might work as well as prescription medications used for cyclic vomiting syndrome.

Diabetes: There is conflicting research about the effectiveness of coenzyme Q-10 for diabetes.  Some research shows that taking coenzyme Q-10 might lower blood sugar levels.  Nevertheless, other research has found no benefit.

Breast cancer: There is preliminary evidence that taking coenzyme Q-10 by mouth might be helpful in advanced breast cancer, along with surgery and conventional treatment plus other antioxidants and omega-3 and omega-6 fatty acids.

Male infertility: There is some evidence that coenzyme Q-10 treatment can improve the movement and density of sperm in men with certain types of infertility.

Chest pain (angina): Some early research suggests that taking coenzyme Q-10 by mouth might improve exercise tolerance in patients with angina.

Fibromyalgia: Some preliminary research suggests taking coenzyme Q-10 along with ginkgo might increase a feeling of wellness and perception of overall health and reduced pain.

A heart condition called hypertrophic cardiomyopathy: Taking coenzyme Q-10 by mouth seems to decrease the thickness of the heart wall, and decrease symptoms of shortness of breath and fatigue.

A muscle condition called “statin-induced myopathy”: Statins, a class of drugs used to lower cholesterol, can sometimes cause muscle pain. There is some evidence that taking coenzyme Q-10 might reduce this pain, but not all evidence has been positive.

Prevention of preeclampsia: Preeclampsia is a condition that some women get during pregnancy. Some research shows that women who are at risk for developing this condition have a lower chance of getting it if that take coenzyme Q-10 from week 20 of pregnancy until the baby is delivered.

Hair loss related to use of the warfarin, a “blood-thinning” drug.


Lyme disease.

Side Effects: Therapeutic doses of Coenzyme Q-10 are LIKELY SAFE for most adults when taken by mouth or when applied directly to the gums.  While most people tolerate coenzyme Q-10 well, it can cause some mild side effects including headache, dizziness, stomach upset, loss of appetite, nausea, vomiting, and diarrhea.  It can cause allergic skin rashes in some people.  It also might lower blood pressure, so check your blood pressure carefully if you have very low blood pressure.  Dividing the total daily dose by taking smaller amounts two or three times a day instead of a large amount all at once can help reduce side effects.

Dosages: 100-225 mg/day, depending on use. 50 mg capsules of ubiquinal, while too small dose for most people, is good for dividing daily dosages into two or three doses, if one has side effects.


Chondroitin Sulfate: Chondroitin sulfate is a chemical that is normally found in cartilage around joints in the body.  Chondroitin sulfate is manufactured from animal sources such as cow cartilage.

Claims: It is used as a chondroprotective (a specific compound or chemical that delays progressive joint space narrowing characteristic of arthritis and improves the biomechanics of articular joints by protecting chondrocytes [cartilage cells] against osteoarthritis, a non-cyclooxygenase inhibitor (e.g., COX-2 inhibitors), and an anti-inflammatory agent.

Mechanism: Unknown.  In animal models, chondroitin sulfate reduces inflammatory response and experimental cartilage destruction.  In vitro (outside the body, such as petri dishes).  It also shows stimulation of chondrocytes to replace or repair damaged proteoglycans (a type of molecule found in the connective tissue of the body) in the joint.

Efficacy: Chondroitin has not been as well studied as glucosamine (see the entry below for more information on glucosamine).  A number of scientific studies suggest that chondroitin may be an effective treatment for osteoarthritis (OA). OA is a type of arthritis characterized by the breakdown and eventual loss of cartilage, either due to injury or to normal wear and tear.  It commonly occurs as people age.

In some studies, chondroitin supplements have decreased the pain of OA. Not all studies are positive, though, and several have not shown any positive effect from taking chondroitin.  It is not clear why the studies have different findings, and experts disagree on whether chondroitin is helpful in treating OA.

In the past, some researchers thought chondroitin may actually slow progression of the disease, unlike other current medical treatments for OA (Many people take either acetaminophen or nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen, for OA pain).  Nevertheless, so far studies have not shown conclusively that chondroitin helps repair or grow new cartilage, or stops cartilage from being further damaged.  Chondroitin is often taken with glucosamine, another supplement that has been studied along with chondroitin for OA.  Like chondroitin, glucosamine also has conflicting results.

The large chondroitin molecules are poorly absorbed with approximately 10% bioavailability (i.e., of every milligram of chondroitin ingested, 90% is wasted).

Side Effects: Chondroitin is safe and relatively free of side effects when used at the recommended daily dosage, at least for short periods.  Some people may experience mild stomach upset. So far, few studies have investigated the safety and effectiveness of chondroitin when used for long chronically.

Risks: In the past, researchers have found that some chondroitin supplements did not contain the amount of chondroitin stated on the label.  The same was true of some combination glucosamine and chondroitin supplements.  Ask your doctor to recommend a brand, or choose a brand you trust.

Many chondroitin supplements are made from cow cartilage.  If you are a vegetarian or are allergic to shell fish (some chondroitin sulfate is made from marine exoskeleton), look for a supplement made from algae instead.

Asthma: There is some concern that chondroitin may worsen asthma symptoms: use with caution.

Prostate Cancer: Preliminary research suggests that chondroitin may cause the spread or recurrence of prostate cancer.  This effect has not been shown with chondroitin sulfate supplements.  Still, until more is known, do not take chondroitin sulfate if you have prostate cancer or are at high risk for developing it (if you have a brother or father with/had prostate cancer!).


Echinacea: Echinacea is one of the most popular herbs in America today.  This Native American medicinal plant called echinacea is named for the prickly scales in its large conical seed head, which resembles the spines of an angry hedgehog (echinos is Greek for hedgehog).

Claims: Echinacea is thought to prevent and shorten the duration of upper respiratory infections and flulike conditions.

People use echinacea to shorten the duration of the common cold and flu and reduce symptoms, such as sore throat (pharyngitis), cough, and fever.  Many herbalists also recommend echinacea to help boost the immune system and help the body fight infections.

Mechanism: Three species of medicinal interest (Echinacea purpurea, E.augustifolia, and E.pallida) act as immunostimulants and help immune defenses combat infection.  It may have indirect antiviral capabilities, possibly by stimulating interferon response (i.e., an antiviral protein produced by cells that have been invaded by a virus; inhibits replication of the virus).

Efficacy: In the December 2010 issue of the Annals of Internal Medicine, there is a study of Echinacea for the treatment of cold symptoms: Echinacea for Treating the Common Cold, A Randomized Trial.  I will not withhold the punch line – the study was completely negative.

Even the larger and somewhat controlled studies have mixed results, but the largest and best-controlled studies are all negative.  The better the studies’ quality, the more negative were the results.

The prior plausibility for echinacea as a cold remedy is very low, but not zero. As an herbal product, it can feasibly have biological activity.  The claim that it “boosts the immune system” is not credible; as such a phenomenon is not generally accepted.

Basic science research essentially finds that the immune system is activated by echinacea, but this has not been distinguished from a non-specific immune response to a foreign substance.  In other words, stimulating the immune system non-specifically (I can do this by punching you in the arm, or by checking reflexes with a little rubber mallet), and “boosting” the immune system so that it functions more effectively against an infection, are not the same thing.  Leaping to the latter conclusion is not justified by the evidence.

Prophylactic treatment with commercially available E. purpurea capsules did not significantly alter the frequency of upper respiratory tract symptoms compared with placebo use.  I have seen patients who took echinacea for a cold, and that cold was particularly long-lived and severe.  However, this does not suggest that echinacea made things worse. Rather, it strongly asserts that the herb did nothing at all.

Side Effects:

Allergies: Typically, echinacea does not cause any side effects when taken orally, according to the National Center for Complementary and Alternative Medicine (NCCAM). Nevertheless, in some people, it can trigger allergic reactions such as rashes, increased asthma and anaphylaxis. You are more like to experience an allergic reaction if you are allergic to daisies, ragweed, chrysanthemums or marigolds. If you have asthma, you should also be more cautious. The Mayo Clinic reports that echinacea is not recommended for children due to reports of rashes.

Gastrointestinal Side Effects: In clinical trials, echinacea has also been linked to gastrointestinal side effects, such as upset stomach, vomiting, nausea and diarrhea, in a small number of people, according to the NCCAM.

Organ Problems: Incidents of organ damage from echinacea use are very rare, but according to the Mayo Clinic, there are some reports of hepatitis, kidney failure or irregular heartbeat in people taking echinacea. It is unclear, however, whether the echinacea itself was at fault. If you have had a liver transplant, use echinacea cautiously, because the herb may increase liver enzyme activity.

Preexisting Autoimmune Disorders: According to the Mayo Clinic, the German Commission E, a government regulatory agency, has declared that patients with autoimmune diseases should not take echinacea. However, they note that this warning is based on theoretical – and not human – data. Long-term use of echinacea may cause low white blood cell counts, the Mayo Clinic reports.

Discomfort: Few side effects are reported when echinacea is taken at recommended doses, according to the Mayo Clinic. However, you may experience stomach discomfort, sore throat, drowsiness, headache or muscle aches.

Possible Interactions: As with any over-the-counter treatment, consult your doctor if you are taking any other medication. The NCCAM suggests always discussing any complementary and alternative practices — which includes taking any herbs — with your health care provider.

Dosage: There is no standard dose of echinacea. It depends in part on the form you use. For example, the usual dose range for pressed juice is 6-9 milliliters daily, and the usual dose range for tinctures (usually a solution of alcohol and herbal extract) is 0.75-1.5 milliliters daily. Standardized extracts have other specific doses. Some people use echinacea tea, 6-8 ounces, four times daily.


Evening Primrose:  

Claims: Evening primrose oil (PMO) is used for the treatment of premenstrual dysphoric disorder (premenstrual dysphoric disorder (PMDD) is a condition in which a woman has severe depression symptoms, irritability, and tension before menstruation.  The symptoms of PMDD are more severe than seen in premenstrual syndrome (PMS); cyclic and noncyclic mastalgia (breast pain); and the reduction of perimenopausal (during menopause) symptoms (e.g., hot flashes) and pain of rheumatoid arthritis (RA). There is not a lot of scientific evidence about using EPO for those conditions.

Mechanism: Gamma-linoleic acid (GLA) found in evening primrose oil is the precursor for prostaglandins (a number of hormone-like substances that participate in a wide range of body functions such as the contraction and relaxation of smooth muscle, the dilation and constriction of blood vessels, control of blood pressure, and modulation of inflammation) E2 and E1. GLA also is converted to 15-hydroxy-dihomo-GLA, which may competitively inhibit the production of prostaglandins and leukotrienes (the leukotrienes are a family of biologically active molecules, formed by leukocytes, mastocytoma cells, macrophages, and other tissues and cells in response to immunological and nonimmunologic stimuli. They exhibit a number of biological effects such as contraction of bronchial smooth muscles, stimulation of vascular permeability, and attraction and activation of leukocytes in the immune system), thereby reducing inflammation. PMDD may be associated with lower GLA levels.


Diabetic Neuropathy: Diabetic neuropathy is a gradual degeneration of nerves caused by diabetes.  There is some evidence that GLA can be helpful, if you give it long enough to work.  In one double blind, placebo-controlled study, 111 people with mild diabetic neuropathy received either 480 mg daily of GLA or placebo.  After twelve months, the group taking GLA was doing significantly better than the placebo group.  Good results were seen in a smaller study as well.  However, these promising findings lack further research validation.  There is some preliminary evidence that GLA may be more effective for diabetic neuropathy when it is combined with lipoic acid.

Eczema: Recent and properly conducted research has failed to find any benefit.

Cyclic Mastalgia: A woman’s breasts become painful during the week or two before her menstrual period. The discomfort is accompanied by swelling, inflammation, and, sometimes, actual cysts that form in the breasts. It is often associated with other symptoms of premenstrual syndrome (PMS). A high quality study found that evening primrose oil, by itself or with fish oil, is not more effective than placebo for cyclic breast pain. Moreover, a randomized trial involving 85 women did not support the effectiveness of evening primrose (alone or with vitamin E) for treating breast pain. Other studies have found evening primrose oil ineffective for established breast cysts.

Rheumatoid Arthritis: According to many studies, fish oil, a source of omega-3 essential fatty acids, improves symptoms of rheumatoid arthritis.  A few studies suggest that GLA may also help.  One double-blind study followed 56 people with rheumatoid arthritis for 6 months.  Sixty-six participants received either 2.8 g daily of purified GLA or placebo.  The group taking GLA experienced significantly fewer symptoms than the placebo group, and the improvements grew over time.  Other studies have found similar results.  The overall conclusion appears to be that purified GLA might offer some benefit for rheumatoid arthritis, especially when used along with standard treatment for rheumatoid arthritis, but the evidence is still weak.

Raynaud’s phenomenon: High dosages of evening primrose oil may be useful for Raynaud’s phenomenon, a condition in which a person’s hands and feet show abnormal sensitivity to cold temperature. A small double blind study found that GLA produced significantly better results than placebo.  Similar results have been obtained with the omega-3 fatty acids found in fish oil. However, larger studies would be necessary to establish actual effectiveness.

Osteoporosis: There is some evidence that essential fatty acids may enhance the effectiveness of calcium for the treatment or prevention of osteoporosis.  In one study, 65 postmenopausal women were given calcium along with either placebo or a combination of omega-6 fatty acids (from evening primrose oil) and omega-3 fatty acids (from fish oil) for a period of 18 months. At the end of the study period, the group receiving essential fatty acids had higher bone density and fewer fractures than the placebo group.  However, a 12-month, double-blind trial of 42 postmenopausal women found no benefit.

The explanation for the discrepancy may lie in the differences between the women studied.  The first study involved women living in nursing homes, while the second studied healthier women living on their own.  The latter group of women may have been better nourished, and already had enough essential fatty acids in their diet.

Side Effects: Nausea, soft stools, indigestion, headache, and seizures when used with phenothiazines (phenothiazines are used to treat serious mental and emotional disorders, including schizophrenia and other psychotic disorders; some are used also to control agitation in certain patients, severe nausea and vomiting, severe hiccups, and moderate to severe pain in some hospitalized patients).

Dosage: Standardized formulations are 9% gamma-linoleic acid. Normal dosages are 2-4 g/day. In the U.K., EPO is a prescription medicine to treat atopic eczema (6-8 g/day).

This concludes this part of this series.  The next article will continue this discussion.

Following this series on nutrition and supplements, in time for football, we will take a comprehensive look at head injuries, including the arguments about the sequelae following concussions. We will concentrate on the science (pro and con) and not on the opinions of the untrained. This will give readers the opportunity to use the facts provided to make up their own minds about the seriousness, or lack thereof, of concussions in football.

As we look forward to fall camp, I wish the Ducks and Duck fans the best of health.

De'Anthony Thomas Picking Up Yardage Against USC - 2012

Kevin Cline

De’Anthony Thomas Picking Up Yardage Against USC – 2012



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FishDuck Has New Off-Season Schedule and see the OUR BELOVED DUCKS Forum!

FishDuck articles will now be on Monday-Tuesday-Wednesday only during the off-season, and then we will go back to seven days a week during the football season beginning in August.

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