Supplements

Dangers of some food supplements- Interactions with foods and medicines- CYP3A4 enzyme

Photo by Polina Tankilevitch from Pexels

Many people believe when they see the word natural, its okay to take as much as they want since its ‘found’ in nature. However ‘natural’ products can be very dangerous.

One interaction most people are aware of is with grapefruit, this is seen as a warning on many prescription packets. Grapefruit juice affects how drugs are changed (metabolised) in the body for eventual elimination and can alter the amount of drug in your blood. This can lead to enhanced side effects or lower drug effectiveness. Drugs or toxins are usually broken down (metabolised) so that they can be eliminated from the body, and they pass through the liver. Grapefruit or grapefruit juice can alter enzymes in the body and affect how drugs are changed in the body before they are eliminated. In the case of grapefruit it decreases the activity of the cytochrome P450 3A4 (CYP3A4) enzymes that are responsible for breaking down many drugs and toxins.

Grapefruit contains compounds known as furanocoumarins that block the CYP3A4 enzymes. When grapefruit juice is consumed, the enzyme’s ability to break down the drug for elimination is decreased. Blood levels of the drug may rise, resulting in a risk for new or worsened side effects. Blood levels of the drug may rise, resulting in a risk for new or worsened side effects. One whole fruit or 200 milliliters of grapefruit juice (a bit less than one cup) can block the CYP3A4 enzymes and lead to toxic blood levels of a drug. (1)

Taking medications at a different time from when grapefruit juice is consumed may not prevent the interaction. The effects of grapefruit juice on certain medications can last for over 24 hours. So, even if you take a medicine that is given only once per day, grapefruit and grapefruit juice should still be avoided for the entire treatment period.

Most worryingly Susan sees on some sites that its okay to take certain supplements two hours after any prescription medication or four hours after a medication that says do not take with grapefruit juice, since the supplement uses the same CYP3A4 pathway. There is no evidence to support this, there are a variety of factors that affect how a drug is metabolised (2). Some interactions can inhibit or change the rate its metabolised, while it may not have much effect on you if your hayfever medication is affected, it could have more serious consequences if its your Contraception, Epilepsy or Blood Pressure medication is affected.

Photo by Nataliya Vaitkevich from Pexels

Other CYP enzymes are also affected, in particular the following foods often found in supplements can have an interaction:-

  • Gingko
  • Grape Seed Extract
  • Liquorice
  • Milk Thistle
  • Echinacea
  • Garlic
  • Ginger
  • Ginseng
  • Piperine
  • Pomegranate
  • Quercetin
  • St John’s Wort
  • Berberine
  • CBD oil
  • Chamomile
  • Cranberry
  • Curcumin

The CYP enzyme system is responsible for the metabolism of 90% of prescribed drugs and herbs can induce or inhibit the CYP enzymes. Medication, toxins and hormones are all processed through the liver and some have more than one pass (3), this varies from drug to drug which is why there is no general rule of when it’s safe to take a product that interacts. In particular as you age your liver metabolism slows down so the risk increases (4), quite often more side effects are seen and then more drugs are prescribed to counteract the side effects.

Susan carries out a drug interaction assessment with every client having a full review to ensure that any current self medicated supplements are safe , and any prescribed supplements are suitable.

  1. https://www.fda.gov/consumers/consumer-updates/grapefruit-juice-and-some-drugs-dont-mix- accessed 24th July 2021

2. https://www.aafp.org/afp/2007/0801/p391.htmlaccessed 24th July 2021

3. https://www.sciencedirect.com/topics/medicine-and-dentistry/drug-metabolism- accessed 24th July 2021

4. https://academic.oup.com/biomedgerontology/article/67A/2/175/555434- accessed 24th July 2021

© 2025 – Susan Monk

Scientific Evidence

Food labelling and health claims

Health claims and other claims on foods we buy in the supermarket such as ‘free from additives’ , ‘preservatives’ etc are valuable tools for both the consumer and the manufacturer . The consumer sees them as a quick way of deciding if a food is what they require without reading the ingredient list and as a sale tool for the manufacturer. What goes on a food label however is highly regulated, but can still be misleading to the consumer.

Vitamin C, may be classed as an ingredient, such as when its added as a nutrient to a drink. A popular children’s drink has this added and the only additives declared on the label is sweeteners. However when it’s added to apple juice as an Antioxidant (Ascorbic Acid E300), for its technological function – The ascorbic acid allows certain oxidation reactions to happen in the juice which develop its flavour, but it prevents the browning of the tannins which make it look unsightly and lead to sedimentation – It’s then classed as an additive and the fruit juice can not be labelled additive free.

Health conscious consumers like to purchase food products that are ‘additive free’, and producers will use this label as a selling point. A high profile case1 concerned the addition of ‘ fermented vegetable broth’ being added to sausages and other cured meats as a way of preserving the meat and the colour, this meat was then labelled additive free. The fermented vegetable broth was high in nitrates, which is normally added to commercially produced cured meats, it was judged to be added solely for the purpose as an additive (as a technological function) and therefore illegal to label the food as additive free.

Label’s such as ‘natural’ there is no legal definition of natural on food labels, and while research shows that consumers believe that food labeled “natural,” according to the does not contain artificial ingredients or preservatives and the ingredients are only minimally processed. However foods labelled ‘natural’ may contain antibiotics, growth hormones, and other similar chemicals, and they do not have to be ‘healthy’.

There is more to a product that what the label may tell us.

References

  1. https://www.fsai.ie/uploadedFiles/Site/FAQs/Opinion%20on%20vegetable%20extracts%20Nov%202018.pdf

© 2024 – Susan Monk

Uncategorized

Supplement Labelling

In the UK, food supplements are required to be regulated as foods and are subject to the provisions of general food law.

There are over 2 million people in the UK with some form of food allergy.

Under the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA)The Federal Drug Administration (FDA) in the USA requires allergen labelling limited to eight food groups – Milk, Eggs, Fish, Crustacean shellfish, Tree nuts, Peanuts, Wheat and Soybeans

This act differs from the EU Food information for Consumers Regulation which requires fourteen food groups to be listed – celery, cereals containing gluten, crustaceans, eggs, fish, lupin, milk, molluscs, mustard, tree nuts, peanuts, sesame seeds, soybeans, sulphur dioxide and sulphites (if they are at a concentration of more than ten parts per million).

The danger arises with many individuals now purchasing supplements via e-bay or Amazon. In simple terms Celery and products thereof, Mustard and products thereof, Sesame seeds and products thereof, required to be listed in the EU/UK are NOT required to be listed on supplements from the USA. 

Practitioners must supply or recommend only products legally appropriate for sale in the UK. One of necessities for a product to be legally sold in the UK is that it complies with EU requirements for labelling. Susan uses Natural Dispensary to supply all her clients, to ensure that all products comply with regulations.

© 2024 – Susan Monk

Uncategorized

Which Sugar is best?

Refined sugar is so processed that it has absolutely no nutritional value – no fibre, nutrients, healthy fats or enzymes. In fact, it acts as an “anti-nutrient,” robbing your body of precious minerals like calcium, magnesium and potassium. As little as 36g of sugar for adults and 18g for children begins to suppress our immune system.⁣

But we have taste buds targeted for ‘sweet’, so we’re obviously designed to want this flavour. Luckily, there are some healthier, natural sweeteners we can use instead.⁣

WHAT ARE NATURAL SWEETENERS?⁣
This may seem obvious, but as more and more dubious products come out claiming to be “natural” sweeteners, I think I should explain more. Natural sweeteners are minimally processed (depending on the quality you purchase) don’t require the use of added chemicals, enzymes or expensive machinery, and still contain minerals and phytonutrients that occur naturally. For instance;⁣

Agave — NOT NATURAL⁣
Rice Bran Syrup — NOT NATURAL⁣
Sugar Alcohols (like xylitol or erythritol) — NOT NATURAL⁣
Stevia Leaf Powder — NATURAL⁣
Maple Syrup — NATURAL⁣
Raw Honey — NATURAL⁣
Rapadura Sugar — NATURAL⁣
Organic Dates — NATURAL⁣

These natural sweeteners nourish the body instead of deplete it.⁣

RAW, LOCAL HONEY⁣
Contains antimicrobial properties, enzymes, antioxidants, vitamins B1, B2, B3, B5, B6, calcium, iron, magnesium, phosphate, potassium.

DATES⁣
Are naturally loaded with potassium, copper, iron, manganese, Vitamin B6 and magnesium. You can also ferment them to make them even lower in sugar, full of probiotics and easier to digest.

STEVIA⁣
Doesn’t affect blood sugar levels, doesn’t feed Candida or pathogens in the gut, or set you up for sugar/ carbohydrate cravings. When purchasing stevia, find one that is pure, as so many contain fillers like maltodextrin, flavours, lactose, glycerin and alcohol.⁣

MAPLE SYRUP⁣
Is an excellent source of manganese, zinc and other antioxidants. Be sure you purchase pure, organic maple syrup as many commercial brands use formaldehyde in processing.⁣

What’s your favourite natural sweetener?

© 2025 – Susan Monk

Social Prescriptions

Social Prescriptions and engaging in nature- the benefits to mental health

 

There are more and more programs that are prescribing nature-based therapy rather than medication.  These programs have shown that they improve well being and could lead to lower NHS costs.

One such program is River Remedies: Improving well -being through nature, this is a scheme run in the South Gloucestershire and Bristol areas on the River Frome.  The individuals in the original scheme their well being scores went from ‘poor’ to being in line with national averages.

Engaging in nature is beneficial for all. Several studies have revealed that exposure to nature has positive associations with well-being.  However Natural England’s last survey of engagement with the natural environment, only 42% of the population had visited the outdoors in the last seven days, and around 50% of these visits were to urban parks.

A report in The Lancet- Planetary Health, found a significant reduction in major depressive disorder in those living in closer proximity to green spaces.

A common factor attributed to the benefits in time in nature is those individuals partake in a greater level of physical activity. However ‘green exercise’ amplifies the benefits of physical activity indoors, being outdoors will also help top up your ‘vitamin D’ levels.

© 2024 – Susan Monk

Vegan, Vegetarian

Increase your fibre intake by having a vegetarian meal.

Vegetarian and vegan meals, tend to have higher fibre levels, with both the vegetables and the protein source being good sources of fibre, and the focus of the meal.

Today Susan made a version similar to Riverford’s Cauliflower Mujaddara,  packed full of vegetables, protein and healthy oils.  The four main ingredients in this dish were onions, cauliflower, kale and lentils.

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Onions

The dish contained a large portion of onions, with a generous 1.5 onions per portion.  Raw onions are nutritionally better due to the sulphur compounds which can be destroyed by heat, however you can still get many of the benefits from cooked as well. Cooked onions tend to taste milder and are often gentler on stomachs.

Onions have been used in folk medicine for the relief of coughs, colds and catarrh, especially asthma (Susan’s great aunt swore by her remedy of Oh Be Joyful which was honey, lemon, onion and whisky! to cure most colds).  One medium onion can provide 20% of RDA of Vitamin C, 4% calcium and 4% of Iron and 12% of your daily fibre requirements.  Most onions are safe to eat, however green onions  (spring onions) contain a high dose of vitamin K, therefore those on Warfarin need to take care.

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Curly Kale

Kale, over the years has been classed as a super food, just one cup will provide you with 3g of protein, 2.5g of fibre, vitamins A.C and K, folate, Alpha-linolenic acid, an omega-3 fatty acid, Lutein and zeaxanthin, nutrients that give kale its deep dark green colouring and may protect against macular degeneration and cataracts.  It also includes minerals such as potassium, calcium and zinc.

Kale being a dark green leafy vegetable, is better cooked than raw due to its indigestible fibre.  Kale is a goitrogenic vegetable and when eaten raw, this vegetable can inhibit the uptake of iodine by the thyroid gland. If it’s eaten in excess, these chemicals can inhibit the incorporation of iodine into thyroid hormone. Also since its a good source of vitamin K those on blood thinner medication need to take this into account.

The body relies on iodine (and tyrosine) to make thyroid hormones, so continually eating these raw greens can cause a thyroid hormone imbalance. Raw kale also contains oxalic acid, which binds with minerals such as calcium and magnesium in the body causing them to crystalize. These crystals can damage tissues, cause inflammation in the body and kidney stones. So, a daily dose of raw kale and other goitrogenic vegetables may not be such a great idea.

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Roasted Cauliflower

Cauliflower is currently a popular  food with cauliflower rice, being a common ingredient for those on diets, it can be boiled, steamed or roasted.

A cup of boiled cauliflower is just 30 calories, provides 4% of daily protein, 92% of vitamin C, 22% of vitamin K, 14% folate, 12% of fibre, 6% potassium and 8% manganese.

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Green Lentils

Brown, green, yellow, red or black — lentils are low in calories, rich in iron and folate and an excellent source of protein.  1/2 a cup of lentils provides 12g of protein and 32% of your daily fibre requirements.   Women need 2,320mg of Potassium per day (possible more if on a diuretic), a 1/2 cup portion provides, 12% of your requirement and 15% of your iron requirement. For vegetarians and vegans, getting enough iron  may be particularly challenging. Regularly including lentils in your diet can help boost your iron intake.

If you are not used to eating lentils it is advisable to slowly increase the amount in your diet to give your digestion system time to adjust to the increased fibre in your diet.

The whole meal provided a very nutritious balanced meal, at 600 calories per portion, it provided 55% of daily fibre requirement, 280% of vitamin C, 34% of protein, 17% of calcium and 30% of iron.

Try one or two vegetarian or vegan meals per week, to see if you can increase your vegetable and fibre intake.

© 2024 – Susan Monk

Elderly

Nutrition and Dementia

The type of food we eat affects our health and our quality of life. Poorly nourished people get sick more often and recover from injury and illness more slowly. Poor nutrition is a major health problem for many older people.

For people with dementia, maintaining good nutrition presents extra challenges. A person with dementia may:

  • Experience a loss of appetite
  • Develop an insatiable appetite or a craving for sweets
  • Forget to eat and drink
  • Forget how to chew or swallow
  • Experience a dry mouth, or mouth discomfort
  • Be unable to recognise the food and drink they are given

Daily nutritional balance

The nutritional requirements of someone with dementia will be similar to other people of their age. However some people with dementia experience increased physical activity such as pacing, which means they will need larger amounts of food to prevent them from losing weight.

Common nutritional problems

Forgetting to eat

What to try

  • An alarm clock, or a phone call, may be a useful reminder at mealtimes
  • Snacks that are easy to eat and don’t need to be refrigerated can be left out where they can be easily seen

Can’t or won’t prepare meals for themselves

It can be particularly difficult for people with dementia who are living alone when they  can’t or won’t prepare meals for themselves.

What to try

  • Meals should be shared social occasions whenever possible
  • Delivered meals such as meals-on-wheels. However these may not provide all of a person’s daily nutritional needs or may not be what the person is used to eating
  • Home support to assist with meal preparation, serving and to discretely prompt with eating
  • Pre-prepared meals from the supermarket
  • Family and friends helping to prepare meals and or eating together
  • Preparing large quantities of food, then freezing into meal size amounts
  • Home delivered ready-to-eat food from restaurants or fast food outlets
  • Eating out. However check first that the person with dementia will be comfortable with the venue and food
  • Stocking up on healthy snacks such as yoghurt, cheese or dried fruit that do not need preparation or cooking

 

Teenagers

Adolescents and nutrition

One for the teenagers in your lives.

As your body is still growing, it’s vital that you eat enough good quality food and the right kinds to meet your energy and nutrition needs.

Being a teenager can be fun, but it can also be difficult as your body shape changes. These physical changes can be hard to deal with if they aren’t what you are expecting. There can be pressure from friends to be or look a certain way, and this might affect the foods you eat. It’s not a good time to crash diet, as you won’t get enough nutrients, and you may not reach your full potential. Following a sensible, well-balanced diet is a much better option, both for now and in the long term.

What should I eat

Eating three regular meals a day with some snacks will help you meet your nutrition needs. Skipping meals means you will miss out on vitamins, minerals and carbohydrates, which can leave you lacking energy or finding it hard to concentrate.

  1. Breads, grains and cereals are carbohydrates that provide energy for your brain and muscles. They’re also an excellent source of fibre and B vitamins. Without enough carbohydrates you may feel tired and run down. Try to include some carbohydrates at each mealtime.
  2. Fruit and vegetables have lots of vitamins and minerals which help boost your immune system and keep you from getting sick. They’re also very important for healthy skin and eyes. It’s recommended you eat two serves of fruit and five serves of vegetables a day.
  3. Meat, chicken, fish, eggs, nuts and legumes (e.g. beans and lentils) are good sources of iron and protein. Iron is needed to make red blood cells, which carry oxygen around your body. During your teenage years, you’ll start to menstruate, or get your period, and this leads to loss of iron. If you don’t get enough iron, you can develop anaemia, a condition that can make you feel tired and light-headed and short of breath. Protein is needed for growth and to keep your muscles healthy. Not eating enough protein when you are still growing, or going through puberty, can lead to delayed or stunted height and weight. Not enough protein is common when you go on strict diets. Include meat, chicken, fish or eggs in your diet at least twice a day. Fish is important for your brain, eyes and skin. Try to eat fish 2 to 3 times a week.

    If you are vegetarian or vegan and do not eat meat, there are other ways to meet your iron needs, for example, with foods like baked beans, pulses, lentils, nuts and seeds.

  4. Dairy foods like milk, cheese and yogurt help to build bones and teeth and keep your heart, muscles and nerves working properly. You’ll need three and a half serves of dairy food a day to meet your needs.
  5. Eating too much fat and oil can result in you putting on weight. Try to use oils in small amounts for cooking or salad dressings. Other high-fat foods like chocolate, chips, cakes and fried foods can increase your weight without giving your body many nutrients.
  6. Fluids are also an important part of your diet. Drink water to keep hydrated, so you won’t feel so tired or thirsty. It can also help to prevent constipation.

 

 

 

 

Supplements

Choose your supplements wisely

Bio-availability refers to the bodies ability to absorb and use a particular substance or nutrient.

Vitamins and minerals are manufactured from either ‘organic’ or ‘inorganic’ materials.  Minerals in the form of sulphates, oxides, carbonates or artificial chelates are  inorganic, meaning they  rarely occur naturally in the plant or animal kingdoms.  Minerals in the form of  gluconates, phosphates, citrates, lactates are called ‘organic’ minerals because they do occur in  the plant and animal kingdoms.  Organic mineral forms are believed to be absorbed  easier by the body.

Calcium

One example can be seen in the supplement calcium, in 1987 Maryland University carried out a study to investigate the different forms of calcium  and absorption since it already had been determined that the solubility of many calcium salts, depends on pH, the type of salt used, the condition of the patient and the time of administration.

Previously it was assumed that all calcium supplements were equal, as long as the amount of calcium in each supplement was the same, however it was found that calcium must be in the form of ions to be absorbed. As with many salts the solubility depends upon the pH of the solution its dissolving in.  To be of use in the body first the tablet must disintegrate, It was found that some tablets had coatings on “enteric-coated” that were insoluble in acid, these coatings are of use to other supplements where the disintegration is needed further down the digestion track, or packed too tightly together ‘bed pan bullets’  (The standard laboratory test for disintegration (part of the test known as the United States Pharmacopeia [USP] “Disintegration and Dissolution of Dietary Supplements” method <2040>), is an important test of product quality, although passing this test alone does not assure bioavailability). The research also found that calcium carbonate and calcium phosphate dissolved well at a pH of 1.01(very acidic) but their solubility reduced as pH increased, the average stomach acid  pH of a human is 1.5-3.5, therefore for bioavailability calcium citrate and calcium lactate are better forms.

Susan has a practitioner account with Natural Dispensary where she can offer her clients a 10% discount off their price list.   If you want to discuss any of your supplements, please contact Susan.

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soup

Soup

Soup is a great way to add additional veg to your diet, and fresh soup tastes far superior than tinned versions and healthier since you control any added salt and sugar.  Soups that are blended down are a great way of hiding veg, and if you slowly add vegetables that you don’t like to a soup you do like, you can slowly retrain your taste buds to like (or at least tolerate) the new foods

Stoup is another version of soup but with really chunky veg, one of Susan’s favourite is from River cottage- ‘much more veg’  a fragrant veg stoup.  This filling stoup is around 339 calories per portion, 105% of vitamin A and 53% of vitamin C and a good 26% of fibre.

There are many tasty soup recipes but many come with a long list of ingredients which puts people off, for a treat Susan purchased a soup recipe bag which came with all the ingredients apart from oil and water, and with many spices involved in this soup, it saves purchasing many different spices.  The soup bags change on a weekly basis and Susan tried their Indian Cauliflower and spinach soup – though the consistency is more of a stoup.  It was a very tasty soup, with the spicy heat not too overpowering. At around 140 calories per portion its more of a light lunch, and with two grown lads Susan would probably add a tin of chickpeas in future to make it more filling. The tomato haters in the family didn’t realise there was chopped tomato on their bowl.    A bowl provides 13% of your daily iron and 15% of your daily potassium, low in carbohydrates and 48% of your daily fibre requirements.