Nutritional Medicine Journal
The Nutritional Medicine Journal (NMJ) is a specialist peer-reviewed scientific publication related to the application of personalised dietary interventions, foods, dietary factors, and nutritional supplements in clinical practice.
Topics include clinical nutrition, personalised nutrition, lifestyle medicine, micronutrients, amino acids, fatty acids, phytochemicals, probiotics, prebiotics, and functional beverages and foods. The aim of the NMJ is to provide health professionals with authoritative and scientifically accurate articles on topics in nutritional medicine.
Pain Management and Nutritional Medicine
Chronic pain is one of the most widespread health problems, with up to 43% of people in the UK reporting that they experience chronic pain, of which 10−14% report moderate to severely disabling chronic pain.1 Chronic pain is typically defined as pain persisting longer than 3 months, and generally refers to pain that has become a disease entity of itself and distinct from pain associated with acute injury or disease.2 As a unique disease state, chronic pain, like other chronic diseases, has unique biological features, clinical symptoms and long-term consequences. Full Article
Cite as: Brown, B. (2022) Pain management and nutritional medicine. Nutr. Med. J., 1 (3), xxx
Migraine Headaches: Opportunities for Management with Precision Nutrition
Chronic migraine headaches are estimated to affect between 1.4% and 2.2% of the population, and have a huge impact on wellbeing and quality of life. A diverse range of therapeutic nutritional options have been explored for migraine headaches, with varying degrees of benefit. Dietary interventions include generally healthy food plans, identification and avoidance of trigger foods, weight-loss diets, low-glycaemic-load diets, ketogenic diets, gluten-free diets, IgG-led elimination diets and a high-omega-3/low-omega-6 diet. Nutritional supplement interventions include riboflavin, niacin, homocysteine-lowering B vitamins, vitamin B12, vitamin E, vitamin D, magnesium, zinc, iron, omega-3 fatty acids, coenzyme Q10 (CoQ10), lipoic acid, soy phytoestrogens, ginger, turmeric, carnitine, 5-hydroxytryptophan (5-HTP), palmitoylethanolamide (PEA), and multi-ingredient formulas. The wide range of therapeutic options may make it challenging to approach nutritional management of migraine in a clinical setting, so a pragmatic model that helps personalise interventions from clinical signs and symptoms and reliable biomarkers would be useful, so-called ‘precision nutrition’. The aim of this narrative review is to explore the clinical evidence for nutritional medicine for migraines, including diet and nutrient-based interventions, from the perspective
of personalised or precision nutrition. Full Article
Cite as: Brown, B. (2022) Migraine headaches: opportunities for management with precision nutrition. Nutr. Med. J., 1 (3), xxx.
Lactobacillus rhamnosus GG : A Review of Clinical Use and Efficacy
Oral Lactobacillus rhamnosus GG (LGG) supplementation is generally recognised as a safe form of supplementation, which acts as an immunomodulator, an antimicrobial, and aids cell growth and proliferation. The aim of this review was to determine diseases where oral LGG supplementation has been indicated; and assess safety, colonisation, mechanisms of action and efficacy, and provide therapeutic recommendations. LGG following supplementation can successfully colonise the gut and other areas of the body owing to the expression of unique morphological features known as pili. Twenty-two disease areas were identified where LGG supplementation has been used, to determine effects. However, small study sizes, the use of multispecies probiotics and adjuvant therapies all meant that strong evidence for the use of LGG was lacking in several disease areas. Despite this, LGG was shown to be of benefit in the reduction of risk of developing attention-deficit hyperactivity disorder and gestational diabetes mellitus, in the prevention of allergies and dental caries, for improving immune reactions following vaccines, and for the management of diarrhoea associated with cancer treatments and antibiotic use. Full Article
Cite as: Steele, C. (2022) Lactobacillus rhamnosus GG: a review of clinical use and efficacy. Nutr. Med. J., 1 (3), xxx.
Vitamin B12: A Review of Clinical Use and Efficacy
Vitamin B12 (B12) is an essential cofactor in cellular metabolism − adequate supplies are needed for normal blood formation and neurological function, and deficiency can therefore lead to macrocytic anaemia and neurological deficits. Deficiency can be due to inadequate dietary intake, especially in vegans, but is otherwise more likely due to problems with absorption, which is more complex than that of other vitamins. Apart from vegans and people with gastrointestinal conditions, infants and children from B12-deficient mothers and the elderly are at particular risk of B12 deficiency.
Whilst in conventional medical practice B12 deficiency is generally treated with intramuscular injections, it is generally accepted that oral (per os) administration at a high dose is as effective at improving B12 status. Diagnosis of B12 deficiency is complicated by the fact that levels of B12 in the blood are maintained even when stores are low at the expense of tissue levels. Where a deficiency is suspected but serum levels are normal, other markers can be used to confirm a deficiency.
Benefits of B12 supplementation have been shown in a number of conditions, including diabetic neuropathy, back pain, mouth ulcers, autism spectrum disorder and elevated homocysteine levels, and it is generally considered to be very safe even at high dosages. Full Article
Cite as: Elgar, K. (2022) Vitamin B12 a review of clinical use and efficacy. Nutr. Med. J., 1 (3), xxx.
N-acetylcysteine: A Review of Clinical Use and Efficacy
N-acetylcysteine (NAC) is a derivative of the amino acid cysteine and a precursor to glutathione, the master antioxidant of the body, which makes it an important compound in detoxification processes, and it is well known for its use as an antidote to paracetamol poisoning. NAC also has direct antioxidant as well as various anti-inflammatory effects, making it a useful supplement in inflammatory conditions. NAC has been extensively used for its mucolytic properties, and research has also demonstrated its ability to interrupt biofilms.
There is evidence for benefits of NAC in diverse conditions, including respiratory infections, various mental health disorders, male infertility and polycystic ovary syndrome.
NAC is generally well tolerated but has a few potential drug interactions, and caution is advised in some underlying conditions including gastrointestinal ulceration, bronchial asthma, liver and kidney failure. Full Article
Cite as: Elgar, K. (2022) N-acetylcysteine: a review of clinical use and efficacy. Nutr. Med. J., 1 (3), xxx.
Zinc: A Review of Clinical Use and Efficacy
Zinc is an essential trace element and is required for many vital functions, including protein folding, as a co-factor for enzymes, in regulating gene expression, supporting cell membrane structure and cell signalling. It also has antioxidant and anti-inflammatory properties. As such, zinc plays an important role in growth and development, immune function, neurotransmission, vision and reproduction. Zinc deficiency is common, especially in developing countries, and can be due to dietary factors, malabsorption and alcoholic liver disease. Zinc supplementation at appropriate levels is considered safe, and has shown benefits in a wide range of medical conditions, including depression, diabetes, attention deficit hyperactivity disorder, male infertility, and the common cold in children. Full Article
Cite as: Elgar, K. (2022) Zinc: a review of clinical use and efficacy. Nutr. Med. J., Sep; 1 (3): xxx.
Bioavailability, Food Supplements, and Clinical Efficacy
Enhanced bioavailability of food supplements is often cited as a reason for product superiority, but in some cases this may not be substantiated with evidence. It may be that, contrary to logic, improved bioavailability does not inevitably translate to improved clinical benefit, or that poor bioavailability precludes effectiveness. This issue of the Nutritional Medicine Journal features a series of review papers on several commonly prescribed food supplements; so, with this theme in mind we explore how to navigate claims of bioavailability as they relate to clinical use. Using examples of commonly prescribed food supplements, we explore some of the myths, truths and controversies around bioavailability. Full Article
Cite as: Brown, B. (2022) Bioavailability, food supplements, and clinical efficacy. Nutr. Med. J., 1 (2), 6-11.
Collagen: A Review of Clinical Use and Efficacy
Orally administered collagen in its many different forms is recognised as a highly biocompatible, safe form of supplementation, which has the potential to act on the body as an anti-inflammatory and antioxidant, and through structural remodelling and reduced lipotoxicity. The aim of this systematic review was to determine diseases where collagen has been indicated; assess safety, bioavailability and efficacy; and to provide therapeutic recommendations. It was concluded that collagen supplementation is strongly indicated for its positive therapeutic effect on pain management of osteoarthritis, balancing blood sugars in type II diabetes, wound healing, skin ageing, and post-exercise body composition and strength. Promising results were also seen for the use of collagen supplementation in osteoporosis, hypertension, rheumatoid arthritis, tendinopathy, cellulite, atopic dermatitis, sarcopenia and brittle nail syndrome. Although therapeutic recommendations were indicated in most of these diseases, owing in the large part to the use of these supplements as part of dual therapy or the uncertainty over translatability of branded products it was concluded that more studies are required to make definitive recommendations. There was a lack of clinical evidence to support the use of collagen for weight loss in obesity, gut health and in fibromyalgia. Full Article
Cite as: Steele, C. (2022) Collagen: a review of clinical use and efficacy. Nutr Med J. 2022 Jul; 1 (2): xxx
Vitamin D: A Review of Clinical Use and Efficacy
Vitamin D3 is produced in the skin on exposure to ultraviolet B radiation, and is metabolised in the liver and kidneys to the biologically active form of vitamin D that binds to vitamin D receptors. Vitamin D was first recognised for its importance in calcium metabolism and therefore bone health, with the classic deficiency disease being rickets in children and osteomalacia in adults, but is now also known for its importance in modulating immunity.
Epidemiological studies have linked vitamin D deficiency to many conditions, including heart disease, cancer, allergies and autoimmunity. Vitamin D supplementation trials have confirmed benefits for some conditions, including atopic dermatitis, chronic urticaria, colorectal cancer, depression, polycystic ovary syndrome and type 2 diabetes mellitus, but not others, such as multiple sclerosis, prevention of allergic sensitisation in infants and psoriasis. Whilst there is some evidence of benefits for cardiovascular risk factors, this does not translate to a reduction in cardiovascular events in clinical trials.
Vitamin D is generally considered safe, and the upper limit set by the National Institute of Health is 4000 IU per day. The main safety concern with vitamin D is hypercalcaemia, based on its role in calcium metabolism, and caution is therefore advised in conditions and with medications that can also affect calcium metabolism. Full Article
Cite as: Elgar, K. Vitamin D: A Review of Clinical Use and Efficacy. Nutr Med J. 2022 Jul; 1 (2): xxx
EPA / DHA: A Review of Clinical Use and Efficacy
Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are omega-3 polyunsaturated fatty acids found in oily fish. Humans can also synthesise them from α-linolenic acid (ALA), which is considered an essential fatty acid as humans cannot synthesise it. However, conversion of ALA to EPA and DHA tends to be low, with significant inter-individual variation, making them conditionally essential nutrients. The benefits of EPA and DHA for cardiovascular health were first recognised in the 1970s. Since then, research has shown benefits in many other conditions, including metabolic, inflammatory and neuropsychiatric disorders, based on their anti-inflammatory and antioxidant effects, as well as their roles in cell membrane structure and function and in regulating gene expression. Fish oil supplements are generally well tolerated, but increased risk of atrial fibrillation and bleeding have been found in several meta-analyses. Full Article
Cite as: Elgar, K. (2022) EPA/DHA: A Review of Clinical Use and Efficacy. Nutr. Med J., 2 (2), xxx.
Resveratrol: A Review of Clinical Use and Efficacy
Resveratrol is a polyphenol found in many plant foods, and in particularly high concentrations in red wine. Epidemiological studies have shown significant reductions in all-cause mortality with dietary patterns high in resveratrol, and preclinical research has identified a number of anti-inflammatory, antioxidant, anti-cancer and cardioprotective mechanisms of resveratrol.
Resveratrol has been studied in a number of conditions, including Alzheimer’s disease, cognitive function, cardiometabolic conditions, osteoporosis, autoimmunity and for cancer prevention. For most clinical uses, studies are limited and conflicting results have been observed. The range of dosages used in clinical trials has also varied widely and there are some suggestions of a non-linear dose−response relationship, with high dosages potentially harmful. More clinical research is needed for practitioners to base their recommendations on. Full Article
Cite as: Elgar K. (2021) Resveratrol: A review of clinical use and efficacy. Nutr. Med. J., Jul; 2 (2): xxx
Nutritional Medicine in Primary Healthcare
Dietary interventions and nutrient-based supplements can prevent disease, reverse established illness and improve health while being very safe and, in some cases, extraordinarily effective. Yet the scientific evidence for nutritional medicine is not well incorporated into medical training, and consequently nutritional therapy is underutilised in clinical practice to the detriment of good patient care. Full Article
Brown, B. (2022) Nutritional medicine in primary healthcare.Nutr. Med. J., 1 (1), 6-9.
Butyrate Therapy for Treatment-Resistant Ulcerative Colitis: A Case Study
A number of patients with ulcerative colitis (UC) fail to achieve clinical remission with standard treatments, and may become less responsive to these treatments over time. Butyrate, a short-chain fatty acid, plays a major role in the immune homeostasis of the colonic mucosa, and oral butyrate has shown some promise as an adjuvant therapy in a small number of clinical studies, including for treatment-resistant patients. This case report describes an individual with a diagnosis of UC resistant to pharmacological and nutritional interventions who responded well to a trial of oral butyrate. Butyrate appears to be a promising therapy for UC, but questions around its efficacy, personalisation and safety require further investigation. Full Article
Gibbs, B. & Brown, B. (2021) Butyrate therapy for treatment-resistant ulcerative colitis: a case study. Nutr. Med. J., 1 (1), 60-67.
Inflammatory Bowel Disease: Towards a Model for Personalised Nutritional Therapy
Inflammatory bowel disease (IBD) has a complex multifactorial aetiology involving interactions between environmental factors (including diet), the microbiome, genetics and the immune system, leading to dysfunctional immune responses and chronic inflammation. Dietary factors and gut dysbiosis have emerged as important treatment targets in the management of IBD as they are involved in the initiation and perpetuation of inflammation, and subsequently disease development and progression. Specific dietary approaches and nutritional interventions have some, albeit limited, clinical evidence to suggest they can modify gene expression, have anti-inflammatory effects, induce mucosal healing, normalise intestinal microbiota, reduce disease activity and/or help maintain remission. This review uses evidence from nutritional science to propose a theoretical pragmatic model for the personalisation of nutritional therapy in patients with active or latent IBD, incorporating disease-modifying dietary recommendations and nutrient-based supplements, primarily as adjuvant therapies, with the intention to stimulate further investigation and research. Full Article
Brown, B. (2022) Inflammatory bowel disease: towards a model for personalised nutritional therapy. Nutr. Med. J., 1 (1), 32-59.
Sulforaphane, 3,3'-Diindolylmethane and Indole-3-Carbinol: A Review of Clinical Use and Efficacy
Sulforaphane (SFN), 3,3′-diindolylmethane (DIM) and indole-3-carbinol (I3C, a precursor of DIM) are compounds that are obtained through eating cruciferous vegetables, which have been shown in epidemiological studies to have health benefits. SFN and DIM have been shown to have antioxidant, anti-inflammatory and anti-cancer effects, as well as playing important roles in cellular detoxification of xenobiotics through their effects on nuclear factor-kappa B (NF-kB) and nuclear factor erythroid 2-related factor 2 (Nrf2). DIM and I3C have also been shown to affect oestrogen metabolism. In view of these properties, SFN, DIM and I3C have been studied in clinical trials and, although clinical research is still limited, promising results have been seen in a number of health conditions. Full Article
Elgar, K. (2022) Sulforaphane (SFN), 3,3′-diindolylmethane (DIM) and indole-3-carbinol (I3C): A Review of Clinical Use and Efficacy. Nutr. Med. J. 2022 Jul; 1 (2): xxx
Ashwagandha: A Review of Clinical Use and Efficacy
Ashwagandha has a long tradition of use in Ayurvedic medicine, and is best known as an adaptogen, a compound that can help increase our resistance to stress. Preclinical research has also shown ashwagandha to have anti-inflammatory, antimicrobial, antioxidant, antidiabetic, anti-tumour, anti-ageing and neuroprotective properties. Steroidal alkaloids and lactones, including withaferin A and withanolides, are thought to be some of the most active compounds of the herb. Clinical research in humans has shown ashwagandha to be safe and of benefit in a range of conditions, including stress/anxiety, athletic performance, cognition, diabetes, insomnia and male infertility. Ashwagandha is generally considered to be safe, with a few minor possible side-effects, although care should be taken alongside certain drugs. Full Article
Cite as: Elgar K. Ashwagandha: A Review of Clinical Use and Efficacy. Nutr Med J. 2021 Mar; 1 (1): 68-78
Coenzyme Q10: A Review of Clinical Use and Efficacy
Coenzyme Q10 (CoQ10) plays an essential role in energy production as part of the mitochondrial electron transfer chain. It also has antioxidant functions and is important for gene regulation, especially of genes involved in cell signalling, metabolism, inflammation, transport and transcription control. Whilst we can obtain small amounts from our diet, most CoQ10 is synthesised in our bodies, which is why it is not considered to be a vitamin. Production declines with age and may also be impaired through illness and/or certain medications, making supplementation an interesting intervention. Although clinical research has been mixed in some indications, CoQ10 supplementation has been found to be a safe and effective intervention in a variety of conditions, including cardiometabolic disorders, fibromyalgia syndrome, migraine and male infertility. Full Article
Cite as (AMA): Elgar K. (2021) Coenzyme Q10: A Review of Clinical Use and Efficacy. Nutr Med J. 2022 Mar; 1 (1): 100-118.
Curcumin: A Review of Clinical Use and Efficacy
Turmeric has a long tradition of use in Ayurvedic medicine for a variety of indications, including digestive and liver support, in mood-related disorders and inflammatory conditions. Modern research has confirmed anti-inflammatory, antioxidant, anti-microbial and anti-tumour activities of compounds isolated from turmeric, including curcumin and other curcuminoids. Curcumin has poor bioavailability and various formulations have therefore been developed to overcome this issue. Clinical trials have shown benefits of curcuminoids in a wide range of conditions, including cardiometabolic, inflammatory and mood disorders. Turmeric extracts have been found to be safe in humans with only mild adverse events being observed in clinical trials, mostly gastrointestinal disturbances, but due to its physiological actions, some drug interactions are possible. Full Article
Cite as (AMA): Elgar K. Curcumin: A Review of Clinical Use and Efficacy. Nutr Med J. 2022 Mar; 1 (1): 10-31.
Magnesium: A Review of Clinical Use and Efficacy
Magnesium is a co-factor for more than 300 different enzymatic processes, and therefore plays a role in virtually every process in the cell, including cellular energy production, neuromuscular and cardiac function, maintaining ionic gradients, regulation of cell membrane receptors and DNA, RNA and protein synthesis. It is also an essential structural component for DNA and RNA on the cellular level, as well as in bones and teeth.
Whilst overt magnesium deficiency is rare, subclinical deficiency appears to be common, and increases the risk of many chronic conditions. Organic magnesium formulations, such as citrate, have been shown to be slightly better absorbed than inorganic ones, but many clinical trials have used inorganic formulations of magnesium, mostly oxide and chloride, and have shown benefits in a range of conditions, including cardiometabolic conditions, bone health, pain and constipation. Full Article
Cite as: Elgar K. Magnesium: A Review of Clinical Use and Efficacy. Nutr Med J. 2022 Mar; 1 (1): 79-99.