Composition and safety evaluation of dietary supplements for detoxification

Ljudje vedno bolj posegajo po prehranskih dopolnilih, za katera proizvajalci trdijo, da izkazujejo različne pozitivne učinke na zdravje, med katerimi je tudi razstrupljanje telesa. V zadnjem času se razstrupljanje telesa oglašuje predvsem kot razstrupljanje jeter. Na slovenskem trgu najdemo različna prehranska dopolnila, ki se oglašujejo z različnimi trditvami o razstrupljanju, ki pa niso dokazane in so lahko tudi zavajajoče. Uporabniki se pogosto ne zavedajo, da lahko prehranska dopolnila povzročajo neželene učinke ali vstopajo v interakcije z zdravili ali drugimi prehranskimi dopolnili. V okviru magistrske naloge smo želeli oceniti sestavo in varnost prehranskih dopolnil za razstrupljanje, ki so dostopna v Sloveniji. Zbrali smo 95 prehranskih dopolnil, pregledali njihovo sestavo in izbrali 45 sestavin, ki bi lahko prispevale k razstrupljanju. Izmed teh sestavin smo za podrobnejšo analizo izbrali 18 sestavin, ki so se v prehranskih dopolnilih pojavile najpogosteje ali kot samostojna sestavina. Povprečno število sestavin v izbranih prehranskih dopolnilih je 4,1. Najpogostejša sestavina je pegasti badelj (49,5 %), sledita mu artičoka (32,6 %) in kurkuma (21 %). Kot samostojna sestavina se najpogosteje nahajata klorela (27,8 %) in pegasti badelj (25 %). S pomočjo strokovne literature smo ugotovili mehanizme delovanja, preko katerih sestavine prispevajo k razstrupljanju, in ocenili njihovo učinkovitost ter varnost. Najpogosteje sestavine izkazujejo hepatoprotektivni učinek. 91,5 % izbranih prehranskih dopolnil vsebuje vsaj eno sestavino, za katero je bila dokazana učinkovitost na ljudeh. Učinkovitih je 32,6 % prehranskih dopolnil z eno sestavino in 58,9 % prehranskih dopolnil z več sestavinami. Glede na najnižje odmerke, uporabljene v raziskavah na ljudeh, in odmerke, prisotne v prehranskih dopolnilih, smo ugotovili, da sta klorela in velika brusnica učinkovitejši od ostalih sestavin. Vitamin E in navadni regrat sta v raziskavah na ljudeh izkazala tako učinkovitost kot neučinkovitost. Za spirulino, črno redkev, veliko koprivo in navadno brezo je bila učinkovitost na ljudeh dokazana samo v kombinaciji z drugimi sestavinami. Na podlagi zbranih podatkov o varnosti smo ugotovili, da 73,3 % izbranih sestavin izkazuje neželene učinke. Vsaj eno takšno sestavino vsebuje 98,8 % izbranih prehranskih dopolnil. Največ neželenih učinkov, tudi resnih, izkazuje klorela. Ugotovili smo, da lahko v interakcije z zdravili in drugimi prehranskimi dopolnili vstopa 37,8 % izbranih sestavin, ki se nahajajo v 80 % prehranskih dopolnil. Največ interakcij smo našli za črni poper. Med iskanjem prehranskih dopolnil, smo našli tudi pakete prehranskih dopolnil, ki se oglašujejo za razstrupljanje. V magistrski nalogi smo želeli oceniti smiselnost kombinacije sestavin v paketih ter njihovo učinkovitost in varnost. Povprečno število sestavin v paketih je 13,6 in je večje, kot pri samostojnih prehranskih dopolnilih. Ugotovili smo, da vsi paketi vsebujejo več učinkovitih sestavin in več sestavin, ki izkazujejo neželene učinke ali vstopajo v interakcije z zdravili ali drugimi sestavinami prehranskih dopolnil. Glede na zbrane podatke smo ugotovili, da lahko večina prehranskih dopolnil in vsi paketi pomagajo pri razstrupljanju. Jih pa veliko lahko povzroča neželene učinke ali vstopa v interakcije z zdravili ali drugimi prehranskimi dopolnili, zato je pomembno, da se uporabniki pred nakupom prehranskih dopolnil posvetujejo s farmacevtom ali drugimi zdravstvenimi delavci.People are increasingly consuming dietary supplements, which manufacturers claim to have various benefits for the health, including detoxification of the body, which has recently been advertised as liver detoxification. There are various dietary supplements on the Slovenian market that are advertised with various claims about detoxification, but which have not been proven and can also be misleading. Users are often unaware that dietary supplements can cause side effects or interact with medication or other dietary supplements. The object of this master thesis was to evaluate the composition and safety of dietary supplements for detoxification, which are available in Slovenia. We collected 95 dietary supplements, reviewed their composition and selected 45 ingredients that could contribute to detoxification. From these ingredients, we selected 18 ingredients, which appeared most commonly in dietary supplements or as a stand-alone ingredient for a more detailed analysis. The average number of ingredients in selected dietary supplements is 4.1. The most common ingredient is milk thistle (49.5%), followed by artichoke (32.6%) and turmeric (21%). Chlorella (27.8%) and milk thistle (25%) are most common stand-alone ingredients. Referring to the data found in the literature, we identified the mechanisms of action through which the selected ingredients contribute to detoxification, and evaluated their efficacy and safety. The most common mechanism of action was hepatoprotective effect. 91.5% of the selected dietary supplements contain at least one ingredient, for which it has been shown to be effective in humans. 32.6% of dietary supplements with one ingredient and 58.9% dietary supplements with several ingredients, are effective. According to the lowest doses used in human studies and the doses present in dietary supplements, we found that chlorella and large cranberry are more effective than other ingredients. Vitamin E and common dandelion have been shown to be both effective and ineffective in human research. For spirulina, black radish, common nettle and silver birch, efficacy in humans has been shown only in combination with other ingredients. Based on the collected data for safety, we found that 73.3% of the selected ingredients exhibit side effects. 98.8% of selected dietary supplements contain at least one such ingredient. Chlorella exhibits the most side effects, including serious ones. We found that 37.8% of selected ingredients, which are found in 80% of dietary supplements, can interact with medications or other dietary supplements. Most interactions were found for black pepper. While searching for dietary supplements, we also found supplement packages, advertised for detoxification. In the master’s thesis we tried to evaluate the sense of the composition in packages, their efficacy and safety. The average number of ingredients in packages is 13.6 and is higher than with dietary supplements. We found that all packages contain more effective ingredients and more ingredients that show side effects or can interact with medications or other dietary supplements. Based on the data collected, we found that most dietary supplements and all packages can help with detoxification. However, many of them can show side effects or interact with medication or other dietary supplements, therefore it is important that users consult a pharmacist or other healthcare professional before purchasing dietary supplements