Nutraceutical Supplements in the Thyroid Setting: Health Benefits beyond Basic Nutrition
1.1. Definition of Nutraceutical
1.2. Search of the Literature
1.3. Market and Sales
1.4. The Issue of Purity
2. Carnitine: Compound and Physiology
Carnitine and Thyroid Function
3. Inositol: Compound and Physiology
Inositol and Thyroid Function/Autoimmunity
4. Melatonin: Compound and Physiology
Melatonin and Thyroid Function
5. Resveratrol: Compound and Physiology
Resveratrol and Thyroid Function
6. Selenium: Compound and Physiology
Selenium and Thyroid Function/Autoimmunity
7. Perspective and Conclusions
Conflicts of Interest
|What is a dietary supplement? §||Congress defined the term “dietary supplement” in the Dietary Supplement Health and Education Act (DSHEA) of 1994. A dietary supplement is a product taken by mouth that contains a “dietary ingredient” intended to supplement the diet. The “dietary ingredients” in these products may include vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites. Dietary supplements can also be extracts or concentrates and may be found in many forms such as tablets, capsules, softgels, gelcaps, liquids, or powders. They can also be in other forms, such as a bar, but if they are, information on their label must not represent the product as a conventional food or a sole item of a meal or diet. Whatever their form may be, DSHEA places dietary supplements in a special category under the general umbrella of “foods”, not drugs, and requires that every supplement be labeled a dietary supplement.|
|What is a “new dietary ingredient” in a dietary supplement? §||The Dietary Supplement Health and Education Act (DSHEA) of 1994 defined both of the terms “dietary ingredient” and “new dietary ingredient” as components of dietary supplements. In order for an ingredient of a dietary supplement to be a "dietary ingredient," it must be one or any combination of the following substances:|
|an herb or other botanical,|
|an amino acid,|
|a dietary substance for use by man to supplement the diet by increasing the total dietary intake (e.g., enzymes or tissues from organs or glands), or a concentrate, metabolite, constituent or extract.|
|A “new dietary ingredient” is one that meets the above definition for a “dietary ingredient” and was not sold in the U.S. in a dietary supplement before 15 October 1994.|
|What are the benefits of dietary supplements?||Some supplements can help assure that you get enough of the vital substances the body needs to function; others may help reduce the risk of disease. But supplements should not replace complete meals which are necessary for a healthful diet–so, be sure you eat a variety of foods as well.|
|Unlike drugs, supplements are not permitted to be marketed for the purpose of treating, diagnosing, preventing, or curing diseases. That means supplements should not make disease claims, such as “lowers high cholesterol” or “treats heart disease.” Claims like these cannot be legitimately made for dietary supplements.|
|Are there any risks in taking supplements?||Yes. Many supplements contain active ingredients that have strong biological effects in the body. This could make them unsafe in some situations and hurt or complicate your health. For example, the following actions could lead to harmful–even life-threatening–consequences.|
|Using supplements with medicines (whether prescription or over the counter)|
|Substituting supplements for prescription medicines|
|Taking too much of some supplements, such as vitamin A, vitamin D, or iron|
|Some supplements can also have unwanted effects before, during, and after surgery. So, be sure to inform your healthcare provider, including your pharmacist about any supplements you are taking.|
|Some Common Dietary Supplements||Calcium|
|St. John’s Wort|
|Note: These examples do not represent either an endorsement or approval by FDA.|
|How can I find out more about the dietary supplement I’m taking?||Dietary supplement labels must include name and location information for the manufacturer or distributor.|
|If you want to know more about the product that you are taking, check with the manufacturer or distributor about:|
|Information to support the claims of the product.|
|Information on the safety and effectiveness of the ingredients in the product.|
|Report Problems to FDA||Notify the FDA if the use of a dietary supplement caused you or a family member to have a serious reaction or illness (even if you are not certain that the product was the cause, or you did not visit a doctor or clinic).|
|Follow these steps:|
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|||“A foodstuff (such as a fortified food or dietary supplement) that provides health benefits in addition to its basic nutritional value. (First known use: 1990)”.|
|||“A food to which vitamins, minerals, or drugs have been added to make it healthier.”|
|||“Nutraceuticals, which have also been called medical foods, designer foods, phytochemicals, functional foods and nutritional supplements, include such everyday products as “bio” yoghurts and fortified breakfast cereals, as well as vitamins, herbal remedies and even genetically modified foods and supplements. Many different terms and definitions are used in different countries, which can result in confusion.”|
|||“I propose to redefine functional foods and nutraceuticals. When food is being cooked or prepared using “scientific intelligence” with or without knowledge of how or why it is being used, the food is called ‘functional food’. Thus, functional food provides the body with the required amount of vitamins, fats, proteins, carbohydrates, etc., needed for its healthy survival. When functional food aids in the prevention and/or treatment of disease(s) and/or disorder(s) other than anemia, it is called a nutraceutical.”|
|||Nutraceutical combines two words the term ‘nutrition/nutrients’ (a nourishing food component) and ‘pharmaceutical’ (medicine or a substance used as a medication) applied to food or food component products sometimes with active principle from plants that can provide health and medical benefits, including the prevention and treatment of disease.|
|Entry||No. of Items||Proportions|
|2||nutraceuticals AND hormones||5698||3664||61.4%||N/A||N/A|
|3||nutraceuticals AND thyroid||656||487||74.2%||0.8%||0.9%|
|5||carnitine AND thyroid||145||68||46.9%||0.9%||0.9%|
|7||inositol AND thyroid||295||141||47.8%||0.6%||0.8%|
|9||melatonin AND thyroid||514||195||37.9%||2.1%||1.8%|
|11||resveratrol AND thyroid||78||47||60.2%||0.6%||0.9%|
|13||selenium AND thyroid||938||576||61.4%||2.8%||4.3%|
|Nutraceutical||Market and Sales ^|
|l-carnitine||l-carnitine market is expected to be worth USD 127 million by 2017, with the United States being the largest market, and the Asia-Pacific region, particularly China, expected to experience a 5.5% annual growth rate through 2017 .|
No. of items on sale-Amazon: 53; Walgreens: No match; CVS Pharmacy:13.
|Myo-inositol||In the consumption market, the global consumption value of inositol increases with the 2.01% average growth rate. Europe and China are the mainly consumption regions . With myo-inositol being the most common form of inositols, over the next five years the inositol market, will register a 6.8% compound annual growth rate in terms of revenue, the global market size will reach US $140 million by 2024, from US $94 million in 2019 .|
No. of items on sale-Amazon: 3; Walgreens: No match; CVS Pharmacy: No match.
|Melatonin||The North America region is the largest supplier of melatonin, with a production market share nearly 54% in 2016, Europe coming next with 27% . The global market size will reach US $2080 million by 2024, from US $700 million in 2019 .|
No. of items on sale-Amazon: 122; Walgreens: 11; CVS Pharmacy: 91.
|Resveratrol||Resveratrol supplements, with annual sales of $30 million in the United States  |
No. of items on sale-Amazon: 45; Walgreens: No match; CVS Pharmacy: 19.
|Selenium||Selenium market reached $87 million U.S. in 2017 .|
No. of items on sale-Amazon: 91; Walgreens: No match; CVS Pharmacy: 84.
|Question: Is There Evidence for Clinical Use of …?||Answer|
|Carnitine||Currently available evidence supports the usefulness of l-carnitine in hyperthyroid patients. Carnitine ameliorates a number of symptoms and signs, including cardiac arrhythmia. Case reports have shown benefits even in the setting of thyroid storm. However, no changes in thyroid function tests were reported. |
One practical setting for the use of l-carnitine (two grams per day) is the control of hyperthyroidism symptomatology when the patients need to take low doses of antithyroid drugs. Only one Korean study is currently available for hypothyroidism, thus precluding conclusions.
|Inositols||Only in one study, MI alone (2 g twice a day) or MI plus melatonin (2 g/d MI plus 3 g/d melatonin) were given in two groups of euthyroid postmenopausal women, and serum FT4 and TSH evaluated. MI alone caused an almost 3.5% increase in serum FT4 and a 10% decrease in serum TSH. This contrasted with the opposite changes (3.5% decrease in serum FT4 and almost 10% increase in serum TSH) observed in the group under MI plus melatonin.|
Few studies have been conducted only in one Western country (Italy), and with the combination of MI plus selenium or MI plus carnitine. Supplementation with the first combination has been used in the setting of patients with Hashimoto’s thyroiditis related SCHypo, and it decreased both serum thyroid autoantibodies and TSH. The combination of MI plus carnitine was only investigated in one study of patients with SCHyper, thus precluding conclusions.
|Melatonin||There has been interest in melatonin and autoimmunity and the thyroid gland has been implicated in the discussion. It is thought that melatonin may have a paracrine role and in thyroid disease under a condition of oxidative stress may reduce the processes involved in thyroid antoimmunity. However, there are no controlled trials or definite data to show conclusively that melatonin can be beneficial in thyroid disease.|
|Resveratrol||No answer can be given, simply for lack of studies.|
|Selenium||Benefits have been demonstrated for mild forms of Graves’ ophthalmopathy. Benefits for the clinical course of GD itself are controversial. In the setting of HT, a benefit has been shown more on serum thyroid autoantibodies than on thyroid function. There is only one study on the benefit given by selenium supplementation, both in terms of serum thyroid autoantibodies and thyroid dysfunction, in the setting of PPT. For the combinations of selenium with MI see above.|
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Benvenga, S.; Feldt-Rasmussen, U.; Bonofiglio, D.; Asamoah, E. Nutraceutical Supplements in the Thyroid Setting: Health Benefits beyond Basic Nutrition. Nutrients 2019, 11, 2214. https://doi.org/10.3390/nu11092214
Benvenga S, Feldt-Rasmussen U, Bonofiglio D, Asamoah E. Nutraceutical Supplements in the Thyroid Setting: Health Benefits beyond Basic Nutrition. Nutrients. 2019; 11(9):2214. https://doi.org/10.3390/nu11092214Chicago/Turabian Style
Benvenga, Salvatore, Ulla Feldt-Rasmussen, Daniela Bonofiglio, and Ernest Asamoah. 2019. "Nutraceutical Supplements in the Thyroid Setting: Health Benefits beyond Basic Nutrition" Nutrients 11, no. 9: 2214. https://doi.org/10.3390/nu11092214