How do clinicians reconcile conditions and medications?The cognitive context of medication reconciliationGeva Vashitz • Mark E. Nunnally • Yisrael Parmet •Yuval Bitan • Michael F. O’Connor •Richard I. CookReceived: 17 April 2011 / Accepted: 22 August 2011Ó Springer-Verlag London Limited 2011Medication omissions and dosing failures aresubjects matched conditions and medications rel
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Novel botanical ingredients for beveragesClinics in Dermatology (2009) 27, 210–216 Novel botanical ingredients for beverages Analyze and Realize AG, Waldseeweg 6, Berlin 13467, Germany Abstract Natural substances are generally preferred over chemical ones and are generally seen ashealthy. The increasing demand for natural ingredients, improving health and appearance, is alsoattracting beverages as the fastest growing segment on the functional food market. Functional beveragesare launched as fortified water, tea, diary or juices claiming overall nutrition, energy, anti-aging orrelaxing effects. The substitution of so called superfruits, such as berries, grapes, or pomegranatedelivers an effective range of beneficial compounds, including vitamins, fatty acids, minerals, and anti-oxidants. In this context, new exotic and African fruits could be useful sources in the near future. Teasand green botanicals, such as algae or aloe vera are also rich in effective bioactives and have been usedtraditionally. The botanical kingdom offers endless possibilities.
2009 Elsevier Inc. All rights reserved.
Beverages do more than quench thirst. Bioactive ingre- beverages) are increasing strongly. In the functional food dients should balance nutrional deficits, support physical and category, functional beverages are the fastest growing segment.
mental health, and may improve beauty from within.
In the forefront of consumer interest, are substances with anti- Costumers tend to favor a healthy lifestyle and the nutrional aging, energy supplying, relaxing, or beauty enhancing effects.
choices that go with it. As natural substances are clearly Functional beverages (among them sports and perfor- preferred over chemical ones, functional botanical ingredi- mance drinks, energy drinks, ready-to-drink teas and ents are more popular than ever on the beverage market. New designer waters) have acquired a claim to being healthy functional beverages, like fortified water, tea and/or diary recently. They meet the consumers' demand for good taste products have increased their convenience, novelty, fun and and ingredients that are good for physical fitness and mental image, but maintain their status as healthy drinks.
well-being. Consumers riding the exercise and healthy diettrend demand a measurable, noticeable health benefit fromtheir functional beverage, and they are growing in number.
This development has led to functional beverages becoming mainstream, and big beverage companies are merging with oracquiring small successful companies. Still as this contribution While some established nutritional markets, like dietary attempts to show, there is room for new ideas and botanical supplements, have been growing more slowly than they did in enhancements discovered by food science.
the 1990s, specific other segments (such as functional There are numerous advantages to using botanical extracts in beverages, functional or otherwise. They offer a ⁎ Waldseeweg 6, Berlin 13467, Germany. Tel.: +49 30 40008100; fax: wide range of active components and functions and a wide range of known raw materials, which means little or no consumer education is necessary prior to bringing a new 0738-081X/$ – see front matter 2009 Elsevier Inc. All rights reserved.
Novel botanical ingredients for beverages product to market. There is still room for new uses of known studied for its ability to prevent E. coli bacteria from adhering raw materials, either by creating new applications or taste to the epithelial wall of the urinary tract, limiting the profiles or by scientific elucidation of previously unknown development of a urinary tract infectioCranberries have functions. The natural colors and overall natural origin of a similar effect on H. pylori and the gastric wall, especially botanical extracts also lend themselves very well to when administered in combination with traditional addressing the consumers' desire for more nature in their drinks, which promotes the healthy properties inherent in Bilberry has been famous for its beneficial effect upon them. Additionally, there is an increasing trend across the visual acuity for a long time. Anthocyanins in bilberry have market toward using botanicals, which is supported by produced positive results for night vision,an effect that has marketing their natural and beneficial aspects.
anecdotally been reported by pilots as far back as in World There is also an increased preference for plant ingredients War II. Specifically, these anthocyanins can increase over animal derived ingredients, but they should be organic, capillary resistance, reduce abnormal vascular permeability, not merely natural. As a consequence, medicinal plants used and scavenge free radicals. Extracts of bilberry recently have traditionally in Europe have found their way into beverages in shown effectiveness in improving visual function in adults small amounts, lending not only new taste, but also the appeal with overworked eyes, which is certainly a problem in the of a health-promoting ingredient, even if their concentration is insufficient for any actual pharmacologic effect.
Another well-known and popular fruit, the strawberry, Another trend is the increasing consumer interest in ethnic also packs quite a healthy punch.Its range of active and traditionally used products. Noni, Cat's claw and substances (including anthocyanins, ellagic acid, and other Baobab are examples of plants used in new products that phytonutrients) can decrease the effect of toxins and limit oxidative damage to DNA, which is key to antioxidantprotection against a number of forms of neurodegenera-tion and cancer.Antioxidants derived from strawberriesalso play a role in helping to lower the risk of Anthocyanins are also abundant in grapes, as are Using fruit as ingredients for beverages means using a proanthocyanidins, quercetin, and resveratrol.These are marketing advantage based on the aura of health surrounding central to this berry's noted benefits for atherosclerosis and fruit.Fruit beverage brands that reach $60 million in almost cardiovascular disease, including decreased lipid oxidation, no time demonstrate this. Combining innovative packaging, cholesterol aggregation, reduced blood pressure, and new delicious taste, and clever marketing is more successful improved vascular endothelial function, as well as reduced than trying to deliver a health benefit, as that can be regarded cell adhesion, a factor in inflammation.
Other berries have shown impressive benefits, according There are hundreds of beneficial compounds contained in to various research results. Blackberries were shown to the various Among these compounds are poly- impede tumor formation in the oral cavity,while unsaturated fatty acids, flavanols (anthocyanins and anthocyanins and other phenolics present in boysenberries proanthocyanidins), flavonols (quercetin), and ellagic acid, and black currants were found to protect cellular DNA all of which combined are not only anti-oxidant, but also against oxidative damage, Black currants combined with deliver antimicrobial, anti-inflammatory, and anti-mutagenic bilberries, lignonberries, and raspberries may protect against lipid oxidation and increase antioxidant capacity in plasma.
Among the varieties of domestic fruit, sea buckthorn Raspberries work well with other berries. Combined with (Hippophae rhamnoides) recently has drawn attention to blueberries, they inhibit mutations in breast and cervical itself, because of its nutrient density of almost 200 active cancer cells. Joined with cloudberries, they counteract both phytochemicals, among them unsaturated fats, carotenoids, gram-negative and gram-positive bacteria.
and high amounts of vitamin C.The juice consists of three A clever approach to get daily rations of fruit, is to use phases, each containing a different substance profile and known fruits, such as strawberries, blueberries, and lending to different beverage applications with high manu- cranberries in fruit smoothies or juices. As science keeps facturing potential. The plant is native to northern Europe and substantiating the age-old adage that fruit is good for you Asia, where it has been a traditional herbal remedy.
and supplies the consumer with knowledge regarding the Blueberries, native to Europe and North America, help active substances contained in fruit and their effects, the protect the brain and central nervous system by increasing beverage industry gladly provides new means of eating serum antioxidant status, which is linked to a reduced risk of them without the hassle of preparation. One new approach chronic and degenerative diseases.Blueberries and their is the combination of various domestic berries to achieve a close relatives, cranberries, have been shown to be effective synergy of effects, while using the appeal of a new product in combating bacterial infection, especially in the urinary tract.
without the regulatory hassle of introducing a new fruit to This property, especially in cranberry juice, has been well The yellow ximenia (Ximenia spp.) fruit traditionally is eaten raw or made into jellies, jams, or syrup. Therefore, it is For those who want to brave the regulatory hassle, an ideal food ingredient for a variety of applications— however, a variety of new African fruit are becoming another fruit whose potential is untapped.
Mabola plum (Parinari curatellifolia) is another tradi- tional African multi-purpose plant with medicinal uses for its Baobab (Adandonia digitata) has a long history of bark, cosmetic uses for its oil, and beverage use for its traditional use in ancient Egypt as a treatment against yellow, plum-like fruit. The fruit pulp contains vitamin C, fevers, dysentery, and bleeding wounds, and it has a long sugar, and mineral ions, making it a valuable basis for soft history of nutritional and medical use in Africa. The pulp, rich in vitamin C,is used today to make drinks, The açai berry (Euterpe oleracea Mart), native to the because it is dissolved easily in water and has a pleasing Amazon rain forests and a traditional staple of Amazo- taste. Fermented milk drinks and iced drinks using the nian diets, has drawn attention to itself recently, pulp also are popular. The Baobab's anti-oxidant and particularly in the United States. This small black berry anti-inflammatory properties make it valuable for a boasts high polyphenol content and an omega-6 to variety of applications in beverages; it also has proven omega-9 ratio comparable to olive In addition, to be an effective prebiotic ingredient.Baobab pulp can its anthocyanin content is up to 33 times higher than that be used in soft drinks, natural fruit smoothies, fruit of red wine. There are other benefits, such as a nearly fillings, jams, sauces, puddings, and desserts. Clearly, the perfect amino acid profile and essential trace mineral possibilities for product development using Baobab fruit contents. Because of these many beneficial substances, açai is being hailed as a superfood with potent antiaging Among the “new" African botanicals with potential use and beauty enhancing properties. In addition, it has a for beverages, Devil's Claw (Harpagophytum procumbens) pleasing flavor reminiscent of boysenberry or cherry with is among the “new" African botanicals with potential use for chocolate overtones. While research into açai's actual beverages, but it is better known for its application in disease prevention capability is scarce at present, there medicine, specifically as an effective therapy for rheumatoid are indications that it may be effective against a variety arthritis.Recently, attempts to cultivate this plant of diseases that have proven susceptible to black (which, until recently, could be harvested only in the wild) have proven successful. Its traditional use as a digestive aid The berries of Lycium barbarum, the Himalayan goji, has prompted research into it's possible application as a have shown neuroprotective and hepatoprotective proper- beverage. If successful, the already high acceptance of the ties.Also called wolfberry, the plant is related to the plant by physicians and consumers will give it a head start in tomato and has been a diet staple in China for several thousand years. The antioxidant properties of wolfberry are The sausage tree (Kigelia pinnata), with the suggestive among the highest found in the plant kingdom, and shape of its fruit, has a long history of medicinal and food traditional usage attests potential benefits against cardio- use, including being a common ingredient in traditional vascular and inflammatory diseases, diabetes, premature beer. Extracts made from the fruit have displayed potent aging, memory deficiencies, vision degeneration, lung antioxidant and anti-inflammatory activity.A variety of disorders, and even some forms of cancerIt has been food and beverage applications using these extracts are cultivated for a variety of food and beverage applications, possible, not to mention expanding on the existing tradition because its pleasant nut-like taste is complementary to a of the fruit as a beer ingredient. A parallel development of nutraceutical, cosmeceutical, or supplement, applications on Noni (Morinda citrifolia) is a fruit traditionally used in the basis of Kigelia's many potent health-promoting Polynesia for hundreds of years. Its uses range from properties would increase recognition and acceptance of medicinal to dietary; its substances of content include vitamins C and E, amino acids, numerous minerals, Another plant with a long history of use (in this case, polysaccharides and carotenoids, and omega-3 and-6 fatty the Stone Age) is marula (Sclerocarya birrea). All parts of acids. Many health benefits are expected from this nutrient the plant are used; its plum-like fruits are traditionally profile, and there are indications from traditional usage of the brewed into a beer, but also lend themselves very well to fruit for possible anti-cancer mechanisms.
being used in the beverage industry.Marula flavor is The tropical evergreen tree mangosteen (Garcinia similar to grapefruit because of the non-volatile substances mangostana) bears purple fruit consisting of a pericarp that cause bitterness; its smell is reminiscent of pineapple.
with multiple functional uses and a fleshy interior that lends The fruit tastes like a cross between an apple, a litchi, and itself to beverage applications. The fruit pulp contains a guava. Many products containing Marula are already on various minerals, vitamin C, traces of B vitamins, beta- the market in juices and liquors, and many more are sure carotene and beta cryptoxanthin, and carbohydrates, fat, Novel botanical ingredients for beverages used in jams, jellies, sauces, beverages, and teas. It providesa tart, refreshing flavor to these foods and drinks.
Green foods provide nutrients like vitamins, proteins, minerals, and antioxidants, which are researched fornumerous health benefits. The challenge is masking the taste generally associated with green foods. They eithertaste like seaweed, or neither of which is something the No overview on botanicals used in beverages would be consumer expects in a beverage. One way to meet this complete without mentioning the many tea varieties. The challenge is to extract the nutrients at low temperatures, recently elucidated benefits of many teas has made tea which lowers the risk of extracting undesirable taste factors extract an attractive additive to functional waters and has increased sales of the beverage itself.
The cereal grasses (young shoots of grain-bearing Tea contains three types of polyphenol flavonoids: plants), including alfalfa, barley, wheat, rye, oat, and catechins, theaflavin, and quercetin. The potency of the kamut, are also beneficial. In their jointing stage, these polyphenols is determined by the varying processes used in plants contain peak concentrations of phytonutrients, tea manufacturing. For example, white and green teas vitamins, and amino acids. Juice made of wheat grass has typically receive the least processing; therefore, their been effective in reducing disease activity of ulcerative naturally occurring catechins are preserved with the greatest colitisand some forms of genetic blood diseases efficacy. Other varieties of teas (eg, black, oolong) are involving anemia.Clearly, more research is needed to oxidized (ie, fermented), resulting in the production of more uncover additional unknown benefits in other species of complex theaflavins. Tea extracts formulated for high- polyphenol content can contain the greatest amounts of One other main type of green food is microalgae, including beneficial substances, because they are highly concentrated spirulina, chlorella, and Aphanizomenon flos-aquae, Duna- liella and Haematococcus. These most primitive plants grow Black tea consists of the withered, fully oxidized (ie, in aqueous solution and, because if their simple cellular fermented) leaves of Camellia sinensis. The purpose of structure and access to water and important aquatic compounds oxidation is to achieve a richer flavor. Black tea is used they convert sunlight to sugars more efficiently than do higher mostly as a beverage. A meta-analysis of demographic plants. They are easily digestible, because they lack a cell wall.
studies concluded that consumption of black tea beverages Research has shown these microalgae to possess various might ensure positive health effects because of high levels of flavonoids in black tea that can protect cells and tissues from Aloe vera is another example of a well-known oxidative damage by scavenging free radicals.
cosmetic ingredient increasingly used in beverage applica- Green tea (C. sinensis), with its high content of tions, mostly in dairy products. The plant (the many xanthines, has anti-inflammatory, anti-irritation and cellu- benefits of which have been used for at least 4000 years), lite-reducing properties, while the polyphenols contained contains more than 200 active substances. Among its many therein have powerful antioxidant effects that are 20 times effects, there is a broad range of effects which are stronger than vitamin E. Its extract has a healthier aura than exploited in beverage application, among them immuno- black tea, making it more attractive to some consumers.
stimulation, digestive aid, anti-diabetic activity/blood sugar Recent studies show that green tea increases the metabolic balance, kidney stone prevention, oral/gum health, anti- resting rate, making it a popular ingredient in weight loss inflammatory for joint comfort, cholesterol/triglyceride reduction, and antioxidant protection and detoxifica- White tea, a rare variety of C. sinensis from China, is tion.It is not surprising, therefore, to find Aloe the least processed form of tea. It is not oxidized or incorporated into a multitude of functional beverages withered, but simply dried by steaming, which leaves it exploiting the health and beauty connection that is with greater polyphenol content than other types of tea. It increasingly moving into the consumers' awareness.
is a little less mature and still has buds on it, whereas A popular but not new botanical ingredient, lemon only leaves are used in other types of tea. Research has verbena, deserves mention. It has certain therapeutic shown white tea has potent anticancer qualities.With properties and has been used for a variety of ailments, the surge in white tea offerings in the ready-to-drink tea including relief of digestive tract spasms, reduction of fever, market, it is only a matter of time before this trend will strengthening of the nervous system, stress relief and as an catch on in the supplement area. White tea has an exotic aura about it that appeals to customers looking for a point can be steeped in hot water to create an aromatic and mildly sedative herbal tea, and its extracts are used in a variety of Green coffee bean extract contains chlorogenic acid, which is twice as effective in neutralizing free radicals as Hibiscus (also not new to the beverage industry is a red- green tea extract. It contains the same amount of caffeine as flowered annual herb and a tropical plant that is commonly boiled coffee, but unlike boiled coffee, the extract is free of cafestol, which increases low-density lipoproteins concen- improving strength, recovery time, endurance, and trations. Making a coffee-like beverage containing green coffee extract without the less healthy aspects of conven- A lesser-known adaptogen is a ashwagandha (Withania tional coffee is certainly an interesting concept. Caffeine, like somnifera). It has been shown to boost the body's resistance green tea extract, raises the resting metabolic rate,a to anxiety and fatigue without any stimulant effect mechanism which is quite trendy in the beverage industry.
Ashwagandha is a popular herb in the Indian Ayurvedic Add the anti-oxidant quality of chlorogenic acid, and you end up with a very attractive beverage ingredient.
The large range of herbal beers is among the alternative Yerba maté, with its long traditional use in South beverages. Recipes are many and varied. One example America, is valued highly for its nutritional profile. It currently on the market incorporates kava kava, scullcap (an contains vitamins A, C, E, B1, B2, Niacin and B5 and herb in the mint family), St. John's wort, and passion flower.
calcium, chromium, manganese, iron, selenium, potassium, The manufacturer claims that the brew has the body, taste, magnesium, phosphorus, and zinc. Other bioactives are and flavor of beer without the dulling effects of alcohol; it carotene, fatty acids, chlorophyll, flavonols, polyphenols, also has a relaxing effect on the consumer.
inositol, trace minerals, antioxidants, tannins, pantothenicacid, and even amino acids. The extract has many healthbenefits besides being an interesting alternative to black and Another tea alternative, rooibos tea, is known as the The botanical kingdom offers practically unending long-life teaq in Africa. The so-called red tea is actually a opportunities to find new functional ingredients for bev- herb (Aspalathus linearis). African women take rooibos erages with a variety of techniques.
during pregnancy to relieve heartburn and nausea; they take As an author for the Physician's Desk Reference for it for its iron content, and they give it to their babies to relieve Herbal Medicines and several other textbooks, the author has colic. Rooibos is gaining acclaim for its vitamin, mineral, an extremely broad overview of the existing literature, and antioxidant content and taste. It also is recognized for its plants, and their activities internationally.
anti-spasmodic properties, which help relieve digestive The partnership with InterMed Discovery ( Unlike other varieties of tea, rooibos contains no caffeine. Its characteristic sweet flavor and high to use a high tech pharmaceutical research platform and antioxidant content (about 50 times that of green tea) make database consisting of tens of thousands of plant ingredients it a very interesting beverage in itself and a valuable with new and never before published activities, permitting the find of completely new, patentable functional ingredi-ents out of the realm of botanicals, but more specifically,food plants, worldwide. This technology permits the separation of every plant into approximately 100-200individual compounds, elucidating their chemical structure,and testing them in bioassays for new functionality. The The range of non-carbonated herbal beverages, some- advantage of the database is that thousands of plants have times called alternative beverages, is increasing. These been analyzed, and many new activities have been beverages include energy drinks, exotic teas, and dairy discovered in bioassays, just waiting for the right partner drinks. Melissa, siberian ginseng, echinacea, guarana, kava to develop them into branded proprietary food ingredients.
root, and gingko biloba are some of the popular ingredients.
These beverages are accompanied by claims and focus on“lifestyle" positioning, such as energy, calm, stimulation,relaxation, or health (eg, protection against colds).
Another popular group of ingredients in wellness and energy beverages are the adaptogens, substances that Botanicals for beverages, which are divided in fruits and nonspecifically increase the resistance of an organism and greens, present different challenges for incorporation in do not disturb normal biological parameters. Rhodiola rosea liquids. The beverage market itself is comprised of various is the best know and increases resistance to a variety of segments, such as juices, bottled waters, teas, dairy drinks, chemical, biological, and physical stressors. Its claimed and alternative beverages. These groups, in turn, present their benefits include anti-fatigue, anti-stress, antihypoxic (protec- own challenges for incorporating ingredients. Among the tion against damaging effects of oxygen deprivation), many botanical ingredients currently available for beverage anticancer, antioxidant, cardioprotective, mood-enhancing/ application, some have been around for a long time in other antidepressant, immune enhancing, and sexual stimulating applications, while others (such as the various African fruits) effects.Another beneficial adaptogenic effect of Rho- are being discovered only now by the industry. The full diola rosea is its ability to increase physical work capacity, potential of various ingredients have not been realized yet.
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TRAITEMENT MEDICAMENTEUX DE L’OSTEOPOROSE CORTISONIQUE – RECOMMANDATIONS – Recommandation de Bonne Pratique TRAITEMENT MEDICAMENTEUX DE L’OSTÉOPOROSE CORTISONIQUE RECOMMANDATIONS AGENCE FRANÇAISE DE SECURITE SANITAIRE DES PRODUITS DE SANTETRAITEMENT MEDICAMENTEUX DE L’OSTEOPOROSE CORTISONIQUE – RECOMMANDATIONS – GROUPE DE TRAVAIL Docteur Christian ROUX, Président