Course Natural products: phytotherapy and food supplements.Topic 9. Digestive and metabolic systemFrom the etymological point of view, the word dyspepsia comes from the Greek and means indigestion.It refers to localized discomfort or pain in the upper central region of the abdomen.Its high frequency has a significant impact on the quality of life of patients who often go to the pharmacy in search of a product to relieve symptoms.This discomfort may occur with greater or lesser intensity and be accompanied by the following signs:A distinction is made between organic dyspepsia, when an organic cause is identified that can explain the symptoms, and functional dyspepsia, when no clear cause is found to explain the reason for the discomfort.The main reasons for dyspepsia are the following:If the symptoms are frequent, it is necessary to rule out a gastric infection due to Helicobacter pylori in order to carry out the appropriate treatment.Avoiding alcohol consumption, quitting smoking, and treating excess weight are recommended as coadjuvant measures in treatment, not only because of their possible effect on symptoms, but also because of their potential benefit on general health.A distinction is made between organic dyspepsia, when an organic cause is identified that can justify the symptoms, and functional dyspepsia, when no clear cause is found to explain the reason for the discomfort.Natural supplements for treating dyspepsiaAloe vera (Aloe barbadensis) is a plant very rich in mucilages with healing, anti-inflammatory and antiviral properties.As internal use, it is recommended to take it in the form of juice or gel to relieve ulcers and digestive tract conditions.Its properties are the result of the synergistic action of the various constituents, to a greater extent complex polysaccharides, which are obtained from the pulp.Preparations without aloin are recommended, an anthracenic compound responsible for the laxative effect of aloe vera.It is an enzyme obtained from the fruit of the papaya (Carica papaya) that facilitates the digestion of proteins.Alone or combined, it is used in cases of dyspeptic disorders, improving digestion and reducing the sensation of bloating.The latex obtained by incision of the green fruits and that presents anthelmintic, antiulcer and gastric antisecretory activity can also be used.Liquorice (Glycyrrhiza glabra) is a plant whose indication is approved by the European Medicines Agency in the treatment of digestive symptoms (including heartburn and dyspepsia) and by the European Commission in Gastroduodenal Ulcers for its ability to inhibit the growth of H. pylori and its adhesion to the stomach mucosa.The compound responsible for its anti-inflammatory and anti-ulcer properties is glycyrrhizin or glycyrrhizic acid.Diarrhea is defined as a symptom characterized by an increase in bowel movements together with a decrease in stool consistency.It is considered acute when it appears suddenly and lasts less than 2 weeks (usually due to infection), and chronic when it is persistent or recurrent and lasts more than 2 weeks (due to food intolerances or allergies and inflammatory bowel diseases).In the treatment of acute diarrhoea, it is important to prevent dehydration and mineral loss.The most appropriate oral rehydration solution is the solution recommended by the World Health Organization (WHO) (Table 1).In the pharmacy there are different preparations for oral rehydration solutions, some of which include probiotics in their composition.It is important to ensure proper preparation by following the instructions for each of them.It is advisable to follow an astringent diet, divided into small volumes and abundant in liquids, such as water, lemon water, water with mineral salts, oral rehydration solutions or tea infusions.Foods low in fat and fiber and lactose-free should be gradually introduced: boiled rice, grated or baked apple, ripe banana, quince, toasted bread, boiled carrot, grilled or boiled chicken or fish.In the pharmacy there are different preparations for oral rehydration solutions, some of which include probiotics in their compositionNatural supplements to treat diarrhea-Butyric acid or butyrateIt is a short-chain fatty acid produced in the colon by fermentation of dietary fiber by the intestinal microbiota (postbiotic).It acts as an energetic substrate for the colonocyte, maintaining and restoring the integrity of the intestinal mucosa and epithelium.It has anti-inflammatory and immunomodulatory activity, while it inhibits the growth of certain pathogenic bacteria and favors the growth of probiotic bacteria.It can be very useful to treat digestive disorders, such as diarrhea or constipation, irritable bowel and inflammatory bowel diseases (Crohn's disease and ulcerative colitis).It acts as an antidiarrheal by inactivating toxins and microorganisms in the digestive tract through a physical process of adsorption.It is also indicated as an antiflatulent, since by the same procedure it can adsorb gas particles and metabolites originating from fermentation that cause abdominal distension and flatulence.Carbon is not absorbed or metabolized, but passes through the gastrointestinal tract until it is eliminated in the feces.It should not be taken at the same time as other medications, as it may prevent their absorption.Its prolonged use is not recommended because it could decrease the absorption of some nutrients.It is an essential mineral with antioxidant, anti-inflammatory and immunoregulatory activity.It is part of numerous proteins related to the processes of reproduction, growth and development, and is a great healing agent.Its deficit increases the risk of viral infections, so it is very useful in cases of viral diarrhea, especially in children.Vegetarians, the elderly, pregnant and lactating women, and patients with inflammatory bowel diseases or malabsorption problems, such as celiac disease, may be more susceptible to zinc deficiency.The WHO defines probiotics as live microorganisms that, when administered in adequate amounts, confer a health benefit to the consumer.When choosing a probiotic, it is important to know that they are classified according to their specific strain —which includes genus, species, subspecies (if applicable) and an alphanumeric designation—, that they are of human origin and that there are studies that support their efficacy and safety .The following probiotics are useful in case of diarrhea: Lactobacillus paracasei B 21060, L. rhamnosus GG, L. acidophilus CL1285, L. casei (Bio-K+ CL1285) and L. reuteri DSM 17938, Saccharomyces boulardii CNCM I-745, Bifidobacterium bifidum W23, B. lactis W18 and B. longum W51.-Blueberry or bilberry juiceIt is obtained from the fruits of Vaccinium myrtillus and has an antidiarrheal effect thanks to the presence of tannins with astringent properties.Nuts also have an antidiarrheal effect due to their high content of tannins and pectin.It is advisable to drink small amounts of juice throughout the day.It is also a fruit with antioxidant activity thanks to the presence of anthocyanidins.Constipation is characterized by decreased frequency of bowel movements, which take on a hard consistency, and is accompanied by a feeling of incomplete evacuation.The normal frequency of bowel movements in the healthy adult population is considered to be between 3 per week and 3 per day, which are passed without difficulty in most cases.From a clinical point of view, constipation is considered to exist when the Rome IV criteria are met for at least the last 3 months and symptoms have started at least 6 months before diagnosis (Table 2).Possible causes of constipation are:It can be associated with pregnancy, travel or stressful situations.It is more common in women and increases with age.Dietary treatment has a very important role not only in the prevention, but also in the improvement of constipation.Dietary fiber increases the volume and viscosity of intestinal content, and promotes fermentation in the large intestine with the formation of short-chain fatty acids and gases that help speed up transit.A fiber intake of 25-30 g/day is recommended.Dietary fiber is found in legumes, whole grains, vegetables, fruits and nuts.It should be noted that the increase in fiber consumption should always be gradual and accompanied by sufficient amounts of water to avoid flatulence and intestinal discomfort.The benefit is seen over several weeks and consists of improved volume, increased frequency, and softening of the stool.The increase in fiber consumption should always be gradual and accompanied by sufficient amounts of water to avoid flatulence and intestinal discomfort.Natural supplements to treat constipation-Butyric acid or butyrateIt is a type of soluble and fermentable fiber belonging to the fructan group, which is found naturally in different foods: onions, garlic, asparagus, leeks and artichokes.In food supplements it is usually obtained from chicory.It has a clear prebiotic effect by promoting the growth of lactic acid bacteria, such as lactobacilli and bifidobacteria.Known for its ability to absorb water, pectin can improve constipation by increasing the volume of stool, and it is also useful in case of diarrhea.It is obtained mainly from citrus fruits and apples.It has a clear prebiotic effect, since when it is fermented by the bacteria of the intestinal microbiota, short-chain fatty acids, hydrogen, carbon dioxide and methane are produced.Due to its property of binding water, pectin has a wide industrial use as a gelling agent, thickener and helps maintain the stability of certain suspensions.The following probiotics have shown utility in the treatment of functional constipation: B. bifidum, B. lactis, B. longum, L. acidophilus, L. rhamnosus and Streptococcus thermophilus.Wheat bran is the outer layer of the wheat kernel.It is one of the richest sources of insoluble fiber, consisting mainly of arabinoxylans and, to a lesser extent, cellulose and beta-glucans.It delays gastric emptying, promotes satiety and accelerates intestinal transit due to an increase in fecal mass.According to the European Food Safety Authority (EFSA), 10 g/day of wheat bran significantly accelerates intestinal transit.- Ispágula or psyllium seedsPopularly known as plantain, ispaghula seeds are obtained from Plantago ovata or Plantago ispaghula.They are very rich in mucilage, so they have a great capacity to absorb water, increase the volume of intestinal content and stimulate peristalsis.They should not be used in case of difficulty swallowing or intestinal obstruction.Cardiovascular diseases are the leading cause of death in developed countries and a major cause of health-related morbidity and quality of life.Dyslipidemias or hyperlipidemias are blood lipid disorders characterized by increased cholesterol levels (hypercholesterolemia), increased triglyceride concentrations (hypertriglyceridemia), or both.As lipids are insoluble in blood plasma, they circulate bound to proteins in the form of lipoproteins.The composition and density of lipoproteins varies according to the relative proportion of lipids and proteins: chylomicrons and very low density lipoproteins (VLDL) are richer in lipids, and high density lipoproteins (high density lipoproteins [HDL]) richer in protein.In hypercholesterolemia, there is an increase in blood cholesterol associated with an increase in low-density lipoproteins (LDL).The increase in these particles in the blood favors the deposition of atherosclerotic plaques inside the arteries and explains a large part of the cardiovascular risk that these patients present.In hypertriglyceridemia there is an increase in triglycerides in the blood, together with an increase in VLDL, low levels of cholesterol linked to HDL (HDL-C) and an excess of visceral fat (Table 3).The most frequent causes of dyslipidemia are usually related to lifestyle and, therefore, are avoidable or modifiable.Despite this, genetics and the presence of other diseases can also be risk factors (Tables 4 and 5).It is advisable to follow a diet based on the Mediterranean diet with an abundance of legumes, vegetables and fruits;reduce the consumption of red and processed meats, and avoid saturated and trans fats frequently present in bakery, fried and precooked products.The most frequent causes of dyslipidemia are usually related to lifestyle and, therefore, are avoidable or modifiable.Despite this, genetics and the presence of other diseases can also be risk factors.Natural supplements useful in the management of hyperlipidemiaIt is extracted from the yeast Monascus purpureus, which grows on rice (which gives it a red color through a fermentation process), and at the same time produces substances called monacolins.Monacolin K has the same structure as lovastatin and acts by inhibiting the synthesis of cholesterol in the body (by inhibiting the enzyme HMG-CoA reductase), helping to reduce LDL-C levels in the blood.This property is achieved with daily intakes of 10 mg of monacolin K from red yeast rice.Other compounds present, such as isoflavones and sterols, can act as adjuvants, given their lipid-lowering properties, and contribute as protectors against oxidative stress.According to a report published by the EFSA in 2018, monacolin K from red yeast rice produces adverse effects similar to lovastatin and statins in general, and has the same contraindications.Red yeast rice preparations cannot contain more than 2 mg/kg of citrinin because it can be toxic.It is advisable to avoid co-administration with statins.Specifically, it is the long-chain polyunsaturated fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) that have properties that improve the lipid profile.They come from fatty fish oil, krill oil, or microscopic algae.Its cardioprotective effect is explained by the beneficial modification of cardiovascular risk factors, such as serum triglyceride concentration, arterial hypertension, endothelial dysfunction, inflammation, and thrombosis.The WHO and the EFSA have set the recommended daily intake of omega-3 (EPA + DHA) at 250 mg/day to contribute to normal heart function, and 2 g/day to contribute to the maintenance of normal triglyceride levels in the body. blood.Food supplements with EPA and DHA can be combined with statins or other drug treatments to control dyslipidemia.Caution should be exercised in its joint administration with anticoagulant drugs.-Betaglucans from oats and barleyBeta-glucans are a class of polysaccharides for which effects on cholesterol, blood glucose, and the immune system have been proposed.Its origin and structure determine its health benefits;oat and barley beta-glucans act as dietary fiber by reducing plasma concentrations of cholesterol and glucose, and improving certain parameters, such as dyslipidemia and insulin resistance.The daily consumption of at least 3 g of beta-glucans from oats or barley can reduce the level of LDL-C and, therefore, reduce the risk of cardiovascular disease.It can be said that foods containing at least 1 g of beta-glucans contribute to maintaining normal blood cholesterol levels, but to obtain this benefit it is necessary to consume at least 3 g/day of beta-glucans.Soluble fibers have a high capacity to absorb water and form a thick gel that delays the absorption of lipids and sugars, which leads to a reduction in LDL-C values.Plantain (Plantago ovata) and konjac or glucomannan (Amorphophallus konjac) are useful.Hyperglycemia occurs when blood glucose levels are elevated and is the defining characteristic of diabetes mellitus (DM).It is caused by a difficulty in producing insulin, the hormone that controls blood glucose levels.In people with type 1 DM, the pancreas does not secrete any insulin and it must be injected, while in type 2 DM there is resistance to the action of this hormone or insufficient production of it, so its action is not it is so effective.The main symptoms of hyperglycemia are:In the long term, neuropathies, poor wound healing, coronary heart disease or vasculopathy, and damage to the kidneys and retinal blood vessels may appear.Hyperglycemia is diagnosed by analyzing blood glucose levels.Table 6 shows the maximum values ​​for a person without and with DM.The main factors that can decompensate DM are increased intake of carbohydrates in the diet and a sedentary lifestyle, so the adjuvant treatment will be based on improving lifestyle.The main factors that can decompensate diabetes mellitus are increased intake of carbohydrates in the diet and sedentary lifestyle, so the adjuvant treatment will be based on improving lifestyleNatural supplements useful in the management of hyperglycemiaBerberine is a natural compound isolated from plants, such as Coptis chinensis and Hydrastis canadensis, which has multiple pharmacological activities.Its antioxidant and anti-inflammatory properties reduce oxidative stress and contribute to the improvement of DM, hyperlipidemia and arterial hypertension.In the case of hyperglycaemia, the co-administration of berberine combined with oral hypoglycemic agents is more effective in lowering the level of glucose and glycosylated hemoglobin than hypoglycemic agents alone.Chromium is an essential trace mineral involved in the regulation of blood glucose.It is part of chromomodulin, a peptide also known as glucose tolerance factor, which increases insulin sensitivity.It can be found in its organic form as chromium yeast or in inorganic or chelated form as chromium chloride or chromium picolinate.It contributes to the maintenance of normal blood glucose levels by improving the response to insulin and promoting the uptake of glucose by the body's cells.The effects on blood glucose are manifested approximately one month after starting treatment.It should not be taken in conjunction with iron or zinc as it can modify its absorption.The hypoglycemic activity of Gymnema sylvestre has been known for centuries.Its leaves contain various saponins, whose extract has the property of increasing the endogenous production of insulin (by regeneration of pancreatic beta cells), and thus reducing blood glucose and glycated hemoglobin levels in patients with type 2 DM. It is also used as a hypolipidemic.It should only be used in conjunction with oral hypoglycemic drugs under medical supervision.It is obtained from the seeds of Cyamopsis tetragonoloba and is very rich in mucilage.It decreases hyperglycemia and postprandial insulinemia similarly to glicazide.In Spain it is authorized as an adjuvant in the pharmacological treatment of DM.It is recommended to start with a dose of 4-5 g/24 h and increase to 4-5 g/8 h.It is also useful in hypercholesterolemia.It can cause bloating and diarrhea.heAlonso Osorio MJ.Protocols in the pharmacy.Food supplements in hyperlipidemia.The pharmacist.2019;575.Castillo E, Martínez I. Phytotherapy Manual, 2nd ed.Barcelona;Elsevier;2016.Dyspepsia for patients.Infogastrum Project of the Spanish Association of Gastroenterology.Available at: https://www.aegastro.es/documents/infogastrum/infogastrum-dispepsia.pdfDong H, Wang N, Zhao L, Lu F. 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Applications of probiotics in gastroenterology and hepatology.Refresher course on autochthonous microbiota, probiotics and prebiotics.Spanish Society of Probiotics and Prebiotics.2021.The information on this website is intended exclusively for healthcare professionals.