The ability of certain foods to impair or augment the absorption of various vitamins and minerals has been recognized for many years. However, the contribution of botanical dietary supplements (BDSs) to altered micronutrient disposition has received little attention. Almost half of the US population uses some type of dietary supplement on a regular basis, with vitamin and mineral supplements constituting the majority of these products. BDS usage has also risen considerably over the last 2 decades, and a number of clinically relevant herb-drug interactions have been identified during this time. BDSs are formulated as concentrated plant extracts containing a plethora of unique phytochemicals not commonly found in the normal diet. Many of these uncommon phytochemicals can modulate various xenobiotic enzymes and transporters present in both the intestine and liver. Therefore, it is likely that the mechanisms underlying many herb-drug interactions can also affect micronutrient absorption, distribution, metabolism, and excretion. To date, very few prospective studies have attempted to characterize the prevalence and clinical relevance of herb-micronutrient interactions. Current research indicates that certain BDSs can reduce iron, folate, and ascorbate absorption, and others contribute to heavy metal intoxication. Researchers in the field of nutrition may not appreciate many of the idiosyncrasies of BDSs regarding product quality and dosage form performance. Failure to account for these eccentricities can adversely affect the outcome and interpretation of any prospective herb-micronutrient interaction study. This review highlights several clinically relevant herb-micronutrient interactions and describes several common pitfalls that often beset clinical research with BDSs.

译文

某些食物损害或增加各种维生素和矿物质吸收的能力已经被认为是很多年了。然而,植物性膳食补充剂 (BDSs) 对改变微量营养素分布的贡献很少受到关注。几乎一半的美国人口定期使用某种类型的膳食补充剂,其中维生素和矿物质补充剂构成了这些产品的大部分。在过去的20年中,BDS的使用量也大大增加,在此期间已经发现了许多临床相关的草药-药物相互作用。BDSs被配制为浓缩植物提取物,其中含有大量在正常饮食中不常见的独特植物化学物质。这些不常见的植物化学物质中的许多可以调节肠道和肝脏中存在的各种异种生物酶和转运蛋白。因此,许多草药-药物相互作用的潜在机制也可能影响微量营养素的吸收,分布,代谢和排泄。迄今为止,很少有前瞻性研究试图表征草药与微量营养素相互作用的患病率和临床相关性。目前的研究表明,某些bds可以减少铁,叶酸和抗坏血酸盐的吸收,而其他bds则有助于重金属中毒。营养领域的研究人员可能不了解BDSs在产品质量和剂型性能方面的许多特质。未能解释这些怪癖会对任何前瞻性草药-微量营养素相互作用研究的结果和解释产生不利影响。这篇综述重点介绍了几种临床相关的草药与微量营养素的相互作用,并描述了经常困扰BDSs临床研究的几种常见陷阱。

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