Fachbeiträge

  • LONG-COVID: EINE MITOCHONDRIOPATHIE?
    Keywords
    Long-COVID, post COVID syndrome, SAR-CoV-2, ACE2, mtRos, mitochondriopathy
    Abstract
    In Germany the vaccination rate is increasing from week to week, so the end of the critical phase of the coronavirus pandemic seems to be in sight. According to WHO estimates, about one in ten COVID-19 patients still suffers from long-lasting symptoms 12 weeks after the infection, even if they did not require hospital treatment. The SARS-CoV-2 virus can affect central mitochondrial functions, thus causing a disorder of innate immunity as well as antiviral signaling pathways and mitochondrial dynamics. In all probability, this plays a central role in the pathogenesis of COVID-19 as well as long-COVID. This article addresses specific cell infection as well as new antiviral strategies with mitotropical micronutrients such coenzyme Q10, SAMe and iron.

    Gröber U, Long-COVID: eine Mitochondriopathie? _EHK_, 2021; 70: 225-230.
  • The Coronavirus disease (COVID-19) - a supportive approach with selected micronutrients
    Keywords
    Malnutrition, elderly, vitamin D, retinol, vitamin C, selenium, zinc, COVID-19
    Abstract
    Worldwide the pandemic of COVID-19 spreads rapidly and has had an enormous public health impact with substantial morbidity and mortality especially in high-risk groups, such as older people and patients with comorbidities like diabetes, dementia or cancer. In the absence of a vaccine against COVID-19 there is an urgent need to find supportive therapies that can stabilize the immune system and can help to deal with the infection, especially for vulnerable groups such as the elderly. This is especially relevant for our geriatric institutions and nursing homes. A major potential contributing factor for elderly is due to their high incidence of malnutrition: up to 80% among the hospitalized elderly. Malnutrition results when adequate macronutrients and micronutrients are lacking in the diet. Often missing in public health discussions around preventing and treating COVID-19 patients are nutritional strategies to support optimal function of their immune system. This is surprising, given the importance that nutrients play a significant role for immune function. Several micronutrients, such as vitamin D, retinol, vitamin C, selenium and zinc are of special importance supporting both the adaptive and innate immune systems. As suboptimal status or deficiencies in these immune-relevant micronutrients impair immune function and reduces the resistance to infections, micronutrient deficiencies should therefore be corrected as soon as possible, especially in the elderly and other vulnerable groups.

    According to epidemiological, experimental and observational studies, some case reports and a few intervention studies the supplementation of vitamin D and/or zinc are promising. The multiple anti-inflammatory and immunomodulatory effects of Vitamin D could explain its protective role against immune hyper reaction and cytokine storm in patients with severe COVID-19. A randomized, placebo-controlled intervention study even shows that high dose vitamin D supplementation promotes viral clearance in asymptomatic and mildly symptomatic SARS-CoV-2 positive individuals. Besides, the data of a recent prospective study with COVID-19 patients reveal that a significant number of them were zinc deficient. The zinc deficient patients had more complications and the deficiency was associated with a prolonged hospital stay and increased mortality. Thus, immune-relevant micronutrients may help to increase the physiological resilience against COVID-19.

    Gröber U, Holick MF, The Coronavirus disease (COVID-19) - a supportive approach with selected micronutrients. _Int J Vitam Nutr Res_, 2021; 1–22, doi.org/10.1024/0300-9831/a000693
  • Ionized Magnesium Deficiency in Elderly Hypertensive Patients – A Pilot Study.
    Keywords
    Hypertension, ionized magnesium, arteriosclerosis, geriatrics
    Abstract
    Objective: According to recent publications, a magnesium deficiency is found in up to 50% of the elderly, depending on co-morbidities, drugs and nutritional status. In addition, it is well known that magnesium insufficiency is a pathogenic factor in the development of hypertension. Calcium-magnesium antagonism, sodium-magnesium antiport, disturbed vitamin D metabolism and disrupted magnesium channels are of interest in this context. Magnesium metabolism is of particular interest in elderly hypertensive patients. Ionized magnesium is the active form and this parameter was thus also measured.
    Design and methods: We studied 45 patients with essential hypertension and normal renal function. None of the patients received diuretics or magnesium. No-one with diabetes was included in the study. The patients (23 men, 22 women) were all aged over 65 years. Measurements of magnesium were performed either in serum (Cobas, Roche, Germany) or ionized in blood (NOVA, Rödermark, Germany).
    Results: Considering the serum magnesium concentrations alone, only 1 person had values below 1.5 mg/dL, all the other elderly hypertensive patients had normal serum magnesium concentrations.
    In contrast, ionized magnesium concentrations were significantly decreased in 15 of the 45 patients (30%), with values below 0.5 mmol/L (p<0.01). However, we found no correlation between total serum and ionized blood magnesium (ns, Pearson or Spearman rank test, p value 0.91 and 0.41 respectively). Blood pressure was well controlled with values below 150/90 mmHg.
    Conclusions: There is no correlation between serum and ionized blood magnesium concentrations. This is of particular importance, as a normal serum magnesium concentration does not exclude a deficiency of ionized magnesium. As ionized magnesium is the vasoactive form, it is more useful to determine ionized magnesium concentrations when assessing body magnesium stores. In elderly hypertensive patients with well-controlled blood pressure, nearly 30% showed an ionized magnesium deficiency despite normal serum magnesium values.

    Gröber U, Kisters K, Gremmler B, et al., Ionized Magnesium Deficiency in Elderly Hypertensive Patients – A Pilot Study. Nutrition and Food Science Journal, 2020; 3(2):129.
  • Brain nutrients: cerebral metabolism and micronutrients
    Keywords
    Brain, diet, vitamin D, n-3 fatty acids, iron, B vitamins
    Abstract
    Optimal cognitive capacity is vital throughout all stages of life. Most notably a healthy nutrition in childhood and adolescence is crucial for brain development and cognitive performance. Micronutrients are an essential component of several general cellular functions as well as of functions to neurologic activity such as the synthesis of dopamine, serotonin, and myelin formation. An adequate dietary supply with brain active micronutrients, such as vitamins, minerals and omega-3 long-chain polyunsaturated fatty acids is therefore in schoolchildren of essential significance. The possibilities and limitations to boost the cognitive capacity of children for the purpose of a “brain doping” will be discussed.

    Gröber U, Brain nutrients: cerebral metabolism and micronutrients. Journal of Translational Science, 2020; 7: 1-5, doi: 10.15761/JTS.1000399.
  • ZINK – DAS UNTERSCHÄTZTE ELEMENT
    Keywords
    Zink-Bedarf, Labordiagnostik, Immunsystem, Augenerkrankungen, Diabetes mellitus, Therapie des Zinkmangels
    Abstract
    Obwohl Zink bei einer Vielzahl von Prozessen notwendig ist, gibt es bis heute keinen Laborparameter mit dem man den Zinkstatus zuverlässig bestimmen kann. Die folgende Übersicht soll dabei helfen, einen Zinkmangel trotzdem zu erkennen und zu behandeln.

    Classen HG, Gröber U, Kisters K, Zink – das unterschätzte Element, _Med Monatsschr Pharm_, 2020; 43(4): 149 - 157.
  • COMMON DRUGS AS VITAMIN D DISRUPTORS
    Keywords
    Vitamin D, pregnane X receptor, CYP2C9, CYP3A4, antiepileptics, antibiotics, anti-inflammatory agents, antineoplastic drugs, antibiotics, antihypertensives, antiretroviral drugs, statins
    Abstract
    In the past, interactions between drugs and vitamin D have received only little or no attention in the health care practices. However, since more and more drugs are used for the treatment of patients, this topic is increasingly relevant. Several drugs can interfere with the vitamin D and bone metabolism. Drugs that activate the pregnane X receptor can disrupt vitamin D metabolism and vitamin D function. Beside this, the medication oriented supplementation of vitamin D can ameliorate the pharmacologic action of some drugs, such as bisphosphonates, cytostatics and statins.

    Gröber U, Common drugs as vitamin D Disruptors. _J Transl Sci_, 2020; 6: 1-4; doi: 10.15761/JTS.1000378.
  • Common Drugs as Micronutrient Disruptors: a Selection for Clinical Practice.
    Keywords
    Micronutrient, drug, interactions, proton pump inhibitors, metformin, vitamin B12, magnesium, TRPM6, SLC41A1, thiazide diuretics, statins, selenium, vitamin D, coenzyme Q10.
    Abstract
    Interactions between drugs and micronutrients have received only little or no attention in the medical and pharmaceutical world in the past. Many drugs are micronutrient disruptors and can increase the need or loss of an essential vitamin or mineral. Since more and more pharmaceutics are used for the treatment of patients, this topic is increasingly relevant. As such interactions  – depending on the duration of treatment and the status of micronutrients – impact the health of the patient and the action of the drugs, physicians and pharmacists should pay more attention to such interactions in the future. This review aims to sensitize physicians and pharmacists on drug micronutrient interactions with selected examples of widely pescribed drugs that can precipitate micronutrient deficiencies. In this context, the pharmacist, as a drug expert, assumes a particular role. Like no other professional in the health care sector, he is particularly predestined and called up to respond to this task. The following article intends to point out the relevance of mutual interactions between micronutrients and various examples of widely used drugs, without claiming to be exhaustive.

    Gröber U, Common drugs as micronutrient disruptors: A selection for clinical practice. Ann Epidemiol Public Health, 2020; 3(1): 1014-1031.
  • DIABETES PREVENTION: VITAMIN D SUPPLEMENTATION MAY NOT PROVIDE ANY PROTECTION IF THERE IS NO EVIDENCE OF DEFICIENCY!
    Keywords
    Vitamin D; type 2 diabetes; 25-hydroxyvitamin D; prediabetes; glucose metabolism; insulin resistance.
    Abstract
    The results of epidemiological and several interventional studies suggest an association between vitamin D deficiency and an increased risk of developing insulin resistance or type 2 diabetes. Various studies have indicated that a lack of vitamin D must be regarded as a pathogenic factor for type 2 diabetes and the metabolic syndrome, since a vitamin D deficiency (25(OH)D < 20 ng/mL) increases insulin resistance and reduces insulin secretion from beta cells in the pancreas. A recent study by _Pittas et al._ did not show a clear preventive effect of vitamin D supplementation with respect to the risk of developing type 2 diabetes. In terms of this study, it must be remembered that more than 70% of the participants in both the vitamin D supplement group and the placebo group did not have a vitamin D deficiency. In medical and pharmaceutical practice, more attention should be paid to vitamin D deficiency than has previously been accorded. Vitamin D status can be assessed objectively when necessary by laboratory testing of the serum25(OH)D levels. Type 2 diabetes patients benefit from improving their vitamin D status with respect to their glucose metabolism and decreased mortality risk. Patients with insulin resistance who are vitamin D deficient should be treated with an appropriate amount of vitamin D to achieve circulating levels of 25(OH)D of 40–60 ng/mL.

    Gröber U, Holick MF, Diabetes Prevention: Vitamin D Supplementation May Not Provide Any Protection If There Is No Evidence of Deficiency! _Nutrients_, 2019; 11, 2651; doi:10.3390/nu11112651
  • ANTIOXIDANZIEN WÄHREND CHEMOTHERAPIE – EIN DOGMA?
    Abstract
    Eine kritische Stellungnahme aus der Praxis

    Freie Radikale haben kanzerogene Eigenschaften und spielen in allen Stadien der Krebsentwicklung eine pathogenetische Rolle. Die chemotherapieinduzierte Bildung freier Radikale wird als Ursache der Organotoxizität und Prämutagenität einiger Zytostatika diskutiert. Die Ergebnisse von randomisierten Studien legen nahe, dass die Supplementierung von spezifischen Antioxidanzien einen positiven Einfluss auf die Effektivität tumordestruktiver Therapien und die Nebenwirkungsrate hat. Im Gegensatz dazu wurden in der MARIE-Studie an postmenopausalen Brustkrebs-patientinnen bei Einnahme von Antioxidanzien negative Auswirkungen auf Mortalität und Rezidivfreiheit beobachtet. Methodische Schwächen relativieren die Aussagekraft dieser Untersuchung. Weitere Studien mit hoher Patientenzahl und definierten Antioxidanzien sind notwendig, um die Wirkungen einer Supplementierung zu untersuchen.

    Gröber U, Friedrichsen HP, Holzhauer P, Antioxidanzien während Chemotherapie – ein Dogma? Eine kritische Stellungnahme aus der Praxis. _OM – Zs f Orthomol Med_, 2019; 17: 1–6.
  • Zinkmangel im Fokus: Ursachen, Symptome, Diagnose und Therapie
    Keywords
    Zinc, mineral substances, zinc deficiency, eye diseases, skin
    Abstract
    The essential trace element zinc is indispensable for numerous processes in our body. This overview is intended to help identifying and treating a zinc deficiency more effectively.

    Gröber U, Classen HG, Kisters K, Zinkmangel im Fokus: Ursachen, Symptome, Diagnose und Therapie. EHK 2019; 68: 278–292
  • Nahrungsergänzungsmittel-Therapie: Weshalb, für wen und welche? – ein Interview.
    Abstract
    Der gezielte individuelle und labordiagnostisch objektivierte Einsatz von Vitaminen und anderen Mikronährstoffen bildet einen wichtigen Baustein effektiver Maßnahmen zur Vorbeugung von Krankheiten sowie zur Verlängerung der beschwerdefreien und leistungsfähigen Lebenszeit.

    Gröber U, Kisters K. Nahrungsergänzungsmittel-Therapie: Weshalb, für wen und welche? Der niedergelassene Arzt, 2019; 9: 8-9.
  • Kurzschluss im Nervensystem: Ausgewählte Umweltfaktoren und Mikronährstoffe bei Multipler Sklerose
    Keywords
    Multiple Sklerose, Autoimmunerkrankungen, Umweltfaktoren, Mikronährstoffe, Vitamin-D-Mangel, Omega-3-Fettsäuren, Darmbakterien, Mikroglia, Antioxidanzien, Vitamin B12, Hyperhomocysteinämie, Biotin, Vitamin A
    Abstract
    Als Ursachen für die chronisch entzündliche Autoimmunerkrankung Multiple Sklerose (MS) werden neben einer genetisch bedingten Prädisposition Infektionen und weitere Faktoren wie Rauchen, Übergewicht, Fehlernährung, Stress und Vitamin-D-Mangel diskutiert. Die Ernährung hat über die Darmmikrobiota direkten Einfluss auf die Gesundheit des ZNS. Es zeichnet sich ab, dass eine Ernährung mit Omega-3-Fettsäuren und viel Gemüse, Hülsenfrüchten und Vollkornprodukten durch positive Beeinflussung von Darmflora und Darmbarriere bei MS günstig wirkt. Besondere Bedeutung kommt Mikronährstoffen wie Antioxidanzien, Vitamin B12, Biotin und Vitamin A zu.

    Gröber U. Kurzschluss im Nervensystem: Ausgewählte Umweltfaktoren und Mikronährstoffe bei Multipler Sklerose. OM – Zeitschr. f. Orthomol. Med. 2019; 17: 5–15.
  • Vitamin A (Retinol) – Stiefkind der Ernährungsmedizin
    Keywords
    Vitamin A, Retinol, Retinal, Retinsäure, Mangel, Intoxikation, Carotinoide, Hirnentwicklung, T-Helferzellen, Immunsystem, Th17:Treg-Ratio, Autoimmunerkrankungen
    Abstract
    Vitamin A erfüllt in seinen 3 aktiven Formen Retinol, Retinal und Retinsäure zahlreiche physiologische Funktionen, u. a. bei Genexpression und Hirnentwicklung, im Immunsystem und beim Sehvorgang. Bei vielen Stoffwechselschritten wirkt es synergistisch mit Vitamin D. Es deutet sich an, dass mind. 25% der Bevölkerung in Deutschland die empfohlene Aufnahme von Vitamin A mit der Ernährung nicht erreichen. Die Bedarfsdeckung durch Carotinoide wurde lange überschätzt, da Absorption und Konversion interindividuell stark schwanken.

    Gröber U. Vitamin A (Retinol) – Stiefkind der Ernährungsmedizin. OM – Zeitschr. f. Orthomol. Med. 2019; 17: 44-49.
  • Magnesium and Drugs
    Keywords
    Magnesium; SLC41A1; TRPM6; diuretics; drug-induced magnesium deficiency; drugs; proton-pump inhibitors
    Abstract
    Several drugs including diuretics and proton-pump inhibitors can cause magnesium loss and hypomagnesemia. Magnesium and drugs use the same transport and metabolism pathways in the body for their intestinal absorption, metabolism, and elimination. This means that when one or more drug is taken, there is always a potential risk of interaction with the magnesium status. Consequently the action of a drug may be adversely affected by magnesium (e.g., magnesium, calcium, and zinc can interfere with the gastrointestinal absorption of tetracycline antibiotics) and simultaneously the physiological function of minerals such as magnesium may be impaired by a drug (e.g., diuretics induce renal magnesium loss). Given the ever-increasing number of drugs on the market and the frequency with which they are used, greater attention must be paid in daily medical and pharmaceutical practice focused in particular on the adverse effects of drug therapy on magnesium status in order to minimize the potential risk to the health of patients.

    Gröber U, Magnesium and Drugs. Int J Mol Sci. 2019; 20(9). pii: E2094. doi: 10.3390/ijms20092094.
  • Zinc deficiency. Symptoms, causes, diagnosis and therapy.
    Keywords
    Zinc, zinc deficiency, causes, diagnosis, zinc administration
    Abstract
    Zinc is an essential trace element being required for numerous metabolic processes. The diagnosis of zinc deficiency is based on four main criteria, namely anamnesis, symptomatology, belonging to well-defined risk groups and the determination of biomarkers. The diagnosis of overt zinc deficiency is unproblematic in contrast to moderate states. The review presented here shall help to detect the latter ones. The pharmacotherapy of of zinc deficiency consists in oral administration of zinc salts.

    Classen HG, Gröber U, Löw D, et al., Zinc deficiency. Symptoms, causes, diagnosis and therapy. Med Monatsschr Pharm. 2011; 34(3):87-95.
  • MAGNESIUM: THE MITOCHONDRIAL BLOCKBUSTER IN COMPETITIVE SPORTS
    Keywords
    Magnesium, competitive sports.
    Abstract
    Magnesium is an essential cofactor of more than 600 enzymatic reactions in intermediary metabolism and is involved in all ATP-dependent processes. If oxygen utilisation, neuromuscular coordination or cardiopulmonary performance, magnesium is a key element in the trouble-free progression of numerous metabolic processes in the athlete. Magnesium is the second most common intracellular divalent cation; it is present in its ionised form Mg2+ and combines with adenosine triphosphate (ATP) to form Mg-ATP complexes. For many physical functions, magnesium is essential to regulate the tone and contractility of smooth muscle in vascular structures. It is particularly important in the regulation of blood pressure, vascular resistance, glucose utilisation, metabolomics, lipid profiles and lactate clearance. DNA polymerases and DNA-dependent RNA polymerase also require magnesium as a cofactor, making metabolic steps in DNA replication, RNA transcription, nucleic acid and protein synthesis dependent upon magnesium. Magnesium stabilises, for example, the active conformation of nucleic acids and is required to reduce or compensate the charge of multivalent anions or polyanions.

    Kisters K, Gröber U, Adamietz I, Magnesium: The Mitochondrial Blockbuster in Competitive Sports. Vitam Miner, 2019; 8.1.DOI:10.4172/2376- 1318.1000181
  • IMPORTANT DRUG-MICRONUTRIENT INTERACTIONS: A SELECTION FOR CLINICAL PRACTICE
    Keywords
    Micronutrient, drug, interactions, proton pump inhibitors, vitamin B12, magnesium, Metformin, thiazide diuretics, statins, selenium, vitamin D, coenzyme Q10.
    Abstract
    Interactions between drugs and micronutrients have received only little or no attention in the medical and pharmaceutical world in the past. Since more and more pharmaceutics are used for the treatment of patients, this topic is increasingly relevant. As such interactions - depending on the duration of treatment and the status of micronutrients - impact the health of the patient and the action of the drugs, physicians and pharmacists should pay more attention to such interactions in the future. This review aims to sensitize physicians and pharmacists on drug micronutrient interactions with selected examples of widely prescribed drugs that can precipitate micronutrient deficiencies. In this context, the pharmacist, as a drug expert, assumes a particular role. Like no other professional in the health care sector, he is particularly predestined and called up to respond to this task. The following article intends to point out the relevance of mutual interactions between micronutrients and various examples of widely used drugs, without claiming to be exhaustive.

    Gröber U, Schmidt J, Kisters K, Important drug-micronutrient interactions: a selection for clinical practice. Crit Rev Food Sci Nutr, 2018; Dec 23:1-19. doi: 10.1080/10408398.2018.1522613. [Epub ahead of print]
  • Vitamin D niemals ohne Vitamin K2 – Imperativ oder Konjunktiv?
    Keywords
    Vitamin D, Vitamin K2, Osteoporose, Osteocalcin
    Abstract
    In der Fachwelt, aber auch auf Seiten der Verbraucher kursiert seit einiger Zeit die Aussage, Vitamin D müsse mit Vitamin K2 kombiniert supplementiert werden. Bisher vorliegende Studien dazu sind allerdings extrem heterogen. Zum einen wurde Vitamin D nicht in einer rationalen Tagesdosierung eingesetzt, zum anderen liegen bisher keine wissenschaftlichen Studien zum Verhältnis von Vitamin D und Vitamin K2 vor. Die Aussage, Vitamin D würde ohne Vitamin K2 eine Gefäßverkalkung verursachen, entbehrt daher jeglicher wissenschaftlichen Evidenz. Studien zur Osteoporosetherapie mit postmenopausalen Frauen zeigten Vorteile einer kombinierten Gabe von Vitamin D und Vitamin K2, die Supplementierung kann unter synergistischen Aspekten daher sinnvoll sein. Insgesamt sind weitere größere Interventionsstudien dringend erforderlich.

    Gröber U, Kisters K, Vitamin D niemals ohne Vitamin K2 – Imperativ oder Konjunktiv? EHK, 2018; 67: 226–230.
  • Vitamin D in der Schmerztherapie
    Keywords
    Vitamin D, Schmerz, Neurotrophine, Tumorschmerzen, Statinassoziierte Muskelschmerzen
    Abstract
    Eine unzureichende diätetische Verfügbarkeit an neuroprotektiven Nährstoffen spielt bei der Pathogenese von Schmerzen eine wichtige Rolle. Deshalb sollte bei der Schmerzdiagnostik immer auch an die Versorgung mit Vitaminen und neuroprotektiven Mikronährstoffen gedacht werden. Neuroprotektive Substanzen wie Vitamin D können die pharmakologische Schmerztherapie sinnvoll unterstützen. Bei muskuloskelettalen Schmerzen unterschiedlicher Genese sollte ein Vitamin-D-Mangel (25(OH)D: < 20 ng/ml) unter ärztlicher Kontrolle ausgeglichen werden (Zielwert-25(OH)D: 40–60 ng/ml). Die Lebensqualität und Schmerzbelastung kann durch Vitamin D signifikant verbessert werden

    Gröber U, Holick MF, Vitamin D in der Schmerztherapie. EHK, 2018; 67: 220–225
  • Nahrungsergänzungsmittel – Nützlich oder Überflüssig?
    Keywords
    Nahrungsergänzungsmittel, Vitamine, Mineralstoffe
    Abstract
    In unserem Land vergeht kein Tag, an dem die Bevölkerung nicht in der Presse, im Rundfunk oder Fernsehen gebetsmühlenartig von Experten über die so genannte gesunde Ernährung mit immer neuen Ernährungstipps und babylonischen Lebensweisheiten konfrontiert wird. Obwohl es in der wissenschaftlichen Literatur eine Vielzahl von Hinweisen dafür gibt, dass eine unzureichende Versorgung mit Mikronährstoffen wie Folsäure, Vitamin B12 (→ Schlaganfall, Demenz), Vitamin D (→ Osteoporose, Krebs, plötzlicher Herztod) oder langkettigen maritimen Omega-3-Fettsäuren EPA und DHA (→ ADHS, Demenz, plötzlicher Herztod) einen bedeutsamen Risikofaktor bei der Entstehung von chronischen Erkrankungen darstellt, wird in Deutschland das darin schlummernde präventive Potential bislang nicht ausreichend ausgeschöpft. Die Anreicherung von Bonbons mit Vitamin C oder von Fruchtzwergen mit Vitamin D stellt mit Sicherheit keine geeignete Maßnahme dar die Mikronährstoffversorgung in der Bevölkerung zu verbessern.

    Gröber U, Kisters K, Nahrungsergänzungsmittel – Nützlich oder überflüssig? Der niedergelassene Arzt 09/2018; 2-4.
  • Metabolic Tuning: Selected Nutrients in competitive sport.
    Keywords
    Sport, performance, micronutrient, ubiquinol, iron, magnesium, electrolytes, vitamin D, proteins.
    Abstract
    Taking food supplements is very popular among competitive athletes as well as amateurs. However, an optimization of the athletic and mental performance can only be expected, if an undersupply is already present. Gaps in micronutrient supply should be closed via an optimization of the diet.
    A lack of important micronutrients like vitamin D, magnesium, iron, ubiquinol, omega-3 fatty acids as well as protein can lead to a loss of performance, faster exhaustion, slower regeneration or perhaps susceptibility to infections. The article summarizes the importance of selected micronutrients which are relevant for athletes and makes recommendations for supplementation.

    Gröber U, Metabolic Tuning: Selected nutrients in competitive sport.
    Erfahrungsheilkunde, 2018; 67: 28-86.

    Der vorliegende Artikel fasst die wichtigsten Punkte eines Vortrages zum Thema «Mikronährstoffe im Sport», vorgetragen auf dem 14. Symposium Hochleistungssport vom 20. November 2017 im Olympia-Stadion in Berlin, zusammen (www.vbg.de).

    The present article summarizes the most important points of a lecture about "Micronutrients and sport", presented on the 14.symposium on high-performance sport, 20th November 2017 at the Olympic stadium in Berlin (www.vbg.de).
  • Positive Effect of Magnesium Orotate Therapy in Hypertensive Heart Disease
    Keywords
    Magnesium; Orotate; Heart insufficiency
    Abstract
    According to the results of the MACH study additional magnesium orotate therapy has shown a positive effect on life expectancy and quality of life in patients with severe forms of heart insufficiency. Both magnesium and orotate can be cardioprotective. In the presented data here additional magnesium orotate therapy was tested in 11 patients with hypertensive heart disease NYHA III-IV as compared to 10 patients with hypertensive heart disease NYHA II-IV as controls. Additional magnesium orotate therapy was 4500 mg magnesium orotate daily for 1 week. NTproBNP levels decreased significantly in the magnesium orotate group versus controls (p<0.01). Under therapy quality of life improved significantly as well. Kidney function remained stable in the normal range. In conclusion an additional therapy with magnesium orotate is safe and can be of additional benefit in hypertensive heart disease with insufficiency. There is an improvement in quality of life and life expectancy in heart insufficiency under an additional magnesium orotate therapy.

    Kisters K, Gremmler B, Schmidt J, Gröber U, Tokmak F (2017) Positive Effect of Magnesium Orotate Therapy in Hypertensive Heart Disease. Metabolomics (Los Angel) 7: 195; doi:10.4172/2153-0769.1000195
  • Myth or Reality - Transdermal Magnesium?
    Keywords
    Magnesium; transdermal
    Abstract
    In the following review, we evaluated the current literature and evidence-based data on transdermal magnesium application and show that the propagation of transdermal magnesium is scientifically unsupported. The importance of magnesium and the positive effects of magnesium supplementation are extensively documented in magnesium deficiency, e.g., cardiovascular disease and diabetes mellitus. The effectiveness of oral magnesium supplementation for the treatment of magnesium deficiency has been studied in detail. However, the proven and well-documented oral magnesium supplementation has become questioned in the recent years through intensive marketing for its transdermal application (e.g., magnesium-containing sprays, magnesium flakes, and magnesium salt baths). In both, specialist and lay press as well as on the internet, there are increasing numbers of articles claiming the effectiveness and superiority of transdermal magnesium over an oral application. It is claimed that the transdermal absorption of magnesium in comparison to oral application is more effective due to better absorption and fewer side effects as it bypasses the gastrointestinal tract.

    Gröber U, Werner T, Vormann J, Kisters K, Myth or reality – transdermal magnesium? Nutrients, 2017; 9, 813; doi:10.3390/nu9080813
  • Reasonable complementary medicinemeasures in gynecological oncology
    Keywords
    Alternative medicine ・ Micronutrients ・ Phytotherapy ・ Adverse drug reactions ・ Fatigue
    Abstract
    The results from studies on the prevalence of utilization of naturopathy or complementary medicine show substantial variation. According to Weis et al. in Germany approximately 70% of patients with gynecological cancers, particularly patientswith breast cancer, make use of complementary treatment. The term complementary medicine is not precisely defined and has to be confined to the commonly used synonymous terms alternativemedicine and alternative therapy procedures. Complementary forms of treatment are utilized as extended supportive treatment options accompanying and supplementary to conventional oncological treatment. The reasons and motivations for the utilization of complementary medicine are varied and are mostly based on and characterized by the salutogenic therapy strategy of patients. This strategy supports coping, healing and overcoming the disease. From the patient perspective the aspects with the highest priority are ensuring autonomy, integration of self-participation and optimization of resilience, in a phase of life that often appears threatening and has to be overcome. Complementary therapies can be integrated into acute phase treatment and also into the rehabilitation phase. Safety and compatibility of the multitude of complementary measures with the conventional tumor treatment has the highest priority.

    Holzhauer P, Gröber U, Viktoria Aivazova-Fuchs, Klaus Friese, Reasonable complementary medicinemeasures in gynecological oncology. Der Gynäkologe, 2016; 49:805–817
  • Vitamin K – in prevention and therapy (PDF)
    Keywords
    Vitamin K, diseases of the bones and vessels, K vitameres.
    Abstract
    The topic of „Vitamin K“ is currently booming on the health products market. Vitamin K is known to be important for blood coagulation. Current research increasingly indicates that the antihaemorrhagic vitamin has a considerable benefit in the prevention and treatment of bone and vascular disease. Vitamin K1 (phylloquinone) is more abundant in foods but less bioactive than the vitamin K2 menaquinones (especially MK-7, menaquinone-7). Vitamin K compounds undergo oxidation-reduction cycling within the endoplasmic reticulum membrane, donating electrons to activate specific proteins via enzymatic gamma-carboxylation of glutamate groups before being enzymatically reduced. Along with coagulation factors (II, VII, IX, X, and prothrombin), protein C and protein S, osteocalcin (OC), matrix Gla protein (MGP), periostin, Gas6, and other vitamin K-dependent (VKD) proteins support calcium homeostasis, inhibit vessel wall calcification, support endothelial integrity, facilitate bone mineralization, are involved in tissue renewal and cell growth control, and have numerous other effects. The following review describes the history of vitamin K, the physiological significance of the K vitamers, updates skeletal and cardiovascular benefits and important interactions with drugs.

    Gröber U, Kisters K. Vitamin K – in der Prävention und Therapie. EHK 2016; 65: 184–191.

    © Thieme Verlagsgruppe, Erfahrungsheilkunde 4/2016; mit freundlicher Genehmigung
  • Magnesium Metabolism, Vitamin D and Interleukins in Cardiovascular Disease (PDF)
    Keywords
    Magnesium; Cardiovascular disease; Metabolism; Arteriosclerosis; Vitamin D
    Abstract
    A magnesium deficiency is known to be involved in the pathogenesis of cardiovascular diseases. In patients with essential hypertension intima media thickness is increased in about 70% (ELSA Study). In our study, we investigated 21 patients (10 female, 11 male, average age 56.3 ± 6.6 years) with untreated essential hypertension (grades I and II according to WHO guidelines). All patients had a hypomagnesiaemia in serum (1.57 ± 0.11 mg%). In all patients we found a significant increase in intima media thickness of arteria carotis communis (0.97 ± 0.08 mm) (r=-0.869, p<0.0001). The results show that a magnesium deficiency in patients with essential hypertension may be of special pathogenetic importance. In addition, the role of magnesium deficiency in the development of arteriosclerosis has to be discussed. Furthermore, we demonstrated a connection between magnesium deficiency and an increased intima media thickness. In this context, calcium antagonist therapy or magnesium supplementation may be of advantage when treating intima media thickness in hypertension.

    In addition in essential hypertensives with diabetes mellitus type IIb showing lowered magnesium (1.72 ± 0.08 mg/dl) and vitamin D (9.55 ± 4.74 ng/ml) levels interleukine 6 concentrations were 8.57 ± 4.14 pg/ml (p<0.01 vs. controls) being a risk factor for metabolic disorder, e.g. arteriosclerosis.

    Kisters K, Gremmler B, Gröber U, Tokmak F, Magnesium Metabolism, Vitamin D and Interleukins in Cardiovascular Disease. Metabolomics; 2016; 6: 177. doi:10.4172/2153-0769.1000177.
  • Micronutrients in oncological Intervention (PDF)
    Keywords
    Micronutrients; antioxidants; vitamin D; selenium; L-carnitine; vitamin C; cancer; treatment related side effects; chemotherapy; radiotherapy
    Abstract
    Nutritional supplements are widely used among patients with cancer who perceive them to be anticancer and antitoxicity agents. Depending on the type of malignancy and the gender 30%–90% of the cancer patients supplement their diets with antioxidant and immuno-stabilizing micronutrients, such as selenium, vitamin C, and vitamin D, often without the knowledge of the treating physician. From the oncological viewpoint, there are justifiable concerns that dietary supplements decrease the effectiveness of chemotherapy and radiotherapy. Recent studies, however, have provided increasing evidence that treatment is tolerated better—with an increase in patient compliance and a lower rate of treatment discontinuations—when micronutrients, such as selenium, are added as appropriate to the patient’s medication. Nutritional supplementation tailored to an individual’s background diet, genetics, tumor histology, and treatments may yield benefits in subsets of patients. Clinicians should have an open dialogue with patients about nutritional supplements. Supplement advice needs to be individualized and come from a credible source, and it is best communicated by the physician.

    Gröber U, Holzhauer P, Kisters K, Holick MF, Adamietz IA, Micronutrients in oncological Intervention. Nutrients 2016; 8(3), 163; doi:10.3390/nu8030163.
  • Das Ultraspurenelement Bor (PDF)
    Keywords
    Bor, Kalzium, Magnesium, Vitamin D, Knochenstoffwechsel, Arthrose, Kaschin-Beck-Krankheit, Krebs, Hirnleistung, S-Adenosylmethionin.
    Abstract
    Aktuell wird Bor in der Ernährungsmedizin als nichtessenzielles Spurenelement bewertet. Es deuten sich aber positive Wirkungen im Knochenstoffwechsel, bei entzündlichen Gelenkerkrankungen sowie bei kognitiven Leistungsstörungen an. In vielen Indikationsbereichen fehlen jedoch noch belastbare Studien, um die bisher vorliegenden Daten zu untermauern. Unter synergistischen Aspekten könnte man Bor (z.B. Kalziumfructoborat) mit anderen knochenwirksamen Nährstoffen (z.B. Vitamin D3, MK-7) zur Unterstützung der Knochengesundheit kombinieren, um möglicherweise einen Zusatzeffekt auf die Knochenintegrität zu erzielen. Eine Rationale, das Kalzium, Magnesium und/oder Vitamin D mit Bor fix kombiniert werden müssen, ist aber derzeit auf gar keinen Fall gegeben. Eine aktuelle Meta-Analyse von Garland diskutiert sogar, ob die Einnahme von Bor potenziell den Abbau von 25(OH)D reduziert und zu einer Akkumulation von letzterem führen könnte, was möglicherweise mit einer erhöhten Mortalitätsrate bei höheren 25(OH)D-Spiegeln in einzelnen Studien assoziiert ist.

    Gröber U, Kisters K. Das Ultraspurenelement Bor. OM - Zeitschr f Orthmol Med, 2015; 4: 9-15.

    © Thieme Verlagsgruppe, Zeitschrift für Orthomolekulare Medizin 4/2015; mit freundlicher Genehmigung
  • Vitamin D in oncology: Update 2015 (PDF)
    Keywords
    Vitamin D, cancer, fatigue, cachexia, vitamin D loading dose, anthracyclines, bisphosphonates, aromatase inhibitors, monoclonal antibodies, taxanes, radiation induced proctitis, opioid dose.
    Abstract
    Vitamin D deficiency is associated with increased incidence of breast and colon cancer as well as with an unfavourable course of non-Hodgkin lymphoma. Vitamin D deficiency is common in cancer patients and is associated with poor cancer prognosis and disease progression. In breast cancer patients under polychemotherapy with anthracycline and taxane, a significant drop in 25(OH)D levels was observed. Osteomalacia represents a new and previously unreported risk factor for the development of bisphosphonate-related osteonecrosis of the jaw. In vitamin D deficiency (until it is corrected) oral and parenteral bisphosphonates should not be used. Vitamin D status should be monitored in all cancer patients and treated by adequate vitamin D3 supplementation. This applies in particular to cancer patients with poor nutritional status, treatment with aromatase inhibitors, bisphosphonates, and CTX containing anthracycline, taxane and monoclonal antibodies as well as in cases of muscular or mucocutaneous disorders, fatigue and tumor cachexia

    Gröber U, Kisters K, Adamietz IA. Vitamin D in oncology: Update 2015. Med Monatsschr Pharm, 2015; 38(12): 512-516.
  • Magnesium in Prevention and Therapy (PDF)
    Keywords
    magnesium; hypomagnesemia; cardiovascular disease; diabetes mellitus; asthma; ADHD; Alzheimer’s disease; pre-eclampsia
    Abstract
    Magnesium is the fourth most abundant mineral in the body. It has been recognized as a cofactor for more than 300 enzymatic reactions, where it is crucial for adenosine triphosphate (ATP) metabolism. Magnesium is required for DNA and RNA synthesis, reproduction, and protein synthesis. Moreover, magnesium is essential for the regulation of muscular contraction, blood pressure, insulin metabolism, cardiac excitability, vasomotor tone, nerve transmission and neuromuscular conduction. Imbalances in magnesium status—primarily hypomagnesemia as it is seen more common than hypermagnesemia—might result in unwanted neuromuscular, cardiac or nervous disorders. Based on magnesium’s many functions within the human body, it plays an important role in prevention and treatment of many diseases. Low levels of magnesium have been associated with a number of chronic diseases, such as Alzheimer’s disease, insulin resistance and type-2-diabetes mellitus, hypertension, cardiovascular disease (e.g., stroke), migraine headaches, and attention deficit hyperactivity disorder (ADHD).

    Gröber U, Schmidt J, Kisters K, Magnesium in Prevention and Therapy. Nutrients, 2015; 7(9): 8199-8266.
  • Natriuretic Peptides, Hypertension, Heart Insufficiency and Magnesium (PDF)
    Keywords
    Magnesium, nT-pro BNP, hypertension, heart insufficiency
    Abstract
    The role of magnesium substitution in heart insufficiency and in hypertension is of special interest. A positive effect on blood pressure lowering and on N-terminal-pro Brain Natriuretic Peptide (nT-proBNP) values has been described in this context. Brain Natriuretic Peptide (BNP) and nTproBNP are of similar quality, but nTproBNP is more stable under clinical conditions. Measurements of BNP has to be done 4 – 8 hours after blood sampling, nT-proBNP determinations can be performed within 2–3 days under room temperature. In a recent study of our group with similar design we investigated hypertensives with heart insufficiency NYHA III-IV given additional magnesium therapy (magnesium orotate of about 2610 mg daily 3 times).

    Kisters K, Gremmler B, Gröber U (2015) Natriuretic Peptides, Hypertension, Heart Insufficiency and Magnesium. Adv Tech Biol Med, 2015; 3: 134. doi: 10.4172/2379-1764.1000134
  • Neuroenhancement with vitamins and other micronutrients? (PDF)
    Keywords
    Vitamin D, fatty acids, iron, fatty acids, brain health, brain doping
    Abstract
    Optimal cognitive capacity is vital throughout all stages of life. Most notably a healthy nutrition in childhood and adolescence is crucial for brain development and cognitive performance. Micronutrients are an essential component of several general cellular functions as well as of functions to neurologic activity such as the synthesis of dopamine, serotonin, and myelin formation. An adequate dietary supply with brain active micronutrients, such as vitamins, minerals and omega-3 long-chain polyunsaturated fatty acids is therefore in schoolchildren of essential significance. The possibilities and limitations to boost the cognitive capacity of children for the purpose of a “brain doping” will be discussed.

    Gröber U, Kisters K, Neuroenhancement with vitamins and other micronutrients?
    Pharmakon, 2015; 3(3): 231-237.
  • Live longer with vitamin D? (PDF)
    Keywords
    vitamin D; 25-hydroxyvitamin D; vitamin D deficiency; breast cancer; cancer; overall mortality
    Abstract
    The global burden of vitamin D deficiency or insufficiency is of great concern for public health. According to recent studies, vitamin D deficiency is an important etiological factor in the pathogenesis of many chronic diseases. Whether or not there is a connection between 25-hydoxyvitamin D (25(OH)D) status and overall mortality is a matter of considerable debate. A new meta-analysis confirmed that low 25(OH)D levels were associated with a significant increased risk for all-cause mortality. Individuals with severe vitamin D deficiency have almost twice the mortality rate as those with 25(OH)D level ≥ 30 ng/mL, (≥75 nmol/L). Unlike previous meta-analyses which suggested that serum 25(OH)D > 50 ng/mL was associated with increased mortality, this new analysis found that there was no increased risk even when 25(OH)D levels were ≥70 ng/mL. In general, closer attention should be paid to vitamin D deficiency in medical and pharmaceutical practice than has been the case hitherto. The results of these studies are consistent with the recommendation to improve the general vitamin D status in children and adults by means of a healthy approach to sunlight exposure, consumption of foods containing vitamin D and supplementation with vitamin D preparations.

    Gröber U, Reichrath J, Holick MF, Live longer with vitamin D? Nutrients, 2015; 7(3):1871-80. doi: 10.3390/nu7031871.
  • Vitamin K: an old vitamin in a new perspective (PDF)
    Keywords
    bone health, cardiovascular health, matrix GLA protein, menaquinone-7, osteocalcin, phylloquinone, vitamin K
    Abstract
    The topic of „Vitamin K“ is currently booming on the health products market. Vitamin K is known to be important for blood coagulation. Current research increasingly indicates that the antihaemorrhagic vitamin has a considerable benefit in the prevention and treatment of bone and vascular disease. Vitamin K1 (phylloquinone) is more abundant in foods but less bioactive than the vitamin K2 menaquinones (especially MK-7, menaquinone-7). Vitamin K compounds undergo oxidation-reduction cycling within the endoplasmic reticulum membrane, donating electrons to activate specific proteins via enzymatic gamma-carboxylation of glutamate groups before being enzymatically reduced. Along with coagulation factors (II, VII, IX, X, and prothrombin), protein C and protein S, osteocalcin (OC), matrix Gla protein (MGP), periostin, Gas6, and other vitamin K-dependent (VKD) proteins support calcium homeostasis, inhibit vessel wall calcification, support endothelial integrity, facilitate bone mineralization, are involved in tissue renewal and cell growth control, and have numerous other effects. The following review describes the history of vitamin K, the physiological significance of the K vitamers, updates skeletal and cardiovascular benefits and important interactions with drugs.

    Gröber U, Reichrath J, Holick MF, Kisters K, Vitamin K: an old vitamin in a new perspective, Dermato-Endocrinology, 2014; 6:1, e968490, DOI: 10.4161/19381972.2014.968490.
  • Micronutrients in diabetology: complementary medicine update 2014 (PDF)
    Abstract
    Diabetes mellitus is one of the most prevalent endocrine diseases that is associated with high oxidative stress and vascular inflammation. Type 1 and 2 diabetes are characterized by significant losses of important micronutrients such as vitamin C, magnesium, zinc or vitamin D due to metabolic basis of the disease, medication and/or its complications. The evidence of changes in micronutrient metabolism as a consequence of the disease and the influence of selective supplementation are reviewed in this paper. The importance of micronutrients notably vitamin C, B-group vitamins, vitamin D, vitamin K, coenzyme Q10, magnesium, zinc, chromium and copper under practical conditions are assessed. There is a lot of evidence that demonstrates the positive influence of micronutrient supplementation on glycemic control and the risk of diabetic complications.

    Gröber U, Kisters K, Schmidt J, Micronutrients in diabetology: complementary medicine update 2014. Med Monatschr Pharm, 2014; 37(8): 284-292.
  • Vitamin D: Update 2013 - From rickets prophylaxis to general preventive healthcare (PDF)
    Keywords
    Vitamin D, 25-hydroxyvitamin D, vitamin D deficiency, osteoporosis, gene expression, cardiovascular diseases, hypertension, diabetes mellitus, autoimmune diseases, degenerative brain disease, respiratory tract infection, atopic dermatitis, cancer, drugs
    Abstract
    Vitamin D has received a lot of attention recently as a result of a meteoric rise in the number of publications showing that vitamin D plays a crucial role in a plethora of physiological functions and associating vitamin D deficiency with many acute and chronic illnesses including disorders of calcium metabolism, autoimmune diseases, some cancers, type 2 diabetes mellitus, infectious diseases and cardiovascular disease. The recent data on vitamin D from experimental, ecological, case-control, retrospective and prospective observational studies, as well as smaller intervention studies, are significant and confirm the sunshine vitamin’s essential role in a variety of physiological and preventative functions. The results of these studies justify the recommendation to improve the general vitamin D status in children and adults by means of a healthy approach to sunlight exposure, consumption of foods containing vitamin D and supplementation with vitamin D preparations. In general, closer attention should therefore be paid to vitamin D deficiency in medical and pharmaceutical practice than has been the case hitherto.

    Gröber U, Spitz J, Reichrath J, Kisters K, Holick, MF. Vitamin D: Update 2013. From rickets prophylaxis to general healthcare. Dermatoendocrinol, 2013; 5:3, e1-e17.
  • Neuroenhancement with Vitamin B12—Underestimated Neurological Significance (PDF)
    Keywords
    Vitamin B12; elderly; Vitamin B12 deficiency; diagnostic of Vitamin B12 deficiency; brain atrophy; neuroenhancement
    Abstract
    Vitamin B12 is a cofactor of methionine synthase in the synthesis of methionine, the precursor of the universal methyl donor S-Adenosylmethionine (SAMe), which is involved in different epigenomic regulatory mechanisms and especially in brain development. A Vitamin B12 deficiency expresses itself by a wide variety of neurological manifestations such as paraesthesias, skin numbness, coordination disorders and reduced nerve conduction velocity. In elderly people, a latent Vitamin B12 deficiency can be associated with a progressive brain atrophy. Moderately elevated concentrations of homocysteine (>10 μmol/L) have been associated with an increased risk of dementia, notably Alzheimer’s disease, in many cross-sectional and prospective studies. Raised plasma concentrations of homocysteine is also associated with both regional and whole brain atrophy, not only in Alzheimer’s disease but also in healthy elderly people. Clinician awareness should be raised to accurately diagnose and treat early Vitamin B12 deficiency to prevent irreversible structural brain damage.

    Gröber U, Kisters K, Schmidt J, Neuroenhancement with vitamin B12 - underestimated neurological significance. Nutrients, 2013; 5(12): 5031-5045.
  • Vitamin D-Update 2013: Von der Rachitis-Prophylaxe zur allgemeinen Gesundheitsvorsorge. (PDF)
    Summary
    Seit der Entdeckung seiner antirachitischen Wirkung in den 1920er Jahren hat man das Sonnenvitamin lange Zeit nur im Hinblick auf seine Funktion im Calcium- und Knochenstoffwechsel betrachtet. Eine Vielzahl von Forschungsergebnissen der vergangenen Jahre hat gezeigt, dass Vitamin D in seiner hormonaktiven Form 1,25-(OH)2-Vitamin D (1,25-(OH)2-D, Calcitriol) nicht nur ein Regulator der Calcium- und Phosphathomöostase ist, sondern zahlreiche extraskelettäre Wirkungen aufweist. Darunter sind von besonderer Bedeutung der Einfluss des Vitamin-D-Hormons auf das Herz-Kreislauf-System, das endokrine System, das Immunsystem sowie auf die Zelldifferenzierung und das Zellwachstum.
  • Komplementärer Einsatz von Antioxidanzien und Mikronährstoffen in der Onkologie. Update 2013 (PDF)
    Keywords
    Antioxidants · Micronutrients · Selenium · L-carnitine · Vitamin D
    Summary
    Context: Many patients being treated for cancer use micronutrient supplements with the intention to complement the cancer treatment or help them cope with the therapy and disease-associated side-effects. Up to 90 % of cancer patients supplement with antioxidants without the knowledge of the treating physician. Methods: Alternatives to textbook medicine were assessed from published scientific data and otherwise available information, e.g. homepages, ESPEN-Guidelines. Results: There are many concerns that antioxidants might decrease the effectiveness of chemotherapy but increasing evidence suggests a benefit when antioxidants and other micronutrients, such as selenium, L-carnitine and vitamin D are added to conventional cytotoxic therapies. Conclusion: However, it is imperative that physicians explore the use of antioxidant and other micronutrient supplements with cancer patients and educate them about potentially negative and also potentially beneficial effects.

    Gröber U, Mücke R, et al., Complementary use of antioxidants and
    micronutrients in oncology. Update 2013. Der Onkologe, 2013; 19(2): 136-143.
  • Mitochondriale Toxizität von Arzneimitteln (PDF)
    Keywords
    Mitochondria · Drugs · Statins · Metformin · Acetaminophen · Valproic acid · Mitochondrial toxicity · Coenzyme Q10 · Glutathione
    Summary
    Considering the complexity of mitochondria it is not surprising that the pathogenesis of adverse drug events often develop on drug-induced mitochondrial injury. Drug induced mitochondrial toxicity can occur though several mechanisms, such as depletion of mtDNA (e.g. NRTIs), inhibition of fatty acid beta-oxidation (e.g. valproic acid), opening of the mitochondrial permeability transition pore (e.g. anthracyclines), formation of mitochondrial oxidative stress and depletion of mitochondrial glutathione pool (e.g. acetaminophen), uncoupling of electron transport from ATP synthesis (e.g. tamoxifen) and inhibition of mitochondrial electron transport chain complexes (e.g. simvastatin). This review focuses on the mitochondrial toxicity of drugs in general and explains the practical relevance of these adverse drug events according to specific drugs (metformin, statins, acetaminophen, valproic acid). Furthermore the significance of mitotropic micronutrients such as coenzyme Q10, L-carnitine and glutathione in the prevention and management of drug-induced mitochondrial injury is discussed.

    Gröber U, Mitochondrial toxicity of drugs. Med Monatsschr Pharm, 2012; 35(12): 445-456.
  • Influence of drugs on vitamin D and calcium metabolism (PDF)
    Keywords
    vitamin D · drugs · 25-hydroxy-vitamin D [25(OH)D] · pregnane X receptor · 1,25-dihydroxyvitamin D [1,25(OH)2D] · bisphosphonates · cytostatics · statins
    Summary
    In the past, interactions between drugs and vitamin D have received only little or no attention in the health care practices. However, since more and more drugs are used for the treatment of patients, this topic is increasingly relevant. Several drugs can interfere with the vitamin D and bone metabolism. Drugs that activate the pregnane X receptor can disrupt vitamin D metabolism and vitamin D function. Beside this, the medication oriented supplementation of vitamin D can ameliorate the pharmacologic action of some drugs, such as bisphosphonates, cytostatics and statins.
  • Antioxidants and Other Micronutrients in Complementary Oncology (PDF)
    Keywords
    Cancer · Micronutrient deficiency · Chemotherapy · Antioxidants · Selenium · Vitamin C
    Summary
    Many patients being treated for cancer use micronutrient supplements, with the intention to complement their cancer treatment or help them cope with the therapy- and disease-associated side effects. The majority are adding antioxidants without the knowledge of the treating physician. There are many concerns that antioxidants might decrease the effectiveness of chemotherapy, but increasing evidence suggests a benefit when antioxidants are added to conventional cytotoxic therapies. However, it is imperative that physicians explore the use of antioxidant and other micronutrient supplements with their cancer patients and educate them about potentially negative as well as potentially beneficial effects.
  • Interactions between drugs and micronutrients (PDF)
    Keywords
    Drug-induced micronutrient deficiencies – homocysteine – pharmacodynamic and pharmacokinetic interactions – Phenprocoumon and vitamin K – diuretics and magnesium – statins and coenzyme Q10 – anti-epileptics and vitamin D – proton pump inhibitors and vitamin B12 – cisplatin and L-Carnitine
    Summary
    Interactions between drugs and micronutrients have received only little or no attention in the medical and pharmaceutical world in the past. Since more and more pharmaceutics are used for the treatment of patients, this topic is increasingly relevant. As such interactions – depending on the duration of treatment and the status of micronutrients – impact the health of the patient and the action of the drugs, physicians and pharmacists should pay more attention to such interactions in the future. In this context, the pharmacist, as a drug expert, assumes a particular role. Like no other professional in the health care sector, he is particularly predestined and called up to respond to this task. The following article intends to point out the relevance of mutual interactions between micronutrients and drugs, without claiming to be exhaustive.
  • Mikronährstoffe im Leistungssport (PDF)
    Summary
    Die Idee des Menschen, seine körperliche Leistungsfähigkeit durch den Verzehr leistungsfördernder Substanzen zu verbessern, ist so alt wie der Sport selber. Schon in der Antike versuchten die griechischen Athleten ihre sportliche Leistung durch die Einnahme von bestimmten Kräutern, Pilzen oder tierischen Geschlechtsorganen wie zum Beispiel Stierhoden zu steigern. Heutzutage gibt es im Spitzensport kaum noch Athleten, die nicht regelmäßig ihren Stoffwechsel mit Nahrungsergänzungsmitteln zur Optimierung der körperlichen und mentalen Leistungsfähigkeit „tunen“. Erhöhte Trainingsintensitäten und -umfänge sowie verschärfte Dopingkontrollen (z. B. Trainingskontrollen) sind die Hauptgründe, warum Nahrungsergänzungsmittel im Sport in immer stärkerem Umfang eingesetzt werden.
  • Schlechtes A, B, C? (PDF)
    Summary
    Vitamintherapie ist jüngst in die Kritik geraten – sie sei meist nutzlos und mitunter schädlich. Uwe Gröber, Leiter der Essener Akademie für Mikronährstoffmedizin, widerspricht
  • L-Carnitin in der Krebstherapie (CARPAN) (PDF)
    Keywords
    Pancreatic adenocarcinoma, L-Carnitine, Quality of life, Survival, Cancer cachexia, Fatique syndrome
    Summary
    Background: Cachexia, a >10% loss of body-weight, is one factor determining the poor prognosis of pancreatic cancer. Deficiency of L-Carnitine has been proposed to cause cancer cachexia.
    Findings: We screened 152 and enrolled 72 patients suffering from advanced pancreatic cancer in a prospective, multi-centre, placebo-controlled, randomized and double-blinded trial to receive oral L-Carnitine (4 g) or placebo for 12 weeks. At entry patients reported a mean weight loss of 12 ± 2,5 (SEM) kg. During treatment body-massindex increased by 3,4 ± 1,4% under L-Carnitine and decreased (−1,5 ± 1,4%) in controls (p>0,05). Moreover, nutritional status (body cell mass, body fat) and quality-of-life parameters improved under L-Carnitine. There was a trend towards an increased overall survival in the L-Carnitine group (median 519 ± 50 d versus 399 ± 43 d, not significant) and towards a reduced hospital-stay (36 ± 4d versus 41 ± 9d,n.s.).
    Conclusion: While these data are preliminary and need confirmation they indicate that patients with pancreatic cancer may have a clinically relevant benefit from the inexpensive and well tolerated oral supplementation of L-Carnitine.