Broad Spectrum Prebiotic Unflavored [Discontinued] by InnovixLabs

POSSIBLY EFFECTIVE

• Diarrhea. Low-quality evidence shows that oral cooked green bananas might be helpful for the management of acute and persistent diarrhea due to various causes in children. Details: Many clinical studies in children aged 5 months to 5 years with acute diarrhea of various etiologies shows that consuming cooked green bananas with or without rice for up to 14 days increases recovery rates by 30% to 266% when compared with control (93451,93462,93463,106469). Consuming cooked green bananas also reduced the need for rehydration therapy and the incidence of dehydration (93462,93463,106469). Clinical trials used cooked green bananas 50-100 grams per day in children aged 6-12 months, 100-200 grams per day in children aged 12-24 months, and 300 grams per day aged 24 months to 5 years (93451,93462,93463,106469). A moderate size, open label clinical study among children aged 6-35 months hospitalized with persistent diarrhea in Bangladesh shows that consuming a diet of green banana mixed with rice suji increases the number of children who recover within 5 days when compared with a full-strength rice suji diet but is equivalent to the standard treatment (control) of 75% strength rice suji diet (112150). Duration of hospital stay is also similar with green banana and 75% strength rice suji and shorter than with full strength rice suji. There is also less relapse at home among children who had been given the green banana rice suji diet in hospital compared with the 75%-strength rice suji. The validity of the study is limited by the lack of blinding. Clinical research also shows that bananas might be beneficial for diarrhea associated with enteral feeding in adults with critical illness. Adding banana flakes (Kanana Banana, Corpak Co) 1-3 tablespoons every 8 hours to the feeding tube seems to be as effective as routine medical treatment involving feeding rate adjustments and use of antidiarrheal agents for reducing symptoms and duration of diarrhea. After 7 days of treatment, 57% of patients in the banana group were free of diarrhea compared with only 24% of patients in the group receiving routine treatment (93453).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Allergic rhinitis (hay fever). Although there has been interest in using oral banana flower for allergic rhinitis, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Athletic performance. It is unclear if oral banana is beneficial for athletic performance. Details: Preliminary clinical research in trained male cyclists shows that consuming 0.4 grams/kg carbohydrate orally from ripe bananas with water 10-20 minutes prior to a 75 km cycling time trial, and 0.15-0.2 grams/kg carbohydrate from bananas with water every 15 minutes during the trial, modestly improves cycling time and oxygen consumption when compared with water alone. This regimen is equally effective to the same dose of carbohydrate from a 6% carbohydrate beverage (Gatorade) (93459,93465). However, another study from the same group of researchers found conflicting results with the use of carbohydrates from banana for this purpose (100995). It is possible that the consumption of carbohydrates in general, not the use of bananas specifically, is beneficial for athletic performance. However, other preliminary clinical research in trained male runners shows that consuming a banana and drinking plain water does not improve the time to run 10 km on a treadmill when compared with plain water alone. No benefit was seen with the consumption of other carbohydrate drinks when compared with plain water; it is possible that the duration of exercise was too short to identify an improvement in performance (93457). Further research is needed to clarify the benefits of banana, if any, for athletic performance.
• Burns. It is unclear if topical banana leaf is beneficial in patients with burns. Details: Preliminary clinical research in adults and children with partial thickness burns shows that daily changes of a banana leaf dressing with povidone iodine reduces pain during dressing changes. Furthermore, wound healing is as effective as a boiled potato peel bandage with povidone iodine, with no increased need for skin grafting (93454). When compared with Vaseline gauze dressing for 8 days following skin graft treatment for burns in adults, banana leaf dressing increases speed of epithelization from 11.7 days to 8.7 days, and improves average pain, pain during dressing removal, and ease of dressing removal. By the 8th day, complete epithelization was present in 57% of the wounds dressed with banana leaves when compared with 0% of the wounds dressed with Vaseline gauze (93455).
• Cancer. Although there has been interest in using topical banana green fruit for cancer, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Constipation. It is unclear if oral green banana is beneficial in patients with constipation. Details: Preliminary clinical research in children with functional constipation shows that consuming cooked green bananas, 30 grams daily for 8 weeks, improves stool consistency and abdominal pain and reduces straining and pain during defecation when compared with baseline. Consuming cooked green bananas with a conventional laxative such as polyethylene glycol plus electrolytes or sodium picosulfate also appears to decrease the dose of laxative needed in these children when compared with baseline (100996). The validity of these findings is limited by the lack of a comparator group.
• Contraception. Although there has been interest in using oral banana root for contraception, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Cough. Although there has been interest in using oral banana flower for cough, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Depression. It is unclear if oral banana is beneficial in patients with depression. Details: A large cross-sectional study in the general Chinese adult population has found that moderate, but not high, banana consumption is associated with a lower likelihood of depressive symptoms in males. However, high banana consumption is associated with a higher likelihood of depressive symptoms in females (106471).
• Diabetes. It is unclear if oral banana starch is beneficial in patients with diabetes. Details: Two small clinical studies in adults with type 2 diabetes shows that taking banana starch 24-57.2 grams orally daily for 4-28 days does not improve serum glucose levels, glucose variability, glucose control scores, or insulin levels when compared with control starches (110619,93448).Other preliminary clinical research in obese patients with type 2 diabetes shows that taking banana starch 24 grams in 240 mL of water each day for 4 weeks reduces body weight when compared with a taking soymilk powder in water. However, banana starch did not improve lipid levels or body fat (93448). Other preliminary clinical research in patients with type 2 diabetes shows that taking desiccated banana 250 grams daily for 12 weeks does not improve lipid levels or glycemic response when compared to baseline (93452).
• Exercise-induced muscle soreness. It is unclear if oral banana is beneficial for exercise-induced muscle soreness. Details: Preliminary clinical research in trained cyclists shows that consuming 0.4 grams/kg of carbohydrates orally from mini-yellow bananas with water 20 minutes prior to a 75 km cycling time trial, and 0.2 grams/kg of carbohydrates from banana every 15 minutes during the trial, decreases muscle soreness ratings 1.5 hours after the time trial when compared with water alone. Consuming carbohydrates from Cavendish bananas in the same manner did not decrease delayed onset muscle soreness, although cyclists reported less muscle cramping with both types of bananas when compared with water (100995). It is unclear whether carbohydrates from banana are any more effective than other carbohydrate sources or whether these results are generalizable to other types of exercise.
• Gastroesophageal reflux disease (GERD). Although there has been interest in using oral banana fruit for GERD, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Hangover. Although there has been interest in using oral banana fruit for hangover, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Headache. Although there has been interest in using topical banana leaves for headache, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Hypercholesterolemia. It is unclear if oral banana is beneficial in patients with hypercholesterolemia. Details: Preliminary clinical research shows that taking desiccated banana 500 grams orally daily for 12 weeks reduces levels of total cholesterol by 7.5% when compared with baseline in patients with hypercholesterolemia. Taking 250 grams daily does not seem to reduce total cholesterol levels; however, high-density lipoprotein (HDL) cholesterol levels increase by 14.5% (93452). The validity of these findings is limited by the lack of a comparator group.
• Hypertension. Although there has been interest in using oral banana fruit for hypertension, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Hypokalemia. Although there has been interest in using oral banana fruit for hypokalemia, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Inflammatory bowel disease (IBD). Although there has been interest in using oral banana fruit for IBD, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Joint pain. Although there has been interest in using oral banana flower for joint pain, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Kidney stones (nephrolithiasis). Oral banana stem has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with calculi of at least 5 mm shows that taking a specific Ayurvedic product (Herbmed) containing banana stem 250 mg and Crateva nurvala 250 mg orally daily for 3 months moderately improves symptoms associated with urinary calculi and reduces the size of the calculi by 11% to 33% when compared with baseline (93460). It is not clear if this is due to banana stem, Crateva nurvala, or the combination. Also, the validity of this finding is limited by the lack of a comparator group.
• Menorrhagia. Although there has been interest in using oral banana fruit for menorrhagia, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Obesity. It is unclear if oral banana is beneficial in patients with obesity. Details: Preliminary clinical research in obese patients with type 2 diabetes shows that taking banana starch 24 grams in 240 mL of water orally each day for 4 weeks reduces body weight by 1 kg more when compared to a control group consuming soymilk powder in water (93448).
• Peptic ulcers. Although there has been interest in using oral banana fruit for peptic ulcers, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Shigellosis. It is unclear if oral green banana is beneficial in patients with shigellosis. Details: Clinical research in children 6-60 months of age who are being treated with antibiotics for shigellosis shows that eating cooked green banana 250 grams per liter of a rice-based diet for 5 days improves symptoms of diarrhea, including the presence of fecal mucus and blood, when compared with a rice-based diet alone. Adding banana to the diet decreased the number of daily stools by 70% in those consuming banana compared to 50% in children consuming the rice diet alone (93461).
• Skin grafts. Although there has been interest in using topical banana leaves for skin grafts, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Smoking cessation. Although there has been interest in using oral banana fruit for smoking cessation, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Stroke. Although there has been interest in using oral banana fruit for stroke, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Tuberculosis. Although there has been interest in using oral banana flower for tuberculosis, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Vaginitis. Although there has been interest in using oral banana root for vaginitis, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Vitamin A deficiency. Although there has been interest in using oral banana fruit for vitamin A deficiency, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Warts. Although there has been interest in using topical banana leaves or peels for warts, there is insufficient reliable information about the clinical effects of banana for this purpose.
• Wound healing. Although there has been interest in using topical banana leaves, peels, or green fruit for wound healing, there is insufficient reliable information about the clinical effects of banana for this purpose. More evidence is needed to rate banana for these uses.

(Read more about BANANA)

POSSIBLY EFFECTIVE

• Atopic dermatitis (eczema). In infants at risk for atopy, providing syrup or formula containing GOS along with probiotics or fructo-oligosaccharides may reduce the risk of developing atopic dermatitis. Details: One large clinical trial in infants at high risk for allergies shows that feeding 20 drops of syrup containing GOS 0.8 grams, in combination with one opened capsule of probiotic bacteria, daily for 6 months reduces the incidence of dermatitis and atopic dermatitis by the age of 2 years when compared with placebo (26707). It is unclear if these findings are due to GOS, probiotics, or the combination, especially since mothers in the treatment group also took probiotics for 2-4 weeks before delivery. Also, a small clinical trial in newborns at risk for atopic disease shows that feeding a formula containing a combination of GOS and fructo-oligosaccharides 8 grams/L as often as necessary for 6 months reduces the risk, but not severity, of developing atopic dermatitis when compared with placebo formula (26708). At 2 years of age, the infants given this formula were half as likely to have developed atopic dermatitis (99223). However, in one study in healthy formula-fed infants, formula containing 4 grams/L of GOS and polydextrose (1:1 ratio) given as often as necessary for approximately 4 months increased the potential of developing atopic dermatitis as an adverse effect by up to 11% when compared with control formula (26709).
• Colic. Providing formula containing GOS and other ingredients may reduce the duration or frequency of crying episodes in infants with colic. Details: One clinical trial in infants with colic shows that feeding a formula containing 8 grams/L of a prebiotic mixture of GOS 90% and fructo-oligosaccharides 10% as often as necessary for 14 days reduces the number of colic episodes when compared with a control formula plus simethicone 6 mg/kg twice daily (26710). Another clinical trial in healthy infants 14-35 days of age shows that feeding a cow's milk-based formula containing 4 grams/L of a prebiotic blend of GOS and polydextrose (1:1 ratio) until around 4 months of age leads to faster normalization of daytime sleep patterns when compared with cow's milk-based formula alone. Episodes of crying were also shorter after 2 months, but not 4 months, of supplementation (106527). It is unclear if the findings from this study in healthy infants can be generalized to those with colic.
• Lactose intolerance. Oral GOS may improve some symptoms of lactose intolerance and allow for increased consumption of lactose-containing products, even after discontinuing GOS. Details: Although a small clinical study found no effect with the use of GOS (99224), one large clinical study in patients with lactose intolerance shows that taking GOS titrated up to 7.5-10 grams twice daily for 30 days improves overall symptoms of lactose intolerance, and in particular cramping and bloating, when compared with placebo (106526). Patients in these studies were asked to avoid lactose-containing products during the treatment period, so the effect of GOS on symptoms in patients actively consuming lactose products is unclear. After the study period, patients were asked to reintroduce lactose products into their diets. Those that had been taking GOS in both studies reported increased milk intake and fewer symptoms when compared with those previously treated with placebo, suggesting that the effects of GOS continue after discontinuation (99224,106526).

POSSIBLY INEFFECTIVE

• Allergic rhinitis (hay fever). Supplementation with oral GOS during the first 6 months of life may not prevent the development of allergic rhinitis in infants at risk for allergies. Details: One large clinical trial in infants at risk for allergies shows that feeding 20 drops of syrup containing GOS 0.8 grams, in combination with one opened capsule of probiotic bacteria, daily for 6 months does not reduce the risk of developing allergic rhinitis by the age of 2 years when compared with placebo (26707).
• Food allergies. Supplementation with oral GOS during the first 6-12 months of life may not prevent the development of food allergies at 1 or 2 years of age. Details: One large clinical trial in infants at risk for allergies shows that feeding 20 drops of syrup containing GOS 0.8 grams, in combination with one opened capsule of probiotic bacteria, daily for 6 months does not reduce the risk of developing food allergies by the age of 2 years when compared with placebo (26707). Another large clinical study in healthy, full-term infants shows that feeding a formula containing GOS 4.4-5 grams/L from 8 weeks of age until 12 months of age does not reduce the incidence of allergic sensitization to foods, based on skin prick testing, when compared with placebo (99218).
• Upper respiratory tract infection (URTI). Large studies suggest that oral GOS do not prevent the development of URTIs in healthy infants or young adults. It is unclear if GOS are beneficial for the prevention of URTIs in premature infants. Details: A large clinical study in healthy, term infants shows that feeding a formula containing GOS 4.4-5 grams/L from before 8 weeks of age until 12 months of age does not reduce the incidence of URTIs (99218). Also, a large clinical trial in healthy university students going through exam-related stress shows that taking GOS (Purimmune, GTC Nutrition) 2.5 or 5 grams daily for 8 weeks does not reduce the total number of cold or flu symptoms when compared with placebo (99221). GOS, in combination with polydextrose, has been evaluated in premature infants. A small clinical trial shows that feeding a 1:1 combination of these at a dose of 600-1200 mg daily during the first 60 days of life reduces the incidence of URTIs, including the common cold, when compared with placebo. However, this prebiotic combination does not seem to reduce the duration or severity of respiratory tract infections that do occur (99211). It is unclear if any effects are due to GOS, polydextrose, or the combination.

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Anxiety. It is unclear if oral GOS are beneficial in patients with anxiety. Details: One small clinical study in healthy females 18-25 years of age shows that taking GOS 5.5 grams daily for 4 weeks does not improve anxiety scores overall or in subgroups of individuals reporting high or low baseline levels of anxiety when compared with placebo (106640).
• Asthma. It is unclear if GOS, alone or in combination with fructo-oligosaccharides, are beneficial for preventing the development of asthma or recurrent wheeze in infants at risk for allergies. Details: One large clinical study in infants at risk for allergies shows that feeding 20 drops of syrup containing GOS 0.8 grams, in combination with one opened capsule of probiotic bacteria, daily for 6 months does not reduce the risk of developing atopic disease, including asthma, by the age of 2 years when compared with placebo (26707). However, another large clinical study in newborns at risk for atopic disease shows that feeding a formula containing a combination of GOS and fructo-oligosaccharides 8 grams/L as often as necessary for 6 months reduces the risk of developing recurrent wheezing, a risk factor for asthma, by 2 years of age when compared with placebo. Approximately 8% of infants given GOS formula developed recurrent wheeze, compared to about 21% of those given placebo formula (99223). These discrepant findings may be due to differences in measured outcomes, as well as the doses and products studied.
• Colorectal cancer. Although there has been interest in using oral GOS for the prevention of colorectal cancer, there is insufficient reliable information about the clinical effects of GOS for this purpose.
• Constipation. It is unclear if oral GOS, when taken with water or added to yogurt, are beneficial in patients with constipation. Details: Preliminary clinical research in adults with constipation shows that taking a specific GOS product (Biotis GOS, Friesland Campina) orally as 5.5-11 grams daily for three weeks does not increase stool frequency when compared with placebo (107730). Similarly, one very small clinical study in elderly females with constipation shows that consuming yogurt containing a specific syrup (Elix'or, Borculo Domo Ingredients) providing GOS 4.5 grams twice daily for 2 weeks does not improve defecation frequency, laxative use, or ease of defecation when compared with placebo (26706). Another small clinical study in elderly patients with mild constipation shows that consuming yogurt containing GOS 12 grams, prunes 12 grams, and linseed 6 grams daily for 3 weeks increases the frequency and ease of defecation and improves relief when compared with a traditional yogurt in elderly patients with mild constipation (21191). However, it is unclear if these findings are due to GOS, other ingredients, _or the combination.
• Depression. It is unclear if oral GOS are beneficial in patients with depression. Details: One small clinical trial in patients with major depressive disorder shows that taking GOS 5 grams daily for 8 weeks does not improve symptoms of depression when compared with placebo, and appears to be less effective when compared with a probiotic supplement containing Lactobacillus helveticus and Bifidobacterium longum (102506).
• Diarrhea. Although there has been interest in using oral GOS for the prevention and treatment of diarrhea, including travelers' diarrhea, there is insufficient reliable information about the clinical effects of GOS for this purpose.
• Insomnia. Oral GOS have only been evaluated in combination with other ingredients; their effect when used alone is unclear. Details: One small crossover trial in adults with sleep disturbances shows that taking a combination product containing GOS 5.2 grams, whey protein 9.5 grams, large neutral amino acids 3.4 grams, and other vitamins and minerals one hour before bed nightly for 3 weeks does not improve sleep quality when compared with a control product containing no GOS and smaller amounts of protein, amino acids, vitamins, and minerals (106528).
• Iron deficiency anemia. GOS increases the absorption and tolerability of iron supplements, and may therefore be beneficial in patients with iron deficiency anemia. Details: Preliminary clinical research shows that taking GOS with iron supplements increases the absorption and tolerability of iron (102509,102510,107729). One small clinical trial in adult females shows that taking GOS 15 grams orally as a single dose increases the fractional iron absorption from oral ferrous sulfate, containing 104 mg iron, by 45% when compared with control (107729). Other clinical research in young, iron-deficient females, shows that giving GOS 963 mg/kg in addition to ferrous sulfate 30 ppm, increases mean hemoglobin, hematocrit, red blood cell count, mean corpuscular volume, serum iron, serum transferrin, and total iron binding capacity when compared with ferrous sulfate alone (110599).
• Irritable bowel syndrome (IBS). It is unclear if oral GOS are beneficial in patients with IBS. Details: One small clinical trial in patients with IBS shows that taking GOS 1.4 grams daily while following a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) for 4 weeks increases the odds of adequate IBS symptom relief by 4.6-fold when compared with placebo plus a sham diet. However, no difference in rate of adequate symptom relief was reported when GOS plus the low FODMAP diet were compared with placebo plus the low FODMAP diet, suggesting that any benefits may have been due to the diet (106525).
• Metabolic syndrome. It is unclear if oral GOS are beneficial in patients with metabolic syndrome. Details: A small clinical study in overweight patients with metabolic syndrome shows that taking GOS 5.5 grams daily for 12 weeks does not improve most measures of metabolic syndrome when compared with placebo. Although levels of total cholesterol, triglycerides, and insulin were reduced by a small amount, these changes were not clinically meaningful (99219).
• Neonatal jaundice. It is unclear if oral GOS are beneficial for the treatment of neonatal jaundice. Details: A small clinical study in healthy infants with mild hyperbilirubinemia shows that providing a formula containing a combination of GOS and fructo-oligosaccharides 8 grams/L as often as necessary for 28 days reduces levels of bilirubin within 72 hours when compared with those given placebo formula. Whether GOS can reduce bilirubin levels in infants with very high levels of bilirubin is unknown, as these infants were excluded from this study (99222).
• Obesity. It is unclear if oral GOS improves weight loss in overweight or obese adults. Details: A small clinical study in overweight adults shows that taking GOS 6 grams, 12 grams, or 18 grams daily in oolong tea for 2 weeks has a small effect on appetite and weight loss when compared with oolong tea alone. Weight loss of 0.1-0.2 kg occurred over the study period, compared with no change in those taking oolong tea alone (99217).
• Osteoporosis. Although there has been interest in using oral GOS for osteoporosis, there is insufficient reliable information about the clinical effects of GOS for this purpose.
• Prematurity. It is unclear if oral GOS are beneficial for improving cognitive or motor development in premature infants. Details: A small clinical study in premature infants shows that adding a combination of GOS, fructo-oligosaccharides, and pectin acidic oligosaccharides up to 1.5 grams/kg daily to breast milk or formula for 30 days after birth does not improve cognitive or motor development outcomes at the age of 2 years when compared with placebo (99216).
• Ulcerative colitis. It is unclear if oral GOS are beneficial in patients with ulcerative colitis. Details: Preliminary clinical research in adults with ulcerative colitis shows that taking a specific GOS product (Bimuno GOS, Clasado Biosciences) orally 2.8 grams daily for 6 weeks does not increase clinical remission or improve IBD severity scores when compared with baseline. However, subgroup analyses suggest that taking GOS may reduce the frequency and urgency of loose stools. The validity of this study is limited by the lack of a comparator group (107728).
• Urticaria. It is unclear if oral GOS are beneficial for the prevention of urticaria in infants. Details: A small clinical study in newborns at risk for atopic disease shows that feeding a formula containing a combination of GOS and fructo-oligosaccharides 8 grams/L as often as necessary for 6 months reduces the risk of developing urticaria at 2 years of age when compared with placebo. Approximately 1.5% of infants in the GOS group developed urticaria, compared to 10.3% of those in the placebo group (99223). More evidence is needed to rate GOS for these uses.

(Read more about GALACTO-OLIGOSACCHARIDES (GOS))

POSSIBLY EFFECTIVE

• Constipation. Glucomannan is generally effective for treatment of constipation in adults, but the efficacy in children is less clear. Details: Clinical research in adults shows that taking glucomannan 1-1.5 grams three times daily orally for 3-5 weeks, sometimes followed by 1 gram twice daily for an additional 4 weeks, can relieve constipation. As a nonabsorbable dietary fiber, glucomannan appears to have a bulk laxative effect (11294,57783,57795,57816). Taking glucomannan 1.45 grams with lactulose 4.2 grams twice daily orally for 1-3 months appears to relieve constipation during pregnancy (57818). In children with constipation, glucomannan can increase the frequency of bowel movements but does not seem to improve stool consistency. A meta-analysis of 3 clinical trials including 122 children with functional constipation shows that glucomannan leads to 1.4 more stools per week but does not improve stool consistency when compared with placebo or a maltodextrin control (97935). Two studies included in this analysis show that taking a specific glucomannan supplement (Dicoplus, Dicofarm) 100 mg/kg once or twice daily (maximum daily dose 5 grams) along with fluids for up to 12 weeks relieves constipation in children (11295,57775). However, the other clinical study included in the analysis shows that taking a different glucomannan supplement (Dicoman Junior, Vitis Pharma) 1.26 grams twice daily for 4 weeks does not improve constipation in children (92005).
• Diabetes. Limited clinical research suggests that glucomannan may improve glycemic control and lipid profiles in patients with type 2 diabetes. Details: Taking glucomannan orally seems to reduce serum cholesterol and blood glucose levels in patients with type 2 diabetes (183,11357,11359,57791,57797,57798,112702). Most clinical research shows that a glucomannan dose of 3-15 grams daily for 4-12 weeks may reduce fasting blood glucose (183,11357,57791,57797,111225). Eating cookies containing glucomannan 0.5-0.7 grams per 100 kcal for 3 weeks has also been used (11358,11359,57797). Accordingly, a meta-analysis of 5 mostly small, low-quality clinical studies in adults with type 2 diabetes, that includes several of these studies, shows that taking glucomannan 1.2-15 grams daily for 4-16 weeks modestly improves fasting blood glucose when compared with placebo or wheat bran. This analysis also shows that taking glucomannan modestly improves 2-hour post-prandial glucose, total cholesterol, and low-density lipoprotein (LDL) levels but not triglycerides (112702). In healthy people, adding a specific glucomannan supplement (PolyGlycopleX, InovoBiologic Inc.) as granules, 2.5-7.5 grams before meals, or as capsules 3-6 grams with meals, can reduce the glycemic index of starchy foods (92003,92007). Also, taking this glucomannan product reduces postprandial glucose in a dose-dependent fashion in healthy people (92002,92007). However, the interpretation of this evidence is limited by low-quality research and variations in dosages and formulations.
• Hyperlipidemia. Most clinical research shows that glucomannan can reduce cholesterol levels in healthy people and those with hyperlipidemia. Details: Although some conflicting evidence exists (57794), most research shows that taking glucomannan orally can improve lipid levels in healthy adults, children and adults with hyperlipidemia, and adults with diabetes (178,11357,11358,11359,57779,57781,57784,57791,57799,97936)(112702). Meta-analyses of clinical research show that taking glucomannan 2.5-15.1 grams daily for up to 12 weeks can reduce total cholesterol by 19 mg/dL, low-density lipoprotein (LDL) cholesterol by 13-16 mg/dL, non-high-density lipoprotein cholesterol by 12 mg/dL, and triglycerides by 11 mg/dL when compared with a control (57797,97936). Clinical research has not demonstrated a dose-response relationship, and the most common glucomannan doses are 5-10 grams daily for up to 6 weeks for adults and 2-3 grams daily in divided doses for up to 8 weeks for children (11358,11359,57797,97936).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Dumping syndrome. It is unclear if oral glucomannan is beneficial in patients with dumping syndrome. Details: Preliminary clinical research shows that taking glucomannan (Propol, Pharmacia) 2.6 or 5.2 grams as a single dose reduces the incidence of reactive hypoglycemia following an oral glucose load in adult patients with previous gastric surgery (57805). Other preliminary clinical research shows that taking glucomannan improves glucose tolerance, but not glucose absorption, in children experiencing gastric dumping syndrome after gastric surgery (57804).
• Hypertension. It is unclear if oral glucomannan is beneficial in patients with hypertension. Details: Preliminary clinical research in patients with hypertension shows that eating cookies containing 0.7 grams of glucomannan per 100 kcal, for a total dose of up to 13 grams of glucomannan daily for 3 weeks, can lower systolic blood pressure by about 7% when compared with placebo (11359).
• Hyperthyroidism. It is unclear if oral glucomannan is beneficial in patients with hyperthyroidism. Details: Preliminary clinical research in patients with hyperthyroidism shows that taking glucomannan 1.3 grams twice daily orally, plus methimazole and propranolol for 2 months, reduces serum triiodothyronine (T3) and thyroxine (T4) levels during the first few weeks of therapy, when compared with methimazole and propranolol alone. However, these effects seem to diminish after 6 weeks of therapy (57793).
• Metabolic syndrome. It is unclear if oral glucomannan is beneficial for metabolic syndrome. Details: A small crossover study in adults with metabolic syndrome, defined as impaired glucose tolerance, reduced high-density lipoprotein (HDL) cholesterol, elevated serum triglycerides, and moderate hypertension, shows that consuming biscuits containing glucomannan 0.5 grams per 100 kcal (equivalent to approximately 8-13 grams/day) daily for 3 weeks may modestly improve fasting glucose, but does not improve blood pressure or levels of triglycerides or HDL cholesterol when compared with wheat bran biscuits (11358). However, the 2-week washout period between interventions may be too short to detect differences in some outcomes.
• Obesity. Although some low-quality research shows that oral glucomannan is beneficial for achieving slight improvements in body weight, other research does not support this. Details: Meta-analyses of clinical research on the use of glucomannan for improving body weight and body composition in adults and children with overweight or obesity show mixed results, with one analysis suggesting that taking glucomannan reduces body weight by around 0.8 kg when compared with placebo (57797), and another showing no improvement in body weight (92014). Reasons for these discrepant findings are not clear, but the discrepancies may relate to differences in the study populations and dosing and duration of glucomannan treatment, as well as the low methodological quality of many studies conducted to date. Similar to the pooled analyses described above, individual clinical study results are also mixed. Several small clinical studies show that taking glucomannan can improve body weight, body mass index (BMI), fat mass, and other measures of body composition in children and adults with overweight or obesity, usually when used in combination with a calorie-restricted diet (180,181,182,183,54240,92008,92010,92011,111224,112701). However, conflicting evidence exists (179,57784,57790,57796,92009,112430). Doses that have been used with positive outcomes in adults are 3-4 grams daily, taken in divided doses, for up to 3 months (181,182,183,92008,112701). In children, doses were 2-3 grams daily for 4 months (180). Specific products evaluated include Propylene TM (Natural Alternatives International), PolyGlycopleX (InovoBiologic, Inc.) 3-5 grams 2-3 times daily for 15 weeks, and. Chrombalance 338 mg before each meal and 226 mg in the afternoon daily for 5 weeks (54240,92010,92011). More evidence is needed to rate glucomannan for these uses.

(Read more about GLUCOMANNAN)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Dental plaque. It is unclear if oral or topical gum arabic is beneficial for preventing or treating dental plaque. Details: Preliminary clinical research shows that chewing gum arabic for 10 minutes, five times daily for 7 days, reduces dental plaque when compared with chewing sugar-free gum (30220). Another small clinical study in adults with mild or moderate plaque-induced gingivitis shows that applying half a teaspoon of gum arabic powder to the buccal surface of dentogingivial areas for 5 minutes then rinsing with tap water twice daily for 60 days reduces dental plaque in patients with moderate, but not high, plaque accumulation when compared with placebo (111508). Gum arabic has also been evaluated in combination with other ingredients for this purpose. A small clinical study shows that applying a pea-size amount of gel containing gum arabic, barleria, medlar, terminalia, and melia (Gum Tone Gel, Charak Pharma Pvt Ltd.) after brushing for 6 weeks decreases plaque severity when compared with placebo. The gel is similar in effectiveness to chlorhexidine 1% gel (92887). However, it's unclear if these findings are due to gum arabic, other ingredients, or the combination.
• Diabetes. It is unclear if oral gum arabic is beneficial in patients with diabetes. Details: Clinical research in adults with type 2 diabetes who are taking oral antidiabetes medications shows that taking gum arabic powder 30 grams daily in the morning for 3 months modestly reduces fasting blood glucose and glycated hemoglobin (HbA1c) when compared with baseline. Gum arabic also modestly reduces low-density lipoprotein (LDL) cholesterol levels, body mass index, and hip circumference, but not waist circumference or blood pressure, when compared with baseline (98700,99098). The validity of these findings is limited by the lack of a comparison to the placebo group.
• Gingivitis. It is unclear if topical gum arabic is beneficial in patients with gingivitis. Details: A small clinical study in adults with mild or moderate plaque-induced gingivitis shows that applying half a teaspoon of gum arabic powder to the buccal surface of dentogingivial areas for 5 minutes then rinsing with tap water twice daily for 60 days reduces gingival inflammation in patients with mild, but not moderate, gingivitis when compared with placebo (111508). Another small clinical study in patients with chronic gingivitis shows that applying a pea-size amount of gel containing a mixture of ingredients including gum arabic, barleria, medlar, terminalia, and melia (Gum Tone Gel, Charak Pharma Pvt Ltd.) after brushing for 6 weeks decreases gingivitis severity when compared with placebo. The gel was no better than using chlorhexidine 1% gel (92887). However, it's unclear if these findings are due to gum arabic, other ingredients, or the combination.
• Hypercholesterolemia. It is unclear if oral gum arabic helps to reduce high cholesterol levels. Details: One small clinical study in patients with hypercholesterolemia shows that taking gum arabic 5 grams twice daily for 4 weeks does not seem to affect plasma lipid levels when compared with baseline (8072).
• Irritable bowel syndrome (IBS). Although there is interest in using oral gum arabic for IBS, there is insufficient reliable information about the clinical effects of gum arabic for this condition.
• Kidney failure. Although there is interest in using oral gum arabic for kidney failure, there is insufficient reliable information about the clinical effects of gum arabic for this condition.
• Metabolic syndrome. It is unclear if oral gum arabic is beneficial for preventing metabolic syndrome. Details: One small clinical study in healthy adults at risk for metabolic syndrome shows that taking gum arabic 20 grams daily for 12 weeks modestly reduces blood pressure and increases fat-free mass when compared with baseline, but not when compared with taking pectin 1 gram. There were no changes in weight, glycated hemoglobin, or cholesterol levels (105039).
• Obesity. It is unclear if oral gum arabic is beneficial for promoting weight loss. Details: One small clinical study in healthy adults shows that taking powdered gum arabic 18 grams in the morning and 12 grams in the evening for 6 weeks reduces body mass index by 0.32 kg/m2 and body fat percentage by about 2% when compared with placebo. Body weight was also reduced by 1.2%, but this was not significant when compared with placebo (18237). It is unclear if gum arabic is beneficial in individuals with obesity.
• Peristomal lesions. It is unclear if topical gum arabic is beneficial for preventing peristomal lesions in patients with a colostomy bag. Details: Preliminary clinical research in infants shows that applying a thick layer of gum arabic gel to peristomal skin before attaching a colostomy bag twice daily for 4 weeks decreases the incidence of postoperative peristomal dermatitis by about 78% when compared with zinc sulfate ointment (92886).
• Sickle cell disease. It is unclear if oral gum arabic is beneficial in patients with sickle cell disease. Details: Preliminary clinical research in patients with sickle cell disease shows that taking gum arabic powder 30 grams daily for 12 weeks does not improve most markers of liver and kidney function in these patients. While an improvement in direct bilirubin levels was observed when compared to baseline, no significant changes in serum levels of total bilirubin, albumin, protein, liver enzymes, urea, or creatinine were reported (102087). However, in this same group of patients, gum arabic did reduce levels of total cholesterol by 8 mg/dL, low-density lipoprotein (LDL) cholesterol by 5 mg/dL, and triglycerides by 12 mg/dL when compared with baseline. Significant improvements in high-density lipoprotein (HDL) cholesterol were lacking (102088). This research is limited by the lack of a control group, Also, it is unclear whether gum arabic can improve clinical outcomes in patients with sickle cell disease. More evidence is needed to rate the effectiveness of gum arabic for these uses.

(Read more about GUM ARABIC)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Asthma. There is some evidence that consumption of vitamin C-rich citrus fruits, including kiwi and others, might improve lung function in people with asthma. Intake of citrus fruits 1-2 times per week has produced this benefit in some studies (6049,6055,6056). However, other studies have not found this benefit (6057,6058).
• Constipation. Preliminary clinical research shows that consuming two kiwi fruits daily for 4 weeks increases the number of complete spontaneous bowel movements from 2.2 to 4.4 per week, and improves bothersomeness and satisfaction, but not straining, when compared with baseline in adults with constipation (57530). The validity of this finding is limited by the lack of a comparator group.
• Hypertension. Preliminary clinical research shows that consuming three kiwi fruits daily for 8 weeks reduces 24-hour ambulatory systolic blood pressure by 3.6 mmHg and diastolic blood pressure by 1.9 mm Hg in patients with mild hypertension when compared with those consuming one apple daily (57648).
• Irritable bowel syndrome (IBS). Preliminary clinical research shows that consuming two kiwi fruits daily for 4 weeks decreases bowel transit time by approximately 8 hours and increases defecation frequency in patients with constipation-predominant IBS when compared to baseline. However, fecal volume does not appear to change (57571). Other preliminary clinical research in patients with constipation-predominant IBS shows that consuming three kiwi fruits daily for 4 weeks increases the number of complete spontaneous bowel movements per week by around 2.5 and improves symptoms of constipation and pain when compared to baseline (103293). The validity of these findings is limited by the lack of control groups. More evidence is needed to rate kiwi for these uses.

(Read more about KIWI)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Common cold. Preliminary clinical research shows that taking a specific larch arabinogalactan extract (ResistAid, Lonza Ltd.) 4.5 grams daily for 12 weeks does not significantly decrease the number, intensity, or symptoms of common colds when compared with placebo in patients who frequently suffer from colds. However, larch arabinogalactan appears to increase the percentage of patients who experience no cold episodes. About 42% of patients receiving larch arabinogalactan extract had no cold episodes, compared to only 28% of patients receiving placebo (93104).
• Hyperlipidemia. Preliminary clinical research shows that taking larch arabinogalactan 8.4 grams daily for 6 months, or 15-30 grams daily for 6 weeks, does not significantly lower total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, apolipoprotein B (apo B), apolipoprotein A-1, body weight, blood pressure, or glucose levels in healthy people (15617,15620). It is not known if larch arabinogalactan lowers lipid levels in patients with hyperlipidemia. More evidence is needed to rate larch arabinogalactan for these uses.

(Read more about LARCH ARABINOGALACTAN)

POSSIBLY EFFECTIVE

• Hypercholesterolemia. Most clinical research shows that oral pectin at a dose of 15 grams daily can slightly lower total cholesterol and low-density lipoprotein (LDL) cholesterol levels in patients with hypercholesterolemia. Details: While some small studies in patients with or without hypercholesterolemia suggest that pectin 1-12 grams daily for up to 12 weeks does not reduce lipid levels (2215,2217), other research in patients with hypercholesterolemia shows that taking pectin 15 grams daily for 4 weeks consistently reduces total cholesterol and LDL cholesterol by around 7% to 10% when compared with baseline or placebo (2214,2216,92473). Some forms of pectin might lower cholesterol levels better than others. Pectin with a higher molecular weight and higher degree of esterification appears to be the most effective (92473). A larger clinical study also shows that taking 20 grams of pectin and guar gum, along with small amounts of insoluble fiber, reduces total cholesterol by nearly 8% and LDL cholesterol by nearly 11%, but does not improve high-density lipoprotein (HDL) cholesterol or triglycerides, when compared with placebo (12547).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Colorectal cancer. Although there has been interest in using oral pectin for the prevention of colorectal cancer, there is insufficient reliable information about the clinical effects of pectin for this purpose.
• Diarrhea. It is unclear if oral pectin is beneficial in children with persistent diarrhea. Details: A small clinical study in children aged 5-12 months in developing nations with persistent diarrhea shows that taking pectin 4 grams/kg reduces the duration of diarrhea and vomiting, and reduces the need for oral rehydration solution and intravenous fluid, when compared with a rice-diet control (12575). Pectin has also been evaluated in combination with other ingredients. One clinical study in children aged 6 months to 6 years with acute diarrhea shows that taking a combination of apple pectin and chamomile (Diarrhoesan, Dr. Loges + Co. GmbH) for up to 5 days reduces the frequency of stools by day 3 by about 1.36-fold when compared with placebo, with improvements maintained through day 5. This combination product was given hourly up to a maximum dose of 50 mL in children 6-12 months of age, 60 mL in children 1-3 years of age, and 80 mL in children 4-6 years of age (19705). It is unclear if these findings are due to pectin, chamomile, or the combination.
• Gastroesophageal reflux disease (GERD). It is unclear if oral pectin is beneficial in children with GERD. Details: A small clinical study in children with GERD and cerebral palsy shows that adding pectin to enteral nutrition in a 1:2 ratio for 4 weeks might reduce some symptoms of GERD. The number of vomiting episodes per week was reduced by 60% and the frequency of coughing/wheezing was reduced by 76% for children given the pectin diet when compared with those given a non-pectin diet (92476).
• Impaired glucose tolerance (Prediabetes). It is unclear if oral pectin is beneficial in patients with impaired glucose tolerance. Details: A small clinical study in middle-aged patients with impaired glucose tolerance or impaired fasting glucose shows that drinking 400 mL of a beverage containing 40 grams/L of sugar beet pectin in two divided doses daily for 12 weeks does not improve fasting or postprandial plasma glucose concentrations or serum lipid levels when compared to baseline (34118).
• Irritable bowel syndrome (IBS). Although there has been interest in using oral pectin for IBS, there is insufficient reliable information about the clinical effects of pectin for this purpose.
• Mercury toxicity. It is unclear if oral pectin is beneficial in patients with mercury toxicity. Details: A small clinical study in children with mercury poisoning shows that taking pectin 2.5 grams daily for 21 days and then 5 grams daily for 39 days increases mercury excretion in the urine, decreases the duration of mercury toxicity, and improves psychological symptoms when compared to baseline (31657). The validity of these findings is limited by the lack of a comparator group.
• Niacin-induced flushing. It is unclear if oral pectin is beneficial for the prevention or management of niacin-induced flushing. Details: A small clinical study shows that taking apple pectin 2 grams 30 minutes prior to taking niacin extended-release 1000 mg reduces the duration of flushing by about 35 minutes when compared with placebo. However, apple pectin does not reduce the incidence of flushing, the time to flush, or the maximum severity of flushing (92477).
• Peptic ulcers. It is unclear if oral pectin is beneficial for the prevention of peptic ulcers. Details: A small clinical study in patients with recently healed duodenal ulcers shows that taking apple pectin 10 grams twice daily for 6 months does not reduce the recurrence of duodenal ulcers when compared with placebo (31697).
• Prostate cancer. It is unclear if oral pectin is beneficial in patients with prostate cancer. Details: Two small clinical studies in patients with prostate cancer show that taking a specific modified citrus pectin product (Pectasol, Econugenics) 4.8 grams three times daily following prostatectomy, radiation, or cryosurgery for up to one year slows disease progression and increases the time to prostate specific antigen (PSA) doubling when compared to baseline (15020,108525). The validity of these findings is limited by the lack of a comparator group.
• Radiation exposure. Although there has been interest in using oral pectin to minimize exposure to environmental radiation, there is insufficient reliable information about the clinical effects of pectin for this purpose. More evidence is needed to rate pectin for these uses.

(Read more about PECTIN)

LIKELY SAFE ...when used in the amounts commonly found in food.

POSSIBLY SAFE ...when the leaves are applied topically and appropriately (93456). There is insufficient reliable information available about the safety of the other parts of the banana plant when used orally or topically as a medicine.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using amounts greater than those found in food.

(Read more about BANANA)

LIKELY SAFE ...when consumed in amounts commonly found in foods. GOS are found in various foods, including dairy products, legumes, and some root vegetables (26702,26732).

POSSIBLY SAFE ...when used orally and appropriately, short-term. GOS or foods fortified with GOS up to 20 grams daily have been safely used in clinical research for up to 30 days (21191,26706,26712,26727,99224,106526,106529,107715,107729). The European Food Safety Authority has concluded that consuming food products providing GOS up to 16.2 grams daily does not present safety concerns (106530). This agency has not evaluated the safety of higher doses in food products.

CHILDREN: POSSIBLY SAFE
when used orally in breast milk or infant formulas containing up to 7. 2 grams/L of GOS provided as the sole prebiotic or in combination with other prebiotics, including fructo-oligosaccharides or polydextrose, daily for 4-12 months (26708,26709,26710,26720,99211,99212,99215,99218,99222,99223,106527). ...when used in doses of up to 10 grams daily for 3 weeks in females 10-13 years of age (99210).

PREGNANCY AND LACTATION: LIKELY SAFE
when consumed in amounts commonly found in foods.

PREGNANCY AND LACTATION: POSSIBLY SAFE
when used orally. GOS have been safely used in clinical research in doses of about 4.5 grams daily from week 25 of pregnancy until delivery (26721).

(Read more about GALACTO-OLIGOSACCHARIDES (GOS))

LIKELY SAFE ...when used orally as food (11358,11359). Glucomannan powder or flour is often used to enrich noodles in traditional Japanese foods.

POSSIBLY SAFE ...when used orally with at least 250 mL (8 ounces) of water or other fluid. Glucomannan has been safely used in studies lasting up to 4 months (178,179,181,182,11046,11294,11357,11294,54240,57775)(57781,57783,57784,92004,92008,92009,92010,92011,106410). In the European Union, the maximum permitted level in foods is 10 grams/kg (106411).

POSSIBLY UNSAFE ...when used orally without any liquid, especially when in tablet form. There have been reports of choking and esophageal or gastrointestinal obstruction when glucomannan products are taken dry. A safety alert for this has been issued by Health Canada (11293,57785,106410).

CHILDREN: POSSIBLY SAFE
when used orally and appropriately with at least 250 mL (8 ounces) of water or other fluid. Glucomannan has been safely used in children for up to 4 months (179,180,11295,57775,57779,92005,92006,97935).

CHILDREN: LIKELY UNSAFE
when used orally without any liquid, especially when in tablet form. There have been reports of esophageal and gastrointestinal obstruction when glucomannan products are taken dry (11293,57785,106410).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about GLUCOMANNAN)

LIKELY SAFE ...when used orally and appropriately in amounts commonly found in foods. Gum arabic has Generally Recognized As Safe (GRAS) status for use in foods in the US. It is also considered to be safe for use as a food additive by the European Food Safety Authority (4912,105040).

POSSIBLY SAFE ...when used orally and appropriately in medicinal amounts (8072). Up to 30 grams daily of powdered gum arabic has been used with apparent safety for 3 months (18237,99098,105040).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using in amounts greater than those found in foods (4912,105040).

(Read more about GUM ARABIC)

LIKELY SAFE ...when used orally in food amounts (6). There is insufficient reliable information available about the safety of kiwi when used orally in amounts greater than those used in foods.

PREGNANCY AND LACTATION: LIKELY SAFE
when used in food amounts (6). There is insufficient reliable information available about the safety of kiwi when used orally in medicinal amounts; avoid use.

(Read more about KIWI)

LIKELY SAFE ...when used orally in amounts found in foods. Larch arabinogalactan has Generally Recognized As Safe (GRAS) status in the US (3529).

POSSIBLY SAFE ...when used orally and appropriately in medicinal amounts, short-term. Larch arabinogalactan has been safely used at doses of 1.5-8.4 grams daily for up to 6 months (15617,15618,17370,93102,93104,104281). Higher doses of 15-30 grams daily have been used with apparent safety for up to 6 weeks (15620). There is insufficient reliable information available about the safety of larch arabinogalactan when used long-term.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about LARCH ARABINOGALACTAN)

LIKELY SAFE ...when used in amounts commonly found in foods. Pectin has Generally Recognized as Safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when used orally in amounts greater than those typically found in food. Pectin 4.8 grams three times daily has been used for up to one year without serious adverse effects (12547,15019,15020,92481,108525).

CHILDREN: POSSIBLY SAFE
when used orally in amounts greater than those found in food, short-term. Pectin 4 grams/kg has been used daily for up to 7 days without reports of serious adverse effects (12575,19705).

PREGNANCY AND LACTATION: LIKELY SAFE
when used in amounts commonly found in foods. Pectin has Generally Recognized as Safe (GRAS) status in the US (4912).

PREGNANCY AND LACTATION: POSSIBLY SAFE
when used orally in medicinal amounts (12577).

(Read more about PECTIN)

LEVODOPA Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Taking banana may reduce the effectiveness of levodopa.  Details A case report describes apparent wearing off in a patient with Parkinson disease after eating a banana every day. The wearing off subsided after removing dietary bananas (110618).

(Read more about BANANA)

IMMUNOSUPPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, GOS might reduce the effects of immunosuppressants.  Details Human and animal studies suggest that GOS may stimulate the immune system (26711,26723). This could theoretically alter the effects of immunosuppressant medications.

(Read more about GALACTO-OLIGOSACCHARIDES (GOS))

ORAL DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = B Theoretically, glucomannan may decrease absorption of drugs taken orally.  Details Due to its viscosity and bulking effects, there is concern that glucomannan can decrease the absorption of oral drugs. A small clinical study in healthy volunteers shows that taking glyburide 2.5 mg plus glucomannan 3.9 grams with breakfast reduces plasma levels of glyburide when compared with breakfast and glyburide alone (11360). In addition, animal research demonstrates this effect on amoxicillin, but shows increased absorption of metronidazole. This mouse model also demonstrates that metronidazole elimination is prolonged, but amoxicillin elimination is enhanced by 38%; glucomannan may also affect the distribution of some drugs (112703). To avoid changes in absorption, take glucomannan 30-60 minutes after taking oral drugs.

(Read more about GLUCOMANNAN)

AMOXICILLIN (Amoxil, Trimox) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = B Gum arabic can reduce the absorption of amoxicillin.  Details A small study in healthy volunteers shows that taking amoxicillin and gum arabic concurrently significantly reduces the absorption of amoxicillin. Separate doses of amoxicillin from gum arabic by at least 2 hours (12654).

ORAL DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Theoretically, gum arabic can alter the absorption of oral drugs due to its fiber content.  Details Gum arabic has been used as a suspending osmotic agent in drug formulations. It might improve bioavailability of water-insoluble drugs like naproxen, but reduce absorption of polar drugs like amoxicillin (12654,104058). To avoid changes in absorption, take gum arabic 30-60 minutes after oral medications.

(Read more about GUM ARABIC)

(Read more about KIWI)

(Read more about LARCH ARABINOGALACTAN)

DIGOXIN (Lanoxin) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Theoretically, pectin might reduce the absorption of digoxin, potentially decreasing its effectiveness.  Details A small clinical study shows that taking digoxin with a kaolin-pectin suspension reduces the absorption of digoxin by about 62% (2212). It is unclear if these effects are due to pectin, kaolin, or the combination.

LOVASTATIN (Mevacor) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, pectin might reduce the absorption of lovastatin, potentially decreasing its effectiveness.  Details Case reports suggest that concomitant use of pectin and lovastatin might reduce the cholesterol-lowering effect of lovastatin, possibly due to reduced intestinal absorption of lovastatin (615).

TETRACYCLINE ANTIBIOTICS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Theoretically, pectin might reduce the absorption of tetracycline antibiotics, potentially decreasing their effectiveness.  Details A small clinical study shows that taking tetracycline with bismuth subsalicylate in a kaolin-pectin suspension reduces the absorption of tetracycline by about 34% (2213). It is unclear if these effects are due to pectin, kaolin, bismuth subsalicylate, or the combination.

(Read more about PECTIN)

General ...Orally, bananas are well tolerated when consumed as food.
Most Common Adverse Effects:
Orally: Bloating, cramping, gas.
Topically: Urticaria.
Serious Adverse Effects (Rare):
Orally: Anaphylaxis, intestinal obstruction.

Endocrine ...In one case report, an adolescent girl who consumed nothing other than 20 bananas daily developed hyperkalemia and hyperdopaminemia. These changes in the blood resulted in pseudoaldosteronism and dysthymia (93780).

Gastrointestinal ...Orally, banana starch isolated from green bananas has resulted in bloating, gas, cramping, and softer feces (93448,93449,110619). When consumed prior to exercise, fullness and bloating during exercise have been reported (93459). In children, nausea, vomiting, and abdominal distension have been reported when banana is used in the treatment of diarrhea (93461). Cases of intestinal obstruction due to banana seeds have been reported (93777).
In one case report, food protein-induced enterocolitis syndrome (FPIES) has been associated with banana consumption (93778).

Immunologic ...Orally, banana has been reported to cause allergic reaction, including urticaria and redness, abdominal pain and nausea, dyspnea (93779,93781,93782,93797,93798,93803), and anaphylaxis (93783,93793,93802,93803). Topically, contact urticara has also been reported (93784). Skin testing is not always accurate, even for patients with severe banana allergy (93793).

Psychiatric ...Orally, high banana consumption has been associated with a higher likelihood of depressive symptoms in females, but not males, in a cross-sectional study of the general Chinese adult population (106471).

(Read more about BANANA)

General ...Orally, GOS seem to be well tolerated in infants, children, and adults.
Most Common Adverse Effects:
Orally: Bloating, constipation, diarrhea, flatulence, and increased stool frequency.
Serious Adverse Effects (Rare):
Orally: Anaphylaxis in sensitive individuals.

Dermatologic ...Orally, giving a formula supplemented with 4 grams/L of GOS and polydextrose (1:1 ratio) to infants has been associated with an increased incidence of atopic dermatitis in one clinical study (26709). However, most other clinical research in infants at risk of atopy shows that GOS-containing formula may actually reduce the risk of developing atopic dermatitis (26707,26708,99223).

Gastrointestinal ...Orally, galacto-oligosaccharides may cause bloating, flatulence, and increased stool frequency (26706,26709,26724,99217,99222). Giving a formula supplemented with 4 grams/L of GOS and polydextrose (1:1 ratio) to infants has been associated with an increased incidence of gastrointestinal adverse effects, primarily constipation and diarrhea, in one clinical study (106527). However, it is unclear if this was due to GOS, polydextrose, or the combination.

Immunologic ...Orally, GOS have been rarely associated with allergic reactions, including anaphylaxis. Research in these patients shows that people who are previously sensitized to Blomia tropicalis, a common dust mite in Southeast Asia, may also experience allergic reactions after consumption of GOS. Blomia tropicalis contains glycosylated allergens that have IgE mediated cross-reactivity to GOS (102508).

Psychiatric ...Orally, giving infants a formula supplemented with 8 grams/L of a 50:33:17 mixture of polydextrose, GOS, and lactulose has been associated with increased infant irritability when compared with control formula (26709). However, it is not known if this was related to the GOS, other ingredients, or the combination. An increase in irritability did not occur in infants given a formula supplemented with 4 grams/L of polydextrose and GOS (1:1 ratio) (26709,106527).

(Read more about GALACTO-OLIGOSACCHARIDES (GOS))

General ...Orally, glucomannan is generally well tolerated when taken with plenty of water or other liquid.
Most Common Adverse Effects:
Orally: Abdominal pain, bloating, constipation, diarrhea, flatulence, nausea, and vomiting.
Serious Adverse Effects (Rare):
Orally: Choking and esophageal or gastrointestinal obstruction, especially when taken as a dry powder or in tablet form.

Gastrointestinal ...Orally, glucomannan can cause gastrointestinal disturbances, including abdominal pain, bloating, constipation, diarrhea, flatulence, nausea, and vomiting, especially when taken in doses of more than 3 grams daily (57781,57784,92004,92010,92011,97935,106411). Esophageal and gastrointestinal obstructions have been reported when dry glucomannan-containing products are taken with insufficient fluid (11293,57785,106410).

Hepatic ...Acute cholestatic hepatitis occurred in a 31-year-old male after taking glucomannan orally for 45 days (57777). He was also taking other supplements, including garlic and chitosan, so it is unclear whether the hepatitis was due to glucomannan, other supplements, or the combination.

Pulmonary/Respiratory ...Cases of occupational respiratory disorders, including respiratory sensitization and bronchial asthma, have been reported in workers exposed to glucomannan (57789,57810).

(Read more about GLUCOMANNAN)

General ...Orally, gum arabic seems to be generally well tolerated.
Most Common Adverse Effects:
Orally: Abdominal bloating, flatulence, mild diarrhea, nausea, and vomiting.

Gastrointestinal ...Orally, gum arabic can cause minor gastrointestinal disturbances such as abdominal bloating, flatulence, nausea, vomiting, cramping, and mild diarrhea (8072,18237,99098,105038,105040,108051). These effects occurred in 15%, 82%, and 90% of subjects respectively in one study (18237). They may subside with continued use within 2 weeks (8072,18237,99098,105038).

Immunologic ...Gum arabic might cause allergic reactions. In one case report, a patient had an immunoglobulin E response after exposure to gum arabic. However, there have been no identified case reports of allergic reactions after oral exposure to gum arabic (19636,105040).

(Read more about GUM ARABIC)

General ...Orally, kiwi fruit is generally well tolerated. Eating kiwi fruit or drinking the juice can lead to hypersensitivity reactions of the lips, mouth, tongue, and throat, including dysphagia, urticaria, dermatitis, angioedema, and vomiting immediately following ingestion in some patients (6,963,57465,57496,57491,57497,57635,57636,109591). Other reported symptoms of kiwi allergy include nausea, diarrhea, and acute pancreatitis (57464,57588,57593,57644). Anaphylactic reactions and kiwi allergy-induced asthma exacerbations have also been reported after eating kiwi fruit (51576,57464,57492,57497,57617,57624,57625,57635,109591,109592).
Topically, kiwi can cause contact urticaria (6). Topical application of kiwi may also cause hypersensitivity reactions, which are more common in patients who are allergic to latex (6197,7853).

Dermatologic ...Orally, eating kiwi fruit or drinking the juice can lead to hypersensitivity reactions of the lips, mouth, tongue, and throat, including urticaria, dermatitis, and angioedema in some patients (6,963,57465,57496,57491,57497,57635,57636,109591,109592).
Topically, kiwi can cause contact urticaria (6). Topical application of kiwi may also cause hypersensitivity reactions, which are more common in patients who are allergic to latex (6197,7853).

Gastrointestinal ...Orally, eating kiwi fruit or drinking the juice can lead to hypersensitivity reactions of the lips, mouth, throat, and tongue, including dysphagia and vomiting immediately following ingestion in some patients (6). Other reported symptoms of kiwi allergy include nausea, diarrhea, and acute pancreatitis (57464,57588,57593,57644).

Immunologic ...Eating kiwi fruit or drinking the juice can lead to hypersensitivity reactions of the lips, mouth, tongue, and throat, including dysphagia, urticaria, dermatitis, angioedema, and vomiting immediately following ingestion in some patients (6,963,57465,57496,57491,57497,57635,57636,109591,109592). Other reported symptoms of kiwi allergy include nausea, diarrhea, and acute pancreatitis (57464,57588,57593,57644). Anaphylactic reactions and kiwi allergy-induced asthma exacerbations have also been reported after eating kiwi fruit (51576,57464,57492,57497,57617,57624,57625,57635,109591,109592). Some observational research suggests that anaphylaxis after consuming kiwi fruit is more common when compared with other fruits, especially in children. Of 250 patients reporting to the emergency department for fruit-induced anaphylaxis, around 16% reported kiwi fruit as the culprit, followed by banana (11%) and mango (9%) (109591). Rarely, exercise may trigger an anaphylactic reaction to kiwi fruit in individuals with no history of kiwi fruit allergy (109592).
Topically, kiwi can cause contact urticaria (6). Topical application of kiwi may also cause hypersensitivity reactions, which are more common in patients who are allergic to latex (6197,7853).

Pulmonary/Respiratory ...Orally, anaphylactic reactions and kiwi allergy-induced asthma exacerbations have been reported after eating kiwi fruit (51576,57464,57492,57497,57617,57624,57625,57635,109591,109592).

(Read more about KIWI)

General ...Orally, larch arabinogalactan is generally well tolerated (3530,17370,93102). Some people can experience bloating and flatulence (3530).

Gastrointestinal ...Orally, larch arabinogalactan can cause bloating and flatulence (3530).

(Read more about LARCH ARABINOGALACTAN)

General ...Orally, pectin seems to be well tolerated.
Most Common Adverse Effects:
Orally: Diarrhea, gas, loose stools, and mild cramps.
Serious Adverse Effects (Rare):
All routes of administration: Allergic reactions, including anaphylaxis, in sensitive individuals.

Gastrointestinal ...Orally, pectin alone or in combination with guar gum and insoluble fiber can cause gastrointestinal adverse effects such as mild cramps, diarrhea, gas, and loose stools (12547,15020,92473).

Immunologic ...Orally and topically, pectin may cause allergic reactions in sensitive individuals. In one case, a 7-year-old boy with a history of oral allergy syndrome after consuming a pectin-containing beverage experienced anaphylaxis after taking a citrus bath containing pectin. Allergy testing confirmed sensitivity to pectin (106928).

Pulmonary/Respiratory ...The occupational inhalation of pectin dust can cause asthma (580,581,582,583,584).

(Read more about PECTIN)