1 EZ Diet Fat & Carb Blocker by Maximum International Inc

POSSIBLY EFFECTIVE

• Hypertension. Substituting table salt with a chitosan-containing table salt may reduce blood pressure in patients with hypertension. Details: Small clinical studies in patients with prehypertension or moderate hypertension show that taking a specific product (Symbiosal) containing chitosan 3% in table salt for 8 weeks decreases systolic blood pressure compared with table salt alone when used as part of a diet containing a maximum of 3 grams sodium chloride daily (97708,97715). In adults with hypertension, this product increased the number of patients with controlled blood pressure by an additional 39% when compared with table salt alone (97715). In adults with prehypertension, this product increased the number of patients with systolic blood pressure less than 130 mmHg by an additional 67% when compared with table salt alone (97708).
• Obesity. Oral chitosan may lead to slight improvements in body weight when combined with a calorie-restricted diet in patients who are overweight or obese; however, it is unclear if this weight loss is clinically significant. Details: Meta-analyses of clinical research in overweight or obese patients show that taking chitosan 1-3 grams daily for up to one year may slightly-to-modestly reduce body weight when compared with placebo; however, the average weight loss in trials lasting up to one year is only 1 kg more than placebo according to the most recent meta-analysis (41729,92781,100170). These analyses also show that taking chitosan can slightly improve systolic and diastolic blood pressure, as well as low-density lipoprotein (LDL) cholesterol and triglyceride levels, in obese or overweight patients (92781,100170). Chitosan may only be beneficial for weight loss when combined with a calorie-restricted diet. Some of the small clinical studies included in the analyses above show that combining chitosan with a calorie-restricted diet can result in modest weight loss (9610,10022,10023,10024,10025), while taking chitosan without calorie reduction does not seem to cause clinically significant weight loss (3243,3244,9986,14314,41724). It also does not seem to significantly increase fecal fat excretion, which is the suggested mechanism of action for reducing weight (9987,10020,11045,14314).
• Postoperative recovery. Application of chitosan gel dressings after endoscopic sinus surgery may improve recovery by lowering the risk of nasal adhesions. Details: A meta-analysis of three small clinical studies shows that use of chitosan gel dressing following endoscopic sinus surgery reduces the risk of nasal adhesions by 75% when compared with saline or no dressing. The chitosan dressings did not influence swelling, crusting, or infections (97713,97714).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Crohn disease. Oral chitosan has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small, uncontrolled clinical study in adults with Crohn disease shows that taking a combination of chitosan 1.05 grams and ascorbic acid daily for 8 weeks increases fecal excretion of fat, but does not improve disease activity, when compared to baseline (9609). The validity of these findings is limited by a lack of control group.
• Dental caries. While small studies suggest that use of chitosan-containing gum or mouthwash can decrease levels of cavity-causing bacteria, it is unclear if these products reduce the risk of developing dental caries. Details: One small clinical study in healthy adults shows that chewing gum supplemented with chitosan decreases the number of cariogenic bacteria in the mouth when compared with non-supplemented gum (15126). Additionally, a small crossover trial shows that rinsing with chitosan 0.5% mouthwash twice daily for 14 days can also decrease the number of cariogenic bacteria in the mouth when compared with placebo (41697). However, there is no reliable evidence that chitosan gum or mouthwash reduces the risk of developing cavities.
• Dental plaque. Small clinical studies suggest that rinsing with chitosan mouthwash may reduce plaque formation. Details: One small crossover trial shows that rinsing with chitosan 0.5% mouthwash twice daily for 14 days significantly reduces plaque formation when compared with placebo (41697). Another small clinical study in patients with dental plaque and gingivitis shows that rinsing with 10 mL of chitosan 0.5% mouthwash twice daily for 3 months reduces plaque formation when compared to baseline, with similar improvements when compared with chlorhexidine 0.2% mouthwash. However, rinsing with a combination of chitosan and chlorhexidine significantly improves plaque formation when compared with either agent alone (106521).
• Diabetic foot ulcers. It is unclear if topical chitosan is beneficial in patients with diabetic foot ulcers. Details: A small clinical study in adults with diabetic foot ulcers shows that applying a thin smear of chitosan 10% gel to the ulcer is no more effective than placebo gel for ulcer healing. Also, when chitosan 10% gel is used in combination with topical isosorbide dinitrate two sprays daily, it is no more effective than the isosorbide dinitrate spray alone (100171). It is not clear if this study was adequately powered to detect a difference between groups.
• Dry eye. It is unclear if chitosan-containing eye drops are beneficial in patients with dry eye. Details: A small clinical study in patients with dry eye shows that applying a specific eye drop (Lacrimera) containing chitosan-N-acetylcysteine 0.1% once or twice daily to the eyes for 5 days improves general symptoms of dry eye by approximately 60% when compared to baseline (97710). The validity of these findings is limited by a lack of placebo control group.
• Gingivitis. It is unclear if rinsing with chitosan mouthwash is beneficial in patients with gingivitis. Details: A small clinical study in patients with gingivitis and dental plaque shows that rinsing with 10 mL of chitosan 0.5% mouthwash twice daily for 3 months reduces gingivitis scores when compared to baseline, with similar improvements when compared with chlorhexidine 0.2% mouthwash. However, rinsing with a combination of chitosan and chlorhexidine significantly improves gingivitis scores when compared with either agent alone (106521).
• Hypercholesterolemia. Despite conflicting study results in patients with hypercholesterolemia, a meta-analysis of small clinical studies suggests that oral chitosan may slightly improve lipid levels when taken for at least 4 weeks in overweight or obese patients with or without hypercholesterolemia. Details: A meta-analysis of seven small clinical studies of obese or overweight patients with or without hypercholesterolemia shows that taking chitosan 1-4.5 grams daily for 4 weeks or longer can reduce both total cholesterol and low-density lipoprotein (LDL) cholesterol by around 6 mg/dL, increase high-density lipoprotein (HDL) cholesterol by around 1 mg/dL, and reduce triglyceride levels by around 11 mg/dL when compared with placebo (92781). However, individual studies in patients with mild hypercholesterolemia show conflicting results. Some small clinical studies show that taking chitosan 1-3 grams daily for 1-3 months does not decrease total cholesterol or LDL cholesterol (3243,9986,11044), while other studies show that taking chitosan 1.2-1.35 grams daily for 8 weeks modestly reduces total cholesterol by 4% to 10% and LDL cholesterol by about 7% when compared with placebo (11307,41693). Several clinical studies also suggest that chitosan-containing combination products seem to reduce cholesterol levels in obese patients or those with hypercholesterolemia. Combinations studied include chitosan 1.2 grams with glucomannan 1.2 grams daily for 1 month (11046); a fiber supplement containing chitosan, guar meal, ascorbic acid, and other micronutrients (10025); chitosan 240 mg, garcinia 55 mg, and chromium 19 mg once or twice daily for 4 weeks (41720); and a specific product (Tegradoc) containing chitosan 10 mg, berberine 200 mg, red yeast extract providing monacolin K 3 mg, and coenzyme Q10 10 mg daily for 12 weeks (97709). It is unclear if the positive findings associated with these combination products are due to chitosan, other ingredients, or the combination.
• Hyperphosphatemia. It is unclear if chewing chitosan-loaded gum is beneficial in patients with hyperphosphatemia who are undergoing hemodialysis. Details: One very small clinical study in patients undergoing hemodialysis with hyperphosphatemia inadequately controlled with sevelamer shows that chewing 20 mg of chitosan-loaded gum twice daily for 2 weeks reduces serum phosphorous levels by 31% when compared to baseline (92784). The validity of this finding is limited by a lack of control group. Conversely, a slightly larger, placebo-controlled clinical study in patients on hemodialysis with phosphorous levels inadequately controlled on phosphate binders shows that chewing 40 mg of chitosan-loaded gum for 30 minutes three times daily for 3 weeks does not significantly reduce serum phosphorous levels when compared with placebo (92779).
• Iron deficiency anemia. Although there has been interest in using oral chitosan for iron deficiency anemia, there is insufficient reliable information about the clinical effects of chitosan for this purpose.
• Kidney failure. It is unclear if oral chitosan is beneficial in patients with kidney failure who are receiving hemodialysis. Details: One small clinical study in patients with kidney failure receiving chronic hemodialysis shows that taking chitosan 450 mg three times daily for 12 weeks reduces elevated cholesterol levels, improves anemia, and enhances physical strength, appetite, and sleep when compared with no treatment (1942).
• Minor bleeding. Small clinical studies suggest that application of chitosan gel dressings after endoscopic sinus surgery may reduce the risk of minor post-surgical bleeding, while application of chitosan-containing gauze to skin grafts does not appear to reduce bleeding risk. Details: A meta-analysis of two small clinical studies shows that use of chitosan gel dressing following endoscopic sinus surgery increases hemostasis by 70% when compared with saline or no dressing (97714). Over 60% of patients using chitosan gel achieved hemostasis within 2 minutes compared with 17.5% of patients not using chitosan gel (97713). However, one small study in patients with skin grafts shows that using chitosan gauze (AnsCare ChitoClot Gauze, BenQ Materials Corporation) with paraffin dressing for 2 weeks does not reduce the amount of blood loss when compared with paraffin dressing alone (97711). These conflicting results might be related to the form of chitosan used or the type of surgical wound to which it is applied.
• Muscle strength. Although there has been interest in using oral chitosan for increasing muscle strength, there is insufficient reliable information about the clinical effects of chitosan for this purpose.
• Periodontitis. It is unclear if topical chitosan is beneficial in patients undergoing surgery for periodontitis. Details: A very small clinical study in patients with periodontitis undergoing dental surgery shows that applying chitosan ascorbate to the gums improves tooth mobility and pocket depths when compared to baseline (1945). The validity of these findings is limited by a lack of control group.
• Wound healing. Several small clinical studies suggest that application of chitosan-containing dressings to skin grafts improves wound healing, scar formation, and nerve regeneration. Details: One small clinical study shows that applying a chitosan mesh dressing increases healing and regeneration of the skin in the first ten days after skin graft placement and reduces itching by about 50% when compared with paraffin dressing (97707). Another small clinical study in patients receiving skin grafts after surgery, burn wounds, or skin malignancy excision shows that application of a chitosan-containing dressing to the skin graft improves wound re-epithelialization and nerve regeneration, but does not improve the rate of healing, when compared with a conventional dressing (41692). Another small clinical study in patients undergoing plastic surgery shows that applying N-carboxybutyl chitosan topically seems to promote donor site tissue regeneration and reduce scar formation when compared with control donor sites (1944). A small clinical study in adults undergoing extraction of an impacted mandibular third molar shows that applying a topical gel (Bexident Post, ISDIN) containing chitosan, allantoin, dexpanthenol, and chlorhexidine as 10 mL three times daily for ten days increases the rate of good wound healing by an additional 52% and 36% after 7 and 14 days, respectively, when compared with no gel. However, this chitosan-containing gel does not appear to reduce postoperative pain or swelling (97712). It is unclear if these findings are due to chitosan, other ingredients, or the combination. More evidence is needed to rate chitosan for these uses.

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LIKELY EFFECTIVE

• Chromium deficiency. Oral or parenteral chromium is effective for the treatment and prevention of chromium deficiency. Details: Chromium is effective for preventing and treating symptoms of chromium deficiency, including hyperglycemia, glycosuria, sudden weight loss, peripheral neuropathy, and confusion (7135).

POSSIBLY EFFECTIVE

• Diabetes. Oral chromium seems to be modestly beneficial for improving glycemic control in diabetes, especially when used in doses greater than 200 mcg daily and in patients with poorly controlled diabetes. It is unclear if chromium helps to prevent the development of diabetes. Details: Epidemiological research has found that lower toenail chromium levels are associated with an increased risk of diabetes and cardiovascular disease (11908). In 2005, the US Food and Drug Administration (FDA) allowed a qualified health claim stating that chromium picolinate may reduce the risk of type 2 diabetes. However, the FDA has determined that any relationship between chromium picolinate and type 2 diabetes is highly uncertain and is based on limited scientific evidence (102362). Research on the use of chromium for the treatment of type 2 diabetes is conflicting but seems to show modest benefit in some patients. Several clinical studies, most including fewer than 80 patients with type 2 diabetes, show that taking chromium decreases fasting blood glucose, postprandial glucose, insulin, and glycated hemoglobin (HbA1c) levels and increases insulin sensitivity (6867,7137,12390,14440,15169,42628,42638,95097,103745). However, other small clinical studies show that chromium is no better than placebo for improving most glycemic indices in patients with diabetes (7060,14325,42679,42707,90059,103746,103749). Some of these studies may not have been adequately powered and some had a high risk of bias. Furthermore, these studies had high heterogeneity related to study population and size, chromium supplementation duration, formulation, and dose, and accepted standards of diabetes care. Multiple meta-analyses pooling results of these small clinical trials also show mixed results (90055,90063,95098,105026,110610,111420). The most recent of the aforementioned meta-analyses show that chromium picolinate lowers HbA1c by about 0.6%, with conflicting findings related to fasting blood glucose and measures of insulin resistance (110610,111420). It is unclear if chromium yeast, chromium dinicocysteinate, or chromium with biotin or other natural ingredients are beneficial. Chromium seems to be most beneficial in doses of greater than 200 mcg taken for 12 weeks or longer, and in patients with poorly controlled diabetes with a baseline HbA1c of 8% or greater (90063,105026). There is also speculation that chromium might primarily benefit patients with low chromium levels; however, there has not been an analysis specifically evaluating this population (6867,7058,13725,14325,95098). Some research suggests that chromium might also modestly improve lipid levels in patients with type 2 diabetes (1934,6867,95098). A meta-analysis of clinical trials in patients with type 2 diabetes shows that taking chromium 42-1000 mcg daily for 5-26 weeks decreases triglyceride levels by 7 mg/dL and increases high-density lipoprotein cholesterol levels by 2 mg/dL when compared with control. Taking chromium did not affect low-density lipoprotein cholesterol levels. However, the validity of these results is limited by high heterogeneity (110605). Another meta-analysis failed to demonstrate any effects of chromium on lipid levels (110610). Research on chromium's effect on blood pressure in patients with type 2 diabetes is mixed. A meta-analysis of clinical trials in patients with type 2 diabetes shows that taking chromium 200-1000 mcg daily for 8-25 weeks lowers diastolic blood pressure by 2 mmHg, but does not improve systolic blood pressure or body mass index, when compared with placebo (110607). Preliminary clinical research shows that chromium picolinate might improve metabolic parameters in patients with other forms of diabetes as well. This includes those with type 1 diabetes (1935), diabetes secondary to corticosteroid use (5039,42829), and gestational diabetes (42817).

POSSIBLY INEFFECTIVE

• Hypertension. Meta-analyses of small clinical trials suggest that oral chromium does not lower blood pressure by a clinically meaningful amount. Details: A meta-analysis of randomized clinical trials in adults with different metabolic disorders shows that taking chromium 42-1000 mcg daily for 12-24 weeks does not lower systolic or diastolic blood pressure when compared with placebo (110609). A meta-analysis of randomized clinical trials in adults with different chronic disorders shows that taking chromium 42-1000 mcg daily for 4-25 weeks lowers systolic and diastolic blood pressure by 3 mmHg and 1 mmHg, respectively, when compared with placebo. However, the validity of this meta-analysis is limited by high heterogeneity (110604). Another meta-analysis of randomized clinical trials including patients with type 2 diabetes shows that taking chromium 200-1000 mcg daily for 8-25 weeks lowers diastolic blood pressure by 2 mmHg, but not systolic blood pressure, when compared with placebo (110607). In addition, the validity of these results is limited by inclusion of patients with and without hypertension at baseline (110604,110607,110609).
• Impaired glucose tolerance (Prediabetes). Oral chromium does not seem to improve glycemic indices in patients with prediabetes. Details: Some clinical research shows that adults with impaired glucose tolerance do not have improved glycemic parameters or insulin sensitivity after taking chromium picolinate 500-1000 mcg daily for up to 6 months when compared with placebo (13053,42670). Likewise, a small clinical study in elderly patients with impaired glucose tolerance shows that chromium supplements do not improve glucose tolerance or triglyceride or cholesterol levels when compared with placebo (13722). Finally, a preliminary clinical study in overweight or obese adults with prediabetes shows that taking two capsules of a combination product containing chromium, cinnamon, and carnosine (Glycabiane, PiLeJe) daily for 4 months decreases fasting plasma glucose by approximately 4 mg/dL when compared with placebo, but does not improve fasting plasma insulin, measures of insulin sensitivity or resistance, or glycated hemoglobin (HbA1C) (94234). The small effect on fasting plasma glucose is clinically insignificant and may be due to the other ingredients in this product.
• Schizophrenia. Oral chromium does not seem to improve psychological measures in patients with schizophrenia. Details: Clinical research in patients with schizophrenia shows that taking chromium polynicotinate 400 mcg daily for 3 months does not affect weight or mental status when compared with placebo (42613).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Antiretroviral-induced insulin resistance. It is unclear if oral chromium is beneficial for preventing antiretroviral-induced insulin resistance. Details: Preliminary clinical research in patients with HIV treated with highly active antiretroviral therapy (HAART) shows that taking chromium nicotinate 200 mcg or chromium picolinate 1000 mcg daily for 8-16 weeks may help decrease insulin resistance and increase glucose disposal when compared to baseline (42630,42662). The validity of this finding is limited by the lack of a control group.
• Athletic performance. It is unclear if chromium enhances athletic performance, although some research suggests that it may improve body composition when used in conjunction with exercise. Details: One large clinical study shows taking chromium 400 mcg daily, in conjunction with resistance training, can increase weight loss, body fat loss, and lean body mass when compared with placebo in conjunction with resistance training (6868). However, other, very small clinical studies show that adding chromium picolinate or chromium chloride 177-400 mcg daily to a weight-training program does not improve body composition when compared with weight-training alone (6860,6861,6862,42747). These studies may not have been adequately powered to detect a difference in outcomes.
• Atypical depression. It is unclear if oral chromium is beneficial in patients with atypical depression. Details: Preliminary clinical research in patients with atypical depression shows that taking chromium picolinate 400 mcg daily for 2 weeks followed by 600 mcg daily for an additional 6 weeks improves response and remission rates when compared with placebo (10309). However, other clinical research shows that taking elemental chromium 400 mcg in the form of chromium picolinate daily for 2 weeks followed by 600 mcg daily for an additional 6 weeks does not improve most symptoms of atypical depression, although appetite and sexual drive may improve, when compared with placebo (42600).
• Beta blocker-induced dyslipidemia. It is unclear if oral chromium is beneficial in patients with dyslipidemia due to beta-blocker use. Details: One small clinical study in patients who take beta-blockers shows that taking glucose tolerance factor (GTF)-chromium 600 mcg daily for 2 months increases high-density lipoprotein (HDL) cholesterol levels by 16%, but does not affect other lipid parameters, when compared with placebo (5040).
• Binge eating disorder. It is unclear if oral chromium is beneficial in patients with binge eating disorder. Details: One small clinical study in adults with overweight and binge eating disorder shows that taking chromium picolinate 600 or 1000 mcg daily for 6 months does not affect binge eating frequency, body weight, or depressive symptoms when compared with placebo (90057).
• Bipolar disorder. It is unclear if oral chromium is beneficial in patients with treatment-resistant bipolar disorder. Details: Preliminary clinical research in patients with treatment-resistant, rapid-cycling bipolar disorder shows that taking chromium chloride (Hypo-A Chrom, Hypo-A GmbH) 600-800 mcg daily for up to 2 years can decrease the frequency of affective episodes by approximately three episodes annually when compared to baseline (42618). The validity of this finding is limited by the lack of a control group.
• Cognitive impairment. It is unclear if oral chromium prevents or treats cognitive impairment. Details: Some clinical research shows that taking chromium picolinate standardized to contain elemental chromium 1000 mcg daily for 12 weeks does not improve memory or depression in elderly patients with mild cognitive impairment when compared with placebo. However, results from neuroimaging scans suggest that chromium increases the activity of certain regions of the brain during memory tasks when compared with placebo (42666).
• Hyperlipidemia. Small clinical studies suggest that oral chromium may modestly reduce lipid levels in patients with hyperlipidemia. Details: One small clinical study in patients with atherosclerotic disease shows that taking chromium 250 mcg as chromium chloride daily for 7-16 months decreases triglycerides and increases high-density lipoprotein (HDL) cholesterol, but not other lipid parameters, when compared with placebo (7060). Other small clinical studies in adults with hyperlipidemia show that taking chromium picolinate 200 mcg daily for 6 weeks, chromium polynicotinate 200 mcg twice daily, or brewer's yeast containing 48 mcg elemental chromium daily for 6-8 weeks decrease total and low-density lipoprotein (LDL) cholesterol when compared to baseline (37178,42585,42710). The validity of this finding is limited by the lack of comparison with a control group. A meta-analysis of small heterogeneous clinical studies in patients mostly without hyperlipidemia shows that taking chromium does not affect lipid levels when compared with placebo (105029). A meta-analysis of randomized clinical trials including patients with type 2 diabetes shows that taking chromium 42-1000 mcg daily for 5-26 weeks modestly improves triglyceride and HDL cholesterol levels, but not LDL cholesterol levels, when compared with control. However, the validity of these results is limited by high heterogeneity and inclusion of patients with and without hyperlipidemia (110605). In addition, some meta-analyses have failed to demonstrate any effects of chromium on lipid levels in adults with diabetes (110610). Limited research has tested high-dose chromium in children. One small clinical study in children with hypercholesterolemia shows that taking chromium polynicotinate 400-600 mcg with glucomannan 1000-1500 mg twice daily for 8 weeks reduces total and LDL cholesterol when compared to baseline (90061). It is unclear if this effect is due to chromium, glucomannan, or the combination.
• Hypoglycemia. It is unclear if oral chromium helps to reverse or prevent hypoglycemia. Details: One very small clinical study in patients with reactive hypoglycemia shows that taking chromium chloride 200 mcg daily for 3 months increases blood glucose levels and improves insulin binding and hypoglycemic symptoms following an oral glucose load (6859). Another small clinical study in patients with symptomatic hypoglycemia shows that taking chromium yeast (Biochrome, Pharma-Nord) 125 mcg daily for 3 months improves symptoms, including chilliness, trembling, and disorientation, when compared with baseline (42711). The validity of this finding is limited by the lack of a control group.
• Metabolic syndrome. It is unclear if oral chromium is beneficial in patients with metabolic syndrome. Details: One small clinical study in patients with metabolic syndrome shows that taking a particular chromium picolinate product (Chromax, Nutrition 21) 500 mcg twice daily for 16 weeks does not affect weight, waist circumference, insulin sensitivity, glycated hemoglobin (HbA1C), or lipid levels when compared with placebo (42654).
• Myocardial infarction (MI). It is unclear if oral chromium helps to prevent MI. Details: Epidemiological research has found that low toenail chromium concentrations are associated with an increased risk of MI (13728). However, toenail chromium concentrations might not be a reliable predictor of body stores of chromium. There is also no reliable research showing that chromium supplements can prevent MI.
• Nonalcoholic fatty liver disease (NAFLD). It is unclear if oral chromium slows NAFLD progression. Details: One small clinical study in patients with NAFLD shows that taking chromium picolinate 200 mcg two times daily after meals for 12 weeks does not affect liver enzyme levels or body weight when compared with placebo (105027).
• Obesity. Although some research suggests that oral chromium may increase weight loss, this increase in weight loss is not likely to be considered clinically relevant. Details: Meta-analyses of clinical studies in adults with overweight or obesity show that taking chromium picolinate 200-1000 mcg daily for 12-16 weeks might result in a cumulative weight loss of about 0.5-1 kg when compared with placebo (90062,90065). However, this small reduction in weight is unlikely to be considered clinically significant. Additionally, small clinical studies in healthy adults and children with overweight or obesity show that taking oral chromium 200-1000 mcg daily for 6-24 weeks does not reduce weight when compared with control (6860,13727,17224,42680). Some of these studies may not have been adequately powered to detect a smaller effect. A meta-analysis of randomized clinical trials among adults with type 2 diabetes shows that taking chromium 200-1000 mcg daily for 8-25 weeks does not lower body mass index when compared with placebo. However, the validity of these results is limited by inclusion of patients with and without obesity at baseline (110607).
• Polycystic ovary syndrome (PCOS). It is unclear if oral chromium improves symptoms of PCOS. Details: One small clinical study in patients with PCOS shows that taking chromium picolinate 1000 mcg daily for 6 months along with diet and exercise counseling decreases body mass index and improves rates of ovulation and regular menstruation when compared with placebo (95094). Also, some clinical research shows that taking chromium picolinate (21st Century HealthCare, Inc. or Nature Made) 200 mcg daily for 8 weeks increases insulin sensitivity when compared with placebo (95095,98687). However, other preliminary clinical research shows that taking chromium picolinate 200 mcg daily for 4 months does not affect insulin sensitivity or improve ovulation rates (42603). Although chromium picolinate at doses of less than 1000 mcg might have very small effects on fasting glucose, these doses do not seem to have clinically beneficial effects on fasting glucose, pregnancy rate, or testosterone levels (95094,95095,98687). A lower dose of chromium has also been studied in combination with carnitine. One small clinical study in adults with overweight and PCOS shows that taking chromium picolinate 200 mcg daily with carnitine 1000 mg daily for 12 weeks modestly reduces fasting blood glucose, insulin resistance, and body weight, and slightly increases insulin sensitivity, when compared with placebo (103747). However, it is unclear if this benefit is clinically significant. Additionally, it is unclear if these effects are due to chromium, carnitine, or the combination. Carnitine has demonstrated clinical benefit when used alone in PCOS.
• Turner syndrome. It is unclear if oral chromium is beneficial in patients with this condition. Details: A small clinical study shows that taking brewer's yeast 30 grams containing chromium 50 mcg daily for 8 weeks might improve abnormalities in glucose and lipid metabolism when compared with baseline in patients with Turner syndrome, a genetic disorder that has a high incidence of diabetes (13729). The validity of this finding is limited by the lack of a comparator group. More evidence is needed to rate chromium for these uses.

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LIKELY EFFECTIVE

• Coronary heart disease (CHD). A diet high in soluble fiber, such as that found in oats, reduces the risk of CHD. Details: Clinical research shows that a diet containing foods high in fiber, such as oats, oat bran, or whole oat flour, reduces the risk of CHD (2737,4960,4962,4963,4964,4965,4966,4967,4968). In 1993, the US Food and Drug Administration (FDA) approved a health claim stating that consuming at least 3 grams of soluble fiber per day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of CHD (102336). However, clinical studies show that at least 3.6 grams of soluble fiber daily is needed to reduce the risk of CHD (5786,5787,5788,5794,5795,5796).
• Dyslipidemia. A diet rich in soluble fiber, such as that found in oats, can reduce cholesterol by a moderate amount. Details: Oats, oat bran, and other soluble fibers can modestly reduce total and low-density lipoprotein (LDL) cholesterol, especially when consumed as part of a diet low in saturated fat. Consuming 56-150 grams of whole oat products such as oatmeal and oat bran, containing 3.6-10 grams of soluble fiber daily, can significantly lower total and LDL cholesterol levels. For each gram of soluble fiber consumed, total cholesterol decreases by about 1.4 mg/dL and LDL by about 1.2 mg/dL. Eating 3-10 grams of soluble fiber daily can reduce total cholesterol by about 4-14 mg/dL (4976,4977,5786,5788,5792,5794,5795,8521,107749,113488,113495). For example, eating 3 bowls of oatmeal (28 gram servings) daily, providing a total of 3 grams of soluble fiber daily, can decrease total cholesterol by about 5 mg/dL (5788). However, consuming more than 10 grams of soluble fiber daily doesn't seem to increase effectiveness (5788). A meta-analysis comparing the effects of oats and isolated beta-glucans shows that both products similarly impact lipid profiles, suggesting that the bioactive component of oats are beta-glucans (113488). Oat bran products, such as oat bran muffins and oat bran flakes, may vary in their ability to lower cholesterol, depending on the total soluble fiber content and other dietary variables (6188). Whole oat products might be more effective for lowering LDL and total cholesterol than foods containing oat bran plus soluble fiber (10145). Although oats are shown to lower total and LDL cholesterol, a meta-analysis and a small clinical study in adults with and without dyslipidemia shows that consuming oatmeal or oat products does not reduce triglycerides or increase high-density lipoprotein (HDL) cholesterol when compared with controls (113488,113495).

POSSIBLY EFFECTIVE

• Diabetes. A diet rich in whole grains, such as oats, may help prevent diabetes or improve blood glucose control in patients with type 1, type 2, or gestational diabetes. Details: Population research shows that for every 16 gram daily serving of whole grains, including oats, there is a 7% to 11% lower risk of developing type 2 diabetes (100622). There is also evidence that consuming oats can decrease blood glucose and insulin levels, as well as lipid levels, in patients with diabetes. The glycemic effects of oats depend on the level of processing of the oat products. Consuming intact oat kernels or thick-cut oats (>0.6 mm) reduces postprandial blood glucose and insulin, but consuming thin-cut, or "quick", oats has no effect (105536). Clinical research shows that consuming oats and oat bran for 4-8 weeks decreases pre-prandial blood glucose, 24-hour plasma glucose, glycated hemoglobin (HbA1c), insulin levels, and low-density lipoprotein (LDL) cholesterol in people with type 2 diabetes (4980,4982,6266,103345). Various doses have been used, including 3 grams of soluble fiber daily, or bread providing 34 grams of total fiber daily (9 grams of soluble fiber) (4961,4980). Additional clinical research in obese adults with type 2 diabetes shows that eating whole grain oats 50-100 grams daily in place of other carbohydrates reduces postprandial blood glucose by 19-27 mg/dL when compared with other carbohydrates in a healthy diet. After 1 year, the groups consuming 50 grams and 100 grams of oats had an additional 0.48% and 0.64% reduction in HbA1c, respectively, when compared with the regular healthy diet group (97520). There is also some evidence that consuming oats 50 grams daily, containing 25 grams of soluble fiber, might be more effective for improving glycemic control and decreasing hyperinsulinemia than the standard moderate fiber diet recommended by the American Diabetes Association (ADA) (6266). Oats have also been evaluated in adolescents with type 1 diabetes. One very small clinical study shows that taking 50 grams of a specific oat product (Betaglucare), providing beta-glucans 6 grams, in three divided doses daily for one week is beneficial for glycemic control and variability when compared with a standard diet without beta-glucans or with taking only 25 grams of the product daily. Maximal, mean, and pre- and post-meal blood glucose levels were modestly lower, and minimal blood glucose levels were modestly higher. Most measures of glycemic variability were statistically different, although there were no differences in the duration of hypoglycemia or hyperglycemia between groups (105261). Oats have also been evaluated in patients with gestational diabetes. A randomized, controlled trial shows that taking 30 grams of a specific oat bran product (OAB; Golden Light Cup Company) orally twice daily at lunch and dinner for 4 weeks improves mean fasting blood glucose and two-hour postprandial glucose when compared with a control group. After 4 weeks, the mean fasting blood glucose and 2-hour postprandial glucose in the treatment group were 85 mg/dL and 104 mg/dL, respectively, compared with 93 mg/dL and 117 mg/dL, respectively, in the control group (107751). The validity of this study is limited by the short treatment duration and lack of follow-up.
• Gastric cancer. A diet rich in soluble fiber, such as that found in oats, might reduce the risk of gastric cancer. Details: Observational research has found that consuming a diet that includes cereal fiber, such as oats and oat bran, might reduce the incidence of gastric cancer (10435).

POSSIBLY INEFFECTIVE

• Colorectal cancer. Regular consumption of oats does not seem to reduce the risk of colorectal cancer. Details: Observational research has found that consuming oat bran or oats orally doesn't seem to reduce the risk of colon cancer. Additionally, consuming fiber, including oat-bran fiber, is not associated with a reduction in the risk for recurrence of colorectal adenomas (4820,5104).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Acne. Although there is interest in using topical oats for acne, there is insufficient reliable information about the clinical effects of oats for this purpose.
• Anxiety. Although there is interest in using oral oats for anxiety, there is insufficient reliable information about the clinical effects of oats for this purpose.
• Atopic dermatitis (eczema). Topical colloidal oatmeal cream may be beneficial in patients with atopic dermatitis. Details: Preliminary clinical research shows that applying a cream containing colloidal oatmeal 1% daily for 2 weeks moderately reduces the severity of atopic dermatitis when compared with baseline (103344). The validity of this finding is limited by the lack of a comparator group. Other research suggests that colloidal oatmeal may be beneficial when used in combination with topical steroids. Clinical research shows that the benefits obtained from applying an ointment containing fluocinolone 0.025% to the hands for 2 weeks were better maintained in the patients who also used a cream containing colloidal oatmeal 1% during this time period and for an additional 4 weeks when compared with patients using fluocinolone and the cream base without colloidal oatmeal. Quality of life was also improved in the patients using colloidal oatmeal (103340).
• Breast cancer. Observational research suggests that regular oatmeal intake may be associated with reduced mortality from breast cancer. Details: Population research in postmenopausal patients has found that those who have eaten 50 grams of oatmeal daily prior to a breast cancer diagnosis have a 20% reduced risk of all-cause mortality in the 7 years following the diagnosis when compared with patients who have not eaten oatmeal. However, no benefit was seen when post-diagnostic oatmeal intakes were examined (103343).
• Burns. Although there is interest in using topical oats for burns, there is insufficient reliable information about the clinical effects of oats for this purpose.
• Chronic fatigue syndrome (CFS). Although there is interest in using oral oats for CFS, there is insufficient reliable information about the clinical effects of oats for this purpose.
• Cognitive function. It is unclear if oral oats are beneficial in healthy adults with mild memory impairment. Details: Preliminary clinical research in healthy middle-aged adults with self-reported memory decline shows that consuming a specific wild green-oats extract (Neuravena, Frutarom) 800 mg as a single dose improves overall speed, but not overall accuracy, of cognitive performance when compared with placebo. However, a higher dose of 1600 mg was ineffective (97519).
• Dry skin. It is unclear if applying lotion containing colloidal oat extract improves dry skin to a greater extent than other lotion products. Details: Preliminary clinical research shows that applying a lotion containing colloidal oat extract (Aveeno Active Naturals Skin Relief 24Hr Moisturizing Lotion, Johnson & Johnson) twice daily for 2 weeks improves itchiness, cracking, scaling, dryness, and roughness when compared to baseline in females with dry skin (91458). Additional preliminary clinical research shows that applying a colloidal oatmeal lotion to the legs twice daily for three weeks reduces skin dryness and improves skin integrity when compared to baseline in adults with dry skin (97518). The validity of these findings is limited by the lack of a comparator group.
• Exercise-induced muscle soreness. It is unclear if oral oats are beneficial for exercise-induced muscle soreness. Details: A small clinical trial shows that eating two cookies containing oat flour 60 grams daily for 8 weeks reduces muscle soreness 48 or 72 hours after downhill running when compared with baseline (103341).
• Fat redistribution syndrome. It is unclear if oral oats are beneficial for fat redistribution syndrome. Details: Consumption of a high fiber diet, including oats, with adequate energy and protein might prevent fat deposition in patients with HIV. A one-gram increase in total dietary fiber may decrease the risk of fat deposition by 7% (12517).
• Gallbladder disease. Although there is interest in using oral oats for gallbladder disease, there is insufficient reliable information about the clinical effects of oats for this purpose.
• Hypertension. It is unclear if oral oats are beneficial for hypertension. Details: A meta-analysis of 21 clinical studies in healthy adults and those with a variety of metabolic conditions including hypertension shows that consumption of oat products reduces systolic blood pressure (SBP) by 3 mmHg but has no effect on diastolic blood pressure (DBP) when compared with control. Subgroup analysis suggests that consuming oat products reduces SBP by 10 mmHg in patients with hypertension at baseline. An additional subgroup analysis suggests that consuming at least 5 grams of beta-glucan-enriched oats daily or consuming oats for a duration at least 8 weeks reduces SBP and DBP (113494). Observational research has found that consumption of oats as oatmeal or oat cereal does not seem to reduce DBPor SBP in males with minor elevations in blood pressure or patients with dyslipidemia (2956,113495). A randomized, controlled trial in patients with stage 1 hypertension receiving dietary guidance shows that taking 30 grams of oat bran, providing 8.9 grams of dietary fiber, once daily with breakfast or in between meals for 3 months improves various blood pressure measures when compared with dietary guidance alone. After 3 months of treatment, 24-hour maximum SBP and DBP decreased by 14 mmHg and 11 mmHg, respectively, and office SBP and DBP decreased by 15 mmHg and 10 mmHg, respectively. Oat consumption may also have impacted antihypertensive medication use. Two patients in the control group increased doses of antihypertensive medications, whereas 6 patients in the treatment group decreased doses and 1 patient discontinued use (107750). The effect of oral oat bran on patients with stage 2 hypertension or pre-hypertension is unknown.
• Irritable bowel syndrome (IBS). Although there is interest in using oral oats for IBS, there is insufficient reliable information about the clinical effects of oats for this purpose.
• Metabolic syndrome. Limited research suggests that oats may not be beneficial for metabolic syndrome. Details: Preliminary clinical research in adults with metabolic syndrome shows that adding oat bran 40 grams daily for 6 weeks to a low-calorie diet does not reduce the incidence of metabolic syndrome. Oat bran also does not improve body weight, blood pressure, low-density lipoprotein (LDL) cholesterol, triglycerides, or blood glucose levels when compared with a low-calorie diet alone in patients with metabolic syndrome (103342).
• Osteoarthritis. Although there is interest in using oral oats for osteoarthritis, there is insufficient reliable information about the clinical effects of oats for this condition.
• Pruritus. Applying oat lotion topically may improve some types of pruritus. Details: Preliminary clinical research shows that applying an oat lotion (Espanol) twice daily for up to 2 weeks can decrease itching intensity by about 20% when compared to baseline in patients with pruritus associated with chronic kidney disease (uremic pruritus). This decrease is similar to the effects of applying vinegar 5% solution or taking hydroxyzine 10 mg orally. However, applying the oat lotion does not appear to decrease the frequency of itching (91457).
• Psoriasis. Although there is interest in using topical oats for psoriasis, there is insufficient reliable information about the clinical effects of oats for this purpose.
• Rheumatoid arthritis (RA). Although there is interest in using oral oats for RA, there is insufficient reliable information about the clinical effects of oats for this purpose.
• Stroke. It is unclear if oral oats are beneficial for reducing the risk of stroke. Details: Population research suggests that consuming oatmeal for breakfast once weekly might reduce the incidence of stroke by a small amount when compared with consuming white bread or eggs for breakfast (103337).
• Ulcerative colitis. Oral oats have only been evaluated in combination with other ingredients; their effect when used alone is unclear. Details: Preliminary clinical research shows that taking a specific oat-based product (Profermin, Nordisk Rebalance) containing fermented oat flour, Lactobacillus plantarum, barley malt flour, and lecithin, 250 mL orally twice daily for 8 weeks, reduces disease activity and increases remission in about two-fold more patients with relapsing ulcerative colitis, when compared with treatment with a specific nutritional beverage (Fresubin Original, Fresenius Kabi) (90271).
• Wound healing. Although there is interest in using topical oats for wound healing, there is insufficient reliable information about the clinical effects of oats for this purpose. More evidence is needed to rate oats for these uses.

(Read more about OATS)

POSSIBLY EFFECTIVE

• Obesity. Oral Phaseolus vulgaris extract may reduce body weight and waist circumference in overweight and obese adults. Details: A meta-analysis of 6 small clinical studies shows that taking Phaseolus vulgaris extract daily for 4-12 weeks reduces body weight by around 1.6% when compared with placebo (107439). While some small studies show conflicting findings (12186,26158), most research in overweight and obese adults suggests that taking white kidney bean extract 800-1000 mg or cranberry bean extract 100 mg three times daily for 5-12 weeks reduces body weight by 1.5-4 kg, body mass index by about 0.7 kg/m2, and waist circumference by about 1.5-5 cm when compared with placebo or other control (26156,29926,93075,93077,104875). Specific products evaluated include Phase 2 (Pharmachem Labs; also marketed as Starchlite and Phaselite) (26156,29926); Carb Intercept with Phase 2 (Natrol LLC) (93075); and Beanblock (Indena S.p.A) (93077). Phaseolus vulgaris extract has also been evaluated in combination with other ingredients, with modestly positive results. These combination products include Blokcal (Pharmachem Labs) containing white kidney bean extract (Phase 2, Pharmachem Labs) 445 mg daily and elemental chromium 50-60 mcg daily for 30 days (15518); Suco-Bloc (Med-Eq), containing white kidney bean extract (Phaseolamin, Leuven Bioproducts) 200 mg, inulin from chicory root (Raftiline, Orafti SA) 200 mg, and garcinia extract 50 mg per tablet, 2 tablets three times daily with meals for 12 weeks (26157); Phaseolamin 1600 diet (Metabolic Inc.), containing the Phaseolus vulgaris constituent phaseolamin 750 mg with clove 200 mg, lysine 20 mg, arginine 20 mg, and alanine 20 mg, taken in two divided doses daily for 8 weeks (93076); and Bonvit (Indena), containing Phaseolus vulgaris extract 100 mg and artichoke 200 mg three times daily for 8 weeks (93080).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Colorectal cancer. It is unclear if oral Phaseolus vulgaris is beneficial for the prevention of colorectal cancer recurrence. Details: Observational research has found that dietary intake of several varieties of Phaseolus vulgaris, including baked beans, kidney beans, pinto beans, lima beans, and navy beans, is inversely associated with the risk of advanced colorectal adenoma recurrence. Results from the study show that the odds for advanced adenoma recurrence is 65% lower for patients who consume higher amounts of Phaseolus vulgaris when compared with those who consume lower amounts (29922).
• Diabetes. Small clinical studies suggest that oral Phaseolus vulgaris may not improve postprandial glucose levels in patients with type 2 diabetes. Details: While results from some small clinical studies in patients with type 2 diabetes suggest that taking Phaseolus vulgaris extract or consuming Phaseolus vulgaris beans can reduce postprandial glucose levels, most studies, including a meta-analysis of 6 small clinical trials, show that Phaseolus vulgaris does not significantly reduce postprandial glucose when compared with placebo or other control (93078,107439). Another small clinical study in patients with type 2 diabetes shows that taking 15 grams of a combination of Phaseolus vulgaris pod, white mulberry, and bilberry three times daily for 2 months decreases blood glucose by up to 24% when compared with baseline (33943). It is unclear if these findings are due to Phaseolus vulgaris, other ingredients, or the combination. Additionally, the validity of these findings is limited by the lack of a control group.
• Hypercholesterolemia. Oral Phaseolus vulgaris has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small, open-label clinical study in overweight and obese patients shows that taking Phaseolus vulgaris (white kidney bean) extract 300-600 mg plus carob gum extract 50-100 mg three times daily for 3-9 months modestly reduces total cholesterol levels and increases excretion of fat in the feces when compared to baseline (10633). The validity of these findings is limited by the lack of a comparator group.
• Kidney stones (nephrolithiasis). It is unclear if oral Phaseolus vulgaris extract is beneficial in patients with kidney stones. Details: A small clinical study in adults with small kidney stones shows that taking a Phaseolus vulgaris extract made from 250 grams of green beans three times a week for 6 weeks modestly reduces the size of kidney stones and lowers urinary calcium and oxalate levels when compared with a control group (104874).
• Lung cancer. It is unclear if oral Phaseolus vulgaris is beneficial for the prevention of lung cancer. Details: Observational research has found that consuming higher amounts of dietary phytoestrogens, such as isoflavones from Phaseolus vulgaris beans and soy, is associated with a 44% to 72% lower risk of developing lung cancer when compared with consuming lower amounts. The beneficial effect appears to be more pronounced in males than females (13190).
• Myocardial infarction (MI). Although there has been interest in using oral Phaseolus vulgaris for the prevention of MI, there is insufficient reliable information about the clinical effects of Phaseolus vulgaris for this purpose.
• Urinary tract infections (UTIs). Although there has been interest in using oral Phaseolus vulgaris for UTIs, there is insufficient reliable information about the clinical effects of Phaseolus vulgaris for this purpose. More evidence is needed to rate Phaseolus vulgaris for these uses.

(Read more about PHASEOLUS VULGARIS)

POSSIBLY SAFE. ..when used orally, short-term. Chitosan has been used with apparent safety in clinical studies at a dose of up to 1.35 grams daily for up to 3 months (1942,9609,9610,10022,10023,10024,10025,11307,13171,14314)(15126,92781,97708). ...when used topically, short-term (1944,1945,4269,4270,97712,106521).

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

(Read more about CHITOSAN)

LIKELY SAFE ...when used orally and appropriately in medicinal amounts, short-term. Chromium has been safely used in doses up to 1000 mcg daily for up to 6 months (1934,5039,5040,6858,6859,6860,6861,6862,6867,6868)(7135,7137,10309,13053,14325,14440,17224,90057,90061)(90063,94234,95095,95096,95097,98687); however, most of these studies have used chromium doses in a range of 150-600 mcg. The Food and Drug Administration (FDA) and Institute of Medicine (IOM) evaluations of the safety of chromium suggest that it is safe when used in doses of 200 mcg daily for up to 6 months (13241,13242).

POSSIBLY SAFE ...when used orally and appropriately in medicinal amounts, long-term. Chromium has been safely used in a small number of studies at doses of 200-1000 mcg daily for up to 2 years (7060,7135,42618,42628,42666,110605,110607,110609). However, the Food and Drug Administration (FDA) and Institute of Medicine (IOM) evaluations of the safety of chromium suggest that it is safe when used in doses of 200 mcg daily for up to 6 months (13241,13242).

CHILDREN: LIKELY SAFE
when used orally and appropriately in amounts not exceeding the daily adequate intake (AI) levels by age: 0-6 months, 0. 2 mcg; 7-12 months, 5.5 mcg; 1-3 years, 11 mcg; 4-8 years, 15 mcg; males 9-13 years, 25 mcg; males 14-18 years, 35 mcg; females 9-13 years, 21 mcg; females 14-18 years, 24 mcg (7135). POSSIBLY SAFE...when used orally and appropriately in amounts exceeding AI levels. Chromium 400 mcg daily has been used safely for up to 6 weeks (42680).

PREGNANCY: LIKELY SAFE
when used orally and appropriately in amounts not exceeding adequate intake (AI) levels. The AI for pregnancy is 28 mcg daily for those 14-18 years of age and 30 mcg daily for those 19-50 years of age (7135).

PREGNANCY: POSSIBLY SAFE
when used orally in amounts exceeding the adequate intake (AI) levels. There is some evidence that patients with gestational diabetes can safely use chromium in doses of 4-8 mcg/kg (1953); however, patients should not take chromium supplements during pregnancy without medical supervision.

LACTATION: LIKELY SAFE
when used orally and appropriately in amounts not exceeding adequate intake (AI) levels. The AI for lactation is 44 mcg daily for those 14-18 years of age and 45 mcg daily for those 19-50 years of age (7135). Chromium supplements do not seem to increase normal chromium concentration in human breast milk (1937). There is insufficient reliable information available about the safety of chromium when used in higher amounts while breast-feeding.

(Read more about CHROMIUM)

LIKELY SAFE ...when used orally and appropriately in food amounts (4960,4969,5792,5797). Oat bran has Generally Recognized as Safe (GRAS) status in the US (4912). Whole grain oats 50-100 grams daily have been used for up to 1 year without serious adverse effects (97520).

POSSIBLY SAFE ...when used topically and appropriately (12). Lotion containing colloidal oat 1% has been used topically without adverse effects for up to 6 weeks (97518,103340). There is insufficient reliable information available about the safety of oats when used orally in medicinal amounts.

PREGNANCY AND LACTATION: LIKELY SAFE
when used orally in food amounts (5792,5797).

(Read more about OATS)

POSSIBLY SAFE ...when used orally and appropriately. Most research has evaluated a specific Phaseolus vulgaris (white kidney bean) extract (Phase 2, Pharmachem Labs), which appears to be safe in doses of up to 3 grams daily for 2-3 months (12186,15518,26157,29926). Other Phaseolus vulgaris (white kidney bean) extracts also seem to be safe in doses of 0.9-2.4 grams daily when used for up to 3 months (10633,104875).

POSSIBLY UNSAFE ...when large amounts of fresh Phaseolus vulgaris husks are ingested. Raw Phaseolus vulgaris husks contain lectins that can cause gastrointestinal upset. Cooking destroys the lectins (18).

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

(Read more about PHASEOLUS VULGARIS)

ACYCLOVIR (Zovirax) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Chitosan can reduce the absorption of acyclovir, potentially increasing the risk for treatment failure.  Details Clinical research in humans shows that taking chitosan along with acyclovir 200 mg reduces acyclovir absorption. Concomitant administration of chitosan 400 mg or 1000 mg reduced the acyclovir area under the curve (AUC) and peak plasma concentration by about 30% and 40%, respectively, compared with control. Concomitant administration with chitosan 1000 mg also increased time to peak concentration from 1 hour to 2 hours (92780). In vitro research suggests that the mechanism for reduced absorption is due to acyclovir entrapment in chitosan-mucus complexes, which reduces intestinal absorption (112352).

WARFARIN (Coumadin) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, chitosan might increase the risk of bleeding when taken with warfarin.  Details In a case report, a patient taking warfarin had a significantly increased international normalized ratio (INR) after starting chitosan 1200 mg daily. The INR normalized after chitosan was discontinued and vitamin K was administered. The patient once again started taking chitosan and again had a significant increase in INR. The INR stabilized again once chitosan was discontinued (15909). Researchers theorize that this interaction might occur because chitosan decreases absorption of fat-soluble vitamins, including vitamin K, which could increase the anticoagulant effect of warfarin.

(Read more about CHITOSAN)

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = A Theoretically, chromium may have additive effects with antidiabetic agents and increase the risk of hypoglycemia.  Details Some research shows that taking chromium might lower blood glucose levels, especially in patients with poorly controlled type 2 diabetes (7137,14440,15169,94234,95097,95098,98687).

ASPIRIN Interaction Rating = Minor Be watchful with this combination. Severity = Insignificant •  Occurrence = Possible •  Level of Evidence = D Theoretically, aspirin might increase chromium absorption.  Details Animal research suggests that aspirin may increase chromium absorption and chromium levels in the blood (21055).

INSULIN Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Theoretically, concomitant use of chromium and insulin might increase the risk of hypoglycemia.  Details In clinical research, chromium has been shown to increase insulin sensitivity (1952,14440,95095),

LEVOTHYROXINE (Synthroid, others) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = B Chromium might bind levothyroxine in the intestinal tract and decrease levothyroxine absorption.  Details Clinical research in healthy volunteers shows that taking chromium picolinate 1000 mcg with levothyroxine 1 mg decreases serum levels of levothyroxine by 17% when compared to taking levothyroxine alone (16012). Advise patients to take levothyroxine at least 30 minutes before or 3-4 hours after taking chromium.

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs) Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D NSAIDs might increase chromium levels in the body.  Details Drugs that are prostaglandin inhibitors, such as NSAIDs, seem to increase chromium absorption and retention (7135).

(Read more about CHROMIUM)

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, oats may have additive effects with antidiabetic agents and might increase the risk of hypoglycemia.  Details Consuming oats can decrease blood glucose in patients with diabetes (4980,4982,6266,103345). In those who require insulin, taking oats 100 grams daily for 2 days reduces the insulin dose required to achieve metabolic control (103336).

INSULIN Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Concomitant use of oats and insulin might increase the risk of hypoglycemia.  Details In patients with insulin-dependent type 2 diabetes, taking oats 100 grams daily for 2 days reduces the insulin dose required to achieve metabolic control (103336).

(Read more about OATS)

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Phaseolus vulgaris might increase the risk of hypoglycemia when taken with antidiabetes drugs.  Details Small clinical studies suggest that Phaseolus vulgaris beans or bean pods, ingested alone or along with white mulberry leaf and bilberry, reduce blood glucose levels in some patients with diabetes (29921,29925,33943).

(Read more about PHASEOLUS VULGARIS)

General ...Orally and topically, chitosan seems to be well tolerated, short-term.
Most Common Adverse Effects:
Orally: Constipation, diarrhea, flatulence, epigastric discomfort, and nausea.

Dermatologic ...In one clinical trial, a subject with kidney failure reported itching during 12 weeks of oral chitosan treatment (1942). It is not clear if this was related to the underlying renal failure or the use of oral chitosan.

Gastrointestinal ...Orally, chitosan has been reported to cause epigastric discomfort, constipation, flatulence, diarrhea, nausea, and dryness of the throat (1942,3243,9986,11307,14314,41688,92781,100170). Excessive discharge of fat in the feces, also known as steatorrhea, has been reported with chitosan therapy (41724,41726). Theoretically, chitosan may alter the normal intestinal flora via antimicrobial activity, which could interfere with lipid digestibility and bile acid metabolism, leading to the growth of resistant pathogens (41687,41709,41725).

Musculoskeletal ...Orally, chitosan has been reported to cause swollen heels and wrists in two patients (41688).

Neurologic/CNS ...Headaches have been reported in patients taking oral chitosan (41688).

Ocular/Otic ...Topically, an eye drop containing chitosan-N-acetylcysteine has been reported to cause itching and irritation of the eyes (97710).

(Read more about CHITOSAN)

General ...Orally, chromium is generally well tolerated.
Most Common Adverse Effects:
Orally: Gastrointestinal irritation, headaches, insomnia, irritability, mood changes.
Serious Adverse Effects (Rare):
Orally: Rare cases of kidney and liver damage, rhabdomyolysis, and thrombocytopenia have been reported.

Dermatologic ...Orally, chromium-containing supplements may cause acute generalized exanthematous pustulosis (42561), skin rashes (42679), and urticaria (17224). Also, chromium picolinate or chromium chloride may cause systemic contact dermatitis when taken orally, especially in patients with contact allergy to chromium (6624,90058). In one clinical study, a patient taking chromium nicotinate 50 mcg daily reported itchy palms that improved after the intervention was discontinued. It is unclear of this effect was due to the chromium or another factor (95096).
Topically, hexavalent chromium, which can be present in some cement, leather products, or contaminated soil, may cause allergic contact dermatitis (42645,42789,90060,90064,110606).
A case of lichen planus has been reported for a patient following long-term occupational exposure to chromium (42688).

Endocrine ...Orally, cases of hypoglycemia have been reported for patients taking chromium picolinate 200-1000 mcg daily alone or 200-300 mcg two or three times weekly in combination with insulin (42672,42783). Chromium picolinate has also been associated with weight gain in young females who do not exercise and in those following a weight-lifting program (1938).

Gastrointestinal ...Orally, chromium in the form of chromium picolinate, chromium polynicotinate, chromium-containing brewer's yeast, or chromium-containing milk powder may cause nausea, vomiting, diarrhea, decreased appetite, constipation, flatulence, or gastrointestinal upset (14325,42594,42607,42622,42643,42679).
Long-term exposure to heavy metals, including chromium, has been associated with increased risk of gallbladder disease and cancer (42682,42704).

Genitourinary ...Orally, chromium polynicotinate has been associated with disrupted menstrual cycles in patients taking the supplement to prevent weight gain during smoking cessation (42643).

Hematologic ...Anemia, hemolysis, and thrombocytopenia were reported in a 33 year-old female taking chromium picolinate 1200-2400 mcg daily for 4-5 months (554). The patient received supportive care, blood product transfusions, and hemodialysis and was stabilized and discharged a few days later. Lab values were normal at a one-year follow-up.

Hepatic ...Liver damage has been reported for a 33-year-old female taking chromium picolinate 1200 mcg daily for 4-5 months (554). Also, acute hepatitis has been reported in a patient taking chromium polynicotinate 200 mcg daily for 5 months (9141). Symptoms resolved when the product was discontinued. Two cases of hepatotoxicity have been reported in patients who took a specific combination product (Hydroxycut), which also contained chromium polynicotinate in addition to several herbs (13037).

Musculoskeletal ...Acute rhabdomyolysis has been reported for a previously healthy 24-year-old female who ingested chromium picolinate 1200 mcg over a 48-hour time period (42786). Also, chromium polynicotinate has been associated with leg pain and paresthesia in patients taking the supplement to prevent weight gain during smoking cessation (42643).

Neurologic/CNS ...Orally, chromium picolinate may cause headache, paresthesia, insomnia, dizziness, and vertigo (6860,10309,14325,42594). Vague cognitive symptoms, slowed thought processes, and difficulty driving occurred on three separate occasions in a healthy 35-year-old male after oral intake of chromium picolinate 200-400 mcg (42751). Transient increases in dreaming have been reported in three patients with dysthymia treated with chromium picolinate in combination with sertraline (2659). A specific combination product (Hydroxycut) containing chromium, caffeine, and ephedra has been associated with seizures (10307). But the most likely causative agent in this case is ephedra.

Psychiatric ...Orally, chromium picolinate has been associated with irritability and mood changes in patients taking the supplement to lose weight, while chromium polynicotinate has been associated with agitation and mood changes in patients taking the supplement to prevent weight gain during smoking cessation (6860,42643).

Renal ...Orally, chromium picolinate has been associated with at least one report of chronic interstitial nephritis and two reports of acute tubular necrosis (554,1951,14312). Laboratory evidence suggests that chromium does not cause kidney tissue damage even after long-term, high-dose exposure (7135); however, patient- or product-specific factors could potentially increase the risk of chromium-related kidney damage. More evidence is needed to determine what role, if any, chromium has in potentially causing kidney damage.
Intravenously, chromium is associated with decreased glomerular filtration rate (GFR) in children who receive long-term chromium-containing total parenteral nutrition - TPN (11787). Topically, burns caused by chromic acid, a hexavalent form of chromium, have been associated with acute chromium poisoning with acute renal failure (42699). Early excision of affected skin and dialysis are performed to prevent systemic toxicity.

Other ...Another form of chromium, called hexavalent chromium, is unsafe. This type of chromium is a by-product of some manufacturing processes. Chronic exposure can cause liver, kidney, or cardiac failure, pulmonary complications, anemia, and hemolysis (9141,11786,42572,42573,42699). Occupational inhalation of hexavalent chromium can cause ulceration of the nasal mucosa and perforation of the nasal septum, and has been associated with pneumoconiosis, allergic asthma, cough, shortness of breath, wheezing, and increased susceptibility to respiratory tract cancer and even stomach and germ cell cancers (42572,42573,42601,42610,42636,42667,42648,42601,42788,90056,90066). Although rare, cases of interstitial pneumonia associated with chromium inhalation have been reported. Symptoms resolved with corticosteroid treatment (42614).

(Read more about CHROMIUM)

General ...Orally, oats are well tolerated.
Most Common Adverse Effects:
Orally: Abdominal distension, bloating, flatulence, and unpleasant taste.
Topically: Burning, contact dermatitis, itching, and redness.

Dermatologic ...Topically, oat-containing preparations can cause contact dermatitis (12515). Redness, burning, and itchiness have also been reported (103340).

Gastrointestinal ...When consumed orally, oats provide fiber. Increasing fiber in the diet can cause flatulence, bloating, abdominal distention, and unpleasant taste. To minimize side effects, doses should be slowly titrated to the desired level. These adverse effects usually subside with continued use (12514).
In patients who have difficulty chewing food, or those with conditions that decrease small bowel motility, oat bran may cause bezoars (concretions) and intestinal obstruction. Oats and oat bran are unlikely to cause obstruction without other causative factors (4979,4985).

Immunologic ...In a case report, a 45-year-old male developed acute generalized urticaria, facial angioedema, and dyspnea immediately after consuming oat flour. The reaction resolved after emergency care for anaphylaxis. Further investigation revealed an IgE-mediated hypersensitivity reaction to oat proteins (113490).

(Read more about OATS)

General ...Orally, Phaseolus vulgaris extract seems to be well tolerated.
Most Common Adverse Effects:
Orally: Constipation, diarrhea, flatulence, nausea, stomach pain, and vomiting.
Serious Adverse Effects (Rare):
Orally: Hypersensitivity reactions, including anaphylaxis, in sensitive individuals.

Dermatologic ...Topically, Phaseolus vulgaris may cause contact dermatitis in sensitive individuals. A case of occupational contact dermatitis characterized by pruritus, erythema, eczema, and dyspnea has been reported for a 41-year-old farmer who handled the green parts of Phaseolus vulgaris (29920).

Gastrointestinal ...Orally, an extract of the Phaseolus vulgaris variety white kidney bean, as well as alpha-amylase inhibitors isolated from Phaseolus vulgaris, might cause nausea, vomiting, diarrhea, flatulence, constipation, satiety, and stomach pains (11265,18223,29925,104874). Also, white kidney bean extract, taken orally along with carob gum, may cause constipation, flatulence, soft stools, and reduced levels of vitamin B12 and folic acid (10633). Consuming large amounts of raw or undercooked Phaseolus vulgaris beans or extract can cause nausea, vomiting, diarrhea, and gastroenteritis due to the content of phytohaemagglutinin, a plant protein lectin (18223,29916,93082). Cooking usually destroys lectins (18).

Immunologic ...Orally, Phaseolus vulgaris may cause hypersensitivity reactions, including anaphylaxis, in sensitive individuals. A case of severe anaphylactic shock requiring epinephrine and steroid treatment has been reported for a 23-year-old following ingestion of cooked kidney beans, a variety of Phaseolus vulgaris. The causative agents were reported to be phaseolin (vicilin) and phytohaemagglutinin (29918). Also, a case of angioedema resulting from type I hypersensitivity has been reported for a one-year-old child following inhalation of vapors from or ingestion of cooked white beans, another variety of Phaseolus vulgaris (29919).

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