Metabolic Tuning: Selected Nutrients in competitive sport.
Sport, performance, micronutrient, ubiquinol, iron, magnesium,
electrolytes, vitamin D, proteins.
Taking food supplements is very popular among competitive athletes as
well as amateurs. However, an optimization of the athletic and mental
performance can only be expected, if an undersupply is already
present. Gaps in micronutrient supply should be closed via an
optimization of the diet.
A lack of important micronutrients like vitamin D, magnesium, iron,
ubiquinol, omega-3 fatty acids as well as protein can lead to a loss
of performance, faster exhaustion, slower regeneration or perhaps
susceptibility to infections. The article summarizes the importance
of selected micronutrients which are relevant for athletes and makes
recommendations for supplementation.
Gröber U, Metabolic Tuning: Selected nutrients in competitive sport.
Erfahrungsheilkunde, 2018; 67: 28-86.
Der vorliegende Artikel fasst die wichtigsten Punkte eines Vortrages
zum Thema «Mikronährstoffe im Sport», vorgetragen auf dem
14. Symposium Hochleistungssport vom 20. November 2017 im
in Berlin, zusammen (www.vbg.de).
The present article summarizes the most important points of a lecture
about "Micronutrients and sport", presented on the 14.symposium on
high-performance sport, 20th November 2017 at the Olympic stadium in
Positive Effect of Magnesium Orotate Therapy in Hypertensive Heart Disease
Magnesium; Orotate; Heart insufficiency
According to the results of the MACH study additional magnesium
orotate therapy has shown a positive effect on life expectancy and
quality of life in patients with severe forms of heart insufficiency.
Both magnesium and orotate can be cardioprotective. In the presented
data here additional magnesium orotate therapy was tested in 11
patients with hypertensive heart disease NYHA III-IV as compared to
10 patients with hypertensive heart disease NYHA II-IV as controls.
Additional magnesium orotate therapy was 4500 mg magnesium orotate
daily for 1 week. NTproBNP levels decreased significantly in the
magnesium orotate group versus controls (p<0.01). Under therapy
quality of life improved significantly as well. Kidney function
remained stable in the normal range. In conclusion an additional
therapy with magnesium orotate is safe and can be of additional
benefit in hypertensive heart disease with insufficiency. There is
an improvement in quality of life and life expectancy in heart
insufficiency under an additional magnesium orotate therapy.
Kisters K, Gremmler B, Schmidt J, Gröber U, Tokmak F (2017) Positive
Effect of Magnesium Orotate Therapy in Hypertensive Heart Disease.
Metabolomics (Los Angel) 7: 195; doi:10.4172/2153-0769.1000195
Myth or Reality - Transdermal Magnesium?
In the following review, we evaluated the current literature and
evidence-based data on transdermal magnesium application and show
that the propagation of transdermal magnesium is scientifically
unsupported. The importance of magnesium and the positive effects
of magnesium supplementation are extensively documented in magnesium
deficiency, e.g., cardiovascular disease and diabetes mellitus. The
effectiveness of oral magnesium supplementation for the treatment of
magnesium deficiency has been studied in detail. However, the proven
and well-documented oral magnesium supplementation has become
questioned in the recent years through intensive marketing for its
transdermal application (e.g., magnesium-containing sprays, magnesium
flakes, and magnesium salt baths). In both, specialist and lay press
as well as on the internet, there are increasing numbers of articles
claiming the effectiveness and superiority of transdermal magnesium
over an oral application. It is claimed that the transdermal
absorption of magnesium in comparison to oral application is more
effective due to better absorption and fewer side effects as it
bypasses the gastrointestinal tract.
Gröber U, Werner T, Vormann J, Kisters K, Myth or reality – transdermal
magnesium? Nutrients, 2017; 9, 813; doi:10.3390/nu9080813
Reasonable complementary medicinemeasures in gynecological oncology
Alternative medicine ・ Micronutrients ・ Phytotherapy ・ Adverse drug reactions ・ Fatigue
The results from studies on the prevalence of utilization of
naturopathy or complementary medicine show substantial variation.
According to Weis et al. in Germany approximately 70% of patients
with gynecological cancers, particularly patientswith breast cancer,
make use of complementary treatment. The term complementary medicine
is not precisely defined and has to be confined to the commonly used
synonymous terms alternativemedicine and alternative therapy
procedures. Complementary forms of treatment are utilized as extended
supportive treatment options accompanying and supplementary to
conventional oncological treatment. The reasons and motivations for
the utilization of complementary medicine are varied and are mostly
based on and characterized by the salutogenic therapy strategy of
patients. This strategy supports coping, healing and overcoming the
disease. From the patient perspective the aspects with the highest
priority are ensuring autonomy, integration of self-participation
and optimization of resilience, in a phase of life that often appears
threatening and has to be overcome. Complementary therapies can be
integrated into acute phase treatment and also into the rehabilitation
phase. Safety and compatibility of the multitude of complementary
measures with the conventional tumor treatment has the highest priority.
Holzhauer P, Gröber U, Viktoria Aivazova-Fuchs, Klaus Friese,
Reasonable complementary medicinemeasures in gynecological oncology.
Der Gynäkologe, 2016; 49:805–817
Vitamin K – in prevention and therapy (PDF)
Vitamin K, diseases of the bones and vessels, K vitameres.
The topic of „Vitamin K“ is currently booming on the
health products market. Vitamin K is known to be important for blood
coagulation. Current research increasingly indicates that the
antihaemorrhagic vitamin has a considerable benefit in the
prevention and treatment of bone and vascular disease. Vitamin K1
(phylloquinone) is more abundant in foods but less bioactive than
the vitamin K2 menaquinones (especially MK-7, menaquinone-7).
Vitamin K compounds undergo oxidation-reduction cycling within the
endoplasmic reticulum membrane, donating electrons to activate specific
proteins via enzymatic gamma-carboxylation of glutamate groups before
being enzymatically reduced. Along with coagulation factors
(II, VII, IX, X, and prothrombin), protein C and protein S,
osteocalcin (OC), matrix Gla protein (MGP), periostin, Gas6, and other
vitamin K-dependent (VKD) proteins support calcium homeostasis,
inhibit vessel wall calcification, support endothelial integrity,
facilitate bone mineralization, are involved in tissue renewal and
cell growth control, and have numerous other effects. The following
review describes the history of vitamin K, the physiological
significance of the K vitamers, updates skeletal and cardiovascular
benefits and important interactions with drugs.
Gröber U, Kisters K. Vitamin K – in der Prävention und Therapie. EHK 2016; 65: 184–191.
© Thieme Verlagsgruppe, Erfahrungsheilkunde 4/2016; mit freundlicher Genehmigung
Magnesium Metabolism, Vitamin D and Interleukins in Cardiovascular Disease (PDF)
Magnesium; Cardiovascular disease; Metabolism; Arteriosclerosis; Vitamin D
A magnesium deficiency is known to be involved in the pathogenesis of
cardiovascular diseases. In patients with essential hypertension intima
media thickness is increased in about 70% (ELSA Study). In our study,
we investigated 21 patients (10 female, 11 male, average age 56.3 ± 6.6
years) with untreated essential hypertension (grades I and II
according to WHO guidelines). All patients had a hypomagnesiaemia in
serum (1.57 ± 0.11 mg%). In all patients we found a
significant increase in intima media thickness of arteria carotis
communis (0.97 ± 0.08 mm) (r=-0.869, p<0.0001). The
results show that a magnesium deficiency in patients with essential
hypertension may be of special pathogenetic importance. In addition,
the role of magnesium deficiency in the development of
arteriosclerosis has to be discussed. Furthermore, we demonstrated
a connection between magnesium deficiency and an increased intima
media thickness. In this context, calcium antagonist therapy or
magnesium supplementation may be of advantage when treating intima
media thickness in hypertension.
In addition in essential hypertensives with diabetes mellitus type
IIb showing lowered magnesium (1.72 ± 0.08 mg/dl)
and vitamin D (9.55 ± 4.74 ng/ml) levels interleukine 6
concentrations were 8.57 ± 4.14 pg/ml
(p<0.01 vs. controls) being a risk factor for metabolic disorder,
Kisters K, Gremmler B, Gröber U, Tokmak F, Magnesium Metabolism,
Vitamin D and Interleukins in Cardiovascular Disease. Metabolomics;
2016; 6: 177. doi:10.4172/2153-0769.1000177.
Micronutrients in oncological Intervention (PDF)
Micronutrients; antioxidants; vitamin D; selenium; L-carnitine; vitamin C; cancer;
treatment related side effects; chemotherapy; radiotherapy
Nutritional supplements are widely used among patients with cancer
who perceive them to be anticancer and antitoxicity agents. Depending
on the type of malignancy and the gender 30%–90% of the cancer
patients supplement their diets with antioxidant and immuno-stabilizing
micronutrients, such as selenium, vitamin C, and vitamin D, often
without the knowledge of the treating physician. From the oncological
viewpoint, there are justifiable concerns that dietary supplements
decrease the effectiveness of chemotherapy and radiotherapy. Recent
studies, however, have provided increasing evidence that treatment
is tolerated better—with an increase in patient compliance and a
lower rate of treatment discontinuations—when micronutrients, such
as selenium, are added as appropriate to the patient’s medication.
Nutritional supplementation tailored to an individual’s background
diet, genetics, tumor histology, and treatments may yield benefits
in subsets of patients. Clinicians should have an open dialogue
with patients about nutritional supplements. Supplement advice
needs to be individualized and come from a credible source, and
it is best communicated by the physician.
Gröber U, Holzhauer P, Kisters K, Holick MF, Adamietz IA,
Micronutrients in oncological Intervention. Nutrients 2016; 8(3),
Das Ultraspurenelement Bor (PDF)
Bor, Kalzium, Magnesium, Vitamin D, Knochenstoffwechsel, Arthrose,
Kaschin-Beck-Krankheit, Krebs, Hirnleistung, S-Adenosylmethionin.
Aktuell wird Bor in der Ernährungsmedizin als nichtessenzielles
Spurenelement bewertet. Es deuten sich aber positive Wirkungen im
Knochenstoffwechsel, bei entzündlichen Gelenkerkrankungen sowie bei
kognitiven Leistungsstörungen an. In vielen Indikationsbereichen
fehlen jedoch noch belastbare Studien, um die bisher vorliegenden
Daten zu untermauern. Unter synergistischen Aspekten könnte man Bor
(z.B. Kalziumfructoborat) mit anderen knochenwirksamen Nährstoffen
(z.B. Vitamin D3, MK-7) zur Unterstützung der Knochengesundheit
kombinieren, um möglicherweise einen Zusatzeffekt auf die
Knochenintegrität zu erzielen. Eine Rationale, das Kalzium,
Magnesium und/oder Vitamin D mit Bor fix kombiniert werden müssen,
ist aber derzeit auf gar keinen Fall gegeben. Eine aktuelle
Meta-Analyse von Garland diskutiert sogar, ob die Einnahme von Bor
potenziell den Abbau von 25(OH)D reduziert und zu einer Akkumulation
von letzterem führen könnte, was möglicherweise mit einer erhöhten
Mortalitätsrate bei höheren 25(OH)D-Spiegeln in einzelnen Studien
Gröber U, Kisters K. Das Ultraspurenelement Bor. OM - Zeitschr f
Orthmol Med, 2015; 4: 9-15.
© Thieme Verlagsgruppe, Zeitschrift für Orthomolekulare Medizin
4/2015; mit freundlicher Genehmigung
Vitamin D in oncology: Update 2015 (PDF)
Vitamin D, cancer, fatigue, cachexia, vitamin D loading dose,
anthracyclines, bisphosphonates, aromatase inhibitors, monoclonal
antibodies, taxanes, radiation induced proctitis, opioid dose.
Vitamin D deficiency is associated with increased incidence of breast
and colon cancer as well as with an unfavourable course of non-Hodgkin
lymphoma. Vitamin D deficiency is common in cancer patients and is
associated with poor cancer prognosis and disease progression. In
breast cancer patients under polychemotherapy with anthracycline
and taxane, a significant drop in 25(OH)D levels was observed.
Osteomalacia represents a new and previously unreported risk factor
for the development of bisphosphonate-related osteonecrosis of the
jaw. In vitamin D deficiency (until it is corrected) oral and
parenteral bisphosphonates should not be used. Vitamin D status
should be monitored in all cancer patients and treated by adequate
vitamin D3 supplementation. This applies in particular to cancer
patients with poor nutritional status, treatment with aromatase
inhibitors, bisphosphonates, and CTX containing anthracycline,
taxane and monoclonal antibodies as well as in cases of muscular
or mucocutaneous disorders, fatigue and tumor cachexia
Gröber U, Kisters K, Adamietz IA. Vitamin D in oncology: Update 2015.
Med Monatsschr Pharm, 2015; 38(12): 512-516.
Magnesium in Prevention and Therapy (PDF)
magnesium; hypomagnesemia; cardiovascular disease; diabetes mellitus;
asthma; ADHD; Alzheimer’s disease; pre-eclampsia
Magnesium is the fourth most abundant mineral in the body. It has
been recognized as a cofactor for more than 300 enzymatic reactions,
where it is crucial for adenosine triphosphate (ATP) metabolism.
Magnesium is required for DNA and RNA synthesis, reproduction, and
protein synthesis. Moreover, magnesium is essential for the regulation
of muscular contraction, blood pressure, insulin metabolism, cardiac
excitability, vasomotor tone, nerve transmission and neuromuscular
conduction. Imbalances in magnesium status—primarily hypomagnesemia
as it is seen more common than hypermagnesemia—might result in
unwanted neuromuscular, cardiac or nervous disorders. Based on
magnesium’s many functions within the human body, it plays an
important role in prevention and treatment of many diseases. Low
levels of magnesium have been associated with a number of chronic
diseases, such as Alzheimer’s disease, insulin resistance and
type-2-diabetes mellitus, hypertension, cardiovascular disease
(e.g., stroke), migraine headaches, and attention deficit
hyperactivity disorder (ADHD).
Gröber U, Schmidt J, Kisters K, Magnesium in Prevention and Therapy.
Nutrients, 2015; 7(9): 8199-8266.
Natriuretic Peptides, Hypertension, Heart Insufficiency and Magnesium (PDF)
Magnesium, nT-pro BNP, hypertension, heart insufficiency
The role of magnesium substitution in heart insufficiency and in
hypertension is of special interest. A positive effect on blood
pressure lowering and on N-terminal-pro Brain Natriuretic Peptide
(nT-proBNP) values has been described in this context. Brain
Natriuretic Peptide (BNP) and nTproBNP are of similar quality, but
nTproBNP is more stable under clinical conditions. Measurements of
BNP has to be done 4 – 8 hours after blood sampling, nT-proBNP
determinations can be performed within 2–3 days under room
temperature. In a recent study of our group with similar design we
investigated hypertensives with heart insufficiency NYHA III-IV
given additional magnesium therapy (magnesium orotate of about
2610 mg daily 3 times).
Kisters K, Gremmler B, Gröber U (2015) Natriuretic Peptides,
Hypertension, Heart Insufficiency and Magnesium. Adv Tech Biol Med,
2015; 3: 134. doi: 10.4172/2379-1764.1000134
Neuroenhancement with vitamins and other micronutrients? (PDF)
Vitamin D, fatty acids, iron, fatty acids, brain health, brain doping
Optimal cognitive capacity is vital throughout all stages of life.
Most notably a healthy nutrition in childhood and adolescence is
crucial for brain development and cognitive performance.
Micronutrients are an essential component of several general cellular
functions as well as of functions to neurologic activity such as the
synthesis of dopamine, serotonin, and myelin formation. An adequate
dietary supply with brain active micronutrients, such as vitamins,
minerals and omega-3 long-chain polyunsaturated fatty acids is
therefore in schoolchildren of essential significance. The
possibilities and limitations to boost the cognitive capacity
of children for the purpose of a “brain doping” will be discussed.
Gröber U, Kisters K, Neuroenhancement with vitamins and other
Pharmakon, 2015; 3(3): 231-237.
Live longer with vitamin D? (PDF)
vitamin D; 25-hydroxyvitamin D; vitamin D deficiency; breast cancer;
cancer; overall mortality
The global burden of vitamin D deficiency or insufficiency is of great
concern for public health. According to recent studies, vitamin D
deficiency is an important etiological factor in the pathogenesis of
many chronic diseases. Whether or not there is a connection between
25-hydoxyvitamin D (25(OH)D) status and overall mortality is a matter
of considerable debate. A new meta-analysis confirmed that low 25(OH)D
levels were associated with a significant increased risk for all-cause
mortality. Individuals with severe vitamin D deficiency have almost
twice the mortality rate as those with 25(OH)D level ≥ 30 ng/mL,
(≥75 nmol/L). Unlike previous meta-analyses which suggested that serum
25(OH)D > 50 ng/mL was associated with increased mortality, this new
analysis found that there was no increased risk even when 25(OH)D
levels were ≥70 ng/mL. In general, closer attention should be paid
to vitamin D deficiency in medical and pharmaceutical practice than
has been the case hitherto. The results of these studies are
consistent with the recommendation to improve the general vitamin D
status in children and adults by means of a healthy approach to
sunlight exposure, consumption of foods containing vitamin D and
supplementation with vitamin D preparations.
Gröber U, Reichrath J, Holick MF, Live longer with vitamin D?
Nutrients, 2015; 7(3):1871-80. doi: 10.3390/nu7031871.
Vitamin K: an old vitamin in a new perspective (PDF)
bone health, cardiovascular health, matrix GLA protein,
menaquinone-7, osteocalcin, phylloquinone, vitamin K
The topic of „Vitamin K“ is currently booming on the
health products market. Vitamin K is known to be important for
blood coagulation. Current research increasingly indicates that
the antihaemorrhagic vitamin has a considerable benefit in the
prevention and treatment of bone and vascular disease. Vitamin K1
(phylloquinone) is more abundant in foods but less bioactive than the
vitamin K2 menaquinones (especially MK-7, menaquinone-7). Vitamin K
compounds undergo oxidation-reduction cycling within the endoplasmic
reticulum membrane, donating electrons to activate specific proteins
via enzymatic gamma-carboxylation of glutamate groups before being
enzymatically reduced. Along with coagulation factors (II, VII, IX,
X, and prothrombin), protein C and protein S, osteocalcin (OC),
matrix Gla protein (MGP), periostin, Gas6, and other vitamin
K-dependent (VKD) proteins support calcium homeostasis, inhibit
vessel wall calcification, support endothelial integrity, facilitate
bone mineralization, are involved in tissue renewal and cell growth
control, and have numerous other effects. The following review
describes the history of vitamin K, the physiological significance
of the K vitamers, updates skeletal and cardiovascular benefits and
important interactions with drugs.
Gröber U, Reichrath J, Holick MF, Kisters K, Vitamin K: an old vitamin
in a new perspective, Dermato-Endocrinology, 2014; 6:1, e968490,
Micronutrients in diabetology: complementary medicine update 2014 (PDF)
Diabetes mellitus is one of the most prevalent endocrine diseases
that is associated with high oxidative stress and vascular
inflammation. Type 1 and 2 diabetes are characterized by significant
losses of important micronutrients such as vitamin C, magnesium,
zinc or vitamin D due to metabolic basis of the disease, medication
and/or its complications. The evidence of changes in micronutrient
metabolism as a consequence of the disease and the influence of
selective supplementation are reviewed in this paper. The importance
of micronutrients notably vitamin C, B-group vitamins, vitamin D,
vitamin K, coenzyme Q10, magnesium, zinc, chromium and copper under
practical conditions are assessed. There is a lot of evidence that
demonstrates the positive influence of micronutrient supplementation
on glycemic control and the risk of diabetic complications.
Gröber U, Kisters K, Schmidt J, Micronutrients in diabetology:
complementary medicine update 2014. Med Monatschr Pharm, 2014;
Vitamin D: Update 2013 - From rickets prophylaxis to general preventive healthcare (PDF)
Vitamin D, 25-hydroxyvitamin D, vitamin D deficiency, osteoporosis,
gene expression, cardiovascular diseases, hypertension, diabetes
mellitus, autoimmune diseases, degenerative brain disease, respiratory
tract infection, atopic dermatitis, cancer, drugs
Vitamin D has received a lot of attention recently as a result of a
meteoric rise in the number of publications showing that vitamin D
plays a crucial role in a plethora of physiological functions and
associating vitamin D deficiency with many acute and chronic illnesses
including disorders of calcium metabolism, autoimmune diseases, some
cancers, type 2 diabetes mellitus, infectious diseases and
cardiovascular disease. The recent data on vitamin D from
experimental, ecological, case-control, retrospective and prospective
observational studies, as well as smaller intervention studies, are
significant and confirm the sunshine vitamin’s essential role in a
variety of physiological and preventative functions. The results of
these studies justify the recommendation to improve the general
vitamin D status in children and adults by means of a healthy
approach to sunlight exposure, consumption of foods containing
vitamin D and supplementation with vitamin D preparations. In
general, closer attention should therefore be paid to vitamin D
deficiency in medical and pharmaceutical practice than has been
the case hitherto.
Gröber U, Spitz J, Reichrath J, Kisters K, Holick, MF. Vitamin D:
Update 2013. From rickets prophylaxis to general healthcare.
Dermatoendocrinol, 2013; 5:3, e1-e17.
Neuroenhancement with Vitamin B12—Underestimated Neurological Significance (PDF)
Vitamin B12; elderly; Vitamin B12 deficiency; diagnostic of Vitamin
B12 deficiency; brain atrophy; neuroenhancement
Vitamin B12 is a cofactor of methionine synthase in the synthesis of
methionine, the precursor of the universal methyl donor
S-Adenosylmethionine (SAMe), which is involved in different epigenomic
regulatory mechanisms and especially in brain development. A Vitamin
B12 deficiency expresses itself by a wide variety of neurological
manifestations such as paraesthesias, skin numbness, coordination
disorders and reduced nerve conduction velocity. In elderly people, a
latent Vitamin B12 deficiency can be associated with a progressive
brain atrophy. Moderately elevated concentrations of homocysteine
(>10 μmol/L) have been associated with an increased risk of dementia,
notably Alzheimer’s disease, in many cross-sectional and prospective
studies. Raised plasma concentrations of homocysteine is also
associated with both regional and whole brain atrophy, not only in
Alzheimer’s disease but also in healthy elderly people. Clinician
awareness should be raised to accurately diagnose and treat early
Vitamin B12 deficiency to prevent irreversible structural brain
Gröber U, Kisters K, Schmidt J, Neuroenhancement with vitamin B12 -
underestimated neurological significance.
Nutrients, 2013; 5(12): 5031-5045.
Vitamin D-Update 2013: Von der Rachitis-Prophylaxe zur allgemeinen
Seit der Entdeckung seiner antirachitischen Wirkung in den 1920er Jahren hat
man das Sonnenvitamin lange Zeit nur im
Hinblick auf seine Funktion im Calcium- und Knochenstoffwechsel betrachtet.
Eine Vielzahl von Forschungsergebnissen
der vergangenen Jahre hat gezeigt, dass Vitamin D in seiner hormonaktiven
Form 1,25-(OH)2-Vitamin D (1,25-(OH)2-D, Calcitriol) nicht nur ein Regulator
der Calcium- und Phosphathomöostase ist, sondern zahlreiche extraskelettäre
Wirkungen aufweist. Darunter sind von besonderer Bedeutung der Einfluss des
Vitamin-D-Hormons auf das Herz-Kreislauf-System, das endokrine System, das
Immunsystem sowie auf die Zelldifferenzierung und das Zellwachstum.
Komplementärer Einsatz von Antioxidanzien und Mikronährstoffen in der
Onkologie. Update 2013 (PDF)
- Antioxidants · Micronutrients · Selenium · L-carnitine · Vitamin D
- Context: Many patients being treated for cancer use micronutrient
supplements with the intention to complement the cancer
treatment or help them cope with the therapy and disease-associated
side-effects. Up to 90 % of cancer patients supplement with
antioxidants without the knowledge of the treating physician.
Methods: Alternatives to textbook medicine were assessed from published
scientific data and otherwise available information, e.g.
Results: There are many concerns that antioxidants might decrease the
effectiveness of chemotherapy but increasing evidence suggests
a benefit when antioxidants and other micronutrients, such as selenium,
L-carnitine and vitamin D are added to conventional cytotoxic
Conclusion: However, it is imperative that physicians explore the use of
antioxidant and other micronutrient supplements with cancer
patients and educate them about potentially negative and also potentially
Gröber U, Mücke R, et al., Complementary use of antioxidants and
micronutrients in oncology. Update 2013. Der Onkologe, 2013; 19(2): 136-143.
Mitochondriale Toxizität von Arzneimitteln (PDF)
- Mitochondria · Drugs · Statins · Metformin · Acetaminophen · Valproic acid · Mitochondrial toxicity · Coenzyme Q10 · Glutathione
- Considering the complexity of mitochondria it is not surprising that the pathogenesis of adverse drug events often develop on
drug-induced mitochondrial injury. Drug induced mitochondrial toxicity can occur though several mechanisms, such as depletion of mtDNA
(e.g. NRTIs), inhibition of fatty acid beta-oxidation (e.g. valproic acid), opening of the mitochondrial permeability transition pore
(e.g. anthracyclines), formation of mitochondrial oxidative stress and depletion of mitochondrial glutathione pool (e.g. acetaminophen),
uncoupling of electron transport from ATP synthesis (e.g. tamoxifen) and inhibition of mitochondrial electron transport chain complexes
(e.g. simvastatin). This review focuses on the mitochondrial toxicity of drugs in general and explains the practical relevance of these
adverse drug events according to specific drugs (metformin, statins, acetaminophen, valproic acid). Furthermore the significance of
mitotropic micronutrients such as coenzyme Q10, L-carnitine and glutathione in the prevention and management of drug-induced mitochondrial
injury is discussed.
Gröber U, Mitochondrial toxicity of drugs. Med Monatsschr Pharm, 2012; 35(12): 445-456.
Influence of drugs on vitamin D and calcium metabolism (PDF)
- vitamin D · drugs · 25-hydroxy-vitamin D [25(OH)D] · pregnane X receptor · 1,25-dihydroxyvitamin D [1,25(OH)2D] · bisphosphonates · cytostatics · statins
- In the past, interactions between drugs and vitamin D have received only little or no attention in the health care practices. However, since more and more drugs are used for the treatment of patients, this topic is increasingly relevant. Several drugs can interfere with the vitamin D and bone metabolism. Drugs that activate the pregnane X receptor can disrupt vitamin D metabolism and vitamin D function. Beside this, the medication oriented supplementation of vitamin D can ameliorate the pharmacologic action of some drugs, such as bisphosphonates, cytostatics and statins.
Antioxidants and Other Micronutrients in Complementary Oncology (PDF)
- Cancer · Micronutrient deficiency · Chemotherapy · Antioxidants · Selenium · Vitamin C
- Many patients being treated for cancer use micronutrient supplements, with the intention to complement their cancer
treatment or help them cope with the therapy- and disease-associated side effects. The majority are adding antioxidants without the
knowledge of the treating physician. There are many concerns that antioxidants might decrease the effectiveness of chemotherapy, but
increasing evidence suggests a benefit when antioxidants are added to conventional cytotoxic therapies. However, it is imperative
that physicians explore the use of antioxidant and other micronutrient supplements with their cancer patients and educate them about
potentially negative as well as potentially beneficial effects.
Interactions between drugs and micronutrients (PDF)
- Drug-induced micronutrient deficiencies – homocysteine – pharmacodynamic and pharmacokinetic interactions – Phenprocoumon and
vitamin K – diuretics and magnesium – statins and coenzyme Q10 – anti-epileptics and vitamin D – proton pump inhibitors and vitamin
B12 – cisplatin and L-Carnitine
- Interactions between drugs and micronutrients have received only little or no attention in the medical and pharmaceutical
world in the past. Since more and more pharmaceutics are used for the treatment of patients, this topic is increasingly relevant. As such
interactions – depending on the duration of treatment and the status of micronutrients – impact the health of the patient and the action of the
drugs, physicians and pharmacists should pay more attention to such interactions in the future. In this context, the pharmacist, as a drug expert,
assumes a particular role. Like no other professional in the health care sector, he is particularly predestined and called up to respond to this task.
The following article intends to point out the relevance of mutual interactions between micronutrients and drugs, without claiming to be exhaustive.
Mikronährstoffe im Leistungssport (PDF)
- Die Idee des Menschen, seine körperliche Leistungsfähigkeit durch den Verzehr leistungsfördernder
Substanzen zu verbessern, ist so alt wie der Sport selber. Schon in der Antike
versuchten die griechischen Athleten ihre sportliche Leistung durch die Einnahme von bestimmten
Kräutern, Pilzen oder tierischen Geschlechtsorganen wie zum Beispiel Stierhoden zu steigern.
Heutzutage gibt es im Spitzensport kaum noch Athleten, die nicht regelmäßig ihren Stoffwechsel
mit Nahrungsergänzungsmitteln zur Optimierung der körperlichen und mentalen Leistungsfähigkeit
„tunen“. Erhöhte Trainingsintensitäten und -umfänge sowie verschärfte Dopingkontrollen (z. B.
Trainingskontrollen) sind die Hauptgründe, warum Nahrungsergänzungsmittel im Sport in immer
stärkerem Umfang eingesetzt werden.
Schlechtes A, B, C? (PDF)
- Vitamintherapie ist jüngst in die Kritik geraten – sie sei meist
nutzlos und mitunter schädlich. Uwe Gröber, Leiter der Essener
Akademie für Mikronährstoffmedizin, widerspricht
L-Carnitin in der Krebstherapie (CARPAN) (PDF)
- Pancreatic adenocarcinoma, L-Carnitine, Quality of life, Survival, Cancer cachexia, Fatique syndrome
- Background: Cachexia, a >10% loss of body-weight, is one factor determining the poor prognosis of pancreatic
cancer. Deficiency of L-Carnitine has been proposed to cause cancer cachexia.
Findings: We screened 152 and enrolled 72 patients suffering from advanced pancreatic cancer in a prospective,
multi-centre, placebo-controlled, randomized and double-blinded trial to receive oral L-Carnitine (4 g) or placebo
for 12 weeks. At entry patients reported a mean weight loss of 12 ± 2,5 (SEM) kg. During treatment body-massindex
increased by 3,4 ± 1,4% under L-Carnitine and decreased (−1,5 ± 1,4%) in controls (p>0,05). Moreover,
nutritional status (body cell mass, body fat) and quality-of-life parameters improved under L-Carnitine. There was a
trend towards an increased overall survival in the L-Carnitine group (median 519 ± 50 d versus 399 ± 43 d, not
significant) and towards a reduced hospital-stay (36 ± 4d versus 41 ± 9d,n.s.).
Conclusion: While these data are preliminary and need confirmation they indicate that patients with pancreatic
cancer may have a clinically relevant benefit from the inexpensive and well tolerated oral supplementation of