Pharmaceutical Medicine

, Volume 33, Issue 4, pp 291–309 | Cite as

Nutraceuticals: Reviewing their Role in Chronic Disease Prevention and Management

  • Amanda Bergamin
  • Evangeline Mantzioris
  • Giordana Cross
  • Permal Deo
  • Sanjay Garg
  • Alison M. HillEmail author
Review Article


Over half the adult population in many Western countries consume nutraceuticals because of their purported therapeutic benefits, accessibility and convenience. Several studies have demonstrated that they may also serve as a useful adjunct to pharmaceuticals to better manage chronic conditions or offset negative side effects. Individuals are advised to consult their physician before using nutraceuticals, but this advice is often overlooked. Thus, the community pharmacist plays an increasingly important role in assisting consumers with selecting a nutraceutical that is safe and for which there is evidence of therapeutic efficacy. Therefore, the aim of this review is to summarise the clinical evidence, safety and purported mechanisms of action for selected nutraceuticals in the management of chronic diseases, including obesity, diabetes, hypertension, hypercholesterolemia and inflammatory-based diseases.


Compliance with Ethical Standards


No external funding was used in the preparation of this manuscript.

Conflicts of interest

Amanda Bergamin, Dr Evangeline Mantzioris, Dr Giordana Cross, Dr Permal Deo, Prof. Sanjay Garg and Dr Alison M. Hill have no potential conflicts of interest that might be relevant to the contents of this manuscript.


  1. 1.
    Santini A, Tenore GC, Novellino E. Nutraceuticals: a paradigm of proactive medicine. Eur J Pharm Sci. 2017;96:53–61. Scholar
  2. 2.
    Burnett AJ, Livingstone KM, Woods JL, McNaughton SA. Dietary supplement use among Australian adults: findings from the 2011–2012 National Nutrition and Physical Activity Survey. Nutrients. 2017;9(11):1248. Scholar
  3. 3.
    Binns CW, Lee MK, Lee AH. Problems and prospects: public health regulation of dietary supplements. Annu Rev Public Health. 2018;39:403–20.CrossRefGoogle Scholar
  4. 4.
    Gong W, Liu A, Yao Y, Ma Y, Ding C, Song C, et al. Nutrient supplement use among the Chinese population: a cross-sectional study of the 2010–2012 china nutrition and health surveillance. Nutrients. 2018;10(11):1733. Scholar
  5. 5.
    Joseph N, Kumar A, Singh H, Shaheen M, Das K, Shrivastava A. Nutritional supplement and functional food use among medical students in India. J Diet Suppl. 2018;15(6):951–64. Scholar
  6. 6.
    Tachi TT, Yoshida A, Kanematsu Y, Sugita I, Noguchi Y, Osawa T, et al. Factors influencing the use of over-the-counter drugs and health foods/supplements. Pharmazie. 2018;73(10):598–604. Scholar
  7. 7.
    Teoh SL, Ngorsuraches S, Lai NM, Bangpan M, Chaiyakunapruk N. Factors affecting consumers’ decisions on the use of nutraceuticals: a systematic review. Int J Food Sci Nutr. 2019;70(4):491–512. Scholar
  8. 8.
    Australian Institute of Health and Welfare. Australia’s Health 2018. Australia’s health series no. 16. AUS 221. Canberra: AIHW; 2018.Google Scholar
  9. 9.
    Euromonitor International. Vitamins and dietary supplements in Australia. Sydney: Euromonitor International; 2013.Google Scholar
  10. 10.
    Complementary Medicines Australia. Australia’s complementary medicines industry snapshot 2018. Mawson: CMA Press; 2018.Google Scholar
  11. 11.
    Dwyer JT, Coates PM, Smith MJ. Dietary supplements: regulatory challenges and research resources. Nutrients. 2018;10(1):41. Scholar
  12. 12.
    Waddington F, Naunton M, Kyle G, Thomas J, Cooper G, Waddington A. A systematic review of community pharmacist therapeutic knowledge of dietary supplements. Int J Clin Pharm. 2015;37(3):439–46. Scholar
  13. 13.
    National Health Medical Research Council. Australian dietary guidelines. Canberra: Australia National Health Medical Research Council; 2013.Google Scholar
  14. 14.
    Dietary Supplements: what you need to know. In: Services USDoHaH, editor. Bethesda, MD: National Institutes of Health Office of Dietary Supplements 2011.Google Scholar
  15. 15.
    Grant SJ, Bin YS, Kiat H, Chang DH. The use of complementary and alternative medicine by people with cardiovascular disease: a systematic review. BMC Public Health. 2012;12:299. Scholar
  16. 16.
    Ibrahim IR, Hassali MA, Saleem F, Al Tukmagi HF. A qualitative insight on complementary and alternative medicines used by hypertensive patients. J Pharm Bioallied Sci. 2016;8(4):284–8. Scholar
  17. 17.
    Manya K, Champion B, Dunning T. The use of complementary and alternative medicine among people living with diabetes in Sydney. BMC Complement Alternat Med. 2012;12:2. Scholar
  18. 18.
    O’Brien SK, Malacova E, Sherriff JL, Black LJ. The prevalence and predictors of dietary supplement use in the Australian population. Nutrients. 2017;9(10):1154. Scholar
  19. 19.
    Zhang AL, Story DF, Lin V, Vitetta L, Xue CC. A population survey on the use of 24 common medicinal herbs in Australia. Pharmacoepidemiol Drug Saf. 2008;17(10):1006–13. Scholar
  20. 20.
    NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19. 2 million participants. Lancet. 2016;387(10026):1377–96.CrossRefGoogle Scholar
  21. 21.
    Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories a systematic review and meta-analysis. JAMA. 2013;309(1):71–82. Scholar
  22. 22.
    Bray GA, Frühbeck G, Ryan DH, Wilding JPH. Management of obesity. Lancet. 2016;387(10031):1947–56. Scholar
  23. 23.
    Greaves CJ, Sheppard KE, Abraham C, Hardeman W, Roden M, Evans PH, et al. Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Public Health. 2011;11(1):119.CrossRefGoogle Scholar
  24. 24.
    Australian Medicines Handbook 2019 (online). Adelaide: Australian Medicines Handbook Pty Ltd;. 2019. Accessed 26 Feb 2019.
  25. 25.
    National Health and Medical Research Council. Summary guide for the management of overweight and obesity in primary care. Melbourne: Department of Health; 2013.Google Scholar
  26. 26.
    Saper RB, Eisenberg DM, Phillips RS. Common dietary supplements for weight loss. Am Fam Physician. 2004;70(9):1731–8.PubMedGoogle Scholar
  27. 27.
    Jurgens TM, Whelan AM, Killian L, Doucette S, Kirk S, Foy E. Green tea for weight loss and weight maintenance in overweight or obese adults. Cochrane Database Syst Rev. 2012. Scholar
  28. 28.
    Hursel R, Viechtbauer W, Westerterp-Plantenga MS. The effects of green tea on weight loss and weight maintenance: a meta-analysis. Int J Obes. 2009;33:956. Scholar
  29. 29.
    Onakpoya I, Hung SK, Perry R, Wider B, Ernst E. The use of garcinia extract (hydroxycitric acid) as a weight loss supplement: a systematic review and meta-analysis of randomised clinical trials. J Obes. 2011. Scholar
  30. 30.
    Onakpoya I, Terry R, Ernst E. The use of green coffee extract as a weight loss supplement: a systematic review and meta-analysis of randomised clinical trials. Gastroenterol Res Pract. 2010. Scholar
  31. 31.
    Hu J, Webster D, Cao J, Shao A. The safety of green tea and green tea extract consumption in adults—results of a systematic review. RTP. 2018;95:412–33. Scholar
  32. 32.
    Administration TG. Camellia sinensis (green tea) extract—Safety advisory—potential risk of harm to the liver. Department of Health. 2018. Accessed 20 Jan 2019.
  33. 33.
    Senanayake SN. Green tea extract: chemistry, antioxidant properties and food applications—a review. J Funct Foods. 2013;5(4):1529–41.CrossRefGoogle Scholar
  34. 34.
    Harpaz E, Tamir S, Weinstein A, Weinstein Y. The effect of caffeine on energy balance. J Basic Clin Physiol Pharmacol. 2017;28:1.CrossRefGoogle Scholar
  35. 35.
    Janssens PL, Hursel R, Westerterp-Plantenga MS. Nutraceuticals for body-weight management: the role of green tea catechins. Physiol Behav. 2016;162:83–7. Scholar
  36. 36.
    Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 Pt B):2985–3023. Scholar
  37. 37.
    Astell KJ, Mathai ML, Su XQ. Plant extracts with appetite suppressing properties for body weight control: a systematic review of double blind randomized controlled clinical trials. Complement Ther Med. 2013;21(4):407–16. Scholar
  38. 38.
    Crescioli G, Lombardi N, Bettiol A, Marconi E, Risaliti F, Bertoni M, et al. Acute liver injury following Garcinia cambogia weight-loss supplementation: case series and literature review. Intern Emerg Med. 2018. Scholar
  39. 39.
    Kothadia JP, Kaminski M, Samant H, Olivera-Martinez M. Hepatotoxicity associated with use of the weight loss supplement Garcinia cambogia: a case report and review of the literature. Case Rep Hepatol. 2018;2018:22.Google Scholar
  40. 40.
    Semwal RB, Semwal DK, Vermaak I, Viljoen A. A comprehensive scientific overview of Garcinia cambogia. Fitoterapia. 2015;102:134–48. Scholar
  41. 41.
    Heymsfield SB, Allison DB, Vasselli JR, Pietrobelli A, Greenfield D, Nunez C. Garcinia cambogia (hydroxycitric acid) as a potential antiobesity agent: a randomized controlled trial. JAMA. 1998;280(18):1596–600.CrossRefGoogle Scholar
  42. 42.
    Mattes RD, Bormann L. Effects of (-)-hydroxycitric acid on appetitive variables. Physiol Behav. 2000;71(1–2):87–94.CrossRefGoogle Scholar
  43. 43.
    Márquez F, Babio N, Bulló M, Salas-Salvadó J. Evaluation of the safety and efficacy of hydroxycitric acid or garcinia cambogia extracts in humans. Crit Rev Food Sci Nutr. 2012;52(7):585–94. Scholar
  44. 44.
    Quick M. Weighing in: green coffee bean extract—a potential safe and effective weight loss supplement? Integr Med Alert. 2013;16(9):97–103.Google Scholar
  45. 45.
    Tajik N, Tajik M, Mack I, Enck P. The potential effects of chlorogenic acid, the main phenolic components in coffee, on health: a comprehensive review of the literature. Eur J Nutr. 2017;56(7):2215–44. Scholar
  46. 46.
    Thom E. The effect of chlorogenic acid enriched coffee on glucose absorption in healthy volunteers and its effect on body mass when used long-term in overweight and obese people. J Int Med Res. 2007;35(6):900–8.CrossRefGoogle Scholar
  47. 47.
    Rhee SY, Woo JT. The prediabetic period: review of clinical aspects. Diabetes Metab J. 2011;35(2):107–16. Scholar
  48. 48.
    Perreault L, Faerch K. Approaching pre-diabetes. J Diabetes Compl. 2014;28(2):226–33. Scholar
  49. 49.
    Kolb H, Eizirik DL. Resistance to type 2 diabetes mellitus: a matter of hormesis? Nat Rev Endocrinol. 2011;8(3):183–92. Scholar
  50. 50.
    Dhingra R, Vasan RS. Diabetes and the risk of heart failure. Heart Fail Clin. 2012;8(1):125–33. Scholar
  51. 51.
    Leszek J, Trypka E, Tarasov VV, Ashraf GM, Aliev G. Type 3 diabetes mellitus: a novel implication of Alzheimers disease. Curr Top Med Chem. 2017;17(12):1331–5. Scholar
  52. 52.
    Davi G, Santilli F, Patrono C. Nutraceuticals in diabetes and metabolic syndrome. Cardiovasc Ther. 2010;28(4):216–26. Scholar
  53. 53.
    Najm W, Lie D. Herbals used for diabetes, obesity, and metabolic syndrome. Prim Care. 2010;37(2):237–54. Scholar
  54. 54.
    Deng R. A review of the hypoglycemic effects of five commonly used herbal food supplements. Recent Patents Food Nutr Agric. 2012;4(1):50–60.Google Scholar
  55. 55.
    Hausenblas HA, Schoulda JA, Smoliga JM. Resveratrol treatment as an adjunct to pharmacological management in type 2 diabetes mellitus–systematic review and meta-analysis. Mol Nutr Food Res. 2015;59(1):147–59. Scholar
  56. 56.
    Liu K, Zhou R, Wang B, Mi MT. Effect of resveratrol on glucose control and insulin sensitivity: a meta-analysis of 11 randomized controlled trials. Am J Clin Nutr. 2014;99(6):1510–9. Scholar
  57. 57.
    Zhu X, Wu C, Qiu S, Yuan X, Li L. Effects of resveratrol on glucose control and insulin sensitivity in subjects with type 2 diabetes: systematic review and meta-analysis. Nutr Metab. 2017;14:60. Scholar
  58. 58.
    Chuengsamarn S, Rattanamongkolgul S, Luechapudiporn R, Phisalaphong C, Jirawatnotai S. Curcumin extract for prevention of type 2 diabetes. Diabetes Care. 2012;35(11):2121–7. Scholar
  59. 59.
    Chuengsamarn S, Rattanamongkolgul S, Phonrat B, Tungtrongchitr R, Jirawatnotai S. Reduction of atherogenic risk in patients with type 2 diabetes by curcuminoid extract: a randomized controlled trial. J Nutr Biochem. 2014;25(2):144–50. Scholar
  60. 60.
    Allen RW, Schwartzman E, Baker WL, Coleman CI, Phung OJ. Cinnamon use in type 2 diabetes: an updated systematic review and meta-analysis. Ann Fam Med. 2013;11(5):452–9. Scholar
  61. 61.
    Akilen R, Tsiami A, Devendra D, Robinson N. Cinnamon in glycaemic control: systematic review and meta analysis. Clin Nutr. 2012;31(5):609–15. Scholar
  62. 62.
    Namazi N, Khodamoradi K, Khamechi SP, Heshmati J, Ayati MH, Larijani B. The impact of cinnamon on anthropometric indices and glycemic status in patients with type 2 diabetes: a systematic review and meta-analysis of clinical trials. Complement Ther Med. 2019;43:92–101. Scholar
  63. 63.
    Kursvietiene L, Staneviciene I, Mongirdiene A, Bernatoniene J. Multiplicity of effects and health benefits of resveratrol. Medicina (Kaunas, Lithuania). 2016;52(3):148–55. Scholar
  64. 64.
    Park SJ, Ahmad F, Philp A, Baar K, Williams T, Luo H, et al. Resveratrol ameliorates aging-related metabolic phenotypes by inhibiting cAMP phosphodiesterases. Cell. 2012;148(3):421–33. Scholar
  65. 65.
    Howitz KT, Bitterman KJ, Cohen HY, Lamming DW, Lavu S, Wood JG, et al. Small molecule activators of sirtuins extend Saccharomyces cerevisiae lifespan. Nature. 2003;425(6954):191–6. Scholar
  66. 66.
    Knop FK, Konings E, Timmers S, Schrauwen P, Holst JJ, Blaak EE. Thirty days of resveratrol supplementation does not affect postprandial incretin hormone responses, but suppresses postprandial glucagon in obese subjects. Diabetic Med. 2013;30(10):1214–8. Scholar
  67. 67.
    Szkudelski T, Szkudelska K. Anti-diabetic effects of resveratrol. Ann N Y Acad Sci. 2011;1215:34–9. Scholar
  68. 68.
    Jain SK, Rains J, Croad J, Larson B, Jones K. Curcumin supplementation lowers TNF-alpha, IL-6, IL-8, and MCP-1 secretion in high glucose-treated cultured monocytes and blood levels of TNF-alpha, IL-6, MCP-1, glucose, and glycosylated hemoglobin in diabetic rats. Antioxid Redox Signal. 2009;11(2):241–9. Scholar
  69. 69.
    Aggarwal BB. Targeting inflammation-induced obesity and metabolic diseases by curcumin and other nutraceuticals. Annu Rev Nutr. 2010;30:173–99. Scholar
  70. 70.
    Soleimani V, Sahebkar A, Hosseinzadeh H. Turmeric (Curcuma longa) and its major constituent (curcumin) as nontoxic and safe substances: review. Phytother Res. 2018;32(6):985–95. Scholar
  71. 71.
    Ford PW, Harmon AD, Tucker AO, Sasser M, Jackoway G, Albornoz G, et al. Cinnamon—differentiation of four species by linking classical botany to an automated chromatographic authentication system. J AOAC Int. 2018. Scholar
  72. 72.
    Cheng DM, Kuhn P, Poulev A, Rojo LE, Lila MA, Raskin I. In vivo and in vitro antidiabetic effects of aqueous cinnamon extract and cinnamon polyphenol-enhanced food matrix. Food Chem. 2012;135(4):2994–3002. Scholar
  73. 73.
    Costello RB, Dwyer JT, Saldanha L, Bailey RL, Merkel J, Wambogo E. Do cinnamon supplements have a role in glycemic control in Type 2 Diabetes? A narrative review. J Acad Nutr Diet. 2016;116(11):1794–802. Scholar
  74. 74.
    Rapsomaniki E, Timmis A, George J, Pujades-Rodriguez M, Shah AD, Denaxas S, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet. 2014;383(9932):1899–911. Scholar
  75. 75.
    Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol. 2014;2(8):634–47. Scholar
  76. 76.
    Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903–13. Scholar
  77. 77.
    National Heart Foundation of Australia. Guideline for the diagnosis and management of hypertension in adults. Melbourne: National Heart Foundation of Australia; 2016.Google Scholar
  78. 78.
    Whelton Paul K, Carey Robert M, Aronow Wilbert S, Casey Donald E, Collins Karen J, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: a Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13–115. Scholar
  79. 79.
    Rosenfeldt FL, Haas SJ, Krum H, Hadj A, Ng K, Leong JY, et al. Coenzyme Q10 in the treatment of hypertension: a meta-analysis of the clinical trials. J Hum Hypertens. 2007;21:297. Scholar
  80. 80.
    Ho MJ, Li ECK, Wright JM. Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension. Cochrane Database Syst Rev. 2016. Scholar
  81. 81.
    Tabrizi R, Akbari M, Sharifi N, Lankarani KB, Moosazadeh M, Kolahdooz F, et al. The effects of coenzyme Q10 supplementation on blood pressures among patients with metabolic diseases: a systematic review and meta-analysis of randomized controlled trials. High Blood Press Cardiovasc Prev. 2018;25(1):41–50. Scholar
  82. 82.
    Ried K. Garlic lowers blood pressure in hypertensive individuals, regulates serum cholesterol, and stimulates immunity: an updated meta-analysis and review. J Nutr. 2016;146(2):389S–96S. Scholar
  83. 83.
    Rohner A, Ried K, Sobenin IA, Bucher HC, Nordmann AJ. A systematic review and metaanalysis on the effects of garlic preparations on blood pressure in individuals with hypertension. Am J Hypertens. 2014;28(3):414–23. Scholar
  84. 84.
    Xiong XJ, Wang PQ, Li SJ, Li XK, Zhang YQ, Wang J. Garlic for hypertension: a systematic review and meta-analysis of randomized controlled trials. Phytomedicine. 2015;22(3):352–61. Scholar
  85. 85.
    Siervo M, Lara J, Ogbonmwan I, Mathers JC. Inorganic nitrate and beetroot juice supplementation reduces blood pressure in adults: a systematic review and meta-analysis. J Nutr. 2013;143(6):818–26. Scholar
  86. 86.
    Bahadoran Z, Mirmiran P, Kabir A, Azizi F, Ghasemi A. The nitrate-independent blood pressure-lowering effect of beetroot juice: a systematic review and meta-analysis. Adv Nutr. 2017;8(6):830–8. Scholar
  87. 87.
    Hidaka T, Fujii K, Funahashi I, Fukutomi N, Hosoe K. Safety assessment of coenzyme Q10 (CoQ10). BioFactors. 2008;32(1–4):199–208. Scholar
  88. 88.
    Huang H, Chi H, Liao D, Zou Y. Effects of coenzyme Q(10) on cardiovascular and metabolic biomarkers in overweight and obese patients with type 2 diabetes mellitus: a pooled analysis. Diabetes Metab Syndrome Obes Targ Ther. 2018;11:875–86. Scholar
  89. 89.
    Tsai K-L, Huang Y-H, Kao C-L, Yang D-M, Lee H-C, Chou H-Y, et al. A novel mechanism of coenzyme Q10 protects against human endothelial cells from oxidative stress-induced injury by modulating NO-related pathways. J Nutr Biochem. 2012;23(5):458–68. Scholar
  90. 90.
    Amagase H. Clarifying the real bioactive constituents of garlic. J Nutr. 2006;136(3):716S–25S. Scholar
  91. 91.
    Shouk R, Abdou A, Shetty K, Sarkar D, Eid AH. Mechanisms underlying the antihypertensive effects of garlic bioactives. Nutr Res. 2014;34(2):106–15. Scholar
  92. 92.
    Ried K, Fakler P. Potential of garlic (Allium sativum) in lowering high blood pressure: mechanisms of action and clinical relevance. Integr Blood Press Control. 2014;7:71–82. Scholar
  93. 93.
    Bonilla Ocampo D, Paipilla A, Marín E, Vargas-Molina S, Petro J, Pérez-Idárraga A. Dietary nitrate from beetroot juice for hypertension: a systematic review. Biomolecules. 2018;8(4):134.CrossRefGoogle Scholar
  94. 94.
    Abdullah Shuaib M, Defina Laura F, Leonard D, Barlow Carolyn E, Radford Nina B, Willis Benjamin L, et al. Long-term association of low-density lipoprotein cholesterol with cardiovascular mortality in individuals at low 10-year risk of atherosclerotic cardiovascular disease. Circulation. 2018;138(21):2315–25. Scholar
  95. 95.
    Kannel WB, Castelli WP, Gordon T, McNamara PM. Serum cholesterol, lipoproteins, and the risk of coronary heart disease: the Framingham study. Ann Intern Med. 1971;74(1):1–12. Scholar
  96. 96.
    Neaton JD, Blackburn H, Jacobs D, Kuller L, Lee D-J, Sherwin R, et al. Serum cholesterol level and mortality findings for men screened in the multiple risk factor intervention trial. Arch Intern Med. 1992;152(7):1490–500. Scholar
  97. 97.
    Ference BA, Schunkert H, Watts GF, Borén J, Fazio S, Horton JD, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017;38(32):2459–72. Scholar
  98. 98.
    Cholesterol Treatment Trialists’ (CTT) Collaboration. Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174 000 participants in 27 randomised trials. Lancet. 2015;385(9976):1397–405. Scholar
  99. 99.
    Grundy Scott M, Stone Neil J, Bailey Alison L, Beam C, Birtcher Kim K, Blumenthal Roger S et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018.
  100. 100.
    National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk. 2012. Accessed 31 Jan 2019.
  101. 101.
    Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315–81. Scholar
  102. 102.
    Taylor BA, Thompson PD. Statin-associated muscle disease: advances in diagnosis and management. Neurotherapeutics. 2018;15(4):1006–17. Scholar
  103. 103.
    Banach M, Patti AM, Giglio RV, Cicero AFG, Atanasov AG, Bajraktari G, et al. The role of nutraceuticals in statin intolerant patients. J Am Coll Cardiol. 2018;72(1):96–118. Scholar
  104. 104.
    Sahebkar A, Saboni N, Pirro M, Banach M. Curcumin: an effective adjunct in patients with statin-associated muscle symptoms? J Cachexia Sarcopenia Muscle. 2017;8(1):19–24. Scholar
  105. 105.
    Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr. 1999;69(1):30–42. Scholar
  106. 106.
    Wei ZH, Wang H, Chen XY, Wang BS, Rong ZX, Wang BS, et al. Time- and dose-dependent effect of psyllium on serum lipids in mild-to-moderate hypercholesterolemia: a meta-analysis of controlled clinical trials. Eur J Clin Nutr. 2008;63:821. Scholar
  107. 107.
    Jovanovski E, Yashpal S, Komishon A, Zurbau A, Blanco Mejia S, Ho HVT, et al. Effect of psyllium (Plantago ovata) fiber on LDL cholesterol and alternative lipid targets, non-HDL cholesterol and apolipoprotein B: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2018;108(5):922–32. Scholar
  108. 108.
    Whitehead A, Beck EJ, Tosh S, Wolever TM. Cholesterol-lowering effects of oat β-glucan: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2014;100(6):1413–21. Scholar
  109. 109.
    Zhu X, Sun X, Wang M, Zhang C, Cao Y, Mo G, et al. Quantitative assessment of the effects of beta-glucan consumption on serum lipid profile and glucose level in hypercholesterolemic subjects. Nutr Metab Cardiovasc Dis. 2015;25(8):714–23. Scholar
  110. 110.
    Ho HVT, Sievenpiper JL, Zurbau A, Blanco Mejia S, Jovanovski E, Au-Yeung F, et al. The effect of oat β-glucan on LDL-cholesterol, non-HDLcholesterol and apoB for CVD risk reduction: a systematic review and meta-analysis of randomised-controlled trials. Br J Nutr. 2016;116(8):1369–82. Scholar
  111. 111.
    Abumweis SS, Barake R, Jones PJH. Plant sterols/stanols as cholesterol lowering agents: a meta-analysis of randomized controlled trials. Food Nutr Res. 2008;52:2. Scholar
  112. 112.
    Demonty I, Ras RT, van der Knaap HCM, Duchateau GSMJE, Meijer L, Zock PL et al. Continuous dose-response relationship of the ldl-cholesterol–lowering effect of phytosterol intake. J Nutr. 2009;139(2):271–84.
  113. 113.
    Baker WL, Baker EL, Coleman CI. The effect of plant sterols or stanols on lipid parameters in patients with type 2 diabetes: a meta-analysis. Diabetes Res Clin Pract. 2009;84(2):e33–7. Scholar
  114. 114.
    Wu T, Fu J, Yang Y, Zhang L, Han J. The effects of phytosterols/stanols on blood lipid profiles: a systematic review with meta-analysis. Asia Pac J Clin Nutr. 2009;18(2):179–86.PubMedGoogle Scholar
  115. 115.
    Ras RT, Hiemstra H, Lin Y, Vermeer MA, Duchateau GSMJE, Trautwein EA. Consumption of plant sterol-enriched foods and effects on plasma plant sterol concentrations—a meta-analysis of randomized controlled studies. Atherosclerosis. 2013;230(2):336–46.
  116. 116.
    Shaghaghi MA, Abumweis SS, Jones PJH. Cholesterol-lowering efficacy of plant sterols/stanols provided in capsule and tablet formats: results of a systematic review and meta-analysis. J Acad Nutr Diet. 2013;113(11):1494–503. Scholar
  117. 117.
    Ras RT, Geleijnse JM, Trautwein EA. LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies. Br J Nutr. 2014;112(2):214–9. Scholar
  118. 118.
    Sahebkar A. Are curcuminoids effective c-reactive protein-lowering agents in clinical practice? Evidence from a meta-analysis. Phytother Res. 2014;28(5):633–42. Scholar
  119. 119.
    Simental-Mendía LE, Pirro M, Gotto AM, Banach M, Atkin SL, Majeed M et al. Lipid-modifying activity of curcuminoids: a systematic review and meta-analysis of randomized controlled trials AU—Simental-Mendía, Luis E. Critical Reviews in Food Science and Nutrition. 2017. pp. 1–10.
  120. 120.
    Qin S, Huang L, Gong J, Shen S, Huang J, Ren H, et al. Efficacy and safety of turmeric and curcumin in lowering blood lipid levels in patients with cardiovascular risk factors: a meta-analysis of randomized controlled trials. Nutr J. 2017;16(1):68. Scholar
  121. 121.
    McRorie JW Jr. Evidence-based approach to fiber supplements and clinically meaningful health benefits, part 2: what to look for and how to recommend an effective fiber therapy. Nutr Today. 2015;50(2):90–7. Scholar
  122. 122.
    Gunness P, Gidley MJ. Mechanisms underlying the cholesterol-lowering properties of soluble dietary fibre polysaccharides. Food Funct. 2010;1(2):149–55. Scholar
  123. 123.
    McRorie JW, McKeown NM. Understanding the physics of functional fibers in the gastrointestinal tract: an evidence-based approach to resolving enduring misconceptions about insoluble and soluble fiber. J Acad Nutr Diet. 2017;117(2):251–64. Scholar
  124. 124.
    McRae MP. Dietary fiber is beneficial for the prevention of cardiovascular disease: an umbrella review of meta-analyses. J Chiropract Med. 2017;16(4):289–99. Scholar
  125. 125.
    Brum J, Ramsey D, McRorie J, Bauer B, Kopecky SL. Meta-analysis of usefulness of psyllium fiber as adjuvant antilipid therapy to enhance cholesterol lowering efficacy of statins. Am J Cardiol. 2018;122(7):1169–74. Scholar
  126. 126.
    Gylling H, Simonen P. Phytosterols, phytostanols, and lipoprotein metabolism. Nutrients. 2015;7(9):7965–77. Scholar
  127. 127.
    Baumgartner S, Ras RT, Trautwein EA, Mensink RP, Plat J. Plasma fat-soluble vitamin and carotenoid concentrations after plant sterol and plant stanol consumption: a meta-analysis of randomized controlled trials. Eur J Nutr. 2017;56(3):909–23. Scholar
  128. 128.
    AbuMweis SS, Marinangeli CPF, Frohlich J, Jones PJH. Implementing phytosterols into medical practice as a cholesterol-lowering strategy: overview of efficacy, effectiveness, and safety. Can J Cardiol. 2014;30(10):1225–32. Scholar
  129. 129.
    Racette SB, Lin X, Ma L, Ostlund JRE. Natural dietary phytosterols. J AOAC Int. 2015;98(3):679–84. Scholar
  130. 130.
    Jacobson TA, Ito MK, Maki KC, Orringer CE, Bays HE, Jones PH, et al. National lipid association recommendations for patient-centered management of dyslipidemia: part 1—full report. J Clin Lipidol. 2015;9(2):129–69. Scholar
  131. 131.
    Lloyd-Jones DM, Morris PB, Ballantyne CM, Birtcher KK, Daly DD, DePalma SM, et al. 2017 focused update of the 2016 ACC expert consensus decision pathway on the role of non-statin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: a Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol. 2017;70(14):1785–822. Scholar
  132. 132.
    National Heart Foundation of Australia. Position statement—phytosterol/stanol enriched foods. Heart Foundation. 2017.Google Scholar
  133. 133.
    Han S, Jiao J, Xu J, Zimmermann D, Actis-Goretta L, Guan L et al. Effects of plant stanol or sterol-enriched diets on lipid profiles in patients treated with statins: systematic review and meta-analysis. Sci Rep. 2016.
  134. 134.
    Zhao Y, Chen ZY. Roles of spicy foods and their bioactive compounds in management of hypercholesterolemia. J Agric Food Chem. 2018;66(33):8662–71. Scholar
  135. 135.
    Dudics S, Langan D, Meka RR, Venkatesha SH, Berman BM, Che CT, et al. Natural products for the treatment of autoimmune arthritis: their mechanisms of action, targeted delivery, and interplay with the host microbiome. Int J Mol Sci. 2018. Scholar
  136. 136.
    Gioxari A, Kaliora AC, Marantidou F, Panagiotakos DP. Intake of omega-3 polyunsaturated fatty acids in patients with rheumatoid arthritis: a systematic review and meta-analysis. Nutrition (Burbank, Los Angeles County, Calif). 2018;45(114–24):e4. Scholar
  137. 137.
    Lee YH, Bae SC, Song GG. Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: a meta-analysis. Arch Med Res. 2012;43(5):356–62. Scholar
  138. 138.
    Hill CL, March LM, Aitken D, Lester SE, Battersby R, Hynes K, et al. Fish oil in knee osteoarthritis: a randomised clinical trial of low dose versus high dose. Ann Rheum Dis. 2016;75(1):23–9. Scholar
  139. 139.
    Lev-Tzion R, Griffiths AM, Leder O, Turner D. Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn’s disease. Cochrane Database Syst Rev. 2014;2:Cd006320. Scholar
  140. 140.
    Kongtharvonskul J, Anothaisintawee T, McEvoy M, Attia J, Woratanarat P, Thakkinstian A. Efficacy and safety of glucosamine, diacerein, and NSAIDs in osteoarthritis knee: a systematic review and network meta-analysis. Eur J Med Res. 2015;20(1):2. Scholar
  141. 141.
    Ogata T, Ideno Y, Akai M, Seichi A, Hagino H, Iwaya T, et al. Effects of glucosamine in patients with osteoarthritis of the knee: a systematic review and meta-analysis. Clin Rheumatol. 2018;37(9):2479–87. Scholar
  142. 142.
    Runhaar J, Rozendaal RM, van Middelkoop M, Bijlsma HJW, Doherty M, Dziedzic KS, et al. Subgroup analyses of the effectiveness of oral glucosamine for knee and hip osteoarthritis: a systematic review and individual patient data meta-analysis from the OA trial bank. Ann Rheum Dis. 2017;76(11):1862–9. Scholar
  143. 143.
    Towheed TE, Maxwell L, Anastassiades TP, Shea B, Houpt J, Robinson V, et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev. 2005;2:Cd002946. Scholar
  144. 144.
    Singh JA, Noorbaloochi S, MacDonald R, Maxwell LJ. Chondroitin for osteoarthritis. Cochrane Database Syst Rev. 2015;1:Cd005614. Scholar
  145. 145.
    Daily JW, Yang M, Park S. Efficacy of turmeric extracts and curcumin for alleviating the symptoms of joint arthritis: a systematic review and meta-analysis of randomized clinical trials. J Med Food. 2016;19(8):717–29. Scholar
  146. 146.
    Begtrup KM, Krag AE, Hvas AM. No impact of fish oil supplements on bleeding risk: a systematic review. Dan Med J. 2017;64(5):A5366.PubMedGoogle Scholar
  147. 147.
    Villani AM, Crotty M, Cleland LG, James MJ, Fraser RJ, Cobiac L, et al. Fish oil administration in older adults: is there potential for adverse events? A systematic review of the literature. BMC Geriatr. 2013;13(1):41. Scholar
  148. 148.
    Caughey GE, Mantzioris E, Gibson RA, Cleland LG, James MJ. The effect on human tumor necrosis factor alpha and interleukin 1 beta production of diets enriched in n-3 fatty acids from vegetable oil or fish oil. Am J Clin Nutr. 1996;63(1):116–22. Scholar
  149. 149.
    Endres S, Ghorbani R, Kelley VE, Georgilis K, Lonnemann G, van der Meer JW, et al. The effect of dietary supplementation with n-3 polyunsaturated fatty acids on the synthesis of interleukin-1 and tumor necrosis factor by mononuclear cells. N Engl J Med. 1989;320(5):265–71. Scholar
  150. 150.
    Meydani SN, Endres S, Woods MM, Goldin BR, Soo C, Morrill-Labrode A, et al. Oral (n-3) fatty acid supplementation suppresses cytokine production and lymphocyte proliferation: comparison between young and older women. J Nutr. 1991;121(4):547–55. Scholar
  151. 151.
    Senftleber NK, Nielsen SM, Andersen JR, Bliddal H, Tarp S, Lauritzen L, et al. Marine oil supplements for arthritis pain: a systematic review and meta-analysis of randomized trials. Nutrients. 2017;9(1):42. Scholar
  152. 152.
    McAlindon T, Formica M, LaValley M, Lehmer M, Kabbara K. Effectiveness of glucosamine for symptoms of knee osteoarthritis: results from an internet-based randomized double-blind controlled trial. Am J Med. 2004;117(9):643–9. Scholar
  153. 153.
    Momomura R, Naito K, Igarashi M, Watari T, Terakado A, Oike S, et al. Evaluation of the effect of glucosamine administration on biomarkers of cartilage and bone metabolism in bicycle racers. Mol Med Rep. 2013;7(3):742–6. Scholar
  154. 154.
    Yoshimura M, Sakamoto K, Tsuruta A, Yamamoto T, Ishida K, Yamaguchi H, et al. Evaluation of the effect of glucosamine administration on biomarkers for cartilage and bone metabolism in soccer players. Int J Mol Med. 2009;24(4):487–94.PubMedGoogle Scholar
  155. 155.
    Kim MM, Mendis E, Rajapakse N, Kim S-K. Glucosamine sulfate promotes osteoblastic differentiation of MG-63 cells via anti-inflammatory effect. Bioorg Med Chem Lett. 2007;17(7):1938–42. Scholar
  156. 156.
    Vasiliadis HS, Tsikopoulos K. Glucosamine and chondroitin for the treatment of osteoarthritis. World J Orthoped. 2017;8(1):1–11. Scholar
  157. 157.
    Salazar J, Bello L, Chávez M, Añez R, Rojas J, Bermúdez V. Glucosamine for osteoarthritis: biological effects, clinical efficacy, and safety on glucose metabolism. Arthritis. 2014. Scholar
  158. 158.
    Bruyère O, Altman RD, Reginster J-Y. Efficacy and safety of glucosamine sulfate in the management of osteoarthritis: evidence from real-life setting trials and surveys. Semin Arthritis Rheum. 2016;45(4):S12–7. Scholar
  159. 159.
    Sahebkar A, Cicero AFG, Simental-Mendía LE, Aggarwal BB, Gupta SC. Curcumin downregulates human tumor necrosis factor-α levels: a systematic review and meta-analysis ofrandomized controlled trials. Pharmacol Res. 2016;107:234–42. Scholar
  160. 160.
    Sahebkar A, Serban M-C, Ursoniu S, Banach M. Effect of curcuminoids on oxidative stress: a systematic review and meta-analysis of randomized controlled trials. J Funct Foods. 2015;18:898–909. Scholar
  161. 161.
    Ansari RM, Omar NS. Weight loss supplements: boon or bane? MJMS. 2017;24(3):1–4. Scholar
  162. 162.
    Borghi C, Cicero AF. Nutraceuticals with a clinically detectable blood pressure-lowering effect: a review of available randomized clinical trials and their meta-analyses. Br J Clin Pharmacol. 2017;83(1):163–71. Scholar
  163. 163.
    Cicero AFG, Colletti A, Bajraktari G, et al. Lipid-lowering nutraceuticals in clinical practice: position paper from an International Lipid Expert Panel. Nut Rev. 2017;75(9):731–67.CrossRefGoogle Scholar
  164. 164.
    Yilmaz Z, Piracha F, Anderson L, Mazzola N. Supplements for diabetes mellitus: a review of the literature. J Pharm Pract. 2017;30(6):631–8. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Amanda Bergamin
    • 1
  • Evangeline Mantzioris
    • 2
  • Giordana Cross
    • 1
  • Permal Deo
    • 1
  • Sanjay Garg
    • 1
  • Alison M. Hill
    • 2
    Email author
  1. 1.School of Pharmacy and Medical SciencesUniversity of South AustraliaAdelaideAustralia
  2. 2.School of Pharmacy and Medical Sciences, Alliance for Research in Exercise, Nutrition and Activity (ARENA)University of South AustraliaAdelaideAustralia

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