Rainer Stange

In der Beratung von Patienten stellen sich sowohl wegen der Möglichkeit einer zweiten Welle sowie der Langzeitprophylaxe insbesondere für Risikopersonen für naturheilkundlich praktizierende Ärzte weiterhin zwei Fragen: Gibt es Möglichkeiten einer primären Prävention im Sinne einer Abhärtung, durch pflanzliche Immunstimulantien, Adaptogene etc.? Und kann man leichtere Infektionen durch Atemwegstherapeutika günstig beeinflussen? Dieser Artikel soll vorläufige Empfehlungen zur Phytotherapie geben. Wir sind uns sehr wohl der Problematik bewusst, dass sich diese zunächst sowohl in der präklinischen wie in der klinischen Evaluation nur an Analogiemodellen orientieren können. Verschiedene Aspekte zu präklinischen Ergebnissen waren bereits in Heft 2 / 2020 dieser Zeitschrift vorgestellt worden [1]. Wir schließen mit einem Ausblick auf die Möglichkeiten und Schwierigkeiten prospektiver klinischer Forschung mit Phytopharmaka. For doctors and pharmacists involved in phytotherapy, two questions will stay for an indefinite time especially in individual counselling. 1. Is there a possibility of primary prevention especially for people at high risk for infection, e.g. through herbal immunostimulants and adaptogens? 2. Can the course of an infection favourably be influenced by herbal agents with known beneficial effects on the respiratory system or even intrinsic antiviral properties? The objective of this article is to provide preliminary recommendations for the use of phytotherapy. The authors are aware of the limitations of these recommendations. At this time, they can only be based on analogy models in both preclinical and clinical evaluation. Several aspects of preclinical results were already presented in issue 2-2020 of this journal [1]. This article here concludes with a perspective on chances and limitations of prospective clinical research with phytodrugs. Received: 06 July 2020 Accepted: 21 July 2020 Publication Date: 01 September 2020 (online) © Georg Thieme Verlag KG Stuttgart · New York

Background/Objectives Metabolism is controlled by macro- and micronutrients. Protein-rich diets should lead to latent acidosis at tissue level with further negative implications. Food supplements with alkaline salts are available and popular pretending to prevent these changes. Subjects/Methods Within a randomised double-blind placebo-controlled trial we tested the hypotheses that (1) a 4-week protein-rich diet induces a latent tissue acidosis and (2) an alkaline supplement can compensate this. Acid–base balance and important metabolic parameters were determined before and after 4 weeks of supplementation by peripheral blood samples, indirect calorimetry and muscle microdialysis before and after a protein-rich test meal. Results Fourty volunteers were randomised 1:1 to either verum or placebo supplements. Protein-rich diet by itself did not significantly affect acid–base balance. Alkaline supplementation increased plasma bicarbonate concentration without changing pH. Postprandial increases in serum glucose and insulin tended to be lower for verum vs. placebo. Resting and postprandial energy metabolism, and carbohydrate and fat oxidation did not differ significantly before and after supplementation in both groups. In muscle, postprandial glucose uptake and aerobic glucose oxidation were significantly higher for verum. In addition, verum significantly increased serum magnesium concentrations. Conclusions Four weeks of protein-rich diet did not significantly influence acid–base balance. However, alkaline supplementation improved systemic and tissue acid–base parameters and oxidative glucose metabolism.

Background/aim Medically supervised fasting has long tradition and broad acceptance in some European countries. The exact amount to which ketone bodies are produced as well as their possible contribution to beneficial effects in this procedure are open. Methods Open-label observational trial with in-patients undergoing medically supervised fasting with supplementation of approximately 40 g/d carbohydrates as part of an established routine care. Daily finger-stick blood samples for measurement of glucose and ß-hydroxybutyrate. Descriptive analysis for all data. Results Complete sets of data of 17 patients (5 m, mean age 63.1) could be evaluated. Mean concentrations of ß-hydroxybutyrate rose continuously to a mean maximum of 3.6 mmol/L with an individual maximum of 5.1 mmol/L, while glucose decreased within normal range. Two patients with type 2 diabetes produced significantly less ß-hydroxybutyrate. Courses for ß-hydroxybutyrate and glucose showed a weak inverse correlation, while no serious adverse effects could be observed. Conclusion Medically supervised fasting with definite small amounts of carbohydrates by fluid intake may lead to limited increases of ketone bodies in their biopositive range, as known e.g. from epileptology or sports medicine. Clinical consequences deserve further research.

Zusammenfassung: Eine den CKD-Krankheitsstadien (CKD: chronic kidney disease, chronische Niereninsuffizienz) angepasste Ernährung kann das dialysefreie Intervall und die Lebensqualität günstig beeinflussen. Da der Ruheenergieumsatz der Nieren circa 7 % beträgt, sollte die Proteinzufuhr zwischen 6 und 8 g/d kg KG betragen. Ein prognostisch ungünstiger Faktor sind auch die Störungen im Säure-Basen-Haushalt, die zum Beispiel durch Gabe von basischen Salzen ausgeglichen werden sollten. Eine Kochsalzzufuhr von weniger als 5,5 g/d kann den Blutdruck und die Osteoporose günstig beeinflussen. Auf die Progression können sich auch L-Arginin, Omega-3-Fettsäuren und Folsäure auswirken. Regelmäßige Ernährungsberatungen und Kontrollen sind empfehlenswert.

Die Blätter des Maulbeerbaumes (verschiedene Morus-Species) werden Berichten zufolge in Asien bei allerlei Erkrankungen verwendet, darunter bei auffälligen Blutzuckerwerten. Tier- und Humanstudien mit Blattextrakten konnten gewisse Wirkungen bei diabetischer Stoffwechsellage zeigen. Eine US-amerikanische Pilotstudie untersuchte nun die hypoglykämische Wirkung sowie Sicherheit eines Blattextrakts bei Typ-2-Diabetikern.

Der diesjährige nationale Kongress der GPT fand vom 28. bis 30.9.2017 unter dem Motto „Von der Innovation zur Evidenz“ im PharmaCampus (Institut für Pharmazeutische Biologie und Phytochemie) der Westfälischen Wilhelms-Universität Münster statt.

Functional dyspepsia (FD) is a gastrointestinal disorder characterized by recurrent and diverse symptoms and pathophysiology that remains unexplained following routine clinical investigation. Enzynorm®f is a pharmaceutical preparation comprising fixed amounts of pepsin of biological origin and organically bound acid in the form of amino acid hydrochloride. It is traditionally used as a mild agent to support gastric function and to stimulate the stomach’s proteolytic activities in FD. In a non-interventional, observational, post-marketing surveillance study, patients with an established diagnosis of FD were treated with a fixed combination of pepsin and amino acid hydrochloride taken as tablets three times daily for 6 weeks. The primary objective of this study was to assess the change in symptoms using the validated Gastrointestinal Symptom Score (GIS©). Secondary objectives included patients’ assessment of their gastrointestinal symptoms as well as treatment safety and tolerability. A total of 97 patients (mean age 58.4 ± 13.9 years; 63.2% females) were included in the study, with 72 data having GIS© score data at baseline and at 6 weeks, and 34 also at 3 weeks. The overall GIS© sum score decreased by 4.1 (p < 0.0001) from 11.6 (±4.8) at baseline to 7.4 (± 4.6) reflecting an improvement of clinical symptomatology after 6 weeks of treatment. In a subgroup of 70 patients who had FD meeting the Rome III criteria a GIS© score reduction of ≥50% was observed after 3 weeks treatment in 24% and in 30.8% after 6 weeks. Adverse events were mostly gastrointestinal in nature and consistent with the underlying disease; no unexpected adverse reactions were reported. Twenty-seven patients discontinued the study, mostly because of gastrointestinal symptoms. The results of this study support the efficacy of a fixed combination of pepsin and amino acid hydrochloride for the treatment of patients with FD and also suggest good to moderate treatment tolerability. These findings should be further explored in a randomised, placebo-controlled clinical trial. This study has been retrospectively registered in the ClinicalTrials.gov registry, trial identifier NCT03076411 .