The age of personalized medicine has arrived. Thanks to information provided by various “omics� we will be able, very soon, to sketch person’s predisposition to the particular disease, choose the best therapy in case of disease, design the best diet and exercise program to improve the health. Yet, in contrast to pharmacogenomics, nutrigenomics is much more complex; in case of particular therapy we are dealing with one, two or maximum several drugs, but in case of prescribing the best diet to someone we are dealing with more than 25000 active compounds present in food. Each of them has particular effect on one biological process, or pathway, but furthermore, their combination in different ratios make the situation even more complex. However, the data which will be obtained from nutrigenomics will provide possibility to understand and to predict individual reaction to particular nutrient. It promises us a huge improvement in prevention of disease, general health and life quality overall. Some people, due to a genetic predisposition suffer undesirable reactions to particular nutrient not knowing that cause of his/her problem lays in bananas, peanuts or sunflower oil. On the other hand, combination of particular drug in combination with particular nutrient (e.g. Herceptin and dietary fish oil, statins and artichoke extract) can significantly improve the desirable therapy effects. However, huge challenges stand in front of us: when to start the particular diet, are the children target population, how to combine drugs and particular nutrients, in positive and negative way. This is why, nutrigenomics becomes of a great interest not only for the clinicians and nutritionists, but also for food and pharmaceutical industries, pharmacologists, and clinical pharmacists. Yet, the age of personalized medicine brought numerous challenges in legislation and ethics, as well as in public information and education. In my lecture I will point out current status in nutrigenomics, prospects for future and conceivable obstacles as well as the impact on the society.
The microbial communities that reside in the human gut and their impact on human health and disease are one of the most exciting new areas of research today. Diet is a key player when it comes to preserving our gastrointestinal health, since through eating and digesting we nourish our gut microbiota, and in this way influence its diversity and composition. Although a disrupted microbial equilibrium can have many causes (e.g. infectious pathogens and/or use of antibiotics) the role of our daily food and lifestyle is crucial. Thus, the maintenance of our gastrointestinal health is to a considerable extent in our own hands. When microbiota balance is disturbed, it might result in a number of disorders, including functional bowel disorders, inflammatory bowel diseases and other immune mediated diseases, such as celiac disease and certain allergies. Also, metabolic conditions, such as type 2 diabetes, and recently even behavioral disorders, such as autism and depression, were reported to be linked to gut microbial imbalances. Excess sugary and salty snacks, foods with high amounts of animal fat, as well as greasy and fried foods is not recommended, while a diet rich in olive oil, vegetables, salads and fruits, rich sources of bio- and polyphenols has proven to be beneficial to maintain the health. The same applies to fermented dairy products containing pro- and prebiotics. Probiotics are defined by the World Health Organization (WHO) and the United Nations’ Food and Agriculture Organization (FAO) as live organisms which, when ingested in adequate amounts, confer a health effect on the host. Probiotic as supplementation may change the microbiota of the digestive tract and modulate the immune defenses and nutritional performance. Additionally, probiotics and prebiotics (mainly, indigestible food ingredients that stimulate the growth and maintenance of beneficial gut microbiota) as supplementation, may strengthen the immune system by stimulating immune mechanisms inside and outside the gut, helping to regulate the gut motility, and acting as antiinflammatory compounds in the gut, with an impact beyond the gut itself. A generally important ability of probiotics that affects various digestive disorders consists in improving the gut's microbial composition and preserving its stability. Recent findings on how diet and dietary supplements (probiotics, prebiotics and vitamins) support the health of our microbiota will be presented.
Professional athletes and recreation enthusiasts are constantly looking for new means to help them achieve better sports results in the shortest possible time. They reach for products that they think can increase their endurance, strength or ability to adapt to training. These products can be divided into several categories. Ergogenic aids improve the physical abilities of athletes, while adaptogens increase the body's ability to adapt to the environment or to avoid the negative effects of environmental factors. In some sports, such as dance, slimming agents are also used. Plants produce unique secondary metabolites that can show different biological activities in human body. Some of them show a strong stimulating effect and, consequently, improve athletic performance. However, the use of certain herbal substances is prohibited by law because of the dangerous side effects that they can produce. On the other hand, manufacturers of products with negligible activity often provide claims of efficacy that are neither scientifically valid nor proven. Furthermore, nutritional supplements sometimes contain undeclared ingredients that may be prohibited for use in sport or harmful to health. All of this implicates a need for scientific testing of dietary supplements for athletes on human subjects, as well as a need for more rigorous analytical control of the products themselves.
Croatia is nowadays affected by the financial crisis which also reflects on the pharmaceutical market, bringing numerous restrictive measures in force. Health care system is under continuous pressure, available health care funds are limited while demographic changes and increased incidence of chronic diseases stand as the challenge for Health care system in Croatia. Within such changes, self-medication should become an important issue and efficient way of improving public health and preventing diseases. The Croatian Association of Self-Medication Industry, HUPBR/CASI (hereinafter "CASI"), was established in 2010 as an association of manufacturers and agents of OTC products, aiming to represent the interests and rights of its members and improving the competitive and transparent market race. With its 23 member companies, CASI represents 85% of the Croatian self-medication market. By its activities, CASI promotes safe and efficient selfmedication and improvement of health. The total value of OTC market in Croatia in 2013, calculated on the basis of wholesaling prices, was 103 million euros, representing approximately 11% of the total pharmaceutical market value. Compared to the previous year data, there is an increase of 4.7%. OTC medications consumption per capita in Western European countries reaches â‚Ź69 per year, while in Central and Eastern Europe it is â‚Ź44. Croatia is at the very bottom of the European scale with its average yearly consumption of only â‚Ź20 per capita. Results of the GfK agency survey carried out in 2011 show that the general population in Croatia chooses to solve minor ailments by using "natural methods" for self-curing and see their doctor after 3-5 days if the symptoms persist. As much as 30-50% of patients visiting physician finally get the prescription medicine. Physicians estimate that patients with minor ailments make even 20-30% of all patients seen within one month. In general, physicians agree that pharmacists could take care of such patients as competent as they do. The results of the aforesaid survey also show that pharmacists are considered as an important link in the process of self-medication and even half of them admit that time set aside to advise patients is insufficient. The general population expects more pharmacy consulting services compared to what they get now.
CASI considers that the solution should be found in the concept of self-medication:
Each individual takes responsibility of its own health and consults pharmacist as the first line health care professional for common health issues.
Pharmacist takes an active role in individual’s health care and holds a key role in responsible self-medication and improvement of health.
Physician has a positive attitude on responsible self-medication and show confidence in pharmacists’ expertise.
Focused cooperation of all stakeholders should result in improved health and life quality of the population with fewer visits to general practitioners related to common health issues.
Herbal medicinal products (HMP) have been commonly used over the years for treatment and prevention of diseases and health promotion as well as a mean to enhance the span and quality of life. The holistic approach to health care makes HMP very attractive to many people, but it also makes pharmacy practice very challenging due to the lack of scientific evidence about their quality, safety and efficacy. On the other hand, pharmacists are ethically and legally bound to provide their patients guidance in the appropriate and safe use of HMP and to warn them which products to avoid. Although all HMP, which include botanical dietary supplements, should be well characterized and produced to the same quality standards as drugs, the situation in practice is very different from that of conventional drugs. Many patients actually think they are taking something that is rigorously tested and regulated by national agencies, but in fact some HMP have been reported to have serious issues with contaminants. Even though HMP are available without a prescription, medical guidance is necessary because of potential for contraindications, adverse effects and herb-drug interactions. Many physicians do not ask patients about HMP and patients are also not disclosing the consumption of these products. Therefore, pharmacists should take the initiative in creating opportunities to discuss herbal medicinal products with patients. Special attention should be given to pregnant women, children, elderly people and patients with chronic medical conditions.
Diabetes is the most common metabolic disease and is a major global public health problem. The prevalence of diabetes is increasing in all age groups. According to the World Health Organization approximately 350 million people worldwide suffer from diabetes. It is estimated that the mortality rate will double by 2030. Type 2 diabetes affects 90% diabetics and is largely the result of excess body weight and physical inactivity. The goal of treatment is to lower blood glucose levels and eliminate symptoms related to hyperglycemia and to prevent the development of acute complications. Having in mind the growing prevalence of diabetes as well as increasing popularity of traditional herbal medicine, the aim of this research was to collect the data on traditional herbal products used in the management of diabetes. In this study 17 herbalists from 14 markets in 6 cities were interviewed. For diabetes management, 25 plants were employed, most often in herbal mixtures. Sting nettle (Urtica dioica), sold either as leaf or root, was the most often used plant, followed by white beans (Phaseolus vulgaris), bilberry leaf (Vaccinium myrtillus). The results of this study show that Croatian herbal tradition offers knowledge of plants potentially useful for diabetes management.
Education of consumers and thereby patients is an important step towards recognizing marketing tricks and incorrect information which make a kind of food better than another kind in a sense that a certain kind of food may be regarded as medicinal. Even Hippocrates contributed to the spreading of the idea of using food as a medication by saying: „Let food be thy medicine and medicine be thy food“. However, nowadays it is known that treatment by food consumption, especially functional food, may be a double-edged sword and can take up time crucial for classic treatment. If a certain illness is connected with patient's eating habits, doctors should point it out to the patient. Furthermore, people should monitor side-effects during food consumption and the interference with drugs of different kind of food, especially functional food. Apart from negative effects of food supplements and diet products (functional food), people should pay attention when consuming new types of food, as well as food which we know from experience can cause negative effects on the human organism. The system is similar to pharmacovigilance as well as cosmetovigilance, which is based on gathering data concerning possible negative effect of drugs and cosmetics. Some countries already effectively monitor negative effects of different types of food such as France (nutrivigilace) and Italy (phytovigilance). Another project is being prepared by the Czechs, who base their communication on a webapplication. The application is aimed towards consumers and professionals dealing with food. Their goal is to gather data concerning the effect of certain kinds of food and to act preventively, not only in order to protect health, but also to form a unique system in the EU.
Pharmacists play a key role in self-care. Self-treatment or self-medication is the oldest form of treatment where the patient has a significantly more active role, faster and easier access to drugs that can be safely taken without medical supervision. Products include OTC (over the counter) medicines obtained without prescription for self-medication, dietary supplements, dermocosmetic products, including the increasingly popular herbal remedies, essential and vegetable oils, homeopathic remedies and others. How will the patient take the medicine and which medicine will be applied, depends on the information offered by the pharmacist. Pharmacists, through their advice and knowledge, provide an understanding of the drug and its effects, possible side effects, contraindications and interactions. The biggest impact on patients comes from media advertising. It is essential in these circumstances that the pharmacists posses the necessary knowledge and competence to educate and advise patients. Therefore, pharmacists, as the most accessible health care professionals with their advisory role, can contribute to the success of treatment. Evidence suggests that pharmacists’ interventions can reduce the burden on other services in primary care to 29% and 25% on the entire healthcare system. The role of pharmacists in patient safety is to correctly advise the patient, especially when there is a risk of possible contraindications or interactions between prescribed therapy and medications used in self-medication therapy. It is necessary to encourage patients to use the drug properly and to follow the instructions that are given because the drug can help only if used as intended. Improper use of therapy doesn’t cure and it can prolong the disease. There are frequent side effects that result from improper use of the drug. Every patient who collects the medicine from the pharmacy needs to know what he/she takes and why, the length of time medication should be taken for, the time between the dosages, possible interactions, contraindications and possible side effects. If this was not explained to the patient properly, it is unlikely that the therapy will be used well, because it is necessary to encourage patients to comply and communicate. According to the World Health Organization, the cost of side effects, including hospitalization, surgery and lost productivity due to misuse of medications, in some countries, exceeds the cost of medicines. Counseling and communication in day to day work can be difficult, due to the presence of a large number of people, patients are often embarrassed to talk about their problem and there is not enough time for quality discussion ... So in pharmacies there are special rooms where patients can discuss their needs in private. During private discussions it
is essential that the pharmacist is smart in appearance, confident and posses great communicational skills. With appropriate advice from a healthcare professional, selfmedication can have a significant impact on the improvement of symptoms for various health problems.