Dr. Bobby V. Khan, M.D., Ph.D.
Cardiologist
Both drugs and nutritional supplements have long been used to improve health and the quality of life. But the traditional delivery of these products—normally in the form or tablets or injectables—can be very difficult and inconvenient for many people. The practice of drug delivery has changed dramatically in the last few decades and even greater changes are anticipated in the near future. Biomedical engineers are exploring and doing excellent research. They have not only contributed substantially to our understanding of needing more efficient product delivery—and they are working on the development of a number of new delivery modes that have entered clinical practice.
Yet, when taking a pill or an injection, even with the most advanced techniques, many medications have unacceptable side effects due to the drug interacting with parts of the body that are not the target of the drug. Side effects limit our ability to design optimal therapies for the management of many diseases such as cancer, cardiovascular diseases, and diabetes mellitus.
Product delivery systems control the rate at which a drug is released and the location in the body where it is released. Some systems can control both.
Clinicians historically have attempted to direct their interventions to areas of disease or areas at risk for disease. Depending on the medication, the way it is delivered, and how our bodies respond, side effects sometimes occur. These side effects can vary greatly from person to person in type and severity. For example, a tablet given for seasonal allergies may cause unwanted drowsiness or an upset stomach.
Administering products by alternative methods are good options to decrease side effects and drug toxicity while maximizing a treatment’s impact. For example, a topical (used on the skin) antibacterial ointment for a localized infection or a cortisone injection of a painful joint can avoid some of the systemic side effects of these medications. There are other ways to achieve targeted product delivery, but some therapies can only be given systemically.
Drugs and nutritional supplements can be taken in a variety of ways—by mouth, by inhalation, by absorption through the skin, or by injection. Each method has advantages and disadvantages, and not all methods can be used for every medication. Improving current delivery methods or designing new ones can enhance the use of existing products. Going forward, we must seriously consider factors such as mode of delivery, which may affect treatment adherence, especially in a disease with serious consequences should exacerbations occur.
A primary reason for finding the right carrier for products helps to ensure they arrive at their destination intact. Beyond broadening treatment options, targeted vehicles for drug delivery may also help to address multi-drug resistant diseases. At this moment, researchers in the drug delivery field are also exploring the use of genes, proteins, and stem cells as treatments. Working backwards on a problem can sometimes reveal a solution. In drug delivery research, this means starting with a delivery method that has a known target, which may be whole organs (heart, lung, brain), tissue types (muscle, nerve), disease-specific structures (tumor cells), or structures inside of cells.
Searching for a nutritional supplement or supplements these days can be a daunting task and it’s easy to become overwhelmed by the number of products available and their accompanying claims. When it comes to your health though, it’s vital to research the differences among the supplements you are considering in order to make a wise, informed decision. There are several ways nutrients are able to get into the bloodstream including: injection, ingestion, through the skin, and by suppositories (1).
As with just about everything, there are pros and cons regarding the best form to consume in addition to other considerations. Most people, especially the elderly and young children, tend to have more difficulty swallowing a handful of pills in order to get the complete range of nutrients needed by the body. Other factors to consider are the speed and ease that a compound or medication can be absorbed and utilized by the body. Generally, supplements in different forms are much more readily broken down and absorbed.
It’s also important to consider that contain synthetic chemical nutrients are bad in almost any form of delivery. Synthetic chemical nutrients are simply ingredients that do not occur in foods naturally. They are formulated in a lab, and do not contain the same molecular structures that occur in nature. Many of these synthetics are made from coal tar and can cause drug-like and potentially somewhat toxic reactions in the body.
Moreover, it has been demonstrated that no more 10%-20% of the nutrients in pills actually are absorbed by the body. The National Advisory Board states that 100 mg consumed in tablet form translates into a concentration of only 8.3% in the blood (2). This results in far less absorption for the money. Additionally, a separate pilot study evaluating the bioavailability and absorption rates of two vitamin B-12 preparations in normal human subjects, demonstrated that absorption rate was significantly increased when dosing was in a form other than a tablet or capsule (3). This is likely due to the plethora of synthetic chemical nutrients, excipients, flow agents, binders, fillers, and coatings.
There are exceptions to every rule however. Large variations in quality exist, and some companies put much effort into their delivery forms. These nutraceuticals are manufactured with great care and use very expensive all natural, potent ingredients and excipients.
While nutritional supplements delivered in forms other than tablets/capsules have their advantages, they are not perfect. For example, liquid supplements may have a shorter expiration date than pills or capsules. Now there are many liquid multivitamins that are stable and can hold their potency for years if combined and processed properly. Pills and capsules, on the other hand tend to have a long shelf life and stability, and stores may hold onto their supplies long after they begin to lose their potency.
Liquids are more suitable for combining many different nutrients into one complete product. Pills and capsules may be lacking in quality vitamins and minerals, fruit and vegetable extracts, omega 3 fatty acids, CoQ10, plant enzymes, organic trace minerals and microcomplexes, antioxidant blends, or herbal adaptogens and are less costly due to inexpensive binders and fillers. Therefore, in order to get complete nutrition, megadoses of many different pills are necessary. These megadoses can lead to toxicity and an overburden on the digestive system, kidneys and liver. Even buffered pills, although they reduce nausea to an extent, slow down the absorption of nutrients.
Binders and fillers used in discounted mass-volume supplements, such as dibasic calcium phosphate (DCP) and microcrystalline cellulose (MCC), cannot be broken down by the body, so they may pass right through along with the beneficial nutrients (4).
With the knowledge and understanding that people desire natural products for issues of safety, efficacy, and convenience, good delivery forms must be considered. Tablets and capsules, long the mainstay of product delivery, have their limitations. Exploring alternative systems provide appropriate methods to deliver a high quality product with efficiency and safety.
1) M Roth. Chiropractic Economic 6/2008.
2) PH Bennett, S Haffner, BL Kasiske, WF Keane, CE, National Advisory Board, – Am J Kidney Dis, 1995
3) Preliminary Study Study #HPI-NF-B12-1 October 15, 2004 Sponsor: Health Plus International, Inc. Herbert V. Vitamin B-12 in Present Knowledge in Nutrition. 17th ed. Washington, D.C
