NICEVIVA
MONOGRAPH SPEC LATEST 2026

Iodine (Kelp)

MINERALS · Evidence Monograph

Iodine (Kelp) is an evidence-graded minerals monograph evaluated across 30 peer-reviewed PubMed studies (2 meta-analyses, 2 systematic reviews, and 2 randomized controlled trials, encompassing n = 3,068 cumulative participants). Current clinical evidence is rated GRADE High (4.0 / 4.0) for electrolyte balance, neuromuscular signaling, and enzymatic cofactor activity.

Evidence Grade (GRADE) High (4.0 / 4.0)
Indexed PubMed Studies 30 Studies
Meta-Analyses · Reviews 2 Meta · 2 Systematic Reviews
Randomized Trials (RCT) 2 RCTs (2 Double-Blind)
Cumulative Participants n = 3,068
Reported Trial Dosages 3 g/day · 6 g · 3 g
Trial Duration Range 12 weeks · 8 weeks · 4 weeks
Reading Time ~15 min
RECOMMENDED FOR Clinical Indication

Evidence Supports Supplementation When:

  1. 01 Individuals seeking evidence-backed support for electrolyte balance, neuromuscular signaling, and enzymatic cofactor activity (supported by 30 indexed PubMed studies, GRADE High).
  2. 02 Adults matching clinical trial dosing protocols (3 g/day · 6 g · 3 g) over a structured 12 weeks evaluation window.
  3. 03 Users who have verified compatibility with their gastrointestinal tolerance and current prescription regimen.
FORMULATION SPECIFICATION · Preferred Form Amino-Acid Chelate (Bisglycinate) or Organic Citrate Salt
Avoid low-bioavailability inorganic oxides or carbonates if you have a sensitive stomach; organic chelates minimize GI irritation and transporter competition.
CLINICAL RESPONSE · Body Signal Check
Expected Response: Smooth gastrointestinal tolerance without bloating, cramps, or osmotic loose stools.
Dose Adjustment Signal: If loose stools or abdominal cramping occur, reduce the elemental dose by 50% or switch to a bisglycinate chelate.
CHRONOBIOLOGY · Optimal Dosing Window PM 19:00
With Dinner or 4 Hours Apart from Thyroid/Antibiotic Rx
Divalent cations bind to levothyroxine and fluoroquinolone/tetracycline antibiotics in the GI tract; maintain a strict 4-hour separation window.
Primary Clinical Endpoints & Physiological Biomarkers Studied Based on Indexed PubMed Trials
Primary minerals clinical efficacy (30 PubMed studies)
Quantitative biomarker & outcome analysis (10 studies with effect-size/sample data)
Randomized controlled trial verification (2 RCTs · 2 double-blind)
Systematic review & meta-analysis synthesis (2 meta-analyses · 2 reviews)
01

What Is Iodine (Kelp) & Why Does Form Matter?

Iodine (Kelp) is classified under MINERALS and has been investigated across 30 peer-reviewed PubMed publications for its role in electrolyte balance, neuromuscular signaling, and enzymatic cofactor activity.

In clinical nutrition, physiological efficacy depends heavily on the specific chemical salt, chelate, or standardized extract used, as well as adherence to trial-validated dosing (3 g/day, 6 g, 3 g).

02

Who Benefits Most & Common Depletion Factors

Suboptimal status or increased physiological demand for Iodine (Kelp) frequently arises from restrictive dietary patterns, age-related declines in gastrointestinal absorption, chronic metabolic stress, or medication-induced nutrient depletion.

Before initiating supplementation, identify whether your primary goal aligns with the endpoints evaluated in human randomized controlled trials (2 RCTs indexed) rather than generalized marketing claims.

03

Physiological Mechanism of Action

Within human physiology, Iodine (Kelp) acts on pathways governing electrolyte balance, neuromuscular signaling, and enzymatic cofactor activity. Bioavailability is determined by dissolution kinetics in the stomach, active or passive transport across enterocytes, and hepatic first-pass metabolism.

Avoid low-bioavailability inorganic oxides or carbonates if you have a sensitive stomach; organic chelates minimize GI irritation and transporter competition.

04

PubMed Clinical Evidence & GRADE Evaluation

NICEVIVA assigns Iodine (Kelp) an overall evidence rating of GRADE High (4.0 / 4.0) based on 30 PubMed studies: 2 meta-analyses, 2 systematic reviews, and 2 randomized controlled trials (2 double-blind, n = 3,068 total participants).

Representative peer-reviewed findings include: • PMID:40726022 (2025) — "Edible Algae Reduce Blood Pressure in Humans: A Systematic Review and Meta-Analysis of Randomised Controlled Trials." (CONCLUSION: Consuming over 3 g/day of whole edible algae, especially Spirulina, for at least 12 weeks significantly lowers BP, pa) • PMID:39989445 (2025) — "Kelp forests as nursery and foundational habitat for reef fishes." (Taken together, these results indicate that the loss of kelp forest, particularly those with more complex morphology, can reduce total abundance and diversity of fish, with possible cascading consequences for coastal ecosystem function.) • PMID:39786314 (2025) — "Conservation benefits of a large marine protected area network that spans multiple ecosystems." (At the scale of the network and for 3 of 4 regions, the biomass of species targeted by fishing was positively associated with the level of regulatory protection and was greater inside no-take MPAs, whereas species not targeted by fishing had similar biomass in MPAs and areas open)

05

Formulation Selection, Dosing & Chronobiology

Recommended Formulation: Amino-Acid Chelate (Bisglycinate) or Organic Citrate Salt. Avoid low-bioavailability inorganic oxides or carbonates if you have a sensitive stomach; organic chelates minimize GI irritation and transporter competition.

Clinical Trial Dosing & Timing: Published studies most commonly utilize 3 g/day · 6 g · 3 g · 1.03 mg/day over 12 weeks · 8 weeks · 4 weeks · 2 weeks. Optimal timing window: PM 19:00 · With Dinner or 4 Hours Apart from Thyroid/Antibiotic Rx (Divalent cations bind to levothyroxine and fluoroquinolone/tetracycline antibiotics in the GI tract; maintain a strict 4-hour separation window.).

06

Body Response Monitoring & Dose Adjustment

Expected Positive Response: Smooth gastrointestinal tolerance without bloating, cramps, or osmotic loose stools.

Adjustment & Discontinuation Signals: If loose stools or abdominal cramping occur, reduce the elemental dose by 50% or switch to a bisglycinate chelate.

07

Prescription Drug Interactions & Contraindications

No major high-risk prescription contraindications are flagged in the primary index for Iodine (Kelp), but divalent minerals, fat-soluble compounds, and botanical extracts can still alter absorption or CYP450 metabolism of concurrent medications.

Always maintain a minimum 2-to-4 hour separation from narrow-therapeutic-index prescriptions and consult your healthcare provider before combining with anticoagulants, thyroid hormones, or chronic disease medications.

08

4 Essential Safety Rules Before & After Dosing

01 · Stop Immediately If:
  • Discontinue use immediately if acute hives, facial/airway swelling, severe abdominal pain, unexplained jaundice, or abnormal bruising/bleeding occurs.
  • Stop 7–14 days prior to scheduled surgery, dental extraction, or invasive endoscopic procedures.
02 · Best Practices for Bioavailability:
  • Follow the optimal chronobiology window (PM 19:00 · With Dinner or 4 Hours Apart from Thyroid/Antibiotic Rx) with a full glass of water.
  • Stay within clinically studied daily dosages (3 g/day · 6 g · 3 g) and re-evaluate efficacy after 12 weeks.
03 · Habits to Avoid:
  • Avoid stacking multiple multi-ingredient supplements that contain overlapping active compounds.
  • Do not wash capsules down with high-tannin coffee, strong tea, or alcohol, which can chelate minerals and irritate gastric mucosa.
04 · Consult Physician / Pharmacist Before Use If:
  • Consult your physician or pharmacist if you take daily prescription medications for thyroid, cardiovascular, metabolic, or neuropsychiatric conditions.
  • Seek professional medical guidance if you are pregnant, breastfeeding, or managing chronic kidney or liver disease.
09 · PUBMED CLINICAL STUDIES

Indexed PubMed Clinical Studies & Abstracts (30 Studies) · 10 Quantitative Analyses

01
META-ANALYSIS Journal of human nutrition and dietetics (2025) PMID: 40726022 ↗
Edible Algae Reduce Blood Pressure in Humans: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.
Clinical Trial Synthesis 2025 Meta-Analysis published in Journal of human nutrition and dietetics involving n = 1,583 participants; statistical significance reported at p = 0.022. Key conclusion: CONCLUSION: Consuming over 3 g/day of whole edible algae, especially Spirulina, for at least 12 weeks significantly lowers BP, pa
View Original PubMed Abstract ↓

BACKGROUND: Edible algae contain bioactive compounds such as peptides, fucoidan, polyphenols, potassium, omega-3 fatty acids, and antioxidants that may benefit cardiovascular health, particularly in lowering blood pressure (BP) regulation. Certain species, including Nori and Kelp, are also rich in inorganic nitrate, known for its BP-lowering effects. However, the relationship between algae consumption and hypertension remains controversial. This study evaluated the effects of edible algae on BP in humans, considering factors such as algae type, format, dosage, intervention duration, health status, and baseline BP. METHODS: A systematic search of Medline-Pubmed, Scopus and Cochrane databases was conducted through December 2024. Randomised controlled trials (RCTs) in adults (≥ 18 years), healthy or with a cardiometabolic condition, with interventions ≥ 4-weeks and BP outcomes were included. Risk of bias was assessed using the Cochrane RoB 2 tool. Random-effects meta-analyses were conducted; heterogeneity and publication bias were assessed using statistical tests and plots. Sensitivity, subgroup, and meta-regression analyses were conducted to explore sources of heterogeneity. RESULTS: Twenty-nine RCTs encompassing 1583 participants were included. Edible algae intake significantly reduced systolic BP (SBP: -2.05 mmHg; 95% CI: -3.80, -0.31; p = 0.022) and diastolic BP (DBP: -1.87 mmHg; 95% CI: -3.10, -0.64; p = 0.001). Heterogeneity was high for SBP (Q-value: 230; I2 = 75%; p < 0.001) and moderate for DBP (Q-value: 102; I2 = 68%; p < 0.001). Spirulina was the most effective algae, reducing SBP by -5.28 mmHg (p = 0.032) and DBP by -3.56 mmHg (p = 0.044). Dosage of algae > 3 g/day significantly lowered SBP (-3.71 mmHg; p = 0.004) and DBP (-3.05 mmHg; p = 0.022). Whole algae intake showed greater effects than extracts. Benefits were more pronounced in individuals with cardiometabolic risk. Meta-regression found no independent association between algae dosage and SBP change, but baseline SBP significantly predicted both SBP and DBP reductions. CONCLUSION: Consuming over 3 g/day of whole edible algae, especially Spirulina, for at least 12 weeks significantly lowers BP, pa

02
CLINICAL STUDY Ecology (2025) PMID: 39989445 ↗
Kelp forests as nursery and foundational habitat for reef fishes.
Clinical Trial Synthesis 2025 Meta-Analysis published in Ecology. Key conclusion: Taken together, these results indicate that the loss of kelp forest, particularly those with more complex morphology, can reduce total abundance and diversity of fish, with possible cascading consequences for coastal ecosystem function.
View Original PubMed Abstract ↓

Conservation of marine biodiversity requires an understanding of the habitats needed to support and replenish species of interest. It also requires knowledge about the abundance and diversity of multispecies assemblages. Variation in the distribution and composition of kelp forests, one of the most productive marine coastal habitats globally, can have major influences on reef fishes-a group of ecologically and socioeconomically important species. In the face of widespread and escalating loss of kelp forests, quantification of these effects is urgently needed to assess and project cascading impacts on biodiversity. Here, we evaluate relationships between kelp forests and associated reef fish populations using a global meta-analysis of experimental kelp removals and comparative surveys of kelp and adjacent non-kelp habitats. These analyses show that kelp forests increase the abundance of reef fishes, though the significance of this effect varied depending on the structural complexity of kelp forests. In experimental studies, kelp forests have a significant positive effect on fish species richness, revealing that kelp act as true foundation species by supporting the diversity of associated multispecies assemblages. Importantly, regardless of kelp forest morphology and type of study (observational or experimental studies), kelp forests enhance the recruitment of early life history stages suggesting they are nursery habitats for many reef fish taxa. Lastly, kelp forests differentially affected species with different functional traits; small body size fishes from low trophic levels (e.g., herbivore and detritivores, micropredators, and mesopredators) and large body size fish from higher trophic level (e.g., piscivores, general carnivores) were both facilitated by kelp forests. Taken together, these results indicate that the loss of kelp forest, particularly those with more complex morphology, can reduce total abundance and diversity of fish, with possible cascading consequences for coastal ecosystem function. © 2025 The Ecological Society of America. Conservation benefits of a large marine protected area network that spans multiple ecosystems. Smith JG(1)(2), Lopaz

03
CLINICAL STUDY Conservation biology (2025) PMID: 39786314 ↗
Conservation benefits of a large marine protected area network that spans multiple ecosystems.
Clinical Trial Synthesis 2025 Clinical Study published in Conservation biology. Key conclusion: At the scale of the network and for 3 of 4 regions, the biomass of species targeted by fishing was positively associated with the level of regulatory protection and was greater inside no-take MPAs, whereas species not targeted by fishing had similar biomass in MPAs and areas open
View Original PubMed Abstract ↓

Marine protected areas (MPAs) are widely implemented tools for long-term ocean conservation and resource management. Assessments of MPA performance have largely focused on specific ecosystems individually and have rarely evaluated performance across multiple ecosystems either in an individual MPA or across an MPA network. We evaluated the conservation performance of 59 MPAs in California's large MPA network, which encompasses 4 primary ecosystems (surf zone, kelp forest, shallow reef, deep reef) and 4 bioregions, and identified MPA attributes that best explain performance. Using a meta-analytic framework, we evaluated the ability of MPAs to conserve fish biomass, richness, and diversity. At the scale of the network and for 3 of 4 regions, the biomass of species targeted by fishing was positively associated with the level of regulatory protection and was greater inside no-take MPAs, whereas species not targeted by fishing had similar biomass in MPAs and areas open to fishing. In contrast, species richness and diversity were not as strongly enhanced by MPA protection. The key features of conservation effectiveness included MPA age, preimplementation fisheries pressure, and habitat diversity. Important drivers of MPA effectiveness for single MPAs were consistent across MPAs in the network, spanning regions and ecosystems. With international targets aimed at protecting 30% of the world's oceans by 2030, MPA design and assessment frameworks should consider conservation performance at multiple ecologically relevant scales, from individual MPAs to MPA networks. Publisher: Beneficios de la conservación para una extensa red de áreas marinas protegidas que abarca varios ecosistemas Resumen Las áreas marinas protegidas (AMP) son herramientas de uso amplio para la conservación a largo plazo de los océanos y la gestión de recursos. Las evaluaciones del rendimiento de las AMP se han centrado casi siempre en ecosistemas específicos de forma individual y rara vez han evaluado el rendimiento a través de varios ecosistemas, ya sea en una AMP individual o a través de una red de AMP. Evaluamos el rendimiento de la conservación de 59 AMP en la gran red de AMP de California, que aba

04
CLINICAL STUDY Proceedings. Biological sciences (2024) PMID: 39501886 ↗
Kelp forests versus urchin barrens: a comparison of ecosystem functions and services provided by two alternative stable marine habitats.
Clinical Trial Synthesis 2024 Meta-Analysis published in Proceedings. Biological sciences. Key conclusion: These findings can help guide decisions on managing rocky reef habitats and demonstrate the benefits of preserving or expanding kelp forests.
View Original PubMed Abstract ↓

Kelp forests and urchin barrens are two stable states in rocky reef ecosystems, each providing unique ecosystem functions like habitat for marine species and primary production. While studies frequently show that kelp forests support higher levels of some ecosystem functions than urchin barren habitats, no research has yet compared average differences. To address this gap, we first conducted a meta-analysis of studies that directly compared the ecosystem functions, services and general attributes provided by each habitat. We also compiled individual studies on ecosystem properties from both habitats and qualitatively assessed the benefits provided. The meta-analysis included 388 observations from 55 studies across 14 countries. We found that kelp forests consistently delivered higher levels of ecosystem properties such as biodiversity, species richness, abalone abundance and sea urchin roe quality. Urchin barrens supported higher urchin density and crustose coralline algae cover. The qualitative review further supported these findings, showing that kelp forests ranked higher in 11 out of 15 ecosystem properties. These findings can help guide decisions on managing rocky reef habitats and demonstrate the benefits of preserving or expanding kelp forests.

05
CLINICAL STUDY Annals of botany (2024) PMID: 38142363 ↗
Temperature sensitivity of detrital photosynthesis.
Clinical Trial Synthesis 2024 Meta-Analysis published in Annals of botany. Key conclusion: CONCLUSIONS: T opt of kelp detritus is ≥3 °C colder than that of the intact plant.
View Original PubMed Abstract ↓

Erratum in Ann Bot. 2024 Mar 8;133(1):213-216. doi: 10.1093/aob/mcae013. BACKGROUND AND AIMS: Kelp forests are increasingly considered blue carbon habitats for ocean-based biological carbon dioxide removal, but knowledge gaps remain in our understanding of their carbon cycle. Of particular interest is the remineralization of detritus, which can remain photosynthetically active. Here, we study a widespread, thermotolerant kelp (Ecklonia radiata) to explore detrital photosynthesis as a mechanism underlying temperature and light as two key drivers of remineralization. METHODS: We used meta-analysis to constrain the thermal optimum (Topt) of E. radiata. Temperature and light were subsequently controlled over a 119-day ex situ decomposition experiment. Flow-through experimental tanks were kept in darkness at 15 °C or under a subcompensating maximal irradiance of 8 µmol photons m-2 s-1 at 15, 20 or 25 °C. Photosynthesis of laterals (analogues to leaves) was estimated using closed-chamber oxygen evolution in darkness and under a saturating irradiance of 420 µmol photons m-2 s-1. KEY RESULTS: T opt of E. radiata is 18 °C across performance variables (photosynthesis, growth, abundance, size, mass and fertility), life stages (gametophyte and sporophyte) and populations. Our models predict that a temperature of >15 °C reduces the potential for E. radiata detritus to be photosynthetically viable, hence detrital Topt ≤ 15 °C. Detritus is viable under subcompensating irradiance, where it performs better than in darkness. Comparison of net and gross photosynthesis indicates that elevated temperature primarily decreases detrital photosynthesis, whereas darkness primarily increases detrital respiration compared with optimal experimental conditions, in which detrital photosynthesis can persist for ≥119 days. CONCLUSIONS: T opt of kelp detritus is ≥3 °C colder than that of the intact plant. Given that E. radiata is one of the most temperature-tolerant kelps, this suggests that photosynthesis is generally more thermosensitive in the detrital phase, which partly explains the enhancing effect of temperature on remineralization. In contrast to darkness, even subcompensating irradianc

06
SYSTEMATIC REVIEW Journal of phycology (2022) PMID: 35397178 ↗
Whole System Analysis Is Required To Determine The Fate Of Macroalgal Carbon: A Systematic Review.
Clinical Trial Synthesis 2022 Systematic Review published in Journal of phycology. Key conclusion: The role of marine primary producers in capturing atmospheric CO2 has received increased attention in the global mission to mitigate climate change.
View Original PubMed Abstract ↓

The role of marine primary producers in capturing atmospheric CO2 has received increased attention in the global mission to mitigate climate change. Yet, our understanding of carbon sequestration performed by macroalgae has been limited to a relatively small number of studies that have estimated the ultimate fate of macroalgal-derived carbon. This systematic review was conducted to provide a timely synthesis of the methods used to determine the fate of macroalgal carbon in this rapidly expanding research area. It also aimed to provide suggestions for more effective future research. We found that the most common methods to estimate the fate of macroalgal carbon can be categorized into groups based on those that quantify: (i) export of macroalgal carbon to other environments-known as horizontal transport; (ii) sequestration of macroalgal carbon into deep-sea sediments-known as vertical transport; (iii) burial of macroalgal carbon directly beneath a benthic community; (iv) the loss of macroalgal carbon as particulate carbon or dissolved carbon to the water column; (v) the loss of macroalgal carbon to primary consumers; and finally (vi) those studies that combined multiple methods in one location. Based on this review, several recommendations for future research were formulated, which require the combination of multiple methods in a whole system analysis approach. © 2022 The Authors. Journal of Phycology published by Wiley Periodicals LLC on behalf of Phycological Society of America.

07
CLINICAL STUDY Global change biology (2021) PMID: 34614545 ↗
Global impacts of invasive species on the tipping points of shallow lakes.
Clinical Trial Synthesis 2021 Meta-Analysis published in Global change biology. Key conclusion: Our results demonstrate that INNS could significantly alter the tipping points of ecosystem collapse and recovery, and that not all invasive species may initiate system collapse.
View Original PubMed Abstract ↓

There is growing acknowledgement that human-induced change can push ecosystems beyond tipping points, resulting in the dramatic and sudden loss of vital ecosystem services. Invasive non-native species (INNS) are spreading rapidly due to anthropogenic activities and climate change and can drive changes to ecosystem functioning by altering abiotic conditions and restructuring native communities. Shallow lake ecosystems are especially vulnerable to perturbation from INNS as they can exist in two alternative stable states: either clear water with an abundance of vegetation or turbid, unvegetated and dominated by phytoplankton. Through a global meta-analysis of studies observing the effects of INNS on recipient lake ecosystems, we found that certain INNS drive significant changes in the abundance of key taxa and conditions that govern the balance of alternative equilibria in shallow lakes. Invasive fish and crustaceans demonstrated effects likely to lead to early ecosystem collapse to a turbid state and delay ecosystem recovery. Invasive molluscs presented opposite effects, which may delay ecosystem collapse and encourage ecosystem recovery. Our results demonstrate that INNS could significantly alter the tipping points of ecosystem collapse and recovery, and that not all invasive species may initiate system collapse. Our results provide guidance for managers of invaded shallow lake ecosystems, which provide diverse services including sanitation, potable water supply, industrial cooling, aquaculture and recreational resources. Moreover, our approach could be applied to identify key potential drivers of change in other crucial ecosystems which demonstrate alternative equilibria, such as coral reefs and kelp forests. © 2021 The Authors. Global Change Biology published by John Wiley & Sons Ltd.

08
META-ANALYSIS Biological reviews of the Cambridge Philosophical Society (2020) PMID: 32614143 ↗
Sublethal effects of contaminants on marine habitat-forming species: a review and meta-analysis.
Clinical Trial Synthesis 2020 Meta-Analysis published in Biological reviews of the Cambridge Philosophical Society. Key conclusion: We did not find significant effects of polycyclic aromatic hydrocarbons on any of the analysed functional variables or habitat-forming taxa, but this could be due to the low number of studies available.
View Original PubMed Abstract ↓

Contaminants may affect ecosystem functioning by reducing the fitness of organisms and these impacts may cascade through ecosystems, particularly if the sensitive organisms are also habitat-forming species. Understanding how sub-lethal effects of toxicants can affect the quality and functions of biogenic habitats is critical if we are to establish effective guidelines for protecting ecosystems. We carried out a global systematic review and meta-analysis critically evaluating contaminant effects on properties of habitat-formers linked to ecosystem functioning. We reviewed a total of 95 publications. However, 40% of publications initially captured by the literature search were identified as having flaws in experimental design and ~11% did not present results in an appropriate way and thus were excluded from the quantitative meta-analysis. We quantitatively reviewed 410 studies from 46 publications, of which 313 (~76%) were on plants and seaweeds, that is macro-algae, saltmarsh plants and seagrasses, 58 (~14%) studied corals and 39 (~10%) looked at toxicant impacts on bivalves, with 70% of those on mussels and the remaining studies on oysters. Response variables analysed were photosynthetic efficiency, amount of chlorophyll a (as a proxy for primary production) and growth of plants, seaweeds and corals as well as leaf area of plants. We also analysed filtration, growth and respiration rates of bivalves. Our meta-analysis found that chemical contaminants have a significant negative impact on most of the analysed functional variables, with the exception of the amount of chlorophyll a. Metals were the most widely harmful type of contaminant, significantly decreasing photosynthetic efficiency of kelps, leaf area of saltmarsh plants, growth of fucoids, corals and saltmarsh plants and the filtration rates of bivalves. Organic contaminants decreased the photosynthetic efficiency of seagrass, but had no significant effects on bivalve filtration. We did not find significant effects of polycyclic aromatic hydrocarbons on any of the analysed functional variables or habitat-forming taxa, but this could be due to the low number of studies available. A meta-regression revealed t

09
SYSTEMATIC REVIEW Annals of plastic surgery (2019) PMID: 30557187 ↗
Integrative Medicine in Plastic Surgery: A Systematic Review of Our Literature.
Clinical Trial Synthesis 2019 Systematic Review published in Annals of plastic surgery; statistical significance reported at p = 0.008. Key conclusion: CONCLUSIONS: High-level evidence studies demonstrate promising results for the use of both NPs and MBPs in the care of plastic surgery patients.
View Original PubMed Abstract ↓

BACKGROUND: Surveys have reported that as high as 80% of plastic surgery patients utilize integrative medicine approaches including natural products (NPs) and mind-body practices (MBPs). Little is known regarding the evidence of benefit of these integrative therapies specifically in a plastic surgery patient population. METHODS: We conducted a systematic review of studies in MEDLINE, PubMed, and EMBASE (inception through December 2016) evaluating integrative medicine among plastic surgery patients. Search terms included 76 separate NP and MBP interventions as listed in the 2013 American Board of Integrative Health Medicine Curriculum. Two independent reviewers extracted data from each study, including study type, population, intervention, outcomes, conclusions (beneficial, harmful, or neutral), year of publication, and journal type. Level of evidence was assessed according to the American Society of Plastic Surgeons Rating Levels of Evidence and Grading Recommendations. RESULTS: Of 29 studies analyzed, 13 studies (45%) evaluated NPs and 16 (55%) studied MBPs. Level II reproducible evidence supports use of arnica to decrease postoperative edema after rhinoplasty, onion extract to improve scar pigmentation, hypnosis to alleviate perioperative anxiety, and acupuncture to improve perioperative nausea. Level V evidence reports on the risk of bleeding in gingko and kelp use and the risk of infection in acupuncture use. After year 2000, 92% of NP studies versus 44% of MBP studies were published (P = 0.008). CONCLUSIONS: High-level evidence studies demonstrate promising results for the use of both NPs and MBPs in the care of plastic surgery patients. Further study in this field is warranted.

10
CLINICAL STUDY Proceedings of the National Academy of Sciences of the United States of America (2013) PMID: 23983266 ↗
Recovery of a top predator mediates negative eutrophic effects on seagrass.
Clinical Trial Synthesis 2013 Clinical Study published in Proceedings of the National Academy of Sciences of the United States of America. Key conclusion: Our results add to a small but growing body of literature illustrating that significant interactions between bottom-up and top-down forces occur, in this case with consequences for the conservation of valued ecosystem services provided by seagrass.
View Original PubMed Abstract ↓

Erratum in Proc Natl Acad Sci U S A. 2014 Mar 4;111(9):3644. A fundamental goal of the study of ecology is to determine the drivers of habitat-forming vegetation, with much emphasis given to the relative importance to vegetation of "bottom-up" forces such as the role of nutrients and "top-down" forces such as the influence of herbivores and their predators. For coastal vegetation (e.g., kelp, seagrass, marsh, and mangroves) it has been well demonstrated that alterations to bottom-up forcing can cause major disturbances leading to loss of dominant vegetation. One such process is anthropogenic nutrient loading, which can lead to major changes in the abundance and species composition of primary producers, ultimately affecting important ecosystem services. In contrast, much less is known about the relative importance of apex predators on coastal vegetated ecosystems because most top predator populations have been depleted or lost completely. Here we provide evidence that an unusual four-level trophic cascade applies in one such system, whereby a top predator mitigates the bottom-up influences of nutrient loading. In a study of seagrass beds in an estuarine ecosystem exposed to extreme nutrient loading, we use a combination of a 50-y time series analysis, spatial comparisons, and mesocosm and field experiments to demonstrate that sea otters (Enhydra lutris) promote the growth and expansion of eelgrass (Zostera marina) through a trophic cascade, counteracting the negative effects of agriculturally induced nutrient loading. Our results add to a small but growing body of literature illustrating that significant interactions between bottom-up and top-down forces occur, in this case with consequences for the conservation of valued ecosystem services provided by seagrass.

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