for seasonal allergies
Forty-four patients (mean age, 36 years) with Japanese cedar pollinosis
were randomly assigned to receive, in double-blind fashion, Bifidobacterium
longum strain BB536 or placebo for 13 weeks during the pollen season.
The dose of the probiotic was 5 x 1010 colony-forming units in 100
ml of milk twice a day. The mean symptom severity was significantly
less with active treatment than with placebo. The mean improvements
compared with placebo were as follows: sneezing, 60% (p < 0.03);
rhinorrhea, 53% (p < 0.01); nasal blockage, 53% (p < 0.02);
eye symptoms, 37% (p < 0.09); throat symptoms, 53% (p < 0.03);
and composite score, 40% (p < 0.02).
Comment: Probiotic agents have a number
of different effects on immune function. Previous studies have suggested
that administration of probiotics can prevent the development of
allergy-related diseases in infants. To my knowledge, the present
study is the first to show that treatment with a probiotic agent
can relieve allergy-related symptoms in adults. Additional research
is needed to determine which strains of probiotic organisms are
effective and what the optimal dose is.
Xiao JZ, et al. Probiotics in the treatment of Japanese cedar pollinosis:
a double-blind placebo-controlled trial. Clin
Exp Allergy. 2006;36:1425-1435.
intravenous vitamins and minerals for seasonal allergic rhinitis
A 38-year-old man had a long history of seasonal allergic rhinitis,
occurring each spring and lasting about a month. Symptoms were severe
and included nasal congestion, itchy eyes, and fatigue. Conventional
treatments provided only minimal benefit. During a symptomatic period,
an intravenous infusion of 2.6 g of vitamin C, 600 mg of magnesium
chloride hexahydrate, 1,000 mcg of vitamin B12 (hydroxocobalamin),
100 mg of pyridoxine, 250 mg of dexpanthenol, and 1 ml of B complex-100
provided rapid relief. This treatment was repeated once a week or
less often, as needed, during the hay-fever season, and successfully
controlled his symptoms. In subsequent years, he began receiving
these injections shortly before, and repeated them periodically
during, the hay fever season. This approach prevented the development
Comment: This treatment, which is a
modified version of the Myers cocktail, was tried empirically based
on potential anti-allergy effects of various individual components.
For example, vitamin C has antihistamine activity, dexpanthenol
may support adrenal function, niacinamide (a constituent of B complex-100)
inhibits mast cell degranulation and experimentally induced anaphylaxis,
and magnesium has been reported to be beneficial in the treatment
of allergic rhinitis. Although there is little or no published research
on using intravenous nutrients to treat hay fever, it worked for
this patient, and he was gratified to be free of his annual month
D for tuberculosis
Sixty-seven Indonesian patients with moderately advanced pulmonary
tuberculosis who did not have AIDS were randomly assigned to receive,
in double-blind fashion, 10,000 IU/day of vitamin D (not specified
whether this was vitamin D2 or vitamin D3) or placebo during the
initial six weeks of conventional treatment. After six weeks, the
sputum conversion rate was 100% in the vitamin D group and 76.7%
in the placebo group (p = 0.002). Among the 36 patients who had
radiological evaluation after six weeks, 87.5% of those in the vitamin
D group and 65% of those in the placebo group showed improvement
(p value not stated). The mean serum calcium concentration after
six weeks of treatment did not differ significantly between groups.
Comment: The results of this study
indicate that the addition of vitamin D to conventional therapy
accelerated recovery in patients with moderately advanced pulmonary
tuberculosis. Patients with tuberculosis have been shown to have
significantly lower serum concentrations of 25-hydroxyvitamin D
when compared with healthy controls. This reduction in vitamin D
levels could not be explained by differences in dietary intake or
sunlight exposure. Vitamin D plays a role in immune function, and
it also appears to enhance the immune system’s specific response
to Mycobacterium tuberculosis. Based on these observations, vitamin
D supplementation should be considered as a component of the overall
treatment of tuberculosis. In addition, 25-hydroxyvitamin D levels
should be monitored in patients with a history of tuberculosis.
In those whose levels are low or suboptimal, vitamin D supplementation
might help prevent a reactivation of the disease.
Nursyam EW, et al. The effect of vitamin D as supplementary treatment
in patients with moderately advanced pulmonary tuberculous lesion.
Acta Med Indones. 2006;38:3-5.
Sixty healthy postmenopausal women were randomly assigned in a crossover
design to consume a low-fat diet or a diet of similar macronutrient
content in which one-half cup per day of unsalted soy nuts (providing
25 g of soy protein and 101 mg of isoflavones daily) replaced 25
g of non-soy protein. The soy nuts were consumed in three or four
portions spaced throughout the day. Each diet was followed for eight
weeks. Compared with the low-fat diet alone, the addition of soy
nuts lowered mean systolic and diastolic blood pressure by 9.9%
(p = 0.003) and 6.8% (p = 0.001), respectively, in hypertensive
women and by 5.2% (p < 0.001)and 2.9% (p = 0.02), respectively,
in normotensive women.
Comment: A previous study showed that
consumption of one liter per day of soy milk for three months significantly
reduced blood pressure in patients with essential hypertension.
However, other studies have found that soy products do not lower
blood pressure. There is strong evidence that eating soy foods lowers
serum cholesterol levels. When combined with its possible antihypertensive
effect, soy appears to be a cardioprotective food. However, soy
products inhibit the absorption of iron and possibly some other
minerals, so excessive soy consumption might promote the development
of nutritional deficiencies. Eating soy three times per week as
part of an overall healthful diet seems reasonable.
Welty FK, et al. Effect of soy nuts on blood pressure and lipid
levels in hypertensive, prehypertensive, and normotensive postmenopausal
women. Arch Intern Med. 2007;167:1060-1067.
Forty-five patients scheduled to undergo surgery for colorectal
cancer were randomly assigned to receive 200 mg of ferrous sulfate
three times per day or no iron supplementation (control group) for
two weeks preoperatively. Operative blood loss did not differ significantly
between groups. Immediately prior to surgery, the mean hemoglobin
concentration was significantly higher in the iron-supplemented
group than in the control group (13.1 g/dl vs. 11.8 g/dl; p = 0.04).
The proportion of patients who required a blood transfusion (26%
vs. 59%; p < 0.05) and the mean number units transfused per patient
(0.65 vs. 3.62; p < 0.04) were significantly lower in the iron-supplemented
group than in the placebo group.
Comment: Blood transfusions are expensive
and are associated with a number of different potential adverse
effects. According to the results of this study, preoperative iron
supplementation can substantially decrease the need for blood transfusions
in patients undergoing surgery for colorectal cancer. These findings
would presumably also apply to other surgical patients with low
or marginal iron stores. Iron status should therefore be measured
in all patients who are scheduled for surgery, and iron supplementation
should be recommended if appropriate.
Lidder PG, et al. Pre-operative oral iron supplementation reduces
blood transfusion in colorectal surgery - a prospective, randomised,
controlled trial. Ann R Coll Surg Engl.
levels associated with macular degeneration
In a case-control study in Wisconsin that included 67 patients with
exudative (wet) age-related macular degeneration (AMD), 75 patients
with non-exudative (dry) AMD, and age- and gender-matched controls,
the mean serum DHEA concentration (measured as DHEA-S) was significantly
lower in patients with either type of AMD than in controls (p =
0.001). There was a significant inverse correlation between AMD
severity and serum DHEA-S levels.
Comment: This study showed that patients
with AMD have significantly lower serum DHEA-S levels than matched
controls. Although the study does not prove that DHEA deficiency
is a cause of AMD, I have seen a reversal of various age-related
conditions (including weight loss, weakness, poor appetite, and
depression) in elderly people with low DHEA-S levels who were treated
with DHEA. Several clinical trials have investigated whether DHEA
supplementation has an "anti-aging" effect, and the results
have been conflicting. It is my practice to measure serum DHEA-S
levels in patients with age-related disorders and to recommend DHEA
supplementation if their levels are below normal or in the bottom
20% of the normal range for young adults of the same gender. The
usual doses I have used are 5-15 mg per day for women and 10-30
mg per day for men. Higher doses have been used in clinical trials,
but these larger doses are supraphysiologic, and their long-term
safety has not been demonstrated.
Tamer C, et al. Serum dehydroepiandrosterone sulphate level in age-related
macular degeneration. Am J Ophthalmol.
oil enhances weight loss
Forty-five formerly obese patients (mean age, 48 years) who had
lost a mean of about 30 kg were randomly assigned to receive, in
double-blind fashion, 5 g per day of borage oil (providing 890 mg
per day of gamma-linolenic acid) or placebo (olive oil) for one
year. After 12 patients in each group had completed one year of
supplementation, the mean weight regain in was 2.17 kg in the borage
oil group and 8.78 kg in the placebo group (p < 0.03). The initial
study was then terminated, and all remaining patients were assessed
over a six-week period. The mean weight regain was 1.8 kg in the
borage oil group and 7.6 kg in the placebo group for the 13 and
17 subjects, respectively, who completed a minimum of 50 weeks.
Comment: The results of this study
indicate that supplementation with borage oil reduced the amount
of weight regained in previously overweight people who had lost
a large amount of weight. The mechanism of action of borage oil
is not known. In a previous study, supplementation with evening
primrose oil (which contains gamma-linolenic acid, the presumed
active ingredient in borage oil) did not enhance weight loss in
overweight women. However, the amount of gamma-linolenic acid used
in that study was only 216 mg per day, which is less than one-quarter
the amount used in the present study.
Schirmer MA, Phinney SD. Gamma-linolenate reduces weight regain
in formerly obese humans. J Nutr.
Lemonade prevents kidney stone
Eleven patients with recurrent kidney stones associated with hypocitraturia
(low urinary citrate excretion) who had been on long-term lemonade
therapy were evaluated after a mean treatment period of 3.7 years.
Lemonade therapy consisted of 120 ml per day of concentrated lemon
juice (containing 5.9 g of citric acid) mixed with two liters of
water and consumed throughout the day. Ten of the 11 patients drinking
lemonade had an increase in urinary citrate levels, and the mean
level increased from 350 mg per day at baseline to 733 mg per day
(p < 0.05). The mean stone formation rate decreased from 1.00
per person per year at baseline to 0.13 per person per year during
lemonade therapy. This 87% decrease failed to achieve statistical
significance, presumably because of the small sample size.
recurrent stone formers have hypocitraturia. Oral administration
of potassium citrate increases the amount of citrate in the urine
and has been shown to reduce the stone recurrence rate substantially.
Potassium citrate is therefore considered first-line therapy by
most urologists for patients with hypocitraturic recurrent nephrolithiasis.
However, potassium citrate can cause gastrointestinal side effects,
which preclude its use in some cases. Lemons have a high concentration
of citrate, about five times as much as oranges. In a previous study,
ingestion of two liters of lemonade per day more than doubled urinary
citrate excretion in a group of recurrent stone formers and increased
the level to normal in seven of 12 patients. The results of the
new study suggest that lemonade is a reasonable alternative to potassium
citrate in patients with hypocitraturic nephrolithiasis.
Kang DE, et al. Long-term lemonade based dietary manipulation in
patients with hypocitraturic nephrolithiasis.
J Urol. 2007;177:1358-1362.
Alan R. Gaby, MD