Literature Review & Commentary

by Alan R. Gaby, MD

Issue #166

Good-deed department

A 70-year-old California man who felt that he did not pay enough to have his hip replaced sent $2,000 to his HMO and $3,000 to the Social Security Administration (which funds Medicare). The retired engineer said he believes that people who can afford to should pay a reasonable part of their healthcare costs. The HMO returned the check and Social Security told the man to donate the money to a fund for Medicare beneficiaries. The man also gave $1,000 to a nurse who had financial problems.

COMMENT: The American media tends to focus on violence, corruption, and other negative behaviors and attitudes. It is refreshing to see a report about altruistic actions. Wouldnt it be nice if we had a cable channel called the Good-Deed Channel or a newspaper called the Unselfishness Daily?

Anonymous. Didnt pay enough, patient sends $ to Social Security. Physicians Financial News, February 15, 1997, p. 21.

 

What type of vitamin C for allergies?

The author found that administration of 1-2 g/day of ascorbic acid was often beneficial in the treatment of various allergy-related symptoms. However, some individuals showed only a moderate response or no improvement at all. In some of these patients, sodium ascorbate (2 g/day) was more effective than ascorbic acid. In addition, the incidence of gastric irritation was less with sodium ascorbate than with ascorbic acid. Increased diuresis was nearly always seen after treatment with sodium ascorbate. Several patients with intractable asthma who had been refractory to almost all treatments remained free of asthma with continuous sodium ascorbate treatment. Patients with seasonal hay fever did particularly well.

COMMENT: Vitamin C has long been known to relieve some of the symptoms of allergies. However it is not widely appreciated that sodium ascorbate is more effective than ascorbic acid for some patients. I have therefore resurrected this old report on its 50th anniversary. There is some evidence that the sodium ion potentiates the effects of adrenal cortical hormones. Sodium ascorbate may therefore be the preferred form of vitamin C for patients who have evidence of hypoadrenocorticism. Unlike sodium chloride, sodium ascorbate at moderate doses does not appear to promote hypertension.

Ruskin SL. Sodium ascorbate in the treatment of allergic disturbances. The role of adrenal cortical hormone-sodium-vitamin C. Am J Dig Dis 1947;14:302-306.

 

Serum cholesterol and suicide

Serum cholesterol was measured in 6,393 French men (aged 43-52 years) at least three times between 1967 and 1972. These men were then followed until 1994. During the follow-up period, 32 men committed suicide. After adjustment for age and other factors, men with low-average serum cholesterol levels were more than three times as likely to commit suicide as were men with average serum cholesterol levels. Men whose serum cholesterol levels decreased by more than 5 mg/dl per year were more than twice as likely to commit suicide as were men whose cholesterol levels remained stable. It is concluded that both low serum cholesterol and declining cholesterol levels were associated with an increased risk of death from suicide in men.

COMMENT: In previous studies, men who took cholesterol-lowering drugs were three times as likely to die from suicide (or other forms of violence) as were men who received a placebo. However, other studies failed to confirm those observations. How might a reduction in serum cholesterol increase the risk of violent death? Cholesterol is a precursor to cortisol, a hormone that is involved in the bodys physiologic response to stress. Testosterone and DHEA, which influence mood, are also manufactured from cholesterol. It is possible that men with low cholesterol levels have a diminished capacity to mount a normal response to stress. These men may also be more likely to develop depression. It is important to remember that cholesterol can be both helpful and harmful, and that too little cholesterol can be just as bad as too much.

Zureik M, et al. Serum cholesterol concentration and death from suicide in men: Paris prospective study I. Br Med J 1996;313:649-651.

 

Selenium prevents cancer: or is it brewers yeast?

A total of 1,312 patients with a history of basal cell or squamous cell carcinoma of the skin were randomly assigned to receive 200 mcg/day of selenium or a placebo. Patients were treated for a mean of 4.5 years and had a total mean follow-up period of 6.4 years. Selenium treatment did not affect the recurrence rate of skin cancers. However, compared with placebo, selenium treatment significantly reduced total cancer mortality (by 50%) and the incidence of lung, colorectal, and prostate cancers. Selenium treatment was also associated with a nonsignificant 17% reduction in all-cause mortality.

COMMENT: This study provides strong evidence that death from cancer and the incidence of specific cancers can be reduced by nutritional supplementation. It should be pointed out that the selenium supplement used was not pure selenium, but, rather, 0.5 g of high-selenium brewers yeast (Nutrition 21). The ingredients of the placebo were not specified, but the placebo was probably not low-selenium yeast (since measures were taken to mask the odor of the yeast supplement). Brewers yeast is one of the most nutrient-dense foods known. In addition, ingestion of brewers yeast can produce favorable (and possibly cancer-preventing) effects on the intestinal flora. Studies in the 1940s showed that supplementation with yeast can prevent cancer in certain animal models. Although 0.5 g/day of brewers yeast is not a large amount, neither is that dose inconsequential. Until we know whether selenium by itself is protective, perhaps we would be better advised to use high-selenium yeast.

Clark LC, et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial. JAMA 1996;276:1957-1963.

 

Ferment the soybeans!

The concentration of genistein was measured in various soybean products. The concentration of genistein in unfermented soy products (soy beans, soy nuts, soy powder, soy milk, tofu) ranged from 1.9 to 18.2 mcg/g. The concentration of genistein in fermented soy products, miso (bean paste) and natto (fermented soybeans), ranged from 38.5 to 229.1 mcg/g. It is suggested that genistin (the beta-glucoside conjugate of genistein) is cleaved by microbes during fermentation to produce genistein.

COMMENT: There is evidence that the isoflavone genistein may help prevent breast cancer and possibly other cancers in humans. Genistein also exhibits antioxidant and phytoestrogenic activity. The relatively low incidence of breast cancer among Japanese women has been attributed in part to the ingestion of soy products (the main dietary source of genistein). The present study indicates that fermentation increases the concentration of genistein in soy products, and suggests that ingestion of these fermented foods may help prevent cancer.

Fukutake M, et al. Quantification of genistein and genistin in soybeans and soybean products. Food Chem Toxicol 1996;34:457-461.

 

Magnesium for childhood asthma

Thirty-one patients (aged 6-18 years) with an acute exacerbation of asthma that had failed to respond to conventional treatment (three beta2-adrenergic nebulizer treatments) in the emergency room were randomly assigned to receive intravenous magnesium sulfate (25 mg/kg; maximum, 2 g in 100 ml of normal saline) or a placebo (normal saline alone), in a double-blind trial. The infusions were administered over a 20-minute period. At 50 minutes, the magnesium group had a significantly greater percentage improvement from baseline in forced expiratory volume at 1 second (34% vs -1%; p = 0.05); this improvement was sustained and even greater at 100 minutes (75% vs 5%; p = 0.01). Results were similar for peak expiratory flow rate and forced vital capacity. Four of 15 children who received magnesium were discharged home from the emergency department, compared to none of 16 children who received placebo (p = 0.03). Magnesium therapy had no significant effect on blood pressure.

COMMENT: This study demonstrates that intravenous administration of magnesium sulfate to children with an acute exacerbation of asthma improves pulmonary function and reduces the need for hospitalization. Similar results have been reported in the past for adults.

For a number of years I have promoted the so-called Myers cocktail, which consists of magnesium, calcium, vitamin C and B-vitamins. This combination of nutrients is administered over a period of 5-15 minutes by slow intravenous push. I have seen this treatment abort acute asthma attacks in a matter of 1-2 minutes in many cases. It has been my observation that the combination of nutrients works better than magnesium alone. In the present study, magnesium treatment allowed 26% of the patients to avoid hospitalization. With the Myers cocktail, I suspect that figure would be closer to 75% or more. I would be happy to work with any emergency-room physician who is interested in performing a controlled trial of this treatment.

Clarallo L, et al. Intravenous magnesium therapy for moderate to severe pediatric asthma: results of a randomized, placebo-controlled trial. J Pediatr 1996;129:809-814.

 

Does kava plus benzodiazepine spell trouble?

A 54-year old man had been taking alprazolam (a benzodiazepine), cimetidine, and terazosin. He added kava to his regimen (as a natural tranquilizer). Three days later he was hospitalized in a semicomatose state, which improved after several hours and then resolved. He denied overdosing on kava or any of the medications, and a drug screen was positive only for benzodiazepines.

COMMENT: The kava plant (Piper methysticum) is a perennial shrub which is sold as a mild anti-anxiety agent. Certain chemicals found in kava act on the same receptor in the brain as do benzodiazepines. It is therefore possible that the effects of kava and benzodiazepines are additive. Until more information is available, these two compounds should probably not be taken together.

Almeida JC. Coma from the health food store: interaction between kava and alprazolam. Ann Intern Med 1996;125:940-941.

 

Vitamin C to prevent complications of diabetes

Eighteen healthy individuals received 1,000 mg of ascorbic acid daily for four weeks. Glycosylation of serum proteins was decreased by an average of 46.8%.

COMMENT: Glycosylation occurs when a sugar molecule binds to a protein molecule. In cooking, this reaction is called the browning reaction; glycosylation also occurs in the body. There is considerable evidence that glycosylation of tissue proteins is one of the main mechanisms whereby diabetics develop organ damage (such as nephropathy, retinopathy, neuropathy, etc.). The extent of tissue glycosylation depends in part on the level of blood glucose. However, several nutrients (including vitamins C, E, and B6) have been shown to inhibit glycosylation without lowering the blood-sugar level. Supplementation with these nutrients might therefore be expected to prevent some of the complications of diabetes.

Vinson JA, Howard TB III. Inhibition of protein glycation and advanced glycation end products by ascorbic acid and other vitamins and nutrients. J Nutr Biochem 1996;7:659-663.