Literature Review & Commentary
by Alan R. Gaby, MD
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?
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
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
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!
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
Fukutake M, et al. Quantification of genistein
and genistin in soybeans and soybean products. Food Chem
Magnesium for childhood asthma
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.
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?
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
Vitamin C to prevent complications of diabetes
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.