oxide, hypertension, and quality of life
Eighty-three patients with mild hypertension, none of whom had previously
been treated with antihypertensive medication, were randomly assigned
to receive placebo or magnesium (approximately 200 mg/day of elemental
magnesium in the form of magnesium oxide) for 12 weeks, in double-blind
fashion. After 12 weeks there was a significant reduction in systolic
blood pressure in the magnesium group compared with the placebo group.
Magnesium had no effect on diastolic blood pressure.
Analysis of a quality-of-life questionnaire revealed improvements in
various measures of quality of life in the magnesium group, compared
with the placebo group. These included a reduction in the frequency
of chest pain, an increase in physical activity, and better respiratory
function, alertness and emotional behavior.
COMMENT: It is noteworthy that the improvements reported
in this study were achieved by supplementing with a relatively small
amount of magnesium oxide. Many practitioners refuse to prescribe magnesium
oxide, because of a belief that it is poorly absorbed. Since magnesium
oxide is far less expensive than other commercially available magnesium
preparations, its use as a supplement should perhaps be reconsidered.
Borrello G, et al. The effects of magnesium oxide on mild essential
hypertension and quality of life. Curr Ther Res 1996;57:767-774.
C, liver cancer, and licorice
A retrospective study was performed to evaluate the effect of long-term
administration of Stronger Neo-Minophagen C (SNMC; an intravenous glycyrrhizin
preparation) in patients with hepatitis C. Of 453 patients diagnosed
with chronic hepatitis C, 84 (Group A) had been treated with SNMC (100
ml/day for 8 weeks, then 2-7 times a week for a median duration of 10.1
years). Another group of patients (Group B) could not be given SNMC,
because of the lack of availability of home health care professionals.
After 10 years, the cumulative incidences of hepatocellular carcinoma
(HCC) for Groups A and B were 7% and 12%, respectively. After 15 years,
the cumulative incidences were 12% and 25%, respectively.
COMMENT: SNMC is a product used in Japan that contains
0.2% glycyrrhizin (a component licorice), 0.1% cysteine and 2.0% glycine
in physiologic saline. Glycine reportedly prevents the aldosterone-like
action of glycyrrhizin, and cysteine has been found to have an antiallergic
and detoxifying effect. Glycyrrhizin has antiviral effects and has been
shown to prevent the development of certain forms of cancer in animals.
The present study suggests that long-term treatment with SNMC prevented
the development of liver cancer in patients with chronic hepatitis C.
As SNMC has not been approved by the FDA, the product is difficult
to obtain in this country. It is possible that orally administered licorice
extract might also be effective. However, because administration of
glycyrrhizin can raise blood pressure, deplete potassium, or cause other
problems, its use should be monitored closely.
Arase Y, et al. The long term efficacy of glycyrrhizin in chronic hepatitis
C patients. Cancer 1997;79:1494-1500.
drugs: more dangerous than they appear
A random sample of 100 general practitioners practicing in the Bordeaux
region of France was surveyed in relation to adverse drug reactions
they had observed. Eighty-one doctors agreed to record during three
non-consecutive working days any effect they believed to be associated
with drug use. The types of effects and the drugs suspected were compared
to spontaneous reports received from general practitioners by the Bordeaux
pharmacovigilance center. The number of suspected adverse drug reactions
per doctor per day was 1.99. The estimate of the under-reporting coefficient
(U) was 24,433, which indicates that, as a whole, general practitioners
might be expected to report only 1 out of every 24,433 adverse drug
COMMENT: A random journey through the Physicians"
Desk Reference underscores the fact that most drugs are poisons which
happen to have a few beneficial side effects. The results of the present
study suggest that many prescription drugs are even more dangerous than
they appear, because doctors rarely report side effects to the appropriate
authorities. On the other hand, millions of Americans already know that
they have been harmed by one or more prescription drugs. That is one
of the main reasons that so many people are seeking safer alternatives,
and that more and more physicians are beginning to embrace natural medicine.
Moride Y, et al. Under-reporting of adverse drug reactions in general
practice. Br J Clin Pharmacol 1997;43:177-181.
Glutamine for the
Eighty-four critically ill patients in an intensive care unit (ICU)
who were unable to receive enteral nutrition were randomly assigned
to receive a glutamine-containing parenteral nutrition formula or an
isonitrogenous, isoenergetic control formula. Survival at six months
was significantly greater in patients receiving glutamine than in those
receiving the control formula (57% vs 33%; p = 0.049). In glutamine
recipients, the total ICU and hospital cost per survivor was reduced
by 50.7%, compared with patients receiving the control formula.
COMMENT: Glutamine is often considered a "non-essential"
amino acid, because it can be synthesized in the body. However, under
conditions of extreme biochemical stress (such as surgery, trauma, or
critical illness), the need for this nutrient exceeds the body"s
capacity to synthesize it. Critical illness is often associated with
low plasma concentrations of glutamine. A deficiency of this amino acid
can result in impaired immune function, as well as a breakdown of the
normal gastrointestinal lining. The present study indicates that glutamine
supplementation of critically ill patients increases survival and reduces
Griffiths RD, et al. Six-month outcome of critically ill patients given
glutamine-supplemented parenteral nutrition. Nutrition 1997;13:295-302.
menopause, and questionable conclusions
Serum concentrations of dehydroepiandrosterone sulfate (DHEA-S) were
measured in 29 patients with premature ovarian failure and in age-matched
menstruating controls. The mean serum concentration of DHEA-S was 25%
lower in patients than in controls. Because the difference was not statistically
significant, the authors concluded that premature ovarian failure does
not affect serum DHEA-S levels.
COMMENT: In women, the ovary is responsible for somewhere
between 10 and 30% of total DHEA production (the rest is made by the
adrenal gland). DHEA supplementation of postmenopausal women has been
shown to enhance certain parameters of immune function and to prevent
bone loss. In addition, some postmenopausal women report that taking
DHEA improves their overall sense of well-being. These observations
strongly suggest that menopause (or premature ovarian failure) results
in a decline in DHEA levels (at least in some women). The authors of
the present study are incorrect when they claim that ovarian failure
does not reduce DHEA-S levels. In fact, in their study, the levels declined
by an average of 25%. Although there is more than a 5% probability that
this reduction was due to chance, it is wrong to conclude that there
was no decline. Other studies have shown that DHEA(S) levels do fall
significantly around the time of menopause. A growing body of evidence
suggests that DHEA replacement therapy may be appropriate for many postmenopausal
Elias AN, et al. Serum levels of androstenedione, testosterone and
dehydroepiandrosterone sulfate in patients with premature ovarian failure
to age-matched menstruating controls. Gynecol Obstet Invest 1997;43:47-48.
oil and heart disease
2-(3,4-di-hydroxyphenyl)-ethanol (DHPE) is a phenolic component of
extra-virgin olive oil that has potent antioxidant activity. In the
present study, preincubation of platelet-rich human plasma with DHPE
inhibited ADP- and collagen-induced platelet aggregation. A partially
characterized phenol-enriched extract obtained from the aqueous waste
from olive oil was also a potent inhibitor of platelet aggregation.
COMMENT: There is evidence that individuals who consume
a Mediterranean diet have a reduced risk of developing heart disease.
Olive oil, a component of the Mediterranean diet, is believed to be
one of the protective factors. Olive oil is rich in oleic acid, a monounsaturated
fatty acid which has been found to inhibit the oxidation of LDL cholesterol.
However, the present study demonstrates that there is at least one other
compound in olive oil (and another substance in whole olives) that might
prevent heart disease by a different mechanism. Therefore, it is unlikely
that the purported cardioprotective effect of olive oil could be duplicated
by other high-oleic-acid foods, such as the specially made high-oleic-acid
sunflower oil that is currently being studied by nutrition scientists.
Petroni A, et al. Inhibition of platelet aggregation and eicosanoid
production by phenolic components of olive oil. Thromb Res 1995;78:151-160.
Unusual cases of diarrhea
Two patients with lactase deficiency who were being treated for Graves"
disease consistently developed severe diarrhea after ingestion of an
antithyroid drug (methimazole plus propylthiouracil) that contained
lactose as a carrier. The close temporal relationship between ingestion
of the lactose-containing tablets, as well as the absence of side effects
following ingestion of lactose-free methimazole tablets, suggested that
lactose was the cause of the diarrhea.
COMMENT: In considering medication side effects, there
is a tendency to overlook the "inert" ingredients in tablets
and capsules. However, the various coloring agents, fillers and binders
found in medications may cause significant reactions in susceptible
individuals. One might wonder how the small amount of lactose present
in a pill could trigger severe diarrhea, even in someone with lactose
intolerance. While maldigestion of lactose could conceivably account
for the symptoms, allergy may also be involved. There is a high correlation
between lactose intolerance and milk-protein allergy. It also has been
shown that commercial-grade lactose contains a small amount of a sugar-protein
complex (presumably a glycosylated milk protein), which might be capable
of provoking symptoms in milk-allergic individuals.
Petrini L, et al. Lactose intolerance following antithyroid drug medications.
J Endocrinol Invest 1997;20:569-570.
Ear candles ineffective
Ear candles are used by some alternative health care practitioners
primarily for removal of cerumen. The hollow candle is placed in the
external auditory canal and a flame is lit at the opposite end. The
lighted candle is thought to create a vacuum, which draws cerumen and
other impurities from the ear canal.
In the present study, tympanometric measurements in an ear canal model
demonstrated that ear candles do not produce negative pressure. A limited
clinical trial (eight ears) showed no removal of cerumen, and candle
wax was actually deposited in some ears. A survey of 122 otolaryngologists
identified 21 ear injuries resulting from the use of ear candles.
COMMENT: If effective, ear candles could be used as
a low-cost alternative to cerumen removal in a doctor"s office.
However, the current study raises questions about the safety and efficacy
of this procedure. I would welcome comments from readers who have had
a more favorable experience with ear candles.
Seely DR, et al. Ear candles - efficacy and safety. Laryngoscope 1996;106:1126-1129.