Policosanol Reported to Decrease Serious Vascular Effects in High Cholesterol Diabetics in 2-Year Study: In a 2-year DB PC study of 239 Type 2 diabetics with high cholesterol, those on policosanol 5 mg/day lowered LDL-C (29.5 %), TC (21.9 %), TG (16.9 %) and raised HDL-C (12.4 %). No significant changes occurred with placebo. The frequency of serious adverse events (SAE), mostly vascular, in policosanol patients (6/119, 5.0 %) was much lower than in placebo (26/120, 43.3 %). Five patients, all placebo, died during the study, four due to myocardial infarction. No drug-related impairment of safety indicators, particularly on glycemic control, was observed. A reduction of systolic and diastolic blood pressure was observed with policosanol. Long- term effects of policosanol on older patients with Type 2 diabetes. Mas R, Castano G, Fernandez J, Gamez RR, Illnait J, Fernandez L, Lopez E, Mesa M, Alvarez E, Mendoza S, Cuba. Asia Pac J Clin Nutr. 2004;13(Suppl):S101

Policosanol Helped Intermittent Claudication in Small Study: Policosanol also has an antiplatelet effect. In a 28-patient, 20-week DB PC study after a 4-week baseline, those on policosanol 10 mg or ticlopidine 250 mg tablets twice daily did equally well. Walking distances in a treadmill, policosanol significantly increased the initial claudication distance from 162.1 to 273.2 m and the absolute (ACD) from 255.8 to 401.0 m. Ticlopidine also raised ICD (166.2 to 266.3 m) and ACD (252.9 to 386.4 m). Policosanol, but not ticlopidine, (p < 0.05) modestly increased the ankle/arm pressure ratio. Policosanol lowered (p < 0.001) LDL-C (30.2%), TC (16.9%), and TC/HDL-C (33.9%), increased HDL-C (+31.7%), and left triglycerides unchanged. Ticlopidine did not affect the lipid profile. Policosanol induced modest reductions (p < 0.01) of fibrinogen levels compared with baseline and ticlopidine. Three ticlopidine patients (21.4%) withdrew, only 1 owing to a serious adverse event (unstable angina). Effects of policosanol and ticlopidine in patients with intermittent claudication: a double-blinded pilot comparative study. Castano G, Mas R, Gamez R, Fernandez L, Illnait J. Havana City, Cuba. Angiology. 2004 Jul-Aug;55(4):361-71. Ed: This policosanol research is very exciting.  It suggests that it is probably poor medical practice to use an expensive statin with potentially serious side-effects without first trying the much safer policosanol. For more, see Cholesterol and Policosanol.

Current Treatment for Intermittent Claudication: The FDA has approved two drugs for intermittent claudication: pentoxifylline and cilostazol. Pentoxifylline is thought to involve red blood cell deformability as well as a reduction in fibrinogen concentration, platelet adhesiveness and whole blood viscosity. Cilostazol is a potent, reversible, phosphodiesterase III inhibitor. The inhibition of phosphodiesterase allows for the increased availability of cyclic adenosine monophosphate (cAMP). cAMP mediates many agonist-induced platelet inhibitory, vasodilatory and vascular antiproliferative responses. Ginkgo biloba, available as an over-the-counter extract, provides symptom relief comparable to pentoxifylline. Two European agents, naftidrofuryl and buflomedil, also have efficacy that is reported to be similar to pentoxifylline. Policosanol may reduce symptoms of claudication. Amino acids, certain peptides and prostaglandins may have a therapeutic role. Drug treatment of intermittent claudication. Jacoby D, Mohler ER. University of Pennsylvania. Drugs. 2004;64(15):1657-70

Blood Pressure Up Again: A recent study of 4,531 adults in the U.S. reports that hypertension has increased by 30% from 1988 to 2000. Now, almost one-third of American adults have hypertension or are on medication to lower blood pressure due to hypertension. JAMA 8/24/04. For more, see High Blood Pressure.

Vitamin E Little Benefit for Respiratory Infection Prevention; Might Help Colds: In a 1-year DB PC study of 617 elderly, vitamin E 200 IU/day had no significant effect on incidence or number of days with infection for all, upper, or lower respiratory tract infections. However, slightly fewer acquired 1 or more respiratory tract infections (60% vs 68%; risk ratio [RR], 0.88; and 65% vs 74%; RR, 0.88), or upper respiratory tract infections (44% vs 52%; RR, 0.84; and 50% vs 62%; RR, 0.81). When common colds were analyzed in a post hoc subgroup analysis, the vitamin E group had a lower incidence of common cold (0.67 vs 0.81 per person-year; RR, 0.83). Vitamin E had no significant effect on antibiotic use. Vitamin E and respiratory tract infections in elderly nursing home residents: a randomized controlled trial. Meydani SN, Leka LS, Fine BC, Dallal GE, Keusch GT, Singh MF, Hamer DH. Tufts University. JAMA. 2004 Aug 18;292(7):828-36. Ed: These are very minimal benefits at best. For more, see the Common Cold.

Fluoxetine Better than CBT, But Combination Did Best for Teens: In a DB PC study of 439 depressed teens ages 12-17 comparing twelve weeks of (1) fluoxetine alone (10 to 40 mg/d), (2) CBT alone, (3) CBT with fluoxetine (10 to 40 mg/d), or (4) placebo (equivalent to 10 to 40 mg/d), the placebo and fluoxetine alone were administered double-blind; CBT alone and CBT with fluoxetine were administered unblinded. Compared with placebo, the combination of fluoxetine with CBT was statistically significant (P =.001) on the Children's Depression Rating Scale-Revised. Compared with fluoxetine alone (P =.02) and CBT alone (P =.01), treatment of fluoxetine with CBT was superior. Fluoxetine alone is a superior treatment to CBT alone (P =.01). Rates of response for fluoxetine with CBT were 71.0%; fluoxetine alone, 60.6%; CBT alone, 43.2%; and placebo, 34.8%. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J; Treatment for Adolescents With Depression Study (TADS) Team. Duke University. JAMA. 2004 Aug 18;292(7):807-20. For more, see Depression and Teens.

Melatonin Might Help Cognition: In a small 4-week DB PC study of 26 elderly, those taking melatonin 1 mg/night had improved morning restedness and decreased sleep latency after noctural awakening as well as improved verbal learning scores suggesting improved cognitive functioning. Cognitive effects of exogenous melatonin administration in elderly persons: a pilot study. Peck JS, LeGoff DB, Ahmed I, Goebert D. University of Hawaii. Am J Geriatr Psychiatry. 2004 Jul-Aug;12(4):432-6. Ed: Melatonin 3-12 mg/night has become my favorite first line treatment for insomnia. For more on melatonin, see Melatonin and Insomnia. 

No Harm From Vitamin D 15,000 IU/week: In a 2-month, 52-patient DB PC study of 15,000 IU/week of vitamin D for postmenopausal women with decrease bone mineral density with both groups receiving calcium 0.5 g/d, none of the vitamin D treated women suffered from hypercalcemia and mild hypercalciuria was observed in one patient. The study presented some evidence on the effectiveness and safety of 15,000 IU/week 25-hydroxycholecalciferol dosage schedule. Intensive vitamin D supplementation in the treatment of osteoporosis. Stefikova K, Chylova K, Krivosikova Z, Spustova V, Dzurik R. Bratislava, Slovenska republika. Vnitr Lek. 2004 Apr;50(4):286-90

Hypercalcemia Cases From Vitamin D; Rare and All Due to Very High Doses: A case of hypercalcemia causing renal colic and neurologic disorders in a 62-year-old Italian man is reported. The hypercalcemia was caused by chronic treatment with injectible slow release vitamins D and A. J Nephrol. 2003 Nov-Dec;16(6):917-21. Hypercalcemia is usually caused by cancer or a parathyroid nodule excreting too much parathyroid hormone. Both processes break down bone tissue. Hyperthyroidism can also cause rare cases of hypercalcemia. A case of hypercalcemia due to vitamin D intoxication of a 3-month-old has been reported. The child recovered with bisphosphonate treatment without sequelae. Eur J Pediatr. 2004 Mar;163(3):163-5. A case of hypercalcemia due to an artificial vitamin D analogue tacalcitol cream being used in large amounts for psoriasis is report. It resolved in 7 days without treatment. The authors note that it was the first case ever reported due to the cream. J Dermatol. 2003 Nov;30(11):801-4. One Turkish study of infants with vitamin D deficiency rickets found that treatment with a single dose of vitamin D 150,000 or 300,000 IU worked fine, but that 600,000 IU caused hypercalcemia. J Pediatr Endocrinol Metab. 2003 Oct-Nov;16(8):1105-9.

Alfacalcidol Better than Vitamin D, but Vitamin K Not Used: In a DB study of D-hormone analog alfacalcidol vs. vitamin D in patients with established steroid-induced osteoporosis, 1 microg alfacalcidol plus 500 mg calcium per day (n=103) did better than 1000 IU vitamin D3 plus 500 mg calcium (n=101). During the 3-year study, the BMD at the lumbar spine increased 2.4% with alfacalcidol and decreased 0.8% with vitamin D ( P<0.0001). The 3-year rates of new vertebral fracture were 9.7% for alfacalcidol and 24.8% for vitamin D (risk reduction 0.61, P=0.005). The 3-year rates of nonvertebral fracture were 15% for alfacalcidol group and 25% for vitamin D (P=0.081). Alfacalcidol showed a substantially larger decrease in back pain than vitamin D ( P<0.0001). Three patients in the alfacalcidol group and two in the vitamin D group had moderate hypercalcemia. Superiority of alfacalcidol over plain vitamin D in the treatment of glucocorticoid-induced osteoporosis. Ringe JD, Dorst A, Faber H, Schacht E, Rahlfs VW. Leverkusen, Germany.  Rheumatol Int. 2004 Mar;24(2):63-70.

Routine Testing for Vitamin D Hypercalcemia Not Cost-Effective: Clinically significant hypercalcemia appears rare with regular vitamin D, except in patients with severe kidney disease where vitamin D treatment is very helpful but occasional cases of hypercalcemia are reported. I have found hypercalcemia reports with long-acting injectibles in high doses, more potent vitamin D analogues, and very high doses of vitamin D given to infants. It does not appear cost-effective to routinely monitor for hypercalcemia in adults without kidney disease taking a moderate daily oral dose (1000 IU or less) of vitamin D chronically, despite some promoting such testing.

Vitamin D Suppresses Renin and Hypertension: Vitamin D is a potent endocrine suppressor of renin biosynthesis. Mice lacking the Vitamin D receptor have elevated production of renin and angiotensin II, leading to hypertension, cardiac hypertrophy and increased water intake. These abnormalities can be prevented by treatment with an ACE inhibitor or AT(1) receptor antagonist. Vitamin D repression of renin expression is independent of calcium metabolism, the volume- and salt-sensing mechanisms and the Ang II feedback regulation. In normal mice, Vitamin D-deficiency stimulates renin expression, whereas injection of 1,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)] reduces renin synthesis. In cell cultures, 1,25(OH)(2)D(3) directly suppresses renin gene transcription by a VDR-dependent mechanism. Vitamin D: a negative endocrine regulator of the renin-angiotensin system and blood pressure. Li YC, Qiao G, Uskokovic M, Xiang W, Zheng W, Kong J. University of Chicago. J Steroid Biochem Mol Biol. 2004 May;89-90(1-5):387-92

Very High Levels of Tropical Sun Exposure May Increase Vitamin D to Harmful Levels: In a case-control study of  25-hydroxyvitamin D3 and IHD of 143 patients with either angiographic evidence of coronary artery disease or patients with acute myocardial infarction and 70 controls, all men ages 45-65, serum levels of 25-OH-D3 above 222.5 nmol/l (89 ng/ml) were observed in 59.4% of cases compared to 22.1% in controls (p < 0.001; unadjusted odds ratio (OR): 5.17). When controlled for age and selected variables using the multivariate logistic regression, the adjusted OR was 3.18. Serum 25-hydroxyvitamin D3 levels are elevated in South Indian patients with ischemic heart disease. Rajasree S, Rajpal K, Kartha CC, Sarma PS, Kutty VR, Iyer CS, Girija G. Trivandrum, India. Eur J Epidemiol. 2001;17(6):567-71. For more, see Vitamin D.

Meat, Mammal Meat, Eggs, Alcohol Bad for Ulcerative Colitis: 183 adults with stable ulcerative colitis were followed for one year during which 52% relapsed. Those who ate the most meat (4 oz. or more a day) were three times as likely to relapse as those who ate the least (less than 2 oz.). If this was mammal meat and/or processed meat,  patients were five times more likely to relapse. A high intake of animal protein in general, fish, and eggs tripled the risk. Those who drank the most alcohol (more than 2 units a day) were also almost three times as likely to relapse compared with those who drank the least (less than 1 unit a day). Surprisingly, the risk of relapse was not associated with high intake of milk and dairy products, and high levels of dietary fiber did not seem to ward off the risk of relapse either. When the food constituents were assessed, high intakes of sulphur and sulphate were associated with relapse, which could explain the link with red meat and alcohol. The main sources of dietary sulphur are the sulphur amino acids, found in high protein foods, such as mammal meat, cheese, milk, nuts and eggs, and sulphate. Sulphate is found in brassica vegetables, such as broccoli, and is used as a preservative in processed foods, especially bread, beer, sausages, and dried fruit. Many alcoholic drinks also contain sulphate. A high sulphur diet produces hydrogen sulphide, which damages the inner lining of the bowel, making it more 'leaky' and increasing cell turnover, say the authors. Newcastle University, Gut 9/2004. For more, see Meat and Ulcerative Colitis.

Lowering LDL Cholesterol Further is Better; Four Studies: The 2-year DB PROVE IT study —  of 4,162 acute coronary syndrome patients with an LDL cholesterol average of 106 mg/dL found pravastatin ( Pravachol) 40 mg daily lowered LDL to 95 with 26% suffering more cardiovascular difficulty (death, myocardial infarction, unstable angina pectoris requiring hospitalization, revascularization and stroke) vs. atorvastatin ( Lipitor) 80 mg daily. with an LDL lowered further to 62 and 22% experiencing difficulty. CP Cannon et al, N Engl J Med 2004; 350:1495. Two other trials also compared atorvastatin 80 mg with pravastatin 40 mg daily. The REVERSAL study, a DB of 502 patients with obstructions in coronary arteries, found that after 18 months, mean LDL cholesterol concentrations were 79 mg/dL with atorvastatin and 110 mg/dL with pravastatin, and there was less progression of atherosclerosis with atorvastatin. SE Nissen et al, JAMA 2004; 291:1071. The ARBITER study used ultrasound to measure carotid intima-media thickness in patients who met criteria for lipid-lowering therapy; after 1 year, mean LDL cholesterol was 76 mg/dL with atorvastatin and 110 mg/dL with pravastatin. There was more regression of atherosclerosis with atorvastatin. AJ Taylor et al, Circulation 2002; 106:2055. In the large 5-year HPS study of patients at high risk for death from coronary heart disease including 3421 with a mean baseline LDL cholesterol below 100 mg/dL, in this sub-group, simvastatin (Zocor) 40 mg/d lowered mean LDL cholesterol to 65 mg/dL and reduced the incidence of a first major vascular event by 22% compared to placebo (Heart Protection Study Collaborative Group, Lancet 2002; 360:7). Ed: Atorvastatin (Lipitor) 80 mg/day is less expensive than the alternative simvastatin (Zocor) ($101 vs. $132). These are the two recommended for the most powerful decrease in LDL. Rosuvastatin (Crestor) is less expensive ($72), but newer with controversial side-effects.  However, policosanol may be as good or better.  Someday, research might be funded.

Very Low LDL Healthy: Patients with heterozygous familial hypobetalipoproteinemia, who have mean LDL cholesterol concentrations <50 mg/dL, have no symptoms and live on average 10 years longer than the general population, suggesting that intensive cholesterol-lowering therapy may not have adverse effects due to low LDL concentrations. For more, see Cholesterol.

Stavelo for Parkinsons: Levodopa combined with carbidopa is the most common treatment for Parkinson’s disease, but after 2 to 5 years most patients develop troublesome complications. The newest treatment for Parkinson’s disease patients with end-of-dose "wearing-off" is Stalevo, a combination of the catechol-O-methyltransferase (COMT) inhibitor entacapone (Comtan) with 3 different doses of levodopa/carbidopa. Levodopa is metabolized by 2 enzymes, dopa decarboxylase and COMT. Levodopa is taken with carbidopa, which inhibits decarboxylation of peripheral levodopa, preventing nausea and permitting more levodopa to reach the brain. COMT inhibitors prolong the half-life of levodopa, decreasing the amount of "off" time, but they may increase dyskinesias. Stalevo is bioequivalent to separate but equivalent doses of levodopa/carbidopa (100/25) plus entacapone. RA Hauser, Neurology 2004; 62 suppl 1:S64. For more, see Parkinson's.

Melatonin Might Help Post-Head Injury: In a DB cross-over trial of head injury patients comparing melatonin 5 mg/night vs. amitriptyline 25 mg/night, there were no differences in sleep latency, duration, quality or daytime alertness for either drug compared to baseline using significance testing. However, effect sizes revealed some encouraging changes. Patients on melatonin reported improved daytime alertness. On amitriptyline, patients reported increased sleep duration. There were no adverse drug effects. The value of melatonin for sleep disorders occurring post-head injury: a pilot RCT. Kemp S, Biswas R, Neumann V, Coughlan A.  Leeds UK. Brain Inj. 2004 Sep;18(9):911-9. For more, see Melatonin.

Tiotropium (Spiriva Inhaler) Better than Atrovent for COPD, But Serevent About as Good: In a 1-year, DB PC study of 921 COPD patients, tiotropium bromide (Spiriva inhaler; $115/mo) 18 mcg daily in addition to short-acting beta2-agonists and other standard drugs for COPD improved FEV1 by an average of 22% at peak and 12% at trough over baseline, and maintained the beneficial effect throughout the study. R Casaburi et al, Eur Respir J 2002, 19:217. A DB study of 535 patients found that once-daily tiotropium was superior to q.i.d. ipratropium bromide (Atrovent; $68) in patients with COPD exacerbations (35% vs. 46%), improvement in FEV1 and decreased use of rescue beta2-agonists (4 fewer inhalations per week). Tiotropium also led to greater improvement in quality-of-life scores, but some of the differences were not statistically significant. W Vincken et al, Eur Respir J 2002; 19:209. In two 6-month DB PC studies of 1207 patients, tiotropium decreased the number of COPD exacerbations (1.07 vs 1.49), decreased the number of hospital admissions, decreased dyspnea, improved quality of life scores, and produced greater improvement in FEV1 compared to placebo. But long-acting twice-daily beta2-agonist salmeterol (Serevent; $88) was superior to placebo in decreasing dyspnea and improving FEV1. The only statistically significant advantage of tiotropium over salmeterol was in FEV1. V Brusasco et al, Thorax 2003; 58:399. for more, see Asthma.

Fluorouracil Best for Most Actinic Keratosis; Aldara Very Expensive: Cryosurgery with liquid nitrogen is the most common technique used to destroy actinic keratosis; other mechanical methods include excision, electrodesiccation and curettage, chemical peels, and laser resurfacing. When lesions are too numerous, topical fluorouracil ($51) is applied once or twice daily for 2-6 weeks. Fluorouracil is effective in more than 90% of patients and treats subclinical AKs, but it can cause temporary erythema, blisters and ulceration. Diclofenac gel (Solaraze; $105) is relatively well tolerated but only modestly effective. Topical aminolevulinic acid ($108) plus blue light ($?) is more effective but less well tolerated. Medical Letter 2002; 44:57. Imiquimod cream 5% ( Aldara; $515) is an immune modifier also approved for treatment of genital and perianal warts. Medical Letter 1997; 39:118. It also be approved soon for treatment of basal cell carcinoma. It produces apoptosis in malignant, but not normal, human keratinocytes. M Schön et al, J Natl Cancer Inst 2003; 95:1138. While it causes fewer side-effects than fluorouracil, it is to be used weekly for 16 weeks. In 2 vehicle-controlled studies, a total of 724 patients with superficial basal cell carcinoma were treated with imiquimod 5 or 7 times a week for 6 weeks. At 12 weeks post-treatment, clinical and histological clearing occurred in 75% of patients treated 5 times a week, and 73% of those treated 7 times a week, compared to 2% with the vehicle alone. J Geisse et al, J Am Acad Dermatol 2004; 50:722.

Niacin Adds to Statin Benefit: In a 164 DB 20-week study with each type IIa or IIb primary hyperlipidemia patient took 4-weeks each of five phases: niacin ER (starting at 500 mg/d, increasing in 500-mg increments to 2500 mg/d); lovastatin (starting at 10 mg, increasing to 20 mg, then 40 mg/d); and 3 combinations arms, each with a constant lovastatin dose and escalating niacin ER doses. LDL-C level reductions were greater with niacin ER/lovastatin (1500/20 mg) than with lovastatin (20 mg) (35% vs. 22%, P<.001) and with niacin ER/lovastatin (2000/40 mg) than with lovastatin (40 mg) (46% vs. 24%, P<.001). Each 500-mg increase in niacin ER, on average, decreased LDL-C levels an additional 4% and increased HDL-C levels 8%. The maximum recommended dose (2000/40 mg/d) increased HDL-C levels 29% and decreased LDL-C levels 46%, triglyceride levels 38%, and lipoprotein(a) levels 14%. All lipid responses were dose dependent and generally additive. Graphs of the dose-response relationships as 3-dimensional surfaces documented the strength and consistency of these responses. Insull W Jr, McGovern ME, Schrott H, Thompson P, Crouse JR, Zieve F, Corbelli J. Baylor College of Medicine. Efficacy of extended-release niacin with lovastatin for hypercholesterolemia: assessing all reasonable doses with innovative surface graph analysis. Arch Intern Med. 2004 May 24;164(10):1121-7

Extended Release Niacin Appears Best: Niacin (nicotinic acid) significantly reduces low-density lipoprotein cholesterol, triglyceride, and lipoprotein(a) levels, while increasing high-density lipoprotein cholesterol levels. Niacin is currently available in 3 formulations (immediate release, extended release, and long acting). Immediate-release niacin is generally taken 3 times a day and is associated with adverse flushing, gastrointestinal symptoms, and elevations in blood glucose levels. Long-acting niacin can be taken once daily and is associated with significantly reduced flushing, but its metabolism increases the risk of hepatotoxic effects. Extended-release niacin, also given once daily, has an absorption rate intermediate between the other formulations and is associated with fewer flushing and gastrointestinal symptoms without increasing hepatotoxic risk. New perspectives on the use of niacin in the treatment of lipid disorders. McKenney J. Virginia Commonwealth University. Arch Intern Med. 2004 Apr 12;164(7):697-705

Increasing HDL Cholesterol Important: For every 1-mg/dL increase in HDL, the risk of cardiovascular events decreases by 2% to 3%. HDL mediates reverse cholesterol transport and has antioxidant, antiinflammatory, and antithrombotic effects on the vasculature. HDL enhances nitric oxide production and improved endothelium-dependent relaxation. The National Cholesterol Education Program Adult Treatment Panel guidelines encourage more aggressive screening and treatment of lipid abnormalities. High-density lipoprotein cholesterol and coronary heart disease. Young CE, Karas RH, Kuvin JT.Tufts University. Cardiol Rev. 2004 Mar-Apr;12(2):107-19. Ed: This increase can be best accomplished by exercise, and policosanol. Niacin can also be of value, although there is no research combining policosanol and niacin. Up to one alcoholic drink per day, cautiously avoiding any addictive urge to increase beyond this, can also increase HDL and protect the heart.  Again, no research exists showing whether alcohol adds any additional benefit to policosanol, although alcohol has high risks of violence, abuse, and addition. For more, see Cholesterol. 

Vitamin B6: No Help for Cognition or Mood: In a research review of all studies to date, no trials of vitamin B6 involving people with cognitive impairment or dementia were found. The two trials (Bryan 2002; Deijen 1992) used a double-blind, randomized, placebo-controlled design and involved 109 healthy older people. One trial restricted enrolment to women and the other to men. Vitamin B6 supplementation and healthy older women: Bryan 2002 enrolled 211 healthy women from various age groups into a 5-week study. The trial was of multifactorial design with folic acid, vitamin B12, vitamin B6 and placebo in its four arms. Twelve healthy women aged 65 to 92 years received 75 mg vitamin B6 orally per day and were compared with 21 healthy women who were allocated to placebo. No statistically significant benefits from vitamin B6 on mood or cognition were observed. Vitamin B6 supplementation and healthy older men: Deijen 1992 recruited 76 healthy men aged 70 to 79 years. They were divided into 38 matched pairs, one member of each pair randomly allocated to 20 mg of vitamin B6 (pyridoxine hydrochloride) per day for 12 weeks the other to placebo. No statistically significant differences between treatment and placebo were found in their effects on cognition or mood. The effect of vitamin B6 on cognition. Malouf R, Grimley Evans J. Oxford, UK. Cochrane Database Syst Rev. 2003;(4):CD004393

Vitamin B6 Doesn't Help Schizophrenia: In a 9-week, 15-patient DB PC study of vitamin B6 starting at 100 mg/day and increasing to 400 mg/day by the fourth week, PANSS scores revealed no differences between vitamin B6- and placebo-treated patients in amelioration of their mental state. Vitamin B6 as add-on treatment in chronic schizophrenic and schizoaffective patients: a double-blind, placebo-controlled study. Lerner V, Miodownik C, Kaptsan A, Cohen H, Loewenthal U, Kotler M. Ben-Gurion University J Clin Psychiatry. 2002 Jan;63(1):54-8. For more, see Vitamin B-6.

Unlubricated Condoms Dramatically Increase Urinary Tract Infections: In a case-control study of sexually active college women ages 18-39 years, cases (N = 144) were women with first urinary tract infection (confirmed by culture); controls (N = 286) were similar women without a history of urinary tract infection. After adjusting for frequency of intercourse, using unlubricated condoms compared with using no birth control method dramatically increased the risk of first urinary tract infection (odds ratio = 29.1). Using a lubricated condom (with or without spermicide in the lubricant) or a spermicidal cream or gel with an unlubricated condom was associated with two- to eightfold risk of first urinary tract infection. Condom use and first-time urinary tract infection. Foxman B, Marsh J, Gillespie B, Rubin N, Koopman JS, Spear S. University of Michigan. Epidemiology. 1997 Nov;8(6):637-41. For more, see UTIs.

Petroleum Jelly, Glycerin, Vegetable Oils Better Vaginal Lubricants for Fertility: Fifteen substances utilizable as vaginal lubricants were therefore tested for their effect on sperm motility in vitro. Petroleum jelly and glycerin had minimal detrimental effects on motility and are the lubricants of choice when an infertility problem exists. The lubricants tested, followed by 15-minute and 2-hour results of sperm motility, are as follows: control: 4+, 3-4+; H-R Jelly: 1+, 0; KY Jelly: 0, 0; Lubifax: 0, 0; Surgilube: 0, 0; Ortho-gynol: 0, 0; Alpha-Keri: 0, 0; Keri lotion: 0-1+, 0; pHisohex: 0, 0; Searle skin lotion: 0-1+, 0; vegetable oil: 3+, 2+; olive oil: 2+, 3+; safflower oil: 3+, 3+; peanut oil: 3+, 3+; Vaseline petroleum jelly: 2-3+, 3-4+; and glycerin: 3+, 3-4+. The effect of vaginal lubricants on sperm motility in vitro. Goldenberg RL, White R. Fertil Steril. 1975 Sep;26(9):872-3

Some Lubricants Impair Sperm Motility: Four lubricants were analyzed: KY jelly, baby oil, olive oil and saliva on sperm motion in 16 samples from patients undergoing infertility investigations. All lubricants except baby oil significantly decreased percentage progressive motility, progressive velocity, curvilinear velocity and lateral head displacement at 12.5% concentration. At a lower concentration of 6.25%, both olive oil and saliva still significantly reduced progressive motility parameters, while KY jelly diminished head movement parameters. Even at these very low concentrations, coital lubricants impair sperm motility and thus may adversely affect fertility. The effects of coital lubricants on sperm motility in vitro. Anderson L, Lewis SE, McClure N. University of Belfast. Hum Reprod. 1998 Dec;13(12):3351-6