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29 Irritable Bowel Syndrome Helped by Antibiotic: IBS affects as many as 36 million Americans; diarrhea, constipation, bloating, gas and abdominal pain are not explained by medical tests such as gastrointestinal endoscopies. Ordinary bacteria normally confined to the large intestine may expand into the small intestine, prompting uncomfortable bloating and gas after meals, a change in bowel movements as well as an immune response that may account for the flu-like illness so common in the IBS patient, including such debilitating symptoms as headaches, muscle and joint pains and chronic fatigue. 92% of IBS patients report bloating after they eat, a symptom he saw again and again in his patients. 84% of IBS patients were found to have abnormal lactulose breath test results suggesting small intestinal bacterial overgrowth. In a DB PC study, 75% given antibiotic therapy reported improvement in symptoms. Small intestinal bacterial overgrowth allows gut bacteria to cross the mucosal barrier, which is the lining of the gut, and enter the body. This activates the patient's immune system as evidenced by increased numbers of inflammatory cells in tissues of IBS patients. The immune response to bacterial antigens may then explain the flu-like symptoms that can greatly diminish the quality of life such as chronic fatigue and pain. Henry C. Lin, USC, JAMA 8/18/04. For more, see Irritable Bowel Syndrome. Nine Factors Predict 90% of Heart Attacks: INTERHEART case control study examined 15,152 individuals from 52 countries with their first heart attack and 14,820 others who did not have heart disease but who were of the same age, gender, and from the same city. The two most important risk factors were cigarette smoking and an abnormal ratio of blood lipids (Apolipoprotein B/Apolipoprotein A-1), which together predicted two-thirds of heart attack. Additional risk factors were high blood pressure, diabetes, abdominal obesity, stress, a lack of daily consumption of fruits and vegetables and a lack of daily exercise. Regular consumption of small amounts of alcohol was also found to be modestly protective. These nine predict more than 90% of the risk of a heart attack. Salim Yusuf, McMaster, Lancet 9/11/2004. For more, see Coronary Heart Disease Risk Factors Vitamin D Levels Lower in Colon Cancer: In a nested case-control study among women in the Nurses' Health Study, 193 colorectal cancer cases, ages 46 to 78 years, diagnosed up to 11 years after blood collection were matched with controls. Odds ratios (OR) for risk of colorectal cancer were calculated using conditional logistic regression adjusted for body mass index, physical activity, smoking, family history, use of hormone replacement therapy, aspirin use, and dietary intakes. Among women in the highest quintile in vitamin D levels, the OR was 0.53 (p=.006). Benefit from higher 25(OH)D concentrations was observed for cancers at the distal colon and rectum (P = 0.02) but was not evident for those at the proximal colon (P = 0.81). Plasma vitamin d metabolites and risk of colorectal cancer in women. Feskanich D, Ma J, Fuchs CS, Kirkner GJ, Hankinson SE, Hollis BW, Giovannucci EL. Harvard Medical Cancer Epidemiol Biomarkers Prev. 2004 Sep;13(9):1502-8. Vitamin D Helps Standing and Walking in Elderly: In a population-based survey of 4100 ambulatory US elderly over 60, an 8-foot walk test compared subjects in the lowest and highest quintiles of serum 25(OH)D; the quintile highest in vitamin D had an average decrease of 0.27 second vs. the lowest quintile [P < 0.001]. On the sit-to-stand test, the highest quintile had an average decrease of 0.67 second vs. the lowest [P = 0.017]. Most of the improvement occurred in subjects with 25(OH)D concentrations between 22.5 and approximately 40 nmol/L, but further improvement was seen in the range of 40-94 nmol/L. In both active and inactive ambulatory elderly, 25(OH)D concentrations between 40 and 94 nmol/L are associated with better musculoskeletal function in the lower extremities than are concentrations < 40 nmol/L. Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged > or =60 y. Bischoff-Ferrari HA, Dietrich T, Orav EJ, Hu FB, Zhang Y, Karlson EW, Dawson-Hughes B. Harvard. Am J Clin Nutr. 2004 Sep;80(3):752-8 Vitamin D and Calcium Appear to Markedly Reduce Breast Cancer Risk: For women ages 40-60 with screening mammograms, multivariate logistic regression found that for increasing vitamin D intake (<50, 50-99, 100-199, and >/=200 IU/d), adjusted odds ratios (OR) for extensive densities were 1.00 (reference), 0.51, 0.37, and 0.24, respectively (P = 0.0005). For increasing calcium intake (<500, 500-749, 750-999, and >/=1,000 mg/d), adjusted ORs were 1.00, 0.63, 0.25, and 0.24 (P = 0.0006). This suggests that dietary vitamin D and calcium could reduce breast cancer risk possibly through influences on breast tissue morphology. Vitamin d, calcium, and mammographic breast densities. Berube S, Diorio C, Verhoek-Oftedahl W, Brisson J. Quebec. Cancer Epidemiol Biomarkers Prev. 2004 Sep;13(9):1466-72. For more, see Vitamin D Benefits. Vitamin D Regulated Calbindin, a Calcium Binding Protein: Calbindin-D(9k) (CaBP-9k) is a cytosolic calcium binding protein mainly expressed in the duodenum, placenta and uterus, and intestinal CaBP-9k is regulated by 1, 25-dyhydroxyvitamin D3. However, despite the presence of vitamin D receptors, uterine CaBP-9k is not under the control of vitamin D. Differential transcriptional and translational regulations of calbindin-D9k by steroid hormones and their receptors in the uterus of immature mice. An BS, Choi KC, Hong EJ, Jung YW, Manabe N, Jeung EB. Chungbuk National University, Korea. J Reprod Dev. 2004 Aug;50(4):445-53. Ed: Calbindin is also present in the human brain and may be involved in some way with schizophrenia. Vitamin D in pregnancy or to infants markedly reduces the risk of adult schizophrenia. 80% Iranian Adults Deficient in Vitamin D: 1210 Tehran adults 20-64 years old were randomly selected. 25 (OH) D serum levels were measured. Prevalence of severe, moderate and mild Vitamin D deficiency was 9.5%, 57.6% and 14.2%. Vitamin D serum levels had no significant statistical relation with the duration of exposure to sunlight, kind of clothing and BMI. Calcium intake in the normal vitamin D group was significantly higher than the other groups (714 mg/day vs 503, 577, and 595). Vitamin D serum levels in young and middle aged females were significantly lower than the older group. In order to avoid complications of vitamin D deficiency, supplemental dietary intake seems essential. Vitamin D deficiency and causative factors in the population of Tehran. Hashemipour S, Larijani B, Pajouhi M, Javadi E, Sedaghat M, Soltani A, Adibi H, Shafaei AR, Hamidi Z, Khalili-Fard AR, Hossein-Nezhad A, Booya F. BMC Public Health. 2004 Aug 25;4(1):38. For more, see Vitamin D. Low Dose Estrogen Patch Helps Osteoporosis: In a 2-year DB PC study of 417 women ages 60-80 with intact uteri and bone mineral density z scores of >-2.0, all received calcium and vitamin D supplementation. Those also on unopposed transdermal estradiol at 0.014 mg/d had lumbar spine bone mineral density increased 2.6% vs. 0.6% for placebo (P <.001). Hip bone mineral density increased 0.4% for estradiol and decreased 0.8% for placebo (P <.001). Endometrial hyperplasia developed in 1 woman in the estradiol group but in none of the placebo group. Effects of ultralow-dose transdermal estradiol on bone mineral density: a randomized clinical trial. Ettinger B, Ensrud KE, Wallace R, Johnson KC, Cummings SR, Yankov V, Vittinghoff E, Grady D. Kaiser Permanente, Oakland, California. Obstet Gynecol. 2004 Sep;104(3):443-51. For more, see Osteoporosis. Moderate Fish or Fish Oil Consumption Best in Pregnancy: In a study of 491 healthy Icelandic mothers, infants of women in the lowest quartile of fish consumption weighed less (p = 0.036), were shorter (p < 0.001), and had a smaller head circumference (p < 0.001) at birth than those of women consuming higher amounts of fish. Infants of women in the highest quartile of fish oil intake (>/=1 tablespoon (11 ml)/day), consuming threefold the recommended dietary allowance of vitamin A and twofold that of vitamin D, were shorter (p = 0.036) and had a smaller head circumference (p = 0.003) than those of women consuming less. Infant size at birth increased with fish consumption, especially for women in the lower quartiles of consumption. Smaller birth size was also linked to the highest levels of fish oil intake. Constituents of fish and fish oil might affect birth size differently depending on the amount consumed. Association of Fish and Fish Liver Oil Intake in Pregnancy with Infant Size at Birth among Women of Normal Weight before Pregnancy in a Fishing Community. Thorsdottir I, Birgisdottir BE, Halldorsdottir S, Geirsson RT. University of Iceland. Am J Epidemiol. 2004 Sep 1;160(5):460-5. For more, see Pregnancy. Inositol Background: Myo-Inositol (mI) is a key metabolic precursor to the phospoinositide (PI) metabolic pathway as a key component of central G-protein coupled receptor signaling systems, including several subtypes of adrenergic, cholinergic, serotonergic and metabotropic glutamatergic receptors. Results suggest that mI reduces 5HT2A-R function at the receptor-G protein level. While fluoxetine also reduced 5HT2A-R function, but to a lesser degree, imipramine increased 5HT2A-R function, which may explain why mI seems to be effective exclusively in selective serotonin reuptake inhibitor-sensitive disorders. In addition mI, and at high concentrations fluoxetine and imipramine, also reduces mAChR function. Furthermore the results suggest that the attenuating effect of mI on mAChRs is partially dependent on the PI metabolic pathway. Effects of myo-inositol versus fluoxetine and imipramine pretreatments on serotonin 5HT2A and muscarinic acetylcholine receptors in human neuroblastoma cells. Brink CB, Viljoen SL, de Kock SE, Stein DJ, Harvey BH. Potchefstroom, South Africa. Metab Brain Dis. 2004 Jun;19(1-2):51-70 Inositol's Benefit for Depression Not Clear: Reviewers found four trials using inositol for depression with a total of 141 participants. These were short term trials of double-blind design. The authors conclude that the trials did not show clear evidence of a therapeutic benefit, nor any evidence of poor acceptability. Ongoing studies should reduce this uncertainty. Inositol for depressive disorders. Taylor MJ, Wilder H, Bhagwagar Z, Geddes J. University of Oxford. Cochrane Database Syst Rev. 2004;(2):CD004049 Inositol Didn't Help PMS in Very Small Study: Inositol, a simple isomer of glucose, serves as a precursor in the phosphatidyl-inositol (PI) second messenger cycle. In a very small 6-month, 11-woman DB PC crossover study of PMDD, myo-inositol, 12 g daily, during the luteal phase only (14 days prior to menses) showed no beneficial effect for inositol over placebo. Myo-inositol has no beneficial effect on premenstrual dysphoric disorder. Nemets B, Talesnick B, Belmaker RH, Levine J., Ben Gurion University of the Negev, Israel. World J Biol Psychiatry. 2002 Jul;3(3):147-9. For more, see Inositol. Ticlid Very Expensive Stroke Preventative; Not Cost Effective: Ticlopidine
(Ticlid) is a platelet aggregation inhibitor used for patients at risk for
strokes due to transient ischemic attacks, transient monocular blindness, or
minor strokes. In two very large, industry-funded studies of 4,142 patients, at
250 mg twice a day, it slightly lowered the risk for a stroke by 4% (18% vs.
14%) over a five year period of time compared to aspirin and by 6% (24% vs. 18%)
when compared to placebo when given to stroke victims over a three year period.
The generic costs $108 per month at Walgreens. This means that it costs $160,000
per stroke actually prevented in medication cost alone when compared to
aspirin. That‘s a huge amount of money. The cost is so high because 24 out of
25 patients taking the medicine won’t be helped by it. Ticlid can have a
number of serious side-effect affecting the white and red blood cells. Light Drinking Keeps Heart Arteries From Blocking Off Again: In 225 males who had balloon angioplasty, 42% of those who drank little or no alcohol needed repeat angioplasty. They had more blocked arteries, worse cholesterol levels and poorer heart function when compared to patients who drank 50 grams of alcohol per week, or about three small 6 oz. glasses of wine or four 12 oz. cans of beers per week, a week of whom only 23% needed repeat angioplasty. Feraydoon Niroomand, Heidelberg University, Reuters, London 9/13/04. Ed: This supports my rule of waiting until age 45 to start drinking and never drinking over 1 drink per day. For more, see Alcohol Health Benefits. Child Suicide Risk Said Highest with Luvox, Effexor, Paxil: Tarek Hammad, an FDA senior medical reviewer, said 2-3% of children are likely to incur increased suicidal thoughts from taking any antidepressant. Looking at all the drug company studies, the relative risks of suicidal behavior or thoughts were highest among youths taking Luvox, Effexor and Paxil and lower among youths taking Celexa, Zoloft and Prozac. 9/13/04 Wash AP. Ed: Fluoxetine, generic Prozac, has the best record and by far the lowest cost. For more, see Teen Depression. 5-HTP Helped Females in Panic Experiment: In a DB PC study to investigate the acute effects of 5-HTP on the response to panicogenic challenge with cholecystokinin-tetrapeptide (CCK-4) in 32 healthy volunteers, the half receiving 200 mg of 5-HTP showed a nonsignificant decrease in panic rate (19% after 5-HTP and 44% after placebo, p = 0.13) with a trend for lower intensity of symptoms after 5-HTP (p = 0.08). Females had a significantly lower panic rate and intensity of cognitive symptoms with 5-HTP. The effect of 5-hydroxytryptophan on cholecystokinin-4-induced panic attacks in healthy volunteers. Maron E, Toru I, Vasar V, Shlik J. University of Tartu, Estonia. J Psychopharmacol. 2004 Jun;18(2):194-9 5-HTP Helped Night Terrors in Children: In a random assignment study of 45 children with night terrors, 93% of those assigned to 20 night of 5-HTP (2 mg/kg) showed improvement vs. 29% with placebo. After 6 months, 84% were still terror-free vs. 29% of controls. L -5-Hydroxytryptophan treatment of sleep terrors in children. Bruni O, Ferri R, Miano S, Verrillo E. University of Rome "La Sapienza", Via dei Sabelli 108, 00185 Rome, Italy. oliviero.bruni@uniroma1.it Eur J Pediatr. 2004 Jul;163(7):402-7. Ed: I may be wrong on how I read this study, but I think the 5-HTP was used only 20 days and not the entire 6 months. 5-HTP Might Help Stress Induced Overeating: In rats, 5-HTP (3-200 mg/kg ip) suppressed food intake in a dose-dependent manner in both models, but was at least eight times more effective in the stress-hyperphagia model. 5-HTP may be useful in controlling the excessive food intake sometimes generated by stress, even if given without decarboxylase inhibitors or other drugs. 5-Hydroxy-L-tryptophan suppresses food intake in food-deprived and stressed rats. Amer A, Breu J, McDermott J, Wurtman RJ, Maher TJ. Massachusetts College of Pharmacy and Health Sciences, Boston. Pharmacol Biochem Behav. 2004 Jan;77(1):137-43. For more, see 5-HTP. Increasing ACE-Inhibitor Almost as Good for Inadequately Controlled Hypertension as Adding Angiotensin Receptor Blocker: The two DB AMAZE studies sponsored by AstraZeneca, maker of ARB candesartan, of 1096 hypertensive patients who were uncontrolled on ACE-Inhibitor lisinopril 20 mg daily were randomized (1:1) to receive either 8 weeks of high-dose lisinopril (40 mg) or the addition of candesartan (16 mg) for 2 weeks followed by 32 mg for 6 weeks. The studies demonstrated decreases in trough sitting systolic/diastolic blood pressures at Week 8 of 7.5/6.1 mm Hg for the lisinopril up-titration treatment group vs. 10.5/7.8 mm Hg for the lisinopril plus candesartan treatment group. The blood pressure control rates (<140/<90 mm Hg) were 36.9% and 42.7%. Both treatment regimens were well tolerated. For hypertensive patients not controlled by lisinopril 20 mg once daily, addition of candesartan (32 mg once daily) or doubling the dose of lisinopril provides safe, additional reduction of blood pressure. Antihypertensive Efficacy of Candesartan-Lisinopril in Combination vs. Up-Titration of Lisinopril: The AMAZE Trials. Izzo JL Jr, Weinberg MS, Hainer JW, Kerkering J, Tou CK. Buffalo. J Clin Hypertens (Greenwich). 2004 Sep;6(9):485-93. Ed: ACE-Inhibitors are much less expensive than ARBs. For more, see ACE Inhibitors. Pynogenol Helped Diabetes a Little: In a DB PC study of 77 diabetes type II patients of the French maritime pine bark extract, Pynogenol(R) 100 mg for 12 weeks, during which a standard anti-diabetic treatment was continued, the supplement significantly lowered plasma glucose levels as compared to placebo. HbA1(c) was also lowered, but this was statistically significant only for the first month. In the Pycnogenol(R)-group endothelin-1 was significantly decreased, while 6-ketoprostaglandin F(1a) in plasma was elevated compared to placebo. Nitric oxide levels in plasma increased during treatment in both groups, but, differences did not reach statistical significance. Pycnogenol(R) was well-tolerated with ECG, electrolytes, creatinine and blood urea nitrogen remaining unchanged in both groups. Mild and transient unwanted effects were reported for both groups without significant differences. Antidiabetic effect of Pycnogenol(R) French maritime pine bark extract in patients with diabetes type II. Liu X, Wei J, Tan F, Zhou S, Wurthwein G, Rohdewald P. Beijing, PR China. Life Sci. 2004 Oct 8;75(21):2505-13 rTMS Didn't Add to SSRI Antidepressant Benefit: In a double blind controlled study, rTMS results in a similar antidepressant effect to sham in combination with paroxetine. Both groups had the same delay in improvement. rTMS seems not to be efficient as an add-on treatment to pharmacological medication in non-resistant major depression. Repetitive transcranial magnetic stimulation does not potentiate antidepressant treatment. Poulet E, Brunelin J, Boeuve C, Lerond J, D'Amato T, Dalery J, Saoud M. Universite Claude Bernard Lyon, France. Eur Psychiatry. 2004 Sep;19(6):382-3. For more, see rTMS for Depression. 6-MP Helps Prevent Crohn's Relapse After Surgery: In a DB PC study of 131 patients after ileocolonic surgery for Crohn's disease, patients receive 6-MP (50 mg), mesalamine (3 g), or placebo. At 24 months, endoscopic recurrence rates were 43% for 6-MP, 63% for mesalamine, and 64% for placebo. Postoperative maintenance of Crohn's disease remission with 6-mercaptopurine, mesalamine, or placebo: A 2-year trial. Hanauer SB, Korelitz BI, Rutgeerts P, Peppercorn MA, Thisted RA, Cohen RD, Present DH. Gastroenterology. 2004 Sep;127(3):723-9 Topiramate Helped Alcoholics in Short Study: In a 150-patient DB PC 12-week study, topiramate (escalating dose of 25 mg/d to 300 mg/d), compared with placebo, improved the odds of overall well-being (odds ratio [OR] = 2.17; P =.01); reported abstinence and not seeking alcohol (OR = 2.63; P =.001); overall life satisfaction (OR = 2.28; P =.01); and reduced harmful drinking consequences (OR = -0.07, P =.01). Oral topiramate reduces the consequences of drinking and improves the quality of life of alcohol-dependent individuals: a randomized controlled trial. Johnson BA, Ait-Daoud N, Akhtar FZ, Ma JZ. University of Texas, San Antonio. Arch Gen Psychiatry. 2004 Sep;61(9):905-12. Ed: This study was published early last year in Lancet. All the authors did is rework the data to make it sound better than it really was. For $200 per month, there was a 26% decrease in heavy drinking. Of course, over a longer period of time this benefit would be expected to be less if any benefit at all. For more, see Medication for Alcoholism.
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