Digestion, health and nutrition: Dr. Anil Minocha, a gastroenterologist and nutritionist

ADHD Treatment: Chinese Compound Herbal Preparation Helps Attention, Impulse Control

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Role of Compound Herbal Prepapration for Attention Deficit Hyperactivity Disorder (ADHD)

Treatment of ADHD or ADD poses numerous challanges. A wide variety of drugs including CNS stimulants, antidepressand and bupropion are frequently used. The response to these medications is variable; besides they are beset with adverse undesirable effects. Parents are frequently looking for alternate herbal, natural and nutrition remedies. 

Background of CHP-ADHD Study:

Compund herbal preparations or CHP derived from Chinese Herbal Medicine  is one such potential strategy. One of the hypothesis underlying ADHD causes is deficiency of essential micronutrients and compound herbal preparations are believe to have coginition enhancing properties by replenishing essential fatty acids, phospholipids, vitamins and minerals.

Dr. Katz and colleagues  from the Sheba Medical Center in Israel examined the efficacy of Nur­ture & Clar­ity in ADHD and published their findings in the paper, "A compound herbal preparation (CHP) in the treatment of children with ADHD: a randomized controlled trial" in the Journal of Attention Disorders 2010.

Composition of compound herbal prepapation (CHP brand name Nur­ture & Clar­ity)

• Paeo­niae Alba
• With­a­nia Som­nifera
• Cen­tella Asi­at­ica
• Spir­ulina Platen­sis
• Bacopa Monieri
• Mel­lissa Offic­i­nalis

Design of CHP-ADHD Study:

• Double blind, randomized, placebo controlled
• Tertiarry care university  medical center
• N=120 kids with a new diagnosis of ADHD based on DSM-IV codes
• Intervention: Compound herbal preparation (n=80) versus placebo (n=40)

Results of CHP-ADHD Study:

1. 91% of kids in treatment and 48% in the control group completed the study
2. Treatment group demonstarted a significant improvement in total TOVA scores as well as 4 subscales
3. The significance of the improved difference between the Chinese  compound herbal preparation (CHP)  treatment versus  placebo group was seen even when using the higher standard of comparison i.e. Intent to treat analysis

Conclusions of Compound Chinese Herbal Prepartion-ADHD Study:

Compound herbal preparation treatment is benficial in treatment of ADHD or ADD and improves the following symptoms:

• Attention
• Cognition
• Impulse control 

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Cranberry versus antibiotic TMP-SMX for preventing recurrent urinary tract infections or UTI

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Is it better to take antibiotics rather than cranberry to prevent urinary tract infections?

Urinary tract infections including bladder infections are common amongst women. Literature supports the use of Cranberries and cranberry juice for preventing urinary tract infections (UTIs). Cranberry is popular because it is natural and devoid of puported side-effects related to antibiotics expecially over long term.

The study authored by Beerepoot and colleagues from the Academic Medical Center in Amsterdam was published in Archives of Internal Medicine. While the study showed antibiotics to be better at preventing UTI over 1 year, are they really supeior to Cranberry over longer term?

Not so fast! There is a subtext to the overall cost to one's health associated with antibiotic TMP-SMX use which I discuss after the author's conclusions.

Study methods: The study involved 221 premenopausal women with history of recurrent urinary tract infections (UTI). Subjects received either TMP-SMX 480 mg once a day or cranberry capsules 500 mg twice a day for 12 months.

Results

1. Mean number of UTIs Cranberry 4.0 vs TMP-SMX 1.8
2. Proportion of women with atleast 1 UTI Cranberry 78% vs TMP-SMX 71%
3. Median time to symptomatic UTI Cranberry 8 months vs TMP-SMX 4 months
4. Antibiotic resistence to E. coli (UTI bacteria) Cranberry 28% vs TMP-SMX 91%

Authors' conclusions: Use of TMP-SMX antibiotic is superior to cranberry for over a period of 12 months at the expense of antibiotic resistence.

My comments

1. The antibiotic group in this study likely had an inherent advantage since the bioavailabilty of active compound in the antibiotic greater than the cranberry capsule group (Clinical significance to be established).
2. The superiority of antibiotic TMP-SMX over 1 year not withstanding, the occurance of more than 90% antibiotic resistence gives me pause and makes me wonder if the results would have reversed if the study was extended over longer term, say 5 years.
3. The long term of use of broad spectrum antibiotic such as TMP-SMX is fraught with dangers, many not well understood including the effect on overall health due to disruption of the bacterial balance and homeostasis in the gut.
4. Many women have moved somewhat past cranberry alone and are using it in combination with mannose.

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Carnitine supplements as treatment of autism?

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Levo-carnitine treatment improves autistic spectrum disorders

 

Abnormalities of mitochondria are widely prevalent in patients with autistic spectrum disorders. Prevalence of abnormal biomarker values of mitochondrial dysfunction is higher in patients with autism. Biomarkers of mitochondrial dysfunction include carnitine and lactate.

 

Filipek from the University of California in Irvine, Ca have demonstrated that patients with autistic spectrum disorders have higher prevalence of carnitine deficiency. Carnitine deficiency has been attributed to the mitochondrial defects. Such alterations could in turn play in role in pathogenesis of effects on brain as manifested by various behavioral effects.

 

Literature suggests potential role for carnitine supplementation for treatment of autism; however, thus far, there has been lack of good randomized controlled trials to examine the effect of carnitine.

 

Hypothesis: L-carnitine supplementation ameliorates the effects of mitochondrial dysfunction in patients with autistic spectrum disorders.

 

Study: Geier and colleagues from the Institute of Chronic Illness in Silver Springs, MD conducted a double blind, randomized placebo controlled trial to evaluate the effect of levocarnitine in 30 patients with autism spectrum disorders.

 

Intervention: Liquid L-carnitine 50 mg/kg bodyweight per day or placebo for 3 months.

Outcome measures:

• Childhood Autism Rating Scale (CARS)
• Hand muscle testing
• Modified clinical global impression (CGI)
• Autism Treatment Evaluation Checklist (ATEC)
• Treatment adherence measurement (TAM)
• Frequency and intensity of side effect rating (FISER)
• Global rating of side effect burden (GRSEB)
• Patient report of incidence of side effects (PRISE)

Results: L-carnitine treatment led to significant improvement in: Childhood Autism Rating Scale, hand muscle testing, modified clinical global impression, and Autism Treatment Evaluation Checklist.

Changes in carnitine levels in serum were positively associated with improvements in associated with hand muscle strength, cognitive scores, and Childhood Autism Rating Scale scores.

 

Conclusions: L-carnitine supplementation results in clinical improvement in several clinical parameters in patients with autistic spectrum disorders.

Dr. Minocha’s opinion: The results of the study are dramatic and provocative; however, further substantiation may be in order.

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Natural Cranberry mannose blend for recurrent UTI

Digestion, Health & Nutrition                    Facebook Dr. Anil

Natural cranberry plus mannose treatment for recurrent urinary tract infections

Authored by Anil Minocha MD of Shreveport, La

Cranberry juice has been widely used by women for natural treatment for for prevention and treatment of urinary tract infections based on promising scientific evidence. In recent years, D-mannose, a sugar has gained a lot of attention for fight against infections of urinary tract including urinary bladder. The use of a combination of these two potentially natural remedies presents an attractive option for those interested in holistic, non-medicinal preventative and therapeutic approach to UTIs especially recurrent UTI.

The cranberry, d-mannose and bromelain study

Efros and colleagues from the Winthrop University Hospital in New York examined the effect of concentrated proprietary cranberry blend, UTI-STAT with Proantinox, in women with recurrent urinary tract infections.

Contents of the cranberry-mannose-bromelain treatment blend

UTI-Stat^® with Proantinox^® contains concentrated cranberry proanthocyanidins, vitamin C, d-mannose, fructo-oligosaccharide and bromelain.

The study was reported in the journal Urology 2010.

Methods of cranberry plus d-mannose and bromelain trial

The women recruited to the study had history of an average of 2.78 recurrent UTIs in less than six months. The goal was to study the effect of the treatment on efficacy and quality of life of these women with recurrent UTI.

28 women with an average age of 46.5 years particiapted in the study.

Results of cranberry plus d-mannose and bromelain study

The recommended dose of blend was set at 60 ml per day.

Based on historical data, only 9% of the women with recurrent urinary tract infections had recurrence of UTI. By 12 weeks, there was a significant reduction of worry among women along with an improved American Urological Association Symptom Index.

Investigator's conclusions about cranberry plus mannose for UTI

The cranberry liquid blend is safe and well tolerated in both pre- and postmenopausal women with history of recurrent urinary tract infections. It is effective in decreasing the incidence of recurrent UTI.

This indicates that such cranberry-mannose supplement might be of benefit in reducing risk of recurrent urinary tract infections in females.

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Do Zinc supplements prevent pneumonia in kids

Digestion, Health & Nutrition                    Facebook Dr. Anil

Effect of zinc supplementation on risk of pneumonia in children

Pneumonia is common in children younger than five years of age and may even be fatal especially in infants and low socio-economic status. Several studies have evaluated the effect of zinc on preventing respiratory tract infection and a pneumonia related decrease in childhood mortality.

Study:

Lassi and colleagues from AK University Hospital examined the literature and conducted a meta-analysis to study the  efficacy of zinc supplementation for reducing risk of pneumonia in kids. The results of the study were reported in the Cochrane Database Reviews (2010).

The investigators considered randomised controlled trials (RCTs) examining the efects of  supplementation of zinc on the risk of pneumonia in children aged 2 to 59 months of age. The database included six trials (n= 7850 children)

Result of zinc supplements on lower respiratory infections:

Zinc supplementation reduced the incidence of pneumonia by 13 percent  (risk ratio 0.87;  0.81 to 0.94).

Zinc supplementaion, based on one study reduced the prevalence of pneumonia by 41% (RR 0.59; 0.35 to 0.99).

Conclusions: Zinc supplementation reduces the incidence and prevalence of pneumonia in kids. By the way, here is a previous post on similar topic.

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 Disclaimer: Everything on this site including the blog and the ads are for your information only. Do your own due diligence. Talk to your doctor for advice. Ads have potential to generate income for the blogger.

Is complimentary and alternative medicine beneficial in fibromylagia

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 Evidence for beneficial effect of alternative medicine in fibromylagia

There is paucity of medications to relieve the suffering of chronic pain disorders like fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome etc. Patients continue to resort to therapeutic interventions for fibromyalgia that may or may not be effective. Complimentary and alternative medicines form a big part. But are they effective?

De Silva and colleagues from School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen, Scotland, UK, critically examined  the evidence related to beneficial effects of regarding complementary and alternative medicines (CAMs) in fibromyalgia. The study was published in the journal Rheumatology.

Study

These investigators performed a systematic review of the randomized controlled trials of fibromyalgia comparing  complimentary and alternative medicine therapies with  treatments or placebo. Methodologic quality of all studies included in analysis was assessed as moderate. 

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 Results

Homeopathy

Three studies in this critical analysis involved the use of homeopathic care. All three studies demonstrated improvement in pain.

Nutritional supplements of benefit 

• Anthocyanidins
• Capsaicin
• S-adenosylmethionine 

Nutritional supplements lacking benefit

• Soy

Some data this yr since publication of above review

Yoga and exercise

A randomized controlled trial by Carson and colleagues from Oregan Health and Sciences University found a 8-week yoga program to be of benefit.

Another randomized controlled trial  reported that moderate to high intensity nordic walking improves functional acpacity of patients without improving pain.

A randomized controlled trial from Wang and colleagues and published in the New England Journal of Medicine concluded that Tai Chi results in improvements in Fibromylagia Impact Questionaire as well as quality of life.

                            Read about Dr. Minocha's book Natural Stomach Care

Traditional Chinese medicine (TCM)

A systemetic review examined 25 randomized controlled trials evaluating the role of traditional Chinese medicine including acupuncture for fibromyalgia. Overall 10 trials merited examination as part of meta-analysis. The investigators concluded that TCM therapies are of benefit for treatment of fibromylagia.

                            Click to read about acupuncture

Cognitive behavioral therapy

Bernardy and colleagues performed a systematic review and meta-analysis on role of cognitive behavioral therapy (CBT) in fibromyalgia and published their results in the Journal of Rheumatology. The investigators concluded that CBT improves coping with pain and reduces depressed mood and health care seeking behavior.

Do you or someone you know have chronic pain disorder like fibromyalgia? Have you tried any of the alternative medicines? Please share your experience.

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Does homeopathy help sleep in coffee-related insomnia

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Homeopathy and coffee induced sleep disorder insomnia

Coffee is notorious for messing up sleep. People try all kinds of remedies to combat that including alcohol! Can the homeopathy (alternative and complimentary medicine) help you sleep? While animal studies indicate effect of homeopathic medicines on sleep such as non rapid eye movement sleep, there is paucity of objective literature in humans.

Dr. Bell and colleagues from the University of Arizona College of Medicine in Tuson, AZ examined the role of homeopathy in coffee related insomnia in young adults.  Authors used the objective parameters of the science of polysomnography to examine the effects of homeopathic remedies in coffee induced sleep dysfunction or insomnia.

Study:

Subjects of both sexes and aged between 18 and 31 years scoring  who scored above-average scores on standardized personality scales were recruited. Sleep recordings were were perfromed at subjects' homes on successive pairs of nights once per wee.

A total of eight recordings were conducted over a month long period.

Subjects (N=54) received either placebo pellets or verum pellets of one of two homeopathic remedies, Nux Vomica or Coffea Cruda. Subjects cmaintained subjective data in their daily morning sleep diaries and weekly Pittsburgh sleep quality index scales.

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 Results on effect of homeopathy on sleep:

Verum remedies significantly increased total sleep time and Non REM sleep. They also had significant impact on awakenings and stage changes.

Conclusions on effect of homeopathy on coffee induced sleep problems:

The investigators concluded that these findings of effects of homeopathic remedy effects are similar though not identical to those reported in animals with the same homeopathic  remedies. They speculated that the effects may be mediated via initial disruption of the nonlinear dynamics of sleep patterns by the verum remedies.

Click here to read more about Homeopathy

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger. 

 

Whole fruit versus fruit juice

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 Should I eat whole fruit or drink fruit juice                 

 The obvious and perhaps the best option between fruit and fruit juice might be to eat the whole fruit and not just the fruit juice. On the other hand, some of us don't like to eat fruit itself for a variety of reasons like taste, convenience or that we don't like the mess associated with it.

Fruit juices also offer opportunity for health fortification programs to combat other nutrient deficiencies. Fruit juice offers no nutritional advantage over fruit unless of course a fortified version of fruit juice is being used.

• Fortification of orange juice with vitamin D is as effective as an oral supplement in maintaining vitamin D status in adults.

However there has been a controversy brewing that suggests that fruit juices may not be helpful and actually cause harm.

Criticisms of fruit and vegetable juice

 

1. Fruit juice increases blood sugar and worsens glycemic control. This may be overblown as long as we are considering the fruit juice itself and not a juice with sugars added. In the latter case, the summation of effect might depend on how much sugar has been added. Just like anything else, moderation is the key and works for most people.

• Wilson and colleagues from Winona State University conducted a cross-sectional study examined the effects of unsweetened low calorie and normal-calorie cranberry juice formulations on the postprandial glycemic response in healthy humans. Results indicated that the consumption of a low-calorie cranberry juice is associated with a favorable glycemic response and may be beneficial for persons with impaired glucose tolerance.

2. Fruit juice has no fiber. This again is lumping all juices. There are juices with pulp just as there are juices made from whole fruit.

3. Kids who drink juice become obese. While one study did suggest the link between excess juice consumption and obesity, another one found that kids who drank more juice have lower body mass index than those who drank less juice. Still other studies have shown no effect on body weight.

4. Fruit juice undergoes pasteurization and hence has no beneficial bacteria. Personally, I doubt that a proclaimed attribute of fruits is the intake of bacteria beneficial or otherwise. You should always clean the fruit well before eating. When in developing contries, peel off the skin before eating.

5. Drinking fruit juice may be harmful to the heart. However, preponderance of scientific evidence suggests otherwise as some of the studies cited below indicate.

• Ghanim et al. from SUNY, Buffalo, NY demonstrated that orange juice neutralizes the proinflammatory effect of a high-fat, high-carbohydrate meal and prevents endotoxin increase.
• A Japanese study documented that four week supplementation with mixed fruit and vegetable juice concentrates increases protective serum antioxidants and folate and decreases plasma homocysteine.
• Dalgard et al showed that supplementation with orange and blackcurrant juice improves inflammatory markers in patients with peripheral arterial disease.
• Tart cherry juice improves antioxidant defenses in older adults as shown by an increased capacity to counteract an oxidative challenge and reduced oxidative damage to nucleic acids.
• A study of pear, apple, orange, grape, peach, plum, kiwi, melon, and watermelon juices prepared from pure fruits ground evaluated effect on antioxidant staus in healthy subjects. Within 30 minutes after consumption, orange, melon, grape, peach, plum, apple, and kiwi juices inhibited reactive oxygen species generation. This radical scavenging effect lasted mostly for up to 90 minutes while grape juice displayed antioxidant activity until 2 hours after supplementation. The authors concluded that fruit juices may reduce damage from oxidative stress via antioxidant activity of fruits in scavenging the reactive oxygen species generated in human plasma.
• Gouado and colleagues from University of Douala, Douala, Cameroon, examined the systemic levels of carotenoids from mangoes and papaya consumed as juice, fresh or dried slices in healthy volunteers. Breakfast served to fasting subjects during breakfast, included bread, yogurt and one of the three forms of fruit. Blood samples were collected at 0, 4 and 8 hours. All three forms of consumption contributed to the rise of serum retinol levels. A comparison between the three forms revealed that papaya and mangoes consumed in form of juice or fresh fruit are the best forms because they had higher bioavailability values.
• A double blind randomized controlled trial of 59 healthy subjects examined the effect of a commercially available encapsulated fruit and vegetable juice powder concentrate (FVJC) on functional indices of health over a 77 day period. The FVJC group tended to have fewer total symptoms than the placebo group (P < 0.076) and this was accompanied by an increase in plasma nutrients and antioxidant capacity, reduction in DNA strand breaks, and an increase in circulating gammadelta-T cells.
• Udani et al conducted an 8 week randomized, double-blind, placebo-controlled study to examine the effect of multiple dosages of a proprietary Mangosteen Juice blend (3, 6 or 9 oz twice a day) on indicators of inflammation and antioxidant levels in obese patients with elevated C-reactive protein (CRP) levels. Authors found that proprietary mangosteen juice blend reduced CRP levels (increased change from baseline) compared to placebo for those taking 18 oz per day.
• Kiefer et al conducted a double-blind randomized cross-over design study involving 59 healthy men and women (40-60 years of age)to examine the effect of supplementation with a natural phytonutrient preparation from fruits and vegetables found that supplementation with mixed fruit and vegetable juice concentrates effectively increased plasma levels of important antioxidant nutrients and folate.
• A randomized double-blind, crossover trial (n=32 men) of supplementation with the encapsulated mixed extract (Juice Plus) compared to placebo found tht the supplement increased the concentrations of plasma beta-carotene, retinol, alpha-tocopherol, ascorbic acid and folic acid while reducing plasma homocysteine. Glucose, insulin and lipid concentrations were unaffected.  Authors concluded that the supplementation produced responses consistent with a reduction in risk of cardiovascular disease.

6. Administration of fruit juice to kids predisposes them to chronic allergic disorders. This notion came from contact dermatitis seen in some kids. The concept of increased risk of chronic allergic disorders has not been confirmed by scientific data.

Caution: Fruit juice just like any other food is a source of calories and should be accounted for in any nutritional counselling. Moderation is the key. Consult your physician.

 

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Food triggers and natural supplements, treatments for migraine headache

Digestion, Health & Nutrition                          Facebook Dr. Anil

Identify foods triggers and supplements beneficial for migraine headaches

Authored by Anil Minocha MD of Shreveport, La

Many patients do not obtain the expected relief from migraine headaches by using the myriad medications alone. Complementary and alternative medicine is playing increasing role in the patient's preferences. Lifestyle modifications and use of supplements has frequently been recommended.

Drs. Sun-Edelstein and Mauskop from the The New York Headache Center, New York reviewed the role of the role of food triggers and supplements for treatment and revention of migraine headaches. The findings were published in the Clinical Journal of Pain.

They studied the English language literature on preclinical and clinical studies pertaining to food triggers and supplements and migraines. They concluded as follows:

1. A thorough food/nutritional history using food diaries can help identify food triggers.

2. A subset of patients may be sensitive to foods that trigger headaches and these include the following:

• Phenylethylamine
• Tyramine
• Aspartame
• Monosodium glutamate
• Nitrates and nitrites
• Alcohol
• Caffeine

3. There is evidence to support the use of certain vitamins and supplements for preventing migraine headaches and many have been endorsed by the American Headache Society and American Academy of Neurology 2012:

• Magnesium
• Petasites hybridus aka butterber
• Mig-99 or Feverfew
• Coenzyme Q10
• Riboflavin
• Alpha lipoic acid

Read about Dr. Minocha's book Natural Stomach Care

Do you or someone you know has migraine headaches? Please share your thoughts.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Riboflavin prevents migraine headache

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Riboflavin or Vitamin B2 for migraine prophylaxis

 

Complementary and alternative medicine is being used for numerous chronic disorders including pain. A disorder of mitochondrial energy metabolism has been implicated in pathogenesis of migraine headaches. Riboflavin may help correct that. Riboflavin deficiency is rare. Studies indicate that high dose of B2 have prophylactic effects against migraine headaches. 

 

Study

Schoenen et al. from the Department of Neurology, University of Liège, CHR Citadelle, Belgium conducted a randomized, double-blind, placebo-controlled examined the role of riboflavin (400 mg/d) in patients (n=55) suffering from 2 to 8 attacks of migraine headaches per month. 

 

Results

Greater than 50% improvement was seen in 54% of treatment group as compared to 19% in placebo. Riboflavin reduced the headache days from 57% as compared to 19% in placebo group. This was associated with a significant improvement in migraine index score of 39 in treatment group as compared to 8% in placebo. The number-needed-to-treat for effective response was 2.3.

 

 

Migraine in children and adolescents

 

Study

Condo and colleagues from the Department of Neurological Sciences, University of Bologna, Bologna, Italy, conducted a retrospective study to examine the role of riboflavin for preventing migraine heaaches in pediatric and adolescent patients (n=41). The findings about beneficial effect of riboflavin were published in the Journal of Headache and Pain.

Methods

Subjects with migraine headaches receieved 200 or 400 mg/day oral dose of riboflavin for 3, 4 or 6 months.

Results

The riboflavin supplementation resulted in a significant reduction in migraine episode frequency and intensity (p<0.05). 

Follow up these subjects revealed that 68 percent of the subjects demonstrated a 50% or greater reduction in frequency of attacks. Adverse events included vomiting and increased appetite which the authors felt were unrelated to the riboflavin administration.

It should however be noted that other studies in children have however provided opposing results.

Do you take riboflavin or anyother vitamin or supplement to prevent migraines? Please share.

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Vitamin D deficiency: Is it a growing epidemic

Digestion, Health & Nutrition                          Facebook Dr. Anil

Vitamin D or calciferol is actually a group of compounds with the molecule comprised of a cholesterol backbone. 1,25(OH)2-vitamin D is the physiologically active form of vitamin D. Several of the metabolites are biologically active.

Sources of vitamin D:

Body vitamin D include is derived from production in skin as well as intestinal absorption.

Skin: Exposure of skin to sunlight leads to production of vitamin D in body.

Diet: In addition to vitamin D fortified milk, the dietary sources rich in vitamin D include fatty fish, cod-liver oil, and eggs. Vitamin D2 or ergocalciferol, a plant steroid is used for milk fortification. Other products that may be fortified include cereals, breads etc. Diet usually provides Vitamin D3.

Vitamin D homeostasis:

Factors involved in vitamin D homeostasis include parathyroid hormone, serum calcium, and phosphorus levels, estrogen, placental growth hormone, and prolactin etc.

Functional significance of vitamin D:

Vitamin D and its metabolites are intricately related to calcium homeostasis and bone metabolism. With increasingly limited exposure to sun, Vitamin D insufficiency as measured by low levels of 25-OH vitamin D is a growing epidemic across the world especially among adolescents and the elderly.

 

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Pathologic disease states with vitamin D involvement:

 

Although rickets in rare these days, subclinical vitamin D deficiency is common.

Since calcium metabolism is involved in not just in numerous metabolic functions in the body including bones, vitamin D deficiency may play a role not just in osteoporosis but also in impairment of immune function,increased risk of various malignancies including colon cancer as well as increased risk for heart disease.

Cancer: An increase of 25 nmol/L in 25-hydroxy-vitamin D levels is associated with a 17 percent decrease total cancer risk.

Bone fractures: Vitamin D and calcium supplementation reduces the risk of falls and fractures.

Vitamin D levels and mortality: Low levels of vitamin D are an increased risk of all cause mortality whereas supplementation of vitamin D results in reduced of all-cause mortality

Vitamin D levels: Best marker is the serum 25-OH vitamin D concentration. While there are considerable disagreements on the “normal” , a level below 20 to 30 ng/ml is considered abnormal. The "normals" may vary with the labs as well.

Vitamin D deficiency:

Vitamin D deficiency can be seen in 57 percent of hospitalized patients of whom 22 percent are severely deficient [Thomas 1998] Vitamin D stores decline with age, especially in the winter because of reduced sun exposure.

The deficiency or resistance may occur due to inadequate dietary intake, malabsorption, lack of sun exposure, liver or kidney dysfunction,or there may be end-organ resistence to vitamin D metabolites. Chronic use of corticosteroids results in decreased vitamin D dependent calcium absorption and hence bone disease.

 

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Dose of vitamin D:

The tolerable upper intake level for vitamin D for healthy adults is 2000 IU per day. A minimum of 200 IU per day is needed in healthy adults.  Many experts argue that the normal daily dose of vitamin D should be 1000-2000 IU per day. Some patients may even require higher doses and should be undertaken under close medical supervision.

Pregnant and lactating mothers: 400 IU/d

Infants who are exclusively breast fed: 400 IU/d. Since infant formulas are fortified with vitamin D, formula-fed infants require supplementation if they consume less than 1000 mL daily of formula.

Elderly: 800 IU/d plus atleast 1.2 g of elemental calcium per day.

Special cases:  

Patients noncompliant with daily vitamin D therapy may benefit from high dose intermittent therapy (100,000 units every four months).

Prevention and treatment of osteoporosis 800 IU (20 micrograms) per day. 

Toxic dose of vitamin D: Greater than 2000 IU per day.

 

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Toxicity of vitamin D:

Vitamin D is not innocuous and excess ingestion can lead to vitamin D intoxication. Subjects prone to this include not only those those who consume megadoses of supplements but also in patients on vitamin D replacement therapy for a variety of disorders. Manifestations of toxicity include hypercalcemia, hypercalciuria, altered mental status, polyuria, polydipsia, anorexia, vomiting, muscle weakness, and bone demineralization with pain.

Caveat:

I would like to pint out that some experts have questioned the issue of extent of prevelance of vitamin D deficiency for a variety of good reasons including in part to the paucity of reliable and reproducible blood tests and that the need for vitamin D may be different in different population sub-groups.

 

Are you taking any vitamin D supplements? If so, what dose and have you talked to your doctor about it? Have you had your vitamin D levels checked? Please share your thoughts.

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New hope for fatty liver in overweight, its natural too: L-carnitine

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L-carnitine and fatty liver (NASH, NAFLD) 

Author: Anil Minocha, Shreveport, LA

Nonalcoholic steatohepatitis (NASH) or nonalcoholic fatty liver disease also known as fatty liver is a growing menace especially with the increase in prevalence of metabolic syndrome and obesity. There is paucity of treatments for effective treatment for NAH or fatty liver and many of these patients go on to liver cirrhosis and need liver transplantation. By the way, aA recent study published in the New England Journal of Medicine showed vitamin E to be of benefit.   

Mechanism of action:  L-carnitine adminsteration can affect  multiple metabolic pathways resulting in modifications of lipid profile, and altered glucose metabolism, oxidative stress, and inflammatory reaction. 

 

Authors and study design:  Malaguarnera et al. from the University of Catania, Italy conducted a randomized controlled trial to examine the role of L-carnitine supplementation on reversing the severity of NASH or fatty liver. 

 

Study: Subjects received 1-g L-carnitine tablet after breakfast plus diet and one 1 g tablet after dinner plus diet for 24 weeks or diet alone. Liver tests, as well as levels of  lipids, profile, fasting plasma glucose, C-reactive protein (CRP), tumor necrosis factor (TNF)-alpha, were measured. Histological scores on liver biopsy specimens were also compared.   

 

Study results: As compared to the controls, patients in treatment group demonstrated superior results on aspartate aminotransferase (AST),  alanine aminotransferase (ALT), gamma-glutamyl-transpeptidase (gamma-GT) , total cholesterol,  low-density lipoprotein (LDL) as well as  high-density lipoprotein, triglycerides (P=0.000), fasting glucose,  C-reactive protein (CRP) and tumor necrosis factor-alpha ( TNF-alpha) levels. This was accompanied by a significant improvement in histology scores on liver biopsy.   

Conclusions: L-carnitine administration helps  reduce inflammatory activity as manifested by effect on TNF-alpha and CRP, along with  improvements in liver function, metabolic functions, better lipid profile along with improved liver histology architecture.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Iron supplements and leaky gut or intestinal permeability

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The effect of iron supplementation on intestinal permeability was examined as part of a randomized iron plus multi-micronutrient (without iron) supplementation trial in Zambian children (n=153; mean age 10.2 years) over period of ten months.

Iron supplementation resulted in a higher lactulose to mannitol ratio indicating increased intestinal permeability as compared to controls whereas there was no impact of no effect of multi-micronutrient supplementation. The authors (Nchito and colleagues) speculated that this could in part explain the deleterious health effects of iron documented in some studies.

Preponderance of evidence suggests that unselected addition of multiple micronutrients to iron supplementation in children with iron deficiency anemia only marginally improve response as assessed by hemoglobin; on the other hand, these additional unselected micronutrients may have an adverse impact of their own and the routine use for treatment of iron deficiency anemia may not be justified.

Bottom line is everything should be in moderation; iron can be toxic; you should take iron if you need it, but be sure that you do actually need it in consultation with your physician.

Are you taking iron supplements? Have your iron levels been checked on periodic basis? Please share your thoughts.

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Yogurt gaining popularity

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Health conscious Americans are increasingly using fermented foods ranging from yogurt to kimchee because of the potential health benefits in a variety of chronic ailments. This was reported by Chicago Tribune/Tribune Media Services (4/28/2010)

Quinoa, Chenopodium quinoa, a high protein pseudocereal or pseudograin

Digestion, Health & Nutrition                          Facebook Dr. Anil

Quinoa, a complete nutrient dense food 

Quinoa (Chenopodium quinoa ) is considered a pseudocereal or pseudograin. High nutritional value of Quinoa has been recognized in South America for thousands of years. It is considered a complete food. For the record, I purchased quinoa flakes and enjoyed them as cereal :Quick and easy to make, tastes good. 

While not a common household item,quinoa (protein) seed has a with a fluffy, creamy, slightly crunchy texture. Cooking tends to give it a flavor when cooked.

In addition to its fiber content, high protein content (15 percent) of quinoa makes it a very attractive protein source for vegetarians. Unlike other vegetarian sources, it contains all essential aminoacids and is thus recognized as a complete protein source. It is an excellent source of important source of minerals and vitamins including magensium and iron, omega-6 and vitamin E content.

Quinoa contains polyphenols, phytosterols, and flavonoids with possible nutraceutical benefits. Its physico-chemical properties including solubility, water-holding capacity, gelation, emulsification, and foaming that allow for its use in a variety of ways.

Noteworthy for patients with Celiac sprue is that it is gluten free.

Because of its nutritional features, quina has potential as a crop in NASA's Controlled Ecological Support Systems for use during long manned space flights.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor. Please your health care professional advisor. 

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Cola fizz, rifaximin, Crohn's, vitamin D, calcium and heart

Digestion, Health & Nutrition                          Facebook Dr. Anil

Coffee may be friendly to the heart. According to news reports, a study found that subjects who drank  four or more cups of coffee each day had an 18 percent lower risk of hospitalization for heart rhythm disturbances.

Cola drinks, whether flat or with fizz, should not be used for hydration in kids with acute gastroenteritis, so say Reece et al in recent Archives of Diseases in Childhood based on clinical as well as laboratory evidence. Majority of children with mild to moderate dehydration can be treated effectively with oral rehydration therapy.

Acute thermal injury from ingestion of extremely hot solid food can be seen in esophagus. The patients present with acute odynophagia. Ulceration and necrosis may be seen on endoscopic evaluation of the esophagus. This was reported by Chung etal. in Journal of Korean Medical Science.

Rifaximin therapy results in clinical improvement in patients with Crohn’s disease as reported by Shafran et al. in Digestive Diseases and Sciences. As such, it may be another option for use for induction and maintainance of remission in Crohn's disease.

Vitamin D deficiency is a growing epidemic and may contribute to multiple ailments including making people more susceptible to Crohn's disease. This was concluded by recently Wang et al as published in the Journal of Biological Chemistry.

Two systemetic reviews on effect of calcium and vitamin D supplementation on heart have been published in recent Annals of Internal Medicine. In accompanying editorial, Guallar and colleagues argue that available evidence in favor of vitamin D supplementation is far more promising than for other vitamin and mineral supplements.

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BMI, hepatitis, CAM, inflammatory bowel disease, antioxidant defense

Digestion, Health & Nutrition                          Facebook Dr. Anil

Systemic review of weight loss strategies for under five year old was conducted by Bond and colleagues.  Of the four randomized controlled trials, only one found a statistically significant benefit from the intervention slowing rate of increase in body mass index. Other studies did show a trend for BMI and loss in weight improvement.  

A recent study by Malgorzata Krzystek-Korpacka and colleagues documented that antioxidant defenses of red blood cells are impaired in patients with inflammatory bowel disease. 

Jain and colleagues have shown that there is increased oxidative stress and a compromised antioxidant defence system in smokers as compared to nonsmokers.

A recent cross-sectional pilot study by Erlichman and colleagues examined the use of complimentary and alternative (CAM) in 68 children with chronic viral hepatitis. Forty-six percent of these kids had used CAM at least once since diagnosis with chronic viral hepatitis and 31% used CAM monthly or more frequently. Herbals and dietary supplements were used most often.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

 

Turmeric, curcumin in ulcerative colitis

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Turmeric curry powder in inflammatory bowel disease 

Curcumin is a biologically active phytochemical component in turmeric or yellow curry powder and has been found to be effective in numerous diseases including cancer. Ulcerative colitis (one form of inflammatory bowel disease) may be one of those conditions with proven benefit.

The study below was discussed at one of the sessions at the annual Digestive Diseases week (2008) which is the largest gathering of the gastroenterologists in the world. The two panelists (Dr. Koratz from UCLA and Dr. Mullen from Johns Hopkins) gave two thumbs up to this study of turmeric and endorsed its used in ulcerative colitis.

Hanai and colleagues studied the effect of turmeric (curcumin) as a maintenance therapy for ulcerative colitis in a randomized controlled fashion. They reported their findings in the journal Clinical Gastroenterology & Hepatology in a study titled, "Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial."89 with ulcerative colitis in remisssion participated in the study. Patients received curcumin (1g twice a day) or placebo in addition to the standard treatment (sulfasalazine or mesalamine) for 6 months.

Of the patients receiving curcumin, 5% relapsed as compared to 21% in the placebo group.

The investigators concluded that curcumin seems to be a promising and safe medication for maintaining remission in ulcerative colitis. 

What are your thoughts on the above study and the action of a "natural remedy" being endorsed at a prominent medical scientific meeting? Please share your thoughts.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger. 

Constipation? Is your colon kinky? Dolichocolon

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Dolichocolon causes constipation-is it true? What is dolichocolon anyway. What is the evidence to support its role in constipation?

The Dolichocolon concept was the brainchild of Arbuthnot Lane and is based on the the theory that kinking of colon leads to constipation. While colon is like a country road with its own twists and turns (and of course each "colonic country road" is different), the Lane theory suggests that gravity leads to unnatural "kinking" or twisting initially in the fixed parts of colon on the left side. It gradually progresses upward and proximally causing elongation and further kinking.

In fact, Lane was a proponent of colonic resection or a byepass. While initially colonic resection became very popular, it came into disrepute in the early 20th century and now is performed in rare selected cases only.

Lets face it-the concept of dolichocolon or kinking causing a partial bowel obstruction appears simple, straightforward, appealing and plausible (perhaps too simple and straightforward). Furthermore, theoretically speaking, the kinking along with elongation of colon has potential for increased fecal stasis in colon leading to increased water absorption from the fecal contents resulting in "drier" stool and constipation.

However, scientific data to support theoretical concepts above is lacking. At the same time, constipation does not appear to be correlated with colonic length and surgery is not beneficial in cases of colonic "kinks" unless a volvulus is present.

 And click here to read about best toilet posture.

Do you or someone close to you have constipation? What is the cause of constipation in your opinion? Does the Lane's theory of dolichocolon make sense and sound believable to you? Please share your thoughts.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger. 

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Constipation, kinky colon and fecal stasis 

What is colitis, diverticulitis and diverticulosis?

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Colitis, diverticulitis and diverticulosis are not the same

Terms like colitis, diverticulitis, diverticulosis and irritable bowel syndrome, spastic colon can be confusing. Colitis, diverticulitis, IBS, irritable bowel syndrome, spastic colon although different are often used interchangeably by some people.

Colitis

Colitis means inflammation of the colon or large intestines. Colitis may be acute or chronic and may occur due to infections, drugs, toxins, ischemia, radiation therapy etc. Colitis may also be a manifestation of chronic IBD or idiopathic inflammatory bowel disease (ulcerative colitis and Crohn’s disease).

Diverticulosis

Diverticulosis is the presence of divertculi (plural for diverticulum), usually in the colon. The colonic divertculosis is very common in the western society presumably because of lack of fiber in diet.

As many as 50% or more may have colonic diverticulosis by the age of 50 years and this number may exceed 80% by the time one reaches the age of 80 years. Usually these diverticuli are asymptomatic and an incidental finding on barium enema or colonoscopy.

In a minority of cases, they may cause complications such as diverticulitis and gastrointestinal bleeding etc which may even become life-threatening.

Diverticulitis

Diverticulitis occurs as a result of micro-perforation in the colon at the site of diverticulum. It is usually on the left side of colon and usually contained giving rise to localized infection and inflammation. This usually responds to medical measures including antibiotics. Interventional radiology techniques are sometimes used.

At times, such a perforation may form an abscess, cause bacteremia and become even become life-threatening. Surgery may be needed in severe cases.

Diverticular bleed

Diverticular bleed occurs more commonly from right sided diverticulosis. It is usually painless and massive and usually requires hospitalization and blood transfusions.

Majority of such bleeds stop spontaneously. Endoscopic and interventional radiology techniques can help stop bleeding in some cases, otherwise they may need surgery. Recurrent cases may need suregry.

Do you or someone you know has colitis or diverticulosis? What has been your experience with these terms? Please share your thoughts.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

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 Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.