Acupuncture and Back Pain

Study: Acupuncture works for back pain

By CARLA K. JOHNSON, Associated Press WriterMon Sep 24, 11:09 PM ET

Fake acupuncture works nearly as well as the real thing for low back pain, and either kind performs much better than usual care, German researchers have found. Almost half the patients treated with acupuncture needles felt relief that lasted months. In contrast, only about a quarter of the patients receiving medications and other Western medical treatments felt better.

Even fake acupuncture worked better than conventional care, leading researchers to wonder whether pain relief came from the body's reactions to any thin needle pricks or, possibly, the placebo effect.

"Acupuncture represents a highly promising and effective treatment option for chronic back pain," study co-author Dr. Heinz Endres of Ruhr University Bochum in Bochum, Germany, said in an e-mail. "Patients experienced not only reduced pain intensity, but also reported improvements in the disability that often results from back pain and therefore in their quality of life."

Although the study was not designed to determine how acupuncture works, Endres said, its findings are in line with a theory that pain messages to the brain can be blocked by competing stimuli.

Positive expectations the patients held about acupuncture — or negative expectations about conventional medicine — also could have led to a placebo effect and explain the findings, he said.

In the largest experiment on acupuncture for back pain to date, more than 1,100 patients were randomly assigned to receive either acupuncture, sham acupuncture or conventional therapy. For the sham acupuncture, needles were inserted, but not as deeply as for the real thing. The sham acupuncture also did not insert needles in traditional acupuncture points on the body and the needles were not manually moved and rotated.

After six months, patients answered questions about pain and functional ability and their scores determined how well each of the therapies worked.

In the real acupuncture group, 47 percent of patients improved. In the sham acupuncture group, 44 percent did. In the usual care group, 27 percent got relief.

"We don't understand the mechanisms of these so-called alternative treatments, but that doesn't mean they don't work," said Dr. James Young of Chicago's Rush University Medical Center, who wasn't involved in the research. Young often treats low back pain with acupuncture, combined with exercises and stretches.

Chinese medicine holds that there are hundreds of points on the body that link to invisible pathways for the body's vital energy, or qi. The theory goes that stimulating the correct points with acupuncture needles can release blocked qi.

Dr. Brian Berman, the University of Maryland's director of complementary medicine, said the real and the sham acupuncture may have worked for reasons that can be explained in Western terms: by changing the way the brain processes pain signals or by releasing natural painkillers in the body.

In the study, the conventional treatment included many methods: painkillers, injections, physical therapy, massage, heat therapy or other treatments. Like the acupuncture patients, the patients getting usual care received about 10 sessions of 30 minutes each.

The study, appearing in Monday's Archives of Internal Medicine, used a broad definition for low back pain, but ruled out people with back pain caused by spinal fractures, tumors, scoliosis and pregnancy.

Funding came from German health insurance companies, and the findings already have led to more coverage in Germany of acupuncture.

In the United States, some health plans cover acupuncture for some conditions, but may require pre-approval, according to the National Center for Complementary and Alternative Medicine. An acupuncture session can cost $45 to $100, Young said.

___

On the Net:

Archives: http://www.archinternmed.co

Still More on Malic Acid

Malic Acid: Top Up Your Body's Own Supplies Of Malic Acid To Increase Your Energy Levels And Overcome Fatigue Malic acid is a natural substance found in fruit and vegetables - one of the richest sources being apples. It is also naturally present in your body's cells and large amounts of it are formed and then eventually broken down again on a daily basis. It possesses many health-related benefits such as boosting immunity, maintaining oral health, reducing the risk of poisoning from a build-up of toxic metals and promoting smoother and firmer skin. However, one of its most significant benefits lies in its ability to stimulate metabolism and increase energy production. This action is linked to the important role it plays in a process known as the Krebs cycle - named after Sir Hans Krebs, a German-born British biochemist. Krebs won the Nobel price for physiology in 1953 for describing how a complex series of biochemical reactions takes place within the body's cells to transform proteins, fat and carbohydrates into water and energy. This process requires a constant supply of vitamins, enzymes and chemical agents such as malic acid, in order to keep it functioning properly 24 hours a day. The Krebs cycle is vital to our very existence and without it energy production would literally grind to a halt. Therefore it is essential that you have adequate supplies of malic acid in order to promote the efficient functioning of this cycle. "Malic acid is safe, inexpensive and it should be considered a valid therapeutic approach for patients with CFS" In particular, malic acid's involvement in the Krebs cycle means it plays an important role in improving overall muscle performance, reversing muscle fatigue following exercise, reducing tiredness and poor energy levels, as well as improving mental clarity. These actions can make it a beneficial treatment for sufferers of fibromyalgia (which involves muscle pain, joint tenderness and poor energy levels) and Chronic Fatigue Syndrome (CFS), which produces similar symptoms. According to Dr Jay Goldstein, Director of the CFS Institute in the US: "Malic acid is safe, inexpensive and it should be considered a valid therapeutic approach for patients with CFS". In relation to fibromyalgia, a six-month study was conducted by scientists working at the Department of Medicine, University of Texas Health Science Centre in the US, to examine the efficacy of 1,200mg of malic acid plus 300mg of magnesium a day on 24 fibromyalgia sufferers. Half of the patients were given the active treatment, while the other half only received placebo. At the end of the study, all of the patients treated with malic acid and magnesium experienced significant improvements in their symptoms - including less pain, reduced muscle stiffness and a more positive mental outlook - without any side effects. Dr Russell, who led the team of scientists, concluded: "The data suggest that malic acid and magnesium are safe and may be beneficial in the treatment of patients with fibromyalgia. Future studies should use malic acid at this dose and continue the therapy for at least two months".1 Malic acid has a diverse range of beneficial actions In addition to increasing energy levels through its involvement in the Krebs cycle, malic acid is also an effective metal chelator. This means it is able to bind to potentially toxic metals that may have accumulated in the body, such as aluminium or lead, and inactivate them. As a result, the risk of toxicity is considerably reduced, which is important as a heavy metal overload has been linked to serious problems like liver disease and brain disorders like Alzheimer's disease. Malic acid also helps maintain oral hygiene. It stimulates the production of saliva, which reduces the number of harmful bacteria circulating in your mouth, teeth and gums. It acts as an antiseptic too, which also helps to ensure that germs in the mouth are kept to a minimum and considerably reduces the risk of infection.2 For these reasons, malic acid is commonly used as an ingredient in mouthwashes and toothpastes. Not only that, but malic acid is also important for maintaining good skin health. It is classified as an 'alpha hydroxy acid' - a chemical term used to describe fruit acids that are used in many cosmetics because of their ability to help exfoliate the skin and act as mild chemical face peels. These actions help your skin look healthier, younger and firmer. For a natural face peel you can apply thin slices of apple (as mentioned earlier, apples are one of the richest sources of malic acid) directly onto your skin for 20 minutes and then wash off with rose water. What to take for best results The recommended dosage for malic acid is 600mg capsules taken one to three times a day before food. There are no known contraindications or toxicity linked to malic acid.3 Taking magnesium alongside malic acid seems to have a much more pronounced effect on muscle fatigue. The recommended dosage for magnesium citrate is 140mg capsules taken twice a day. 1. Russell IJ, Michalek JE, Flechas JD. J Rheumatol 1995, 22(5):953-958 2. Fernandes-Naglik L, Downes J, Shirlaw R. Oral Dis 2001, 7(5):276-280 3. Abraham G, Flechas J. J Nutr Med 1992, 3:49-59

More on Malic Acid

Malic Acid

Fibromyalgia Syndrome (fibromyalgia) is a condition which is characterized by a syndrome of generalized musculoskeletal pain, aches, stiffness, and tenderness at specific anatomical sites. Since it was first described, fibromyalgia has become recognized as a fairly common rheumatic complaint with a clinical prevalence of 6 to 20%. Additionally, fibromyalgia has been associated with irritable bowel syndrome, tension headache, mitral valve prolapse, and Chronic Fatigue Syndrome, to name a few.

In recent years, evidence has accumulated to suggest that the pain associated with fibromyalgia may be the result of local hypoxia to the muscles. Patients with fibromyalgia have low muscle-tissue oxygen pressure in affected muscles, and to a lesser degree the same is true of other tissues. Muscle biopsies from affected areas showed muscle tissue glycolysis is inhibited, reducing ATP synthesis. This stimulates the process of gluconeogenesis, which results in muscle tissue breakdown and mitochondrial damage. Additionally, low levels of the high-energy phosphates ATP, ADP, and phosphocreatine were found. It is hypothesized that in hypoxic muscle tissue, glycolysis is inhibited, reducing ATP synthesis. This muscle tissue breakdown, which has been observed in muscle biopsies taken from fibromyalgia patients, is hypothesized to result in the muscle pain characteristic of fibromyalgia.

Malic acid is synthesized in the body through the citric acid cycle. Its importance to the production of energy in the body during both aerobic and anaerobic conditions is well established. Under aerobic conditions, the oxidation of malate to oxaloacetate provides reducing equivalents to the mitochondria through the malate-aspartate redox shuttle. During anaerobic conditions, where a buildup of excess of reducing equivalents inhibits glycolysis, malic acid’s simultaneous reduction to succinate and oxidation to oxaloacetate is capable of removing the accumulating reducing equivalents. This allows malic acid to reverse hypoxia’s inhibition of glycolysis and energy production, possibly improving energy production in fibromyalgia, and reversing the negative effect of the relative hypoxia that has been found in these patients.

Because of its obvious relationship to energy depletion during exercise, malic acid may be of benefit to healthy individuals interested in maximizing their energy production, as well as those with Fibromyalgia, or Chronic Fatigue Syndrome.

As a result of the compelling evidence that malic acid plays a central role in energy production, especially during hypoxic conditions, malic acid supplements have been examined for their effects on fibromyalgia. Subjective improvement in pain was observed within 48 hours of supplementation with 1200-2400 mg of malic acid, (with higher doses being more effective), and this improvement was lost following the discontinuation of malic acid for 48 hours. While these studies also used magnesium supplements, due to the fact that magnesium is often low in fibromyalgia patients, the rapid improvement following malic acid, as well as the rapid deterioration after discontinuation, suggests that malic acid is the most important component. This interesting theory of localized hypoxia in fibromyalgia, and the ability of malic acid to overcome the block in energy production that this causes, should provide hope for those afflicted with fibromyalgia.

Additionally, many hypoxia-related conditions such as respiratory and circulatory insufficiency, are associated with deficient energy production. Therefore, malic acid supplements may be of benefit in these conditions. Chronic Fatigue Syndrome has also been found to be associated with fibromyalgia, and malic acid supplementation may be of use in improving energy production in this condition as well. Lastly, malic acid may be of use as a general supplement, ensuring an optimal level of malic acid within the cells, and thus, maintaining an optimal level of energy production.

It is very important that the L-isomer of Malic acid is used as it is the active form that exists naturally. When synthesised the malic acid produced contains both the D- and L- forms with the D- form being inactive. When extracted from apples only the L-form (active form) is present.

Malic Acid and Magnesium in Fibro

DESCRIPTION

Malic acid, an alpha-hydroxy organic acid, is sometimes referred to as a fruit acid. This is because malic acid is found in apples and other fruits. It is also found in plants and animals, including humans. In fact, malic acid, in the form of its anion malate, is a key intermediate in the major biochemical energy-producing cycle in cells known as the citric acid or Krebs cycle located in the cells' mitochondria.

Malic acid, also known as apple acid, hydroxybutanedioic acid and hydroxysuccinic acid, is a chiral molecule. The naturally occurring stereoisomer is the L-form. The L-form is also the biologically active one. There is some preliminary evidence that malic acid, in combination with magnesium, may be helpful for some with fibromyalgia. Malic acid sold as a supplement is mainly derived from apples and, therefore, is the L-form. L-malic acid has the following chemical structure:

L-malic Acid
ACTIONS AND PHARMACOLOGY
ACTIONS

Malic acid, in combination with magnesium, has putative antifibromyalgic activity.
MECHANISM OF ACTION

The mechanism of malic acid's putative antifibromyalgic activity is unknown.
PHARMACOKINETICS

Malic acid is absorbed from the gastrointestinal tract from whence it is transported via the portal circulation to the liver. There are a few enzymes that metabolize malic acid. Malic enzyme catalyzes the oxidative decarboxylation of L-malate to pyruvate with concomitant reduction of the cofactor NAD+ (oxidized form of nicotinamide adenine dinucleotide) or NADP+ (oxidized form of nicotinamide adenine dinucleotide phosphate). These reactions require the divalent cations magnesium or manganese. Three isoforms of malic enzyme have been identified in mammals: a cytosolic NADP+-dependent malic enzyme, a mitochondrial NADP+-dependent malic enzyme and a mitochondrial NAD(P)+-dependent malic enzyme. The latter can use either NAD+ or NADP+ as the cofactor but prefers NAD+. Pyruvate formed from malate can itself be metabolized in a number of ways, including metabolism via a number of metabolic steps to glucose. Malate can also be metabolized to oxaloacetate via the citric acid cycle. The mitochondrial malic enzyme, particularly in brain cells, may play a key role in the pyruvate recycling pathway, which utilizes dicarboxylic acids and substrates, such as glutamine, to provide pyruvate to maintain the citric acid cycle activity when glucose and lactate are low.

Clearly, the metabolism of malic acid is complex and what any of the above has to do, if anything, with malic acids' putative activity in those with fibromyalgia is entirely unclear.
INDICATIONS AND USAGE

Malic acid may help some with fibromyalgia.
RESEARCH SUMMARY

Results have been mixed in studies of malic acid's possible effects in those with fibromyalgia. In a double-blind, placebo-controlled crossover study, subjects with primary fibromyalgia syndrome were randomized to receive a combination of 200 milligrams of malic acid and 50 milligrams of magnesium per tablet (three tablets twice a day) or placebo for four weeks. This was followed by a six-month, open-label trial with dose escalating up to six tablets twice a day. Outcome variables were measures of pain and tenderness, as well as functional and psychological measures.

No clear benefit was observed for the malic acid/magnesium combination in the lower-dose blinded trial. But in the open-label trial, at higher doses, there were significant reductions in the severity of all three primary pain/tenderness measures. Follow-up is needed.
CONTRAINDICATIONS, PRECAUTIONS, ADVERSE REACTIONS
CONTRAINDICATIONS

None known for malic acid. See Magnesium.
PRECAUTIONS

Because of lack of long-term safety studies, supplementary malic acid should be avoided by pregnant women and lactating mothers. See Magnesium.
INTERACTIONS

None reported for malic acid. See Magnesium.
DOSAGE AND ADMINISTRATION

The doses used in the fibromyalgia studies were L-malic acid, 1200 to 2400 milligrams daily, and magnesium, 300 to 600 milligrams daily.
HOW SUPPLIED

Tablets — 350 mg
LITERATURE

Russell IJ, Michalek JE, Flechas JD, Abraham GE. Treatment of fibromyalgia syndrome with Super Malic: a randomized, double-blind, placebo-controlled pilot study. J Rheumatol. 1995; 22:953-958.

Young Z, Floyd DL, Loeber G, Tong L. Structure of a closed form of human malic enzyme and implications for catalytic mechanism. Nature Struct Biol. 2000; 7:251-257.

The Super Triumvirate of Energy Supplements

Acetyl-L-Carnitine (ALC)
Acetyl-L-Carnitine, ALC, Acetylcarnitine, ALCAR

Acetyl-l-carnitine is a molecule that occurs naturally in the brain, liver, and kidney. Natural levels of Acetyl-l-carnitine diminish as we age.

Common uses for supplemental Acetyl-l-carnitine:

* To enhance cognition.
* Involved in the metabolism of food into energy.
* Mild mental impairment in the elderly showed a significant improvement of several performances during and after Acetyl-l-carnitine treatment.
* Reports indicate that Acetyl-l-carnitine may be effective in the treatment of dementia.
* Treated Down syndrome patients showed statistically significant improvements of visual memory and attention both in absolute terms and in comparison with the other groups.
* To significantly reduce severity of depressive symptoms in the elderly.
* To significantly improve items measuring quality of life.
* Improve both spatial and temporal memory, and reduce the amount of oxidative damage to RNA in the brain's hippocampus, an area important in memory.
* Acetyl-l-carnitine is widely used as an energy supplement in Italy.

Alzheimer's

The acetyl group that is part of acetyl-L-carnitine contributes to the production of the neurotransmitter acetylcholine, which is required for mental function. Several double-blind clinical trials suggest that acetyl-L-carnitine delays the progression of Alzheimer’s disease and enhances overall performance in some people with Alzheimer’s disease. Alzheimer’s research has been done with the acetyl-L-carnitine form, rather than the L-carnitine form, of this nutrient.

Several clinical trials have found that acetyl-L-carnitine supplementation delays the progression of Alzheimer’s disease, improves memory, and enhances overall performance in some people with Alzheimer’s disease. Overall, most short-term studies have shown clinical benefits, and most long-term studies (one year) have shown a reduction in the rate of deterioration.

Brain

One double-blind trial has found that acetyl-L-carnitine may be helpful for people with degenerative cerebellar ataxia, a loss of muscular coordination caused by disease in the cerebellum (the hind part of the brain that controls muscle tone and balance).

Several clinical trials suggest that acetyl-L-carnitine delays onset of ARCD and improves overall cognitive function in the elderly. In a controlled clinical trial, acetyl-L-carnitine was given to elderly people with mild cognitive impairment. After 45 days of acetyl-L-carnitine supplementation at 1,500 mg per day, significant improvements in cognitive function (especially memory) were observed. Another large trial of acetyl-L-carnitine for mild cognitive impairment in the elderly found that 1,500 mg per day for 90 days significantly improved memory, mood, and responses to stress. The favorable effects persisted at least 30 days after treatment was discontinued. Controlled and uncontrolled clinical trials on acetyl-L-carnitine corroborate these findings.

Depression

Acetyl-L-carnitine may be effective for depression experienced by the elderly. A preliminary trial found that acetyl-L-carnitine supplementation was effective at relieving depression in a group of elderly people, particularly those showing more serious clinical symptoms. These results were confirmed in another similar clinical trial. In that trial, participants received either 500 mg three times a day of acetyl-L-carnitine or a matching placebo. Those receiving acetyl-L-carnitine experienced significantly reduced symptoms of depression compared to those receiving placebo. At least two other clinical studies of acetyl-L-carnitine for depression in the elderly have reported similar results.

Drug interactions:

Are there any drug interactions? A. Didanosine (Depletion or interference) Didanosine is a drug that blocks reproduction of the human immunodeficiency virus (HIV). HIV is the virus that infects people causing acquired immunodeficiency syndrome (AIDS). Didanosine is used in combination with other drugs to treat HIV infection.

Acetyl-l-carnitine suggested dosage is 500 mg two to three times daily.

Alpha Lipoic Acid (ALA)

Alpha Lipoic Acid serves as a coenzyme in the energy production process in the cells which can provide quick bursts of energy. Alpha Lipoic Acid is unique in that it is both water and fat soluble witch allows it to enter all parts of the cell to neutralize free radicals. Alpha Lipoic Acid contributes to invigorating mental and physical energy and a reduction in muscle fatigue. Dr. Lester Packer, a leading researcher in the area of antioxidants and a professor of molecular and cell biology at the University of California at Berkeley says "Alpha-Lipoic acid could have far-reaching consequences in the search for prevention and therapy of chronic degenerative diseases such as diabetes and cardiovascular disease" .... "and because it’s the only antioxidant that can easily get into the brain, it could be useful in preventing damage from a stroke".

Common uses for supplemental alpha Lipoic Acid:

* Currently used in Europe to treat peripheral nerve degeneration (neuropathy) resulting from diabetes.
* May play a role in controlling blood sugar.
* May help prevent the onset of type 2 diabetes.
* Important for the production of energy inside the cell by utilizing sugar to produce energy contributing to mental and physical stamina.
* Neutralizes free radicals. Unlike Vitamin C which is water soluble and Vitamin E which is fat soluble, alpha Lipoic Acid is both water and fat soluble which allows it to enter all parts of the cell to neutralize free radicals.
* May help reduce LDL (bad) blood cholesterol.
* May help improve memory.
* Chelates (grabs) heavy metals and binds them reducing these oxidants from blood system.
* Inhibits Glycation which is responsible for accelerated tissue damage.
* Recycles and enhances the effects of other antioxidants such as Vitamin E and Vitamin C.
* Significantly increase survival in rats that have suffered a stroke if given before the stroke occurs.
* Prevents tissue damage and death after a heart attack.
* Not only does it act as an antioxidant itself, it also stimulates production of glutathione (an antioxidant produced by the body), giving cells a double dose of antioxidant.
* Easily absorbed when taken orally and once inside cells is quickly converted to its most potent form, dihydrolipoic acid.
* Because both alpha lipoic acid and dihydrolipoic acid are antioxidants, their combined actions give them greater antioxidant potency than any natural antioxidant now known.
* Important for regulating aspects of the immune system, in particular immune cells called T-lymphocytes.
* May be useful in relieving syptoms of stomatopyrosis, or Burning Mouth Syndrome (BMS).

ALPHA-LIPOIC ACID MAY HELP REDUCE INFLAMMATION

October 11, 2002. The incidence of inflammatory diseases such as arthritis increases with age. Free radicals promote inflammatory reactions, which antioxidants have been successful at diminishing. Scientists recently stimulated the inflammatory response of white blood cells, resulting in an increase of Intracellular Adhesion Molecule 1 (ICAM-1), which encourages white blood cells to stick to other cells, thereby inflaming tissues. Alpha-lipoic acid, a potent antioxidant, was then added to the mix. Researchers said the acid reduced the activity of ICAM-1 to levels in normal, un-stimulated cells in a dose-dependent manner. It also lowered the activity of NFkB (NFkB can increase the activity of genes responsible for inflammation). According to the study, these changes suggest that alpha-lipoic acid may help reduce the effects of inflammatory diseases such a rheumatoid arthritis and psoriasis.

Suggested dosage for Alpha Lipoic Acid is 200 mg two to three times daily.

CoQ10 (Coenzyme Q10)

CoQ10 is a vitamin-like compound also called ubiquinone. It is an essential component of cells and is utilized by the mitochondria in the normal process of energy production. It helps convert food into energy at a very basic, cellular level and it is an antioxidant. CoQ10 (Coenzyme Q10) is one in a series of ubiquinones, naturally occurring compounds produced in nearly every cell of the body, and was discovered as recently as 1957. This Coenzyme Q10 is the highest quality available and synergistically blended with Bioperinewhich has been demonstrated to aid in absorption.

Doctors commonly prescribe CoQ10 (coenzyme Q10) to treat heart disease in Japan, Sweden, Italy, Canada, and other countries.

Common Uses for CoQ10:

*

Improves the heart and circulation in those with congestive heart failure, a weakened heart muscle (cardiomyopathy), high blood pressure, heart rhythm disorders, chest pain (angina), or Raynaud's disease.
*

Treats gum disease and maintains health gums and teeth.
*

Protects the nerves and may help slow Alzheimer's or Parkinson's disease.
*

May help prevent cancer and heart disease, and play a role in slowing down age-related degenerative changes.
*

May improve the course of AIDS or cancer.
*

CoQ10 has shown small significant benefit in treating ALS, also known as Lou Gehrig's disease, and it has also been used to treat a range of rare pediatric neurological diseases.
*

Because any disease process that involves free radical damage could be treated with CoQ10, the theoretical therapeutic potential of this compound seems limitless. Cataracts, macular degeneration, side effects of chemotherapy and skin damage related to radiation exposure could all be helped by doses of CoQ10, proponents believe.

The primary function of CoQ10 (coenzyme Q10) is as a catalyst for metabolism - the complex chain of chemical reactions during which food is broken down into packets of energy that the body can use. Acting in conjunction with enzymes, the compound speeds up the vital metabolic process, providing the energy that the cells need to digest food, heal wounds, maintain healthy muscles, and perform countless other bodily functions. Because of the nutrient's essential role in energy production, it's not surprising that it is found in every cell in the body. It is especially abundant in the energy-intensive cells of the heart, helping this organ beat more than 100,000 times each day. In addition, coenzyme Q10 acts as an antioxidant, much like vitamin C and E, helping to neutralize the cell-damaging molecules known as free radicals.

CoQ10 (Coenzyme Q10) may play a role in preventing cancer, heart attacks, and other diseases linked to free-radical damage. It's also used as a general energy enhancer and anti-aging supplement. Because levels of the compound diminish with age (and with certain diseases), some doctors recommend daily supplementation beginning about age 40.

CoQ10 has generated much excitement as a possible therapy for heart disease, especially congestive heart failure or a weakened heart. In some studies, patients with a poorly functioning heart have been found to improve greatly after adding the supplement to their conventional drugs and therapies. Other studies have shown that people with cardiovascular disease have low levels of this substance in their heart. Further research suggest that CoQ10 may protect against blood clots, lower high blood pressure, diminish irregular heartbeats, treat mitral valve prolapse, lessen symptoms of Raynaud's disease (poor circulation in the extremities), and relieve chest pains (angina).

A few small studies suggest that CoQ10 may prolong survival in those with breast or prostate cancer, though results remain inconclusive. It also appears to aid healing and reduce pain and bleeding in those with gum disease, and speed recovery following oral surgery. CoQ10 shows some promise against Parkinson's and Alzheimer's Diseases and fibromyalgia, and it may improve stamina in those with AIDS. Certain practitioners believe the nutrient helps stabilize blood sugar levels in people with diabetes. There are many other claims make for CoQ10 that it slows aging, aids weight loss, enhances athletic performance, combats chronic fatigue syndrome, relieves multiple allergies, and boosts immunity.

Alpha-Lipoic acid

Alpha-Lipoic acid:
Quite Possibly the "Universal" Antioxidant

This article originally appeared in the July 1996 issue of The Nutrition Reporter™ newsletter.


If it's essential role in health is any indication, alpha-lipoic acid may very well join the ranks of vitamins C and E as part of your first-line of defense against free radicals. Discovered in 1951, it serves as a coenzyme in the Krebs cycle and in the production of cellular energy. In the late 1980s, researchers realized that alpha-lipoic acid had been overlooked as a powerful antioxidant.

Over the past few years, the pace of research on lipoic acid has increased dramatically. Last year, Lester Packer, PhD, of the University of California, Berkeley, published a lengthy review article on alpha-lipoic acid in Free Radical Biology & Medicine (1995;19:227-50). In April 1996, he presented a short review of it in the same journal (FRBM;20:625-6).

Several qualities distinguish alpha-lipoic acid from other antioxidants, and Packer has described it at various times as the "universal," "ideal," and "metabolic" antioxidant. It neutralizes free radicals in both the fatty and watery regions of cells, in contrast to vitamin C (which is water soluble) and vitamin E (which is fat soluble).

The body routinely converts some alpha-lipoic acid to dihydrolipoic acid, which appears to be an even more powerful antioxidant. Both forms of lipoic acid quench peroxynitrite radicals, an especially dangerous type consisting of both oxygen and nitrogen, according to a recent paper in FEBS Letters (Whiteman M, et al., FEBS Letters, 1996; 379:74-6). Peroxynitrite radicals play a role in the development of atherosclerosis, lung disease, chronic inflammation, and neurological disorders.

Alpha-lipoic acid also plays an important role in the synergism of antioxidants, what Packer prefers to call the body's "antioxidant network." It directly recycles and extends the metabolic lifespans of vitamin C, glutathione, and coenzyme Q10, and it indirectly renews vitamin E.

In Germany, alpha-lipoic acid is an approved medical treatment for peripheral neuropathy, a common complication of diabetes. It speeds the removal of glucose from the bloodstream, at least partly by enhancing insulin function, and it reduces insulin resistance, an underpinning of many cases of coronary heart disease and obesity. The therapeutic dose for lipoic acid is 600 mg/day. In the United States, it is sold as a dietary supplement, usually as 50 mg tablets. (The richest food source of alpha-lipoic acid is red meat.)

"From a therapeutic viewpoint, few natural antioxidants are ideal," Packer recently explained in Free Radical Biology & Medicine. "An ideal therapeutic antioxidant would fulfill several criteria. These include absorption from the diet, conversion in cells and tissues into usable form, a variety of antioxidant actions (including interactions with other antioxidants) in both membrane and aqueous phases, and low toxicity."

"Alpha-lipoic acid...is unique among natural antioxidants in its ability to fulfill all of these requirements," he continued, "making it a potentially highly effective therapeutic agent in a number of conditions in which oxidative damage has been implicated."

Other research on alpha-lipoic acid has shown that it might:

* help people with genetic defects leading to muscle myopathies (Barbiroli B, et al., Journal of Neurology, 1995;242:472-7);

* reduce ischemia/reperfusion injury to the heart and brain. (Schonheit K, et al., Biochimica et Biophysica Acta, 1995;1271:335-42; and Cao X and Phillis JW, Free Radical Research, 1995;23:365-70); and

* inhibit the activation of "nuclear factor kappa-B," a protein complex involved in cancer and the progression of AIDS. (Suzuki YJ, et al., Biochemical & Biophysical Research Communications, 1992;189:1709-15).

"The therapeutic potential of alpha-lipoic acid is just beginning to be explored," observed Packer, "but this compound holds great promise."

Malic Acid, Energy, & Fibromyalgia

Malic Acid, Energy, & Fibromyalgia


Primary fibromyalgia (FM) is a condition affecting principally middle-aged women, characterized by a syndrome of generalized musculoskeletal pain, aches, stiffness, and tenderness at specific anatomical sites. This condition is considered primary when there are no obvious causes. Since it was first described, FM has become recognized as a fairly common rheumatic complaint with a clinical prevalence of 6 to 20 percent. Additionally, FM has been associated with irritable bowel syndrome, tension headache, mitral valve prolapse, and chronic fatigue syndrome. Numerous treatment modalities have been attempted to treat patients with FM, but unfortunately the results have usually been poor. The primary reason for this lack of success was undoubtedly due to our lack of understanding FMs etiology.

In recent years, evidence has accumulated to suggest that FM is the result of local hypoxia in the muscles. For instance, patients with FM have low muscle-tissue oxygen pressure in affected muscles, and to a lesser degree
the same was found in other tissues. Muscle biopsies from affected areas showed muscle tissue breakdown and mitochondrial damage. Additionally, low levels of the high energy phosphates ATP, ADP, and phosphocreatine were found. It has been hypothesized that in hypoxic muscle tissues glycolysis is inhibited, reducing ATP synthesis. This stimulates the process of gluconeogenesis, which results in the breakdown of muscle proteins to amino acids that can be utilized as substrates for ATP synthesis. This muscle tissue breakdown, which has been observed in muscle biopsies taken from FM patients, is hypothesized to result in the muscle pain characteristic of FM.

Malic acid is both derived from food sources and synthesized in the body through the citric acid (Krebs) cycle. Its importance to the production of energy in the body during both aerobic and anaerobic conditions is well established. Under aerobic conditions, the oxidation of malate to oxaloacetate provides reducing equivalents to the mitochondria through the malate-aspartate redox shuttle. During anaerobic conditions, where a buildup of excess of reducing equivalents inhibits glycolysis, malic acids simultaneous reduction to succinate and oxidation to oxaloacetate is capable of removing the accumulating reducing equivalents. This allows malic acid to reverse hypoxias inhibition of glycolysis and energy production. This may allow malic acid to improve energy production in FM, reversing the negative effect of the relative hypoxia that has been found in these patients.

Because of its obvious relationship to energy depletion during exercise, malic acid may be of benefit to healthy individuals interested in maximizing their energy production, as well as those with FM. In the rat it has been found that only tissue malate is depleted following exhaustive physical activity. Other key metabolites from the citric acid cycle needed for energy production were found to be unchanged. Because of this, a deficiency of malic acid has been hypothesized to be a major cause of physical exhaustion. The administration of malic acid to rats has been shown to elevate mitochondrial malate and increase mitochondrial respiration and energy production. Surprisingly, relatively small amounts of exogenous malic acid were required to increase mitochondrial energy production and ATP formation. Under hypoxic conditions there is an increased demand and utilization of malic acid, and this demand is normally met by increasing the synthesis of malic acid through gluconeogenesis and muscle protein
breakdown. This ultimately results in muscle breakdown and damage.

In a study on the effect of the oral administration of malic acid to rats, a significant increase in anaerobic endurance was found. Interestingly, the improvement in endurance was not accompanied by an increase in
carbohydrate and oxygen utilization, suggesting that malic acid has carbohydrate and oxygen-sparing effects. In addition, malic acid is the only metabolite of the citric acid cycle positively correlated with physical activity. It has also been demonstrated that exercise-induced mitochondrial respiration is associated with an accumulation of malic acid. In humans, endurance training is associated with a significant increase in the enzymes involved with malic acid metabolism.

Because of the compelling evidence that malic acid plays a central role in energy production, especially during hypoxic conditions, malic acid supplements have been examined for their effects on FM. Subjective improvement in pain was observed within 48 hours of supplementation with 1200 - 2400 milligrams of malic acid, and this improvement was lost following the discontinuation of malic acid for 48 hours. While these studies also used magnesium supplements, due to the fact that magnesium is often low in FM patients, the rapid improvement following malic acid, as well as the rapid deterioration after discontinuation, suggests that malic acid is the most important component. This interesting theory of localized hypoxia in FM, and the ability of malic acid to overcome the block in energy production that this causes, should provide hope for those afflicted with FM. The potential for malic acid supplements, however, reaches much farther than FM. In light of malic acids ability to improve animal exercise performance, its potential for human athletes is particularly exciting.

Additionally, many hypoxia related conditions, such as respiratory and circulatory insufficiency, are associated with deficient energy production. Therefore, malic acid supplements may be of benefit in these conditions. Chronic Fatigue Syndrome has also been found to be associated with FM, and malic acid supplementation may be of use in improving energy production in this condition as well. Lastly, malic acid may be of use as a general supplement aimed at ensuring an optimal level of malic acid within the cells, and thus, maintaining an optimal level of
energy production.


Reference:
G.E. Abraham and J.D. Flechas, J of Nutr Medicine 1992; 3: 49-59.
Copyright 1995 - 2005 Intelegen Inc. All right Reserved
Google WWW http://intelegen.com

Drink More Diet Soda, Gain More Weight?

Overweight Risk Soars 41% With Each Daily Can of Diet Soft Drink
By Daniel J. DeNoon
WebMD Medical News
Reviewed by Charlotte Grayson Mathis, MD

People who drink diet soft drinks don't lose weight. In fact, they gain weight, a study shows.

The findings come from eight years of data collected by Sharon P. Fowler, MPH, and colleagues at the University of Texas Health Science Center, San Antonio.

"What didn't surprise us was that total soft drink use was linked to overweight and obesity," Fowler tells WebMD. "What was surprising was when we looked at people only drinking diet soft drinks, their risk of obesity was even higher."

In fact, when the researchers took a closer look at their data, they found that nearly all the obesity risk from soft drinks came from diet sodas.

"There was a 41% increase in risk of being overweight for every can or bottle of diet soft drink a person consumes each day," Fowler says.
More Diet Drinks, More Weight Gain

Fowler's team looked at seven to eight years of data on 1,550 Mexican-American and non-Hispanic white Americans aged 25 to 64. Of the 622 study participants who were of normal weight at the beginning of the study, about a third became overweight or obese.

For regular soft-drink drinkers, the risk of becoming overweight or obese was:

* 26% for up to 1/2 can each day
* 30.4% for 1/2 to one can each day
* 32.8% for 1 to 2 cans each day
* 47.2% for more than 2 cans each day.

For diet soft-drink drinkers, the risk of becoming overweight or obese was:

* 36.5% for up to 1/2 can each day
* 37.5% for 1/2 to one can each day
* 54.5% for 1 to 2 cans each day
* 57.1% for more than 2 cans each day.

For each can of diet soft drink consumed each day, a person's risk of obesity went up 41%.
Diet Soda No Smoking Gun

Fowler is quick to note that a study of this kind does not prove that diet soda causes obesity. More likely, she says, it shows that something linked to diet soda drinking is also linked to obesity.

"One possible part of the explanation is that people who see they are beginning to gain weight may be more likely to switch from regular to diet soda," Fowler suggests. "But despite their switching, their weight may continue to grow for other reasons. So diet soft-drink use is a marker for overweight and obesity."

Why? Nutrition expert Leslie Bonci, MPH, RD, puts it in a nutshell.

"You have to look at what's on your plate, not just what's in your glass," Bonci tells WebMD.

People often mistake diet drinks for diets, says Bonci, director of sports nutrition at the University of Pittsburgh Medical Center and nutrition consultant to college and professional sports teams and to the Pittsburgh Ballet.

"A lot of people say, 'I am drinking a diet soft drink because that is better for me. But soft drinks by themselves are not the root of America's obesity problem," she says. "You can't go into a fast-food restaurant and say, 'Oh, it's OK because I had diet soda.' If you don't do anything else but switch to a diet soft drink, you are not going to lose weight."
The Mad Hatter Theory

"Take some more tea," the March Hare said to Alice, very earnestly.
"I've had nothing yet," Alice replied in an offended tone, "so I can't take more."
"You mean you can't take less," said the Hatter: "It's very easy to take more than nothing." Lewis Carroll, Alice's Adventures in Wonderland

There is actually a way that diet drinks could contribute to weight gain, Fowler suggests.

She remembers being struck by the scene in Alice's Adventures in Wonderland in which Alice is offended because she is offered tea but is given none -- even though she hadn't asked for tea in the first place. So she helps herself to tea and bread and butter.

That may be just what happens when we offer our bodies the sweet taste of diet drinks, but give them no calories. Fowler points to a recent study in which feeding artificial sweeteners to rat pups made them crave more calories than animals fed real sugar.

"If you offer your body something that tastes like a lot of calories, but it isn't there, your body is alerted to the possibility that there is something there and it will search for the calories promised but not delivered," Fowler says.

Perhaps, Bonci says, our bodies are smarter than we think.

"People think they can just fool the body. But maybe the body isn't fooled," she says. "If you are not giving your body those calories you promised it, maybe your body will retaliate by wanting more calories. Some soft drink studies do suggest that diet drinks stimulate appetite.