Regulating High Blood Pressure with Vitamins

Regulating Blood Pressure Naturally with Vitamins
by Darrell Miller

High blood pressure, which is also called hypertension, affects about one in three adults. Although there are many causes of hypertension, there are not necessarily any symptoms, with 30% of people having high blood pressure not knowing it. Therefore, just because you don't have symptoms doesn't mean you don't have high blood pressure, which is why it is called "the silent killer." High blood pressure is very dangerous, being the number one cause of stroke, as well as the cause for heart attack and heart failure. Changing blood pressure numbers depends a great deal on the choices we make every day, such has how much we exercise, the foods we ear, and our overall lifestyle. However, for those times when extra help is needed, there is a new scientifically-studied supplement that will help us lower our blood pressure and give us better overall health.

Blood pressure is divided into two parts, systolic and diastolic. Systolic is the pressure of the heart beating; while diastolic is the pressure of the heart vessels when they are filling. Although a persons' blood pressure can vary naturally throughout the day, if numbers are consistently high after many visits to the doctor, it is possible that you have pre-hypertension or high blood pressure. Healthy blood pressure numbers are about 115/75 mm/Hg. Arteries that are kept young through healthy diet and exercise are usually more elastic and unclogged compared to those that have plaque buildup from diets high in saturated fat and sedentary lifestyles. These unclogged arteries are able to transport blood through them easily and without much effort. However, clogged arteries result in faster blood flow, all of the time, which can cause damages to heart tissue, arteries, kidney, and other major organs in the long run.

High blood pressure can be caused by a variety of lifestyle factors being: body type, sedentary lifestyle. Sodium intake, low potassium intake, heavy alcohol intake, unhealthy eating, and smoking. Although weight isn't always a reliable indicator of whether or not you'll have high blood pressure, the type of weight is. Lean body mass (muscle) doesn't increase blood pressure levels, but fat does, especially when it is around your mid-section. Many of our jobs require us to sit all day at work and then we continue to sit more when we get home. With time, this leads to weight gain, which makes your heart work harder to pump blood through the body. Inactivity usually leads to higher heart rates. Even though salt intake itself isn't necessarily bad, it leads to more water retention, which increases blood pressure. A moderate intake of salt, especially sea salt or Celtic salt, for healthy individuals is fine. Most Americans do not get enough potassium. It helps to regulate the amount of sodium in our cells and expels the rest to our kidneys. Low levels of potassium can lead to a build up of sodium in the body. Because having three or more alcoholic drinks a day doubles and individuals' chance of developing high blood pressure, it is important to limit the amount of alcohol intake. Drinking a large amount will eventually put a lot of stress on the heart, liver, pancreas, and brain. Eating a lot of processed and fatty foods can lead to high blood pressure as well. By adapting a diet rich in fruits and vegetables as well as whole grain products, fish, nuts, magnesium, and potassium, blood pressure can be brought back down. Smoking damages the heart and arteries, while the nicotine constricts blood vessels, increases heart rate, and raises blood pressure. The carbon monoxide in smoke replaces oxygen in the blood, which makes the heart work even harder to make up for the difference. It is important if you have high blood pressure that you do not smoke.

Along with the above diet and lifestyle changes, there are other natural ways to lower blood pressure. These supplements include: fish oil, CoQ10, and garlic. Although these are very effective, they usually lower systolic pressure much more than diastolic pressure. There is a blend of natural ingredients that lower systolic and diastolic blood pressure separately and work even better combined, dandelion leaf extract, lycopene, stevia extract, olive leaf extract, and hawthorn extract. Dandelion leaf extract provides a healthy supply of vitamins, including vitamins A, B, C, D, iron, silicon, magnesium, zinc, potassium, and manganese. This extract produces a diuretic effect in the body relieving hypertension in the body by drawing excess water and sodium from the body and releasing it through the kidneys as urine, which allows the blood vessels to relax and in turn lowers blood pressure. Lycopene, which is mostly found in tomatoes and processed tomato products, has great antioxidant abilities as well as free-radical scavenging properties. It also lowers LDL (bad) cholesterol, lowers homocysteine levels, and reduces blood platelet stickiness which leads to clogged arteries. Higher intakes of lycopene mean less thickening of arteries and a reduced risk of heart attack. Stevia extract, which is often used as a sweetener, relaxes arteries and helps to prevent the buildup of calcium on artery walls, which keeps them healthy and reduces blood pressure. Many scientific studies have proven that stevia controls blood sugar levels as well as has great potential in treating type 2 diabetes along with hypertension. Olive leaf extract relaxes blood vessels and prevents buildup of plaque in the arteries, which in turn lowers blood pressure. It also acts as an antioxidant. Hawthorn extract has been used to support heart health for many centuries. It improves blood pressure levels by increasing blood vessel elasticity, as well as improves coronary artery blood flow and contractions of the heart muscle. This supplement also has antioxidant properties, as well as the anti-anxiety abilities and blood sugar regulation properties.

After taking a combination of these herbs, you should notice both systolic and diastolic numbers lowering within two weeks. When you are taking herbs that support your blood pressure, it is important to keep it monitored so that you have an adequate reading of your numbers. To do so, you can purchase a home blood pressure monitoring device for thirty to two-hundred dollars. However, buying one in the thirty to fifty dollar range is sufficient and will be money well-spent. Although there are no side effects noted in the study, you may notice an increase in the number of trips you take to the bathroom do to the diuretic effect of the dandelion leaf extract. The vitamins mentioned above can be found at your friendly internet health food store.

More Migraine Help

Re: CAM Remedies for Migraine Headaches Examined

Evans R, Taylor F. "Natural" or alternative medications for migraine prevention. Headache. June 2006;46(6):506-516.

Many people with migraines are concerned about the side effects of prescription medications and are interested in natural or alternative therapies to prevent migraine attacks. People who suffer from episodic migraine, in which they return to normal between migraines episodes, are at risk for progression to chronic (continuous) headaches. The overuse of medications to treat the symptoms of migraine may increase the risk of chronic headache conditions. Complementary and alternative medicine (CAM) can be a viable option in reducing the frequency of attacks and the risk of progression to a chronic condition. This "Expert Opinion" article reviews the effectiveness and safety of several CAM therapies for migraine prevention.

The leaves of feverfew (Tanacetum parthenium) are used to prevent migraines and to reduce migraine symptoms such as nausea and vomiting. A review of randomized, controlled trials (RCT) conducted before 1998 found five such trials involving 216 subjects. Two thirds of the subjects in these studies experienced greater benefit from feverfew than from placebo. A Cochrane review conducted in 2004 examined five double-blind trials involving 343 subjects and concluded that feverfew lacked convincing evidence of efficacy. Some of the inconsistent results may stem from different extraction techniques used for feverfew products and uncertainty regarding the active ingredients in the plant. A study published in 2005 reported that MIG-99, a highly enriched parthenolide extract, was more effective than placebo in reducing the number of migraine attacks per month. Feverfew side effects can include systematic sore mouth and tongue, swollen lips, loss of taste, abdominal pain, and intestinal disturbances. No long-term studies have been conducted to assess the safety of feverfew.

Butterbur (Petasites hybridus) is an herb native to Europe. Although parts of the butterbur plant contain toxic pyrrolizidine alkaloids, a patented, standardized extract of butterbur root (Petadolex®, Weber and Weber GmbH & Co. KG, Germany) is free of toxic substances and is marketed for the prevention of migraine headaches. Two RCTs have been published on Petadolex. In the first trial of 60 people, 45% of those taking 100 mg per day of Petadolex and 15% of those taking placebo experienced a 50% or greater reduction in migraine frequency. In the second trial of 245 people, the migraine frequency decreased an average of 48% in the group taking 150 mg per day of Petadolex while the migraine frequency decreased an average of 26% in the placebo group. The migraine frequency was not significantly different between the group taking 100 mg per day Petadolex and the placebo group. Side effects in the Petadolex groups and placebo group were comparable except for excess burping in people taking Petadolex. Short-term use of Petadolex appears to be safe; however, no long-term safety studies have been conducted.

Magnesium levels are reported to be lower in the brain, in the blood, or inside the cells of people who experience migraines. Several RCTs have been conducted to test the effects of magnesium supplements on migraine prevention. Two of the trials indicated a benefit for magnesium and the other two trials found no significant effect of magnesium over placebo. Magnesium is an essential mineral, and it is safe when consumed as a dietary supplement. However, diarrhea is a common side effect when magnesium is taken at very high doses.

Riboflavin (vitamin B2) is required for the production of energy in the cell. One RCT tested riboflavin in people with migraines. In this study, 55 subjects took 400 mg of riboflavin or a placebo daily for three months. Subjects taking riboflavin had significantly fewer migraines and fewer headache days than subjects taking placebo. In another study, subjects took a combination of 400 mg riboflavin, 300 mg magnesium, and 100 mg feverfew or a placebo (25 mg riboflavin) daily for 3 months. There were no significant differences in the frequency of migraine attacks or number of headache days between the two groups. It is possible that the riboflavin "placebo" (used to color the urine so subjects would not know which group they were in) had a treatment effect in this study. Riboflavin is safe and well tolerated even at very high doses.

Coenzyme Q10 is also essential for energy production in cells, and it is being tested in a variety of neurological conditions. One RCT involving 42 subjects found that by the fourth month of the study, migraine frequency had dropped by at least 50% in 48% of subjects taking coenzyme Q10 and 14% of subjects taking placebo. Side effects were similar between the two groups, and previous studies indicate coenzyme Q10 is safe and well tolerated.

Although several studies have reported an association between lower levels of melatonin and migraine, no RCTs have tested the effects of melatonin on migraine prevention or treatment.

The authors conclude by evaluating the strength of the evidence for these CAM therapies in migraine prevention. With the exception of melatonin, all the therapies are rated as "Grade B," which means there is limited evidence from a single randomized trial, from nonrandomized trials, or from multiple trials with inconsistent outcomes. Based on the evidence presented in the article, they rank Petadolex as the therapy with the relatively strongest evidence, followed by magnesium, feverfew, riboflavin, coenzyme Q10, and melatonin. This article reveals how few randomized, controlled trials have been conducted on CAM therapies for the prevention of migraine and points out the need for more well-designed trials in the future.

—Heather S. Oliff, PhD

Boost Your Energy

Boost Energy and Reduce Stress Naturally
by Darrell Miller

These days, more and more Americans are feeling overworked and overtired, lacking the energy needed to meet the responsibilities required for everyday life. This constant feeling of fatigue has become a part of the American way of life. Research has proven that the same processes that cause lack of energy in Americans can also keep us from getting an adequate amount of sleep, cause weight gain, disrupt hormonal balance, and add a significant amount of stress to our daily lives. However, people do not have to accept the pain, insomnia, or fatigue associated with chronic fatigue syndrome and fibromyalgia thanks to the following three step process called "Vitality 101."

The first of the three steps is nutrition. Good overall nutrition is important for everyone. To obtain this, a foundation product that supports energy levels, such as a powdered drink mix, can ensure that you are getting all of the necessary vitamins, minerals, and amino acids that you need. This drink should include the following ingredients: vitamin A, C, D, and E; magnesium; malic acid; betaine; selenium; zinc; amino acids; and frutooligosaccharides. Vitamin A is essential for healthy skin, mucous membrane, immune system responses, bone growth, and reproductive processes. In the form of beta-carotene, vitamin A is an antioxidant and a free radical fighter. Vitamin C, which is necessary for the proper functioning of the immune system, is an antioxidant free radical fighter as well as an assistant in hormone synthesis and a supporter of healthy skin integrity and iron absorption. Vitamin D is essential for healthy calcium and phosphorus metabolism. It is also responsible for the absorption of vitamin A and supports bone mineralization. Vitamin E, which helps oxygen circulation, supports healthy nerve transmissions, leg nerves and muscles, and helps boost energy levels. Magnesium supports enzyme activity involved in energy productions and healthy nerve and muscle function, as well as supports the immune system functions, while malic acid acts as a catalyst to stimulate the complete burning of fuel for energy. It also supports healthy connective tissue and muscle functioning. Betaine, which works with B vitamins, may have an effect on overall mood elevation. Where as selenium works with vitamin E to maintain healthy cell membranes and support healthy thyroid functioning. Zinc supports a healthy immune system, enzyme processes, and immune response. Amino acids are essential for the production of energy in the body, which is essential for brain function. Finally, fructooligosacchardies provide nutrition for good bacteria in the intestinal tract which improves digestion and healthy microflora. In addition to the powdered energy drink mix, it is important to take a high potency vitamin B-complex supplement that includes riboflavin, vitamin B6, vitamin B12, pantothenic acid, and choline, which are each important in restoring the energy production needed in your body. It is also very important to get enough water.

The second step of the process is to rest your body. Because having trouble sleeping is one of the most troubling symptoms of stress and can cause pain and hormonal and immune dysfunction, it is important to break the stress/insomnia cycle early. It may be helpful to use herbal products in order to get the good quality sleep that will repair and re-energize the body. Although there are many formulas that are marketed for sleep, it is very important that the right ingredients are in the sleep formula that you buy. This formula should include herbs that promote deep sleep including: valerian, L-theanine, hops, passionflower, Jamaica dogwood and wild lettuce. Wild lettuce has been found to have sedative effects and similarly hops acts as a mild sedative and has a sleep inducing effect. Similar to hops and wild lettuce, Jamaica dogwood has been found to be mildly sedative and it is often used for anxiousness. L-theanine causes a significant increase of neurotransmitter concentrations in the brain which promotes muscle relaxation and improves sleep. Valerian has been clinically proven to improve sleep quality. Lastly, passionflower eases nervousness and insomnia. Each of these herbs addresses a different aspect of sleeplessness, making the combination very important.

The third step in this process is to manage excess stress levels. In the world we live in today, it is important to manage the stressors in our lives. Adrenal extract, as well as other glandular extracts, can offer natural support to help our bodies deal with the effects of stress. In turn, they can also boost your energy levels. Exercise is also a good way to reduce stress and is important for good health. Not only can stress cause you sleepless nights, it can also lead to adrenal burnout or adrenal fatigue, which occurs when the adrenal glands are constantly producing cortisol in response to chronic stress. However, when stress is decreased, changes in our hormone levels can return to normal. The key is learning how to deal with daily stress so that the body is able to return to its normal state.

In addition to stress control, it is important to provide yourself with an adrenal supplement to improve the health of your adrenal glands and repair them when they are malfunctioning. If your adrenal glands are stressed-out, great results can be seen from taking a raw adrenal supplement. Be sure to buy a supplement that contains whole adrenal and cortex adrenal as well as vitamin C, vitamin B6, pantothenic acid, and licorice. The adrenal glands use these nutrients to manufacture cortisone and other compounds. Liver extract also improves energy levels by providing an excellent source of nutrients such as iron, B vitamins, and other minerals. It has been shown to support healthy function of the liver and increase the energy levels inside our body. A high-quality liver extract supplement should be cold-processed and encapsulated to enhance speed and absorption of nutrients from the liver because heat will destroy the key components in the liver. Along with the above listed nutrients, there are many other natural alternatives that promote relaxation and increase energy levels during the day. Rhodiola rosea relieves stress and increases energy as well as lifts our moods, improves sexual satisfaction, and helps in certain nervous system disorders. Remember to consult your health care practitioner before changing any medications. The above mentioned vitamin supplements are available at your friendly internet health food store.

Magnesium and Malic acid in Fibromyalgia

Magnesium & Malic Acid Supplementation Often Beneficial for CFS & FM Quality-of-Life Measures – Studies and Top Specialists Report by Editor
ImmuneSupport.com

08-18-2006

Clinical studies have consistently reported that Fibromyalgia and Chronic Fatigue Syndrome patients tend to be deficient in the essential mineral magnesium (Mg), and research indicates many may achieve quality-of-life benefits by adding supplemental Mg to their diets.^1,2,3 Leading CFS and FM specialists routinely recommend magnesium supplementation to their patients specifically for support of improved muscle pain and fatigue. And most favor a combination of Mg plus malic acid, an extract of tart apples, as a dietary supplement for individuals with below-normal Mg in the blood and tissues.^4,5,6

The importance of magnesium for energy and muscle comfort. Magnesium plays a role in at least 300 biochemical functions in the body. One of the most important is that it activates almost all the enzymes involved in transforming fat and sugar into high-energy adenosine triphosphate (ATP), the body’s energy source, reports Georges Ramalanjaona, MD, an expert on the benefits of Mg supplementation for FM patients based at Seton Hall University’s School of Graduate Medical Education.¹ A low level of Mg leads to a low level of ATP, which is especially crucial in the brain, where 20 percent of the body’s ATP is stored, he explains.

Magnesium is also an essential in muscle metabolism and function. Among the high-profile researchers emphasizing the importance of sufficient Mg in the tissues of FM/CFS patients is Paul Cheney, MD, whose highly publicized recent research involves studies of the association between ATP production and abnormal heart function in CFS.

Blood tests alone don’t tell the whole Mg story, says Dr. Cheney, because they are not sensitive to intra-cellular magnesium.¹ “Magnesium, like potassium, is pumped into the cell, so [there should be] a higher concentration inside the cell than there is in the blood,” he explains. “And that pump mechanism may not work very well in people with CFS, so their magnesium levels can be normal in the blood and low in the cell.”

Studies have also shown that Mg inhibits many nerve receptors related to the origins of certain types of pain in FM patients. As a result, when Mg is deficient in the body, it is borrowed from muscle cells, and “calcium [moves] in to replace it, causing the muscles to grow stiff and tense,” writes Richard Firshein, DO, author of The Nutraceutical Revolution.⁷

While magnesium helps activate production of ATP, malic acid allows the body to make the ATP more efficiently, even under low oxygen, or “hypoxic” conditions. Chemical analyses of tissues have identified low “oxygen pressure” in the muscles of many FM patients studied, and indicated that these patients’ “tender points” were often deficient in ATP.¹ Tender points are areas of muscle attachment to bone, ligaments, and tendons which may be painful when pressed in FM patients.

Jay Goldstein, MD – known for his CFS studies focused on disturbances in neurotransmitters, the chemical substances responsible for transmitting cell-to-cell information – indicated he found malic acid to be a safe, inexpensive nutritional supplement which he recommends for CFS and FM patients suffering continuing or recurring muscle soreness, discomfort, and fatigue.⁸

Other top CFS clinicians who recommend a combination of Mg and malic acid for improved quality-of-life measures include Dr. Cheney and Daniel L. Peterson, MD – who together earned their places in medical history by documenting the 1985 CFS outbreak in Incline Village, Nevada – and leading CFS clinician Dr. David Teitelbaum, as discussed in his book From Fatigued to Fantastic.⁹

In their 1999 book Making Sense of Fibromyalgia,¹⁰ noted rheumatologist Daniel J. Wallace, MD, and Janice Brock Wallace cite controlled studies in England and Texas supporting the success of a proprietary combination of malic acid and magnesium in FM patients with recurring soreness or tenderness in the muscles. “If subjects take a dose larger than recommended on the bottle… its effects become apparent within a week.…and side effects are uncommon,” they note, referring to a study that started doses of magnesium at 300 mg and increased them until symptoms were reduced or side effects appeared. “This combination may work as a result of interactions between magnesium and calcium channels within muscles and the generation of adenosine triphosphate (ATP).”

Jorge Flechas, MD, MPh, an FM specialist in Hendersonville, ND, has participated in two studies that have tested a combination of malic acid and magnesium for pain and fatigue. In these studies, subjects diagnosed with Fibromyalgia reported a significant reduction in discomfort and tenderness within 48 hours and without any side effects. Specifically, he says, his experience with about 500 individuals who used this combination was that “the results are positive 90 percent of the time.”¹¹

Billie J. Sahley, PhD, a San Antonio-based nutritional specialist and author, has also reported improved energy and comfort with the Mg/malic acid combination for FM and CFS patients.4 He reports prescribing doses ranging from 800 to 1200 mg per day, “using diarrhea as the limiting factor,” because “FM patients tend to be extremely low in magnesium… [and] the sooner malic acid and magnesium are started, the faster individuals begin to return to their normal lifestyles.”

Things to know about Mg supplementation. In addition to maintaining normal muscle and nerve function, “magnesium keeps heart rhythm steady, supports a healthy immune system, and keeps bones strong” by aiding with calcium absorption, according to a National Institutes of Health fact sheet.¹² “It also helps regulate blood sugar levels, promotes normal blood pressure, and is known to be involved in energy metabolism and protein synthesis. It is essential in the conversion of vitamin D to its biologically active form, which then helps the body absorb and utilize calcium.” And, especially important for CFS and FM patients, studies indicate that sleep deprivation is associated with low levels of magnesium in the red blood cells.¹³

The many sources of Mg range from milk and “hard” mineral-containing water to “sunshine” foods such as spinach, whole grains, and bananas. But with refined foods, magnesium-depleted soil, and the lack of Mg in commercial fertilizers, the vast majority of the U.S. population fails to obtain even 40 percent of the recommended dietary intake (RDI) of Mg from their diet, according to the USDA.¹⁴

A blood test may identify suboptimal Mg levels, though as noted this does not tell the whole story, since most of the body’s magnesium is found within the cell membranes and not in blood. The U.S. recommended RDI of Mg for an adult is 400 milligrams per day. Therapeutic doses used in clinical trials have typically been higher, ranging from 500 to 1500 mg per day, and “while many prescription medicines can cause side effects,” by comparison healthcare practitioners have found dietary magnesium supplements “extremely safe,” says Mg expert and author Alan R. Gaby, MD.¹⁵

Individuals with kidney disease are generally advised to avoid Mg supplementation. Anyone taking prescription or over-the-counter drugs should consult their doctor or a pharmacist: Certain diuretics, antibiotics, and other drugs may reduce Mg absorption. Laxatives and antacids often contain Mg. Diarrhea and loose stools are the most common side effects of Mg supplementation, and Mg “toxicity” is rare, as healthy kidneys excrete any reasonable excess.¹⁶

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1. Go to ImmuneSupport.com to find a review summarizing the findings of 16 studies addressing Mg deficiencies in FM patients and benefits of supplementation, titled “Magnesium in the Treatment of Fibromyalgia,” by Georges Ramalanjaona, MD, DSc, FACEP, MBA, from Alternative Medicine Alert, March 2002.

2. Go to ImmuneSupport.com to find “A magnesium deficiency?” an abstract of “Review and hypothesis: Might patients with the Chronic Fatigue Syndrome have latent tetany of magnesium deficiency?” by Mildred Selig, MD, MPH, in the Journal of Chronic Fatigue Syndrome, Vol. 4, #2, 1998.

3. “NMR spectroscopy of muscle in Fibromyalgia Syndrome patients and sedentary controls,” R.W. Simms, et al., Arthritis and Rheumatism 1993.

4. Malic Acid and Magnesium for Fibromyalgia and Chronic Pain Syndrome, by Billie J. Sahley, PhD, Pain & Stress Therapy Center Publications, San Antonio 1995.

5. “Top CFIDS Researchers and Physicians Find Nutritional Supplement to Reduce Muscle Pain and Fatigue in Some Cases,” CFIDS Association of America, October 1994, ImmuneSupport.com

6. “Magnesium and Malic Acid: Partners in Muscle Health,” by Molly Hozschlag, December 1, 1994; and “American College of Physicians on Malic Acid, by ImmuneSupport.com Editor, June 6, 2006.

7. “Magnesium’s Profound Effect on CFS,” by Richard Firshein, DO, from The Nutraceutical Revolution, Riverhead Books, 1998.

8. Betrayal by the Brain: The Neurologic Basis of Chronic Fatigue Syndrome, Fibromyalgia Syndrome, and Related Neural Network Disorders, by Jay Goldstein, MD, Haworth Medical Press, 1998.

9. From Fatigued to Fantastic, Dr. David Teitelbaum, Avery Penguin Putnam, 2001.

10. Dr. Wallace is Medical Director of the Wallace Rheumatic Study Center in Los Angeles, an Attending Physician at Cedars-Sinai Medical Center, and Clinical Professor of Medicine at UCLA’s David Geffen School of Medicine. He has written numerous books on “central pain syndromes.”

11. “Malic Acid and Magnesium for Fibromyalgia and Chronic Pain Syndrome,” by G.E. Abraham and J.D. Flechas, published in the March 1992 issue of the Journal of Nutritional Medicine, archived at http://www.immunesupport.com/message/malic.htm

12. NIH Clinical Center, Office of Dietary Supplements, at dietary-supplements.info.nih.gov/factsheets/magnesium.asp

13. “Erythrocyte magnesium and prostaglandin dynamics in chronic sleep deprivation,” K. Tanabe, et al., Clinical Cardiology, March 1997.

14. “Percentage of Individuals Meeting DRI - Magnesium” by state, USDA Community Nutrition Research Service site, at www.ba.ars.usda.gov/cnrg/services/magnesium.html

15. “Magnesium is the Missing Link in Many Chronic Ills,” from Magnesium, by Alan R. Gaby, MD, Keats Publishing, 1994.

16. Drug-Induced Nutrient Depletion Handbook, 2nd Edition, by Ross Pelton, RPh, PhD, CCN, et al., Lexi-Comp, Inc., 2001.

Many angioplasties are unnecessary

By MARILYNN MARCHIONE, AP Medical Writer1 hour, 53 minutes ago

More than half a million people a year with chest pain are getting an unnecessary or premature procedure to unclog their arteries because drugs are just as effective, suggests a landmark study that challenges one of the most common practices in heart care.

The stunning results found that angioplasty did not save lives or prevent heart attacks in non-emergency heart patients.

An even bigger surprise: Angioplasty gave only slight and temporary relief from chest pain, the main reason it is done.

"By five years, there was really no significant difference" in symptoms, said Dr. William Boden of Buffalo General Hospital in New York. "Few would have expected such results."

He led the study and gave results Monday at a meeting of the American College of Cardiology. They also were published online by the New England Journal of Medicine and will be in the April 12 issue.

Angioplasty remains the top treatment for people having a heart attack or hospitalized with worsening symptoms. But most angioplasties are done on a non-emergency basis, to relieve chest pain caused by clogged arteries crimping the heart's blood supply.

Those patients now should try drugs first, experts say. If that does not help, they can consider angioplasty or bypass surgery, which unlike angioplasty, does save lives, prevent heart attacks and give lasting chest pain relief.

In the study, only one-third of the people treated with drugs ultimately needed angioplasty or a bypass.

"You are not putting yourself at risk of death or heart attack if you defer," and considering the safety worries about heart stents used to keep arteries open after angioplasty, it may be wise to wait, said Dr. Steven Nissen, a Cleveland Clinic heart specialist and president of the College of Cardiology.

Why did angioplasty not help more?

It fixes only one blockage at a time whereas drugs affect all the arteries, experts said. Also, the clogs treated with angioplasty are not the really dangerous kind.

"Even though it goes against intuition, the blockages that are severe that cause chest pain are less likely to be the source of a heart attack than segments in the artery that are not severely blocked," said Dr. David Maron, a Vanderbilt University cardiologist who helped lead the new study.

About 1.2 million angioplasties are done in the United States each year. Through a blood vessel in the groin, doctors snake a tube to a blocked heart artery. A tiny balloon is inflated to flatten the clog and a mesh scaffold stent is usually placed.

The procedure already has lost some popularity because of emerging evidence that popular drug-coated stents can raise the risk of blood clots months later. The new study shifts the argument from which type of stent to use to whether to do the procedure at all.

It involved 2,287 patients throughout the U.S. and Canada who had substantial blockages, typically in two arteries, but were medically stable. They had an average of 10 chest pain episodes a week — moderately severe.

About 40 percent had a prior heart attack more than three months previously.

"We deliberately chose to enroll a sicker, more symptomatic group" to give angioplasty a good chance to prove itself, Boden said.

All were treated with medicines that improve chest pain and heart and artery health such as aspirin, cholesterol-lowering statins, nitrates, ACE inhibitors, beta-blockers and calcium channel blockers. All also were counseled on healthy lifestyles — diet, exercise and smoking cessation.

Half of the participants also were assigned to get angioplasty.

After an average of 4 1/2 years, the groups had similar rates of death and heart attack: 211 in the angioplasty group and 202 in the medication group — about 19 percent of each.

Heart-related hospitalization rates were similar, too.

Neither treatment proved better for any subgroups like smokers, diabetics, or older or sicker people.

At the start of the study, 80 percent had chest pain. Three years into it, 72 percent of the angioplasty group was free of this symptom as was 67 percent of the drug group.

That means you would have to give angioplasties to 20 people for every one whose chest pain was better after three years — an unacceptably high ratio, Nissen said.

After five years, 74 percent of the angioplasty group and 72 percent of the medication group were free of chest pain - "no significant difference," Boden said.

The study was funded by the U.S. Department of Veterans Affairs, the Medical Research Council of Canada and a host of drug companies. Stent makers refused to help pay for the research, said scientists who led the study.

The study renewed a heated animosity between doctors who perform angioplasty and other heart specialists.

In fact, one who does the procedures and who spoke at a meeting in New Orleans sponsored by stent maker Boston Scientific Corp. was responsible for the early release of the study's results, which were not due out until Tuesday.

The study "was rigged to fail, and it did," the Wall Street Journal quoted Dr. Martin B. Leon of Columbia University telling several hundred of his colleagues Sunday night.

"A lot of people have been taking shots at us, and we need to go on the offense for awhile," the Journal reported Leon said.

He claimed to have inside knowledge of the results because he reviewed the study for the New England Journal. The journal would not comment, saying the identity of its reviewers is confidential.

The cardiology college issued a statement saying it was "extremely disappointed" results were released prematurely, "betraying the confidentiality of the scholarly process and the professional integrity of the scientific community."

The college "will be considering strong sanctions against the individual or individuals involved," the statement said.

Shares of Boston Scientific were down $1.15, or nearly 8 percent, to $14.07 in afternoon trading on the New York Stock Exchange. It was a nearly five-year low for the stock.

Dr. Spencer King of Piedmont Hospital in Atlanta, a leading cardiologist who does many angioplasties, said he was disappointed in the study results.

"How many patients have interventions in which the only expectation is to reduce the use of nitroglycerin or to walk a bit faster? Most patients anticipate a better prognosis and might opt for an extended course of medical therapy if they believe they are not putting their life at excess risk," he wrote in a recent editorial in an American Heart Association journal.

In an interview at the cardiology meeting, King said he recently had surgery for back pain and did not expect permanent relief but added, "If it only held up for five years, I wouldn't be happy about it."

The new study "should lead to changes in the treatment of patients with stable coronary artery disease, with expected substantial health care savings," Dr. Judith Hochman of New York University wrote in an editorial in the journal.

Angioplasty costs $30,000 to $40,000. The drugs used in the study are almost all available in generic form.

Maron, the Vanderbilt doctor who helped lead the study, said people should give the drugs a chance.

"Often I think that patients are under the impression that unless they have that procedure done, they're not getting the best of care and are at increased risk of having a heart attack and die," he said.

The study shows that is not true, he said.

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On the Net:

New England Journal: http://www.nejm.org

Trans Fat

Trans Fats Refresher

Posted: 3/13/2007

Posted Mar 13, 2007

Here's a refresher about trans fats: Artificial trans fats are made by adding hydrogen to vegetable oil to make it stable. Companies began using them to give certain foods a desirable taste, shape and texture (think flaky pie crust or perfect french fries). At home, you can find artificial trans fats in many crackers, cookies and frostings. Just look for words like "hydrogenated" or "partially hydrogenated" in the ingredients label. Health and nutrition groups including the American Heart Association say artificial trans fats can clog arteries and raise the body's level of LDL or "bad" cholesterol, setting the stage for heart disease and stroke. Thus, health departments across the country are pushing food companies and eateries to label trans fats or eliminate them from recipes as part of a larger effort to help consumers be better informed about what we're eating.

Q: If my cereal/cookies/frosting claims to be trans-fat free, how come there are still hydrogenated items on the ingredients list?

A: Since last year, the Food and Drug Administration has required most packaged foods to list trans-fat content in their ingredients list. Some products that say they are trans-fat free still list hydrogenated or partially hydrogenated oils as ingredients, which is allowed under FDA guidelines so long as the amount is less than 0.5 grams of trans fat per serving.

Q: What's this I hear about trans-fat alternatives that also could be harmful for my health?

A: Some restaurants searching for alternatives to artificial trans fats have turned to oils high in saturated fats, including palm and coconut oils. As any nutritionist will tell you, just because something is trans-fat free doesn't necessarily mean it's healthful.

Why Green Tea?

7 Reasons to Drink Green Tea

Posted Tue, Feb 27, 2007, 11:54 am PST

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The steady stream of good news about green tea is getting so hard to ignore that even java junkies are beginning to sip mugs of the deceptively delicate brew. You'd think the daily dose of disease-fighting, inflammation-squelching antioxidants - long linked with heart protection - would be enough incentive, but wait, there's more! Lots more.

CUT YOUR CANCER RISK
Several polyphenols - the potent antioxidants green tea's famous for - seem to help keep cancer cells from gaining a foothold in the body, by discouraging their growth and then squelching the creation of new blood vessels that tumors need to thrive. Study after study has found that people who regularly drink green tea reduce their risk of breast, stomach, esophagus, colon, and/or prostate cancer.

SOOTHE YOUR SKIN
Got a cut, scrape, or bite, and a little leftover green tea? Soak a cotton pad in it. The tea is a natural antiseptic that relieves itching and swelling. Try it on inflamed breakouts and blemishes, sunburns, even puffy eyelids. And that's not all. In the lab, green tea helps block sun-triggered skin cancer, whether you drink it or apply it directly to the skin - which is why you're seeing green tea in more and more sunscreens and moisturizers.

STEADY YOUR BLOOD PRESSURE
Having healthy blood pressure - meaning below 120/80 - is one thing. Keeping it that way is quite another. But people who sip just half a cup a day are almost 50 percent less likely to wind up with hypertension than non-drinkers. Credit goes to the polyphenols again (especially one known as ECGC). They help keep blood vessels from contracting and raising blood pressure.

PROTECT YOUR MEMORY, OR YOUR MOM'S
Green tea may also keep the brain from turning fuzzy. Getting-up-there adults who drink at least two cups a day are half as likely to develop cognitive problems as those who drink less. Why? It appears that the tea's big dose of antioxidants fights the free-radical damage to brain nerves seen in Alzheimer's and Parkinson's.

STAY YOUNG
The younger and healthier your arteries are, the younger and healthier you are. So fight plaque build-up in your blood vessels, which ups the risk of heart disease and stroke, adds years to your biological age (or RealAge), and saps your energy too. How much green tea does this vital job take? About 10 ounces a day, which also deters your body from absorbing artery-clogging fat and cholesterol.

LOSE WEIGHT
Oh yeah, one more thing. Turns out that green tea speeds up your body's calorie-burning process. In the every-little-bit-counts department, this is good news!

High Energy Foods

Wonder Foods

Posted Tue, Mar 06, 2007, 10:11 am PST

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Here's why these three foods are practically a staple among health - conscious celebs and foodies - plus how to pronounce them, so you can casually order an açaí smoothie with all the cool of George Clooney.

Açaí berries (ah-sigh-EE or ah-SIGH-ee) Brazilian surfers eat theirs with granola, and we know what their bodies look like! Packed with twice the disease-fighting antioxidants of blueberries, açaí has already made Oprah's list of Top 10 Superfoods and The Washington Post called the blackberry-flavored fruit the "new pomegranate." But you may find it easier to sip yours: Celestial Seasonings sells an açaí-green tea blend, and açaí martinis are on chic bar menus everywhere.

• DIY açaí fruit soda: Just mix chilled sparkling mineral water with a few ounces of açaí juice, available at health-food stores. Sip. Look cool. Feel healthy.

Quinoa (KEEN-wah) Dry quinoa looks a bit like sesame seeds but when cooked it becomes fluffy with a hint of crunch, making it an excellent substitution for rice, cous cous, and pasta. Quinoa's major claim to food fame, however, is what RealAge researchers call its "nutritional profile." A cup of quinoa has more protein than a quarter-pound hamburger and more calcium than a quart of milk. Yowza. It's also loaded with iron, magnesium, and a bevy of other minerals and B vitamins. No wonder the Incas named it "the mother grain." Try it in this warm winter salad from our friends at Eating Well.

• Quinoa and Black Beans
  Stir in your favorite jarred salsa for extra zing.
  This is also good the next day for lunch.
  Makes 2 servings, about 1/2 cup each
  
  1 teaspoon canola oil
  1/2 bell pepper, chopped
  2 tablespoons chopped red onion
  1/2 cup canned black beans, rinsed
  2 tablespoons broth (or water)
  1/2 cup hot quinoa (cook according to package directions)
  
  Heat oil in a small saucepan over medium heat. Add bell pepper and onion and cook until almost tender. Add beans and broth (or water) to the pan. Cook until heated through. Stir in quinoa.
  
  Per serving: 162 calories; 4 g fat (0 g sat); 0 mg cholesterol; 27 g carbohydrate; 6 g protein; 4 g fiber; 60 mg sodium; 224 mg potassium.

Matcha (MAH-cha) When you drink a cuppa matcha (also spelled maccha), you're getting green tea's powerful antioxidants to the max, because you're actually consuming the whole green tea leaf in powdered form. In Japan, slightly bitter matcha is traditionally served syrupy thick. But in the US, you'll find matcha stirred into lattes, sprinkled on ice cream, and used to bolster energy drinks and turn smoothies into pick-me-ups (it's said to boost alertness). Just be respectful of matcha if you're caffeine sensitive: Ounce for ounce, it has almost as much caffeine as coffee.

• To rev up a hot homemade latte, whisk in 1/2 teaspoon of the powder.
• For a quick summer cooler, blend 1 1/2 teaspoon with a cup of milk and some ice cubes.

High blood pressure? Check your neck.

Chiropractic Cuts Blood Pressure

Study Finds Special 'Atlas Adjustment' Lowers Blood Pressure

By Daniel J. DeNoon
WebMD Medical News

Reviewed by Louise Chang, MD

March 16, 2007 -- A special chiropractic adjustment can significantly lower high blood pressure, a placebo-controlled study suggests.

"This procedure has the effect of not one, but two blood-pressure medications given in combination," study leader George Bakris, MD, tells WebMD. "And it seems to be adverse-event free. We saw no side effects and no problems," adds Bakris, director of the University of Chicago hypertension center.

Eight weeks after undergoing the procedure, 25 patients with early-stage high blood pressure had significantly lower blood pressure than 25 similar patients who underwent a sham chiropractic adjustment. Because patients can't feel the technique, they were unable to tell which group they were in.

X-rays showed that the procedure realigned the Atlas vertebra -- the doughnut-like bone at the very top of the spine -- with the spine in the treated patients, but not in the sham-treated patients.

Compared to the sham-treated patients, those who got the real procedure saw an average 14 mm Hg greater drop in systolic blood pressure (the top number in a blood pressure count), and an average 8 mm Hg greater drop in diastolic blood pressure (the bottom blood pressure number).

None of the patients took blood pressure medicine during the eight-week study.

"When the statistician brought me the data, I actually didn't believe it. It was way too good to be true," Bakris says. "The statistician said, 'I don't even believe it.' But we checked for everything, and there it was."

Bakris and colleagues report their findings in the advance online issue of the Journal of Human Hypertension.

Supplements for Migraines

Migraines: Much-needed relief from migraine attacks

When the big guns aren't effective, it may be time
to go back and give some simple tools a try. That's
the finding of a new study that tested dietary
supplements on patients who had been unsuccessful in
relieving migraines with a variety of drugs.


Migraines: Preliminary results look promising


Could free radical damage contribute to migraine
headaches? Dr. Sirichai Chayasirisobhon of Kaiser
Permanente Medical Center set out to address that
question when he recruited a dozen patients, each
with a long-term history of little or no success at
treating migraines with various drugs, including
antidepressants, beta-blockers and anticonvulsants.

At the outset of the study, subjects completed a
migraine disability assessment (MIDAS) questionnaire
to assess the impact of migraine flare-ups on
activities at home, at work and while interacting
with friends and family. For the three-month trial
period, each subject received daily supplements that
contained 600 mg of vitamin C, 300 IU of vitamin E
and 1,200 mg of a pine bark extract. Subjects were
allowed to continue using whatever medications they
were currently taking.

When subjects completed a second MIDAS questionnaire
at the end of the study period, their responses
indicated a marked improvement. And even though the
lack of a control group opens the possibility of
placebo effect, the results were promising:

* The overall MIDAS score improvement was more
than 50 percent

* Average Number of migraine days was reduced
from 44 days in the three months prior to
supplementation, to just 26 days during the trial
period

* Average migraine severity score was reduced
from 7.5 (out of 10) to 5.5

One subject dropped out of the trial. Of the
remaining 11, two reported no change in migraine
frequency, duration or severity. Among the other
nine, the overall MIDAS score improvement was nearly
68 percent.


Migraines: CoQ10 helps alleviate migraines


So...what's up with this pine bark extract?

Although not identified in the study, I believe the
extract is almost certainly Pycnogenol; a natural
antioxidant extracted from French maritime pine
bark. Pycnogenol contains a variety of polyphenols
with anti-inflammatory properties that have been
shown to benefit the cardiovascular system by
promoting proper blood flow. In a previous e-Alert
we compared the effectiveness of Pycnogenol's
antioxidant qualities to two of the most powerful
antioxidants: glutathione and coenzyme Q10 (CoQ10).

In fact, Dr. Chayasirisobhon might have produced

even more impressive migraine relief if he had added
CoQ10 to the supplement mix.

In a CoQ10 trial conducted in 2002, 32 migraine
patients each received 150 mg of the antioxidant
daily for three months. In the month before the
study began, the group experienced an average of
more than seven days of migraine each. But by the
end of the study that monthly average had dropped to
just under three days. About 60 percent of the
subjects reported that their frequency of migraines
dropped to less than half of what it had been before
the study.

And in another e-Alert I told you about a Swiss
study in which 42 migraine patients received either
100 mg of CoQ10 three times each day, or a placebo.
No other methods were used to prevent migraines.
After three months of supplementation, researchers
found that migraine frequency, total days with
migraine, and total days with nausea were all
significantly reduced in the CoQ10 group, compared
to placebo. Overall, the incidence of migraines was
almost cut in half in the CoQ10 group, while the
reduction of migraines in the placebo group was less
than 15 percent.

When this research was presented at the 2004 annual
meeting of the American Academy of Neurology, the
Swiss team noted that migraines might be triggered
by a breakdown in the production of cellular energy.
They theorised that CoQ10 helps prevent migraines by
promoting proper respiration in the powerhouses of
the cell: the mitochondria.

If you suffer from migraines, talk to your doctor or
a healthcare professional about these promising
antioxidant studies before expanding your supplement
regimen.

Sources:

"Use of a Pine Bark Extract and Antioxidant Vitamin
Combination Product as Therapy for Migraine in
Patients Refractory to Pharmacologic Medication"
Headache: The Journal of Head and Face Pain, Vol.
46, No. 5, May 2006, Blackwell-synergy.com
"Antioxidant Combo May Prevent Some Migraines"
Reuters Health, 6/1/06, reutershealth.com "Teen
Refuses Court-Ordered Test to Check Cancer Status"
Elizabeth Simpson, The Virginian-Pilot, 6/26/06,
home.hamptonroads.com "Judge OKs Alternative
Treatment for Teen" The Guardian, 6/2/06,
guardian.co.uk

Help for Retinoblastoma

Tree bark extract might help treat rare eye cancer

By Julie SteenhuysenFri Mar 16, 1:07 AM ET

An extract from the bark of a South American tree might lead to better treatments for a rare but deadly childhood eye cancer called retinoblastoma, U.S. researchers reported on Friday.

Retinoblastoma affects 1 in 15,000 children, causing about 3 percent of all cancers in children. It forms when developing cells in the retina -- the eye's main light sensor -- go haywire and start reproducing out of control.

"The great majority of the cases exist in the developing world, where it is a fatal disease," said Dr. Joan O'Brien of the University of California, San Francisco, who led the study.

The cancer usually develops in children under age 6 and kills within two to four years after diagnosis if not treated.

If detected early and treated with a combination of chemotherapy agents or radiation, 90 to 95 percent of children live. But conventional treatment has significant side effects.

Combination chemotherapy can cause hearing loss, kidney failure and leukemia. Radiation therapy, which is now less commonly used, disfigures the child.

In children who have the cancer in only one eye, the eyeball is sometimes replaced with an implant.

"We can cure them, but at cost," said O'Brien. "It's important to find a cheap, easily administered, nontoxic therapy."

O'Brien and colleagues at UCSF wanted to see whether the tree bark extract beta-lapachone could cause the abnormal cells to commit suicide -- something it has been shown to do in a number of cancer types, including breast and prostate cells.

They tested the extract in the laboratory and found that beta-lapachone significantly blocked rapid cell growth of human tumor cells and that low doses could cause damaged cells to kill themselves in a process called apoptosis, or programmed cell death.

Writing in the journal Eye, the scientists said their findings support other studies of the extract in different human cancers and may lead to an effective treatment.

"The nice thing about the agent is that it kills at very low doses and it appears to be selective to cancer," O'Brien said.

Substances that zero in on cancer are less toxic because they do less harm to healthy cells, O'Brien said. Her lab is now testing the extract in mice with retinoblastoma to look for possible toxic side effects.

5-HTP; Help for mood and sleep

5-Hydroxytryptophan (5-HTP)

Overview Uses Dietary Sources Available Forms How to Take It Precautions Possible Interactions Supporting Research

Overview

5-hydroxytryptophan (5-HTP) is an amino acid. The body makes 5-HTP from tryptophan (an essential amino acid) and converts it to an important brain chemical known as serotonin. Tryptophan and 5-HTP dietary supplements help raise serotonin levels in the brain, which may have a positive effect on sleep, mood, anxiety, aggression, appetite, temperature, sexual behavior, and pain sensation. It is important to note, however, that an outbreak of eosinophilic myalgia syndrome (EMS; a potentially fatal disorder that affects the skin, blood, muscles, and organs) caused by a contaminated batch of tryptophan led to the removal of all tryptophan supplements from the United States market in 1989. Although the manufacturing of 5-HTP is different from that of tryptophan, there is still concern that some 5-HTP supplements may contain similar contaminants. It is important to obtain dietary supplements from manufacturers that adhere to high quality standards. At least two organizations, NSF International and the United States Pharmacopeia (USP), offer programs that make sure manufacturers follow high quality practices. As a result, these manufacturers often indicate this information on their product labels.

Uses

5-HTP may be helpful in treating a wide variety of conditions related to low serotonin levels, including the following: Depression Low levels of serotonin in the brain can contribute to the development of depression. Many drugs prescribed for depression increase serotonin levels. Some studies indicate that 5-HTP may be as effective as certain antidepressant drugs in treating individuals with mild to moderate depression. Such individuals have shown improvements in mood, anxiety, insomnia, and physical symptoms. Fibromyalgia Although many factors can influence the stiffness, pain, and fatigue associated with fibromyalgia, evidence from several studies indicates that low serotonin levels may play a role in the development of this condition. 5-HTP has been shown to improve sleep quality and reduce pain, stiffness, anxiety, and depression in individuals with fibromyalgia. Insomnia Medical research indicates that supplementation with tryptophan before bedtime can induce sleepiness and delay wake times. Studies also suggest that 5-HTP may be useful in treating insomnia associated with depression. Headaches Some studies suggest that 5-HTP may be effective in children and adults with various types of headaches including migraines. Obesity There is some evidence that low tryptophan levels may contribute to excess fat and carbohydrate intake (which can result in weight gain). A study of overweight individuals with diabetes suggests that supplementation with 5-HTP may decrease fat and carbohydrate intake by promoting a feeling of satiety (fullness). Additional similar studies of obese men and women without diabetes found that supplementation with 5-HTP resulted in decreased food intake and weight loss.

Dietary Sources

5-HTP is not commonly available in food but the amino acid tryptophan, from which the body makes 5-HTP, can be found in turkey, chicken, milk, potatoes, pumpkin, sunflower seeds, turnip and collard greens, and seaweed.

Available Forms

5-HTP can be obtained in the diet (from the conversion of tryptophan) or in supplement form. 5-HTP supplements are made from extracts of the seeds of the African tree Griffonia simplicifolia. 5-HTP can also be found in a variety of multivitamin and herbal preparations.

How to Take It

Pediatric There are no known scientific reports on the pediatric use of 5-HTP. Therefore, it is not currently recommended for children. Adult 50 mg of 5-HTP taken one, two, or three times per day is generally recommended for most of the conditions discussed in the Uses section.

Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider. As mentioned previously, tryptophan use has been associated with the development of serious conditions such as liver and brain toxicity, and with eosinophilic myalgia syndrome (EMS), a potentially fatal disorder that affects the skin, blood, muscles, and organs. Such reports prompted the FDA to ban the sale of all tryptophan supplements in 1989. As with tryptophan, EMS has been reported in 10 people taking 5-HTP. 5-HTP may cause mild gastrointestinal disturbances including nausea, heartburn, flatulence, feelings of fullness, and rumbling sensations in some people. Pregnant or nursing women and individuals with high blood pressure or diabetes should consult a healthcare practitioner before taking 5-HTP. In addition, as described in the Interactions section below, 5-HTP should not be taken at the same time as antidepressants.

Possible Interactions

If you are currently being treated with any of the following medications, you should not use 5-HTP without first talking to your healthcare provider. Antidepressant Medications Individuals taking the antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs) (such as fluoxetine, paroxetine, sertraline, and citalopram) and monoamine oxidase inhibitors (MAOIs) (such as phenelzine, isocarboxazid, selegiline, and tranylcypromine) should not use 5-HTP as these medications enhance the action of these drugs and may increase the risk for developing a dangerous condition known as "serotonin syndrome." Serotonin syndrome is characterized by mental status changes, rigidity, hot flashes, rapidly fluctuating blood pressure and heart rate, and possibly coma. Similarly, other drugs for depression that interfere with the uptake of the neurotransmitter serotonin, namely trazodone and venlafexine, may also lead to serotonin syndrome when used along with 5-HTP. Carbidopa Taking 5-HTP with carbidopa, a medication used to treat Parkinson's disease, has been associated with side effects including scleroderma-like illnesses (a condition in which the skin becomes hard, thick, and inflamed). Sumatriptan Similar to antidepressants, sumatriptan, a medication used for migraine headaches that works by stimulating serotonin receptors in the brain, should also not be used in combination with 5-HTP because of the risk for serotonin syndrome. Tramadol Tramadol, used for pain control, may also increase serotonin levels too much if taken in combination with 5-HTP. Serotoninsyndrome has been reported in some people taking the two together. Zolpidem Use of zolpidem, a medication for insomnia, can cause hallucinations when used with SSRI antidepressants. Because 5-HTP may work similarly to SSRIs, the combination of 5-HTP with zolpidem could, theoretically, lead to hallucinations as well.

Zinc Increases Immune Response

ORIGINAL RESEARCH COMMUNICATION

Zinc supplementation decreases incidence of infections in the elderly: effect of zinc on generation of cytokines and oxidative stress^1,2,3

Ananda S Prasad¹, Frances WJ Beck¹, Bin Bao¹, James T Fitzgerald¹, Diane C Snell¹, Joel D Steinberg¹ and Lavoisier J Cardozo¹

¹ From the Wayne State University School of Medicine, Detroit, MI (ASP, FWJB, BB, DCS, JDS, and LJC), and the University of Michigan, Ann Arbor, MI (JTF)

Background: Zinc deficiency, cell-mediated immune dysfunction, susceptibility to infections, and increased oxidative stress have been observed in elderly subjects (ie, those >55 y old). Zinc is an effective antiinflammatory and antioxidant agent.

Objectives: The primary objective was to determine the effect of zinc on the incidence of total infections in healthy elderly subjects. The secondary objective was to determine the effect of zinc on cytokines and oxidative stress markers.

Design: A randomized, double-blind, placebo-controlled trial of zinc supplementation was conducted in elderly subjects. Fifty healthy subjects of both sexes aged 55–87 y and inclusive of all ethnic groups were recruited for this study from a senior center. The zinc-supplemented group received zinc gluconate (45 mg elemental Zn/d) orally for 12 mo. Incidence of infections during the supplementation period was documented. The generation of inflammatory cytokines, T helper 1 and T helper 2 cytokines, and oxidative stress markers and the plasma concentrations of zinc were measured at baseline and after supplementation.

Results: Compared with a group of younger adults, at baseline the older subjects had significantly lower plasma zinc, higher ex vivo generation of inflammatory cytokines and interleukin 10, and higher plasma oxidative stress markers and endothelial cell adhesion molecules. The incidence of infections and ex vivo generation of tumor necrosis factor and plasma oxidative stress markers were significantly lower in the zinc-supplemented than in the placebo group. Plasma zinc and phytohemagglutin-induced interleukin 2 mRNA in isolated mononuclear cells were significantly higher in the zinc-supplemented than in the placebo group.

Conclusions: After zinc supplementation, the incidence of infections was significantly lower, plasma zinc was significantly higher, and generation of tumor necrosis factor and oxidative stress markers was significantly lower in the zinc-supplemented than in the placebo group.

Key Words: Elderly subjects • infections • interleukin 2 mRNA • zinc • oxidative stress • tumor necrosis factor • interleukin 1ß

The Cost of Untreated Insomnia

Untreated Insomnia Has Exhausting Effect on Health Resources

Caroline Cassels

Medscape Medical News 2007. © 2007 Medscape

March 8, 2007 — The costs of untreated insomnia far outweigh the costs of not treating this common disorder, which affects 10% of the US population, a new study suggests.

Investigators from Cornell University found even the most expensive medications cost less than $200 per year for the typical insomnia patient vs $924 to $1143 more in medical expenses in the 6 months before treatment initiation.

"Our study suggests that it costs far less to treat insomnia than to ignore it. Untreated insomnia affects individuals' health, quality of life,and job performance — and increases their use of healthcare services substantially," said the study's lead author, Ronald Ozminkowski, PhD, from the Institute for Health and Productivity Studies, Cornell University, Washington, DC, in a statement from the American Academy of Sleep Medicine.

The study is published in the March issue of Sleep.

Using data from self-insured, employer-sponsored health insurance plans in the United States, investigators examined health and employment data from 214,378 patients with insomnia and looked at their health costs in the 6 months before diagnosis.

Unconventional Approach

According to the authors, the typical approach used to assess the burden of insomnia has been has been to focus on the current cost of treatment. However, they note, looking at costs of untreated insomnia may be more informative.

"Unlike many other medical conditions, insomnia is not an expensive condition to treat. . . . We therefore assumed that a more complete understanding of its burden of illness can be gained by estimating cost differences between similar insomnia and noninsomnia patients, shortly before diagnosis or treatment begins," they write.

Direct costs were investigated using information from medical claims for inpatient, outpatient, pharmacy, and emergency room expenses from July 1, 1999 to June 30, 2003. Expenditures for these services were all adjusted for inflation to reflect 2003 metrics.

Expenditures for 138,820 patients aged 18 to 64 years and 75,558 elderly insomnia patients older than 64 years were compared with 2 equal-sized, matched control groups who did not have insomnia.

To estimate indirect costs, absenteeism records and short-term disability program records were examined for matched workers who did and did not develop insomnia.

Insomnia Burden Underestimated?

The investigators found that combined direct and indirect medical expenses for younger patients were $1253 higher for those eventually diagnosed with insomnia compared with controls without insomnia. Similarly, combined costs for elderly patients diagnosed with insomnia were $1,143 higher that those of their counterparts without insomnia.

With approximately 25 million to 30 million Americans suffering from chronic insomnia, the authors point out that their findings have major implications for employers, health plans, government insurance programs, and individuals.

In addition, they note, the study did not take into account the impact of insomnia on psychosocial functioning, accident rates, or productivity at work and therefore the calculations in this study may be an underestimation of the insomnia burden in the United States.

Furthermore, it is known that many insomnia patients do not seek medical treatment and therefore it is likely that a proportion of the control groups had undiagnosed or untreated insomnia, which may also lead to a conservative estimate of cost burden.

Sleep. 2007;30:263-273.

I find this study interesting but the practical applications are still a ways off. Cluster headaches can be a huge problem. Very difficult to control.




Brain stimulation may ease headaches



Stimulating the brain with implanted electrodes appears to help ease the pain of cluster headaches, two separate teams of researchers reported on Wednesday.

In one study, six out of eight patients said they got relief from cluster headaches, blindingly painful headaches that come back again and again.

Two out of eight patients in a second study said they were headache-free for more than a year using the device, and three more reported a 90-percent drop in the frequency of attacks.

Writing in the Lancet medical journal and its sister publication Lancet Neurology, the researchers said it was important to target the correct area -- the occipital nerve.

"Occipital nerve stimulation in cluster headache seems to offer a safe, effective treatment option that could begin a new era of neurostimulation therapy for primary headache symptoms," Peter Goadsby of University College London in Britain and the University of California, San Francisco, said in a statement.

Cluster headaches are marked by periods with many attacks of extremely severe headaches. Patients often must take preventive medication every day for years. But in some cases, drugs do no good.

Researchers have tried using brain stimulation before but it targeted a region called the posterior hypothalamus. Patients risk developing a fatal hemorrhage.

Techniques that stimulate the occipital nerve have been tested on other types of headaches.

Goadsby and colleagues tested the technique on eight patients with chronic cluster headaches that defied medications. After more than a year and a half, six of the eight said they would recommend the treatment to others.

Symptoms returned almost immediately when the device's battery wore down and it stopped working, the researchers said.

In the second report, Jean Schoenen and colleagues from the Headache Research Unit of Belgium's Liege University tested eight patients separately.

Two patients had no pain after 16 months and 22 months, respectively, and three more said they had 90 percent fewer headaches.

Only one patient switched off his stimulator after four months because he said it did not work.

In a commentary, Anna Ambrosini of the Headache Clinic at Neuromed in Pozzilli, Italy, said stimulating the hypothalamus got better results, but the new approach was worth testing in a larger group of patients.