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From the Townsend Letter,
the Examiner of Alternative Medicine
April 2006


Literature Review and Comment
by Alan R. Gaby, MD

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Broccoli sprouts eradicate Helicobacter pylori
Nine patients with gastritis and Helicobacter pylori infection were randomly assigned to receive 7g, 14g, or 28g of broccoli sprouts on an empty stomach twice a day for seven days. Stool antigen testing for H. pylori was done at the end of the treatment period (day 8) and at day 35. Urea breath testing (another test for the presence of H. pylori) was performed on patients who had a negative stool antigen test at day 35. Seven of nine patients (78%) were stool-antigen-negative at the end of the treatment period, and six remained negative at day 35. H. pylori eradication was confirmed by the urea breath test in one patient from each of the three dosage groups. Of the four patients who had symptoms at baseline, two improved, one had no change, and one reported worsening. Six patients rated the taste of broccoli sprouts from acceptable to very good; one patient stated they were "not good."

Comment: H. pylori infection of the stomach is associated with peptic ulcer and gastritis and appears to increase the risk of developing gastric cancer. Conventional treatment to eradicate H. pylori usually consists of two antibiotics and a proton-pump inhibitor. While this "triple therapy" is usually successful, it can cause significant side effects and may also promote the development of resistant strains of the organism. A number of natural alternatives to triple therapy have been tried, but none have a high success rate (see Gaby AR. Altern Med Rev. 2001;6:355-366).

Broccoli sprouts contain sulforaphane, an isothiocyanate that has been found to inhibit H. pylori in vitro. Broccoli sprouts contain 20-50 times more sulforaphane and related compounds than does mature broccoli. The results of the present study suggest that eating broccoli sprouts for one week can successfully eradicate H. pylori in at least one-third of cases.

Galan MV, et al. Oral broccoli sprouts for the treatment of Helicobacter pylori infection: a preliminary report.
Dig Dis Sci. 2004;49:1088-1090.

Making your children "egg-heads"
This review article points out that choline plays a key role in brain development. Choline contributes to the structure and function of cell membranes and serves as a precursor to the neurotransmitter acetylcholine. In experimental animals, the availability of choline during the prenatal period influences cognitive function throughout the life span. Thus, animals that receive abundant amounts of choline in utero, as compared with a normal amount of choline, have greater memory capacity in adulthood and a slower rate of cognitive decline with advancing age (Neurosci Biobehav Rev. 2003;27:385-399). Conversely, choline deficiency during early development leads to permanently impaired brain function and greater cognitive decline with age.

Comment: Foods rich in choline include eggs, soybeans, spinach, nuts, wheat germ, chicken, beef, salmon, and cod. Whole wheat contains more than twice as much choline as does refined flour. The recommended Adequate Intake for choline is 425 mg/day for adult females and 550 mg/day for lactating females (because human milk contains large amounts of choline). The mean daily choline intake of women has been estimated to be 258 mg or 443 mg, depending on the method of analysis. In a study of California women, dietary choline intake was found to vary enough to have a potential influence on pregnancy outcome. Pregnant women should make an effort to include some high-choline foods in their diet, and those who are unable to do so should consider taking a multivitamin that contains choline or lecithin (which contains choline).

Zeisel SH. Choline, homocysteine, and pregnancy.
Am J Clin Nutr. 2005;82:719-720.

Nutritional supplement improves heart failure
Thirty patients (mean age, 75.4 years) with heart failure (mean left ventricular ejection fraction [LVEF], 26.1%) were randomly assigned to receive, in double-blind fashion, a daily micronutrient supplement or placebo for nine months. The supplement provided the following daily: calcium (250 mg), magnesium (150 mg), zinc (15 mg), copper (1.2 mg), selenium (50 mcg), vitamin A (800 mcg), thiamine (200 mg), riboflavin (2 mg), vitamin B6 (200 mg), folic acid (5 mg), vitamin B12 (200 mcg), vitamin C (500 mg), vitamin E (400 mg), vitamin D (400 IU), and coenzyme Q10 (CoQ10; 150 mg). All patients were on stable optimal medical therapy for at least three months before the start of the study. The mean left ventricular end-diastolic volume decreased by 13.1% in the active-treatment group and increased by 5.7% in the placebo group (p = 0.03 for the difference in the change between groups). The mean LVEF increased in the active-treatment group from 25.6% to 30.9%, and decreased in the placebo group from 26.6% to 26.2% (p = 0.03 for the difference in the change between groups). The mean quality-of-life score increased (improved) by 14.8% (p < 0.05 compared with baseline) in the active-treatment group, and decreased (worsened) by 1.6% in the placebo group (p = 0.02 for the difference in the change between groups).

Comment: The results of this study demonstrate that long-term micronutrient supplementation can improve left ventricular volume, left ventricular ejection fraction, and quality of life in elderly patients with heart failure. The beneficial effect was probably not due to any one nutrient, but rather to a combination of nutrients. CoQ10 has been reported in several uncontrolled trials to improve LVEF and cardiac function in patients with heart failure. Two double-blind studies, however, failed to find a beneficial effect of CoQ10. It is likely that some of the patients in these negative CoQ10 trials were deficient in other nutrients that play a role in myocardial function, such as thiamine, magnesium, and selenium. Had the patients in those studies been given a comprehensive nutritional-support program in addition to CoQ10 or placebo, the results may have been very different. Further research is needed to determine the optimal combination and doses of nutrients for the prevention and treatment of heart failure.

Witte KKA, et al. The effect of micronutrient supplementation on quality-of-life and left ventricular function in elderly patients with chronic heart failure.
Eur Heart J. 2005;26:2238-2244.

Does calcium make teens taller?
One hundred forty-three boys (aged 16-18 years) were randomly assigned to receive, in double-blind fashion, 1,000 mg/day of calcium (from calcium carbonate) or placebo for 13 months. Compared with placebo, calcium supplementation significantly increased bone mineral content (BMC) of the whole body, lumbar spine, and hip. Compared with placebo, calcium supplementation also significantly increased mean height gain by 7 mm (p = 0.0004). The increase in BMC diminished after adjustment for size, suggesting that the effect of calcium on BMC was due to increased growth.

Comment: The results of this study indicate that calcium supplementation of teenage boys increases skeletal growth, resulting in greater height gain and bone mineral acquisition. This effect of calcium may be due simply to a change in the tempo of growth, or it may reflect an actual height gain that persists into adulthood. Additional studies are needed to determine whether calcium supplementation makes people taller.

Prentice A, et al. Calcium supplementation increases stature and bone mineral mass of 16- to 18-year-old boys.
J Clin Endocrinol Metab. 2005;90:3153-3161.

Progesterone cream as an alternative to progestins
Twenty-six postmenopausal women (mean age, 57.3 years) received 0.625 mg/day of conjugated equine estrogens and 2.5 mg of medroxyprogesterone acetate (Prempro; Wyeth) or 0.625 mg/day of conjugated equine estrogens and 20 mg twice a day of transdermal progesterone cream (Pro-gest; Transitions for Health). After six months, each woman was switched to the alternate treatment for an additional six months. Endometrial biopsies were performed at the end of each treatment period. Seventy-seven percent of the women preferred progesterone cream to medroxyprogesterone acetate (p < 0.001). Of the 52 post-treatment endometrial biopsies performed, 40 revealed atrophic endometrium, and 12 showed proliferative endometrium (seven in the medroxyprogesterone acetate group, and five in the progesterone cream group). There was no evidence of endometrial hyperplasia in any of the specimens. The incidence of vaginal spotting was similar in the two groups.

Comment: The results of this pilot study suggest that a low-dose of transdermal progesterone has a similar effect on the endometrium as does medroxyprogesterone acetate in postmenopausal women receiving conjugated equine estrogens. A larger study is needed to confirm that such a small dose of natural progesterone is sufficient to prevent endometrial hyperplasia in women received estrogen-replacement therapy. Nevertheless, the results are encouraging, considering that medroxyprogesterone acetate causes numerous side effects and low-dose natural progesterone is generally well tolerated. As an added benefit, some studies suggest that transdermal application of progesterone can reverse osteoporosis in postmenopausal women, although other studies have failed to confirm that finding.

Leonetti HB, et al. Transdermal progesterone cream as an alternative progestin in hormone therapy.
Altern Ther. 2005;11(6):36-38.

Does alcohol prevent heart disease? Maybe not
Alcohol prevents heart disease?Numerous observational studies have shown that moderate alcohol drinkers have a lower incidence of cardiovascular disease (CVD) than do non-drinkers. Although most of these studies controlled for major cardiac risk factors, CVD is independently associated with other factors that could explain the benefits attributed to moderate drinking.

Data from the 2003 Behavioral Risk Factor Surveillance System, a population-based telephone survey of US adults, was used to assess the prevalence of CVD risk factors and potential confounding factors among moderate drinkers and non-drinkers. Moderate drinking was defined as the consumption of two drinks or fewer per day for men and one drink or fewer per day for women. After adjusting for age and gender, non-drinkers were more likely to have characteristics associated with increased CVD mortality in terms of demographic factors, social factors, behavioral factors, access to health care, and health-related conditions. Of the 30 CVD-associated factors or groups of factors that were assessed, 27 (90%) were significantly more prevalent among non-drinkers. Removing those with poor health status or a history of CVD did not change the results.

Comment: While alcohol is a known cardiac poison when consumed in high doses, most researchers and practitioners believe that moderate drinking is beneficial for the heart. All of the evidence supporting that viewpoint has come from observational studies or from controlled trials that measured intermediate endpoints such as lipid levels or platelet function, and there have been no randomized controlled trials directly assessing the effect of alcohol on heart disease. Reliance on observational studies has in the past led the scientific community to incorrect conclusions; for example, estrogen-replacement therapy was believed to prevent heart disease until randomized controlled trials found that it probably does the opposite.

The results of the present study suggest that there are fundamental differences between non-drinkers and people who drink moderate amounts of alcohol. Some of these differences, rather than alcohol consumption per se, might explain the association between alcohol consumption and heart disease. I have observed that many non-drinkers stay away from alcohol because consuming even small amounts makes them feel ill. Perhaps their higher risk of heart disease is caused not by the fact that they avoid alcohol, but by the same constitutional weakness which renders them intolerant to alcohol. If that is the case, then alcohol avoidance would be a marker, not a cause, of increased CVD risk, and persuading non-drinkers to drink alcohol would make them sicker, not healthier.

To be sure, there are some potentially cardioprotective substances in certain alcoholic beverages, such as silicon and a glucose-tolerance factor in beer and polyphenols in red wine. However, these beneficial substances are also present in a wide range of healthful foods that do not contain alcohol.

Naimi TS, et al. Cardiovascular risk factors and confounders among non-drinking and moderate-drinking US adults.
Am J Prev Med. 2005;28:369-373.

Pyridoxal phosphate more effective than pyridoxine for childhood epilepsy
Ninety-four children (aged eight months to 15 years) with idiopathic intractable epilepsy received intravenous pyridoxal phosphate (PLP) at a dose of 10 mg/kg, followed by 10 mg/kg/day in four divided doses. If seizures recurred within 24 hours, another dose of 40 mg/kg was given, followed by 50 mg/kg/day in four divided doses. For patients whose seizures were totally controlled, PLP was replaced by the same dose of oral pyridoxine. If seizures recurred, intravenous PLP was infused, followed by oral PLP (50 mg/kg/day). Eleven patients had a dramatic and sustained response to PLP; of these, five also responded to pyridoxine. The remaining six responders responded only to PLP. The average final oral dose of PLP was 30 mg/kg/day (range, 7-38 mg/kg/day), which was significantly higher than the average pyridoxine dose (18 mg/kg/day) in the pyridoxine responders.

Comment: This study demonstrates that PLP can successfully control epilepsy in some children who fail to respond to pyridoxine. PLP appeared to be particularly useful for patients with infantile spasms. Because PLP could replace pyridoxine, but perhaps not vice versa, PLP should be considered for first-line treatment of patients with intractable childhood epilepsy, particularly those with infantile spasms.

It has long been known that PLP is the major biologically active form of vitamin B6, and that pyridoxine must be converted to PLP in order to exert an effect in the body. However, virtually all previous clinical research on vitamin B6 has used pyridoxine. Parenterally administered PLP was reported to be beneficial in a few studies in which pyridoxine was not effective, but there has been uncertainty about whether orally administered PLP can be absorbed. The results of this study strongly suggest that sufficient amounts of PLP can be absorbed to exert a biological effect. Because some people may have a defect in their capacity to convert pyridoxine to its biologically active form, oral PLP should be considered for patients with potentially vitamin B6-responsive conditions that fail to respond to pyridoxine. Other disorders that may improve with vitamin B6 supplementation include asthma, carpal tunnel syndrome, premenstrual syndrome, autism, pregnancy nausea, and gestational diabetes.

Wang HS, et al. Pyridoxal phosphate is better than pyridoxine for controlling idiopathic intractable epilepsy.
Arch Dis Child. 2005;90:512-515.

Evidence-based medicine takes a fall
To determine whether parachutes are effective in preventing major trauma related to gravitational challenge, a systematic review was performed of all studies examining the effects of using a parachute during free fall. Data sources included Medline, Web of Science, Embase, and the Cochrane Library databases. The main outcome measure was death or major trauma, defined as an injury severity score > 15. The authors were unable to identify any randomized controlled trials of parachute intervention. They concluded that the effectiveness of parachutes has not been subjected to rigorous evaluation by randomized controlled trials.

Comment: Advocates of evidence-based medicine have criticized the acceptance of interventions that have been evaluated only by observational studies. The use of parachutes during free fall is one such unproven intervention. The authors of this report suggest that everyone might benefit if the most radical proponents of evidence-based medicine organized and participated in a double blind, randomized, placebo-controlled, crossover trial of the parachute.

Smith GCS, Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials.
BMJ. 2003;327:1459-1461.


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