Case
Report: D-Pinitol for Polycystic Ovary Syndrome
A 35-year-old woman had a nine-month history of amenorrhea, acne
on the face and chest, and intermittent abdominal pains in the area
of the ovaries. Her serum testosterone level was more than twice
the upper limit of normal. She was given a presumptive diagnosis
of polycystic ovary syndrome (PCOS) and was started on D-pinitol
(Vital Nutrients) at a dosage of 600 mg twice a day. The D-pinitol
product also provided daily 500 mcg of chromium and 1,200 IU of
vitamin D. Within two weeks, the acne and abdominal pains had resolved,
and menstruation returned shortly thereafter. After one month of
treatment, the supplement was discontinued and the acne and abdominal
pains returned rapidly. Resumption of treatment was again followed
by a rapid resolution of symptoms. Menstruation has remained normal
for several months, since shortly after D-pinitol treatment was
started.
Comment: D-Pinitol (3-O-methyl-D-chiro-inositol) is present
in foods such as legumes and citrus fruits. It is structurally similar
to and has biochemical actions similar to those of D-chiro-inositol,
a compound found in small concentrations in the body. D-chiro-inositol
is a component of an endogenous phosphoglycan that has been reported
to mediate the action of insulin. There is evidence that the insulin
resistance seen in women with PCOS is due in part to a deficiency
of this D-chiro-inositol-containing phosphoglycan or to a defect
in its tissue availability or utilization. In a double-blind trial,
supplementation with 1,200 mg per day of D-chiro-inositol for eight
weeks improved insulin resistance, decreased serum testosterone
levels, and restored ovulation in women with PCOS. D-chiro-inositol
is not commercially available, but the present case report and other
anecdotal evidence suggest that D-pinitol is also useful for treating
PCOS.
Nestler JE, Jakubowicz DJ, Reamer P, et al. Ovulatory and metabolic
effects of d-chiro-inositol in the polycystic ovary syndrome. N
Engl J Med. 1999;340:1314-1320.
Probiotic Treatment
for Bacterial Vaginosis
One hundred-ninety women with bacterial vaginosis (Nugent scores
between 7 and 10 on a scale of 0 to 10) received 300 mg of clindamycin
twice a day for 7 days and were then randomly assigned to receive
or not to receive (control group) vaginal capsules containing 109
colony-forming units of Lactobacillus casei rhamnosus (Lcr35) for
seven days. Vaginal swabs for Nugent scoring were taken four weeks
after the last probiotic dose. The proportion of women showing an
improvement in the Nugent score of at least 5 points was significantly
greater in the active-treatment group than in the placebo group
(83% vs. 35%; p < 0.001). The median degree of improvement from
baseline was 6.61 in the active-treatment group and 4.13 in the
control group (p < 0.001).
Comment: Bacterial vaginosis, the most
common form of vaginitis, is caused by an imbalance of the bacterial
flora in the vagina. The condition can usually be treated successfully
with antibiotics, but there is a high recurrence rate. Certain probiotic
organisms can help restore normal vaginal flora and thereby prevent
recurrences of bacterial vaginosis. In addition to the specific
Lactobacillus strain investigated in this study, the combination
of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14
(Fem-Dophilus; Jarrow Formulas) has been shown to enhance the effect
of antibiotics in eradicating bacterial vaginosis, and may also
help prevent recurrences of this condition. (FEMS Immunol
Med Microbiol. 2003;35:131-134; Microbes
Infect. 2006;8:1450-1454.)
Petricevic L, Witt A. The role of Lactobacillus casei rhamnosus
Lcr35 in restoring the normal vaginal flora after antibiotic treatment
of bacterial vaginosis. BJOG. 2008;115:1369-1374.
Healthful Pregnancy
Diet for Healthy Children . . .
The association between maternal dietary patterns and fetal growth
was investigated in a prospective cohort study of 44,612 women in
Denmark. Compared with women who consumed large amounts of red and
processed meat and high-fat dairy products, women who had a high
intake of vegetables, fruits, poultry, and fish had 26% lower risk
of having a small-for-gestational-age infant (birth weight below
the 2.5th percentile for gestational age), even though the mean
daily energy intake was 17% lower in the former than the latter.
The analysis was adjusted for parity, maternal smoking, age, height,
prepregnancy weight, and father's height.
Comment: The results of this study
suggest that what a mother eats during pregnancy influences its
outcome. Vegetables, fruits, poultry, and fish, which are considered
helpful for preventing chronic diseases such as heart disease, hypertension,
and cancer, now seem to be good for fetuses, too. In contrast, red
and processed meat and high-fat dairy products, which are believed
to promote the development of various chronic illnesses, may also
make babies enter the world too short and too skinny. Many women
avoid eating fish during pregnancy because of the fear that the
mercury in fish might harm their babies. However, observational
studies have shown that children of women who consume moderate amounts
of fish during pregnancy (2 to 3 helpings per week) have better
neurological development than children of women who avoid fish during
pregnancy.
Knudsen VK, et al. Major dietary patterns in pregnancy and fetal
growth. Eur J Clin Nutr. 2008;62:463-470.
Hepatitis from Red Yeast
Rice?
A 62-year-old woman developed hepatitis after taking 1,200 mg per
day of red yeast rice for four months. Clinical improvement was
seen after the product was discontinued. The woman was also taking
two prescription drugs, fluoxetine and montelukast sodium, both
of which have been reported to cause hepatitis. These drugs were
apparently not discontinued after hepatitis occurred.
Comment: Red yeast rice contains a
group of compounds called monacolins, which have similar actions
to those of statin drugs. In fact, some red yeast rice products
contain substantial quantities of lovastatin, a statin drug sold
under the brand name Mevacor. Hepatotoxicity is a known side effect
of statins, but has not been reported previously with red yeast
rice. While red yeast rice was not proven to be the cause of hepatitis,
it cannot be ruled out as the causative factor. If red yeast does
cause hepatitis, the incidence of this side effect is certainly
rare. Concomitant use of two potentially hepatotoxic drugs may have
increased this patient's susceptibility to liver damage. Based
on this report, it would be prudent for individuals taking red yeast
rice to discontinue it if they develop unexplained hepatitis or
unexplained elevations of liver enzymes.
Roselle H et al. Symptomatic hepatitis associated with the use of
herbal red yeast rice. Ann Intern Med.
2008;149:516-517.
Caffeine: A Cause of
Panic Attacks
Twenty-five patients with panic disorder, 27 healthy first-degree
relatives of these patients, and 22 healthy volunteers with no family
history of panic disorder (controls) were randomly assigned to receive,
in double-blind fashion, 480 mg of caffeine or placebo, and then
the alternate treatment seven days later. After the caffeine challenge,
52% of the patients, 41% of their relatives, and none of the controls
had a panic attack (p < 0.001 for patients vs. controls and for
relatives vs. controls). The attacks usually began 30 to 40 minutes
after caffeine ingestion. No panic attacks occurred after ingestion
of placebo.
Comment: The results of this study
indicate that ingestion of 480 mg of caffeine (equivalent to about
6 cups of coffee) can trigger a panic attack in people with a history
of panic disorder, but not in healthy people. The fact that caffeine
also triggered panic attacks in healthy relatives of patients with
panic disorder suggests that caffeine sensitivity is genetically
determined. Individual differences in susceptibility to caffeine-induced
anxiety and caffeine-induced insomnia have also been observed. As
part of a routine medical history, it might be useful to ask whether
a patient has first-degree relatives who suffer from panic disorder.
Patients who have such a family history might be more likely than
others to benefit from avoiding caffeine.
Nardi AE et al. A caffeine challenge test in panic disorder patients,
their healthy first-degree relatives, and healthy controls. Depress
Anxiety. 2008;25:847-853.
Vitamin D Deficiency
and Anticonvulsant Drugs
Of 38 children (mean age, 8 years) taking anticonvulsant drugs for
epilepsy, 76% had vitamin D deficiency (serum 25-hydroxyvitamin
D < 20 ng/ml) and an additional 21% had vitamin D insufficiency
(serum 25-hydroxyvitamin D, 20-30 ng/ml). Markers of bone formation
and resorption suggested that these patients had accelerated bone
turnover. The mean serum 25-hydroxyvitamin D level was significantly
lower in patients receiving more than one anticonvulsant than in
those receiving a single drug (p < 0.04).
Comment: A number of anticonvulsant
drugs induce liver enzymes that inactivate vitamin D. As a result,
patients taking these drugs are at risk of developing vitamin D
deficiency. Rickets, osteomalacia, and low bone mineral content
have been observed in some drug-treated epileptic patients. The
results of the present study indicate that vitamin D deficiency
is extremely common in this patient population. Serum 25-hydroxyvitamamin
D levels should be monitored in patients taking anticonvulsants,
and vitamin D supplementation in doses sufficient to correct deficiencies
should be recommended.
Nettekoven S et al. Effects of antiepileptic drug therapy on vitamin
D status and biochemical markers of bone turnover in children with
epilepsy. Eur J Pediatr. 2008;167:1369-1377.
Panax Ginseng for Alzheimer's
Disease
Fifty-eight patients (mean age, 66 years) with Alzheimer's
disease were randomly assigned to receive 4.5 g per day of Panax
ginseng (Asian ginseng) for 12 weeks or to serve as an untreated
control group. Outcome was determined by the Alzheimer Disease Assessment
Scale Cognitive Subscale (ADAS-cog) score. The mean ADAS-cog score
improved by 15% in the active-treatment group and by 2% in the control
group (p < 0.03 for the difference in the change between groups).
The improvement reverted to the baseline value after the treatment
was discontinued.
Comment: Ginseng has been reported
to attenuate learning deficits in the damaged or aging brains of
rodents and to increase the density of hippocampal synapses in mice.
If this herb also increases synapse density in humans, then it might
be capable of slowing or possibly even reversing the disease process
in patients with Alzheimer's disease. Longer-term trials are
needed to investigate that possibility. Panax ginseng is usually
well tolerated, although it may cause overstimulation, increase
blood pressure, or have estrogenic effects.
Lee ST et al. Panax ginseng enhances cognitive performance in Alzheimer
disease. Alzheimer Dis Assoc Disord.
2008;22:222-226.
Probiotics Prevent Serious Complication of
Prematurity
Four hundred thirty-four very-low-birth-weight infants (< 1500
g) who were being breast-fed or receiving mixed feedings (breast
milk and formula) were randomly assigned to receive 109 colony-forming
units each of Bifidobacterium bifidum and Lactobacillus acidophilus
added to their feedings twice a day for 6 weeks or to receive the
same feedings without the probiotics. The incidence of death or
necrotizing enterocolitis stage 2 or greater was significantly lower
in the active-treatment group than in the control group (1.8% vs.
9.2%; p = 0.002). The incidence of necrotizing enterocolitis stage
2 or greater was also significantly lower in the active-treatment
group than in the control group (1.8% vs. 6.5%; p = 0.02). No adverse
effects, such as sepsis, flatulence, or diarrhea, were seen.
Comment: Necrotizing
enterocolitis is a serious gastrointestinal disease seen mainly
in premature, very-low-birth-weight infants. It is characterized
by necrosis of part of the intestine, which can lead to life-threatening
complications. While the cause is unknown, it appears to be related
to intestinal ischemia and to the presence of abnormal intestinal
flora. The results of the present study indicate that the addition
of probiotics to the feedings of very-low-birth-weight infants can
reduce the incidence of necrotizing enterocolitis and decrease the
death rate in these infants.
Lin HC, et al. Oral probiotics prevent necrotizing enterocolitis
in very low birth weight preterm infants: a multicenter, randomized,
controlled trial. Pediatrics.
2008;122:693-700.
Alan R. Gaby, MD
drgaby@earthlink.net
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