Lactobacillus GG for
prevention of childhood eczema
One hundred fifty-nine pregnant women who had at least one first-degree
relative (or partner) with atopic eczema, allergic rhinitis, or asthma
were randomly assigned
to receive, in double-blind fashion, Lactobacillus GG (1010 colony-forming units
per day) or placebo for 2-4 weeks before expected delivery. After delivery, breastfeeding
mothers continued their respective treatment, whereas non-breastfeeding infants
were given the active treatment or placebo orally for 6 months. At 2 years of
age, the prevalence of atopic eczema in the Lactobacillus GG group was 23.5%,
compared with 45.6% in the placebo group (48.4% reduction; p = 0.008).
Comment: These results suggest that supplementation
with the probiotic agent Lactobacillus GG can prevent the development of atopic
eczema in high-risk children.
Lactobacillus GG may work by enhancing immune function, by improving the integrity
of the developing gut, or by some other mechanism. Supplementing with this organism
does not appear to cause adverse effects either in pregnant women or young children.
Kalliomaki M, et al. Probiotics in primary prevention of atopic disease: a randomised
placebo-controlled trial. Lancet 2001;357:1076-1079.
High-dose folic acid for psoriasis
Seven patients with long-standing psoriasis were given 20 mg of folic acid
4 times per day. Marked improvements were noted after 3-6 months of treatment.
Three additional patients who had previously received methotrexate treatment
for psoriasis were also given folic acid. In one patient, new lesions appeared
all over the trunk in places where they had never existed. One patient showed
decided worsening and the third patient improved considerably.
Comment: The rationale for using high-dose folic acid is based on the fact
that allopurinol, a xanthine oxidase inhibitor, is effective against psoriasis.
The author of the present study has found that folic acid fortified with specific
amounts of ascorbic acid (to keep it in the reduced state as tetrahydrofolate)
is also an effective xanthine oxidase inhibitor. Although no controlled trials
have been done with folic acid, other clinicians have observed the same beneficial
effect against psoriasis that Oster reported more than a quarter-century ago.
Methotrexate interferes with folic acid metabolism and, for reasons that are
not clear, appears to cause an adverse reaction to high-dose folic acid in
some cases. However, for patients who have not previously been treated with
methotrexate, folic acid appears to be a safe and promising therapy for chronic
psoriasis. Of course, when using high-dose folic acid, it is important to remember
that it can mask the laboratory diagnosis of pernicious anemia.
Oster KA. A cardiologist considers psoriasis. Cutis 1977;20:39-41.
Eating fish for a better pregnancy outcome
The relationship between seafood consumption and risk of pre-term delivery
and low birth weight was assessed in a prospective cohort study of 8,729
Danish pregnant women. The incidence of pre-term delivery was 7.1% among
women who never consumed fish, compared with 1.9% among women in the highest
category of fish intake (i.e., the highest quintile among women who consumed
any fish). The adjusted odds ratio for pre-term delivery was 3.6 in the zero-consumption
group, compared with the highest-consumption group. Most of the risk reduction
was seen between zero intake and a daily intake of 15 g of fish, corresponding
to 150 mg of omega-3 fatty acids. Estimates of risk for low birth weight
were similar to those for pre-term delivery.
Comment: These results suggest that consuming as little as 15 g (one-half ounce)
of fish per day or 150 mg/day of omega-3 fatty acids (provided by 500 mg/day
of fish oil) during pregnancy might reduce the incidence of pre-term delivery
and low-birth-weight babies. In addition to this potential benefit, eating
fish supplies the growing fetus with substantial amounts of docosahexaenoic
acid (DHA), which plays a critical role in development of the brain and retina.
Concern has been raised that eating too much fish, particularly tuna, may expose
the fetus and nursing infant to excessive amounts of mercury. Therefore, it
is important for pregnant and lactating women not to overdo their fish intake.
Some have suggested that alternative sources of omega-3 fatty acids, such as
flaxseed oil, would produce the same benefits as fish oil, without the potential
risks. Flaxseed oil contains large quantities of alpha-linolenic acid, which
is metabolized in the body into eicosapentaenoic acid (EPA), and then to DHA.
However, the capacity of infants (particularly premature ones) to convert alpha-linolenic
acid to DHA may be limited. Studies have shown that eating flaxseed oil does
not increase the concentration of DHA in breast milk, whereas consuming DHA
does increase breast-milk levels of DHA. Consuming flaxseed oil does increase
breast-milk concentrations of EPA, which might then be converted by the infant
into DHA. However, until more is known, consuming at least small amounts of
pre-formed DHA seems like a good idea for pregnant and lactating women.
Olsen SF, et al. Low consumption of seafood in early pregnancy as a risk factor
for preterm delivery: prospective cohort study. BMJ 2002;324:447-450.
Genistein reverses bone loss
Ninety healthy postmenopausal women (aged 47-57 years) with osteopenia (bone
mineral density [BMD] of the femoral neck of less than 0.795 g/cm2), were
randomly assigned to receive, in double-blind fashion, either 1) continuous
hormone-replacement therapy (HRT; 1 mg of 17beta-estradiol combined with
0.5 mg of norethisterone acetate daily), 2) genistein (54 mg/day), or 3)
placebo for 1 year. Genistein significantly reduced the excretion of pyridinium
cross-links (an indicator of bone resorption) at 6 and 12 months; a similar
decrease was seen in the HRT group. Genistein also significantly increased
serum levels of bone-specific alkaline phosphatase and osteocalcin (markers
of bone formation) at 6 and 12 months, whereas HRT significantly decreased
these values at 6 and 12 months. At 12 months, compared with baseline, the
mean BMD of the femoral neck increased by 3.6% in the genistein group and
by 2.4% in the HRT group, compared with a 0.65% decrease in the placebo group
(p < 0.01 for each active treatment vs. placebo). At the lumbar spine
the mean changes in BMD were 3.0% for genistein, 3.8% for HRT, and -1.6%
for placebo (p < 0.001).
Comment: These results indicate that administration of genistein (an isoflavone
present in soybeans) to osteopenic postmenopausal women reduced bone resorption,
increased bone formation, and increased BMD of the femoral neck and lumbar
spine. The effect on BMD was similar to that of conventional hormone-replacement
therapy. The results of this study are consistent with those of previous research,
in which genistein stimulated osteoblastic bone formation, inhibited osteoclastic
bone resorption, and prevented bone loss in ovariectomized rats. Beneficial
effects of isoflavone-rich soy protein on BMD have also been reported in both
animals and postmenopausal women. The effect of genistein may be mediated,
in part, by its estrogenic activity. However, the response to genistein in
the present study differed from that of conventional HRT. Specifically, both
treatments reduced markers of bone resorption, but only genistein increased
markers of bone formation. Because their actions are not the same, it is possible
that genistein (or soy protein) might enhance the effect of HRT; it is also
possible that soy isoflavones might increase the risks associated with HRT.
Additional research is needed to investigate these possibilities.
Morabito N, et al. Effects of genistein and hormone-replacement therapy on
bone loss in early postmenopausal women: a randomized double-blind placebo-controlled
study. J Bone Miner Res 2002;17:1904-1912.
Nutritional supplement effective against bipolar disorder
Fourteen patients (aged 19-46 years) with a DSM-IV diagnosis of bipolar disorder,
who were taking a mean of 2.7 psychotropic medications each, were treated
for 6 months with a broad-based nutritional supplement (E.M. Power+), containing
the following (daily doses): vitamin A (3,333 IU), vitamin C (250 mg), vitamin
D (400 IU), vitamin E (100 IU), thiamine (5 mg), riboflavin (5.5 mg), niacinamide
(25 mg), pyridoxine (7 mg), folic acid (400 mcg), vitamin B12 (250 mcg),
biotin (25 mcg), pantothenic acid (6 mg), calcium (550 mg), magnesium (250
mg), iron (6 mg), phosphorus (350 mg), iodine (75 mcg), zinc (20 mg), selenium
(100 mcg), copper (3 mg), manganese (4 mg), chromium (250 mcg), molybdenum
(66 mcg), potassium (100 mg), and a proprietary blend (doses not specified)
of DL-phenylalanine, L-glutamine, citrus bioflavonoids, grape seeds, choline,
inositol, Ginkgo biloba, L-methionine, germanium, boron, vanadium, and nickel.
At baseline and periodically thereafter, patients were assessed with the
Hamilton Rating Scale for Depression (HAM-D), the Brief Psychiatric Rating
Scale (BPRS), and the Young Mania Rating Scale (YMRS). For the 11 patients
who completed the trial, the mean HAM-D decreased (improved) from 19.0 at
baseline to 5.4 at the last visit (71% improvement; p < 01); the mean
BPRS score decreased (improved) by 79%; p < 0.05); the mean YMRS score
decreased (improved) by 60% (p < 0.01); and the need for psychotropic
medications decreased by 63% (p < 0.01). In two cases, the supplement
replaced psychotropic medication and the patients remained well. The only
reported side effect was nausea, which was infrequent, minor, and transient.
In general, improvement began within two weeks of starting the nutritional
Comment: This open-label study suggests that a broad-spectrum nutritional
supplement can reduce the severity of illness in some patients
with bipolar disorder.
Although there was no control group in this study, the magnitude of the improvement
was greater than one might expect from a placebo effect alone. Other investigators
have also found this supplement to be effective for bipolar disorder (J Clin
Psychiatry 2001;62:933-935). This product should be used cautiously, as it
may potentiate the effect of antipsychotic drugs, possibly increasing their
toxicity. Additional research is needed to determine the optimal way to transition
patients from psychotropic drugs to nutritional therapy. E.M. Power+ was
originally manufactured by Evince International; it is currently
manufactured by Synergy
Group of Canada (1-888-878-3467). The monthly retail cost is $68.00.
Kaplan BJ, et al. Effective mood stabilization with a chelated mineral supplement:
an open-label trial in bipolar disorder. J Clin Psychiatry 2001;62:936-944.
Breast-feeding reduces risk of obesity
A population-based sample of 32,200 Scottish children was studied at age 39-42
months. The prevalence of obesity (defined as body mass index [BMI] at or
above the 95th percentile) was 9.1% in those who had been formula-fed and
7.2% in those who had been breast-fed. The prevalence of obesity was 20.8%
lower in children who had been breast-fed than in those who had been formula-fed.
After adjustment for birthweight, gender, and socioeconomic status, the risk
of obesity was significantly lower by 28% in breast-fed children than in
Comment: These results suggest that breast-feeding reduces the risk of becoming
obese later in childhood. Although the mechanism by which breast-feeding might
prevent obesity is not known, there are several possible explanations. First,
the higher content of docosahexaenoic acid (DHA) in human milk than in infant
formulas may promote better development of the brain, including the area in
the hypothalamus that controls appetite. Second, as many formulas contain refined
sugars, feeding such formulas might promote the development of reactive hypoglycemia,
resulting in cravings for refined carbohydrates. Third, infants who experience
the comfort of the breast might be less likely to seek substitute forms of
comfort, such as overeating. Whatever the mechanism, this study provides one
more reason for mothers to breast-feed their babies.
Armstrong J, et al. Breastfeeding and lowering the risk of childhood obesity.
Vegetarian source of vitamin B12
Feeding nori (dried purple laver, a commonly consumed seaweed) to vitamin B12-deficient
rats significantly improved vitamin B12 status, as demonstrated by the elimination
of methylmalonic acid from the urine and by a significant increase in hepatic
vitamin B12 concentrations (especially adenosylcobalamin). The amount of
total vitamin B12 in nori, determined by 1) Lactobacillus bioassay and 2)
chemiluminescent assay with hog intrinsic factor, was estimated to be 55
and 59 mcg/100 g dry weight, respectively. Five different biologically active
vitamin B12 compounds were identified in nori (cyanocobalamin, hydroxocobalamin,
sulfitocobalamin, adenosylcobalamin and methylcobalamin).
Comment: Vegetarians are at risk of developing vitamin B12 deficiency, as this
vitamin is present almost exclusively in animal products. Several different
seaweeds have been claimed to contain vitamin B12. The research in this area
is conflicting, however, and many of the studies purporting to show vitamin
B12 activity did not distinguish between true vitamin B12 and biologically
inactive vitamin B12 analogues. The present study provides strong evidence
that nori does, indeed, contain bioavailable forms of vitamin B12.
Takenaka S, et al. Feeding dried purple laver (nori) to vitamin B12-deficient
rats significantly improves vitamin B12 status. Br J Nutr 2001;852:699-703.
Hawthorn (crataegus) effective against heart failure: double-blind
Two-hundred nine patients (mean age, 68 years) with chronic congestive
heart failure (New York Heart Association [NYHA] class III) were randomly
to receive, in double-blind fashion, crataegus extract WS 1442 standardized
to contain 18.75% oligomeric procyanidins (900 or 1,800 mg/day) or placebo
for 16 weeks. After 16 weeks of treatment, the maximal tolerated workload during
a bicycle exercise test had increased to a significantly greater extent in
the high-dose crataegus group than in the low-dose crataegus group (p = 0.01)
and the placebo group (p < 0.02). Symptoms of heart failure decreased to
a significantly greater degree in the high-dose (p = 0.004) and low-dose (p
= 0.04) crataegus groups than in the placebo group; the high dose was slightly
but not significantly more effective than the low dose. No serious adverse
events were reported, and the number of adverse events was nearly twice as
high in the placebo group as in the crataegus group.
Comment: This study demonstrated that crataegus extract WS 1442 increased exercise
capacity and reduced signs and symptoms of heart failure, without causing significant
adverse effects, in patients with NYHA class III congestive heart failure.
Hawthorn has been used for many decades by a minority of doctors to treat heart
failure. Recently, several controlled clinical trials have been published that
have confirmed its safety and effectiveness. Despite this evidence, conventional
cardiologists have shown little interest in using this herbal treatment. Now
that the American Heart Journal, a conventional cardiology journal, has published
a positive study on hawthorn, perhaps more doctors will prescribe this herb
for patients with heart failure.
Tauchert M. Efficacy and safety of crataegus extract WS 1442 in comparison
with placebo in patients with chronic stable New York Heart Association class-III
heart failure. Am Heart J 2002;143:910-915.
Literature Review & Commentary
by Alan R. Gaby, MD
301 Dorwood Drive • Carlisle, Pennsylvania 17013