Iodine treatment of fibrocystic
One hundred-eight women with fibrocystic breast disease were treated
with a preparation containing molecular (diatomic elemental) iodine at
a dose of 0.08 mg per kg of body weight per day orally for nine months.
Ninety-eight percent of the women were pain-free by the end of the study
and objective improvement was seen in 71.8% of cases. Sixty-five percent
of the women had a reduction in breast size coincident with clinical
improvement. In a larger series of women (n = 1,365) treated with molecular
iodine, side effects (usually minor) occurred in 10.9% of cases; these
included acne, nausea, diarrhea, hair thinning, hyperthyroidism (0.1%
incidence), hypothyroidism (0.3% incidence), skin rash, headache, or
transient increase in breast pain (5.7% incidence).
Two other groups of women were treated with Lugo's solution (a
preparation containing 95% sodium iodide and 5% free iodine) and iodized
casein, respectively. The response rate with Lugo's solution was
70%, and with iodized casein was 40%. Molecular iodine was associated
with a lower incidence of thyroid dysfunction than the other preparations.
Comment: Fibrocystic breast disease
is one of the most common health problems in women. Although the symptoms
are frequently minor, some women
experience debilitating pain and discomfort. Treatments that are often
effective include complete avoidance of dietary caffeine and other methylxanthines
and supplementation with 400 to 800 IU per day of vitamin E. There are
anecdotal reports that thiamine supplementation (100 mg per day) is also
For women who do not respond to these treatments, oral iodine preparations
are an important option. The molecular iodine used in the current study
is not commercially available, but a compounding pharmacist should be
able to make a similar preparation. Lugo's solution is readily
available, but it has a lower success rate and causes a higher incidence
thyroid dysfunction than does molecular iodine. Thyroid function should
be monitored periodically in people taking pharmacological doses of iodine
or iodides. Side effects may include metallic taste, excessive salivation,
runny nose, and skin rash.
Ghent WR, et al. Iodine replacement in fibrocystic disease of the breast.
Can J Surg 1993;36:453–460.
Indole-3-carbinol for cervical intraepithelial neoplasia
Twenty-seven women with biopsy-proven cervical intraepithelial neoplasia
(CIN) classes II or III were randomly assigned to receive, in double-blind
fashion, indole-3-carbinol (I-3-C; 200 or 400 mg/day) or placebo
orally for 12 weeks. None of the 10 patients in the placebo group
had a complete regression of CIN. In contrast, 4 of 8 patients receiving
200 mg/day of I-3-C and 4 of 9 receiving 400 mg/day had a complete
regression of CIN after 12 weeks of treatment. In all, 47% of the
women receiving I-3-C reverted to normal cervical cytology.
Comment: I-3-C is a compound found
in cruciferous vegetables (e.g., broccoli, cabbage, cauliflower, and
Brussels sprouts). It has been
shown to have anti-cancer activity in animals, possibly by inducing
hepatic P450 enzymes that are involved in the detoxification of carcinogens.
I-3-C also promotes the metabolism of endogenous estrogens to non-carcinogenic
metabolites and may, therefore, be capable of preventing the development
of estrogen-dependent cancers. The lower dose of I-3-C used in the
present study (200 mg/day) can be obtained by eating about 200 g (7
ounces) of raw cabbage or Brussels sprouts per day.
It has been claimed that diindolylmethane (DIM), a compound that is
formed in the stomach from the metabolism of I-3-C, is preferable to
I-3-C itself as a therapeutic agent. Most of these claims have come
from individuals who appear to have a financial interest in the sale
of DIM, and the scientific validity of their statements is difficult
to evaluate. Until clinical studies demonstrate the effectiveness of
DIM, I will continue to prefer I-3-C for the prevention and treatment
of CIN and cervical dysplasia.
Bell MC, et al. Placebo-controlled trial of indole-3-carbinol in the
treatment of CIN. Gynecol Oncol 2000;78:123–129.
Female infertility: consider thyroid hormone
Forty-two women with idiopathic infertility
of 1 to 12 years' duration
were treated empirically with desiccated thyroid. The initial dose
was 1 grain per day; for patients who did not respond, the dose was
gradually increased, as tolerated. Twenty-eight similar patients received
a placebo. Ten women (23.8%) became pregnant after 1 to 12 months of
thyroid therapy, compared with 10.7% of those receiving placebo. Although
this difference was not statistically significant, the response rate
was more than double in the active-treatment group than in the placebo
Comment: Hypothyroidism is a known
reversible cause of infertility. Most doctors rely on laboratory tests
to diagnose hypothyroidism, but
there is a considerable amount of anecdotal evidence that standard
thyroid-function tests fail to detect a large proportion of cases of
clinical hypothyroidism (Gaby AR. "Sub-laboratory" hypothyroidism
and the empirical use of Armour thyroid. Altern Med Rev 2004;9:157–179.).
I have seen many women with signs and symptoms suggestive of hypothyroidism
(e.g., fatigue, depression, cold extremities, dry skin, constipation,
thinning hair, menstrual irregularities, delayed Achilles tendon reflexes)
who were treated with thyroid hormone empirically despite having normal
laboratory tests. It was not uncommon to see pregnancies rapidly ensue
in women who previously had been unable to conceive. Thyroid hormone
should not be used indiscriminately, but a therapeutic trial for infertile
women with clinical evidence of hypothyroidism is not unreasonable.
Thyroid treatment should not be discontinued during pregnancy, as doing
so may increase the risk of a miscarriage. If anything, thyroid hormone
requirements increase during pregnancy. On the other hand, the use
of excessive doses of thyroid hormone during pregnancy may also increase
the risk of miscarriage (JAMA 2004;292:691–5), so clinical status
should be monitored carefully.
Buxton CL, Herrmann WL. Effect of thyroid therapy on menstrual disorders
and sterility. JAMA 1954;155:1035–1039.
A score bait
Forty-two healthy young adults (mean age, 24.4 years) with a current
sexual partner were randomly assigned to receive, in double-blind
fashion, 3,000 mg/day of vitamin C or placebo for 2 weeks. Among
women, the frequency of sexual intercourse during the study was significantly
greater in the vitamin C group than in the placebo group (mean, 10.3
vs. 3.7 episodes per month; 178% increase; p = 0.03). Vitamin C had
no significant effect in men (mean episodes per month: vitamin C,
5.9; placebo, 6.3). The increase in intercourse frequency occurred
only among non-cohabitants, whereas in cohabitants, vitamin C supplementation
was associated with a nonsignificant decrease in frequency. The vitamin
C group also experienced a decrease (improvement) in Beck Depression
scores, whereas no change was seen in the placebo group.
Comment: Supplementation with vitamin
C led to an increase in the frequency of sexual intercourse among women
not living with their sexual partner.
The specificity of the effect to that subset of the study population
suggests that vitamin C acts on the brain in a way that reduces inhibitions.
Previous studies have shown that administration of vitamin C decreases
reactions to stress and improves approach anxiety, effects which may
influence sexual behavior and mood.
Brody S. High-dose ascorbic acid increases intercourse frequency and
improves mood: a randomized controlled clinical trial. Biol
Nuts for your gallbladder
The association between nut intake (peanuts,
other nuts, and peanut butter) and cholecystectomy was examined prospectively
women participating in the Nurses' Health Study who were 30–55
years old in 1980 and had no history of gallstones. During a mean
follow-up period of 17.3 years, 7,831 cholecystectomies were performed.
After adjustment for age and other known or suspected risk factors,
women who consumed five or more ounces of nuts per week had a 25%
lower risk of cholecystectomy than women who never ate nuts or who
ate less than one ounce per month (p for trend < 0.0001). Further
adjustment for fat consumption (saturated fat, trans fat, polyunsaturated
fat, and monounsaturated fat) did not materially alter the findings.
In analyses examining consumption of peanuts and other nuts separately,
both were associated with a lower risk of cholecystectomy.
Comment: These results indicate that
frequent nut consumption is associated with a reduced risk of gallbladder
disease requiring cholecystectomy.
Other studies have shown that eating nuts can help control high blood
pressure, reduce serum cholesterol, and lower the risk of heart disease.
While nuts are high in fat, intervention studies have shown that incorporating
nuts into the diet has little or no effect on body weight. There is
now strong evidence that nuts should be considered as an important
component of a health-promoting diet.
Tsai CJ, et al. Frequent nut consumption and decreased risk of cholecystectomy
in women. Am J Clin Nutr 2004;80:76–81.
Calendula prevents radiation-induced dermatitis
Two hundred fifty-four patients receiving
postoperative radiation therapy for breast cancer were randomly assigned,
in single-blind fashion,
to apply topically either trolamine (triethanolamine salicylate;
considered by many to be the treatment of choice) or Calendula officinalis
(Pommade au Calendula par Digestion; Boiron Ltd, Levallois-Perret,
France) ointment on the irradiated fields after each session. Treatment
was begun after the first radiation session and was applied twice
a day or more, depending on the occurrence of dermatitis and pain.
The incidence of acute dermatitis of grade 2 or higher was significantly
lower (41% v 63%; p < 0.001) with calendula than with trolamine.
Compared with trolamine, calendula was associated with fewer interruptions
of radiotherapy because of skin toxicity (0 vs. 12 patients) and
significantly less radiation-induced pain (p = 0.03). Calendula was
more difficult to apply, but overall satisfaction with its use was
greater than with trolamine.
Comment: Acute dermatitis is a common
side effect of radiation therapy. Calendula is a common garden plant
in North America and Europe. Its
flowers have been used traditionally as a topical soothing agent, to
treat minor burns and eczema and to promote wound healing. The results
of the present study indicate that topical Calendula officinalis is
effective for the prevention of acute dermatitis in patients undergoing
postoperative irradiation for breast cancer.
Pommier P, et al. Phase III randomized trial of Calendula officinalis
compared with trolamine for the prevention of acute dermatitis during
irradiation for breast cancer. J Clin Oncol 2004;22:1447–1453.
Pesticides: less is more
Tadpoles of four species of frogs were exposed for 30 days at early
and late developmental stages to low concentrations of the pesticide
atrazine (3, 30, or 100 ppb; the U.S. Environmental Protection Agency
drinking water standard is 3 ppb). Survival was significantly lower
for all animals exposed to 3 ppb, compared with either 30 or 100
ppb, except for the late stages of two species.
Comment: Atrazine is the most widely used pesticide in the United States.
The results of the present study indicate that, within a certain dosage
range, lower concentrations of this chemical are more toxic than higher
concentrations. This pattern is characteristic of many endocrine-disrupting
Scientists often disregard studies that demonstrate a toxic effect
of a chemical at low doses, but no toxic effect at high doses. One
should not assume, however, the effects of toxic chemicals always increase
with increasing levels of exposure. Many chemicals function as catalysts
at low concentrations, but become inhibitors at higher concentrations.
Some compounds influence one biochemical pathway when present at a
low concentration and a different pathway when present at a higher
concentration. The results of the present study demonstrate the importance
of evaluating the effect of toxic substances at realistic concentrations
and at various developmental stages.
Storrs SI, et al. Survivorship patterns of larval amphibians exposed
to low concentrations of atrazine. Environ
Health Perspect 2004;112:1054–1057.
See also: Kon SH. Underestimation of chronic toxicities of food additives
and chemicals: the bias of a phantom rule. Med
Let your food be your medicine
Thirty-eight patients undergoing cardiac surgery who would be receiving
oral furosemide postoperatively were randomly assigned to consume
potassium-rich foods (diet) or potassium chloride (KCl) pills (medication).
The standard KCl dose was equivalent to half the furosemide dose
per day (for example, 60 mg/day of furosemide would require 30 mEq/day
of supplemental KCl). Patients in the diet group chose their potassium-rich
foods from a list that was provided. If a patient's serum potassium
level fell below 3.8 mEq/L, the potassium dose was increased to 75%
of the furosemide dose. The mean serum potassium concentration on
postoperative days 3 and 4 did not differ significantly between groups.
The mean length of hospital stay was significantly lower in the diet
group than in the medication group (5.0 vs. 6.3 days; p = 0.03).
The reason for that reduction was not apparent, and it did not appear
to be due to a decrease in the number of gastrointestinal side effects.
When asked their preference for method of supplementation, 79% of
patients preferred the diet method.
Comment: Potassium supplementation is often necessary for patients
treated with thiazide or loop diuretics. Prescription potassium preparations
contain highly concentrated potassium salts, which can cause gastrointestinal
side effects including gastric ulceration. High-potassium foods are
better tolerated than potassium medication (particularly when the patient
is given a range of food choices), and they also provide many other