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Literature review & commentary.

B Vitamins Prevent Poststroke Depression

Five hundred sixty-three patients with a history of a stroke were randomly assigned to receive, in double-blind fashion, daify folic acid (2 mg), vitamin B6 (25 mg), and vitamin B12 (0.5 mg) or placebo for 1 to 10.5 years. Among the 273 people who completed the final assessment after a mean of 7.1 years (mean age at entry, 63 years), the incidence of major depression was significantly lower in the active-treatment group than in the placebo group (18.4% vs. 23.3%; p value not stated).


Comment: Depression frequently develops after a stroke, and affects about one-third of all stroke survivors. A deficiency of any of a number of different B vitamins can cause various mental symptoms, including depression. In a previous double-bfind trial, supplementation with large doses of folic acid (5 mg per day) and vitamin B12 (1500 meg per day) prevented hip fractures in patients who had had a stroke. That finding suggests that some stroke patients are deficient in folic acid and vitamin B12, or that some stroke patients have a higher-than-normal requirement for these vitamins. While the etiology of poststroke depression is multifactorial, the results of the present study indicate that B-vitamin deficiency or a higher-than-normal requirement for B vitamins is involved in a small proportion of cases.

Almeida OP et al. B-vitamins reduce the long-term risk of depression after stroke: The VITATOPS-DEP trial. Ann Neurol. 2010;68:503-510.

Preventing Depression in the Elderly with Omega-3 Fatty Acids

Forty-six depressed elderly women (aged 66-95 years) living in a nursing home were randomly assigned to receive, in double-blind fashion, 2.5 g per day of omega-3 fatty acids (1.67 g per day of eicosapentaenoic acid [EPA] and 0.83 g per day of docosahexaenoic acid [DHA]) or placebo for 8 weeks. The response rate (response was defined as at least a 33% reduction in the score on the Geriatric Depression Scale [GDS]) was significantly higher in the active-treatment group than in the placebo group (45.5% vs. 8.3%; p = 0.004). The remission rate (remission was defined as a GDS score < 11) was nonsignificantly greater in the active-treatment group than in the placebo group (40.9% vs. 16.7; p = 0.07). The physical function score and the mental function score on the Short-Form 36 Health Survey (which measures health-related quality of life) were significantly better in the active-treatment group than in the placebo group (p < 0.001 for each).

Comment: Some randomized controlled trials have found that EPA and DHA (the omega-3 fatty acids present in fish oil) are effective in the treatment of depression, although not all studies have found a positive effect (see Gaby AR. Nutritional Medicine. Chapter 287. 2011; The results of the present study demonstrate that EPA and DHA are of value for depressed, elderly women living in a nursing home. The dosage of omega-3 fatty acids used in this study is equivalent to approximately 8 g per day of fish oil.

Rondanelli M et al. Effect of omega-3 fatty acids supplementation on depressive symptoms and on health-related quality of life in the treatment of elderly women with depression: a double-blind, placebo-controlled, randomized clinical trial./ Am Coll Nutr. 2010;29:55-64.

Acetyl-L-Carnitine for Alcoholism

Sixty-four alcohol-dependent patients were randomly assigned to receive, in double-blind fashion, acetyl-L-camitine (ALC) or placebo for 90 days. ALC was given each day intravenously for the first 10 days at a dose of 1 g or 3 g (given over 3 to 4 hours) and then orally at a dosage of 3 g 3 times per day for the remaining 80 days. Patients treated with ALC remained completely abstinent for longer than did those treated with placebo (p < 0.05). The relapse rate was nonsignificantly lower with ALC (18%) than with placebo (40%). The frequency of adverse events did not differ significantly between groups.

Comment: ALC functions as a neurotransmitter and as a source of carnitine, which plays a role in energy production. Although the mechanism of action is not clear, this study suggests that ALC is of value in the treatment of alcohol dependence. The dosage of ALC used in the present study is considerably larger than that used to treat dementia (typically 1.5-3.0 g per day). Further research is needed to determine whether ALC in this lower dosage range would be effective for alcoholism. Other nutrients that have been found to be beneficial for alcohol craving include giutamine, niacinamide, and taurine.

Marti notti G et al. Acetyl-L-carnitine for alcohol craving and relapse prevention in anhedonic alcoholics: a randomized, double-blind, placebo-controlled pilot trial. Alcohol Alcohol. 2010;45:449-455.

N-Acetylcysteine for Bipolar Disorder

Fourteen patients with bipolar disorder II were randomly assigned to receive N-acetylcysteine (NAC; 500 mg twice a day) or placebo for 24 weeks. The mean age of the patients was 43 years in the NAC group and 52 years in the placebo group. All patients received conventional therapy. Six of 7 patients receiving NAC, as compared with 2 of 7 receiving placebo, achieved full remission of both depressive and manic symptoms (p = 0.03).

Comment: Bipolar disorder (also called manic-depressive disorder or manic depression) can be a serious, chronic, and difficult-to-treat disorder, and suicide or attempted suicide is not uncommon. Bipolar disorder I is the most severe form of the condition. Bipolar disorder II is characterized by less-severe symptoms and does not typically lead to significant impairment of functioning. The present study was conducted in patients with bipolar disorder II. Additional research is needed to determine whether NAC is also helpful for people with the more severe form of the disease. While the mechanism of action of NAC is not known, it might work by increasing glutathione levels, thereby improving the antioxidant deficit that has been observed in patients with bipolar disorder. NAC might also work by mitigating abnormalities of glutamatergic function.

Magalhaes PV et al. N-acetyl cysteine add-on treatment for bipolar II disorder: a subgroup analysis of a randomized placebo-controlled trial. /Affect Disord. 2011;129:317-320.

High-Fructose Corn Syrup: A Cause of Obesity?

Male rats were fed standard chow for 8 weeks, during which time they were given water (control group), 8% high-fructose corn syrup (HFCS) solution for 12 hours per day, 10% sucrose solution for 12 hours per day, or 8% HFCS solution for 24 hours per day. Rats given HFCS 12 hours per day gained significantly more weight than did animals given sucrose 12 hours per day, even though they consumed the same number of total calories, and consumed fewer calories from HFCS than from sucrose. Rats given HFCS for 24 hours per day did not show an increase in weight gain compared with the control group. In a second experiment, rats received chow for 6 months (males) or 7 months (females), during which time they were given water (control group), 8% HFCS for 12 or 24 hours per day, or (for females only) sucrose for 12 hours per day. Rats given HFCS gained significantly more weight than the control group. The increase in body weight with HFCS was accompanied by an increase in fat accumulation in the abdominal region.

Comment: In this study, rats given HFCS gained more weight than did rats given sucrose, even though their total caloric intake was not higher. That finding suggests that HFCS could promote the development of obesity, irrespective of its caloric content. Increased consumption of HFCS over the past 30 years in the US has been accompanied by a marked increase in the prevalence of obesity.

Bocarsly ME et al. High-fructose corn syrup causes characteristics of obesity in rats: increased body weight, body fat and triglyceride levels. Pharmacol Biochcm Behav. 2010;97:101-106.

Magnesium Has an Anti-Inflammatory Effect

One hundred individuals (aged 51-85 years; mean, 59 years) living in North Dakota who had poor sleep quality were randomly assigned to receive, in double-blind fashion, 320 mg per day of magnesium (as magnesium citrate) or placebo (sodium citrate) for 7 weeks. Assessments were made at 5 and 7 weeks after the start of the study, and the results of these two assessments were combined to decrease intra-individual variability. At baseline, 58% of the participants were consuming less than the US Estimated Average Requirement for magnesium. Among the 36 participants who had a C-reactive protein (CRP) level greater than 3.0 mg/L, the mean CRP level decreased by 1.6 mg/L (approximately a 20% decrease) in the magnesium group and increased by 1.5 mg/L (approximately a 21% increase) in the placebo group (p < 0.002 for the difference in the change between groups).

Comment: A large proportion of people living in Western societies consume less than the Recommended Dietary Allowance for magnesium. In experimental animals, severe magnesium deficiency results in inflammatory changes in various tissues. In the present study, magnesium supplementation decreased serum concentrations of CRP, which is an indicator of inflammation. An elevated CRP levels has been found to be an independent risk factor for cardiovascular disease. In addition to helping prevent heart disease, assuring optimal magnesium intake might be useful for other conditions that have an inflammatory component.

Nielsen FH et al. Magnesium supplementation improves indicators of low magnesium status and inflammatory stress in adults older than 51 years with poor quality sleep. Magnes Res. 2010;23:158-168.

Sambucus Nigra L (Black Elderberry): Not Just for Influenza

An extract of Sambucus nigra L (black elderberry) was found to have antimicrobial activity in vitro against the gram-positive bacteria Streptococcus pyogenes and group C and G Streptococci, against the grarn-negative bacterium Branhamella catarrhalis, and against human influenza viruses.

Background: Traditionally, elderberries have been used for a wide range of conditions. Today, black elderberry is used primarily to treat the common cold and influenza. In a previous study, an extract of Sambucus nigra L demonstrated antimicrobial activity in vitro against 13 common nosocomial gram-positive and gram-negative pathogens, including methicillinresistant Staphylococcus aureus, Escherichia colif and Pseudomonas aeruginosa. The present study expands the antimicrobial spectrum of black elderberry, and suggests that it could be useful as a treatment for a wide range of infections.

Krawitz C et al. Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. BMC Complement Ahem Med. 2011;11;16

Probiotic Improves Regurgitation in Infants

Forty-two formula-fed infants (mean age, 40 days) with uncomplicated regurgitation (functional gastroesophageal reflux) were randomly assigned to receive Lactobacillus reuteri DSM 17938 at a dose of 1 x 108 colony-forming units per day or placebo for 4 weeks. The median number of episodes of regurgitation per day during the last 7 days of treatment was significantly lower in the active-treatment group than in the placebo group (1.0 vs. 4.0; p < 0.001). In addition, compared with placebo, active treatment significantly decreased gastric distension and increased the rate of gastric emptying. Comment: Uncomplicated regurgitation ("spitting up") is a common problem among infants. It is not considered a serious condition, and it eventually resolves in most cases, but it can cause various symptoms including heartburn, coughing, wheezing, fussiness, and decreased appetite. The present study demonstrates that a specific probiotic preparation is beneficial for uncomplicated regurgitation. The treatment presumably works by altering the gastrointestinal flora.

Indrio F et al. Lactobacillus reuteri accelerates gastric emptying and improves regurgitation in infants. Eur J Clin Invest. 2011;41:417-422.

by Alan R. Gaby, MD
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Title Annotation:vitamin B complex and depression; omega 3 to prevent depression; acetyl-L-carnitine for the treatment of alcoholism
Author:Gaby, Alan R.
Publication:Townsend Letter
Geographic Code:1USA
Date:Oct 1, 2011
Previous Article:Psychiatry and drugs.
Next Article:Anti-Aging Medicine: An anti-aging approach to depression.

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