Correa A, Botto L, Liu Y, Mulinare J, Erickson JD.

Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. acorrea@cdc.gov

OBJECTIVE:

To evaluate whether the risk for birth defects associated with maternal diabetes is attenuated by use of multivitamin supplements during the periconceptional period. METHODS: In the population-based Atlanta Birth Defects Case-Control Study, we identified case infants who had nonsyndromic birth defects that were reported to be associated with diabetes (n = 3278) and were born during 1968-1980 to residents of metropolitan Atlanta. Controls were infants without birth defects (n = 3029). Maternal diabetes was defined as reported diabetes with onset before the date of birth of the index infant, and periconceptional use of multivitamins was defined as reported regular use of multivitamin supplements from 3 months before pregnancy through the first 3 months of pregnancy.

RESULTS:

Offspring of mothers with diabetes had an increased risk for selected birth defects. However, the increased risk was limited to offspring of mothers who had diabetes and had not taken multivitamins during the periconceptional period (odds ratio: 3.93; 95% confidence interval: 1.79-8.63). Offspring of mothers who had diabetes and had taken multivitamins during the periconceptional period had no increased risk for birth defects (odds ratio: 0.15; 95% confidence interval: 0.00-1.99).

CONCLUSIONS:

Periconceptional use of multivitamin supplements may reduce the risk for birth defects among offspring of mothers with diabetes.

Publication Types:

Evaluation Studies

Question

A father in my practice has been treated with fish oil and Co-10 for hypercholesterolemia, and has had very good results with no side effects. There is a strong family of high cholesterol and CVD. He is now asking if it would be safe and/or effective to use fish oils in his 10-year-old son if we find that he also has high cholesterol. Are there any data on the use of fish oil in children for this purpose?

Michael Harkness, MD

Response : from Desiree A. Lie, MD, MSEd, 05/02/2003

The National Cholesterol Education Program (NCEP) Expert Panel on Blood Cholesterol in Children and Adolescents recommends dietary intervention to lower cholesterol in children at least 2 years of age with risk factors for cardiovascular disease, such as strong family history.[1] Clinical evidence suggests that serum cholesterol measured at 22 years of age is predictive of risk of coronary heart disease (CHD) over the next 30-40 years.[2] The NCEP recommends screening children over 2 years of age with parental hypercholesterolemia or a first-degree family history of premature cardiovascular disease. The goal is to lower low-density lipoprotein levels to < 190 mg/dL; to < 160 mg/dL if there is a positive family history of premature CHD; and to < 130 mg/dL if there are more risk factors.[1]

The primary approach in children is dietary and consists of (1) the American Heart Association step 1 and 2 diets, equivalent to the NCEP step 1 and 2 diets, (2) an increase in fiber intake, and (3) adding certain dietary supplements such as antioxidants, garlic, soy, or fish oils. Colestipol is not tolerated.

There are indications for a number of the HMG-CoA reductase inhibitors for use in adolescent boys and postmenarchal girls of differing ages with heterozygous familial hypercholesterolemia, if the following findings are present after an adequate trial of diet therapy:

• LDL cholesterol is >/= 190 mg/dL, or
• the LDL cholesterol remains >/= 160 mg/dL (> 160 mg/dL for Mevacor)
  and
  - there is a positive family history of premature cardiovascular disease (CVD) or
  - 2 or more other CVD risk factors are present in the adolescent patient.

References to prescribing information, including age ranges, can be found below.[3-6]

Fish oils were first documented to have a positive cholesterol-lowering effect in adults in the 1980s and early 1990s.[7-9] Most studies conducted have been short-term in nature (6 months or less) with the end point being lipid levels rather than mortality or CHD events. An extensive Cochrane Review in 2001[10] examined the evidence that a cholesterol-lowering diet is more effective at lowering cholesterol than no intervention, or other dietary interventions, including supplements. This rigorous systematic review found only 5 studies that met their criteria for inclusion: randomized, double-blind, controlled, crossover trials looking at children and adults with familial hypercholesterolemia. Of these 5 studies, only Balestrieri and colleagues[11] compared dietary fat manipulation with fish oil intake as a comparison. There was no difference between the 2 groups in outcomes as measured by cholesterol and other lipid levels. The review found studies generally to be of poor methodologic quality, with inadequate control of other dietary and confounding lifestyle factors. The conclusion was that, at that time, there were insufficient data to reach any conclusions on the efficacy of different dietary treatments, including fat reduction and the use of dietary supplements. Larger, more rigorous trials are needed.

The authors of a Cochrane review on the use of fish oils for asthma control[12] reached similar conclusions: There was inadequate evidence to support the use of marine N-3 fatty acids (fish oil) to improve asthma control. However, there was no evidence of risk with the use of fish oils in these patients either.

According to the same review, to date, adverse effects of fish oil use in children have not been reported in the medical literature. However, the possibility of undiagnosed allergies in young children (under 10 years) would warrant caution in its use in young children, the review's authors report.

References

1. National Cholesterol Education Program Coordinating Committee. Report of the Expert Panel on Blood Cholesterol in Children and Adolescents. Bethesda, Md: National Heart, Lung and Blood Institute; 1991. NIH Publication no. 91-2732.
2. Klag MJ, Ford DE, Mead LA, He J, et al. Serum cholesterol in young men and subsequent cardiovascular disease. N Engl J Med. 1993;328:313-318.
3. Lipitor product information. Available at: http://www.lipitor.com/pi/default.asp Accessed 4.21.03
4. Mevacor product information. Available at: http://www.merck.com/product/usa/pi_circulars/m/mevacor/mevacor_pi.pdf Accessed 4.21.03
5. Pravachol product information, available through. Available at: http://www.pravachol.com Accessed 4.21.03
6. Zocor product information. Available at: http://www.zocor.com Accessed 4.21.03
7. Kromhout D, Bosschieter EB, Coulnader CL. The inverse relation between fish consumption and 20 yr. Mortality from coronary heart disease. N Engl J Med. 1985;312:1205-1209.
8. Herold PM, Kinsella JE. Fish oil consumption and decreased risk of cardiovascular disease: a comparison of findings from animal and human feeding trials. Am J Clin Nutr. 1986;43:566-598.
9. Beil FU, Terres W, Orgass M, Heimer G. Dietary fish oils lower lipoprotein a in primary hypertriglyceridemia. Atherosclerosis. 1991;90:95-97.
10. Poustie VJ, Rutherford P. Dietary treatment for familial hypercholesterolemia. Cochrane Database Syst Rev. 2001;(2):CD001918.
11. Balestrieri GP, Maffi V, Sleiman I, et al. Fish oil supplementation in patients with heterozygous hypercholesterolemia. Recenti Prog Med. 1996;87:102-105.
12. Woods RK, Thien FC, Abramson MJ. Dietary marine acids (fish oil) for asthma in adults and children. Cochrane Database Sys Rev. 2002;(3):CD001283.

Shamir R, Fisher EA. Dietary therapy for children with hypercholesterolemia. Am Fam Physician. 2000;61:675-682.

About the Panel Members

Desiree Lie, MD, MSEd, Associate Clinical Professor of Family Medicine and Director, Division of International Faculty Development, Irvine Medical Center, University of California, Irvine.

Plasma Vitamin B6 Levels Correlate Inversely With Rheumatoid Arthritis Severity

NEW YORK (Reuters Health) Apr 23 - Markers of vitamin B6 status in patients with rheumatoid arthritis (RA) are associated with disease activity and severity, synovial burden, and pain, according to results of a study published in the March issue of the American Journal of Medicine.

"Patients with rheumatoid arthritis have low plasma vitamin B6 levels and elevated plasma homocysteine responses to a methionine load," Dr. Ronenn Roubenoff and colleagues from Tufts University Boston, Massachusetts, note. In a cross-sectional study, they examined whether there was an association between these abnormalities and clinical and biochemical indicators of disease status in 37 RA patients.

The researchers found an inverse correlation between plasma pyridoxal 5'-phosphate levels and the erythrocyte sedimentation rate (p = 0.02) and C-reactive protein levels (p = 0.002). Plasma pyridoxal 5'-phosphate levels were also inversely correlated with disability score (p = 0.02), morning stiffness (p = 0.02), and degree of pain (p = 0.04).

An increase in homocysteine levels following a methionine load correlated significantly with the erythrocyte sedimentation rate (p = 0.02) and the C-reactive protein level (p = 0.03). A significant correlation was also observed between the increase in homocysteine levels and the disability score (p = 0.04), the degree of pain (p = 0.02), the degree of fatigue (p = 0.01), the number of painful joints (p = 0.007), and the number of swollen joints (p = 0.05).

Dr. Roubenoff and colleagues note that it has previously been shown that low vitamin B6 in such patients is not attributable to lower intake or higher catabolism of the vitamin. They believe the current findings indicate "the possibility that impaired vitamin B status in these patients is a results of inflammation."

The investigators also suggest that the combination of chronic inflammation, low vitamin B6 and elevated homocysteine may contribute to an increased risk of cardiovascular disease in patients with RA.

Am J Med 2003;114:283-287.

Moderate substitution of saturated fatty acids with monounsaturated fatty acids has beneficial effects on lipid metabolism in healthy individuals. This was a key finding of a study by Dr AA Rivellese and colleagues of the Department of Clinical and Experimental Medicine, School of Medicine, Federico II University, Naples, Italy.

The study was carried out on 162 people who were randomly assigned to follow one of two isoenergetic diets: one rich in saturated fatty acids, and the other in monounsaturated fatty acids. The groups were further randomised to receive supplementation with 3.6 g/day fish oil (n-3 fatty acids) or placebo. It was found that the monounsaturated diet significantly reduced LDL cholesterol and triacylglycerol compared with the saturated fatty acid diet. In addition, VLDL cholesterol and triacylglycerol were significantly reduced and LDL cholesterol significantly increased by fish-oil supplementation. Plasma triacylglycerol was significantly lower in those taking n-3 fatty acids 1 and 3 hours after a test-meal, as well.

Neither of the diets or the fish-oil supplementation affected the size of LDL. With respect to fish-oil supplementation, the researchers said, "

A moderate supplementation of long-chain n-3 fatty acids in healthy individuals reduces both fasting and post-prandial triacylglycerol concentrations but increases LDL cholesterol, irrespective of the type of diet."

We have the following Services Available for your health.

Dr. Donald Underwood will attend and administer all I.V. Drips

Some Medical Services require Laboratory Tests

• Intravenous Mega Vitamins and Minerals
• Vitamin C, Vitamin B complex, Vitamin B-12, Folic Acid, Multi-vitamins, Vitamins E, D, A, Calcium, Magnesium, Zinc, 7 trace minerals
• Iron (Lab test required)
• Glutathione IV Push
• Vitamin Injections
• Sceretin I.V.
• Trigger Point Injections
• Antibiotic IV Therapy
• Chelation Therapy for Heavy Metals (Lab. Test Required)

• All Intravenous IV’s are prepared and Administered by Medical Physician at Rapid Recovery Hyperbarics.
• Comfortably administered in our Private IV rooms with T.V. and Videos for your comfort.
• Full Medical Exams with Nutritional counseling.
• Antibiotic Therapy for Mycoplasma, and Lyme disorders.
• After hour, appointments are available for our patients who work. (Prearrangement Needed)
• Followed by Hyperbaric Oxygen Therapy if needed.

On the Run? You've No Air to Spare

By Kathy Wollard
Kathy Wollard is a regular contributor to Newsday.

August 20, 2002

Why do we sometimes feel out of breath when we run very fast? asks Kazi Rahman, a student in Woodside.

Ever run up the stairs to answer the phone and find you were breathing too hard to talk? It seems strange that speeding up can make us feel like we are drowning. But the faster we move, the more oxygen we need.

Sunk into the sofa cushions watching TV, you might breathe in and out about 12 times a minute, every five seconds. With each shallow breath, you might suck in about two cups of air.

But peel yourself off the couch and go outside for a brisk walk, and your breathing rate will speed up to about 35 times a minute, every 1.7 seconds.

With each breath, you gulp in some eight cups of air.

Let's do the math: A minute as a couch potato? 24 cups of air. A minute walking down the sidewalk at a good clip? 280 cups of air.

(Which is why, in science fiction movies, when the spaceship's oxygen supply is running low, the astronauts try to avoid moving around much.)

Here on Earth, where air and oxygen are abundant, it's hard to understand why we feel breathless as we move faster and faster. After all, the faster we move, the more air (and oxygen) we take in.

When you're couchbound, each smallish breath delivers enough oxygen to the blood for all of your lazy muscles to work just fine. But on a run, muscles demand more and more oxygen to move legs faster and faster, while speedily burning sugar and fat for energy. Even the rapid 2-quart breaths you took while walking may not supply oxygen fast enough when you speed up to a run.

Carbon dioxide builds up in the lungs, and must be quickly exhaled out. You take even more breaths per minute, and your heart rate increases, to pump oxygen-rich blood to the hardworking muscles that need it.

If your heart isn't already well-conditioned from brisk exercise, it can't pump as efficiently. And if your muscles aren't toned and used to running, they won't be as good at extracting oxygen from the blood they get. The body will yell for more and more oxygen - and you may be gasping for breath.

If you find yourself breathless (and don't have asthma, other breathing problems or a heart condition), you may also have neared your maximum heart rate. With each "beat," your heart muscle contracts to push out blood - and then expands to fill up again. There is a limit to how fast the heart can beat, because there must be time for it to refill with blood between contractions.

The good news: Regular brisk exercise gradually conditions your heart so that it pumps more blood with each stroke, increasing the oxygen sent to your (strengthened) muscles. So you can run and breathe comfortably at the same time.

Absorption

When you speak of absorption, you have hit a large nail on the head. Absorption is the KEY issue. The (very hard) drug industry has conditioned us to use oral medication, in other words the gastrointestinal tract, to deliver drugs, by swallowing them. Taking a tablet by the mouth, a considerable amount remains in food, some stays in the tissues of the GI tract, then some is lost on the first pass from the drainage of the gut into the liver circulation where it is metabolized. Some is also lost to the lungs before the drug reaches the arterial circulation. It is then transported in plasma to be supplied to the target tissue. However, if the microcirculation is reduced in that tissue because of inflammatory edema then very little of the drug becomes available to deal with the problem addressed. Meanwhile the kidney is rapidly excreting it in the urine. As an example, a 400 mg NSAID taken orally may produce plasma concentrations in the range 5 and 35 micrograms per ml one hour after being taken. Therefore, patients getting only 5 mg get the GI side effects but little benefit.

Oxygen however is delivered through the lungs and this is extremely reliable. We cannot only measure the plasma concentration but also the actually concentration delivered to the target site so we have better data on which to proceed with oxygen than with any pharmaceutical.

The drug industry has spent half a billion dollars on encapsulating drugs in ultra microspheres so that they can be breathed but bronchial reactivity will I suspect prevent the use of this route.

Dr P.B. James MB ChB DIH PhD FFOM
Wolfson Hyperbaric Medicine Unit
University of Dundee

Reprinted with Permission

Summary

The vitamin D - endocrine system has mostly been studied for its role in calcium and phosphorus metabolism and its possible role as an antioxidant has been neglected. This study attempts to elucidate the antioxidative properties of the prohormone with respect to vitamin E, a membrane antioxidant.

Results herein show that D3 treatment brought about similar reduction in the extent of lipid peroxidation and induction in superoxide dismutase (SOD) activity, as with vitamin E supplementation. While selenium dependent glutathione peroxidase (Se-dep. GPx) activity reflected no change with vitamin D3 treatment, total GPx activity was more significantly influenced by vitamin D3 than by vitamin E. The glutathione (GSH) content in the experimental rats also reflected similar changes. Vitamin E supplementation caused 8.57% increase in glutathione reductase (GR) activity, while vitamin D3 decreased the concerned enzymes activity by 11.11%. Vitamin D3 treatment so caused 25% increase in glucose 6-phosphate dehydrogenase (G6PD) activity. These data thus suggest that vitamin D3 may function as an antioxidant in the liver in vivo and illustrate an effectiveness higher than that observed with vitamin E supplementation.

Reprinted with Permission

Vitamins and Minerals may be helpful in deterring violent and anti-social behavior among children with disruptive behaviors that may be suffering from nutritional deficiencies.

That's the conclusion of a study published in the February issue of The Journal of Alternative and Complementary Medicine (www.liebertpub.com/acm/), that found vitamin and mineral supplementation of school-age children (ages 6 to 12 years old) with behavioral problems led to a reduction in incidence of anti-social behavior.

Previous studies have shown similar findings among older institutionalized offenders, ages 13 to 17 and 18 to 26. The study authors in this case wanted to see if testing of school-aged children - in this case a group of working-class children in Phoenix who were known to be disruptive - would reveal similar results, with the hope that early intervention could prevent later violent and anti-social behavior.

Over a four-month period, one group of 40 subjects was given daily supplements formulated to provide the nutritional equivalent of vitamins and minerals present in a well-balanced diet; the other group of 40 received placebo.

Subjects were later rated on differences in types of serious rule violations that occurred during intervention period. Violations included vandalism, refusal to work, uttering obscenities, being disrespectful, disorderly conduct, assault/ battery, and defiance, among others.

The study was led by Stephen J. Schoenthaler, professor of sociology and criminal justice at California State University, Stanislaus (www.lead.csustan.edu), and Ian D. Bier, of LB Scientific, LLC, Durham, N.H. They found that of the children who were disciplined during the school year, the 40 who received the active supplements were disciplined 47 percent less during the intervention process than those who received placebo.

"Poor nutritional habits in children," wrote the authors, "lead to low concentrations of water-soluble vitamins in blood, impair brain function and subsequently cause violence and other serious anti-social behavior."

The nutrient supplements, they theorized, corrected the low concentrations of vitamins in blood, improved brain function and lowered the incidence of violent and anti-social behaviors. The authors cautioned that findings "do not imply that human behavior is not largely a learned phenomena. The fact that most children cease to be behavioral problems after one or two incidents is evidence that most children prefer rewards over escalating sanctions and they have learned from their experiences with the school administration." However, the researchers argued that their findings have important ramifications for a minority of children for whom both rewards and sanctions are not effective. For this group, there is evidence that "undiagnosed and untreated malnutrition may be impairing their brain function to such an extent that normal learning from discipline does not occur.

"With low-dose supplementation of vitamins and minerals, according to researchers, the 40 offenders in the group "were able to appreciate the seriousness of their actions and the disciplinary consequences." Schoenthaler and Bier urged wider application of medical and nutritional intervention as one possible approach to improving the behavior of disruptive and anti-social children.

The Journal of Alternative and Complementary

Reprinted with permission

You have probably heard what we call the "Magic Fitness Formula." For years, the experts have told us that in order for your exercise program to be successful, you have to work out at 60% - 80% of your maximum heart rate, for 20 - 30 minutes each session, at least 3 - 4 times each week. While this is a very good goal to strive for, if you limit yourself to only using this formula, you could be setting yourself up for failure. It is too easy to convince yourself that you don't have a half-an-hour right now, so you can exercise later. Many times, "Later" never comes.

A recent study conducted at Stanford University took a group of people and divided them into two groups. Half exercised for 30 consecutive minutes, the other half exercised in 10 minute intervals - once in the morning, afternoon, and evening. At the end of the study, both groups increased their fitness levels at the same amount and at the same pace. So, not having a consecutive half hour is no longer a reason not to get up and get moving! If you only have 10 minutes, use it to your advantage. It will all add up to a healthier you!

Time is one of our most precious commodities. Here are a few ideas on how you can find the time for YOU!

• Always have an extra pair of walking shoes in your car.
• Park ten minutes away from your office. Take the stairs.
• Instead of a coffee break take a walking break.
• Use at least ten minutes of your lunch time for walking.
• If after work you are waiting for your kids' at lessons or practice --- Walk!
• Plan your walks and schedule them in your appointment book.
• Recognize how much better you feel when you get back to your desk.
• Look at your walk as a welcome break from work, not as a disruption.
• Let your co-workers know what you are doing. Some of them will want to join in.
• If you are feeling tired and unmotivated, you may need a snack. Low blood sugar level can make you feel lack luster.
• Set short term goals and plan a reward. This week I will walk 5 times this week, or 8 miles or a total of 2 hours. After you reach your goals make sure you reward yourself -- a new walking t-shirt, tape, shoes, flowers, massage.
• Set a long term goal and shoot for something even bigger -- a fully planned active vacation.

REMEMBER ... TEN MINUTES COUNTS!

B-12 NEUROLOGICAL DISEASE

Japanese scientists have identified a form of vitamin B12 that protects against neurological disease and aging by a unique mechanism that differs from current therapies. Vitamin B12 is a general label for a group of essential biological compounds known as cobalamins. The cobalamins are structurally related to hemoglobin in the blood, and a deficiency of vitamin B12 can cause anemia. However, over the last 10 years, a number of central and peripheral neurological diseases maybe related to a deficiency of a very specific cobalamin, the methylcobalamin form.

DHA Fatty Acids May Reduce Postpartum Depression

References:

Methods and Findings of Experimental and Clinical Pharmacology is published in Spain. NLM ID:7909595 The date of this article was 1995, not 1986.

"Jalaludin MA. Methylcobalamin treatment of Bell's Palsy. Methods Find Exp Clin Pharmacol. 1995 Oct;17(8);539-44" From Pub Med site PMID:8749227

Report supports folic acid for heart health

Nov 25 (Reuters Health) - High blood levels of the amino acid homocysteine may raise the risk of heart disease, stroke and blood clots in the legs, a new study confirms. The good news, researchers say, is that supplements containing the B vitamin folic acid might help reduce this risk.

Homocysteine is a normal byproduct of metabolism, but high levels of the amino acid in the blood have been linked to heart disease, stroke and blood clots. Folic acid is known to aid in breaking down homocysteine, and researchers are studying whether the vitamin can help ward off cardiovascular disease by lowering homocysteine in the blood.

But while this question is not yet answered, existing research gives "strong evidence" that high homocysteine levels do promote cardiovascular disease, according to the new report, published in the November 23rd issue of the British Medical Journal.

The researchers, led by Dr. David S. Wald of Southampton General Hospital in the UK, base that conclusion on their review of 92 studies on homocysteine and cardiovascular disease risk.

Across the studies, they report, each unit increase in blood homocysteine was associated with a 32% to 42% increase in the risk of ischemic heart disease, in which blood flow to the heart is reduced. Similar patterns were found for stroke and deep vein thrombosis (DVT)--blood clots in deep veins, usually in the legs, that can be life- threatening if they dislodge and travel to the lungs.

On the bright side, though, Wald's team estimates that lowering homocysteine levels by an amount achievable with daily folic acid supplements could cut the risks of heart disease, stroke and DVT.

To "maximally" cut homocysteine levels--and, potentially, disease risk--a person would have to take about 0.8 milligrams (mg) of folic acid a day, according to Wald's team. US dietary recommendations call for adults to get 0.4 mg of folic acid daily.

In the US, where many grains are fortified with folic acid, Wald told Reuters Health, a healthy diet plus a daily multivitamin containing folic acid may help maintain normal homocysteine levels.

"Adults," Wald said, "particularly those aged 55 and older, stand to benefit from taking a folic acid supplement everyday."

Currently, the American Heart Association does not recommend taking folic acid specifically for the prevention of cardiovascular disease, due to the lack of studies showing the vitamin prevents these conditions. However, it does advise that people at risk of cardiovascular disease be especially sure to get enough folic acid, as well as vitamins B-6 and B-12, in their diets.

Besides fortified grains, good dietary sources of folate--the form of the vitamin that naturally occurs in food--include beans, leafy green vegetables and orange juice.

SOURCE: British Medical Journal 2002;325:1202- 1206.

Bell's Palsy See Research References on Neurological Disorders

Bell's palsy is non-lethal paralysis of the facial nerve. Any or all branches of the nerve may be affected, and, in fact, Bell's palsy victims may not be able to open an eye or close one side of the mouth.

The results of this study, published in Methods and Findings of Experimental Clinical Pharmacology (17[8]:539-44 1996 Oct), showed that methylcobalamin maybe effective in some patients with Palsy Neurological Disorders.

The Text Book of Hyperbaric Medicine, Vol. 3 Page 268
K.K. Jain MD.
Lists Facial Palsy is treatable with Hyperbaric Oxygen Therapy.

Brain Aging

In a study in the European Journal of Pharmacology (1993 Sep.7;7;241 (1):1-6), it was shown that methylcobalamin protected against glutamate-, aspartate- and nitroprusside- induced neurotoxicity in rat cortical neurons.

Parkinson's Disease

Hyperbaric oxygenation (HBO2) was used to treat 64 patients suffering from Parkinsonism of diverse etiology. HBO2 sessions were provided daily) 8-12 per course; treatment pressure ranged from 1.3 to 2 atm and exposure time ranged from 40 to 60 minutes. A marked beneficial effect was noted in 55 patients. HBO2 treatment produced better results in the presence of vascular Parkinsonism, in patients under 65 years of age, and when the history of disease ranged from 1 to 5 years. The akineticorigid syndrome regressed to a greater extent, with HBO2 proving to be less effective when trembling hyperkinesis was present Submitted to the editorial office on 03 March 1988

Alzheimer's Disease

A study in Clinical Therapeutics (1992 May;14(3):426-437) showed that the intravenous administration of large doses of methylcobalamin to Alzheimer's patients improved the patients' intellectual functions such as memory, emotions, and communication with other people. The scientists concluded that methylcobalamin might help in some cases, for psychiatric disorders in patients with Alzheimer-type dementia.

See SPECT Brain Scans and Neurological, Brain disorders Research References

Multiple Sclerosis See Research References for Multiple Sclerosis and Hyperbaric Oxygen Therapy

A study in the journal Internal Medicine (1994 Feb. 33(2):82-86) investigated the daily administration of 60 mg of methylcobalamin to patients with chronic progressive multiple sclerosis (MS)

The effects of methylcobalamin were studied on an animal model of muscular dystrophy. This study, published in Neuroscience Letters (1994 Mar 28; 170[1] 195-197), looked at the degeneration of axon motor terminals.

Regenerating Nerves See Research References on Hyperbaric Oxygen and Neurological Disorders

Journal of Neurological Science (1994 Apr. 122[2]:140-143) postulated that methylcobalamin could increase protein synthesis and help regenerate nerves.

Journal of Inherited Metabolic Diseases (1993;16[4]:762-770).

The scientists stated that a deficiency of methylcobalamin causes demyelination disease in people with this in-born defect.

An early study published in the Russian journal Farmakol Toksikol (1983 Nov; 46[6]: 9-12) Nov 1983) showed that the daily administration of methylcobalamin in rats markedly activated the regeneration of mechanically damaged axons of motor neurons. An even more-pronounced effect was observed in laboratory rats whose sciatic nerves were crushed mechanically.

Two studies published in the Japanese journal Nippon Yakurigaku Zasshi (1976, Mar, 72, [2]: 269-278) showed that the administration of methylcobalamin Might help with these disorders.

Cancer & Immune Function

A study in the journal Oncology (1987; 44[3]:169-173) examined the effects of methylcobalamin on several different kinds of tumors in mice. The effects of methylcobalamin on human immune function were investigated in the Journal of Clinical Immunology (1982 Apr 2; [2]:101-109).

MedscapeWire Infants Need Long-Chain Fatty Acids for Developing Vision

Laurie Barclay, MD

MedscapeWire 2002. © 2002 Medscape Portals, Inc

NEW YORK (MedscapeWire) Mar 14 — Long-chain polyunsaturated fatty acids (LCPs) support the developing vision of infants, according to a randomized trial of formula supplementation reported in the March 1 issue of the American Journal of Clinical Nutrition.

"The critical period during which the dietary supply of [LCPs]…may influence the maturation of cortical function in term infants is unknown," write Eileen E. Birch and colleagues from the Retina Foundation of the Southwest in Dallas, Texas. "The results suggest that [this] critical period … extends beyond six weeks of age."

In this study, 65 healthy term infants weaned from breast-feeding at 6 weeks of age were randomized to formula with or without LCP supplementation. Because breast milk is rich in LCPs, all infants received LCPs in the first 6 weeks of life.

Compared with infants receiving formula supplemented with LCPs, infants receiving formula that did not provide LCPs had significantly poorer visual acuity at 17, 26, and 52 weeks of age and significantly poorer stereoacuity at 17 weeks of age.

Better acuity and stereoacuity at 17 weeks was correlated with higher plasma concentrations of docosahexaenoic acid (DHA). Better acuity at 52 weeks was correlated with higher DHA concentrations in plasma and red blood cells. There were no significant differences in growth between the 2 groups.

"There is a clear need to define safe and effective alternatives to breast-feeding after weaning to infant formula," the authors write. "The results presented here suggest that LCP-supplemented formula is well-tolerated and beneficial to the maturation of the visual cortex."

Am J Clin Nutr. 2002;75(3):570-580
Reviewed by Gary D. Vogin, MD

DHA Fatty Acids May Reduce Postpartum Depression

Laurie Barclay, MD

NEW YORK (MedscapeWire) Apr 12 — Several studies summarized at the 223rd national meeting of the American Chemical Society on April 8 suggest that docosahexaenoic acid (DHA) fatty acid supplements given to nursing mothers may improve early infant development. DHA supplements may also reduce the incidence of postpartum depression.

"We believe that the high incidence of postpartum depression in the United States may be triggered by a low dietary intake of DHA," presenter David J. Kyle, PhD, from the Mother and Child Foundation and Advanced BioNutrition Corp in Columbia, Maryland, said in a news release. "The higher the intake of DHA, the lower the incidence of depression."

A 1998 study by Joseph Hibbeln of the National Institutes of Health found a significant inverse correlation between DHA intake and incidence of clinical depression, and a more recent study by Hibbeln found the same relationship between DHA levels in breast milk and incidence of postpartum depression. During pregnancy, the placenta pumps DHA from the expectant mother to the fetus, increasing the mother's susceptibility to depression.

Maternal diet influences the level of DHA in breast milk. "The DHA content of mother's milk in the United States is among the lowest in the world," Kyle said, noting that daily dietary intake of DHA is about 40-50 mg in US women, 200 mg in European women, and about 600 mg in Japanese women.

DHA supplements of 200 mg daily double the DHA content of nursing mothers' milk relative to those who received placebo, according to a study by Craig Jensen from the Baylor College of Medicine in Houston, Texas.

"The toddlers who were nursed from the mums getting the extra DHA performed significantly better [on standard neurological motor function tests] than those toddlers nursed from mums who were getting the placebo," Kyle said.

Last year, the FDA approved the addition of DHA to infant formulas. Women who want to increase their DHA levels can take dietary supplements or eat more tuna, salmon, algae, and other foods rich in DHA. To avoid mercury contamination, however, current guidelines suggest limiting fish to 12 ounces of cooked fish per week during pregnancy and breastfeeding, and avoiding shark, swordfish, king mackerel, and tilefish.