Literature Review & Commentary


Literature Review & Commentary

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- Johns Hopkins discovers Broda Barnes

Measurement of glucose metabolism in red blood cells offers an alternative test for hypothyroidism in selected patients, according to Steven Sherman, M.D., instructor of endocrinology and medicine, Johns Hopkins University. The test measures the amount of carbon dioxide produced in the hexose monophosphate shunt pathway. Increased activity in this pathway is indicative of hypothyroidism. Although this test will not replace standard diagnostic tests, it is said to be useful in cases where the clinical picture is at odds with the test results.

COMMENT: This report confirms what many "alternative" physicians have known for a long time; that hypothyroidism is a clinical diagnosis and that functional tests can be reliable indicators of thyroid status. Standard veterinary texts state that if it looks, acts, and smells like hypothyroidism, then it is hypothyroidism until proven otherwise, regardless of what the standard blood tests show. Even the inventor of the thyroid stimulating hormone assay stated that hypothyroidism is a clinical diagnosis. Followers of Broda Barnes, M.D. have successfully used the basal axillary temperature as an empirical test for hypothyroidism. Although it is not 100% accurate, this simple and inexpensive test detects many patients who can benefit from low-dose thyroid supplementation.

Anonymous. Red blood cell test reveals hypothyroidism. Modern Med 1992;60:44.

- Thyroid dysfunction and postpartum depression

Three hundred-three pregnant women participated in a prospective study of postpartum thyroid dysfunction and depression. In women who developed depression, the incidence of thyroid dysfunction (hyperthyroidism or hypothyroidism) was twice as high as in those who did not develop postpartum depression. Normalization of thyroid function was associated with resolution of the depression.

COMMENT: Postpartum depression and postpartum thyroid dysfunction both occur frequently, the peak incidence of each occurring two to five months postpartum. The present study suggests that thyroid dysfunction may play a causal role in some cases of postpartum depression. It is important to remember that both hyperthyroidism and hypothyroidism can cause depression, and that the clinical presentation of these opposite ends of the thyroid spectrum is sometimes quite similar.

Pop VJM, et al. Postpartum thyroid dysfunction and depression in an unselected population. N Engl J Med 1991;324:1815-1816.

- Bugs in the carpal tunnel

More than 100 cases have been reported of carpal tunnel syndrome (CTS) in which infectious agents were isolated from the tissue removed during surgery. Some cases of CTS have been associated with toxic shock syndrome and rubella. In these cases, the CTS resolved with treatment of the primary disease. The range of other infections linked with CTS include some fungi, tuberculosis, and some common bacterial infections. Patients treated with surgery combined with appropriate antimicrobial agents had a better clinical outcome than did those treated with surgery alone.

COMMENT: Vitamin B6 has been used with considerable success in many cases of CTS. In other individuals, thyroid hormone is of value. Chiropractors have told me that some patients respond well to manipulation. Nevertheless, a substantial number of patients fail to respond to any of these treatments, and surgery becomes necessary. The present report suggests that infection may be an overlooked contributing factor in CTS. In patients who fail to respond to conservative treatment, a careful search should be made for evidence of infection. In addition, cultures should be taken of all tissue obtained during carpal tunnel surgery.

Marchesani RB. Infections found in carpal tunnel syndrome cases. Infect Dis News, November, 1991, pp. 1,5.

- Lifestyle and allergy

Total IgE levels were determined in 706 metal workers who responded to a questionnaire including 17 items related to physical and mental health practices. Multivariate analyses demonstrated a dramatic synergism of unhealthy lifestyles determining a high risk for either elevated or suppressed IgE levels, which may in turn result in allergic diseases or immunosuppression. Factors tending to normalize IgE levels upward were: enjoying hobbies, working time, physical exercise, sleeping patterns, and subjective mental stress. Factors tending to normalize IgE downward were: feeling busy, alcohol consumption, and smoking habits.

COMMENT: Recent studies have demonstrated an increasing prevalence of both allergic and autoimmune disorders in economically developed societies. Although it is likely that environmental pollution plays a significant role in development of allergy, the role of lifestyle should not be overlooked. This study suggests that behaviors which might generally be considered "bad" for one's health may have an adverse effect on the immune system. It is reassuring to consider that cleaning up one's lifestyle might improve allergic or autoimmune conditions.

Shirakawa T et al. Lifestyle effect on total IgE. Lifestyles have a cumulative impact on controlling total IgE levels. Allergy 1991;46:561-569.

- Chromium supplementation raises HDL-cholesterol

Sixty-three men receiving beta-blockers for hypertension were given 600 mcg/day of chromium or a placebo for eight weeks, in a double-blind trial. Compared with placebo, chromium increased mean HDL-cholesterol levels by 5.8 mg/dl (+16% from baseline). Two months after the end of the trial, the effect of chromium had disappeared.

COMMENT: Beta-blocking drugs, which are commonly used to treat hypertension, frequently result in decreased levels of HDL-cholesterol. This effect may explain why reducing blood pressure with beta-blockers does not substantially decrease mortality from coronary heart disease (CHD), even though hypertension is a known risk factor for CHD. Several previous studies have shown that chromium supplementation increases HDL-cholesterol levels. Animal studies have shown that chromium can reverse experimental atherosclerosis. Hopefully, the present report, published in a well respected, peer-reviewed journal, will awaken physicians to the importance of nutritional therapy.

Roeback JR Jr, et al. Effects of chromium supplementation on serum high-density lipoprotein cholesterol levels in men taking beta-blockers. Ann Intern Med 1991;115:917-924.

- Another conventional remedy bites-the-dust department

The effect of antibiotic prophylaxis for the prevention of valvular endocarditis was evaluated in a case-control study in the Netherlands. In individuals undergoing a procedure for which prophylaxis was "indicated," antibiotic prophylaxis had little effect on the incidence of endocarditis. Estimates from the present study are that, in a country such as the Netherlands, complete compliance with endocarditis prophylaxis would prevent only about five cases of the disease per year.

COMMENT: Medical "wisdom" holds that individuals with mitral valve prolapse and other more severe valvular conditions should receive antibiotic prophylaxis prior to dental procedures. Even though there is little solid evidence that such treatment prevents bacterial endocarditis, nearly all physicians recommend antibiotic prophylaxis, because it seems to many like a logical thing to do. Innovative practitioners have often found themselves in a medico-legal quandry: not wanting to expose their patients to the adverse effects of antibiotics, yet worrying what might happen if a patient develops endocarditis. The issue has been especially important for patients suffering from Candida-related-complex. The present study demonstrates that antibiotic prophylaxis does little or no good. It is reassuring, therefore, to know that finally we do not have to ask our patients to sign a consent form excusing us from refusing to poison them.

van der Meer JTM, et al. Efficacy of antibiotic prophylaxis for prevention of native-valve endocarditis. Lancet 1992;339:135-139.

- Melatonin for sleep disturbances

Eight individuals with a delayed sleep phase syndrome received 5 mg of melatonin daily or a placebo, each for four weeks, in a randomized, double-blind crossover trial. The medication was administered at 10 PM, which was five hours before the mean time of sleep onset. In all eight people, the sleep onset time was significantly earlier (mean advance, 82 minutes) during melatonin treatment than during placebo. Mean total sleep time was also reduced by 34 minutes in the melatonin group (p = 0.07).

COMMENT: Melatonin secretion occurs during the night and is inhibited by light. There is increasing evidence that melatonin acts as a phase setter for sleep-wake cycles in humans. Although melatonin does not act as a hypnotic, it appears to have an effect on circadian rhythms. Previous studies have demonstrated a beneficial effect of melatonin on jet lag. The results of the present study indicate that this compound may also be useful for individuals who cannot fall asleep until 3 o'clock in the morning.

Dahlitz M, et al. Delayed sleep phase syndrome response to melatonin. Lancet 1991; 337:1121-1124.

- Folic acid treatment of cervical dysplasia

In a case-control study of 294 women with cervical dysplasia, plasma nutrient levels were generally not associated with risk. However, red blood cell (RBC) folate levels at or below 660 nmol/L interacted with human papilloma virus (HPV-16) infection. The adjusted odds ratio for HPV-16 was 1.1 among women with RBC folate levels above 660 nmol/L, compared to 5.1 among those with lower levels. Interactions of RBC folate with cigarette smoking and parity were also present, but were not statistically significant.

COMMENT: This study suggests that folic acid deficiency enhances the effect of other risk factors for cervical dysplasia, particularly that of HPV-16 infection. In fact, maintaining adequate RBC folate levels, appeared to eliminate almost entirely the effect of HPV-16 infection on risk of cervical dysplasia. This study supports previous work demonstrating a beneficial effect of folic acid treatment (10 mg/day) on cervical dysplasia induced by oral contraceptives and on carcinoma in situ.

Butterworth CE Jr. Folate deficiency and cervical dysplasia. JAMA 1992;267:528-533.

Townsend Letter for Doctors & Patients.


By Alan R. Gaby

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