Two hundred-ten patients with Helicobacter pylori infection, as determined by gastric biopsies, were randomly assigned to one of seven treatment groups: 1) standard eradication treatment (lansoprazole, clarithromycin, and amoxicillin for 14 days), 2) standard treatment plus 1,000 mg/day of ascorbic acid, 3) 1,000 mg/day of ascorbic acid for 14 days, 4) standard treatment plus 120 mg/day of beta-carotene, 5) 120 mg/day of beta-carotene for 14 days, 6) standard treatment plus allicin, or 7) allicin for 14 days. The dose of allicin used was reported as both 1,200 and 4,200 mcg/day throughout the study, so it is not clear what the actual dose was. Gastric biopsies were repeated four weeks after the end of the treatment period. The eradication rate was 66.7% with standard treatment, 50% with standard treatment plus ascorbic acid, 10% with ascorbic acid alone, 50% with standard treatment plus beta-carotene, 0% with beta-carotene alone, 90% with standard treatment plus allicin, and 23.3% with allicin alone. Thus, 1,000 mg/day of ascorbic acid for 14 days resulted in an eradication rate of 10%, but the addition of ascorbic acid to standard treatment did not increase the eradication rate, compared with standard treatment alone. Allicin produced an eradication rate of 23.3%, and the addition of allicin to standard treatment increased the eradication rate from 66.7% to 90%. Beta-carotene was ineffective.

Comment: The search for effective natural alternatives to standard triple-therapy for patients with H. pylori infection has so far been frustrating (see Gaby AR. Altern Med Rev 2001;6:355-366). Although some treatments (such as mastic) are claimed to be beneficial, the research has been done only in vitro, which does not necessarily translate to effectiveness in vivo. In a previous report (Eur J Cancer Prev 1998;7:449-454) supplementation with 5 g/day of vitamin C was said to eradicate H. pylori in 30% of cases. In that study, however, the patients were assessed at the end of the treatment period, rather than the more appropriate 30 days after treatment was discontinued. Consequently, it was not possible to distinguish between transient suppression of H. pylori and true eradication.

In the present study, both vitamin C and allicin (a component of garlic) eradicated H. pylori in a small proportion of patients. As each of these treatments is safe, they may be considered as alternatives to conventional therapy, which has a higher incidence of side effects. Higher doses of vitamin C might be more effective than the 1 g/day used in this study. Of course, patients should be followed up, to determine whether re-treatment with conventional therapy is necessary.

Kockar C, et al. Helicobacter pylori eradication with beta carotene, ascorbic acid and allicin. Acta Medica 2001;44:97-100.

A case-control study was conducted by interviewing 296 patients with colorectal cancer and 597 controls in Cordoba, Argentina, regarding their dietary habits. With respect to meat consumption, a preference for darkly browned meat surfaces was significantly associated with an increased risk for all cooking procedures (odds ratio = 4.57; 95% CI, 3.10 to 6.73). Increased risk seemed to be related to high cooking temperature and close contact of the food to the heating source, because higher risks were observed for heavily browned surfaces when meats were barbecued or iron-pan cooked.

Comment: Exposure of meat to high cooking temperatures results in the formation of many toxic compounds, including heterocyclic amines, polycyclic aromatic hydrocarbons, cholesterol oxides, lipid peroxides, and advanced glycation end products. Some of these compounds are known carcinogens. Cooking at lower temperatures for longer periods of time results in the formation of less of these compounds than does cooking at higher temperatures for shorter periods of time. If you are a meat-eater, it is probably safest to cook your steak midway between E. coli and heterocyclic amines.

Navarro A, et al. Meat cooking habits and risk of colorectal cancer in Cordoba, Argentina. Nutrition 2004;20:873-877.

Twenty-two British adults with relatively low plasma selenium concentrations were randomly assigned to receive, in double-blind fashion, 50 or 100 mcg/day of selenium or placebo for 15 weeks. All subjects received an oral live attenuated poliomyelitis vaccine after six weeks. Compared with placebo, selenium supplementation increased the cellular immune response to polio vaccine (as determined by increased production of interferon gamma and other cytokines, an earlier peak in T cell proliferation, and an increase in T helper cells) and resulted in a more rapid clearance of the poliovirus. The higher dose of selenium tended to be more effective than the lower dose.

In a second study, oral administration of a single 2-g dose of vitamin C along with the first dose of rabies vaccine increased the mean serum concentration of alpha-interferon 22-fold, compared with rabies vaccine alone. This effect of vitamin C was considered to be of potential clinical importance, since the protective effect of rabies vaccine is related in part to its capacity to stimulate interferon production

Comment: In these studies, supplementation with selenium or vitamin C enhanced the immune response to certain vaccines. Other research has found that vitamin A can increase the antibody response to diphtheria vaccine, although the effects of vitamin A on the response to other vaccines have been conflicting. Good nutrition may also reduce the adverse effects of vaccination. In the 1970s, Kalakerinos observed that supplementing with vitamin C could prevent post-vaccination deaths, which had been a frequent occurrence among aborigine children.

There is still a great deal to be learned about the interaction of nutrition and vaccination. However, if we as a society are going to subject our children to a host of vaccines, it should be a high priority to determine how best to enhance their safety and efficacy.

Broome CS, et al. An increase in selenium intake improves immune function and poliovirus handling in adults with marginal selenium status. Am J Clin Nutr 2004;80:154-162.

Stantic-Pavlinic M, et al. Vitamin C - a challenge in management of rabies. Swiss Med Wkly 2004;134:326-327.

Fifty-four patients with cancer of the oral cavity or oropharynx who were scheduled to undergo radiation therapy were randomly assigned, in double-blind fashion, to rinse their mouth with a solution containing either 400 mg of vitamin E or placebo before each irradiation session and again 8 to 12 hours later. The solution was dissolved in the saliva, rinsed all over the oral cavity for five minutes, and then swallowed. The treatment was continued throughout the course of radiation therapy (five to seven weeks during). Episodes of mucositis occurred during 21.5% of patient-weeks in the vitamin E group, compared with 33.5% of patient-weeks in the placebo group (36% reduction; p = 0.038). Pain grades 2 or 3 (on a scale of 0-4, with higher scores indicating more severe pain) were experienced by 10.7% of patients in the vitamin E group, and by 53.8% of patients in the placebo group (p = 0.0001). No episodes of grade 4 pain occurred in either group. Vitamin E treatment had no effect on survival.

Comment: Mucositis is an important side effect of radiation therapy to the head and neck area; it can also occur with certain chemotherapy regimens. Mucositis can cause severe pain, making it difficult to eat, and sometimes requires temporary interruption of therapy. The results of the present study indicate that administration of vitamin E (as a rinse and swallow) can decrease the incidence and severity of radiation-induced mucositis in patients with cancer of the oropharynx or oral cavity. Although some doctors have expressed concern that supplementation with antioxidants might block the anti-cancer effects of radiation or chemotherapy, there is little or no evidence that this actually occurs in cancer patients.

Ferreira PR, et al. Protective effect of alpha-tocopherol in head and neck cancer radiation-induced mucositis: a double-blind randomized trial. Head Neck 2004;26:313-321.

Thirty-two obese adults were randomly assigned to one of the following diets for 24 weeks: 1) a standard diet containing 400-500 mg per day of calcium, plus a placebo supplement, 2) a standard diet supplemented with 800 mg per day of calcium, or 3) a diet containing three servings per day of dairy products, providing 1,200-1,300 mg per day of calcium, plus a placebo supplement. Each diet had an energy deficit of 500 kcal per day. The mean weight loss was 6.6 kg with the standard diet, 8.6 kg with the calcium-supplemented diet, and 11.1 kg with the high-dairy diet (p < 0.01 for calcium-supplemented vs. standard diet, and p < 0.01 for high-dairy vs. calcium-supplemented diet). Fat loss from the trunk region represented 19.0% of total fat loss on the standard diet, 50.1% of total fat loss on the calcium-supplemented diet, and 66.2% of total fat loss on high-dairy diet (p < 0.01 for calcium-supplemented vs. standard diet, and p < 0.01 for high-dairy vs. calcium-supplemented diet).

Comment: These results indicate that increasing dietary calcium intake enhanced weight loss and fat loss in obese individuals consuming a low-calorie diet. Furthermore, higher calcium intake increased the percentage of fat lost from the trunk region. Consuming calcium in the form of dairy products was significantly more effective than taking calcium supplements. The latter finding should be viewed with caution, however (i.e., the possibility of publication bias should be considered), as the study was funded by the National Dairy Council. As noted in the article, "The costs of publication of this article were defrayed, in part, by the payment of page charges. This article must, therefore, be hereby marked 'advertisement' in accordance with 18 U.S.C. section 1734 solely to indicate this fact."

Zemel MB, et al. Calcium and dairy acceleration of weight and fat loss during energy restriction in obese adults. Obes Res 2004;12:582-590.

A 55-year-old man with previously normal taste and smell treated a cold with a 2% zinc gluconate spray (Zicam). He noticed immediate burning in the nose, as well as anosmia, and did not use the spray again. Tests of smell function performed 13 and 23 months after the incident demonstrated severe hyposmia. Subsequently, a total of 10 patients from the Department of Otolaryngology, University of Colorado School of Medicine, were identified who had previously normal taste and smell, and who developed immediate, severe burning of the nose, followed by severe hyposmia with parosmia or anosmia, after the use of intranasal zinc gluconate. The severe hyposmia or anosmia appeared to be long lasting or permanent in some cases.

Comment: Nasal sprays, nasal gels, and oral lozenges that contain zinc are among the most widely used treatments for the common cold. Studies have shown that zinc ions, which are released in high concentrations from these products, can kill the virus that causes colds (rhinovirus). Zinc ions also protect the cells of the respiratory tract from damage caused by viral toxins, and may prevent rhinovirus from entering and infecting the cells of the nose. Clinical trials of zinc lozenges and nasal preparations have produced conflicting results, but a substantial number of studies have found that these treatments reduce the duration of colds by 50% or more.

Although loss of smell was not reported in clinical trials of intranasal zinc, research from the 1930s suggested that zinc ions are toxic to olfactory epithelium. In 1937, during a polio epidemic in Toronto, 5,000 children received intranasal sprays of 1% zinc sulfate and 0.5% Pontocaine on 2 separate occasions, 10-12 days apart. It had been theorized that zinc ions would coagulate proteins in the olfactory epithelium, forming a protective coating around the nerves, thereby preventing them from absorbing poliovirus. The treatment did not prevent polio, and 10-13% of the children developed anosmia, apparently permanently. In 1976, mice subjected to intranasal irrigation with a 1% aqueous solution of zinc sulfate demonstrated degeneration and subsequent regeneration of the olfactory epithelium.

The fact that anosmia was not found in clinical trials suggests that this side effect does not occur frequently. Nevertheless, because permanent loss of smell is a serious problem, using intranasal zinc to treat the common cold may not be worth the risk. Zinc lozenges are also effective for adults (but apparently not children) with colds, and they do not appear to cause problems with smell function.

Jafek BW, et al. Anosmia after intranasal zinc gluconate use. Am J Rhinol 2004;18:137-141.

Ninety patients (aged 30-80 years; mean, 53 years) with untreated mild-to-moderate hypertension were randomly assigned to receive 500 ml of Hibiscus sabdariffa tea once a day before breakfast or 25 mg of captopril twice a day for 4 weeks. Hibiscus tea was prepared by adding 10 g of dry calyx from H. sabdariffa to 500 ml of boiling water and letting stand for 10 minutes. Seventy patients completed the trial. In the hibiscus group, the mean systolic blood pressure (BP) decreased from 139.1 to 123.7 mm Hg (p < 0.03) and the mean diastolic BP decreased from 90.8 to 79.5 mm Hg (p < 0.06). The mean reductions in systolic and diastolic BP in the captopril group were slightly, but not significantly, greater than the reductions in the hibiscus group. A reduction in diastolic BP of at least 10 mm Hg was seen in 79% of patients receiving hibiscus and 84% of patients receiving captopril (p > 0.25). Hibiscus had a natriuretic effect: mean 24-hour urinary sodium excretion increased from 106 mEq to 125 mEq (p < 0.001). Both treatments were well tolerated.

Comment: These results suggest that Hibiscus sabdariffa tea is as effective, or nearly as effective, as captopril in the treatment of mild-to-moderate hypertension. Other natural treatments for hypertension that have been shown to be effective include magnesium, calcium, hawthorn, essential fatty acids, and coenzyme Q10. Despite this seemingly large arsenal of natural antihypertensives, non-pharmacological treatment of hypertension often produces disappointing results. While Rauwolfia serpentina (the natural source of reserpine) is a fairly strong antihypertensive agent, it has the potential to cause depression. According to the German Commission E Monographs, Hibiscus sabdariffa is considered nontoxic; its use should therefore be considered for hypertensive patients.

Herrera-Arellano A, et al. Effectiveness and tolerability of a standardized extract from Hibiscus sabdariffa in patients with mild to moderate hypertension: a controlled and randomized clinical trial. Phytomedicine 2004;11:375-382.

Nine lean, healthy women (aged 18-42 years) were randomly assigned to consume their normal diet on six occasions per day or to follow an irregular meal frequency pattern (three to nine meals per day) for two weeks. After a two-week washout period, each participant consumed the alternate diet for an additional two weeks. During the irregular diet, the women consumed their usual diet sequentially on seven, four, nine, three, five, eight, six, five, nine, eight, three, four, seven, and six occasions per day (average, six per day). Fasting glucose and serum insulin levels were not affected by meal frequency, but peak insulin and area under the curve of insulin responses to a high-carbohydrate test meal were higher after the irregular than after the regular eating pattern (p < 0.01). The irregular meal pattern was associated with higher fasting total (p < 0.01) and LDL (p < 0.05) cholesterol levels.

Comment: These results suggest that eating irregularly produces a degree of insulin resistance and higher cholesterol levels, compared with regular eating. Diabetes and heart disease can now be added to gambling addiction as potential consequences of variable-interval reinforcement.

Farshchi HR, et al. Regular meal frequency creates more appropriate insulin sensitivity and lipid profiles compared with irregular meal frequency in healthy lean women. Eur J Clin Nutr 2004;58:1071-1077.