Vitamin K status and rate of bone resorption were measured in 44 patients (mean age, 36.9 years; mean disease duration, 10.5 years) with Crohn's disease in clinical remission and 44 age- and sex-matched healthy controls. Vitamin K status was determined by measuring the serum concentration of undercarboxylated osteocalcin, and rate of bone resorption was determined by measuring urinary excretion of N-telopeptides of type I collagen [NTx]). Vitamin K status was significantly lower in patients than in controls, and there was a significant inverse correlation between vitamin K status and rate of bone resorption, even after controlling for vitamin D status, calcium intake, and other potential confounding variables.

Comment: There is a high prevalence of osteopenia and osteoporosis in people with Crohn's disease. Bone loss may result from many factors, including nutritional deficiencies and glucocorticoid use. Deficiencies of magnesium, zinc, vitamin D, and B vitamins are common in patients with Crohn's disease, and a deficiency of any one of these nutrients could increase the risk of bone loss.

Vitamin K is required to manufacture osteocalcin, a unique protein found in bone that attracts calcium to bone tissue. Without adequate vitamin K, normal bone mineralization is impaired. Vitamin K has also been shown to inhibit bone resorption, although the mechanism is not clear. Vitamin K status has been found to be lower in people with osteoporosis than in age-matched healthy controls. While the degree of deficiency is typically not great enough to compromise the blood-clotting system, it appears that bone health can be adversely affected by even marginal vitamin K deficiency. The results of the present study suggest that people with Crohn's disease, even those in remission, should increase their vitamin K intake, perhaps by several hundred milligrams per day. The main dietary sources of vitamin K are dark green vegetables and soybean oil. Vitamin K is also present in some multiple-vitamin preparations.

Duggan P, et al. Vitamin K status in patients with Crohn's disease and relationship to bone turnover. Am J Gastroenterol 2004;99:2178-2185.

Some 13,017 French men and women (aged 35-60 years) were randomly assigned to receive, in double-blind fashion, a daily nutritional supplement or placebo for a median of 7.5 years. The supplement provided daily 120 mg of ascorbic acid, 30 IU of vitamin E, 6 mg of beta-carotene, 100 mcg of selenium (as selenium-enriched yeast), and 20 mg of zinc (as zinc gluconate). Among the group as a whole there were no significant differences in incidence of total cancers, ischemic heart disease, or all-cause mortality. When total cancer incidence was analyzed according to gender, however, a protective effect of antioxidants was seen in men (relative risk [RR] = 0.69; 95% CI, 0.53-0.91) but not in women (RR = 1.04; 95% CI, 0.85-1.29). A similar trend was observed for all-cause mortality in men (RR = 0.63; 95% CI, 0.42-0.93) and women (RR = 1.03; 95% CI, 0.64-1.63).

Comment: The results of this study indicate that a low-dose antioxidant supplement taken for a median of 7.5 years reduced the incidence of cancer by 31% and all-cause mortality by 37% in men. In contrast, no beneficial effect was seen in women. The different results seen in men and women may be due to the fact that men have lower baseline levels of certain antioxidants, especially beta-carotene, than women do.

These findings are encouraging, considering the spate of bad news that has recently appeared regarding antioxidant supplementation. The most widely publicized negative study, reported in the Annals of Internal Medicine (2005;142:37–46), suggested that high-dose vitamin E supplementation (400 IU/day or more) increases all-cause mortality. As I pointed out in an editorial about that study (see Healthnotes Newswire, at http://www.emersonecologics.com), important flaws render the study's conclusions questionable. Furthermore, if long-term use of high-dose alpha-tocopherol does have a small negative effect in some people, the same is probably not true of mixed tocopherols (the form in which vitamin E occurs naturally in food).

Hercberg S, et al. The SU.VI.MAX Study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Arch Intern Med 2004;164:2335-2342.

One hundred twenty-eight 128 otherwise healthy children (aged 6-24 months; mean, 12.6 months) with acute diarrhea were randomly assigned to receive, in double-blind fashion, oral glutamine (0.3 g per kg of body weight per day) or placebo for 7 days, in addition to standard therapy. The mean duration of diarrhea was significantly shorter in the glutamine group than in the placebo group (3.40 vs. 4.57 days; 25.7% reduction; p = 0.004). Compared with placebo, glutamine had no effect on serum interleukin-8 and salivary IgA levels, suggesting that its effects on the gastrointestinal mucosa, rather than on immune function, were responsible for the improvement in diarrhea.

Comment: Glutamine is known to protect the structure and function of the intestinal mucosa in various catabolic states. The present study demonstrates that glutamine supplementation can decrease the duration of acute diarrhea in children. While the dose used was relatively large (equivalent to 21 g/day for a 70-kg person), even larger doses of glutamine have been given to humans without producing any apparent deleterious effects. Glutamine should, therefore, be considered for the treatment of young children with acute diarrhea.

Yalcin SS, et al. Effect of glutamine supplementation on diarrhea, interleukin-8 and secretory immunoglobulin A in children with acute diarrhea. J Pediatr Gastroenterol Nutr 2004;38:494-501.

One hundred-twelve people (aged 18-70 years) with seasonal allergic rhinitis were randomly assigned to receive, in double-blind fashion, 800 IU/day of vitamin E or placebo, in addition to their regular anti-allergy treatment, during the pollen season (March through May, 2002). The mean daily total symptom score was 23.4% lower (indicating less severe symptoms) in the vitamin E group than in the placebo group (p = 0.04). The percent reductions in nasal and ocular symptoms were similar, but only the reduction in nasal symptoms was statistically significant. The percentage of days with serious symptoms was nonsignificantly lower (by 17% to 37%, depending on the symptom) in the vitamin E group than in the placebo group. Vitamin E did not reduce the percentage of days that medications were used to control allergic symptoms.

Comment: These results indicate that vitamin E is a useful adjunct to conventional allergy therapy in the treatment of seasonal allergic rhinitis. Some older studies suggest that vitamin E by itself is not effective against hay fever, although there is one case report of vitamin E relieving symptoms of nasal allergy. Future studies should investigate whether combining vitamin E with other nutrients (such as vitamin C, magnesium, pantothenic acid, and calcium) can be successfully used as an alternative to anti-allergy medications.

Shahar E, et al. Effect of vitamin E supplementation on the regular treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2004;92:654-658.

A water-soluble, low-molecular-weight fraction from tomato paste, when present at a concentration of 8% of the total incubation mixture, inhibited the formation of advanced glycation end products after incubating protein with either glucose or fructose. The inhibitory effect of the tomato extract appeared to be due mainly to its rutin content, but other factors may have contributed, as well.

Comment: Advanced glycation end products (AGEs) are compounds formed by the interaction of protein molecules and reducing sugars (fructose, glucose, or lactose). The formation of AGEs in the body is believed to be a significant contributing factor to the aging process, and may also play an important role in the pathogenesis of cardiovascular disease and complications of diabetes. The results of the present study suggest that eating tomato products might inhibit the formation of these tissue-damaging compounds. When these findings are combined with the known antioxidant and anti-cancer effects of lycopene (a carotenoid present in large amounts in tomatoes), as well as recent reports that tomato extracts inhibit platelet aggregation, tomatoes are looking more and more like a "health food." One wonders what our ancestors were thinking when they proclaimed that tomatoes are poisonous.

Kiho T, et al. Tomato paste fraction inhibiting the formation of advanced glycation end-products. Biosci Biotechnol Biochem 2004;68:200-205.

Fifteen patients with psoriasis who were taking lithium were randomly assigned to receive, in double-blind fashion, 6 g/day of inositol or placebo for 10 weeks. After a 4-week washout period, each patient received the alternate treatment for an additional 10 weeks. The severity of psoriasis, as determined by the Psoriasis Area and Severity Index (PASI) score, was assessed at the beginning and end of each treatment period. The median PASI score decreased (improved) by 35% during treatment with inositol, whereas the score increased (worsened) by 63% during treatment with placebo (p = 0.015 for the difference in the change between treatment periods). Thirteen of 15 patients improved while receiving inositol, compared with 7 of 15 during treatment with placebo. In 11 other psoriasis patients who were not taking lithium, there was a nonsignificant trend toward a worse outcome with inositol, compared with placebo.

Comment: Treatment with lithium carbonate can trigger or exacerbate psoriasis. The therapeutic effect of lithium in bipolar disorder appears to be mediated by a depletion of inositol. Supplementation with inositol has been shown to reduce some of the adverse peripheral side effects of lithium (such as polyuria), without reducing its beneficial central effects. The results of the present study indicate that inositol is beneficial in the treatment of lithium-induced psoriasis, but does not improve psoriasis in people not taking lithium.

Allan SJR, et al. The effect of inositol supplements on the psoriasis of patients taking lithium: a randomized, placebo-controlled trial. Br J Dermatol 2004;150:966-969.

People over the age of 50 are advised to undergo periodic colonoscopy, as a screening test for colon cancer. Most people who have a colonoscopy in the United States are sedated for the procedure, whereas in most other countries it is done without sedation. The advantages of a sedation-free procedure are that it takes less time, is much less expensive (because of a reduced need for equipment, facilities, and anesthesiologist and nurse time), and permits patients to resume their normal activities much more rapidly after the procedure is finished.
In a prospective study of 1,061 colonoscopy patients who were given the option of a sedation-free procedure, 36% agreed to try it. Of those, 94% completed the colonoscopy without sedation. Five factors were identified that could be used to predict which patients could successfully undergo the procedure without sedation. These factors were 1) male gender, 2) younger age, 3) endomorphic body type in women, 4) no prior hysterectomy, and 5) willingness to try the sedation-free procedure (with the assurance that at any point during the procedure the patients could change their mind and immediately receive sedation).

Comment: Some 60 million Americans are over the age of 50. At an average cost of $1,000 per colonoscopy, it would cost approximately $60 billion to screen this population just one time for colon cancer. With increasing numbers of insurers now agreeing to pay for routine colonoscopies, the added cost burden to the health-care system will be substantial. If all appropriate candidates were offered the sedation-free alternative, billions of dollars a year could be saved.

Jancin B. Identify candidates for sedation-free colonoscopy. Fam Pract News 2004(September 15):38.

Thirty-three patients with a history of migraines associated with photophobia were given specially made red-tinted contact lenses to insert during acute attacks. Thirty-one patients experienced rapid pain relief, of whom 26 had complete relief. For most patients, improvement began within 5 minutes, and pain relief was maximal within 90 minutes. In 5 cases, complete relief of pain occurred within 10 seconds of inserting the lenses. The contact lenses used were dark red and blocked 90% of wavelengths of 600 nm or less, while admitting 90% of wavelengths of 700 nm or more.

Comment: The investigators who performed this study hypothesized that certain wavelengths of light may over-stimulate retinal receptors, resulting in the typical migraine pain that is exacerbated by light exposure. The choice of contact-lens color was based on their earlier discovery that patients with photophobia caused by cone-rod dystrophy benefited from that type of lens. Contact lenses were chosen over eyeglasses, because eyeglasses allow glare to reach the retina through the sides and from above.

There are three types of color-sensing cones in the retina that are sensitive to long, medium, and short wavelengths of light, respectively. The lenses used in this study blocked the medium and short wavelengths, allowing selective stimulation of the long-wavelength cones. It is possible that certain wavelengths stimulate migraine pain, whereas other wavelengths inhibit it. Being in total darkness is known to provide some degree of pain relief for migraine sufferers, but selectively blocking specific wavelengths appears to be even more effective.

The investigators, Dr. Richard L. Garrison and Kathleen Saathoff of San Jacinto Methodist Hospital in Baytown, TX, acknowledge that the lens color chosen for this study may not be optimal; tints that filter different wavelengths may turn out to be even more effective.

Mahoney D. Red contact lenses help relieve acute migraine. Fam Pract News 2004(December 1):59.