Fifty-eight adults (mean age, 49 years) with normal to mildly elevated plasma cholesterol concentrations were randomly assigned to receive, in double-blind fashion, 20 mg/day of wheat germ policosanol or placebo for 4 weeks. There were no significant changes in either group in plasma total-, LDL-, or HDL-cholesterol levels, or triglyceride concentrations when compared with baseline values, and there were no significant differences in these parameters between groups at the end of the study. Chemical analysis showed that wheat germ policosanol consists of 8% hexacosanol, 67% octacosanol, 12% triacosanol, and 13% other long-chain alcohols, which is similar to the composition of sugar cane policosanol.

Comment: Policosanol is a mixture of long chain (C24 to C34) primary alcohols, originally isolated from sugar cane wax. These long-chain primary alcohols are also found in bee's wax, rice bran, and wheat germ. A number of studies have found that sugar cane policosanol lowers serum cholesterol levels as effectively as various statin drugs. However, all published studies demonstrating a beneficial effect of sugar cane policosanol were conducted by one research group or sponsored by one company. In a study in hamsters, neither sugar cane policosanol nor rice wax policosanol lowered plasma total- or LDL-cholesterol levels. The failure of wheat germ policosanol to lower cholesterol levels in the present study cannot be explained by the initially normal or mildly elevated cholesterol concentrations, because sugar cane policosanol has been reported to lower cholesterol levels independently of the initial levels. Beeswax policosanol is also said to be ineffective.

There seems to be two possible conclusions from the available evidence: that sugar cane policosanol is the only effective form of policosanol or that there is something wrong with the sugar cane policosanol research. An independent investigation of sugar cane policosanol would be worthwhile, as would letters from readers about their experiences with policosanol.

Lin Y, et al. Wheat germ policosanol failed to lower plasma cholesterol in subjects with normal to mildly elevated cholesterol concentrations. Metabolism 2004;53:1309-1314.

Twenty-four patients (mean age, 61 years) with tinnitus for a mean duration of 11.3 years received 3 mg/day of melatonin 1-2 hours before bedtime for four weeks, followed by four weeks of observation with no melatonin treatment. The Tinnitus Handicap Inventory (THI) and the Pittsburgh Sleep Quality Index (PSQI) were administered at baseline and after four and eight weeks. Compared with baseline, the mean THI score decreased (improved) significantly by 18.6% after four weeks and by 29.4% after eight weeks. The mean PSQI also improved after four weeks (p < 0.0001) and eight weeks (p = 0.0003). There was an association between the improvement in sleep and the improvement in tinnitus, but this association was significant only at four weeks. The impact of melatonin on sleep was greatest among patients with the worst sleep quality, but its impact on tinnitus was not associated with the severity of the tinnitus.

Comment: The results of this study indicate that melatonin may be an effective treatment for idiopathic tinnitus. Melatonin is known to improve sleep quality in some patients. However it is not clear whether the improvement in tinnitus in this study was due to better sleep or to some other mechanism. The improvement in tinnitus is noteworthy, because this condition is frequently refractory to treatment. Of note, tinnitus continued to improve after melatonin was discontinued and after the improvement in sleep resulting from melatonin therapy reverted partially back toward the baseline value during the second four-week period. This suggests that a four-week course of melatonin may have produced a lasting benefit.

Megwalu UC, et al. The effects of melatonin on tinnitus and sleep. Otolaryngol Head Neck Surg. 2006;134:210-213.

Benzene, a known carcinogen, has been found in a number of soft drinks at concentrations far in excess of the legal limit for drinking water. Various regulatory agencies around the world have set upper limits for benzene in drinking water between 1 and 10 parts per billion (ppb). However, recent tests by an independent New York laboratory found benzene concentrations several times higher than 10 ppb. In the 1990s, Perrier sparkling water was recalled when benzene was found at concentrations lower than those reported for the soft drinks, but no recall was ordered this time for the offending drinks.

It has been known for at least 15 years that that sodium benzoate (a preservative) and ascorbic acid can react in drinks to form benzene. The formation of benzene can easily be prevented by not adding sodium benzoate to drinks that contain ascorbic acid.

Comment: In the past, the soft drink industry was successful at keeping benzene out of beverages. However, according to an industry spokesman, "there are a lot of new companies, a lot of new brands, and things have changed." It's like the old Steve Martin routine:
Judge: "Didn't you know it is against the law to rob a bank?"
Defendant: "Yes, your honor, I did, but I forgot."
Almost makes you want to stop drinking sugary, acidic, artificially colored drinks.

Mercer C. Soft drinks industry pledges to tackle benzene in drinks. http://www.beveragedaily.com/news/ng.asp?n=66084-benzene-soft-drinks-aba. Accessed April 5, 2006.

Sixty-four patients (mean age, 66 years) with chronic obstructive pulmonary disease (COPD) were randomly assigned to receive 400 kcal/day day of a nutritional supplement that was either high (0.6 g/day) (omega-3 group) or low (0.07 g/day) (control group) in omega-3 polyunsaturated fatty acids (mainly alpha-linolenic acid) for two years. In six-minute walk testing, both dyspnea and the decrease of arterial oxygen saturation significantly improved in the omega-3 group. Leukotriene B4 levels in serum and sputum and tumor necrosis factor-alpha and interleukin-8 levels in sputum decreased significantly in the omega-3 group, but did not change in the control group.

Comment: These results indicate that supplementation with a modest dose of omega-3 polyunsaturated fatty acids for two years reduced inflammatory markers and improved exercise tolerance in patients with COPD. Most patients with COPD have a broad range of nutritional deficiencies, and a comprehensive nutritional-support program (including adequate amounts of calories and protein) may be beneficial. Aside from omega-3 fatty acids, nutrients that have been shown to improve clinical status include magnesium, N-acetylcysteine, L-carnitine, and creatine. In addition, food allergy is sometimes a contributing factor to the chronic bronchitis component of COPD. Inhaled glutathione has been used empirically by some practitioners, and the results have been highly encouraging.

Matsuyama W, et al. Effects of omega-3 polyunsaturated fatty acids on inflammatory markers in COPD. Chest 2005;128:3817-3827.

Eleven children (median age, 2.6 years; range, 1.8-10.3 years) who had avoided cow's milk for 1.4 to 9.5 years (median, 2.3 years) because of atopic dermatitis underwent double-blind placebo-controlled food challenges. Before the elimination of cow's milk from their diet, all 11 children had had positive skin prick or specific IgE tests, or both, to cow's milk, but had ingested it without the development of acute reactions. After elimination of cow's milk, the dermatitis had not improved, but the diet was continued. During the elimination period, 8 of 11 children developed severe acute allergic reactions after accidental ingestion of cow's milk. During evaluation at the clinic, all 11 children experienced acute allergic reactions to cow's milk (manifesting as urticaria, dyspnea, vomiting, cough, or rhinoconjunctivitis) during double-blind placebo-controlled challenges. The authors concluded there is a considerable chance of developing acute allergic reactions to cow's milk after prolonged cow's milk elimination in children with atopic dermatitis who did not experience acute problems from cow's milk before avoiding it. They suggested that a tolerant state can be maintained by continuous exposure to small amounts of cow's milk.

Comment: Having supervised elimination diets for more than 2,000 patients, I have no doubt that identifying and avoiding allergenic foods is one of the most important components of treating many chronic illnesses. Acute and exaggerated reactions to allergenic foods are common during the first several weeks on an elimination diet, but the severity of the reactions gradually diminishes in most cases with continued avoidance of the offending foods. However, going on an elimination diet will occasionally open up a Pandora's box, in which the patient begins to react to various foods and chemicals to which he or she had not previously reacted. Even if the patient's original symptoms improve, the development of these new reactions can be problematic. The results of the present study indicate that such reactivity to cow's milk can persist for years in some children. In certain cases, it may be advisable to have the patient ingest small amounts of the allergenic food at regular intervals in order to induce tolerance, or to attempt to desensitize the patient to the allergen.

Flinterman AE, et al. Acute allergic reactions in children with AEDS after prolonged cow's milk elimination diets. Allergy. 2006;61:370-374.

The association between breastfeeding and subsequent development of myopia was examined in a cross-sectional study of 797 children aged 10-12 years in Singapore. The prevalence of myopia was significantly lower in children who had been breastfed than in those who had not (62% vs. 69.1%; p = 0.04). A history of being breastfed was associated with a decreased risk of myopia (odds ratio = 0.73; 95% confidence interval, 0.54-0.98). The duration of breastfeeding (three months or less vs. more than three months) was not associated with myopia risk.

Comment: The results of this study suggest that breast-feeding, even for a relatively short period time, can reduce the incidence of nearsightedness among children. Presumably, certain substances in human milk influence the shape of the developing eyeball or cornea. Prevention of myopia can now be added to the long list of potential benefits to be derived from breast-feeding, including better brain development, improved immune function, and lower risk of allergies.

Chong YS, et al. Association between breastfeeding and likelihood of myopia in children. JAMA. 2005;293:3001-3002.

Twelve outpatients with bipolar disorder who currently suffered from mild-to-moderate depression received 1.5-2.0 g/day of eicosapentaenoic acid (EPA; Laxdale, Ltd.) for up to 6 months, in addition to their usual medication (lithium, valproate, carbamazepine, or others). Eight of the 10 patients who completed at least 1 month of follow-up achieved a 50%-or-greater reduction (improvement) in Hamilton Rating Scale for Depression scores within one month. One other patient achieved a 50% reduction by the end of the second month. No patient developed hypomania or manic symptoms. No significant side effects were reported.

Comment: Treatment of bipolar disorder with conventional antidepressants is associated with a high risk of inducing mania. In the present study, administration of EPA appeared to reduce the severity of depression, without precipitating a manic episode in patients with mild-to-moderate bipolar depression. Consequently, this treatment might turn out to be a safe and effective treatment for bipolar disorder. However, there is one previous case report of hypomania developing in a depressed woman treated with a combination of EPA (220 mg/day) and docosahexaenoic acid (DHA; 330 mg/day), two fatty acids found in fish oil. Patients with bipolar disorder should therefore be monitored closely during treatment with EPA or fish oil. Pure EPA is apparently not yet commercially available in the U.S. It is not known whether the combination of EPA and DHA, as one would obtain from fish oil, would have the same effect on depression as pure EPA does.

Osher Y, et al. Omega-3 eicosapentaenoic acid in bipolar depression: report of a small open-label study. J Clin Psychiatry. 2005;66:726-729.

Eight patients (aged 45-79 years) receiving warfarin, whose international normalized ratios (INRs) had been fluctuating for reasons that were not clear, received 100 mcg/day of oral vitamin K1. After vitamin K supplementation, INR fluctuations decreased in nearly all patients. A significant decrease was seen in the INR standard deviation (p < 005), and more INRs were within 0.2 units of the target range (57% vs. 32% prior to supplementation).

Comment: Warfarin is a frequently prescribed anticoagulant that reduces the risk of cardiovascular events in certain high-risk groups. Warfarin works by interfering with the action of vitamin K. The main side effect of warfarin is bleeding, which sometimes causes serious problems. Patients receiving warfarin must have their INR (a measure of blood clotting efficiency) checked frequently, to assure that their warfarin dose is therapeutic but not excessive. In some cases, the INR fluctuates substantially, resulting in both undertreatment and overtreatment. It has been shown previously that keeping vitamin K intake relatively stable is a good way to minimize INR fluctuations. The results of the present study suggest that stabilizing vitamin K intake at a higher level, by taking a daily low-dose vitamin K supplement, would be an even more effective way to prevent INR fluctuations. The extra vitamin K might also reduce the risk of osteoporosis and of vascular calcifications. The risk of developing these two conditions is increased by warfarin supplementation, presumably because the drug interferes with the beneficial effects of vitamin K on bone and vascular tissue.

Reese AM, et al. Low-dose vitamin K to augment anticoagulation control. Pharmacotherapy 2005;25:1746-1751.