Rice bran treatment for patients with hypercalciuric stones: experimental and clinical studies

A case-based review of dietary management of calcium oxalate stones

PURPOSE

The purpose of this paper is to help patients with calcium oxalate stones to access prevention and treatment options with dietary management.

METHODS

Typical cases in our hospital and other hospitals were selected for case review; combined with literature review through PubMed search, comprehensive analysis and suggestions were put forward.

RESULTS

By retrieving the literature with sufficient evidence, selecting, and summarizing, analysis of dietary liquid, oxalate and oxalate precursors, calcium, protein, fruits and vegetables, salt, high dietary fiber, and other content with high evidence index was carried out, respectively.

CONCLUSION

Through the retrospective analysis of typical cases and literature review, the importance of diet management in the prevention and treatment of calcium oxalate stones was emphasized again, and suggestions were put forward to promote the prevention and treatment of calcium oxalate stones.

Status of Bioactive Compounds from Bran of Pigmented Traditional Rice Varieties and Their Scope in Production of Medicinal Food with Nutraceutical Importance

Consumption of pigmented rice as a staple food is rapidly increasing due to their healthy prospective and considered as functional food ingredients. Greater interest has been shown in many color rice varieties due to their multiple biological activities. The phenolic compounds have been found to consist of anthocyanidins, ferulic acid, diferulates, anthocyanins and polymeric proanthocyanidins. Anthocyanin is located in the bran layers of the rice kernel, while phenolic acids are mainly present in the bran layers of rice, existing as free, conjugated and bound forms. Keeping in view the several health benefits associated with the functional ingredients, such as anti-inflammatory, antioxidative and anticancer effects, pigmented rice is considered as a functional food and food ingredient in many Asian countries. The application and incorporation of bran into food products for the preparation of functional foods is increasing. Within the scope of this review, we highlighted the significant bioactive compounds from pigmented rice varieties and their potentials for medicinal and nutraceutical ingredients. The information provided from this could be of high benefit to the functional food industry and further research advance medicinal products.

Exploring the Potential Relationship Between Phytate Ingestion, Urinary Phytate Excretion, and Renal Stone Risk in a Unique Human Model: No Hard Evidence in Support of Phytate as a Stone Inhibitor

OBJECTIVE

Dietary phytate (IP6) enjoys a reputation as an inhibitor of calcium renal stone formation, although there are very few human studies to support this notion. In South Africa, urolithiasis occurs in the white (W) but is rare in the black (B) population. We undertook this unique human model to further investigate the IP6 theory.

METHODS

Healthy W and B males completed baseline food-frequency recall questionnaires. Dietary intake of IP6 was restricted for 18 days. An IP6 dietary supplement was ingested on days 15-18. Twenty-four-hour urinary phytate and other urinary components were determined. Relative supersaturations of calcium salts were calculated. The urinary metastable limit (MSL) of calcium oxalate (CaOx) and its crystallisation kinetics were determined experimentally.

RESULTS

Habitual dietary intake of IP6 and its urinary excretion were significantly higher in B than in W (1650 ± 202 vs. 640 ± 134 mg/d, P = .0002 and 1.13 ± 0.12 vs. 0.75 ± 0.13 μM, P <.05, respectively). In B, urinary phytate decreased significantly after 15 days of IP6 restriction, but in W, its excretion remained constant. After supplementation, urinary IP6 increased significantly in both groups reaching levels commensurate with the baseline value in B. No significant differences occurred in B in any of the routine urinary risk factors throughout the trial. However, in W, urinary citrate excretion increased on day 18 relative to day 0. There were no significant intragroup or intergroup changes in relative supersaturation, metastable limit, or crystallization kinetics.

CONCLUSIONS

Despite notable differences in the renal handling of ingested IP6, there were no changes in any of the well-established urinary risk factors for calcium renal stone formation in either of our uniquely different test groups. We conclude that, in the absence of hard evidence, claims that IP6 is a stone inhibitor remain unproven.

Dietary intake of fiber, fruit and vegetables decreases the risk of incident kidney stones in women: a Women's Health Initiative report

PURPOSE

We evaluated the relationship between dietary fiber, fruit and vegetable intake, and the risk of kidney stone formation.

MATERIALS AND METHODS

Overall 83,922 postmenopausal women from the Women's Health Initiative observational study were included in the analysis and followed prospectively. Cox proportional hazards regression analyses were used to evaluate the associations between total dietary fiber, fruit and vegetable intake, and the risk of incident kidney stone formation, adjusting for nephrolithiasis risk factors (age, race/ethnicity, geographic region, diabetes mellitus, calcium supplementation, hormone therapy use, body mass index and calibrated caloric intake; and dietary water, sodium, animal protein and calcium intake). Women with a history of kidney stones (3,471) were analyzed separately.

RESULTS

Mean age of the women was 64±7 years, 85% were white and 2,937 (3.5%) experienced a kidney stone in a median followup of 8 years. In women with no history of kidney stones higher total dietary fiber (6% to 26% decreased risk, p <0.001), greater fruit intake (12% to 25% decreased risk, p <0.001) and greater vegetable intake (9% to 22% decreased risk, p=0.002) were associated with a decreased risk of incident kidney stone formation in separate adjusted models. In women with a history of stones there were no significant protective effects of fiber, fruit or vegetable intake on the risk of kidney stone recurrence.

CONCLUSIONS

Greater dietary intake of fiber, fruits and vegetables was associated with a reduced risk of incident kidney stones in postmenopausal women. The protective effects were independent of other known risk factors for kidney stones. In contrast, there was no reduction in risk in women with a history of stones.

A novel model to explain dietary factors affecting hypocalcaemia in dairy cattle

Most dairy cows exhibit different degrees of hypocalcaemia around calving because the gestational Ca requirements shift to the disproportionately high Ca requirements of lactation. Ca homeostasis is a robust system that effectively adapts to changes in Ca demand or supply. However, these adaptations often are not rapid enough to avoid hypocalcaemia. A delay in the reconfiguration of intestinal Ca absorption and bone resorption is probably the underlying cause of this transient hypocalcaemia. Several dietary factors that affect different aspects of Ca metabolism are known to reduce the incidence of milk fever. The present review describes the interactions between nutrition and Ca homeostasis using observations from cattle and extrapolations from other species and aims to quantitatively model the effects of the nutritional approaches that are used to induce dry cows into an early adaptation of Ca metabolism. The present model suggests that reducing dietary cation–anion difference (DCAD) increases Ca clearance from the blood by dietary induction of systemic acidosis, which results in hypercalciuria due to the loss of function of the renal Ca transient receptor potential vanilloid channel TRPV5. Alternatively, reducing the gastrointestinal availability of Ca by reducing dietary Ca or its nutritional availability will also induce the activation of Ca metabolism to compensate for basal blood Ca clearance. Our model of gastrointestinal Ca availability as well as blood Ca clearance in the transition dairy cow allowed us to conclude that the most common dietary strategies for milk fever prevention may have analogous modes of action that are based on the principle of metabolic adaptation before calving.

Stereospecificity of myo-inositol hexakisphosphate hydrolysis by a protein tyrosine phosphatase-like inositol polyphosphatase from Megasphaera elsdenii

Inositol polyphosphatases (IPPases), particularly those that can hydrolyze myo-inositol hexakisphosphate (Ins P(6)), are of biotechnological interest for their ability to reduce the metabolically unavailable organic phosphate content of feedstuffs and to produce lower inositol polyphosphates (IPPs) for research and pharmaceutical applications. Here, the gene coding for a new protein tyrosine phosphatase (PTP)-like IPPase was cloned from Megasphaera elsdenii (phyAme), and the biochemical properties of the recombinant protein were determined. The deduced amino acid sequence of PhyAme is similar to known PTP-like IPPases (29-44% identity), and the recombinant enzyme displayed strict specificity for IPP substrates. Optimal IPPase activity was displayed at an ionic strength of 250 mM, a pH of 5.0, and a temperature of 60 degrees C. In order to elucidate its stereospecificity of Ins P(6) dephosphorylation, a combination of high-performance ion-pair chromatography and kinetic studies was conducted. PhyAme displayed a stereospecificity that is unique among enzymes belonging to this class in that it preferentially cleaved Ins P(6) at one of two phosphate positions, 1D-3 or 1D-4. PhyAme followed two distinct and specific routes of hydrolysis, predominantly degrading Ins P(6) to Ins(2)P via: (a) 1D-Ins(1,2,4,5,6)P(5), 1D-Ins(1,2,5,6)P(4), 1D-Ins(1,2,6)P(3), and 1D-Ins(1,2)P(2) (60%) and (b) 1D-Ins(1,2,3,5,6)P(5), 1D-Ins(1,2,3,6)P(4), Ins(1,2,3)P(3), and D/L-Ins(1,2)P(2)(35%).

Influence of a low- and a high-oxalate vegetarian diet on intestinal oxalate absorption and urinary excretion

OBJECTIVE

To compare quantitatively the effect of a low- and a high-oxalate vegetarian diet on intestinal oxalate absorption and urinary excretion.

SUBJECTS AND METHODS

Eight healthy volunteers (three men and five women, mean age 28.6+/-6.3) were studied. Each volunteer performed the [(13)C(2)]oxalate absorption test thrice on a low-oxalate mixed diet, thrice on a low-oxalate vegetarian diet and thrice on a high-oxalate vegetarian diet. For each test, the volunteers had to adhere to an identical diet and collect their 24-h urines. In the morning of the second day, a capsule containing [(13)C(2)]oxalate was ingested.

RESULTS

On the low-oxalate vegetarian diet, mean intestinal oxalate absorption and urinary oxalate excretion increased significantly to 15.8+/-2.9% (P=0.012) and 0.414+/-0.126 mmol/day (P=0.012), compared to the mixed diet. On the high-oxalate vegetarian diet, oxalate absorption (12.5+/-4.6%, P=0.161) and urinary excretion (0.340+/-0.077 mmol/day, P=0.093) did not change significantly, compared to the mixed diet.

CONCLUSIONS

A vegetarian diet can only be recommended for calcium oxalate stone patients, if the diet (1) contains the recommended amounts of divalent cations such as calcium and its timing of ingestion to a meal rich in oxalate is considered and (2) excludes foodstuffs with a high content of nutritional factors, such as phytic acid, which are able to chelate calcium.

Herbs or Natural Products That Protect Against Cancer Growth: Part Three of a Four-Part Series

PURPOSE/OBJECTIVES

To provide evidence-based research information about 47 herbs and natural products that have the potential to protect against the development of cancer.

DATA SOURCES

Natural Medicines Comprehensive Database and Lawrence Review of Natural Products-Monograph System. Information about these herbs has been found in evidence-based studies cited in the references.

DATA SYNTHESIS

Early research shows that some herbs and natural products appear to have the potential to prevent cancer growth.

CONCLUSIONS

This preliminary evidence may be useful to healthcare professionals or patients who are concerned about cancer.

IMPLICATIONS FOR NURSING

Oncology nurses who receive this information can become resources for patients or other healthcare professionals.

Protection against cancer by dietary IP6 and inositol

Inositol hexaphosphate (IP(6)) is a naturally occurring polyphosphorylated carbohydrate, abundantly present in many plant sources and in certain high-fiber diets, such as cereals and legumes. In addition to being found in plants, IP(6) is contained in almost all mammalian cells, although in much smaller amounts, where it is important in regulating vital cellular functions such as signal transduction, cell proliferation, and differentiation. For a long time IP(6) has been recognized as a natural antioxidant. Recently IP(6) has received much attention for its role in cancer prevention and control of experimental tumor growth, progression, and metastasis. In addition, IP(6) possesses other significant benefits for human health, such as the ability to enhance immune system, prevent pathological calcification and kidney stone formation, lower elevated serum cholesterol, and reduce pathological platelet activity. In this review we show the efficacy and discuss some of the molecular mechanisms that govern the action of this dietary agent. Exogenously administered IP(6) is rapidly taken up into cells and dephosphorylated to lower inositol phosphates, which further affect signal transduction pathways resulting in cell cycle arrest. A striking anticancer action of IP(6) was demonstrated in different experimental models. In addition to reducing cell proliferation, IP(6) also induces differentiation of malignant cells. Enhanced immunity and antioxidant properties also contribute to tumor cell destruction. Preliminary studies in humans show that IP(6) and inositol, the precursor molecule of IP(6), appear to enhance the anticancer effect of conventional chemotherapy, control cancer metastases, and improve quality of life. Because it is abundantly present in regular diet, efficiently absorbed from the gastrointestinal tract, and safe, IP(6) + inositol holds great promise in our strategies for cancer prevention and therapy. There is clearly enough evidence to justify the initiation of full-scale clinical trials in humans.

Intestinal transport of an obdurate anion: oxalate

In this review, we focus on the role of gastrointestinal transport of oxalate primarily from a contemporary physiological standpoint with an emphasis on those aspects that we believe may be most important in efforts to mitigate the untoward effects of oxalate. Included in this review is a general discussion of intestinal solute transport as it relates to oxalate, considering cellular and paracellular avenues, the transport mechanisms, and the molecular identities of oxalate transporters. In addition, we review the role of the intestine in oxalate disease states and various factors affecting oxalate absorption.

Novel biosensors for quantitative phytic acid and phytase measurement

Phytase (EC 3.1.3.26) and phytic acid (myo-inositol hexaphosphate) play an important environmental role in poultry industry and have a health aspect in food industry. Novel biosensors have been developed for simple, one step quantitative phytic acid and phytase detection. A system based on the sequentially acting enzyme phytase and pyruvate oxidase (POD) was employed for the development of phytase and phytic acid biosensors. Poly(carbamoylsulphonate) (PCS) hydrogel immobilized POD electrode was applied for the detection of phytase. It was based on the indication of phosphate ions produced by the hydrolysis of phytic acid. The phytase biosensor showed a linear response ranging from 0.5 to 6.0 units/ml. A bi-enzyme sensor based on co-immobilization of phytase and POD was developed for the detection of phytic acid on the basis of amperometric detection of the enzymatically-generated hydrogen peroxide at 0.6 V versus Ag/AgCl. It showed a linear response ranging from 0.2 to 2.0 mM with a detection limit of 0.002 mM.

Cancer inhibition by inositol hexaphosphate (IP6) and inositol: from laboratory to clinic

Inositol hexaphosphate (IP6) is a naturally occurring polyphosphorylated carbohydrate that is present in substantial amounts in almost all plant and mammalian cells. It was recently recognized to possess multiple biological functions. A striking anticancer effect of IP6 was demonstrated in different experimental models. Inositol is also a natural constituent possessing moderate anticancer activity. The most consistent and best anticancer results were obtained from the combination of IP6 plus inositol. In addition to reducing cell proliferation, IP6 increases differentiation of malignant cells, often resulting in a reversion to normal phenotype. Exogenously administered IP6 is rapidly taken into the cells and dephosphorylated to lower-phosphate inositol phosphates, which further interfere with signal transduction pathways and cell cycle arrest. Enhanced immunity and antioxidant properties can also contribute to tumor cell destruction. However, the molecular mechanisms underlying this anticancer action are not fully understood. Because it is abundantly present in regular diet, efficiently absorbed from the gastrointestinal tract, and safe, IP6 holds great promise in our strategies for the prevention and treatment of cancer. IP6 plus inositol enhances the anticancer effect of conventional chemotherapy, controls cancer metastases, and improves the quality of life, as shown in a pilot clinical trial. The data strongly argue for the use of IP6 plus inositol in our strategies for cancer prevention and treatment. However, the effectiveness and safety of IP6 plus inositol at therapeutic doses needs to be determined in phase I and phase II clinical trials in humans.

The pathway of dephosphorylation of myo-inositol hexakisphosphate by phytate-degrading enzymes of different Bacillus spp

The pathway of dephosphorylation of myo-inositol hexakisphosphate by the phytate-degrading enzymes of Bacillus subtilis 168, Bacillus amyloliquefaciens ATCC 15841, and Bacillus amyloliquefaciens 45 was established using a combination of high-performance ion chromatography analysis and kinetic studies. The data demonstrate that all the Bacillus phytate-degrading enzymes under investigation dephosphorylate myo-inositol hexakisphosphate by sequential removal of phosphate groups via two independent routes; the routes proceed via D-Ins(1,2,4,5,6)P5 to Ins(2,4,5,6)P4 to finally Ins(2,4,6)P3 or D-Ins(2,5,6)P3 and via D-Ins(1,2,4,5,6)P5 to D-Ins(1,2,5,6)P4 to finally D-Ins(1,2,6)P3. The resulting myo-inositol trisphosphate D-Ins(1,2,6)P3 was degraded via D-Ins(2,6)P2 to finally Ins(2)P after prolonged incubation times in combination with increased enzyme concentration.

Anti‐cancer function of phytic acid

Summary Inositol hexaphosphate (InsP6 a.k.a. phytic acid or IP6) is ubiquitous. In the plant kingdom it is particularly abundant in cereals and legumes; in much smaller amounts IP6 and its lower phosphorylated forms (IP1−5) are contained in most mammalian cells, where they are important in regulating vital cellular functions. Both in vivo and in vitro experiments have demonstrated striking anticancer (preventive as well as therapeutic) effects of IP6. Inositol also is anti‐carcinogenic, albeit to a lesser extent; it acts synergistically IP6 in inhibiting cancer. In addition to reduction in cell proliferation, IP6 increases differentiation of malignant cells often resulting in reversion to the normal phenotype. IP6 is quickly absorbed from the rat stomach and upper intestine and distributed as inositol and IP1. In vitro, it is instantaneously taken up by malignant cells undergoing variable dephosphorylation to inositol and IP1−5, pointing towards their role in mediating the action of IP6. In humans, IP6 has recently been detected in urine, plasma and other biological fluids; the levels fluctuating with ingestion or deprivation of IP6 or IP6‐rich diet. As IP6 is high in high‐fibre diets, these also may explain, at least in part, the epidemiological observation showing the association of ingesting high‐fibre diets with a lower incidence of certain cancers. Along with safety, the reproducible efficacy of IP6 and inositol in the prevention of cancer in laboratory animals warrant their inclusion in our strategies for cancer prevention and perhaps therapy in humans. Aside from the anticancer action, IP6 and inositol also have numerous other health benefits. All these facts of normal physiological presence of IP6 in our body the level of which fluctuates with intake, association of an IP6‐rich diet with low incidence of several diseases and vice versa, and finally reversal of some of these conditions, at least in part, by IP6 supplementation strongly argue in favour of its inclusion as an essential nutrient or perhaps a vitamin.

Stereospecificity of myo-inositol hexakisphosphate dephosphorylation by a phytate-degrading enzyme of Escherichia coli

Using a combination of high-performance ion chromatography analysis and kinetic studies, the stereospecificity of myo-inositol hexakisphosphate dephosphorylation by the phytate-degrading enzyme P2 of Escherichia coli was established. High-performance ion chromatography revealed that the phytate-degrading enzyme P2 of E. coli degrades myo-inositol hexakisphosphate by stepwise dephosphorylation via D/L-Ins(1,2,3,4,5)P(5), D/L-Ins(2,3,4,5)P(4), D/L-Ins(2,4,5)P(3) or D/L-Ins(1,2,4)P(3), D/L-Ins(1,2)P(2) or Ins(2, 5)P(2) or D/L-Ins(4,5)P(2) to finally Ins(2)P or Ins(5)P. Kinetic parameters for myo-inositol pentakisphosphate hydrolysis by E. coli and wheat phytase, respectively, showed that the myo-inositol pentakisphosphate intermediate produced either by the phytate-degrading enzyme of wheat or E. coli are not identical. The absolute configuration of the myo-inositol pentakisphosphate isomer produced by the E. coli enzyme was determined by taking into consideration that wheat phytase produces predominantly the D-Ins(1, 2,3,5,6)P(5) isomer (Lim, P.E., Tate, M.E., 1973. The phytases: II. Properties of phytase fraction F(1) and F(2) from wheat bran and the myo-inositol phosphates produced by fraction F(2). Biochim. Biophys. Acta 302, 326-328). The data demonstrate that the phytate-degrading enzyme P2 of E. coli dephosphorylates myo-inositol hexakisphosphate in a stereospecific way by sequential removal of phosphate groups via D-Ins(1,2,3,4,5)P(5), D-Ins(2,3,4,5)P(4), D-Ins(2,4,5)P(3), Ins(2,5)P(2) to finally Ins(2)P (notation 6/1/3/4/5).

Modeling the effect of temperature and pH on activity of enzymes: the case of phytases

In this study, the behavior of enzyme activity as a function of pH and temperature is modeled on the basis of fundamental considerations. A formulation is developed that includes the activation of enzymes with increasing temperatures and the deactivation of enzymes at higher temperature, together with the effect of protonation and hydroxylation on activity at various constant pH levels. The model is calibrated and validated against an extensive set of experimental data on phytases from seven different origins. The percentage variance accounted for (R(2)(adj)), obtained by statistical nonlinear regression analysis on all data sets, was shown to range from 97.6% to 99.5%. The equilibrium constant of protonation and hydroxylation proved to be independent of temperature.

The role of phytic acid in legumes: antinutrient or beneficial function?

This review describes the present state of knowledge about phytic acid (phytate), which is often present in legume seeds. The antinutritional effects of phytic acid primarily relate to the strong chelating associated with its six reactive phosphate groups. Its ability to complex with proteins and particularly with minerals has been a subject of investigation from chemical and nutritional viewpoints. The hydrolysis of phytate into inositol and phosphates or phosphoric acid occurs as a result of phytase or nonenzymatic cleavage. Enzymes capable of hydrolysing phytates are widely distributed in micro-organisms, plants and animals. Phytases act in a stepwise manner to catalyse the hydrolysis of phytic acid. To reduce or eliminate the chelating ability of phytate, dephosphorylation of hexa- and penta-phosphate forms is essential since a high degree of phosphorylation is necessary to bind minerals. There are several methods of decreasing the inhibitory effect of phytic acid on mineral absorption (cooking, germination, fermentation, soaking, autolysis). Nevertheless, inositol hexaphosphate is receiving increased attention owing to its role in cancer prevention and/or therapy and its hypocholesterolaemic effect.

Aspectos nutricionais de fitatos e taninos

Os grãos de leguminosas contêm uma variedade de fatores antinutricionais que podem provocar efeitos fisiológicos adversos ou diminuir a biodisponibilidade de certos nutrientes. Danos crônicos leves devidos à prolongada ingestão de antinutrientes são muito difíceis de se avaliar. Como conseqüência, existem muitas controvérsias em estudos de biodisponibilidade in vivo a respeito da extrapolação de resultados de sistemas experimentais, para seres humanos que se alimentam com dietas complexas. O papel dos fatores antinutricionais tem sido rediscutido, em função de descobertas recentes que evidenciam o potencial de algumas dessas substâncias em exercer funções benéficas ao organismo humano. A habilidade do ácido fítico em atuar como anticarcinogênico, antioxidante e prestar contribuição nutricional no tratamento de diabetes, através da ação inibidora de a-amilases, são exemplos da diversidade de atuação dessas substâncias. Os taninos são antioxidantes, inibidores de determinadas enzimas e influenciam negativamente a digestibilidade de proteínas, no entanto, os seus efeitos em seres humanos ainda são desconhecidos.

[Alternative foods: a critical analysis of a proposal for nutritional intervention]

The nationwide use of a 'Multimixture' a formula based on alternative foods such as rice and/or wheat bran, sesame and squash seeds, cassava, beet and carrot leaves, several indigenous leafy vegetables, and ground egg shells has been proposed by the National Institute of Food and Nutrition (INAN) as an official solution to fight hunger among poor Brazilians. The fragile nutritional state of the target population may make technical or ethical questions appear purely academic, yet nutritional, toxicological, and practical feasibility considerations appear to warrant a revision of the INAN proposal. While the Multimixture approach may prove valid as a temporary solution in cases of extreme poverty, it is not universally applicable for the intended use, failing to take into account the age and nutritional status of the subjects or duration of the intervention.

Phytic acid in health and disease

Phytic acid (PA), a major phosphorus storage compound of most seeds and cereal grains, contributes about 1 to 7% of their dry weight. It may account for more than 70% of the total kernel phosphorus. PA has the strong ability to chelate multivalent metal ions, especially zinc, calcium, and iron. The binding can result in very insoluble salts that are poorly absorbed from the gastrointestinal tract, which results in poor bioavailability (BV) of minerals. Alternatively, the ability of PA to chelate minerals has been reported to have some protective effects, such as decreasing iron-mediated colon cancer risk and lowering serum cholesterol and triglycerides in experimental animals. Data from human studies are still lacking. PA is also considered to be a natural antioxidant and is suggested to have potential functions of reducing lipid peroxidation and as a preservative in foods. Finally, certain inositol phosphates, which may be derived from PA, have been noted to have a function in second messenger transduction systems. The potential nutritional significance of PA is discussed in this review.

Effects of magnesium citrate and phytin on reducing urinary calcium excretion in rats

The aim of this study was to determine and compare the effects of both magnesium citrate and phytin on reducing urinary calcium excretion under high-calcium-diet conditions during single and combined treatments. An animal experiment was carried out over a period of 4 weeks in 35 male rats. Urinary calcium excretion was reduced significantly by magnesium citrate and/or phytin in rats fed on high-calcium diets. The hypocalciuric effect of magnesium citrate was more evident than that of phytin. Urinary magnesium excretion was high in all experimental groups. However, the urinary magnesium/calcium ratios showed a consistent increase only in the groups treated with magnesium citrate. Urinary citrate excretion showed a relative increase with the introduction of magnesium citrate plus phytin; however, in both the high-calcium-diet group and the magnesium-citrate group this was found to be reduced. Urinary phosphate excretion was slightly higher in the groups treated with phytin. There was no definite difference in urinary oxalate concentration between the groups. No significant change was noted in the serum concentration of calcium, magnesium, or phosphate.

Effect of Desmodium styracifolium-triterpenoid on calcium oxalate renal stones

We have studied the inhibitory effects of Desmodium styracifolium-triterpenoid (Ds-t) (extracted from Desmodium styracifolium (Osbeck) Merr, a herbal medicine) on the formation of calcium oxalate renal stones induced experimentally by ethylene glycol (EG) and 1 alpha(OH)D3 (1 alpha D3) in rats. The incidence of urinary stone formation was 81% in the control group, which received EG and 1 alpha D3, and 29% in the Ds-t group, which received EG and 1 alpha D3 supplemented by Ds-t. The serum calcium (Ca) concentration in the Ds-t group was significantly elevated and urinary Ca excretion was markedly reduced. Urinary excretion of citrate (Cit), a factor that prevents stone formation, was significantly increased in the Ds-t group. Excretion of urinary phosphorus (P), which was elevated to a significantly greater extent in the controls than in the Ds-t group, was increased in both groups. The increase in urine volume in the Ds-t group was significantly greater than in the control group. The 24-h creatinine clearance rate (Ccr) was significantly lower in the controls. These findings suggest that Ds-t inhibits the formation of Ca oxalate stones in rat kidneys by increasing the output of urine, decreasing the excretion of calcium and increasing the urinary excretion of citrate. Ds-t may be useful in preventing the recurrence of urinary Ca oxalate stones in the clinical setting.

Results of long-term rice bran treatment on stone recurrence in hypercalciuric patients

A series of 182 calcium stone formers with idiopathic hypercalciuria underwent treatment with rice bran for 1 to 94 months. Urinary calcium excretion was considerably reduced, but there was some increase in urinary phosphate and oxalate. Urinary excretion of magnesium and uric acid, serum calcium, magnesium, phosphate, uric acid, parathyroid hormone (PTH) and ALP was unaffected. There were no obvious changes in serum iron, zinc and copper even when patients were treated for long periods. Rice bran was well tolerated in almost all cases and there were no serious side effects; 49 patients have undergone treatment for more than 3 years (average duration of administration 5.09 years). The frequency of new stone formation was drastically reduced (individual stone formation rate (no./year) from 0.720 +/- 0.533 to 0.125 +/- 0.204; group stone formation rate (no./patient-year) from 0.721 to 0.120) compared with the 3-year period before treatment. During treatment, 61.2% of patients remained in remission. Although rice bran therapy should be effective in correcting absorptive hypercalciuria, there may be limits to the overall ability of rice bran monotherapy to prevent recurrence.

Wheat bran in the selective therapy of absorptive hypercalciuria: a study performed on 18 lithiasic patients

The binding properties of raw vegetable fiber towards bivalent cations suggested the prescription of brain as a dietary supplement to limit intestinal calcium absorption in hypercalciuric patients. A group of 18 patients with a specific diagnosis of absorptive hypercalciuria received a dietary supplement of 14 gm. wheat bran at the 2 principal meals for 90 days. A complete assessment of mineral metabolism was performed after 45 and 90 days. Mean basal calciuria was 357 mg. per 24 hours and a significant decrease was noted after 45 days (245 mg. per 24 hours) and 90 days (240 mg. per 24 hours), with a p value of less than 0.01. Urinary oxalate did not vary significantly (0.34 to 0.38 to 0.31 mMol. per 24 hours) and neither did phosphate levels (1,020 to 900 to 893 mg. per 24 hours). A slight and pathologically insignificant decrease was noted in serum iron and urinary magnesium; this fact could be considered a side effect owing to the nonselective binding properties of fiber. Therefore, the positive results achieved confirm the effective action of wheat bran in the treatment of correctly diagnosed absorptive hypercalciuria.

Rice-bran treatment for calcium stone formers with idiopathic hypercalciuria

The efficacy of rice-bran therapy was studied in patients with hypercalciuria who were suffering from calcium stones. The frequency of stone episodes was reduced dramatically, especially in "active recurrent stone formers". Urinary calcium excretion was considerably reduced, while urinary phosphate and oxalate were slightly increased. Urinary magnesium, uric acid, serum calcium, phosphate, magnesium and uric acid were not affected. There were no changes in serum iron, copper and zinc even when patients were treated for long periods. The treatment was tolerated well and there were no serious side effects. Rice-bran therapy is particularly useful in patients with hyperabsorptive hypercalciuria and it is effective in the prevention of recurrent urinary stone disease.

Etiopathogenesis, clinical manifestations, and management of canine calcium oxalate urolithiasis

Calcium oxalate uroliths are commonly called metabolic uroliths because they are sequelae of a variety of metabolic abnormalities that alter the composition of body fluids and urine. Factors incriminated in the etiopathogenesis of calcium oxalate urolithiasis include hypercalciuria, hyperoxaluria, and hyperuricosuria. The predominant type of calcium oxalate urolith encountered in dogs is the monohydrate form; however, the dihydrate form may also occur. Male dogs have been more frequently affected than female dogs. Medical therapy should be formulated with the goal of reducing urine concentration of calculogenic substances.