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Ashton MM, Berk M, Ng CH, Hopwood M, Kavanagh B, Williams LJ, Sarris J, Dean OM. Nutraceuticals and nutritional supplements for the treatment of bipolar disorder: protocol for a systematic review. BMJ Open 2019; 9:e025640. [PMID: 30948585 PMCID: PMC6500254 DOI: 10.1136/bmjopen-2018-025640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 02/14/2019] [Accepted: 02/20/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION First line pharmacological treatments for bipolar disorder (BD) can leave shortfalls in recovery leading to patients seeking alternative and adjunctive treatments such as nutraceuticals. This protocol for a systematic review and proposed meta-analysis aims to answer the research question: in patients with BD, how does use of nutraceutical treatments compare with placebo in reducing depressive and mania symptoms? METHODS AND ANALYSIS Clinical trials will be identified through database searches using PubMed via PubMed, EMBASE via embase.com, Cochrane Central Register of Controlled Clinical Trials (CENTRAL) via cochranelibrary.com and CINAHL Complete via EBSCO. Search terms for BD and specific nutraceuticals (75 total search terms) will be used. Double-blind, randomised, controlled, clinical trials of adults with BD will be included in the review. Risk of bias will be assessed using the Cochrane Collaboration's tool for assessing risk of bias in randomised trials. ETHICS AND DISSEMINATION This review will only look at published data (already reviewed for ethical compliance); therefore, ethical approval is not required. We aim to publish the systematic review in a peer-reviewed journal and present at conferences. PROSPERO REGISTRATION NUMBER CRD42019100745.
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Affiliation(s)
- Melanie M Ashton
- IMPACT Strategic Resarch Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, University of Melbourne, Richmond, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Michael Berk
- IMPACT Strategic Resarch Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- Centre of Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Chee H Ng
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, University of Melbourne, Richmond, Victoria, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, The University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Professorial Psychiatry Unit, The Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Bianca Kavanagh
- IMPACT Strategic Resarch Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Lana J Williams
- IMPACT Strategic Resarch Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Jerome Sarris
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, University of Melbourne, Richmond, Victoria, Australia
- NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
| | - Olivia M Dean
- IMPACT Strategic Resarch Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Brenna JT. Long-chain polyunsaturated fatty acids and the preterm infant: a case study in developmentally sensitive nutrient needs in the United States. Am J Clin Nutr 2016; 103:606S-15S. [PMID: 26791188 PMCID: PMC4733252 DOI: 10.3945/ajcn.114.103994] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The vast majority of infant formulas in the United States contain the long-chain polyunsaturated fatty acids (PUFAs) docosahexaenoic acid (22:6n-3) and arachidonic acid (20:4n-6), which were first permitted by the US Food and Drug Administration in 2001. As a scientific case study, preclinical animal studies of these nutrients definitively influenced the design and interpretation of human clinical studies. Early studies were tied to the availability of test substances, and in hindsight suggest re-evaluation of the essential fatty acid concept in light of the totality of available evidence. Research in the 1950s established the essentiality of n-6 PUFAs for skin integrity; however, widespread recognition of the essentiality of n-3 PUFAs came decades later despite compelling evidence of their significance. Barriers to an understanding of the essentiality of n-3 PUFAs were as follows: 1) their role is in neural function, which is measured only with difficulty compared with skin lesions and growth faltering that are apparent for n-6 PUFAs; 2) the experimental use of vegetable oils as PUFA sources that contain the inefficiently used C18 PUFAs rather than the operative C20 and C22 PUFAs; 3) the shift from reliance on high-quality animal studies to define mechanisms that established the required nutrients in the first part of the 20th century to inherently challenging human studies. Advances in nutrition of premature infants require the best practices and opinions available, taking into account the totality of preclinical and clinical evidence.
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MESH Headings
- Animals
- Child Development
- Congresses as Topic
- Evidence-Based Medicine
- Fatty Acids, Essential/deficiency
- Fatty Acids, Essential/metabolism
- Fatty Acids, Essential/therapeutic use
- Fatty Acids, Omega-3/administration & dosage
- Fatty Acids, Omega-3/metabolism
- Fatty Acids, Omega-3/therapeutic use
- Fatty Acids, Omega-6/administration & dosage
- Fatty Acids, Omega-6/metabolism
- Fatty Acids, Omega-6/therapeutic use
- Humans
- Infant Formula/chemistry
- Infant Formula/standards
- Infant Nutritional Physiological Phenomena
- Infant, Newborn
- Neurogenesis
- Nutritional Requirements
- Practice Guidelines as Topic
- Premature Birth/diet therapy
- United States
- United States Food and Drug Administration
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Affiliation(s)
- J Thomas Brenna
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
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3
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McCabe D, Colbeck M. The effectiveness of essential fatty acid, B vitamin, Vitamin C, magnesium and zinc supplementation for managing stress in women: a systematic review protocol. JBI Database System Rev Implement Rep 2015; 13:104-118. [PMID: 26455850 DOI: 10.11124/jbisrir-2015-2298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/17/2015] [Accepted: 06/18/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Delia McCabe
- The Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Australia
| | - Mark Colbeck
- The Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Australia
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Carlson SJ, Nandivada P, Chang MI, Mitchell PD, O'Loughlin A, Cowan E, Gura KM, Nose V, Bistrian BR, Puder M. The addition of medium-chain triglycerides to a purified fish oil-based diet alters inflammatory profiles in mice. Metabolism 2015; 64:274-82. [PMID: 25458829 PMCID: PMC4277814 DOI: 10.1016/j.metabol.2014.10.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 09/29/2014] [Accepted: 10/06/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Parenteral nutrition associated liver disease (PNALD) is a deadly complication of long term parenteral nutrition (PN) use in infants. Fish oil-based lipid emulsion has been shown in recent years to effectively treat PNALD. Alternative fat sources free of essential fatty acids have recently been investigated for health benefits related to decreased inflammatory response. We hypothesized that the addition of medium-chain triglycerides (MCT) to a purified fish oil-based diet would decrease the response to inflammatory challenge in mice, while allowing for sufficient growth and development. MATERIALS/METHODS Six groups of ten adult male C57/Bl6 mice were pair-fed different dietary treatments for a period of twelve weeks, varying only in fat source (percent calories by weight): 10.84% soybean oil (SOY), 10% coconut oil (HCO), 10% medium-chain triglycerides (MCT), 3% purified fish oil (PFO), 3% purified fish oil with 3% medium-chain triglycerides (50:50 MCT:PFO) and 3% purified fish oil with 7.59% medium-chain triglycerides (70:30 MCT:PFO). An endotoxin challenge was administered to half of the animals in each group at the completion of dietary treatment. RESULTS All groups demonstrated normal growth throughout the study period. Groups fed MCT and HCO diets demonstrated biochemical essential fatty acid deficiency and decreased IL-6 and TNF-α response to endotoxin challenge. Groups containing PFO had increased inflammatory response to endotoxin challenge, and the addition of MCT to PFO mitigated this inflammatory response. CONCLUSION These results suggest that the addition of MCT to PFO formulations may decrease the host response to inflammatory challenge, which may pose potential for optimized PN formulations. Inclusion of MCT in lipid emulsions given with PN formulations may be of use in therapeutic interventions for disease states resulting from chronic inflammation.
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MESH Headings
- Animals
- Anti-Inflammatory Agents, Non-Steroidal/adverse effects
- Anti-Inflammatory Agents, Non-Steroidal/chemistry
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Deficiency Diseases/etiology
- Deficiency Diseases/prevention & control
- Dietary Fats, Unsaturated/administration & dosage
- Dietary Fats, Unsaturated/adverse effects
- Dietary Fats, Unsaturated/therapeutic use
- Dietary Supplements/adverse effects
- Disease Models, Animal
- Emulsions
- Fatty Acids, Essential/adverse effects
- Fatty Acids, Essential/deficiency
- Fatty Acids, Essential/therapeutic use
- Fish Oils/adverse effects
- Fish Oils/chemistry
- Fish Oils/therapeutic use
- Lipopolysaccharides
- Liver/immunology
- Liver/metabolism
- Liver/pathology
- Male
- Mice, Inbred C57BL
- Non-alcoholic Fatty Liver Disease/etiology
- Non-alcoholic Fatty Liver Disease/metabolism
- Non-alcoholic Fatty Liver Disease/pathology
- Non-alcoholic Fatty Liver Disease/prevention & control
- Parenteral Nutrition, Total/adverse effects
- Triglycerides/administration & dosage
- Triglycerides/adverse effects
- Triglycerides/chemistry
- Triglycerides/therapeutic use
- Weight Gain
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Affiliation(s)
- Sarah J Carlson
- Boston Children's Hospital Department of Surgery and the Vascular Biology Program, Boston MA
| | - Prathima Nandivada
- Boston Children's Hospital Department of Surgery and the Vascular Biology Program, Boston MA
| | - Melissa I Chang
- Boston Children's Hospital Department of Surgery and the Vascular Biology Program, Boston MA
| | - Paul D Mitchell
- Boston Children's Hospital Clinical Research Center, Boston MA
| | - Alison O'Loughlin
- Boston Children's Hospital Department of Surgery and the Vascular Biology Program, Boston MA
| | - Eileen Cowan
- Boston Children's Hospital Department of Surgery and the Vascular Biology Program, Boston MA
| | - Kathleen M Gura
- Boston Children's Hospital Department of Pharmacy, Boston MA
| | - Vania Nose
- Massachusetts General Hospital Department of Pathology, Boston MA
| | - Bruce R Bistrian
- Beth Israel Deaconess Medical Center Department of Medicine, Boston MA
| | - Mark Puder
- Boston Children's Hospital Department of Surgery and the Vascular Biology Program, Boston MA.
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5
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Vahlquist A. From the melanoma incidence in Australia to the role of essential fatty acids in acne. Acta Derm Venereol 2014; 94:499. [PMID: 25364810 DOI: 10.2340/00015555-1915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Considerable information has accumulated to show that DHA and EPA have unique roles that differ from other n-3 fatty acids and the n-6 fatty acids, with increasing understanding of the mechanisms through which these fatty acids reduce risk of disease. DHA and EPA regulate hepatic lipid and glucose metabolism, but are present in foods of animal origin, which are generally high in protein with variable triglycerides and low carbohydrate. Biological activity at intakes too low to provide significant amounts of energy is consistent with the definition of a vitamin for which needs are modified by life-stage, diet and genetic variables, and disease. Recent studies reveal that DHA may play a central role in co-coordinating complex networks that integrate hepatic glucose, fatty acid and amino acid metabolism for the purpose of efficient utilization of dietary protein, particularly during early development when the milk diet provides large amounts of energy from fat.
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Affiliation(s)
- S M Innis
- Department of Paediatrics, Nutrition and Metabolism Research Program, Child and Family Research Institute, Vancouver, BC, Canada V5Z 4H4.
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Affiliation(s)
- David Forbes
- School of Paediatrics & Child Health, University Of Western Australia, Perth, WA, Australia.
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Matthews H, Granger N, Wood J, Skelly B. Effects of essential fatty acid supplementation in dogs with idiopathic epilepsy: a clinical trial. Vet J 2012; 191:396-8. [PMID: 21641244 DOI: 10.1016/j.tvjl.2011.04.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 03/09/2011] [Accepted: 04/25/2011] [Indexed: 11/17/2022]
Abstract
The effects of essential fatty acid supplementation (EFA) on the control of idiopathic epilepsy in dogs were investigated in a blinded, placebo-controlled trial. Fifteen dogs were treated with triple purified Ω-3 oil containing 400 mg eicosapentaenoic acid, 250 mg docosahexaenoic acid and 22 mg vitamin E per 1.5 mL at a dose of 1.5 mL/10 kg once daily for 12 weeks, followed by a 12 week placebo period of supplementation with olive oil. Owners recorded seizure frequency and severity and any adverse events. EFA supplementation did not reduce seizure frequency or severity in dogs with idiopathic epilepsy.
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Affiliation(s)
- Helen Matthews
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
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Fiscella RG. Understanding dry eye disease: a managed care perspective. Am J Manag Care 2011; 17 Suppl 16:S432-S439. [PMID: 22435675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Dry eye disease (DED) is a multifactorial disorder that results in eye discomfort, visual disturbance, and often ocular surface damage. This supplement to The American Journal of Managed Care discusses the prevalence of DED and the economic burden associated with DED. The etiology and pathophysiology of DED will also be discussed, including disease progression and impact on the patient's quality of life. With greater understanding of the pathophysiology of DED, there are numerous available therapies/strategies for the management of the disorder, ranging from artificial tear substitutes, anti-inflammatory agents, secretagogues, punctal plugs, and systemic immunosuppressives, to surgery. This activity will aim to provide managed healthcare professionals with an understanding of when and how to use these different strategies to reduce morbidity and prevent complications.
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Affiliation(s)
- Richard G Fiscella
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA
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10
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Kruger PS. Forget glucose: what about lipids in critical illness? CRIT CARE RESUSC 2009; 11:305-309. [PMID: 20001883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A high serum cholesterol level is a risk factor for cardiovascular disease and has commonly been linked with worse outcomes. It is now well recognised that, in many critically ill patients, the opposite is true, with hypocholesterolaemia being associated with poor outcomes. In critical illness, particularly sepsis, total and high-density lipoprotein (HDL) cholesterol levels are commonly decreased, with varying changes in triglyceride levels. The magnitude of the changes seems to reflect the severity of inflammation. Plausible biological explanations exist to explain these associations, including an interaction of lipoproteins with endotoxin and the regulation of cytokine production. It remains unclear whether these observed alterations in lipid profile are a consequence of the physiological disturbance or whether they have a more causative role, worsening organ dysfunction or predisposing to infection. Lipid emulsions provide a vehicle for drug delivery, have become an important part of nutrition, and are emerging as a therapy for specific intoxications. The nature, dietary source and amount of lipid provided to critically ill patients may be enormously important and warrant more rigorous investigation. Further understanding of the alterations in lipid metabolism may have therapeutic implications in treatment of sepsis with specific compounds that manipulate lipid profiles, such as fibrates, statins, niacin and even reconstituted HDL.
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Affiliation(s)
- Peter S Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD.
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Goodfield M, Kownacki S, Berth-Jones J. Double‐blind, randomised, multicentre, parallel group study comparing a 1% coal tar preparation (Exorex) with a 5% coal tar preparation (Alphosyl) in chronic plaque psoriasis. J DERMATOL TREAT 2009; 15:14-22. [PMID: 14754644 DOI: 10.1080/09546630310017843] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Exorex lotion is a novel formulation of prepared coal tar indicated for the treatment of psoriasis. OBJECTIVES To compare the efficacy and tolerability of 1% prepared coal tar lotion versus 5% coal tar extract in patients with mild to moderate plaque psoriasis. PATIENTS AND METHODS This was a double-blind, randomised controlled study. Patients initially entered a 7-day washout period, during which they applied a yellow soft paraffin plus emulsifying wax ointment used as an emollient three times a day to their plaques. They were then randomised to receive treatment with 1% coal tar (Exorex) lotion or 5% conventional coal tar lotion (Alphosyl), three times a day for 12 weeks. Both treatment groups continued to apply the emollient throughout the duration of the study. Two target plaques were selected at entry for assessment. The clinical measures used were: 1) Total Sign Score (TSS), the sum of 5-point rating scores for erythema, induration and scaling averaged for the two target plaques (range 0-12), 2) the Psoriasis Area and Severity Index (PASI), and 3) patient and investigator 7-point global assessments of improvement at 12 weeks. Patients were assessed at 0, 4, 8 and 12 weeks during the treatment period or at the point of withdrawal. Spontaneously reported and observed adverse events were noted. RESULTS Three hundred and twenty four of 338 randomised patients were evaluable (ITT analysis): 158 patients received 1% coal tar lotion and 166 patients received conventional coal tar. Both groups showed decreases from baseline to end of treatment in mean TSS (decrease of 2.4 points from 5.6 to 3.2 with 1% coal tar lotion and 1.8 points from 5.5 to 3.7 with conventional coal tar), and mean PASI (decrease of 2.4 points with 1% coal tar lotion and 1.5 points with conventional coal tar). Two hundred and twenty eight patients completed the full course of treatment. There was a statistically significant treatment difference in the percentage change in mean TSS at week 12, in favour of 1% coal tar lotion (-10.6%, 95% CI -20.6% to -0.5%, p=0.04). There was also a difference between treatments in the change in mean PASI in favour of 1% coal tar that was of borderline statistical significance (-11.7%, 95% CI -23.8% to 0.4%, p=0.06). Investigator global assessments also favoured 1% coal tar lotion (38% vs. 27% of patients showed clearance or marked improvement). The 1% coal tar lotion had a similar safety profile to 5% conventional coal tar lotion with the majority of treatment-related events being mild to moderate in severity. CONCLUSIONS 1% coal tar lotion is more effective than a conventional coal tar lotion in mild to moderate psoriasis and may be preferred for first-line topical treatment.
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Affiliation(s)
- M Goodfield
- Department of Dermatology, Leeds General Infirmary, Leeds, UK.
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Das UN. Essential fatty acids and their metabolites could function as endogenous HMG-CoA reductase and ACE enzyme inhibitors, anti-arrhythmic, anti-hypertensive, anti-atherosclerotic, anti-inflammatory, cytoprotective, and cardioprotective molecules. Lipids Health Dis 2008; 7:37. [PMID: 18922179 PMCID: PMC2576273 DOI: 10.1186/1476-511x-7-37] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 10/15/2008] [Indexed: 01/04/2023] Open
Abstract
Lowering plasma low density lipoprotein-cholesterol (LDL-C), blood pressure, homocysteine, and preventing platelet aggregation using a combination of a statin, three blood pressure lowering drugs such as a thiazide, a beta blocker, and an angiotensin converting enzyme (ACE) inhibitor each at half standard dose; folic acid; and aspirin-called as polypill- was estimated to reduce cardiovascular events by approximately 80%. Essential fatty acids (EFAs) and their long-chain metabolites: gamma-linolenic acid (GLA), dihomo-GLA (DGLA), arachidonic acid, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) and other products such as prostaglandins E1 (PGE1), prostacyclin (PGI2), PGI3, lipoxins (LXs), resolvins, protectins including neuroprotectin D1 (NPD1) prevent platelet aggregation, lower blood pressure, have anti-arrhythmic action, reduce LDL-C, ameliorate the adverse actions of homocysteine, show anti-inflammatory actions, activate telomerase, and have cytoprotective properties. Thus, EFAs and their metabolites show all the classic actions expected of the "polypill". Unlike the proposed "polypill", EFAs are endogenous molecules present in almost all tissues, have no significant or few side effects, can be taken orally for long periods of time even by pregnant women, lactating mothers, and infants, children, and adults; and have been known to reduce the incidence cardiovascular diseases including stroke. In addition, various EFAs and their long-chain metabolites not only enhance nitric oxide generation but also react with nitric oxide to yield their respective nitroalkene derivatives that produce vascular relaxation, inhibit neutrophil degranulation and superoxide formation, inhibit platelet activation, and possess PPAR-gamma ligand activity and release NO, thus prevent platelet aggregation, thrombus formation, atherosclerosis, and cardiovascular diseases. Based on these evidences, I propose that a rational combination of omega-3 and omega-6 fatty acids and the co-factors that are necessary for their appropriate action/metabolism is as beneficial as that of the combined use of a statin, thiazide, a beta blocker, and an angiotensin converting enzyme (ACE) inhibitor, folic acid, and aspirin. Furthermore, appropriate combination of omega-3 and omega-6 fatty acids may even show additional benefits in the form of protection from depression, schizophrenia, Alzheimer's disease, and enhances cognitive function; and serve as endogenous anti-inflammatory molecules; and could be administered from childhood for life long.
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Affiliation(s)
- Undurti N Das
- UND Life Sciences, 13800 Fairhill Road, #321, Shaker Heights, OH 44120, USA.
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Gaby AR. Nutritional therapies for ocular disorders: Part Three. Altern Med Rev 2008; 13:191-204. [PMID: 18950246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Parts one and two of this series discussed nutritional and botanical treatments for cataracts, glaucoma, and retinal diseases (macular degeneration, diabetic retinopathy, retinopathy of the newborn, and retinitis pigmentosa). This review discusses nutritional treatments for asthenopia, blepharitis, chalazion, conjunctivitis (including giant papillary conjunctivitis), gyrate atrophy of the choroid and retina, keratoconus, myopia, sicca syndrome (dry eyes), and uveitis. The evidence presented in this three-part series indicates natural medicine has an important role to play in the practice of ophthalmology.
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Affiliation(s)
- R E Lister
- IBCHN, London Metropolitan University, London N7 8DB.
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Gaby AR. Natural approaches to epilepsy. Altern Med Rev 2007; 12:9-24. [PMID: 17397265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This article reviews research on the use of diet, nutritional supplements, and hormones in the treatment of epilepsy. Potentially beneficial dietary interventions include identifying and treating blood glucose dysregulation, identifying and avoiding allergenic foods, and avoiding suspected triggering agents such as alcohol, aspartame, and monosodium glutamate. The ketogenic diet may be considered for severe, treatment-resistant cases. The Atkins diet (very low in carbohydrates) is a less restrictive type of ketogenic diet that may be effective in some cases. Nutrients that may reduce seizure frequency include vitamin B6, magnesium, vitamin E, manganese, taurine, dimethylglycine, and omega-3 fatty acids. Administration of thiamine may improve cognitive function in patients with epilepsy. Supplementation with folic acid, vitamin B6, biotin, vitamin D, and L-carnitine may be needed to prevent or treat deficiencies resulting from the use of anticonvulsant drugs. Vitamin K1 has been recommended near the end of pregnancy for women taking anticonvulsants. Melatonin may reduce seizure frequency in some cases, and progesterone may be useful for women with cyclic exacerbations of seizures. In most cases, nutritional therapy is not a substitute for anticonvulsant medications. However, in selected cases, depending on the effectiveness of the interventions, dosage reductions or discontinuation of medications may be possible.
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Cormier E, Elder JH. Diet and child behavior problems: fact or fiction? Pediatr Nurs 2007; 33:138-43. [PMID: 17542236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Dietary treatment of children with behavioral disorders has had wide public appeal and been a source of controversy since the 1920's. Yet, to date, there is little empirical evidence supporting the effectiveness of dietary restrictions in treating child psychiatric disorders, in particular, autism and attention deficit hyperactivity disorder (ADHD). Thus, the purpose of this article is (a) to provide historical background information regarding dietary treatment in children with behavioral disorders, (b) review the evidence-based literature for common dietary interventions, (c) discuss limitations in the research, including challenges inherent in conducting well-controlled dietary studies, and (d) provide recommendations regarding how nurses in primary care settings can assist families in making informed decisions.
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Affiliation(s)
- Eileen Cormier
- Florida State University College of Nursing, Tallahassee, USA
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Affiliation(s)
- Gary J Myers
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA.
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18
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Abstract
Essential fatty acids (EFAs): cis-linoleic acid (LA) and alpha-linolenic acid (ALA) are essential for humans and their deficiency is rare in humans due to their easy availability in diet. EFAs are metabolized to their respective long-chain metabolites: dihomo-gamma-linolenic acid (DGLA), and arachidonic acid (AA) from LA; and eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) from ALA. Some of these long-chain metabolites form precursors to respective prostaglandins (PGs), thromboxanes (TXs), and leukotrienes (LTs), lipoxins (LXs) and resolvins. EFAs and their metabolites may function as endogenous angiotensin converting enzyme and HMG-CoA reductase inhibitors, nitric oxide enhancers, anti-hypertensives, and anti-atherosclerotic molecules. EFAs react with nitric oxide (NO) to yield respective nitroalkene derivatives that have cell-signaling actions via ligation and activation of peroxisome proliferator-activated receptors (PPARs). In several diseases such as obesity, hypertension, diabetes mellitus, coronary heart disease, alcoholism, schizophrenia, Alzheimer's disease, atherosclerosis, and cancer the metabolism of EFAs is altered. Thus, EFAs and their derivatives have significant clinical implications.
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Affiliation(s)
- Undurti N Das
- UND Life Sciences, 13800 Fairhill Road, Shaker Heights, OH 44120, USA.
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Menendez JA, Lupu R. Mediterranean dietary traditions for the molecular treatment of human cancer: anti-oncogenic actions of the main olive oil's monounsaturated fatty acid oleic acid (18:1n-9). Curr Pharm Biotechnol 2007; 7:495-502. [PMID: 17168666 DOI: 10.2174/138920106779116900] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The final proof about the specific mechanisms by which the different components of olive oil, the principal source of fat in a typical "Mediterranean diet", exert their potential protective effects on the promotion and progression of several human cancers requires further investigations. A recent discovery that dietary fatty acids can interact with the human genome by regulating the amount and/or activity of transcription factors has opened a whole new line of research aimed to molecularly corroborate the ant-cancer benefits of the olive oil-based Mediterranean diet and the underlying mechanisms. Our most recent findings reveal that oleic acid (OA; 18:1n-9), the main olive oil's monounsaturated fatty acid, can suppress the overexpression of HER2 (erbB-2), a well-characterized oncogene playing a key role in the etiology, invasive progression and metastasis in several human cancers. First, exogenous supplementation with physiological concentrations of OA significantly down-regulates HER2-coded p185(Her-2/neu) oncoprotein in human cancer cells naturally harboring amplification of the HER gene. Second, OA exposure specifically represses the transcriptional activity of the human HER2 gene promoter in tumor-derived cell lines naturally exhibiting HER2 gene amplification and p185(Her-2/neu) protein overexpression but not in cancer cells expressing physiological levels of HER2. Third, OA treatment induces the up-regulation of the Ets protein PEA3 (a transcriptional repressor of the HER2 gene promoter) solely in cancer cells naturally displaying HER2 gene amplification. Fourth, HER2 gene promoter bearing a PEA3 site-mutated sequence cannot be negatively regulated by OA, while treatment with OA fails to repress the expression of a human full-length HER2 cDNA controlled by a SV40 viral promoter. Fifth, OA-induced inhibition of HER2 promoter activity does not occur if HER2 gene-amplified cancer cells do no concomitantly exhibit high levels of Fatty Acid Synthase (FASN; Oncogenic antigen-519) as specific depletion of FASN, which itself similarly suppresses HER2 overexpression by inducing PEA3-dependent repression of HER2 gene promoter, strongly antagonizes the inhibitory effects of OA on HER2 gene promoter activity. Considering that OA treatment efficiently blocks FASN activity and down-regulates FASN protein expression, it is reasonable to suggest that an accumulation of supra-physiological concentrations of the FASN substrate malonyl-CoA, due to its reduced utilization by FASN in the presence of exogenous OA, appears to act as an indicator of "cell fuel" availability capable to suppress HER2 expression via formation of inhibitory "PEA3 protein-PEA3 DNA binding site" complexes on the endogenous HER2 promoter. Indeed, malonyl-CoA on its own dramatically decreases HER2 promoter activity, while OA or malonyl-CoA similarly up-regulates PEA3 gene promoter activity. This previously unrecognized ability of OA to directly affect the expression of a cluster of interrelated human cancer genes (i.e., HER2, FASN and PEA3) should open a new line of research aimed to explore the anti-cancer effects of OA. Certainly, an appropriate dietary intervention reproducing this prominent anti-oncogenic feature of the "Mediterranean diet" must be carried out in animal models and human pilot studies in the future. Only then we will know whether the old "Mediterranean dietary traditions" will become a new molecular approach in the management of cancer disease.
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Affiliation(s)
- Javier A Menendez
- Fundació d'Investigació Biomèdica de Girona Dr. Josep Trueta (IdIBGi), Girona, Catalonia, Spain.
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Williams AL, Katz D, Ali A, Girard C, Goodman J, Bell I. Do essential fatty acids have a role in the treatment of depression? J Affect Disord 2006; 93:117-23. [PMID: 16650900 DOI: 10.1016/j.jad.2006.02.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Accepted: 02/27/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND Complementary and alternative medicine (CAM) therapies are used more than conventional therapies by people with self-defined anxiety and depression. Preliminary evidence supports a hypothesis that low plasma concentration of essential fatty acids is associated with depression. Reported here is the result of a systematic review examining the therapeutic efficacy of essential fatty acids for depression. METHODS Data sources included Medline, Psychinfo, AMED (Allied and Complementary Medicine), and Cochrane Controlled Trials Register databases searched from inception through September 2001. English language randomized controlled trials, controlled clinical trials, intervention studies, case control studies, reviews, and case reports of humans were selected, without limits for demographics or co-morbidities. Two abstractors independently evaluated each study, then reconciled findings. When possible, between group treatment effect size was noted or calculated. RESULTS Six articles met inclusion criteria: one RCT, two reviews, and three case control trials. A common outcome measure among the case control trials allowed for direct comparison of effect sizes. CONCLUSIONS The evidence implies promise of a treatment effect of omega-3 fatty acids for depression in adults; although a statement of definitive clinical efficacy is premature. Further study of essential fatty acids as independent and adjuvant therapy for adult depression is indicated, including more sophisticated investigation of dose-response in particular populations.
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Triggiani V, Resta F, Guastamacchia E, Sabbà C, Licchelli B, Ghiyasaldin S, Tafaro E. Role of antioxidants, essential fatty acids, carnitine, vitamins, phytochemicals and trace elements in the treatment of diabetes mellitus and its chronic complications. Endocr Metab Immune Disord Drug Targets 2006; 6:77-93. [PMID: 16611166 DOI: 10.2174/187153006776056611] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Nowadays, the treatment of diabetes mellitus is based on the variable use and combination of diet, antidiabetic oral agents (metformin, sulphanylureas, glynides, acarbose and thiazolidinediones) and insulin or its analogs, depending on the type of diabetes and the needs of the patient. The prevention and treatment of chronic micro- and macrovascular complications, on the other hand, is based on the achievement and maintenance of an optimal glycaemic control and requires the combined use of adjunctive therapy such as antihypertensive drugs and cholesterol-lowering medications. Furthermore, several herbal preparations and dietary supplements, such as antioxidants, essential fatty acids, lipid metabolism activators, vitamins and trace elements, are advertised and prescribed to patients as a useful adjuvant to a diabetic diet and conventional medications in order to improve glycaemic control and reduce the impact of chronic complications. In this regard, we have attempted to review the current concepts dealing with the usefulness of these complementary therapies in treating diabetic patients.
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Affiliation(s)
- Vincenzo Triggiani
- D.E.T.O- Endocrinology and Metabolic Diseases, University of Bari, Bari, Italy.
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Lerman RH. Essential fatty acids. Altern Ther Health Med 2006; 12:20-9; quiz 30-1. [PMID: 16708767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Cleary MA, Feillet F, White FJ, Vidailhet M, Macdonald A, Grimsley A, Maurin N, de Baulny HO, Rutherford PJ. Randomised controlled trial of essential fatty acid supplementation in phenylketonuria. Eur J Clin Nutr 2006; 60:915-20. [PMID: 16523206 DOI: 10.1038/sj.ejcn.1602401] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The long-chain polyunsaturated fatty acids (LC-PUFA) status of children with PKU is often compromised. LC-PUFA, which are important fatty acids in the development of the CNS, can be synthesised endogenously from the parent essential fatty acids (EFA) provided dietary intakes are adequate. This study was designed to assess the biochemical effect over a 20-week period of a phe-free protein substitute that has been supplemented with a balanced blend of n-3 and n-6 EFAs on LC-PUFA status of children with PKU. DESIGN, SETTING AND SUBJECTS Fifty three community-living children aged 1-10 years diagnosed with PKU in the newborn period were recruited from seven tertiary centres in the UK and France and randomised to a fat-free control formula or the EFA-supplemented test-treatment formula in an open, prospective study. Forty four children completed the study (20 controls, 24 test-treatments). Fatty acid status was assessed at entry and 20-weeks follow-up. Three day dietary diaries were recorded at 20 weeks' follow-up. The safety, efficacy and palatability of the test-treatment formula were also assessed. RESULTS The test-treatment group had significantly higher intakes of fat and EFA than the control group. There was a significant between group difference (P=0.04) in increases in median docosahexaenoic acid (DHA) concentrations in erythrocyte phospholipids, which increased by 19% in the test-treatment group and by 0.5% in the control group over the study period. Growth and phe control were satisfactory in all subjects. CONCLUSIONS Supplementing the diets of children with PKU with a balanced blend of n-6 and n-3 EFA improves DHA status without compromising AA status.
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Affiliation(s)
- M A Cleary
- Department of Metabolic Medicine, Great Ormond St. Hospital for Sick Children, London, UK.
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Joshi K, Lad S, Kale M, Patwardhan B, Mahadik SP, Patni B, Chaudhary A, Bhave S, Pandit A. Supplementation with flax oil and vitamin C improves the outcome of Attention Deficit Hyperactivity Disorder (ADHD). Prostaglandins Leukot Essent Fatty Acids 2006; 74:17-21. [PMID: 16314082 DOI: 10.1016/j.plefa.2005.10.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2005] [Revised: 09/17/2005] [Accepted: 10/16/2005] [Indexed: 11/23/2022]
Abstract
Considerable clinical and experimental evidence now supports the idea that deficiencies or imbalances in certain highly unsaturated fatty acids may contribute to a range of common developmental disorders including Attention Deficit Hyperactivity Disorder (ADHD). Few intervention studies with LCPUFA supplementation have reported inconsistent and marginal results. This pilot study evaluates the effect of alpha linolenic acid (ALA)-rich nutritional supplementation in the form of flax oil and antioxidant emulsion on blood fatty acids composition and behavior in children with ADHD. Post-supplementation levels of RBC membrane fatty acids were significantly higher than pretreatment levels as well as the levels in control. There was significant improvement in the symptoms of ADHD reflected by reduction in total hyperactivity scores of ADHD children derived from ADHD rating scale.
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Affiliation(s)
- Kalpana Joshi
- Interdisciplinary School of Health Sciences, University of Pune, Ganeshkhind, Pune-411007, Maharashtra, India.
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Solanki K, Matnani M, Kale M, Joshi K, Bavdekar A, Bhave S, Pandit A. Transcutaneous absorption of topically massaged oil in neonates. Indian Pediatr 2005; 42:998-1005. [PMID: 16269830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To study the transcutaneous absorption of traditionally massaged oil in newborns and to specifically compare the effects of (i) essential fatty acid (EFA) rich - safflower oil and (ii) saturated fat rich coconut oil, on fatty acid profiles of massaged babies. DESIGN A short term randomised controlled study. SETTING Tertiary care NICU of a large teaching hospital and a research laboratory of a University complex. METHODS 120 study babies were randomly assigned to three oil groups (i) safflower oil (n = 40) (ii) coconut oil (n = 40) and (iii) no oil controls (n = 40). In each group, babies were selected in three subsets as per their gestational ages viz (a) less than 34 weeks, (b) 34-37 weeks, (c) greater than 37 weeks. 5 mL of the designated oil was massaged four times a day for five days under controlled conditions of temperature and feeding. Pre and post oil massage samples of blood were analysed for triglycerides and fatty acid profiles using gas chromatography. RESULTS Post oil triglyceride values were significantly raised in both the oil groups and also in controls. However, the quantum of rise was significantly higher in oil groups as compared to controls. Fatty acid profiles (gas chromatography) showed significant rise in EFAs (linolenic acid and arachidonic acid) in safflower oil group and saturated fats in coconut oil group. Changes were more evident in term babies. There were no side effects associated with the massage. CONCLUSIONS This study shows that topically applied oil can be absorbed in neonates and is probably available for nutritional purposes. The fatty acid constituents of the oil can influence the changes in the fatty acid profiles of the massaged babies.
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Affiliation(s)
- Kriti Solanki
- Department of Pediatrics, KEM Hospital, Pune 411 011, India
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Verhoeven MO, van der Mooren MJ, van de Weijer PHM, Verdegem PJE, van der Burgt LMJ, Kenemans P. Effect of a combination of isoflavones and Actaea racemosa Linnaeus on climacteric symptoms in healthy symptomatic perimenopausal women: a 12-week randomized, placebo-controlled, double-blind study. Menopause 2005; 12:412-20. [PMID: 16037756 DOI: 10.1097/01.gme.0000170603.63022.62] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2004] [Revised: 11/02/2004] [Accepted: 11/02/2004] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the effects of a novel dietary supplement containing soy isoflavones and Actaea racemosa Linnaeus (formerly called Cimicifuga racemosa L.) on climacteric symptoms in healthy perimenopausal women. DESIGN In a multicenter, randomized, placebo-controlled, double-blind study, 124 women experiencing at least five vasomotor symptoms every 24 hours were randomized to receive daily either a phytoestrogen-containing supplement (n = 60) or placebo (n = 64) for 12 weeks. The modified Kupperman Index and Greene Climacteric Scale, a visual analogue scale designed to measure quality of life and the daily number and severity of hot flushes, was used in the screening period and in weeks 6 and 12. Changes in these scores from baseline were calculated. RESULTS At weeks 6 and 12, all scores in both groups had improved compared with baseline, though the overall difference in scores between the groups was not statistically significant. CONCLUSION The supplement containing soy isoflavones and A racemosa L. had no statistically significant effect on climacteric symptoms in perimenopausal women experiencing at least five vasomotor symptoms per day.
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Affiliation(s)
- Marieke O Verhoeven
- Project Ageing Women, Department of Obstetrics & Gynecology, VU University Medical Center, Amsterdam, The Netherlands
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Das UN. Can COX-2 inhibitor-induced increase in cardiovascular disease risk be modified by essential fatty acids? J Assoc Physicians India 2005; 53:623-7. [PMID: 16190133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Selective COX-2 inhibitors increase the risk of myocardial infarction and stroke. This has been attributed to their ability to inhibit endothelial COX-2 derived prostacyclin (PGI2) but not platelet COX-1 derived thromboxane A2 (TXA2). On the other hand, aspirin blocks both COX-1 and COX-2 enzymes without decreasing PGI2 but blocks TXA2 synthesis that explains its beneficial action in the prevention of coronary heart disease (CHD). The inhibitory action of aspirin on COX-1 and COX-2 enzymes enhances the tissue concentrations of dihomo-gamma-linolenic acid (DGLA), arachidonic acid, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). These fatty acids form precursors to PGE1, PGI2, PGI3, lipoxins (LXs), and resolvins that have anti-inflammatory actions. In contrast, increase in the concentrations of DGLA, AA, EPA, and DHA is much less with specific COX-2 inhibitors since they do not block the formation of eicosanoids through COX-1 pathway. COX-2 inhibitors interfere with the formation of LXs and resolvins that have neuroprotective and cardioprotective actions. EPA and PGI2 have anti-arrhythmic action. EPA, DHA, and AA augment eNO formation that prevents atherosclerosis. This suggests that COX-2 inhibitors increase cardiovascular and stroke risk by interfering with the formation of eNO, PGI2, LXs, and resolvins and implies that combining EFAs with COX-2 inhibitors could prevent these complications.
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Affiliation(s)
- U N Das
- UND Life Sciences, #205, 2477 Overlook Road, Cleveland Heights, OH 44106, USA
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Abstract
OBJECTIVES We review nonpharmacologic treatments for depression in patients with coronary heart disease (CHD), including psychological therapies such as cognitive behavior therapy (CBT) and interpersonal therapy (IPT), aerobic exercise, St. John's wort (SJW), essential fatty acids (EFAs), S-Adenosylmethionine (SAMe), acupuncture, and chromium picolinate (CP). METHOD Medline searches and reviews of bibliographies were used to identify relevant articles. Each treatment was reviewed with particular attention paid to empirical support, as well as to potential mechanisms of action that might affect not only depression but also CHD endpoints. RESULTS Nearly all randomized controlled trials (RCTs) of depression treatments have been conducted with non-CHD patients. These studies have provided the most support for psychological treatments, particularly CBT and IPT. Aerobic exercise, SJW, and SAMe also have considerable empirical support in otherwise healthy persons, but SJW may have undesirable side effects for CHD patients. Data for EFAs, CP, and acupuncture are limited; however, the use of aerobic exercise shows considerable promise for cardiac patients. CONCLUSIONS There are few RCTs of patients with clinical depression and CHD, and those that exist have significant methodological limitations. Nonetheless, there is preliminary evidence that nonpharmacologic treatments are effective for cardiac patients with depression. In terms of reducing depression, the most evidence exists for psychological treatments, particularly CBT and IPT. However, there is little evidence that such treatment would also improve CHD risk factors. Aerobic exercise offers more promise to improve both mental and physical health due to its effect on cardiovascular risk factors and outcomes and thus warrants particular attention in future trials.
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Affiliation(s)
- Heather S Lett
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Abstract
Use of complementary and alternative medicine (CAM) for treatment of attention-deficit hyperactivity disorder (ADHD) has become widespread in both referral and primary care populations. We review the purported mechanism of action and available evidence for selected CAM therapies for ADHD. Enduring controversies, such as elimination of artificial food additives, colors, and/or preservatives; the effect of sugar on behavior in children; and the use of EEG biofeedback, have been well studied but lack support as effective sole treatments for ADHD. The initial evidence for some emerging CAM therapies, such as essential fatty acid supplementation, yoga, massage, homeopathy, and green outdoor spaces, suggests potential benefits as part of an overall ADHD treatment plan. More rigorously designed studies are needed to evaluate their effectiveness as single therapy for ADHD.
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Affiliation(s)
- Neal L Rojas
- Division of General Pediatrics, Children's Hospital Boston, Boston, MA 02115, USA
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Chiaverini C. [What are means of preventing flares and the adjuvant measures to be taken in atopic dermatitis in children?]. Ann Dermatol Venereol 2005; 132 Spec No 1:1S243-66. [PMID: 15984311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Abstract
The non-triglyceride fraction of unrefined evening primrose oil has recently been shown to contain 3-O-trans-caffeoyl derivatives of betulinic, morolic, and oleanolic acid. These lipophilic pentacyclic triterpenes have free radical scavenging, cyclooxygenase and neutrophil elastase inhibitory activities, and are therefore likely to be of benefit to human health. However, biochemical assays have suggested that these lipophilic antioxidants only occur in trace amounts, if at all, in commercial samples of evening primrose oil. A newly available commercially available cold-pressed, non-raffinated evening primrose oil preparation was found to contain a pentacyclic triterpene ester. Given the potential benefits of the triterpene esters, it is suggested that such a cold-pressed, non-raffinated commercially available evening primrose oil product is likely to have greater health benefits than conventional evening primrose oil preparations.
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Affiliation(s)
- Basant K Puri
- Department of Imaging Sciences, MRI Unit, MRC Clinical Sciences Centre, Faculty of Medicine, Imperial College School of Medicine, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS, UK.
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Willemse T. [Atopic dermatitis in dogs: current knowledge of background and therapeutic possibilities]. Tijdschr Diergeneeskd 2004; 129:402-8. [PMID: 15232964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- T Willemse
- Universiteit Utrecht, Faculteit der Diergeneeskunde, Hoofdafdeling Geneeskunde van Gezelschapsdieren, Yalelaan 8, 3584 CM Utrecht.
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Abstract
The treatment of affective disorders continues to present significant clinical challenges, notwithstanding the existence of available mood stabilizers and antidepressants. These difficulties include incomplete response, relapse, and intolerable medication side effects. Fundamental to the therapeutic impasse is incomplete knowledge concerning the neurobiology of mood disorders. Although some relevant biochemical pathways have been identified, including abnormalities of monoamine neurotransmission and of immunological functioning, a fuller understanding is likely to embrace other interrelated pathways. Arachidonic acid (AA) and prostaglandins (PGs) are important second messengers in the central nervous system that participate in signal transduction, inflammation and other vital processes. Their release, turnover, and metabolism represent the 'arachidonic acid cascade'. A significant body of diverse clinical and preclinical research suggests that the AA cascade may be important in affective states. This paper reviews the literature describing the association of affective illness with AA and its metabolites. Possible links between this and other prevailing hypotheses are considered, and implications for further research and for treatment are discussed.
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Affiliation(s)
- M Elizabeth Sublette
- Psychiatry Department, The Zucker Hillside Hospital North Shore - Long Island Jewish Health System, Glen Oaks, NY 11004, USA.
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Gallagher S. Omega 3 oils and pregnancy. Midwifery Today Int Midwife 2004:26-31. [PMID: 15124319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Women can safely commence omega 3 intake in early pregnancy to allow the full benefits to be incorporated into the body. Pregnant women should consider the intake of omega 3 oils and evening primrose oil throughout pregnancy in order possibly to prevent preterm delivery, promote an easier birth, assist the baby's brain and eye health and preprogram the baby's cell membranes for optimum lifelong wellness. Benefits to the mother may include prevention of postnatal depression and the comfort of knowing that she is giving her baby a healthy start in life.
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Vogelzang JL. Fat facts and fallacies. Home Healthc Nurse 2003; 21:725-7. [PMID: 14614382 DOI: 10.1097/00004045-200311000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Tzaneva S, Hönigsmann H, Tanew A. Observer-blind, randomized, intrapatient comparison of a novel 1% coal tar preparation (Exorex) and calcipotriol cream in the treatment of plaque type psoriasis. Br J Dermatol 2003; 149:350-3. [PMID: 12932242 DOI: 10.1046/j.1365-2133.2003.05421.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In a recent pilot study a novel, patented fatty acid-based 1% coal tar preparation (Exorex) has been found to be similar in efficacy to calcipotriol in the treatment of psoriasis. OBJECTIVES Our aim was to investigate the therapeutic efficacy, safety and cosmetic acceptability of the new 1% coal tar preparation in comparison with calcipotriol cream in a larger patient cohort. PATIENTS AND METHODS Forty patients with chronic plaque type psoriasis were included in this randomized, observer-blind, intrapatient comparison trial. In each patient two comparable target plaques were treated twice daily with 1% coal tar preparation or calcipotriol cream. At the onset of therapy and at weeks 2, 4, 6 and 8, the response to treatment was determined by the psoriasis severity index (PSI) that assesses the degree of erythema, infiltration and scaling of the psoriatic lesions on a five-point scale. In addition, all treatment-related side-effects were recorded and cosmetic acceptability of both treatments was rated every second week by the patients. After complete or near complete clearing the patients were followed up until relapse or for a maximum period of 18 months. RESULTS Thirty-eight patients completed the study. At termination of the trial the mean +/- SD baseline PSI score of 9.2 +/- 1.5 was reduced to 3.0 +/- 2.9 by 1% coal tar preparation and to 2.8 +/- 2.7 by calcipotriol. The mean PSI reduction between baseline and final assessment did not differ significantly between 1% coal tar preparation and calcipotriol (P = 0.77). The mean intraindividual difference in reduction of PSI score between 1% coal tar preparation and calcipotriol was 0.1 score points (95% confidence interval - 0.84 to + 0.63). No difference between either preparation was observed with regard to time until relapse. Itching was caused by 1% coal tar preparation in four patients and by calcipotriol in one patient. Unpleasant odour or staining of the 1% coal tar preparation was reported by six patients, whereas one patient complained about the smell of the calcipotriol cream. CONCLUSIONS The novel 1% coal tar preparation was found to be comparably as effective as calcipotriol in treating psoriasis. Tolerability and cosmetic acceptability was better for calcipotriol. Taking into consideration that the coal tar preparation is considerably less expensive than calcipotriol this new product appears as a very useful topical medication for chronic plaque type psoriasis.
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Affiliation(s)
- S Tzaneva
- Division of Special and Environmental Dermatology, Department of Dermatology, University of Vienna Medical School, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Pieper B, Caliri MHL. Nontraditional wound care: A review of the evidence for the use of sugar, papaya/papain, and fatty acids. J Wound Ostomy Continence Nurs 2003; 30:175-83. [PMID: 12851592 DOI: 10.1067/mjw.2003.131] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
With global travel and immigration, WOC nurses may see or be asked questions about wound care practices that are different from those traditionally taught in their educational programs. The purpose of this article is to review the evidence about 3 commonly used wound products, namely, sugar, papaya/papain, and essential fatty acids. Although these products are used in numerous countries, their application in Brazil will provide the examples of use in this article. Nontraditional wound care is still frequently practiced even in countries where access to evidence-based products is fairly good. Research studies about sugar, papain/papaya, and essential fatty acids generally are case reports/studies and descriptive. Protocols in the use of the products varied. Use of these products is often based on tradition and economics. WOC nurses need to be knowledgeable regarding nonstandard wound care products and procedures so they can respond appropriately in situations where these products are used.
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Affiliation(s)
- Barbara Pieper
- College of Nursing, Wayne State University, Detroit, Michigan, USA.
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Affiliation(s)
- Zhiguo Wang
- Research Center, Montreal Heart Institute, 5000 Belanger East, Montreal, Canada PQ H1 T 1C8.
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Seibel MM. Treating hot flushes without hormone replacement therapy. J Fam Pract 2003; 52:291-6. [PMID: 12681090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Abstract
BACKGROUND Many persons use botanicals and dietary supplements for chronic conditions that do not respond to traditional Western medications. Tricyclic antidepressants, a common treatment option for diabetic neuropathy, can have many side effects and are a poor choice in certain populations (eg, the elderly). As such, patients might turn to botanicals and dietary supplements, not realizing that these products are not well regulated. METHODS This article reviews botanicals and dietary supplements that have been involved in randomized controlled trials (RCTs) for diabetic neuropathy. We searched MEDLINE for English-language literature dating from 1966 to April 2001 using the following subject headings: (1) diabetes and botanical, herb, and supplement, (2) neuropathy and botanical, herb, and supplement, and (3) diabetic neuropathy and botanical, herb, and supplement. RESULTS Our search found agents that might improve symptoms of neuropathy (eg, evening primrose oil, alpha-lipoic acid, capsaicin) without affecting glucose control. Botanicals and dietary supplements involved in only one RCT or associated with little clinical benefit were reviewed in brief. CONCLUSIONS Evening primrose oil, alpha-lipoic acid, and capsaicin have received the greatest attention for their use in diabetic neuropathy, but further studies are needed to confirm their efficacy. Patients using these products need to be informed of potential drug interactions and side effects.
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Affiliation(s)
- Kathleen M Halat
- California College of Podiatric Medicine, San Francisco, Calif, USA
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Food for good behavior? Harv Ment Health Lett 2002; 19:6. [PMID: 12499139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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Blommers J, de Lange-De Klerk ESM, Kuik DJ, Bezemer PD, Meijer S. Evening primrose oil and fish oil for severe chronic mastalgia: a randomized, double-blind, controlled trial. Am J Obstet Gynecol 2002; 187:1389-94. [PMID: 12439536 DOI: 10.1067/mob.2002.127377a] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of evening primrose oil and fish oil on breast pain in premenopausal women with severe chronic mastalgia, in a randomized double-blind factorial clinical trial. STUDY DESIGN One hundred twenty women were placed randomly into four groups: (1) fish oil and control oil, (2) evening primrose oil and control oil, (3) fish and evening primrose oils, or (4) both control oils during 6 months. Corn oil and corn oil with wheat germ oil were used as control oils. The change in the percentage of days with breast pain after 6 months of treatment was analyzed on an intention-to-treat basis. RESULTS The decrease in days with pain was 12.3 % for evening primrose oil and 13.8% for its control oil (P =.73); the decrease in days with pain was 15.5% for fish oil and 10.6% for its control oil (P =.28). CONCLUSION All groups showed a decrease in pain. Neither evening primrose oil nor fish oil offered clear benefit over control oils in the treatment of mastalgia.
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Affiliation(s)
- Jacqueline Blommers
- Department of Clinical Epidemiology and Biostatistics, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands
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Abstract
As dietary sources of gamma-linolenic acid [GLA; 18:3(n-6)], borage oil (BO; 24-25 g/100 g GLA) and evening primrose oil (PO; 8-10 g/100 g GLA) are efficacious in treating skin disorders. The triglycerol stereospecificity of these oils is distinct, with GLA being concentrated in the sn-2 position of BO and in the sn-3 position of PO. To determine whether the absolute level and/or the triglycerol stereospecificity of GLA in oils affect biological efficacy, epidermal hyperproliferation was induced in guinea pigs by a hydrogenated coconut oil (HCO) diet for 8 wk. Subsequently, guinea pigs were fed diets of PO, BO or a mixture of BO and safflower oil (SO) for 2 wk. The mixture of BO and SO (BS) diet had a similar level of GLA as PO but with sn-2 stereospecificity. As controls, two groups were fed SO and HCO for 10 wk. Epidermal hyperproliferation was reversed by all three oils in the order of BO > BS > PO. However, proliferation scores of group PO were higher than of the normal control group, SO. The accumulations of dihomo-gamma-linolenic acid [DGLA; 20:3(n-6)], an elongase product of GLA, into phospholipids and ceramides, of 15-hydroxyeicosatrienoic acid (15-HETrE), the potent antiproliferative metabolite of DGLA, and of ceramides, the major lipid maintaining epidermal barrier, in the epidermis of group BO were greater than of groups BS and PO. Group BS had higher levels of DGLA, 15-HETrE and ceramides than group PO. With primary dependence on absolute levels, our data demonstrate that the antiproliferative efficacy of GLA in the epidermis is preferably exerted from sn-2 stereospecificity of GLA in BO.
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Affiliation(s)
- S Chung
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Seoul, Korea
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Ramanathan G, White GE. Attention-deficit/hyperactive disorder: making a case for multidisciplinary management. J Clin Pediatr Dent 2002; 25:249-53. [PMID: 12049088 DOI: 10.17796/jcpd.25.3.gx4131w514x45138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Attention Deficit/Hyperactivity Disorder (AD/HD) is characterized by a cluster of age-inappropriate behavioral abnormalities comprising inattentivity, hyperactivity and impulsivity. The definition is controversial and without an accurate diagnosis. Therefore, it seems prudent that a multidisciplinary treatment protocol should begin with non-drug psychological and behavioral strategies plus nutritional intervention.
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Affiliation(s)
- G Ramanathan
- Department of Pediatric Dentistry, Tufts University School of Dental Medicine, Boston, MA 02111, USA
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Gesch CB, Hammond SM, Hampson SE, Eves A, Crowder MJ. Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners. Randomised, placebo-controlled trial. Br J Psychiatry 2002; 181:22-8. [PMID: 12091259 DOI: 10.1192/bjp.181.1.22] [Citation(s) in RCA: 298] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is evidence that offenders consume diets lacking in essential nutrients and this could adversely affect their behaviour. AIMS To test empirically if physiologically adequate intakes of vitamins, minerals and essential fatty acids cause a reduction in antisocial behaviour. METHOD Experimental, double-blind, placebo-controlled, randomised trial of nutritional supplements on 231 young adult prisoners, comparing disciplinary offences before and during supplementation. RESULTS Compared with placebos, those receiving the active capsules committed an average of 26.3% (95% CI 8.3-44.33%) fewer offences (P=0.03, two-tailed). Compared to baseline, the effect on those taking active supplements for a minimum of 2 weeks (n=172) was an average 35.1% (95% CI 16.3-53.9%) reduction of offences (P<0.001, two-tailed), whereas placebos remained within standard error. CONCLUSIONS Antisocial behaviour in prisons, including violence, are reduced by vitamins, minerals and essential fatty acids with similar implications for those eating poor diets in the community.
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Affiliation(s)
- C Bernard Gesch
- University Laboratory of Physiology, University of Oxford, UK
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Abstract
OBJECTIVE To review some of the promising natural remedies within dermatology to explore their potential clinical benefit in supplementing conventional drugs. DATA SOURCES MEDLINE searches from January 1966 through October 2000 and Science Citation Index searches from January 1974 through October 2000 were conducted. STUDY SELECTION Primary importance was given to in vivo and in vitro controlled studies, the results of which encourage further exploration. DATA EXTRACTION The controls used, the statistical approach to analysis, and the validity of the experimental method analyzed were considered particularly important. Data were independently extracted by multiple observers. DATA SYNTHESIS Natural remedies seem promising in treating a wide variety of dermatologic disorders, including inflammation, phototoxicity, psoriasis, atopic dermatitis, alopecia areata, and poison oak. CONCLUSIONS The alternative medications presented seem promising, although their true effects are unknown. Many of the presented studies do not allow deduction of clinical effects. Further experimentation must be performed to assess clinical benefit.
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Affiliation(s)
- Cheryl Levin
- Department of Dermatology, UCSF Medical Center, 90 Medical Center Way, Room 110, San Francisco, CA 94143, USA
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