In This Issue….
-   Carnitine reduces walking pain in people with peripheral artery disease
-   Glutamine supplementation increases antioxidant activity in damaged muscle
-   Osteoporosis meds may deplete coQ10 and vitamin E
-   Questions on hormone therapy arise for both men and women
-   Vitamin D is particularly effective at reducing inflammation and pain in people with very low levels
-   Controversy arises over conclusion in study that says supplements don’t prevent cancer or heart disease
-   High dose vitamin C alleviates chemotherapy side effects: case study

CLINICAL UPDATE – Carnitine reduces walking pain in people with peripheral artery disease

In a randomized, double-blind trial, 239 patients received either 2grams per day of carnitine supplements or placebo for four months. All participants had established peripheral artery disease and intermittent claudication (pain during walking). In the group receiving carnitine, walking time and distance improved significantly over those taking placebo and was well tolerated in these patients.
(Thrombosis Research, October 2013)

LINK to ABSTRACT
A study on the efficacy and safety assessment of propionyl-L-carnitine tablets in treatment of intermittent claudication.

CLINICAL UPDATE – Glutamine supplementation increases antioxidant activity in damaged muscle

This study confirms this mechanistic link between glutamine and its antioxidant properties. Glutamine is known to be involved in glutathione synthesis which this study confirms. Specifically, oral supplementation of glutamine decreased inflammatory markers in damaged muscle by upregulating the antioxidant activity of glutathione. Levels of the inflammatory markers TNF-α (tumor necrosis factor alpha) and IL-1β (interleukin 1beta) were decreased when glutamine was given, and this result occurred due the increased activity of the powerful glutathione-containing antioxidants, glutathione reductase and glutathione peroxidase.
(Journal of Nutritional Biochemistry, March 2014)

LINK to ABSTRACT
Oral supplementations with free and dipeptide forms of l-glutamine in endotoxemic mice: effects on muscle glutamine-glutathione axis and heat shock proteins.

CLINICAL UPDATE – Osteoporosis meds may deplete CoQ10 and vitamin E

71 postmenopausal women with osteoporosis were evaluated in this study. Those taking nitrogen-bisphosphonate therapy, the most widely prescribed medicine for bone loss (Fosamax, Boniva, Actonel, etc) had significantly lower vitamin E and CoQ10 levels. Authors point out that the metabolic pathway involved in the pharmacological activity of this medicine is the same that is involved in the synthesis of the antioxidant coenzyme Q10, which may explain its effect on CoQ10 levels. They conclude “the degree of nitrogen-bisphosphonate exposure appears related to compromised coenzyme Q10 status and vitamin e gamma-tocopherol levels in postmenopausal women with osteoporosis” which may “link to certain adverse nitrogen-bisphosphonate associated events.”
(Journal of Clinical Endocrinology and Metabolism, January 2014)

LINK to ABSTRACT
Nitrogen-bisphosphonate therapy is linked to compromised coenzyme Q10 and vitamin E status in postmenopausal women.

CLINICAL UPDATE – Questions on hormone therapy arise for both men and women

In a recently published cohort study on over 55,000 men who were prescribed testosterone therapy, it was found that men who took prescribed testosterone actually doubled their risk of heart attack. This occurred in both men over 65 and younger men with heart disease, leading some researchers to imply that testosterone therapy in men deserves closer scrutiny.

Conversely, a study on hysterectomized women aged 50 to 59 years old who received placebo instead of hormone replacement therapy (part of the Women’s Health Initiative) estimated that between 18,000 and 91,000 women died prematurely because they did not take estrogen replacement therapy. Authors of the paper conclude that mortality is increased when estrogen is not replaced, although no distinction between synthetic and bioidentical hormones was made in their conclusions.
(PLoS One, January 2014)
(American Journal of Public Health, September 2013)

LINK to ABSTRACT
Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. LINK to FREE FULL TEXT
LINK to ABSTRACT
The mortality toll of estrogen avoidance: an analysis of excess deaths among hysterectomized women aged 50 to 59 years.

CLINICAL UPDATE – Vitamin D is particularly effective at reducing inflammation and pain in people with very low levels

In people with no acute illness or injury, vitamin D reduced inflammatory markers in those with levels below 21ng/mL, considered very deficient. Similarly, a study on thirty women with fibromyalgia who had vitamin D levels below 32ng/mL, also considered deficient, were given oral vitamin D supplements or placebo. After 20 weeks, optimization of vitamin D status had a “positive effect on the perception of pain.”(Nutrition Reviews, February 2014)
(Pain, February 2014)

LINK to ABSTRACT
Ability of vitamin D to reduce inflammation in adults without acute illness.
LINK to ABSTRACT Effects of vitamin D on patients with fibromyalgia syndrome: A randomized placebo-controlled trial.

CLINICAL UPDATE – Controversy arises over conclusion in study that says supplements don’t prevent cancer or heart disease

Dr. Katherine Nori Janosz, MD, FACP, Director of Nutritional Medicine and Associate Professor of Medicine at the Oakland University William Beaumont School of Medicine (Division of Nutrition and Preventative Medicine) provides a review and commentary of a recently published paper in the Annals of Internal Medicine. This paper concludes vitamin and mineral supplements do not aid in the primary prevention of cancer and heart disease.

In this paper, 26 studies on the benefit or harm of vitamin and mineral supplements in the primary prevention of cancer and heart disease were assessed. Although two of the studies showed a lower incidence of cancer in men taking a multivitamin, and no adverse effects were reported in adult non-smokers, the authors concluded that “limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or CVD.”

Many experts, including Dr. Janosz, point to several key points that paint a bigger picture of the context in which this conclusion was drawn. Notably, the Dr. Fortman, author of the paper states “The results of vitamin supplementation trials have been disappointing at best, despite having solid mechanistic basis…One explanation for this result could be that the physiologic systems affected by vitamins and other antioxidants are so complex...”   In addition, some argue there were few good-quality studies available for review and none evaluated individual deficiencies or use targeted supplementation therapies. Additional reasons cited by Dr. Janosz for lack of apparent benefit include the following:

(1) Most trial duration was less than a decade and vitamin effects may take longer to manifest
(2) Broad multivitamin protocols were used versus targeted supplementation with known deficiencies
(3) Varying doses and types of supplements complicated conclusions
(4) Serum levels may not, and indeed very often don’t, reflect functional intracellular nutrient status
(5) Patient non-compliance with multivitamins in trials may be considerable
(6) The studies looked at disease that was already well-established versus prevention
(7) Clinical trials are not well-suited to identify effects from multivitamins
(Annals of Internal Medicine, December 2013)

LINK to ABSTRACT
Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force.

CLINICAL UPDATE – High dose vitamin C alleviates chemotherapy side effects: case study

In this case report, a women with breast cancer undergoing weekly chemotherapy was given 50g vitamin C intravenously twice per week. Her chief complaint of chemotherapy-induced fatigue and insomnia were substantially mitigated when pharmacological doses of vitamin C treatment were administered after chemotherapy sessions.
(New Zealand Medical Journal, January 2014)

LINK to ABSTRACT Relief from cancer chemotherapy side effects with pharmacologic vitamin C.