July 2016 – Vol. 10, Issue 7

 In This Issue…

  • Selenium reduces mortality from heart disease but only in those who are deficient
  • Vitamin D may lower blood pressure, but only at higher dose
  • L-carnitine reduced fatigue in hypothyroid patients on thyroid meds
  • Biotin deficiency may increase inflammatory response
  • Vitamin B12 deficiency misdiagnosed as rare blood clotting disorder


CLINICAL UPDATE – Selenium reduces mortality from heart disease but only in those who are deficient
       In this clinical trial, 668 healthy elderly people in Sweden were divided into three groups:  (1) Group 1 received selenium and coenzyme Q10 supplementation daily for four years, (2) Group 2 received placebo for four years and (3) Group 3 received no treatment.  Each participant was also measured for blood levels of selenium at the beginning of the trial.
       After 5.2 years of follow-up, the authors determined two major conclusions:  First, that death from cardiovascular disease was higher in those with the lowest levels of selenium.  Second, supplementation was only cardio-protective in those who were low in selenium.  In other words, supplementation did not affect mortality in people who were not deficient, reinforcing the notion that “if some is good, more is better” does not apply to vitamin and mineral supplementation.
       (Public Library of Science PLoS ONE, July 2016)
Supplementation with Selenium and Coenzyme Q10 Reduces Cardiovascular Mortality in Elderly with Low Selenium Status. A Secondary Analysis of a Randomised Clinical Trial. LINK to FREE FULL TEXT


CLINICAL UPDATE – Vitamin D may lower blood pressure, but only at higher dose
       An updated meta-analysis on the effect of vitamin D supplementation indicated that the beneficial effects of vitamin D3 on blood pressure depend largely on the dosage used and the demographics of the patients studied.  In a review of 30 randomized controlled trials of over 4700 patients, no overall benefits on hypertension were seen in vitamin D trials when reviewed in totality.
       However, when the authors groups trials by dosage, they found that vitamin D did lower blood pressure in doses of at least 800 IU per day, and only in healthy or hypertensive patients.  In overweight people, the vitamin D supplementation actually increased blood pressure.  Similarly, when calcium was included in the trial, blood pressure increased.  Such disparate results highlight the complexity in which micronutrients function and suggest targeted supplementation versus blind supplementation is key.
       (Nutrition Metabolism and Cardiovascular Disease, August 2016)
 Effect of vitamin D3 supplementation on blood pressure in adults: An updated meta-analysis.



CLINICAL UPDATE – L-carnitine reduced fatigue in hypothyroid patients on thyroid meds
       In this clinical trial, 60 hypothyroid patients that were being treated with levothyroxine were given either carnitine (990mg twice daily) or placebo for twelve weeks.  Both physical and mental fatigue scores improved in the carnitine supplemented group compared to the placebo group, and the improvement in fatigue was more dramatic in younger participants (those under 50 years old).  Since thyroid hormone plays such a key role in fatty acid metabolism, the results suggest carnitine may be a useful treatment for fatigue that persists in hypothyroid patients that are already taking thyroid medicine.
       (Endocrinology Journal, July 2016)
L-carnitine supplementation for the management of fatigue in patients with hypothyroidism on levothyroxine treatment: a randomized, double-blind, placebo-controlled trial. LINK to FREE FULL TEXT



CLINICAL UPDATE – Biotin deficiency may increase inflammatory response
       In this study, a specialized type of immune cell called a dendritic cell which exists in areas of the body that interact with the outside environment (such as skin or intestinal epithelial cells) was cultured in biotin-deficient, biotin-sufficient and biotin-oversupplemented media. Once stimulated by a bacterial pathogen, the cells in the biotin-deficient media displayed much higher levels of inflammatory proteins (cytokines such as TNF-α and various interleukins) compared to the cells bathed in plenty of biotin. The authors concluded that a deficiency in biotin, also known as vitamin B7, increases the inflammatory response of these immune cells.
       (American Journal of Physiology and Cell Physiology, July 2016)
 Biotin Deficiency Enhances the Inflammatory Response of Human Dendritic Cells.


CASE REPORT – Vitamin B12 deficiency misdiagnosed as rare blood clotting disorder
       A 46 year old woman presented with stomach pain, vomiting and diarrhea that had been occurring for two days.  She had also experienced persistent fatigue and tingling in her limbs for the previous month. Initial bloodwork indicated anemia with several malformed red blood cells (shisotcytes) and irregular white blood cells (hypersegmented neutrophils). This led to an initial diagnosis of TPP (thrombotic thrombocytopenic purpura), a rare blood clotting disorder that causes multiple blood clots throughout the body and damages organs.  Typical treatment of TPP involves removing, then treating blood from a patient, but in this case, the woman refused treatment based on religious beliefs.
       Once the initial treatment option (plasmapheresis) was refused, the patient’s vitamin B12 was checked and found to be extremely low.  Antibodies consistent with pernicious anemia were also found and a regimen of intramuscular B12 shots was started which dramatically improved both the neurological and anemia symptoms.  This is a rare case of vitamin B12 deficiency misdiagnosed as TPP, which if treated with plasmapheresis may have actually exacerbated the problem.
       (Transfusion, January 2016)
To treat or not to treat: a rare case of pseudo-thrombotic thrombocytopenic purpura in a Jehovah's Witness.