Friday, August 24, 2007

Vitamins, Vitamin C, and Niacin Complement Mainstream Medicine

High potency vitamin supplements have only been available to the consumer for 30 years. The benefits of vitamins are difficult to perceive, and tend to be long-lasting (bad things only happen on rare occasions when vitamin supplements are stopped). The side effects are readily perceived, and can cause intense discomfort. Side effect thresholds vary widely between individuals. Side effect thresholds can also vary widely for an individual changing with age and state of health. It will take a long time for society to optimize the use of vitamins.

If this weren’t enough, vitamin optimization faces political challenges. Despite the fact that vitamins were among the greatest scientific discoveries of the twentieth century, and the fact that numerous Nobel prizes were awarded, vitamin optimization is overseen by the alternative medicine community instead of the mainstream medicine community. This makes vitamins appear unscientific and greatly reduces the funding available for controlled clinical trials.

My view is that vitamins and mainstream medicine are complementary. Vitamins and drugs are usually safe to use together. This is not always the case, so people who want to take high potency vitamins and drugs are strongly advised to consult with their physicians.

I believe that my view is gaining ground. Science has proven the benefits of vitamins in doses well above the RDA as a treatment for five conditions: vitamin deficiency diseases (today that means eating disorders including anorexia and bulimia); colds; heart disease; burns; and skin damage from the sun. Physicians have shown a remarkable lack of interest in the effectiveness of vitamin C for fighting colds. This single topic is of great interest to both the medical community and the public, and attracts far more media attention than any other vitamin-related topic. This leads to the impression that mainstream medicine is not changing its view of vitamins. This is not the whole picture. Cardiologists and cosmetics company scientists have embraced the benefits of vitamins and are developing combinations of vitamins and drugs that clearly combine the benefits of both. This is a promising sign that more and more people will be using more and more combinations of vitamins and drugs to improve health and wellness around the world.

Vitamins and Drugs Work Together to Treat Heart Disease and Skin Conditions: References

(1) Improvement in the appearance of wrinkles with topical transforming growth factor  1 and L-ascorbic acid. Ehrlich, Michelle; Rao, Jaggi; Pabby, Anju; Goldman, Mitchel P. American Society for Dermatologic Surgery Preceptorship Program, Dermatology/Cosmetic Laser Associates of La Jolla Inc., La Jolla, CA, USA. Dermatologic Surgery (2006), 32(5), 618-625. Publisher: Blackwell Publishing, Inc., CODEN: DESUFE ISSN: 1076-0512. Journal written in English. CAN 146:168790 AN 2007:22218

Abstract

Facial rhytides are a common cosmetic concern. Surgical treatment effects dramatic improvement; however, the assocd. risk and cost may be prohibitive. Recent focus is on developing topical products contg. biol. active ingredients for at-home therapy. Our study examines the effects of a topical cream contg. transforming growth factor-1 (TGF-1), L-ascorbic acid, and Cimicifuga racemosa ext. (CRS) (Topix Pharmaceuticals, North Amityville, NY, USA). In the first arm of the study, 12 subjects were randomized to apply CRS to the left or right side of their face and a cream contg. L-ascorbic acid and C. racemosa in silicone base (vitamin C [Vit C]) to the contralateral side twice daily for 3 mo. In the second arm of the study, 20 subjects were randomized to apply CRS to the left or right side of their face and Tissue Nutrient Soln. Recovery Complex (TNS) (SkinMedica, Carlsbad, CA, USA), a product contg. a variety of growth factors including VEGF, PDGF-A, G-CSF, HGF, IL-6, IL-8, and TGF-1 (Nouricel-MD) without L-ascorbic acid, C. racemosa ext., or silicone base, to the contralateral side of their face twice daily for 3 mo. Digital photographs were scored by study-blinded physicians, and self-assessments were completed by all subjects at baseline and at the conclusion of the protocol. CRS and TNS were well tolerated, and all subjects completed the 3-mo protocol for the CRS vs. Vit C arm of the study. Physicians rated success in facial wrinkling scores on the CRS-treated side of the face for 27 of 31 subjects. Responders showed, on av., 21.7% improvement in physician-rated wrinkle scores. The mean improvement in the group of 31 patients as a whole was 12%. Eighteen of 31 subjects reported a noticeable improvement on their CRS-treated side. Both CRS and TNS demonstrate significant success between baseline and 3-mo scores, and both growth factor products are superior to Vit C. Patients preferred CRS over TNS. CRS is effective in minimizing the appearance of facial rhytides. The success of the CRS product is largely attributable to the incorporation of TGF-1.

(2) Maximizing coronary disease risk reduction using nicotinic acid combined with LDL-lowering therapy. Brown, B. Greg. Division of Cardiology, University of Washington, Seattle, WA, USA. European Heart Journal Supplements (2005), 7(Suppl. F), F34-F40. Publisher: Oxford University Press, CODEN: EHJSFT ISSN: 1520-765X. Journal; General Review written in English. CAN 143:431803 AN 2005:889563

Abstract

A review. Treatment with statins markedly reduces levels of LDL-cholesterol, and large, well-designed evaluations of these agents have demonstrated redns. in cardiovascular event rates of .apprx.20-40%. Addnl. therapeutic strategies will be required to make further inroads into the substantial residual burden of cardiovascular disease in statin-treated patients. Epidemiol. studies over several decades and outcome studies with agents that raise levels of this lipoprotein (nicotinic acid or fibrates) have established low HDL-cholesterol as an important therapeutic target. Combining agents which decrease LDL-cholesterol and increase HDL-cholesterol within a single regimen might provide a means of improving cardiovascular prognosis beyond that possible with statins alone. Six randomized clin. trials involving treatment with nicotinic acid in combination with a statins or bile acid sequestrant have demonstrated regression, or markedly slowed progression, of atherosclerosis in patients at high risk of a cardiovascular event. Three of these trials, the HDL-Atherosclerosis Treatment Study, the Familial Atherosclerosis Treatment Study, and the Armed Forces Regression Study, have assocd. these benefits with significant improvements in clin. outcomes. Correcting low HDL-cholesterol in statin-treated patients may provide a means to achieve the next leap forward in the management of cardiovascular disease.

The Debate is Over: Vitamin C and Niacin Protect the Skin from the Sun

Food does not provide enough vitamin C and niacin to provide maximum protection against damage caused by exposure to the sun (skin aging). The benefits of vitamin C and niacin have been proven in numerous controlled clinical trials using high potency vitamin C and niacin creams. The evidence is indisputable. I found 29 reports published since 2003 using niacin creams and 8 using vitamin C creams. Many of the niacin reports were in the form of patents. Unilever, Proctor and Gamble, and L’Oreal were among the companies developing niacin-containing anti-aging skin creams.

Last week I visited a dermatologist for the first time. The purpose of my visit was to consult with a doctor that would have to be aware of the benefits of vitamin supplements and could not subscribe to the view that one RDA was enough. I intended to get advice about which brand of niacin and vitamin C cream to buy, because poorly formulated creams are known to be ineffective. The dermatologist acknowledged that the vitamin creams probably worked, but confessed to a lack of expertise. Dermatologists do not see preventing skin aging as their job. Their job is to diagnose skin diseases, prescribe drugs, and perform surgery. I was stunned. Vitamin supplements in the form of creams are mainstream treatments for the skin. There is a consensus between the mainstream and alternative medicine communities that they work when properly formulated. Yet somehow dermatologists rationalize the view that vitamin creams are not their business.

The studies I read showed that vitamin creams maintain skin barrier properties, elasticity, and smoothness, and prevent skin pigmentation and possibly skin cancer. Some of the testing involved sophisticated biochemistry. Other described tests are easily understood. For example, researchers use a “tape stripping test”. Tape is attached to shaved skin and then torn off. Several minutes later the skin is photographed to document the damage caused. The less redness and swelling observed, the healthier the skin.

Clinical trials and patents from leading cosmetics companies prove that creams containing vitamin C and niacin help maintain the skin in a healthy, youthful state. To me, this means that a substantial portion of skin aging is a disease that can be prevented. I believe it is the responsibility of dermatologists to inform their patients that they should be using vitamin skin creams, just like it is the responsibility of my dentist to inform me that I have to brush and floss my teeth every day. I believe it is also the responsibility of dermatologists and cardiologists to teach their colleagues that vitamins have proven benefits at doses well above one RDA.

Examples of Recent Science Proving the Benefits of Vitamin Skin Creams

(1) Perifollicular pigmentation is the first target for topical vitamin C derivative ascorbyl 2-phosphate 6-palmitate (APPS): randomized, single-blinded, placebo-controlled study. Comments. Inui, Shigeki. Japan. Journal of Dermatology (2007), 34(3), 221-223. Publisher: Blackwell Publishing Asia Pty Ltd., CODEN: JDMYAG ISSN: 0385-2407. Journal written in English. CAN 147:110083 AN 2007:373252

Abstract

The effect of topical vitamin C deriv. ascorbyl 2-phosphate 6-palmitate (APPS) on the conspicuous facial pores evidenced by randomized, single-blinded, placebo- controlled study was evaluated. In this study, 10 healthy Japanese females and one male, aged 20-60 years, participated between March and May 2006 at Hojikai Ikeda Hospital. Six subjects applied 1 % APPS lotion on the face twice a day at morning and night for 4 wk. Five subjects applied the base soln. twice a day at morning and night for 4 wk. Results showed that APPS significantly reduced the blackish pores corresponding to perifollicular pigmentation but showed no significant effect on the size of the facial pores. One possible reason for this discrepancy is that the treatment period was not enough to obtain size redn. by APPS. Indeed, the preferential tendency for size redn. was obsd. Thus, a longer-term trial will provide more information for the effect APPS effect on the pore size. Taken together, it is suggested that perifollicular pigmentation is the first target, preceding the pigmentation of interfollicular epidermis, for skin whitening.

(2) Topical ascorbic acid on photoaged skin. Clinical, topographical and ultrastructural evaluation: double-blind study vs. placebo. Humbert, Philippe G.; Haftek, Marek; Creidi, Pierre; Lapiere, Charles; Nusgens, Betty; Richard, Alain; Schmitt, Daniel; Rougier, Andre; Zahouani, Hassan. Department of Dermatology, Hospital Saint Jacques, University of Franche-Comte, Besancon, Fr. Experimental Dermatology (2003), 12(3), 237-244. Publisher: Blackwell Munksgaard, CODEN: EXDEEY ISSN: 0906-6705. Journal written in English. CAN 140:35875 AN 2003:604716 CAPLUS (Copyright (C) 2007 ACS on SciFinder (R))

Abstract

Vitamin C is known for its antioxidant potential and activity in the collagen biosynthetic pathway. Photoprotective properties of topically applied vitamin C have also been demonstrated, placing this mol. as a potential candidate for use in the prevention and treatment of skin ageing. A topically applied cream contg. 5% vitamin C and its excipient were tested on healthy female volunteers presenting with photoaged skin on their low-neck and arms in view to evaluate efficacy and safety of such treatment. A double-blind, randomized trial was performed over a 6 mo period, comparing the action of the vitamin C cream vs. excipient on photoaged skin. Clin. assessments included evaluation at the beginning and after 3 and 6 mo of daily treatment. They were performed by the investigator and compared with the volunteer self assessment. Skin relief parameters were detd. on silicone rubber replicas performed at the same time-points. Cutaneous biopsies were obtained at the end of the trial and investigated using immunohistochem. and electron microscopy. Clin. examn. by a dermatologist as well as self-assessment by the volunteers disclosed a significant improvement, in terms of the "global score", on the vitamin C-treated side compared with the control. A highly significant increase in the d. of skin microrelief and a decrease of the deep furrows were demonstrated. Ultrastructural evidence of the elastic tissue repair was also obtained and well corroborated the favorable results of the clin. and skin surface examns. Topical application of 5% vitamin C cream was an effective and well-tolerated treatment. It led to a clin. apparent improvement of the photodamaged skin and induced modifications of skin relief and ultrastructure, suggesting a pos. influence of topical vitamin C on parameters characteristic for sun-induced skin ageing.

(3) Effect of vitamin C on skin disease. Ichihashi, Masamitsu. Sch. Med., Kobe Univ., Kobe, Japan. Fragrance Journal (1997), 25(3), 29-33. Publisher: Fureguransu Janaru Sha, CODEN: FUJAD7 ISSN: 0288-9803. Journal; General Review written in Japanese. CAN 126:324780 AN 1997:233740

Abstract

A review with 21 refs. Lack of vitamin C is not a serious problem in the developed countries, but scurvy patients are still seen in many parts of the world where general malnutrition is common. In vitamin C deficiency, collagen synthesis is depressed and multiple syndromes with bone, mucous membrane and skin abnormalities develop. Vitamin C is clin. applied to treat pigmentary disorders, such as chloasma, and post-inflammatory pigmentation, and also used to treat pigmented purpura in combination with vitamin E and tranexamic acid. Magnesium ascorbyl phosphate (VC-2P) shown to be effective in the prevention of lipid peroxidn., melanogenesis and cell death may be applied effectively for human skin to prevent photoaging.

(4) The new efficacy of niacinamide in the skin and the application to the skin care products of cosmetics. Tanno, Osamu. Basic Res. Lab., Kanebo Ltd., Odawara, Japan. Fragrance Journal (2004), 32(2), 35-39. Publisher: Fureguransu Janaru Sha, CODEN: FUJAD7 ISSN: 0288-9803. Journal; General Review written in Japanese. CAN 140:275682 AN 2004:194729

Abstract

A review. Niacin and niacinamide play an important role as coenzymes, NAD+ and NADP+, in the skin. Recently, some studies of new efficacy of niacinamide were reported that it may work through without NAD+ and NADP+. We had reported the new efficacy of niacinamide that increased the synthesis of the stratum corneum lipids. The topical application of niacinamide improved the water contents and the TEWL of the winter xerosis. In this paper, I present other possibility of niacinamide in the skin. Niacinamide suppress the scratching of NC mice and decrease the stinging score for sensitive skin. Niacinamide also prevents and improves the acne. Finally, I discuss about the new efficacy of niacinamide for skin care products.

(5) A topical lipophilic niacin derivative increases NAD, epidermal differentiation and barrier function in photodamaged skin. Jacobson, Elaine L.; Kim, Hyuntae; Kim, Moonsun; Williams, Joshua D.; Coyle, Donna L.; Coyle, W. Russell; Grove, Gary; Rizer, Ronald L.; Stratton, M. Suzanne; Jacobson, Myron K. Department of Pharmacology and Toxicology, College of Pharmacy, University of Arizona, Tucson, AZ, USA. Experimental Dermatology (2007), 16(6), 490-499. Publisher: Blackwell Publishing Ltd.

Abstract

The effects of myristyl nicotinate (MN), a nicotinic acid deriv. designed to deliver nicotinic acid to skin without vasodilatation, on subjects with photodamaged skin have been studied. MN increased skin cell NAD (NAD) by 25% (P = 0.001) demonstrating effective delivery of nicotinic acid to skin. Relative to placebo, MN treatment of photodamaged facial skin increased stratum corneum thickness by approx. 70% (P = 0.0001) and increased epidermal thickness by approx. 20% (P = 0.001). In two sep. studies, MN treatment increased rates of epidermal renewal by 6% (P = 0.003) to 11% (P = 0.001) and increased the minimal erythemal dose by 8.9 (P = 0.07) and 10% (P = 0.05) relative to placebo. MN treatment resulted in redns. in the rates of transepidermal water loss (TEWL) of approx. 20% relative to placebo on cheeks (P = 0.012) and arms (P = 0.017) of study subjects. Results of a tape stripping challenge before and after MN treatment demonstrated a significant correlation (P = 0.03) between increased skin NAD content and resistance to changes in TEWL for MN treated but not placebo subjects. Rates of TEWL changed more rapidly and to a greater extent in atopic subjects compared with normal subjects. The results indicate that MN enhances epidermal differentiation and barrier function in skin, suggesting that this method of nicotinic acid delivery may prove useful in limiting progression of actinic skin damage and possibly in treating other conditions involving skin barrier impairment.

(6) Antiaging topical formulations containing niacin and ubiquinones. Moro, Osamu. (Shiseido Co., Ltd., Japan). Jpn. Kokai Tokkyo Koho (2005), 20 pp. CODEN: JKXXAF JP 2005298370 A 20051027 Patent written in Japanese. Application: JP 2004-113613 20040407.

Abstract

Antiaging topical formulations contain niacin and ubiquinones selected from ubiquinone Q7, Q8, Q9, and Q10. A skin cream contg. 0.5 wt.% coenzyme Q10 and 1.0 wt.% nicotinamide showed good antiwrinkle, antiaging, and pigmentation-preventing effects on human skin.

(7) Peeling composition containing vitamin B3 and vitamin C. Sore, Gabrielle; Hansenne, Isabelle. (L'Oreal, Fr.). Fr. Demande (2005), 13 pp. CODEN: FRXXBL FR 2861595 A1 20050506 Patent written in French. Application: FR 2003-50742 20031029. Priority: . CAN 142:435386 AN 2005:394075


Abstract

A compn. for topical application on the skin comprises: (a) 10-70% in wt. of nicotinic acid, esters of nicotinic acid and nicotinamide, and (b) 10-70% in wt. of ascorbic acid and its precursors. This compn. is used in dermatol. prepns. intended to carry out chem. peeling of surface of the skin, in order to attenuate the visible and/or tactile irregularities of the skin, and to attenuate the pigmentary wrinkles in particular and/or spots and/or the scars such as the marks of acne or chicken pox. A topical peeling compn. contained niacinamide 10, ascorbic acid 10, glycerin 10, and water q.s. 100%.

(8) Skin care composition containing glycerin and a vitamin B3 compound that increase and repair skin barrier function. Evans, Erica Louise; Matts, Paul Jonathan. (The Procter & Gamble Company, USA). Eur. Pat. Appl. (2004), 14 pp. CODEN: EPXXDW EP 1459736 A1 20040922 Patent written in English. Application: EP 2003-251574 20030314.

Abstract

Skin care compns. are provided comprising (i) greater than 7% glycerin, (ii) a vitamin B3 compd., i.e., niacinamide, nicotinic acid, tocopherol nicotinate, and inositol hexanicotinate, and (iii) a natural moisturizing factor selected from amino acids or sodium 2-pyrrolidone-5-carboxylate. The skin care compns. of the present invention provide improved acute skin hydration in combination with increased skin barrier function repair that result in improved chronic skin hydration.

(9) Skin lightening compositions comprising vitamins and flavonoids. Yates, Paula Rachel; Charles-Newsham, Rebecca Louise. (Unilever Plc, UK; Unilever NV; Hindustan Lever Limited). PCT Int. Appl. (2005), 32 pp. CODEN: PIXXD2 WO 2005094770 A1 20051013 Patent written in English. Application: WO 2005-EP2596 20050310.

Abstract

A compn. is provided comprising a flavanoid, vitamin C, vitamin E and niacin. The compn. can be used as a skin lightening agent for systemic or topical administration. Thus, a combination of a flavanoid (Pycnogenol), vitamin C, vitamin E, and niacinamide inhibited dark melanin prodn. in vitro in a synergistic manner and increased light melanin prodn. Further effects were seen in combination with vitamin A with the best results being obtained with a seven component combination also including vitamin B12 and cysteine.

Sunday, August 19, 2007

Children and Vitamin C: Vitamin C, Niacin, and Multivitamins Catalyze Growth and Development

I believe that the primary function of vitamins is to catalyze the growth and development of and egg and sperm into a healthy adult. Read more here. I therefore believe that the importance of vitamin C, niacin, and multivitamin supplements are a function of age. Optimal daily consumption of vitamins is most important for the youngest members of our society. I recommend 2000 to 3000 mg/day vitamin C, 125 mg time-release niacin two or three times/week, and a one RDA multivitamin/day. This is about half what my own children were raised on.

The RDA’s for children are not set based on the results of experiments with children. They are set based on experiments with healthy adult men. It appears that the doses required to keep healthy men healthy were scaled down for children roughly in proportion with body weight. Adult men are not growing. They can’t benefit as much from vitamin supplements. Scaling down doses required for adults just doesn’t make any sense to me.

My beliefs are based on science. I’ve been studying biology for a second time in order to help my son. His high school text does a wonderful job covering the basics. I learned from the text that the DNA in the nucleus of every human cell contains close to 3 billion DNA base pairs. Every time a cell divides (this happens over and over again during the process of growth and development), an average of 3 mistakes are made. The DNA in the new cell is not exactly the same as the DNA in the parent cell.

No-one grows up perfectly. Vitamin dependent pathways are involved in a large fraction of the chemical reactions that are required for cell division (growth and development). It is perfectly reasonable to hypothesize that taking vitamin C, niacin, and multivitamin supplements can reduce the error rate, especially in times of stress (e.g. when a child is suffering a bad cold).

Not surprisingly, the food manufacturing industry is out front testing the hypothesis that vitamin supplements improve growth and development. In the last ten years numerous studies have been documented proving the benefits of supplementing the diets of baby fish, shrimp, and poultry. I found 7 trials using niacin supplements, and an incredible 50 trials with vitamin C. The aquaculture industry (fish and shrimp) has done so much work with vitamin C that I found three review articles. The results of this body of work are unequivocal – the amount of vitamin C in ordinary food is insufficient to optimize the health and development of fish and shrimp. Food is not enough. Vitamin C supplements are required. Fish and shrimp challenged by bacterial infections and other stresses benefit from roughly 10 times the dose of vitamin C required to optimize growth rates in the absence of stress.

Our society is not going to conduct controlled trials to find the optimum doses of vitamin C for the growth and development of children. This would be both unethical and misguided. The primary concern of parents and regulators is safety. Parents can confidently provide their children with up to 4,000 mg/day of vitamin C every day and up to 10,000 mg/day when they are fighting colds. The only risk is short term discomfort. If 500 or 1000 mg was the optimal dose, no parent will care as long as 4000 mg/day is safe and remains free of discomforts. In other words, if a parent is supplementing his/her children with 4000 mg/day and the children are healthy and happy, that parent is unlikely to explore lower doses in order to find an optimum.

All parents should consider vitamin C, time-release niacin, and multivitamin supplements for their children. The children have everything to gain and almost nothing to lose by giving this approach a try.

Recent Scientific Papers Proving Vitamin C Improves the Growth and Development of Children

(1) Effect of dietary vitamin C on the disease susceptibility and inflammatory response of mrigal, Cirrhinus mrigala (Hamilton) to experimental infection of Aeromonas hydrophila. Sobhana, K. S.; Mohan, C. V.; Shankar, K. M. College of Fisheries, Department of Aquaculture, Fish Pathology and Biotechnology Laboratory, University of Agricultural Sciences, Mangalore, India. Aquaculture (2002), 207(3-4), 225-238. Publisher: Elsevier Science B.V.

Abstract

Two groups of 3-day-old hatchlings of Cirrhinus mrigala were fed with vitamin C supplemented (at 1000 mg vitamin C/kg diet) and non-supplemented practical diet for a period of 4 mo. At the end of the feeding period, fishes were examd. for their disease susceptibility and inflammatory response to a virulent strain of Aeromonas hydrophila. Mortality curves were clearly distinct and the vitamin C non-supplemented (VNS) group showed significantly higher mortality rates compared to the vitamin C supplemented (VS) group. While studying the inflammatory response to A. hydrophila, it was found that in the VS group, the infiltration of phagocytic cells was quicker with very limited lesion development at the injection site and there was complete resoln. by day 9 post-injection. In the VNS group, the bacterium was able to produce necrotic lesions clin. and histol. typical of a disease condition.

(2) Optimization of dietary vitamin C in fish and crustacean larvae: a review. Merchie, G.; Lavens, P.; Sorgeloos, P. Laboratory for Aquaculture and Artemia Reference Center, University of Ghent, Rozier 44, Ghent, Belg. Aquaculture (1997), 155(1-4), 165-181. Publisher: Elsevier

Abstract

A review with 64 refs. HPLC techniques have been adapted and standardized for quantification of ascorbic acid (AA) and its derivs. in both diets and target organisms. To assess the dietary needs for AA at the start of exogenous feeding, the AA content in the various live diets currently used in aquaculture (algae, rotifers, Artemia) was analyzed. Application of techniques for boosting vitamin C using ascorbyl palmitate as the source enabled the transfer of elevated levels (up to 2500 g AA/g DW) of bioactive vitamin C. Larvae of fish (Clarias gariepinus, Dicentrarchus labrax, Scophthalmus maximus), white shrimp (Penaeus vannamei) and prawn (Macrobrachium rosenbergii) are enriched via the live food chain. This vitamin C enrichment procedure has proven to be a valuable technique for the evaluation of the effects of high levels of dietary vitamin C on stress resistance. However, in most of the species examd., the initial level of AA in Brachionus and Artemia impaired the detn. of the AA requirements for optimal growth and survival. Formulated diets contg. variable levels of stable AA-phosphate esters were used for the detn. of minimal requirements for AA in the early post-weaning stage of marine fish species (D. labrax, S. maximus) and the postlarval stage of penaeid shrimp (Penaeus monodon, P. vannamei). For both fish species, results indicated that, within the concn. range tested, 20 mg AA/kg diet is sufficient for normal growth and survival. For prodn. of postlarval shrimp, this level amts. to a min. 20 and 130 mg AA/kg diet for P. monodon and P. vannamei, resp., while a level of 2000 mg AA/kg diet is needed to enhance the resistance of shrimp postlarvae to stress conditions and bacterial infections.

Thursday, August 16, 2007

Vitamin C and Heart Disease: New Study

Common vitamins no help for women's hearts: study

This is the headline from a Reuters article yesterday explaining the results of an eight-year study published in the August 13, 2007 issue of the Archives of Internal Medicine. The study followed more than 8,000 women, average age 61, for about nine years. The supplementation these women took was 500mg of vitamin C daily and 600 IU of vitamin E and 50mg of beta carotene taken every other day.

According to the Reuters story, study author Nancy Cook of Brigham and Women's Hospital and Harvard Medical School in Boston said "widespread use of these individual agents for cardiovascular protection does not appear to be warranted,"

So you are probably thinking, "hey, Rusty, all this time you have been touting vitamin C and you've been wrong." So, let us look a little deeper. First and most obvious is the low dosage. 500 mg of vitamin C a day is woefully inadequate. Studies that use dosages of vitamin C less than several grams per day should be disregarded, in my opinion, or at least considered with the understanding of the inadequacy of the dose. But most important is the interpretation of the study results.

Mike Adams of newstarget.com explains how the data from this study were misrepresented in his article Unraveling the lies about the antioxidant study on vitamins E and C . Mike says "Overall, if you look at the entire group of women followed in this study, you find that cardiovascular protective benefits were only marginal: An 11 percent reduction in the risk of combined cardiovascular disease. But that benefit is diluted by the fact that it includes all the women who neglected to actually take the vitamins! If you include only the women who complied with taking the vitamins on a regular basis, the results increase substantially and become quite significant with a 31 percent reduction in the risk of stroke and 22 percent reduction of risk in heart attacks. In other words, those women who actually took vitamins E and C experienced substantial benefits from doing so."

It does seem only fair to exclude those women from the study results that did not take the supplements. Studying the effects of the supplements was the whole point. Even with this huge distortion, "an 11 percent reduction in the risk of combined cardiovascular disease" is something the statin drug proponents can only dream of!

It is very important to look at these studies critically. I say this for ALL studies, because, unfortunately, an expected or desired outcome often plays a role in how the study is interpreted. This is a travesty of science, but nonetheless true. The story is all in the telling.

Sunday, August 12, 2007

Vitamin C, Niacin, and Multivitamins – Insurance Against Eating Disorders (Anorexia and Bulimia)

If you are caring for an anorexic, vitamins complement all other treatment approaches. You can confidently pursue vitamins simultaneously with any other treatment options that you believe will help. The behavioral psychologists that specialize in eating disorders are not trained in nutrition and are not qualified to recommend nutritional approaches. Without further training, it would be unethical for them to make recommendations concerning vitamins.

Vitamins are so safe that you are empowered to research the relationship between eating disorders and vitamins on your own, and to provide treatment on your own. Treatment is easy, just go down to the corner store and purchase vitamin C, time release niacin, and multivitamins. If you want a second opinion, you’ll need to seek out an orthomolecular physician.

Eating disorders are the only remaining vitamin deficiency diseases in the developed world. There is a scientific consensus that eating disorders are intertwined with vitamin deficiency. If you don’t eat, you can’t consume the R.D.A.’s for essential nutrients. Anorexia is a known symptom of pellagra (niacin deficiency) and beriberi (vitamins B1 and B2 deficiency). Many other mental health problems are associated with vitamin deficiency. Vitamins are not a magic cure for eating disorders, and should not be substituted for the advice of specialists. There is much to gain and nothing to lose, however, by providing anorexics with vitamins in addition to following the advice of eating disorder specialists.

I believe that vitamin C, niacin, and multivitamins can reduce the incidence of full-blown eating disorders. All parents of teenage girls should consider supplements. Thanks to the ready availability of supplements, it is straightforward for parents to ensure that their children consume ample amounts of essential nutrients for just pennies per day. Now that’s inexpensive insurance.

Vitamin C, Niacin, and Multivitamins for Children Taking Antibiotics

Occasional bacterial infections are part of a normal childhood. Bacterial infections (ear infections, lung infections, infected wounds, vaginal infections, tooth infections) are dangerous and need to be treated promptly with antibiotics.

Vitamin C, niacin, and multivitamins also help the body fight off bacterial infections. You and your doctor don’t need to choose between antibiotics and vitamins. Vitamins work by completely different mechanisms, and do not interfere with the action of antibiotics. Vitamins and antibiotics are synergistic. Taking them together cures the body faster than taking either of them alone.

This isn’t just my opinion. It’s been proven for vitamin C. Researchers in India did a controlled clinical trial with cows with infected udders. The cows were divided into two groups. One group was treated with antibiotics alone, and the other group was treated with antibiotics and 10,000 mg/day injections of vitamin C. The vitamin C group got well in just over half the time. These scientific observations have been clinically confirmed by orthomolecular physicians. Many of these physicians treat bacterial infections with combined vitamin and anti-biotics and report prompt recoveries.

5,000 to 20,000 mg/day of vitamin C, 250 mg/day of time-release niacin, and a multivitamin for several days is safe and the risk of uncomfortable side effects is low. Children with bacterial infections have a lot to gain and almost nothing to lose by trying this treatment.

The synergy between vitamins and drugs is much broader than antibiotics. Vitamins and prescription drugs are rarely counter-indicated. Read more here. One example is niacin and statin drugs. Niacin and statins often work better together than either does alone. In this case, like the vitamin C and antibiotics case, there are controlled clinical trials that prove the hypothesis. Vitamins have also been reported to improve the potency of medications for diabetes. There are many other examples. There are, of course, occasional counter indications so patients must inform their doctors about the vitamins they are taking.

Vitamins are a powerful tool to help fight infections. One reason they are underutilized is because it is impossible to separate the action of the vitamin from the antibiotic. Patients can’t feel the vitamins working, and scientists have difficulty raising the funds required to pay the high costs of conducting controlled trials. On the other hand, patients can feel the discomforts caused by proven vitamin side effects. So, it will take time to optimize treatment. In the meantime, I recommend risking the discomforts of vitamin side effects in exchange for reducing the much greater risks associated with a prolonged bacterial infection.

Support for Antibiotics + Vitamin C + Niacin: Abstracts from Recent Scientific Publications

The following abstracts are examples of recent scientific studies supporting the blog entry using vitamin C, niacin, and drugs together to optimize the recovery of good health.

(1) The effect of 24 months of combination statin and extended-release niacin on carotid intima-media thickness: ARBITER 3. Taylor, Allen J.; Lee, Hyun J.; Sullenberger, Lance E. Cardiology Service, Walter Reed Army Medical Center, Washington, DC, USA. Current Medical Research and Opinion (2006), 22(11), 2243-2250. Publisher: LibraPharm Ltd.
Abstract

The ARBITER 2 trial showed that extended-release niacin (ERN) when added to statin monotherapy slowed the progression of carotid atherosclerosis over 12 mo. Whether longer treatment with ERN would have a greater effect on carotid intima-media thickness (CIMT) is unknown. The long-term effects of ERN on high-d. lipoprotein (HDL-C) cholesterol and CIMT were examd. during 12-24 mo treatment with ERN in ARBITER 2 participants who either continued or were crossed over (from placebo) to ERN 1000 mg daily. Among 149 subjects completing ARBITER 2, 130 (88%) enrolled in ARBITER 3. The prespecified primary endpoints were the within-group change in CIMT and HDL-C in patients receiving placebo for 12 mo (n = 71), ERN for 12 mo (comprised of subjects from ERN treatment during ARBITER 2 (n = 78) and those crossed over to ERN from placebo after ARBITER 2 (n = 47)), and ERN for 24 mo spanning ARBITER 2 and 3 (n = 57). Five subjects discontinued the study due to flushing side effects. The study was completed by 104 subjects (47 crossed over from placebo; 57 with ERN continued from ARBITER 2). HDL-C increased in the ERN group from 39.5  6.7 to 48.6  13.3 mg/dL (p < 0.001) along with modest redns. in LDL-C and TG. Among 125 participants treated with ERN for 12 mo, there was a net regression of CIMT of -0.027  0.011 mm (p < 0.001 vs. placebo). Among 57 participants treated with ERN for 24 mo, there was addnl. significant regression of CIMT of -0.041  0.021 mm (p = 0.001 vs. placebo). Controlling for changes in LDL and triglycerides, only changes in HDL-C were independently assocd. with regression of CIMT (P = -0.25; p = 0.001). When added to statin therapy, ERN significantly increases HDL-C and induces atherosclerosis regression measured by CIMT over 24 mo. Limitations to this study include its open-label design and the inability to relate CIMT effects to clin. outcomes.

(2) Evaluation of efficacy and safety of fixed dose lovastatin and niacin ER combination in Asian Indian dyslipidemic patients: a multicentric study. Sharma, Manoj; Sharma, Deepika R.; Singh, Vikram; Panwar, R. B.; Hira, H. S.; Mohan, Bishav; Kumar, Naveen; Sharma, S. K.; Gupta, Rajeev. Clinical Research Division, Panacea-Biotec Ltd., New Delhi, India. Vascular Health and Risk Management (2006), 2(1), 87-93. Publisher: Dove Medical Press (NZ) Ltd.

Abstract

Asian Indian dyslipidemia is characterized by: borderline high low-d. lipoprotein (LDL) cholesterol and apolipoprotein (apo) B; high triglycerides, low high-d. lipoprotein (HDL) cholesterol and apoA1; and high lipoprotein(a) (lp[a]). We performed a controlled multicentric trial in India to evaluate the efficacy and safety of a fixed dose combination of lovastatin and niacin extended release (niacinER) formulation in patients with moderate to severe dyslipidemia. Consecutive subjects that satisfied the selection criteria, agreed to an informed consent, and with no baseline presence of liver/renal disease or heart failure were enrolled in the study. After a 4-wk run-in period there were 142 patients with LDL levels  130 mg/dL. Eleven patients were excluded because of uncontrolled hyperglycemia and 131 patients were recruited. After baseline evaluation of clin. and biochem. parameters all subjects were administered lovastatin (20 mg) and niacinER (500 mg) combination once daily. Dose escalation was done on basis of lipid parameters at 8 wk and in 11 patients increased to lovastatin (20 mg) and niacinER (1000 mg). An intention-to-treat anal. was performed and data was analyzed using nonparametric Wilcoxon signed rank test. Thirteen patients (10%) were lost to follow-up and 4 (3%) withdrew because of dermatol. adverse effects: flushing, pruritus, and rash. The mean values of various lipid parameters (mg/dL) at baseline, and at weeks 4, 12, and 24 resp. were: total cholesterol 233.927, 206.327, 189.831, and 174.927 mg/dL; LDL cholesterol 153.422, 127.321, 109.227, and 95.123mg/dL; triglycerides 171.172, 159.575, 149.245, and 135.240mg/dL; HDL cholesterol 45.67, 48.97, 51.69, and 53.910mg/dL; lp(a) 48.526, 40.121, 35.421, and 26.919mg/dL; and apoA1/apoB ratio 0.960.7, 1.040.4, 1.170.5, and 1.450.5 (p<0.01). The percentage of decline in various lipids at 4, 12, and 24 wk was: total cholesterol 11.8%, 18.8%, and 25.2%; LDL cholesterol 17.0%, 28.8%, and 38.0%;
triglyceride 6.8%, 12.8%, and 21.0%; lp(a) 17.5%, 26.9%, and 44.5% resp. (p<0.01). HDL cholesterol and apoA1/apoB increased by 7.2%, 13.1%, and 18.2%; and 7.9%, 21.9%, and 51.6% resp. (p<0.01). Target LDL levels (<100mg/dL in subjects with manifest coronary heart disease or diabetes; <130 mg/dL in subjects with >2 risk factors) were achieved in 92 (80.7%) patients. No significant changes were obsd. in systolic or diastolic blood pressure, blood creatinine, transaminases, or creatine kinase. A fixed dose combination of lovastatin and niacinER significantly improved cholesterol lipoprotein lipids as well as lp(a) and apoA1/apoB levels in Asian Indian dyslipidemic patients. Satisfactory safety and tolerability profile in this population was also demonstrated.

(3) Evaluation of ascorbic acid treatment in clinical and subclinical mastitis of Indian dairy cows. Naresh, Ram; Dwivedi, S. K.; Swarup, D.; Patra, R. C. Division of Medicine, Indian Veterinary Research Institute, Izatnagar, India. Asian-Australasian Journal of Animal Sciences (2002), 15(6), 905-911. Publisher: Asian-Australasian Journal of Animal Sciences.
Abstract

A study was carried out to assess the therapeutic effect of ascorbic acid in mastitis of dairy cows. The herd with a population of 250-275 lactating cows was screened for clin. and subclin. mastitis for 5 mo. Based on inclusion and exclusion criteria, 18 animals each with clin. and subclin. mastitis in one quarter only were selected as study population. Twelve cows (group A) with normal udder and health were also selected as a healthy control. Clin. mastitis cows were grouped as B (n=12) and C (n=6). Cows of group B were treated with ascorbic acid at 25 mg/kg, s.c. for 5 consecutive days and intramammary infusion (Ampicillin sodium 75 mg and Cloxacillin sodium 200 mg/infusion) based on antibiotic sensitivity test, till complete recovery. Group C cows received only intramammary infusion till the complete recovery. Eighteen subclin. mastitis cows were divided in group D (n=12) and E (n=6). Cows of group D were treated with ascorbic acid at 25 mg/kg s.c. for 5 consecutive days while group E did not receive any treatment. California mastitis test (CMT), somatic cell count (SCC), phys. changes of udder, and milk were used to diagnose and classify the mastitis. Evaluation of the therapy was based on CMT score and phys. changes of udder and milk. Sample size calcn. was also performed but was not followed for control groups due to the scarcity of cases. Adequate blinding was done when and where required to avoid the biases. Confounding variables like herd, age of the cow; stage of the lactation, season, and geog. region were duly considered and adequate blocking was followed. Ascorbic acid was administered in clin. and subclin. cases even after cure considering its immunostimulatory and healing inducing effects. The recovery rate was faster in the cases of clin. mastitis treated with ascorbic acid along with an intramammary infusion (group B) than the quarters of group C cows. Quarter wise the av. duration/no.
(3.160.11 days) of antimicrobial intramammary infusion was significantly (p<0.01) less in group B than that of av. duration/no. (5.330.20 days) of group C. Subclin. mastitis cows treated with ascorbic acid showed 83.33% recovery while 16.77% did not respond to treatment till the last day of the study. Cows of group E (untreated) did not recover from the mastitis. Subjective parameters viz. swelling, pain reflex of udder, and phys. changes in milk from quarter of ascorbic acid-treated cows (group B) disappeared earlier than that of group C cows. Thus, the ascorbic acid might be useful as an adjunct in the case of clin. mastitis to get quick recovery with a less no. of intramammary infusions. High recovery rate in subclin. mastitis quarters of group D cows is appreciable and opens a new avenue to conduct further trials in a larger population in various field conditions. However, the pharmacol. of ascorbic acid with particular ref. to the health of mammary gland needs to be investigated.

Sunday, August 05, 2007

Vitamin C, Niacin, and Multivitamins for Bedsores

My recent column on vitamins and bed sores has attracted considerable interest (type niacin and bed sores into Google and it comes up on the first page). As a result of the column, readers pointed my attention to topical skin creams. Why suffer with injections if soothing creams are available that can accomplish the same objectives?

Skin creams formulated with vitamin C have been available for at least a decade. Magnesium ascorbyl phosphate (MAP) is an active and stable form of vitamin C used in creams. Used regularly, creams formulated with high concentrations of MAP have been proven (using modern analytical wonder tools) to deliver a steady time-released dose of vitamin C to the skin.

Skin creams formulated with niacin are a very recent innovation. Spurred on by questions from readers, I investigated the use of niacin in creams. It turns out that niacin skin creams are a 21rst century innovation, and have only very recently become readily accessible to consumers. The easiest way to get them is to visit a dermatologist.

These new medications have been developed by the cosmetics industry in an effort to slow the inevitable aging of the skin. The primary cause of skin aging is damage caused by exposure to sunlight. The industry has conducted numerous controlled trials that prove beyond doubt that these creams are an effective means of protecting the skin from the sun. They have also proved beyond doubt that niacin and vitamin C creams effectively treat a variety of chronic, disfiguring skin conditions.

If you are responsible for caring for some one who is at risk for bed sores, high concentration skin creams containing derivatives of niacin and vitamin C with scientifically proven potency represent a novel opportunity. If you are convinced, like me, that delivering elevated doses of vitamin C and niacin directly and selectively to the skin is likely to help, then you can apply the creams to the whole body. If you want to test the effectiveness, then you can apply the vitamin creams to select spots and leave the rest of the skin as a control experiment.

Using injections of vitamin C and/or niacin to treat bed sores is a radical idea. Using skin creams developed by the cosmetics industry for general use is perfectly ordinary and extraordinarily safe. If these creams are the slightest bit effective for treating bed sores, it is hard to imagine a more comforting solution to a problem that currently causes untold suffering. Readers responsible for caring for individuals at risk for bed sores have everything to gain and nothing to lose by giving this a try.