I have had tinnitus for a little over a year now. With tinnitus retaining/ear device therapy, giving up caffeine, and taking Ginkgo biloba I have been pretty good. I want to lose a few pounds so was advised to take bitter orange. I was told it did not have any stimulants in it to elevate my blood pressure or pulse rate. However, it exacerbated my tinnitus and made me have restless sleep. Why is this?

JG, USA

Editor: Thank you for sharing your experience with overcoming tinnitus. Bitter orange (Aurantii pericarpium) is usually prescribed as a digestive tonic to help people with a low level of stomach acid. I have not heard of it being used to induce weight loss and, as far as I know, it does not contain any stimulants.

I have very carefully researched coenzyme-Q10. In some research I have found that once you start taking it you can never quit. Is this true? I am considering taking it to help my battle with cancer and would appreciate your comments.

BP, USA

Editor:I have not come across anything in the medical literature which would indicate that you have to stay on coenzyme Q10 indefinitely once you start taking it.

ABSTRACTS

BOSTON, MASSACHUSETTS. The development of full-fledged Alzheimer's disease (AD) is preceded by a period of milder dementia and memory loss. Researchers at the Boston University School of Medicine now believe that they have found a test which will predict who will and who won't develop Alzheimer's disease as much as 10 years before the actual diagnosis is made. Their study, part of the large Framingham Study, involved 1076 men and women who were free of dementia at baseline (initial) neuropsychological testing. The participants were followed for 22 years and examined every two years to detect the presence of AD. During the follow-up period 109 of the participants were diagnosed with AD. The researchers found no correlation between education level or occupation and the likelihood of developing AD. They did observe that the participants who had developed AD had scored significantly poorer on standard memory retention and abstract reasoning tests administered ten years prior to their diagnosis. The researchers conclude that memory retention and abstract reasoning tests can be used with considerable accuracy to predict the likelihood of developing AD ten years down the road. This finding is important as it may give enough time to implement effective preventive measures.
Elias, Merrill F., et al. The preclinical phase of Alzheimer disease. Archives of Neurology, Vol. 57, June 2000, pp. 808-13

LONDON, UNITED KINGDOM. The use of aspirin for the prevention of heart attacks is a fairly common practice especially in North America. Clinical trials have shown that taking 75 mg of aspirin per day may reduce the incidence of major cardiovascular events by about 20 per cent over a seven-year period. British doctors now report that while daily aspirin usage may benefit some men it may actually harm others. Their study involved 5499 men between the ages of 45 and 69 years who were at increased risk of coronary heart disease. The men were given either a placebo or 75 mg aspirin in a controlled release formulation. The researchers found that the younger men with a relatively low systolic blood pressure (less than 130 mm Hg) benefitted significantly from taking aspirin while the older men (over 65 years of age) and the men with higher systolic pressure (above 145 mm Hg) actually were worse off if taking aspirin. The researchers point out that a recent large-scale study in the UK found that men who take 75 mg of aspirin per day have a 2.3 times higher risk of developing bleeding ulcers than do men not taking aspirin. They conclude that "it may be that four or five heart attacks would be avoided by treating 1000 men for a year, but the risk of serious non-cerebral bleeding would also need to be taken into account." They further conclude that "men with higher blood pressure derive no cardio-protective benefit from aspirin but risk possible serious bleeding." NOTE: This study was partly funded by DuPont Pharma and Bayer.
Meade, T.W., et al. Determination of who may derive most benefit from aspirin in primary prevention: subgroup results from a randomised controlled trial. British Medical Journal, Vol. 321, July 1, 2000, pp. 13- 17

LONDON, UNITED KINGDOM. Colostrum has long been advocated as a perfect supplement by the healthfood industry. It is touted as supporting the immune system, assisting in healing, and being of particular value for people with inflammatory bowel disease. Colostrum is the first milk produced after birth and is particularly rich in growth factors, immunoglobulins, and antimicrobial peptides. Researchers at the Imperial College School of Medicine have just released an excellent review of the current knowledge regarding colostrum. Colostrum contains peptides which are essential to the welfare of the intestinal tract and help heal injuries caused by aspirin, alcohol, excessive stomach acid, and high-dose chemotherapy. It also contains many hormones affecting the thyroid and sexual glands and is rich in cytokines which help combat inflammation. The researchers conclude that defatted bovine colostrum preparations may be useful in the treatment of short bowel syndrome, inflammatory bowel disease, gut injuries caused by aspirin or other NSAIDs (nonsteroidal anti-inflammatory drugs), and prevention and treatment of infective diarrhea. They note that several clinical trials are underway to further define the benefits of colostrum and conclude their report with "Early results are encouraging and we envisage the standard use of these products (colostrum and derivatives) in the clinical management of gastrointestinal diseases within the next decade." [104 references]
Playford, Raymond J., et al. Colostrum and milk-derived peptide growth factors for the treatment of gastrointestinal disorders. American Journal of Clinical Nutrition, Vol. 72, July 2000, pp. 5-14

PITTSBURGH, PENNSYLVANIA. Dr. John Fernstrom of the University of Pittsburgh School of Medicine presents an excellent overview of the current knowledge regarding the influence of nutrients on brain development and function. Dr. Fernstrom points out that docosahexaenoic acid (DHA) found in fish oils is of crucial importance in the proper development of the fetus' brain, retina, and central nervous system. Folic acid supplementation is highly effective in preventing neural tube defects (spina bifida). A recent clinical trial found a 350 per cent reduction in the number of infants born with neural tube defects among women who had supplemented with 4 mg/day of folic acid prior to and during pregnancy. The amino acid tryptophan is a precursor to the important neurotransmitter serotonin. Oral tryptophan supplementation can improve mood and sleep. Dr. Fernstrom emphasizes that it is safe and that no toxicity has ever been observed in pharmaceutical-grade tryptophan. Tyrosine, another amino acid, is the precursor to the neurotransmitters dopamine, norepinephrine, and epinephrine (adrenalin). Tyrosine supplementation has been found to improve performance in soldiers under stress, but was found ineffective in the treatment of Parkinson's disease. Choline is the precursor to the neurotransmitter acetylcholine. The synthesis of acetylcholine in the nervous system can be increased by oral supplementation with choline or lecithin (phosphatidylcholine). Choline and lecithin have been found effective in the treatment of tardive dyskinesia, but results with Alzheimer's disease have so far been disappointing. Dr. Fernstrom concludes that many common nutrients affect brain function significantly and advocates further research to determine the benefits of supplementation.
Fernstrom, John D. Can nutrient supplements modify brain function? American Journal of Clinical Nutrition, Vol. 71 (suppl), June 2000, pp. 1669S-73S

BETHESDA, MARYLAND. Researchers at the National Heart, Lung, and Blood Institute report that men with low blood levels of vitamin C have a higher risk of dying prematurely especially from cancer than do men with high levels. Their study involved 3347 men and 3724 women who had their vitamin C status determined from blood samples at the start of the study in 1976-1980. By the end of 1992 791 men and 566 women had died. After adjusting for age, race, educational level, smoking, alcohol consumption, systolic blood pressure, BMI (body mass index), and diabetes status the researchers concluded that the men with a blood level of vitamin C below 28.4 micromol/L had a 57 per cent higher risk of dying prematurely from any cause and a 62 per cent higher risk of dying from cancer than did the men with serum levels above 73.8 micromol/L. No significant differences were found for the women of differing vitamin C status. The researchers believe this is because the women generally had significantly higher vitamin C levels than the men and also experienced more hormone-dependent cancers which are not believed to be affected by vitamin C status. The researchers also found that the use of vitamin supplements was vastly more prevalent among men with high vitamin C status and lower mortality. Nineteen per cent of the men in the high survival rate group used vitamin C supplements versus 0.2 per cent in the low survival rate group (low vitamin C status). Corresponding numbers for users of vitamin E supplements were 10.6 per cent versus 0.8 per cent. More than 30 per cent of the men in the high survival group used multivitamins compared to only 0.8 per cent in the low survival group. The researchers conclude that men with low vitamin C intakes are at a significantly greater risk of dying prematurely especially from cancer.
Loria, Catherine M., et al. Vitamin C status and mortality in US adults. American Journal of Clinical Nutrition, Vol. 72, July 2000, pp. 139-45

BORDEAUX, FRANCE. Much of the evidence linking aluminum to Alzheimer's disease (AD) has been controversial. The results of a study just released by researchers at the University of Bordeaux should go a long way to support the contention that a high intake of aluminum is a potent risk factor for AD. The study involved 2700 older (65 years and over) French citizens (non-demented) who had lived in the same location for many years. The researchers measured the aluminum and silica content of the participants' drinking water over an eight-year period and also exposed the participants to psychological and neurological examinations to determine their mental status. At the end of the experiment 253 of the subjects had been diagnosed with dementia including 182 cases of AD. Analysis of the collected data showed that participants living in areas where the water supply contained 0.1 mg/L of aluminum or more were twice as likely to have developed AD as were subjects whose water supply had less aluminum. This correlation held true even after adjusting for other known risk factors for the development of AD. A high silica content, on the other hand, was found to be protective. The participants who lived in areas where the water contained 11.25 mg/L or more had a 26 per cent lower risk of developing AD than did the participants drinking water with a lower silica content. The researchers conclude that a high (above 0.1 mg/L) concentration of aluminum in drinking water may be a significant risk factor for dementia and Alzheimer's disease.
Rondeau, Virginie, et al. Relation between aluminum concentrations in drinking water and Alzheimer's disease: an 8-year follow-up study. American Journal of Epidemiology, Vol. 152, July 1, 2000, pp. 59- 66

DAVIS, CALIFORNIA. Several studies have shown that exposure of non-smokers to second-hand tobacco smoke (passive smoking) results in increased oxidative stress which in turn has been linked to an increased risk of heart and lung diseases. It is known that smokers have lower blood levels of vitamin C than do non- smokers and that smokers use up about twice as much vitamin C per day as do non-smokers. There is now evidence that passive smokers have vitamin C levels intermediate between smokers and non-smokers and also use up more vitamin C on a daily basis than do non-smokers. A recent experiment carried out by Finnish researchers found that exposing non-smokers to passive smoking for 30 minutes created considerable oxidative stress in their body and increased lipid peroxidation - a strong risk factor for coronary heart disease. A second experiment found that ingesting three grams of ascorbic acid prior to the exposure to smoke provided complete protection against the development of oxidative stress. Other researchers have found that vitamin C also protects against ozone-induced damage to the lungs. These finding underscore the need for an adequate vitamin C intake in order to reduce the risk of lung and heart diseases.
Jacob, Robert A. Passive smoking induces oxidant damage preventable by vitamin C. Nutrition Reviews, Vol. 58, August 2000, pp. 239-41

BOSTON, MASSACHUSETTS. Professor Mohsen Meydani of the Human Nutrition Research Center on Aging at Tufts University is one of the world's foremost authorities on aging. In a recent presentation to the Ross Research Conference on Medical Issues Dr. Meydani presented convincing evidence to support the free radical theory of aging. According to this theory free radical attacks on cells and DNA are the main cause of aging and degenerative diseases such as arthritis, atherosclerosis, cancer, cardiovascular disease, inflammatory bowel disease, senile dementia, and cataracts. Dr. Meydani points out that aging and degenerative diseases take hold once the body's antioxidant defenses and repair mechanism become unable to deal with the challenge of free radical attacks. Research has shown that the body's defenses can be augmented by oral supplementation with antioxidants such as vitamins C, E and the carotenes. For example, supplementation with 400 IU or 800 IU of vitamin E reduced the risk of non-fatal heart attacks by 77 per cent in men and resulted in some regression of atherosclerosis. Heart bypass surgery patients have also been found to benefit significantly from vitamin E supplementation. Several studies have shown that elderly men and women can improve their immune status quite significantly by supplementing with 200 IU/day of vitamin E. Dr. Meydani concludes that supplementing with 200 IU/day of vitamin E and including plenty of fruits and vegetables in the diet (5-8 servings a day) can reduce the risk of cardiovascular disease and improve immune function in later life.
Meydani, Mohsen. Effect of functional food ingredients: vitamin E modulation of cardiovascular diseases and immune status in the elderly. American Journal of Clinical Nutrition, Vol. 71 (suppl), June 2000, pp. 1665S-68S

BOSTON, MASSACHUSETTS. Barium enemas have been used for many years in the detection of polyps, cancers, and lesions of the colon. In the 1970s with the development of fiberoptics colonoscopy came into being and by now has become the "gold standard" of colon examination. Dr. Robert Fletcher, MD of the Harvard Medical School now questions whether barium enemas should be used at all. He points to a recent study which concluded that the results of radiologic examination employing barium enemas are quite inaccurate when compared to the results of colonoscopy. The study involved 580 patients who were at increased risk for polyps. All patients underwent both colonoscopy and double-contrast barium enemas and the results were compared. Barium enema examinations found only about one third of the adenomas found upon colonoscopic examination and in 18 per cent of the examinations the barium enema procedure predicted a polyp which could not be confirmed in a second colonoscopy examination. The barium enema technique was particularly inaccurate in detecting small polyps (0.5 cm or smaller); it identified only 21 per cent of the number of polyps found by colonoscopy. Dr. Fletcher concludes that barium enema should only be used when colonoscopy is not available or is contraindicated.
Fletcher, Robert H. The end of barium enemas? New England Journal of Medicine, Vol. 342, June 15, 2000, pp. 1823-24 (editorial)

STOCKHOLM, SWEDEN. The relative roles of genes and environment in the development of cancer have been debated for years. It is now generally accepted that only 10-20 per cent of all cancers are genetically "preordained" while the remaining 80-90 per cent are caused by wrong diet, infections or by excessive exposure to carcinogens such as tobacco, alcohol, radiation, occupational toxins, and drugs. Swedish medical researchers at the Karolinska Institute now report that the "heritage factor" varies widely for different types of cancer. Their conclusions are based on an exhaustive study of the medical history of 44,788 pairs of twins, 15,669 of which were identical (monozygotic) twins. The researchers confirmed that the overall contribution of genetic constitution to the risk of all cancers is about 15 per cent. However, they also found that some cancers have a much larger genetic component than others. They estimate that 42 per cent of the total risk of prostate cancer is related to heritable factors, 27 per cent of breast cancer cases are related to genetic constitution, and 35 per cent of colorectal cancer cases may be genetically "preordained". Nevertheless, they point out that the absolute risk of an identical twin developing breast, prostate or colorectal cancer before the age of 75 years if their sibling has it is only somewhere between 15 and 18 per cent. For other cancers the risk is considerably smaller and for family members who are not twins the inherited component is of even less importance. The researchers conclude that the heritable component of cancer is not a very significant risk factor even among close relatives. Dr. Robert Hoover, MD of the National Cancer Institute lauds the new study and points out that it clearly shows the futility of trying to predict an individual's risk of cancer from their genetic constitution.
Lichtenstein, Paul, et al. Environmental and heritable factors in the causation of cancer: analyses of cohorts of twins from Sweden, Denmark, and Finland. New England Journal of Medicine, Vol. 343, July 13, 2000, pp. 78-85
Hoover, Robert N. Cancer - Nature, nurture, or both. New England Journal of Medicine, Vol. 343, July 13, 2000, pp. 135-36 (editorial)

We generally do not report results of animal experiments, but found the following so intriguing that we decided to make an exception.

TOULOUSE, FRANCE. French researchers report that high molecular weight polyethylene-glycols are highly effective in preventing the development of precancerous lesions and tumors in the colons of laboratory rats. Polyethylene-glycols (PEGs) of the type used in the experiments are commonly used as laxatives in France (PEG 3350); they are not absorbed or metabolized and have no known toxicity. The rats were exposed to two cancer-causing agents (nitrosamine and heterocyclic amine) and were then given either normal drinking water or water containing five per cent PEG for 30 or 162 days. At the end of the tests the rats who had received PEG had 20 times fewer carcinomas than did the rats given normal drinking water. The researchers speculate that PEG may quickly reverse or regress cancerous lesions (aberrant crypt foci) in the human colon and thereby prevent colorectal cancer in people at risk. They recommend that a clinical trial involving humans be carried out to test this assumption.
Corpet, Denis E., et al. Consistent and fast inhibition of colon carcinogenesis by polyethylene glycol in mice and rats given various carcinogens. Cancer Research, Vol. 60, June 15, 2000, pp. 3160-64

ROTTERDAM, THE NETHERLANDS. A lack of serotonin in the brain has been linked to depression and reduced ability to cope with stress. Serotonin is synthesized from tryptophan and its concentration increases with the intake of a meal rich in carbohydrates and low in protein. Dutch researchers now report the discovery that a whey protein enriched with alpha-lactalbumin (Borculo Domo Ingredients, Borculo, Netherlands) is highly effective in increasing tryptophan levels in the brain and improving the ability to cope with stress among stress-vulnerable people. Their double-blind, placebo-controlled study involved 29 university students who were easily stressed and 29 students who were relatively immune to stress. The students were given a chocolate-flavoured drink containing either the whey protein or a casein placebo and were then exposed to a highly stressful arithmetic test which has been found to induce significant psychological and physiologic stress. Blood analysis showed a significantly higher concentration of tryptophan (relative to other large neutral amino acids) in the subjects who had consumed the fortified whey protein than in those who had consumed the casein drink. The stress-vulnerable students who had consumed the whey protein also showed an improvement in mood and a reduced cortisol stress response when compared to the stress-vulnerable students who had consumed the casein drink. The researchers conclude that a diet containing tryptophan-enriched whey proteins could improve the ability to cope with stress in healthy but stress-vulnerable subjects.
Markus, C. Rob, et al. The bovine protein alpha-lactalbumin increases the plasma ratio of tryptophan to the other large neutral amino acids, and in vulnerable subjects raises brain serotonin activity, reduces cortisol concentration, and improves mood under stress. American Journal of Clinical Nutrition, Vol. 71, June 2000, pp. 1536-44

EDMONTON, CANADA. Infectious diseases initiated by virus, parasite or bacteria are common worldwide and tend to affect people with compromised immune systems to a greater extent than they affect healthy people. There is growing evidence that the two amino acids, glutamine and arginine, are essential to a healthy immune system and that supplementation can be highly beneficial in patients with infectious diseases. Researchers at the University of Alberta have just released a major review of the current knowledge regarding glutamine, arginine and the immune system. Burn injuries have been found to cause a massive deficiency in both glutamine and arginine and supplementation has been found highly beneficial in burn patients. Cancer patients are very prone to infections due to the immunosuppressive effects of radiation, chemotherapy, and surgery. There is some evidence that glutamine supplementation is beneficial for cancer patients, but the benefits of arginine have not been proven. HIV patients have highly compromised immune systems, but whether supplementation with glutamine or arginine is of benefit is still unclear. Surgery and trauma result in various degrees of immune system dysfunction and supplementation with glutamine and arginine has been found beneficial in preventing infections and reducing the length of hospital stays. Serious athletes in vigorous training suffer an increased incidence of infections due to an immune system overload caused by the physical stress of intense exercise. The researchers conclude that there is not enough evidence that healthy athletes participating in high-intensity training will benefit from glutamine/arginine supplementation. People who suffer from chronic or acute infections, on the other hand, may benefit significantly from supplementation with at least 12 grams/day each of glutamine and arginine. [144 references]
Field, Catherine J., et al. Glutamine and arginine: immunonutrients for improved health. Medicine & Science in Sports & Exercise, Vol. 32 (suppl), July 2000, pp. S377-88

NEWSBRIEFS

BMA endorses acupuncture.
The British Medical Association has just completed a two-year study to "investigate the scientific basis and efficacy of acupuncture." The study concludes that acupuncture is effective in treating back pain, nausea and vomiting, migraine and dental pain. A recent survey of UK family doctors revealed that nearly half of them had arranged acupuncture for some of their patients and 58 per cent referred patients to some form of alternative or complementary therapies. Dr. Vivian Nathanson, head of health policy at the BMA says "Greater use of acupuncture would save the NHS millions of pounds each year."
British Medical Journal, July 1, 2000, p. 11

Stem cell research given a boost.
Stem cells are the very first cells formed after an egg is fertilized. Researchers believe that it is possible to grow specific human organs from these cells for use in organ transplants. The problem is that further research requires the use of human embryos (fertilized eggs) and this is very much opposed by the Catholic Church and Pro-Life groups. Most governments including the American and British have so far banned research involving human embryos. This may now change as the British government has decided to draft legislation permitting embryo research in certain cases. This legislation will be presented to Parliament later this year and MPs will be free to vote according to their consciences.
New Scientist, August 19, 2000, p. 4-5

Are soft drinks addictive?
A study carried out at Johns Hopkins University in Baltimore concluded that the caffeine content of soft drinks/colas (about 0.1 mg/mL) adds nothing to the taste, but may promote addiction in young consumers. Americans consume more than 15 billion cans of soft drinks every year and 70 per cent of them contain caffeine. Says psycho-pharmacologist Roland Griffiths who led the study "I'd like to see the soft-drinks industry come out of denial about the role of caffeine in their products; they are adding a mildly addictive drug, one which surely accounts for the fact that people drink far more sodas with caffeine than without." Earlier studies by Griffiths and his colleagues found evidence of withdrawal symptoms in children who were cut off from their usual supply of caffeinated soft drinks.
New Scientist, August 19, 2000, p. 10

Is obesity infectious?
It is fairly well-accepted that bacterial infections cause stomach ulcers and may be involved in some cases of heart disease as well. Now Dr. Nikhil Dhurandhar of Wayne State University proposes that many cases of obesity may have their root in a viral infection. Dr. Dhurandhar and colleagues have found that as many as 32 per cent of obese people have antibodies to the adenovirus AD- 36 in their blood. Only about four per cent of lean people have these antibodies. The researchers have also found that they can produce obese mice, chicken, and monkeys by injecting them with the AD-36 virus. This virus is highly contagious and can be transferred by being in the same room as a carrier. Fortunately, it would appear that very few obese people actually harbour the live virus even though they do have the antibodies. Dr. Dhurandhar and his fellow researchers are currently working on an anti-viral drug which is effective against AD-36.
New Scientist, August 5, 2000, pp. 26-30

Male menopause: is it real?
There is growing evidence that men just like women go through a profound change in mid-life which deeply affects their reproductive system and related functions. Erectile dysfunction (impotence) becomes more common, interest in sex wanes, muscle disappears from the arms and legs, osteoporosis may set in, and fatigue and sleep disturbances may become problems. Many experts now believe that these changes can be halted and even reversed by testosterone replacement therapy (TRT) just like symptoms of female menopause can be alleviated by estrogen replacement therapy. Some doctors now enthusiastically promote TRT either through injections or using the newly released testosterone gel AndroGel. They estimate that 55 per cent of men over 50 years of age have low testosterone levels and point to trials which have shown that TRT can increase bone density and improve mood, libido, and muscle strength. Other doctors warn that TRT could increase the risk of prostate cancer and strokes.
New Scientist, July 22, 2000, pp. 36-41