Richard G. Petty, MD

Goldilocks and the, err, Vitamins

We are often told that we should take much higher amounts of many vitamins than the doses that are usually recommended.

The late Linus Pauling was one of the most famous proponents of the idea of using huge amounts to Vitamin C to present colds and an array of other health problems. Over the years I have heard enough recommendations to confuse anyone: and one of my degrees is in biochemistry! The only answer with so many conflicting pieces of advice is to do some good research.

Vitamin A is an important fat-soluble vitamin involved in the maintenance of many of many key systems in the body. The recommended daily allowance for vitamin A is 5000 international units (IU) for adults and 8000 IU for pregnant or lactating women.

Vitamin A deficiency is one of the major nutritional problems worldwide and it threatens the survival and health of millions of children. According to a report published in 2002, 127 million preschool children and 7·2 million pregnant women are deficient in vitamin A.

Vitamin A deficiency can cause night blindness, drying and degeneration of the cornea that can lead on to total blindness, as well as impairment of the immune system.

Children living in regions where vitamin A intake is insufficient need to receive adequate amounts of vitamin A through breastfeeding, together with improved diets, food fortification and supplementation with vitamin A.

Providing vitamin A supplementation in countries where there is a deficiency of the vitamin has been proven to decrease mortality. As a result, most developing countries have adopted a standard World Health Organization (WHO) dosing schedule for vitamin supplementation, which calls for 200,000 IU to mothers early postpartum and then 200,000 IU every 4 to 6 months. For infants, the recommendation is 100,000 IU at 9 months and 200,000 IU at 12 months.

However, in 2002 the International Vitamin A Consultative Group (IVACG) Annecy Accord recommended a new high-dose regimen for mothers and infants which includes a doubling of the initial postpartum dose for mothers, and adding 50,000 IU at 2, 3 and 4 months for infants.

An article just published in the Lancet indicates that this high dose protocol does not have any benefit over the older recommendation.

Professor Andrew Prentice and a team of researchers at the International Nutrition Group at the London School of Hygiene and Tropical Medicine in London and colleagues, studied 220 women-infant pairs in an area of moderate vitamin A deficiency in Gambia. One group received the WHO recommended dose, while the other received the IVACG recommended dose.

They measured blood plasma levels of vitamin A, the incidence of Helicobacter pylori infection, how many of them had pneumococcus in the nasopharynx and the integrity of the infants’ intestines.

The problem is that too much vitamin A can also create problems, including nausea and vomiting, jaundice, irritability, anorexia, blurred vision and worst of all, increased intracranial pressure that can cause headaches, drowsiness and even death. These are not such big problems in well-nourished adults living in the Western world, but in malnourished infants, particularly if they are also being vaccinated, this can be a big problem.

There is one specific occasion when a high dose of Vitamin A can be helpful: if a child in a deficient area gets severe measles, the WHO recommendation is that two doses of 200,000 IU should be given to the child. It is easy to forget that in some parts of the world measles can be a killer.

The authors of the article, as well as an accompanying editorial suggest that we should be looking at lower, rather than higher doses of vitamin A.

The editorial is by Professor Bernard Brabin of the Child and Reproductive Health Group in Liverpool, England and he finishes by saying,

“Future trials should emphasize the importance of exclusive breastfeeding, because early feeding with formula milk might reduce potential benefits from early supplementation with vitamin A in infants.”

This story shows us once again the extreme importance of having just the right amount of a vitamin or nutrient.

If someone claiming to be an expert in nutrition or vitamin therapy tells you to “take as much as you want” of anything, please be careful.

Just remember the story of Goldilocks and the Three Bears….

Morning Sickness and Breast Cancer

Morning sickness has always been a puzzle and there are almost as many theories as there are sufferers.

Amongst some of the most popular theories are:

I have always been interested in the idea that it is a device to protect the baby from dietary toxins. This theory was expressed very eloquently by Margie Profet, who suggested that eating vegetables may also be a factor. Vegetables produce a small amount of toxins to deter insect infestation and while these toxins are normally harmless to adult humans, they are potentially dangerous to the baby. It is also impressive that morning sickness is usually at its worst in the first trimester, when the baby is extremely sensitive to many kinds of toxins. It would be nice if Margie’s theory turns out to be correct. She was largely ignored by specialists in reproduction because she was not one, and a the time did not have an advanced degree.

So I was very interested to see some research from the University of Buffalo that was presented last week at the Society for Epidemiologic Research’s Annual Meeting in Boston. The epidemiologists found that women who had morning sickness may have a 30 percent lower risk of developing breast cancer later in life than mothers-to-be who went through pregnancy without any nausea.

The study was based on data from participants in the Western New York Exposure and Breast Cancer Study, a population-based case-control study of breast cancer conducted in women 35-79 from two Western New York counties between 1996 and 2001.

The analysis compared extensive data on pregnancy-related conditions from 1,001 women with primary breast cancer and 1,917 women without breast cancer matched to cases by age and race who served as controls.

The data presented suggest that the lower risk of developing breast cancer observed with nausea and vomiting was stronger as the symptoms became more severe, or persisted longer into pregnancy. A modest trend toward increased cancer risk was seen in premenopausal women who gained more than 40 pounds during pregnancy, compared to those who gained less than 23 pounds but the trend did not reach statistical significance.

Perhaps the link has to do with sensitivity to estrogen.

But the other possibility is that the nausea and vomiting not only expel toxins that may harm the baby. but also toxins that may eventually increase a woman’s risk of breast cancer. And why might three months of vomitinj make the difference?

Because one of the reasons for weight gain during pregnancy is a subtle change in the intestinal absorption of certain nutrients that the baby needs.

Acupuncture and Acupressure for Morning Sickness

Although I am most definitely of the male persuasion, I know that morning sickness can be an awful problem, though there is some evidence that it is an attempt by the body to rid itself of toxins that could otherwise harm the baby.

I have had a longstanding interest in the use of acupuncture and acupressure for the treatment of nausea and vomiting, whether pregnancy related or caused by infections, anesthesia or chemotherapy. Over twenty years ago my committee at the Research Council for Complementary Medicine helped fund research on the topic at the University of Belfast, and I have used both acupuncture and acupressure to treat many hundreds of people with nausea and vomiting. Before I left England, we were planning to do a clinical trial of acupuncture on morning sickness at Queen Charlotte’s hospital in London.

So I was delighted to see a meta-analysis published in the journal Explore.

The authors identified 14 eligible trials that had been completed over the last sixteen years, involving a total of 1615 women who had been treated with either acupressure, acupuncture or electrical stimulation at acupuncture points.

The conclusions were that these methods may reduce nausea by more than 50% compared with controls and vomiting by around 40%. These figures look about right, though acupuncture and acupuncture are very “operator-dependent:” some therapists get better results than others. What was interesting was that the effect was all due to acupressure: acupuncture was not shown to be effective, but acupressure was.

The analysis also points out a potential weakness in other meta-analyses. It is not wise to lump all acupuncture and acupressure together, since each may work somewhat differently.

As a sidebar, when we use acupuncture or acupressure, we always tailor the treatment to the individual, but the most commonly used points are Liver-3 on the top of the foot between the big toe and second toe, and Pericardium-6, which lies on the inside of the forearm, about two inches above the wrist.

Growing Evidence for the Efficacy of Homeopathic Medicine

When you first hear about homeopathy it sounds like utter nonsense: "like curing like"; vital forces; miasms and super-dilute remedies that no longer contain a single molecule of the original substance.

The trouble is that – apart from two centuries of clinical experience – there is a respectable and growing body of evidence that there is indeed something to homeopathy. David Reilly from the Center for Integrative Care in Glasgow, Scotland, has written a very useful paper that is available for free download.

Over in the "Resources" section on the left hand side of the blog I have a link to a reading list that I put together for

There are many good introductory books on homeopathy, and I have mentioned some of the best. There are also a few books that delve into some of the science that could well provide a mechanism by which homeopathy may work.

In the coming weeks I shall be putting together some more reading list as well as summaries of the research into this fascinating field.

There is a final point. Homeopathic medicines, Flower essences and many forms of "Energy medicine" seem to have been becoming more effective over the last few decades, and this observation was one of the reasons for believing that New Laws of Healing are emerging.

Let me give you a simple example. Two weeks ago, I heard about a woman in the first trimester of pregnancy was being seen because of a quite severe mood problem. She had such severe morning sickness that she asked to have a trash can positioned next to her chair. Many experts believe that morning sickness begins as a reflex to expel food toxins that might harm the baby, but then develops into a neurologically-mediated cycle.

The patient had never heard of homeopathy and probably did not understand why she was asked some apparently irrelevant questions. She answered that she would feel better in the evening, if she applied pressure or a wash cloth to her stomach. She also reported that the sudden cold spell had made her much worse, and that stress and spicy foods made her much worse.

She was given the remedy Nux vomica in a very low potency. The nausea and vomiting stopped immediately, never to return. And her mood – which had been bad for many months before she became pregnant – also improved.

This is another one of those "N of one" reports, and the plural of anecdote is not data. But I was trained by homeopaths, some of whom had been in practice since the 1930s, and all had sat at the feet of some of the greatest homeopaths on the last century. Yet they all said that problems like morning sickness normally need repeated treatments over several days. Not a single treatment and it’s gone.

If you keep you eyes open you will be amazed to see how the efficacy of some forms of treatment appear to be getting better, while some others are becoming less effective with time.

Acupuncture and Acupressure for Chemotherapy Induced Nausea and Vomiting

During the years that I served on the Research Council for Complementary Medicine, one of the most successful pieces of research that we funded was an investigation by the late Professor John Dundee into the use of acupuncture to treat and to prevent post-operative nausea, and chemotherapy-induced nausea and vomiting.

Those early trials helped us learn a lot about how to do trials in acupuncture, and over the years this work has progressed in a number of enters around the world. The Cochrane Collaboration in Oxford has just published a systematic review of the use of acupuncture and acupressure for the treatment of chemotherapy induced nausea and vomiting. Acupuncture was shown to reduce vomiting on the first day after chemotherapy compared with those who did not receive acupuncture: 22% compared with 33%. Acupuncture did not help with nausea but acupressure did. Though acupressure did not help with vomiting.

This shows once again that acupuncture and acupressure almost certainly work by different mechanisms.

For many years, the department of oncology at the Royal Postgraduate Medical School in London used an array of complementary practices. Not to treat the cancers, but to make it possible for people to tolerate the chemotherapy and radiation therapy.

I recently spoke to a woman who had an illness that would only respond to a certain antibiotic. She was very involved with natural medicine, and did not like taking it. But treatment by world-class homeopaths, naturopaths and acupuncturists had not helped her. My solution was to use the antibiotic, but to also use acupressure, homeopathy, a precisely designed diet and some qigong. With that combination she sailed through the conventional treatment, the organism that was causing her problems has gone, and she has re-built her resilience. That is integrated medicine in action.

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Migraine and Hormones

Migraine (can be a frightfully difficult problem to treat. It is such an interesting puzzle, that the first book that I ever wrote was on migraine and other types of headache. Migraine is a great deal more than just a severe headache. It is can also be associated with neurological symptoms, and people often become exquisitely sensitive to light and sound. Additionally, at the beginning of the attack, the stomach stops working properly, which can make the absorption of medicines very difficult. Then comes the vomiting and sometimes diarrhea.

Although migraine is usually described as a “vascular” headache, there are strong reasons for thinking that it is more than that. People who suffer from the classic type of migraine often have spreading visual problems or partial visual loss, which goes on for between ten and sixty minutes. These visual problems are likely the result of a spreading wave of neurological depression spreading over the visual cortex at the back of the brain. The sensitivity to light and sound suggests that something is going wrong in the neurological systems that normally filter sensations, and the gastrointestinal problems indicate that something is going wrong in some of the control centers of the brain. There are some real oddities about migraine: it is exceptionally uncommon in people with diabetes; appears to be slightly more common in people who are left handed and is one of the only illnesses that tends to gets better as we get older.

There are a number of well-known triggers to migraine attacks. Though the scientific literature on triggers is not conclusive, here are some of the more common ones, that if avoided, have helped a great many people:

  • Stress (either during stress, or when the pressure comes off)
  • Cheese
  • Chocolate
  • Coffee
  • Citrus fruit
  • Red wine
  • Changes in the weather (especially when there are a lot of positive ions in the atmosphere)
  • Mono-sodium glutamate (MSG)

One of the best-known features of migraine is that it is considerably more common in women and that there is often a relationship between headaches and phases of the menstrual cycle, in particular during the pre-menstrual days. There have been many small studies that have indicated that oral contraceptives might increase the risk of suffering from migraine. A new study from Trondheim in Norway, has confirmed a link between oral contraceptive and migraine. The Nord-Trøndelag Health Study was done between 1995 and 1997. It included 14,353 pre-menopausal women, of whom 13,944 (97%) responded to questions regarding their use of contraceptives. There was a significant association between migrainous and non-migrainous headaches and the women’s reported use of estrogen-containing oral contraceptives. An important finding was that there was no relationship between the number of headaches and the amount of estrogen in the contraceptive pill.

There is one more thing to factor into the equation. Over the last two decades, there have been many reports of an association between certain types of migraine and cerebrovascular accidents (“strokes”). In the largest analysis of the data, that was published in the British Medical Journal, there was indeed a higher rate of strokes in women who had migraine and who were taking oral contraceptives. These studies included some of the older ones done in the days when the doses of hormones were higher than they are today, but when making decisions, it is important to be aware of this rare association.

An editorial in the British Medical Journal made these recommendations, with which I agree:

1. In an otherwise healthy young person, there is little cause for concern because the absolute risk of stroke is very low.

2. People with migraine who are on oral contraceptives have another reason for not smoking

3. Use low dose estrogen or progesterone only contraceptives in young women with migraine.

4. Although there isn’t much good evidence, many neurologists suggest stopping oral contraceptive pills if the migraine becomes more frequent or changes in character.

5. The risk of stroke gradually increases over age, particularly in smokers, so a slightly older smoking woman with migraine, should probably not be taking an oral contraceptive, unless it is the only option for her.

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