Richard G. Petty, MD

Nutrition, Learning and Memory

We have talked about the burgeoning data linking food with mood, behavior and cognition.

I have just seen a new study that really adds to our knowledge and contributes information that we can all use.

Scientists in Europe, Australia and Indonesia have published data in the American Journal of Clinical Nutrition suggesting that nutrition can improve verbal learning and memory in schoolchildren.

This study was undertaken by the NEMO study group (Nutrition Enhancement for Mental Optimization) that consists of the Unilever Food and Health Research Institute (Vlaardingen, The Netherlands); CSIRO, Human Nutrition (Adelaide, Australia) and the SEAMEO-TROPMED Regional Center for Community Nutrition, University of Indonesia (Jakarta Pusat, Indonesia).

It was a 12-month study of 780 children in Australia and Indonesia in which the researchers evaluated the effects of adding a specific vitamin and mineral mixture to a daily drink.

The study population consisted of 396 well-nourished children in Australia and 384 poorly nourished children in Indonesia. In each country, the children were randomly allocated to one of four groups, receiving a drink with either:

  1. A mixture of micronutrients (iron, zinc, folate and vitamins A, B-6, B-12 and C)
  2. Fish oil (DHA and EPA)
  3. Both the micronutrient mixture and the fish oil
  4. Nothing added, i.e. placebo

In Australia, children who received the daily drink with the added vitamin and mineral mixture performed significantly better on tests of mental performance tests than children in a control group who received the drink but without added nutrients. In Indonesia a similar trend was observed, but this time only in the girls.

After twelve months, children in Australia who received the drink with the nutrient mix showed higher blood levels of these micronutrients, which means that their bodies were taking up the nutrients. In addition, they performed significantly better on tests measuring their learning and memory capabilities compared to children in the other groups. A similar trend was observed in Indonesia, but only in the girls. The addition of fish oil to the fortified drink did not conclusively show any additional effects on cognition.

This study adds to the mounting evidence that nutrition plays an important role in cognitive development in children, even in children who are enjoying a “normal” diet. Deficiencies in iron and iodine have been linked to impaired cognitive development in young children for over a century and there is now emerging evidence that deficiencies in zinc, folate and vitamin B12 may each compromise mental development in children. More recently, fish oils (EPA, DHA) have also been linked to child cognitive development.

Most previous studies have focused on deficiencies in single nutrients in young age groups, despite the well-known observation that the brain continues to grow and develop during childhood, adolescence and early adulthood. Little is known about the role of nutrition on mental development after the age of 2. In addition very other few studies have looked at the effect of offering a mix of nutrients. Until this study, there were very few randomized controlled intervention studies assessing the impact of a multiple-micronutrient intervention on cognitive function in schoolchildren.

The investigators recommend further research to investigate the exact role of DHA and EPA in healthy school-aged children. Another research focus is the further optimization of cognitive development tests with respect to their validity and sensitivity across cultures. The scientists suggest that the smaller effects of the vitamins and minerals in Indonesia could be a result of a lower sensitivity of the cognitive tests in that country.

This research raises many interesting points:

  • Is it possible that the healthy Australian diet is actually nothing of the sort?
  • Is it possible that if the diet is adequate, that “super-nutrition” can help a child to exceed his or her potential?
  • Are there key ages when nutrition can help, or is the effect maintained across the age range?
  • Does nutritional supplementation have a long-term impact on a child?
  • Have we even found the optimal mixture for child cognitive development? Might higher amounts of any nutrients – particularly fish oils – produce better effects, or might they be toxic, as we saw in the case of vitamin A supplementation?
  • Are we using the correct cognitive development tests to pick up changes in different cultures? As an example, could the smaller effects of the vitamins and minerals in Indonesia be a result of a lower sensitivity of the cognitive tests in that country? Or is it that the children are also missing out on some other trace nutrients?

Many questions, but the take home message is this: careful nutritional supplementation may have considerable benefits to a child, even one growing up in an affluent culture.

“Learning is a weightless treasure you always carry easily.”
–Chinese Proverb

Depression, Folic Acid and Bread

A remarkable study was published in the July edition of the Journal of Epidemiology and Community Health, by researchers at the University of York and Hull York Medical School.

They reviewed 11 studies involving 15,315 individuals and confirmed that there is a link between depression and low levels of folate, a vitamin that comes primarily from leaf vegetables such as spinachturnip greens, dried beans and peas, fortified cereal products, sunflower seeds and certain other fruits and vegetables are rich sources of folate, as is liver. and

Last month, the British Food Standards Agency recommended to Health Ministers that they should introduce mandatory fortification of either bread or flour with folic acid to prevent neural tube defects, which can result in miscarriage, neonatal death or lifelong disability. This new study suggests that the measure may also help to reduce the frequency and severity of depression.

Lead author Simon Gilbody said:

“Our study is unique in that for the first time all the relevant evidence in this controversial area has been brought together. Although the research does not prove that low folate causes depression, we can now be sure that the two are linked. Interestingly, there is also some trial evidence that suggests folic acid supplements can benefit people with depression. We recommend that large trials should be carried out to further test this suggestion.”

Recent research from the same team published in the American Journal of Epidemiology has also shown that people with depression, bipolar disorder and schizophrenia commonly have a genetic mutation named MTHFR C677T in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene on chromosome 1. The enzyme that the gene codes for is involved in folate metabolism, and the mutation (polymorphism) means that they process folate less efficiently. Folate is linked to the production of some of the chemicals in the brain, including serotonin, that in some part some the brain elevate mood. The identification of this gene provides a plausible explanation as to why folic acid supplements may help people with depression.

There is also another implication of the finding: it is well known that some diseases are more common in people who have depression, bipolar disorder and schizophrenia, including coronary artery disease ad some forms of cancer.

This same genetic polymorphism has been linked to cancers of the breast and lung, as well as coronary artery disease. It may be that folate is one of the factors involved in both.

Yet another research project!

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….

Neurological Complications of Gastric Bypass Surgery

Our bodies are highly complex systems. They are not just bags of randomly assorted organs. So tinkering with one part of the system can have an impact in an entirely different part of the body. Many of us have worried for some time about the long-term consequences of gastric bypass surgery for weight loss. We know that some people who have had the surgery develop “substitution addictions.” If they had a real addiction to food before the surgery, after it they may begin to develop an addiction to something else, such as drugs or alcohol.

Now neurologists at the University of Arkansas for Medical Sciences (UAMS) in Little Rock have reported the results of a ten-year study found a link between gastric bypass surgery and several serious neurological conditions.

The study was published online May 22 in the medical journal Neurology and concludes that patients who undergo gastric bypass surgery, also known as bariatric surgery, are at risk for long-term vitamin and mineral deficiencies and as a result may develop a variety of neurological symptoms.

We know that ever more of these operations are being done every year, and so long as people are motivated they are usually successful in reducing weight. But they are not without risk, and we always have to balance that risk against the risk of being morbidly obese. This work is important because it suggests that there is an extra risk about which we previously knew very little. Many of the complications that patients experience affect the nervous system, and they are often disabling and irreversible.

More than 150 patients who came to the UAMS Neurology Clinic following gastric bypass were included in the report. In 26 of these patients a link between the surgery and their neurological condition was found.

All of the patients involved in the study had previously undergone what is known as the Roux-en-Y gastric bypass procedure in which a small stomach pouch is created by stapling part of the stomach together and bypassing part of the small bowel, resulting in reduced food intake and a decreased ability to absorb the nutrients in food. The interval between surgery and onset of neurological symptoms ranged from 4 weeks to 18 years.

The neurological problems involved many different parts of the nervous system, and the symptoms included confusion, auditory hallucinations, optic neuropathy, weakness and loss of sensation in the legs, and pain in the feet, among other conditions. None of the patients had prior neurological symptoms.

Many of the patients also experienced multiple nutritional abnormalities, especially low serum copper, vitamin B12, vitamin D, iron and calcium.

This study underlines something very important. Many heavy people are actually malnourished, because they eat the wrong things and an excess of fat in the diet can create problems in the absorption of some vitamins and minerals. In addition, surgery like this can cause a form of malabsorption.

It is therefore essential to make sure that people who have this kind of surgery have an adequate long-term intake of vitamin and mineral supplements to prevent these neurological complications. It is important for everyone to know about these potential problems and to be on the lookout for neurological symptoms.

Twelve Tips to Reduce Your Risk of Colorectal Cancer

Colon cancer, or, more accurately colorectal cancer, includes cancerous growths in the colon, rectum and appendix. It is the third most common form of cancer and the second leading cause of death among cancers in the Western world. Colorectal cancer surpasses breast and prostate cancers as a leading cause of cancer deaths in both men and women.

And the key point is that with early screening and a few simple dietary modifications, you can dramatically reduce your risk of getting it.

These are the 12 Tips to Slash Your Risk of Colorectal Cancer

  1. Receive regular colorectal cancer screenings beginning at age 50 if you are at normal risk
  2. If you are at higher risk due to a personal or family history of colorectal cancer, other cancers or inflammatory bowel disease have a discussion with your health care provider about screenings before age 50
  3. Eat between 25 and 30 grams of fiber each day from fruits, vegetables, whole grain breads and cereals, nuts, and beans
  4. Eat a low-fat diet: colorectal cancer has been associated with diets high in saturated fat, particularly fat from red meat
  5. Eat foods with folate, such as leafy green vegetables
  6. Try to drink at least 80 fluid ounces of pure water a day unless you have a medical reason for not doing so
  7. Drink alcohol in moderation: 2 units of alcohol or less each day
  8. If you smoke, here is another good reason for quitting. Alcohol and tobacco in combination are linked to colorectal cancer and other gastrointestinal cancers
  9. Exercise for at least 20 minutes three to four days a week. Moderate exercise such as walking, gardening or climbing stairs may help reduce your risk
  10. If you get any persistent symptoms such as blood in the stool, a change in bowel habits, weight loss, narrower-than-usual stools, abdominal pains or other gastrointestinal complaints, it is essential to report them to your health care provider
  11. Maintain a healthy weight. Obesity may increase the risk of colorectal cancer
  12. Maintain a good intake of calcium and vitamin D: this combination has been shown to reduce the risk of colorectal cancer

For more information, I recommend visiting the Web site of the American Cancer Society.

I keep their details in the “Resources” section on the left hand side of this blog.

Checking Data

Following my brief piece on the sun and some of its potentially adverse effects, someone was kind enough to leave this comment:

"Don’t forget that skin cancer is cured by melatonin and vitamin A.
Reference 1
Reference 2

I am extremely grateful that he wrote, because it gives me the opportunity to illustrate the point about checking the data. The person who wrote was obviously motivated by a desire to help, but he had been given some information that was not correct.

I pulled out both of these papers and discovered that they said something rather different.

The first paper in the Indian Journal of Medical Sciences is quite a good review article about melatonin. There are several reasons for us to be interested in melatonin, and I actually plan to write a brief review about it as soon as I have finished analyzing the literature. There is indeed some experimental work to suggest that melatonin may modulate and in some cases arrest the growth of some malignant cell lines (1. 2. 3.) But we are still a long way from being able to say that melatonin is a viable treatment option for melanoma.

The second paper does not talk about melanoma treatment at all: it is a paper about the possible use of Vitamin A as protection against cancer in sun-damaged skin.

As I mentioned in my piece about the new open access journals, our next task is to help people learn how to interpret the data in all of these papers. I am on the review and editorial boards for several scholarly research journals and it is amazing how often the article summary does not tally with the data in the paper.

And also how often people cite articles that they cannot have read. Within the last 24 hours, the editor of a well-known journal asked me to review a research paper that had been submitted for publication. There was very interesting data in the paper, but the author had made at least one error in his citations. He accidentally claimed that a piece of research had discovered one thing, when the research had actually said something quite different. I happened to know that because I wrote the original paper!

This problem of misinterpreting data keeps coming up, and I’m sure that we may all have missed something at some time. It’s sometimes hard to analyze all the ins-and-outs of a piece of research.

You may have heard about a bit of a scandal over a book on gender differences that was just published. I liked reading the book, but I was worried about some of the references about hormonal effects on behavior. I know this literature very well, and some of the statements and inferences were a bit questionable. Now several experts have been checking some of the citations about gender differences in language that were used by the author. They discovered that some were just plain wrong.

Have you ever heard that one about, “Women talk more than men?” It always sounded pretty silly. And of course, if something sounds silly it probably is. Does it matter? If someone is going to write a popular book, good luck to them: I actually think that scientists have a duty to make their work accessible to the public.

But if they quote a lot of papers to give themselves an air of authority, they really have to make sure that they are not misleading anyone. If some references are wrong, then it’s difficult to be sure which ones we can trust.

We cannot have one set of rules for a book written for professionals and another for the general public. Each must be created with the utmost care, clarity and attention to detail.

My last book and CD seriesHealing, Meaning and Purpose – cites over 800 books and websites, all carefully checked by yours truly. I did this just so that people can follow up on what I say. That way my books, articles, papers – even this blog – become portals to a world of ideas and information that you can use to improve your life.

Multiple Sclerosis and Vitamin D

I have commented before that the increasing rates of multiple sclerosis as we move away from the equator has lead to speculation that it might have something to do with lack of sunlight and therefore reduced production of vitamin D in the skin.

A lack of vitamin D may also explain the increased rates of both type 1 and type 2 diabetes, as well as cluster headache at higher latitudes.

Vitamin D is not a single vitamin, but is instead a group of fat-soluble prohormones as well as the metabolites and analogues of these substances. There are two major forms of vitamin D: D2 (or ergocalciferol) and D3 or cholecalciferol. Vitamin D3 is produced in skin exposed to sunlight, specifically ultraviolet B radiation. Very few foods are naturally rich in vitamin D, and most vitamin D intake is in the form of fortified products including milk and cereal grains.

It used to be that we all made plenty of Vitamin D simply by being outside in the sun, but our time outside has been steadily falling since the beginning of the Industrial Revolution, and there are the increasing concerns about exposure to sunlight and some skin cancers.

Vitamin D is involved in many critically important chemcial reactions in the body, and Vitamin D receptors are found in cells in most organs in the body, including the brain, heart, skin, gonads, prostate, and breast. Apart from its effects on regulating calcium and phosphorus, Vitamin D is involved in maintaining the integrity of cell membranes and in modulating the immune system. There is some evidence that a modest increase in Vitamin D intake may reduce the risk of colon, breast and ovarian cancers.

There is a risk of overdosing with Vitamin D. The U.S. Dietary Reference Intake
Tolerable Upper Intake Level (UL) of vitamin D for childern and adults
is 50 micrograms/day (2000 IU/day). In adults, a daily intake of 2500
μg/day (100,000 IU) can, over a period of weeks and months, produce toxicity  and, if
taken for years, as little as 50 to 75 μg/day (2000 to 3000 IU) can
produce toxicity.

In this week’s issue of the Journal of the American Medical Association, there is an important report that endorses everything that we have been saying. Researchers from
several prominent institutions in the United States have examined the
hypothesis that higher levels of 25-hydroxyvitamin D are associated
with a lower risk of multiple sclerosis.

The study confirmed the hypothesis: the risk of multiple sclerosis (MS) fell as blood levels of the vitamin rose.

The researchers uncovered 257 cases of MS among more than seven million military personnel who had given blood samples to the US Department of Defense.

Amongst white personnel, there was a 41% decrease in MS risk for every 50 nanomoles per litre increase in 25-hydroxyvitamin D, the key form of the vitamin found in the blood.

Those whose vitamin level was in the top 20% had a 62% lower risk of MS than those whose level was in the bottom 20%.

The researchers found no such association among black and hispanic personnel, but this could be a reflection of the smaller size of these sample groups.

This new research ties in with other work that has shown that Vitamin D supplements can prevent or favourably affect the course of a disease similar to MS in mice, as well as evidence that if you live in the Northern Hemisphere, being born in May is associated with a lower risk of MS than if you were born in the winter. If you are born in May, your mother will probably have been exposed to more sunlight – and therefore have produced more Vitamin D – during the later part of pregnancy when the final development of the nervous system takes place. Or alternatively you may have had a heathy dose of sunlight in the weeks immediately after your birth.

It is most likely that the Vitamin D helps by modulating the immune system and suppressing autoimmune reactions caused by specialised T helper 1 cells attacking myelin, the insulating material that sheathes most nerves. It is these attacks that are thought by most experts to play a key role in the development of MS.

If confirmed, the finding suggests that many cases of MS could be prevented or its severity reduced by increasing our levels of Vitamin D.

The data also confirm a point that we have made before: we should not be aiming to "boost" our immune systems, but to "modulate" them.

If you see an advertisement for some potion that is supposed to boost your immune system to help you ward off colds, the flu or something more serious, be suspicious: if the seller does not know the  difference between boosting and modulating, it would be best to move on.

Violence and Nutrition

There is a small but impressive body of evidence about the impact of nutrition on violence. It started with some simple observations concerning nutrient content and behavior in animals. In 1942 the wartime British government was persuaded to supplement the diet of all children with cod-liver oil and orange juice. It was speculated that among other ills, poor diets could lead to antisocial behavior. You humble reporter was still required to take this foul-tasting concoction when he was a child in England very many years after the War.

Over the years evidence has grown to support this link between nutrition and antisocial behavior and a longstanding debate developed about the possible role of nutrition and food additives on the ever-increasing rates of violence in society as a whole. Regular readers may remember the publication several months ago of a report entitled Feeding Minds that implicated nutritional changes in the burgeoning rates of mental illness in the United Kingdom.

Part of the problem with much of the work on nutrition and violence has been that there were vested interested involved. Some people have been trying to prove that all the world’s ills are the result of food additives and others have been trying just as hard to prove that their products are safe. The other problem has been the simplistic notion that it is possible to reduce human behavior to a single nutrient.

Humans are complex creatures. Coffee may make you irritable. If you happen to be a small coffee-drinking furry rodent, you may not be you may not have much choice in the matter. But one of the points about developing frontal lobes is that you should have the ability to override the coffee: you can choose whether or not you want to be irritable. A teenager may not be able to do that: he or she does not yet have fully formed frontal lobes. Alcohol can be such a big problem because not only does the alcohol stimulate some of the emotional regions of the brain but it also suppresses the frontal lobes. Whatever you may have done while under the influence probably seemed like a really good idea at the time!

There have now been a couple of very interesting studies that do suggest that nutritional supplementation may have a significant impact on violent behavior in prisoners.

The first modern experiment was reported in the British Journal of Psychiatry in 2002. 231 young adult prisoners were enrolled in a double blind, placebo-controlled, randomized trial of nutritional supplements comparing disciplinary offences before and during supplementation. The prisoners were given a capsule of “Forceval” as well as a combination of essential fatty acids (A daily dosage of four capsules providing 1260 mg linoleic acid, 160 mg gamma linolenic acid, 80 mg eicosapentaenoic acid and 44 mg docosahexaenoic acid). Those receiving the supplements committed an average of 26.3% fewer offences, which improved yet further with longer supplementation. The conclusion of the study was that, “Antisocial behavior in prisons, including violence, are reduced by vitamins, minerals and essential fatty acids with similar implications for those eating poor diets in the community.”

The British Guardian newspaper recently ran a well-balanced article about some of these research initiatives.

This research is being replicated at various sites because if it is true it has enormous implications for personal well-being and for the whole concept of legal responsibility.

Could it be that some of society’s ills are the result of a failed uncontrolled experiment in force-feeding the population?

Multiple Sclerosis

Multiple sclerosis (MS) can be a horrible illness that does not respect age or class. Neil Cavuto, Captain Beefheart and Montel Williams are just three well-known people who have said that they have the illness. Here is a list of many other sufferers.

MS is a chronic, inflammatory disease that affects the central nervous system (CNS). MS can cause a wide variety of symptoms, including changes in sensation, visual problems, muscle weakness, depression, difficulties with coordination and speech, severe fatigue, and pain. The classic pathology is what is known as demyelination (loss of the myelin that insulates nerve cells). Since myelin is white, the lesions are typically fuond in the white matter of the CNS.

The cause remains unknown, though I shall have more to say about some of the MS theories. Amongst the candidates have been autoimmunity, slow viruses, myelinic enzymes and polio vaccination.

Most people begin to experience symptoms between 20 and 40 years old, and rarely after 50. The onset is usually insidious, though every now and then someone starts with sudden onset of a catastrophic neurological or visual problem. Symptoms are usually vague and the diagnosis is often missed in the early stages. Females are affected slightly more than males. MS seems to be a disease of temperate latitudes in both the Northern or Southern hemispheres and is rarely seen in equatorial regions. This association with latitude has fueled some of the viral theories as well as ideas to do with the impact of decreasing sunlight on vitamin D and cell membrane function.

One of the things that makes the disease such a great masquerader is that it is typically marked by apparently random exacerbations and remissions. As the disease progresses, the remissions become less complete and permanent deficit more apparent.

There is an enormous research literature on MS: over 35,000 papers at last count. But there have been some recent highlights.

There has recently been a major breakthrough in discovering the mechanism by which myelin forms. The finding from the Keck School of Medicine of the University of Southern California and the Institut de Recherches Cliniques de Montreal in Canada, could have a major impact on the treatment of multiple sclerosis and demyelination as a result of spinal cord injuries.

Jonah Chan and his colleagues showed that a protein, Par-3, is at the base of the myelination process. This protein becomes localized to one side of the myelin-forming cells that are known as Schwann cells, upon contact with the axon that is to be myelinated. Par-3 acts like a kind of molecular scaffold to set-up an "organizing centre" that brings together the key proteins essential for myelination, in particular a receptor for a molecule that is secreted by the neurons.

The researchers found that when they disrupted this organizing centre, cells could not form myelin normally. Importantly, their discovery demonstrates that Schwann cells need to become polarized so that they know which side is in contact with the axon to initiate wrapping and to bring essential molecules to this critical interface.

These studies open up some new possibilities that should help to identify other components that are recruited at the organizing center set-up by Par-3. In multiple sclerosis, or after injury, Schwann cells can re-myelinate axons of the central nervous system to some degree. Therefore, these experiments bring about the possibility that manipulating the Par-3 pathway might allow for more efficient re-myelination of damaged or diseased nerves.

In a separate study researchers from the Virginia Commonwealth University researchers have identified a unique mechanism of action of a new drug that shows great promise for the treatment of MS.

The researchers reported the unique action of FTY720, or Fingolimod, an immunosuppressant drug that was already known to affect the functioning of the immune system by preventing the egress of white blood cells from the lymph nodes into the blood. The article was published in Blood: The Journal of the American Society of Hematology, that appeared online on Sept. 28.

In this study, the research team found that FTY720 also inhibited the activity of a key enzyme called cPLA2, which is necessary for the production of inflammatory mediators, known as eicosanoids. Eicosanoids drive inflammatory disorders such as asthma and multiple sclerosis.

The inhibition of cPLA2 would shut down the entire inflammatory pathway, possibly without the side-effects caused by medications such as Vioxx, that have been withdrawn from the pharmaceutical market.

FTY720, is a drug developed by Novartis, has shown considerable therapeutic effects in a recent small, placebo-controlled clinical trial involving patients with relapsing multiple sclerosis. The study was published in the September 2006 issue of the New England Journal of Medicine by an international research team.

I could easily select a dozen more important papers published in the last year, but I am particularly interested in basic research that teaches us something new, and treatments that could fit into a comprehensive Integrated plan of treatment.

I am going to post more about the causes of this illness as well as less orthodox approaches to help the physical, psychological, social, subtle and spiritual aaspects of these illnesses.

Calcium, Vitamin D, Diabetes and Schizophrenia

There are some odd puzzles in medicine. For more than 100 years it has been known that diabetes is more common in people suffering from schizophrenia, bipolar disorder and probably also depression. There has also been data indicating that some children with ADD and autism have metabolic disturbances that may underlie some of the cognitive difficulties. It has also been observed in Europe that dark skinned immigrants – whose skin coloring makes them less able to make Vitamin D – are more likely to develop diabetes. Some dark skinned immigrants are also far more likely to develop schizophrenia compared with their families that stayed in sunny tropical regions. Children – particularly boys – who are breastfed and/or have Vitamin D supplements in the first year of life are less likely to develop schizophrenia in later life. Vitamin D is not only involved in calcium absorption, but also in maintaining the integrity of cell membranes. So the link between diabetes and schizophrenia may have something to do with Vitamin D.

A new study just published in the journal Diabetes Care indicates that women with high intakes of vitamin D and calcium appear to have a lower risk of developing type 2 (maturity onset) diabetes. The study from Tufts-New England Medical Center looked at data on 83,779 women enrolled in the Nurses’ Health Study. The women had no history of diabetes, cardiovascular disease or cancer when they enrolled in the study. Vitamin D and calcium intake from foods and from supplements were evaluated every 2 to 4 years. Over the 20 years of follow-up a total of 4843 new cases of diabetes were discovered. The lowest risk of diabetes was observed among women with the highest combined intakes of calcium and vitamin D compared with those with the lowest.

These are important findings, because interventions to raise both vitamin D and calcium intake and quick, cheap and easy, and may significantly reduce the risk of developing type 2 diabetes.

So how much should we take? Although we should be able to make enough of our own Vitamin D by spending even ten minutes in the sun, not everyone can do that, the sun is not without its risks, and the mechanisms for making Vitamin D become less effective as we become older. Though a balanced diet should also help provide some vitamin D and enough calcium, the data indicates that we should take in at least 1200mg of calcium each day, and 400 International Units (10 micrograms) Vitamin D each day. It is possible, though uncommon for people to take too much Vitamin D, and that can have all manner of health consequences.

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