11/09/01 NEWSLETTER carlstonmd.com
In This Issue: INDEX
Choline And Memory Loss TOP
     Choline is a chemical used in every human cell. Evidence is accumulating that it is very important in many aspects of human biochemistry, including liver function and memory. This chemical is used as a part of every cell wall. It is important in the metabolism of homocysteine and cholesterol. We know that people who live on diets deficient in choline eventually died of liver failure. Choline has been shown to dramatically effect learning and memory in rats. Prenatal supplementation of the mother rat leads to offspring who are dramatically smarter, and much less likely to experience memory declines with aging. They are also more resistant to chemicals that are toxic to brain tissue. We don�t know a lot about dietary sources at this point but we do know that the biggest dietary sources appear to be meat and eggs. So people who restrict their intake of meat and eggs might hurt their memory. The good news is that this memory loss seems to be reversible. The bad news is that one of the aspects of our ignorance is that we just don�t know how much choline is needed. It appears that 500 mg/day will prevent liver damage. Is more than that needed for good health? Probably but we don�t know how much. Can too much harm you? So far it looks very safe with adults tolerating 20 grams a day with only a fishy body odor and some stomach distress reported.
     In addition to its obvious potential for elderly patients with memory loss, it looks like pregnant women should add choline to their prenatal regimen of folic acid, calcium and lactobacillus GG.
Vitamin D And Diabetes Prevention TOP
     Vitamin D and diabetes prevention Along the same lines we just learned something about Vitamin D from a study which started 45 years ago. In 1966 Finnish researchers recorded information about vitamin D supplementation in children up to one year of age. In 1997 they tabulated which of those children had grown up to develop Type I (Insulin dependent) diabetes. Taking 2,000 iu of vitamin D during infancy lowered the rate of Type I diabetes by 88%. Even irregular intake of lesser amounts reduced the risk by 78%.
Ritilin And Cocaine TOP
     I attended the American Academy of Pediatrics� Annual National Meeting 3 weeks ago. One thing I learned (while reading a medical journal between talks) was about recent evidence showing that the brain responds to Ritalin very much as it does to cocaine (J Neuroscience 2001). Investigations of Ritalin are interesting because conventional medicine has no explanation for its function. Homeopaths believe that drugs which make you hyper can cure hyperactivity so it makes sense that it could be useful in these children. Fortunately children take it as a pill in oral form because researchers were shocked to discover that injected as a liquid addicts really liked it way too much.
     Despite that reassurance, this discovery leads to further questions. One of them most important is the possibility that chronic use of Ritalin could make patients more prone to drug addiction. To date there have only been two studies looking at this question � one said yes, the other no. While awaiting the research needed to answer the question we have another reason to be careful about medicating the minds of our children.
B Vitamins And Heart Disease Prevention TOP
     UCSF researchers recently reviewed the effects of supplementing food with folic acid and B12 on the prevention of heart disease by lowering homocysteine in the blood. They found that supplementing all men over age 45 and women over age 55 with 1 mg of folic acid and 0.5 mg of B12 over a 10 year period would save over 300,000 lives, $2 billion dollars (and this funny statistical thing almost 500,000 �quality-adjusted-life-years�). The bottom line is that this approach could prove to be significantly more powerful that cholesterol reduction.

Preventing Pancreatic Cancer TOP
     Pancreatic cancer strikes fear into the hearts of just about anyone who has come in contact with it. Patients tend to succumb rapidly and suffer a great deal of pain in the process. Statistics are pretty grim with over 95% of patients dying in less than 5 years of diagnosis. An editorial in the Journal of the American Medical Association reports accumulating evidence that suggests that pancreatic cancer is largely preventable.
     Being overweight (BMI more than 25) increases risk especially if the person is tall. In these patients exercise reduces the risk significantly. Eating large meals increases vulnerability � patients who ate one large meal and then a few snacks had a 50% lower risk than patients who ate 3 large meals a day in one study. Approximately 25% of pancreatic cancers are attributed to cigarette smoking. Unanswered questions remain about the risk of specific foods � it appears that foods with a high glycemic index (they make the blood sugar rise and fall rapidly) may increase the risk of pancreatic cancer.
Surgical Nutrition TOP
     One further note in this hodgepodge � Patients who are facing surgery do a whole lot better if they get the right stuff to eat. This is obvious to any thoughtful person but in medicine sometimes we don�t let common sense muddle our opinions. Seriously there is a rising tide of research around specific nutrients which might be helpful (various amino acids, yeast RNA, L-arginine, omega-3 oils and others). The manufacturers are lining up to try to tap into a potential lucrative �captive� market. Keep you eyes open.
     Remember the waning light makes most of us melancholic to varying degrees. Catch some sun when you can or dust off your light box.
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