CURRENT NEWS AND BIOLAB TESTS September 2003
Continuing the occasional
series of brief comments from Dr John McLaren Howard, Laboratory Director, on
medical and general news items together with Biolab tests that may be useful in
the investigation of these areas of concern. Your feedback on the questions
posed below will help us in developing future individual tests and test
profiles.
Almost a quarter of a
million prescriptions for Ritalin were issued in 2002! As far as I can
determine, official figures suggest that 306 youngsters had serious side
effects. There was one death earlier this year and three others died in 1997,
1998, and 2001. Biolab has enjoyed a long relationship with the Hyperactive
Childrens Support Group whose excellent work has helped so many parents. They,
and we, promote a non-drug approach to ADHD. There is certainly enough evidence
to suggest that the use of Ritalin should be the last resort. Tests that can be
helpful include general nutritional screening, the Gastrogram (assessing gastric
acid and pancreatic enzyme function), urinary Kryptoppyroles (increased in
concurrent zinc and B6 deficiencies) and essential fatty acids
(delta-6-desaturase block is very common in ADHD). Some of the children also
have increased levels of toxic metals and many have allergic problems that
include gluten sensitivity. Measuring antigliadin antibodies can negate the need
for Jejunal Biopsy.
In addition to dealing
with specific test requests in Autism, we have performed a range of tests on 61
Autistic children where tests additional to those initially requested have been
performed without charge but with the full consent of parents and the referring
doctor. We have seen an unexpectedly high incidence of abnormal levels of
Short-Chain Polypeptides (usually from incomplete digestion of protein) and
DNA-adducts to toxic metals. Polypeptides can mimic hormones (especially gut
hormones) and cytokines (immune-system-messenger-chemicals).
Among many important
functions, vitamin C is required for the formation of collagen. In this process,
vitamin C hydroxylates proline and lysine inside cells. These help to form the
pre-cursor, pro-collagen that is later used to promote the formation of collagen
outside of the cells. As well as its obvious implications for bone formation,
collagen is critical to the integrity of blood vessels, arterial compliance and
it is an essential factor in wound healing. Of course, vitamin C is also
important as an antioxidant, for the absorption of iron and in correct immune
function. In some cases, the measurement of vitamin C can be useful in
determining whether a low level is likely to be playing a causative part in the
patient’s illness. When vitamin C supplements are already in use, the best
test is leucocyte vitamin C. For those not taking supplemental vitamin C, the
cheaper serum vitamin C level is adequate.
Carbamates are very
effective pesticides that are used World-wide. Agricultural run-off can
contaminate water sources and might end up in drinking water. Direct exposure to
carbamates is not a major factor for most of the general population but concerns
about trace levels of these compounds has increased. The water industry is
increasingly challenged to provide assurances that supplies are safe with regard
to these endocrine-disrupting chemicals. The analytical methods available have
been insufficiently sensitive for the detection of trace amounts. New
developments in a combination of liquid chromatography and mass spectrometry
(LC/MS) have moved a long way towards a highly sensitive environmental screen
for 46 of the 52 carbamates targeted.
Much of the concern about
endocrine disrupting chemicals has centred on the effects of environmental
oestrogens on male reproduction. A wide range of chemicals have oestrogenic
properties but exposure level is not of itself a reliable predictor of unwanted
affects on human metabolism. The individual’s endogenous hormone balance,
their nutrient status and any underlying disease conditions can influence both
the up-take and the effect of exposure. Equally, chemicals that predispose to
conditions such as testicular and breast cancer can, in some people, be present
at increased levels without promoting a malignancy while low level exposure is
associated with neoplasm in others.
Your
comments please? It would be very expensive to test for all the known endocrine
disrupters but I am concerned that we currently only address this difficult area
in a piece-meal way. I would like your help in deciding whether to invest the
considerable time and energy that would be required to develop a profile of
appropriate tests. A way of lowering the cost of this screening would be to do
what we do with the DNA adducts where we identify organic chemical adducts by
their chemical grouping rather than as individual compounds. If applied to a
more general screen of environmental chemicals, we could include DNA adducts and
SCPPs in the proposed profile. I do not yet have any way of assessing overall
oestrogenic effects but that is under investigation here and elsewhere.
It
is now estimated that one in three women and one in 12 men are affected by some
degree of bone loss. How clinically relevant this is will depend on their peak
bone density or bone mass earlier in life and whether the bone loss is rapid
enough to present a major risk within their probable life span.
We presently offer an
osteoporosis screen that looks at the balance between bone alkaline phosphatase
(bone production) and tartrate-resistant acid phosphatase (bone resorption). The
profile includes studies of the status of nutrients that are known to be
involved in bone metabolism and the urinary excretion products that increase
during bone loss.
Should
we expand this profile by including other markers of bone metabolism? Do you
have a favourite test that you would like to see in this profile? If so, please
let me know what it is and its usefulness in your own experience.
We can all sympathise with
those who genuinely find it hard to stop smoking. For some of them the loss of
the psychological prop is too much to cope with while for others the physical
addiction is the limiting factor. Recent work has shown that a mutant gene
(known as CYP2A6del) is a defective variant of a gene that promotes the
induction of enzymes that help to break down nicotine. People with this defect
have much more difficulty when they try to stop smoking.
In
our work on DNA adducts we have confirmed what other workers have found that
smokers frequently have adducts to nitrosamines. We have also identified cadmium
and nickel adducts in at least 50% of smokers. We are not able to determine
whether these adducts block the gene referred to above or promote a mutation of
it but that is a possibility. What we are seeing is that the smokers with these
toxic metals adducts have the greatest struggle when they try to give up.
As
nutrient intervention seems to be able to reduce the adduct burden, it can be
valuable to identify these patients in order to facilitate their efforts to
break the habit. Reducing the adduct burden should also reduce the cancer risk.
High-level zinc
supplementation can impair immune function. This is not a new finding but it is
confirmed by studies that show that excessive zinc supplementation can increase
the risk of prostate cancer. The study involved 50,000 American males and
covered a 14 year period.
Biolab is not able to
undertake such large studies but we have seen six patients where immune function
has been compromised by high dose zinc supplements either self-prescribed (2
cases), prescribed by their doctor (3 cases) or by a nutritionist (1 case). The
doses ranged from 60 to a massive 400mg of zinc each day.
We have never seen this
effect in any patient taking less than 60mg each day. We would never suggest a
zinc dose that exceeds 50mg per day and it is my own feeling that any patient
whose zinc status does not replete on 30mg per day is taking the wrong form of
supplement, taking it with food or has a severe malabsorption. Zinc, copper and
iron compete with one another in the gut. Zinc supplements should be taken on an
empty stomach either last thing at night or half-way between meals.
Supplemental
zinc citrate gives a very high serum zinc peak but much of the zinc is rapidly
lost in the urine. For most patients, zinc as a simple amino acid chelate (zinc
gluconate is inexpensive) works well and gives an increased serum level for up
to four hours after ingestion.
Please
note that zinc orotate is poorly absorbed and not absorbed at all by around 25
to 30% of people. It should not be used.
There is no doubt that
sitting for long periods without exercising the legs increases the risk of DVT.
Obesity is also a factor in some cases. The airlines have experienced a very bad
press over this issue, perhaps, not too unfairly given the cramped seating
provided in some aircraft. However, they are now giving advice to passengers and
it seems logical that simple exercises and getting up to walk around will be
helpful.
Simple nutritional
measures may also be of value. Vitamin E and omega-3 fatty acids are
particularly helpful in the avoidance of venous thrombosis. However, these
cannot be expected to fully protect people who adopt positions that restrict
venous return. As advisers and as travellers ourselves, we all need to promote
active measures to avoid venous congestion.
We should also encourage
those who suffer from cramped conditions in flight, or for that matter in road
or rail travel, to complain to the operating company. Airlines, in particular,
are likely to find that laws are passed to define passenger space and seating
conditions unless they take this matter seriously and act rapidly. DVT is a
potentially very serious condition but it is one where simple forethought and
inexpensive measures can reduce its incidence in a highly significant way.
Dr Alan Stewart recently
drew our attention to the need for disease-related profiles. This is not the
first time that we have considered this possibility but, with the exception of
the osteoporosis profile, we have done little about it and the reminder is
timely.
Dr
Stewart has made suggestions for profiles for appropriate nutritional
investigations. As he points out, it is helpful if we distinguish between
main-stream tests that are well documented and understood by many doctors and
those that are more specialist areas that may still be the subject of ongoing
research.
I think the best way of making this distinction would be by offering a basic profile with the option of widening this to include some of the newer tests. A list is appended to this Newsletter. The basic profiles are based on Dr Stewart’s recommendations and the extended profiles include other tests that I consider appropriate when a wider investigation is justified.
These
profiles can be requested by writing their title in the ‘Other Tests’ space
on the request form. However, if you want a different spectrum of tests we need
you to tick the individual test boxes.
We
hope it will help to have these profiles available. We are all familiar with the
feeling of not being clear about the nutritional test requirements when we see a
patient with a proven disease that we infrequently see. These profiles may also
be helpful to d
If you require further details about these news items or or any further information about Biolab please contact us directly: info@biolab.co.uk