The effects of cranberry supplement on urinary tract infection.

The effects of cranberry supplement on urinary tract infection.

by | تیر 28, 1402 | Articles

The Impact of Cranberry Juice Consumption on Bacteriuria

One of the common complications experienced by individuals with spinal cord injuries is urinary tract infections (UTIs). These infections, caused by various types of bacteria in the urine, can make treatment challenging. In these patients, due to antibiotic resistance, there is a need to find appropriate alternatives for treating these infections. Therefore, the aim of this study was to investigate the impact of cranberry juice consumption on bacteriuria and pyuria in patients with spinal cord injury and neurogenic bladder. The study was conducted with the goal of finding a suitable solution for treating urinary infections in spinal cord injury patients.

Spinal Cord Injuries

Spinal cord injuries can occur at any part of the spinal cord. Depending on the location and severity of the injury, it can lead to various neurological problems. For instance, damage to the cervical spinal cord may result in complete or partial paralysis from the neck down. Similarly, damage to the thoracic spinal cord can lead to respiratory issues, muscle weakness, and loss of sensation in the affected areas.

Types of Spinal Cord Injuries

Spinal cord injuries can be either temporary or permanent. The treatment varies based on the severity, location of the injury, and the duration since the injury occurred. Treatment may include physiotherapy, medication, and surgery.

Prevalence of Spinal Cord Injuries

The prevalence of spinal cord injuries varies from country to country. However, the global incidence of this condition is 40 cases per million population. Patients with spinal cord injuries live many years with severe disabilities. Most of these injuries are seen in individuals aged 34 and younger. Although life expectancy in individuals with spinal cord injuries has increased, these patients are at high risk of various diseases and secondary complications.

Common Complications

The most common complication leading to frequent hospitalizations for these patients is urinary tract infections. These infections, manifested as symptomatic urinary tract infections, cause significant pain and make it more difficult for these patients to tolerate their disabilities. These infections threaten their survival, have a long-term negative impact on their health, increase their dependency, and reduce their quality of life. Additionally, they impose a significant financial burden on both the patients and the healthcare system.

Urinary Tract Infection (UTI)

Urinary tract infection (UTI) refers to infections affecting any part of the urinary system, including the kidneys, bladder, urinary tract, and prostate (in men). UTIs are primarily caused by bacteria, although fungi and viruses can also cause these infections.

Causes and Risk Factors for UTIs

Most UTIs are caused by bacteria that move from the intestines to the urinary tract. Women are more prone to UTIs than men because their urinary tracts are shorter, making it easier for bacteria to travel to the bladder. Other risk factors for developing UTIs include pregnancy, old age, diabetes, urinary tract obstructions, and the use of urinary catheters.

Factors Contributing to UTIs in Spinal Cord Injury Patients

Several factors contribute to the occurrence of UTIs in spinal cord injury patients, including invasive procedures without antibiotic prophylaxis, cervical injuries, neurogenic bladder, urinary retention, the use of urinary catheters, increased bladder pressure, urinary and fecal incontinence, structural and functional urinary disorders, hydronephrosis, reflux, and urinary stones. These factors contribute to recurrent and chronic bacteriuria, resulting in symptomatic or asymptomatic urinary infections. In spinal cord injury patients, UTIs are often polymicrobial and resistant to treatment.

Treatment and Prevention of UTIs

UTIs are typically treated with antibiotics. To help prevent UTIs, patients are advised to drink plenty of water, empty their bladder when necessary, and avoid irritant chemicals in soaps and powders. If you experience UTI symptoms, it’s important to consult a healthcare professional, as untreated UTIs can lead to more severe infections and kidney damage.

Complications of Long-Term Antibiotic Prophylaxis

On the other hand, long-term antibiotic prophylaxis is not always very effective in these patients. The presence of multi-drug-resistant bacteria poses a life-threatening risk. Concerns about overuse of antibiotics in spinal cord injury patients highlight the need for alternative methods to treat recurrent UTIs. Studies have shown that spinal cord injury patients use cranberry supplements for their preventive effects and believe they are beneficial for urinary health.

Review of Studies Conducted

Numerous studies have been conducted to assess the effectiveness of cranberry in preventing UTIs in at-risk patients. In one study, consumption of cranberry juice three times a day reduced the microbial biofilm load in the bladder of 15 spinal cord injury patients. Another study confirmed the role of cranberry in preventing UTIs in women with recurrent UTIs. A study by Heitz and colleagues, aimed at evaluating the effect of cranberry capsules in preventing UTIs in children with neurogenic bladders due to myelomeningocele, showed the positive impact of this intervention.

Sterilizing the Urine

Maintaining sterile urine in spinal cord injury patients with functional or anatomical urinary system defects is more critical than in healthy individuals. Preventing the colonization of pathogenic microbes that cause UTIs, without antibiotic treatment, is extremely important and valuable in these patients.

Clinical Trial Results

This clinical trial, a double-blind, randomized, controlled study, was conducted on 60 spinal cord injury patients who were randomly assigned to control and test groups. Before the intervention, a complete urinalysis and urine culture were performed for patients in both groups. The test group consumed 250 to 300 ml of diluted 30% cranberry syrup for two weeks. The control group consumed the same volume of placebo syrup. After two weeks, urinalysis and urine culture were performed for both groups.

Results of the Current Study

The present study showed that cranberry juice consumption had no effect on urinary pH, contrary to previous assumptions that cranberry’s effect on UTI treatment was due to the presence of benzoic acid, which is excreted in urine as hippuric acid and prevents bacterial growth by acidifying the urine. In the current study, cranberry consumption had a greater effect in patients who did not have an indwelling urinary catheter or who used intermittent catheterization or condom catheters, compared to those with permanent urinary catheters or condom catheters. The most common complaints among spinal cord injury patients were urinary problems, urinary retention, and foul-smelling urine. The findings showed that cranberry juice was effective in reducing foul-smelling urine.

Conclusion

In conclusion, short-term cranberry juice consumption in spinal cord injury patients with normal filtration, especially in cases where they do not have an indwelling urinary catheter or a permanent urinary drainage system, reduces pyuria and bacteriuria and is effective in reducing the odor of urine. It also does not cause intolerable gastrointestinal or systemic side effects.

References Rajaei M, Hafize M, Noorian K. Evaluation of cranberry juice on bacteriuria and pyuria in spinal cord injured patients with neurogenic bladder. Armaghanj 2014; 19 (8): 662-674.

The effect of eight weeks of chitosan supplementation

The effect of eight weeks of chitosan supplementation

by | تیر 12, 1402 | Articles

Cardiovascular diseases are part of preventable chronic diseases that are related to lifestyle changes. The prevalence of cardiovascular diseases is increasing globally. According to the World Health Organization’s report, over 17.5 million people die annually due to cardiovascular diseases. This article examines the impact of eight weeks of chitosan supplementation and combined exercise on blood pressure and lipid profile in women with high blood pressure.

Main Risk Factors for Cardiovascular Diseases

Hypertension, dyslipidemia, and abnormal increases or decreases in serum lipid levels are major risk factors for cardiovascular diseases and cause over 80% of deaths and disabilities in low- and middle-income countries. Hypertension is common worldwide, with one in three adults in the United States diagnosed with high blood pressure. Moreover, 90% of individuals in middle-aged and elderly populations are at risk of developing high blood pressure.

The Relationship Between Cardiovascular Diseases and Dyslipidemia

In most cases, cardiovascular diseases are associated with dyslipidemia. There are widespread changes in serum lipid profiles across various population groups worldwide, with increased levels of:

  • Total serum cholesterol
  • Triglycerides
  • Low-density lipoprotein (LDL)
  • Decreased high-density lipoprotein (HDL)

These changes are linked to the main risk factors for cardiovascular diseases.

Promoting Heart and Vascular Health

Lifestyle changes should be considered as a guide to reducing inactivity and promoting healthy dietary patterns. It is evident that inactivity and high-fat diets lead to:

  • Insulin resistance
  • Fat oxidation
  • Dyslipidemia

In contrast, regular exercise increases maximum oxygen uptake, boosts energy from fat reserves, and reduces dyslipidemia. Optimizing lifestyle is the first line of treatment for overweight or obese patients. Some foods may also help manage and treat metabolic syndrome components like:

  • Obesity
  • Hypertension
  • Lipid disorders

Moreover, regular physical activity is an effective adjunctive treatment for managing and controlling blood pressure.

Controlling Blood Pressure with Exercise

Regular aerobic and resistance exercises are fundamental for blood pressure control. Studies have shown that combined exercise programs lead to:

  • Increased muscular strength
  • Favorable lipid profile changes
  • Increased apolipoprotein levels

Research supports the beneficial effects of regular physical activity on cholesterol levels. When combined exercise is implemented in older patients with coronary artery disease, it has the most positive impact on blood lipid profiles. These positive changes in blood lipids are associated with weight and body fat loss. Changes in metabolism, such as using lipids instead of glycogen, may also contribute to these improvements.

Introduction to Chitosan

Chitosan is a natural polysaccharide derived from glucosamine residues in chitin, the second most abundant biopolymer on Earth, sourced primarily from the exoskeletons of crustaceans or fungal cell walls. Chitosan is derived from deacetylation of chitin and is recommended as a weight loss supplement and adjunctive treatment for:

  • Blood lipids
  • Blood glucose
  • Blood pressure

Natural or functional food products with protective heart and vascular properties may help patients achieve and maintain cardiovascular health and improve lipid disorders through novel mechanisms.

Mechanism of Chitosan

Chitosan is not digested in the digestive system. It swells and induces satiety by physically filling the stomach. By inhibiting pancreatic lipase activity, chitosan can reduce fat absorption in the intestines. It can also bind to fat and deposit it in the intestines, preventing absorption. Chitosan cations bind to the carboxyl groups of fatty acids and bile acids, disrupting the emulsification of neutral lipids like cholesterol and other sterols by creating hydrophobic interactions. This reduces the absorption of fat and cholesterol in the digestive tract.

Adverse Biochemical Effects of Chitosan

One of the adverse biochemical effects of chitosan is the reduced absorption of minerals and fat-soluble vitamins. In addition to trapping lipids and cholesterol, chitosan gels formed in the intestines bind to minerals and vitamins. When chitosan is administered with sodium ascorbate to rats fed a high-fat diet for two weeks, it led to a significant decrease in the absorption of minerals, which was associated with reduced bone mineral content.

Investigating the Effects of Exercise in Individuals with Cardiovascular Disease

Extensive research has examined the effects of exercise in individuals with cardiovascular disease, but there is limited research on women with hypertension. The choice of a combined exercise program for this study was based on the potential additive effects of aerobic and resistance training in reducing cardiovascular risk factors. Combined exercise results in temporary reductions in blood pressure, even after a single session, due to a phenomenon known as post-exercise hypotension (PEH). Factors such as:

  • Intensity
  • Duration
  • Type of exercise
  • Resting blood pressure levels

may influence the range and duration of PEH and lead to various cardiovascular system responses that significantly alter blood pressure in acute, subacute, and chronic phases after exercise.

Clinical Trials on Chitosan Supplementation

Previous clinical trials have investigated the effects of chitosan supplementation on blood pressure and lipid profiles, either alone or combined with a simple exercise program. This study aimed to explore the additive effect of chitosan supplementation and combined aerobic and resistance exercise on blood pressure and lipid profile. This innovative approach could serve as an adjunctive treatment for managing hypertension and lipid profile issues as part of a healthy lifestyle with proper medical supervision.

Research Results

Given the importance of hypertension, with one in three adults affected by the condition, the results of this study emphasize the significant impact of chitosan supplementation in both the chitosan group and the combined chitosan-exercise group on systolic and diastolic blood pressure. Chitosan may thus be considered a new adjunctive treatment for hypertension alongside a healthy lifestyle. Moreover, based on the observed properties in previous studies and the changes observed in this clinical trial on lipid profile indicators such as:

  • Total cholesterol
  • Triglycerides
  • LDL
  • HDL
  • VLDL
  • Weight reduction
  • Improved body composition index

Chitosan could be regarded as a dietary supplement in conjunction with weight loss programs and even independently when combined with regular exercise.

Reference: Rasouli Jokar E., & Shamlou Kazemi S. The Effect of Eight-Weeks Chitosan Supplementation and Combined Exercise on Blood Pressure and Lipid Profile of Women With Hypertension. Journal of Sport Biosciences. 2023; 15 (1): 37-46.

The effect of Vitamin B6 on breast pain reduction

The effect of Vitamin B6 on breast pain reduction

by | تیر 7, 1402 | Articles

In this article, we examine the effect of Vitamin B6 on reducing breast pain. Breast pain is one of the common issues among women who visit healthcare centers, accounting for 50 to 70 percent of visits to breast clinics.

In a large study of 2400 women over a period of 10 years, breast pain was the most common complaint, requiring evaluation and diagnostic procedures. Additionally, the fear of breast cancer is a major reason for these visits, although pain is the sole symptom of cancer in only 7% of cases. Most women experience breast pain at some point in their lives, with a prevalence rate of 65 to 70 percent. In some cases, the pain can be so severe that it affects a woman’s daily activities and quality of life, leading to interference with work, exercise, sexual activity, and social interactions.

Breast pain is categorized into three types:

  1. Cyclical pain
  2. Non-cyclical pain
  3. Exogenous pain

Cyclical Pain: This pain is related to the menstrual cycle, where it increases before menstruation and decreases with the onset of menstruation.

Non-Cyclical Pain: Pain not related to the menstrual cycle.

Exogenous Pain: The etiology of this pain is unknown. Although various factors such as hormone imbalances and psychological factors have been proposed, the exact cause remains unclear.

In many cases, after a careful evaluation and exclusion of cancer, reassurance is enough to provide adequate treatment for the pain. Several approaches have been suggested for managing this pain, including:

Non-pharmacological Treatments: These include wearing appropriate undergarments, relaxation exercises, changes in dietary habits such as limiting intake of fatty foods and caffeine.

Pharmacological Treatments: These include non-steroidal anti-inflammatory drugs, vitamins, and evening primrose oil.

Hormonal Medications: Medications like Danazol, Tamoxifen, and dopamine agonists are also used.

However, hormonal treatments can have side effects such as:

  • Hirsutism
  • Fluid retention
  • Irregular bleeding

Therefore, these treatments are recommended primarily for patients with severe pain. Additionally, in more than half of the cases, the pain recurs after discontinuing the medication. Thus, an optimal treatment plan is yet to be fully defined, and ongoing research continues to explore newer treatments with fewer side effects.

One treatment under discussion is the use of vitamins. Previous studies have focused on Vitamin E, but Vitamin B6 has emerged as a more recent treatment option for breast pain.

Features of Vitamin B6:

  • Inexpensive
  • Accessible
  • Low side effects

Recent studies have examined the effect of Vitamin B6 on breast pain, with promising results showing that it helps in reducing both the severity and frequency of pain. Other vitamins such as Vitamin B1, B6, and E have also been used in managing breast pain, with positive outcomes observed in various studies.

Research and Effects of Vitamin B6
In a study, it was identified as part of treatments for breast pain, along with non-steroidal anti-inflammatory drugs (NSAIDs), evening primrose oil, hormonal medications such as Danazol, and Tamoxifen. It was also mentioned that specialists in the field of breast care usually initiate treatment for breast pain with NSAIDs, evening primrose oil, Vitamin B6, and/or Tamoxifen, and use other hormonal drugs for more serious issues.

In another study on cyclical breast pain, 13% of 276 general surgeons who were randomly selected, used Vitamin B6 as an elective treatment for post-confirmation cyclical pain and for persistent pain. This study suggests that specialists in the field of breast care are more inclined to use treatments with fewer side effects, such as Vitamin B6, as compared to medications like Danazol and bromocriptine, which are prescribed for patients with severe and prolonged pain.

In studies conducted by some researchers, patients with cyclical pain were divided into groups treated with aspirin, a combination of retinol, Vitamin B6, tocopherol acetate, and another group with various medications. All patients experienced a reduction in pain intensity, with the medication group showing the most significant reduction. This study was specifically focused on cyclical breast pain, using a combination of vitamins, not just Vitamin B6 alone.

Another study revealed that Vitamin B6 is effective for both types of breast pain, particularly cyclical pain.

Another important point is the psychological factors affecting the response to treatment. Many patients with breast pain are deeply concerned that their pain might be a symptom of breast cancer. Providing reassurance significantly alleviates their anxiety. Additionally, responses to treatment were positive in all patients who participated in the study, regardless of the type of medication used.

The effectiveness of reassurance in treating patients with breast pain:

78% to 85%

Conclusion:
Given the findings from various studies, Vitamin B6 can be used alongside reassurance to reduce breast pain. It is a low-cost, accessible, and safe medication, with no reported side effects when taken at a dose of 200 mg per day.

Source:
Soltany S, Hemmati H R, Alavy Toussy J, Gholamaliyan E. Effect of vitamin B6 on mastalgia: A double-blind clinical trial. Koomesh 1395; 17(4): 950-956.

The Effect of the Medicinal Plant Artichoke on Fatty Liver

The Effect of the Medicinal Plant Artichoke on Fatty Liver

by | تیر 4, 1402 | Articles

Review of the Effect of Artichoke Herb on Fatty Liver Markers

In this article, we will examine the effect of the medicinal plant artichoke on fatty liver. Fatty liver is one of the major causes of chronic liver disease in humans. Non-alcoholic fatty liver disease (NAFLD) ranges from asymptomatic fatty liver to severe liver inflammation, fibrosis, and sometimes cirrhosis. If left untreated, it can ultimately lead to liver cell cancer and death.

What is Fatty Liver? Liver diseases come in various forms, each causing damage to this vital organ. Fatty liver is one of the most common liver diseases, caused by the accumulation of fat in the liver. Also known as hepatic steatosis, fatty liver occurs when fat accumulates in the liver cells.

Having a small amount of fat in the liver is natural, but excessive fat buildup can become a major problem. If more than 5-10% of your liver weight is fat, you may have this disease. The liver, the second largest organ in the body, helps process food and filters harmful substances from the blood. This disease is often referred to as the “silent liver disease” because it can occur without any noticeable symptoms.

The prevalence of this disease is rising in many parts of the world, especially in Western countries, affecting around 25% of the global population. The good news is that this disease is reversible and can be treated through lifestyle changes.

Non-alcoholic fatty liver, which occurs in the absence of alcohol consumption, has become a major health concern due to its widespread prevalence.

Symptoms of Fatty Liver

  • Leads to obesity
  • Increases insulin resistance
  • Even in cases without diabetes, it can occur
  • Heart disease and vascular conditions are common
  • Often diagnosed through simple blood tests and liver imaging methods such as ultrasound

Causes of Fatty Liver Insulin resistance exacerbates lipid metabolism disorders, leading to an increase in free fatty acids reaching the liver, disruption of mitochondrial beta-oxidation, new lipogenesis, and a decrease in fat excretion from the liver, all contributing to the development of fatty liver.

Preventing Liver Damage Progression

  • Weight loss may reduce liver damage
  • Managing blood fat levels is effective in preventing further liver damage
  • Various serum enzymes are used for diagnosing liver damage

Common Liver Enzymes:

  • Aspartate Aminotransferase (AST)
  • Alanine Aminotransferase (ALT)

These enzymes are typically elevated in liver diseases and damage, with the highest levels occurring during severe liver necrosis.

There are no specific drugs for treating fatty liver, and while some doctors prescribe vitamin E, its effectiveness for this disease remains unclear due to the high doses required, which may increase the risk of heart attacks and atherosclerosis.

Past studies have shown that antioxidant-rich diets and anti-inflammatory agents, such as active compounds in medicinal plants, can be effective in treating non-alcoholic fatty liver disease.

Artichoke (Cynara scolymus) Artichoke is a plant from the Asteraceae family and is also known as “Erdeh Shahy” in Persian. In traditional medicine across various countries, artichoke is recommended for lowering blood sugar, improving digestion, supporting heart health, and promoting liver health. Artichoke extract, rich in concentrated compounds from the plant, has gained popularity as both a dietary and medicinal supplement.

Nutritional Value of Artichoke: Artichoke is low in fat yet high in fiber, vitamins, minerals, and antioxidants. It contains a significant amount of vitamin B6, vitamin C, and vitamin K, along with essential minerals like magnesium, phosphorus, potassium, and iron.

One medium-sized artichoke provides about 7 grams of fiber, which covers 23-28% of the daily fiber intake. With only 60 calories and about 4 grams of protein per stalk, it is more nutritionally dense than many other vegetables and edible plants. Most notably, artichoke is also considered a potent antioxidant.

Artichoke Extract and Liver Protection: Artichoke leaf extract can protect the liver from damage and promote tissue regeneration. It also enhances bile production, which helps eliminate harmful toxins from the liver.

Studies: In one study, artichoke extract was given to a group of laboratory mice and compared with a control group. The results showed that artichoke consumption led to less liver damage, higher antioxidant levels, and better liver function after excessive drug consumption. Human studies have also shown positive effects on liver health.

For example, a trial involving 90 individuals with non-alcoholic fatty liver disease demonstrated that daily consumption of 600 mg of artichoke extract for two months improved liver function.

Artichoke’s Properties:

  • Liver supporter
  • Antimicrobial
  • Reduces cholesterol
  • Lowers blood fat
  • Stimulates nitric oxide synthase gene expression
  • Improves endothelial cell function in atherosclerosis

Active Compounds in Artichoke:

  • Phenolic compounds: These protect the liver from toxicity and reduce liver enzymes, which aligns with findings from recent studies.
  • Flavonoids: Artichoke leaves contain phenolic compounds like caffeic acid and flavonoids that offer liver protection and increase glucose uptake in peripheral tissues. They also reduce intestinal glucose absorption by inhibiting digestive enzymes and aid in the repair and regeneration of beta cells. These effects help regulate blood sugar and improve lipid levels.

Use of Artichoke Herb:

  • For people with liver and gallbladder issues
  • Those with functional dyspepsia and reduced symptoms of irritable bowel syndrome (IBS)
  • As an adjunct treatment for mild to moderate hypercholesterolemia
  • It helps reduce blood sugar levels
  • For appetite loss

Factors Increasing Fatty Liver Risk:

  • Overweight individuals are more prone to developing fatty liver.
  • Sedentary lifestyle, especially in housebound individuals, increases the risk.
  • High levels of triglycerides and cholesterol in the blood are contributing factors.

Factors Reducing Fatty Liver Risk:

  • A balanced lifestyle is the key treatment for non-alcoholic fatty liver disease.
  • Studies show that after 45 days of consuming artichoke herb, blood sugar, triglycerides, and cholesterol levels decreased, indicating positive effects on liver function and lipid management.
  • Artichoke acts on lipid and lipoprotein reduction through its influence on cholesterol biosynthesis and bile production in the liver.

Reported Effects:

  • Cynarine and caffeic acid have shown protective effects against liver damage caused by carbon tetrachloride. This protective effect has also been observed for artichoke extract, linked to the plant’s antioxidant properties. Hepatic regeneration has been reported in studies where water extracts of artichoke were administered orally to rats after partial liver resection.

Clinical Studies: In a two-month trial, 208 patients with irritable bowel syndrome (IBS) and dyspepsia were treated with 320-640 mg of standardized artichoke leaf extract (ALE). After treatment, significant improvements were seen in IBS symptoms (26%), quality of life (20%), and changes in bowel movement patterns.

Another study showed significant reductions in symptom severity in IBS patients who took ALE for six weeks. Additionally, 96% of patients rated ALE as more effective or at least equivalent to previous treatments, and its tolerance was very good.

Conclusion: Results showed that women experienced more significant improvements in fatty liver grades than men. This may be due to the fact that many of the study participants were housewives who adhered to the precise consumption of artichoke tea, whereas men, due to work schedules, may not have used the tea regularly. Additionally, studies show a significant relationship between serum AST and ALT levels with the severity of non-alcoholic fatty liver disease, where increasing liver disease grade correlates with elevated enzyme levels.

Traditional medicine experts have also noted that women, due to their cold temperament and phlegmatic constitution, are more susceptible to fatty liver than men.

The protective effects of L-carnitine and acetyl-L-carnitine.

The protective effects of L-carnitine and acetyl-L-carnitine.

by | خرداد 9, 1402 | Articles

In recent years, the use of pharmaceutical agents with significant metabolic effects for the treatment of ischemic heart diseases has gained considerable attention.

These include:

  • Atomoxetine
  • Ranolazine
  • L-carnitine (LC)
  • Acetyl-L-carnitine (ALC)

These pharmacological agents are discussed for their roles in heart failure, angina, and other ischemic heart diseases.

Carnitine Carnitine is a naturally occurring biological substance in the human body that plays a crucial role in the production of energy required for the heart and certain other tissues by facilitating the oxidation of long-chain fatty acids.

L-carnitine (LC) is a pharmaceutical formulation with multiple clinical applications, including:

  • Correcting carnitine deficiency in patients with chronic fatigue syndrome
  • Dialysis patients
  • Enhancing exercise tolerance in patients with angina
  • Correcting muscle weakness
  • Growth retardation
  • Motor skill impairment in children and premature infants
  • Treatment of toxicity caused by anthracyclines and sodium valproate

Acetyl-L-carnitine (ALC) Acetyl-L-carnitine (ALC) is the esterified form of LC, synthesized by the ALC transferase enzyme in the brain, liver, and kidneys. This substance facilitates the transport of acetyl-CoA during fatty acid oxidation into the mitochondria, increases acetylcholine production, and stimulates protein and phospholipid synthesis in membranes. Like LC, ALC plays a crucial role in mitochondrial function and serves as an important molecule for the transport of free fatty acids and acetyl groups in metabolism and beta-oxidation of free fatty acids. The primary storage of ALC in the body occurs in skeletal and cardiac muscles.

Effects of ALC Supplementation

  • Neuroprotective effects in brain ischemia
  • Prevention of peripheral nerve damage
  • Effective in the treatment of Parkinson’s disease in animal models
  • Reduction of cognitive decline in aging
  • Treatment of Alzheimer’s disease

Effects of Myocardial Ischemia Myocardial ischemia leads to:

  • Reduced carnitine reserves in the heart
  • Accumulation of toxic metabolites of fatty acids in the heart
  • Inhibition of beta-oxidation
  • Reduced ATP production in the myocardium
  • Toxic metabolites (including acylcarnitine and beta-hydroxy-acyl-CoA metabolites)

Fatty acids have harmful effects on myocardial recovery during reperfusion.

Metabolite Toxicity

  • Membrane damage
  • Enzyme attachment to the cytoplasmic membranes of heart cells
  • Disruption of ion transport across membranes
  • Changes in the integrity of ion channels and transporters
  • Activation of signaling pathways
  • Activation of protein kinases
  • Gene transcription
  • Initiation of apoptosis

Side Effects of LC and ALC Administration The administration of drugs like LC and ALC, through mechanisms that are not fully understood, results in the following effects:

  • Preservation of metabolism
  • Improvement of heart function under ischemic conditions

In a study conducted in 2003, the administration of 5 and 0.5 mM concentrations of ALC and LC 10 minutes before inducing global ischemia (complete ischemia) did not prevent the occurrence of ventricular fibrillation in rats, but the 5 mM concentration reduced the infarct size.

Study Results Adding LC to the Krebs solution as a pharmacological agent in post-conditioning from 10 minutes before the start of reperfusion to 10 minutes afterward showed heart protective effects, including a reduction in infarct size. So far, comparative studies on the protective effects of LC and ALC on infarct size due to regional ischemia and reperfusion are unclear.

Potential Differences Between LC and ALC Effects In a study comparing the effects of LC and ALC during 30 minutes of regional ischemia and 120 minutes of reperfusion in isolated rat hearts, both LC and ALC reduced infarct size compared to the control group. The infarct size was reduced by 43% and 56% with 1.5 and 3 mM LC, respectively, and by 48% and 65% with the same concentrations of ALC.

Reduction of Infarct Area LC and ALC administration during 30 minutes of ischemia and 120 minutes of reperfusion led to a significant reduction in infarct area. Although the decrease in infarct size and infarct area volume was higher with ALC than LC, the effects of both were not statistically significantly different.

Since both substances exist biologically in the body and can be converted into each other enzymatically, it is not surprising that they exhibit similar effects as drugs (qualitatively, not quantitatively). Studies have shown that:

  • In humans, ALC has better bioavailability and gastrointestinal absorption than LC.
  • Other findings suggest that ALC penetrates mitochondria more effectively than LC, which could explain the more prominent heart protection observed with ALC compared to LC.

LC and AC Play Key Roles in Arrhythmia LC and acyl-CoA molecules are key players in arrhythmogenesis. In animal studies, LC consumption resulted in:

  • Reduction of high-energy phosphate loss during ischemic periods
  • Decreased tissue necrosis
  • Preservation of mitochondrial function
  • Improved mechanical and electrophysiological heart function

Benefits of LC Administration LC administration in an ischemic isolated dog heart model resulted in a significant reduction of ventricular arrhythmias, as it reduced the size of the necrotic heart region.

Effects of Oral LC Supplementation Daily oral administration of 2 grams of LC for 28 days significantly reduced the occurrence of arrhythmias and congestive heart failure in patients with acute myocardial infarction.

Studies have also shown that ALC provides effective protection under brain ischemic conditions. Researchers have shown that administering 5 mM ALC and LC shortly before global ischemia reduces infarct size and inhibits cell death.

Methodological Differences in Ischemia The duration of ischemia and reperfusion, the duration of drug administration, and the varying concentrations of LC and ALC used in studies may explain differences in results. In particular, in studies where only the 5 mM concentration of LC or ALC reduced infarct size significantly, prolonged drug administration could be a factor influencing the effectiveness of protection.

Global vs. Regional Ischemia In global ischemia, no drug enters the heart during ischemia, while in regional ischemia, part of the coronary circulation remains partially open, allowing the Krebs solution to flow. This difference in ischemia type plays a role in the varied effects of drugs in the aforementioned studies. Although the exact reasons for the heart protective effects of LC and ALC remain unclear, further studies are needed to better understand these mechanisms.

Introduction of Multiple Mechanisms Additional mechanisms proposed include the administration of LC and ALC, which increases fatty acid transfer into mitochondria and stimulates beta-oxidation during ischemia. This reduces the accumulation of toxic fatty acid metabolites in mitochondria, especially molecules like LCAC and acyl-CoA, and even their transport out of mitochondria. This results in a protective effect against the detergent-like activity of these molecules on mitochondrial membranes, thereby preserving their function in fatty acid metabolism and reducing arrhythmias and other harmful effects of reperfusion injury.

Effects of Increased Glucose Oxidation

Increasing glucose oxidation during reperfusion, while simultaneously inhibiting the transfer of fatty acids into mitochondria, as opposed to ischemia, leads to increased ATP production, resulting in enhanced contractile power and heart compliance, as well as a reduction in the necrotic area. On the other hand, increasing glucose oxidation reduces lactate and H+ ion accumulation, thereby preventing intracellular acidosis in myocardial cells during ischemia, which aids in the faster recovery of ischemic heart function during reperfusion. Increased blood flow to tissues by dilating their blood vessels, inhibiting the harmful effects of free radicals released during reperfusion, and the resistance of heart cells to R/I damage (by stabilizing heart cell membranes) have also been attributed to this. Perhaps a combination of these mechanisms plays a role in their cardiac protective effects.

Conclusion

Overall, the results of this study showed that the protective effects of administering LC and ALC were evident, including a reduction in infarct size and infarct area, without significant statistical differences between the two. Among the proposed mechanisms for these effects, the reduction of toxic metabolites from fatty acids, especially LCAC under ischemic conditions, increased glucose oxidation during reperfusion, and consequently the reduction of lactate and H+ ion accumulation, resulting in the inhibition of acidosis in myocardial cells during ischemia, as well as the inhibition of harmful effects of free radicals released during reperfusion, are more prominently noted. Conducting additional studies may help better identify the effects of these drugs and their protective mechanisms.

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  • L-Carnitine 250 mg
  • L-Carnitine 1000 mg
Use of inositol in clinical practice

Use of inositol in clinical practice

by | خرداد 1, 1402 | Articles

Over the past few decades, the use of inositols in clinical practices has been continuously growing. Inositol is a polyol naturally found in fruits, beans, grains, nuts, and also in animals. The most common forms are inositol hexaphosphate, myo-inositol, and subsequently, D-chiro-inositol. Inositols are found in phospholipids, which act as cellular signal mediators, playing a role in cell metabolic regulation.

Due to its function as an insulin-sensitizing molecule, inositols have positive effects on the treatment of:

  • Polycystic Ovary Syndrome (PCOS)
  • Type 2 Diabetes
  • Gestational Diabetes (GDM)

Inositols, as dietary supplements, offer promising benefits for improving women’s health.

Myo-Inositol, D-Chiro-Inositol, Inositol Hexakisphosphate (InsP6) are utilized in various therapeutic fields. They also play a significant role in male fertility, thyroid function recovery, and the reduction of metabolic syndrome and anxiety.

PCOS:
The pivotal role of inositols in mediating various insulin actions for the treatment of PCOS has been thoroughly demonstrated.

Effectiveness of Myo-Inositol:
Several studies strongly confirm the effectiveness of:

  • Myo-Inositol
  • D-Chiro-Inositol
  • Inositol Hexakisphosphate (InsP6)

whether used alone or in combination with other inositols. These findings show improvements in spontaneous ovulation and fertility enhancement in women with Polycystic Ovary Syndrome.

Insulin Resistance in Women:
The use of inositols as an insulin-sensitizing agent to regulate metabolism and enhance ovulation is considered a valuable and therapeutic approach. Inositols improve hormonal disorders such as hyperandrogenism and metabolic disturbances caused by Polycystic Ovary Syndrome.

Benefits of Inositol Supplements:
Inositol supplements improve sensitivity to clomiphene citrate, thereby enhancing ovulation and pregnancy rates in women with PCOS.

Inositols as a Valuable Alternative to Metformin:
Since Metformin is one of the first approaches for treating PCOS, researchers have compared its therapeutic role with inositols. Interesting findings showed that in insulin-resistant patients with Polycystic Ovary Syndrome, inositols can be a valuable replacement for Metformin as a treatment for insulin resistance. When used in the doses prescribed by a specialist, no side effects are observed.

Infertility:
Worldwide, about one-third of infertility cases can be attributed to:

  • Reduced sperm count
  • Sperm motility
  • Sperm morphology changes

Medications, assisted reproductive technologies, and surgery are common treatments for male infertility. Inositols, whether taken orally or incubated with semen, improve sperm quality, thus increasing the potential success of spontaneous pregnancies.

GDM:
During the first trimester of pregnancy, the onset of:

  • Glucose intolerance
  • Insulin resistance

can be a risk factor for GDM, the most common pregnancy complication associated with adverse maternal and fetal outcomes. Inositols have also been tested for preventing and treating gestational diabetes in several clinical trials.

High doses of inositols may cause minor side effects such as nausea and diarrhea. However, a case report by researchers showed that this molecule, even at high concentrations:

  • 4 grams of inositol
  • 3 times per day for 3 weeks

is safe. Moreover, its effectiveness in reducing blood glucose levels has been proven. These findings provide new insights into the use of inositols in the treatment of GDM.

Thyroid Disorders:
Hashimoto’s thyroiditis is the most common autoimmune disorder globally, affecting more than 10% of women and 2% of men. The quality of life is often disrupted by the symptoms of this disease. However, no specific treatment has been established for autoimmune thyroiditis. Two studies examined the effects of combining inositol and selenium in Hashimoto’s patients with subclinical hypothyroidism and those with chronic euthyroid for six months. The findings of these studies matched and showed a reduction in the levels of:

  • Thyroid Stimulating Hormone (TSH)
  • Autoantibodies after treatment with inositols

The use of inositol supplements in conjunction with selenium was evaluated, and the result indicated a decreased risk of hypothyroidism. Therefore, according to the findings, the use of inositol and selenium supplements is a beneficial treatment for autoimmune thyroiditis.

Oncology:
Several preliminary studies have investigated the involvement of inositols in aiding cancer treatment. Inositols, especially inositol hexaphosphate (InsP6), have antioxidant effects and are effective in reducing inflammatory activities. This is a chemical immune factor.

Proietti and colleagues examined the anticancer effects of inositol hexaphosphate during chemotherapy, specifically focusing on its effectiveness in preventing chemotherapy-related complications and improving the quality of life in women with breast cancer.

Conclusion:
This highlights the significant attention scientists are paying to ongoing research on the use of inositols in clinical practice. This section covers many areas, showing advancements and new therapeutic approaches in women’s health, endocrinology, and oncology.

References:
Unfer, V. and Facchinetti, F., 2017. Editorial–Update on inositol(s). European Review for Medical and Pharmacological Sciences, 21(2), pp.1-3