The effect of pine bark extract supplement on LDL and HDL levels in women with type 2 diabetes.

The effect of pine bark extract supplement on LDL and HDL levels in women with type 2 diabetes.

by | بهمن 30, 1402 | Articles

The Effect of Supplementation with French Pine Bark Extract (Oligopin) on LDL and HDL Levels in Selected Women with Type 2 Diabetes

Diabetes is one of the most common chronic diseases worldwide, occurring due to either insufficient insulin secretion or the body’s inability to use insulin. An important aspect of the epidemiology of this disease is the growing trend of cases in the coming years. The International Diabetes Federation estimates that the global prevalence of diabetes will rise from 463 million people in 2019 to 578 million in 2030, with about 90% of these individuals suffering from type 2 diabetes. In Iran, the prevalence of this disease in individuals aged 20 to 79 years is approximately 10%.

Most Common Cause of Mortality in Type 2 Diabetic Patients: The leading cause of disability and mortality in type 2 diabetic patients is cardiovascular disease. Several risk factors contribute to cardiovascular disease in diabetic patients, with lipid disorders and hypertension being the primary risk factors. Timely identification and intervention can prevent the onset of chronic complications, including cardiovascular diseases and heart attacks.

In addition to dietary changes aimed at controlling risk factors such as blood lipoproteins, various pharmaceutical drugs have been discovered and are currently being used to control these complications. However, these drugs come with various side effects and high costs for both families and governments.

Effect of Herbal Supplements on Lipid Control: Given the long-term side effects of these medications, the use of herbal supplements can be a more effective method for controlling acute and chronic complications, reducing the need for lipid-lowering drugs in these patients. One such supplement is the French Pine Bark extract, a dietary supplement rich in procyanidins, sold under the brand name Oligopin.

What is Oligopin? Oligopin is a reddish-brown powder derived from the bark of the French Maritime Pine tree. Each Oligopin capsule contains 50 mg of French Pine Bark extract, with procyanidin being the active ingredient, which constitutes about 67 to 75% of the supplement as a strong antioxidant compound.

Research: According to the findings of this study, daily supplementation of 100 mg of Oligopin for six weeks in the selected women group resulted in significant changes in LDL levels in the supplement group compared to the placebo. However, there were no significant changes in HDL levels between the supplement and placebo groups. The positive effects of this supplement on blood lipoprotein control, especially LDL levels, seem to be due to its mechanism of reducing oxidative stress and free radicals in plasma, thereby improving lipid profile levels.

Study Trends: In a study conducted in 2010, supplementation with Oligopin in individuals with metabolic syndrome showed significant changes in HDL levels in the supplement group compared to the placebo group. Finally, it is important to note the limitations beyond the control of the current study, including the lack of reporting on changes in the types, amounts, and frequencies of medications used, the simultaneous use of any herbal supplements, vitamins, or minerals without prior report, dietary changes during the study period, and changes in activity levels, sleep patterns, or any potential lasting changes in personality or daily economic events, psychological traits, individual motivations, and work-related factors. These could have influenced social persistence and cooperation in the study.

Research Suggestions: Based on the study background, it is recommended that future studies examine the effects of Oligopin supplementation in type 2 diabetic patients who are not using lipid-lowering drugs, with a dosage of 200 mg per day, and conducted over short-term (2-3 weeks) and long-term (3-6 months) periods. Additionally, the effects of this supplement on systolic and diastolic blood pressure or other lipid profiles, such as cholesterol and triglycerides, should also be studied as primary variables. Further research can also be conducted to examine the effectiveness of simultaneous use of this supplement in men with type 2 diabetes.

Reference: The Effects of Supplement French Pine Bark Extract (Oligopin) on LDL and HDL in Selected Women with Type II Diabetes. October 2020. Journal of Diabetes Nursing 8(3).

Clinical Applications of N-Acetylcysteine in Dermatology

Clinical Applications of N-Acetylcysteine in Dermatology

by | بهمن 15, 1402 | Articles

N-acetylcysteine (NAC) is a metabolite of cysteine and a specific antidote for acetaminophen toxicity. In fact, this drug is approved by the FDA only for treating acetaminophen poisoning, although it is commonly used in internal medicine to treat idiopathic pulmonary fibrosis. NAC is traditionally used as an expectorant (mucolytic). It also has antimicrobial effects and vasodilatory properties. Additionally, this drug is used to prevent kidney damage during radiographic procedures with contrast agents, as an adjunct in eradicating Helicobacter pylori, to prevent hearing loss caused by gentamicin in dialysis patients, and as a dietary supplement. Given its various pharmacological effects and relative safety, there has been increasing interest in the use of NAC for various purposes in recent years. This article will review the potential applications of NAC in dermatology.

Pharmacology The usual dose of NAC is 1200 to 2400 mg per day. The pharmacokinetic parameters of NAC are not well defined. The plasma concentration of NAC varies widely among individuals, and since this substance is also synthesized endogenously in the body, pharmacokinetic calculations become more challenging. In studies conducted, no severe side effects of NAC have been reported. Even high doses of NAC have been used safely for up to one year in patients with pulmonary fibrosis. However, like any other antioxidant, the use of NAC may be associated with certain risks. In most clinical studies, side effects of NAC were no different from those of a placebo.

Side Effects of NAC Nausea, vomiting, diarrhea, bloating, headache, itching, and increased blood pressure are some of the side effects reported with the use of NAC, although they are rare. NAC can enhance the effects of nitroglycerin and related medications, which may lead to a drop in blood pressure in patients using these drugs.

Mechanism of Action Glutathione is one of the body’s primary antioxidants. It detoxifies various harmful substances, including xenobiotics, peroxide compounds, and other free radical-generating molecules, thus playing a crucial role in cellular protection. During oxidative stress, glutathione levels decrease. NAC helps replenish this deficiency, acting as an antioxidant by increasing glutathione levels. Since reactive oxygen species are involved in a wide range of diseases, NAC is expected to have therapeutic applications across various conditions.

Therapeutic Uses of NAC As mentioned, NAC is converted into cysteine in the body, which is a substrate for the antiporter glutamate-cysteine. This results in the reverse exchange of glutamate into the extracellular space, reducing glutamate release from synapses and modulating compulsive behaviors. Moreover, NAC facilitates nitric oxide production, leading to vasodilation, which provides various therapeutic applications.

Dermatological Uses of NAC

  1. Prevention of Malignant Melanoma: Melanoma is an aggressive cancer with a poor prognosis. Despite ongoing efforts to control it, its incidence continues to rise. The most significant environmental factor in the development of melanoma is ultraviolet (UV) radiation, which increases the production of reactive oxygen species (ROS) and leads to oxidative DNA damage. These free radicals further contribute to cellular damage by depleting intracellular reducing agents like glutathione. Melanocytes are especially sensitive to oxidative stress. Therefore, reducing oxidative stress caused by UV radiation could serve as a preventive measure.

    In a study by Goodson et al., administering NAC before UV exposure in patients’ moles prevented a decrease in glutathione levels in half of the patients. Thus, NAC could safely modulate UV-induced oxidative stress in moles, reducing the long-term risk of malignant melanoma.

  2. Treatment of Toxic Epidermal Necrolysis (TEN): TEN is a life-threatening drug reaction that leads to widespread damage of the epithelial and epidermal tissues. While the pathophysiology of this condition is not fully understood, keratinocytes are considered key initiators of the process. The damage caused by TNF-α and oxidative stress in keratinocytes may result in a combination of apoptosis and necrosis. Therefore, a combination of anti-apoptotic/anti-necrotic drugs such as TNF-α antibodies and NAC could be used to target different stages of keratinocyte dysfunction.

    The first report of NAC’s efficacy in treating TEN was published in 1994 by Redondo, where intravenous NAC combined with pentoxifylline was successfully used as a treatment.

    Overall, NAC may play a role in improving severe drug reactions by:

    • Increasing intracellular cysteine and interfering with oxidative mediators,
    • Inhibiting TNF-α and interleukin-1 production,
    • Suppressing CLAAg (cutaneous lymphocyte-associated antigen) expression.

    Another study by Sabri and colleagues investigated the protective effects of NAC, oxotiazolidine carboxylate (OTC), acetaminophen, or their combination on sulfur mustard-induced cytotoxicity in human skin fibroblast cell lines. The results showed that NAC alone enhanced cell viability, increased glutathione levels, and increased catalase activity.

  3. Treatment of Trichotillomania: Trichotillomania is a compulsive disorder. Although it has been described for over two centuries, its pathophysiology is still not fully understood. Despite two decades of research on this condition, no standard FDA-approved treatment exists. A meta-analysis revealed that clomipramine had only moderate efficacy compared to a placebo for treating this disorder.

    One factor involved in the pathogenesis of obsessive-compulsive disorders is dysfunction in glutamatergic activity. It appears that disruption of the glutamatergic pathway plays a role in the pathogenesis of trichotillomania. In a double-blind study involving 50 patients with trichotillomania, NAC (1200 to 2400 mg daily for 12 weeks) was compared with a placebo. At the end of the study, 56% of patients in the NAC group had a significant reduction in disease severity, compared to 16% in the control group, indicating a meaningful difference.

  4. In other skin disorders related to obsessive-compulsive disorders: It is quite plausible that NAC might be effective in other obsessive-compulsive disorders as well. For example, Berk demonstrated the efficacy of this drug in improving nail-biting habits in three patients. NAC may also be effective in other obsessive-compulsive disorders such as compulsive gambling and cocaine addiction. Moreover, in other skin diseases where anxiety or obsessive-compulsive disorders play a role, this drug might be beneficial. However, naturally, separate research would be necessary to confirm or refute these claims in all such cases.

    Reference: Zarghari, Omid, & Kiani Far, Kambiz. (2010). Clinical applications of N-acetylcysteine in dermatology. Skin and Beauty, 1(4), 201-206. https://sid.ir/paper/157590/fa

The Effect of L-Arginine Supplementation on Fat Metabolism during Endurance Exercise in Athletes

The Effect of L-Arginine Supplementation on Fat Metabolism during Endurance Exercise in Athletes

by | دی 5, 1402 | Articles

Acute Effect of L-Arginine Supplementation on Fat and Carbohydrate Metabolism Before, During, and After Endurance Exercise in Athletes

In today’s societies, supplement consumption is practiced in various ways, and it is believed that supplements can improve athletic performance, leading to better movement execution during both training and competition. Generally, supplements are categorized into three groups: nutritional (vitamins, amino acids, carbohydrates, proteins), performance enhancers (caffeine, creatine, L-carnitine), and doping (nutritional supplements aimed at enhancing physical strength). Among the various amino acids, the effect of L-arginine supplementation on athletic performance or recovery quality improvement is of particular interest.

L-Arginine According to research, L-arginine plays a cellular signaling role in tissues. In fact, arginine is a semi-essential amino acid and a precursor for nitric oxide production, leading to vasodilation. This process facilitates blood flow to the organs engaged in physical activity, enhancing the athlete’s performance, particularly in aerobic activities. In healthy adults with normal protein consumption, endogenous synthesis of L-arginine is usually sufficient to meet physiological needs. However, during intense exercise, the body’s endogenous production may not be enough; therefore, L-arginine is considered a semi-essential or conditionally essential amino acid.

L-Arginine Use The use of L-arginine supplementation is common among athletes, and it is marketed as a nitric oxide booster aimed at increasing power and endurance. Researchers studied the impact of L-arginine supplementation on the metabolic response after exercise in twelve male judokas. They showed that this supplement can increase glucose and insulin concentrations and decrease free fatty acids (FFAs) during the recovery phase.

Effects of L-Arginine In a study by McConnell, the impact of L-arginine supplementation on exercise metabolism was examined, and the results showed that the supplement improved endothelial function and increased plasma insulin, growth hormone, glucagon, catecholamines, and prolactin at rest. Nascimento and colleagues also studied the effects of L-arginine supplementation and acute resistance exercise on blood lipid profiles and inflammatory proteins in overweight men. The results showed no significant changes in triglycerides, total cholesterol, adiponectin levels, or time-dependent changes under various conditions.

Based on existing literature, it appears that L-arginine supplementation can cause vascular changes via nitric oxide. However, its specific effects on metabolism cannot be definitively stated, and since research on the availability of L-arginine during and after exercise is limited, further studies are needed.

L-Arginine Implications This line of research seems to have important implications for fat and carbohydrate metabolism during exercise. Therefore, the current study aimed to investigate the acute effects of L-arginine supplementation on fat and carbohydrate metabolism before, during, and after endurance exercise, as well as its potential impact on athletic performance.

Study The present study investigated the acute effects of L-arginine supplementation on fat and carbohydrate metabolism before, during, and after endurance exercise. The results showed that acute L-arginine supplementation increased maximum oxygen consumption (VO2max), maximum heart rate, and prolonged the time to exhaustion during progressive exercise. However, the mechanisms through which L-arginine supplementation affects performance are not fully understood. Therefore, the study also examined the effect of acute L-arginine supplementation on VO2max, heart rate, and time to exhaustion during progressive exercise.

The results aligned with those of Majzoub and colleagues, who investigated the effects of a one-week L-arginine supplementation on respiratory gases and lactate levels in female handball players. They reported that one week of supplementation increased VO2max.

Research Process They attributed this increase to nitric oxide-induced vasodilation, suggesting that interventions affecting nitric oxide bioavailability can alter oxygen cost, influence blood flow, and improve nutrient delivery while assisting in the removal of metabolic waste products. Researchers also found that L-arginine supplementation increased carbohydrate metabolism following high-intensity interval training in overweight individuals. The underlying mechanisms may include increased GLUT-4 expression in muscle tissue, activation of AMPK, and glucagon release induced by L-arginine supplementation, which can generally increase carbohydrate metabolism during exercise compared to pre-exercise levels.

Research Methodology Catecholamines, glucagon, and cortisol are secreted more during high-intensity endurance exercise than during other types of training, positively affecting glycolysis and glycogenolysis, thus increasing carbohydrate metabolism. L-arginine supplementation activates glycolysis and glycogenolysis due to increased GLUT-4, AMPK, and glucagon levels, leading to a significant increase in carbohydrate metabolism post-exercise. Additionally, the increased heart rate at exhaustion, prolonged exercise duration, higher VO2max, and enhanced carbohydrate metabolism suggest that acute L-arginine supplementation helps the body experience a higher aerobic capacity, necessitating a higher maximum heart rate.

L-Arginine Supplementation Impact L-arginine supplementation increases functional factors such as VO2max, time to exhaustion, and glucose metabolism. Since the respiratory exchange ratio is influenced by the balance of fat and carbohydrate metabolism, it is not surprising that L-arginine supplementation may elevate this ratio.

Acute L-arginine supplementation did not affect blood glycerol levels before progressive exercise but did increase glycerol levels during and after progressive exercise. These findings are consistent with those of Forbes and colleagues, who showed that one dose of L-arginine increased glycerol levels following acute cycling exercise, a key marker of lipolysis.

Nascimento’s Research Nascimento and colleagues also found that one session of L-arginine supplementation after acute resistance exercise reduced non-esterified fatty acid levels one hour post-exercise during recovery, indicating an increase in fat oxidation. However, their results are in contrast to the current study, which found no such reduction in glycerol levels. Researchers attributed the reduction in glycerol during exercise to elevated nitric oxide levels and catecholamine stimulation, which inhibited lipolysis. However, there is no definitive evidence that L-arginine directly inhibits lipolysis.

Conclusion The current study found that acute L-arginine supplementation increased VO2max, heart rate, and time to exhaustion during progressive exercise. It also increased maximum carbohydrate oxidation, respiratory exchange ratio, and glycerol and glucose concentrations post-exercise. Since L-arginine supplementation was shown to enhance VO2max and time to exhaustion, it is suggested that athletes use L-arginine to enhance aerobic capacity, improve endurance performance, and reduce fatigue during aerobic training. This study aimed to investigate the effects of L-arginine supplementation on carbohydrate and fat oxidation and certain cardiovascular-respiratory factors during progressive exercise.

Benefits of L-Arginine Supplementation Overall, L-arginine supplementation reduced carbohydrate oxidation and increased fat oxidation during and after progressive exercise. It also increased VO2max and heart rate. However, due to limited data, caution is advised in explaining these mechanisms, and further research is necessary.

The Effect of Combined Exercise and Coenzyme Q10 Supplementation in Patients with Multiple Sclerosis

The Effect of Combined Exercise and Coenzyme Q10 Supplementation in Patients with Multiple Sclerosis

by | آذر 28, 1402 | Articles

The Effect of Eight Weeks of Combined Exercise and Coenzyme Q10 Supplementation on Motor Function in Patients with Multiple Sclerosis

Multiple sclerosis (MS) is a chronic autoimmune disease where lymphocytes cross the blood-brain barrier and initiate inflammatory processes in the central nervous system, which can lead to various physical and cognitive disabilities. This disease affects approximately 2.5 million people worldwide and 40,000 to 50,000 people in Iran.

Average Age of MS Onset The average age of onset is 30, the time of employment and family formation, which confronts patients with the consequences of being unable to perform daily activities, reducing personal independence, and subsequently leading to a decrease in quality of life and social interactions. Due to the lack of definitive and effective drug treatments and the high cost of such treatments, non-pharmacological methods, including exercise, can at least help improve symptoms and are easily accepted by patients.

The Impact of Physical Activity on the Disease It was previously believed that exercise in MS patients could cause fatigue, increase body temperature, and prevent energy storage, thus exercise was not recommended for these patients. However, regular participation in exercise is now considered a key factor in improving symptoms and increasing physical abilities in MS patients. It is believed that a lack of exercise may cause more weakness, fatigue, and worsening of the disease. Exercise has become an established part of rehabilitation programs for MS patients, improving strength, endurance, cardiovascular function, and reducing fatigue.

Research Method Although recent studies have examined the effect of coenzyme Q10 supplementation in MS patients, for instance, researchers observed a reduction in serum levels of tumor necrosis factor-alpha after 12 weeks of coenzyme Q10 supplementation (500 mg daily) in MS patients, comparing the experimental group with the placebo group. These researchers found coenzyme Q10 to be effective in reducing inflammation. Additionally, another study showed that 12 weeks of daily 500 mg coenzyme Q10 supplementation reduced fatigue and depression in MS patients.

In summary, eight weeks of combined exercise and coenzyme Q10 supplementation can improve how long patients with MS can sit, stand, and walk (motor function).

Research Results It is recommended that, for maximum benefit, combined exercise and coenzyme Q10 supplementation be done together. This is particularly reasonable given the role of this coenzyme in the electron transfer chain and aerobic energy production. Therefore, this non-invasive method can be suggested to MS patients to improve their ability to perform daily activities.

Sources: Ahmadi, Amin, Tajrishi, Amirhossein, Nikkhah, Karim, and Asgari, Roya. (2018). The effect of eight weeks of combined exercise and coenzyme Q10 supplementation on motor function in patients with multiple sclerosis. Journal of the Faculty of Medicine, Mashhad University of Medical Sciences, 61(2), 958-970. https://sid.ir/paper/51969/fa

Nakhzari Khodakhir, Javad, Haghighi, Amirhossein, Hamedi Nia, Mohammadreza, and Ahmadi, Amin. (2018). The effect of combined exercise with an aerobic emphasis and coenzyme Q10 supplementation on muscle performance in multiple sclerosis patients. Ofoq-e Danesh, 24(4), 286-293. https://sid.ir/paper/68293/fa

Comparison of the Effects of L-Arginine and Fluid Therapy in Pregnant Mothers with Oligohydramnios

Comparison of the Effects of L-Arginine and Fluid Therapy in Pregnant Mothers with Oligohydramnios

by | آذر 21, 1402 | Articles

Comparison of the Effects of L-Arginine and Fluid Therapy in Pregnant Women with Oligohydramnios

The Role of Amniotic Fluid

Amniotic fluid plays various roles in fetal development, including promoting proper growth, lung maturation, and preventing physical injuries during pregnancy. Naturally, amniotic fluid increases between weeks 32 and 34 of pregnancy, reaching approximately one liter. However, it gradually decreases, reaching about 400 cc at the time of delivery.

Determining Amniotic Fluid Levels

Accurately measuring amniotic fluid volume is challenging. However, the Amniotic Fluid Index (AFI), measured through ultrasound by summing the vertical depths of the largest amniotic fluid pockets in each of the four quadrants of the uterus, is considered a reliable method. Oligohydramnios refers to a lower-than-normal amniotic fluid volume relative to gestational age. This condition can lead to fetal deformities, fetal distress, abnormal presentation, the need for cesarean section, umbilical cord compression, and, in severe cases, fetal death. Based on available sources, an AFI of 8 or above is considered normal, between 5 and 8 is borderline, and below 5 is classified as oligohydramnios.

Benefits of Early Diagnosis

Timely and accurate diagnosis of oligohydramnios, along with proper management, is associated with better pregnancy outcomes. The prevalence of oligohydramnios varies due to differences in diagnostic criteria, study populations (low-risk, high-risk, screening groups), and gestational age. The etiology of oligohydramnios differs based on pregnancy trimester. In the third trimester, the most common causes include premature rupture of membranes, fetal kidney abnormalities, and placental insufficiency, which can lead to intrauterine growth restriction (IUGR).

Prognostic Factors

The prognosis of oligohydramnios depends on various factors such as etiology, severity, gestational age, and the duration of the condition. Studies indicate that patients with this condition generally have a poorer prognosis compared to the control group. While modern diagnostic methods have made detection easier, a highly effective, cost-efficient, and widely accessible treatment remains unavailable. Several therapeutic approaches have been proposed, including fluid therapy.

Mechanism of Fluid Therapy

Fluid therapy works by reducing maternal plasma osmolality, which in turn increases the amniotic fluid index. Another recently introduced treatment for these patients is L-Arginine supplementation. L-Arginine is a semi-essential amino acid utilized by all body cells. It serves as a precursor for nitric oxide, a known vasodilator. Consequently, L-Arginine helps regulate placental perfusion and increases umbilical artery blood flow, which may alleviate fetal growth restrictions.

Study Methodology

In this study, 64 patients were initially assessed. Pregnant women between 28 and 36 weeks of gestation, diagnosed with oligohydramnios based on ultrasound and clinical examination, were included. Before participation, written informed consent was obtained. Inclusion criteria included a singleton pregnancy with an intact amniotic sac and an AFI below 8 cm. Exclusion criteria encompassed pregnancies with fetal anomalies, maternal conditions such as diabetes, severe preeclampsia, lupus, kidney, cardiac, or pulmonary disease, and pre-labor rupture of membranes.

The intervention group received 3 grams of L-Arginine twice daily along with oral or intravenous (IV) fluid therapy. If the patient did not have gestational hypertension, IV Ringer’s lactate was administered at a rate of 3 liters per 24 hours, depending on gestational age and AFI. The control group received only oral (2 liters over 2 hours) or IV (3 liters per 24 hours) fluid therapy.

Study Design

Amniotic fluid levels were measured using ultrasound. The uterus was divided into four quadrants, and the largest vertical fluid pocket in each region was measured and summed to calculate the AFI in centimeters. An AFI below 5 cm was classified as oligohydramnios, between 5 and 8 cm as borderline, and above 8 cm as normal. During IV fluid therapy, patients were monitored for signs of vascular overload. The procedure was carried out under the supervision of high-risk pregnancy nurses, with vital signs checked throughout. Patients were followed weekly via ultrasound until delivery to assess changes in AFI.

Outcome Measures

Primary outcomes included changes in amniotic fluid volume and its effect on gestational age at delivery. Secondary outcomes included Apgar scores at 1 and 5 minutes post-birth, birth weight, gestational age at delivery, delivery method (vaginal or cesarean), small-for-gestational-age (SGA) status (defined as birth weight below the 10th percentile for gestational age), and abnormal fetal presentation.

The sample size was calculated based on a study by Iqbal et al., with a power of 90% and an alpha error of 0.01. Allowing for potential dropout, 25 patients per group were required, totaling 50 participants. A four-block randomization method was used.

Study Findings

The findings of this study suggest that both L-Arginine combined with fluid therapy and fluid therapy alone can effectively increase amniotic fluid volume in pregnant women with oligohydramnios, thereby reducing pregnancy complications. However, L-Arginine with fluid therapy resulted in a greater increase in AFI and a reduction in pregnancy complications compared to fluid therapy alone, making it a potentially superior choice for these patients.

Ultrasound in the Diagnosis of Oligohydramnios

Today, with the use of ultrasound, the diagnosis of oligo-hydramnios has become easier than before. Therefore, it is now possible to easily and quickly diagnose a decrease in amniotic fluid volume and take necessary actions for patients. Various modalities are suggested for patients with oligo-hydramnios, including maternal hydration, antioxidant supplements, and essential amino acids. The use of non-invasive methods that do not require hospitalization and have fewer complications is now receiving more attention.

Ways to Improve Oligohydramnios

One of the simplest ways to improve oligo-hydramnios is maternal hydration. According to physiological principles, the transfer of water between the mother and fetus is regulated by osmotic forces. Due to the higher concentration of electrolytes in the fetus, more fluid is transferred to the fetus. Studies also show that therapeutic fluid can increase amniotic fluid volume in these patients.

L-Arginine

L-arginine is a semi-essential amino acid that is used by all cells in the body. L-arginine consists of an alpha-amino group, an alpha-carboxylic acid group, and a side chain of a three-carbon aliphatic chain in the guanidine group. L-arginine is a precursor to nitric oxide, which is known as a vasodilator. Nitric oxide regulates gonadotropin hormones, egg maturation, ovulation, uterine tube movements, uterine contractions during labor, sperm capacitation, erection, and ejaculation, all of which are functions of this molecule in the reproductive system. L-arginine also regulates placental perfusion. Nitric oxide penetrates smooth muscle cells of blood vessels and causes vasodilation through platelet stabilization in a GMP-dependent process.

Side Effects of L-Arginine

In the present study, no significant side effects were observed in patients receiving L-arginine. Research has also shown that this therapeutic method is safe for pregnant women. Therefore, it seems that maternal hydration combined with this method of treatment is both safe and effective.

Amniotic Fluid Function

Decreased amniotic fluid during labor leads to umbilical cord compression and fetal hypoxia. The results of the present study showed that the average Apgar score in the L-arginine receiving group was higher than that in the fluid therapy group, which could be due to the larger volume of amniotic fluid in these patients. Limitations of this study include not measuring the serum L-arginine level to ensure medication compliance, lack of long-term follow-up for complications and mortality, and the inability to generalize the results because only patients with idiopathic oligohydramnios in the third trimester were included.

It is recommended that studies be conducted with a larger sample size and different doses of L-arginine. The findings of this study suggest that in pregnant women with reduced amniotic fluid volume, L-arginine intake combined with therapeutic fluid infusion, which increases amniotic fluid volume, could lead to better outcomes.

What Happens Due to Decreased Amniotic Fluid?

Decreased amniotic fluid during labor leads to umbilical cord compression and fetal hypoxia. The results of the present study showed that the average Apgar score in the L-arginine receiving group was higher than that in the fluid therapy group, which could be due to the larger volume of amniotic fluid in these patients. Limitations of this study include not measuring the serum L-arginine level to ensure medication compliance, lack of long-term follow-up for complications and mortality, and the inability to generalize the results because only patients with idiopathic oligohydramnios in the third trimester were included.

It is recommended that studies be conducted with a larger sample size and different doses of L-arginine. The findings of this study suggest that in pregnant women with reduced amniotic fluid volume, L-arginine intake combined with therapeutic fluid infusion, which increases amniotic fluid volume, could lead to better outcomes.

Determining the Effect of Chromium on Blood Sugar Control in Patients with Type 2 Diabetes

Determining the Effect of Chromium on Blood Sugar Control in Patients with Type 2 Diabetes

by | آبان 24, 1402 | Articles

Determining the Effect of Chromium on Blood Sugar Control in Patients with Type 2 Diabetes

The Effect of Chromium on Blood Sugar Control in Patients

Chromium is an essential mineral that appears to be necessary for the normal homeostasis of glucose and lipids. Trivalent chromium is found in a complex called the Glucose Tolerance Factor (GTF), which is considered biologically active. Chromium was first discovered in brewer’s yeast.

Types of Chromium

Chromium chloride, chromium nicotinate, and chromium picolinate are trivalent chromium compounds commonly used, with chromium picolinate having the highest absorption rate. Severe chromium deficiency can lead to insulin resistance and diabetes. Under normal conditions, chromium binds to a low-molecular-weight oligopeptide, increasing the number of insulin receptors and their phosphorylation. As a result, insulin receptor enzyme activity increases, regulating blood glucose and glycated hemoglobin (HbA1C).

Chromium Behavior Outside the Body

Studies conducted outside the body have shown that chromium supplements, particularly chromium bound to niacin, can reduce insulin resistance and lower cholesterol levels. Additionally, evidence suggests that chromium picolinate administration outside the body enhances insulin sensitivity by intensifying insulin receptor stimulation.

Research

Several studies, including those conducted in Iran, have demonstrated that chromium concentration in the serum and hair of diabetic patients and individuals with glucose intolerance is significantly lower than in the control group. However, the findings on chromium supplementation in both healthy individuals and diabetes patients have been inconsistent. Several studies indicate that chromium intake, combined with increased physical activity, can enhance muscle mass, promote fat metabolism, and improve glucose and lipid metabolism.

This study was conducted as a prospective, double-blind, randomized, placebo-controlled trial. Patients with type 2 diabetes who were undergoing oral drug treatment and had an HbA1C level of 7% or higher were recruited from outpatient diabetes clinics.

Research Methodology

At the beginning of the study, a questionnaire was completed for each patient, including age, gender, and body mass index (BMI). Patients were instructed to continue their current medications, maintain their usual diet and physical activity levels, and refrain from consuming ferrous sulfate, zinc sulfate, other minerals, and vitamins during the study.

The following parameters were measured at baseline:

  • Fasting blood glucose (using the glucose oxidase method)
  • Glycated hemoglobin (HbA1C) (using the Iron Chromatographic Micro Assay Exchange method)
  • Low-density lipoprotein (LDL) (using the Direct Chol-LDL method)
  • High-density lipoprotein (HDL) (using the HDL Direct Chol method)
  • Triglycerides (using the PAP-GPO/lipase method)
  • Blood urea nitrogen (BUN) (using the urease-kinetic method)
  • Serum creatinine (using the Joffe method)
  • Alanine aminotransferase (ALT) (using the colorimetric method)
  • Aspartate aminotransferase (AST) (using the colorimetric method)
  • Serum chromium levels (using the Less Flame Absorption Atomic method)

Study Process

Patients were randomly divided into two groups: the treatment group and the control group, with 20 patients in each group. Random sampling was performed systematically. The treatment group received 200 micrograms of chromium picolinate daily, while the control group received a placebo for three months.

At the end of the treatment period, the same parameters (fasting blood glucose, HbA1C, LDL, HDL, triglycerides, BUN, creatinine, and serum chromium levels) were re-measured and recorded.

Research Findings

The results of this study showed that after three months of administering 200 micrograms of chromium picolinate, there was a significant reduction in HbA1C levels compared to the control group. In general, double-blind studies on the effects of chromium in patients with type 2 diabetes are limited. Therefore, findings from other studies may be of lower value due to potential external factors, although most have reported reductions in glucose and HbA1C levels.

In this study, all participants had type 2 diabetes and were undergoing oral antidiabetic treatment, with HbA1C levels above 7%. The results suggest that administering a small amount of highly absorbable chromium in the short term can improve the metabolic status of type 2 diabetic patients. However, it does not have a significant effect on plasma lipid levels or anthropometric indices.

References:

Payami, S., Safarian, S., & Hassanzadeh, A. (2012). Determining the Effect of Chromium on Blood Sugar Control in Patients with Type 2 Diabetes. Iranian Journal of Endocrinology and Metabolism, 14(3 (Serial 63)), 215-221. SID. https://sid.ir/paper/27952/fa