Clinical Briefs
February 28, 1999
Clinical Briefs
By Louis Kuritzky, MD
Oral or Parenteral Therapy for B12 Deficiency
Vitamin b12 deficiency is most commonly treated with parenteral vitamin B12. A survey of 1991 Minnesota clinicians reported that most (90%) believe intramuscular injections are necessary to treat pernicious anemia; indeed, 95% of physicians surveyed did not know that oral preparations for pernicious anemia are effective or available. In 1998, a controlled trial indicated that oral cobalamin is at least as effective as parenteral therapy, and in other nations such as Sweden, such therapy has been widely used.
Although every medical student learns about the classical system of B12 absorption that requires intrinsic factor, other transport systems are functional. When given in large oral doses (300-100,000 mcg), about 1% of B12 is absorbed, substantially above the daily requirement of 1-2.5 mcg. Indeed, a comparison trial of oral B12 1000 mcg bid vs. IM B12 on days 1, 3, 7, 10, 30, 60, and 90, showed that both regimens were comparable as far as hematologic and neurologic responses were concerned. The serum concentrations attained with the oral regimen were actually more than three times higher than the parenteral regimen.
Given that parenteral B12 is painful and may be associated with noncompliance due to failure to obtain the injection, and that contrary to propagated opinion, oral B12 is efficacious in pernicious anemia, Elia suggests an increased opportunity for the use of oral B12. Since mild cobalamin deficiency affects up to 15% of senior citizens, much restorative opportunity is at hand.
Elia M. Lancet 1998;352:1721-1722.
Effect of Tragus Clips on Gastric Peristalsis: A Pilot Study
Clinical observations as early as 1977 noted that needles placed in the ear tragus assisted in weight loss by producing early satiety. Barium swallow studies have shown delay in gastric emptying subsequent to needle placement. In theory, vagus nerve stimulation is responsible for these effects. Acupuncture points have shown effects on gastric motility and pyloric sphincter pressure.
Ear clips are earring-like devices intended to clamp onto the tragus without cutaneous puncture. This trial (n = 11) measured the effect of tragal ear clips on the duration of gastric peristalsis in normal healthy volunteers. Peristaltic wave time was defined from the first observable gastric contraction to the end of the wave at the pylorus, as measured with dilute barium sulfate.
Within minutes of application of the ear clips, peristalsis was reduced by about one-third. One patient had complete cessation of peristalsis, which only resumed after clip cessation. Subjects underwent four cycles of ear clip application and removal seven minutes later, with consistent reductions in gastric peristalsis during each application. Choy and Eidenschenk conclude that reduction in gastric emptying induced by tragus ear clips results in a sense of fullness, hence, early satiety. This technique may prove valuable in weight control therapy.
Choy DS, Eidenschenk E. J Altern Complement Med 1998;4(4):399-403.
Fish Oil and Glycemic Control in Diabetes: A Meta-Analysis
Fish oil supplementation has demonstrated beneficial effects on hypertriglyceridemia and in the prevention of cardiovascular disease. Diabetes, both Type 1 and Type 2, is disproportionately associated with both factors. Friedberg and associates performed a meta-analysis to evaluate the relationship of fish oil supplementation to glycemic control. Main outcome measures included fasting glucose, hemoglobin A-1-C, triglycerides, cholesterol, HDL, and LDL. The meta-analysis included 26 trials.
Although fish oil supplementation did significantly increase fasting blood glucose among Type 2 diabetics and reduced it in Type 1 diabetics, neither impact was sufficient to have an effect on hemoglobin A-1-C. Triglycerides were reduced by more than 25% in both Type 1 and Type 2 diabetes. The dose of fish oil used contained 1.8 g of eicosapentaenoic acid and 1.2 g of docosahexaenoic acid.
Cardiovascular deaths remain the most prominent cause of demise for diabetic patients. Reduction of triglycerides in diabetic patients by fish oil supplementation may have a favorable effect on cardiovascular end points.
Friedberg CE, et al. Diabetes Care 1998;21(4):494-500.
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