Saturday, December 4, 2010

CAM Watch: December 2010

I read several journals regularly: JAMA, NEJM, JACC, Circulation, Annals, and several others. As a nonrandom sample, I pull out everything I find about CAM and collect them for a regular feature here: CAM Watch.

This month on CAM Watch, we have glucosamine, folic acid for cardiovascular disease, and fish oil during pregnancy.

1. Glucosamine: NEGATIVE
(Wilkens et al, JAMA July 7, 2010)

This randomized, double blind trial of 250 patients with chronic low back pain compared glucosamine (1500 mg daily) to placebo for 6 months of treatment and measured improvement in disability and quality of life using standardized questionnaires after treatment and at 1 year. No difference between the groups was detected.

2. Folic Acid: HARMFUL (?)
(Miller et al., Am J Cardiol 2010)

Background: homocysteine in the blood has been linked to higher risk cardiovascular events and taking folic acid can reduce homocysteine levels in the blood, however it is not known if this reduction actually prevents cardiovascular events.

This meta analysis combined the results of 14 trials to assess the impact of baseline homocysteine levels and taking supplemental folic acid to prevent cardiovascular disease. Overall, treatment with folic acid did not prevent cardiovascular events (heart attack, stroke, death). Curiously, for patients who had a high level of homocysteine (and therefore would be presumed to benefit from folic acid), there was a 6% increase risk of cardiovascular events. This result was barely statistically significant and could be a spurious finding, or it could indicate that folic acid can change the blood levels of homocysteine but does not actually change whatever the underlying process is that leads to a higher risk of cardiovascular events.

(Makrides et al, JAMA Oct 20, 2010)

This randomized double blind trial compared the rate of post-partum depression in 2399 pregnant women from 5 hospitals who were randomly assigned to docosahexaenoic acid fish oil capsules (800 mg per day) or placebo using a standardized depression screening survey. There was no difference between the groups in postpartum depression in the mothers. They also tested for cognitive impairments in the children and found no differences between the groups.

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