Search

Background: People with kidney failure are often deficient in zinc and selenium, but little is known about the optimal way to correct such deficiency., Methods: We did a double-blind randomized trial evaluating the effects of zinc (Zn), selenium (Se) and vitamin E added to the standard oral renal vitamin supplement (B and C vitamins) among hemodialysis patients in Alberta, Canada. We evaluated the effect of two daily doses of the new supplement (medium dose: 50 mg Zn, 75 mcg Se, 250 IU vitamin E; low dose: 25 mg Zn, 50 mcg Se, 250 IU vitamin E) compared to the standard supplement on blood concentrations of Se and Zn at 90 days (primary outcome) and 180 days (secondary outcome) as well as safety outcomes., Results: We enrolled 150 participants. The proportion of participants with low zinc status (blood level <815 ug/L) did not differ between the control group and the two intervention groups at 90 days (control 23.9% vs combined intervention groups 23.9%, P > 0.99) or 180 days (18.6% vs 28.2%, P = 0.24). The proportion with low selenium status (blood level <121 ug/L) was similar for controls and the combined intervention groups at 90 days (32.6 vs 19.6%, P = 0.09) and 180 days (34.9% vs 23.5%, P = 0.17). There were no significant differences in the risk of adverse events between the groups., Conclusions: Supplementation with low or medium doses of zinc and selenium did not correct low zinc or selenium status in hemodialysis patients. Future studies should consider higher doses of zinc (≥75 mg/d) and selenium (≥100 mcg/d) with the standard supplement., Trial Registration: Registered with ClinicalTrials.gov (NCT01473914).

"Organic acids" refers to a broad class of compounds used in fundamental metabolic processes of the body. They provide valuable clues about functional nutrient deficiencies, mitochondrial energy production, intestinal dysbiosis, free radical overload, and more, including where to start when diagnosing a patient with complicated symptoms. Organic acids present a whole new exciting world of therapeutic options. They are one of the tools that enable us to identify and correct the underlying causes of disease, and not merely temporarily suppress symptoms with pharmaceuticals. The sicker the patient, the more they need this intervention: half the patients in intensive care units were found to be nutrient-deficient in studies that look at only 1 or a few of the many nutrients. Studies show that a patient's outcome is more dismal and his chances of dying are greater as undiagnosed nutrient deficiencies mount. Furthermore, studies confirm that giving pennies' worth of antioxidants to patients in intensive care can cut the death rate in half. What drug can accomplish this, much less for pennies a day? Doesn't it make more sense to individually determine the patients' deficiencies and correct them? Combined with companion tests of intracellular minerals, toxic elements (heavy metals), fatty acids, vitamins, and amino acids, organic acids testing can clearly indicate health challenges the patient will face in the future. In many cases, they are correctable and curable. This article explored only 5 categories of organic acids out of more than 9 and 29 organic acids out of more than 47. For physicians who want more information, there are several resources available. This knowledge, along with biochemical knowledge and patient experience, can further empower physicians to help truly heal their patients.

Weight loss is a very common problem for patients with Alzheimer's Disease (AD), whether they live at home or in long-term care facilities. At any rate it depends on an imbalance between energy expenditure and intake. Though in the initial phases of the illness, the weight loss might be caused by socio-environmental and psychological factors and reduced autonomy, in the following stages it depends on Adversive Feeding Behaviours (AFBs). The AFBs invariably lead to protein, fat and sugar deficits as well as a vitamin deficit which presents a positive correlation with the cognitive performance level and negatively affects the course of the disease. Thus it is important to identify AFBs (Blandford Scale) as soon as possible, especially when they can be treated. Furthermore it is very important to recognise weight loss immediately and identify a possible malnutrition state, using investigative methods which allow for follow-up monitoring (Mini Nutritional Assessment). Pharmacological therapy of cognitive deficit and AFBs together with possible contemporary conditions (depression) and intervention on the nutrition, will be useful to avoid a deficiency state and the consequent negative repercussion on the disease.

The daily vitamin intake of the Swiss population seems to be good. In certain situations or population groups a vitamin or mineral salt deficiency is still possible. It seems more useful to show the different changes of the skin, mucous membranes, hair or nails in the various vitamin or mineral salt deficiencies than to enumerate the vitamins. In a first part, skin signs such as seborrhoic-dermatitis-like or acrodermatitis-enteropathica-like changes, perlèches, xeroderma, hyperpigmentation or less frequent skin changes e.g. edema, intertriginous or ichthyosiform lesions, are mentioned. The second portion then shows lesions of the mucous membranes which are seen in different vitamin or mineral salt deficiencies, e.g. glossitis, cheilitis, stomatitis, aphthous ulcers or gingivitis. In a third chapter the consequences on the hair as alopecias or hair shaft alterations are discussed. Finally, in the last section, the possible nail changes as dystrophies or discolorations are mentioned. A table with the functions and the daily recommended doses of the vitamins and some mineral salts is given.

The authors have presented a discussion of some of the more common nutritional deficiency syndromes. A discussion of the etiology, clinical manifestation, diagnosis, and prognosis has been provided. Special attention has been given to the relationship between nutritional deficiency and the development of peripheral neuropathies. When patients suffering from peripheral neuropathy present, the possibility of a nutritional deficiency should be considered. The diagnosis of a nutritional deficiency neuropathy is rarely established. This may not merely be the result of a low incidence of the problem. The prompt diagnosis and treatment may afford dramatic results. The more protracted the course for diagnosis, the less favorable the prognosis. It is often difficult to pinpoint the exact nutritional deficiency present. Various methods have been discussed in this article; however, often multiple deficiencies are present simultaneously. The treatment with pharmacologic supplementation is usually very innocuous. It often proves beneficial to administer pharmacologic supplementation for a short period. This will aid in the differential diagnosis. Often prescribing a patient large doses of the B-complex vitamins for a limited time will allow the physician to determine if a nutritional neuropathy is present. It should also be remembered that just because a patient is suffering from a peripheral neuropathy from a metabolic disease or secondary to medication, they may also be suffering from a nutritional deficiency simultaneously. We believe that the podiatric physician is well trained to extend comprehensive treatment of pedal manifestations of peripheral neuropathies. Podiatric physicians have a large armamentarium at their disposal to treat the pedal manifestations of the disease sufficiently. These treatments may be conservative or surgical in nature, as previously discussed. We hope that this discussion will increase the awareness of the physician to the various ramifications of nutritionally induced neuropathies as well as the provision of insight into the most efficacious means available for appropriate management.