Literature review & commentary

Townsend Letter for Doctors and Patients, Dec, 2003 by Alan R. Gaby

Magnesium treatment of narcotic addiction

Eighteen patients on a methadone-maintenance program who were continuing to use illicit opiates and cocaine (as determined by urine testing) were randomly assigned to receive oral magnesium (Mg; 732 mg/day, as Mg L-aspartate hydrochloride) or placebo for 12 weeks. Patients also received a 30-minute counseling session once a week. In intent-to-treat analysis, the percentage of urine screens testing positive for opiates was 22.6% in the Mg group, compared with 46.4% in the placebo group (51% reduction; p =0.04). The difference was even greater among those who demonstrated at least 50% compliance with the treatment (16.3% vs. 47.9%; 66% reduction; p = 0.02). Although cocaine craving was lower in the Mg compared than in the placebo group, there was no difference between groups in the amount of cocaine used.

[ILLUSTRATION OMITTED]

Comment: This study demonstrates that supplementation with Mg L-aspartate hydrochloride can decrease illicit opiate use among individuals in a methadone-maintenance program. The results are consistent with those of animal studies, in which Mg delayed the development of morphine tolerance. An animal study also showed that Mg can decrease cocaine self-administration; however, the dose of Mg used in that study was greater (on a body-weight basis) than that used in the present study.

I once worked with a patient who was experiencing the typical symptoms of morphine withdrawal. I gave him an intravenous injection of 1 g of magnesium chloride, plus calcium gluconate, B vitamins, and 1.3 g of vitamin C (the Myers' cocktail). Within 2 minutes of the start of the injection, all of his withdrawal symptoms had disappeared, and this improvement lasted approximately 36 hours. When the benefit wore off, he was given a second injection, which again produced the same rapid improvement. In all, he received three treatments, which allowed him to remain essentially symptom-free during his five-day withdrawal period.

Margolin A, et al. A preliminary, controlled investigation of magnesium L-aspartate hydrochloride for illicit cocaine and opiate use in methadone-maintained patients. J Addict Dis 2003;22:49-61.

Preventing diabetic nephropathy

One hundred ninety-one patients with type 2 diabetes who had been referred to a nephrology clinic for various degrees of renal failure and proteinuria were randomly assigned to consume either 1) a carbohydrate-restricted (35% of energy), low-iron-available, polyphenol-enriched (CR-LIPE) diet or 2) a standard low-protein diet (control). A reduction in iron availability was accomplished by substituting red meats with poultry and fish, and by consuming foods that inhibit iron absorption (dairy products, eggs, tea, and soy). All beverages other than tea, water, and red wine (maximum, 150 ml with lunch and 150 ml with dinner) were eliminated, except for milk, which was recommended at breakfast. Tea, which is rich in polyphenols, was highly recommended. Outside mealtimes, water was the only beverage permitted. Polyphenol-rich extra-virgin olive oil was used for dressing and frying. In the CR-LIPE group, during a mean follow-up period of 3.9 years, the mean serum ferritin concentration decreased from 301 to 36 mcg/l (p < 0.001), but was unchanged in the control group. During the follow-up period, the serum creatinine concentration doubled in 21% of patients on CR-LIPE and in 39% of controls (p < 0.01). Renal replacement therapy (dialysis or transplantation) or death occurred in 20% of patients on CR-LIPE and in 39% of controls (p < 0.01).

Comment: The results of this study indicate that this specific dietary approach was considerably more effective than a standard low-protein diet for preventing the progression of renal failure in type 2 diabetics with renal failure and proteinuria. Previous studies have shown that iron can adversely affect glycemic control, by promoting insulin resistance. Depleting body-iron stores, even in patients without iron overload, can improve insulin sensitivity. In addition, because of its role as an oxidizing agent, excess iron presumably can increase free-radical damage to tissues. Polyphenols, on the other hand, function as antioxidants, and may protect tissues from oxidative damage. The importance of decreasing dietary carbohydrates is not clear, although such a dietary change has been shown in some studies to improve blood-glucose regulation.

Facchini FS, et al. A low-iron-available, polyphenol-enriched, carbohydrate-restricted diet to slow progression of diabetic nephropathy. Diabetes 2003;52:1204-1209.

Don't cook your goose

Eleven type 1 or type 2 diabetics consumed each of two different diets for two weeks, with a washout period of one-to-two weeks between diets. Thirteen other diabetics participated in a six-week randomized trial of the same diets. The two diets had a similar content of protein, carbohydrate, and fat, but differed by approximately 5-fold in the content of advanced glycation end products (AGEs), which was accomplished by varying the cooking time and temperature. After two weeks on the high-AGE diet, serum AGEs increased by 64.5% from baseline (p = 0.02); on the low-AGE diet serum AGEs decreased by 30% from baseline (p = 0.02). The values at six weeks were 28.2% (p = 0.06) and -40% (p = 0.02), respectively. After six weeks, the mean C-reactive protein concentration increased by 35% relative to baseline on the high-AGE diet and decreased by 20% relative to baseline on the low-AGE diet (p = 0.014). Other inflammatory mediators also increased on the high- and decreased on the low-AGE diet.