Two separate studies published in the Journal of the American Medical Association (JAMA) and New England Journal of Medicine demonstrated the benefits of homocysteine-lowering therapy in those with severe coronary artery disease.

These studies were conducted on heart disease patients who underwent angioplasty procedures to re-open occluded coronary arteries. Angioplasty is the surgical repair of an artery. When it comes to treating angina, this procedure normally involves the insertion of a catheter into an extremity artery that is then threaded into a coronary artery where a balloon is inflated. The balloon compresses the atherosclerotic plaque against the arterial wall, resulting in an immediate increase in blood flow to the heart. The major limitation of this procedure is that restenosis (re-occlusion of the artery) often occurs within a relatively short time period.

In the JAMA study [2002 Aug 28;288(8):973-9], about half of 553 patients who underwent angioplasty were randomly assigned to homocysteine-lowering therapy, consisting of a combined daily regimen of 1000 mcg of folic acid, 400 mcg of vitamin B12, and 10 mg of vitamin B6 for six months. Compared to placebo, the patients receiving the vitamin supplements experienced a 38% decrease in the need for repeat angioplasties or heart bypass operations.

An earlier New England Journal of Medicine study [2001 Nov 29;345:1593-600] showed similar findings in 205 patients. Compared to placebo, those who received the vitamin supplements showed a 48% decrease in the need for another angioplasty or bypass surgery within the first six months post-operatively. The short length of these studies reflects the fact that restenosis (re-narrowing of the artery after therapy) usually occurs within six months of surgery in about 40% of trimethylglycine (TMG) patients.

While these studies are impressive, original research funded by The Life Extension Foundation [Life Extension magazine, March 1995] showed that the actual dosing required to optimally lower homocysteine to safe ranges varies widely between individuals. This means while moderate doses of folic acid, vitamins B12 and B6 are suitable for some people, others need much higher amounts.

Some progressive cardiologists are now prescribing B-vitamins to lower homocysteine, but few of them check their patients blood to verify that enough vitamins are being consumed. This negligence is equivalent to prescribing an anti-hypertensive drug and never checking the patient's blood pressure to verify that the drug is working.

Ideally, homocysteine levels should be below 7 (umol/L of blood) to protect against angina and heart attack. In the JAMA study, homocysteine levels were lowered to 7.47 umol/L. Perhaps more aggressive therapy (using trimethylglycine [TMG] and/or additional B6) would result in even better results.

Hormone Replacement Therapy (HRT) in women increases the risk of dangerous, even life-threatening diseases, according to a British article that confirmed the findings of an earlier American study. Researchers at the British charity, Cancer Research UK, conducted a review of four previous studies

focusing on the adverse effects of HRT [Beral V et al. Lancet 2002 Sept 21;360(9337):942]. They found that women who used the therapy for at least five years faced a higher risk of breast cancer, stroke and pulmonary blood clots. They also found a lower risk of bowel cancer and hip fractures. The results were consistent, even though each trial employed varying methods, the researchers pointed out.

The meta-analysis, which focused on a combined 20,000 postmenopausal women, confirmed the findings of the American trial known as the Women's Health Initiative. In that study, the effects of combined estrogen and progestin were analyzed. The British meta-analysis focused on the effects of combined HRT, as well as estrogen monotherapy.

Likewise, researchers at The Oregon Health and Science University in Portland conducted a similar review of the medical literature to determine the safety of HRT [Nelson HD et al. JAMA 2002 Aug 21;288(7):872-81]. "Although postmenopausal hormone replacement therapy (HRT) is widely used in the United States, new evidence about its benefits and harms requires reconsideration of its use for the primary prevention of chronic conditions," the scientists noted.

After assessing studies dating as far back as 1966, the researchers concluded that even though HRT provides benefits relative to menopause, osteoporosis and colorectal cancer, it increases the risk of heart disease, stroke, thromboembolic events, breast cancer with long-term use, and a chronic inflammatory disorder of the gallbladder known as cholecystitis.

-John Martin

At Chernobyl, the site of history's worst nuclear power plant accident, some fortunate residents in the surrounding areas were able to take potassium iodide (KI) tablets in the aftermath. Those that took potassium iodide now have much lower rates of thyroid cancer. No better real-life example of the effectiveness of properly timed doses of KI for the protection of the thyroid gland against radioactive iodine (RI)-one of the most abundant components of radioactive fallout-exists. Authorities know it works. It's inexpensive and the likelihood of adverse effects with the pills is virtually nil. In the aftermath of September 11th, the likelihood of a terrorist attack on nuclear power plants or an attack using devices that produce radioactive fallout has become a grim but altogether plausible prospect. And yet, the government has hesitated to supply citizens who live near nuclear power plants with stockpiles of potassium iodide.

The American Thyroid Association (ATA) released a statement following its annual meeting that brings this issue to light. This association of experts on thyroid health has determined that while current programs in the U.S. do exist, they are woefully inadequate. Of the 34 states that either have an operating nuclear power plant or are located within 10 miles of a nuclear power plant, only 16 have accepted or implemented the KI distribution program offered by the Nuclear Regulatory Commission (NRC) last December. This program would allow for the distribution of free potassium iodide supplies within a 10-mile radius of nuclear facilities. Two states have their own KI programs. According to the ATA, this level of participation falls far short of what should be in place.

The ATA also stated that a 10-mile radius is not sufficient for KI distribution. It is well known among those who have studied the patterns of radioactive iodine fallout that this substance can drift hundreds of miles, and that it's certainly not likely to only affect those in a 10-mile radius around an accident or explosion. The Public Health Security and Bioterrorism Bill, has since recommended an increase in potassium iodide distribution to a 20-mile radius, but the American Thyroid Association posits that the ideal radius is actually 200 miles.

Some experts have stated that the lag in implementing KI stockpiling programs has mostly to do with the nuclear power industry's concern about its image. While the debate between the NRC, government and those who favor increased KI stockpiles goes on, the public's best bet is to purchase their own supplies of potassium iodide. A 14-day supply of 130 mg tablets for each person is an inexpensive insurance plan against RI in these uncertain times.

Potassium iodide works by flooding the thyroid gland-a butterfly-shaped gland in the neck that regulates metabolism-with safe, stable iodine. This prevents radioactive iodine from being taken up by the gland. In the case of radioactive iodine fallout, those who are not protected by KI will end up with excessive amounts of radioactivity concentrated in their thyroid glands. Over time, this will cause thyroid damage and, eventually may lead to thyroid cancer.

If you do purchase KI, please be aware that it won't work if taken before a nuclear accident. The timing of the dosages is crucial. Only take KI when notified to do so by public health officials.

-Melissa Block