Clinical Abstracts
Clinical Abstracts
With Comments from Adriane Fugh-Berman, MD
Calcium Effective for Premenstrual Syndrome
March 1999; Volume 1: 31-32
Source: Thys-Jacobs S, et al. Calcium carbonate and the premenstrual syndrome: Effects on premenstrual and menstrual symptoms. Am J Obstet Gynecol 1998;179:444-452.
Design and Setting: Randomized, double-blind, placebo-controlled, parallel group multi-center trial at 12 outpatient health centers across the United States.
Subjects: 497 healthy premenopausal women ages 18-45 with moderate to severe, cyclically recurring premenstrual symptoms.
Treatment: Calcium carbonate (TUMS®-EX)
Dose/Route/Duration: 1500 mg calcium carbonate (containing 600 mg elemental calcium) PO bid for three menstrual cycles.
Outcome Measures: Changes in the PMS Diary, a previously validated 17-parameter symptom score. The four categories of symptoms assessed were negative affect, water retention, food cravings, and pain.
Results: By the third treatment cycle, calcium treatment resulted in an overall 48% reduction from baseline in total symptom scores, compared to a 30% reduction with placebo. The difference was statistically significant in the luteal phase of both the second and third treatment cycles.
Funding: SmithKline Beecham Consumer Healthcare, manufacturers of TUMS®-EX, a calcium carbonate antacid.
Comments: This reasonable study provides evidence that calcium decreases symptoms associated with PMS. Symptoms assessed included mood swings, crying spells, breast tenderness, abdominal bloating, food cravings, and lower abdominal or low back pain. Supplemental calcium is safe and has the added benefit of providing some protective effect against osteoporosis. It can be difficult to persuade young women of the importance of early calcium supplementation (as peak bone mass is laid down prior to age 35). Perhaps this study will provide incentive for younger women to take calcium supplements.
Alternative Therapy Use Among Women with Chronic Vaginal Symptoms
March 1999; Volume 1: 32
Source: Nyirjesy P, et al. Over-the-counter and alternative medicines in the treatment of chronic vaginal symptoms. Obstet Gynecol 1997;90:50-53.
Objective: Survey to investigate the use of over-the-counter (OTC) and alternative medicines in women with chronic vaginal symptoms.
Setting: Temple University Vaginitis Referral Center
Methods: Self-administered questionnaire given to all new patients referred for evaluation of chronic vaginal symptoms between September and December 1994.
Subjects: 105 (mean age 36)
Results: 73.3% of patients had used OTC medications in the preceding year, including miconazole, clotrimazole, povidone-iodine, and hydrocortisone, and 41.9% had used one or more alternative medicines. Of the latter group, 50% had tried supplementing their diet with acidophilus; 20.5% tried yogurt, 9.1% garlic pills, and 9.1% "herbal tea." In addition, 20.6% had tried topical applications of acidophilus or yogurt, 13.6% had tried vinegar douches, and 13.6% had tried topical application of boric acid. Two patients (4.5%) had tried acupuncture. The median yearly expenditure for these treatments was $35 (range $0-$1,200). Approximately 70% reported that their health care providers were aware of the treatment (this number was significantly lower than the 88.3% in the OTC group who reported that their health care providers were aware of the treatment).
Funding: Not noted.
Comments: With the exception of the two patients who tried acupuncture, all of the alternative therapies used by the subjects in this survey were self-administered, "home remedy" type therapies. The therapies listed are harmless and have some theoretical basis for efficacy, at least for candidal infections. Boric acid was once used for yeast infections; garlic has antifungal effects in vitro; vinegar douches acidify the vagina; and the use of yogurt or acidophilus is clearly an attempt to colonize the vagina with beneficial flora.
Eat Your Candy
March 1999; Volume 1: 32
Source: Lee IM, Paffenbarger RS Jr. Life is sweet: Candy consumption and longevity. BMJ 1998;317:1683-1684.
Setting/Methods/Subjects: This subset of the Harvard alumni health study included 7,841 men, free of cancer and cardiovascular disease, who responded to a 1988 health survey that included information on candy consumption.
Results: Between 1988 and 1993, 7.5% of non-consumers of candy died, compared to 5.9% of candy consumers (age-adjusted relative risk was 0.83). Compared with non-consumers, the relative risks of mortality among men who consumed candy 1-3 times a month was 0.64, 1-2 times a week was 0.73, and 3 or more times a week was 0.84.
Funding: HL 34174 and CA 44854 from NIH.
Comments: This is cheerier news than one is used to getting from a medical journal. It bears noting that there does not seem to be increased benefit from increased intake; if anything, the opposite is true. Still, candy consumers do better than non-consumers in overall mortality. It is unfortunate that the relevant questions in this survey did not distinguish between chocolate and other types of candy. My favorite part of this report was the competing interests note at the end that states: "The authors admit to a decided weakness for chocolate and confess to an average consumption of one bar a day each."
March 1999; Volume 1: 31-32Subscribe Now for Access
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