ROCHESTER, MINNESOTA. IgA nephropathy is a fairly common kidney disorder. It is caused by an inflammation (glomerulonephritis) in the network of blood capillaries involved in the filtration of waste products from the blood. More specifically, it manifests itself through the deposit of the antibody immunoglobulin A (IgA) in the mesangial cells, which support the walls of the capillaries. The IgA deposits and accompanying lesions to the capillaries interfere with proper filtration of waste products from the blood. IgA nephropathy is more common in men than in women and its incidence peaks between the ages of 16 and 35 years. IgA nephropathy is associated with a gradual decline in kidney function leading to end-stage renal disease within 5 to 25 years of diagnosis in 20-40% of patients. The disease is usually diagnosed after blood or excess protein is observed in the urine. Serum creatinine levels are abnormally high in IgA nephropathy because the kidneys are unable to filter creatinine (a waste byproduct of creatine, a protein that supplies energy for muscle contraction) out of the blood and excrete it in the urine. A doubling in serum creatinine level corresponds to a 50% decline in kidney function. There are no pharmaceutical drugs that will slow down or reverse the progression of IgA nephropathy.

Researchers at the Mayo Clinic previously reported that supplementation with 1.9 grams/day of EPA (eicosapentaenoic acid) plus 1.4 grams/day of DHA (docosahexaenoic acid) is effective in retarding the progression of IgA nephropathy. The researchers have now carried out another clinical trial to determine whether doubling the daily dose of fish oil supplement would be even more effective. Their randomized clinical trial involved 73 patients with biopsy-diagnosed IgA nephropathy. Ten of the patients had quite severe disease as indicated by a baseline serum creatinine level of 3.0-4.9 mg/dL while the remaining 63 patients had moderate disease (serum creatinine between 1.5-2.9 mg/dL). The fish oil supplement used in the trial was supplied by Pronova in Norway (trade name – Omacor) in the form of highly purified ethyl esters of EPA and DHA.

At the end of the 2-year study period the serum creatinine level in the low-dose group (1.9 g/day of EPA plus 1.5 g/day of DHA) had increased by 0.08 mg/dL per year while patients in the high-dose group (3.8 g/day of EPA plus 3.0 g/day of DHA) saw an average yearly increase of 0.10 mg/dL. Rapid deterioration in kidney function (creatinine increase of more than 0.5 mg/dL per year) was observed in 70% of the patients with severe disease as compared to only 23% in the group with moderate disease. There was no significant difference in the number of patients in the low and high dose groups who developed end-stage renal disease (ESRD). At the end of 2 years 86% in the low-dose group and 80% in the high-dose group were still free of ESRD. The corresponding numbers after 3 years were 73% and 76%. The 2-year number of about 85% ESRD-free compares to only 63% ESRD-free in a previously investigated placebo group.

The Omacor supplement was generally well-tolerated, but two patients (out of 73) did discontinue their treatment as a result of gastrointestinal intolerance. There were no unfavourable effects on serum lipid profiles (cholesterol levels), hematocrits, peripheral blood leucocytes or platelets. The researchers conclude that low- dose and high-dose fish oil supplementation is equally effective in slowing the progression of IgA nephropathy.
Donadio, JV, et al. A randomized trial of high-dose compared with low-dose omega-3 fatty acids in severe IgA nephropathy. Journal of the American Society of Nephrology, Vol. 12, 2001, pp. 791-99

GAINESVILLE, FLORIDA. Fibromyalgia is the third most commonly diagnosed rheumatologic disorder (after osteoarthritis and rheumatoid arthritis). It affects mostly women with an average age of onset of between 29 and 37 years and diagnosis most often made between the ages of 34 and 53 years. It is estimated that fibromyalgia affects between 3 and 6 million people in the USA alone. The disorder is characterized by fatigue, morning stiffness, sleep disturbances, and widespread pain and tenderness.

Pharmacists at the University of Florida believe that monosodium glutamate (MSG) and aspartame (NutraSweet) are the underlying causes of fibromyalgia in a subset of patients. They describe 4 cases where patients completely eliminated their fibromyalgia and accompanying disorders by adhering to a diet free of MSG and aspartame. The symptoms reappeared when MSG was reintroduced into the diet and disappeared again when eliminated. The 4 patients were all women who had suffered from fibromyalgia for anywhere from 2 to 17 years. They all suffered from numerous other conditions including irritable bowel syndrome, carpal tunnel syndrome, allergic rhinitis (hay fever), TMJ, GERD, anxiety, depression, and headaches. All of these symptoms disappeared within a couple of months after MSG and aspartame were eliminated from the diet. One patient was able to reduce her number of medications from 15 to 1.

MSG is, unfortunately, an extremely common ingredient in most processed foods. It is also known under the aliases of gelatin, hydrolyzed vegetable protein, textured protein, and yeast extracts. Eliminating it and aspartame from the diet requires constant vigilance.

The researchers point out that MSG was classified as safe by the FDA in 1959. Because of its long history of "safe" usage it was approved automatically before new stringent test requirements for food additives went into effect in 1958. The researchers question the safety of MSG and suggest that much of the research performed to prove its safety for human consumption may have been flawed. Both MSG and aspartame are now known to be potent neurotoxins (excitatory amino acids) and can affect the body through their action on central NMDA (N- methyl-D-aspartame) receptors and through the inappropriate release of pituitary hormones into the general circulation. The Florida pharmacists urge large scale clinical trials to further explore the connection between fibromyalgia and MSG and aspartame, but do point out that not all fibromyalgia patients may be sensitive to the two food additives.
Smith, JD, et al. Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins. Annals of Pharmacotherapy, Vol. 35, June 2001, pp. 702-06

BERLIN, GERMANY. Whether or not melatonin improves sleep pattern is a subject of controversy. A team of Dutch and German researchers now weigh in with a new study that clearly shows that melatonin increases the duration of rapid-eye-movement (REM) sleep and helps alleviate disorders associated with disturbed REM sleep. The double-blind, placebo-controlled, parallel design study involved 5 women and 9 men with an average age of 50 years who suffered from reduced REM sleep duration and neuropsychiatric sleep disorders such as narcolepsy (daytime sleepiness), restless leg syndrome, insomnia, and periodic limb movement disorder. The participants took placebo or a 3-mg melatonin capsule as closely as possible to their normal bedtime, but always between the hours of 2200 and 2400 (10 p.m. to midnight) every night for 4 weeks and were then assigned to the opposite treatment after a 1-week washout period.