Ironjustic
Mon, Aug-14-06, 06:15
Letters to the Editor
Indian Pediatrics 2005; 42:618-620
Natural Antioxidant Therapy for Patients with Hemolytic Anemia
We read with interest the article by Marwaha, et al.(1) on the
use of wheat grass juice (WGJ) to reduce transfusion
requirements in patients with thalassemia major. We applaud
the authors for their efforts in this innovative pilot study,
and wish to speculate on possible mechanisms of action that
may be considered in the event the authors or others wish to
pursue this line of investigation.
TABLE I
Effect of WGJ Therapy on Blood Transfusion Requirements.
Pre-WGJ therapy * Post-WGJ therapy * p value =A7 Interval
between transfusions (days)
22.4 (22.4, 17.5 - 27.5)
22.4 (23.7, 20.7 - 42.2) .001
Blood Transfusion (g/kg/year)
22 (5.6, 156 - 306)
22 (6.5, 91 - 291) .001
(N =3D 16, * Median, Mean, Minimum - Maximum; =A7 Wilcoxon
signed-rank test). First, likely recognizing that all
statistically significant results may not be clinically
significant, the authors chose a clinical albeit arbitrary
endpoint to evaluate the success of the WGJ therapy to
decrease transfusion requirements in the study patients.
Using their definition of success (>25% reduction of blood
transfused compared to the pre-WGJ period), they reasoned
that 50% of the patients responded to the WGJ therapy. Using
the data they provided in the table in the paper, we
performed relevant statistical analyses on the entire cohort
to evaluate the effects of WGJ on the total amount of blood
transfused and the mean interval between transfusions. We
found that WGJ therapy decreased the total volume of blood
transfused and increased the intervals between blood
transfusions of the entire study cohort (Table
I). More importantly, the blood transfusion requirements and
intervals between transfusions of the post-WGJ therapy
period demonstrated negative and positive relation-ships
respectively to the duration of WGJ therapy (Pearson's
correlation co-efficient of 0.560, P <0.05 and =2E627, P
<0.01, respectively). These analyses suggest that not only
is WGJ therapy effective, but also that the benefit is
related to the duration of WGJ therapy. Second, as the
authors chose not to speculate on the mechanism of the
beneficial action of the WGJ therapy on their transfusion
dependent patients, we would like to propose a testable
hypothesis for consideration to facilitate future studies in
this area. Historically, the beneficial effects of WGJ
therapy have been attributed to its rich nutritional content
that include antioxidant vitamins (C&E) and
bio-flavenoids(2). We speculate that the effects of the WGJ
therapy may be due to the action of natural antioxidants on
red blood cell (RBC) antioxidant function, and corresponding
effects on cellular enzyme function and membrane integrity.
This thought is supported by studies that show decreased
antioxidant capacities of RBCs of patients with
thalassemia(3) as well as beneficial effects on RBC
life-span by supplementation of antioxidants in vivo in
other hemolytic disorders(4). Although, in this study, the
authors did not measure RBC life-span, the greater interval
between blood transfusions following institution of WGJ
therapy suggests that RBC life-span was increased.
Interestingly, the authors noted that the response to WGJ
therapy took some months (the "neutral period"); this may
suggest that the natural antioxidants contained in the WGJ
are better able to prevent cellular injury than to repair
RBC enzymes/membranes once damaged. Hence, RBCs, once
damaged, would be cleared from the circulation by the
reticulo-endothelial system as they would prior to the onset
of the WGJ therapy, but newly formed RBCs would not be
damaged and have a longer life-span. This antioxidant
hypothesis can be easily tested by measuring indices of RBC
antioxidant capacity previously noted to be abnormal in
patients with thalassemia(3) in study subjects currently on
WGJ therapy and matched control patients not consuming WGJ.
Studies of RBC life-span may be attempted, but are more
complex and are not likely to yield more information than
the interval between blood transfusions already noted. Such
an antioxidant mechanism of action of WGJ was also cited by
Ben-Arye et al to explain the beneficial effects of WGJ
therapy in patients with ulcerative colitis(2). While
clinical trials are currently underway to find suitable
blood substitutes for patients needing blood transfusions,
they may not be readily available in developing countries
nor would they be preferable to natural therapies aimed at
preserving a patient's own RBCs. Indeed, WGJ and other
nutritional therapies may be considered as adjuvants to drug
therapy. Using nutritional therapy to augment a patient's
antioxidant defenses in an effort to decrease morbidity and
mortality has similarly been advocated in other more dreaded
diseases such as cancer(5).
Caraciolo J. Fernandes, Section of Neonatology, Department of
Pediatrics, Texas Children Hospital, Baylor College of
Medicine, Houston, Tx 77030, E-mail: fernande@bcm.edu Donough
J. O'Donovan, Department of Pediatrics, University College
Hospital, Galway, Ireland.
References
1=2E Marawaha RK, Bansal D, Kaur S, Trehan A. Wheat grass
juice reduces transfusion requirement in patients with
thalassemia major: a pilot study. Indian Pediatr 2004;
41: 716-720.
2=2E Ben-Arye E, Goldin E, Wengrower D, Stamper A, Kohn
R, Berry E. Wheat grass juice in the treatment of active
distal ulcerative colitis: a randomized double-blind
placebo-controlled trial. Scand J Gastroenterol 2002;
37: 444-449.
3=2E Chan AC, Chow CK, Chiu D. Interaction of antioxidants and
their implication in Genetic Anemia. Proc Soc Exp Biol Med
1999; 222: 274-282.
4=2E Hafez M, Amar ES, Zedan M, Hammad H, Sorour AH,
el-Desouky ES, Gamil N=2E Improved erythrocyte survival with
combined vitamin E and selenium therapy in children with
glucose-6-phosphate dehydrogenase deficiency and mild chronic
hemolysis. J Pediatr 1986; 108: 558-561.
5=2E Donaldson M. Nutrition and cancer: A review of the
evidence for an anti-cancer diet. Nutrition Journal
2004; 3: 19.
Who loves ya. Tom
Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com
Man Is A Herbivore! http://tinyurl.com/a3cc3
DEAD PEOPLE WALKING=20 http://tinyurl.com/zk9fk
Indian Pediatrics 2005; 42:618-620
Natural Antioxidant Therapy for Patients with Hemolytic Anemia
We read with interest the article by Marwaha, et al.(1) on the
use of wheat grass juice (WGJ) to reduce transfusion
requirements in patients with thalassemia major. We applaud
the authors for their efforts in this innovative pilot study,
and wish to speculate on possible mechanisms of action that
may be considered in the event the authors or others wish to
pursue this line of investigation.
TABLE I
Effect of WGJ Therapy on Blood Transfusion Requirements.
Pre-WGJ therapy * Post-WGJ therapy * p value =A7 Interval
between transfusions (days)
22.4 (22.4, 17.5 - 27.5)
22.4 (23.7, 20.7 - 42.2) .001
Blood Transfusion (g/kg/year)
22 (5.6, 156 - 306)
22 (6.5, 91 - 291) .001
(N =3D 16, * Median, Mean, Minimum - Maximum; =A7 Wilcoxon
signed-rank test). First, likely recognizing that all
statistically significant results may not be clinically
significant, the authors chose a clinical albeit arbitrary
endpoint to evaluate the success of the WGJ therapy to
decrease transfusion requirements in the study patients.
Using their definition of success (>25% reduction of blood
transfused compared to the pre-WGJ period), they reasoned
that 50% of the patients responded to the WGJ therapy. Using
the data they provided in the table in the paper, we
performed relevant statistical analyses on the entire cohort
to evaluate the effects of WGJ on the total amount of blood
transfused and the mean interval between transfusions. We
found that WGJ therapy decreased the total volume of blood
transfused and increased the intervals between blood
transfusions of the entire study cohort (Table
I). More importantly, the blood transfusion requirements and
intervals between transfusions of the post-WGJ therapy
period demonstrated negative and positive relation-ships
respectively to the duration of WGJ therapy (Pearson's
correlation co-efficient of 0.560, P <0.05 and =2E627, P
<0.01, respectively). These analyses suggest that not only
is WGJ therapy effective, but also that the benefit is
related to the duration of WGJ therapy. Second, as the
authors chose not to speculate on the mechanism of the
beneficial action of the WGJ therapy on their transfusion
dependent patients, we would like to propose a testable
hypothesis for consideration to facilitate future studies in
this area. Historically, the beneficial effects of WGJ
therapy have been attributed to its rich nutritional content
that include antioxidant vitamins (C&E) and
bio-flavenoids(2). We speculate that the effects of the WGJ
therapy may be due to the action of natural antioxidants on
red blood cell (RBC) antioxidant function, and corresponding
effects on cellular enzyme function and membrane integrity.
This thought is supported by studies that show decreased
antioxidant capacities of RBCs of patients with
thalassemia(3) as well as beneficial effects on RBC
life-span by supplementation of antioxidants in vivo in
other hemolytic disorders(4). Although, in this study, the
authors did not measure RBC life-span, the greater interval
between blood transfusions following institution of WGJ
therapy suggests that RBC life-span was increased.
Interestingly, the authors noted that the response to WGJ
therapy took some months (the "neutral period"); this may
suggest that the natural antioxidants contained in the WGJ
are better able to prevent cellular injury than to repair
RBC enzymes/membranes once damaged. Hence, RBCs, once
damaged, would be cleared from the circulation by the
reticulo-endothelial system as they would prior to the onset
of the WGJ therapy, but newly formed RBCs would not be
damaged and have a longer life-span. This antioxidant
hypothesis can be easily tested by measuring indices of RBC
antioxidant capacity previously noted to be abnormal in
patients with thalassemia(3) in study subjects currently on
WGJ therapy and matched control patients not consuming WGJ.
Studies of RBC life-span may be attempted, but are more
complex and are not likely to yield more information than
the interval between blood transfusions already noted. Such
an antioxidant mechanism of action of WGJ was also cited by
Ben-Arye et al to explain the beneficial effects of WGJ
therapy in patients with ulcerative colitis(2). While
clinical trials are currently underway to find suitable
blood substitutes for patients needing blood transfusions,
they may not be readily available in developing countries
nor would they be preferable to natural therapies aimed at
preserving a patient's own RBCs. Indeed, WGJ and other
nutritional therapies may be considered as adjuvants to drug
therapy. Using nutritional therapy to augment a patient's
antioxidant defenses in an effort to decrease morbidity and
mortality has similarly been advocated in other more dreaded
diseases such as cancer(5).
Caraciolo J. Fernandes, Section of Neonatology, Department of
Pediatrics, Texas Children Hospital, Baylor College of
Medicine, Houston, Tx 77030, E-mail: fernande@bcm.edu Donough
J. O'Donovan, Department of Pediatrics, University College
Hospital, Galway, Ireland.
References
1=2E Marawaha RK, Bansal D, Kaur S, Trehan A. Wheat grass
juice reduces transfusion requirement in patients with
thalassemia major: a pilot study. Indian Pediatr 2004;
41: 716-720.
2=2E Ben-Arye E, Goldin E, Wengrower D, Stamper A, Kohn
R, Berry E. Wheat grass juice in the treatment of active
distal ulcerative colitis: a randomized double-blind
placebo-controlled trial. Scand J Gastroenterol 2002;
37: 444-449.
3=2E Chan AC, Chow CK, Chiu D. Interaction of antioxidants and
their implication in Genetic Anemia. Proc Soc Exp Biol Med
1999; 222: 274-282.
4=2E Hafez M, Amar ES, Zedan M, Hammad H, Sorour AH,
el-Desouky ES, Gamil N=2E Improved erythrocyte survival with
combined vitamin E and selenium therapy in children with
glucose-6-phosphate dehydrogenase deficiency and mild chronic
hemolysis. J Pediatr 1986; 108: 558-561.
5=2E Donaldson M. Nutrition and cancer: A review of the
evidence for an anti-cancer diet. Nutrition Journal
2004; 3: 19.
Who loves ya. Tom
Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com
Man Is A Herbivore! http://tinyurl.com/a3cc3
DEAD PEOPLE WALKING=20 http://tinyurl.com/zk9fk