Scurvy ..

http://www.findarticles.com/p/articles/mi_m0PDG/is_1_2/ai_110152641

Brittle nails: pathogenesis and treatment
Journal of Drugs in Dermatology,  Jan, 2003  by Hendrik Uyttendaele,
Adam Geyer,  Richard K. Scher

It is equally important to rule out systemic etiologies for brittle
nails. These include infections such as tuberculosis, endocrinopathies
(hypo- and hyperthyroidism (7,8), hypoparathyroidism (9), and pituitary
disorders (10)), hypochlorhydria, iron deficiency anemia (11),
hemochromatosis (12), arsenical intoxication, glucagonoma (13),
osteoporosis, osteomalacia, diseases that cause severe arthritic
deformities of the distal joints, Sjogren's syndrome and nutritional
disturbances such as cachexia (14), vitamin and zinc deficiencies (15).

The treatment of brittle nails is often difficult. If no precipitating
or contributing factors can be elucidated and if the brittle nails have
been present for many years, available treatments are often
ineffective. However, the initial approach to the treatment of brittle
nails should focus on the removal of any exogenous factors that may
cause or exacerbate nail fragility. Patients should be instructed not
to wash hands frequently and to avoid contact with water or other
dehydrating chemicals. Rehydration of the nail plate, cuticle and
surrounding nail fold can be obtained by soaking the nails in lukewarm
water followed by application of an effective moisturizer.
Alpha-hydroxy acid containing moisturizer and preparations that contain
hydrophilic substances such as phospholipids have been successfully
used for this (16). Occasionally, the once a week use of nail enamel is
encouraged to slow water evaporation from the nail plate. It is also
recommended that the patients keep their nails short, and clip them
after soaking them in lukewarm water.

Numerous therapies have been tried for brittle nails. These include
application of essential fatty acids, vitamin c, pyridoxine, iron,
vitamin D, calcium, and gelatin (17-19). Several systemic therapies for
the treatment of brittle nails have also been tried. Oral iron,
primrose oil, pyridoxine and ascorbic acid have been suggested to be of
some value (20). More recently biotin, a water-soluble B-complex
vitamin, has been demonstrated in several studies to be beneficial in
the treatment for brittle nails (21-23). The initial rational for this
treatment came from the field of veterinary medicine where biotin had
been used for the treatment of pathologic hoof changes in horses (24).
An association between deficiency of B-complex vitamins had also been
proposed as early as 1940 (25). The recommended daily oral biotin dose
is 2.5 mg, with two months being the average time before clinical
improvements are observed and the recommended time of treatment is 3-6
months. An increase in nail thickness, decreased lamellar splitting,
and decreased irregularities of the dorsal nail plate surface were
observed in patients with brittle nails treated with Biotin (21). It is
not known how long the improvement in nail strength lasts after
cessation of biotin treatment. It also remains unclear how
biotin-dependent biochemical mechanisms are responsible for nail plate
strength, and whether they are necessary for nail keratin or
intercellular cement substance production. Lastly, treatments that
would increase the rate of nail growth would be beneficial in the
treatment of brittle nails.
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If you notice in this article .. the treatment of scurvy resulted
in alleviation of .. anemia.
Anemia is considered to be THE 'greatest' nutritional problem in
the world?
Anemia in India is treated successfully with vitamin C.
Therefore accordig to these stats on vitamin C deficiency .. the
percentage of anemic individuals seems to parallel those with
vitamin C deficiency.

Lack of vitamin C and NOT ..iron deficiency?

  J Med Assoc Thai 2001 Jun;84 Suppl 1:S106-10

Scurvy: a case report.

   Chatproedprai S, Wananukul S

  Department of Pediatrics, Faculty of Medicine, Chulalongkorn
  University, Bangkok, Thailand.

  An 8-year-old child with cerebral palsy came with progressive
purpuric
  rash affecting the trunk and legs. He had tenderness on palpation of

  his extremities. Physical examination revealed a moderately pale and

  cachectic boy. There was bleeding per swollen gums and petichiae on
  the hard palate. Generalized multiple discrete palpable petichiae
  spots at hair follicles along the whole body, more on both legs,
were
  observed. He also had tenderness on palpation of his extremities.
His
  hemoglobin was 6.6 g/dl. Platelet count and coagulogram were normal.

  Roentgenographic findings showed generalized osteoporosis,
metaphyseal
  white line of distal femur, proximal tibia. proximal fibula, distal
  radius, and distal ulna with submetaphyseal lucency bilaterally.
Skin
  biopsy showed dilated hair follicles, filled with keratinous
material
  and a small corkscrew hair. A diagnosis of scurvy was made; and
  vitamin C at a dosage of 300 mg per day was given. His swollen gums,

  bleeding per gums and muscle tenderness improved within 2 days.
  Perifollicular hemorrhage, follicular hyperkeratosis, and anemia
  improved in 2 and 3 weeks respectively.

  PMID: 11529321, UI: 21420014
    _________________________________________________________________

Studies in India have shown anemia to be far more easily corrected by
the
inclusion of vitamin C than supplementing iron.
This study shows the 'anemia' present and considered by most doctors to
be
'iron deficient' anemia .. is NOT .. and is due to lack of vitamins.

Iron-deficiency anemia in young working women can be reduced by
increasing the
consumption of cereal-based fermented foods or gooseberry juice at the
workplace.

Gopaldas T.

Tara Consultancy Services, Bangalore, India.

This efficacy for both employers and employees (young working women 18
to 23
years of age) was undertaken to determine whether culturally acceptable
dietary
changes in lunches in the workplace and at home could bring about a
behavioral
change and improvement in their iron-deficiency anemia status. Maximum
weight
was given to increasing consumption of iddli, a popular
cereal-based-fermented
food, or of gooseberry juice. Four small factories were selected in
periurban
Bangalore, with a sample of 302 women. The 180-day interventions were
supervised at the workplace. In unit 1 (72 women), the intervention
consisted
of iddli four times a week plus information, education, and
communication (IEC)
related to iron-deficiency anemia. Unit 2 (80 women) received 20 ml of
gooseberry juice (containing 40 mg of vitamin C) three times a week
plus IEC
once a month. Women in unit 3 (70 women), the positive control,
received 400 mg
albendazole once plus ferrous sulfate tablets (60 mg elemental iron)
two times
a week. No IEC was given. Unit 4 (70 women) served as the negative
control and
received no intervention. The pre-post impact measures were dietary and

nutrient intake, knowledge and practice, and hemoglobin status. In
units 1, 2,
and 3, the hemoglobin status of the women improved significantly from
11.10 to
12.30 g/dl, 11.20 to 12.70 g/dl, and 11.50 to 13.00 g/dl, respectively.
In unit
4 there was no change: the values were 10.90 g/dl before and after
intervention. The results show that the type of workplace lunch was of
greater
significance than IEC. Knowledge gains were impressive, but behavioral
change
was not sustained. It was concluded that the hemoglobin levels of the
workers
can easily be improved by cost-effective workplace lunches that also
lead to
better employer-employee relations.

PMID: 11975375 [PubMed - indexed for MEDLINE]

--------------------------------------------------------------------------

CORRECTION OF ANEMIA AND IRON DEFICIENCY IN VEGETARIANS BY
ADMINISTRATION OF
                              ASCORBIC ACID

                    DINESH C. SHARMA* AND RATI MATHUR

                          *Corresponding Author

    Department of Biochemistry S M S Medical College, Jaipur - 302 004

                      (Received on December 8, 1994)

  Abstract: Twenty-eight strict vegetarians were given 500 mg ascorbic

  acid twice daily after lunch and dinner for two months. Hemoglobin
and
  certain iron status parameters were measured before and after the
  treatment. Ascorbate treatment increased mean hemoglobin by 8%,
serum
  iron by 17% and transferrin saturation by 23% and decreased total
iron
  binding capacity by 7%. All these changes were statistically
  significant. The rise in serum ferritin was 12%. The serum protein
or
  copper level did not indicate their dietary deficiency, while
initial
  serum ascorbate level were low which rose by 60% on therapy. It is
  concluded that ascorbate supplementation is a better method of
  improving hematologic and iron status than iron salt administration.

  Key words: ascorbic acid, iron deficiency, anemia, vegetarians,
  hemoglobin, iron, ferritin
    _________________________________________________________________

                               INTRODUCTION

  Anemia is the second most common affliction in the world and iron
  deficiency is the most common cause of it (1). The incidence of iron

  deficiency anemia is much greater in India than western countries,
  despite the fact that daily iron intake of Indians is twice that of
  westerners (2, 3). This apparent paradox is attributed to
consumption
  of predominantly cereal based diet, rich in phytate, oxalates,
  phosphates, fiber and other inhibitors of iron absorption, by the
  majority of Indians who practice vegetarianism on account of
religion
  or poverty (4, 5). So we had found significantly lower serum iron in

  healthy vegetarians as compared to healthy non-vegetarians (6).
  Similarly vegetarian parturient women had significantly lower
  hemoglobin, serum iron and transferrin saturation in comparison to
  their non-vegetarian counterparts (7). Recently in a closely matched

  study all the parameters (hemoglobin, serum iron, transferrin
  saturation and ferritin) were significantly lower in vegetarian
women
  and their newborns, respectively, despite having received
supplemental
  iron (Ferrous sulphate=60 mg Fe) for about six months during
antenatal
  period (5). The absence of expected response in hemoglobin
  regeneration was perhaps due to the fact the vegetarian diet was not

  deficient in iron but some other nutrient. The dietary survey of
  vegetarian mothers revealed that their diet was lacking in ascorbic
  acid as the consumption of fruits and citrus fruits was meagre (5).

  The present study was, therefore, undertaken to see the effect of
  administration of ascorbic acid on hemoglobin and iron status of
  strictly vegetarian people.
    _________________________________________________________________

                                 METHODS

  The subjects of this study were taken from the staff of the
Department
  of Biochemistry, medical and nursing students, neighbours etc. who
  volunteered for the study and were vegetarians. All person were
known
  to be healthy so that the drug compliance could be checked
frequently
  and follow up was easy. They were selected on the basis of their
  dietary habit (vegetarianism) rather than initial hemoglobin level.
  All the subjects were free from infection and inflammation which are

  known to affect serum iron, total iron binding capacity and ferritin

  values (3).

  The study started with 36 persons but ended with 28; eight persons
  discontinued vitamin tablets or were erratic in taking them. All the

  subjects were asked to take a 500 mg ascorbic acid tablet (Celin,
  Glaxo) within half an hour after lunch and dinner regularly for two
  months. Then each person received 1 gm ascorbic acid daily and a
total
  of 60 gm during the study. The dose was not large enough to cause
any
  harmful effect. No one had complained of any side effect. The
subjects
  were not allowed to take any hematinic during this study.

  The blood was collected before and after the drug trial. The
following
  estimations were performed on both the samples immediately after the

  collection - blood hemoglobin (Hb) (cyanmethemoglobin method), serum

  iron (8), total iron binding capacity (TIBC) (8), percent saturation

  (PS), (by calculation), serum ferritin (9), serum copper (10), total

  proteins (11) and ascorbic acid (12).

  An oral questionnaire method was used to find out the details of the

  diet intake and dietary habits of all the subjects studied.

  The results were statistically analyzed by the paired `t' test (13).

  The critical level of significance was 5 percent (probability,
0.05).
    _________________________________________________________________

                                 RESULTS

  Out of 28 subjects of this study, 10 were male, 18 were female, and
28
  had initial Hb level below the WHO normal range. Their age ranged
  between 18-50 years. All were vegetarians and had regularly taken
  vitamin C tablets. This is confirmed by a rise in ascorbic acid of
  about 60% in two months time (Table I)

  The pre- and post-treatment values are shown in Table I. There was a

  statistically significant rise in blood hemoglobin, highly
significant
  rise in serum iron and a significant fall in total iron binding
  capacity. The rise in transferrin saturation of plasma was highly
  significant. Interestingly, the response to therapy was better in
  those who were iron deficient/anemic. Serum ferritin level also
showed
  a rise but statistically insignificant. It may be because (i) the
  normal range of serum ferritin is very wide, (ii) increased iron was

  preferentially utilized for hemoglobin regeneration rather than
  storage, and (iii) ferritin reflects storage iron which was not
  expected to rise appreciably in such a short time.

  TABLE I. : Hematalogic and iron status of vegetarians before and
after
                           ascorbate treatment

                                Parameter

                           Pre-treatment level

                           Post-treatment level

                                   "t"
                                 (paired)

                                   "P"

                                 Percent
                                   rise
  Hemoglobin (g/dl) 10.10  01.80 10.90  01.40 5.81 <0.001 07.90
  Iron (g/dl) 63.70  13.70 74.50  13.00 6.36 <0.001 16.90
  Total Iron Binding Capacity (g/dl) 325.30  49.60 301.70 55.40
-3.62
  <0.010 -07.20
  Percent Saturation (%) 19.90  05.40 24.40  04.90 4.32 <0.001 22.60

  Ferritin (ng/ml) 39.90  39.30 44.70  40.80 1.23 NS 12.00
  Ascorbic Acid (mg/dl) 00.47  00.10 00.75  00.20 7.03 <0.001 59.50
  Total Proteins (g/dl) 08.33  00.47 06.42  00.43 0.09 NS 01.40
  Copper (g/dl ) 80.90  18.00 81.40  19.30 0.53 NS 00.60

  All values are Mean  SD; NS-Indicates Not Significant
    _________________________________________________________________

                                DISCUSSION

  The improvement in iron status and correction of anemia in
vegetarians
  by giving only ascorbic acid is a very important finding. Such
studies
  were also conducted in the past but the results were not conclusive
  (14), because the studies were multifactorial (14).

  The role of ascorbic acid in iron metabolism is manyfold. It reduces

  ferric iron to ferrous form which is then absorbed, lowers the pH
  which is conducive to iron absorption, reverses the inhibitory
effect
  of phytate, oxalate, phosphate etc., and also forms chelate with
iron
  for absorption (15).

  As dietary proteins and copper also affect iron absorption and
  utilization, so in this study total serum proteins and serum copper
  were also estimated. Their levels were within normal range (16)
  suggesting nutritional adequacy of these nutrients. On the other
hand
  ascorbate level in serum was low or on the lower side of normal (16)

  indicating inadequate vitamin C nutrition. This confirms our
  contention of Vitamin C nutritional inadequacy in vegetarian
  population on account of meagre intake of fruits, especially citrus
  fruits (5). The intake of fruits by subjects of present study was
also
  very bow, as revealed by diet survey during oral questionnaire.

  The control of nutritional anemia is one of the national health
  programme of Government of India (17) and pregnant women are advised

  to take ferrous sulphate tablets. As iron preparations did not give
  desired response in our previous study (5) and are not well
tolerated
  by many persons we instead suggest vitamin C tablets (500 mg) to be
  given twice daily after every major meal. This will improve iron
  status and correct anemia as shown in this study. In contrast to
iron
  preparations ascorbic acid is well tolerated, quite palatable and
  harmless. The risk of forming oxalate stones was reported with only
  megadoses of vitamin C (18), and even this was not confirmed in
  experimental animals (19). In addition, the daily consumption of
  vitamin C may confer following benefits (20) - prevent common cold
and
  other viral infections, retard atherosclerosis, decrease risk of
  cancer, slow down ageing and reduce toxicity of metals.

  It is hoped that this study will stimulate further work in this
field
  and that physicians will see the need for prescribing vitamin `C'
  tablets instead of iron tablets for amelioration of anemia or iron
  deficiency, especially because men and women need to absorb only
1.14
  to 2.38 mg of iron per day (21) while the actual intake iron
  vegetarian diet in this region is calculated to range from 22.0 to
  37.0 mg per day (22).
    _________________________________________________________________

                             ACKNOWLEDGEMENTS

  This work was supported by a Research Grant from S.M.S. Medical
  College, Jaipur for which we are thankful to the Principal, Dr. P.
L.
  Nawalakha.

                                REFERENCES

   1. DeMeayer EM, Adiels-Tegman M. The prevalence of anemia in the
      world. World Health Stat Q 1985;38:302-316.
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      Government of India 1991:1-8
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      ascorbate in calculi formation. Clin Chem 1986;32:333-336.
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      the role of ascorbic acid in renal calculogenesis in albino
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    _________________________________________________________________

  From Indian Journal of Physiology and Pharmacology, October 1995,
  Volume 39, Number 4, pp. 403-406

  HTML Revised 16 January, 2000.
  Corrections and formatting  2000 AscorbateWeb

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--
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http://jesuswasavegetarian.7h.com

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DEAD PEOPLE WALKING
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