Issue 40


Anorexia Nervosa

This is a case report of a 19-year-old female with anorexia nervosa who had extensive weight loss over 1 year associated with vegetarianism and excessive exercise. She had severe muscle wasting and muscle weakness in the legs and bilateral weakness of eye closure. There was purpuric rash which developed due to the vitamin C deficiency. The author notes that the myopathic and scorbutic features may have a common cause. It is noted that the eye signs have not been demonstrated previously in anorexia nervosa and they could be explained by a myopathy, a bilateral VII nerve palsy, myasthenia gravis, or Guillain-Barre Syndrome. Vitamin C deficiency may link the purpurae and myopathy and the muscle weakness can be caused by vitamin C deficiency which can be mediated by carnitine. Carnitine is required to move fatty acids into the mitochondria for energy production. Measuring plasma carnitine levels in future cases of myopathy associated with anorexia nervosa may prove valuable.

"Neuromyopathic Complications in a Patient With Anorexia Nervosa and Vitamin C Deficiency", Woodruff, Peter W.R., et al, International Journal of Eating Disorders, 1994;16(2):205-209.

Bone Loss & Hormone Replacement Therapy, Iron, Menopause

In a study of 112 women not on hormone replacement therapy (mean age 56.6 years, mean time past menopause 6.6 years) compared with 116 women (mean age 54.6 years, mean time past menopause 4.9 years) who were on hormone replacement therapy, subjects were examined over 1 year, in which all women received 800 mg/day of supplemental elemental calcium. Iron was associated with greater positive bone mineral density change at the trochanter and Ward's triangle in women using hormone replacement therapy. Calcium was associated with bone mineral density change at the trochanter and femur neck for women not using hormone replacement therapy. In women using hormone replacement therapy in the lowest tertile of calcium intake, change in femur neck bone mineral density increased linearly as iron intake was increased. In women not on hormone replacement therapy, bone mineral density increased in women in the highest tertile of calcium intake. This longitudinal analysis indicates a positive association of iron intake with bone mineral density in a cross-sectional study and demonstrates an influence of hormone replacement therapy on iron and calcium and bone mineral density relations. The major finding of this study was the positive association in cross- sectional analyses for iron intake and bone mineral density at the femur trochanter and Ward's triangle, with the association remaining significant only for women using hormone replacement therapy. Calcium was associated with positive changes in femoral neck and trochanter bone mineral density only in women not using hormone replacement therapy.

"Dietary Iron Positively Influences Bone Mineral Density in Postmenopausal Women on Hormone Replacement Therapy," Maurer J, Harris MM, et al, J Nutr, 2005;135:863-869. (Address: Jaclyn Maurer, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.)

Bone Loss

Osteopenia, Boron Deficiency and Parenteral Nutrition

Boron deprivation has been shown to affect calcium metabolism and bone formation in 2 human trials. Children receiving long term total parenteral nutrition (TPN) suffered from metabolic bone disease of unknown etiology. Serum boron was evaluated in 28 subjects, mean age of 10 years, receiving total parenteral nutrition for approximately 9 years. Mean serum boron was significantly higher in controls and correlated well with the duration of total parenteral nutrition. There was contamination of boron in individual glucose amino acid solutions and fat emulsion. The authors found that there was enough boron contamination in total parenteral nutrition solutions to maintain serum boron at above normal levels. Boron deficiency is not characteristic of osteopenia seen in children receiving long term parenteral nutrition.

"Is Boron Deficiency An Etiological Factor in Osteopenia of Parenteral Nutrition in Bone Disease of Children?", Moukarzel, A.A., et al, Journal of the American College of Nutrition, October 1992;11(5):601/Abstract 14.

NAC Supplementation May Improve Physical Performance in Patients with COPD


In a randomized, double-blind, placebo-controlled, crossover study involving 24 patients over 40 years of age with COPD (chronic obstructive pulmonary disease), results indicate that supplementation with NAC (N-acetylcysteine) may exert a beneficial effect on physical performance. The patients were randomized to NAC (1200 mg/d) or placebo for 6 weeks, after which the interventions were crossed over for another 6 weeks. At intervention end, inspiratory capacity (IC) and FVC were higher after exercise in the NAC-supplemented group, compared with the placebo group. Additionally, greater reduction in residual volume to total lung capacity was observed in the NAC group. Lastly, exercise endurance time was greater in the NAC group. Thus, the authors of this study conclude, "NAC treatment of stable, moderate and severe COPD patients has a beneficial effect on physical performance, probably due to a reduction in air trapping."

"Total Antioxidant "Effect of N-Acetylcysteine on Airtrapping in COPD: A Randomized Placebo-Controlled Study," Stav D, Raz M, Chest. 2009 May 15; [Epub ahead of print]. (Address: Pulmonary Institute (Dr. Stav), Assaf Harofeh Medical Center, Zerifin, Israel).



  • Fennel contains the antioxidant flavonoid quercetin 

  • This herb is anti-carcinogenic and can be useful for cancer patients 
undergoing chemotherapy or radiation
  • Fennel can be useful for indigestion and spasms of the digestive tract 

  • It also helps expel phlegm from the lungs

Drinking Milk Associated with Fractures and Death

High cow’s milk intake is associated with increased risk for bone fractures and death, according to a new study in the British Medical Journal. Researchers followed 61,433 women and 45,339 men for more than 20 years and 11 years, respectively.

Among women, those who consumed three or more glasses of milk per day had a 60 percent increased risk for developing a hip fracture and a 16 percent increased risk for developing any bone fracture. These results are similar to previous studies showing no protective effect of increased milk consumption on fracture risk.

Additionally among women, for each glass of milk consumed, risk of dying from all causes increased by 15 percent, from heart disease by 15 percent, and from cancer by 7 percent. For the women who consumed three or more glasses of milk per day, compared with less than one glass, risk of dying increased by 93 percent. Men had a 10 percent increased risk of dying when consuming three or more glasses of milk per day, compared with less than one glass.

Michaëlsson K, Wolk A, Langenskiöld S, et al. Milk intake and risk of mortality and fractures in women and men: cohort studies. BMJ. 2014;349:g6015.
Feskanich D, Willett WC, Colditz GA. Calcium, vitamin D, milk consumption, and hip fractures: A prospective study among postmenopausal women. Am J Clin Nutr. 2003;77:504-511

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