[dwallach's note: vitamins and nutritional supplements crop up on the SOREHAND mailing list on a regular basis. While these may be helpful to a condition you may have, self-medication can be a dangerous business and too-much is often much worse than none-at-all. Consult a doctor or three first. On the other hand, don't be afraid to bring a print-out of this file along to your doctor!] Date: Sun, 19 Feb 1995 11:00:06 -0800 From: Pat Fox Subject: Vitamin linked to carpal tunnel DIET, NOT MOTION, MAY BE LINKED TO CARPAL TUNNEL A new collaborative study by researchers on campus and a hand surgery center in Portland suggests a possible link between vitamin B-6 deficiency and certain symptoms of carpal tunnel syndrome. Though the researchers stop short of saying that a lack of vitamin B-6 is a contributing cause of carpal tunnel, they strongly endorse further studies of nutritional links to the syndrome. They will present their research findings in April at the Biology '94 meeting in Anaheim, Calif. Carpal tunnel syndrome, a condition characterized by numbness, pain or tingling in the hands and awakening at night, historically has been associated with repetitive motions. Many office workers, industrial employees, computer operators and store clerks suffer from carpal tunnel syndrome or its symptoms. The study at OSU looked at 294 persons who were at high risk for carpal tunnel syndrome. The researchers found that a significant number of the test subjects who had symptoms characteristic of the syndrome --including pain and tightness in the hands--also had low levels of vitamin B-6 in their blood. "We think there may be a nutritional link," said Jim Leklem, a professor of nutrition and food management and principal investigator in the study. "Vitamin B-6 is directly associated with the neural system, including messages to the brain about pain cessation. That function may play a role with carpal tunnel syndrome." Leklem, who has studied B-6 for some 20 years, said the vitamin also has a potential use in reducing edema, or swelling. One hypothesis is that swelling along nerve passages in the arm, exacerbated by lack of vitamin B-6, may either cause the pain and tightness associated with carpal tunnel syndrome, or impede "pain cessation messages" heading toward the brain. "We're still trying to sort out the variables," he said. Vitamin B-6 can be found in significant quantities in soybeans, most nuts, red meats, chicken and turkey, salmon, tuna, bananas, avocados, most legumes and wheat germ. The body uses vitamin B-6 to break down amino acids which come from protein, to break down glycogen, a storage form of glucose (or sugar), stored in the muscles, and to help the formation of red blood cells. Other functions of the vitamin include formation of neuro- transmitters which carry signals to the brain, and maintaining the immune system. A lack of vitamin B-6 can lead to anemia; changes in brain patterns which lead to irritability, depression and neurological disorders; and a change in metabolism among the elderly. An excess of vitamin B-6 can also cause problems. "It fries your nerves," he said. "Excess B-6 is associated with peripheral neuropathy, which causes a loss of sensation in the nerves of the hands and feet." Leklem said it would be difficult to take too much vitamin B-6 from natural sources, such as chicken or avocados. "Women who have taken certain remedies for PMS (pre- menstrual syndrome) on occasion take more vitamin B-6 than is advisable," he said. The OSU research was done in conjunction with the Portland Hand Surgery and Rehabilitation Center. It is directed by Dr. Peter Nathan. Nathan's research suggests that high body weight or mass, age, genetics, and a lack of exercise are factors which may be associated with the syndrome. "Any relationship between repetitive motions and CTS (carpal tunnel syndrome) is tenuous at best," said Dr. Richard Keniston, senior research associate working with Dr. Nathan. "The most repetitive job we have studied, keyboard data entry, is actually at significantly reduced risk for CTS relative to the general population of over 2,600 subjects we have studied." Leklem said carpal tunnel syndrome is a complex condition, difficult to define and characterize. One common symptom of carpal tunnel sufferers is waking in the night with extreme pain in the hands. Another symptom involves the Phalen's test, a clenching of the hands for 30 to 60 seconds in a claw-like formation. An ensuing loss of sensation, or a tingling in the hands, may indicate a disorder. His previous studies were funded primarily by OSU's Agricultural Experiment Station. Mark Floyd =============================================================== Date: Mon, 20 Feb 1995 00:48:44 -0800 From: Judith Winter Subject: Re: Vitamin B6 >>>I would like to hear from anyone who has found help for carpal >>>tunnel syndrome using vitamin B6. > >>>Eric >>>76440@ef.gc.maricopa.edu > >My doc (admittedly a hand surgeon who doesn't want to operate) prescribed >100 mg of B6 twice a day. Reminder, For women, whatever dosage is "right" for you, half that amount is right for the first two weeks of menstraual cycle. i.e. pre-mentrual time (regardless of whether or not it is PMS) is marked by water-retention, and water retention aggravates CTS etc., and B-6 reduces retention (mild diuretic), so you need more B-6 then. (I think this also may be a partial answer to the person who posted about why growth hormone may have CTS as side-effect.) >Medical texts warns >that you can take too much and get tingling/numbness but this ususally >is from over 300mg a day. I haven't had any problems (but how could >you really tell since these are symptons of cts in general). It may feel like a "different" numbness/tingling. In connection, Judith Winter island@whidbey.net =============================================================== Date: Mon, 20 Feb 1995 12:39:21 -0500 From: Ned Walsh Subject: Re: Vitamin B6 I have a pamphlet of medical educational articles on MAO inhibitor antidepressants (Nardil, Parnate, etc.) which has the following two passages on B6. Maybe it will be of interest. From Richard I Shader, MD, ed., MAOI Therapy (1988, Audio Visual Medical Marketing, Inc.): "In this author's experience, pyridoxine (vitamin B6) deficiency (less than 3 ng/mL) may increase the likelihood of myoclonus. In these cases, the addition of vitamin B[6] 25-100 mg/day may reduce myoclonic movements. However, excess pyridoxine can cause similar symptoms. A patient recently described by Dalton and Dalton complained of 'electric-shock pains in her head' after taking vitamin B6 for premenstrual tension. Pyridoxine, structurally similar to isoniazid and iproniazid, is transformed to its aldehyde, pyridoxal, as it is metabolized. Pyridoxal is converted to pyridoxal phosphate (PLP) by the action of pyridoxal kinase. MAOIs inhibit pyridoxal kinase. PLP is an essential coenzyme in the metabolism (decarboxylation, transamination) of important neurotransmitters. For example, PLP is required for the formation of dopamine from L-dopa and serotonin from 5-hydroxytryptophan and for the conversion of glyoxylate to glycine. Lowered pyridoxine levels also reduce available gamma-aminobutyric acid (GABA). As in idiopathic myoclonus, clonazepam and valproic acid may be helpful in some instances of MAOI-induced myoclonus." (p. 27, RI Shader, Current clinical applications of monoamine oxidase inhibitors: Issues and concerns.) "Carpal tunnel syndrome, as well as myoclonic jerks, muscle weakness, and parasthesias, may be related to a relative deficiency of pyridoxine. These side effects may be alleviated by addition of pyridoxine 100-200 mg/day. Nocturnal myoclonus has been reported to respond to clonazepam 0.5-2mg at bedtime." (p. 41, JG Rabkin et al., Update on side effects associated with MAOIs and their management.) For what it's worth, Ned =============================================================== Date: Mon, 20 Feb 1995 13:31:44 EST From: "MARGARET M. BERSON" Subject: Re: Vitamin B6 Chiropractors have been recommending vitamin B6 for CTS for a long time, but most MD's think it's hooey. I think there was a Dr. Ellis at a Texas university who published something on this originally (like more than 3 years ago?). They (the chiropractors, I mean) usually recommend about 300 mg a day for six weeks, then 100-200 mg daily. My acupuncturist recommended Pyridoxal 5 Phosphate, which is apparently what plain vitamin B6 gets processed into in your body. The idea seemed to be that this gets absorbed better/faster than plain b6. I could only find it under a brand called "Healthways." (have seen it referred to as a co-enzyme, but maybe all vitamins are co-enzymes, I don't know). As mentioned in the other post, one shouldn't take much more than 300 mg. I think I saw in a non-medical book somewhere that vitamin B6 "lubricates" the tendons, but haven't read/heard this anywhere else and doubt that it's true. =============================================================== Date: Mon, 20 Feb 1995 11:48:13 -0700 From: "DEBORAH L. BELL" Subject: Re: Vitamin B6 I'm looking at my bottle of B-vitamins, and it seems to indicate that the US RDA is about 2 mg. So 100-200 mg would be a megadose, I think. Could this be harmful? Tom Bell =============================================================== Date: Mon, 20 Feb 1995 11:44:25 -0700 From: "DEBORAH L. BELL" Subject: Re: Vitamin B6 The issue of vitamin B-6 is also being discussed on the USENET group bit.listserv.c+health Unfortunately, this is one of those cyber-snobby "moderated" groups, and isn't easy to post to. One of the posts about B-6 indicated that mega-doses can actually cause additional damage to your body. My personal belief is that vitamin therapy is quackery. Yes, vitamins are necessary, but megadoses of vitamins are not a miracle cure. Tom Bell =============================================================== Date: Mon, 20 Feb 1995 12:08:16 -0800 From: Glen Kohler Subject: Re: Vitamin B6 On Mon, 20 Feb 1995, DEBORAH L. BELL wrote: > I'm looking at my bottle of B-vitamins, and it seems to indicate that > the US RDA is about 2 mg. So 100-200 mg would be a megadose, I think. > Could this be harmful? Tom: It might be useful to bear in mind that the "Recommended Daily Allowance" of a nutrient is technically defined as an amount that prevents clinical manifestations of deficiency-induced illness. In the case of B vitamins, it means the smallest amount necessary to prevent beri-beri! The amount necessary to maintain glowing, vital health may be quite another dosage altogether! And that needed to achieve a therapeutic effect yet another.... Best Regards, Glen Glen Kohler, CMT gkohler@crl.com : Box 9719, Berkeley, CA 94709 Health Arts Wellness Services : 510/845-8485 =============================================================== Date: Mon, 20 Feb 1995 15:24:36 EST From: "Michael M. McClatchey" Subject: Re: Vitamin B6 Tom Bell wrote: >My personal belief is that vitamin therapy is quackery. Oh, please...We have lots of noise already without adding blanket judgements based on limited information. Your mileage may vary, but vitamins have helped any number of people. I take 50mg of B6 every day on the recommendation of a leading hand surgeon (who shall remain nameless since I don't have permission to use his name) and if I don't take it, my wrist hurts. Works for me. On a Monday, Michael M. McClatchey mmm@aisinc.com Applied Intelligent Systems, Inc. 110 Parkland Plaza Ann Arbor, MI 48103 313-995-2035 Fax 995-2138 =============================================================== Date: Mon, 20 Feb 1995 23:47:00 EST From: Carol Waller <0007078901@MCIMAIL.COM> Subject: Re: Vitamin B6 >>Reminder, For women, whatever dosage is "right" for you, half that amount >>is right for the first two weeks of menstraual cycle. i.e. pre-mentrual >>time (regardless of whether or not it is PMS) is marked by water-retention, >>and water retention aggravates CTS etc., and B-6 reduces retention (mild >>diuretic), so you need more B-6 then. (I think this also may be a partial >>answer to the person who posted about why growth hormone may have CTS as >>side-effect.) Thanks, Judith, my doc didn't mention anything about B6 and PMS. carol