Sound Medicine -- September 21, 2002

Barbara Lewis, Dr. David Crabb, and Dr. Kathy Miller talk to physicians and experts about:

Lou Gehrig's disease and creatine
Hepatitis B

Lou Gehrig's Disease and creatine

The average life span of someone diagnosed with Lou Gehrig's disease (also called ALS) is about four years. There is no cure, but researchers have found many ways to improve the quality-of-life for patients. One substance that may prove helpful can be found on the shelf of any health food store, creatine. Athletes and body builders use creatine to help increase muscle strength. Now researchers are testing whether it can save the dying motor nerves of people with ALS. We carry creatine in our bodies and ingest it when we eat meat, so how does this natural substance boost energy and improve movement in people with ALS?

Barbara Lewis and Dr. David Crabb cover the topic with neurologist Bob Pascuzzi, who is researching the benefits of creatine in his patients with Lou Gehrig's disease (or ALS).

Dr. Pascuzzi discusses the history of his creatine research which is aimed at slowing, improving, or evening halting the disease. Studies began with mice. Now the Northeast ALS Consortium, of which Dr. Pascuzzi is a member, is performing double-blind studies using creatine to treat real ALS patients. Pascuzzi and his fellow researchers measure improvements in function, survivability, and the absolute strength of a variety of muscles. They even count a patient's motor nerves. The researchers won't know for another year just how much creatine can help.

Dr. Pascuzzi explains that creatine is a substance like an amino acid, that it's created by the liver, and that it deals with energy. Creatine preserves energy, and serves as a "battery" or "buffer" for muscles, he says. Still, he cautions that it's the loss of nerve supply to muscle that one sees in ALS patients, and says that's what researchers want to preserve. He says that creatine is proving useful in many brain diseases like Huntington disease.

There are lots of treatments available to treat ALS symptoms, including speech and writing tools. Pascuzzi also discusses current drug treatments which can slow the onset of ALS. Although they are in the beginning states, Pascuzzi is optimistic about other treatments now being tested, including over-the-counter drugs, nerve growth factors, and stem cell therapy.

Dr. Robert Pascuzzi is professor and vice chairman of the Department of Neurology at the IU School of Medicine.

Resources

The National Institute of Neurological Disorders and Stroke (NINDS) provides a good factsheet on Lou Gehrig's disease, or Amyotrophic lateral sclerosis (ALS).

Get more information about ALS, including reports on recent research, from a variety of sources listed at MEDLINEplus.

Hepatitis B

Sometimes patients become experts on a health condition, simply in order to survive it. After William Finley Green was diagnosed with hepatitis B, he began studying the disease. When his search for the perfect book ended in frustration, Green decided to write the book he wished he had the first year after his diagnosis. He discusses his experience and his book, called The First Year--Hepatitis B, with Dr. Kathy Miller and Barbara Lewis.

Like many patients, Will Green discovered he was infected with hepatitis B when he was tested for the virus during another illness. When diagnosed, it was estimated that he'd had the virus for twenty years. Green reports frightening statistics about this long-lived and hardy virus. For instance, worldwide there are more then 400 million people with chronic hepatitis B, making it more prevalent than HIV.

As the body tries to rid itself of the virus, hepatitis B patients suffer liver damage. After years of strain, the overworked liver gets fibrosis, then ultimately cirrhosis. Many patients require liver transplants. Five percent of chronic hepatitis B patients get liver cancer.

Green explains the lifestyle changes he made to alleviate strain on his liver. He stopped drinking alcohol and taking certain medications whichar are absorbed through the liver, like Tylenol. Foods heavy in fat and sodium are especially bad for people with liver disease, he explains, as are raw fish and high-nitrate foods like salami and bacon. Green discovered that like himself, most newly diagnosed HBV patients rearrange their life priorities and try to spend time doing things they really enjoy.

For people to avoid infection, Green says avoid contact with other people's blood. He urges children and adults be vaccinated, and that adults get tested for the antigen before they are vaccinated. Green also talks briefly about the safe antiviral drugs that can lower viral load on the liver, staving off fibrosis or cirrhosis.

Resources

The First Year -- Hepatitis B: An Essential Guide for the Newly Diagnosed, by William Finley Green, published by Marlowe and Company, Publishers Group West, ISBN 1-56924-533-9. Available at Amazon.com.

The Centers for Disease Control Web site offers a comprehensive list of hepatitis B topics.

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