Complementary and Alternative Medical Lab Testing Part 1: EENT (Eyes, Ears, Nose and Throat)

By Ronald Steriti

Complementary and Alternative Medical Lab Testing (CAM Labs) contains summaries of the published research on lab tests, primarily from PubMed trials on humans. Each chapter (disease) begins with a brief summary of conventional lab tests, followed by additional lab tests, including diabetes, insulin resistance, metabolic syndrome, inflammation, etc. There are sections on endocrine hormones (thyroid, adrenal, sex steroids) and environmental medicine (toxic heavy metals). The nutritional assessments section includes minerals, vitamins and amino acids.

CAM Labs 1 – EENT

Eyes
1. Cataracts
2. Dry Eyes
3. Glaucoma
4. Macular Degeneration
5. Macular Edema
6. Retinitis pigmentosa
7. Retinopathy

Ears
8. Hearing Loss
9. Meniere’s Disease
10. Otitis media
11. Tinnitus

Nose
12. Epistaxis
13. Sinusitis

Throat
14. Bruxism
15. Burning Mouth Syndrome
16. Dry Mouth
17. Dysphagia
18. Laryngitis
19. Periodontal Disease
20. Tonsillitis

• Language: English
• Publisher: Ronald Steriti
• Release date: Jun 4, 2016
• ISBN: 9781310586552

Ronald Steriti

Dr. Ronald Steriti is a graduate of Southwest College of Naturopathic Medicine and currently is researcher for Jonathan V. Wright at the Tahoma Clinic.

Book preview

Chapter 1. Cataracts

A cataract is any opacity of the lens. Cataracts are the single largest cause of blindness in the world, blinding an estimated 17 million people. Most cataracts (over 90%) are age-related or senile cataracts.

Conventional Lab Tests

Diagnosis of senile cataracts is made from history and physical exam.

Fasting Glucose, Hemoglobin A1C (Kim and Kim, 2006)

Additional Lab Tests

Insulin Resistance, Metabolic Syndrome

A prospective cohort of persons 49 years of age and older were followed over 10 years in the Blue Mountains Eye Study, west of Sydney, Australia. After accounting for changes in metabolic syndrome components over time and controlling for possible confounders, metabolic syndrome was found to be associated with an increased 5-year incidence of cortical cataract (HR 1.48; 95% CI, 1.05-2.09) and PSC cataract (HR 1.75; 95% CI, 1.01-3.04). Among the five metabolic syndrome components, high glucose and obesity predicted an increased 5-year incidence of cortical cataract. In addition, low high-density lipoprotein and high glucose were associated with an increased 10-year incidence of cortical and PSC cataracts, respectively. (Ghaem Maralani et al., 2013)

Total, HDL and LDL cholesterol, Triglycerides

A comparison of ninety patients with cataract and 90 age- and sex-matched healthy controls shoed that hypercholesterolemia, hypertriglyceridemia, high LDL chol and high FBS are associated with cataract. Also lower plasma antioxidant levels and higher levels of oxidative stress were seen in cataract patients than healthy controls. (Heydari et al., 2012)

Fasting hypertriglyceridemia (>/=250 mg/dl) was associated with an increased risk of PSC cataract in men (P = 0.02). High-density lipoprotein cholesterol levels

A population-based prevalence study of adults aged 43 to 86 years (n = 4,926) in Beaver Dam, Wisconsin examined cardiovascular disease risk factors with the prevalence of age-related cataract. In multivariate models, higher glycated hemoglobin was significantly and consistently associated with increased risk of nuclear cataract in women. For cortical cataract, higher serum high density lipoprotein cholesterol was associated with decreased risk in women. For posterior subcapsular cataract, men with higher ratios of total to high-density lipoprotein cholesterol were at increased risk. (Klein et al., 1997)

C-Reactive Protein (CRP)

In the Physicians' Health Study, baseline CRP was significantly higher among men who later developed cataract than levels among those who remained free of cataract, P = 0.02 (median 1.53 versus 1.23 mg/L). In exploratory analyses of a threshold effect, the excess risk was significant only among men with levels at or above the 97.5th centile (6.17 mg/L); compared to those with lower levels, the relative risk in these men was 3.00 (95% confidence interval, 1.53 to 5.91; P = 0.002). (Schaumberg et al., 1999)

Fibrinogen

The Blue Mountains Eye Study is a large (n=3654) population-based cross-sectional study conducted among people aged 49-97 years residing in the Blue Mountains, a region west of Sydney, Australia. Cortical cataract was associated with a history of myocardial infarction, higher plasma fibrinogen, and higher serum cholesterol. Nuclear cataract was associated with a higher platelet count but hypertension was associated with lower prevalence of nuclear cataract. Posterior subcapsular cataract was associated with higher plasma fibrinogen and lower body mass index. Some of these associations appeared to be stronger in women than in men: fibrinogen and cortical cataract and body mass index and posterior subcapsular cataract. (Goodrich et al., 1999)

Digestive Assessments

Celiac Disease

A study in Sweden found increased risk of cataract among 28,000 patients with celiac disease (hazard ratio = 1.28, 95% confidence interval: 1.19, 1.36). (Mollazadegan et al., 2011)

Lactose Malabsorption

Lactose consumption has been associated with a high incidence of cataract in northern Indian and southern Italian populations. Milk ingestion was dose-related with cataract risk in lactose digesters (particularly in diabetics) but not in lactose maldigesters. Red blood cell galactokinase activity was significantly lower in elderly subjects (> 60 y) than in young individuals (P < 0.05), and galactose-1-phosphate uridyl-transferase activity was significantly lower in institutionalized subjects and in home-living elderly with cataract than in healthy elderly subjects (P < 0.05). The cataractogenic action of milk lactose is dependent on the disturbance of galactose metabolism in elderly subjects. (Birlouez-Aragon et al., 1993)

Comprehensive Adrenal Panel

DHEA

High levels of dehydroepiandrosterone sulfate (DHEAS) were associated with a reduced risk of cataract (OR=0.79; 95% CI: 0.63-0.99). (Defay et al., 2003)

Toxic Heavy Metals

Cadmium

Cadmium had a statistically significant higher concentration in blood and lenses of smokers compared with that of non smokers (p < 0.0001). There was a significantly high accumulation of cadmium in the lenses of cataractous smokers reaching about a four-fold increase in heavy smokers (15.4 +/- 0.4 micromol/g) and nearly a three-fold increase in light smokers (10.1 +/- 0.4 micromol/g) when compared to that of nonsmokers (3.7 +/- 0.9 micromol/g). (Mosad et al., 2010)

Lead

The age-adjusted OR (95% CI) for cataract for men in the highest vs lowest quintile of tibia lead level was 2.68 (1.31-5.50). Further adjustment for pack-years of cigarette smoking, diabetes, blood lead levels, and intake of vitamin C, vitamin E, and carotenoids resulted in an OR of 3.19 (95% CI, 1.48-6.90). For patella lead level, there was an increased risk of cataract in the highest vs lowest quintile (OR, 1.88; 95% CI, 0.88-4.02), but the trend was not significant (P = .16). Blood lead levels, more indicative of short-term exposure levels, were not significantly associated with cataract (OR, 0.89; 95% CI, 0.46-1.72; P = .73). (Schaumberg et al., 2004)

Mercury

Higher blood mercury (Hg) (B-Hg; > or = 25th percentile, 25 microg/L) was associated with a higher prevalence odds ratio (POR) of age-related cataracts (adjusted POR 95% confidence interval 4.45, 1.43-13.83). (Lemire et al., 2010)

Nutritional Assessments

Homocysteine, Folate and Vitamin B12

A study of 40 cataract patients and 20 age matched control subjects found serum homocysteine level is significantly increased in cataract patients when compared with control (p< 0.001). There was a significant decrease in the level of folate as compared with control (p<0.001). There was a negative correlation between homocysteine vs. vitamin B12 (p<0.01) and folate (p<0.01) in the cataract patients. These findings suggest that increased plasma homocysteine level is associated with decreased plasma levels of folate and VitaminB12 in cataract patients. (Sen et al., 2008)

Vitamin C

A meta-analysis of the association of vitamin C with the risk of age-related cataract included 15 articles with 20 studies for vitamin C intake and eight articles with 10 studies for serum ascorbate. The relative risk (RR) and 95% confidence interval of cataract for the highest versus the lowest category of vitamin C intake was 0.814 (0.707-0.938), and the associations were significant in America and Asia. Significant association of cataract risk with highest versus the lowest category of serum ascorbate was found in general [0.704 (0.564-0.879)]. Inverse associations were also found between serum ascorbate and nuclear cataract and posterior subcapsular cataract. Higher vitamin C intake and serum ascorbate might be inversely associated with risk of cataract. (Wei et al., 2015)

A cross-sectional study examined people aged >or=50 years from a household enumeration of 11 randomly sampled villages in North India. Compared with levels in Western populations, antioxidants were low, especially vitamin C. Vitamin C was inversely associated with cataract. Odds ratios (OR) for the highest (>or=15 micromol/L) compared with the lowest (

A study of 50 cataract patients and controls found the mean plasma ascorbic acid level in the test group was 0.96 +/- 0.08 mg/dl and 1.12 +/- 0.15 mg/dl in the control group. Ascorbic acid level in the test group was significantly lower than the control group and p value = 0.00001. (Jalal et al., 2009)

Selenium

In a study of adults from 12 riverside communities, lower plasma selenium (Se) (P-Se; < 25th percentile, 110 microg/L) was associated with a higher prevalence odds ratio (POR) of age-related cataracts (adjusted POR 95% CI 2.69, 1.11-6.56). (Lemire et al., 2010)

References

Birlouez-Aragon, I., et al. (1993), ‘Disturbed galactose metabolism in elderly and diabetic humans is associated with cataract formation’, J Nutr, 123 (8), 1370-76. PubMed: 8336207

Defay, R., et al. (2003), ‘Relationships between hormonal status and cataract in french postmenopausal women: the POLA study’, Ann Epidemiol, 13 (9), 638-44. PubMed: 14732303

Dherani, M., et al. (2008), ‘Blood levels of vitamin C, carotenoids and retinol are inversely associated with cataract in a North Indian population’, Invest Ophthalmol Vis Sci, 49 (8), 3328-35. PubMed: 18421094

Ghaem Maralani, H., et al. (2013), ‘Metabolic syndrome and risk of age-related cataract over time: an analysis of interval-censored data using a random-effects model’, Invest Ophthalmol Vis Sci, 54 (1), 641-46. PubMed: 23258144

Goodrich, M. E., et al. (1999), ‘Plasma fibrinogen and other cardiovascular disease risk factors and cataract’, Ophthalmic Epidemiol, 6 (4), 279-90. PubMed: 10544342

Heydari, B., et al. (2012), ‘Correlation of cataract with serum lipids, glucose and antioxidant activities: a case-control study’, West Indian Med J, 61 (3), 230-34. PubMed: 23155978

Hiller, R., et al. (2003), ‘Serum lipids and age-related lens opacities: a longitudinal investigation: the Framingham Studies’, Ophthalmology, 110 (3), 578-83. PubMed: 12623825

Jalal, D., F. Koorosh, and H. Fereidoun (2009), ‘Comparative study of plasma ascorbic acid levels in senile cataract patients and in normal individuals’, Curr Eye Res, 34 (2), 118-22. PubMed: 19219683

Kim, S. I. and S. J. Kim (2006), ‘Prevalence and risk factors for cataracts in persons with type 2 diabetes mellitus’, Korean J Ophthalmol, 20 (4), 201-4. PubMed: 17302203

Klein, B. E., R. Klein, and K. E. Lee (1997), ‘Cardiovascular disease, selected cardiovascular disease risk factors, and age-related cataracts: the Beaver Dam Eye Study’, Am J Ophthalmol, 123 (3), 338-46. PubMed: 9063243

Lemire, M., et al. (2010), ‘Selenium and mercury in the Brazilian Amazon: opposing influences on age-related cataracts’, Environ Health Perspect, 118 (11), 1584-89. PubMed: 20716509

Mollazadegan, K., et al. (2011), ‘Increased risk of cataract among 28,000 patients with celiac disease’, Am J Epidemiol, 174 (2), 195-202. PubMed: 21624959

Mosad, S. M., et al. (2010), ‘Lens cadmium, lead, and serum vitamins C, E, and beta carotene in cataractous smoking patients’, Curr Eye Res, 35 (1), 23-30. PubMed: 20021251

Schaumberg, D. A., et al. (1999), ‘High levels of plasma C-reactive protein and future risk of age-related cataract’, Ann Epidemiol, 9 (3), 166-71. PubMed: 10192648

Schaumberg, D. A., et al. (2004), ‘Accumulated lead exposure and risk of age-related cataract in men’, JAMA, 292 (22), 2750-54. PubMed: 15585735

Sen, S. K., P. Pukazhvanthen, and R. Abraham (2008), ‘Plasma Homocysteine, Folate and Vitamin B(12) levels in senile cataract’, Indian J Clin Biochem, 23 (3), 255-57. PubMed: 23105765

Wei, L, et al. (2015), ‘Association of vitamin C with the risk of age-related cataract: a meta-analysis.’, Acta Ophthalmol, PubMed: 25735187

Chapter 2. Dry Eyes

Dry eye disease (keratoconjunctivitis sicca) commonly affects the elderly population. In the United States, it is estimated that 40 million people are affected.

Conventional Lab Tests

RF, ANA, anti-Ro, anti-La (Sjögren syndrome)

Additional Lab Tests

Fasting Glucose, Hemoglobin A1C

Fifty patients with diabetes were enrolled. The majority of the subjects were female (76%), African American (56%), and/or had a diagnosis of type 2 diabetes (82%). The mean +/- standard deviation (SD) for age was 54.6+/-13.4, and maximum tear