KOREAN FOUNDATION FIGHTING BLINDNESS

번역... 아니 나름대로 해석
아직쓸만한눈	2007/02/06	1,198
New Findings Lead to Revised Therapeutic Regimen to Slow RP The Berman-Gund Laboratory for the Study of Retinal Degenerations, at Harvard Medical School, has just completed the second in an ongoing series of clinical trials testing nutritional or other supplements as potential therapies for retinitis pigmentosa (RP). RP를 늦출 치료 식이요법이 새롭게 부각되고 있다. 망막 퇴보에 대한 연구를 하는 Berman-Gund 실험실(하버드 의학 학교)는 RP의 잠재적인 치료법으로서 다른 영양보충을 실험하는 일련의 의학적 시도에 두 번째 단계를 완성했다.?? The first clinical trial completed in 1993 demonstrated a beneficial effect on visual function of Vitamin A and a deleterious effect of Vitamin E. As a result, the Foundation Fighting Blindness and the National Eye Institute jointly recommended for most adults the daily administration of 15,000 units of Vitamin A palmitate. 그 첫 의학 시도는 1993년에 끝냈는데 비타민 A의 시각적 기능과 비타민E의 해로운 효과에 대한 이로운 결과로 표현된다. 그 결과 실명과 싸우는 단체와 국립안학회가 공동으로 대부분의 어른들에게 15000유닛의 비타민 A 팔미테이트를 섭취하는 것을 추천했다. Not fully understood, either then or now, the beneficial effect of Vitamin A was slow to take effect, becoming evident in the original clinical trial only after several years of administration. 완벽히 이해되지 않지만 그 때나 지금이나 비타민 A의 이로운 효과는 매우 늦게 발현되지만 수년간의 관리 후에 그 의학 시도는 명백해진다. Just completed, a second study was designed to test whether a lipid of special relevance to vision, DHA, taken as a dietary supplement would enhance the already recognized sight-saving benefit of Vitamin A. The results of the second trial are published in two reports in the September 2004 issue of the American Medical Association’s Archives of Ophthalmology. 지방질 DHA가 시각과 특별한 관계가 있는지를 알아보는 두 번째 연구가 막 완성되었는데, 식이보충제로 DHA를 섭취하면 이미 알려진 비타민A의 시야보존 기능을 증진시켜준다. 그 연구의 결과는 미국안과의학협회 2004년 9월 문서에 발표되었다. The lead author of the report, Eliot L. Berson, M.D., is a member of the Scientific Advisory Board of The Foundation Fighting Blindness. The results are complex and are best understood when it is kept in mind that the benefit to vision observed in the original trial took several years to become evident. In fact, some wondered at the announcement of the results of the first clinical trial if treatment effects so delayed were indeed valid. The second trial sheds light on the question of validity as it demonstrates an interaction between Vitamin A and DHA such that DHA apparently foreshortens the time for Vitamin A to become effective. 그 연구의 주 저자인 의학박사 Eliot L. Berson는 반실명단체의 과학자문위원 중 한사람이다. 그 결과는 복잡하고 수년간에 걸친 본래의 시도를 잘 따라야 시각에 이익을 준다는 사실을 마음 깊이 인식하고 있어야 쉽게 이해할 수 있다. 사실, 어떤 사람들은 첫 번째 의학적 시도의 결과 발표를 걱정했다. 만약 매우 늦게 나타나는 치료 결과가 정말 유효하다면, ??? This became evident when it was recognized that two groups of participants took part in the second clinical trial: subjects already taking Vitamin A and subjects not taking Vitamin A. Among many other considerations, this distinction was not recognized in the original study design and, hence, no notice of it was taken in the original randomization. 이것은 두 그룹으로 나누어 두 번째 의학연구를 한다면 분명해진다. 한 그룹은 비타민A를 복용하고 한집단을 비타민 A를 복용하지 않는다. 다른 많은 고려사항 중에 이런 구분은 원래 연구 설정에서 인식되지 않고 그래서, 원래 무작위로 .... 어렵다 ..이부분은 However, early in the course of the just reported clinical trial an interaction was recognized. Thereafter, the clinical course of the two categories of participants was followed annually. At the conclusion of the clinical trial, subgroup analyses clearly documented that DHA accelerated the onset of visual benefit for those who were newly started on Vitamin A. But in participants who had already taken Vitamin A for a period of time long enough to achieve its full benefit, DHA did not add to that benefit. 그러나 발표된 의학 연구의 초기 과정에 상호작용이 인지되었다. 그 후 두 그룹의 참여자의 의학 과정이 매년 뒤따랐다. 의학 연구 결과 하위그룹이 DHA가 새롭게 비타민A를 시작하는 사람들에게 시각적 이익을 배가시킨다는 것을 문서로서 명백히 분석되었다. 그러나 이미 비타민A를 오랫동안 복용하여 최대 이익을 얻은 참여자들에게는 DHA는 그 이익을 별로 증대시키지 않았다. The second clinical trial included a careful survey of dietary practices of all participants. When these were analyzed, it was discovered that intake once or twice a week of fish with a high fat content (such as tuna, mackerel, sardines, salmon or herring) conferred an additional visual benefit. The study from the Berman-Gund Laboratory also showed that patients with higher red blood cell levels of DHA experienced a substantially slower loss of vision field sensitivity than did patients with lower levels. These results are consistent with findings from a previous FFB-sponsored trial by Dr. Dennis Hoffman of the University of Texas Southwestern Medical Center and colleagues in subjects with X-linked RP showing that increased DHA levels in the blood were associated with a decreased rate of decline in visual function. 두 번째 의학연구는 모든 참여자의 식이요법의 조심스런 조사를 포함한다. 분석결과, 고지방을 함유한 생선(참치,고등어,정어리,연어,청어 등)을 일주일에 1~2회 섭취하면 추가적인 시각 이익을 준다. Berman-Gund 실험실 연구에 따르면, 고 적혈세포수준의 DHA를 가진 환자가 저 적혈세포단계의 DHA를 가진 환자보다 실질적으로 시각 손실을 민감하게 늦출 수 있다고 한다. 이런 결과는 텍사스대학 남서의학센터의 Dennis Hoffman 의사의 FFB가 보조한 이전 연구와 일맥상통하고 X염색체와 연결된 RP를 가진 사람이 피속의 증가된 DHA이 시각기능 상실율을 낮추는 것과 관련이 있다..... Based on the findings of these clinical trials, Dr. Berson and his colleagues have issued an advisory letter. The letter follows and is also available on the Foundation Fighting Blindness web site (FightBlindness.org). It contains specific recommendations and cautions. These include obtaining blood tests periodically as well as information on sources of appropriate Vitamin A and DHA supplements. The research was supported by grants from The Foundation Fighting Blindness and the National Eye Institute. 이런 의학 연구에 따르면 Berson 박사와 그의 동료는 조언이 담긴 문서를 발표했다. 그 문서는 반실명단체 웹사이트(FightBlindness.org)에서 볼 수 있다. 그 내용에는 구체적인 추천과 주의사항을 포함한다. 그리고 규칙적인 피검사와 적당한 비타민 A와 DHA 섭취의 정보를 포함한다. 그 연구는 반실명단체와 국립안학회가 무상으로 서포트 했다. -------------------------------------------------------------------------------- HARVARD MEDICAL SCHOOL * MASSACHUSETTS EYE AND EAR INFIRMARY BERMAN-GUND LABORATORY FOR THE STUDY OF RETINAL DEGENERATIONS 243 Charles Street Boston Massachusetts 02114 September 23, 2004 New Treatment Regimen for Patients with Retinitis Pigmentosa In June 1993, we reported in the Archives of Ophthalmology that vitamin A palmitate 15,000 IU/day helped to preserve retinal function while vitamin E 400 IU/day appeared to hasten the loss of retinal function among patients with retinitis pigmentosa (RP). This led to the recommendation that most adults with the typical forms of RP should take vitamin A palmitate 15,000 IU/day and avoid high dose vitamin E supplements such as the 400 IU/day used in this study. RP 환자의 새로운 처치법이 1993년 6월,,,우리(누구?)가 안과책자에 발표되었다. 15000IU/일는 망막기능을 보존하는 것을 돕는 반면 비타민E 400IU/일은 RP환자 중에 망막기능 손실을 재촉하게 보인다. 그 연구에 따르면 대부분의 RP 전형적인 형태를 가진 성인은 비타민A 팔미테이트를 15000IU/일을 섭취하고 고용량의 비타민E 보충제(400IU/일 이상)를 피하는 것이 좋다고 추천한다. This recommendation remains the same today. In September 2004, the Archives of Ophthalmology has just published two reports that summarize the results of 8 years of work to evaluate the effects of docosahexaenoic acid (DHA) for adults with typical RP also receiving vitamin A palmitate 15,000 IU/day. The results are complex. The first new report on all participants taken together showed that DHA supplementation by capsules (600 mg twice each day) did not, on average, slow the course of RP over a four-year interval. Therefore, we cannot make any general recommendation for DHA supplementation by capsules for patients already taking vitamin A palmitate. 이 추천은 오늘날도 똑같이 적용된다. 2004년 9월 안과학회지는 비타민A 팔미테이트 15000IU/일을 섭취하는 전형적RP 성인을 위한 DHA의 영향을 평가하는 8년간의 노력의 결과를 요약하는 두 연구를 발간했다. The second new report describes the results in subgroups of the participants. Here we observed that DHA supplementation did provide a benefit. However, the benefit was limited to the subgroup of patients starting vitamin A palmitate for the first time. In a comparison among randomized patients in this subgroup, DHA supplementation by capsules slowed the course of RP for two years. In addition, a dietary benefit of omega-3 rich food became evident as stated in the second report. 두 번째 새로운 보고서는 하위그룹 참석자들의 결과를 묘사한다. DHA보충제가 이익을 줄것이라는 것일 따른다??? 그러나 그 영향은 비타민A를 처음으로 시작한 하위 집단의 환자에게 제한된다. 그 하위 집단의 무작위 환자과 비교해서 캡슐 DHA 보조제는 RP의 진행을 2년간 늦춘다. 그리고 두 번째 보고서에는 오메가3이 풍부한 음식의 식이 이익은 분명하다고 한다. We observed that patients taking vitamin A palmitate (but not on DHA capsules) with a higher omega-3 rich diet intake (i.e., equivalent to eating 1-2 three-ounce servings per week of omega-3 rich fish, such as salmon, tuna, mackerel, herring, or sardines, which contain among other constituents considerable DHA) had, on average, a 40 - 50% slower annual rate of loss of visual field than patients with a lower omega-3 rich diet intake. The results in the second report lead us to offer the following general recommendations. (1) For adults with typical RP already on vitamin A palmitate 15,000 IU/day, we advise that they continue vitamin A palmitate and eat 1-2 three-ounce servings per week of omega-3 rich fish. (DHA를 안먹고) 비타민A 팔미테이트와 고용량의 오메가3 음식을 섭취하는 환자는 저용량의 오메가3음식을 섭취하는 환자보다 평균 40~50% 시각손실을 낮출 수 있다. 두 번째 보고서의 결과에 따르면 1. 비타민A(15000IU/일)를 먹고 있던 전형적인 RP 성인환자는 계속 비타민A를 먹고 매주 오메가3가 풍부한 생선을 3온스씩 1~2회 먹어라 Including this amount of fish in the diet is consistent with current American Heart Association recommendations. About three months after starting omega-3 rich fish, we advise a measurement of fasting red blood cell (RBC) DHA through their physician to confirm that the RBC DHA level is at least 4% of total RBC fatty acids, as we reported that such patients have, on average, a slower rate of decline of visual field than patients with lower levels. If the RBC DHA level is not at least 4%, we advise patients to consult with their physician on how best to reach this level through food. If the level is 4% or greater, this test could be repeated annually thereafter. 이 생선 섭취량은 현재 미국심장협회 추천과 일맥상통한다. 오메가3이 풍부한 생선을 섭취한지 약3개월이 의사로부터 지나면 빠른적혈세포(RBC) DHA를 측정하여 RBC DHA 수준이 RBC 지방산 중 최소 4%가 될것을 확인할 것을 권한다. RBC DHA 수준이 낮은 환자에 비해 높은 사람이 평균적으로 낮은 시각손실률이 나타난다고 보고되었기에... RBC DHA 수준이 최소 4%가 안되면 의사와 상담하여 음식을 통해 어떻게 그만큼의 수준으로 만들 수 있는지 상담한다. 만약 4% 이상일 경우 이 테스트는 그 후 매년 논문에 실릴 수 있다?? (2) For adults with typical RP who plan to start vitamin A palmitate 15,000 IU/day for the first time, the results support the following. If fasting serum vitamin A and liver function profile are normal, we advise that they take this dose of vitamin A palmitate and also supplement with DHA capsules 600 mg twice each day (i.e., three 200 mg capsules in both the AM and PM with meals) for two years. After two years patients should discontinue DHA supplementation by capsules because no evidence was found for continued benefit and because a slight tendency toward adversity on ocular function was observed over the longer term among patients concurrently on vitamin A palmitate. (2)전형적인 RP환자가 비타민 A를 복용하기 시작하는 사람들은,,, 다음과 같이 해라. 단식혈청비타민A와 간기능형태가 정상적이라면 비타민A와 2년간 DHA 600mg을 하루 두 번 먹기를 권한다.(예를 들어 (예를 들어 200mg 짜리 캡슐을 오전 오후 식사시에 3회 먹는 것) 2년 후 환자는 DHA를 캡슐로 더 먹으면 안된다. 왜냐하면 계속된 이익의 증거가 밝혀진 게 없기 때문에 그리고 비타민 A 팔미테이트를 동시에 섭취하는 사람 중에 시각기능의 어려움에 대한 경향이 관찰되기 때문이다. After stopping DHA capsules after two years, patients should continue vitamin A palmitate 15,000 IU/day and also eat 1-2 three-ounce servings of omega-3 rich fish each week. Then, about three months after starting omega-3 rich fish, we advise measurement of fasting RBC DHA as described above. It should be noted that combining an omega-3 rich fish diet with DHA capsules did not provide any additional benefit. The study results reported in the second paper show that the potential benefit of combining vitamin A palmitate with dietary intake of 1-2 servings of omega-3 rich fish per week is substantial: the rate of decline of loss of visual field sensitivity was reduced by 40 - 50% per year. 2년후 DHA를 끊고 난 후에 환자는 비타민A 팔미테이트 15000IU/일은 계속 먹고 오메가3이 풍부한 생선을 매주 1~2회 3온스씩 먹어야 한다. 그리고 오메가3이 풍부한 생선을 먹고 3개월정도 지나면 RBC DHA를 위와 같이 검사해 본다. 주의할 점은 DHA캡술과 함께 오메가3이 풍부한 생선을 먹는 것은 부가적인 이익을 제공하지 않는 다는 것이다. 연구 결과에 따르면 비타민A와 오메가3생선을 섭취가 실질적이다고 한다. ::: 시각감소효과를 40~50%감소시켜준다는 것이다. Therefore, combining vitamin A palmitate with this diet regimen could achieve a gain of almost two decades of visual preservation. For example, we have estimated that an average patient age 37 with typical RP already on vitamin A palmitate 15,000 IU/day who maintains an omega-3 fatty acid food intake of at least 0.2 grams per day (i.e., equivalent to eating 1-2 three ounce servings of omega-3 rich fish per week) would be expected to lose virtually all central visual field sensitivity by age 78, whereas an average patient who eats less than 0.2 grams per day would be expected to lose all central visual field sensitivity by age 59. It should be noted that beta-carotene is not vitamin A. It is the precursor of vitamin A, but it is not predictably converted into vitamin A. 따라서 비타민A와 식이 요법을 병행하는 것은 거의 20년간 시각보존을 성취할 수 있다. 예를 들어 팔미테이트를 먹고 오메가3지방산 음식섭취를 하루0.2g 섭취하는 전형적인 RP를 보유한 평균 37세의 환자는 시각적인 모든 중심시야를 78살까지 손실할 수 있다 반면 0.2g이하의 오메가3지방산 음식을 먹는 사람은 59살까지 보존할 것으로 기대된다. 주의할 점으 베타카로틴은 비타민 A가 아니라는 것이다. 그것은 비타민 A의 전신이지 바로 비타민A로 전환되지 않는다. Therefore beta-carotene is not a suitable substitute for vitamin A palmitate in the context of this treatment regimen. Although no toxic side effects have been observed among adults with RP in good general health on vitamin A palmitate 15,000 IU per day (Sibulesky et al., Safety of Less Than 25,000 IU Vitamin A Daily in Adults with Retinitis Pigmentosa, Am J Clin Nutr 69:656-663 1999), we continue to advise that patients obtain a fasting serum vitamin A and liver function profile annually and continue vitamin A palmitate only if these tests are normal. 따라서 그 처치법에 따르면 베타카로틴은 비타민A를 대체하는데 적절하지 못한 것이다. 비록 건강한 성인이 비타민 A 팔미테이트를 하루 15000IU 섭취하는 사람에게 해로운 부작용이 없지만, 단식혈청비타민A와 간기능검사를 매년 받아서 테스트 결과 정상적일때 비타민 A를 섭취해야 할 것이다. We have observed no toxic side effects among adults with RP in good general health on DHA supplementation by capsules. The results apply to most adult patients with typical RP including those with partial hearing loss. The results do not apply to patients with RP and profound congenital deafness, RP as part of the Bardet-Biedl syndrome, or atypical or rare forms of RP as such patients were not included in this study. Women with RP who are pregnant or planning to be pregnant should not take the combination of vitamin A palmitate and DHA by capsules because high vitamin A intake has been associated with an increased risk of birth defects. We did not study patients under age 18 or patients with best-corrected visual acuity of less than 20/100 in both eyes; therefore, we cannot make any formal recommendation for such patients. Our conclusions are based on group averages and, therefore, we cannot provide assurance that this regimen will benefit a specific patient or that it is appropriate for any particular patient. Sources of vitamin A palmitate 15,000 IU as well as DHA in 200 mg gelcaps and the procedure for obtaining a RBC DHA level are attached. DHA캡슐을 먹는 건강한 성인에게 부작용이 있는 것은 발견되지 않았다. 이 결과는 부분적 청력손실이 있는 사람을 포함하여 전형적인 RP성인에게 적용된다. 이 결과는 선천적인 청력장애를 가진 RP 환자, Bardet-Biedl증후군 RP환자, 비전형적이거나 드문형태의 RP환자에게는 적용되지 않는다. 임신한 또는 임신할 계획이 있는 여성 RP 환자는 비타민A 팔미테이트와 DHA 캡슐을 같이 먹어서는 안된다. 왜냐하면 비타민A 과다섭취는 출생결함 위험을 증가시키기 때문이다. 이 연구는 18세 이하에게는 적용되지 않으며 양쪽눈의 20%이하의 잘교정된 시각을 가진 사람에게도 적용안된다. 따라서 이런 환자들에게는 어떤 공식적인 방법을 권할 수 없다. 우리의 연구결과는 그룹평균에 따른 것이며 따라서 이 처치법은 특정 환자에게 보증을 할 수는 없다. 비타민 A 팔미테이트 15000IU와 DHA 200mg 젤캡슐과 RBC DHA 수준 측정과정은 첨부시켜준다. Please share this information with your ophthalmologist and family physician to determine if this regimen is appropriate for you. This treatment regimen should be done only under medical supervision. You are referred to the Archives of Ophthalmology Volume 122, pages 1297-1305 and pages 1306-1314, 2004 if you or your doctors wish to review the details of our research. If you still have questions, please write to us at the above letterhead address. Eliot L. Berson, M.D. ELB/jbq -------------------------------------------------------------------------------- 이 정보를 이 처치법이 당신에게 적절한지 알아보기 위해서 안의학자들과 공유해라. 이 처치법은 의학적인 감독아래에서 이루어져야 한다. 너는 안학회지 2004년판 122권 1297~1305쪽 1306~1314쪽을 보길 권한다. 너 또는 너의 주치의가 우리 연구를 보길 원한다면,,, 질문이 있으면 위에 주소로 편지를 써 주라. Eliot L. Berson M.D. 이하 아래는 위애 같은 소리를 반복하는 것 같아서... Known Sources of Vitamin A Palmitate Vitamin A palmitate 15,000 IU/day has been recommended for most adults with typical forms of retinitis pigmentosa (see Berson et al; Archives of Ophthalmology 111:761-772, 1993). Patients with retinitis pigmentosa should consult with their doctor concerning whether vitamin A is appropriate for them before ordering this supplement. Adults planning to take vitamin A palmitate should have a normal fasting serum vitamin A and liver function profile before starting this treatment and annually thereafter. It is important to note that beta-carotene (the precursor of vitamin A) is not predictably converted into vitamin A; therefore beta-carotene is not a suitable substitute for vitamin A palmitate in the context of this treatment. The recommended dose of vitamin A palmitate is not available in most food stores. Some known sources are listed below. Sources of 15,000 IU of vitamin A palmitate FREEDA VITAMINS, INC. 36 East 41st Street New York, NY 10017 1–800–777–3737 (outside NY) or 1–212–685–4980; FAX 1-212-685–7297 AKORN OPHTHALMICS 2500 Millbrook Drive Buffalo Grove, IL 60089 1–800–932–5676 A–Palmitate–15 100 Tablets $5.90/bottle 250 Tablets $11.65/bottle Shipping & Handling $4.95 Will ship outside USA for extra postage Palmitate–A 15000 100 Tablets/Bottle $7.50/bottle (minimum order of two bottles) Shipping & Handling included J.R. CARLSON LABORATORIES, INC. 15 College Drive Arlington Heights, IL 60004–1985 1–888–234–5656 (outside Chicago) or 1–847–255–1600 Products #1101 and 1102 120 Gel-caps $6.90/bottle 240 Gel-caps 12.90/bottle Shipping & Handling 4.50 Will ship outside USA for extra postage Precautions: Women who are pregnant or planning to be pregnant should not take this dose of vitamin A because of the increased risk of birth defects among women on high-dose vitamin A supplements. Because of a slight increase (1% or less) in the risk of developing a hip fracture noted in post-menopausal women not on hormones but taking vitamin A supplements (Feskanich et al: JAMA 287:47-54, 2002) and in men age 49 or older with high serum vitamin A levels (Michaelsson et al: NEJM 348:287-294, 2003), such patients should have a periodic evaluation of bone health with their physician. This dose should not be used in children or young adolescents with RP because of a potential for toxicity. Disclaimer: The listing of these suppliers and their products should not be misinterpreted as a recommendation or indication of proprietary interest in any of these companies. -------------------------------------------------------------------------------- Known Sources of Neuromins® DHA 200mg DHA in a dose of 600 mg twice a day has been recommended for most adult patients with typical retinitis pigmentosa who are starting vitamin A palmitate 15,000 IU/day for the first time (see Berson et al; Archives of Ophthalmology 122: 1306-1314, 2004). Patients with retinitis pigmentosa should consult with their doctor concerning whether DHA is appropriate for them before ordering this supplement. Neuromins® DHA 200 was the form of DHA used in this study. Neuromins® DHA 200 is available in many health food stores across the country. Brands of Neuromins® DHA 200 include Nature’s Way, Source Naturals, Solaray, Natrol, and Solgar. The above brands are sold directly to retail stores and clearing houses (two listed below) rather than to individual consumers. However, both Nature’s Way (1-800-962-8873 or www.naturesway.com) and Natrol (1-800-262-8765 or www.natrol.com) will help you locate a local supplier. The dose recommended is 600 mg twice each day (3 in the AM and 3 in the PM with meals) only for 2 years. Therefore, patients ordering Neuromins® DHA 200 will be taking six softgels per day. For example, a one-month supply would be 180 softgels and patients should plan accordingly. The following are sources of Neuromins® DHA 200 readily accessible by toll-free phone or via their websites. SWANSON HEALTH PRODUCTS P.O. Box 6003 Fargo, ND 58108-6003 1–800–437-4148 www.swansonvitamins.com (search Neuromins® on the homepage) 30 softgels (SWU092) 200mg 12.49/bottle Shipping & Handling 4.95 Ship abroad for additional fee. THE VITAMIN SHOPPE Customer Care Department 2101 91st Street North Bergen, NJ 07047 1-800-223-1216 www.vitaminshoppe.com (search Neuromins® on the homepage) 60 softgels (SR-5558) 200mg 30.80/bottle 120 softgels (SR-5559) 200mg 59.98/bottle Shipping & Handling 4.99 Ship abroad with restrictions for added fee Precautions: Please be reminded that DHA supplementation in a dose of 600 mg twice a day for adults with typical retinitis pigmentosa (RP) on vitamin A palmitate was reported to be effective for only two years and only in patients starting vitamin A for the first time. The products described above in this dose have not been tested or evaluated to determine their safety or effectiveness in children or adolescents with RP. Stopping instructions: This dose of DHA should not be continued beyond two years because no evidence was found of a continued benefit and also because a slight tendency toward adversity on ocular function was observed over the longer term among patients on vitamin A palmitate 15,000 IU/day (see Archives of Ophthalmology, Volume 122, pages 1306-1314, 2004). This supplement in combination with vitamin A palmitate should not be taken by women who are pregnant or planning to become pregnant because of an increased risk of birth defects among women on high dose vitamin A intake. Disclaimer: The listing of these suppliers and their products should not be misinterpreted as a recommendation or indication of proprietary interest in any of these companies. -------------------------------------------------------------------------------- September 23, 2004 PROCEDURE FOR OBTAINING A RED BLOOD CELL DOCOSAHEXAENOIC ACID (DHA) LEVEL 1. Patients should fast overnight. If not feasible, fast at least 4 hours prior to the blood draw. 2. Use a 5 ml EDTA - Lavender top vacutainer tub (Becton Dickenson Catalog #DB366452 or #DB367863). Collect about 3 ml of blood in an EDTA tube. The tube should be labeled with the PATIENT'S NAME and the DATE THE BLOOD WAS DRAWN. 3. The patient's blood should be packaged in a Specimen Collection Kit provided by the laboratories below only on request from your physician. Your physician should fill in the required information on a Test Requisition Form, available at the websites of the laboratories listed below, and request a RBC DHA level which is part of a RBC total lipid fatty acid profile. 4. Send the lavender EDTA tube of whole blood at room temperature by same day courier on the day collected (Mondays through Thursdays only) in a Specimen Collection Kit following kit instructions for packaging and shipping along with the Test Requisition Form to either one of the three laboratories listed below to arrive within 24 hours after the specimen was drawn via DHL or Federal Express: Peroxisomal Diseases Laboratory Kennedy Krieger Institute 707 North Broadway, Room 530 Baltimore, MD 21205 Tel # 443-923-2788 Fax# 443-923-2755 www.genetics.kennedykrieger.org $150.00 with specimen (pre-pay) Great Smokies Diagnostic Laboratory 63 Zillicoa Street Asheville, NC 28801 Tel# 800-522-4762 Fax# 828-252-9303 www.gsdl.com $150.00 with specimen (pre-pay) Metametrix Clinical Laboratory 4855 Peachtree Ind. Blvd Norcross, GA 30092 Tel# 800-221-4640 Fax#770-441-2237 www.metametrix.com $150.00 with specimen (pre-pay) A report will be sent within about 1 month. Adults with typical retinitis pigmentosa on vitamin A palmitate 15,000 IU/day and an omega-3 rich diet should strive to have a RBC DHA level of 4% or greater of total RBC fatty acids. If the level is 4% or greater, the level could be rechecked annually. Patients who have not achieved this level should consult with their physician on ways to increase their RBC DHA level through food intake and then recheck their level about 3 months after changing their food intake (See Archives of Ophthalmology 122:1306-1314, 2004). Disclaimer: The listing of these suppliers and their tests should not be misinterpreted as a recommendation or indication of proprietary interest in any of these companies. http://www.blindness.org/rp-nutrition/index.asp 저도 위에것처럼 복용중인데요. DHA는 2년 먹고 끊어야 한다네요. DHA는 아침 저녁 식사 직후에 1개씩 먹고 팔미테이트는 아침이나 점심먹고 나서 먹는데요. 간염보균자라서 간기능 검사도 3개월마다 받기는 하는데 아직 정상범위에는 있던데 약먹기 전보다 GPT, GOT 수치가 좀 오르긴 했더라구여... 술이 원인인지 비타 A랑 DHA가 원인인지 알 수는 없으나 지속 검사 중입니다. 비타민 A는 평생 무라는 말인가 보네요???? 근데 그 결과는 어떻게 알 수 있는 것인지... 계속 쓸만하다면 다행인 거겠죠..? 2년 먹으려면 지금 1병 180알짜리 먹는데, 1병에 3개월 1년에 4병 2년에 8병... 아직 6병 반은 더 먹어야 한다는 말이되네요. 주5일한다고 주말에 빠지고 평일에도 한번씩 거르는 경우도 많은데 안빠뜨리고 먹어야 겠습니다. 참 DHA 집에 4병 정도 남았는데 필요하신분 연락주세요. 제 폰은 011-564-8081입니다. 그리고 DHA 필요할 사람도 연락주세요. 사람수 모이면 보내달라구 주문하려구여. 오래 보려면 잘 먹어야 겠어요.. 위엣분 좋은 정보 고맙습니다.