PRODUCT SPOTLIGHT From time to time, Bariatrics Today reports on new products of potential interest to our readers, particularly if academic research data is involved.
PNT-200 and Immunocal
Milk Fractions
Promote Optimal Pre- and Post-Op Care by William Code, MD, FRCPCP
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he medical community has long known that milk consumption offers significant health benefits. However, the full spectrum of milk-derived substances with proven health-promoting properties has not yet been exhaustively explored. Research has revealed, however, several exciting possibilities for those turning to milk for healing. Two such possibilities are PNT-200 (a milk-derived sleep aid) and Immunocal, a cysteine-rich whey protein isolate. Mothers often offer glasses of milk to calm their children. Research into nature’s tranquilizing peptide in milk, under professors Guy Linden and Jean-François Boudier in France, has shown that there is scientific support for this common maternal action. Linden and Boudier started with the concept that newborn babies settled and slept soon after breast feeding, while older infants did not settle as completely. With study, they realized that a newborn had fewer gastrointestinal enzymes to break down proteins. Subsequent investigation revealed a decapeptide with anxiolytic properties. This research may prove beneficial to those looking for new options to deal with the inability to sleep. With the recent class-action suit against Ambien in the United States, many sleep-disorder patients are likely to be searching for alternative sleep aids. A milk byproduct called PNT-200 may be the answer for some of these patients. Initially discovered and patented in France, the protein is now available throughout Canada and the USA without prescription and was awarded a U.S. Patent on December 8, 1998. PNT-200 is a milk byproduct with ten amino acids, a decapeptide. Studies have shown that PNT-200 works on the gammaaminobutyric acid (GABA) A receptor complex in the brain—not unlike the benzodiazepines Valium and Librium. However, unlike benzodiazepines, it does not suppress dream or rapid eye movement (REM) sleep. A recent study confirms that the isolate also lowers cortisol, a key step in the weight loss struggle and optimal function of insulin receptors. PNT-200 is safe for sleep issue treatment even in the morbidly obese, as it does not depress respiration and does not interact with prescribed medication. Once the function and efficacy of the decapeptide had been established, the next step was to determine its safety for human use. To that end, the decapeptide was double blind tested for its possible addictive effect. Researchers used the standard paradigm
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of the Conditional Place Preference in male Wistar rats. Diazepam (Valium) was used as a reference substance. Unlike diazepam, the decapeptide did not Note: Neither this publication nor its owner receive fiinduce dependence. nancial support from the manufacturer of this product. Further in vivo tests revealed no memory loss or amnesiac effect in subjects receiving PNT-200, while those receiving diazepam experienced memory impairment. Finally, the substance was evaluated for “tolerance.” No tolerance was revealed, meaning that the effectiveness of the decapeptide did not decrease over time. The positive outcomes of these trials set the stage for human trials. The first human study was on the oral ingestion of the decapeptide by healthy people to study their blood pressure, heart rate, anxiety and cognitive function under conditions of moderate stress. Two outcomes were noted. First, human subjects with a high anxiety level had a slower increase in their global anxiety score when they received the decapeptide. Second, there was no apparent effect of the decapeptide on cognitive function or on hemodynamic parameters under these conditions. The second human trial was on healthy volunteers, measuring their hemodynamic parameters and hormonal stress indicators (cortisol and adrenocorticotropic hormone, or ACTH) under conditions of moderate stress. The study found that during stress tests, the ACTH and cortisol increased in the control group, but not in the decapeptide group. In summary, this agonist effect of the decapeptide enhances the inhibiting action of the neurotransmitter GABA and so modulates the anxiety response, proving it is a valuable tool in the sleep-challenged and the anxious client—both common problems in the postoperative bariatric population. While PNT-200 may have a positive impact on bariatric patients, another milk-derived product offers the enhancement of intracellular glutathione (GSH), which impacts healing, immune optimization and detoxification. Significant study into the effects of GSH has been undertaken by Gustav Bounos, MD, FRCSC, and immunologist Patricia Kongshavn, PhD, at McGill Univer-
B a r i a t r i c s To d a y 2 0 0 6 I S S U E 2 ©2006 ObesityHelp, Inc. All rights reserved. Reprinted with permission from Bariatrics Today Magazine. For information about reprints or to subscribe, please e-mail editor@obesityhelp.com or call toll-free (866)957-4636 ext. 353
sity in Montreal. Their research led to the development of a cysteine-rich whey protein isolate capable of raising GSH in the body. Fresh milk whey contains GSH precursors of bioactive cysteine such as lactoferin, beta-lactalbumin and serum albumin. Whey protein is the optimal protein source. If eggs are the standard of protein at 100, cheese is 80, soy is 70, and whey protein is 140. Whey proteins are absorbed both quickly and easily. Hence, they are termed “fast proteins.” The GSH derived from milk has three primary functions in the bariatric patient: 1. It is the “master” antioxidant, recycling vitamins C and E. 2. It contributes to white blood cell optimization. 3. It provides a detoxifying effect, ridding the body of xenobiotics and drugs, which enhances the preoperative preparation and optimization of bariatric patients. Raising intracellular GSH pre-operatively over the recommended six-month period between the surgeon consultation and the surgery date can have profound benefits. The first role of GSH is that of master antioxidant. The GSH and the cysteine-cysteine combinations in the cell are the main control items in the redox (reduction-oxidation) balance within the cell. These compounds permit normal superoxide molecule signaling but protect against excess free-radical injury within the cell. These activities validate GSH’s role as the cells’ master antioxidant. In addition, adequate GSH permits actual recycling of both Vitamins C and E, perhaps our best-known antioxidants. This “recycling” reduces the need for large use of either of these vitamins. Furthermore, the body has multiple feedback loops so there is never too much GSH produced. The second key benefit of adequate amounts of GSH is optimal function of white blood cells. We now know a white blood cell can deplete half of its stores of GSH in five to six hours. Optimal GSH in our white blood cells permits our best control of both viral and bacterial infections. This includes improving outcomes from MRSA (methicillin-resistant staph aureus) and clostridium difficile. In addition, the optimal performance of white blood cells reduces general cancer risks. The third major role of GSH in our cells is detoxification. Almost all drugs on the market bind with GSH prior to removal from the body. Similarly, GSH removes most xenobiotics and other toxins, including heavy metals, herbicides and pesticides. This is hugely important if fat loss is anticipated, as an ongoing detoxification is not only good, but also critical, as fat tissue is burned as energy. Most toxins are fat-soluble and are released as fat is broken down. Glutathione is depleted in virtually all chronic diseases. Cysteine and glutathione are also key in insulin receptor response—important in both fat loss and insulin resistance in type 2 diabetes mellitus. When one links the above concept with cysteine supplementation’s ability to reverse negative nitrogen balance in severe illness or the perioperative period, one can appreciate the significance of a whey protein isolate which assists the healing response. A patented process has been developed to allow for optimal
concentrations. The product that results is the closest ever developed to “Humanized Milk Serum” (HMS), which is essentially human breast milk. In Canada, this product is called HMS-90 for the above reasons, and in the USA and other international markets it is called Immunocal. The process involves low-temperature pasteurization and micro-filtration of milk whey through a ceramic filter. The end product contains 10-gram units of (WPI) Immunocal, 90 percent protein. Immunocal permits optimal gut absorption through the gut wall/lining and into the blood stream. This bioactive cysteine, in
Research has revealed, however, several exciting possibilities for those turning to milk for healing. Two such possibilities are PNT-200 and a cysteinerich whey protein isolate. glutamyl-cysteine and cysteine-cysteine form, is readily absorbed into all cells, including those through the blood brain barrier. Furthermore, these non-polar dipeptides are readily transported across cell membranes, hence providing the rate-limiting component for optimal intracellular glutathione GSH production. GSH formation involves nearly 100 steps and is optimized by several co-factors such as selenium, vitamins B1, B2, B6, B12, folic acid and vitamins C and E. In conclusion, the milk-derived products PNT-200 and Immunocal can have significant effect on the overall health and healing of bariatric patients. n Dr. Bill Code MD, FRCPC is an anesthesiologist, board-certified in the U.S. and Canada, who is passionate about Integrative Medicine—especially nutrition—for enhancing brain function and reducing chronic pain. In 1996, Dr. Code was diagnosed with Multiple Sclerosis, which left him off work, and on a 13month progressive downhill course. His journey of recovery and his ongoing solutions can be found in several books, including Winning the Pain Game, which is due for release this summer. Recommended Reading Droge, Wulf, Redox Regulation In Anabolic and Catabolic Processes, Current Opinion in Clinical Nutrition and Metabolic Care 9: 190-195 (2006) Droge, Wulf, Oxidative Aging and Insulin Receptor Signaling, The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 60: 1378-1385 Kongshavn P., Glutathione in Health and Disease, Research Brief, Today’s Dietician 2005, January Lang, et al, Journal of Laboratory and Clinical Medicine, Volume 135 Number 5
B a r i a t r i c s To d a y 2 0 0 6 I S S U E 2 ©2006 ObesityHelp, Inc. All rights reserved. Reprinted with permission from Bariatrics Today Magazine. For information about reprints or to subscribe, please e-mail editor@obesityhelp.com or call toll-free (866)957-4636 ext. 353
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