Cetyl Myristoleate Documentation

Interest in 9-cis-cetyl myristoleate (CMO) a fatty acid apparently found in mice -- and in a species known for immunity from arthritis -- has been intense at least since Dr. Jonathan Wright interviewed the discoverer, Harry Diehl, in Nutrition and Healing over a year ago. (1) Until recently, animal data provided by Diehl(2) were supported only by anecdotes in humans.(3)

For several months, the text of a double-blinded randomized trial with CMO executed by Humberto Siemandi, a medical doctor from Mexico, has been circulating in the world of natural medicine. The full text was recently published in the Townsend Letter.(4) Whether the author of that report has any vested interest in "CM Plus" or other CMO products produced by Draco International was not clear from the Townsend Letter report.

In that report, placebo or 90 grams of oil containing 18 g of CMO was administered over the course of one month, with or without the addition of glucosamine HCl, sea cucumber, and cartilage, for "a total dosage of 18 grams each of these nutrients." Apparently this means 600 mg of each ingredient per day. Topical CMO was also applied as 60 cc of 25% solution -- again, this appears to have been the total dose for the month. ("CM Plus" contains all four ingredients; the same supplier sells topical CMO as a separate product.) The follow-up appears to have been done in eight week cycles.

The daily dose of glucosamine sulfate used in virtually all previous research is 2.5 times the amount of glucosamine HCl used in this trial. Moreover, The HCl version has not yet been tested, making its inclusion and the dose selected for it both poor choices for a multi-agent trial. Almost certainly, the 600 mg per day of cartilage is too low a dose to affect humans. Doctors of natural medicine generally use higher amounts if they use cartilage at all. The optimal amount of sea cucumber remain a matter of conjecture, but the support for this product in the treatment of rheumatoid arthiritis (RA) is weak enough to have made its inclusion in the protocol a potential mistake.

Although the study is labeled "multicentric," it has only one author. Nonetheless, the large number of subjects (N = 382 completed the study) appears to support this claim. Most patients had RA, though a few had psoriatic arthritis. Tobacco and caffeine were discouraged for participants in all groups. The placebo contained salicylates or ibuprofen as excipients -- a questionable choice that could have worked against an anticipated positive effect for CMO.

Among those receiving all interventions, 88% reported subjective improvement compared with 59% for CMO alone and 16% for placebo. The overall assessments by attending medical doctors were similar. Moreover, a treatment response was seen in 87% of those taking all interventions vs. 63% receiving only CMO and 14.5% on placebo. These results were highly statistically significant.

Although a fair amount was said about indices Siemandi followed in determining a "response," the actual definition of clinical "response" was not stated. The fact that nothing was said about complete responses suggests that they did not occur. Diehl, on the other hand, had originally described CMO as a "cure" for arthritis.

It is fair to say that this report would not have been published in its current form by a normal peer-reviewed journal. The Townsend Letter claims to have recently initiated a partial peer-review process, but the quality of some of its articles suggests otherwise. Nonetheless, the inclusion of a double-masked protocol paired with highly statistically significant outcomes suggests that something did happen. It now becomes critically important for CMO, with or without adjunctive natural therapies, to be studied. It may be equally critical that the principal investigator be unaffiliated with any commercial interests -- this may or may not have been the case with the current trial but the written report remains unclear in this regard. The results also need to be published in a peer-reviewed journal. The definition of "response" must also be dearly delineated. If/when all that is successfully achieved, CMO may potentially become an important part of the natural treatment of RA.

Until then, it remains an expensive (though apparently safe) experiment. There can be little doubt, however, that the current report will stimulate great interest in CMO. Let's hope it also stimulates some more research.

(1) Wright JV. Searching for a cure for arthritis. Nutr Healing 1996; Aug:5-6.

(2) Diehl HW, May EL. Cetyl myristoleate isolated from Swiss albino mice: an apparent protective agent against adjuvant arthritis in rats. J Pharmaceutical Sci 1994; 83:296-9.

(3) Cochran C, Dent R. Cetyl myristoleate -- a unique natural compound valuable in arthritis conditions. Townsend Letter for Doctors & Patients 1997; July:70-74.

(4) Siemandi H. The effect of cis-9-myristoleate (CMO) and adjunctive therapy on arthritis and autoimmune disease -- a randomized trial. Townsend Letter for Doctors & Patients 1997; Aug/Sept:58-63.