Positive Medical
Changes
Cancer Prevention
Lifestyle Risk
Reduction
Exercise and Osteoarthritis
Ask Dr. J: Beta Sitosterol
References
In The Health News
Diet and Disease
Autumn Vegetable
Stew
Dear Friends,
I have often heard a commentary
on the development of science
(and medical science in particular),
meant to be reassuring to those
of us on the cutting edge of medicine,
that goes something like this:
a new idea is at first ignored
and then ridiculed for a number
of years and considered “impossible;”
then it is attacked as dangerous
for some time; then, when dead
bodies do not pile up, it is regarded
as ineffective but harmless; and
finally, after about thirty years,
it becomes commonly accepted,
with many professionals saying
“Oh, but we’ve known
this for 30 years!”
Part of this reluctance to accept
new ideas results from a reasonable
caution, and concern that latching
on to new ideas too readily will
lead to inappropriate acceptance
of many that turn out to be false.
This is understandable, and it
is wise to wait for scientific
evidence before wholehearted adoption
of new ideas. The problem is that
scientific evidence is often discounted
by people who are mired in one
model of thinking. As John Kenneth
Galbraith said, “Faced with
the choice between changing one’s
mind and proving that there is
no need to do so, almost everyone
gets busy on the proof.”
In medicine, this has a long
and colorful history. Dr. Ignaz
Semmelweis proposed handwashing
when going from the autopsy room
to the delivery room, and the
maternal infection-related mortality
on his wards was virtually nil,
but very high on other wards.
His ideas were ignored by most
of the medical profession, who
refused to accept that doctors
could be carriers of disease.
When Barry Marshall and Robin
Warren proposed that Helicobacter
pylori was the cause of most peptic
ulcers, it was discounted by most
physicians who “knew”
that ulcers were caused by stress
and high acidity levels, not an
infection. They just won the Nobel
prize for their discovery. When
Kilmer McCully found, in 1969,
that high serum homocysteine was
a risk factor for heart disease,
he was forced out of his pathology
position at Harvard, only to be
vindicated almost 30 years later.
At the recent meeting of the
American College for Advancement
in Medicine, several presentations
seemed to confirm this schedule
of “ignoring-rejecting-accepting”
new treatment ideas. Of particular
interest was a presentation on
natural treatments for hypertension.
These are treatments that I have
been recommending in various forms
(and with more recent additions)
since 1976. What was exciting
was that the presenter. Mark Houston,
MD, is the Director of the Hypertension
Institute at a Nashville Tennessee
hospital, and a Clinical Professor
of Medicine at Vanderbilt University
School of Medicine. He presented
research and recommended essential
fatty acids, fiber, garlic, vitamins
C, D, and E, coenzyme Q10, alpha-lipoic
acid, taurine, lycopene, hawthorn,
and other supplements. This is
a welcome departure from the usual
medical school dogma. I suppose
it’s been 30 years.
Cancer of almost any kind is
difficult to treat, making prevention
the most important defense. In
a recent article in The Lancet,
a British medical journal, researchers
concluded that at least one third
of deaths from twelve common cancers
could be prevented by changes
in lifestyle and living situations.
Among the risk factors they evaluated
were smoking, obesity, alcohol
consumption, lack of exercise,
and poor diet (primarily low fruit
and vegetable intake).
Among the most common malignant
tumors are cancers of the lung,
colon and rectum, breast, prostate,
uterus, cervix, liver, stomach,
and bladder. Early detection of
these tumors has helped reduce
the mortality attributed to them,
but early detection is not the
same as prevention. In areas where
smoking has declined, lung cancer
has been proportionately reduced.
In China, on the other hand,
60 percent of men smoke, and they
are often also exposed to indoor
pollution from heating and cooking
with coal or related fuels, and
these risks are synergistic. If
you ever enjoy the smell of a
wood stove or charcoal cooking,
be aware that you are exposed
to extra carcinogens. You can
reduce such risks with good ventilation
of the home, and by grilling outdoors,
and using gas instead of charcoal.
Some foods are particularly protective
against a variety of cancers.
Those rich in flavonoids, such
as fruits and vegetables, have
a high antioxidant capacity, which
lowers cancer risks. Flavonoids
include thousands of a variety
of related compouds, such as flavones,
flavanones, isoflavones, catechins,
anthocyanidins and chalcones,
and they include quercetin (in
apples and yellow onions), rutin
(in buckwheat), hesperidin and
naringenin (found in citrus fruits),
and genistein (from soy and other
beans).
Reducing exposure to environmental
toxins is partly a function of
dietary choices. Organic foods
contain fewer toxins, reducing
the consumer’s burden of
carcinogens. Meat consumption
(as I reported in July, 2005)
is associated with an increased
risk of colorectal cancer. Diets
high in meat, cheese, and milk
are associated with stomach and
esophageal cancer. Meat and milk
are also linked to higher rates
of ovarian and prostate cancers,
while dietary tomato products
(containing the carotenoid lycopene)
reduce prostate cancer risks.
Virgin olive oil contains substances
called phenols that inhibit DNA
damage that leads to cancer in
a laboratory model of colon cancer
causation, suggesting that they
might reduce colon cancer risk.
These phenols also reduce the
invasiveness of the colon cancer
cells. Fatty acids from fish also
reduce cancer risks, but it is
important to eat uncontaminated
fish, such as wild salmon and
sardines (packed in water with
no salt).
Many other plant-derived compounds
(phytochemicals) protect against
cancer. They range from sulforaphane,
isothiocyanates, and indole-3
carbinol in broccoli and other
cruciferous vegetables, to ellagic
acid, flavones, catechins, and
phytates, found in berries, melons,
beans, seeds, grains, and green
tea. Consuming a wide variety
of these high-fiber and antioxidant
foods will help prevent many of
the most common and deadly cancers.
Maintaining normal weight reduces
cancer risk. Exercise level is
another modifiable risk factor.
In a Japanese study of 9039 men,
those at the highest level of
cardiorespiratory fitness, as
measured on a stress test, had
a 60 percent reduction in cancer
mortality compared to those at
the lowest level of fitness.
In a study of 2987 women diagnosed
with breast cancer, 3-5 hours
of walking per week reduced mortality
by about half compared to less
activity. An earlier study of
13,905 men showed that moderate
intensity physical activity for
6-8 hours per week lowered lung-cancer
risk by 40 percent.
Toxic exposures to pollutants,
include hydrocarbons, heavy metals,
household chemicals, radon and
other sources of ionizing radiation.
Therefore, it is important to
take protective nutrients and
herbs as part of a comprehensive
nutritional approach. Numerous
dietary supplements can help prevent
cancer (and they often contribute
to greater survival in people
who already have the diagnosis).
Vitamins C, D, and E, carotenoids,
coenzyme Q10, selenium, calcium
D-glucarate, curcumin, beta-glucan,
fish oil, and garlic, are among
the many protective nutrients.
By combining all of these lifestyle
changes, I think that a majority
of cancers are preventable.
It is often thought that exercise
is not good for joints at risk
of osteoarthritis (OA), which
is considered to be a “wear
and tear” disease. The concern
is that the more use of joints,
such as the knee, the more likely
that the physical stress will
cause them to deteriorate more
quickly. Research in animals has
suggested that this is not the
case, and now a human study confirms
this good news for exercisers.
Researchers evaluated the cartilage
content of glycosaminoglycan (GAG),
an important indicator of cartilage
strength, in 30 subjects who had
had previous knee cartilage surgery,
and were at high risk for developing
OA. After four months of moderate
exercise three times a week (the
goal was to increase strength,
aerobic capacity, and agility),
the exercise group had increased
GAG content of their cartilage
(as measured by MRI) compared
to the controls.
A number of studies have shown
that moderate exercise training
is actually valuable as a treatment
for OA. A study of 109 participants
showed that exercise reduced pain
and self-reported disability,
and improved functional capacity.
A number of supplements can help
treat OA. Glucosamine sulfate
(1500-2000 mg/day), MSM (1000-2000
mg), and chondroitin sulfate (1200
mg) not only relieve symptoms,
but they also appear to help restore
the joint cartilage. Vitamin C,
fish oil, boswellia, curcumin,
and ginger all help to reduce
inflammation and pain.
Q. Why do you
not recommend beta sitosterol
in any of your prostate programs?
—CS, via Email
Phytosterols are components
of many seeds, nuts, beans (including
peanuts or peanut butter and peanut
oil), and cereal grains. Beta
sitosterol is one of several of
these compounds. Some good evidence
suggests that beta sitosterol,
one of the phytosterols found
in saw palmetto and pygeum, is
effective by itself for prostate
symptoms. However, the research
on beta sitosterol is not nearly
as extensive as the research on
standardized extract of saw palmetto.
Also, I have found that beta-sitosterol
supplements, at least until recently,
have been more expensive than
the other treatments, such as
saw palmetto. Recently, I have
noticed a reduction in the prices
of all of these supplements.
While I do not include beta sitosterol
in my prostate protocols, it is
certainly worth considering as
part of a prostate program, especially
if the combinations that you have
tried are not working to reduce
your symptoms. The typical dose
is about 130 mg daily.
Beta sitosterol is structurally
similar to cholesterol, and supplements
have been shown to reduce cholesterol
levels, possibly by blocking absorption
of dietary cholesterol (if you
do not eat cholesterol-containing
foods, it may not be effective).
The doses used to lower cholesterol
are much higher than those used
for the prostate, from 500 mg
to 10,000 mg per day.
Prostate symptoms are usually
reduced by some combination of
saw palmetto (300-500 mg of standardized
extract), pygeum (50-100 mg),
and nettle (250 mg). I also like
to add extra lycopene (6 mg) for
protection from prostate cancer.
Goodarz D,
et al., Causes of cancer in the
world: comparative risk assessment
of nine behavioural and environmental
risk factors. Lancet 2005, Nov
19;366:1784-93.
Wolk A, Diet,
lifestyle and risk of prostate
cancer. Acta Oncol. 2005;44(3):277-81.
Gill CI, et
al., Potential anti-cancer effects
of virgin olive oil phenols on
colorectal carcinogenesis models
in vitro. Int J Cancer. 2005 Oct
20;117(1):1-7.
Norat T, et
al., Meat, fish, and colorectal
cancer risk... J Natl Cancer Inst.
2005 Jun 15;97(12):906-16.
Slattery ML,
et al., Eating patterns and risk
of colon cancer. Am J Epidemiol.
1998 Jul 1;148(1):4-16.
Sawada SS,
et al., Cardiorespiratory fitness
and cancer mortality in Japanese
men: a prospective study. Med
Sci Sports Exerc. 2003 Sep;35(9):1546-50.
Rock CL, Demark-Wahnefried
W, Can lifestyle modification
increase survival in women diagnosed
with breast cancer? J Nutr. 2002
Nov;132(11 Suppl):3504S-3507S.
Demark-Wahnefried
W, Rock CL, Nutrition-related
issues for the breast cancer survivor.
Semin Oncol. 2003 Dec;30(6):789-98.
Holmes MD,
et al., Physical activity and
survival after breast cancer diagnosis.
JAMA 2005 May 25;293(20):2479-86.
Lee IM, et
al., Physical activity and risk
of lung cancer. Int J Epidemiol.
1999 Aug;28(4):620-5.
Roos EM, Dahlberg
L, Positive effects of moderate
exercise on glycosaminoglycan
content in knee cartilage...in
patients at risk of osteoarthritis.
Arthritis Rheum. 2005 Nov;52(11):3507-14.
Kettunen JA,
Kujala UM, Exercise therapy for
people with rheumatoid arthritis
and osteoarthritis. Scand J Med
Sci Sports. 2004 Jun;14(3):138-42.
Bennell K,
Hinman R, Exercise as a treatment
for osteoarthritis. Curr Opin
Rheumatol. 2005 Sep;17(5):634-40.
Tak E, et al.,
The effects of an exercise program
for older adults with osteoarthritis
of the hip. J Rheumatol. 2005
Jun;32(6):1106-13.
A probiotic supplement, Bifidobacterium,
similar to the bacteria found
in yogurt and other fermented
foods, reduces the symptoms of
irritable bowel syndrome (IBS,
or spastic colon). IBS symptoms
include gas, bloating, alternating
diarrhea and constipation, abdominal
discomfort, and fatigue. The bacteria
help both diarrhea and constipation.
Supplements also appear to reduce
inflammation and restore immune
balance in inflammatory bowel
disease (IBD), converting the
pro-inflammatory state to anti-inflammatory.
(O’Mahony L, et al., Lactobacillus
and bifidobacterium in irritable
bowel syndrome: symptom responses
and ...cytokine profiles. Gastroenterology.
2005 Mar;128(3):541-51.)
Exercise in the elderly can reduce
the risk of falling. A six-month
supervised exercise program (for
strength, agility, and flexibility)
cut the risk in half, and the
benefits lasted for a year after
the program finished (Liu-Ambrose
TY, et al., The beneficial effects
of group-based exercises on fall
risk.... J Am Geriatr Soc. 2005
Oct;53(10):1767-73.) Vitamin D
supplements, 1000 IU daily for
two years, also reduce falling
in elderly people, even if their
vitamin D levels are normal. (Flicker
L, et al., Should older people...receive
vitamin D to prevent falls....
J Am Geriatr Soc. 2005 Nov;53(11):1881-8.)
Omega-3 fatty acids prevent dry
eye syndrome (a lack of tear production
leading to corneal damage), but
common vegetable oils (such as
corn, and safflower with omega-6
fats) can more than double the
risk. Among 32,470 women, the
highest omega-3 intake lowered
risk by 17 percent compared to
the lowest intake. Tuna was specifically
beneficial, but you risk mercury
toxicity by eating it. I recommend
other omega-3 sources. (Miljanovic
B, et al., Relation between dietary
n-3 and n-6 fatty acids and clinically
diagnosed dry eye syndrome in
women. Am J Clin Nutr. 2005 Oct;82(4):887-93.).
Root vegetables provide hearty
flavor and texture as well as
good nutrition. In a crock pot,
mix cubed potatoes, butternut
squash, carrots, and parsnips
with chopped onions and garlic.
Add thyme, marjoram, fresh minced
parsley, and a dash of cumin (and
cinnamon if you like). Add chopped
fresh hot peppers (or ground cayenne)
and a small amount of soy sauce
to taste. Add pre-cooked pinto
beans (soak for 4-8 hours, discard
the soaking water, and pressure
cook for about 20 minutes in fresh
water), diced fresh tomatoes (or
organic fire-roasted tomatoes,
tomato sauce, or salsa), and vegetable
stock to cover the bottom 1-2
inches. Cover the crock pot and
cook on low or high until the
vegetables are tender. This may
take all day on low, so you can
go away in the morning and come
back to a finished meal. (You
can also pressure cook this in
10 minutes.)
