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Positive Medical Changes
Cancer Prevention
Lifestyle Risk Reduction
Exercise and Osteoarthritis
Ask Dr. J: Beta Sitosterol
References
In The Health News
Diet and Disease
Recipe of the Month: 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.)
drjanson@drjanson.com
Year-round phone: 386-409-7747
180 Massachusetts Ave.,
Arlington, MA 02474
225 North Causeway, New Smyrna Beach, FL 32169
3 Overlook Dr., Suite 3, Amherst, NH 03131
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