Nutritional Supplements cont. next page Dr. Weiss is a member of both the Enzymatic Therapy and PhytoPharmica Scientific Advisory Boards and is considered an expert in integrative cardiology. Dr. Weiss performed many hours of internship, and a cardiology residency at the Arizona Heart Institute. Dr. Weiss continues his work in cardiology becoming one of the first Naturopathic physicians to have hospital privileges in a conventional medical facility by being assigned to the Department of Medicine in 1998 as a consulting staff physician at the Arizona Heart Hospital. Dr. Weiss continues his work by maintaining his hospital privileges and by seeing patients and training interns and res- idents at the Southwest College of Naturopathic Medicine. Dr. Weiss is adjunct faculty of the Canadian College of Naturopathic Medicine. Prostate Cancer and Nutritional Supplements Years of research have discovered that the foods a man chooses to eat (or doesnt eat) can have a profound impact on the health of his prostate gland. 1-3 Because of this close nutritional link, prostate cancer may be the most preventable type of cancer (after smoking- related lung cancers). 4,5 Recently, there has been an incredible amount of research and investigation of prostate cancer. Many of these studies have explored the use of certain nutrients to prevent and actually treat prostate cancer. These nutrients, calcium D-glucarate, selenium, broccoli, green tea, maitake, and lycopene are powerful prostate cancer fighters. All are available as nutritional supplements that men can take every day as an important part of a healthy diet. In this issue of Ask the Doctor, we will discuss prostate cancer and how men can actually pre- vent it with the use of these six nutrients. Plus, if men already have prostate cancer, these nutrients can be an important part of their treatment regimen in fighting their disease. Decker Weiss: NMD, AACVPR (member) Ask the Doctor publications are available on the Internet at: www.ATDonline.org Q. What does the prostate gland do? A. The prostate is a gland in a man's reproductive system. It makes and stores seminal fluid, the milky fluid that nour- ishes sperm. This fluid is released to form part of the semen. The prostate is about the size of a walnut and it is located below the bladder and in front of the rec- tum. The prostate actually wraps around the upper part of the urethra, the tube that empties urine from the bladder through the penis. 6 Q. What are the symptoms of prostate cancer? A. Early prostate cancer often does not cause any symptoms. However, many symptoms of prostate cancer are also symptoms of other problems with the prostate, such as an infection or benign prostatic hyperplasia, a prostate enlargement associated with age- related changes. 7,8 A man who has any of these symptoms should see his health care practitioner for evaluation: A need to urinate frequently, especially at night Difficulty starting urination or holding back urine Inability to urinate Weak or interrupted flow of urine Painful or burning urination Difficulty in having an erection Painful ejaculation Blood in urine or semen Frequent pain or stiffness in the lower back, hips, or upper thighs. 7,8 Q. Are certain men more prone to get prostate cancer? A. Age is the biggest risk factor: most prostate cancers occur in men over 65 years of age. A man's risk for developing prostate cancer is higher if his father or brother has had the disease. African- Americans are at higher risk for the disease. Mechanics, farmers, sheet metal workers, and workers exposed to cadmium have also have high rates of prostate cancer. 4,5 Q. How is prostate cancer diagnosed? A. A man who has any of these risk fac- tors may want to ask his health care pro- fessional whether to begin screening for prostate cancer (even though he does not have any symptoms), what tests to have, and how often to have them. 4,5 The usual prostate tests include: Digital rectal exam: the doctor inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall to check for hard or lumpy areas. Blood test for prostate-specific antigen (PSA): a lab measures the levels of PSA in a blood sample. The level of PSA may rise in men who have prostate cancer, benign prostatic hyperplasia ( a non- cancerous enlargement of the prostate gland), or an infection in the prostate. These tests will only determine if there is a problem with a mans prostate gland. They cannot determine if the problem is cancer. Only a biopsy of a sample of prostate tissue can reveal the presence of actual prostate cancer. 4,5 Q. What nutrients help prevent or treat prostate cancer? A. The prostate health nutrients, calcium D-glucarate, selenium, broccoli, green tea, maitake, and lycopene, each work in unique ways. Some help mens bodies work more effectively, some keep cancer cells from growing, while others actually kill prostate can- cer cells. Lets discuss each nutri- ent and how it works. Calcium D-Glucarate It is a troubling fact of modern life that we are continuously exposed to cancer-causing chem- icals and toxins. These toxins come in part from contaminants in the food we eat and pollutants in the air we breathe. There are also natural toxins that are produced in our bodies. Excess hormones, such as estrogen and testosterone, can cause cancer when they are no longer needed. Cancer causing chemicals not only initiate cancer, but exposure to them can also cause existing cancers to grow bigger, stronger, and more deadly. 9 Our bodies do a fairly good job of elimi- nating some of these toxins before they can cause us harm. In the liver, the toxin is bound or attached to a chemical called glucuronic acid. The bound toxin is then excreted in bile and eventually eliminated as a waste product in the stool. 10-13 However, yet another chemical, an enzyme called glucuronidase, can break this bond between the toxin and glucuronic acid. When this happens, the hormone or toxin is released back into our bodies, capable of causing us harm once more. The longer the toxins and excess hormones are in our bodies, the greater the chances they can make us seriously sick. Scientists have discovered that increased glucuronidase activity in the body is strongly associated with prostate cancer. 14 Fortunately, scientists have also discov- ered that a natural substance found in foods, calcium D-glucarate, can greatly reduce the activity of glucuronidase. Calcium D-glucarate helps our bodies keep the harmful toxins and chemicals bound to glucuronic acid. While CDG is found in fruits and vegetables, the amounts may not be sufficient to main- tain effective levels to stop beta- glucuronidase. CDG has been shown in many experimental studies to significant- ly stop prostate cancer growth. 10-13 Studies have shown that by taking calci- um D-glucarate, our bodies can get rid of the toxic chemicals and excess hormones that might stimulate cancer formation. 10-14 Selenium Selenium is an essential trace mineral found in the soil. Both plant foods like oatmeal, and meats that we eat, such as chicken and beef, contain selenium. How much selenium, however, is difficult to determine. This is because the amount of selenium in soil, which varies by region, determines the amount of seleni- um in the plant foods that are grown in that soil. Animals, too, will have varying levels of selenium in their muscle, depending on the amount of selenium in their feed. The actual selenium level in the grasses and grains that make up animal feed reflect the amount of the selenium in the soil where they grew. 15 A major antioxidant, selenium slows down aging, keeps our skin supple, and helps prevent dandruff. Selenium also keeps our blood vessels healthy and pro- tects us from heart disease. However, some of seleniums most powerful effects are on the prostate gland. 17,18 In a recent study, researchers recruited 974 men to take part in a large clinical trial to deter- mine if selenium could prevent cancer. Half of the men were given selenium supplements and half were given a placebo. Researchers, who did know which group got the selenium and which group got the place- bo, watched and recorded the mens progress. The researchers were amazed to learn that sele- nium cut the rate of prostate cancer by 63%! 18 The results of this study were so impressive that it has led to many other studies of selenium and prostate cancer. In fact, researchers at the Arizona Cancer Center and the Arizona College of Public Health in Tucson are currently studying the effect of selenium on prostate cancer in four ongoing clinical trials. 19 Broccoli Scientists have observed over for a long period of time, that men who eat lots of broccoli have a lower risk of getting prostate cancer. It seems that sulfora- phane, a compound abundant in broccoli, is the secret ingredient responsible for this connection. 20,21 Sulforaphane increas- es certain enzymes in the body, called phase 2 enzymes, that deactivate cancer- causing chemicals. 22 In lab experiments, Rectum Bladder Penis Prostate Urethra Testis prostate cancer cells that were exposed to sulforaphane, the compound inhibited the growth of the cancer cells up to 80 percent. 23 Green Tea There is a potent plant substance in green tea that is a very effective killer of prostate cancer cells. A recent study tested four common components of green tea and determined that one of these compounds, epigallocatechin gallate or EGCG, has a special affinity for prostate cancer cells. Scientists discovered that EGCG can stop the growth of prostate cancer dead in its tracks. The chemical structure of EGCG is very similar to substances in red wine and cruciferous vegetables, known cancer killers. 24-26 Maitake mushroom For many years, maitake mushrooms have been linked to good health in those who eat them. Called dancing mushrooms (possibly due to their wavy, rippling appearance or possibly due to the little dance of joy mushroom hunters perform when they find them in the woods), maitakes contain an important com- pound called D-fraction. 27,28 A recent study at New York Medical College showed that maitake D-fraction destroyed 95% of human prostate cancer cells in lab experiments. 29 Lycopene Some of the most exciting nutritional news in relation to prostate health involves lycopene. This carotenoid is found primarily in tomatoes, and men who eat lots of cooked tomatoes have very low rates of prostate cancer. 30,31 Because promising preliminary reports demonstrate that lycopene can actually kill prostate cancer cells, there has been an explosion of lycopene and prostate cancer studies. 32-34 In one of these studies, 32 prostate can- cer patients ate a pasta meal covered with three-fourths cup of tomato sauce every day for three weeks. Results showed their PSA levels dropped two points. Even signs of DNA damage dropped sharply. The ability of lycopene to drop these levels in just three weeks has impressed researchers and scientists worldwide. 34 Q. Do I have to take each nutrient separately? A. While you can pur- chase each one of these nutrients and take them separately, all of these nutrients are available in prostate health formulas. Make sure the formula you buy contains calcium d-glucarate, lycopene, selenium, broccoli standardized to contain a minimum of 125 mcg sul- foraphane, green tea, and maitake mush- room extract. Standardized ingredients provide consistently effective nutrients. Q. What else can men do to prevent prostate cancer? A. Adopting a healthy diet, including eating 5 to 9 servings of fruits and vegetables every day, eating several servings of whole grain cereals and bread, and reducing red meat consump- tion to 2 or 3 servings per week has been shown to reduce the risk of all kinds of cancer. In addition, the recent lycopene studies suggest that a diet that regularly includes tomato-based foods may help protect men from prostate cancer. 34 Men 50 years and older should have a digital rectal exam (DRE) and PSA test each year. African- Americans and those at higher risk should begin at age 40. 4,5 Talk with your health care profes- sional to determine how fre- quently the test should be done. Conclusion This year doctors expect to find 180,000 new cases of prostate cancer is the United States and 37,000 men will die of it. Prostate cancer is the second leading cause of cancer death in men. 5 But there is hope. More cancers are caught early and new treatments might help make it possible for men to live long and healthy lives following their diagnosis. By taking a few simple steps, men diagnosed with prostate cancer can take charge of their lives and overcome much of the fear and anxiety that accompany a cancer diagnosis. HEALTH FACT: Age is the biggest risk factor: most prostate cancers happen in men over 65 years of age. A man's risk for developing prostate cancer is higher if his father or brother has had the disease. Adopting a healthy diet, including eating 5 to 9 servings of fruits and vegetables every day...has been shown to reduce the risk of all kinds of cancer. T3223X702 66286 Ref erences 1. Jankevicius F, Miller SM, Ackermann R. Nutrition and risk of prostate cancer. Urol Int. 2002;68:69-80. 2. Fleshner NE, Kucek O. Antioxidant dietary supplements: Rationale and current sta- tus as chemopreventive agents for prostate cancer. Urology. 2001;57:90-94. 3. Fair WR, Fleshner NE, Heston W. Cancer of the prostate: a nutritional disease? Urology. 1997;50:840-848. 4. National Institutes of Health Cancer Institute. Accessed on April 9, 2002. Available at: http://www.cancer.gov/cancer_information/. 5. American Cancer Society. Prostate cancer information. Available at: http://www3.cancer.org/cancerinfo/load_cont.asp?ct=36&language=English Accessed: July 17, 2000. 6. Guyton AC, Hall JE. Reproductive and hormonal functions of the male (and the pineal gland). In: Textbook of Medical Physiology. 9th ed. Philadelphia, Pa: WB Saunders Company; 1996: 1003-1016. 7. Stewart SM. Alterations in structure and functions of the male genitourinary sys- tem. In: Porth CM. Ed. Pathophysiology: Concepts of Altered Health States. 5th ed. Philadelphia, Pa: Lippencott-Raven Publishers; 1998: 1175-1215. 8. Held-Warmkessel J. Prostate cancer. In: Groenwald SL, Hansen FM, Goodman M, Yarbo CH, eds. Cancer Nursing: Principles and Practice. 4th ed. Sudbury, Mass: Jones and Bartlett Publishers; 1997: 1334-1354. 9. Groenwald SL, Hansen Frogge M, Goodman M, Henke Yarbo C. Controversies in car- cinogenesis. In: Cancer Nursing: Principles and Practice. 4th ed. Sudbury, Ma: Jones and Bartlett; 1997: 46-47. 10. Walaszek Z, Szemraj J, Narog M, et al. Metabolism, uptake, and excretion of a D- glucaric acid salt and its potential use in cancer prevention. Cancer Detect Prev.1997;21:178-190. 11. Walaszek Z. Potential use of D-glucaric acid derivatives in cancer prevention. Cancer Lett 1990;54:18. 12. Walaszek Z, Hanausek-Walaszek M, Webb TE. Dietary glucarate-mediated reduc- tion of sensitivity of murine strains to chemical carcinogenesis. Cancer Lett 1986;33(1):2532. 13. Walaszek Z, Hanausek-Walaszek M, Webb TE. Repression by sustained-release beta-glucuronidase inhibitors of chemical carcinogen-mediated induction of a marker oncofetal protein in rodents. J Toxicol Environ Health 1988;23:1527. 14. Dwivedi C, Heck WJ, Downie AA, et al. Effect of calcium glucarate on beta-glu- curonidase activity and glucarate content of certain vegetables and fruits. Biochem Med Metab Biol 1990;43:8392. 15. Fleming T. ed. Selenium. In: PDR for Nutritional Supplements. Montvale, NJ: Medical Economics Company; 2001: 416-422. 16. Brooks JD, Metter EJ, Chan DW, et al. Plasma selenium level before diagnosis and the risk of prostate cancer development. J Urol. 2001;166:2034-20348. 17. Brawley OW, Barnes S, Parnes H. The future of prostate cancer prevention. Ann N Y Acad Sci. 2001;952:145-152. 18. Clark LC, Dalkin B, Krongrad A, et al. Decreased incidence of prostate cancer with selenium supplementation: results of a double-blind cancer prevention trial. Br J Urol.1998;81:730-734. 19. Clark LC, Marshall JR. Randomized, controlled chemoprevention trials in popula- tions at very high risk for prostate cancer: Elevated prostate-specific antigen and high-grade prostatic intraepithelial neoplasia. Urology. 2001;57:185-187. 20. Verhoeven DT, Goldbohm RA, van Poppel G, Verhagen H, van den Brandt PA. Epidemiological studies on brassica vegetables and cancer risk. Cancer Epidemiol Biomarkers Prev. 1996;5:733-748. 21. Kolonel LN, Hankin JH, Whittemore AS, et al. Vegetables, fruits, legumes and prostate cancer: a multiethnic case-control study. Cancer Epidemiol Biomarkers Prev. 2000;9:795-804. 22. Fahey JW, Zhang Y, Talalay P. Broccoli sprouts: an exceptionally rich source of inducers of enzymes that protect against chemical carcinogens. Proc Natl Acad Sci U S A. 1997;94:10367-72. 23. Brooks JD, Paton VG, Vidanes G. Potent induction of phase 2 enzymes in human prostate cells by sulforaphane. Cancer Epidemiol Biomarkers Prev. 2001;10:949- 954. 24. Hiipakka RA, Zhang HZ, Dai W, Dai Q, Liao S. Structure-activity relationships for inhibition of human 5alpha-reductases by polyphenols. Biochem Pharmacol. 2002;63:1165-1176. 25. Gupta S, Hastak K, Ahmad N, Lewin JS, Mukhtar H. Inhibition of prostate car- cinogenesis in TRAMP mice by oral infusion of green tea polyphenols. Proc Natl Acad Sci U S A. 2001;98:10350-10355. 26. Chung LY, Cheung TC, Kong SK, et al. Induction of apoptosis by green tea cate- chins in human prostate cancer DU145 cells. Life Sci. 2001;68:1207-1214. 27. Matsui K, Kodama N, Nanba H. Effects of maitake (Grifola frondosa) D-Fraction on the carcinoma angiogenesis. Cancer Lett. 2001;172:193-198. 28. Kodama N, Yamada M, Nanba H. Addition of Maitake D-fraction reduces the effective dosage of vancomycin for the treatment of Listeria-infected mice. Jpn J Pharmacol. 2001;87:327-332. 29. Fullerton SA, Samadi AA, Tortorelis DG, et al. Induction of apoptosis in human prostatic cancer cells with beta-glucan (Maitake mushroom polysaccharide). Mol Urol. 2000;4:7-13. 30. Giovannucci E, Rimm EB, Liu Y, Stampfer MJ, Willett WC. A prospective study of tomato products, lycopene, and prostate cancer risk. J Natl Cancer Inst. 2002;94:391-398. 31. Lu QY, Hung JC, Heber D, et al. Inverse associations between plasma lycopene and other carotenoids and prostate cancer. Cancer Epidemiol Biomarkers Prev. 2001;10:749-756. 32. Chen L, Stacewicz-Sapuntzakis M, Duncan C, Sharifi R, Ghosh L, van Breemen R, Ashton D, Bowen PE. Oxidative DNA damage in prostate cancer patients consum- ing tomato sauce-based entrees as a whole-food intervention. J Natl Cancer Inst. 2001;93:1872-1879. 33. Kucuk O, Sarkar FH, Sakr W, et al. Phase II randomized clinical trial of lycopene supplementation before radical prostatectomy. Cancer Epidemiol Biomarkers Prev. 2001;10:861-868. 34. van Breemen RB, Xu X, Viana MA, et al. Liquid Chromatography-Mass Spectrometry of cis- and all-trans-Lycopene in Human Serum and Prostate Tissue after Dietary Supplementation with Tomato Sauce. J Agric Food Chem. 2002;50:2214-2219. Ask the Doctor publications are available on the Internet at www.ATDonline.org A n s w e r s