We are what we do - Exercise changes the DNA

http://www.youngadventuress.com/2010/10/snowy-peaks-swiss-alps.html 

We often say 'You are what you eat.' Well, your genetic code also adapts to what you do.

The genetic heredity a person is born with isn't that impossible to change as one might think. In a new study in Cell Metabolism, researchers of Karolinska Institutet show that when healthy but inactive men and women are made to exercise it actually alters their DNA - in a matter of minutes.

The underlying genetic code stays the same. However, the DNA molecules within the muscle cells gets chemically and structurally altered in very particular ways, by gaining or losing marks of methyl groups on certain familiar DNA sequences. Those so called epigenetic modifications to the DNA, at precise locations, appear to be an important part of the physiological benefits of exercise.

"Our muscles are really plastic," says Juleen Zierath, Professor of Clinical Integrative Physiology at the Department of Molecular Medicine and Surgery of Karolionska. "Well, muscle adapts to what you do. If you don't use it, you lose it and this is one of the mechanisms that allow that to happen."

The current study in Cell Metabolism shows that the DNA within skeletal muscle taken from people after a burst of exercise bears fewer methyl groups than it did before exercise. Those changes occur in stretches of DNA that serve as landing sites for different kinds of enzymes, called transcription factors, which in turn are involved in turning 'on' genes already known to be important in muscles' adaptation to exercise.

Juleen Zierath likens transcription factors to keys that unlock our genes. With those methyl groups firmly in place, transcription factor 'keys' are prevented from entering those DNA 'locks'. But when the methyl groups are removed, it allows the keys to turn the locks and boosts the capacity of muscle for work.

"Exercise is already known to induce changes in muscle, including increased metabolism of sugar and fat", Zierath says, "Our discovery is that the methylation change comes first."

When the researchers made muscles contract in lab dishes, they saw a similar loss of methyl groups. Exposure of those muscles to caffeine had the same effect as well, as caffeine induces a release of calcium in a way that mimics the muscle contraction that comes with exercise. However, the researchers don't recommend anyone to drink a cup of coffee in place of exercise, as it isn't clear that caffeine has all the other beneficial effects of exercise.

"Exercise is medicine, and it seems the means to alter our epigenomes for better health may be only a jog away", says Juleen Zierath.

Even modest to moderate exercise is associated with several beneficial health outcomes, including a decreased risk of obesity, coronary heart disease, stroke, certain types of cancer, and all-cause mortality. Exercise may also increase the likelihood of stopping tobacco use; reduce disability for activities of daily living in older persons; delay cognitive decline in older adults; and reduce stress, anxiety, and depression.

A screening medical evaluation for coronary heart disease prior to starting exercise is recommended for symptomatic or moderate-to-high risk individuals.

We suggest that all healthy adults incorporate moderate to vigorous exercise into their lifestyle, e.g., cardio-respiratory endurance training (walking, running, swimming, or bicycling) as an interval training three to four times per week, for 45-60 min, well in the aerobic range (to be determined individually by ergospirometry = exercise ECG testing with ventilatory gas analysis), e.g., slow-fast-slow-fast (walk-run-walk-run) alternating for 2 min each, with 2-3 sprints of 50 to 100 m at maximum speed interspersed, in addition, for 20 min. daily muscle strengthening exercises, Pilates, or weight lifting in the gym, ideally with a personal instructor, or whole body vibration training (Physionic training by Swiss Physio www.swissphysio.com).

But just telling people what to do doesn't always work. So we have developed a NeuroLeadership-based coaching method that makes it easier for people to change behaviour, setting goals that can be reached by small, simple steps, creating internal awards for positive behaviours which incidentally help them to do more.

References:

Romain Barrès, Jie Yan, Brendan Egan, Jonas Thue Treebak, Morten Rasmussen, Tomas Fritz, Kenneth Caidahl, Anna Krook, Donal J. O'Gorman & Juleen R Zierath: Acute Exercise Remodels Promoter Methylation in Human Skeletal Muscle. Cell Metabolism, online ahead of print 7 March 2012

http://www.uptodate.com/contents/overview-of-the-benefits-and-risks-of-exercise?source=search_result&search=exercise+health+benefits&selectedTitle=1%7E150#H38

http://www.thedoldergrand.com/fileadmin/user_upload/thedoldergrand.com/factsheets/Spa/SpaMenu_e.pdf

Complementary and Alternative Oncology: Innovative Approaches to Optimize Standard Therapy for Cancer

Cancer demands diagnostic and therapeutic measures with proven quality, safety and efficacy.

Complementary and alternative medicine in oncology has emerged out of disappointment with the results of traditional treatment options. Despite innovative approaches towards cancer destruction, including surgery, chemo-, radio- or hormone therapy, cancer mortality rates have not been significantly reduced in the past twenty years. Notable treatment success, however, has been achieved in rare cancers such as testicular cancer, leukaemia and lymphoma.

Global analyses dampened the optimism associated with chemotherapy for advanced carcinomas, especially when responses (temporary cancer shrinkage) are used as a measure of therapeutic success. Therefore, some researchers urge the medical community to think about new therapeutic strategies.

(Source presently not identified.)

While mainstream oncology has introduced promising therapeutic innovations, e.g. targeted antibody/antisense therapies, specific inhibitors of cancer cell growth factors, efficient but tolerable new chemotherapeutic agents, advanced concepts for radiotherapies, novel non-toxic but promising complementary approaches have been tested in scientific and clinical trials.

Presently, there is no compelling evidence that any alternative therapy is associated with prolongation of life. However, the search for effective alternative therapies continues to be intense. It is important to note that claims of efficacy should be supported with acceptable evidence by those who make these claims, rather than rejected through research carried out by those who doubt them.

Also, outlandish and irresponsible claims continue to be published in the medical literature, therefore, it is understandable that oncologists are concerned about the high level of acceptance of alternative therapies by cancer patients.

On the other hand, outright rejection of these treatments might be counter-productive for the following reason: Every now and then impressively successful case reports emerge from credible sources. An open mind toward plausible complementary options might therefore be a good general policy.

Jürg Reinhard. Weitblick. Merligen, 2009.

Users of complementary and alternative oncology are generally not dissatisfied with conventional medicine but find alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life. Factors reported to be associated with use of complementary and alternative therapies in cancer patients include:

• Increased psychosocial stress (eg, anxiety, depression)
• Being given a less hopeful prognosis
• Having the feeling of "nothing to lose"
• Attending support groups
• Age (younger versus older) and gender (women more than men)

The role of complementary therapies in palliative and supportive cancer is a different matter and seems more promising. Several of these therapies have potential for improving quality of life. Proponents of these therapies have repeatedly argued that it would be inhumane not to provide such treatments if patients want them. Oncologists should certainly not hinder patients from seeking such help. On the other hand, one should still insist that the usefulness of these therapies be demonstrated beyond reasonable doubt.

The often emotional conflicts between opponents and proponents of complementary and alternative oncology are, to a large degree, a regrettable artifact caused by the lack of reliable evidence in this area. If more convincing data existed, there would be far less room for disagreement. It follows that more research efforts (and research funds) should be directed towards creating reliable evidence. In the United States, the National Institutes of Health (NIH) Center for Complementary and Alternative Medicine and the National Cancer Institute are supporting well designed studies of alternative medicine. Information is available through the NCI website (cancer.gov/cancerinfo/treatment/cam), and the Cochrane Collaborative (http://www.compmed.umm.edu/cochrane.asp).

Favoring a holistic approach to cancer treatment, we present an unique opportunity to profit from the interface of academic and complementary medicine. At the Dolder Grand medical wellness, we offer an integrative approach for managing a patient with cancer targeting multiple biochemical and physiological pathways of interrupting tumor development while minimizing toxicity.

http://www.thedoldergrand.com/fileadmin/user_upload/thedoldergrand.com/factsheets/Spa/SpaMenu_e.pdf

http://www.thedoldergrand.com/en/hotel.html

ALTERNATIVE CANCER TREATMENTS (ACTs) are defined as complementary and alternative medicine (CAM) therapies that are promoted for reducing tumor burden or prolonging the life of cancer patients. The following ACTs are currently popular and will be discussed:

Dietary treatments

Herbal medicinal products

Non-herbal supplements

Dietary treatments — A systematic review of the evidence found that so far none of the many dietary regimens has been convincingly shown to cure cancer or significantly prolong the life of cancer patients. However, selected vegetables and herb mix (SV) a blended product containing ingredients with purported immune-stimulatory and anticancer properties: soybeans, mushrooms, mung beans, red dates, scallion, garlic, lentils, leek, hawthorn fruit, onion, ginseng, angelica, dandelion, senegal root, licorice, ginger, olives, sesame seeds, and parsley has been investigated in two small studies conducted in patients with cancer. In a matched-control study involving patients with stage III/IV non-small cell lung cancer, median survival duration among the 11 patients who ingested SV daily was three-fold longer than that of 13 patients who did not receive the supplement (15 versus 4 months). A similar suggestion of prolonged survival was noted in a second study of 18 patients with stage III/IV NSCLC who had either rejected or failed to respond to conventional therapies. The median survival was 33.5 months for the 12 patients who used SV for two months or longer, and at five years, 50 percent of the patients remained alive. When these data were presented to the Cancer Advisory Panel for Complementary and Alternative Medicine, SV was judged worthy of further definitive research. Further information can be found at the NCI website (cancer.gov/cancerinfo/pdq/cam/vegetables-sun-soup).

Herbal medicinal products — Numerous herbal medicinal products (HMPs) are promoted as ACTs. The examples listed below represent only a brief selection.

Individualized therapy — Chinese herbal medicines are widely used in many areas of Asia to reduce the toxicity associated with conventional anticancer therapy; however, the efficacy of herbal therapy to minimize chemotherapy-related toxicity is unclear:

This approach was assessed in a double-blind, placebo-controlled trial, in which 120 patients receiving adjuvant chemotherapy for breast or colon cancer were evaluated by a qualified Chinese herbalist. Treatment was prescribed and the active herbs or a matched control were dispensed in a blinded fashion. There was no difference between the two groups in hematologic toxicity, which was the primary end point. Among 16 non-hematologic parameters assessed, the only statistically significant difference was a reduction in the severity of nausea with active treatment.

A systematic review was conducted of four trials in which 270 patients with advanced or late stage gastric cancer were randomly assigned to the traditional Chinese medicinal herb Huachansu plus chemotherapy compared with the same chemotherapy alone. The authors concluded that there was relatively weak evidence that Huachansu improved leukopenia when used together with chemotherapy, but it did not improve any other side effect or the short-term efficacy of chemotherapy.

Of note, several Cochrane and other reviews were unable to find convincing evidence from randomized trials supporting the benefit of Chinese herbal medicine as a treatment for esophageal or lung cancer; none of the trials that claimed to be randomized were actually randomized.

Green tea — Green tea is derived from the plant Camellia sinensis, and contains a number of biologically active polyphenols. Herbal products are widely used as CAMs in cancer patients. Green tea is the most widely used herbal product, used by 24 to 30 percent of all cancer patients. The polyphenols in green tea have a variety of biologic activities that might influence tumor behavior. There are only limited data on possible clinical efficacy: A single case control study from China suggested that consumption of large amounts of green tea may have a protective effect against the development of prostate cancer. However, other case-control and cohort studies have not found a link between green tea intake and prostate cancer risk among Japanese men or Japanese-Americans living in Hawaii. A phase I study in lung cancer patients and a phase II study in prostate cancer patients showed no antitumor activity. Consumption of large amounts of green tea may correlate with improved survival in patients with ovarian cancer.

Essiac — Essiac is an herbal mixture originally formulated by a Canadian Ojibwa healer that has become popular in North America. The formula consists of burdock root (Arctium lappa), turkey rhubarb (Rheum palmatum), sheep or sheepshead sorrel (Rumex acetosella), and the inner bark of slippery elm (Ulmus fulva). Later, watercress, blessed thistle, red clover, and kelp were added. In vitro studies of the individual components of this mixture have demonstrated some evidence of biological activity, including antioxidant, antiestrogenic, immunostimulant, and antitumor actions. However, an attempted systematic review did not find a single published clinical trial testing this mixture in cancer patients. The author concluded that there is no definitive evidence of its utility but that Essiac is unlikely to cause serious adverse effects.

Mistletoe — Mistletoe extracts (Iscador, Helixor) contain various lectins and viscotoxins (including viscum fraxini-2). Evidence from in vitro experiments and animal models suggests that these components have some anticancer activity. Although dozens of matched pair cohort studies have largely supported a benefit for mistletoe extract in patients treated for cancer, randomized trials with various mistletoe preparations have given conflicting results. Three independent systematic reviews of the clinical evidence concluded that there are insufficient data to support the use of mistletoe extracts. A more recent meta-analysis suggested a modest survival benefit for cancer patients who received the mistletoe preparation Iscador. However, benefit was observed only in nonrandomized studies (hazard ratio [HR] for death 0.33, 95% CI 0.17 to 0.65) and not in randomized trials (HR for death 1.24, 95% CI 0.79 to 1.92), and there was a high probability of publication bias skewing the results. Numerous adverse effects are on record; the most serious is anaphylactic shock. Based upon the available evidence, it cannot be concluded that there is benefit from mistletoe extract.

PC-SPES — PC-SPES is an herbal dietary supplement consisting of seven Chinese and one American herbal extract. The name of the product emphasizes its intention: PC stands for 'prostate cancer' and spes is Latin for 'hope'. The eight herbs were selected for their immune stimulating, cytotoxic, and cytostatic properties. PC-SPES has potent estrogenic activity. In men with advanced prostate cancer, decreases in serum prostate specific antigen, improvement in bone scans, and objective shrinkage of soft tissue measurable disease have been reported with PC-SPES. However, adulteration and toxicity (an acquired bleeding diathesis) forced a recall of this compound by the United States Food and Drug Administration in February 2002. As a result, it is no longer commercially available.

Sho-saiko-to — Sho-saiko-to is a traditional Chinese herbal mixture that contains extracts of seven medicinal herbs. It is widely administered in Japan to patients with chronic hepatitis and cirrhosis. Sho-saiko-to inhibits stellate cell activation and reduces hepatic fibrosis in vitro and in vivo.  It also inhibits chemical hepatocarcinogenesis in animals, acts as a biological response modifier, and suppresses the proliferation of hepatoma cells by inducing apoptosis. A prospective study of 260 cirrhotic patients found that a daily oral dose of sho-saiko-to (7.5 g) in addition to conventional therapy reduced the cumulative incidence of hepatocellular carcinoma over five years of follow-up compared with controls (p = 0.071). The difference was significant in patients who were hepatitis B surface antigen (HBsAg) negative (p = 0.024). Survival was also improved with sho-saiko-to therapy (p = 0.053), and again, the difference was significant in those who were HBsAg negative. Based on these results, the use of sho-saiko-to seems promising, but more clinical trials are required to be sure.

St. John's wort — St. John's wort has primarily been used to treat depression. An extract of St. John's wort, hypericin, has been noted to have a cytotoxic effect on tumor cells after photoactivation. In vitro studies and in vivo investigations in mice have demonstrated that intralesional hypericin has the potential for use in a number of tumors, including bladder, squamous cell, pancreatic, and prostate cancer. The only human study has involved intralesional injection of hypericin into basal cell and squamous cell carcinomas of the skin. Injection with the extract three to five times per week was followed by irradiation with visible light. The authors claim that hypericin displayed selective tumor targeting; penetration in the surrounding tissues did not induce necrosis or cell loss, and generation of a new epithelium at the surface of the malignancy was noticed. Clinical remissions were observed after six to eight weeks. These preliminary results require replication in a randomized trial.

Astragalus — The Chinese herb astragalus membranaceous is postulated to boost host immune function. A meta-analysis of randomized 34 trials found that the addition of astragalus to chemotherapy was associated with a reduced risk of death, an improved response rate, and a better performance status. However, significant methodologic limitations in these trials prevented definitive conclusions about the efficacy of this herb.

Jürg Reinhard. Täschelkraut. Merligen, 2009. 

Nonherbal supplements — Among the nonherbal supplements that have been evaluated are melatonin, shark and bovine cartilage, hydrazine, and thymus extracts.

Melatonin — Melatonin, a normal secretion of the pineal gland, has captured public attention because of its effects on mood, sleep, and jet lag. It has also been suggested that melatonin stimulates the immune system  and has antioxidant, anticancer, and antiaging properties. Although melatonin has been evaluated in a number of settings in patients with cancer, it does not yet have an established role. Melatonin has been evaluated in combination with aloe vera, which may have immunomodulating properties. In one report, 50 patients with advanced solid malignancies for whom no effective standard anticancer therapy existed, were treated either with melatonin (920 mg per day) or with melatonin and aloe vera tincture (1 mL twice daily). No response was seen in the former group while two partial responses were observed in the group treated with aloe vera. This result awaits confirmation through a more rigorous trial.

Hydrazine — Hydrazine is a chemical with a variety of actions. It is an inhibitor of the enzyme phosphoenolpyruvate carboxykinase, a key enzyme in mammalian gluconeogenesis, a metabolic pathway that is thought to play a role in cancer cachexia. Four controlled trials have been reported. The first study, which randomly assigned 64 patients with lung cancer to receive chemotherapy with or without hydrazine (60 mg three times daily) failed to show a significant difference in survival between the two groups. Three subsequent trials, two in lung cancer, and one in colorectal cancer, also failed to demonstrate a positive impact of hydrazine on survival.

Coenzyme Q10 — Coenzyme Q10 (also known as Vitamin Q10, ubiquinone, or ubidecarenone) has been widely promoted for patients undergoing treatment for cancer, based upon the suggestion that it might improve tolerance for chemotherapy. However, in a preliminary report of a double-blind placebo-controlled trial in patients with newly diagnosed breast cancer, there was no benefit from the use of coenzyme Q in self-reported cancer treatment-related fatigue.

Thymus extracts — Several in-vitro studies have demonstrated that thymus extracts restore lymphocyte function, improve immunological variables, activate natural killer cells, and increase cytotoxic activity as well as mitogen-induced interferon levels in human lymphocytes. In addition, animal experiments have suggested that thymus extracts inhibit tumor growth. A systematic review located 13 randomized, controlled trials of thymus extracts for various human cancers. Five of these studies suggested that thymus extract therapy may have some benefit. However, the low average methodological quality of the trials and overt contradictions in terms of outcomes prevented firm conclusions. Thymus preparations can cause severe allergic reactions and possibly serious infections when injected.

Shiitake mushroom extract — Shiitake mushrooms are among the most consumed mushrooms in the world, and they have been used in traditional Asian medicine for over 2000 years. In vitro, several polysaccharide components exhibit antitumor activity. The antitumor efficacy of a shiitake mushroom extract was tested in an open-label study in which 62 men with advanced prostate cancer received oral extracts of shiitake mushroom daily for six months. The clinical endpoint was the tumor marker, serum prostate specific antigen (PSA). By six months, 23 patients had a rising PSA, while 38 remained stable. No patient had a conventional PSA response, defined as a reduction of ≥50 percent of serum PSA over baseline. The authors concluded that shiitake mushroom extract alone was an ineffective treatment for men with clinical advanced prostate cancer.

Lycopene — Multiple studies have suggested that the carotenoid lycopene, which is particularly rich in tomatoes, may have a role in preventing prostate cancer, although this has not been established in controlled clinical trials. A detailed review of the available evidence by the United States Food and Drug Administration found that there was no credible evidence to support a relationship between lycopene intake and a reduced risk of cancer.

Vitamin C — A number of studies have examined the hypothesis that antioxidants such as vitamin C can prevent cancer by augmenting the body's ability to dispose of toxic free radicals, thereby retarding oxidative damage. Although there is little evidence to support an important role for vitamin C in cancer prevention, many patients who have cancer take supplemental vitamin C, often at high doses. High-dose intravenous vitamin C is widely used by practitioners of CAM.

Gustav Klimt: Tod und Leben. Museum Leopold, Wien.

COMPLEMENTARY SUPPORTIVE CARE — Complementary therapies are adjuncts to mainstream care that may be used to manage cancer symptoms, adverse effects of therapy or improve quality of life or even quality of death. In contrast to alternative therapies, many complementary therapies have been shown to be of benefit in patients with cancer.

Acupuncture and related therapies — Acupuncture has been studied in patients with cancer to reduce chemotherapy and radiotherapy-induced nausea and vomiting, for pain control, and to reduce vasomotor symptoms in women receiving antiestrogen treatment for breast cancer as well as in men treated with gonadotropin analogs for prostate cancer. Some reports suggest acupuncture also may have a role in patients with radiation-induced xerostomia, and for persistent chemotherapy-related fatigue.

Nausea and vomiting — Several different techniques have been used to stimulate the pericardium 6 (P6 or neiguan) site, which is commonly thought to be useful in the management of chemotherapy-induced nausea and vomiting, and possibly radiotherapy-induced nausea and vomiting. These include manual stimulation with the insertion of fine needles, electrostimulation through needles or percutaneously, and noninvasive pressure on the skin over the P6 pressure point (ie, acupressure).The potential benefits and limitations of these approaches are illustrated by two of the larger randomized trials: Low frequency noninvasive electroacupuncture at classic antiemetic acupuncture points was evaluated in a trial in which 104 women with breast cancer were randomly assigned to the active intervention, mock electrostimulation on the same schedule, or no intervention. All patients received concurrent three drug antiemetic pharmacotherapy and highly emetogenic chemotherapy. The number of emesis episodes occurring during the five days was significantly lower for patients receiving electroacupuncture compared with those receiving the mock procedure or antiemetic pharmacotherapy alone (median number of episodes, 5, 10, and 15, respectively). During the nine day follow-up period, no significant differences were observed between groups, suggesting that the observed effect had a limited duration. A lack of benefit from acupuncture was suggested in a trial in which 80 patients undergoing high-dose chemotherapy with autologous hematopoietic stem cell transplantation were randomly assigned to ondansetron plus either invasive acupuncture at P6 or non-skin penetrating placebo acupuncture. There were no significant differences between the groups in the rate of emesis or retching, nausea, or use of rescue antiemetics. A systematic review in 2005 examined the results from 11 randomized trials with 1247 patients receiving chemotherapy regimens of moderate or high emetogenicity. Overall, acupuncture-point stimulation significantly reduced the proportion of patients with acute vomiting (31 versus 22 percent). However, the mean number of emetic episodes was not significantly decreased and no benefit was apparent in the control of delayed emesis. Electrostimulation through acupuncture needles appeared to be the most effective modality. However, not all studies utilized state-of-the-art antiemetics, and the role of acupuncture and acupressure remains uncertain.

Pain control and xerostomia — Although some trials have suggested that acupuncture can be useful in ameliorating cancer pain, a systematic review concluded that the value of acupuncture has not been established. On the other hand, benefit for acupuncture after treatment for head and neck cancer was suggested in a trial in which 70 patients with pain and dysfunction three or more months after neck dissection and irradiation were randomly assigned to four weekly acupuncture treatments or usual care (physical therapy, analgesia, antiinflammatory drugs); the use of sialagogues was not described. In a preliminary report, acupuncture was associated with a significant reduction in pain and dysfunction as well as a greater improvement in patient-reported xerostomia as compared to usual care. The duration of benefit was not stated. Independent confirmation of these data is needed.

Vasomotor symptoms — Acupuncture has been studied as a potential therapy for hot flashes, but its value is unproven. In a meta-analysis of five trials comparing acupuncture to sham acupuncture in menopausal women with vasomotor symptoms, reductions in severity and frequency of hot flashes were seen with both therapies, but there were no significant differences between the two groups.

In men receiving gonadotropin analogs for prostate cancer, a small pilot study suggested that acupuncture decreases hot flashes, but there are no data from a randomized trial.

Hypnotherapy — Several (mostly small) randomized, controlled trials have demonstrated the usefulness of hypnotherapy in palliative cancer care, with efficacy in controlling pain and nausea/vomiting in various settings. A systematic review of hypnosis may be particularly useful for reducing the anticipatory emesis associated with chemotherapy. In addition, hypnosis can be useful in children for preventing anxiety and pain due to procedures such as lumbar puncture or bone marrow aspiration. The use of hypnotherapy has also been evaluated as an adjunct to radiation therapy in a randomized study. In a study of 69 patients undergoing curative radiotherapy for a variety of cancers, benefit could not be documented with formal instruments assessing anxiety and quality of life, although patients reported an improved sense of both overall and mental wellbeing.

It is unclear to what extent these effects are due to specific or nonspecific (placebo) effects. An older review that summarized published clinical trials of hypnotherapy concluded that there is encouraging, albeit not compelling, evidence to suggest that hypnotherapy is helpful for controlling anxiety and pain as well as nausea and vomiting in cancer patients. A later systematic review of randomized trials of self-care strategies for managing common chemotherapy-related adverse effects concluded that randomized trials of reasonable quality provided limited support for the benefit of hypnosis in reducing nausea and vomiting.

 

Behavioral intervention — Behavioral intervention encompasses a number of techniques, which have been applied separately and in combination. In a randomized trial with 115 patients, a structured multidisciplinary program including cognitive, emotional, physical, social, and spiritual interventions was useful in patients receiving radiation therapy for advanced cancer. Those receiving the active intervention were able to maintain their quality of life during the four week treatment period, while the control group who did not receive this adjunctive treatment had a significant decrease in quality of life.

Relaxation therapy — Relaxation techniques such as imagery, breathing exercises, manual massage, music therapy, art therapy, yoga, medical Qigong and reflexology  have been used to reduce symptoms (such as nausea and vomiting, fatigue) and improve mood, sleep, and quality of life in cancer patients. The systematic review discussed above concluded that there was limited evidence to support a benefit for relaxation and exercise to reduce nausea and vomiting, with some benefit for this practice seen in 10 of 13 published randomized trials. The benefit of yoga for reducing fatigue and improving sleep quality has been demonstrated in a randomized trial. The impact of relaxation therapy on mood and quality of life are less certain. In one randomized study, 96 women receiving chemotherapy for newly diagnosed breast cancer were assigned to receive either regular relaxation training and imagery or standard care only. The experimental group experienced better quality of life than the control group. However, another trial of relaxation therapy in women with early breast cancer and hot flashes found no benefits in terms of anxiety or quality of life.

Manual massage therapy can convey intensive relaxation to both the body and the mind, but benefits are usually transient: In a retrospective series of 1290 cancer patients in whom pain, fatigue, anxiety, and nausea were assessed before and after massage therapy, moderate to severe symptoms decreased by approximately 50 percent. Therapeutic benefits persisted for at least 48 hours in outpatients, although the total duration of benefit was not reported. Massage therapy was compared to simple touch in a randomized trial involving 298 persons with advanced cancer. Massage was associated with significant immediately beneficial effects on pain and mood (just after the treatment session), but they were not sustained in the following weeks.

Not all behavioral interventions have been shown to be effective. Although many studies are encouraging, we need to determine which approaches are best for what type of patient and to establish how these interventions compare to conventional methods used in palliative care.

Aromatherapy — Aromatherapy uses various aromatic oils, often in conjunction with massage, to treat symptoms of anxiety and depression. This approach has been widely used, and evidence from small trials suggests that it may have some benefit in relieving self-reported symptoms. Aromatherapy massage was assessed in a multicenter trial in which 282 cancer patients were randomly assigned to aromatherapy weekly for four weeks or to a control arm. No benefits were present at 10 weeks after treatment, the primary endpoint of the trial. Although patients experienced improvement two weeks after treatment, these benefits were no longer present at six weeks after therapy.

Therapeutic touch — Several clinical trials have tested the effectiveness of therapeutic touch (Reiki) to reduce anxiety, improve wellbeing or quality of life, or reduce pain in cancer patients. Some of these studies have yielded positive results. Due to weaknesses in study design, however, it is unclear whether the observed effects were due to specific therapeutic or nonspecific (placebo) effects.

Ginseng and fatigue — A beneficial effect of ginseng on chemotherapy-induced fatigue was suggested by a pilot double-blind trial of 20 patients who were randomly assigned to ginseng supplements or placebo (from the same manufacturer) during chemotherapy. A second trial, involving 282 patients, randomly assigned patients to placebo or one of three doses of ginseng. Preliminary results of that trial also suggested some activity in treating cancer-related fatigue. Additional trials are required to determine whether ginseng has a role in treated cancer-related fatigue.

Fish oil for symptom control — Fish oil, which contains alpha-3 omega fatty acids, has been studied as a pharmacologic treatment for cancer-related anorexia/cachexia. At least one trial has examined the benefit of fish oil for control of cancer-related symptoms in addition to anorexia. Sixty patients with a variety of cancers were randomly assigned to fish oil capsules or placebo in addition to their conventional treatments. Among the 60 patients who both began and completed two weeks of their allotted therapy (27 dropped out during treatment because they could not tolerate the regimen), supplemental fish oil did not influence appetite, fatigue, nausea, weight loss, caloric intake, nutritional status or sense of wellbeing.

While the importance of cancer prevention has moved into the forefront of public consciousness, due to intense awareness campaigns by the cancer societies, the areas that include diagnosis, therapy and follow-up need to achieve similar recognition. Widespread passive follow-up ought to be replaced by an active treatment plan tailored to the respective indications of the patient's disease. In order to reach this goal, oncologists should aim to expand on proven complementary medicinal approaches and optimize the timing and the benefits of therapy.

Overview of Complementary Therapies in Oncology

Complementary medicine should primarily be regarded as an addition to or enhancement of current standard treatment options in oncology.

Nutrition

The National Cancer Institute (NCI) of the United States attributes about 35% of all types of cancer to malnutrition. The potential for prevention of cancer is thus large and general nutrition guidelines for primary and secondary prevention are of much value, according to the German Society of Nutrition (DGE) and the International Society for Nutrition and Cancer (9).

It is striking to see that both fruit and vegetables play a prominent role in the prevention of cancer. For almost every type of cancer, there is evidence of protective nutritional factors. Among the cancer promoting factors, obesity plays a major role in addition to smoking and alcohol. The role ofanimal fats as a carcinogenic factor remains unclear. Although fats are considered to increase the risk of cancer, there is neither compelling evidence from epidemiological studies nor any other indication that a causal relationship exists. This statement does not address the role of fats as an energy source or their possible role in the development of obesity.

Once cancer becomes apparent, the success of therapy and the healing process, are decisively determined by the patients nutritional state. Fundamentally, a specific advisory for the patient's optimized nutrition is of great importance at this point, since malnutrition and cachexia can have a significant effect on the quality and duration of life. Malnutrition increases cancer mortality by about 30%  and cachexia worsens the prognosis of disease significantly, since it is associated with reduced response to treatment, more complications from and adverse reactions to the treatment and prolonged hospitalization.

Exercise; Physical Activity

Exercise in the form of “moderate endurance training” (such as walking, jogging, swimming and cycling, all under strict aerobic conditions) and “focused gymnastics” (such as stretching, functional, water, spinal column gymnastics) have proved to be beneficial in the prevention and follow-up of cancer as well as during cancer destructive therapies.

Cancer imposes an enormous psychological and physiological stress on those afflicted, weakening the immune, hormone and other metabolic systems. Exercise, in contrast, ensures a certain tolerance to stress which can be developed particularly through endurance training. The diagnosis and therapy of cancer exert a maximum of stress that is processed in a variety of ways. Stress entails an adaption syndrome of neurovegetative and psychoimmunological regulatory circuits as a result of an acute or chronic challenge to the physical and psychological capabilities of the afflicted person. The patient can be trained to adapt to this burden by means of a coping strategy which includes physical activity.

Endurance exercise induces stress resistance and has beneficial effects on the psyche, thereby strengthening immune defences and the cardio-vascular, hormone and metabolic systems. Recently published clinical studies (RCTs, representing level I of the Evidence-based Medicine classification) proved in vivo the beneficial effects of moderate endurance exercises to cancer patients in the follow-up period and during standard therapies; significantly reduced frequency and severity of fatigue syndrome and other therapy related adverse reactions.

Psycho-oncological Support

Psychotherapeutic measures should be an integral part of any acute treatment or rehabilitation of cancer patients. It is widely known that disabilities may lead to psychosomatic diseases and that these can be relieved or even cured with appropriate psychological aid or therapeutic modalities. In addition, psychotherapeutic measures are indicated for dealing with the following types of problems or symptoms: emotional disturbances, such as fear or depression; conflicts within a relationship or family; impairment in social behaviour; social withdrawal tendencies; psychological impairment with physical decline or deterioration; problems in accepting the disease; discrepancies between therapeutic expectancy and actual treatment options and inadequate behaviour towards the disease.

Psychotherapy is an integral part of acute and rehabilitative treatment in oncology and it has proved its beneficial effects (for example improvement of quality of life and prolongation of disease free intervals) especially for breast cancer patients in well designed RCTs. Psycho-oncological treatment options (such as visualization, relaxation, creativity training and discourse) should be recommended individually and have recently been published.

Balanced Vitamin/Trace Element Mixtures

Cancer patients have an increased requirement for essential micronutrients that are rarely adequately supplied even through a wholesome and balanced diet. This especially holds true before or during cancer destructive therapy, since the need for micronutrients in these phases is increased due to side-effects such as reduced appetite, nausea, vomiting, diarrhea, and perspiration. It has been demonstrated that a deficit in micronutrients (vitamins, trace elements and minerals) results in a reduced tolerance of current standard cancer therapy.

For further study: http://www.uptodate.com/contents/patient-information-complementary-and-alternative-medicine-treatments-cam-for-cancer?source=see_link

Jürg Reinhard. Krokuswiese. Merligen, 2009. 

The Dolder Grand Zurich - Novel Spa Program

The Dolder Grand Spa

http://www.thedoldergrand.com/fileadmin/user_upload/thedoldergrand.com/factsheets/Spa/SpaMenu_e.pdf

My novel Mind and Body spa program:

Come to Zurich, and stay with us for a unique and transforming experience

http://www.thedoldergrand.com/en/metanavigation/home.html

Nutrition & Cancer

 

Excerpts with amendments (ra) from the original article "Nutrition & Breast Cancer" by Natalie Ledesma, 
Ida & Joseph Friend Cancer Resource Center, UCSF Helen Diller Family Comprehensive Cancer Center
University of California, San Francisco

Good nutrition may reduce the incidence of cancer and the risk of cancer progression or recurrence. There are many studies in progress to help further understand how diet and cancer are related. We do know, however, that improved nutrition reduces risk of chronic diseases, such as diabetes, obesity, hypertension and heart disease, and also enhances overall quality of life. It is estimated that one third of cancer deaths in the U.S. can be attributed to diet in adulthood [1].

Guidelines for a Healthy Diet

• Plant-based diet

o Plenty of fruits and vegetables

o High fiber – whole grains and beans/legumes

• Emphasis on healthy fats

• Exclude processed and refined grains/flours/sugars

• Drink plenty of fluids

• Be physically active to help achieve and maintain a healthy weight

Plant based diet

A lifelong commitment to a plant based diet may lower a person’s risk of developing cancer and may also reduce the risk of recurrent cancer. A plant based diet consists primarily of fruits, vegetables, whole grains, beans/legumes, and other plant protein sources.

FRUITS AND VEGETABLES

• Contain vitamins, minerals, fiber, and various cancer-fighting phytonutrients (for example: carotenoids, lycopene, indoles, isoflavones, flavonols).

• Vibrant, intense COLOR is one indicator of phytonutrient content.

• There is extensive and consistent evidence that diets high in fruits and vegetables are associated with decreased risks of many cancers, and while results for breast cancer risk are not yet conclusive, they are promising [2-12].

• A Korean case-control study reported that a high intake of certain fruits and vegetables resulted in a significantly lower risk of breast cancer in premenopausal (tomatoes) and postmenopausal women (grapes and green peppers) [6].

• A study assessing plasma or blood carotenoids as a marker for fruit and vegetable intake reported that individuals in the top 1/4 had a 43% lower risk of breast cancer recurrence when compared to those in the lowest 1/4 [17].

• Breast cancer survivors significantly reduced mortality by following a diet low in fat, high in vegetables, high in fiber, and high in fruit [19].

• The combination of consuming five or more daily servings of vegetables and fruits, and accumulating 540+ metabolic equivalent tasks-min/wk (equivalent to walking 30 minutes 6 d/wk) decreased mortality by nearly 50% [11].

 

Beta-Carotene

• Beta-carotene is one of the 600 carotenoids that can be partially converted into vitamin A in the body.

• Carotenoids have a protective role for certain sites of cancer, including breast cancer [7, 21-24].

• Cartenoid intake was significantly associated with reduced mortality in breast cancer survivors [19].

• In vitro research indicates that carotenoids may inhibit the production of breast cancer cells [30-31].

• Beta-carotene may hinder the development of breast cancer cells by inducing apoptosis*, or programmed cell death [32].

• Research indicates that dietary sources of beta-carotene are likely much more protective than supplemental sources against the risk of cancer [33-35].

 

Cruciferous Vegetables

• Some evidence suggests that the cruciferous vegetables, in particular, are associated with a reduced risk of breast cancer [36-40].

• A Swedish study of postmenopausal women reported one to two daily servings of cruciferous vegetables to reduce the risk of breast cancer, possibly by as much as 20-40% [37].

• Women who ate more turnips and Chinese Cabbage, in particular, significantly reduced the risk of postmenopausal breast cancer [40].

• Consumption of cruciferous vegetables, particularly broccoli, was inversely, though not statistically significant, associated with breast cancer risk in women [36].

• The U.S. component of the Polish Women’s Health Study found that women who consumed raw- or short-cooked cabbage and sauerkraut 3 or more times weekly had a significantly reduced risk of breast cancer [39].

o Cabbage that was cooked for a long time had no effect on breast cancer risk.

o Researchers suggested that glucosinolates, compounds in cabbage, may affect both the initiation phase of carcinogenesis*, cell mutation*, and inhibit apoptosis*.

• Indole-3-carbinol (I3C) is a compound found in cruciferous vegetables that has anticancer properties and anti-proliferative effects on breast cancer cells [47].

o I3C may inhibit the growth of blood vessels that the tumor needs to grow (anti-angiogenesis) [48].

• I3C and diindolylmethane (DIM) induce apoptosis, or cell death, in breast cancer cells [41,49] for both ER+ and ER- tumor cells [50].

• Dietary I3C may have effects that bolster immune function [52].

Nutrient Dietary Sources Recommendation

Beta-carotene: Carrots, sweet potatoes, winter squash, cantaloupe, and mango, include these fruits and

Cruciferous vegetables: Arugula, broccoli, Brussels sprouts, cabbage, cauliflower, collard greens, horseradish, kale, kohlrabi, mustard greens, radishes, rutabaga, turnips and turnip greens, and watercress, include these vegetables daily.

Organic Produce

• Organic fruits and vegetables have fewer pesticides, lower levels of total pesticides, and less overall pesticide toxicity than fruits and vegetables grown with chemicals. Although more research is needed, recent evidence indicates a significant increase in antioxidants in organic and sustainably grown foods versus conventionally grown foods [54-58].

o Organic vegetables contained a greater concentration of phytonutrients* (phenolic acids) when compared to conventionally grown vegetables [57,58].

• Consuming organic foods appears to increase salicylic acid, which may contribute to a lower risk of cancer [57].

• Choosing organic produce will help you reduce your levels of pesticide exposure and will most likely increase your phytonutrient* consumption.

o Although washing and peeling your non-organic fruits or vegetables may help to reduce pesticide residues, it will not eliminate them.

• Listed below are produce with the most and least pesticide contamination, both in terms of number of pesticides used and the level of pesticide concentration on an average sampling. Thus, for the fruits and vegetables shown on the most contaminated list, it is wise to buy organic. Alternatively, if organic choices are not available, you may want to consider substituting with produce that tends to contain the least amount of pesticides.

Produce most contaminated by pesticides:

Peaches, Apples, Bell peppers, Celery, Nectarines, Strawberries, Cherries, Lettuce, Grapes–imported, Pears, Spinach, Potatoes.

Produce least contaminated by pesticides:

Onions, Avocado, Sweet corn, Pineapples, Mango, Sweet peas, Asparagus, Kiwi, Bananas, Cabbage, Broccoli, Eggplant.

 **Adapted from Environmental Working Group – A Shopper’s Guide to Pesticides in Produce

• It is most important, however, to eat fruits and vegetables – organic or conventional. If the availability or cost of organic produce is a barrier, you may wish to avoid those fruits and vegetables that have the highest pesticide residue content.

 

Pomegranate (Punica granatum; Punicaceae)

• Various parts of the pomegranate fruit (for example: seed oil, juice, fermented juice and peel extract) have expressed the suppressive effects on human breast cancer cells in laboratory research [65].

• Pomegranate seed oil and fermented juice block the cancer cells’ oxygen supply, slow cell growth, and promote cell death [66].

• Fermented pomegranate juice polyphenols* appear to have twice the anti-proliferative effect as fresh pomegranate juice polyphenols* [67].

• Furthermore, one study suggests that pomegranate seed oil may have the greatest preventive activity (87% reduction in lesions) compared to fermented pomegranate juice (42% reduction) [68].

FIBER – A PLANT-BASED DIET IS NATURALLY HIGH IN FIBER

• A diet rich in natural fiber obtained from fruits, vegetables, legumes (for example: lentils, split peas, black beans, pinto beans), and whole-grains may reduce cancer risk and/or reduce risk of cancer progression.

• Fiber binds to toxic compounds and carcinogens, which are then later eliminated from the body [69].

• A high fiber diet is also associated with less obesity [72].

• Women who ate beans and lentils at least twice a week had a 24% lower risk of developing breast cancer than women who ate them less than once a month [86].

High-Fiber Sources

FRUITS:

Table: Food Serving Size Fiber Grams/ Serving

Apple 1 medium 3.7

Banana 1 medium 2.8

Blackberries 1/2 cup 1.9

Blueberries 1 cup 1.3

Cantaloupe 1/2 cup 6.0

Figs (dried) 1/4 cup 6.0

Grapefruit 1 medium 3.4

Grapes 1 cup 1.6

Guava 1 medium 4.9

Kiwi 1 medium 2.6

Orange 1 medium 3.1

Pear 1 medium 4.0

Persimmon 1 medium 6.0

Prunes 1/4 cup 3.1

 

GRAINS & OTHER PRODUCTS:

Table: Food Serving Size Fiber Grams/ Serving

Amaranth 1/4 cup dry 7.4

Barley 1/2 cup cooked 3.0

Beans, black 1/2 cup cooked 8.3

Beans, red kidney 1/2 cup cooked 8.2

Beans, garbanzo 1/2 cup cooked 5.0

Bran cereals 3/4 cup Check labels (5.0-22.0)

Brown rice 1/2 cup cooked 1.4

Bulgur 1/2 cup cooked 4.0

Cream of wheat 1/2 cup cooked 0.5

Oatmeal 1/2 cup cooked 2.0

Peanuts 1/4 cup 2.9

Quinoa 1/4 cup dry 2.5

White rice 1/2 cup cooked 0.3

VEGETABLES:

Table: Food Serving Size Fiber Grams/ Serving

Artichokes 1 medium 6.9

Beets 1/2 cup cooked 1.7

Broccoli 1/2 cup cooked 2.3

Brussel sprouts 1/2 cup cooked 2.0

Carrots 1/2 cup cooked 2.6

Kale 1/2 cup cooked 1.3

Lima beans 1/2 cup cooked 4.5

Peas, green 1/2 cup cooked 4.4

Spinach 1/2 cup cooked 2.2

Squash, winter-type 1/2 cup cooked 3.4

Sweet potatoes (yams) 1/2 cup cooked 2.7

 

SUGARS AND THE ROLE OF INSULIN*

• High sugar foods are usually highly processed and refined, low in nutrient value, and also low in dietary fiber. In addition, these foods appear to increase serum insulin* and serum IGF-I levels [87], which appear to stimulate cancer cell growth.

o In premenopausal women, women in the highest quartile of serum glucose had a 280% increased risk of breast cancer compared with women in the lowest quartile.

• Hyperinsulinemia may contribute to the development of breast cancer in overweight or obese women [103].

• A recent case-control* study reported that carbohydrate intake significantly increased risk of breast cancer; sucrose (table sugar) imparted the greatest risk [105]. This risk was lessened considerably with a higher fiber intake.

• The consumption of sweet foods with a high glycemic index (GI) and glycemic load (GL) have been implicated as a risk factor for breast cancer due to their effects on insulin and IGF-I [107-110].

• Adding credence to the idea that blood sugar levels may affect disease progression, women who consumed a high GI and GL diet had a 57% and 253% increased risk of breast cancer, respectively [108].

INSULIN HIGH TIDE. The observed link between obesity and cancer may be explained by the growthpromoting activities of insulin and IGF-1. One theory posits that excess weight sets off a biochemical cascade that increases insulin and, in turn, IGF-1 levels. Both hormones may activate IGF-1 receptors on cells, which can spur cell growth and inhibit cell death pathways that usually protect against tumor development.
E. Roell/Source: Nature Reviews Cancer, 2004

Sugars & Insulin* – Bottom Line

• To help control your insulin* level:

o Eat a high-fiber diet with limited refined/processed foods

o Follow an only plant fat diet rich in omega-3 fatty acids

o Exercise

o Maintain a healthy body weight

LOW FAT DIET

Several studies have investigated the relationship of fat and the risk of breast cancer, but the results remain inconsistent.

Saturated Fats

• Several studies indicate a positive association between saturated fat intake from meat and dairy products (animal sources) and cancer [114-117]. The breast cancer research, however, is inconclusive.

Trans-Fatty Acids

• Preliminary research indicates that these fatty acids may be associated with an increased risk of cancer [123-126].

• These fats may disrupt hormonal systems that regulate healing, lead to the destruction of defective membranes, and encourage the development of cancer.

• One study reported a 40% increased risk of breast cancer in postmenopausal women who had higher tissue levels of trans-fatty acids [128].

• Women who consumed greater amounts of trans-fatty acids significantly increased their risk of breast cancer [126].

o Women in the highest quintile of trans-fatty acid consumption had a 75% increased risk compared with women in the lowest quintile.

Omega-9 Fatty Acids (Monounsaturated Fats)

• Most research at this time indicates a neutral relationship [120,126] or a slightly protective effect [122,129-131] between these fats and risk of breast cancer.

• Several case-control* studies reported that olive oil consumption, rich in omega-9 fats, resulted in a 13-34% reduction in breast cancer risk [132-135].

o One study found that women who consumed =8.8 g/day of olive oil had a 73% lower risk of breast cancer [131].

Essential Fatty Acids (EFA)

Essential fatty acids are necessary for the formation of healthy cell membranes, the proper development and functioning of the brain and nervous system, and for the production of hormone like substances called eicosanoids* (thromboxanes, leukotrienes, prostaglandins). Among other body functions, these chemicals regulate immune and inflammatory responses.

Eicosanoids* formed from the omega-6 fatty acids have the potential to increase blood pressure, inflammation, platelet aggregation, allergic reactions and cell proliferation. Those formed from the omega-3 fatty acids have opposing affects. Current research suggests that the levels of essential fatty acids and the balance between them may play a critical role in the prevention and treatment of cancer.

Omega-3 Fatty Acids

• Research is growing supporting a protective relationship between omega-3 fatty acids [alpha linolenic acid (ALA), eicosapentanoic acid (EPA), and docosahexanoic acid (DHA)] against the risk of breast cancer [118,120,135-141].

• Studies show that omega-3 fatty acids inhibit breast cancer tumor growth and metastasis. Additionally, these fats are immune enhancing.

• Fish and plant-based foods, however, contain different types of omega-3 fatty acids.

o Fish contains EPA and DHA, two specific fatty acids that have shown promising results in the research literature [135,140,144].

o Fish consumption in general has been associated with a protective effect against breast cancer [136,138,140,145].

o The plant-based omega-3 fatty acid sources, such as flaxseed and others listed in the table below, contain ALA. In an ideal environment, ALA is converted to EPA and DHA, however, this process is inefficient [69,142,146]. On the positive side, the conversion process is enhanced by following a diet that is low in saturated fats and low in omega-6 fatty acids [142,147].

Omega-6 Fatty Acids

• Recent studies indicate that a high intake of omega-6 fatty acids (linoleic acid, which can be converted to arachidonic acid) promote breast tumor development and metastasis [117,137,138,148,149].

• A meta-analysis* of 3 cohort* studies found palmitic acid, a type of omega-6 fatty acid, to be significantly associated with an increased risk of breast cancer [118].

• Additionally, researchers reported that arachidonic acid, an omega-6 fatty acid almost exclusively from meat, significantly increased oxidative damage as measured by urinary biomarkers [150].

• A very interesting finding was reported in a prospective study that found no overall association between omega-6 fatty acids and risk of breast cancer [120]. However, omega-6 fat consumption increased risk by 87% in women who consumed 25 g or less of marine omega-3 fatty acids. This effect was even greater for advanced breast cancer.

o Thus, the balance between omega-6 and omega-3 fatty acids may be of paramount importance. This was further supported by other studies [137,138,151,152].

Fat – Bottom Line

• Less animal fat is better.

• Avoid hydrogenated fats.

• Extra-virgin olive oil, canola oil, macadamia nut oil or almond oil is preferred for salads and cooking.

• Increase omega-3 fatty acids.

Fatty Acid Dietary Sources Recommendation

Saturated fatty acids from: Meats, poultry skin, baked goods, and whole milk dairy products, including butter, cheese, and ice cream

Reduce or eliminate meat and whole milk dairy products.

Trans fatty acids from: Margarine, fried foods, commercial peanut butter, salad dressings and various processed foods including breads, crackers, cereals, and cookies

Avoid trans or hydrogenated fats. Products may be labeled “trans fat free” if they contain less than 0.5 mg per serving.

Omega-9 fatty acids from: Extra-virgin olive oil, almond oil, canola oil, macadamia nut oil, almonds, and avocados, include these healthy fats daily.

Omega-3 fatty acids:

Include these healthy fats

EPA and DHA Cold-water fish (for example: salmon, sardines, black cod, trout, herring), daily through diet and/or supplements.

It may be wise to consume cold water fish, algae or fish oil, ALA Flaxseeds, chia seeds, walnuts, hempseeds, and pumpkin seeds supplements at least twice weekly to obtain an adequate amount of EPA and DHA.

If you choose to use a supplement, opt for one that is highest in EPA and DHA concentration.

Omega-6 fatty acids: Reduce or eliminate meat, reduce butter.

Limit consumption of linoleic acid-rich oils. Linoleic acid Common vegetable oils, such as corn oil, safflower oil, sunflower oil, and cottonseed oil, and processed foods made with these oils

Substitute an omega-9 fatty acid-rich oil for your current cooking oil or fat.

 

Meat

• In a study of over 35,000 women, meat consumption significantly increased the risk of breast cancer in both premenopausal and postmenopausal women [153].

• Consumption of red and fried meat quadrupled the risk of breast cancer in a case-control study in Brazil [12].

• Meat consumption increased the risk of breast cancer risk by 56% for each additional 100 g (3.5 oz) daily of meat consumption in a French case-control study [135].

• Regular consumption of fatty red meat and pork fat increased the risk of breast cancer by 348% and 632%, respectively in a small Brazilian study [154].

• A large case-control* study found that women who consumed very well-done meat for hamburger, bacon, and steak had a 54%, 64%, and 221% increased risk for breast cancer, respectively [155].

o Frequent consumers of these well-done meats had a 462% greater risk of breast cancer.

Food Category Summary Recommendation

Fruits and vegetables: At least 5, preferably 8-10 servings total

½ cup fruit or vegetable servings daily [156]

1 cup raw leafy greens

¼ cup dried fruit or vegetable

6 oz fruit or vegetable juice

Eat 1 cup or more vegetables with lunch and dinner.

5 or more vegetable servings

3 fruit servings

Fiber Choose breads with 3 or more grams of fiber per slice. First ingredient on the label should be whole or sprouted grain flour, not white flour, unbleached white flour, or enriched wheat flour.

Whole grains include, among others, oats, barley, brown rice, quinoa, amaranth, bulgur, millet, buckwheat, spelt, wild rice, and teff.

30-45 grams daily

This goal can be achieved by meeting your fruit and vegetable goal plus one serving of legumes or at least two servings of whole grains.

Refined carbohydrates and Dietary sources: Limit or avoid consumption of all sugars, refined flours (for example: white bread, white rice, white pasta) or refined grains, alcohol, sodas, drinks containing added sugars, and desserts, such as candy, cookies, cakes, and pastries.

Reduce or eliminate meat consumption. Avoid processed, grilled or fried meats.

GENOTOXINS:

Heterocyclic Amines (HCAs) & Polycyclic Aromatic Hydrocarbons (PAHs)

• Natural components in meat, such as amino acids, creatine*, and polysaccharide precursors, are converted to HCAs during high-temperature cooking. HCAs are known to cause cancer in laboratory animals [157,158].

• While human research is forthcoming, the majority of studies [155,157-162] although not all [163,164] have observed a significant association between HCAs and breast cancer.

• Carcinogenic activity of HCA’s is affected by various dietary factors [165]:

o Factors that enhance carcinogenesis* when combined with HCAs include:

• High-fat diet

• Caffeine

o Factors that inhibit carcinogenesis* when combined with HCAs include:

• DHA

• Conjugated linoleic acid (CLA)

• Isoflavones

• Diallyl Sulfides (found in the allium family, such as garlic, onions, leaks, and shallots)

• Green tea catechins*

• Indole-3 carbinol

• Probiotics

• Gamma-tocopherol

• The most important variables contributing to the formation of HCAs are:

o Cooking temperature (greater than 300°F)

o Cooking time (greater than 2 minutes)

o Cooking method (frying, oven grilling/broiling, barbecuing)

• Charring of food (charcoal-broiled or smoked foods) contribute to PAHs [166].

• Meat can potentially be made “safer” to eat by being cooked in a way that does not lead to HCA formation.

o Choose lean, well-trimmed meats to grill.

o Using marinades significantly reduces the amount of HCAs.

o Brief microwave preheating substantially reduces HCA content of cooked meat.

o Small portions require less time on the grill.

• Additionally, the type of protein cooked can also affect the concentration of HCAs. It has been reported, for example, that chicken has more than 100 times the number of HCAs than salmon [165]. London broiled steak had more than 600 times the amount of HCAs when compared to salmon.

• Grill vegetables or meat alternatives that do not lead to the formation of HCAs or PAHs.

 

ALCOHOL

• Regular consumption of alcohol may increase the risk for breast cancer [167-176].

o A recent review study reported that data from many well-designed studies consistently shows a small rise in breast cancer risk with increasing consumption of alcohol [172].

o Furthermore, 1-2 drinks a day increased risk by 21% and 2 or more drinks a day increased risk by 37%.

• Women who drank two or more alcoholic drinks daily in the five years prior to diagnosis had an 82% increased risk of breast cancer compared to non drinkers [173].

o Greatest risk was among heavy drinkers who were also postmenopausal and had a history of benign breast disease or who used hormone replacement therapy (HRT) [168].

• Similarly, a French study found that drinking 10-12 g wine (~ 1-1.5 drinks) daily lowered the risk of breast cancer, but when intake increased above 12 g daily, the risk of breast cancer increased [180].

• These differing findings between pre- and postmenopausal women are likely related to the effect of alcohol on estrogen levels. Alcohol appears to increase endogenous* estrogen levels [183-187].

• Folate, a B vitamin, may be of even greater significance with alcohol consumption. It has been observed that women with low folate and high alcohol consumption had a 43% greater risk of breast cancer when compared with nondrinkers with adequate folate intake [188].

Alcohol – Bottom Line

• It is best to limit or avoid alcohol.

ADEQUATE FLUIDS

The functions of water in the body include the following:

o Carries nutrients and waste products.

o Participates in chemical reactions.

o Acts as a lubricant and cushion around joints.

o Acts as a shock absorber in the eyes and spinal cord.

o Aids in the body’s temperature regulation.

o Maintains blood volume.

• Increased fluid intake is needed for a high fiber diet.

• Drink plenty of water daily to help meet fluid needs.

CALORIC INTAKE

• The risk of breast cancer is much higher in industrial countries than in developing countries where women are characterized by lower energy intake and higher energy expenditure.

• Modest caloric restriction has been shown to inhibit tumor growth in animal models decrease oxidative DNA damage [189].

BODY MASS

• Epidemiologic evidence suggests a positive association between body mass and postmenopausal breast cancer [193-196].

o Increasing BMI was associated with a 40% increased incidence and mortality of breast cancer in postmenopausal women [197].

o Women with a BMI of =25 had a 58% increased risk of breast cancer [5].

• Eating foods high in vitamin C, such as fruits and vegetables, may provide a protective effect from breast cancer for overweight women (BMI>25) [215].

 

PHYSICAL ACTIVITY

• Low levels of physical exercise appear to be associated with the risk of breast cancer [172,195,216-218].

• Lifetime total physical activity has been associated with a decreased risk of breast cancer [219-221].

o Exercise between the years of 14-20 appears to be the most beneficial in reducing risk of breast cancer [219].

• Women who engaged in regular strenuous physical activity at age 35 had a 14% reduced risk of breast cancer compared with less active women [217]. A similar trend was observed for regular strenuous activity at age 18 and at age 50. These findings were consistent with women who did and did not use HRT.

• Furthermore, a prospective observational study reported that physical activity after a breast cancer diagnosis may reduce the risk of death from this disease [216]. The greatest benefit occurred in women who performed the equivalent of walking 3 to 5 hours per week at an average pace. The benefit of physical activity was particularly apparent among women with hormone-responsive tumors.

• As noted earlier, the combination of consuming five or more daily servings of vegetables and fruits, and accumulating 540+ metabolic equivalent tasks-min/wk (equivalent to walking 30 minutes 6 d/wk) decreased mortality by nearly 50% [11].

• Increased physical activity following breast cancer diagnosis significantly decreased the risk of dying from breast cancer and improved overall survival when compared with women who exercised <2.8 MET-h/wk [224].

• Physical activity can help ease cancer-related fatigue during and following cancer treatment [228,229].

Additional Nutritional and Lifestyle Factors for Breast Cancer Survivors

ANTIOXIDANTS* – Found in abundance in fruits and vegetables!

• Prevent oxidative damage in body cells.

o Research indicates a link between oxidant damage and breast carcinogenesis*.

• Examples of antioxidant* nutrients and non-nutrients include vitamins A, C, and E, selenium, lycopene, and beta-carotene.

• Note that patients may be advised to NOT consume high-dose antioxidant* supplements during chemotherapy or radiation therapy. Antioxidant* consumption via food sources and a basic multivitamin supplement are very safe.

Selenium

• Antioxidant* that scavenges free radicals and suppresses damage due to oxidation. Also is essential for the immune system.

• Promising evidence indicates that selenium may decrease the risk of breast cancer [234-239].

o Inhibits cell proliferation and induces apoptosis* [238,239].

• A recent study suggested the combination of selenium and iodine, typical of a Japanese diet, act synergistically in decreasing breast cancer risk [241]. It is known that iodine plays an important role in thyroid function. Thus, selenium status may affect both thyroid hormone status and iodine availability.

• Selenium is a precursor to the glutathione* (GSH) antioxidant* system. GSH is the principal protective mechanism of the cell and is a crucial factor in the development of the immune response by the immune cells [242].

Turmeric (Curcumin)

• Curcumin, the yellow pigment and active component of turmeric and many curries, is a potent antioxidant*, that exhibits chemopreventive and growth inhibitory activity in several tumor cell lines [243-246].

• Evidence suggests that curcumin may suppress tumor initiation, promotion and metastasis [245,247].

• Additionally, curcumin promotes detoxification in the liver and possesses anti-inflammatory activity, possibly by inhibiting COX-2 activity [248,249].

Vitamin C

• Most research [250-255], although not all [7,19,256,257], has shown no protective relationship between vitamin C and the risk of breast cancer.

o Vitamin C induces apoptotic effects on breast cancer cells [257].

• Low plasma levels of vitamin C have been associated with a greater risk of breast cancer [258].

• Dietary vitamin C has been significantly associated with reduced mortality in breast cancer survivors [19].

• Furthermore, risk of recurrence and mortality was reduced in women who consumed vitamin C supplements for more than three years [259].

Vitamin E

• Vitamin E acts as a cellular antioxidant* and an anti-proliferating agent. It consists of both tocopherols and tocotrienols.

o Some research indicates that tocotrienols are the components of vitamin E responsible for growth inhibition in human breast cancer cells [260].

• Research is inconsistent on the protective effects of vitamin E and breast cancer. Data from most prospective studies have not revealed a protective relationship between vitamin E and risk of breast cancer [250].

• Supplemental vitamin E does not consistently appear to offer protection against breast cancer [150] although taking vitamin E for more than three years has been associated with a modest protective effect [259]. Additionally, these researchers reported a decreased risk of recurrence and mortality associated with long-term use of vitamin E supplements.

• It was demonstrated recently that dietary vitamin E, unlike supplemental sources of vitamin E, significantly reduced oxidative damage as measured by urinary biomarkers [150].

• Note that findings suggest that vitamin E supplements may interfere with the therapeutic effects of tamoxifen [261].

 

Resveratrol

• Resveratrol is a polyphenol found primarily in red grape skins with known antioxidant and antiinflammatory properties, and is emerging as a potent chemopreventive and anticancer drug [262].

• Resveratrol has exhibited potential anticarcinogenic activities in several studies.

o Reduced tumor growth, decreased angiogenesis, and induced apoptosis in mice [263].

Nutrient/Phytonutrient Summary Recommendation

Selenium Dietary sources include Brazil nuts, seafood, enriched brewer’s yeast, and grains. Selenium content depends somewhat on the amount of selenium in the soil in which the products are grown. 200 mcg selenium daily through diet and/or supplements. Two Brazil nuts provide 200 mcg selenium.

Turmeric (curcumin) A deep orange-yellow spice commonly used in curries and Indian cuisine. Eat liberally.

Vitamin C Dietary sources include various fruits and vegetables, including papaya, citrus fruits, kiwi, cantaloupe, mango, strawberries, bell peppers, broccoli, and tomatoes.

Include these fruits and vegetables daily.

Vitamin E Dietary sources include vegetable oils, wheat germ, sweet potatoes, nuts, seeds, and avocados. Eat vitamin E-rich foods regularly.

More research is needed to assess whether or not supplements would be beneficial.

Resveratrol Dietary sources include grapes, grape products, peanuts, soy, mulberries, and cranberries. Eat resveratrol-rich foods regularly.

More research is needed to assess whether or not supplements would be beneficial.

Flax

• Flax may also work to block tumor growth, inhibit angiogenesis*, and enhance the immune system [268].

• A recent study indicates that flaxseed (25 g daily) and its metabolites, such as lignans*, reduced tumor growth in patients with breast cancer [271].

• An animal study reported that flaxseed inhibited established human breast cancer growth and reduced incidence of metastasis by 45% [272].

GREEN TEA

• Tea contains phytonutrients* known as polyphenols* (flavonoids) that provide antioxidant* and anticancer properties [277].

o May block the formation of cancer-causing nitrosamines* [278].

o Prevents DNA damage [279].

o May inhibit tumor growth and induce apoptosis* [280-282].

o Increase immune response [281].

o Epigallocatechin gallate (EGCG) alters gene expresssion to lower the risk of breast cancer [283].

• There is a significant amount of in vitro and in vivo evidence suggesting tea polyphenols* have chemopreventive agents against various cancers [280,284,285]. More human data is needed.

• Research suggests that while green tea did significantly decrease tumor mass, when green tea was combined with soy phytonutrients*, the tumor mass decreased even further [294]. Further evidence indicates a possible synergistic relationship between soy and green tea consumption [288].

• Similarly, a synergistic effect of green tea and Ganoderma lucidum extracts on the suppression of growth and invasiveness of metastatic breast cancers was observed [295].

• Additionally, green tea increased the inhibitory effect of tamoxifen on the proliferation of ER + breast cancer cells [296].

SOY

• Associated with reduced rates of heart disease [297-299], protection against osteoporosis [300,301], and certain types of cancer, including breast cancer [302,303].

• While there has been contention regarding soy and breast cancer, research findings are predominantly neutral [304], if not protective [6,305,306].

• Soy consumption has been suggested to exert potential cancer-preventive effects in premenopausal women, such as increased menstrual cycle length and SHBG* levels and reduced estrogen levels.

• Furthermore, vegan protein sources, such as soy, appear to decrease circulating IGF-I activity, which may impede cancer induction [298,314,315].

Source Amount of Soy

Protein (gm)

Amount of Soy

Isoflavones (mg)

Miso (1 tbsp) 2 7-10*

Soybeans, edamame (1/2 cup) 11 35*

Soymilk (8 fl oz) 10 23*

Soy nuts (1/4 cup) 19 40-50*

Tempeh (1/2 cup) 19.5 36*

Tofu (4 oz) 13 39*

* Isoflavone content varies by brand

 

Vitamin D

• Epidemiological studies suggest an inverse relationship between sun exposure, serum levels of 25(OH)-vitamin D, and vitamin D intake and the risk of developing and/or surviving cancer [318].

o Possible mechanisms that may explain the protective effects of vitamin D may be its role as a nuclear transcription factor that regulates cell growth, differentiation, apoptosis and a wide range of cellular mechanisms central to the development of cancer.

o Furthermore, breast density, a factor that may increase the risk of breast cancer, was inversely associated with vitamin D intake [319].

• The women in the Nurses’ Health Study observed a 30% reduction in risk of breast cancer comparing the highest with lowest quintiles of 25(OH)-vitamin D levels. [320].

• Post-menopausal breast cancer risk was significantly inversely associated with serum 25(OH)vitamin D levels [321].

o Risk decreased as women’s levels increased from 30 nM (12 ng/ml) to = 75 nM (30 ng/ml), [which is still very low, ra].

• It is now believed that the recommended vitamin D dose should be much higher, between 2’000 and 8’000 IU per day (ra).

o Research indicates that vitamin D3 (cholecaciferol) is better absorbed than vitamin D2 (ergocalciferol) [322].

• Due to the likelihood of a biochemical deficiency without clinical symptoms or signs, a serum 25(OH)-vitamin D level is recommended.

o Optimal serum 25-hydroxy vitamin D levels have not been established though research suggests 50-90 ng/ml (ra) may be ideal. Some believe the normal level of vitamin D is 50-60 ng/ml.

o While supplementation may be recommended, more appropriate dosing of vitamin D supplementation can be made once a serum 25(OH)-vitamin D level has been established.

 

Food or Beverage Summary Recommendation

Flaxseed: Good source of omega-3 fatty acids and fiber, contains protein, calcium, potassium, B vitamins, iron, and boron. Opt for ground flax seeds rather than whole flax seeds, flax seed oil, flax supplements to increase bioavailability. Flax seeds may be ground in a coffee grinder, blender, or food processor. 2 Tbsp ground flaxseed daily, Flax can have a laxativelike effect, thus, it is wise to gradually increase consumption. Sprinkle into various foods and beverages, including hot cereals, tomato sauces, fruit smoothies, brown rice or other grains. Store flax in the refrigerator or freezer.

Green tea: Green tea contains does contain caffeine though much less than coffee or black tea. Avoid decaffeinated teas or coffee, typical caffeine extraction results in a significant loss of phytonutrients. 1-4 cups daily.

Soy: Contains various nutrients, including protein, fiber, calcium, and B vitamins. Rich in antioxidants*, known as isoflavones, namely genistein and daidzein. Among others, dietary sources include soybeans, edamame, tofu, soymilk, tempeh, miso, and soy nuts. Unless soy has been a part of your diet for years, postmenopausal individuals with ER+ breast cancer may be advised to limit soy consumption to 1-3 daily servings. Soy supplements or isoflavone extracts are not recommended.

Vitamin D: A fat-soluble vitamin that we generate through skin synthesis of sunlight (ultraviolet rays). Dietary sources include cold-water fish, eggs, and fortified products, such as milk, soy milk, and cereal. Maintain serum 25 (OH)-vitamin D >50 ng/mL.

MELATONIN

• Melatonin is a hormone produced by the pineal gland. Its primary function involves the regulation of the body’s circadian rhythm, endocrine secretions, and sleep patterns.

• Some research indicates that individuals with low levels of melatonin are at greater risk for breast cancer.

• The risk of breast cancer was reduced by 33% in postmenopausal women who slept 9+ hours compared to those who slept =6 hours daily [324].

o Melatonin levels were 42% higher in those who slept 9+ hours vs =6 hours daily.

o In vitro and animal research has supported the protective effect of melatonin against breast cancer [328].

• Melatonin may act by:

o Inhibiting cell proliferation [330,331].

o Inducing apoptosis* [332].

o Enhancing the immune system [330,333].

• May improve survival in cancer patients by protecting the immune system from damage caused by chemotherapy [332].

o Reducing IGF-I [334,335].

o Decreasing the number and activity of estrogen receptors, thus reducing ways that the cancer cell connects to estrogen [336].

• Furthermore, the combination of melatonin and retinoids* [339] as well as the combination of melatonin and vitamin D3 [340] appear to work synergistically to inhibit the growth of breast cancer cells.

• Melatonin does have blood thinning properties, thus it is recommended to not use supplemental melatonin 7-10 days prior to surgery.

FOOD SAFETY

• Especially important for those with weakened or impaired immune systems and while on chemotherapy

• The following recommendations have been adapted from guidelines provided by the American Cancer Society.

o Wash foods thoroughly before eating.

o Keep all aspects of food preparation meticulously clean.

o Use special care in handling raw meats, poultry, and eggs.

• Thoroughly clean all utensils, countertops, cutting boards, and sponges that contacted raw meat.

• Thaw meats and fish in the refrigerator.

o Transfer large volumes of leftovers, such as soup, rice, or casseroles, to shallow containers and place in refrigerator. This process ensures proper cooling.

o Do not eat perishable foods that have been left out of the refrigerator for more than two hours.

o Store foods at low temperatures (less than 40oF) to minimize bacterial growth.

o When eating in restaurants, avoid foods that may have bacterial contamination, including sushi, salad bars, buffets, unpasteurized beverages or food products, and raw or undercooked meat, poultry, fish, and eggs.

 

SUMMARY - HEALTHY CANCER DIET

• Eat 8 to 10 colorful fruit and vegetable servings daily

o Two to three pieces of fruit

o One cup or more of vegetables with lunch and dinner

o 8 fl oz vegetable juice

• Consume 30 to 45 grams of fiber daily

o You will likely meet your fiber goal if you eat 8 to 10 servings of fruits and vegetables plus one serving of beans/legumes or at least two servings of whole grains daily.

• Avoid processed and refined grains/flours/sugars

o Keep WHITE off your plate: bread, pasta, rice, cream sauces, cakes, and more.

• Limit meats and whole milk dairy products

• Include healthy fats like cold-water fish, flaxseed, walnuts, soybeans, olive oil, avocados

• Eat 2 Tbsp ground flax daily

• Limit alcohol consumption

• Drink 1 to 4 cups of green tea daily

• Maintain serum 25 (OH)-vitamin D levels above 50 ng/mL

• Drink plenty of fluids, water or non-caffeinated beverages, daily to help meet fluid needs

• Engage in daily physical activity to help achieve and maintain a healthy weight

WORDS OF WISDOM

“Let food be your medicine.”

 -Hippocrates

This blog is designed for educational purposes only and is not intended to replace the advice of your physician or health care provider, as each patient’s circumstances are individual. We encourage you to discuss with your physician or us any questions and concerns that you may have.

Nutrition Resources

Books

How to Prevent & Treat Cancer with Natural Medicine – written by Michael Murray (2002)

The Color Code – written by James Joseph, Daniel Nadeau, & Anne Underwood (2002)

Ultra Metabolism – written by Mark Hyman (2006)

Cookbooks

Cancer Lifeline Cookbook - written by Kimberly Mathai & Ginny Smith (2004)

Fat-Free and Easy: Great Meals in Minutes – written by Jennifer Raymond (vegetarian cookbook) (1997)

Lickety-Split Meals – written by Zonya Foco (1998)

One Bite at a Time – written by Rebecca Katz, Marsha Tomassi, & Mat Edelson (2004)

The Peaceful Palate – written by Jennifer Raymond (vegetarian cookbook) (1996)

12 Best Foods Cookbook: Over 200 Recipes Featuring the 12 Healthiest Foods – written by Dana Jacobi (2005)

Newsletters/Magazines

Cooking Light www.cookinglight.com Fax: (205) 445-6600

Environmental Nutrition http://www.environmentalnutrition.com (800) 829-5384

Nutrition Action Health Letter http://www.cspinet.org/nah/ Fax: (202) 265-4954

Websites

American Cancer Society http://www.cancer.org (415) 394-7100

American Institute for Cancer Research http://www.aicr.org (800) 843-8114

Caring4Cancer - Provides up-to-date & comprehensive information on the connection between

nutrition & cancer – http://www.caring4cancer.com

Center for Informed Food Choices - Offer cooking classes in the Bay Area that emphasize plantbased

foods. http://www.informedeating.org

Consumer Lab - Evaluates quality of over-the-counter supplements http://www.consumerlab.com

Diana Dyer, MS, RD – Breast cancer survivor & dietitian http://www.cancerrd.com

Ida & Joseph Friend Cancer Resource Center – UCSF Mt.Zion http://cancer.ucsf.edu/crc

National Cancer Institute http://www.nci.nih.gov/ (800) 4-CANCER (800-422-6237)

Oncolink – Provides information regarding clinical trials, newsgroups, psychosocial support, & more.

http://oncolink.upenn.edu

San Francisco Vegetarian Society – Monthly restaurant outings & pot-luck dinners; call 415-273-5481.

http://www.sfvs.org

The Vegetarian Resource Group - Provides vegetarian nutrition information & vegetarian recipes

http://www.vrg.org

WebMD http://my.webmd.com

Glossary

Angiogenesis – The formation of new blood vessels.

Antioxidant – A substance that inhibits oxidation or inhibits reactions promoted by oxygen or peroxides.

Apoptosis – Programmed cell death.

Carcinogenesis – Beginning of cancer development.

Case-Control Studies – An epidemiological study in which a group of, say, cancer patients (cases) is compared to a similar but cancer-free population (controls) to help establish whether the past or recent history of a specific exposure such as smoking, alcohol consumption and dietary intake, etc. are causally related the risk of disease.

Catechin – One of the tannic acids; phytonutrient, specifically, one of the flavonoids found in green tea.

Creatine – An amino acid that is formed in the muscle tissue of vertebrates; supplies energy for muscle contraction.

Cohort Studies – Follow-up study of a (usually large) group of people, initially disease-free. Differences in disease incidence within the cohort are calculated in relation to different levels of exposure to specific factors, such as smoking, alcohol consumption, diet and exercise, that were measured at the start of the study and, sometimes, at later times during the study.

Eicosanoids – Biologically active compounds that regulate blood pressure, blood clotting, and other body functions. They include prostaglandins, thromboxanes, and leukotrienes.

Endogenous – Originating from within, as within the body.

Estradiol – A naturally occurring powerful estrogen secreted by the mammalian ovary.

Estrone – A naturally occurring weak estrogen secreted by the mammalian ovary.

Glutathione – A polypeptide produced primarily in the liver; involved in DNA synthesis and repair, protein and prostaglandin synthesis, amino acid transport, metabolism of toxins and carcinogens, immune system function, prevention of oxidative cell damage, and enzyme activation.

Insulin - Insulin is a hormone produced by the pancreas in the body that regulates the metabolism of carbohydrates and fats, especially the conversion of glucose to glycogen, which lowers the body’s blood sugar level.

Lignans - Phytoestrogens that have a similar chemical structure to estradiol and tamoxifen; appear to offer protection against breast cancer.

Meta-analysis – The process of using statistical methods to combine the results of different studies.

Mutation – Abnormal cell development.

Nitrosamines – Derivatives of nitrites that may be formed in the stomach when nitrites combine with amines; carcinogenic in animals.

Phytonutrients – Plant compounds that appear to have health-protecting properties.

Polyphenols – Phytonutrients that act as an antioxidant; compounds that protects the cells and body chemicals against damage caused by free radicals, reactive atoms that contribute to tissue damage in the body.

Retinoids – Chemically related compounds with biological activity similar to that of retinol; related to vitamin A.

Sex hormone-binding globulin (SHBG) – A protein in the blood that acts as a carrier for androgens and estradiol; inhibits the estradiol-induced proliferation of breast cancer cells.

For References see:
http://cancer.ucsf.edu/_docs/crc/nutrition_breast.pdf

 

High Testosterone Levels Protect Against Stroke And Heart Attack

 

By Lisa Nainggolan
Medscape

Testosterone and sex hormone-binding globulin (SHBG) levels have important metabolic effects that might contribute to the risk for cardiovascular disease among  men. The authors of a current study note that low serum testosterone levels are associated with increased adiposity, an adverse metabolic risk profile, and atherosclerosis. Low levels of SHBG are associated with pre-diabetes and obesity.

Cross-sectional studies suggest that adults with coronary heart disease have lower testosterone levels, but the results of prospective research evaluating the possible link between testosterone levels and cardiovascular risk are more mixed. Moreover, limited data exist regarding the role of SHBG in the development of cardiovascular disease. The current study by Ohlsson and colleagues uses data from a large cohort of older men to address these issues.

Study Synopsis and Perspective

A new Swedish study has shown that elderly men in the highest quartile of serum testosterone levels have around a 30% lower risk of cardiovascular events over five years compared with men in the lower three quartiles [1].

And the association remains even after adjustment for traditional cardiovascular risk factors and excluding those with cardiovascular disease at baseline, say Dr Claes Ohlsson (University of Gothenburg, Sweden) and colleagues in their paper in the October 11, 2011 issue of the Journal of the American College of Cardiology.

Senior author Dr Asa Tivesten (University of Gothenburg) told heartwire : "This paper is an important start, because previously data have been inconsistent about whether there is an association between serum testosterone and cardiovascular events or not. We now know there is an association, but we don't know what is causing it."

(Unpublished research we had done years ago at the University of Munich, indicated that testosterone blocks the release of  the most potent endogenous vasoconstrictor endothelin from blood vessel wall cells - endothelial cells -  thus counteracting any decrease in blood vessel diameter. ra)

 Endothelin-1 in human cell line

Study Looked at Community-Dwelling Elderly Men

Ohlsson and colleagues analyzed baseline levels of testosterone in 2416 men aged 69 to 81 years who were participating in the prospective, population-based Osteoporotic Fractures in Men Study (MrOS). They also measured SHBG and obtained cardiovascular clinical outcomes from central Swedish registries.

This paper is an important start, because previously data have been inconsistent about whether there is an association between serum testosterone and cardiovascular events or not.

Over a median of five years of follow-up, there were 485 fatal and nonfatal cardiovascular events, and both total testosterone and SHBG levels were inversely associated with risk of cardiovascular events (trend over quartiles p=0.009 and p=0.012, respectively).

Tivesten said initially they used quartile 1 (ie, the lowest levels of serum testosterone) as a reference and compared events in this group with those in quartiles 2, 3, and 4. However, they saw no significant difference in the number of cardiovascular events between the first three quartiles.

But men in the highest quartile of testosterone (>550 ng/dL) had a lower risk of cardiovascular events compared with men in the lower three quartiles (hazard ratio 0.70; p=0.002). This association remained when the first 2.6 years of follow-up were excluded--in order to rule out any effect of baseline (subacute) disease--and was only slightly attenuated after adjustment for confounding factors (hazard ratio 0.77; p=0.032).

In models that included testosterone and SHBG, testosterone, but not SHBG, predicted risk.

 

More Research to Assess Risk/Benefit of Testosterone Supplements

Tivesten says that more work is required to investigate whether testosterone supplements should be used to try to prevent cardiovascular disease, because one trial using high doses of exogenous testosterone in older men has actually shown an increase in cardiovascular events.

However, what is established, she says, is that men with testosterone deficiency should receive testosterone supplementation. But there is currently a debate as to what level of testosterone represents a true deficiency, so this is a gray area, she notes.

References

1. Ohlsson C, Barrett-Connor E, Bhasin S, et al. High serum testosterone is associated with reduced risk of cardiovascular events in elderly men. The MrOS (osteoporotic fractures in men) Study in Sweden. J Am Coll Cardiol 2011; 58:1674-1681.   

Clinical Implications

• Low serum testosterone levels are associated with increased adiposity, an adverse metabolic risk profile, and atherosclerosis. Low levels of SHBG are associated with higher rates of insulin resistance and obesity.
• The current study by Ohlsson and colleagues suggests that high serum testosterone levels are significantly protective against the risk for cardiovascular events among older men.