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Diplomate of the American Board of Urology and American Board of Holisitic Medicine
“Smart Medicine for a Healthy Prostate”
DUKE CENTER FOR INTEGRATIVE
At one time or another, most men will be affected by at least one of the following prostate problems. Prostate cancer – the leading cause of cancer in men – begins as early as puberty and affects nearly every man if he lives long enough. Prostate enlargement (BPH), another common condition, affects half the men over the age of sixty, one third of whom need treatment. Finally, prostatitis accounts for more than two million doctor visits yearly. In fact, prostatitis is the most frequent reason that men under the age of fifty see a urologist. Fortunately, it is often possible these prostate diseases – naturally.
How to Prevent Benign Prostatic Hypertrophy
How to Prevent Prostate Cancer
Every year over 200,000 men are newly diagnosed with prostate cancer. That makes prostate cancer the leading cause of cancer in men. Although most of these men won’t die as a result of their prostate cancer, prostate cancer still claims the lives of almost 30,000 men every year. This trend can be reversed.
To begin with, prostate cancer can be prevented. Scientists theorize that prostate cancer is a complex interplay between dietary, lifestyle, environmental, and genetic factors. The first three of these influences are under our control. Even though the last factor – our genetic make-up - can’t be changed, we can change the expression of our genes. For instance, even though there may be an increased genetic risk of developing prostate cancer (due to a strong family history of prostate cancer), this risk can be decreased by making healthy dietary, lifestyle, and environmental choices. In the following pages, I’ll list healthy choices within each of these three areas – choices that can dramatically decrease the risk of developing prostate cancer.
In addition, these recommendations also apply to men who’ve already been diagnosed with or treated for prostate cancer. Scientific research suggests that healthy dietary, lifestyle, and environmental choices may prevent prostate cancer recurrence and/or spread.
Finally, curing cancer requires more than just surgically removing the tumor or treating it with radiation. Curing cancer requires a holistic approach that treats the whole person - body, mind and spirit. Even when cancer can’t be cured, a holistic approach can significantly improve the quality of life and survival of men with prostate cancer. In the following pages, I’ll share some of these simple techniques with you.
Cancer doesn’t occur overnight - it’s a dynamic process. Therefore, it’s is potentially reversible. Cancer cells originate from normal cells that have been altered because of dietary, lifestyle, genetic, and environmental influences. Since cancer cells (like normal cells) continually adapt to changes in their local environment, it may be possible to slow down or even reverse cancer by altering these risk factors.
Establishing healthy eating habits is one of the best ways to prevent prostate cancer. You can immediately start lowering your risk of prostate cancer by adopting the suggestions made in each of the following categories:
· Eliminate Fat. Follow a low fat diet (20% or less of total calories from fat) by making the following changes:
1. Eliminate saturated fats by cutting down or eliminating red meat (men who eat red meat have twice the risk of prostate cancer - replace red meat and poultry with cold water fish and soy protein), unskinned poultry, whole milk and whole milk products (since dairy products are high in saturated fat, they also increase the risk of prostate cancer) , creamy salad dressings, butter, partially hydrogenated oils (margarine, vegetable shortening), and all products made from tropical oils (palm and coconut oils). (read about the arachidonic acid cascade on page 4 to learn how saturated fat increases the risk for prostate cancer)
2. Eliminate polyunsaturated vegetable oils (safflower, sunflower, corn, soy, peanut, and cottonseed).
3. Reduce total fat by eliminating deep-fried and fast foods.
4. Reduce or eliminate consumption of chips, nuts, avocados, butter, cheese and other high-fat foods.
5. Read labels and look for fat content of different foods. Don’t be confused by high fat foods camouflaged under the label of “no cholesterol”. Focus on low fat health food brands.
6. Increase consumption of omega-3 fatty acids by eating deep-water fish (yellow-fin tuna, cod or haddock). The type of fatty acid found in fish protects against prostate cancer. (read more about fatty acids starting on page 4)
7. Use extra -virgin olive oil as your principal fat.
· Eliminate white sugar. Although not directly related to prostate cancer, refined sugar depresses the immune system, elevates insulin levels, and stimulates tumor growth (by increasing arachidonic acid) Use the natural sweetener stevia (available in health food stores) in place of artificial sweeteners.
· Eat soy protein such as tofu, tempeh and soy milk. Rich in cancer- fighting substances called isoflavones (most notably genistein), soy protein dramatically inhibits the growth of prostate cancer cells. Eat two helping daily (one cup of tofu, two 8 oz. Glasses of soy milk, or one half package of tempeh).
· Increase fiber in your diet by eating oatmeal, bran and legumes. Eliminate white flour - substitute whole grain products instead. Thirty grams of fiber a day is recommended (read package labels or consult a cookbook for the fiber content of different foods).
· Eat fruits and vegetables. Packed with cancer-fighting vitamins, minerals and fiber, fruits and vegetables decrease the risk of prostate cancer. The National Cancer Institute recommends eating at least five (or better yet, nine) daily servings of fruits and vegetables.
· Eat organic foods whenever possible. Regular produce is often contaminated with pesticides and other chemicals. They heighten the risk of prostate cancer by causing DNA damage and altering hormone metabolism.  Finally, in addition to being high in fat, dairy and beef products are often contaminated with toxic pesticide and hormone residues.
· Eat garlic - one to two cloves daily. Although the precise mechanism is unknown, garlic prevents prostate cancer by helping the liver get rid of toxins and blocking the conversion of arachidonic acid to inflammatory leucotrienes.  ,
· Eat tomatoes. Harvard researchers found that eating tomatoes at least four times a week lowers the risk of prostate cancer by twenty percent. Eating ten weekly helpings of tomatoes lowers the risk by forty-five percent.
Vitamins, minerals and trace elements
Supplementing your diet with certain vitamins can also decrease the risk of prostate cancer. Research suggests that vitamins can decrease carcinogen formation, improve detoxification of harmful substances, decrease cancer cell growth, improve cellular communication, and control cellular differentiation and the expression of cancer. Antioxidants work better in combination. Therefore, I recommend taking a high potency multivitamin.
· Take a high potency multivitamin that is rich in antioxidants, trace elements and minerals every day with meals. (Brands such as one-a-day brand or Centrum silver do not contain sufficient amounts of the necessary vitamins, minerals and trace elements.) High potency vitamins are available in any health food store. If your multivitamin doesn’t contain 400 I.U. of vitamin E and 200 micrograms of the trace mineral selenium, supplement your multivitamin so that your daily intake equals this amount. (read more about antioxidants on page 5)
ŢVitamin E 400 I.U. - A number of studies have shown that vitamin E decreases prostate cancer incidence and mortality. In fact, taking as little as 50 I.U. daily cuts the risk of prostate by a third.
ŢYeast-selenium 200 micrograms - Men who supplement their diet with 200 micrograms of selenium reduce their risk of prostate cancer by two thirds. Selenium also decreased the promotion and progression of prostate cancer.
Green Tea (Camillia sinensis). Researchers
· Lycopene. For those men who can’t tolerate eating tomatoes, or tomato-based food products, they can still obtain the cancer-preventive benefits of tomatoes by taking supplemental lycopene. According to one study, men with prostate cancer who supplemented with thirty milligrams of lycopene daily, for three weeks prior to having their prostate removed, slowed the growth of their cancer cells. Take a ten milligram, oil-based lycopene supplement, twice daily with meals for prevention, and three times daily, if there is a family history of prostate cancer, or if prostate cancer is present.
Life Style Changes
· Lose weight.. Overweight men are two and a half times more likely to develop prostate cancer and three and a half times more likely to die as a result of their cancer. Shedding even a few pounds lowers the risk.
· Stop Smoking. Male smokers have a one third greater chance of developing prostate cancer.  They’re also more likely to die from prostate cancer since smoking induces a more aggressive form of prostate cancer. 
· Exercise. According to one study, regular exercise reduces the risk of prostate cancer by forty percent. Other investigators report that men (under the age of sixty) with the highest cardiovascular fitness were four times less likely to develop prostate cancer than those least fit.
· Reduce stress. Although acute stress can enhance immune function, chronic stress has the opposite effect.
Reduce stress by doing the following:
a. Eliminate caffeine.
b. Avoid violent movies, books, television programs, etc.
c. Go on a “news fast” by not reading the paper, listening to the radio or watching the news on TV for a week. Then try extending this for a longer period of time.
d. Exercise regularly.
e. Associate with calm people.
f. Practice yoga and meditation daily.
g. Learn biofeedback and guided visualization techniques.
h. Try natural relaxants such as the herbs kava kava, chamomile, or passionflower.
i. Try using Bach flower remedies such as rescue formula (available in health food stores).
j. Get at least 7 hours of deep sleep daily. Try taking valerian, skullcap, or kava kava either individually or in combination if insomnia is a problem.
k. Practice forgiveness and understanding, starting with yourself. Release any grudges.
l. Rectify any existing relationship problems.
m. Beautify your environment. Plant flowers. Appreciate nature.
n. Slow down and smell the roses!
o. Tell yourself you love and appreciate yourself. Learn to mean it. If you can’t, get help understanding why.
p. Tell others you love them.
q. Take time to really listen to others.
r. Find a purpose in life. Volunteer. Do something good for others. Practice random acts of kindness and senseless acts of joy.
s. Practice saying positive affirmations daily. Subscribe to The Daily Word, a treasure trove of positive affirmations, by calling 1-800-669-0282.
t. Make a list every day of ten things you are truly grateful for.
u. Listen to uplifting music. Skip music with depressing lyrics.
v. Cultivate your inner life through reading quality literature, reflecting on it, and keeping a journal of your higher thoughts.
w. Control your thoughts and speech. Speech and the thoughts and attitudes you hold are energies. The dominant ones become the main energies you communicate to your body. Negative energies such as habitual dissatisfaction, depression, despair, ill-will, resentment, hatred, and aggression disrupt the body’s harmony and depress the immune system. Positive energies such as truth, gratitude, patience, harmlessness, generosity, respect, honesty, and peace restore the body’s energy, promote harmony, and strengthen the immune system.
x. Try the following breathing exercise at least 4 times a day. (Adapted from Dr. Andrew Weil):
Place the tip of your tongue just behind your upper front teeth and keep it there throughout the entire exercise. 1) Exhale completely through your mouth (with your lips pursed), making a whoosh sound. 2) Next close your mouth and inhale quietly through your nose to a mental count of four. 3) Hold your breath for a count of seven. 4) Exhale completely through your mouth, making a sound to the count of eight. The absolute time spent on each phase is not as important as the ratio of 4:7:8. Repeat the process for a total of five times, at least twice a day and anytime you feel under stress.
The following information is excerpted from Smart Medicine for a Healthy Prostate (NY:Avery Publishing Group, 2001).
Arachidonic Acid Cascade
Arachidonic acid, an omega-6 fatty acid (see the insert on fatty acids), is a double-edged sword. On one hand, our health depends on arachidonic acid. Arachidonic acid is essential to the nervous and immune system. On the other hand, too much arachidonic acid can be deadly. Unfortunately, Americans suffer from an overabundance, not a lack, of arachidonic acid. Excess arachidonic acid has been linked to the current epidemic of heart disease, degenerative diseases, and cancer in this country.
Inside the body, arachidonic is converted to powerful hormone-like molecules called eicosanoids. Two types of eicosanoids - called prostaglandins and leucotrienes - are derived from arachidonic acid. (Prostaglandins were first discovered in prostatic fluid.) Eicosanoids can either be inflammatory or anti-inflammatory. The types of eicosanoids that are found in fish (prostaglandin E3) are anti-inflammatory. The eicosanoids that are derived from arachidonic acid (prostaglandin E2 and series four leucotrienes) are inflammatory. Arthritic joint pain and the throbbing pain of a headache are caused by inflammatory prostaglandins.
Arachidonic acid-derived eicosanoids cause more problems than inflammation. To begin with, PGE2 eicosanoids enable prostate cancer cells to evade the immune system. PGE2 inactivates natural killer cells and cytotoxic T cells (cells that attach themselves to prostate cancer cells, and kill them). This is particularly scary, since prostate cancer cells produce ten times as much PGE2 as normal prostate cells.
Series four leucotrienes, the other class of arachidonic-derived eicosanoids, are just as dangerous as PGE2. Series four leucotrienes by the name of 12-HETE allow prostate cancer cells to form new blood vessels and invade surrounding tissues. Another class of series four leucotrienes, called 5-HETE, stimulates prostate cancer growth, and prevents prostate cancer cells from dying by preventing them from committing suicide.
Fortunately, the harmful effects of arachidonic acid can be blocked. A combination of nutritional, herbal, and pharmaceutical agents can interrupt the arachidonic acid cascade at three critical points by blocking the following enzymes:
ęPhospholipase A2 enzyme. This enzyme allows arachidonic acid to be mobilized from phospholipids (fats) in cell membranes. This conversion can be blocked by:
Quercetin , vitamin E, licorice (Glycyrrhiza glabra), tumeric (Curcumin longa), and prescription corticosteroids (cortisone).
ę5 and 12-lipoxygenase enzymes. This enzyme enables arachidonic acid to be converted to series four leucotrienes (5-HETE and 12-HETE). This conversion can be blocked by:
Quercetin, Vitamin E, fish oil, tumeric, red and yellow onions (Allium cepa), garlic (Allium satinum), and boswellia (Boswellia serrata).
ęCyclooxygenase 1 and 2 enzymes. These enzymes convert arachidonic acid to PGE2 eicosanoids. This conversion can be blocked by:
Fish oil, ginger (Zingiber officinale), tumeric, black willow (Saslix nigra), wintergreen (Gaultheria procumbens), and nonsteroidal anti-inflammatory medications (aspirin and ibuprofen).
Celebrex®, and Vioxx® are two new anti-inflammatory prescription drugs that selectively block cyclooxygenase-2. COX-2 inhibition can suppress angiogenesis and prostate cancer cell growth.
Fatty acids are a family of fats that are composed of carbon atoms. Like cars in a train, these carbon atoms are arranged in a row, with a carboxyl group at one end, and a methyl group at the other end. Although closely related, fatty acids can trace their heritage to either the saturated or the unsaturated branch of the family.
An unsaturated family member can be identified by a double bond that appears between the carbon atoms (monounsaturated means one double bond; polyunsaturated means more than one double bond). Olive oil is a monounsaturated fatty acid, whereas corn oil is a polyunsaturated fatty acid. Saturated fatty acids are from the other side of the family – they lack any double bonds. Animal fat is rich in saturated fatty acids.
Giving unsaturated fatty acids an additional name (based on the location of their double bond) helps differentiate one family member from another. For instance, if their double bond is located on the third carbon atom from the methyl (omega) end, they’re called omega-3 fatty acids. Family members from this clan include fish, flax seed, and walnuts. If their double bond is six carbon atoms from the end, they’re called omega-6 fatty acids. Family members of the omega-6 fatty acid clan include most plant oils (for instance, oils that are made from corn, safflower, and soy). If their double bond is nine carbon atoms from the end, they’re called omega-9 fatty acids. Olive oil is proud member of the omega-9 fatty acid family.
Finally, Omega-3 and omega-6 fatty acids have an added distinction. They’re called essential fatty acids because our bodies can’t manufacture them. Therefore, they must be come from the diet.
Now that you’ve met the family members, let’s see what they make of themselves. In the process of digestion, fatty acids are converted to offspring called prostaglandins. Prostaglandins are hormone-like molecules that regulate vital bodily functions such as heart function, kidney function, blood pressure, blood clotting ability, and inflammation. Here’s where the story gets interesting.
Another ‘relative’ comes into play. An enzyme called delta-6 desaturase determines the fate of Omega-3 and Omega-6 fatty acids. If the enzyme is working properly, these fatty acids are preferentially converted into offspring that suppress inflammation. These anti-inflammatory offspring are called series one (PGE1) and series three (PGE3) prostaglandins.
On the other hand, if the delta-6 desaturase enzyme isn’t functioning properly or is in short supply, omega-3 (e.g., flax seed) and omega-6 (e.g., corn oil) essential fatty acids are shunted into the arachidonic acid cascade (see the insert on arachidonic acid). Arachidonic acid, another member of the omega-6 fatty acid family, can cause serious problems at a family reunion.
Overcrowding by the omega – six branch of the family
is one way that the delta-6 desaturase enzyme can become depleted. For instance, in other parts of the world,
there are two omega-6 relatives for every omega-3 family member. In the
The Good, The Bad, And The Ugly – Antioxidants, Oxidants, And Free Radicals
Antioxidants are ‘anti’ or against oxidants. Oxidants are formed anytime a substance combines with oxygen. Although essential for life, oxygen can be dangerous to our existence. When a substance combines with oxygen, it becomes oxidized. Rust is caused by oxidation. Oxidation also causes oils to become rancid and apples to turn brown when they are sliced and exposed to air.
Normally electrons are paired or balanced. During the oxidation process, a molecule loses an energy particle called an electron. Whenever a molecule loses an electron, it becomes unbalanced. These unbalanced molecules are called free radicals.
Free radicals are dangerous. If they don’t get an electron in a hurry, they go haywire and damage nearby tissue. Consequently, these highly reactive particles become electron-thirsty predators. They immediately rip an electron from the first molecule they encounter. The unwitting electron donor, now shy an electron, turns mean and starts an electron scavenger hunt of its own.
If left unchecked, within the blink of an eye, this electron free-for-all can cause a lot of damage. For instance, free radicals can pulverize cell membranes, poison mitochondria (the power generator within our cells), inactivate enzymes, and break DNA molecules.
Fortunately, antioxidants come to the rescue. Antioxidants stop the deadly game of hot potato by donating an electron. Although the donor antioxidant momentarily become a free radical itself, another antioxidant jumps in and recycles the spent antioxidant by donating an electron, and so forth.
Antioxidants (such as glutathione peroxidase, catalase, and superoxide dismutase) are generated within every cell of the body. Antioxidants, in the form of vitamins and minerals, also come from food, or are ingested as dietary supplements. The excess supply of antioxidants is deposited into a health savings account. Withdrawals are made every time an antioxidant is used to balance a free radical.
Although plentiful, the supply of antioxidants isn’t endless. If withdrawals exceed deposits, deficit spending occurs. The cost of deficit spending includes fatigue, tissue damage, and the accumulation of toxic byproducts. If deficit spending continues unchecked, the bank account is drained dry. The resulting bankruptcy exacts a heavy toll of premature aging, degenerative diseases, and cancer.
Establish a healthy bank account (and even earn interest) by maintaining a healthy life style, eating a nutritious well-balanced diet, and taking a high potency multivitamin daily.
Prevent side effects
of androgenwithdrawal therapies for prostate cancer
Hot flashes and osteoporosis are two common side effects of androgen-deprivation therapy (male hormone withdrawal). Men treated in this fashion often complain that these two conditions make their lives miserable. Fortunately, prescription drugs and a variety of natural remedies can reduce the incidence and severity of these common side effects.
Natural therapies can also prevent liver damage, particularly hepatitis (liver inflammation) – a rare but potentially fatal complication of androgen-deprivation therapy.
Natural Remedies For Hot Flashes –
When male hormone is removed, most men experience hot flashes. Similar to the hot flashes women experience during menopause, men experience sudden skin flushing accompanied by profuse sweating.
Although anecdotal (based on experience), I have found that the following natural remedies may reduce or eliminate hot flashes:
Taking Herbs. Take a dropper full (forty drops) of a standardized liquid extract or one capsule of dried extract of the following herbs twice daily:
Eating Soy Protein – Phytoestrogens in soy can reduce hot flashes. Eat at least two servings daily.
Exercising. Regular exercise improves hormone balance.
Eliminating Bad Habits. Smoking cigarettes, consuming caffeinated beverages, and drinking alcohol can make hot flashes worse.
Taking Vitamins. The following vitamins may reduce hot flashes:
Acupuncture. Although the mechanism is unclear, acupuncture can eliminate hot flashes in men.
Natural Remedies For Osteoporosis –
The moment men are started on androgen deprivation therapy they begin losing bone mass.  Complications of bone loss include bone pain and a greater risk of bone fractures. In addition to prescription drugs, the following natural remedies can forestall osteoporosis:
Exercising. Aerobic and resistance-type exercises prevent osteoporosis (see page ___).
Changing Your Diet. Eliminating junk food, colas, refined sugar, red meat, dairy, caffeine, alcohol, and excess salt reduces the risk of osteoporosis. (These food items increase calcium loss.)
Eating Soy protein. Adding soy protein to the diet also prevents osteoporosis. Eat two servings daily. Ipriflavone, a commercially available soy derived isoflavone, is used to treat and prevent of osteoporosis. Take two hundred milligrams twice daily.
Eliminating Tobacco Products.
Taking Vitamins And Minerals. Bones need vitamins and minerals to grow. Take a high potency multivitamin and supplement the vitamin with an additional nighttime dose of calcium-magnesium citrate (containing one thousand milligrams of calcium and five hundred to a thousand milligrams of magnesium).
Natural Remedies To Prevent Medication-Induced Liver Damage
Most drugs are metabolized in the liver. This includes flutamide (brand name Eulexin®) and bicalutamide (brand name Casodex®) – two anti-androgen drugs that are frequently used to treat men with prostate cancer. Hepatitis is a rare but dangerous side effect of oral anti-androgen therapy. Men taking these two drugs should avoid substances that can impair liver function (such as alcoholic beverages and acetaminophen). In addition, the following natural therapies may prevent drug-induced liver damage:
Alpha-lipoic Acid. This coenzyme (a substance that helps other enzymes) is vital to cellular energy production. It also works with an antioxidant called glutathione to protect the liver. Alpha-lipoic acid can even help a damaged liver repair itself. Take one, two hundred fifty to five hundred milligrams twice daily.
N-acetyl-L-cysteine. This antioxidant amino acid restores and maintains glutathione levels in the liver. N-acetyl-L-cysteine is used to treat patients with acetaminophen liver toxicity, and hepatitis induced liver failure., Take one six hundred milligram capsule of N-Acetyl-L-cysteine three times daily.
High Potency Multivitamin. A variety of vitamins, minerals, and trace elements are required for effective liver detoxification of drugs. Follow the directions on the bottle.
Vitamin E. This versatile antioxidant is also used to treat hepatitis. Take four hundred milligrams twice daily (allowing for the amount in your multivitamin).
Vitamin C. Vitamin C also protects liver function. Take at least one gram twice daily.
Milk Thistle (Silybum marianum). Rich in antioxidants, milk thistle promotes healthy liver function. Take one hundred to two hundred milligrams three times daily of a standardized extract that contains seventy percent silymarin.
Fruits And Vegetables. Garlic, onions, cabbage, and cruciferous vegetables (broccoli and cauliflower, for instance) protect the liver. Add them to your daily diet.
Prevent side effects of Radiation Therapy:
How to Prevent Bladder Cancer
Radiation therapy and chemotherapy can damage the genetic information (DNA) in normal cells. Consequently, these cancer therapies can actually cause cancer.
Even though the structures around the prostate (such as the bladder and rectum) are shielded against the harmful effects of radiation, they are still caught in the crossfire of radiation beams. Although the radiation-induced changes aren’t immediately apparent, cancer can develop years later. Bladder cancer is the most common type of cancer that develops following external beam irradiation to the prostate.  Fortunately, scientific research has shown that the following measures reduce the risk of bladder cancer:
Taking vitamins. According to researchers from the
· Forty thousand I.U. of vitamin A
· One hundred milligrams of vitamin B6
· Two thousand milligrams of vitamin C
· Four hundred I.U. of vitamin E
· Ninety milligrams of zinc
Taking supplements. Researchers have determined that the following supplements can prevent bladder cancer:
· Selenium. Although not specific for bladder cancer prevention, selenium prevents secondary tumors induced by both CT and RT (take two hundred micrograms daily).
· Green Tea (Camillia sinensis). According to Japanese investigators, green tea decreases the incidence of bladder cancer. Take an extract containing five hundred milligrams twice daily.
· Lactobacillus casei. Japanese researchers discovered that these friendly bacteria can decrease the risk of bladder cancer. (See page ___ for further details on Lactobacillus.)
Drinking water. According to scientific research, drinking at least six, eight-ounce glasses of water daily can prevent bladder cancer.  Water flushes away toxins. (Avoid chlorinated water, though, since it may increase the risk of bladder cancer. Drink filtered or bottled water instead.) 
Eating Plenty Of Fruits And Vegetables. Researchers have shown that a diet that is rich in fruits, vegetables, and cereals decreases the risk of bladder cancer.
Avoiding harmful substances. Toxins found in tobacco products, caffeinated beverages, and artificial sweeteners may increase the risk of bladder cancer. Avoid them.
Androgen Insensitive Prostate Cancer
When prostate cancer cells are deprived of androgen (male hormone made by the testicles and adrenal glands), the majority of the cells stop growing and commit suicide. Cancer cells that continue to grow despite a reduction in the concentration of androgen are called androgen insensitive. The following natural therapies are useful for men with androgen insensitive prostate cancer:
Milk Thistle (Silybum marianum). Rich in antioxidant flavonoids known as silymarin, an extract of milk thistle seeds has been shown to inhibit prostate cancer initiation, promotion, and progression. Researchers report that milk thistle works by altering signaling molecules and adaptor proteins affecting epidermal growth factor receptor (a potent stimulus of cell growth). As a result, prostate cancer cells, even androgen-resistant prostate cancer cells (the most dangerous kind), stop growing. Since the protective effect of milk thistle is dose dependent, I recommend taking two hundred fifty milligrams, four times daily with food. Buy a standardized extract that contains seventy percent silymarin complex. There are no known contraindications, drug interactions, or side effects.
PC SPES. PC SPES (‘PC’ stands for prostate cancer, and ‘SPES’ is Latin for hope) contains eight different Chinese herbs. PC SPES stops prostate cancer cell growth by inducing apoptosis and causing differentiation (reduction or reversal of cancer activity). Scientific research has shown that PC-SPES kills prostate cancer cells in men with hormone-sensitive and hormone-resistant prostate cancer. Although effective, PC SPES should only be taken by men with biopsy-proven prostate cancer who are under the supervision of a urologist or oncologist.
Melatonin. Melatonin, a hormone made in the brain by the pineal gland, directly and indirectly inhibits the growth of prostate cancer cells. It does this by decreasing the production of prolactin and IGF-1, stimulating the anti-tumor immune system, and causing differentiation of cancer cells.According to one study, over half of the patients with hormone-resistant prostate cancer taking melatonin (twenty milligrams at bedtime) had their hormone sensitivity restored! (Taking supplemental melatonin doesn’t interfere with the brain’s normal production of melatonin.) Research has also shown that melatonin can enhance chemotherapy effectiveness.Patients with androgen-resistant prostate cancer may wish to consider taking twenty milligrams of melatonin one hour before bedtime.
Note: Although melatonin doesn’t cause any serious side effects, it can cause drowsiness.
Reduce the amount of androgen receptor made by prostate cancer cells
Prostate cancer cells contain docking stations for androgen molecules called receptor sites. Under certain circumstances, prostate cancer cells develop an increased number of receptor sites, which allows the prostate cancer cells to grow at extremely low androgen concentrations. In this situation, androgen mutations (genetic abnormalities) can develop and allow anti-androgens such as Eulexinâ to cause prostate cancer cells to actually grow instead of being killed. The following natural therapies can help prevent this scenario by reducing the amount of androgen receptors made by prostate cancer cells.
Green Tea (Camillia sinensis). According to
researchers at the
Researchers theorize that green tea prevents cancer by preventing DNA strand breaks, inhibiting cell proliferation, decreasing the contact of carcinogens with cells, blocking cancer initiation, and slowing cancer progression.
Since the protective benefit of green tea is dose dependent, I recommend taking five hundred milligrams of an herbal extract (standardized to contain eighty percent total polyphenol and fifty-five percent EGCG) once daily for prevention, and twice daily for men with prostate cancer.
Quercetin, a naturally occurring plant flavonoid, dramatically increases the effectiveness of radaiation and it alaso reduces the amount of androgen receptors in prostate cancer cells. (Flavonoids are plant pigments that give fruits and vegetables their bright colors. So far, over four thousand flavonoid compounds have been identified.)
Quercetin is naturally available in foods. Onions, parsley, sage, tomatoes, and citrus fruits are rich sources of quercetin. Although quercetin is also available as a supplement, naturally occurring quercetin is better absorbed than supplemental forms. One way to improve the absorption of supplemental quercetin is to take supplemental bromelian (see page ____) at the same time. The recommended dosage for quercetin is two hundred to four hundred milligrams twenty minutes before meals three times daily with an equivalent amount of bromelain. Quercetin is safe when taken as directed.
Resveratrol: An oxidant found in grapes and wine, and commercially available in certain nutritional supplements, resveratrol can block androgen receptor production and function in prostate cancer cells.
Stinging nettle (Urtica dioica). Stinging nettle root may prevent prostate cancer by inhibiting the binding of sex hormone binding globulin (abbreviated SHBG) to the prostate cell membrane. SHBG is a protein that has two main functions - it binds to male and female hormones in the blood and (when it’s not bound to sex hormones) it binds to the prostate cell membrane.
If estradiol (female hormone) binds to SHBG when it’s attached to the prostate cell membrane, the SHBG-estradiol complex mimics dihydrotestosterone and releases a message telling prostate cells (both benign and malignant) to start growing. (The prostate is one of several sites where males generate female hormones.) The SHBG-estradiol complex also stimulates prostate cells to make extra IGF-1, an action that is blocked by nettles.  IGF-1 sends a powerful message to prostate cancer cells telling them not to commit suicide. It also alters protein phosporylation, which increases the risk of androgen receptor mutations.
In addition, nettles prevent prostate cancer by blocking the conversion of androgens to estrogens (a process known as aromatization), and by inhibiting the biosynthesis of arachidonic acid metabolites that stimulate prostate cancer cell growth and progression.,,
The normal daily dose is three to six grams, taken as a tablet or capsule containing six hundred to twelve hundred milligrams of a five to one dry extract, or one hundred twenty milligrams twice daily of a ten to one extract (standardized for amino acid content),  There are no known contraindications, drug interactions, or significant side effects. (See page ___ for more information.)
Celebrex. Celebrex is a selective COX 2 inhibitor. As such it decreases the formation of harmful arachidonic acid metabolites. It also blocks Akt function (an intracellular protein that inhibits prostate cancer cell apoptosis) and therefore induces prostate cancer cell death.
Indol 3-carbinol. Cabbage, brocolli, cauliflower, kale, collard greens, and other members of the cruciferous vegetable family can reverse the effect of Bcl-2, a protein that blocks prostate cancer cell apoptosis.
Brief Overview of Nutritional Supplements
Government sponsored studies
have shown that fifty percent of the
Vitamins are essential organic compounds that our bodies use for normal metabolic function. (The Latin word ‘vita’ means life.) Vitamins are called essential because bodies can’t manufacture most of them. They’re also called micronutrients because they’re only needed in small amounts. Before vitamins can be utilized, though, the body must first convert them into another substance called a co-enzyme. Coenzymes make enzymes work better. Enzymes are substances that catalyze chemical reactions in the body.
Like vitamins, minerals are micronutrients that are essential for proper health. Eighteen different minerals play a role in human physiology. Minerals are also needed for proper bone growth, muscle contractions, and nerve function. Vitamins and minerals form a buddy system - as coenzymes, they help each other initiate or facilitate biochemical reactions, which explains why multivitamins contain a mixture of both products.
Vitamins are either water-soluble or fat-soluble. As their name implies, water-soluble vitamins dissolve in water. The B-vitamins and vitamin C make up the family of water-soluble vitamins. Water-soluble vitamins can’t be stored (they’re excreted in the urine over a period of one to four days). Therefore, water-soluble vitamins must be taken daily. As a rule, since water-soluble vitamins don’t accumulate in the body, they have a wide safety range and are rarely toxic.
On the other hand, fat-soluble vitamins (which include vitamins D, E, A, and K) are stored in adipose tissue (body fat) and the liver. Therefore, it’s possible to get an overdose of fat-soluble vitamins. Just the same, if taken as directed, fat-soluble vitamins rarely cause serious side effects; or if they occur, most are reversible once the vitamins are stopped.
Although vitamins are available in a variety of shapes, sizes, and formulations, they’re all well absorbed and utilized as long as they’re made by a reputable company (see the discussion below) and taken as directed. (As a general rule, vitamins should be taken with food.)
In natural foods, vitamins are bound to proteins, lipids (fat), carbohydrates, and bioflavonoids (compounds that are found in green plants). Vitamins that are derived from natural foods are called natural vitamins. In contrast, synthetic vitamins are made in the laboratory from isolated chemicals that mirror natural vitamins. However the difference between the two types of vitamins only matters if the natural form is better absorbed or utilized than the synthetic form. With the exception of vitamin E, natural and synthetic vitamins work equally well.
According to scientific research, the body is able to utilize natural vitamin E more effectively than the synthetic variety. Natural vitamin E is designated by the prefix ‘dextro’ or simply ‘d’ ( ‘dextro’, which is Latin for right, refers to the way the molecule is turned). Food contains a mixture of natural vitamin E isomers (subtypes), most notably d- alpha and d-gamma tocopherols (another name for vitamin E). That’s why most experts suggest taking a mixture of natural vitamin E isomers called “mixed tocopherols”. Nevertheless, most commercial multivitamins simply contain dl-alpha tocopherol, which is a combination of the natural (‘d’) and synthetic (‘l ‘ or levo’, which is Latin for left) forms of alpha tocopherol.
Minerals are divided into two groups: major minerals and minor (trace) minerals. The body needs at least one hundred milligrams (one milligram equals one-thousandth of a gram) of the major minerals (calcium, magnesium, sodium, potassium, and phosphorus) daily. In contrast, the body only needs microgram (one microgram equals one-millionth of a gram) amounts of trace elements (such as zinc and selenium) daily.
The best way to ensure that you get a sufficient amount of minerals is to eat plenty of fresh vegetables. Just the same, the following factors influence mineral intake: Individual dietary habits; mineral content of the soil; degree of intestinal absorption; and influence of other minerals. Binding minerals to a protein in the middle of a larger molecule, a process called chelation, enhances mineral absorption. For example, zinc picolinate, one of the best-absorbed zinc supplements, is formulated by chelating zinc to an organic salt called ‘picolinate’.
As a rule, minerals are also better absorbed when they are taken with food. There are exceptions to the rule, though. For instance, fiber supplements decrease mineral absorption; hence, they should not be taken together. In addition to fiber, calcium absorption is impaired by excess dietary fat, caffeine, and alcohol. (Try taking calcium is at bedtime since it’s not only better absorbed; it also promotes sleep.) Finally, too much calcium adversely affects magnesium absorption; therefore choose a calcium supplement is balanced in a one-to-one or two-to-one ratio with magnesium.
Contrary to popular belief, vitamins have a wide safety range. Scientific studies have shown that high doses of individual vitamins, particularly water-soluble vitamins, can be safely given to prevent or treat certain conditions without any associated serious side effects. Nevertheless, vitamins and minerals can affect the absorption or action of prescription medication, and high doses of fat-soluble vitamins (in excess of the amount contained in a multivitamin) can cause harmful side effects.
Although minerals also have a wide safety range, when taken in excessive amounts, they too can cause harmful side effects. For instance, taking more than 100mg. of zinc daily can cause a copper deficiency, and taking more than 900mg. of selenium daily can be toxic. Furthermore, minerals can interfere with the absorption of certain antibiotics and other medications. For instance, zinc and calcium adversely affect the absorption of quinilone antibiotics. Therefore, if you take prescription medication, check with your physician before taking supplemental minerals or vitamins.
How To Read A Vitamin Label
As a final measure, let me teach you how to read a vitamin label. Items in bold type are discussed in further detail.
Serving Size: six capsules
Six capsules contain: %DV
Vitamin C . . . . . . . . . . . . 1200mg 1333%
Vitamin E . . . . . . . . . . . . 400IU 1818%
Selenium . . . . . . . . . . . . . 200mcg 363%
Vanadium . . . . . . . . . . . . 50mcg *
Bromelain . . . . . . . . . . . . 25mg *
L-Cysteine . . . . . . . . . . . . 200mg *
*Daily Value not established
Other ingredients: cellulose, and magnesium stearate.
Best if used by: January 2002.
· Serving size is the unit of measure (number of capsules, in this case) that must be taken to yield the daily amount specified on the label.
· DV stands for ‘Daily Value’ or the recommended daily amount.
· 1333% indicates that the 1200mg of vitamin C contained in a serving (six tablets) is 13.33 times the recommended daily amount of vitamin C (ninety milligrams for non-smoking men). Although high potency multivitamins contain vitamins concentrations that are hundreds or even thousands of times greater than the DV, don’t be alarmed, they’re safe to take. The DV was established to prevent nutritional disease, not promote optimal health.
· The abbreviation ‘mg’ stands for milligram.
· The abbreviation ‘mcg’ stands for microgram.
· The statement ‘Daily Value not established’ is self-explanatory. Many vitamin supplements contain ingredients that don’t have an established daily requirement. These items include certain trace elements(such as Vanadium), digestive enzymes, and amino acids. Digestive enzymes (chemicals that promote digestion) are identified by their word endings: Words that end in ‘ain’ (such as bromelain- a digestive enzyme made from pineapple), or ‘ase’ (such as lipase – a digestive pancreatic enzyme) are digestive enzymes. (The bottle should state whether the enzymes are derived from plant or animal sources.) Amino acids (the building blocks of proteins) are identified by a ‘L’ or ‘DL’ before their name, for example L-cysteine.
· Other ingredients: Read this section carefully. Supplements often contain other ingredients that are best avoided such as artificial coloring, preservatives, flavorings, corn, soy protein, wheat gluten, sugar, yeast, and dairy products. These ‘fillers’ can cause an allergic reaction in susceptible individuals.
Best if used by: Signifies the expiration date.
I recommend protecting yourself by purchasing vitamins from companies that conform to good manufacturing practices. This is, give your business to a company that lists all of the ingredients on the bottle label or package insert; assays their products for purity and batch-to-batch consistency; doesn’t make false claims; lists an expiration date on their products; conforms to industry standards of excellence; and provides a certificate of analysis upon request.
Based upon my research and experience, I have become familiar with the following companies, which manufacture over-the-counter brands that I trust: Enzymatic Therapies, Nutricology, Ethical Nutrients, Solgar, Jarrow Formulas, Solaray, Nature’s Way, Nature’s Plus, Source Naturals, Life Extension Foundation, and Twin Labs.
Similarly, companies that manufacture ‘professional brands only’(available only through pharmacies or health professionals) that I trust include: PhytoPharmica, Metagenics, Biotics Research, Tyler Encapsulations, CVR/Ecological Formulas, Thorne Research, ARG/Allergy Research Group, Pure Encapsulations, Murdock Madaus Schwabe (MMS ProÔ), Douglas Laboratories, Priority One, and American Biotics.
Herbs have been used for millennia to promote wellness and treat disease. Although herbs may appear confusing at first glance, this brief overview should help you separate ‘the wheat from the chaff’. For additional resources see page XXX.
Before we begin, I’d like to say a few words about self-diagnosis and treatment. As a rule, I tell patients that it’s safe to experiment with an herbal remedy for a mild complaint, such as a runny nose or an upset stomach. However, self-diagnosis based on symptoms (complaints) can be risky business. Therefore, if the symptoms are severe; if they get worse despite simple measures; or if the symptoms linger for more than a few days, see a doctor.
Although drugs can trace their ‘roots’ to herbs, there are fundamental differences between the two ‘branches’ of the family. For instance, herbal remedies are significantly less expensive than prescription medication. They’re also less likely to cause side effects; or if they do, the side effects are usually mild and disappear once the herb is stopped. That’s because herbal therapies work differently than prescription drugs: Herbs can take as long as four to six weeks to reach peak effectiveness, whereas prescription drugs work within minutes (however potent drugs can also cause side effects just as quickly). Although herbs are generally safe, they can interact with prescription medication. Therefore, if you take prescription medication, check with your physician before taking an herbal supplement.
How To Tell If An Herb Is “Working”.
Herbs contain hundreds, or even thousands of ingredients that work together to promote health by supporting the body’s own healing abilities. As a result, herbs have a subtle effect on the body that is often difficult to measure. Nevertheless, if symptoms remain unchanged after taking an herb for two to four weeks, or if there is any doubt, stop taking the herb and see if the symptoms recur. Bear in mind though, that a lack of improvement may not be the herb’s fault. The blame can often be traced to an inferior herbal product (which was bought because it’s cheaper), failure to take the herb as directed, an improper diagnosis, or choosing the wrong herb in the first place. Which lead us to the next topic.
How To Select A Quality Herbal Product.
Dr. Andrew Weil, a noted authority on herbal medicine, suggests the following guidelines:
· Become knowledgeable by doing your homework. For instance, read a reputable book on herbs, talk with your doctor, consult a medical herbalist (experts in herbal medicine; contact the American Herbalists Guild, http://www.healthy.net/herbalists to find one in your area). Watchdog organizations also provide free information about nutritional and herbal supplements (www.consumerlabs.com).
· Select the most effective form by choosing a standardized herbal product if one is available (see below). Standardized products are assayed (checked in a laboratory) to make sure that they contain a specified amount of a particular ingredient. However, be advised that standardization doesn’t guarantee potency or quality. A product is only as good as the raw ingredients and the quality of the manufacturing process. Bulk herbs that are stored in open bins quickly lose their potency, and powdered herbs are subject to adulteration (addition of a substance other than the desired herb). Although adulterants usually consist of the wrong part of the plant or the wrong herb, they can also include heavy metals such as Mercury and Lead, toxic pesticides, and bacterial or fungal contaminants. With regard to cost, liquid and solid herbal extracts offer the best buy for the money. Finally, it’s generally better to select a product that contains a single herb, instead of one that tries to cover all the bases with a shopping list of herbal ingredients. On the other hand, herbalists can get away with mixing and matching herbs since they know which ones work best together.
· Buy From Reputable Companies. I recommend purchasing herbs from companies that have an established reputation (not to be confused with companies that advertise the most). Select a company that adheres to “good manufacturing practices” . Companies that I trust include all of the companies listed in the overview of nutritional supplements plus the Eclectic Institute, herbalist & Alchemist, Inc., and GAIA Herbs, Inc.
The following information is typically listed on an herbal supplement label. Items in bold type are discussed in further detail.
Serving Size: two 160mg. softgels
Amount per serving (two soft gels) %Dv*
Saw palmetto (Serenoa repens) Extract (10:1) 320 mg.
Extracted from saw palmetto berries
Standardized to yield 85-95% fatty acids and sterols
Other ingredients: gelatin, glycerin, and water
* Daily Value Not Established
Saw palmetto helps maintain proper urine flow†
Usage: Take two softgels daily, or as directed by your qualified health consultant.
†This statement has not been authorized by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
Serving size specifies the number of capsules that must be taken to yield the recommended daily amount.
Saw palmetto (Serenoa repens): Herbs are identified by a common name, which comes first (Saw palmetto), followed by a botanical name that is enclosed in parentheses and italicized (Serenoa repens). The part of the herb that was used to make the formulation (saw palmetto berries) is also identified.
Extract. A solvent, usually water or alcohol, is used to ‘extract’ (withdraw) a herb’s active ingredients. Water extracts water-soluble ingredients, whereas alcohol extracts fat-soluble items such as fatty acids, sterols, and other substances that are water-insoluble. Extracts are categorized by the concentration of herb relative to the amount of solvent. Herbal infusions (a fancy name for tea) and tinctures contain more solvent than herb, while the reverse is true for liquid and solid extracts. Most popular herbal liquid tinctures contain one part herb to five or ten parts solvent (written as 1:5 or herbal tincture). On the other hand, an herbal liquid extract contains at least the same amount or more herbal product than solvent. For instance, a 2:1 liquid extract contains two parts herb for every part solvent. Finally, an herbal solid extract usually contains at least four parts herb for every part solvent (expressed 4:1 solid extract); or in this case, ten parts herb to one part solvent (10:1).
Standardization. Whenever the active ingredient is known, it’s possible to standardize a product that contains a specified percentage of active ingredient(s), for instance, 85-95% fatty acids and sterols. An active ingredient is the chemical that presumably accounts for an herb’s healing properties. Products can also be standardized to contain a certain concentration of herbal ingredients, for example a standardized 10:1 herbal extract.
Other Ingredients: Anything that is contained in the product other that the pure herb should be listed in this section. Unless stated otherwise, gelatin vitamin capsules are derived from processed animal collagen (for instance, animal hoofs). “Vegicaps” on the other hand are made from vegetable protein and glycerine (a fat derivative).
Daily Value. Unlike vitamins and minerals, herbs don’t have a recommended daily value (amount).
Structure/Function Statement: The Food and Drug Administration permits manufacturers to describe how an herb affects the body’s structure or function - for example, they can state that saw palmetto “helps maintain proper urine flow” - as long as they also include the disclaimer listed above†.
Usage: The recommended dosage may vary depending on a person’s weight, medical condition, other medications, and the nature of the condition being treated. For instance, if a man weighs over two hundred pounds, I recommend taking three instead of two 160mg saw palmetto softgels daily.
Note: Liquid herbal preparations are measured in “cc” (cubic centimeter) or “ml” (milliliter) amounts (the two measurements are equivalent). Common liquid measurements include: One teaspoon equals 5ccs, one tablespoon equals fifteen ccs, one ounce equals thirty ccs. Liquid herbal tinctures or extracts are also dispensed by the drop (one dropper full equals approximately forty drops).
Dried herbs, on the other hand, are dispensed by weight. One heaping teaspoon of dried herb averages between one to four and half grams (flowers average one gram, bark averages four and a half grams, and the remaining herbal parts weigh somewhere in between).
· American Urological Association,Inc.1120 N. Charles St., Baltimore, MD, 21201-5559, (410) 727-1100, web site: http://www.auanet.org
· American Foundation for Urologic Disease (AFUD), 300 W. Pratt St., Suite 401, Baltimore, MD, 21201, (800) 242-2383, web site: http://www.afud.org/
Patients Advocates for Advanced Cancer Treatments (PAACT),
· Prostate Cancer Research Institute, 5777 W. Century Boulevard, Suite 885, Los Angeles, CA, 90045, (310) 743-2116, web site: http://www.prostate-cancer.org
· US-TOO Prostate Cancer Survivor Support Groups, 930 N. York Rd., Suite 50, Hinsdale, IL, 60521-2993, (630) 323-1002, web site: http://www.ustoo.com
National Association for Continence,
Books and Booklets
· Nutrition & Prostate Cancer: A Monograph from the CaP CURE Nutrition Project, CaP Cure, 1250 Fourth St., Suite 360, Santa Monica, CA, 90401, (310) 458-2873
· Prostate Cancer and Bone Metastases, CaP Cure, 1250 Fourth St., Suite 360, Santa Monica, CA, 90401, (310) 458-2873
Prostate Cancer Resource Guide,
American Foundation for Urologic Disease (AFUD),
Charles E. “Snuffy” Myers, Jr., Sara Sgarlat Steck, and Rose Sgarlat
Eating Your Way To Better Health (
· CancerNet @ http://cancernet.nci.nih.gov/
· Gary Huckabay’s Prostate Pointers @ http://www.prostatepointers.org/
· Prostate Forum @ http://www.prostateforum.com/
· FDA Guide to Choosing Medical Treatments @ http://www.fda.gov//oashi/aids/fdaguide.html
· Internet Resources on Cancer@ http://cpmcnet.columbia.edu/dept/rosenthal/Guide6.html
PCRInsights, Prostate Cancer Research Institute, 5777 W. Century
· Cancer Communications Newsletter, Patients Advocates for Advanced Cancer Treatments (PAACT), P.O. Box 141695, Grand Rapids, MI, 49514-1695, (616) 453-147
· US TOO Prostate Cancer Communicator, US-TOO Prostate Cancer Survivor Support Groups, 930 N. York Rd., Suite 50, Hinsdale, IL, 60521-2993, (630) 323-1002
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