Perlmutter Health Center

A Quarterly Health Update • Winter 1997 • Vol. 2 No. 1

David Perlmutter, MD, FACN

Quotes

"When I was 40, my doctor advised me that a man in his forties shouldn’t play tennis. I heeded his advice carefully and could hardly wait until I reached 50 to start again." ---- Hugo Black

"40 is the old age of youth; 50 is the youth of old age." --- French Proverb

"Body and mind, like man and wife, do not always agree to die together." ---- Charles C. Colton

"I have everything now I had 20 years ago - except now it's all lower." ---- Gypsy Rose Lee

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Selenium Gains Mainstream Endoresement

As if it were a new discovery in nutritional medicine, the trace element selenium has recently been the subject of medical headlines. This excitement no doubt has been fostered by a recent report appearing in the December 25, 1996 issue of the Journal of the American Medical Association. This study, conducted by the Nutritional Prevention of Cancer Study Group evaluated 1,312 patients over an eight year period of time. The participants either received selenium, 200 mcg per day or a placebo. The results were truly astounding. The total cancer mortality risk in the selenium treated group was a remarkable 50% less than the group given the placebo. Total cancers were reduced by 37% with significant reductions in incidence of lung, colo-rectal, and prostate cancers. In fact, the results of the study were so compelling that the researchers actually stopped the program early in order to allow the placebo group the benefits of selenium supplementation.

Despite the fact that this news was presented as some dramatic new discovery, nutritionally minded health care providers have known about the benefits of selenium for decades. Various studies have clearly demonstrated an inverse relationship between selenium levels and cancer incidence. Selenium is an important trace element typically found in grains. The selenium content of grains directly reflects the amount of selenium in the soil in which the grains are grown. Modern agriculture has yet to recognize the importance of selenium and other trace elements in the production of our foods. Thus, the overutilization of our agricultural lands now produces vegetables and grains containing precious little of the important trace elements like selenium.

In a study appearing in the Archives of Environmental Health in 1991, a direct relationship was noted between the incidence of cancer in various geographic areas of the United States and low levels of selenium in locally grown vegetables and grains. The specific cancers studied included lung, colon, rectum, bladder, esophagus, pancreas, breast, ovary, and cervix. This study confirms what over 200 other scientific reports involving human volunteers have demonstrated - low selenium levels increase risk of developing cancer.

Selenium has several important biological functions in the human. Perhaps most notable is its anti-oxidant activity. Thus, selenium participates in the activity of enzymes which limit the life span of free radicals - chemicals which may damage DNA and thus pave the way for malignancy. In this role, selenium joins other important anti-oxidants like vitamins C, E, and A. In fact, frequently selenium supplements are combined with vitamin E to help reduce the oxidation or free radical damage of the body’s fats.

Selenium has another interesting and vitally important role. The thyroid gland normally produces thyroid hormone containing four iodine atoms, typically referred to as T4. T4, however, has very little biological activity in terms of carrying out the various functions of the thyroid gland. Under the influence of a specific enzyme, T4 has one of the iodine atoms removed and becomes T3. T3 is far more active in the body, playing a pivotal role in regulation of metabolism. Truly, it is T3 that does the work of the thyroid. The role that selenium plays in this process is critical since the enzyme which allows the conversion of T4 into T3 is selenium dependent. So, while the thyroid may be producing adequate amounts of T4, in the absence of adequate selenium, the conversion to active T3 may not take place effectively rendering that individual functionally thyroid deficient. Further, low thyroid function is typically treated by conventional medical practitioners with drugs like Synthroid® - or pure T4. While most patients may have fairly adequate ability to convert T4 into active T3, some individuals, by virtue of the fact that their converting enzyme is defective because of low selenium levels or other reasons, may not be able to fully utilize T4. It is for this reason that many health care practitioners are now reassessing their usage of thyroid medications and choosing more natural thyroid supplements which contain both T3 and T4.

It is always a pleasant surprise when a journal such as JAMA publishes a report so profoundly favorable for the concepts of nutritional supplementation. Unfortunately, almost as if it were a disclaimer, this important research was followed in the same issue by an editorial entitled, "Selenium and Cancer Prevention - Promising Results Indicate Further Trials Required." Despite the profound decrease in cancer incidence reported in this journal, as well as the corroboration of hundreds of other well conducted scientific studies, the editorial concludes by stating, "For now, it is premature to change individual behavior, to market specific selenium supplements, or to modify public health recommendations based on the results of this one randomized trial."

Perhaps the author of the editorial feels it is more appropriate to divert more millions of dollars to the development of more potent chemotherapy and radiation therapy techniques to treat cancer, rather than recognize the importance of prevention. As cancer statistics of mortality and incidence continue to rise, we must examine the changes that are occurring around us like the trace element depletion of our soils and consequently our vegetables and grains. It is unlikely that large scale agricultural industry will commit resources to enrich the soil in which our produce is grown to produce healthier crops. That being the case, nutritional supplementation makes sense.

Selenium is widely available at heath food stores and even at most grocery stores and drug stores. The adult recommended dosage is 200 mcg each day. Remember, prevention is the ultimate principal of wisdom.

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Tomatoes and Prostate Cancer

Recently, several reports have indicated that tomato product consumption may lower the risk of prostate cancer. A new report appearing in the Journal of the National Cancer Institute evaluated the consumption of 42 specific fruits and vegetables in over 47,000 men in order to determine a relationship between diet and prostate cancer risk. Overall, tomato-based foods were clearly associated with reduced risk of prostate cancer. Interestingly, the only food associated with increased risk of prostate cancer was strawberries. Tomatoes are known to have high levels of lycopene. Lycopene, like various vitamins acts as an anti-oxidant. This may reduce genetic damage which could otherwise lead to cancer production.

Further, the study demonstrated that raw tomato products such as tomato juice did not significantly reduce prostate cancer incidence. Oil cooked tomato products such as tomato or pizza sauce preparations, perhaps because they allow better absorption of lycopene, were among the most significant food products related to decreased prostate cancer risk.

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Sunscreen and Beta Carotene Offer Best Protection

As we watch the ever increasing incidence rates of sun induced skin cancers, our population is becoming more and more attuned to the importance of sunscreen utilization. Typically, we are told to choose the highest sun protection factor (SPF) rating available for our sunscreen products. A new study now demonstrates that a nutritional supplementation approach may offer additional protection.

In a recent issue of the European Journal of Dermatology, researchers evaluated the effectiveness of sunscreen in individuals taking a beta carotene supplement or placebo. Skin damage including the development of redness after exposure to natural sun light was significantly less in the beta carotene supplemented group when compared to those receiving placebo. The author stated, "Pre-supplementation with moderate doses of beta carotene before and during natural sun light exposure combined with topical sunscreens are more effective than sunscreen cream alone. From our results, the use of such a combination for the general health of populations at risk e.g., before UV exposure during vacation, would seem advisable."

Beta carotene is converted in the body to vitamin A. Vitamin A is, like selenium, vitamin C and vitamin E, an anti-oxidant. This means that it can limit the damaging effects of free radicals - damaging chemicals that can be produced in skin exposed to ultraviolet rays. Free radical damage in the skin leads to a number of changes including premature aging, pre-cancerous lesions, and cancer of several types.

Beta carotene supplementation (25,000 units each day for adults) is safe and should be an important part of your overall health plan. But keep in mind that beta carotene supplementation alone certainly does not obviate the need for liberal use of sunscreen.

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Melatonin - More Benefits Reported

Hardly a day goes by that we do not hear some bit of news about melatonin. Widely available in health food stores and pharmacies across the country, melatonin has been recommended for a variety of problems including insomnia, jet lag, and a type of depression called seasonal affective disorder.

Perhaps in an attempt to put the melatonin controversy in perspective, the January 16, 1997 issue of the prestigious New England Journal of Medicine devoted an entire section to reviewing melatonin and its activity in humans.

Melatonin is produced by the pineal gland which is situated between the two cerebral hemispheres in the back of the brain. Melatonin production increases soon after the onset of darkness and peaks somewhere between 2:00 am and 4:00 am, gradually falling in the second half of the night. As we age, melatonin secretion from the pineal gland decreases. For this reason, researchers have proposed that lower levels of melatonin in the elderly may be responsible for some sleep abnormalities. In addition, it has been demonstrated that one form of depression known as seasonal affective disorder is likely due to insufficient amounts of natural light. Studies have demonstrated that these individuals may lack sufficient amounts of melatonin. Melatonin plays an important role in maintaining our 24 hour circadian rhythm. It is for this reason that melatonin has been recommended and indeed used effectively in individuals suffering from so called "jet lag" or alterations of their circadian rhythm when traveling from west to east.

The report was certainly quite favorable in its discussion of melatonin as a sleep aid. It stated, "Ingestion of melatonin affects sleep propensity (the speed of falling asleep), as well as the duration and quality of sleep, and has hypnotic effects. In young adults, oral administration of 5 mg of melatonin caused a significant increase in sleep propensity and the duration of rapid-eye-movement (REM) sleep. In other studies, sleep propensity was increased in normal subjects given much lower doses of melatonin (0.1, 0.3, or 1 mg), either in the day time or in the evening, and sleepiness in the morning was not increased."

With respect to aging the report stated, "The decrease in night time serum melatonin concentrations that occurs with aging, together with its multiple biologic effects, has led several investigators to suggest that melatonin has a role in aging and age-related diseases. ... Melatonin may provide protection against aging through attenuation of the affects of cell damage induced by free radicals or through imuno-enhancement."

Perhaps the most startling confirmation appearing in this report was in the effects of melatonin in cancer. The report stated, "There is evidence from experimental studies that melatonin influences the growth of spontaneous and induced tumors in animals. Pinealectomy (removing the pineal gland) enhances tumor growth, and the administration of melatonin reverses this affect or inhibits tumorigenesis (formation of tumors) caused by carcinogens. ... Low serum melatonin concentrations and low urinary excretion of melatonin metabolites have been reported in woman with estrogen-receptor-positive breast cancer and men with prostate cancer. The mechanism by which melatonin may inhibit tumor growth is not known. One possibility is that the tumor has anti-mitotic (reduces abnormal cell growth) activity."

It will be interesting to see how main stream physicians respond to this extremely supportive information with respect to the usefulness of melatonin as a nutritional supplement.

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Aged Garlic Extract (KYOLIC) Lowers Blood Cholesterol

The concept that lowering blood cholesterol levels reduces coronary artery disease risk has been deeply ingrained into the consciousness of the American populous. And for good reason. There is a very straight forward relationship between elevated serum cholesterol levels and heart disease risk. A recent study published in the Journal of the American Medical Association raised serious concerns regarding increased risk of cancer in long term users of several cholesterol lowering drugs. Indeed, when reading the Physician’s Desk Reference describing the use of these drugs, the prescribing physician is warned that they should be used "only after strict dietary measures have failed."

Obviously reducing cholesterol consumption (reducing consumption of animal based products) is a key concept for reducing blood cholesterol. Nutritional supplements in addition have been demonstrated to be significantly helpful in a program to lower blood cholesterol.

Kyolic garlic, perhaps one of the most useful nutritional supplements now available, has been the subject of a series of well conducted scientific research studies in several countries. The unique process by which aged garlic extract (Kyolic) is prepared fortifies its potential when compared to other garlic supplements in terms of its biological activity. In a recent study published in Nutrition Research, Kyolic Aged Garlic Extract supplementation not only reduced total cholesterol, but also had a significant effect on lowering LDL cholesterol which is a major risk factor for heart disease. Further, HDL cholesterol (good cholesterol) increased in the subjects taking Kyolic garlic.

In addition to Kyolic garlic, niacinamide 200 mg twice each day is a useful nutrient in a cholesterol lowering program. Regular aerobic exercise does tend to raise HDL, and avoiding hydrogenated oils reduces the tendency for the liver to manufacture cholesterol.

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And Finally...

I was recently amused at a cocktail party watching an attorney friend give hours of free advice. "Why do you do that?" I asked. "Simple," he replied. "Tomorrow morning I will send them each a bill." "Gee," I replied. "People are always asking me for free medical advice. Maybe I should give it a try." "You certainly should," he answered. The next morning I got his bill.

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Book Review

The Yeast Connection and the Woman by William G. Crook, M.D.
ISBN 0-933478-22-4, Professional Books, Inc., Publisher, Jackson, TN

The concept that yeast overgrowth in the body may be related to disease has yet to gain a significant foothold in main stream medicine. Nevertheless, alternative health practitioners have long known that yeast (Candida) overgrowth can be associated with a variety of problems related to physical abnormalities, mental dysfunction, and chronic fatigue. This well organized text presents an overview of the yeast problem emphasizing various factors which increase susceptibility to this common malady. This is followed by sections dealing with specific disease entities likely related to yeast overgrowth. Nutritional, pharmacological, and lifestyle management plans are then presented, allowing the formulation of a meaningful plan to deal with Candidiasis. Finally, Dr. Cook presents other related topics of interest which may also have a bearing on many of our modern day illnesses including the mercury amalgam controversy, free radicals and anti-oxidants, progesterone and estrogen therapy, and a host of others.

This book is widely available at major book stores and health food stores and should certainly be considered for anyone suffering a chronic illness for which main stream medical approaches have been less than satisfactory.

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