Perlmutter Health Center

A Quarterly Health Update • Spring 1997 • Vol. 2 No. 2

David Perlmutter, MD, FACN

Quotes

"A rule of thumb in the matter of medical advice is to take everything any doctor says with a grain of aspirin." -- Goodman Ace

"Thousands upon thousands of persons have studied disease. Almost no one has studied health." -- Adelle Davis

"There is no curing a sick man who believes himself in health." -- Henri Amiel

"It is a lot harder to keep people well than it is to just get them over a sickness." --DeForest Clinton Jarvis

"Think of health-care reform as throwing a trillion-dollar pot of gold up for grabs." -- Joseph Califano, Former Secretary Health, Education and Welfare

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Nutritional Supplements to Preserve Memory and Brain Function

As the 20th century comes to a close, we are witnessing a staggering increase in dementing illnesses. At present, approximately 4.5 million Americans have Alzheimer's disease. By the year 2030, it has been estimated that this number will approach 9 million.

Unfortunately, the pharmaceutical industry has yet to develop a drug with any meaningful activity with respect to memory enhancement or enhancing cognitive performance. Fortunately, however, over the past decade, there has been extensive research carried out at our most well respected medical institutions demonstrating the profound effectiveness of a variety of nutritional supplements in enhancing memory and other brain functions.

The following nutritional supplements are the key players in a program designed to preserve and enhance cerebral function:

These nutritional supplements are available without a prescription from most health food stores. Neuro·Logic® marketed by Wakunaga of America Co., Ltd. (800) 421-2998, contains all of the above brain essential nutrients.

Two capsules twice daily provide the following:

Phosphatidylserine (30%) 15 mg
Acetyl-L-carnitine (99%) 50 mg
Aged Garlic Extract 800 mg
Lecithin 480 mg
Gingko Biloba Extract 120 mg
Folic Acid 400 mcg
Vitamin B12 200 mcg

Neuro·Logic® represents a major advance in nutritional support with a unique formulation of ingredients that have been the subject of extensive scientific research.

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Exercise Reduces Breast Cancer Risk

Despite the billions of dollars devoted to cancer research since the "war on cancer" was established by presidential decree in 1971, advances in effective treatments for breast cancer have, for the most part, not been forth coming. In fact, over the past 50 years there has been relatively little change with respect to breast cancer survival despite the variety of treatment techniques that wax and wane in popularity.

But what about preventing breast cancer? What can a woman do to reduce her chances of receiving this devastating diagnosis? In 1960, the risk of an American woman developing breast cancer in her lifetime was 1 in 20. It now stands at 1 in 8. Clearly this represents an epidemic completely out of control, especially in light of the sobering statistic that _ of woman diagnosed as having breast cancer will die as a consequence of that disease.

The good news is that there are a variety of modifiable factors which can substantially reduce breast cancer risk. These include dietary changes, reducing estrogen supplementation, avoiding the use of oral contraceptives, and cutting back on alcohol consumption.

Now, a new study published in the New England Journal of Medicine (May 1, 1997), strongly supports the addition of increased physical activity as a lifestyle modification to reduce the risk of breast cancer. This study evaluated the physical activity of over 25,000 women between the ages of 20 to 54 years and compared their level of physical activity to their risk of subsequently developing breast cancer.

The results were truly remarkable. Overall, those women who engaged in increased physical activity reduced their risk of breast cancer by 37%. In younger women (45 years or younger) who regularly exercised, the risk reduction compared to more sedentary women was even more dramatic, 68%. It is important to note that the study evaluated not only exercise related activity, but activity related to work as well.

What could account for such a profound decrease in breast cancer risk in active women compared to those more sedentary? First, physical activity burns calories. In a variety of animal studies, it has been demonstrated that calorie restriction inhibits mammary carcinogenesis (breast cancer formation). In humans, increased calorie intake relative to decreased caloric utilization (sedentary lifestyle) has been reported to be a risk factor for breast cancer. Second, triglycerides (simple fats found in the blood) when elevated, lead to an increased level of free estradiol, an important female hormone linked to increased risk of breast cancer. Sedentary women have higher levels of triglycerides, and thus their total exposure to estrogen may be greater than in more active women. Third, physical activity directly reduces estrogen, and again, this may have a direct role in breast cancer risk reduction.

So the bottom line is concentrate on prevention. Relying upon your annual mammogram is not breast cancer prevention. Indeed, by the time a mammogram demonstrates even the smallest breast tumor, it has been growing for at least a decade. There are steps you can take today that can have a substantial impact on your breast cancer risk with the added benefit of improving your overall health. (Please see book review this issue).

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New Prostate Test Proves Effective

Recent media attention on the deaths of Telly Savalis, Bill Bixby, Frank Zappa, and other celebrities from prostate cancer as well as the public announcements by media celebrities like Norman Schwartzkopf that they suffer from this affliction have certainly increased the public awareness of just how wide spread the prostate cancer problem really is. Men are finally getting the message about prostate cancer and are learning how truly important early detection is in enhancing survivability.

Until recently, the two important screening techniques for prostate cancer included the digital (finger) rectal prostate examination coupled with a blood test to measure the prostate specific antigen (PSA) which is typically elevated when prostate cancer is present.

Typically, values of PSA below 4.0 ng/mL have been considered "normal," which is to say no further evaluation would be necessary. In fact, most men have felt quite secure when being told by their doctor that because their PSA was less than 4.0 they were in the "safe range." Incredibly, however, more than 20% of men with prostate cancer have a PSA level less than 4.0.

Detecting prostate cancer earlier enables men to have treatment while their prostate cancer is still curable. To that end, a new screening test has been developed which is far more accurate in detecting early prostate cancer than the widely accepted PSA blood test.

Recently, in an article published in the Journal of the American Medical Association (May 14, 1997), researchers at the Washington University School of Medicine described a new technique designed to detect early prostate cancer much more accurately. Their research demonstrated the effectiveness of evaluating the "free" PSA. The PSA in the blood exists either bound to a carrier protein or is "free." By specifically evaluating the free PSA, the authors were much more able to predict which patients would have prostate cancer, even with a total PSA in the so called "normal" range (less than 4.0).

The free PSA measurement is now widely available. It is a much more specific test for identifying early prostate cancer. There is nothing "free" about it in that it is somewhat more expensive than the standard PSA measurement. Nevertheless, in light of this new study, the free PSA blood test should become an integral part of the general physical examination for men.

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Vitamin E and Immunity in the Elderly

Nutrition plays a critically important role in the maintenance of a healthy immune system in all age groups. Most scientific research evaluating various nutritional parameters has been conducted on healthy young adults. Aging is associated with a significant reduction in many parameters of immune function. Unfortunately, very few studies have evaluated the important roles of vitamins and micronutrients in the preservation of proper immune function in the elderly.

Research published in the Journal of the American Medical Association (May 7, 1997), specifically evaluated the impact that vitamin E supplementation had in a group of elderly (65 years or greater) otherwise healthy individuals.

The subjects in the study received various dosages of vitamin E over a four month period of time. At the conclusion of the study, these subjects underwent an evaluation which involved challenging their immune systems and measuring its response.

The results demonstrated a profound enhancement of various measurements of immune system competence. Subjects consuming 200 mg per day of vitamin E during the course of the study, demonstrated a remarkable 6-fold increase in one measurement of immune system function.

Vitamin E plays an important role in maintaining immuno competence. Nevertheless, there is a paucity of research data addressing the vitamin E needs in the elderly population. Factors which may lead to low levels of vitamin E in the elderly include diets restricted in nuts, seeds, seed oils, and vegetable oils. In addition, the elderly may have more difficulties in purchasing a healthful variety of foods, preparing foods adequately, and even chewing foods that are rich in vitamin E.

Vitamin E is inexpensive, and virtually non toxic in a typical therapeutic dosage of 400 units daily (d-alpha tocopherol). Other benefits of vitamin E supplementation take advantage of its antioxidant properties and include reduction of risk of coronary heart disease, reduced risk of death from coronary heart disease, and a reduced frequency of angina attacks.

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Chinese Herb Helpful in Alzheimers Disease

Despite the devastating impact that Alzheimer's disease has on the individual, family members, and society at large, precious few pharmacological interventions are at present available for treatment of this affliction.

The abnormality of brain chemistry thought to play an important role in the loss of cognitive function in Alzheimer's disease patients is the reduction of an important brain chemical, acetylcholine. There exists in the brain a specific enzyme, acetylcholinesterase, which normally serves to break down acetylcholine. Blocking this enzyme allows increased levels of acetylcholine which is the rationale for the use of the two drugs presently approved by the FDA for treatment of Alzheimer's disease. Unfortunately, these medications (Tacrine and Donepezil) have proven to be of limited usefulness and are associated with various side effects.

For years, the Chinese have been using the herbal medicine Qian Ceng Ta to treat dementia, in some cases with fairly good success. In a recent article appearing in the Journal of the American Medical Association entitled, "Old Chinese Herbal Medicine Used for Fever Yields Possible New Alzheimer's Disease Therapy," the mechanism by which this ancient moss derived herbal preparation may benefit Alzheimer's patients was elucidated. As it turns out, the herbal medicine functions exactly like our modern pharmaceutical products by blocking the acetylcholinesterase enzyme and allowing the build up of acetylcholine which, as described above, is typically lower in the Alzheimer's patient. In addition, Qian Ceng Ta has the added benefit of acting as a neuro-protective agent. That is, it has the ability to protect delicate brain cells, making them less susceptible to the damaging effects of certain toxic chemicals.

How very surprising but certainly encouraging it is to see a description of the usefulness of an herbal medicinal preparation in a mainstream, fairly conservative medical journal.

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Improving Your Cholestrol Ratio

Cholesterol continues to command center stage in the public awareness of factors related to the risk of developing coronary heart disease and stroke, and with good reason. The relationship between cholesterol and risk for developing vascular disease is quite clear. But focusing on just the level of blood cholesterol is far less accurate than examining the cholesterol ratio.

We have all heard about the "good" and "bad" cholesterols, HDL and LDL respectively. A far more accurate predictor of coronary artery disease risk is a ratio formed by dividing the total cholesterol by the HDL. Thus, a total cholesterol/HDL ratio of 4.0 or less is typically associated with reduced risk of coronary artery disease.

Therapeutic schemes to reduce coronary artery disease risk can involve lowering the total cholesterol, raising the HDL, or most advantageously, doing both. Typically, most therapies seem to concentrate on lowering the total cholesterol. This may involve dietary changes, the use of nutritional supplementation, or the utilization of pharmaceutical interventions. However, it should be remembered that raising the HDL will also lower the total ratio, and thus decrease coronary artery disease risk. Regular exercise is known to increase HDL, sometimes dramatically. Nicotinic acid, and niacinamide, both forms of the B vitamin niacin, also raise the HDL while actually lowering the total cholesterol. Nicotinic acid, however, is often poorly tolerated in higher dosage levels. Niacinamide, which is now widely available in health food stores, has proven itself to be quite effective in improving the cholesterol ratio. A typical dosage for an adult is in the range of 100 mg twice a day. Regular niacin, which also has a significant effect upon total cholesterol and HDL, typically causes a "flush," or a transient warm sensation of the skin. Time-released niacin has been associated with abnormalities of liver function. Neither of these problems is experienced with niacinamide.

Aged Garlic Extract (Kyolic®) also improves the cholesterol ratio by lowering the total cholesterol while actually increasing the HDL, and so it may also play an important role along with a reduced cholesterol diet and regular exercise in reducing coronary artery disease risk.

So remember, relying upon the total cholesterol number alone as an indicator for coronary artery disease risk is inadequate. Make sure that when your cholesterol level is checked, that it is a fasting study, which means that it should be checked no sooner than twelve hours after the last meal, with measurement of the HDL included so you can determine your cholesterol ratio.

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Book Review

Breast Health by Charles B. Simone, M.D.
I.S.B.N. 0-89529-660-8, Avery Publishing Group, Garden City Park, NY, 1995.

Dr. Charles B. Simone, a nationally renowned practicing cancer specialist and former researcher at The National Cancer Institute is the author of the best selling book, Cancer and Nutrition. Now, with the publication of Breast Health - What You Need to Know, the reader is provided in clear understandable text, a wealth of knowledge concerning not only breast cancer, but breast health in general.

Breast Health begins with a sobering look at the dramatic escalation of cancer incidence with a specific description of the epidemic rise of breast cancer to the extent that now approximately 1 in 8 American women will experience breast cancer at some point in their lives. This is vividly contrasted with the death rate of breast cancer which has remained remarkably and unfortunately essentially unchanged for the past 65 years. With these statistics in mind, Dr. Simone then pursues an overview of risk factors and provides a convenient "self test" which allows women to assess their risk of breast cancer.

Part two looks at a variety of modifiable factors which can reduce risk and enhance the body's cancer fighting ability, including nutrition, lifestyle modification, antioxidants, and other cancer fighting nutrients.

Part three looks at various risk factors including smoking, alcohol and caffeine, hormonal factors, and even more obscure causative factors like electromagnetic radiation and even the air that we breathe and the water that we drink. This section ends with an interesting discussion of the dangers of silicone breast implants as well as the role that genetics plays in breast disease.

Part four focuses on breast cancer and describes the various means by which breast cancer can be detected and diagnosed as well as treated conventionally. There is even a section dealing with breast cancer in the male as well as what happens when breast cancer is left untreated.

The final section describes a comprehensive "10-point plan" for breast care.

Breast Health is an important resource for woman and men as well. Many of the topics covered in The Perlmutter Letter are supported by Dr. Simone's research. Make Breast Health a part of your health library.

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