Perlmutter Health Center

A Quarterly Health Update • Spring, 1998 • Vol. 3 No. 2

David Perlmutter, MD, FACN

Quotes

"Not less than two hours a day should be devoted to exercise." -- Thomas Jefferson

"If you are physically sick, you can elicit the interest of a battery of physicians; but if you are mentally sick, you are lucky if the janitor comes around." -- Martin H. Fischer

"We don't believe in rheumatism and true love until after the first attack." --Marie Von Ebner-Eschenbach

"To avoid sickness, eat less; to prolong life, worry less." -- Chu Hui Weng

"The trouble with heart disease is that the first symptoms is often hard to deal with: sudden death." -- Michael Phelps

"When meditating over a disease, I never think of finding a remedy for it, but, instead, a means of preventing it." -- Louis Pasteur

"There are only two things a child will share willingly - communicable diseases and his mother's age." -- Benjamin Spock

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Is Exercise Really That Important?

These days, everyone seems to be exercising or at least thinking about it. No doubt this "exercise craze" is fueled by the ever increasing number of studies published both in medical as well as popular journals supporting the health benefits of physical activity. But is there really any sound scientific evidence indicating that regular exercise is beneficial? To answer this question, researchers from the University of Helsinki studied the relationship between physical activity and mortality. In order to obtain truly meaningful results, they designed the study to all but eliminate an important confounding variable – genetic differences. This was achieved by studying twins, which allowed comparison of two genetically identical populations.

Between the years 1977 through 1994, about 8,000 pairs of twins were followed with respect to physical activity. The results of the study were truly compelling. The risk of death in those who exercised most frequently was approximately half the risk of the sedentary group. As the authors stated in their February 11, 1998 publication in the Journal of the American Medical Association, "The results from the entire study cohort are consistent with earlier study findings that there is an inverse association between baseline physical activity and future premature mortality …. Comparison of the physically active co-twins with their less active siblings produced further evidence that familial factors do not explain the mortality differences by physical activity found in individual-based analysis."

Thus, the contention that a "genetic predisposition" is responsible for the increased physical activity which confers longevity may not be valid. By studying twin pairs, this study eliminated genetic bias and focused essentially on lifestyle choices made by the participants.

The take home message of the report is simply that while we are dealt a specific genetic hand, how we choose to play our cards profoundly influences the outcome of the game.

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Good News About Vitmain E

Previous issues of The Perlmutter Letter have explored the usefulness of vitamin E in a variety of clinical conditions including heart disease, Alzheimer's disease, and diabetes. This fat soluble antioxidant vitamin is the subject of intensive worldwide research.

A new study reported in the March 28, 1998 issue of The Lancet reveals a striking reduction of prostate cancer incidence in male smokers taking vitamin E supplements. The research carried out by both the U.S. National Cancer Institute and the University of Helsinki, Finland, evaluated prostate cancer incidence in a group of about 29,000 male smokers aged 50-69 years, some of whom received vitamin E 50 mg per day, while others received a placebo for up to 8 years. The incidence of prostate cancer was 32% lower in the group taking vitamin E compared to the control group. Even more striking is the incidence of mortality which was 41% lower in the vitamin E supplemented group.

The author reports, "The reduction in clinically overt cancer appeared within two years after supplementation was started, which suggests that (vitamin E) blocks tumor progression from subclinical to clinical phase."

Prostate cancer is now the fourth most common cancer in the male population and has demonstrated an alarming increase in incidence over the past decade. Treatment options including radical prostatectomy, radioactive "seed" implantation, external radiation, and hormonal therapies, while certainly effective in many cases, may be associated with a variety of compromising side-effects. The importance of this study is well summarized by British urologist Roger Kirby who stated, "although hormone treatment puts a hold on prostate cancer, it does not cure the disease. We desperately need new prevention and treatment strategies for prostate cancer, and this study is an interesting new development."

Vitamin E may have an important role in the treatment of childhood epilepsy. Despite adequate blood levels of various anti-epilepsy medications, 10% to 20% of epileptic children will continue to have inadequate control of their seizures. Research published in the well respected journal Epilepsia has demonstrated a significant reduction in seizure frequency in 10 of 12 children who were given 400 I.U. of vitamin E each day in addition to their seizure medication. Similar results were described by Dr. A. O. Ogunmekan writing in International Clinical Nutrition Reviews. Vitamin E has long been shown to control, and indeed at times prevent seizures in experimental animal models. Now that clinical trials have demonstrated the effectiveness of vitamin E in humans, it should certainly be considered as part of an overall program including anti-convulsive medication for seizure control. As stated in the December, 1997 issue of Veris Research Summary, "Although the clinical data on effectiveness of vitamin E in addition to standard anti-convulsant drug therapy are limited, the majority of the study results suggest that vitamin E supplements may have a role as add-on therapy in improving seizure control."

Parkinson's disease is a progressive neuro-degenerative disorder effecting approximately 10% of people over 65 years of age. While some cases are known to be associated with a specific viral infection or drug exposure, in most cases the disease is considered "idiopathic" meaning that the exact cause remains elusive. Regardless of the triggering event, however, what ultimately destroys brain tissue in the Parkinson's patient is the activity of so-called "free radicals" which represent a group of highly reactive molecules produced as a normal consequence of metabolism. In the early 1990's, various researchers demonstrated a reduction of antioxidant protection in the brains of Parkinson's patients. These findings prompted research to evaluate the effectiveness of various antioxidants in the treatment of this disorder. Vitamin E, being a fat soluble antioxidant, was immediately looked upon as being a prime candidate, and indeed was extensively studied with favorable results. In one study, the ability to carry out activities of daily living was evaluated as an effectiveness parameter comparing two groups of Parkinson's disease patients, one receiving vitamin E supplementation, while the other did not. After an average of 7 years, the vitamin E supplemented group had a significant improved ability to carry out various activities of daily living compared to the non-supplemented group. More striking results are noted in a study which evaluated how long Parkinson's patients were able to go until they absolutely required specific pharmaceutical intervention. It was noted that in a group receiving 3,200 I.U. of vitamin E along with 3,000 mg of vitamin C, the length of time before they required the mainstay treatment for Parkinson's disease (levodopa) was extended by about 2½ years.

Vitamin E is safe, inexpensive, and readily available. Its usefulness in a wide variety of clinical conditions is truly impressive. To learn more about the health benefits of vitamin E, visit VERIS on the world wide web at: http://www.veris-online.org.

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The Health Benefits of SAC

S-Allyl-Cysteine (SAC) is an organosulphar compound derived from garlic which is receiving a lot of attention as of late in the field of nutritional medicine. And with good reason. SAC has been demonstrated to have a wide variety of biological effects. In experimental animals it has been shown to lower serum cholesterol, reduce damage to blood vessels from free-radical oxidative injury, and inhibit carcinogen induced mammary tumors. In a recent issue of the journal Oncology, Japanese researchers reported that SAC derived from Aged Garlic Extract™ (Kyolic® garlic) inhibited the proliferation of 9 human melanoma cell lines in a dose dependent manner. After oral administration, SAC is rapidly and easily absorbed from the GI tract, thus providing high bioavailability. Aged Garlic Extract™ (Kyolic® garlic) is standardized with SAC and thus provides an excellent source for this compound. To learn more about Aged Garlic Extract™ and SAC, contact Wakunaga of America at (800) 421-2998.

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Breast Cancer Prevention Dichotomy

It has been estimated that there are approximately 180,000 new cases of breast cancer diagnosed in the United States each year. In light of this epidemic, intensive study is under way to determine specifically what can be done to reduce a woman's risk which to this day proves fatal to a third of women given the diagnosis.

Given the staggering statistics of breast cancer incidence and fatality in this country, it is not surprising that the pharmaceutical industry has devoted millions of dollars in an attempt to develop drugs which ultimately might prove useful in reducing breast cancer risk. One such drug, Tamoxifen, has been the subject of study for the past 6 years by the National Cancer Institute and the National Surgical Adjuvant Breast and Bowel Project. Because of favorable reduction of breast cancer incidence in healthy women at high risk of developing breast cancer receiving Tamoxifen compared to those receiving placebo, the investigation was halted 14 months early to allow women not receiving the drug to begin receiving Tamoxifen therapy. As Bernard Fisher, one of the scientific directors of the study recently stated, "This is the first time in history we have evidence that breast cancer not only can be treated, but that it can be prevented." His enthusiasm however, may be somewhat inappropriate. Researchers in the United Kingdom involved in a similar evaluation of the effectiveness of Tamoxifen in breast cancer prevention recently expressed their concern regarding the American data since these results are very preliminary and have not been fully evaluated by an independent peer review committee. As Trevor Powles, a researcher in the study of Tamoxifen recently reported in the journal The Lancet, "Although we are encouraged by the reduction in incidence, we need to see whether it is just a delay in disease development or whether deaths from breast cancer will also be reduced."

In the American study, so-called "high risk" women were given Tamoxifen in an attempt to reduce their breast cancer risk. To be considered "high risk" for developing breast cancer, participants simply needed to be age 60 years or older. This obviously represents a huge market should Tamoxifen receive FDA approval for breast cancer risk reduction.

It's important to recognize that Tamoxifen is a potentially dangerous pharmaceutical agent. In the U.S. study, there was a significant increase in incidence of both pulmonary embolisms (blood clots to the lungs) and uterine cancer in women given Tamoxifen. Further, it has never been demonstrated whether or not Tamoxifen is safe to take beyond 5 years. Intense public interest in Tamoxifen as a "magic bullet" to reduce breast cancer risk was recently generated when the data from the American study was somehow leaked to the press. Interestingly, an article regarding breast cancer risk reduction published in the November 5, 1997 issue of the Journal of the American Medical Association has received very little attention. This study, entitled "Dual Effects of Weight and Weight Gain on Breast Cancer Risk" from the Harvard School of Public Health, revealed a striking relationship between weight gain during adult years and risk of breast cancer after menopause. The study evaluated 95,256 women for up to 16 years. The results were truly remarkable. Women who never used post-menopausal hormones and who gained more than 20 kg. (44 lbs.), had twice the risk of breast cancer compared to those women whose weight remained essentially unchanged. Further, the study demonstrated that women who did not gain significant amounts of weight but did use post-menopausal hormone replacement therapy were also at an increased risk of breast cancer by about 5%.

Why would increased weight be directly related to increased risk of breast cancer? The authors state, "...among post-menopausal women, indogenous estrogen levels, which are believed to increase breast cancer incidence, are 50% to 100% higher among heavy women compared with lean women." Further, they conclude, "Thus, avoiding weight gain during adult life may contribute importantly to the prevention of breast cancer incidence and mortality after menopause, particularly among women who did not use post-menopausal hormones." Noted epidemiologist Dr. Jennifer Kelsey of Stanford University School of Medicine in her editorial entitled, "Weight and Risk for Breast Cancer" in the same issue of the Journal of the American Medical Association summarized the contribution of the this research by stating, "The estimate … that as much as a third of new cases of post-menopausal breast cancer may be attributable to adult weight gain, replacement hormone use, or both is sobering and encouraging: sobering because this is a large percentage and encouraging because both of these exposures are modifiable in many women."

The Tamoxifen study and the study recognizing the relationship between weight gain and breast cancer incidence represent a profound dichotomy in approaching a serious medical problem. On the one hand, we observe intensive efforts on the part of the pharmaceutical industry to develop yet another "magic bullet" to treat and now potentially prevent an increasingly common malady of modern society. Further, it does not take much imagination to recognize that the so-called "leak" of the Tamoxifen data to the press represents nothing more than a thinly veiled pre-marketing strategy on the part of the manufacturer in an attempt to reassure us that "help is on the way."

On the other hand, various simple and safe lifestyle modifications including regular exercise, avoidance of weight gain, and reduction of alcohol consumption, have long been demonstrated to play important roles in reducing breast cancer risk. Unfortunately, it is usually the "wonder drug" that makes the headlines.

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Adverse Drug Reactions - A Major Cause of Death

"The incidence of serious and fatal adverse drug reactions (ADR's) in U.S. hospitals was found to be extremely high," stated authors of a review study entitled, "Incidence of Adverse Drug Reactions in Hospitalized Patients," published in the April 15, 1998 issue of the Journal of the American Medical Association. This troubling report revealed striking evidence that pharmaceutical drugs, properly prescribed and administered, are frequently the cause of serious adverse drug reactions which are often fatal.

The researchers stated, "The figure are much higher than expected and suggest that ADR's are considerably under-reported." Further, they stated," We estimate that in 1994, overall 2,216,000 hospitalized patients had serious ADR's and 106,000 had fatal ADR's, making these reactions between the fourth and sixth leading causes of death." These numbers are truly astounding. To put these figures in perspective, it has been estimated that in the United States there are approximately 40,000 deaths attributed to breast cancer while more than 100,000 deaths are attributed to appropriately administered medications. Further, the number of deaths due to adverse drug reactions is about two-thirds the total number of deaths due to stroke.

Despite these alarming figures, deaths and severe complications due to adverse drug reactions hardly ever receive media attention. It has been estimated that in the United States alone about 20,000 deaths occur annually related to the use of non-steroidal anti-inflammatory drugs, so commonly prescribed for the treatment of arthritis and other inflammatory conditions.

Perhaps as a response to the increasing public awareness of the dangers of pharmaceutical medications, the use of herbal and other botanical remedies in this country is now booming. It has been estimated that in the United States alone, consumers spend in excess of $2.5 billion dollars on so-called "natural" remedies. Some of the more popular botanical options include tea tree oil for athlete's foot and acne, stinging nettles for sinus congestion, chamomile and peppermint for heartburn, feverfew for headaches, saw palmetto for prostate hypertrophy, ginger for motion sickness, valerian for anxiety, and St. John's Wort for depression. To learn more about natural herbal remedies, visit the American Botanical Council and Herb Research Foundation website at www.herbalgram.org.

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Book Review

Sinus Survival, by Robert S. Ivker, D.O., I.S.B.N. 0-87477-807-7

It has been estimated that sinusitis affects one out of every seven people in the United States. While the public at large remains unaware of the magnitude of this problem, Dr. Ivker reveals that the pharmaceutical industry is well tuned in to this epidemic, devoting millions of dollars to advertising for their various sinus remedies.

Typically, the "quick fix" approach to sinus disease utilizing decongestants, antihistamines, nasal steroids, and antibiotics, while offering temporary reprieve, does not cure the problem for most patients. Sinus disease, like so many other problems, requires a more comprehensive and balanced approach which is so well described in Dr. Ivker's Sinus Survival.

The book begins with an introduction to sinus and respiratory disease providing a clear understanding of the nature of the problem including the multitude of factors known to be responsible for sinus disease. In part two of Sinus Survival, Dr. Ivker outlines a comprehensive game plan to restore sinus health and overall health as well. Included in this section is an explanation of Holistic Medicine, environmental changes helpful in sinus health, an explanation of the importance of physical, mental, emotional, spiritual, and social health, as well as answers to most frequently asked questions concerning sinus problems.

Having personally treated over 20,000 patients with sinus disease, and suffering from chronic sinusitis himself, Dr. Ivker has become a world authority in the successful treatment of sinus disease. He is a clinical instructor in the department of family medicine and otolaryngology at the University of Colorado School of Medicine, and he presently serves as president of the American Holistic Medical Association.

Sinus Survival is available at all major bookstores.

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