Increased prostate cancer risk from vitamin E supplements

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Men who took 400 international units (I.U.) of vitamin E daily had more prostate cancers compared to men who took a placebo, according to an updated review of data from the Selenium and Vitamin E Cancer Prevention Trial (SELECT). The findings showed that, per 1,000 men, there were 76 prostate cancers in men who took only vitamin E supplements, vs. 65 in men on placebo over a seven-year period, or 11 more cases of prostate cancer per 1,000 men. This represents a 17 percent increase in prostate cancers relative to those who took a placebo. This difference was statistically significant and therefore is not likely due to chance. The results of this update appeared Oct. 12, 2011, in the Journal of the American Medical Association.

SWOG, an international network of research institutions, carried out SELECT at more than 400 clinical sites in the United States, Puerto Rico, and Canada. SELECT was funded by the National Cancer Institute (NCI) and other institutes that comprise the National Institutes of Health.

The crystalline structure of Vitamin E“Based on these results and the results of large cardiovascular studies using vitamin E, there is no reason for men in the general population to take the dose of vitamin E used in SELECT as the supplements have shown no benefit and some very real risks,” said Eric Klein, M.D., a study co-chair for SELECT, and a physician at the Cleveland Clinic. “For now, men who were part of SELECT should continue to see their primary care physician or urologist and bring these results to their attention for further consideration.”

The SELECT study began in 2001 and included over 35,000 men. It was started because earlier research had suggested that selenium or vitamin E might reduce the risk of developing prostate cancer. However, based on an independent safety monitoring review in autumn 2008, participants were told to stop taking their study supplements because it had become clear that the trial would never produce the 25 percent reduction in prostate cancer the study was designed to show with the use of these supplements. In 2010, the study sites were closed and over half of the participants consented to have their health monitored via mail questionnaires. Now, because of this latest finding, researchers are encouraging all participants to consider taking part in long-term study follow-up so investigators can continue to track outcomes.

SELECT was undertaken to substantiate earlier, separate findings from studies in which prostate cancer risk was not the primary outcome. A 1998 study of male smokers in Finland who took 50 I.U. of vitamin E daily to prevent lung cancer, showed 32 percent fewer prostate cancers in men who took the supplement. A 1996 study of men and women with a history of skin cancer who took selenium for prevention of disease recurrence showed that men who took the supplement had 52 percent fewer prostate cancers than men who did not take the supplement.

Based on these and other findings, men were recruited to participate in SELECT. They were randomly assigned to take one of four sets of supplements or placebos, with more than 8,000 men in each group. One group took both selenium and vitamin E; one took selenium and a placebo that looked similar to vitamin E; one took vitamin E and a placebo that looked similar to selenium; and the final group received placebos of both supplements. Men who took selenium alone or vitamin E and selenium together were also more likely to develop prostate cancer than men who took a placebo, but those increases were small and possibly due to chance.

“SELECT has definitively shown a lack of benefit from vitamin E and selenium supplements in the prevention of prostate cancer and has shown there is the potential for harm,” said Lori Minasian, M.D., study co-author and acting director of NCI’s Division of Cancer Prevention. “Nevertheless, this type of research has been critically important to understanding the potential benefits and risks from supplements.”

SELECT researchers are now measuring the amount of vitamin E, selenium, and other nutrients in the blood of participants when they joined the trial, to see if the effect of the supplements depended upon this baseline level of micronutrient. Other researchers are looking at single nucleotide polymorphisms, which are DNA changes known as SNPs, to see if a change in one or more genes could affect cancer risk or perhaps increase a man’s risk of developing prostate cancer while taking vitamin E.

The participant samples come from the study biorepository of blood and toe nail clippings which, when coupled with the extensive clinical information on participants, is a vital resource for further study. “SWOG is soliciting proposals from researchers nationwide to use the SELECT biorepository to help answer the biological question of why vitamin E increased risk instead of decreasing it,” said Laurence Baker, D.O., study co-author and chairman of SWOG. “There are many more questions raised by these study results than we have answers for, and thus the need for further investigation.”

Except for skin cancer, prostate cancer is the most common type of cancer in men in the United States. The current lifetime risk of prostate cancer for American men is 16 percent. In 2011, there will be an estimated 240,890 new cases of prostate cancer and 33,720 deaths from this disease in the United States.

Heart Disease: Eating Fruits and Raw Vegetables Can Change the Effect of Your Genes

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A long-held mantra suggests that you can't change your family, the genes they pass on, or the effect of these genes. Now, an international team of scientists, led by researchers at McMaster and McGill universities, is attacking that belief.

The researchers discovered the gene that is the strongest marker for heart disease can actually be modified by generous amounts of fruit and raw vegetables. The results of their study are published in the current issue of the journal PLoS Medicine.

"We know that 9p21 genetic variants increase the risk of heart disease for those that carry it," said Dr. Jamie Engert, joint principal investigator of the study, who is a researcher in cardiovascular diseases at the Research Institute of the McGill University Health Centre (RI-MUHC) and associate member in the Department of Human Genetics at McGill University. "But it was a surprise to find that a healthy diet could significantly weaken its effect."

The research, which represents one of the largest gene-diet interaction studies ever conducted on cardiovascular disease, involved the analysis of more than 27,000 individuals from five ethnicities -- European, South Asian, Chinese, Latin American and Arab -- and the effect that their diets had on the effect of the 9p21 gene. The results suggest that individuals with the high risk genotype who consumed a prudent diet, composed mainly of raw vegetables, fruits and berries, had a similar risk of heart attack to those with the low risk genotype.

"We observed that the effect of a high-risk genotype can be mitigated by consuming a diet high in fruits and vegetables," said Sonia Anand, joint principal investigator of the study, and a researcher at the Population Health Research Institute and a professor of medicine and epidemiology at the Michael G. DeGroote School of Medicine at McMaster University. "Our results support the public health recommendation to consume more than five servings of fruits or vegetables as a way to promote good health."

"Our research suggests there may be an important interplay between genes and diet in cardiovascular disease," says the study's lead author Dr. Ron Do, who conducted this research as part of his PhD at McGill and is now based at the Center for Human Genetics Research at the Massachusetts General Hospital, Boston, Massachusetts. "Future research is necessary to understand the mechanism of this interaction, which will shed light on the underlying metabolic processes that the 9p21 gene is involved in."

Exercise Just as Good as Drugs at Preventing Migraines

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Although exercise is often prescribed as a treatment for migraine, there has not previously been sufficient scientific evidence that it really works. However, research from the Sahlgrenska Academy at the University of Gothenburg, Sweden, has now shown that exercise is just as good as drugs at preventing migraines.

Doctors use a variety of different methods to prevent migraines these days: on the pharmaceutical side a drug based on the substance topiramate has proved effective, while non-medical treatments with well-documented effects include relaxation exercises.

No previous evidence

Exercise is also frequently recommended as a treatment, though there has not been sufficient scientific evidence that it really has any effect on migraine patients.

In a randomized controlled study researchers from the University of Gothenburg's Sahlgrenska Academy have now analysed how well exercise works as a preventative treatment for migraines relative to relaxation exercises and topiramate.

40 minutes of exercise

Published in the journal Cephalalgia, the study involved 91 migraine patients, a third of whom were asked to exercise for 40 minutes three times a week under the supervision of a physiotherapist, with another third doing relaxation exercises, and the final third given topiramate. The study lasted for a total of three months, during which the patients' migraine status, quality of life, aerobic capacity and level of phyical activity were evaluated before, during and after their treatment. Follow-ups were then carried out after three and six months.

Exercise just as effective

The results show that the number of migraines fell in all three groups. Interestingly, there was no difference in the preventative effect between the three treatments.

"Our conclusion is that exercise can act as an alternative to relaxations and topiramate when it comes to preventing migraines, and is particularly appropriate for patients who are unwilling or unable to take preventative medicines," says Emma Varkey, the physiotherapist and doctoral student at the Sahlgrenska Academy who carried out the study.

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Herbal Supplements May Cause Dangerous Drug Interactions

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Complementary and alternative medical (CAM) treatments such as herbal supplements have become increasingly popular in the United States, especially among older patients and those with chronic pain. However, many of these products can have serious and potentially harmful side effects when combined with medications prescribed during and after surgery, according to a review article in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).

About 20 percent of prescription users also take an herbal supplement, and those rates are higher — studies suggest between 35 and 70 percent — among orthopaedic patients who are candidates for surgery.

“Herbal remedies are classified as dietary supplements, meaning they are exempt from the safety and efficacy regulations that the U.S. Food and Drug Administration (FDA) requires for prescription and over-the-counter medications,” said David T. Rispler, MD, director of the Grand Rapids/Michigan State University Orthopedic Residency Program. “As a result, individual herbal remedies have not been thoroughly evaluated in large clinical trials, and little information is available on the interactions between drugs and herbs.”

In addition, many herbal products are marketed as “natural” or “homeopathic,” which may lead consumers to assume the products are safe, even when taken with prescription medicines, Dr. Rispler noted. “Herbal supplements can have a negative impact on patients both before and following surgery, and may interact with conventional medicines used to manage chronic conditions.”

“Traditional physician-patient communications, like intake interviews, often do not include the subject of alternative medical products. As a result, patients may fail to report that they are using them and continue to take them along with any prescribed medicines and before surgery, thinking the herbal products pose no risk,” said Dr. Rispler.

Many of the most popular herbal supplements used today can have serious side effects when combined with prescription medicines. For example:

• Feverfew (used for migraine prevention), ginger, cranberry, St. John’s Wort and ginseng can interact with the anti-clotting drug warfarin;
• Feverfew, ginger, and gingko can interact with aspirin;
• Garlic can interfere with anti-clotting medications and the immunosuppressant drug cyclosporine (prevents transplant rejection);
• Valerian (used as a sedative) can intensify anesthetics; and
• St. John’s Wort can interact with immunosuppressive drugs and potentially lead to transplant rejection.

Herbal products marketed for osteoarthritis also can pose serious risks when combined with prescription medications. For example:

• Glucosamine, chondroitin and flavocoxid can affect clotting agents;
• Black cohosh can interact with the cancer drug tamoxifen; and
• Cat’s claw can interact with clotting agents, blood pressure medications and cyclosporine.

Most surgery-related side effects can be avoided by stopping the CAM product at least one to two weeks prior to surgery and during the postoperative period while prescription medications such as blood thinners or antibiotics are being used. The problem arises when physicians do not know that a patient is using a CAM product, Dr. Rispler said.

“One of the main reasons that patients do not disclose the use of a CAM product is that they may not believe it is important information to convey to the physician because they feel they are safe to use and all-natural,” he said. “Patients may also decide not to report CAM product use if they are worried their physician may be prejudiced against the supplement’s use, or believe their physician will not have an understanding of the supplement.”

Although the use of herbal medicines should be monitored by patients’ primary care physicians, Dr. Rispler said orthopaedic surgeons should have an understanding of the potential side effects of some of the most common CAM products used by their patients, and be able to guide them in suspending use prior to surgery.

To help ensure physicians are aware of the products their patients may be using, Dr. Rispler also recommends including CAM product-use questions on health/medical assessment forms to encourage patient disclosure.

“Physician-patient communication often does not include the use of CAM therapies, which results in underreporting of their use,” he said. “To help avoid potential side effects, orthopaedists should develop questionnaires that can be used prior to surgery to help determine if their patients are using CAM products.” Alternatively, patients should also report usage of any herbal products or other supplements they may be taking to all their physicians.

“By opening up a conversation on the use of herbal medications around the time of surgery and compiling a complete list of all prescribed and self-prescribed medications and supplements, patients and physicians may be able to work together to decrease the risk of complications that can occur during and following surgery,” Dr. Rispler said.

Health benefits of broccoli require the whole food, not supplements

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New research has found that if you want some of the many health benefits associated with eating broccoli or other cruciferous vegetables, you need to eat the real thing – a key phytochemical in these vegetables is poorly absorbed and of far less value if taken as a supplement.

The study, published by scientists in the Linus Pauling Institute at Oregon State University, is one of the first of its type to determine whether some of the healthy compounds found in cruciferous vegetables can be just as easily obtained through supplements.

The answer is no.

And not only do you need to eat the whole foods, you have to go easy on cooking them.

"The issue of whether important nutrients can be obtained through whole foods or with supplements is never simple," said Emily Ho, an OSU associate professor in the OSU School of Biological and Population Health Sciences, and principal investigator with the Linus Pauling Institute.

"Some vitamins and nutrients, like the folic acid often recommended for pregnant women, are actually better-absorbed as a supplement than through food," Ho said. "Adequate levels of nutrients like vitamin D are often difficult to obtain in most diets. But the particular compounds that we believe give broccoli and related vegetables their health value need to come from the complete food."

The reason, researchers concluded, is that a necessary enzyme called myrosinase is missing from most of the supplement forms of glucosinolates, a valuable phytochemical in cruciferous vegetables. Without this enzyme found in the whole food, the study found that the body actually absorbs five times less of one important compound and eight times less of another.

Intensive cooking does pretty much the same thing, Ho said. If broccoli is cooked until it's soft and mushy, its health value plummets. However, it can still be lightly cooked for two or three minutes, or steamed until it's still a little crunchy, and retain adequate levels of the necessary enzyme.

The new study was published in the Journal of Agricultural and Food Chemistry. It was supported by the National Institutes of Health.

Broccoli has been of particular interest to scientists because it contains the highest levels of certain glucosinolates, a class of phytochemicals that many believe may reduce the risk of prostate, breast, lung and colorectal cancer. When eaten as a raw or lightly-cooked food, enzymes in the broccoli help to break down the glucosinolates into two valuable compounds of intensive research interest – sulforaphane and erucin.

Studies have indicated that sulforaphane, in particular, may help to detoxify carcinogens, and also activate tumor suppressor genes so they can perform their proper function.

Most supplements designed to provide these glucosinolates have the enzyme inactivated, so the sulforaphane is not released as efficiently. There are a few supplements available with active myrosinase, and whose function more closely resembles that of the whole food, but they are still being tested and not widely available, Ho said.

Small amounts of the myrosinase enzyme needed to break down glucosinolates are found in the human gut, but the new research showed they accomplish that task far less effectively than does whole food consumption.

Although broccoli has the highest levels of glucosinolates, they are also found in cauliflower, cabbage, kale and other cruciferous vegetables. The same cooking recommendations would apply to those foods to best retain their health benefits, Ho said.

Many people take a variety of vitamins, minerals and phytochemicals as supplements, and many of them are efficacious in that form, researchers say. Higher and optimal levels of popular supplements such as vitamins C, E, and fish oil, for instance, can be difficult to obtain through diet alone. Some researchers believe that millions of people around the world have deficient levels of vitamin D, because they don't get enough in their diet or through sun exposure.

But for now, if people want the real health benefits of broccoli, there's a simple guideline.

Eat your vegetables.

Those taking statins when admitted to the hospital with serious head injuries were 76 percent more likely to survive

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Older patients who happened to have been taking cholesterol-lowering statin drugs when admitted to the hospital with serious head injuries were 76 percent more likely to survive than those not taking the drugs, according to results of a Johns Hopkins study.
Those taking statins also had a 13 percent greater likelihood of achieving good, functional recovery after one year.

The findings hold out the promise of a specific drug treatment for traumatic brain injury, for which there is none, the researchers say, and could increase use of what is already an incredibly popular class of drugs prescribed to more than four in 10 senior citizens in the United States alone.

“These data are intriguing,” says Eric B. Schneider, Ph.D., an epidemiologist at the Johns Hopkins University School of Medicine’s Center for Surgical Trials and Outcomes Research, and the study’s leader. “We don’t think it’s the lowering of cholesterol that’s helping the brain recover in those who have been taking statins. We think there are other, less well-known properties of statins that are causing the benefits we seem to be seeing here.”

The results are reported in the October issue of The Journal of Trauma.

Schneider says he and his colleagues now want to do a clinical trial administering statins to brain-injured patients not already on the cholesterol-lowering drugs immediately upon arrival in the emergency department, to study whether the medication would have a direct beneficial impact on recovery.

“If you get this drug into people very quickly after the injury, we may get the same effect as if the drug were in the body before the accident,” he says.

The researchers caution that no one should see these results as a signal to initiate or increase statin use as a hedge against brain injury.
“At this time, we cannot recommend that statins be provided as a treatment,” Schneider says. “Not everyone should be on statins. There are unknowns and there are downsides, including that some people who take them develop serious muscle disorders.”

Schneider knew there was data showing that mice subjected to brain injury while on statins showed promising recoveries. For this new study, he and his team examined data collected between July, 2001, and November, 2002, at 69 hospitals in the United States as part of the National Study on Costs and Outcomes of Trauma. They focused on patients over the age of 65 because this group was much more likely to be taking statin medication. The team identified 523 patients with moderate to severe brain injury, 117 of whom (22 percent) were using statins at the time of injury. Those who used statins were 76 percent less likely to die than those who were not. Patients who already had documented heart disease did not experience the same brain benefit from the statins they were taking.

Schneider says that along with its cholesterol-lowering properties, statins appear to play at least two other biological roles. They are anti-inflammatory and also are known to modulate the body’s immune response. After the brain is injured, a secondary injury can occur when the body launches an immune response to clean up the mess, attacking healthy tissue along with the damaged. A statin may keep aspects of that from happening. The statin might also support the function of the blood-brain barrier, keeping excess white blood cells out of the brain and any dangerous chemical byproducts of the injury from the rest of the body.

Statins have not been studied in humans with acute brain injury in the past, but one previous study found that mortality was significantly lower in ischemic stroke patients who had been on the cholesterol-lowering medication at the time of their stroke. The Hopkins team in 2008 found a similar survival benefit associated with statin use in patients with all types of trauma, not specifically head trauma.
Schneider says that if a clinical trial were to show a significant benefit in patients treated with statins after head injury, it would open up a wide variety of possibilities for its use. He says it could someday make sense to use statins prophylactically in people who are likely to be exposed to mild repetitive brain injury such as football players in the NFL or soldiers in combat.

“Historically there is nothing you can give someone with a brain injury to limit its effect,” Schneider says. “Perhaps this will prove to be that, but much more study is needed.”

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Jon's Health Tips - Latest Health Research

1. I will continue to take lots of Vitamin D, even if I'm not pale

Vitamin D Could Lower Risk of Developing Diabetes

Vitamin D deficiency common in cancer patients

Pale people may need vitamin D supplements

2. Too much iron in the blood has been linked to heart attacks, but here is another reason I will continue to avoid cereals with added iron, and red meat (and drinking white tea)

Reducing iron may lower age-related brain disease risk

"Iron accumulates in our bodies as we age," Bartzokis said, "and in the brain contributes to the development of abnormal deposits of proteins associated with several prevalent neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease and dementia with Lewy bodies. Higher brain iron levels in men may be part of the explanation for why men develop these age-related neurodegenerative diseases at a younger age, compared to women."

"But there are things postmenopausal women and especially men can do to reduce their iron levels through relatively simple actions," Bartzokis said. "These include not overloading themselves with over-the-counter supplements that contain iron, unless recommended by their doctor; eating less red meat, which contains high levels of iron; donating blood; and possibly taking natural iron-chelating substances, molecules that bind to and remove iron, such as curcumin or green tea, that may have positive health consequences."

3. I'm not homeless, but I imagine playing soccer three times a week is good for my health as well

Could soccer give homeless men a health kick?

Playing street football two or three times a week could halve the risk of early death in homeless men.

Small Amount of Exercise Could Protect Against Memory Loss

A Bout of Exercise May be the Cure for Brain Fatigue

4. I have switched from green tea to white tea, (click on link for the reasons) but here is another reason to keep drinking one or the other

Green tea may slow down weight gain

5. I will continue to drink red wine (and an occasional beer) and take reservatrol supplements

Resveratrol stops breast cancer growth

Alcohol can reduce asthma risk

6. I have high-but-normal blood pressure, so will continue to take Co-enzyme Q for its many benefits, including reducing blood pressure

Even high-but-normal blood pressure elevates stroke risk

People with prehypertension have a 55 percent higher risk of experiencing a future stroke than people without prehypertension, report researchers at the University of California, San Diego School of Medicine.

Prehypertension is clinical category created by experts in 2003 to describe patients whose blood pressure was elevated, but still considered within normal range. Hypertension or abnormally high blood pressure is a major risk factor for cardiovascular disease and strokes, but much less is known about the health threat posed of prehypertension, which is defined by a systolic pressure reading between 120 and 139 mmHg (the top number) and a diastolic reading between 80 and 89 mm Hg (the bottom number)

High Blood Pressure Is Linked to Increased Risk of Developing or Dying from Cancer

The overall risk of developing any cancer increased by 29% between men in the lowest quintile and those in the highest. The researchers also found that, as blood pressure rose, the risk of oral, colorectal, lung, bladder, and kidney cancers, melanoma and non-melanoma skin cancers rose in men. In women, increased blood pressure was not statistically significantly associated with the overall risk of developing any cancer, but was associated with an increased risk of cancers of the liver, pancreas, cervix and endometrium and melanoma.

7. I stopped taking saw palmetto quite a while ago

Saw palmetto no more effective than placebo for urinary symptoms


8. I may resume taking B12

Low Vitamin B12 Levels May Lead to Brain Shrinkage, Cognitive Problems

Older people with low levels of vitamin B12 in their blood may be more likely to lose brain cells and develop problems with their thinking skills, according to a study published in the September 27, 2011, print issue of Neurology®, the medical journal of the American Academy of Neurology. Foods that come from animals, including fish, meat, especially liver, milk, eggs and poultry, are usually sources of vitamin B12.

8. I think I may need to start drinking coffee

Increased Caffeinated Coffee Consumption Associated With Decreased Risk of Depression

Depression Associated With Increased Risk of Stroke and Stroke-Related Death

9. I need to use more olive oil and keep eating nuts

Monounsaturated Fatty Acids = Less Cognitive Decline

The researchers found that a higher intake of dietary monounsaturated fatty acids was associated with less cognitive decline over a 3-year period. Monounsaturated fats are found in olive and canola oils,and nuts. Further, after testing for associations between monounsaturated fatty acids and individual components of cognitive function, the researchers found that greater intake of monounsaturated fatty acids was associated with less decline in visual-spatial ability and memory after adjusting for other factors (i.e., age, education, reading ability).

The researchers noted that monounsaturated fatty acids have anti-inflammatory effects and suggested that these effects may provide one explanation for their protection against cognitive decline (as chronic inflammation appears to be one contributor to Alzheimer’s disease).

10. I think I'm OK on this one

Exposure to goats could increase the risk of lung cancer

11. It's really, really hard to get enough vegetables in my diet now that the salad bar near my office has closed.

Fruits and vegetables reduce risks of specific types of colorectal cancers

12. I'll try to remember this next time I throw my back out.

Moving Despite Back Pain Better Than Resting