Monthly Archives: June 2013

#Palliative Care
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In a recent talk by a local palliative care doctor, it was discussed how cancer is a necessary evil.  Everything comes at a cost.  In order for us to adapt to constant changes in our environment, our DNA must be adaptable.  Because of this plasticity, our DNA makes itself changeable and because of this changeability, we open ourselves up to wrong mutations and are susceptible to cancer.  The reason we get fat is because of a deep rooted ability of the body to hang onto fat in case the next famine arrives.  In his words, the ability to get cancer is what prevents us from being “protoplasmic slime”.    Without this ability we would certainly be worse off, or even extinct.  With the change in our diets in the last three generations, we see an artificial example of this.  Our genes simply cannot keep up with how quick we change our environments.

It is incredible how different individuals perceive the same problem.  Quadratic equations teach us that different problems can have more than one result that is correct.  This is the case in treating palliative care patients.  We have the right to make a decision, even if it is the wrong one.   Several sons and daughters can be around the same table with the palliative care doctor, even their cancer afflicted mother can be present, and each can have a different right answer in how to proceed with their mother’s health.

It is human nature to wonder if we had only done something different What the outcome would have been.   What if I had quit smoking?  What if I had exercised more?   The truth is we only know what happened, not what could have happened.  True, we know the gym membership might have prolonged his life, but maybe he would have been hit by a bus and died on his way to the gym one day. The best way is to decide the best solution and live with it. Wasting time on wether or not it was the best answer is pointless. The best reflection is that death is an inevitable part of being born and that most of us don’t really consider the fact that we are immortal .

One important lesson I learned is in the area of euthanasia.  It not only involves the wishes of the patient, but the wishes of the caregiver.  In an oath to do no harm, what of the feelings of the physician who does not want to be responsible for the death of the patient.  Also, the patient should have the trust of their caregiver that this won’t be done in an effort to ease their suffering.  This Doctor reflected on patients that finally found their own peace eventually, even if their family did not.  He remembered patients that had a laugh with their family even in their last hour of life.  It was postulated that we could cram all of our best memories into a very short period of time.  Any time given to his patients was valuable.

 

I have worked with this doctor for years in ways to help improve the quality of life and dignity of his palliative care patents in the areas of pain control but I now understand the role I was providing – a very small role.  As he said, everyone perceives things differently and “everything is in our head”.

Support your local Palliative care or hospice society.

take care.

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Control #Prostate Cancer Before It Starts
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A while back, I posted a blog on prostate health.  It mentioned some supplements on how to improve the health of this organ.  Reports show that 14-46% of men over the age of 40 have prostate cancer cells(1).  The percent increases as you age.  Prostate cancer looms over men in the same way breast cancer does for women.  I see no other potential disease state that men will actively try to prevent both in nutraceuticals and lifestyle changes than prostate cancer.  As many more men die from cardiovascular issues, prostate cancer seems to cause more fear in men.

So what can you do to prevent this disease?  What can you do if you have established prostate cancer?  Keep in mind that estrogen is more an issue than testosterone.  The more we can keep estrogen down, the more favourable the outcome.

1)Keep alcohol consumption down to no more than 1 drink per day and coffee to no more than 2 cups per day.  More than this will increase estradiol levels.

2)Keep weight down!  Fat tissue increases aromatase activity that converts testosterone to estrogen.

3)Low animal protein intake may tip the conversion of testosterone to estradiol from aromatase instead of the conversion to DHT thru the 5-alpha-reductase enzyme.  There is some debate as to the effect this would have, but it would seem prudent to increase animal protein content especially in favour of extra carbohydrates.  Sugar feeds cancer so increasing protein and fiber will benefit.  Taking zinc will help to block both pathways.

4)  Coming into contact with estrogen either directly or not.  We see men  with symptoms of estrogen dominance because their partner is taking topical estrogen and it gets transferred by direct contact to them.  Xenoestrogens in the environment can also contribute to male estrogen dominance.  Eat organic!  Herbicides, pesticides, fertilizers, hormones in food, plastic drinking containers, microwaving plastics, all can contribute to estrogen load.

5)Wearing tight underwear causes the temperature of the testicles to increase and restricts blood flow.  This results in more estradiol and less testosterone production.

6)Men with longterm stress that have low cortisol tend to have increased production of estradiol.  Stress causes abdominal weight gain that increases estradiol as well.  There are several ways to bring back adrenal health and we can help with this.  The best first step is reduce stress, eat well, and exercise.

7)Keep your thyroid in shape.  Overactive thyroid especially is a culprit that can cause testosterone conversion to estrogen.

8)Increase your intake of cruciferous vegetables.  One of our supplements, I3C is used by both men and women to funnel the metabolism of estrogen down to less harmful metabolites.  Another supplement, DIM is also used for this purpose.  The cruciferous vegetable family uses this pathway to keep estrogen load down.

8)Keep your testosterone levels optimal.  Use a saliva test to determine your levels.  Too high or too low causes an unfavourable estrogen level.  When you do this saliva test, be sure to determine your progesterone and cortisol levels.  Progesterone deficiency and out of range cortisol need to be corrected.

9)Ask your pharmacist if any of your medications you are taking are reducing your androgens or competing with androgen receptors.

Check back on our previous prostate health blog for more recommendations on keeping your prostate health up.  Other supplements, like resveratrol, antioxidants, zinc, and other nutraceuticals are all recommended.

Take care!

1) Hertoghe, T. MD, The Hormone Handbook, SA Medical Books, 2010 pages 331-334

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Fighting #Cancer with Nutrition and #Nutraceuticals @grahamcmackenzi
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Cancer prevention is just as important as cancer treatment.  Perhaps you have a family history, maybe you have a long term exposure to a known carcinogen, or you’ve done genetic testing to determine risk, maybe you are just wondering if you will randomly be diagnosed with this terrible disease next year, or the year after that.  We are not destined to get cancer.  We can drastically increase the odds of getting cancer based on nutrition and lifestyle choices.

What do I recommend?  Although the exact details depend on the patient and the type of cancer, many recommendations are similar.

1) VITAMIN D.  What can’t I say about this vitamin?  Recent studies have shown a 50% decrease in certain cancers (like breast cancer) when a blood level of 50 ng/ml were maintained.  It is impossible to guess your level of vitamin D so get it checked!  How much should be taken, for most people in my area of the world in Canada I recommend a minimum of 2000 iu per day.  To get to where they need to be, they may need 4000 or 10,000 or more.  Some feel this is overdosing but sunbathing for 30 minutes gives you more than this.

2)FISH OIL.  Just as above, high quality fish oil (EPA / DHA) that gives you omega-3 daily not only helps to prevent cancer but has been shown to increase weight gain in cancer patients and improve outcomes.  Patients typically take 4-12g daily.

3)METABOLIC CLEANSE.  Whether or not you agree with the concept of a cleanse, your body needs all of the ability it can muster to fight off or prevent cancer.  GI/liver/kidney detox will open up your body to operating at fuller capacity.  There are various cleanses available.  Some gear towards the stress and damage of the mitochondria that produce the energy in your cells.  Feeding the body the right energy from sources like Coconut oil can benefit.  Along the mitochondrial lines, glutathione is a key supplement for energy production although its oral absorption is poor; IV is better but it still needs to be broken down into its constituents and reassembled in the cell.  Eating Cysteine rich foods, taking SAMe, N-acetyl-cysteine (NAC), whey protein, alpha lipoic acid, milk thistle and melatonin can all replenish glutathione levels and are all good supplements especially in the cancer patient experiencing side effects from their chemotherapy. L-Carnitine and acetyl-L-Carnitine help the mitochondria transport fatty acids like the ones in Coconut oil.

4)Vitamin E.  Although I often recommend supplements for various conditions, I tend to lean towards dietary sources of this vitamin.  Because of the different isomers vitamin E comes in, it gives a better spread when eaten unless your supplement contains them all.  It also have the effect of reducing tumor growth.

5)Green Tea/EGCG-This is another supplement that shows promise in various types of cancer and cancer prevention and has a good safety profile.

6)Overall Diet- Most of us would not be surprised with the following suggestions.  Obesity increased inflammation and increases the risk of several types of cancer.  Maintaining a proper BMI and a fat percent under 25% are recommended.  As studies emerge, the consumption of red meat (especially well cooked at high temps) appears to be associated with increased rates of some cancers.  Processed meat consumption is also not great for cancer prognosis.  Increased fiber decreases the risk of several cancers.  Whole food consumption from fruits and vegetables is shown to reduce the risk of cancer.  We understand that eating this is difficult for many people big and small, so recently we began recommending Juice Plus+ brand of whole food supplements to ensure our patients were getting their intake of fruits and vegetables.

7) Exercise!!!!!

There are many other recommendations, involving vitamin C, zinc, selenium, probiotics, vitamin A, magnesium and others that we like to tailor to each individual and their prevention and complimentary treatment regimens.

Take care

References

Gaby, Alan,R MD, Nutritional Medicine., Fritz Perlberg Publishing 2011

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Food Sensitivity, Inflammation and Fixing Gut Health
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Leaky gut is a condition where the lining of the intestines become compromised and are unable to effectively control what gets absorbed, fully digested or not.  Some sensitivities to food can become worse when the food that is ingested is not fully digested before it passes into our circulation and into the body.  In this way, food that we are not normally sensitive to becomes a source of inflammation.  Even in a seemingly healthy individual, this happens to some degree.  It’s when the problem becomes more widespread that our health is affected adversely.  When the food particles are absorbed, IgG antibodies form against them.  These antibodies bind to the particles and form an immune complex that circulates throughout the body.  Normally a healthy immune system will use macrophages to eat up these complexes.  If not, the complex will eventually settle in any tissue they like and the individual is left with inflammation and possibly a food sensitivity induced disease.

In some patients this could be rheumatoid arthritis, in others it could be psoriasis, or chronic fatigue.  So is it possible to remove the offending allergen, say something from the nightshade family like potatoes, paprika or tomatoes and cure yourself of an autoimmune condition like RA?  Of course it is.  You could continue to take that new NSAID that is so great on your stomach; I give them out on prescription all the time (plus medications to deal with stomach side effects, plus the resulting digestive issues that those secondary meds cause).  Pinpointing symptoms is what we do best medically.  It even seems to work in many cases.  It is what is happening further upstream in the body that ties much of these seemingly unrelated symptoms together.  Why do people with RA have other issues like skin problems, lung disease, eye complications, heart and blood vessel disease, blood issues and so on.  This is one example of how we can deal with many issues with one common pathway rather than adding new meds for each problem.

So how do we heal the gut?  Well of course removing the offending food is important – at least 3-6 months or more if the sensitivity is severe.  But if the issue is due to leaky gut causing general inflammation from many foods, we can perhaps solve the problem by healing the gut and tightening the junctions between the cells in the lining of the intestine.  This will reawaken the gatekeeper that was lost in the original leaky gut where it was a free-for-all and everything went through into the circulation.  Here are some suggestions to help repair the gut:

Stay clear of acid lowering medications that reduce digestion

Add acid to your meal in the form of Betaine HCl, apple cider vinegar, or lemon juice to help stimulate digestion (if you do not have an active ulcer). Don’t consume too much liquid with your meal and dilute the acid.

If you are low in digestive enzymes, supplement with a good quality one.

Digestion begins in the mouth so chew until the food is gone.

Take a good quality probiotic and take it daily.  The strength of the probiotic isn’t as important as simply taking it daily.

Other key nutrients include omega 3, MSM, glutamine, vitamin A, vitamin B6, Vitamin C, Vitamin D, Magnesium, Zinc, Selenium,  N-acetyl cysteine, glycyrrhiza glabra, slippery elm, marshmellow root, aloe, Quercetin, bromelain and butyric acid.  All important to rebuilding the gut.  As is a well balanced diet low in refined carbohydrates, exercise, avoidance of stress, restricted use of antibiotics PPI’s and NSAIDS, and initiating life with breast feeding.

Regardless of how you determine the offending agent, sometimes you can just feel better by healing your gut.  Ask us how!

 

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The Misconception and Misuse of the “Scientific Study”
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The other day I had suggested a physician give their patient chromium as a supplement to help even out their blood sugar.  He said to me, “Chromium?! You’re going to have to give me some studies on that before I give them something like that!”

Immediately I said, “Sure, no problem.”  So by the end of the day I presented him two studies from prestigious journals.  One supporting my claim, and the other refuting it. Why not just load him with studies supporting my claim?  Well first of all it kind of goes against the scientific method to do this.  I couldn’t skew the thinking of the doctor with a bunch of studies hand picked by me to support my argument.  The reason for the two studies was to force the doctor to read and critique both studies and decide why they came to the exact opposite conclusion.  Whether or not the patient got the chromium in the end wasn’t really my goal, but rather to open their eyes to what scientific studies actually do for us – collect conclusions.  The same doctor had recently expressed interest that omega 3’s and coenzyme q10 were worthless now because a study in England just concluded that they had zero benefit.  Does one study prove anything? No.  Does a duplicated second study prove anything? No.

In fact I knew if I kept digging I could probably present this doctor with a desk full of studies showing both results for chromium.  My reasoning was to have the doctor understand that giving drug A to patient B to give result C as thousands of variables that were responsible for the results of that trial.  Did the patient have water that day, were they Chinese, did they consume dairy, did they have arthritis, were they stressed out in traffic going to the trial, the variables are limitless.

Don’t get me wrong.  The scientific method has brought us to the moon and back. There is nothing more valuable than a well designed placebo controlled, double blinded, cross-over trial with a large sample size randomly chosen.  But what I am more interested in is “is the drug safe to take?” and secondly “is it effective most of the time?”  I wanted the physician to realize that the drug was safe to use and that it might work in their patient. How many times did that doctor write for a medication that did not work for someone?  They would argue that the science shows it works in the majority of patients – true; but it did not work in that patient.  As far as that one patient feels, the drug was worthless and wasted their time and money.

There is no substitute for gathering and reading these studies on your own and making an informed professional decision – on your own.  Not based on a position statement by a group that claims to be the expert opinion.  At a recent presentation from PCCA, Sebastion said “How many studies are there to prove that parachutes work?  or that you should drink water?”  Zero. But yet people dive from 10,000 feet daily knowing they will probably be ok on the other end.  Quite a feat knowing there are no scientific studies to prove their actions.  Why spend millions of dollars a year on water when there really is no good placebo controlled, blinded, crossover trials with a good number of participants to prove that you even need it.  You can argue that I feel terrible when I don’t drink water, but so does an alcoholic when they don’t have alcohol.

When I recommend a nutraceutical or hormone therapy or pain cream that I compound at my store, I run into the same wall – where are all of the studies.  As it turns out there are studies available.  However if I know it is safe to give in my professional opinion, and I will do no harm by giving it, then the physician will only become comfortable by using it one by one on their patients and evaluating it themselves.  “I can get into trouble if it is not indicated officially though” is a common fear of the physician.  I never once recommended in 20 years the drug gabapentin for pain (as it was not indicated for this use), but yet I sold enough on prescription to sink a ship!

As a professional we need to personally evaluate and critique studies and realize that an N of 1 is significant – if only to that one patient.  Another physician once told me that they gave a new drug to someone who ended up in the hospital from an obscure side effect buried in the monograph that occurred only rarely.  That physician now thinks of that side effect each time they write that drug and even write for different medications instead of it – all because of that N of 1.

Compounding pharmacies like ours and pharmacists that have faith in nutraceuticals to prevent and treat disease have these principles in mind each day.  Scientific studies are tools to guide their decisions as a whole, not something to use as a deception to make your point.

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Prostate Health
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According to Canada’s Movember, the following statistics show alarming facts about Prostate health

1 in 7 men will develop prostate cancer during his lifetime and 1 in 28 will die of it.

A man dies from prostate cancer every 15.6 minutes.

In 2013, 26,500 new cases of the disease will be diagnosed and 4,000 men will die of prostate cancer.

Prostate cancer is the most frequently diagnosed cancer in men after skin cancer.

The incidence rates are nearly double for in African American men.

If detected and treated early, prostate cancer has a 95 percent success rate.

While there are cases of prostate cancer showing up in younger men, it is recommended that men begin an annual screening at age 50 and at age 40 if there is a family history.

(http://ca.movember.com/mens-health/prostate-cancer/)

The older you get the better the chance of Prostate Cancer occurring.  The prostate is notoriously slow the act and react to its surroundings in a good or bad way.  Therefore your prostate health is as much preventative as it is treatment based.  This means there are things you should be doing now at any age rather than wait for prostatic hypertrophy (enlarged prostate), prostatitis, or prostate cancer to occur.

Testosterone can change to DHT via an enzyme called 5-alpha-reductase or to estrogen via aromatase.  Most men believe that it is the excess of testosterone that causes the problem, but it is more the conversion of testosterone to these metabolites that results in hypertrophy (enlarged prostate).  Estrogen dominance is not only a common problem in women but also in men due to diet, environmental factors, and being overweight (aromatase works in fat tissue in abundance in men and women).  Some supplements you can take to help reduce this include:

  • Zinc – which helps stop the conversion of testosterone to harmful metabolites.
  • Prostaglandins in the prostate decrease with age.  It is believed that these  substances help to control the growth of the prostate from hormonal factors.  Essential Fatty Acids are precursors to these substances and can help reduce the prostatic hypertrophy
  • Saw Plametto inhibits the 5-alpha-reductase enzyme and reduces the DHT produced and has other actions that help to reduce the size of the prostate.  It is well studied in prostatic health.
  • Pumpkin seed , Pygeum Africanum (an endagered species), Saw Palmetto and stinging nettle contain phytosterols that have been studied extensively for prostatic hypertrophy and shown to have beneficial effects.
  • Prostatitis, which is an inflammation or infection of the prostate can be aided with zinc due to it’s antibacterial effects, and Quercetin (a natural anti-inflammatory flavanoid).  Also, we here from our patients all the time how diet affects their prostatitis.

Ask us more on doses and sources of these supplements and which foods to avoid and other proactive things you can do to avoid this condition.  Estrogen metabolism is just as important in men and we can help you funnel estrogen down to favourable metabolites and decrease your estrogen dominance.

 

Gaby, Alan R. Nutritional Medicine – A Textbook, chapter 210

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