Biomedical subjects
Publications and source records attributed to Mark A Moyad.
This article provides a foundation for clinicians willing to provide lifestyle change recommendations for the prevention of prostate cancer. In part II, more general and specific lifestyle recommendations will be provided. It is imperative to provide patients with realistic and practical recommendations that are not only consistent in the medical literature, but will improve overall compliance.
This article provides a foundation for men who want to incorporate lifestyle changes to reduce their risk for prostate cancer and, more importantly, impact all-cause mortality. Table 1 summarizes some of these lifestyle changes that can be recommended to patients in most settings. Minimal time is required to suggest these changes, and a copy of Table 1 can be provided as a reminder to patients. Although these recommendations may seem simple, past studies of men have demonstrated that few (less than 5%) adhere to numerous healthy behaviors simultaneously. It seems to be more common to follow one healthy change in excess than to make multiple changes in moderation. This may be the result of past studies focusing on one lifestyle change to affect disease risk; poor compliance; lack of attention, time, or understanding to this detail; or lack of motivation on the part of the health professional and the patient. Clinical trials of combined moderate lifestyle changes, however, demonstrate that the total effort to make healthy lifestyle changes is more important than one or two behavioral changes in affecting cardiovascular markers, cancer, and all-cause mortality. Recommending a pill is an easy answer, but few supplements for prostate-cancer prevention or total mortality reduction can be recommended, and long-term compliance is a concern with any agent. Additionally, the potential for supplements to increase the risk for prostate cancer or interfere with conventional treatment continues to be a concern, and no dietary supplement has come close to matching the reduction in all-cause mortality observed in clinical trials of lifestyle changes. The time seems ripe to redirect our attention regarding lifestyle changes and prostate cancer risk. What is heart-healthy is prostate-healthy, which makes it more likely that any man concerned about the risk for prostate cancer will make healthy lifestyle changes.
OBJECTIVES: To measure the self-reported intake of vitamins, selenium, vitamin E, and saw palmetto supplements in African-American men. METHODS: A correlational study was conducted of 198 African-American men, aged 40 to 70 years old, who attended a community-based free prostate cancer educational and screening program. The rates of supplement use were compared among demographic groups. RESULTS: Just more than one half of the men (51%) took one or more of the supplements. Almost one half (46%) took multivitamin supplements. About 34% took vitamin E supplements, 6% took selenium supplements, and 7% took saw palmetto. Higher income men were more likely to take nutritional supplements. No statistically significant associations were found between supplement use and age, education, or marital status. Almost all use of selenium, vitamin E, and saw palmetto was among men who were already taking a multivitamin supplement. CONCLUSIONS: The implications from the results of this study include the need to conduct an assessment of supplement intake as part of the health history.
Dietary and supplemental zinc, especially in excess, has received much attention in numerous alternative medicine resources. There is a small amount of medical evidence that zinc may alleviate some mostly rare medical conditions (such as Wilson's disease). However, in prostate conditions, such as BPH, large concentrations of zinc are found in the prostate gland. Excess intake of zinc, especially with individual supplements, has the potential to encourage the growth of prostate conditions from BPH to cancer. In fact, one large study found a significantly higher risk of advanced prostate cancer in men consuming large intakes of these supplements. Large doses of zinc can inhibit the benefits of bisphosphonate drugs, increase testosterone level, increase cholesterol, reduce levels of "good cholesterol" or HDL, and can promote immune dysfunction. More research is needed in this area, but in the meantime, the time seems more than ripe to discourage or immediately discontinue the intake of larger concentrations of zinc for most individuals until adequate research resolves this controversial issue.
Obesity is a recognized epidemic in many regions around the world and billions of dollars are spent each year in attempting to combat this problem. However, before a discussion of the different conventional and alternative treatments for obesity can be initiated, it is first critical to determine whether or not a certain individual is actually overweight, obese, or has an excess of adipose tissue. Therefore, a review of the various popular and unpopular measurements of obesity is needed. A variety of measurements exist such as bioelectrical impedance, body mass index (BMI), crude weight, densitometry, dual energy x-ray absorptiometry (DEXA), lean body mass (LBM), skinfold thickness, and waist-to-hip ratio (WHR). All of these measurements contain inherent advantages and disadvantages, but many of these can still be used in a clinical setting. Health professionals should acquaint themselves with these different measurements in order to take the first step in bringing attention to and potentially treating a condition that affects virtually every medical discipline.
Low-carbohydrate diets are not only highly popular but also controversial. The theory or general concept behind the low-carbohydrate dietary approach needs to receive more attention to provide more objectivity to this discussion. The theory or concept that actually has some evidence currently lies in the values of the glycemic index (GI) and glycemic load (GL). Basically, the higher the GI, the greater the glucose response. However, the GI system that was originally proffered in 1981 comes with one apparent limitation in that some foods or beverages need to be obtained in enormous amounts in order to observe such a glucose change. Therefore, the newer concept of GL (derived from the GI) is based on a more moderate-portion size and the resultant glucose change with some of the higher GI foods or beverages actually demonstrating a low GL. These and other limitations and some advantages of low-carbohydrate diets with an emphasis of what an actual GI or GL means are discussed.
Low-carbohydrate books continue to be some of the biggest selling publications in the United States. However, what are the similarities and differences between some of the most popular books? This overview of what some of these books advocate or discourage is important to better facilitate the discussion between the health professional and the patient interested in some of these methods. Regardless of the low-carbohydrate diet discussed with patients and whether or not health professionals agree or disagree with this approach, it is imperative that health professionals at least learn the basics of some of the more popular diets to facilitate better communication between the practitioner and patient.
PURPOSE OF REVIEW: The number one cause of death in the United States and in most countries around the world is cardiovascular disease. The number one or number two cause of death in prostate cancer patients is also cardiovascular disease. These observations do not serve to belittle the impact of prostate cancer, but are a reminder that the ultimate goal of healthy lifestyle recommendations is to reduce the burden of both of these major causes of death, especially after definitive prostate therapy. Patients need to be encouraged to know their cholesterol levels and other cardiovascular markers including blood pressure, as well as being aware of their prostate-specific antigen values. RECENT FINDINGS: Patients should not smoke, they should reduce their intake of saturated and trans fats, increase their consumption of a diversity of fruit and vegetables, consume moderate quantities of dietary soy or flaxseed, increase their consumption of fish or fish oils and other omega-3 fatty acids, as well as maintaining a healthy weight, getting at least 30 min/day of physical activity, and lifting weights several times a week. When in doubt it is important for the clinician and patient to realize that what is healthy for the heart is generally found to be healthy for the prostate. Many of these lifestyle changes, when accomplished on a regular basis, may dramatically reduce the risk of overall early mortality. Despite the simplistic and moderate recommendations in this manuscript, research suggests that few individuals are currently following these suggestions. SUMMARY: Clinicians need to constantly emphasize these basic changes in order to truly impact the overall health of any patient following definitive prostate therapy.
PURPOSE OF REVIEW: The number one cause of death in the United States and in most countries around the world is cardiovascular disease. The number one or two cause of death in prostate cancer patients is also cardiovascular disease. These observations do not serve to belittle the impact of prostate cancer, but serve as a reminder that the ultimate goal of dietary supplement recommendations is to reduce the burden of both of these major causes of death, especially after definitive prostate therapy. Several supplements should be discussed with a patient following definitive prostate cancer therapy. RECENT FINDINGS: On the basis of observational studies, a general cheap multivitamin that provides the recommended daily values of folic acid, B6, B12 and vitamin D may reduce the risk of a variety of chronic diseases. Selenium supplements at 200 microg/day should be reserved only for men with a deficient level of plasma selenium, but healthy dietary sources should be recommended for most men. Low-dose vitamin E supplements may be adequate for current or recent smokers but not non-smokers. All men should be encouraged to consume healthy dietary sources of vitamin E, regardless of smoking status. Low-dose daily aspirin may be the best over the counter product to utilize as a preventive agent; this statement is made on the basis of the numerous clinical studies that support its use for individuals that qualify after consulting with their physician or a specialist to evaluate current cardiovascular risk. In addition, fish oil supplements have gained acceptance as a possible therapy in high-risk cardiovascular patients. SUMMARY: The potential future role in prostate cancer should be of interest, and preliminary data is noteworthy. Regardless, all of these supplements have indirect evidence for effects in prostate cancer, but it seems that only a minority of men overall qualify for them currently, with the exception of a low-dose aspirin or multivitamin.
PURPOSE OF REVIEW: Comprehensive reviews of lifestyle changes and dietary supplements that may prevent bladder cancer are needed in order to facilitate discussions between clinicians and patients. RECENT FINDINGS: Novel data exist that numerous lifestyle/diet and dietary supplements may lower the risk of this disease. For example, reducing arsenic exposure, incorporating dietary changes, and vitamin E supplements continue to accumulate research that supports their use with some patients at a higher risk for this disease. Regardless, smoking cessation seems to have the largest impact on reducing risk and incorporating these other changes after smoking cessation may reduce an individual's risk to an even greater extent. SUMMARY: However, a large percentage of cases of individuals diagnosed with this cancer apparently have no known etiology. Diets lower in calories or possibly specific sub-types of fat, and higher in fruits and especially vegetables, seem to provide some protection. Other dietary/supplement options may affect risk, but these benefits could be seriously attenuated by smoking. Dietary selenium, but currently not selenium supplements, may also affect risk, especially in non-smokers. Dietary vitamin E, and vitamin E supplements, may provide some protection. Non-selective (e.g. non-steroidal anti-inflammatory drugs) and selective cyclooxygenase-2 inhibitors are generating interest because bladder tumors seem to contain higher concentrations of this enzyme. Drinking-water quality, especially arsenic concentrations, may seriously affect risk. Providing recommendations for patients with regard to some of these lifestyle modifications is currently recommended because the majority of these alterations are also recommended currently for cardiovascular or general oncology disease reduction.
PURPOSE OF REVIEW: The purpose of this review is to provide the clinician with an adequate summary of current potential recommendations for reducing the risk of bladder cancer recurrence so that this topic can be discussed with patients that are dealing with this specific situation. RECENT FINDINGS: Several potential novel methods to reduce the risk of recurrence should be discussed with patients. Non-selective and selective cyclo-oxygenase 2 inhibitors have preliminary data from from laboratory and epidemiologic investigations. Several preliminary trials have found that a combination dietary supplement of vitamins and minerals or a probiotic agent (Lactobacillus casei) may impact recurrence rates. Smoking cessation may be one of the best routes for reducing recurrence and reducing the risk of overall early morbidity and mortality. Garlic or fluid intake need more clinical data. SUMMARY: Clinical recommendations for reducing the risk of bladder cancer recurrence need more attention. Preliminary data seem to support a potential role of numerous lifestyle and dietary supplement regimens. In the future, more reviews on the potential impact of reducing recurrence should be separated from reviews on prevention because these can be confusing when treated as a single subject.
The potential benefits of dietary or supplemental calcium and vitamin D for osteoporosis prevention have been well reviewed. However, less well known is the potential of these two compounds to reduce the risk of recurrence of a number of overall general health conditions. For example, calcium may play a role in increasing levels of high-density lipoprotein, preventing colon polyp formation, reducing blood pressure in some hypertensive individuals, reducing kidney stone recurrence, promoting weight loss, and reducing the symptoms of premenstrual syndrome. Vitamin D may play a role in cancer prevention, provide synergism or enhancement to some chemotherapy protocols, prevent Type I diabetes, and along with calcium reduce the risk of tooth loss.
The increasing popularity of complementary and alternative medicine (CAM) around the world over the past decade has brought about interest within several health care organizations including the National Institutes of Health (NIH). An overview of the development of CAM definitions and classifications that summarize these developments follows.
Conventional medical thought several decades ago was to restrict the amount of calcium intake in individuals with a history of calcium oxalate stones. In the past decade, several studies have suggested that increasing the intake of calcium may actually reduce the risk of calcium oxalate stone formation. The largest randomized trial of diet and stone recurrence was recently completed. Interestingly, individuals that had normal calcium intakes and lower intakes of protein and salt had a significantly reduced rate of calcium oxalate stone recurrence. This recent trial along with several past epidemiologic studies should be discussed with patients at high risk of stone recurrence. Currently, health professionals have a wealth of information that can be distributed to individuals at high risk of nephrolithiasis, and simple dietary recommendations may be one of the best ways to reduce the risk of calcium oxalate stones.
Occupational exposure to arylamines, schistosomiasis, and especially smoking are well-known potential causes of bladder cancer. However, numerous individuals who are diagnosed with this cancer apparently have no known etiology. Increased consumption of a variety of fluids, including water, may significantly reduce the risk of bladder cancer by reducing the overall impact time of potential carcinogens on bladder tissue. However, the quality of drinking water could also have an impact on risk. Health care professionals could play a large role in preventing bladder cancer by providing patients with new data on the impact of water quantity and quality on risk.
Benign prostatic hyperplasia (BPH) is one of the most prevalent conditions found in men, and increases with age. Drug, surgical, and phytotherapy tend to dominate the medical literature when discussing potential treatments for this condition. These treatments have demonstrated remarkable effectiveness for the various degrees of BPH. However, the potential for lifestyle changes to actually prevent this disease or reduce the severity of this condition when used as an adjunct to conventional treatment is not only intriguing but is strongly supported by past limited studies. More research is needed, but the time is ripe to discuss with patients the potential lifestyle changes that could influence risk. Obesity, a lack of physical activity, dyslipidemia, diabetes, hypertension, a heart unhealthy diet, and other factors may significantly increase the risk of BPH. Patients should be told that factors that increase the risk of cardiovascular disease seem to be associated with an increased risk of BPH or a greater severity of BPH.
A possible relation may exist between higher insulinlike growth factor (IGF)-1 levels and the risk of premenopausal breast, prostate, or other cancers from recent prospective and case-control studies. Separately, a large prospective study has shown a potential association between chronic depression and cancer risk, whereas other preliminary studies have suggested a link between increasing IGF levels with major depression. Other studies have found that certain standard cancer treatments reduce the effect and levels of IGF, and 1 small study has found that standard antidepressants may reduce IGF levels in some patients diagnosed with major depression. It is possible that IGF-1 (or other IGFs) may be a mediator between depression and cancer, because separately both have been implicated in the risk of various cancers. This hypothesis first and foremost relies on the unsettled notion that an actual relation already exists or may be found in the future. It requires more extensive investigation because several studies have not found an association between IGF or depression and cancer risk, and other limitations such as small sample sizes and other influential factors on IGF levels need to be elucidated. Whether or not a mind-body effect exists with cancer, as seems to be the case with other diseases, remains to be seen. Is depression a potential confounder of human studies that attempts to establish a relation between IGF and disease? All of the studies to date have attempted to at least determine the effect of a variety of factors on IGF levels-including age, sex, diet, family history, weight, smoking status-and then have adjusted their results accordingly. Depression has not been included in this list of potential factors that may need to be considered when analyzing IGF-1 data and cancer risks. The time seems ripe to at least define further the relation, if any, between IGF-1 and depression.
Osteoporosis in women has received a substantial amount of attention, but its impact in men is also significant and noteworthy. Those men who benefit from treatment for prostate cancer with androgen deprivation therapy (ADT) may also be at a higher risk for osteoporosis. Pharmacologic approaches to reduce this risk have received some attention. For example, agents such as bisphosphonates, estrogen receptor-binding drugs (diethylstilbestrol, tamoxifen, and raloxifene), calcitonin, and fluoride are some of the more promising interventions that have been previously outlined. In addition, statin drugs, or hepatic 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, have recently been hypothesized to lower osteoporosis risk. However, complementary therapies, which may also have an impact on reducing osteoporosis risk, have not received attention. Dietary and supplemental calcium and vitamin D have been shown, in some preliminary investigations, to maintain bone density in women and men. Numerous healthy and affordable dietary sources of this mineral and vitamin exist, and large intakes can be realistically achieved through proper education. Similarly, the supplemental dosages required to impact risk have been moderate, appear to be safe, are of low cost, and thus may provide an additional route for reducing risk, especially if these interventions are initiated at the start of medical treatment. More studies in men receiving ADT are needed because the existing work has mostly focused on men without castrate levels of male hormone. Additionally, many studies with conventional and nonconventional agents have only focused on individuals with baseline osteoporosis, rather than normal bone mineral densities or osteopenia. Other promising complementary therapies, such as weight-bearing exercise and abstaining from smoking, may also be of benefit. Newer estrogenic-type supplements (eg, ipriflavone) appear interesting and have some preliminary data, but more research is desperately required to determine their actual impact and potential for adverse effects (such as lymphocytopenia from a recent trial). Simple, inexpensive, and potentially effective dietary and supplemental approaches to reduce the risk of osteoporosis in men exist, and they should be discussed with patients. Whether these approaches effectively reduce the risk of osteoporosis in men receiving androgen ablation remains to be determined. The possibility is intriguing, and future research is needed. In the meantime, it is important to keep in mind that these complementary approaches are, at the very least, an integral part of the conventional options used today to the reduce the risk of osteoporosis in men and women.