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IN THIS ISSUE – UPDATE ON THE PROSTATE
More than 27,000 men will die from prostate cancer this year. Yet, in the years since Dr. John Lee wrote his booklet Hormone Balance for Men, remarkably little progress has been made in our knowledge of the biochemistry of the prostate. We don’t even know for sure which hormones are high or low in men who get prostate cancer—a pivotal point of understanding that could have dramatic effects on the way the disease is treated. Plenty of research has been published, but there’s no consistency in results.
For example, a large study in the Feb 08 issue of the Journal of the National Cancer Institute combines data from 18 different studies of endogenous (in the body) sex hormone levels in men, and found no significant association between levels of any one hormone and prostate cancer.
Since we know that hormones are, in some way, related to prostate problems, it seems entirely possible that the data was so tweaked and juggled to fit into the study parameters that it lost all meaning. The only piece of relevant data that did get teased out of this study is that men with the highest sex hormone binding globulin levels (SHBG) had a 14 percent lower risk of prostate cancer. In men, the body uses SHBG first to bind testosterone and second to bind estradiol. In other words, when a man’s body gets the message that there’s too much testosterone or estradiol, it’s removed from active duty by binding with SHBG.
…men with the highest sex hormone binding globulin levels (SHBG) had a 14 percent lower risk of prostate cancer.
I believe there are two reasons that there’s not a consistent hormone imbalance associated with prostate problems in mainstream research. One is that most researchers test the blood serum, which is not the most accurate way to measure hormones. The other is that xenoestrogens are present and driving prostate growth, but aren’t tested for. Xenoestrogens are “foreign” or “not made in nature” estrogens that are found in pesticides, many plastics, dairy products, meats, and scented products such as laundry soaps. Researchers don’t test for all estrogens as a group, they measure a specific estrogen, usually estradiol. Xenoestrogens fit into estrogen receptors, and have estrogen effects on the body, but have their own weird molecular structures that don’t register in the typical serum blood tests. Thus, a man’s body could be loaded up with xenoestrogens that are having estrogen effects, but they won’t show up in the research unless they’re specifically tested for.
Test tube and rodent studies show that male exposure to xenoestrogens from the womb onwards is either associated with prostate cancer or directly causes it. This should put xenoestrogens on every man’s watch list.
Dr. David Zava, who has run thousands of saliva hormone tests for men and tracks results in a database, consistently finds that men with prostate cancer have low testosterone, low DHEAS, and elevated estradiol. This correlates with Dr. Lee’s take on the subject.
Dr. David Zava… consistently finds that men with prostate cancer have low testosterone, low DHEAS, and elevated estradiol.
My purpose in this issue of the newsletter isn’t to re-explain the various ways things can go wrong with the prostate, or revisit the effects of hormones on the prostate, it’s to update what else we know about prostate problems. When it comes to understanding the hormone biochemistry of the prostate, Dr. Lee’s Hormone Balance for Men is still the best. Nobody explains it as well as he does, and it’s all in a booklet, so I would still say it should be required reading for every guy over the age of 50 who wants a better understanding of how his hormones and his prostate work. It’s also now available in a downloadable pdf version.
UPDATE ON THE PROSTATE
Men Can Benefit from Some of the New Prostate Research On Risk Factors
There’s not much good news to report on detecting prostate cancer or conventional medical treatment of prostate enlargement or prostate cancer, but there is useful new research about prostate risk factors.
No Visible Progress in Prostate Treatment
According to a recently released report from the federal government’s Agency for Healthcare Research and Quality (AHRQ) that reviewed 592 published articles and compared eight prostate cancer treatment strategies, “Not enough scientific evidence exists to identify any prostate cancer treatment as most effective for all men, especially those whose cancers were found by PSA testing.” In essence, the AHRQ report says that we have no prostate cancer treatment that’s consistently safe and effective, and that it's questionable whether many of the prostate cancers detected by the PSA test should even be treated.
Surgical and radiation treatments carry a high risk of permanent side effects such as urinary and rectal problems, and impotence. One study showed that men who get external beam radiation treatment for prostate cancer have a 70% higher risk of rectal cancer than those who had surgery. As Dr. Lee used to say, “The treatment worked but the patient died.” The only treatment that causes these problems temporarily (vs. permanently) is androgen (male hormone) suppression with drugs, but the lack of hormones quickly increases the risk for diabetes and heart disease, similar to what happens when a woman gets a hysterectomy and loses her hormones. At best, androgen suppression is a temporary fix. When it’s stopped, the cancer often comes back, and with a vengeance.
That leaves “wait and watch,” which isn’t a bad option if the cancer is small and localized, and if you can stand it. It’s estimated that 80 to 96 percent of men have a bit of prostate cancer when they die, meaning it’s a very slow-growing cancer that most often does no harm. Thanks to research on prostate cancer risks, we have a pretty good idea of what blocks or feeds prostate cancer growth—more about that shortly.
The PSA Test
The PSA test isn’t faring any better than prostate cancer hormone research and treatment. According to the AHRQ:
“The lifetime risk of being diagnosed with prostate cancer has nearly doubled to 20 percent since the late 1980s, due mostly to expanded use of the Prostate Specific Antigen (PSA) blood test. But the risk of dying of prostate cancer remains about 3 percent. Therefore, considerable overdetection and overtreatment may exist. The U.S. Preventive Services Task Force, a panel of outside experts convened by AHRQ that makes independent evidence-based recommendations, maintains there is insufficient evidence to recommend for or against PSA testing for routine prostate cancer screening. PSA tests can detect early-stage cancer when it is potentially most treatable but also lead to frequent false-positive results and identification of prostate cancers unlikely to cause harm.”
Doctors like to say they have to treat prostate cancer because they don't know which ones will cause harm, but thanks to recent research on prostate cancer risk factors, we know a lot more about what drives prostate cancers to grow.
The Good News about Prostate Research
The good news about prostate research is that a lot has been done to examine non-hormone-related risk factors for both benign prostatic hypertrophy (BPH) and prostate cancer, including lifestyle, nutrition and diet. This research gives us an abundance of information that can be used to prevent and treat prostate problems ranging from a little bit of trouble urinating to prostate cancer.
Western Lifestyles Create a Convergence of Risk Factors for Prostate Problems
If we wanted to make a sweeping generalization about prostate cancer, we could say that the biggest risk factor for both having it and dying from it is living in the U.S., Canada and most of Europe. Asian men have, by far, the lowest incidence of prostate cancer, and the lowest risk of dying from it. (Unless they move to the U.S., and then it goes up.)
Our Western lifestyles increase prostate cancer risk pretty much the same way they increase breast cancer risk: we eat too many bad fats and sugars and not enough fiber and veggies, we don’t exercise enough, we're too fat, and we’re bombarded with xenoestrogens everywhere from pesticides and tap water to meat and perfumed garbage bags. This lifestyle leads to chronic inflammation.
Dousing the Fires of Inflammation
Inflammation plays an important role in prostate cancer. One of the primary causes of inflammation in the prostate is too much of certain fats and oils. The saturated fat found in meat is one culprit. Let me emphasize here that the key concept is excess; there’s no evidence that having a steak or lamb chop or bacon now and then does any harm. Ironically, the other fatty acid culprit is at the other end of the saturation spectrum—the omega-6 unsaturated oils such as corn, cottonseed, safflower and soybean. These are the oils found in chips, cookies, mayonnaise, salad dressings, and countless processed food products. The third culprit in prostate inflammation is (you guessed it) refined carbohydrates, especially the fatty carbs like French fries and the sweet carbs like cookies and doughnuts.
One of the primary causes of inflammation in the prostate is too much of certain fats and oils.
Both types of fatty acids (in excess) and refined carbohydrates cause the body to set up a multi-layered defense system to break down and dispose of them. In the normal workaday world of the body, this is no big deal, but when you overload the system it overcreates enzymes known as 5-LOX, COX-1 and COX-2. These enzymes, in turn, wreak all sorts of havoc further along the biochemical pathways. Part of the collateral damage of this havoc is inflammation—in the heart, the blood vessels, the joints, and the prostate in particular. In fact, not only does this havoc do damage, it actually feeds and protects cancer cells in the process. To add insult to injury, literally, it also pushes estrogens down more destructive pathways. Again, these are normal biochemical processes that run amok when they become overloaded. As we age we become increasingly susceptible to these types of inflammation and the DNA damage they cause, which can be the first step in the creation of a cancer.
Weapons Against LOX and COX
You can help your body reduce LOX and COX damage with some targeted supplement choices. The idea here, however, is not so much to try to help your body get over the shock of a burger and fries every other day, as to add a weapon to a prostate health arsenal that is already well stocked with overall good lifestyle choices. In other words, make the lifestyle changes and take these next suggestions an extra layer of protection. And let me make abundantly clear that I am in no way advocating any type of super-strict diet purgatory where you can never again eat meat or have a doughnut. That’s too stressful, and stress depletes the adrenals, which also creates inflammation, which…. well, you get the idea.
One of the easiest ways to block LOX and COX damage is to eat fish a few times a week, or take fish oil supplements.
One of the easiest ways to block LOX and COX damage is to eat fish a few times a week, or take fish oil supplements. A lot of people like flax oil as a source of beneficial oils, but I don’t recommend it. It’s so extremely unsaturated that unless you grind the seeds and eat them right away, it’s pretty much guaranteed to be rancid, which is like throwing the doors wide open for LOX and COX damage. Even when you grind the seeds, flax still has to go through conversion processes in the body to have benefit. In the hardware or paint store, flax oil is known as linseed oil and is used as a wood varnish, a carrier for oil paints, and glazing putty. If you put a coat of linseed oil on wood and leave it in the sun, it’ll harden in a few hours. That type of oxidation reaction is good for protecting wood, but may not be so good for protecting the body. And yes, the lignans in flax are phytoestrogens that can be beneficial, but there are other ways to get lignans (whole grains, broccoli, pumpkin seeds, sesame seeds, soybeans). Longtime health newsletter editor Dr. David Williams recently recommended chia seeds as an alternative to flax.
Another way to combat LOX and COX damage is to take an anti-inflammatory drug such as aspirin or ibuprofen. Remember, though, that when taken regularly, these drugs carry the risk of gastrointestinal bleeding, which kills more than 10,000 people a year. Use them with discretion. If you have a sensitive stomach, this is probably not a good choice for you.
Some supplement formulas are specifically designed to douse LOX and COX inflammation. Most notable are New Chapter’s Zyflamend and Life Extension’s 5-Loxin. Zyflamend is a blend of herb and spice extracts that has been well researched and shown to have benefit. For details please visit the New Chapter website.
And remember, our old friend estrogen is potently inflammatory in excess. It doesn’t take much estrogen to make a man estrogen dominant, in this case meaning too much estrogen relative to testosterone and progesterone. In women and men, fat cells are estrogen factories, which is part of why obesity is a risk factor for prostate problems.
For more details on xenoestrogens and how to avoid them, here are some articles by Dr. John Lee and myself, the first two originally published in the John R. Lee, M.D. Medical Letter:
Xenohormones and Your Health: Part I
Xenohormones in Your Environment: Part II
You’ll also find a detailed chapter on xenohormones that’s useful for both men and women in our book (and by the way, many of the lifestyle recommendations for breast health also apply to the prostate):
What Your Doctor May Not Tell You about Breast Cancer by John R. Lee, M.D., Dr. David Zava and Virginia Hopkins
More Support for a Healthy Prostate
— Saw Palmetto extract
— Lycopene (carrots, tomatoes, tomato sauce)
— Milk Thistle (helps the liver clear excess hormones)
— Vitamin D (men with prostate cancer tend to be low in vitamin D)
— Melatonin (helps balance estrogen)
A Word about Vitamin D and Melatonin
I’m a big advocate of getting beneficial substances the old fashioned way. That means, if possible, get your vitamin D from sunshine and your melatonin from a good night’s sleep. If you suspect you may need a little extra support in the form of supplements, it’s always a good idea to test levels. Both a vitamin D test and a melatonin test will help you gauge how much, if any, to supplement. If you’re not low, there’s no reason to spend the money and add burden to your liver with supplements.
The Lifestyle Reminder
Just a reminder that you can take handfuls of supplements every day to keep your prostate healthy, but if you’re overloading it with an excess of “bad” fats, sugar and refined carbohydrates and not getting any exercise or sleep, they won’t have much effect. Good prostate health requires a multi-faceted approach with a healthy lifestyle, hormone balance, avoidance of xenoestrogens, and—last but not least—supplements as needed.