New York Buyers’ Club - The Blog

We recently took a look at The Wake Forest University Center for Botanical Lipids website. This Center is one of five such dietary supplement research centers funded through the federal government’s National Institutes of Health–so this website represents our tax dollars at work!

The main goal of this new research center is to “determine the role of fatty acid based dietary supplements in the prevention and treatment of chronic human diseases associated with inflammation.” The center’s website also makes the point that “nearly 20% of Americans use dietary supplements, many of them botanicals, but scientific evidence for their safe and effective use in the prevention or treatment of human diseases has lagged behind the use of the products.”

Actually, we think the 20% estimate may be on the low side, especially if you include use of basic multivitamins; and certainly among groups with chronic conditions (such as osteoarthritis) the rate of supplement use is often higher than 20%. But we certainly agree that we need more scientific evidence about the effectiveness and safety of supplements, and we’re glad to know that the NIH has continued to fund such research, especially through its National Center for Complementary and Alternative Medicine (NCCAM) and its Office of Dietary Supplements (ODS).

OK, enough of the federal governmental acronyms, and back to the Wake Forest website. We’re pleased to see that it includes a user-friendly section with some publications easily understood by the general public (”Articles for Everyday People”). Here’s a sample from the piece entitled “The Use of Dietary Flaxseed for the Prevention of Human Disease”:
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Flaxseed (also called linseed) has been a part of the human and animal diet for thousands of years. It is the richest known plant source of omega-3 fatty acids - 58% of the total fat in flax is composed of alpha-linolenic acid (LNA); however, this fatty acid is a short chain omega-3 as opposed to the long chain omega 3s found in fish oil. A number of studies have shown that flaxseed does not replace fish oil in the diet because the conversion of LNA to the omega-3 fatty acids found in fish oil is very inefficient.

While most studies show a benefit of flaxseed oil, there have been studies which have not been positive. In 5 out of 6 epidemiological studies on prostate cancer, flaxseed was shown to increase cancer risk, and LNA is a strong growth stimulus in isolated prostate cancer cells (4). Neither of these effects has been seen with fish oil. In addition, recent studies suggest that flaxseed may increase the risk of macular degeneration or speed up the progression of the disease.

In a nutshell: flaxseed looks to be very interesting for breast cancer and cardiovascular disease, but not recommended when prostate cancer or prostate cancer risk is present.

The University of Maryland Medical Center’s Complementary Medicine website provides an assessment of some recent studies on melatonin as an adjunct treatment for breast cancer. Of course melatonin is best known and has been most researched for its effects on sleep and its potential to address sleep disorders. Most of these investigations have focused on people whose circadian rhythms are disrupted by factors such as jet lag or work schedules, but there have also been studies looking at melatonin as a sleep aid for the elderly or for those with HIV (see other “Melatonin” entries on this Blog).

This excerpt from the UMMC article on Melatonin indicates, however, that this supplement may be eliciting additional interest as an auxiliary to certain cancer treatment regimens. We have highlighted the last sentence in this passage, which repeats one of the crucial guides in using supplements: be sure to consult your health care professional.

“Several studies indicate that melatonin levels may be linked with breast cancer risk. For example, women with breast cancer tend to have lower levels of melatonin than those without the disease. In addition, laboratory experiments have found that low levels of melatonin stimulate the growth of certain types of breast cancer cells, while adding melatonin to these cells inhibits their growth. Preliminary laboratory and clinical evidence also suggests that melatonin may enhance the effects of some chemotherapy drugs used to treat breast cancer. In a study that included a small number of women with breast cancer, melatonin (administered 7 days before beginning chemotherapy) prevented the lowering of platelets in the blood. This is a common complication of chemotherapy, known as thrombocytopenia that can lead to bleeding.

In another study of a small group of women whose breast cancer was not improving with tamoxifen (a commonly used chemotherapy medication), adding melatonin caused tumors to modestly shrink in over 28% of the women. People with breast cancer who are considering taking melatonin supplements should consult their doctors before beginning supplementation.“

Astragalus is traditional botanical that has drawn new research attention in recent years, especially for its usefulness in increasing the effectiveness of some cancer treatments while diminishing side effects. As background on this herb, we present the excerpt below from the NYBC entry on Astragalus (See complete entry for more information and cautions.)
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Astragalus is considered a strong immune booster and an energy herb and may help to restore depleted red blood cell formation in bone marrow. Some evidence indicates that it stimulates the body’s natural interferon production, helps adrenal function, is a diuretic for edema and inflamed kidneys and helps cancer patients withstand the side effects of chemotherapy.
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Some recent research on astragalus as an adjunct in cancer treatment
The Memorial Sloan Kettering Cancer Center Integrative Medicine website reports on two major reviews, from 2005 and 2006, which examined published evidence about the use of astragalus as an adjunct therapy in certain cancer treatment settings:

–McCulloch M, et al. Astragalus-based Chinese herbs and platinum-based chemotherapy for advanced non-small-cell lung cancer: Meta-analysis of randomized trials. J clin Oncol 2006;24(3):419-430.
This analysis sought to determine whether Chinese herbal medicine containing Astragalus increases the effectiveness of platinum-based chemotherapy for advanced non-small-cell-lung cancer.

–Taixiang W, et al. Chinese medical herbs for chemotherapy side effects in colorectal cancer patients (Review). The Cochrane Database Syst Rev 2005; (1):CD004540.
Four clinical trials were included in this review to assess the effectiveness of Astragalus (Huangqi) compounds on the quality of life, side effects of chemotherapy, and on adverse effects in colorectal cancer patients.

See also the University of Maryland Medical Center’s Complementary Medicine website entry on Astragalus for this overview:

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Astragalus (Astragalus membranaceus) has been used in Traditional Chinese Medicine for thousands of years, often in combination with other herbs, to strengthen the body against disease. It contains antioxidants, which protect cells against damage caused by free radicals, byproducts of cellular energy. Astragalus is used to protect and support the immune system, for preventing colds and upper respiratory infections, to lower blood pressure, to treat diabetes, and to protect the liver.

Recent research in China indicates that astragalus may offer antioxidant benefits to people with severe forms of heart disease, relieving symptoms and improving heart function. At low to moderate doses, astragalus has few side effects, although it does interact with a number of other herbs and prescription medications.

Curcumin is an extract of the kitchen spice turmeric, the main ingredient in curry. It’s also among those traditional botanicals that in very recent times have been the subject of new scientific interest. (Several National Institutes of Health studies of curcumin have been conducted or are currently underway.)

Here’s a capsule history from the NYBC entry on Curcumin:

“…Curcumin’s use dates back to the time of Egyptian pharaohs and Indian rajas more than 6,000 years ago. A tall, stemless, perennial plant cultivated throughout the tropics, especially in India, China and Indonesia, turmeric is what gives curry its unique flavor and color; but in addition to its kitchen uses, curcumin has been used by traditional medicine for liver disease (particularly jaundice), indigestion, urinary tract diseases, blood purification, inflamed joints (rheumatoid arthritis), insect bites, dermatological disorders and as an atherosclerosis preventative. Although the chemical structure of curcumin was determined in 1910, it was only during the mid 1970s and 1980s that the potential uses of curcuminoids in medicine began to be extensively studied.”

There’s more about the anti-inflammatory properties of curcumin in the NYBC web entry, where you also find information on dosing recommendations. Note that curcumin has also been studied in recent decades for its anti-cancer properties, as well as for its usefulness to people with HIV.

The University of Maryland Medical Center’s Complementary Medicine website provides this guidance on dosage for CoQ 10 (Coenzyme Q 10, sometimes known as ubiquinone):

Note: these recommendations apply to Adults; also remember that CoQ10 is fat-soluble and generally best absorbed if taken when eating the fattiest meal of the day.

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The general recommended dose for CoQ10 supplementation is 30 to 60 mg daily. Higher doses have been used in studies and may be recommended for the following conditions:

The following summaries from the UMMC website may also be useful in deciding whether CoQ 10 supplementation should be considered. Please remember that the conditions described are both serious and complex, and it is thus very important that any supplement use be discussed with your doctor.

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Heart Disease

Studies of women with breast cancer suggest that CoQ10 supplements (in addition to conventional treatment and a nutritional regimen including other antioxidants and essential fatty acids) may shrink tumors, reduce pain associated with the condition, and cause partial remission in some individuals. It is important to recognize that the beneficial effects these women experienced cannot be attributed to CoQ10 alone. Additional antioxidants used in these studies include vitamins C, E, and selenium

See also NYBC’s discussions of CoQ 10 - 100mg and CoQ 10 - 30mg.

The University of Maryland Medical Center’s website on Complementary Medicine (a clearly written, up-to-date resource, by the way) provides this review of folic acid (also known as folate or Vitamin B9) as a supplement protecting against the development of cancers. The strongest evidence appears to be for folic acid’s ability to protect against colorectal and breast cancers. In our excerpt below, we have highlighted two significant passages.

For recommendations on how to take this supplement (you may be getting it in a multivitamin or a B-complex supplement), see the NYBC entry on Folic Acid.

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Cancer
Folic acid appears to protect against the development of some forms of cancer, particularly cancer of the colon, as well as breast, esophagus, and stomach, although the information regarding stomach cancer is more mixed. It is not clear exactly how folate might help prevent cancer. Some researchers speculate that folic acid keeps DNA (the genetic material in cells) healthy and prevents mutations that can lead to cancer.

Low dietary intake of folate may increase the risk of developing breast cancer, particularly for women who drink alcohol. Regular use of alcohol (more than 1 ½ to 2 glasses per day) is associated with increased risk of breast cancer. One extremely large study, involving over 50,000 women who were followed over time, suggests that adequate intake of folate may lessen the risk of breast cancer associated with alcohol.

CoQ10 has been studied extensively for its potential in addressing cardiovascular health concerns, but recent research has suggested its usefulness as an anti-cancer agent as well. In a striking set of studies, University of Miami Medical Center investigators identified a mechanism whereby CoQ10 induces the death of cancer cells while causing no significant collateral damage. Here’s a news article about this work on CoQ10, which was presented at a meeting of the American Association for Cancer Research:

http://www.med.miami.edu/news/view.asp?id=519

We expect to hear more about CoQ10 and its anti-cancer potential in the future, so stay tuned.  

Here’s an excerpt from the upcoming issue of the New York Buyers’ Club newsletter, THE SUPPLEMENT.

While it covers some of the same territory on supplements and cancer that we’ve posted earlier on this Blog, it’s valuable as an overview of the question, and balances the news of some notable advances in 2007 with notes and cautions at the end.

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Can Supplements Reduce Cancer Risk?

If you have a question about the usefulness of a supplement as an anti-cancer agent, we recommend the Memorial Sloan-Kettering Integrative Medicine website. This web resource came into being because health professionals recognized the widespread use of supplements by people concerned about their cancer risk or already diagnosed with cancer, and wanted to provide them with evidence-based information to guide their choices. This is also the approach of New York Buyers’ Club: we want to bring up-to-date, scientifically-based information to our members so that they can make good choices about supplement use.

This review, published in late 2007, concludes that studies of prostate cancer prevention are now maturing to the point where recommendations may soon be in order for reducing cancer risk by supplementing with such promising dietary supplement agents as lycopene, alpha-tocopherol, or selenium. Decreased dietary fat, nonsteroidal anti-inflammatory drugs and selective estrogen receptor modulators are also interventions under review.

Chemoprevention of prostate cancer: agents and study designs

PURPOSE: With the completion of the Prostate Cancer Prevention Trial and the ongoing performance of several additional large-scale prostate cancer prevention trials interest in this intervention has increased. We review promising agents for prostate cancer prevention, clinical trial designs and how these agents may be used clinically. MATERIALS AND METHODS: We reviewed current and completed randomized chemoprevention trials for prostate cancer as well as the most promising agents for which evidence suggests that a decreased prostate cancer risk may result from their use. RESULTS: Evidence suggests that lycopene, decreased dietary fat, antioxidants such as alpha-tocopherol and selenium, nonsteroidal anti-inflammatory drugs and selective estrogen receptor modulators such as toremifene and 5alpha-reductase inhibitors may prove useful for decreasing the risk of prostate cancer in a man. Ongoing studies are examining these agents in the 3 general scenarios of 1) general population studies (finasteride, alpha-tocopherol and selenium), 2) increased prostate specific antigen with negative biopsy (dutasteride) and 3) prostatic intraepithelial neoplasia (toremifene and selenium). CONCLUSIONS: There are many agents that may decrease the risk of prostate cancer. It requires careful study of the agents in specific populations to determine whether risk is reduced, the magnitude of the risk reduction and the spectrum of side effects associated with the agent. Physicians caring for men entering the range of age of prostate cancer risk must be aware of these preventive opportunities.

Citation: Chemoprevention of prostate cancer: agents and study designs.
Thompson IM. J Urol. 2007 Sep;178(3 Pt 2):S9-S13. Epub 2007 Jul 20.

Milk thistle, or silymarin, has long been used as a botanical treatment for liver disease. In 2007, researchers at the University of California, Irvine, published a study showing that a biologically active component of milk thistle has significant effect against liver cancer cells (see brief summary below).

Compound of milk thistle (silymarin) has a significant anti-cancer effect
Dr. Ke-Qin Hu and his research team at the University of California, Irvine recently published a study showing the significant anti-cancer effects of silibinin, a major biologically active compound of milk thistle (aka silymarin). Milk thistle has a long tradition of use as a remedy for liver diseases, is generally safe and well-tolerated, and is also known to protect the liver from drug or alcohol-related injury. (Silibinin is purified from milk thistle, with a defined chemical structure and molecular weight.)

Dr. Hu is an experienced research scientist and physician in the field of hepatology. He has published over 70 scientific journal articles, many focused on viral hepatitis B and C, cirrhosis, and liver cancer.

Dr. Hu and his research team found that silibilin can significantly reduce the growth of several human hepatoma cell lines. These findings suggest that silibinin can be used to prevent the development of liver cancer, one of the most common cancers worldwide.

Citation:
Lah JJ, Cui W, Hu KQ. Effects and mechanisms of silibinin on human hepatoma cell lines.
World J Gastroenterol 2007; 13(40): 5299-5305

We were impressed by the lead article on Vitamin D in the February 2008 issue of the University of California, Berkeley’s Wellness Letter (a “newsletter of nutrition, fitness, and self-care”). The Wellness Letter is usually quite conservative about recommending nutritional supplements, but in this case it finds the recent wave of research on Vitamin D promising enough to recommend that people “consider taking 800 to 1000 IU of supplemental D a day.”  As the newsletter reports, studies have now gone much beyond the well-known benefit of this vitamin in working with calcium to keep bones strong; recent research has ranged over a much broader field, focusing on Vitamin D’s “potential to reduce risk of everything from some common cancers and multiple sclerosis to diabetes, hypertension, and age-related muscle weakness.” 

Although not going so far as to suggest testing blood levels of D for the general population, the Wellness Letter does recommend talking to your doctor about testing, “especially if you are over 60 [...] or have low bone density.”

A further recommendation: “When shopping for a supplement, read the fine print: look for D3 (also called cholecalciferol), which is more potent than D2 (ergocalciferol).”

For other commentary on recent Vitamin D research, see the “Vitamin D” category on this blog.

And you can also read the Vitamin D3 entry on the New York Buyers’ Club website.

This was the title of a New York Times article by Jane Gross published on January 6, 2008.  Focusing on several case studies, the piece highlighted “a constellation of ailments showing up prematurely or in disproportionate numbers among the first wave of AIDS survivors to reach late middle age.”

There’s no doubt that the article is timely: the number of people 50 and older living with HIV has increased 77 percent from 2001 to 2005, according to the federal Centers for Disease Control, and they now are a quarter of all cases in the United States (about 116,000). And, it’s certainly true, as the piece suggests, “the graying of the AIDS epidemic has increased interest in the connection between AIDS and cardiovascular disease, certain cancers, diabetes, osteoporosis, and depression.”

The New York Buyers’ Club (like its predecessor DAAIR) has always been engaged in looking ahead in order to size up and respond to the special health issues faced by people with HIV, whether those issues derive from the virus itself, or from medication side-effects. So if you’d like to know more about how our membership has used dietary supplements over the longer haul to maintain and improve their health, and to counter symptoms and medication side-effects, please do continue to consult this blog, as well as our website, found at www.newyorkbuyersclub.org. Also–if you’d like to be included the mailing and/or email list for our quarterly publication THE SUPPLEMENT, just drop a line to contact@newyorkbuyersclub.org. NYBC doesn’t claim to have all the answers to the health concerns of people with HIV, but you might be surprised at how many useful recommendations and suggestions (based on much reviewing of the science and many years of accumulated experience) our nonprofit information exchange has to offer.