Weekly Health Update

Tuesday, July 7, 2009

Prostate Cancer & Green Tea

Health Report:

Prostate Cancer & Green Tea

"A critical weekly review of important new
research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS

Last Updated: 07/05/2009

The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.

PROSTATE CANCER & GREEN TEA

Green tea has been consumed for thousands of years, and many claims regarding the health-promoting properties of
this ancient beverage have been made over the millennia.
However, we are just beginning to scratch the surface of green tea’s potential to aid in disease prevention and
treatment through the use of modern laboratory and clinical research methods. While many of the fantastic claims being made
for green tea are, doubtless, unlikely to be true, recent research has
shown a surprising array of potentially beneficial effects associated with a group of compounds found in green tea. Green tea
polyphenols, and epigallocatechins and epicatechins in particular, have
especially piqued the interest of researchers looking at ways to improve the prevention and treatment of both cardiovascular disease and cancer. Unfortunately, most of the available research
data for green polyphenols has been derived from low-powered dietary survey-based studies, or from laboratory studies of green tea extracts and their effects on cells artificially grown in culture dishes.

Now, a newly published clinical research study in the journal Cancer Prevention Research offers some intriguing insights into some
potentially important clinical effects of green tea polyphenols in men with newly diagnosed prostate cancer.

In this small pilot study, 26 men with newly diagnosed prostate cancer took daily supplements of green tea polyphenols while they were awaiting prostate cancer surgery (1.3 grams of polyphenols per day). At both the beginning and the end of this short-term study, blood was drawn to assess for tumor markers known to be associated with the stage and extent of prostate cancer (the study was
concluded for these patients, individually, on the day that each underwent prostate cancer surgery). Additionally, cancer-associated fibroblast cells, which are often associated with multiple
different types of cancer, and which are thought to secrete proteins that directly and indirectly increase tumor growth, were cultured in
laboratory dishes, and then treated with green tea polyphenols. Changes in tumor-stimulating proteins from these prostate cancer-associated fibroblasts cells were then measured following polyphenol treatment.

Prostate-specific antigen (PSA), which is uniquely secreted by both normal and malignant prostate gland cells, is the most commonly used blood marker for prostate cancer. As prostate cancer progresses, PSA levels in the blood will rise in the vast majority of men with thisdisease. When prostate cancer is successfully treated, PSA levels will trend back towards normal levels. (Rising PSA levels following previous prostate cancer treatment almost always signify cancer recurrence.) Other important tumor-associated factors include vascular endothelial growth factor (VEGF) and hepatocyte growth
factor (HGF). These proteins are known to stimulate the growth and spread of many types of cancer, including prostate cancer. Other known adverse tumor growth factors include insulin-like growth factor (IGF), and IGF binding protein. All of these tumor growth factors were measured in the blood samples collected from these 26 men, both at the beginning of this brief study and at its conclusion.

When all of the data was analyzed, some tantalizing results were discovered. Blood levels of PSA, VEGF, HGF, IGF and IGF binding
protein were all significantly decreased following a brief period of dietary supplementation with green tea polyphenols. Additionally,
VEGF and HGF secretion by prostate cancer-associated fibroblasts
significantly decreased, as well, following treatment of these cultured cells with green tea polyphenols.

While this brief and small pilot does not provide any direct proof that dietary supplementation with green tea polyphenols can prevent prostate cancer, or improve survival in patients
already diagnosed with prostate cancer, it does offer indirect evidence, based upon a decrease in prostate cancer-associated tumor markers, that green tea polyphenols may be able to inhibit prostate cancer cell growth, and not only in cancer cells growing in a laboratory culture dish, but also in a living, breathing human being with prostate cancer.

The obvious next step is to conduct several large, long-term, prospective, randomized, placebo-controlled clinical research trials to put the findings of this small but intriguing pilot study to the test. Fortunately, there are several such clinical trials already underway.
Until the results of these clinical trials are known, however, it remains unclear if green tea polyphenols are capable of reducing the risk of
prostate cancer (or any other type of cancer), or the risk of dying from a previously diagnosed prostate cancer, to any clinically significant degree. When the data from these larger prospective clinical research trials become available, I will certainly provide an update in this important area of cancer prevention and treatment research. Stay
tuned!

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and the Physician-in-Chief for Surgical
Oncology at the Kaiser Permanente healthcare system in Orange County, California

(Anticipated Publication Date: March 2010)

(Click above image for TV36 interview of Dr. Wascher)

Email this Page to a Friend

Send your feedback to Dr. Wascher
at: rwascher@doctorwascher.net

Dr. Wascher's Biography

Links to Other Health & Wellness Sites

Robert A. Wascher, MD, FACS.

Dr. Wascher's Archives:

6-28-2009:
Air Pollution & the Risk of Deep
Venous Thrombosis (DVT)

6-21-2009:
Red Yeast Rice, Statins & Cholesterol

6-14-2009:
Bone Marrow Stem Cell Transplant &
Congestive Heart Failure (CHF)

6-7-2009:
Diet, Soy & Breast Cancer Risk

5-31-2009:
Diet and Prostate Cancer Risk

5-24-2009:
Diabetes, Glucose Control & Death

5-17-2009:
Drug Company Marketing & Physician
Prescribing Bias

5-10-2009:
Hemorrhoids & Surgery

5-03-2009:
Statin Drugs & Blood Clots
(Thromboembolism)

4-26-2009:
Are We Really Losing the War on Cancer?

4-19-2009:
Exercise in Middle Age & Risk of
Death

4-12-2009:
Can Chronic Stress Harm Your Heart?

4-05-2009:
Does PSA Testing for Prostate Cancer Save
Lives?

3-22-2009:
CABG Surgery vs. PCI in Diabetics with
Coronary Artery Disease; Sweetened Beverages and Coronary Artery Disease

3-15-2009:
Depression, Stress, Anger & Heart
Disease

3-8-2009:
Coronary Artery Disease: CABG vs. Stents?;
Swimming Lessons & Drowning Risk in Children

3-1-2009:
Aspirin & Colorectal Cancer
Prevention; Fish Oil & Respiratory Infections in Children

2-22-2009:
Health Differences Between Americans
& Europeans; Lycopene & Prostate Cancer

2-15-2009:
Statin Drugs & Death Rates; Physical Activity, Breast Cancer &
Sex Hormones

2-8-2009:
Hormone Replacement Therapy (HRT) &
Breast Cancer; Stool DNA Testing & Cancer of the Colon
& Rectum

2-1-2009:
Obesity and the Complications of
Diverticulosis (Diverticulitis & Bleeding); Obesity, Weight
Loss & Urinary Incontinence

1-25-2009:
Prostate Cancer, Fatigue & Exercise;
Does your Surgeon “Warm-up” Before Surgery?

1-18-2009:
Cancer & Vitamins; Teenagers,
MySpace and Risky Behaviors

1-11-2009:
Exercise Reverses Some Effects of Fatty Meals; Vitamin C and Blood Pressure

1-4-2009:
Secondhand Smoke & Heart Attack
Risk; Poor Physical Fitness During Childhood & Heart Disease
Risk During Adulthood

12-28-2008:
Stress & Your Risk of Heart Attack; Vitamin D & the Prevention of Colon &
Rectal Polyps

12-21-2008:
Breast Cancer Incidence & Hormone Replacement Therapy; Circumcision & the Risk of HPV & HIV Infection

12-14-2008:
Vitamin E, Vitamin C and Selenium Do Not Prevent Cancer; Postscript: A Possible Cure for Down’s Syndrome

12-7-2008:
Generic vs. Brand-Name Drugs; Stress & Breast Cancer Survival

11-30-2008:

A Possible Cure for Down’s Syndrome?; Smoking & Cognitive Decline; Calcium & Vitamin D & Breast Cancer Risk

11-23-2008:
Breast Cancer & Fish Oil; Lymphedema
after Breast Cancer Treatment; Vasectomy & Prostate Cancer Risk

11-16-2008:
Vitamin E & Vitamin C: No Impact on
Cardiovascular Disease Risk; Does Lack of Sleep Increase Stroke
& Heart Attack Risk in Hypertensive Patients?

11-9-2008:
Statins Cut Heart Attack Risk Even with
Normal Cholesterol Levels; Statins & PSA Level

11-2-2008:
Radiation Treatment of Prostate Cancer
& Second Cancers; Sexual Content on TV & Teen Pregnancy Risk

10-26-2008:
Smoking & Quality of Life

10-19-2008:
Agent Orange & Prostate Cancer

10-12-2008:
Pomegranate Juice & Prostate Cancer

10-5-2008:
Central Obesity & Dementia; Diet, Vitamin D, Calcium, & Colon Cancer

9-28-2008:
Publication & Citation Bias in Favor of Industry-Funded Research?

9-21-2008:
Does Tylenol® (Acetaminophen) Cause Asthma?

9-14-2008:
Arthroscopic Knee Surgery- No Better than
Placebo?; A Healthy Lifestyle Prevents Stroke

8-23-2008:
Alcohol Abuse Before & After Military Deployment; Running & Age; Running & Your Testicles

8-12-2008:
Green Tea & Diabetes; Breastfeeding & Adult Cholesterol Levels; Fish Oil & Senile Macular Degeneration

8-3-2008:
Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients

7-26-2008:
Viagra & Sexual Function in Women; Patient-Reported Adverse Hospital Events; Curcumin & Pancreatic Cancer

7-13-2008:
Erectile Dysfunction & Frequency of
Sex; Muscle Strength & Mortality in Men; Cryoablation for
Prostate Cancer

7-6-2008:
Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins

6-29-2008:
Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer

6-22-2008:
Obesity, Lifestyle & Heart Disease;
Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo
Biloba, Ulcerative Colitis & Colorectal Cancer

6-15-2008:
Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort

6-8-2008:
Vitamin D & Prostate Cancer Risk;
Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense
Telomerase & Cancer

6-2-2008:
Acute Coronary Syndrome- Do You Know the
Symptoms?; Green Tea & Lung Cancer; Episiotomy &
Subsequent Deliveries- An Unkind Cut

5-25-2008:
Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely

5-18-2008:
Can Statins Reverse Coronary Artery
Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?;
Preventive Care Services at Veterans Administration (VA) Medical Centers

5-11-2008:
Smoking Cessation & Risk of Death;
Childhood Traumas & Adult Suicide Risk; “White Coat
Hypertension” & Risk of Cardiovascular Disease

5-4-2008:
Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight &
Coronary Artery Disease; Contamination of Surgical Instruments in the
Operating Room

4-27-2008:
Stents vs. Bypass Surgery for Coronary Artery Disease; The “DASH” Hypertension Diet & Cardiovascular Disease Prevention; Testosterone Therapy
for Women with Decreased Sexual Desire & Function

4-20-2008:
BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention
with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke

4-13-2008:
Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid
Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention

4-6-2008:
Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer;
Human Papilloma Virus (HPV) Infection & Oral Cancer; Hormone
Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux
Disorder (GERD)

3-30-2008:
Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment
& Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria

3-23-2008:
Age of Transfused Blood & Risk of Complications after Surgery;
Obesity, Blood Pressure & Heart Size in Children

3-16-2008:
Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen
Conversations about Sex; Soy (Genistein) & Prostate Cancer

3-9-2008:
Flat Colorectal Adenomas & Cancer; Health Risks after Stopping
Hormone Replacement Therapy (HRT); Television, Children & Obesity

3-2-2008:
Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death

2-23-2008:
Universal Healthcare Insurance Study; Glucosamine & Arthritis

2-17-2008:
Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer;
Smoking & Pre-malignant Colorectal Polyps

2-10-2008:
Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for Down's Syndrome?

2-3-2008:
Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer;
Green Tea & Colorectal Cancer

1-27-2008:
Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the
2008 American Society of Clinical Oncology's Gastrointestinal Cancers
Symposium

1-20-2008:
Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution
& DNA Damage in Sperm; Statins & Trauma Survival in the Elderly

1-12-2008:
Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer

1-7-2008:
Testosterone Supplements in Elderly Men; Colorectal Cancer-- Reasons for Poor Compliance with Screening Recommendations

12-31-2007:
Minority Women, Hormone Replacement Therapy
& Breast Cancer; Does Health Insurance Improve Health?

12-23-2007:
Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment;
Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease

12-16-2007:
Honey vs. Dextromethorphan vs. No Treatment
for Kids with Night-Time Cough, Acupuncture & Hot Flashes in
Women with Breast Cancer, Physical Activity & the Risk of
Death, Mediterranean Diet & Mortality

12-11-2007:
Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease

12-2-2007:
Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer

Home

Top of Page

Sunday, June 28, 2009

Air Pollution & the Risk of Deep Venous Thrombosis (DVT)

Health Report:

Air Pollution & the Risk of Deep Venous Thrombosis (DVT)

"A critical weekly review of important new research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS

Updated: 06/28/2009

The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.

AIR POLLUTION & THE RISK OF DEEP VENOUS THROMBOSIS (DVT)

As I’ve mentioned in previous columns, venous thromboembolic (VTE) disorders are a major cause of disability and death throughout the world. Deep venous thrombosis (DVT) results when blood clots form within the deep veins of the body (most commonly within the large veins of the legs and pelvis). A variety of conditions and circumstances can lead to DVT formation. These include decreased blood flow, or “stasis,” involving the body’s deep veins, injury or inflammation of the internal surfaces (endothelium) of these veins, and any underlying health condition that increases the blood’s tendency to form blood clots (hypercoagulable state). Pulmonary embolism (PE) is a potentially life-threatening condition, and most commonly arises in patients who have already developed DVT (PE occurs when chunks of DVT-associated clots break away and travel to the lungs). When the lungs’ circulation becomes clogged-up with these itinerant clots (emboli), patients may experience shortness of breath, chest pain, or in severe cases of PE, complete cardiovascular collapse and death.

VTE remains an underappreciated cause of serious illness, disability, and death. Patients with severe or repeated cases of DVT often develop chronic swelling, pain, and skin damage of the affected extremities, due to the progressive destruction of the one-way valves in the large veins of the lower body that help to prevent pooling of blood in these dependent areas (post-thrombotic syndrome). Patients who survive significant PEs may also go on to develop permanent damage to the venous circulation of the lungs, leaving them with decreased blood flow to the lungs (pulmonary hypertension) and, in severe cases, chronic shortness of breath, lung injury, and heart damage (PE also remains the most common cause of unexpected death in hospitalized patients). An estimated 900,000 new cases of VTE occur in the United States each year, and as many as one-third of these cases of VTE are fatal, which makes VTE a more common cause of death than either heart attacks or strokes! As these statistics suggest, VTE remains a very serious public health problem in the United States, and throughout much of the world, as well.

While exposure to particulate air pollution from diesel and gasoline engines has previously been linked to an increased risk of coronary artery disease, the effects of these environmental pollutants on the body’s venous system, if any, are less clear. Now, an innovative new study from Italy suggests that chronic exposure to automobile and truck exhaust may actually increase the risk of VTE. In this study, which has just been published in the journal Circulation, 663 patients who were diagnosed with DVT were compared with 859 age-matched “control” patients without any history of DVT. All patients who were included in this study lived in cities with a population of more than 15,000 inhabitants in the Lombardia region of Italy. In this study, the researchers calculated the distance that each study volunteer lived from major highways and high-traffic streets. The researchers also factored other DVT risk factors, for each of the patient volunteers, into their analysis of the data collected in this study. Among those patient volunteers who lived between 0 feet and 2,400 feet from major highways and high-traffic streets, the risk of developing DVT was more or less linearly proportional to the distance between these patients’ homes and the site of increased automobile and truck traffic. When comparing the patients who lived approximately 10 feet from major streets and highways with patients who lived 800 feet away from major thoroughfares, and after adjusting for other risk factors for DVT among these 1,522 patient volunteers, the researchers noted a 47 percent greater risk of DVT among the patient volunteers who lived closer to high-traffic highways and streets.

Therefore, the findings of this study strongly suggest that chronic exposure to particulate air pollution from vehicle exhaust significantly increases the risk of developing DVT. Other well established risk factors for DVT include prolonged immobility (e.g., sitting for long periods on a plane or in a car; or prolonged bed rest), cancer, recent major injury or surgery, pregnancy, birth control pills or other forms of hormonal therapy, heart failure, obesity, smoking, severe infections, older age, high blood pressure, chronic lung disease, inherited clotting abnormalities, and a family history of DVT or other forms of VTE.

As many of the known risk factors for DVT, and other forms of VTE, are preventable, it is possible to reduce the risk of developing potentially life-threatening blood clots by taking steps to avoid as many of these risks as possible. For example, if you must take a long plane or automobile ride, you should take frequent walking breaks, and remember to also frequently exercise your legs while you are seated. Drinking plenty of caffeine-free and alcohol-free drinks will also reduce the risk of DVT during long trips. If you also have one or more non-modifiable risk factors for VTE and you must take a long trip, you might also want to talk with your doctor about taking aspirin or/and anticoagulant medications before and during your trip, as well as wearing compression stockings on your legs during your long trip. As for the risk of DVT associated with increased exposure to gasoline and diesel engine exhaust (in addition to an increased risk of lung disease and heart disease), this new clinical research study suggests that it is best to avoid living close to busy highways and high-traffic streets, if at all possible.

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and a Surgical Oncologist at the Kaiser Permanente healthcare system in Orange County, California

(Anticipated Publication Date: March 2010)

(Click above image for TV36 interview of Dr. Wascher)

Send your feedback to Dr. Wascher at:

rwascher@doctorwascher.net

Dr. Wascher's Biography

Links to Other Health & Wellness Sites

http://doctorwascher.com

Copyright 2009

Robert A. Wascher, MD, FACS

All rights reserved

Dr. Wascher's Archives:

6-21-2009: Red Yeast Rice, Statins & Cholesterol
6-14-2009: Bone Marrow Stem Cell Transplant & Congestive Heart Failure (CHF)
6-7-2009: Diet, Soy & Breast Cancer Risk
5-31-2009: Diet and Prostate Cancer Risk
5-24-2009: Diabetes, Glucose Control & Death
5-17-2009: Drug Company Marketing & Physician Prescribing Bias
5-10-2009: Hemorrhoids & Surgery
5-3-2009: Statin Drugs & Blood Clots (Thromboembolism)
4-26-2009: Are We Really Losing the War on Cancer?
4-19-2009: Exercise in Middle Age & Risk of Death
4-12-2009: Can Chronic Stress Harm Your Heart?
4-5-2009: Does PSA Testing for Prostate Cancer Save Lives?
3-22-2009: CABG Surgery vs. PCI in Diabetics with Coronary Artery Disease; Sweetened Beverages and Coronary Artery Disease
3-15-2009: Depression, Stress, Anger & Heart Disease
3-8-2009: Coronary Artery Disease: CABG vs. Stents?; Swimming Lessons & Drowning Risk in Children
3-1-2009: Aspirin & Colorectal Cancer Prevention; Fish Oil & Respiratory Infections in Children
2-22-2009: Health Differences Between Americans & Europeans; Lycopene & Prostate Cancer
2-15-2009: Statin Drugs & Death Rates; Physical Activity, Breast Cancer & Sex Hormones
2-8-2009: Hormone Replacement Therapy (HRT) & Breast Cancer; Stool DNA Testing & Cancer of the Colon & Rectum
2-1-2009: Obesity and the Complications of Diverticulosis (Diverticulitis & Bleeding); Obesity, Weight Loss & Urinary Incontinence
1-25-2009: Prostate Cancer, Fatigue & Exercise; Does your Surgeon “Warm-up” Before Surgery?
1-18-2009: Cancer and Vitamins; Teenagers, MySpace and Risky Behaviors
1-11-2009: Exercise Reverses Some Effects of Fatty Meals; Vitamin C and Blood Pressure
1-4-2009: Secondhand Smoke & Heart Attack Risk; Poor Physical Fitness During Childhood & Heart Disease Risk During Adulthood
12-28-2008: Stress & Your Risk of Heart Attack; Vitamin D & the Prevention of Colon & Rectal Polyps
12-21-2008: Breast Cancer Incidence & Hormone Replacement Therapy; Circumcision & the Risk of HPV & HIV Infection
12-14-2008: Vitamin E, Vitamin C and Selenium Do Not Prevent Cancer; Postscript: A Possible Cure for Down’s Syndrome
12-7-2008: Generic vs. Brand-Name Drugs, Stress & Breast Cancer Survival
11-30-2008: A Possible Cure for Down’s Syndrome?; Smoking & Cognitive Decline; Calcium & Vitamin D & Breast Cancer Risk
11-23-2008: Breast Cancer & Fish Oil; Lymphedema after Breast Cancer Treatment; Vasectomy & Prostate Cancer Risk
11-16-2008: Vitamin E & Vitamin C: No Impact on Cardiovascular Disease Risk; Does Lack of Sleep Increase Stroke & Heart Attack Risk in Hypertensive Patients?
11-9-2008: Statins Cut Heart Attack Risk Even with Normal Cholesterol Levels; Statins & PSA Level
11-2-2008: Radiation Treatment of Prostate Cancer & Second Cancers; Sexual Content on TV & Teen Pregnancy Risk
10-26-2008: Smoking & Quality of Life
10-19-2008: Agent Orange & Prostate Cancer
10-12-2008: Pomegranate Juice & Prostate Cancer
10-5-2008: Central Obesity & Dementia; Diet, Vitamin D, Calcium, & Colon Cancer
9-28-2008: Publication & Citation Bias in Favor of Industry-Funded Research?
9-21-2008: Does Tylenol® (Acetaminophen) Cause Asthma?
9-14-208: Arthroscopic Knee Surgery- No Better than Placebo?; A Healthy Lifestyle Prevents Stroke
8-23-2008: Alcohol Abuse Before & After Military Deployment; Running & Age; Running & Your Testicles
8-12-2008: Green Tea & Diabetes; Breastfeeding & Adult Cholesterol Levels; Fish Oil & Senile Macular Degeneration
8-3-2008: Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients
7-26-2008: Viagra & Sexual Function in Women; Patient-Reported Adverse Hospital Events; Curcumin & Pancreatic Cancer
7-13-2008: Erectile Dysfunction & Frequency of Sex; Muscle Strength & Mortality in Men; Cryoablation for Prostate Cancer
7-6-2008: Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins
6-29-2008: Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer
6-22-2008: Obesity, Lifestyle & Heart Disease; Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo Biloba, Ulcerative Colitis & Colorectal Cancer
6-15-2008: Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort
6-8-2008: Vitamin D & Prostate Cancer Risk; Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense Telomerase & Cancer
6-2-2008: Acute Coronary Syndrome- Do You Know the Symptoms?; Green Tea & Lung Cancer; Episiotomy & Subsequent Deliveries- An Unkind Cut
5-25-2008: Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely
5-18-2008: Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers
5-11-2008: Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease
5-4-2008: Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight & Coronary Artery Disease; Contamination of Surgical Instruments in the Operating Room
4-27-2008: Stents vs. Bypass Surgery for Coronary Artery Disease; The “DASH” Hypertension Diet & Cardiovascular Disease Prevention; Testosterone Therapy for Women with Decreased Sexual Desire & Function
4-20-2008: BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke
4-13-2008: Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention
4-6-2008: Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer; Human Papilloma Virus (HPV) Infection & Oral Cancer; Hormone Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux Disorder (GERD)
3-30-2008: Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment & Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria
3-23-2008: Age of Transfused Blood & Risk of Complications after Surgery; Obesity, Blood Pressure & Heart Size in Children
3-16-2008: Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen Conversations about Sex; Soy (Genistein) & Prostate Cancer
3-9-2008: Flat Colorectal Adenomas & Cancer; Health Risks after Stopping Hormone Replacement Therapy (HRT); Television, Children & Obesity
3-2-2008: Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death
2-23-2008: Universal Healthcare Insurance Study; Glucosamine & Arthritis
2-17-2008: Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer; Smoking & Pre-malignant Colorectal Polyps
2-10-2008: Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for Down's Syndrome?
2-3-2008: Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer
1-27-2008: Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology's Gastrointestinal Cancers Symposium
1-20-2008: Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly
1-12-2008: Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer
1-7-2008: Testosterone Supplements in Elderly Men; Colorectal Cancer-- Reasons for Poor Compliance with Screening Recommendations
12-31-2007: Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?
12-23-2007: Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease
12-16-2007: Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough, Acupuncture & Hot Flashes in Women with Breast Cancer, Physical Activity & the Risk of Death, Mediterranean Diet & Mortality
12-11-2007: Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease
12-2-2007: Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer

Dr. Wascher's Home Page

Sunday, June 21, 2009

Red Yeast Rice, Statins & Cholesterol

Health Report:

Red Yeast Rice, Statins & Cholesterol

"A critical weekly review of important new research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS

Last Updated: 06/21/2009

RED YEAST RICE, STATINS & CHOLESTEROL

According to the American Heart Association, more than 50 million Americans require some sort of intervention to prevent or treat coronary artery disease, and another 15 million, or more, require medication in order to lower their cholesterol levels to a safer range.

Today, the statin class of drugs plays a dominant role in the management of elevated cholesterol (hyperlipidemia), and these drugs are widely used to both prevent and treat coronary artery disease when diet and exercise prove inadequate by themselves. While the full spectrum and extent of the health benefits of statin drugs continues to be the subject of debate, there is ample high-level clinical research evidence that statins significantly reduce the risk of clinically significant coronary artery disease, heart attack (myocardial infarction), and death in patients with elevated blood levels of “bad cholesterol” (LDL), and even in patients who have normal LDL levels, but who also have elevated C-reactive protein (CRP) levels. (CRP is a protein that becomes elevated in the blood in the presence of inflammation.)

Unfortunately, as with all medications, the statins are associated with potentially significant side effect. The most serious side effects that have been associated with statin drugs are muscle injury (rhabdomyolysis) and liver injury. Based upon recent research data, approximately 5 percent of patients taking statin drugs will experience significant muscle pain and weakness, requiring that they discontinue their statin medication. In severe cases, rhabdomyolysis can lead to permanent muscle injury and kidney failure. An additional 2 percent of patients may have to stop taking statins due to significant liver toxicity. Joint pain, peripheral nerve injury, and memory loss have also been associated with the use of some statin drugs, although the link between statins and these more uncommon side effects is less clear than for rhabdomyolysis and liver injury.

When diet and exercise alone fail to reduce elevated LDL levels, particularly when there is a personal or family history of cardiovascular disease, statins are generally the first line of treatment (in addition to aspirin, if there are no contraindications to taking aspirin). However, patients who do not tolerate statins have limited choices in terms of effective alternative lipid-lowering therapy.

Niacin, which is one of the oldest forms of therapy for hyperlipidemia, is one alternative option , and although not as effective as statins, this vitamin supplement, when given in high enough doses, can not only reduce LDL cholesterol, but also triglycerides (the predominant form of fat in the blood) as well. Additionally, niacin therapy can also raise the “good cholesterol” (HDL) level in the blood. (By comparison, statins have only small effects on triglyceride levels, and minimal effects on HDL levels in the blood.) The biggest disadvantage of niacin therapy, however, is its tendency to cause severe flushing in about half of patients who take the standard form of this drug, as well as the abdominal pain, nausea and vomiting that occurs in another 8 to 10 percent of patients. However, newer extended-release preparations of niacin are much better tolerated, with an incidence of adverse side effects of approximately 6 to 8 percent. (Fortunately, in most cases, flushing and the other adverse side effects associated with niacin therapy will improve over time if patients continue to take this medication.) As with statin drugs, however, there is a 1 or 2 percent risk of liver toxicity associated with niacin therapy for hyperlipidemia, and most patients who take either statin drugs or niacin for elevated LDL levels should be periodically monitored for elevations of liver enzymes in their blood. Long-term niacin therapy may also increase blood sugar (glucose) levels in patients with pre-diabetes or diabetes, and may also raise blood levels of uric acid, which may, in turn, lead to the development of gout in susceptible individuals. Therefore, fasting blood glucose levels and the level of uric acid in the blood should be monitored, as well, in patients who are taking niacin for hyperlipidemia (these two latter complications of niacin therapy also appear to be less common when taking the newer extended-release niacin preparations.)

Other non-statin therapies are also available for the treatment of elevated LDL and triglyceride levels, but they are seldom used, as they are not only less effective than statins and niacin, but their side effects profiles are so significant that very few patients remain compliant with these alternative lipid-lowering therapies.

Red yeast rice (Monascus purpureus, for you botanists out there), has been used in China for at least 1,200 years. The yeast spores are typically grown on rice, from which this product gains its name. In addition to its use, for centuries, as an herbal medication (mostly in East Asia) for stomach complaints and poor circulation, Chinese food lovers will recognize the brick-red color of red yeast rice whenever they eat Peking duck or char siu.

A handful of small previous research studies have suggested that red yeast rice may be as effective as some statins in reducing LDL and triglyceride levels when taken as a dietary supplement. This is not surprising, as most pure preparations of red yeast rice actually contain naturally-occurring lovastatin, one of the early statin drugs (and which, by the way, was first isolated from aspergillus, which is another form of fungus). However, other compounds contained within red yeast rice are also thought to additively contribute to the claimed LDL-lowering effects of this dietary supplement, above and beyond the contribution of the small amount of lovastatin contained within many of these preparations.

A new prospective, randomized, placebo-controlled clinical research study of red yeast rice strongly suggests that at least some forms of red yeast rice supplements may, indeed, be highly effective in reducing elevated blood levels of LDL in patients who have been unable to tolerate standard statin medications. This study, which appears in the current volume of the Annals of Internal Medicine, randomized 31 patients to receive 1,800 milligrams of red yeast rice twice per day, while the other 31 patients in this study received placebo (sugar) pills that looked identical to the red yeast rice supplement pills. Neither the patients nor the researchers knew which patients were receiving the red yeast rice and which patients were receiving the placebo pills until after the study was completed. All 62 patients were also enrolled in a 12-week lifestyle and dietary modification program for patients with hyperlipidemia.

This study was continued for 24 weeks, and blood levels of LDL, HDL, triglycerides, and liver enzymes were measured at the beginning of the study, as well as 12 weeks and 24 weeks into the study. Additionally, blood levels of creatinine phosphokinase (CPK), a muscle enzyme that is released when statin-induced rhabdomyolysis occurs, were also measured at these same time points. (All of these 62 patients had previously discontinued statin therapy due to muscle pain.)

At the 12-week point, the average LDL levels of the patients in the red yeast rice group had declined by a very significant 43 milligrams per deciliter (mg/dl), compared to the 11 mg/dl reduction obtained in the placebo group with lifestyle and diet modification alone. At the 24-week point, a 35 mg/dl reduction in LDL levels was observed in the red yeast rice group versus a 15 mg/dl average decrease in LDL levels at 24 weeks in the placebo pill group. (It is very important to note, by the way, that even the “placebo group” of hyperlipidemia patients were able to reduce their elevated LDL levels with diet and exercise alone!)

While LDL and total cholesterol levels were significantly reduced in the red yeast rice group, when compared to the patients in the placebo group, blood levels of HDL, triglycerides, liver enzymes, and CPK did not differ between the two groups of patients. Moreover, there were also no significant differences in weight loss or the incidence of muscle pain between the two patient groups following 24 weeks of red yeast rice supplementation.

In summary, this was a small prospective, randomized, placebo-controlled clinical research study involving patients who had previously discontinued statin therapy due to muscle toxicity. In this study, which lasted for a relatively short duration of about 6 months, red yeast rice supplementation (in addition to lifestyle and dietary modifications) significantly reduced blood levels of LDL and total cholesterol. Throughout this research study, there was no clinical or laboratory evidence of liver or muscle toxicity associated with the use of red yeast rice supplements.

The results of this study are highly intriguing, although it does leave some important questions unanswered. In particular, it is not clear to what extent that naturally-occurring lovastatin, contained within in the red yeast rice supplement used in this study, is responsible for the LDL-lowering effects of red yeast rice that were observed in this study (a small previous research study has suggested, but not proven, that the degree of LDL reduction observed with red yeast rice supplementation is greater than what would be predicted by the actual lovastatin content of red yeast rice).

Despite the very intriguing results of this small pilot study, all readers should be reminded of some very important caveats regarding the purchase and use of red yeast rice supplements. Because of the variable but significant lovastatin content of many red yeast rice dietary supplements, the Food and Drug Administration (FDA) has recently sent warning letters to several dietary supplement manufacturers, indicating the Government’s concern that red yeast rice contains a known prescription-only drug and, therefore, that the FDA’s position is that such supplements should probably not be sold as over-the-counter dietary supplements. The variability of lovastatin content in various forms of red yeast rice also makes it difficult for consumers to know how much lovastatin is contained within these supplements, which may be a problem for patients who are predisposed to liver, muscle, or kidney toxicity associated with statin use. Also, because lovastatin, and other potentially active compounds in red yeast rice, can pass into both the placenta and breast milk, women who are pregnant (or who may be pregnant), and women who are breastfeeding, should not be exposed to any supplement or foods that contain red yeast rice. Finally, other compounds that may be toxic to the liver and kidneys have previously been detected in some red yeast rice preparations.

Because of these various health-related concerns, I want to make it very clear that I am not, at this time, advocating the routine use of red yeast rice for medicinal purposes. However, if you have failed all other forms of lifestyle, dietary, and medical therapy for significant hyperlipidemia, then you may wish to forward a link to this column to your Internist or Cardiologist. If they are open to the possibility of incorporating red yeast rice into your lipid-lowering regimen, and they are willing to closely monitor you for signs of toxicity (as well as unexpected pregnancy, for fertile female patients), then this approach may be something that you and your doctor may wish to consider. However, I absolutely do not recommend that you begin taking red yeast rice supplements without the involvement and approval of your physician, because of the health-related safety concerns that I have already discussed.

Finally, I will close out this week’s column by wishing all of you other hard-working dads out there a very happy and warm Fathers Day. Among all of the blessings and fortunes that we might be lucky enough to acquire during our busy and often stressful lives (and especially during these trying times), being a dad, and having the privilege of making such a tremendous difference in the lives of our children, is surely one of the greatest gifts that we can receive. Please remember to try to carve out some special time, everyday, to spend with your children.

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and the Physician-in-Chief for Surgical Oncology at the Kaiser Permanente healthcare system in Orange County, California