In this latest study, 63 percent of African-American men were deficient in vitamin D compared with 18 percent of Caucasian men. To make matters worse, the blood serum levels of vitamin D in the African-American men were even lower than those in Caucasian men who were deficient: vitamin D levels were only 17.2 ng/ml among black men compared with 24.2 ng/ml among the white men.

When vitamin D levels fall below 20 ng/ml, “the bone starts to become brittle in adults and in kids it causes rickets,” noted Murphy. Vitamin D deficiency is also associated with prostate cancer, diabetes, multiple sclerosis, and rheumatoid arthritis. The commonly used and healthier cutoff point is 30 ng/ml of vitamin D, although the Vitamin D Council recommends 50 ng/ml as the optimal, minimal level for health.

All the men in this study were from Chicago, an area of low sunlight compared with more southern regions. When you combine insufficient exposure to sunlight with the fact that the pigment called melanin in darker skin blocks the ultraviolet rays needed by the body to produce vitamin D, the result is that African-American men need up to six times more exposure to sunlight than Caucasian men, Murphy noted.

Murphy, a Chicago-based African-American physician, pointed out that he needs 90 minutes of sunlight three times a week to get enough vitamin D compared with just 15 minutes three times a week for a Caucasian male in Chicago.

Murphy explained that all men who live in the northern third of the United States need to increase their vitamin D supplementation.  To achieve a healthy level of vitamin D in their bloodstream, Murphy said African-American men who live in Chicago need to take nearly 2,500 International Units of a vitamin D supplement. Yet the standard, one-size-fits-all recommendation from the Institute of Medicine is merely 600 IUs daily for adults.

All men, and especially African-American men, should evaluate their vitamin D intake and talk to their doctor about supplementation. Foods that contain vitamin D include cold-water fish such as salmon, herring, trout, sardines, and halibut; fortified orange juice, tuna, and fortified cereals are moderate sources.

Sources:

Northwestern University

Vitamin D Council: http://www.vitamindcouncil.org/about-vitamin-d/vitamin-d-deficiency/am-i-vitamin-d-deficient/

Ginger has anti-inflammatory and antioxidant properties that have been studied in the management of other health conditions, including rheumatoid arthritis and nausea, especially when associated with chemotherapy. In the realm of cancer, however, little research has been done.

This study evaluated the effect of whole ginger extract in mice given human prostate cancer xenografts (the transplantation of cells from one species to another). When the mice were fed whole ginger extract, growth and progression of the prostate cancer xenografts declined by about 56 percent when compared with mice not given ginger. The ginger extract did not cause any toxicity.

The study’s authors noted that they believe theirs is the first study to show anticancer activity of whole ginger extract for management of prostate cancer. Naturally, these results are very preliminary, but they do suggest ginger may have a role in managing prostate cancer.

Sources: Funk JL et al. Comparative effects of two gingerol-containing Zingiber officinale extracts on experimental rheumatoid arthritis. J Nat Prod 2009 Ma 27; 72(3): 403-7

Karna P et al. Benefits of whole ginger extract in prostate cancer. Br J Nutr 2011 Aug 18: 1-12

Ryan JL: Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: a URCC CCOP study of 576 patients. Support Care Cancer 2011 Aug 5

While a healthy diet is certainly important in the fight against many diseases, adding dietary supplements is not a sure-fire way to prevent problems from occurring.  Most recently, researchers from the University Health Network in Toronto, Canada found that three hopeful contenders in the fight against prostate cancer – vitamin E (as alpha-tocopherol), selenium, and soy – were not found to be effective, even after three years of taking them daily.

For the study, Dr. Neil Fleshner MD, FRCSC, MPH, the head of the urology department at UHN, and colleagues randomly assigned 303 men to take either a combination of the three nutrients or a placebo every day.  The experimental group received 40 grams of soy (equivalent to about 1/3 of a cup), 800 IU of vitamin E (as alpha-tocopherol) (35 times the recommended dietary levels), and 0.2 grams of selenium (4 times the RDA).

All of the men had a precancerous condition called high-grade prostatic intraepithelial neoplasia (HGPIN) that placed them at a higher risk for developing prostate cancer.  After three years, twenty-six men out of every 100 developed prostate cancer regardless of whether they took the dietary supplement or the placebo control.

Selenium and vitamin E (principally, as alpha-tocopherol) are two nutrients that were also studied in the large SELECT prevention clinical trial funded by the National Cancer Institute.  Both are antioxidants which are thought to help control cell damage that can lead to cancer.  Over 35,000 men participated in the study however, the researchers found that selenium, either alone or combined with vitamin E (as alpha-tocopherol), did not prevent the development of prostate cancer. The researchers did observe a statistically nonsignificant increased risk of prostate cancer with vitamin E alone and newly diagnosed type 2 diabetes with selenium alone. (Lippman 2009) A post-SELECT Trial analysis, however, has suggested that further research is needed to determine whether selenium should still be considered in the fight against prostate cancer. (Ledesma 2010)

“I think in the absence of more compelling scientific data for vitamin E and selenium that we should move on” said Dr. Eric Klein.  Dr. Klein was not involved with the Canadian study, but is the chair of the Glickman Urological and Kidney Institute at the Cleveland Clinic and headed previous research into the nutrients’ potential affects against prostate cancer.

It should be noted that the studies that have evaluated the potential benefit of vitamin E supplements and health conditions use the form alpha-tocopherol, which is the most common form of the vitamin in both body tissues and dietary supplements.  Emerging research is taking into consideration another form of vitamin E, known as gamma-tocopherol which is the major form of vitamin E found in plant seeds and the diet.  According to a study published in 2001 in the American Journal of Clinical Nutrition, gamma-tocopherol may well be more effective of an antioxidant than alpha-tocopherol and it has been shown that alpha alone, without gamma is not as effective as when higher concentrations of gamma exist in the right ratio.  Researchers are looking into the gamma form for benefits in preventing both prostate cancer and heart disease and the results to date are encouraging.

On the other hand, previous research has shown a beneficial association between soy and prostate cancer.  Genistein is an antioxidant and isoflavone found primarily in soybeans and has been shown in test tube and animal studies to interfere with the growth of prostate cancer cells and help prevent metastasis.  Observational studies note that men in countries such as China in Japan who regularly eat soy products such as tofu and miso have lower rates of prostate cancer incidence, although the type and quantity of soy consumed in those countries is much different than consumed in the West.

Dr. Fleshner notes that the study may not have shown positive benefits because taking the dietary supplements for just three years may not have been enough to prevent HGPIN from progressing to prostate cancer.

Resources:

1.  Original Reports – Urologic Oncology:Progression From High-Grade Prostatic Intraepithelial Neoplasia to Cancer: A Randomized Trial of Combination Vitamin-E, Soy, and Selenium

Neil E. Fleshner, Linda Kapusta, Bryan Donnelly, et al. JCO May 2, 2011:JCO.2010.32.0994; published online on May 2, 2011;

http://jco.ascopubs.org/content/early/2011/04/26/JCO.2010.32.0994

2.  Medical News Today, Prostate Cancer: More Soy In Diet May Protect Against Deadly Disease, accessed May 5, 2011 at http://www.medicalnewstoday.com/articles/224373.php

3.  NCHS Data Brief, Number 61, April 2011

Dietary Supplement Use Among U.S. Adults Has Increased Since NHANES III (1988–1994), accessed May 5, 2011 athttp://www.cdc.gov/nchs/data/databriefs/db61.htm

4.  gamma-tocopherol, the major form of vitamin E in the US diet, deserves more attention.  Jiang Q, Christen S, Shigenaga MK, Ames BN.  Source:  University of California, the Department of Molecular and Cell Biology, Berkeley, USA.  Am J Clin Nutr. 2001 Dec;74(6):714-22.  accessed May 7 at http://www.ncbi.nlm.nih.gov/pubmed/11722951

5.  Dr. Neil Fleshner’s profile can be found at:

http://www.uhnresearch.ca/researchers/profile.php?lookup=1843

In a new review of the literature, J. Kellogg Parsons, MD, MHS, associate professor of surgery at the University of California, San Diego, Moores Cancer Center, outlined the modifiable lifestyle factors that contribute to the development of BPH and LUTS.  These two conditions are often studied together because BPH is the main cause of LUTS.

In the review, Parsons named three factors associated with an increased risk of both BPH and LUTS: obesity, diabetes, and consumption of meat and fat. He noted that most studies have found a relationship between obesity and an increased risk of both BPH and LUTS, including a Norwegian study of 21,700 men (Seim 2005) and the seven-year prospective analysis of 5,700 men who participated in the Prostate Cancer Prevention Trial. (Kristal 2007)

Parsons stated that “disruptions in glucose homeostasis have been strongly and robustly associated with a higher likelihood of prostate enlargement, BPH, and LUTS” in a variety of studies involving tens of thousands of men. Results from the Prostate Cancer Prevention Trial also show that meat and fat consumption are associated with an increased risk of BPH and LUTS. (Kristal 2008)

On the positive side, lifestyle factors found to help reduce the risk of BPH and LUTS include exercise, vegetable intake, and alcohol consumption. Regarding exercise, Parsons noted a 2008 study in which a meta-analysis of 11 studies involving 43,083 men found that moderate to vigorous exercise was associated with up to a 25 percent reduced risk of both BPH and LUTS. (Parsons 2008)

Vegetable consumption can reduce a man’s risk of BPH and LUTS, (Kristal 2008) and benefits are especially good for higher blood levels of carotene and lycopene, which are found in high concentrations in vegetables such as tomatoes, carrots, and greens. (Tavani 2005; Rohrmann 2004)

The research findings on alcohol consumption are mixed. While a meta-analysis of 19 studies involving 120,091 men found a 35 percent reduced likelihood of BPH among men who drank moderately daily, the study also found an increased risk of LUTS. (Parsons 2009)

Parsons also reported that research thus far has not reached any definite conclusions about the associations between cholesterol/triglycerides and BPH and LUTS, nor between smoking and both of these conditions.

This review suggests that modifiable lifestyle factors, including exercise, obesity, diabetes, diet, and alcohol consumption have a substantial impact on the development of BPH and LUTS. Parsons thus noted “there is little, if any, downside to promotion of healthy lifestyle interventions—weight loss, exercise, decreasing meat and fat intakes, and increasing vegetable intake—among BPH and LUTS patients.”

Sources

Kristal AR et al. Race/ethnicity, obesity, health related behaviors and the risk of symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial. J Urol 2007; 177:1395–1400.

Kristal AR et al. Dietary Patterns, Supplement Use, and the Risk of Symptomatic Benign Prostatic Hyperplasia: Results from the Prostate Cancer Prevention Trial. Am J Epidemiol 2008; 167:925–34.

Parsons JK. Lifestyle factors, benign prostatic hyperplasia, and lower urinary tract symptoms. Curr Opin Urol 2011; 21:1-4

Parsons JK, Im R. Alcohol consumption is associated with a decreased risk of benign prostatic hyperplasia. J Urol 2009; 182:1463–68.

Parsons JK, Kashefi C. Physical activity, benign prostatic hyperplasia, and lower urinary tract symptoms. Eur Urol 2008; 53:1228–35.

Rohrmann S et al. Association between serum concentrations of micronutrients and lower urinary tract symptoms in older men in the Third National Health and Nutrition Examination Survey. Urology 2004; 64:504–9.

Seim A et al.  The prevalence and correlates of urinary tract symptoms in Norwegian men: the HUNT study. BJU Int 2005; 96:88– 92.

Tavani A et al. Intake of selected micronutrients and the risk of surgically treated benign prostatic hyperplasia: A Case–Control Study from Italy. Eur Urol 2005. http://www.sciencedirect.com/ and http://www.europeanurology.com/.

He was introduced to Dr. Eliaz who found that an old injury in Vietnam was the missing piece that needed to be addressed. Read more

“It’s a really sad thing about selenium,” concedes Dr Helen Rippon, head of research management at the UK Prostate Cancer Charity (www.prostate-cancer.org.uk). “All the initial laboratory data seemed to suggest it could be particularly useful in combating prostate cancer, but when it came down to the really big human-based trials it just didn’t cut it.” READ MORE

Q. Dr. Geo. Great article about beta sitosterol, especially the advice to take it on an empty stomach to increase absorption when using it for BPH. Can you clarify the statement ”When purchasing beta-sitosterol, look for products designed to treat BPH and not those for treating high cholesterol.” Are the formulations different such that only the BPH formulation is well absorbed (as opposed to the cholesterol reducing formula which is designed to bind cholesterol in the gut and not be absorbed?

Kevin

A. Plant sterols (also known as stanols) supplements often contain ingredients other than beta-sitosterol, based on whether they are for BPH or for lowering cholesterol. For example,  beta-sitosterol supplement is targeted for BPH and prostate health while beta-sitosterol, along with all the other phytosterols (campesterol  campestanol, and sitostanol) are used combined to lower cholesterol. So if the primary goal is to obtain prostate health then a mixed phytosterol supplement with higher concentrations of  beta-sitosterol  levels (above 60 mg) should be used. Consumers should look at the amount of beta-sitosterol in the product and make sure they are getting the amount their healthcare provider recommends.