Positive Health Online

As we publish this October 2010 Issue 175 of Positive Health PH Online, news items have been prominent across the media regarding progress with targeted genome molecular research in melanoma cancer - the development of PLX4032, which has shown to reduce tumour size in late-stage melanoma patients.

Customizing treatments, i.e. drugs to the mutated gene affected - BRAF - will eventually, it is hoped, result in cancer treatment approaches which are less globally toxic and more specific to the affected body cells. Less the proverbial slash, cut and burn approach and more the individualized, gentler approach which may destroy the cancer but save the patient.

The article published in this issue Prostate Cancer - Natural Prevention Strategies and Information for Females by Aris Antoniou discusses a variety of nutritional and herbal prevention strategies for prostate cancer:

"A sufficient supply of zinc in the diet can help prevent prostate disorders from developing. Eating foods high in zinc like seafood and pumpkin seeds, plus zinc supplementation is highly recommended. This can reverse the zinc deficient diets many of us in the West consume. Pumpkin seeds also contain plant sterols and essential fatty acids such as Oleic and Linoleic. They are even used as therapy for BPH sufferers in some countries.

Plenty of antioxidant rich fresh vegetables and brightly coloured fruits should be included in the diet as well, along with lots of fresh still mineral water to keep the body hydrated. Essential nutrients such as Selenium should be consumed either in food or supplementation form. Selenium removes heavy metals such as Cadmium, which can stimulate the growth of prostate tissue, from the body. The richest source of this nutrient is Brazil nuts.

Recent scientific research suggests that eating tomatoes can help too. Tomatoes contain an antioxidant called Lycopene. Men who eat tomatoes and tomato products such as unsweetened puree, every day, are 33 per cent less likely to develop prostate cancer than those who never eat tomatoes.

Saw Palmetto is another popular natural remedy which can be used to prevent and treat prostate problems. This berry extract counteracts the effects of hormonal changes in the body.

Finally, an extract from a large evergreen tree - Pygeum Africanum - is also thought to reduce enlarged prostates by reducing inflammation, fluid retention and helping to repair damaged blood vessels. Pygeum contains active components such as Beta Sitosterol and Phytosterols. However, more research is needed to confirm that it successfully treats prostate problems as does Saw Palmetto."

Also published today is the result of a Network Meta-Analysis including 10 randomized controlled trials including 3803 patients by Wandel et al. [1] The conclusions from this meta-analysis, in which "direct comparisons within trials were combined with indirect evidence from other trials using a Bayesian model" and in which data regarding osteoarthritis of the knee and hip were interchanged were as follows:

"Compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space. Health authorities and health insurers should not cover the costs of these preparations, and new prescriptions to patients who have not received treatment should be discouraged."[1]

In these days of instant electronic media, a ripost to this trial Don't count your chickens until they are ALL hatched has been issued by Orthopaedic Registrar Shyan Goh.[2]  [Editor's Note: Please see this letter for full references.]

"I am no fan of health supplements but I am aware of the increasing use of Glucosamine and similar preparation promoted for use for osteoarthritis (OA). There is few good research on the efficacy of glucosamine and chondroitin in their effectiveness therefore I appreciate the efforts of the authors  (Ref 1) to help differentiate the information available out there.

However like several meta-analysis and guidelines including those of American Academy of Orthopaedic Surgeons (Ref 2), the researchers failed to consider several current factors in their assessment of these drugs, specifically glucosamine:

1. Glucosamine comes in 2 different formulation and manufactured often in conditions not the same as pharmaceutical standards. Higher quality studies reporting favourable response of glucosamine to knee OA involves glucosamine sulphate not hydrochloride. It also appears that Rottapharm is involved in these studies where trials are industry-funded. Whether or not it is only Rottapharm-patented glucosamine sulphate formulation that gives better results than other glucosamine formulation is unclear.

2. While I cannot account for all the guidelines and recommendations of Glucosamine in the world, I am aware of several prominent groups like OsteoArthritis Research Society International and Arthritis Foundation mostly discuss their recommendations of use of glucosamine on knee (and not hip) osteoarthritis. I believe that the heterogeneity in several meta- analyses of glucosamine trials may also be due to the group analysis of knee and hip OA in the attempt to improve the power of the analyses.

3. Some studies have remarkably high placebo effect (60.1% in the GAIT study: Ref 3) and also complicated by the variation in severity of OA of participants between trials. It is therefore difficult to conclude if glucosamine is only beneficial to certain stages of knee OA; in milder OA the gross fluctuation of symptoms make it too hard to detect a difference while in advanced OA the symptoms is too severe to modify outcome.

I noted that initial results of LEGS trial (ref 4), which investigates glucosamine sulphate in knee OA with pain score 4 to 10 on Visual Analogue Scale, would not be available before October 2011. Nevertheless in view of the issues with highlighted above, I do not believe that we can draw any firm conclusion without the results of this trial, which addresses all my concerns with the meta-analyses of efficacy of glucosamine (sulphate) on (knee) osteoarthritis performed so far.

The last egg has not hatched yet. It may very well be the golden goose you are waiting for, and not a chicken!"

From the above, it would appear that this story is far from complete; however this did not prevent the appearance on Radio 4's Today Programme of a Senior Author of this study, advocating that glucosamine and chondroitin supplements should definitely not be available on the NHS. No doubt similar noises are emanating from the USA and other countries.

Glucosamine is the precursor to Glycosaminoglycans, amino acids that are naturally produced in your body to help form cartilage. Chondroitin sulfate is a sulfated glycosaminoglycan (GAG), an important structural component of cartilage  and provides much of its resistance to compression. Hence these 'supplements' being researched are naturally occurring in joints. Although the placebo effect is being waved around again, it is unlikely that research of the past 20 years with osteoarthritis has been figments of the imagination.

I guess we have to take the long view that nowadays, argument and counterargument are a necessary component of the evolution of healthcare - conventional and natural, which appear to be converging at a faster rate, with the emergence of the human genome sequencing.

For a view of more natural approaches to bodywork and rehabilitation, please read the excellent bodywork features: Looking After Yourself with Trager Mentastics, Neuromuscular Taping: Innovative Rehabilitation Technique and Spinal Stenosis and Fusion Surgery.

References

1. Simon Wandel, Peter Jüni, Britta Tendal, Eveline Nüesch, Peter M Villiger,  Nicky J Welton,     Stephan Reichenbach and  Sven Trelle. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ    2010;  341:c4675   doi: 10.1136/bmj.c4675. 16 September 2010.
2. Shyan Goh, Orthopaedic Registrar, Lismore Base Hospital NSW Australia. Don't count your chickens until they are ALL hatched. 2010