Eliaz also expressed the view that surgical removal of the prostate may be undesirable, not only because of the frequent unpleasant side effects, but, more importantly, because the main tumor produces anti-angiogenetic compounds-chemicals that inhibit the growth of new blood vessels in distant tumors. He is more comfortable with the use of radiation, since radiation has been shown to increase the levels of endostatin.
The final speaker on cancer treatments was Rigdon Lentz, M.D., director of the Nashville Apheresis Center. Apheresis is blood filtration similar to dialysis. It can selectively remove certain proteins from the serum. Dr. Lentz focused on the use of aphoresis as therapy for melanoma.
Melanoma responds poorly to chemotherapy, interferon and other mainstream treatments. On the other hand, tumor necrosis factor alpha (TNF alpha), a cytokine produced by macrophages, kills melanoma completely. When a molecule of tumor necrosis factor alpha attaches to the cell membrane, it causes tremendous oxidative stress; the cell dies in seconds.
What stops tumor necrosis factor apha from working, according to Lentz, is being bound to a decoy receptor produced by the tumor. "Cancer patients make plenty of tumor necrosis factor alpha, but it goes to the wrong receptors," Lentz stated. Fortunately, these receptors (the soluble tumor necrosis factor alpha receptors shed into circulation by the tumor tissue) can be filtered out. Lentz concentrated on melanoma cases, but stated that the treatment works also for breast cancer and ovarian cancer, colon cancer, soft-tissue sarcoma and non-small cell lung cancer.
Integrative diabetes treatment
Claude Lardinois, M.D., an endocrinologist at the University of Nevada and medical director of the Nevada Diabetes Association, gave a provocative lecture on Syndrome X and type II diabetes. Syndrome X is also known as the "deadly quartet," consisting of dyslipidemia (elevated serum lipids), insulin resistance (and the high insulin levels that go with it), obesity and high blood pressure. Hypercoagulability is also associated with this syndrome, which perhaps should be called the "deadly quintet." But Dr. Lardinois has come up with a new label that accurately pins down the two chief causes of Syndrome X. It is the "deadly duet of hyperactive fork and hypoactive foot, or the foot and fork disease." In other words, it is a disease brought about by the consumption of excess calories combined with lack of exercise. Hence, the best treatment is the hypoactive fork (calorie restricted, low-glycemic diet and weight loss) combined with hyperactive foot (regular exercise).
Make no mistake about it: while Dr. Lardinois' renaming of Syndrome X and diabetes as the "foot and fork disease: hypoactive foot, hyperactive fork," sounds humorous, it is extremely useful. Rather than simply describing symptoms, it shifts attention to the causes of these pathologies.
We are currently experiencing an explosive epidemic of type II diabetes. African-Americans and Hispanics have especially high rates of diabetes. The label "adult-onset diabetes" has become dubious, since 75% of diabetes now diagnosed among children is type II, once seen mainly only after the age of forty-five. Type II diabetics produce plenty of their own insulin, at least in the earlier stages of the disease. However, insulin is a hormone that downregulates its own receptor. Thus, the higher the insulin levels, the less sensitive the receptors, until severe insulin resistance develops, and glucose remains in circulation rather than entering the tissues. Excess glucose is toxic. This "glucotoxicity" results in accelerated aging and a number of disabling diabetes-related conditions, including heart disease, neuropathy (damage to the nerve cells), kidney disease (nephropathy) and kidney failure, and retinopathy that may lead to blindness.
An effective treatment should address the causes of diabetes (the "deadly duet," leading to insulin resistance), and not just try to ameliorate the symptoms. Metformin, which increases insulin sensitivity, is very useful, and has become the number one drug for the treatment of type II diabetes. Lardinois referred to metformin as a "powerhouse drug." It's interesting that metformin was developed from guanidine, the active component of such botanical folk remedies against diabetes as French lilac and goat rue.
Simply giving patients insulin can be counterproductive. "Doctors make patients even more insulin-resistant by giving them too much insulin," the speaker cautioned.
Dr. Lardinois stated that diabetes has become the number three killer in this country. The reason that this fact is not widely known is that the death certificate tends to list "heart attack" as the immediate cause. Hence the public still doesn't understand the danger that lies in the consumption of a diet high in refined carbohydrates and low in fiber and omega-3 fats (fish oil, flax oil, walnuts) and lack of sufficient exercise. Smoking constitutes another serious risk for diabetes, since it increases insulin resistance. Those who smoke more than 25 cigarettes a day have double the risk of diabetes.
Surprisingly, alcohol consumption decreases insulin resistance, but it may do so through a peculiar mechanism. Alcohol appears to impair the function of beta cells, which leads to less insulin release. Lower insulin levels are then reflected in more sensitive insulin receptors. Both glucose and insulin levels are lower in moderate drinkers than non-drinkers. Lardinois warned, however, that the beneficial effect of alcohol is seen in individuals with body mass index (BMI) over 22 (the average American has a BMI of 26). A thin person (BMI < 22) who drinks too much is at an increased risk of alcohol-dependent diabetes, related to pancreas damage.
The best predictor of diabetes is the body mass index (BMI), and also the type of obesity (being apple-shaped or abdominally obese correlates with diabetes risk, rather than being pear-shaped, with most fat on thighs and buttocks). Obese smokers tend to be abdominally obese. Interestingly, 90% of all diabetic amputations (loss of a foot or limb due to diabetes-induced gangrene) are among smokers. Even smokers who do not develop full-blown diabetes show lower HDL cholesterol, higher triglycerides, greater insulin resistance and higher blood pressure; basically, smoking causes Syndrome X.
A low-glycemic diet that is high in fiber and in healthy fats (with special attention to fish oil) is the cornerstone of holistic treatment of diabetes. "Low-glycemic" means that the diet doesn't increase blood sugar to the degree that typical American diet does, due to heavy reliance on white bread, sugary breakfast cereals, and other highly processed carbohydrates. Because omega-3 fats lead to a profound reduction in insulin resistance, diabetics would do well to eat fish daily.
Omega-3 fatty acids are known to enhance the utilization of fat for energy, thus helping prevent obesity. Long-term supplementation with omega-3 fatty acids has been shown to lower blood pressure and serum lipids.
To point out the importance of low-glycemic diet, Lardinois cited the example of traditional Eskimos, whose typical diet consisted of 45% fat (much of it omega-3), 40% protein and only 5% carbohydrates. Diabetes and cardiovascular disease were unknown. And yet Lardinois hesitated to recommend the Atkins diet. In his opinion, calorie restriction was more important than the actual composition of the diet. Exercise plays a major role both in the prevention and treatment of diabetes. A patient can achieve a 50 to 60 points drop in blood glucose with exercise alone. Skeletal muscles have a unique ability to take up glucose without the need for insulin. The process is regulated by glucose transporters (GLUT-4). Regular exercise induces a greater expression of glucose transporters (GLUT-4), thus lowering blood sugar and improving insulin sensitivity.
If blood sugar is extremely high (over 250), however, no exercise is permitted. "First, get blood glucose down to 125-then any treatment is effective because glucotoxicity is down," the speaker stated. Giving insulin can be the lesser evil, since glucotoxicity is more harmful than the bad effects of high insulin. By the way, the speaker stressed that in a normal person, insulin is a beneficial hormone; for instance, it increases nitric oxide production. Insulin is atherogenic only when there is insulin resistance, which leads to the pancreas secreting too much insulin. Chronically high levels of insulin are particularly dangerous. When insulin resistance develops, nitric oxide production goes down and coagulation increases, paving the way for a heart attack.
When it comes to supplements, Lardinois cautioned that chromium and vanadium do not seem to work for everyone. He was in favor of magnesium. "I strongly feel that all my patients should be on magnesium," he stated, adding, however, that "we don't really know the dose." Testing for magnesium levels is not reliable. We have more knowledge about lipoic acid, especially helpful for neuropathy, and CoQ10, essential for energy production. Likewise, conjugated linoleic acid (CLA) has been shown to be beneficial. Antioxidants such as vitamin E and vitamin C also appear to help.
The overall message is that the patient needs to be "in the driver's seat," taking responsibility for his/her diet, exercise and supplements. Furthermore, the implications go beyond those officially diagnosed with diabetes. As we age, our insulin levels typically increase, and insulin sensitivity decreases. "It's not that people eat more as they get older; it's that they become less active," Lardinois explained. Keeping insulin low should be one of the primary goals of any anti-aging program. Fortunately, there is no mystery about how to accomplish this goal: stay away from processed, refined carbohydrates, get daily exercise and take supplements that support healthy metabolism, including fish oil, CLA, CoQ10 and lipoic acid.
This year's Denham Harman Lecture was delivered by Gerald Lemole, M.D., Chief of cardiac surgery at Christina Care Hospital in Newark, Delaware. This innovative surgeon explained how he uses supplements both before and after heart surgery.
Before discussing supplements, however, Dr. Lemole stated that he was one of the pioneer surgeons who participated in the first heart transplants. A lot of the early patients didn't live very long after the transplant. It turned out that the surgeons used to sever thoracic lymphatic vessels. Impeded lymphatic circulation (and thus waste clearance) led to "galloping atherosclerosis." Lemole concluded that lymphatic clearance was a very important factor in cardiovascular health, and increasing lymphatic function was vital to the cardiac patients' recovery.
Fortunately, it is relatively easy to promote lymph clearance. First, deep breathing is vital to thoracic lymph circulation. Massage and exercise also promote good lymphatic function. Finally, flavonoids (phenolic compounds found in red wine, tea, chocolate, berries, citrus and other fruit and many vegetables) also enhance lymphatic clearance. The speaker emphasized that vegetables do not have their previous content of nutrients, due to nutrient depletion in the soil and factors such as long storage; animal food likewise is not as nutritious as in the past. In addition, many drugs cause micronutrient deficiencies. Supplements have become a necessity.
Lemole uses supplements both before and after surgery. A novel supplement that has turned out to be very helpful is ribose, a pentose sugar involved in energy production. Supplementing patients with ribose, both pre- and post-op, increases their ATP levels (ATP is our "energy molecule"). This helps prevent post-surgery heart failure due to a drop in energy production. The recommended dose is 1 gram for healthy individuals, and 5 grams or more for cardiac patients, 20 grams being the uppermost dose. Ribose has gained some popularity with athletes, but the public is still largely unaware of the benefits of this new supplement.
Besides ribose, pre-operative loading includes CoQ10, carnitine and adenine (one of the building blocks of nucleic acids, as well as a part of nicotinamide adenine dinucleotide [NAD], a coenzyme involved in energy production). Together with ribose, these supplements help the heart muscle produce the energy it needs for its contractions.
In addition, Lemole uses such supplements as magnesium, arginine, N-acetyl-cysteine, flavonoids, omega-3 fatty acids, B vitamins, vitamins C and A (to increase fibrinolysis, and thus make the patient less prone to clotting) and vitamin E (which acts as a vasodilator, among its many benefits).
Supplements are not a substitute for a diet change. Lemole pointed out that processed food constituted only 10% of the American diet in 1940; today it is a shocking 90%. A return to unprocessed, fiber-rich food is needed, together with a shift from meat consumption to much more fish consumption. Rather than speak of a low-fat diet, physicians should promote the "good-fat diet," high in omega-3 fatty acids.
Exercise is also a necessity for cardiac patients. Lemole recommends a brisk two-mile walk every day. In addition, the patient can benefit from massage and deep breathing.
Finally, noting the strong connection between depression and heart disease, Lemole urged physicians to become aware of the need for stress reduction and positive emotions in cardiac patients. Through positive self-talk, affirmations and setting positive goals, the patient can learn to become more optimistic. Quality self-help books such as Victor Frankl's Man's Search for Meaning can become an important recovery tool. Meditation and yoga also have proven cardiovascular benefits.
With the use of this "tripod approach" of exercise, stress reduction and diet combined with supplements, hospital re-admissions could be dramatically reduced.
The ACAM conference in Nashville confirmed the need to fight inflammation and hypercoagulabity as we grow older, pointing to the hitherto relatively neglected idea: adequate blood flow of the immense importance if we are to prevent the ravages of local ischemia and the tissue atrophy that follows. Aging-related tissue atrophy is a universal biomarker of decline, yet until now we have not really regarded sluggish, viscous blood and circulation impeded by fibrin deposits as a major causal factor in local ischemia and tissue atrophy.
One technique for improving circulation is exercise, and the need for exercise came up again and again in terms of diabetes and cardiovascular disease prevention and treatment. Keeping overall calories and the insulin levels low is another requirement for longevity. Finally, it became apparent that certain supplements kept being mentioned over and over. This was especially true of omega-3 fatty acids and curcumin (turmeric extract) as both an anti-cancer agent and a fibrinogen reducer, and thus an anticoagulant.
Aging still seems like an immensely complex biological jigsaw puzzle. Finally, however, more and more pieces are beginning to fall into place. Conferences such as that of the ACAM are helping keep physicians aware of these advances.