BPH Medication and Prostate Cancer

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The medications used for treating BPH can mask true PSA levels; based on prior research, the PSA value should be doubled. I didn’t know that and evidently neither do many of the men who take the medications known as 5-alpha reductase inhibitors. Does it have an impact on prostate cancer diagnosis and mortality?

Researchers examined a large group of men treated at the Veterans Administration to answer that question. They compared men that did and did not use one of the medications to see if there were differences in when men were diagnosed via biopsy, the severity of the cancer at treatment, and the death rate between medication users and non-users. The results showed that the men who were taking the type of medications known as 5-alpha reductase inhibitors were diagnosed later, had more advanced disease, and died at a higher rate than those who didn’t use those types of medications.

One type of 5-alpha reductase inhibitor, finasteride, has a familiar name: Propecia or Proscar, which is also used to treat male-pattern baldness. Taking one of those meds can affect PSA, so be sure to discuss that with your doctor.

Does this mean that men shouldn’t use the medication? That’s a personal choice. To me, it means that both the man and his physician should be aware of the problem, have regular PSA tests, and double the value of the results. That way, the prostate cancer won’t be masked by the medication and like every type of cancer, the sooner it’s diagnosed, the sooner treatment can begin if warranted.

And that raises another issue: what about men who take herbs for BPH? Are they at risk? I’ll let you know what I found on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Intern Med. 2019;179(6):812-819. doi:10.1001/jamainternmed.2019.0280.

BPH Treatment and PSA

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One of the reasons I love what I do is that I learn something new just about every day. In this case, it may help some men sooner rather than later if they have benign prostatic hyperplasia (BPH).

The urethra runs right through the prostate gland. As a man ages, the prostate gland has a tendency to enlarge, and when it does, it can interfere with urine flow. The result is the inability to empty the bladder completely, which can cause frequent urination; a man may have to get up multiple times through the night to urinate.

The typical treatment is to use a medication called a 5-alpha reductase inhibitor that includes finasteride and dutasteride. By reducing the production of a specific form of active testosterone, the prostate can stop enlarging and urination improves. The problem with using the medication is that it can reduce the protein specific antigen level, a marker that can indicate a man has prostate cancer. Could it impact the diagnosis, treatment, and even death from prostate cancer? We’ll look at a recently published study that examined those very questions on Thursday.

The monthly Insider conference call is tomorrow night. You can take part by becoming an Insider today at drchet.com; if you’re a Member, you can upgrade to Insider and the charge will be prorated.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Intern Med. 2019;179(6):812-819. doi:10.1001/jamainternmed.2019.0280.

Does Fenugreek Extract Raise Testosterone Levels?

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“Do nothing and remain a shell of the man you could be!” That’s ad copy used for a popular brand of male virility product called Nugenix on their website. Nugenix is one of a number of products that try to address low testosterone levels in men; it contains fenugreek, among other substances.

Fenugreek has many documented uses: as a dietary supplement for diabetes, to stimulate milk production during breastfeeding, and for other health conditions. It has some positive research that suggests it will help reduce triglycerides and improve carbohydrate metabolism.

But what’s the connection with virility? What does fenugreek do for testosterone levels? Fenugreek extract may help increase testosterone levels slightly in the few human clinical trials that have been done. Based on quality of life assessments, men felt their overall sexual health had improved. The problem is that the products such as Nugenix all contained other ingredients that might have explained some of the effects, and of course there’s also the possibility of a placebo effect, especially in studies that ask for a subjective judgment of the substance’s benefits. And four clinical trials spread out over nine years isn’t exactly overwhelming clinical evidence.

There isn’t enough science to suggest whether products containing fenugreek extract will help raise testosterone levels, but there are two actions proven to increase testosterone: weight loss and exercise. If you want to do things naturally, that’s the way to do it.

What are you prepared to do today?

        Dr. Chet

References:

1. Aging Male. 2016 Jun;19(2):134-42.
2. Phytother Res. 2011 Sep;25(9):1294-300.

Can Medium-Chain Triglycerides Help with Alzheimer’s Disease?

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Medium-chain triglycerides are hot today. Derived from coconut oil or palm oil, they have the advantage of being used for energy without much processing by the liver. People doing the ketogenic diet use them, as well as athletes looking for more energy. From a medical perspective, MCTs are used for people with fat-absorption problems and to treat epilepsy in some people. For today, I’ll focus on the use of MCTs for preventing and treating Alzheimer’s disease.

From an examination of the research on those two specific areas, the research is sparse. There’s little to no research that MCTs will prevent Alzheimer’s disease. There are a couple of small studies that have been done to treat Alzheimer’s patients with coconut oil or MCTs, but the results are equivocal.

The reason MCTs may benefit the brain is energy production via a non-sugar-based pathway. Whether additional energy for the brain helps learning and memory is unknown. What seems clear is that prediabetes and type 2 diabetes contributes to the development of Alzheimer’s, so it seems more important to lower refined carbohydrates and eat a more plant-based diet. I think including extra virgin coconut oil in a better diet could be helpful. At this point, specific MCT products seem unwarranted due to the lack of research. They may prove to be useful for some groups based on genetics, phenotype, and microbiome. Just not yet.

What are you prepared to do today?

        Dr. Chet

References:

1. Lancet Neurol. 2018 Jan;17(1):84-93. doi: 10.1016/S1474-4422(17)30408-8.
2. Am J Alzheimers Dis Other Demen. 2014 Aug;29(5):409-14. doi: 10.1177/1533317513518650.

Will a Jellyfish Extract Help You Remember?

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For this week’s Memos, I’m reviewing products I get asked about frequently, all products that seem to have a large online or television presence. I’m going to review the base research on the product, and then you can decide whether you want to use it or not.

One of the most prevalent television commercials at this time is for a product called Prevagen, a dietary supplement whose tag line is “Improves Memory.” Prevagen contains an extract called apoaequorin from a type of jellyfish that appears to be well researched; however I found only a single clinical trial on the use of apoaequorin and memory. The 90-day trial of 211 subjects aged 40 to 91 showed no significant differences on a variety of cognitive tests between the placebo group and those using apoaequorin. However when a sub-group of subjects who were concerned about memory were tested using the AD8 test, there were statistically significant differences. When accounting for the actual differences in the reported percentages, the differences did not seem significant in the real world.

The product does appear to be safe in standardized toxicology tests on animals. Beyond that, there doesn’t seem to be any clear benefit for supplement use at this time because of the limited clinical research. It should not harm you, but it’s up to you to decide if the small chance it will help is worth your investement.

What are you prepared to do today?

        Dr. Chet

Reference: Adv Mind Body Med. 2016 Winter;30(1):4-11.

The Bottom Line on Human Fat as Medicine

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The final question in our look at human fat is whether there are actual benefits to the use of human fat for human health. Human fat is primarily long-chain saturated fatty acids; we’re animals and that’s the type of fat animals make. There are some hormones present in fat tissue and probably other factors related to blood vessel growth, but there were no proven benefits for the use of human fat for anything related to human health 400 or 500 years ago.

Why not? Science had not yet begun to use research techniques to assess the benefits. I sometimes criticize randomized clinical trials and the way they’re conducted, but even with its faults, research is necessary to assess whether benefits exist for any chemical. At its core, that’s what human fat is: simply a chemical.

Could there be unknown benefits? We’ll most likely never know for two reasons. First, no Human Subjects Committee would approve the research for the use of human fat for research. The legal and scientific quandaries of using fat from some humans on other humans are mind-bending.

Second, even if some benefits could be proven, there’s the issue of collection. We do not dispose or treat corpses in the same way we did 500 years ago. Where would the human fat come from? Just the thought would be disturbing to many people.

The Bottom Line

The historical look at human fat as medicine illustrates why the scientific process is important and irreplaceable, flawed though it may be. It’s a slow process and can be frustrating, especially as it relates to nutrition. In today’s “get a product to market first” climate, we end up with too many nutritional products in a marketplace with little to no science behind them. That will be our topic for next week’s Memos.

What are you prepared to do today?

        Dr. Chet

Reference: Christopher Forth PhD. 2019. Fat: A Cultural History of the Stuff of Life.

The Benefits of Human Fat

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Imagine that you woke up this morning with lower back pain; that’s not unusual for many people. You make it to your bathroom, pull out your nicely painted apothecary jar of human fat, and rub some into the painful areas. Or you have arthritis and you rub the human fat into your knees. No way, you say? Not if you lived in Europe in the 1600s. Human fat was thought to be able to heal and repair the body.

Not only that, it was thought it was able to heal wounds and promote the growth of connective tissue. How did they come to the idea that fat could help these conditions? There was supposed to be a spiritual quality to human fat that enabled these medicinal qualities, something that wasn’t present in fat from other animals or plants. Yes, they thought some of the dead person’s “vital force” was still there in the harvested fat.

Could there really be any medicinal benefit of human fat? We’ll take a look on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Christopher Forth PhD. 2019. Fat: A Cultural History of the Stuff of Life.

How Are You Fixed for Axungia Hominis?

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When the title of any article is written in Latin, you might think that what follows is probably complicated. How about if you knew that Axungia hominis simply means “human fat”? What follows isn’t complicated but it sure is surprising—at least it was to me. I read an excerpt from a forthcoming book I’m adding to my reading list; it’s titled Fat: A Cultural History of the Stuff of Life by Christopher Forth PhD. It explores human fatness over the ages.

For the Memos this week, I’m going to focus on human fat from a different perspective: medicinal qualities. Medicinal qualities? Yes. That was the belief from the 16th century through the middle of the 19th century according to Forth.

The first question has to be: how did they collect human fat to use as medicine? From corpses, of course. An entire industry was developed to collect human fat, and getting it from the recently deceased was a logical source. Battlefields also provided many recently deceased corpses from which to collect fat. What surprised me was the entrepreneurial spirit of the executioners during those times; they were compensated for the hangings or beheadings and then sold the fat that was harvested from the bodies.

That’s enough gross stuff for today. What exactly made the fat so valuable? What was it supposed to be able to do? I’ll cover that on Thursday.

What are you prepared to do today?

        Dr. Chet

Reference: Christopher Forth PhD. 2019. Fat: A Cultural History of the Stuff of Life.

Looking for Single-Nutrient Solutions

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As you might expect, I get asked a lot of questions about health, especially diet and exercise. One of the similarities between questions is whether a specific nutrient is special or unique. When I do the research to learn about the nutrient, I’ve never found one that’s the be-all and end-all—not turmeric or echinacea or omega-3 fatty acids or anything else. Can they be beneficial? Absolutely. But they’re a finishing touch, not a foundation.

The foundation of health begins with vegetables, fruits, whole grains, quality protein, and the best oils. The foundation also includes basic supplementation such as a multivitamin-multimineral and probiotics, among others. If you don’t begin with the best diet, then specific nutritional gaps, whether due to food preferences or genetic issues, can’t be bridged effectively because the body isn’t built on a strong foundation. Once you build your foundation, some of the specific nutrients can fill in gaps and act as insurance for the days you can’t eat as well as you know you should.

Eat better. Eat less. Move more. Build a foundation and you might find miracle nutrients aren’t really necessary.

What are you prepared to do today?

        Dr. Chet

P.S. Paula and I wish all of you a happy Memorial Day weekend! Travel and celebrate safely, and we’ll see you back here on Tuesday.

What Counts: Exercise or Movement?

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This week is planting week around the house, so Paula and I will be working around the yard each day. What we won’t do is go to the gym to work out. In thinking about it, that raises the issue of the myth of physical activity: does yardwork count or do you have to get your heart rate to a certain amount?

The answer is it all counts. In fact, if your lifestyle forces you to move a couple of times an hour, all day long, that’s associated with living longer. We’ve lost the equivalent of 700 calories of daily activity due to technological advances in the past century; those are calories that contribute to the weight gain that’s been creeping up on us. We could cut 700 calories from our daily diet or we can find ways to use another 700 calories every day. Anything and everything you can do to use calories throughout the day counts. Gardening and yardwork definitely count in that process, and as the image shows, it’s movement you can pass on to future generations.

We’ll look at a food myth on Thursday.

What are you prepared to do today?

        Dr. Chet