Author: noorali

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Role of Calcium and Milk Products in Prostate Cancer

Dear Dr. B: We are in Arizona for the winter. My husband and I have always taken calcium and Vitamin D. There seems to be a lot of controversy here with several people who feel that calcium for men is putting them at high risk for prostate cancer.
Apparently this warning was on T.V. and in the newspapers. What is the truth, doctor?

Answer: Nobody knows exactly what causes prostate cancer. There are a variety of factors implicated in this process. There are some factors (diet and weight) you can change but others like age, ethnicity and family history cannot be changed.

As we know, prostate gland is present only in man. Any normal man can develop prostate cancer because normal men have male hormones (testosterone). Lack of testosterone due to any cause can reduce the risk of prostate cancer.

Age is an important factor. Prostate cancer is rare before the age of 45. As one gets older, the risk increases. Men of African or Caribbean ancestry have the highest risk.

What has race to do with prostate cancer? Scientists are not sure about that. There may be subtle genetic, dietary, environmental and hormonal differences. Another interesting fact is that dark skin absorbs less sunlight than light skin, which may contribute to the higher incidence of prostate cancer among men of African or Caribbean ancestry because of lack of vitamin D.

Family history is important. If your father or brother has had prostate cancer you are approximately two to two and half times more likely than the average man to be diagnosed with the disease during your lifetime. Having two first-degree relatives with prostate cancer increases your risk to about five to 10 times that of a man with no family history, and your risk soars to almost 100 per cent if three or more first-degree relatives have had prostate cancer.

Diet is linked to prostate cancer. A low fat diet may help prevent prostate cancer. Foods rich in saturated fats have been associated with increased risk of prostate cancer, possibly because they are metabolized into testosterone. Fish oils may protect against prostate cancer especially omega-3 fatty acids found in fatty fish like trout, anchovies, bluefish and white albacore tuna.

What about the role of milk, cheese and calcium? The American Cancer Society website article of 2001says, “Experts say excessive calcium intake may be unwise in light of recent studies showing that high amounts of the mineral may increase risk of prostate cancer.”

Here is a dilemma. There is a reasonable evidence to suggest that calcium may play an important role in the development of prostate cancer but evidence also shows calcium may lower the risk of colon cancer and age-related thinning of the bones.

The recommended daily allowance (RDA) of calcium is 1,000 mg per day for men and 1,500 mg for women. Important thing to remember is the words, “excessive calcium intake.” It is also critical to remember that this evidence is not conclusive. The word “may” is used quite often in this context.

You can have milk, cheese and other dairy products in moderation. An 8-ounce glass of milk contains about 300 mg of calcium, an ounce of cheese has about 200 mg, and a serving of yogurt has about 312 mg of calcium. Men should stay within 1000 mg of calcium per day. And don’t forget your vitamin D 1000 to 2000 IU per day especially in winter months. Vitamin D has an important role in preventing prostate cancer and other cancers.

A balanced diet, combined with regular exercise, is always a good idea.

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What to Use for Bowel Cleansing Prior to Colonoscopy?

Dear Dr. B: I have been booked for a colonoscopy. I know I have to have my bowel cleaned out for this test to be successful. I am worried about using Fleet Phospho-soda (oral sodium phosphate product) bowel cleansing laxative because of the recent negative media reports. What should I do, doctor?

Answer: US Food and Drug Administration (FDA) issued an alert in December, 2008 which said, “FDA has become aware of reports of acute phosphate nephropathy, a type of acute kidney injury, associated with the use of oral sodium phosphate products (OSP) for bowel cleansing prior to colonoscopy or other procedures.”

FDA also says that in some cases when OSP is used for bowel cleansing, kidney failure has occurred in patients without identifiable factors that would put them at risk for developing acute kidney injury.

FDA recommends, in light of the risk of acute phosphate kidney injury, over-the-counter laxative OSPs should not be used for bowel cleansing. Consumers should only use OSPs for bowel cleansing pursuant to a prescription from a healthcare professional.
Fleet Phospho-soda has been used for many years, on millions of people, in many countries. It has been popular because of low cost and small volume of fluid to drink. The incidence of side effects is minimal in healthy individuals. There are three dangers associated with OSP in venerable patients who have heart failure or kidney disease – dehydration, electrolyte imbalance and phosphate injury to kidneys.

OSP is popular amongst physicians because it has been found to be a better bowel cleansing preparation than many other similar products.

FDA’s warning regarding kidney injury with OSP is of real concern to physicians and patients. A study published in the American Journal of Gastroenterology (103(11):2707-16, 2008 Nov.) concluded that in patients with preexisting kidney disease, OSP use was associated with an increased risk of kidney dysfunction. Their suggestion was to measure the kidney function before OSP administration in order to avoid its use in patients with renal disease.

Is bowel preparation before colonoscopy a risky business for the kidneys? This is the title of an article in Nature Clinical Practice Nephrology (4(11):606-14, 2008 Nov.). It says that in 2004, five cases of irreversible renal failure after bowel preparation with OSP were reported.

The authors say that more recently, several retrospective studies have shown that the incidence of acute kidney injury after OSP use is in the range of one to four per cent, similar to the incidence of contrast kidney disease in patients who undergo special x-rays where contrast dye is used.

During bowel preparation physicians should watch for and correct any fluid and electrolyte imbalance. Patients should be checked for kidney function and serum phosphorus level after colonoscopy. Other option would be to use alternative bowel cleansing agents.

What should you do if you are going for a colonoscopy? If your doctor wants you to use Fleet Phospho-soda to cleanse your bowel then your kidney function should be normal and you should have no cardiac problems like heart failure. The risk of kidney damage in healthy individuals is about one to four per cent. There are other bowel cleansing agents in the market. You can discuss with your physician what are your best options for a good clean out.

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Role of Flouride in Preventing Dental Caries

Dear Dr. B: Last evening I listened to a radio program regarding fluoride. The doctor who hosted the show had nothing good to say about fluoride and was quite adamant that it should not be in toothpaste or in our water. He said that just bathing in water with fluoride in it is causing too much absorption and is harming our bones amongst other things. I am especially interested because I have a hygienist appointment coming up and the procedure is always finished by applying fluoride in your favorite flavor.

Answer: Health Canada website is a good source of information on this subject. The information is summarized here.

There is enough evidence to show that the use of fluoride decreases dental caries. The introduction of fluoride to drinking water in 1958 resulted in a dramatic reduction of dental caries. It is also clear that the ingestion of too much fluoride can result in varying degrees of fluorosis.

Fluorosis is an abnormal condition caused by excessive intake of fluorides, characterized in children by discoloration and pitting of the teeth and in adults by abnormal bone changes. Thus, to prevent fluorosis, the administration of fluoride should strike a right balance.

Fluoride prevents caries mainly by its local effect. Dental caries result when plaque, a sticky film of bacteria on the surface of the tooth, feeds on sugar and food residue to produce acid, which dissolves the surface of the tooth (demineralization). Bathing the surface of the tooth with fluoride causes a dramatic decrease in enamel solubility. Ingested fluoride, on the other hand, has little effect on caries, but contributes significantly to the development of fluorosis.

Fluorosis of our skeleton is a progressive but not life-threatening disease in which bones become more brittle. In mild cases, the symptoms may include pain and stiff joints. In more severe cases, the symptoms may include difficulty in moving, deformed bones and a greater risk of bone fractures.

The Health Canada website has a statement from Dr. Peter Cooney, Canada’s Chief Dental Officer which says, “In light of recent news features, Canadians may be wondering if fluoride is, in fact, safe for use in our water supply and dental hygiene products such as toothpaste.

An expert panel, commissioned by Health Canada to review the scientific studies available on fluoride and its possible effects on health, made a number of recommendations to Health Canada, including:
-to decrease slightly the amount of fluoride that can be added to municipal drinking water,
-to encourage the availability and use of low-fluoride toothpaste by children, and
-to suggest to makers of infant formula to reduce levels of fluoride in their products.”

Community water fluoridation has been identified by U.S. Centers for Disease Control as one of 10 great public health achievements of the 20th century. Canadian and international studies agree that water that was fluoridated at optimum levels does not cause adverse health effects. About 40 percent of Canadians receive fluoridated water.

Experts say there are several steps you can take to maintain your fluoride intake within the optimal range for attaining the dental benefits. Never give fluoridated mouthwash or mouth rinses to children under six years of age, as they may swallow it. Health Canada does not recommend the use of fluoride supplements (drops or tablets).

Make sure that your children use no more than a pea-sized amount of toothpaste on their toothbrush, and teach them not to swallow toothpaste. Children under six years of age should be supervised while brushing and children under the age of three should have their teeth brushed by an adult without using any toothpaste.

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More Women Die From Heart Disease Than Cancer

“Cardiovascular disease is responsible for half of all deaths among women aged 50 and older in Canada and the United States,” says an article in the Canadian Medical Association Journal (CMAJ March 13, 2007). Heart attacks and strokes account for more deaths in women than all cancers combined.

We know heart disease is a number one killer in men and women. We also know sudden cardiac arrest is the leading cause of death in Canada, claiming about 40,000 people each year. About 95 per cent of them die before reaching the hospital. Can you imagine two-thirds of Medicine Hat’s population dying each year from heart attack? Scary, eh! So, if you are going to have a heart attack then you better be in the hospital or pretty close to it. The other options – stay healthy.

Most women worry about cancer of the breast, ovary, uterus and cervix. It is natural to worry about these cancers but it is also important to take care of your heart health. Scientists bear some of the blame for ignoring women’s heart health issues in the past. Most research studies previously were restricted to men. But in the last few years there has been significant interest in women’s heart health issues.

So, ladies, heart month of February is not over yet. Start a plan for yourself and your family. Make a list of things you can do to prevent heart disease.

Let us start with obesity. We are a nation of too many obese people. Central obesity is a more important risk factor for heart disease than body mass index in both sexes. So losing body fat is important. There are two things to do to lose excess fat: exercise and eat less. This isn’t rocket science but you need the discipline and determination of an astronaut.

It has been found that diabetes increases the risk of cardiovascular disease among women to a greater extent than it does among men. If you are a diabetic then make sure it is under control. Discuss with your doctor if you need to take any medications to prevent heart disease.

Differences in cardiovascular presentation – one recent study suggests that men report more severe chest pain and sweating and that women report less severe pain and more nausea. Does that mean man get more attention than women? Quite likely. Women with atypical symptoms and no severe chest pain are more likely to remain undiagnosed. Women have more silent heart attacks than men. Physicians should remember this and pay more attention to women’s chest symptoms.

It has also been shown that women with acute heart attack are less likely than men to receive thrombolysis (clot busting immediate therapy) or revascularization (bypass surgery).

Women’s heart health is getting more attention now. Hopefully, this will reflect in the future studies in a positive way. So, ladies, do your part and stay healthy that means your family will be healthy as well.

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