Vincent Pastore Goes Public With Prostate Cancer Battle

Actor Vincent Pastore has gone public with his prostate cancer fight after secretly battling the disease for the past year.

The Sopranos star reveals he was diagnosed with the illness in March, 2013, shortly after landing a role as a mobster in Woody Allen’s stage adaptation of Bullets Over Broadway and he was so worried cancer would rob him of his chance to shine on Broadway, he kept the news of his health crisis to himself.

He underwent surgery last July (13) and received radiation treatment at White Plains Hospital in New York between November (13) and January (14), all while attending “physically exhausting” rehearsals for the musical in Manhattan.

Pastore finally decided to come clean about his cancer battle to play director Susan Stroman and he was relieved when she didn’t fire him from the cast.

He tells the New York Daily News, “I told her that if she had to get rid of me, to just get rid of me. Instead she started to cry. She hugged me and said, ‘I will never get rid of you.’ It was an amazing moment that gave me the strength to work even harder.”

Pastore has also heaped praise on filmmaker Allen for his support throughout the ordeal and he cannot believe he has since made it to his 100th performance of Bullets Over Broadway, which opened in April (14).

He says, “I kept setting goals for myself during this illness. First, make it through rehearsals. Then to previews. I did that. Then to opening night. I did that. Then to 100 performances, a big deal on Broadway. Now I wanna make it to my 68th birthday, July 14th. Now producers are talking to me about maybe taking Bullets Over Broadway to London…

“Now I can officially say, ‘Ok, I’m a proud prostate cancer survivor.’ I feel great…”

The actor is now making it his mission to raise awareness about the disease and he reveals his efforts helped one famous pal spot his cancer early.

He adds, “I warned a lot of my friends to go get checked out. One well-known actor did and he caught his prostate cancer in time.”

Sourced:http://www.contactmusic.com/story/vincent-pastore-goes -public-with-prostate-cancer-battle_4274889

Chronic inflammation of prostate cancer tissue might increase the risk of high- grade prostate cancer.

BOTTOM LINE Chronic inflammation is a common finding in biopsy tissues and could increase the risk of high-grade cancer. This is yet another reason to reduce your risk of heart disease to as close to zero as possible and to get up to date with your vaccines (is that a typo…what is Moyad talking about – sorry but you need to read the whole story). WHAT ELSE DO I NEED TO KNOW? Inflammation is a buzzword and helps to sell a lot of commercial products today. Part of the reason these products sell is that inflammation appears to be responsible for a number of diseases today. For example, inflammation of the arteries appears to play a role in the increased risk of heart disease. There is a blood test known as “hs-CRP” or high-sensitivity CRP or cardiac CRP that is now used by many doctors to determine cardiac risk beyond what cholesterol tells us. Hs- CRP is simply a potential measure of inflammation. There are also other medical conditions that are also clearly linked to inflammation. For example, inflammatory bowel disease can increase the risk of colon cancer and inflammation caused by a parasite in some third world countries can increase the risk of bladder cancer. Inflammation in the esophagus caused by chronic acid reflux can increase the risk of throat cancer. Inflammation of the liver, hepatitis, caused by a virus for example is known to increase the risk of liver cancer. Therefore, researchers for a long time have also suspected that inflammation in the prostate could be associated with an increased risk of prostate cancer. Researchers from the Prostate Cancer Prevention Trial (PCPT) tried to gain further insight recently into this matter since most of the patients in this study also had biopsies done before, during and/or after the study was concluded. They looked at 191 cases of prostate cancer and 209 matched controls. Interestingly, men with at least one biopsy core with inflammation had 1.78 times the odds of prostate cancer versus men with no cores with inflammation. Of further interest, the association was greater for high-grade prostate cancer. And, to eliminate the chance for bias the researchers also found that this relationship existed even for men with low PSA levels and not just higher PSA levels. Chronic inflammation in the prostate could cause cellular changes or mutations and as more abnormal cells divide it could cause the growth of a cancer or inflammation, which can cause abnormal cellular communication, which could also create a better environment for a cancer to grow, including aggressive disease. Well, all this stuff sounds great but it’s not yet proven but this doesn’t matter. Almost everything deemed to be heart healthy actually reduces inflammation in the body from head to prostate to toe. For example, lowering cholesterol, normal blood glucose, blood pressure, weight/waist and a healthy diet, exercise and no tobacco (Ahhh, Moyad Miracle 7) are all responsible for reducing heart disease risk and inflammation. Some of our pills with the most research in heart disease prevention, from aspirin to statins, also have the ability to reduce inflammation. And, let me let you in on another secret! Vaccines may also do a good job of reducing whole body inflammation! What? I believe nothing replaces a flu shot (or other needed vaccines), especially the long list of supplements readers send to me inquiring about what they could do in order to replace the flu shot or other vaccines. The reason that nothing replaces the flu shot is because it is designed based on the most current strains of virus that are infecting folks around the world. In other words it is incredibly up to date and no dietary supplement for the flu will ever be this up to date. Second, the flu shot provides ancillary benefits we are just beginning to appreciate, for example it appears to be reducing the risk of cardiovascular events like heart attack and strokes (Udell JA, et al. JAMA 2013;310:1711-1720). It may be doing this by preventing the body from having an extreme inflammatory reaction. Interestingly, new research on the SHINGLES vaccine is beginning to show that it can also reduce the risk of a cardiovascular event like a heart attack or mini-stroke (Breuer J, et al. Neurology 2014)! I also believe that if you get the flu, the disease itself is usually not as bad and you recover quicker if you have had a flu shot (you get over it in several days as oppose to several weeks). I also believe that every time you get a flu shot you are committing a selfless act by protecting more vulnerable elderly and children you come in contact with from getting this medical condition. There is a concept called “Herd Immunity” (google it please…actually I mean “Michigan it” because one of the inventors of google went to the University of Michigan so I am starting a new trend whereby I say “Michigan it” instead of “google it”) which shows that the more folks in a population that get vaccinated the lower and lower the prevalence of the disease in the community even for people that do not get vaccinated. This has occurred multiple times with other diseases. The biggest problem I see with the flu or shingles vaccine is many individuals are waiting too long before they get it. You should get it the week it becomes available such as August or September because it takes 2-4 weeks to develop the antibodies to fully protect you from the flu. So, if you get it in October or November you are really late in the game! Now I will return you to your regularly scheduled program!

Sourced: Prostate Cancer Newsletter

Family history is ‘a bigger risk factor than lifestyle’ for some cancers.

A Swedish study of nearly 71,000 adopted people has used data from both their natural and adoptive parents to find that family history is a greater risk factor than lifestyle for developing breast, prostate, or colorectal cancer.

The genetic factors behind these three major cancers are well established, but this large survey of data published in the European Journal of Cancer has looked a unique group of people in a bid to disentangle familial risk from environmental factors.

By looking at adoptees, the researchers were able to see how being raised in an environment that was independent of hereditary genetics – being brought up by adoptive parents – revealed the true extent of the biological influence exerted by the genes of their real parents.

In effect, the study separated out the cancer effects of family history versus those of the environment.

If a person’s biological parent had cancer, there was an 80-100% higher chance of them developing the same disease than if their natural parents were free of the cancer.

Yet the history of adoptive parents had no influence on the risk of developing cancer. If an adoptive parent had cancer, there was no increased effect on the adoptee.

The study was led by Bengt Zoller, a reader at Lund University in Sweden. Dr. Zoller says:

“The results of our study do not mean that an individual’s lifestyle is not important for the individual’s risk of developing cancer, but it suggests that the risk for the three most common types of cancer is dependent to a greater extent on genetics.” The study also found that adoptees who had a biological parent with cancer developed the disease at a younger age than those without a biological parent with the same cancer. This effect was not seen in relation to adoptive parents, however – whose cancer had no influence on the adoptees’ age of disease onset.

Robust cancer data

The researchers analyzed data held in the Swedish Cancer Register, the validity and coverage of which is “almost 100%,” and in the Swedish Total Population Register, a “unique” block of information that also has “very few missing data.”

The fact that adoptees do not share the same family environment as their biological parents means that studying these data gives a purer picture of the genetic influence on cancer.

Even studies of twins, who share the same inherited genes, cannot separate the influence of parental genetics versus the influence of the environment they create.

Talking to Medical News Today, Dr. Zoller explains this further: “I think the study design is convincing regarding the possibility to separate nature and nurture. The classical study design for this is otherwise twin studies. Monozygotes are genetically identical but share environment to the same degree as dizygote twins (who share 50% genetic similarity).”

Dr. Zoller also told MNT that most adoptive children in Sweden are adopted before the age of 1, meaning their environment is separate from that of their biological parents. “We controlled for age, time period, sex, region of residence, and education.”

“Although it is well known that genetic factors contribute to the risk of prostate, breast and colorectal cancer,” the study paper says, “our finding that genetic factors seem to be more important than family environmental factors in the familial transmission of prostate, breast and colorectal is novel.”

The study analyzed the records of 70,965 adoptees born between 1932 and 1969. Their cancer diagnoses were made during the period between 1958 and 2010. Prostate cancer cases numbered 798, breast cancer cases were 1,230, and colorectal cancer, 512.

The researchers conclude that their “novel findings” are useful in the clinic for doctors assessing individuals’ risks of cancer as influence by the history of their biological parents. Dr. Zoller adds:

“The occurrence of breast cancer, prostate cancer and colorectal cancer in biological parents is an important risk factor that should be included in patients’ medical history and examinations.

It is therefore important that doctors ask about family history so that they can decide whether further tests are needed.”

In other cancer genetics research, a study published in July 2013 found that family cancer risk may be wider than relative’s specific type – that is, the higher risk of cancer was not confined to the specific type carried by the parent, and the risk of other cancers was raised, too.

Meanwhile, parental cancer hands down other effects – including the inflation of perceived prostate cancer risk by increased diagnosis seeking, the conclusion of Swedish research in 2010.

Another genetic analysis has found that family history of colorectal cancer may increase the risk of the aggressive form of the disease.

Sourced: http://www.medicalnewstoday.com/articles/278962.php Prostate Cancer Progression Linked to Obesity

Obesity may increase the long-term risk of disease progression in men on active surveillance for low-risk prostate cancer (PCa), according to study findings presented at the Canadian Urological Association annual meeting in St. John’s, Newfoundland.

Bimal Bhindi, MD, and colleagues at the University of Toronto studied 565 PCa patients on active surveillance for low-risk disease. Patients underwent digital rectal examinations (DRE) and PSA testing every 3 months (6 months in stable patients). The men had confirmatory biopsies at a median of 1 year. Of the 565 patients, 124 (22%) were obese (body mass index [BMI] of 30 kg/m2 or greater). The cohort had a median follow-up of 48 months.

The researchers observed pathologic progression (defined as no longer meeting criteria for low-risk criteria on follow-up biopsy) in 168 men (30%) and therapeutic progression (defined as intent to start active treatment) in 172 men (30%). Obesity was not associated with reclassification risk after confirmatory biopsy. It was associated with an increased risk of progression beyond confirmatory biopsies. Each 5-unit increment in BMI was associated with a significant 49% increased risk of pathologic progression and a significant 37% increased risk of therapeutic progression.

In a poster presentation, Dr. Bhindi’s group concluded that their findings have implications for risk assessment and counseling for men currently on active surveillance.

Other studies have suggested that obesity might impede PCa detection because of increased prostate size, more difficult DRE, and PSA hemodilution. Studies have also suggested that obesity also might cause biologic abnormalities that promote carcinogenesis, cancer proliferation, and progression, they explained. The new study suggests that in patients on active surveillance, there may be a true biological progression risk rather than merely an issue of misclassification.

In an interview with Renal & Urology News, Dr. Bhindi explained that when patients are diagnosed with low-risk PCa and go on active surveillance, there are always two questions: was a higher-risk cancer misdiagnosed as low risk and will this cancer progress?

“We typically perform a confirmatory biopsy at an average of 6-12 months following the initial diagnosis to make sure we did not miss a higher risk cancer,” Dr. Bhindi said. “Our study found no association between obesity and risk of re- classification at the time of confirmatory biopsy. The next phase [of the study] was the longer-term monitoring. During this phase, we detected that obesity is associated with an increased risk of progression.”

The apparent link between obesity and an increased risk of cancer progression while on active surveillance presents a clinical dilemma, Dr. Bhindi said. “Obese men are at an increase of dying of other causes such as cardiovascular disease, making them great candidates for active surveillance: They will die of something else before prostate cancer. On the other hand, they are also at an increased risk of cancer progression. This makes decision-making challenging for obese patients with low risk prostate cancer. We feel active surveillance should still be used in obese men, but increased vigilance is required.”

Dr. Bhindi added that obesity is, theoretically, a modifiable risk factor. “Thus the next logical question is, can this risk of progression be modified by diet, exercise, and/or certain medications? This will be the topic of future studies.”

Sourced: http://www.renalandurologynews.com/prostate-cancer-progression -linked-to-obesity/article/358187/

Low-Dose Aspirin May Reduce Risk of Some Cancers

What if an aspirin a day could keep cancer away? A growing body of scientific research suggests that aspirin can prevent some cancers of the digestive system, and maybe even breast and prostate, too.

In the latest study, published on Thursday in the journal Cancer Epidemiology, Biomarkers & Prevention, Yale University researchers found that patients from 30 hospitals across the state were less likely to develop pancreatic cancer if they took a small, daily dose of aspirin.

Researchers are stopping short of recommending aspirin as a broad cancer prevention tool, because of its possible side effects, including stomach pain and gastrointestinal bleeding.

“Aspirin is not a risk-free substance,” said Dr. Harvey Risch, a professor of Epidemiology at the Yale School of Public Health, who led the research. People who are already taking aspirin to prevent heart attacks or fight pain should feel good that they may be reducing their cancer risk, too, he said.

Those at extra risk for colon, esophageal, or pancreatic cancer – either because of a previous bout, family history or smoking habit – may want to talk to their doctor about whether a baby aspirin a day makes sense for them, said Dr. Andrew Chan, a gastroenterologist at Massachusetts General Hospital and associate professor of medicine at Harvard Medical School.

The same small dose – usually 81 mg a day – is often prescribed to prevent heart attacks, and researchers first discovered a connection when they noticed that people taking aspirin for heart disease did not develop as many cancers as would be expected.

A higher dose, usually taken for pain, also helps, but isn’t necessary and is more likely to bring side effects, Risch said. A lower dose may work, too, but doctors don’t yet know how low is enough or how long someone needs to take aspirin to see a cancer benefit.

Researchers aren’t entirely sure why aspirin reduces cancer risk, but presume that it helps by reducing inflammation. Other anti-inflammatory drugs like Tylenol did not show the same anti-cancer benefit in the Yale study, Risch said, probably because they work in slightly different ways.

The mounting evidence that aspirin can prevent some cancers is prompting researchers to look more carefully at who benefits from aspirin therapy, how much should be given, and who can tolerate it, said Daniel W. Rosenberg, an investigator at the Center for Molecular Medicine at the University of Connecticut Health Center in Farmington.

The new study, Rosenberg said, “adds fuel to speed that along.”

Rosenberg has been studying several thousand colon cancer patients at John Dempsey Hospital at UConn, and also found a connection between aspirin and cancer prevention.

The strongest evidence for aspirin is in colon cancer prevention, Chan said. There is substantial evidence of a benefit for esophageal and pancreatic cancer, and emerging data suggesting protection against breast and prostate cancer as well.

The Yale study, which took place from 2005 to 2009, suggested that taking aspirin cut the risk of pancreatic cancer in half, but Chan cautioned that it’s probably much less.

Risch said he is studying pancreatic cancer in patients across the state to get a better understanding of what factors may contribute to the nation’s fourth deadliest cancer – and therefore what might be done to prevent it. He’s also been looking at the role of the bacteria H. pylori, known to cause ulcers and gastric cancer, as well as smoking and alcohol use.

Prevention is a better approach than treatment or early detection for pancreatic cancer, he said, because detecting the disease a year or two earlier is unlikely to make much difference in lifespan.

Sourced: This story was reported at WNPR.org under a partnership with the Connecticut Health I-Team (c-hit.org). http://wnpr.org/post/low-dose-aspirin-may-reduce-risk-some-can cers

Active Surveillance Underused for Low-Risk Prostate Cancer

Although most prostate cancer specialists believe active surveillance to be effective and underused, fewer endorse active surveillance than other therapies for low-risk prostate cancer, according to a study published in the July issue of Medical Care. Simon P. Kim, M.D., M.P.H., from Yale University in New Haven, Conn., and colleagues surveyed 1,366 radiation oncologists and urologists about their perceptions of active surveillance and recommendations for low-risk prostate cancer treatment. Differences in physician perceptions on active surveillance and treatment recommendations were compared for 717 physicians that completed the survey.

The researcher found that 71.9 percent of physicians stated that active surveillance is effective, and 80.0 percent reported that it was underused in the United States. However, most physicians (71.0 percent) reported that their patients were not interested in active surveillance. More physicians recommended radical prostatectomy (44.9 percent) or brachytherapy (35.4 percent), while fewer recommended active surveillance (22.1 percent) for low-risk prostate cancer. Compared with radiation oncologists, urologists were more likely to recommend surgery and active surveillance (odds ratios, 4.19 and 2.55, respectively) but less likely to recommend brachytherapy and external beam radiation therapy (odds ratios, 0.13 and 0.11, respectively), in multivariable analysis.

“Most prostate cancer specialists in the United States believe active surveillance effective and underused for low-risk prostate cancer, yet continue to recommend the primary treatments their specialties deliver,” the authors write.

Sourced: http://www.doctorslounge.com/index.php/news/pb/47696

New treatment for enlarged prostate successful in dogs

Enlarged prostate is a common problem in older males (both humans and non-humans!). Parsemus Foundation sponsored a study by Dr. Raffaella Leoci to investigate a potential new non- invasive treatment in dogs with benign prostatic hyperplasia. The method was very effective at reducing the size of the prostate gland and we expect that it is relevant for human use too. The study was just published in the journal The Prostate.

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia (BPH) is an age-related enlargement of the prostate gland. BPH is one of the most frequent medical problems in elderly males. In humans, it can result in urinary tract problems, obstruction of the urethra, sexual dysfunction and blood in the urine. One of the most frequent symptoms is having to get up to use the bathroom multiple times during the night. Older dogs also commonly have BPH and there is little difference from humans in anatomy, physiology and symptoms of this disease. The most common clinical sign of BPH in dogs is bloody fluid dripping from the penis not associated with urination. In severe cases it can obstruct the colon and result in constipation.

BPH results from urogenital aging. Recent studies suggest that an age-related impairment of the blood supply to the lower urinary tract plays a role in the development of BPH and thus may be a contributing factor in the pathogenesis of BPH.

Simple and effective treatment for canine prostate disease could also help humans

The new method used in the study to treat dogs with BPH was pulsed electromagnetic field therapy (PEMF). PEMF is a noninvasive method that generates both an electrical and magnetic field and is used in orthopedics, neurology, and urology. It has been reported to have an anti-inflammatory effect and increases healing and blood circulation. The idea of using this method for BPH is to improve prostate blood flow and reduce the size of the prostate gland.

The study included 20 dogs with BPH. They received treatment with PEMF for 5 minutes, twice a day for three weeks. The device was simply held over the skin where the prostate is located. The study used a Magcell® Vetri device from Physiomed Elektromedizin AG, Germany.

An average 57% reduction in the size of the prostate resulted from PEMF treatment in only three weeks, a remarkable improvement. There was no interference with semen quality, testosterone levels or libido. Doppler parameters showed a reduction of peripheral blood resistances and a progressive reduction in resistance of the blood flow in the dorsal branch of the prostatic artery.

The efficacy of PEMF on BPH in dogs, with no side effects, suggests that it might be a great treatment in humans. The study also supports the hypothesis that impairment of blood supply to the lower urinary tract may be a causative factor in the development of BPH.

How does pulsed electromagnetic field therapy work?

The mechanism of action of PEMF on canine BPH is not exactly known and could involve several modalities. It may have an effect on nitric oxide or directly on inflammation. Recent research has shown that PEMF is mediated by an increase in nitric oxide synthesis, which may contribute to the pathogenesis of BPH. By reducing inflammation PEMF may prevent complications or may play a role in reducing changes linked to BPH and related conditions. By producing an increase in blood circulation, PEMF may also help to prevent secondary complications caused by reduced arterial blood flow such as prostatitis (inflammation of the prostate gland) and improve BPH symptoms. Next steps

A clinical trial could test whether this approach works as well in humans as in dogs. Parsemus Foundation can’t fund a human clinical trial, but is making the information available so that others can. Since clinical trials are expensive and take time to arrange, some men who are particularly bothered by BPH symptoms, haven’t had success with herbal medicine (like saw palmetto) and don’t want surgery may decide in conjunction with their doctors to get one of the devices and try it.

Sourced: http://www.medicalnewstoday.com/releases/278720.php

You Are What You Eat: Food Choices and Cancer Risk

This month, researchers at the nonprofit Physicians Committee of Responsible Medicine published new cancer prevention dietary guidelines. The recommendations, culled from varied cancer risk studies, are designed to increase consumer awareness about the very real connection between nutrition and disease. The Committee encourages a plant-based diet with emphasis on foods that promote a healthy weight and contain antioxidants and other cancer-fighting properties. Prostate cancer is among the leading cancers discussed in the guidelines.

David Samadi, MD, Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital, encourages patients to consider the large body of evidence supporting these guidelines. “Limiting meat consumption and focusing on natural verses processed foods are things we can all do easily. Why not take advantage of controllable ways to improve wellness and hopefully prevent prostate cancer and other cancers?”

Foods that help you prevent or fight cancer:

1) Soy product – Soy protein reduces prostate cancer risk, recurrence, and mortality. Natural forms of soy are best – organic tofu, tempeh, and edamame.

2) Fruits and veggies – Consuming higher quantities of fruits and vegetables helps both men and women fight a wide range of cancers including colorectal, stomach, lung, and gastric cancers. Tomatoes and tomato products are packed with antioxidants, while leafy greens, broccoli, and kale contain additional cancer fighters. Carotenoid-rich vegetables like carrots and sweet potatoes help women fight breast cancer.

Foods found to increase cancer risk:

1) Dairy – Prostate cancer risk climbs 32 percent per 35 grams of dairy protein/day and as much as 60 percent per two glasses of milk each day. Calcium supplements of more than 400 milligrams per day increase fatal prostate cancer risk by 51 percent.

2) Alcohol – Just one drink of wine, beer, or spirits per week can increase risk of oral cancers — mouth, pharynx, and larynx — by 24 percent. Colorectal cancer risk increases 21 percent when 2-3 drinks are consumed daily.

3) Red meat and processed meat – Colorectal cancer risk increases 28 percent per 120-gram daily serving of red meat and 21 percent per 50-gram daily serving of processed meat. Researchers believe that red and processed meats encourage the growth of cancerous cells.

4) Grilled, fried, and broiled meat – The cooking temperatures and times of meat are associated with increased risk of colon cancer and rectal cancer. Cooked meats are also linked to prostate cancer, as well as breast, kidney, and pancreatic cancers.

“Over the years, Americans have adopted diets that are very high in meats in fats. Unfortunately, we’ve grown accustomed to convenience foods that do more harm than good,” said Dr. Samadi. “The risks are real and with very manageable modifications we have the potential to change our health forecast.”

The guidelines details are available online at the Physicians Committee for Responsible Medicine, http://www.pcrm.org/pdfs/health/cancer/Dietary-guidelines-for- cancer-prevention.pdf and will be published in the Journal of the American College of Nutrition June 30 issue.

Sourced: http://www.einnews.com/pr_news/210343365/you-are-what-you-eat- food-choices-and-cancer-risk

Soy Okay in Diabetic Men with Low T

Soy supplements won’t send testosterone levels plummeting in men with type 2 diabetes who already have low levels of the hormone, researchers reported here.

Testosterone levels actually rose with supplementation with either a soy protein bar or a soy protein bar that also contained phytoestrogens, Thozhukat Sathyapalan, MBBS, MD, of Hull York Medical School in England, and colleagues reported at the joint meeting of the Endocrine Society and the International Congress on Endocrinology here. Some possible benefits in metabolic parameters were also seen with the phytoestrogen-containing soy bars, the group indicated.

“There’s no concern that soy will effect testosterone,” Sathyapalan said. “In fact, it can maybe have a positive effect.”

Some researchers have expressed concerns that the phytoestrogens in soy have estrogen-mimicking effects that may affect testosterone levels — particularly in men who already have low testosterone. These phytoestrogens include genistein and daidzein.

To assess whether these phytoestrogens can impact testosterone levels in men with type 2 diabetes who have borderline low testosterone levels, Sathyapalan and colleagues assessed 210 men with the condition who were between the ages of 55 and 70 and whose testosterone levels were below 12 nmol/L.

They were randomized to a 30-g soy protein cereal bar that either contained phytoestrogens (66 mg) or no phytoestrogens, eating two a day for the three months of the study.

Overall they saw an increase in testosterone levels in both study arms: “We thought there would be a reduction in testosterone levels, but there was an increase in testosterone levels in both groups,” Sathyapalan said at a press briefing.

Mean levels rose from 9.8 to 11.3 nmol/L in the combination group and from 9.2 to 10.3 nmol/L in the soy alone group, his group reported. No changes in estrogen levels were seen in either group.

The researchers also found that those taking the phytoestrogen bar had additional benefits in terms of metabolic parameters and cardiovascular risk.

Specifically, that group showed a significant drop in mean fasting plasma glucose, from 142 mg/dL to 116 mg/dL, compared with a slight uptick from 141 mg/dL to 151 mg/dL in the soy- alone group, as well as a drop in HbA1c not seen with soy alone.

Patients assigned to the phytoestrogen-containing bar also had a significant improvement in insulin sensitivity, with HOMA-IR scores falling from 7.2 to 2.5 compared with a rise from 10.2 to 11.3 for those on soy alone.

The phytoestrogens group also had a decrease in triglycerides, C-reactive protein, and diastolic blood pressure that wasn’t seen in the soy-alone group.

Sathyapalan said the results weren’t surprising given the fact that soy has long been used as a medical food in diabetes. He concluded, however, that further studies are needed to determine the differing effects of soy protein alone and soy protein plus phytoestrogens.

He added that he and his colleagues have also investigated the differences between these two cereal bars in postmenopausal women, finding that both improve bone turnover markers which could have implications for osteoporosis.

Another study, however, showed that soy supplementation may have ties to hypothyroidism; further study is needed to definitively determine if that is the case.

The study was supported by the Food Standards Agency in the U.K.

Sourced: http://www.medpagetoday.com/MeetingCoverage/ENDO/46461?xid=nl_ mpt_DHE_2014-06-24&utm_content=&utm_medium=email&utm_campaign= DailyHeadlines&utm_source=WC&eun=g558671d0r&userid=558671&emai [email protected]&mu_id=5685532 Task Force: ‘No’ to Routine Vit D Screening

Routine vitamin D screening for healthy adults can’t be recommended, according to the U.S. Preventive Services Task Force (USPSTF).

Uncertainty over even the threshold to define vitamin D deficiency or accuracy of screening tests led to a determination of insufficient evidence, the group noted in a draft statement released online.

While there’s adequate evidence that treating the deficiency early while still asymptomatic has little to no risk of harm, the evidence on benefit of doing so based on screening was sketchy, so the balance of risk to benefit couldn’t be determined, the USPSTF concluded.

A final statement will appear in the Annals of Internal Medicine after a chance for public comment until July 21, although experts contacted by MedPage Today indicated little dispute would be likely.

Clinical Implications

The conclusions were consistent with guidelines from the Institute of Medicine and the Endocrine Society, noted Holly Kramer, MD, MPH, an internist nephrologist at Loyola University in Chicago.

There still could be a big clinical impact given the skyrocketing performance of vitamin D testing, she predicted.

“Currently, many patients actually request their physician to do vitamin D testing based on what they read in the literature or the lay press regarding the impact of vitamin D on perhaps depression, cardiovascular disease, or other factors aside from bone health,” she told MedPage Today.

While good data on screening in primary care settings aren’t available, surveys have shown a tripling in the annual rate of inpatient and outpatient visits associated with a diagnosis code for vitamin D deficiency from 2008 to 2010, and at least a 50% year-over-year increase in vitamin D testing reported by more than half of clinical laboratories surveyed in 2009.

“What we really should do is focus on groups that may have a higher risk for vitamin D deficiency,” Kramer said. “If we do routine screening of the general population, it could cost billions of dollars, not only just for the laboratory testing but also for follow-up testing and the vitamin D treatment itself.”

High-risk groups would include patients with evidence of osteoporosis or elevated parathyroid hormone levels, she suggested.

Jagdeesh Ullal, MD, an endocrinologist at Eastern Virginia Medical School in Norfolk, saw the recommendations as mainly affecting primary care.

“It might help settle the dust for those who think vitamin D is a panacea,” he told MedPage Today. “However, in more specialized practice dealing with bone disorders, this may have little impact.”

For the predominantly osteoporotic patients he sees, vitamin D and calcium are still key go-to supplements added to bone rebuilding therapies, he said.

Such symptomatic patients weren’t covered by these guidelines.

“Having said this, most guideline such as this are set for the vast majority and a case by case approach may have to be utilized in prescriptions for vitamin D and calcium,” Ullal said.

The Evidence

No studies have assessed the health impact of screening asymptomatic adults who have serum hydroxyvitamin D concentrations of 30 ng/mL or less without any medical conditions that increase risk for deficiency, according to an evidence review led by Erin LeBlanc, MD, MPH, of Oregon Health & Science University in Portland, that accompanied the draft recommendation.

Supplementation studies in that population have shown reduced mortality, with a pooled risk ratio across 11 studies of 0.83 (95% CI 0.70-0.99).

But that benefit was limited to three studies with older, institutionalized populations (pooled RR 0.72, 95% CI 0.56-0.94).

Vitamin D treatment, with or without calcium supplementation, didn’t correlate with lower risk of falling (pooled RR 0.84, 95% CI 0.69-1.02) or fewer fractures across the five studies looking at those outcomes (pooled RR 0.98, 95% CI 0.82-1.16).

But there were fewer falls per person with vitamin D in those studies (pooled RR 0.66, 95% CI 0.50-0.88), “suggesting decreased falls among fallers,” LeBlanc’s group pointed out.

Neither vitamin D dose used in the studies nor the baseline serum vitamin D level of the studied population influenced the results, the researchers noted.

Too few studies to meta-analyze evaluated vitamin D supplementation in the context of cancer risk, type 2 diabetes risk, psychosocial functioning, disability, and physical functioning; none in cardiovascular disease or immune disease met inclusion criteria. The USPSTF has previously issued statements also concluding insufficient evidence for vitamin D supplementation in prevention of cardiovascular disease, falls, fractures, and cancer, albeit those recommendations touched on the general population of people who may or may not be vitamin D deficient.

“These other statements differ from the current statement in that they address vitamin D supplementation in certain populations at high risk for falls, fractures, cardiovascular disease, or cancer, without first determining a patient’s vitamin D status,” the USPSTF statement noted.

Toxicity from vitamin D treatment occurs well above levels considered sufficient, the evidence review noted; and the task force pointed to no significant increase in total adverse events, hypercalcemia, kidney stones, or gastrointestinal complaints in the studies reviewed.

Sourced: http://www.medpagetoday.com/PrimaryCare/DietNutrition/46464?xi d=nl_mpt_DHE_2014-06-24&utm_content=&utm_medium=email&utm_camp aign=DailyHeadlines&utm_source=WC&eun=g558671d0r&userid=558671 [email protected]&mu_id=5685532