ONCOLOGY UPDATE

Tamoxifen, an estrogen antagonist, is associated with side effects classically seen during menopause. These side effects include hot flashes, night sweats, and joint pain and stiffness. An interesting study in the October 30, 2008, Lancet Oncology, suggests that these specific side effects may be a sign that the treatment is working. In a “look-back” study, also known as a retrospective study, 3,964 women with early-stage breast cancer were treated with either tamoxifen or anastrozole (Arimidex). Both drugs block estrogen in different ways. Tamoxifen is a direct receptor blocker and anastrozole blocks the activity of aromatase, an enzyme important in the production of estrogen in fat and other tissues. Nearly 40% of the 3,964 women reported vasomotor symptoms (hot flashes and night sweats) and 31% reported joint pain and stiffness. After nine years, women who experienced both vasomotor symptoms and joint symptoms had an 11.4% lower risk for a tumor recurrence. Women who experienced only joint pain had a 10% reduction in recurrence and women who reported only vasomotor symptoms had a 6% reduction in symptoms. Now, don’t panic if you’re reading this, on tamoxifen, and you’re not having any symptoms. It doesn’t mean that your tamoxifen ISN’T working. It most likely means that some women have enhanced or intensified hormonal effects—most likely due to genetic or epigenetic reasons.

NUTRITIONAL NUGGETS

Dark chocolate. Consuming moderate amounts of dark chocolate could help lower your levels of C-reactive protein, which can be measured to determine the general degree of inflammation in the body. In a study published in the October 2008 issue of the Journal of Nutrition, a study of more than 2,000 people found that those who ate up to one serving (20g) of dark chocolate every three days had CRP concentrations significantly lower than those who ate none or who ate larger amounts. Researchers suggested that eating too much could result in an increase in lipids and calories that would wipe out the anti-inflammatory benefits of the dark chocolate. Other research has also noted the cardiovascular and anti-inflammatory benefits of flavonoid-rich foods such as dark chocolate. YES!

B12 and the incredible shrinking brain.Is there no end to the benefits of vitamin B12? YES, it helps maintain a healthy production of red blood cells, and YES, it keeps your neurons happy, and YES, it helps maintain peripheral nervous system myelin, so what else is new? A study in the journal Neurology, (September  9, 2008), found that older people with low, but still “normal,” levels of B12 were 6 times more likely to experience brain atrophy (shrinkage) than those with the highest B12 levels. The low-B12 group in the study also lost twice as much brain volume on average. WHOA!! But, before you run out and buy all of the B12 on every shelf in Wal-Mart, Kmart, and Target, note that this study had a few flaws—1) it was an observational study and couldn’t prove a causal connection between vitamin B12 intake and brain shrinkage, and 2) the sample size was relatively small (107 men and women). BUT, that being said, most of us over 50 could use a little boost of B12 and it certainly couldn’t hurt, and it has all of the potential in the world to help. So…

Next question? How can we pump up the B12? B12 is naturally found in foods that come from animals, including fish, meat, poultry, eggs, milk, and dairy products. The RDA (Recommended Daily Allowance) for adults is 2.4 micrograms per day—roughly the amount found in 3 ounces of lean beef. Most Nutrition Facts labels don’t list a food’s B12 content; those that do use percentages based on the DV (Daily Value), which for B12 is 6.0 micrograms. Up to 30% to 40% of people over 50 may have a problem with B12 absorption because of a reduced production of stomach acid that prevents them from absorbing sufficient B12 from food, so their dietary adjustment to boost B12 isn’t quite so easy.

So, how about some examples of B12-containing foods? These food servings all provide at least 25% of the Daily Value of vitamin B12:

     Clams, 3 oz. cooked

     Beef liver, braised, 1 slice

     100% fortified breakfast cereal, ¾ cup

     Rainbow trout, 3 oz.

     Sockeye salmon, 3 oz.

     Lean top sirloin, broiled, 3 oz.

     Plain skim yogurt, 1 cup

Is sushi (raw fish) nutritionally better than cooked seafood? Nope, cooking doesn’t IN ANY WAY, destroy the omega-3 fatty acids and the proteins that make fish such a superb choice. In fact, cooking fish kills the harmful bacteria and intestinal parasites found in raw seafood. Cooking fish is absolutely imperative for patients with compromised immune systems.

(Tufts University Health and Nutrition Newsletter, December 2008)

Peanut allergies—some interesting new findings. The rise in peanut allergies has been astronomical and of course, explanations have NOT been forthcoming. However, a few hypotheses have been proposed and most of them related allergies to genes and a genetic predisposition. But, that really doesn’t make any sense because genes don’t change as rapidly as the rise in peanut allergies. Another hypothesis having nothing to do with genes seems to stand out amongst all others. A 2003 study by Allergist Gideon Lack of King’s College of London found that preschool children who were allergic to peanuts were much more likely as infants to have been treated with skin lotion containing peanut oil than were children who didn’t have the allergy. The researchers hypothesized that exposure to peanut protein through the skin laid the foundation for an aberrant immune reaction that resulted in allergy.

A second finding by the same researcher found that early exposure to peanuts via the diet decreases a child’s risk of developing a peanut allergy later in life. This of course, flies in the face of the usual recommendations given to parents by Pediatricians. The new study suggests that early exposure to peanuts, in the form of eating peanut butter, might induce tolerance and head off the aberrant immune response that underlies an allergic reaction. (Journal of Allergy and Clinical Immunology, November 2008)

NEUROLOGY QUIPS 

Neurologic symptoms and denture cream. Can the use of denture cream cause neurologic symptoms? Whaaaaaaaaaaaaat are you talking about, BB? A couple of studies discussed a total of 4 patients with myelopathy and found that all four patients had hyperzincemia (high zinc), hyopcupremia (low copper) and myeloneuropathy (disease of the central nervous system myelin). The commonality between all four patients was the use of copious amounts of denture cream. So, the authors of the two studies examined the three formulations of denture cream used by the 4 patients and found zinc contents ranging from 17 mg/g to 34 mg/g. Cessation of denture cream use in three patients was accompanied by a reduction in serum zinc levels. Copper supplementation in all 4 patients resulted in normalization of copper levels. Only two patients improved neurologically.

So, what’s the bottom line here? It appears as if acquired copper deficiency is being recognized by neurologists and a cause of myelopathy. And, of course, the causes of copper deficiency include gastrointestinal by-pass surgery as well as malabsorption. It’s been known for years that zinc decreases copper absorption and the cause of zinc excess is usually not apparent. The current studies illustrate the importance of considering excess use of zinc-containing denture creams as a potential source of zinc in patients with neurologic disease related to copper deficiency. Don’t forget that zinc has been touted as the be all and end-all for cold prevention, so many over-the-counter cold prevention medications may also be a cause of zinc overload. (Nations SP et al. Denture cream: An unusual source of excess zinc, leading to hypocupremia and neurologic disease. Neurology 2008 Aug 26;71;639; Schaumburg H and Herkovitz S. Copper deficiency myeloneuropathy: A clue to clioquinol-induced subacute myelo-optic neuropathy? Neurology 2008 Aug 26;71:622.)

NEW DRUG APPROVAL FOR PAIN MANAGEMENT—Tapentadol for moderate-to-severe pain. Available in tablet form in doses of 59, 75, and 100 mg. It’s an opiod receoptor agonist and a norepinephrine reuptake inhibitor. Read more about it? http://tinyurl.com/66188a.