Hi, I'm Dr. Scholz. Let's talk about prostate cancer.
We come to a point now where we need to talk about food, vitamin, and mineral supplements.
This question comes up very frequently when I'm talking to patients, and it is a very
important question. This goes way back, as many of you are aware, the whole field of
prostate cancer has evolved rapidly, technology has improved. But I started back in the early
1990s when there were relatively few available treatments. Some people think that doctors
are kind of anti-supplement, but there's no doubt that some vitamin and food supplements
can be beneficial. How do you determine which ones work and which ones don't work?
I can't tell you how many times I've had people come in with a long list of stuff that they've
been on for years, kind of like an old closet where they just throw stuff in there and then
they really don't reassess whether it's working or it's effective or they really should be
taking them. A process of analysis is necessary to decide both in a generic sense, is a supplement
useful, should it even be considered? And then in a personal sense, is it working for
you?
This is the first of a two-part video, and in this video, we'll talk about the principles
for selecting a supplement. In the second video, we're going to go through sequentially
and talk about specific individual supplements and their role and usefulness and how to evaluate
their effectiveness.
One reason why I think this has become a big part of the prostate cancer world is because
prostate cancer is a different type of a condition. It has a long natural history and people are
therefore looking at the impact of these supplements which may have modest effects. If you think
about it, taking a supplement for a rip-roaring condition like lung cancer or pancreas cancer,
its not going to have a very big impact. But what about prostate cancer, where people can
live with it for 10 or 20 years or more? Another thing about prostate cancer is you can look
at outcomes in how does the PSA behave over time as you change around dietary and supplement
patterns. So you can actually get some feedback, some objective feedback as to what's working
and what's not working. The other thing about prostate cancer is men live with it for long
periods of time, and so other general health issues—supplements aren't just for prostate
cancer but they're for men's health, heart disease, blood sugar, all kinds of different
things—and those issues can be looked at too because people will live with prostate
cancer for so many years.
I want to share a short example of a supplement that made a big splash in the prostate cancer
world 15-20 years ago called PC-SPES. PC-SPES with a compilation of Chinese herbs developed
by a scientist named Sophie Chen, and it went into manufacturing, it was distributed, and
there was no doubt that this product was causing PSA declines in men with prostate cancer.
It appeared to be effective; Eric Small at UCSF did clinical trials with PC-SPES. However,
like all anti-cancer agents, PC-SPES had a side effect profile. It appeared to have some
sort of hormonal or estrogenic effect. So men would get breast enlargement; men would
get blood clots. These are the types of things that happen with estrogenic effects. A number
of lawsuits ensued, and unfortunately, PC-SPES and the company that manufactured it went
bankrupt, and it's no longer available.
This does point to the possibility that alternative medicines can have real benefits and those
benefits are measurable. When talking about this idea of an estrogenic effect, I've seen
a number of patients through the years who have sort of given up on Western medicine,
gone down below the border to Mexico, and undergone treatment with herbal products,
alternative products, and in some cases seem to get benefits. I've had patients come back
praising the types of treatments they had. Their PSA levels dropped, if they had pain
from prostate cancer, it went away. And mysteriously, they also would complain of breast enlargement,
and no doubt they were getting some surreptitious estrogen mixed in with herbal products. So
one of the things that we have to watch out for with this whole field of alternative medicine
and supplements is adulteration with other pharmacologic agents being mixed in which
were actually the active ingredients.
There are many challenges presented by the supplement industry, and even though there's
potential good, there's also potential bad. What are the principles you should use in
trying to discern which supplement is effective for you?
Well, the first and the very easy one is "does it work for you?" For example, as we get older
many of us develop arthritic pains and discomfort and there are alternative supplements like
glucosamine and chondroitin which have been used to try and alleviate arthritic type pains.
This has been studied and there are definitely people that benefit. Does that mean that everyone
with arthritis should be taking glucosamine and chondroitin? Of course not, but it's very
reasonable for you as an individual to try it for a couple of months and see if you personally
benefit. So the first principle is, go ahead and experiment with some of these things,
assuming they're safe, and determine if it's effective for you personally. After a few
months, if there's no benefit—there's no effect—then discontinue it.
The next reason to try a supplement and determine if you should be taking it or not has to do
with the specific authority you're relying upon to make such decisions. Different companies,
different individuals, and you use the same process that you would use for any other decision-making
process. You look at the individual, do they have a conflict of interest? Are they getting
paid? Have they got an overall reputation of integrity? Have they been consistent in
making good predictions in other arenas? The character of the person or the company that's
making the recommendation needs to be looked at. To assume that all sources of information
are equal is incredibly foolish, and I run into this type of thinking even in intelligent
people. You have to look at the source of the information critically and decide if they
are looking out in a general dispassionate scientific sense and providing information,
or if there's a conflict of interest behind the curtains that is driving their recommendations.
The third way to determine if a supplement or a mineral is being used in an effective
way in you personally is to check blood levels. There are a number of vitamins which if they're
too high or too low, minerals, whether they're too high or too low, can be either causing
problems or the absence can be causing problems. Vitamin B12, vitamin D are a couple of examples.
And rather than just shotgunning a certain amount of a specific vitamin, you can check
those levels in the blood and determine if they fit into the normal range. I think that
the important underlying principle is that you can't accept any source of authority without
questioning and determining if it has specific application for you personally. I think if
you use that sort of critical decision-making process you'll be able to determine which
things are going to be helpful and which ones are unnecessary or even harmful.