Magnesium and Hot Flashes

by Jake Psenka, ND

Hot flashes are one of the most common and irritating conditions experienced by women.  They are often experienced by women going through menopause and also frequently encountered as an unpleasant side effect of breast cancer therapy.  Anti-estrogen drugs such as Arimidex and Tamoxifen are notable promoters of hot flashes. 

The ideal treatment for hot flashes would be one that:

a) Was effective at decreasing both the frequency and intensity of the hot flash

b) Didn’t interfere with other drugs

c) Was safe and didn’t cause more problems that it was fixing.

Unfortunately, very few effective treatments are available which decrease both the frequency and severity of hot flashes.  Occasionally SSRI drugs (selective serotonin reuptake inhibitors) are used to control hot flashes.  However, concerns exist about these medications interfering with the metabolism and effectiveness of anti-estrogen drugs including Tamoxifen.  The SSRI drugs, which are mostly used to treat depression, also come with some less than exciting side effects of their own.  Botanical medicines such as black cohosh (cimicifuga racemosa) are frequently used however there are some doctors have voiced concerns about the use of this plant in cancer patients.  While botanical medicines are much less likely to have unpleasant side effect than drug therapy, they do not seem to provide relief from hot flashes reliably in all patients.

A study published recently in Supportive Cancer Care described magnesium oxide as a potentially effective treatment for hot flashes.  Magnesium seems to be an ideal candidate, it’s very safe, doesn’t interfere with anti-estrogen therapies (i.e.. it's safe for women with a history of breast cancer), and according to the study is relatively effective.  This study used magnesium oxide at either 400mg or 800mg doses per day for 4-weeks in breast cancer patients.  Both the frequency and severity of hot flashes were measured.  Severity was assessed using a “hot flash score,” which was defined as frequency x severity. 

The frequency of hot flashes decreased by 41%.  There was also a 50% reduction in the hot flash score compared to baseline.  Study participants reported improvements in sweating, distress, and fatigue.  Two women reported experiencing headaches, and another two reported grade-1 diarrhea (diarrhea is graded 1-4 with 4 being the worst).   Considering the effectiveness and excellent safety profile of magnesium, the authors concluded that this treatment was worthy of additional study.

A magnesium dosage of 800mg is considered to be an optimal intake by many healthcare professionals.  It is also interesting to note that magnesium levels have been found to be decreasing rapidly over the past 100 years.  Inadequate intake of foods containing magnesium is likely to be responsible for this.  It is also important to point out that many drugs can induce a magnesium deficiency including antibiotics, chemotherapy drugs, corticosteroids, and laxatives.  Alcohol is another potent promoter of magnesium deficiency.

Magnesium is a very safe mineral, with diarrhea being the most frequently encountered side effect.  Dosages of 800mg may produce loose stool in some people, with others being able to tolerate much higher dosages.  This potential side effect can also make magnesium effective in some cases of constipation.  Starting with a lower dose is generally the best way to start any supplementation.

It is important to remember that when taking magnesium is it important to supplement with calcium as well.  This is especially true for those who are post-menopausal, and those who have previously been treated with chemotherapy or radiation and are thus at increased risk for osteoporosis.

Reference:  Support Cancer Care, 2011, 19:859-863.

Mayo Clinic Researchers Report That Vitamin D Deficiency Can Double The Risk of Death in Chronic Lymphocytic Leukemia

It’s pretty amazing that a deficiency of a single vitamin can double a person’s risk of dying from a particular disease. This is exactly what a group of researchers from the Mayo Clinic in Rochester, NY found out when studying the effects of vitamin D in a population of patients with chronic lymphocytic leukemia (CLL).

During this study researchers determined that out of 390 patients with known CLL 119 of them (30.5%) were found to be deficient in vitamin D. Thirty percent is a fairly large number, and is most likely indicative of the chronic vitamin D deficiency that exists throughout society. In fact, the authors of this research study cited reports of both vitamin D’s anti-cancer properties, and it’s widespread deficiency as reasons why they felt this research was important to perform. Another goal of this study was to investigate the relationship that vitamin D may play in CLL, as past research had not fully investigated this relationship.

Vitamin D is unique in that our bodies have the ability to synthesize this vitamin when our skin is exposed to the sun’s ultraviolet rays. It has been estimated that 400 IU can be achieved with the exposure of 30% of a person’s skin surface for 30 minutes at moderate latitudes (Recommended Daily Allowance is 400-800IU/day). However, most people don’t receive this kind of exposure. Vitamin D can also be obtained by eating foods that contain vitamin D such as fish liver oil, morel mushrooms, and egg yolks. Additionally vitamin D can also be obtained by eating foods that have been fortified with this vitamin: milk (cow, soy, and rice), Cherrios, and some cheeses. Vitamin D is also often frequently taken in supplement form.

It is important to understand that excessive dosages of vitamin D can produce toxic side effects. The National Academy of Sciences has determined that dosages up to 2000 IU per day are safe, although some studies have found that higher dosages can also be used without toxicity. However, as with most vitamins it is not wise to assume that “natural means safe,” and it is a good idea seek the guidance of a qualified health practitioner when considering the use of higher dose vitamins.

It’s quite easy to determine if you are one of the people who would benefit from taking some additional vitamin D, as vitamin D levels can be obtained via a blood test. It is a good idea to ask your physician to include vitamin D testing when having your blood drawn. If you have CLL, or any other kind of cancer, you should insist on checking your vitamin D level. If found to be deficient then returning it to a normal level may be a very important part of your overall treatment.

Vitamin D for cancer prevention: global perspective

"It is projected that raising the minimum year-round serum 25(OH)D level to 40 to60 ng/mL would prevent approximately 58,000 new cases of breast cancer and 49,000 new cases of colorectal cancer each year..."

Vitamin D and prevention of breast cancer: pooled analysis

"According to the pooled analysis, individuals with serum 25(OH)D of approximately 52 ng/mL had 50% lower risk of breast cancer than those with serum levels less than 13 ng/mL."

Vitamin D and prevention of colorectal cancer

"Intake of 1000IU/day of vitamin D, half the safe upper intake established by the National Academy of Sciences, was associated with 50% lower risk."

Serum vitamin D concentrations are related to depression in young adult US population: the Third National Health and Nutrition Examination Survey

"In this large population based study, likelihood of having depression in persons with vitamin D deficiency is significantly higher compared to those with vitamin D sufficiency."

Environmental and Occupational Causes of Cancer

At a recent lecture I gave for the Wellness Community's Cancer Transitions Program I referenced this 2005 paper which discusses environmental chemical exposure and cancer risk. Several people asked for a copy, so here it is.

Click HERE for the paper.

High-Dose Vitamin C IV's on 60 Minutes

High-dose vitamin C therapy has been something that hasn't received too much attention outside of the complementary and alternative medical field- until now. Recently the New Zealand version of the television show 60 Minutes published an investigative report concerning vitamin C being used in hospitals, sometimes despite the hospital's best efforts to not do so. After watching this video you may find yourself asking why there is such resistance to this therapy. After prescribing 1000's of these IV's over the years I find myself asking the same question. It's inexpensive, safe, and provides many benefits. The video is really worth watching.

To watch the video choose the link below:
Show #1

A follow-up report was aired which detailed the response of New Zealanders. Also a video worth watching:
Follow up show

Lastly, here is a link to a study published in the Proceeding of the National Academy of Sciences regarding the action of high-dose vitamin C therapy. Click HERE.

Vitamin D, Hydrogen Peroxide, and Breast Cancer

Vitamin D has received quite a bit of attention over the past two years. It has shown the ability to prevent disease, keep the immune system functioning, and help people keep mentally sound. It has also been shown to help fight off cancer. One of the ways that it may do this is by increasing the action of hydrogen peroxide inside cancer cells.

You might be asking yourself "how does hydrogen peroxide get into cancer cells, and why is this important?" It's a good question. The answer has to do with free radicals. It is a fact that many conventional and alternative treatments for cancer work by producing free radicals inside of the cancer cells. These free radicals react with other substances within the cell which can ultimately lead to that cell's death. Placing free radicals specifically into cancer cells is a very good therapeutic target, as often these cells don't have the ability to protect themselves from this sort of insult. Hydrogen peroxide is an intermediary-type molecule in the production of free radicals. Some treatments, like high dose vitamin C IV's, work by generating high levels of hydrogen peroxide inside cancer cells. In turn this hydrogen peroxide then is changed into free radicals which destroy the cancer cell from the inside out. It has been found that cancer cells are particularly sensitive to the actions of hydrogen peroxide due to their lacking of an enzyme known as catalase. Don't make my word for though. The Proceedings of the National Academy of Sciences has a bit to say about this too.

Interestingly, vitamin D has been found to increase sensitivity of breast cancer cells to the action of hydrogen peroxide. That means vitamin D has the potential to make many anti-cancer therapies work better. Vitamin D is sometimes called the sunshine vitamin, because your body can synthesize it using sunlight. Well, yes, it can make vitamin D, but not always in sufficient quantities. I routinely analyze patients blood to assess their vitamin D3 (the most active form of vitamin D) levels, and even though I'm in AZ, a real sunshine state, I often find low levels of vitamin D.

It is easy to take a vitamin D supplement, and it's probably a good idea. I think that adding a vitamin D analysis to your annual checkup would be a smart move. I think that an even smarter move would be to get a vitamin D3 test prior to starting an anti-cancer treatment. Also, it is important to point out that vitamin D can be problematic to the liver when taken at high doses for a prolonged period of time. Therefore it's a good idea to let your physician know that you are taking it.

Exercise, Acidosis, and Cancer

Nearly everyone should have heard by now that exercise is beneficial for people with cancer. It is also fairly well known that regular exercise has been proven to prevent the development of many cancers, such as breast cancer. There are many theories which try to explain how exercise is beneficial, but not a lot of scientific data proving these hypotheses. In our increasingly toxic world, where the majority of cancers are thought to arise from some sort of environmental exposure, the need to identify prevention strategies has never been more important.

Recently researches decided to try and uncover the mechanisms by which exercise may help to prevent cancer. It is an established fact that the transition from a pre-cancerous cell to an invasive malignant, or cancerous, type of cell is a prolonged multistep process. This process is regulated by changes which occur in the body in response to different exposures or events. Diet, exercise, stress, and environmental exposures are all things that can influence the change from a non-cancerous cell into a cancerous one.

These researchers, who published their work in the April edition of Biology Direct, used cell cultures in which they subjected those cells to exposures similar to what happens in the body during exercise. The researchers found that the transient acidosis that occurs with exercise interrupted the evolution to the invasive cancer phenotype.

If you have ever had a vigorous day at the gym and then paid for it the next day with sore muscles, you have experienced the acidosis that accompanies exercise. The culprit is lactic acid, and it is a byproduct of energy metabolism. It is interesting to note that acidosis is often trumpeted as a causative agent for cancer development. This study demonstrates that in reality things might not be so cut and dry. Indeed a healthy balance of acidity, alkalinity, exercise, diet, and mental well being are all necessary for health.

Here's a link to the study: Episodic, transient systemic acidosis delays evolution of the malignant phenotype: Possible mechanism for cancer prevention by increased physical activity.

Iodine Helps Prevent and Treat Breast Cancer

Hello Everyone and Happy New Year

So, after way too long I’ve finally found the time to add some more information to this site. It’s not that there haven’t been any newsworthy topics in the cancer field in the past six months, I just need an 8th day in the week. However, for 2009 I’m going to try and post something useful every month.

Many of you may have heard about the relationship between iodine and breast disease. It has been known for a while that women with fibrocystic breasts, and women who suffer from cyclic mastalgia (aka. tender breasts during menstruation), can find substantial relief by taking molecular iodine. What you may not be aware of is that an iodine deficiency can lead to structural changes in breast tissue, and has even been shown to lead to an increase in breast malignancy in animal models. On the flip side iodine has been shown to reverse the development of cancer cells in chemically-induced animal cancers. Researchers have also suggested that iodine decreases early cancer progression through an inhibitory effect on cancer initiating cells.

Wow, iodine, how about that? But the question is how the iodine is protecting the breast tissue. When doctors talk about iodine they are usually doing so in reference to the thyroid gland, as 75% of the iodine in the body is found in there. Interestingly, women with breast cancer have larger thyroid glands than women without cancer. Could iodine be decreasing breast cancer risk through the action of the thyroid gland?

That is one of the questions that researchers from Drexel University College of Medicine in Philly, PA set out to answer. These people attempted to determine how the iodine was working by examining the genetic profiles of breast cancer cells which were exposed to iodine. In their study, which was performed in vitro (in a Petri dish), they used the estrogen responsive MCF-7 breast cancer cell lines. Breast cancer cells that are estrogen responsive (aka “estrogen positive”) have estrogen receptors on their cell surface, and are stimulated to grow and divide in the presence of estrogen (one reason that HRT post-menopause can lead to increased risk of breast cancer). Breast cancer cells can also be estrogen receptor “negative,” which implies that the cells are not as sensitive to estrogen. The classification of negative vs. positive is determined by testing done on tissue that has been removed from the body, such as in a biopsy.

Anyway, in this study they used estrogen responsive breast cancer cells and treated them with Lugol’s iodine solution. Lugol’s is 5% iodine and 10% potassium iodide. Iodine is the term used to describe “free” iodine, and iodide is used to describe iodine that is molecularly bound to something else, like potassium. What these researchers found was that 29 genes were up regulated, and 14 genes were down regulated in response to the iodine/iodide treatment. Genes are the biological entity responsible for defining traits. Remember Gregor Mendel, the priest with the peas? These genes cannot only determine which peas will be wrinkled and which will be round, but other things like eye color, or even the number and type of estrogen receptors on a breast cancer cell. This evidence, along with other data, does not suggest that the beneficial effects of iodine are mediated by the thyroid gland, and for the most part are independent of the thyroid gland.

Of the 43 genes that were effected by the iodine/iodide treatment several were involved in hormone metabolism; more were involved in the regulation of cell cycle progression, growth and differentiation. Importantly, this study found that treated cells expressed genes which regulate estrogen metabolism. One of the mechanisms that was influenced by the iodie/iodide treatment is the Cytochrome P450 system. This system, often referred to as just the “P450” system, is made up of a family of enzymes which are responsible for processing, modifying, and eliminating things from the body. The P450 system is responsible for eliminating drugs (like some types of chemotherapy), dietary chemicals (like caffeine), and substances produced within our own bodies like hormones. In the iodine study, it was discovered that there was an increase in the enzymes of the P450 system which are responsible for metabolizing estrogen into a form which inhibits cellular proliferation. This means that iodine/iodide can change the body's estrogen into a form which inhibits abnormal cellular reproduction.

It was also found that treatment with iodine/iodide diminished the effect that estrogen had in estrogen-receptor positive cells. Specifically, treated cells showed evidence of having an activated BRCA1 gene. The BRCA1 gene, often called the “Breast Cancer Gene,” seems to be widely misunderstood. This gene is not something that promotes cancer, but something that helps to prevent it. The BRCA1 gene is a tumor suppressor gene, and as such is used by the body to repair damaged DNA. Cancer develops from damaged DNA. BRCA1 can also influence the effectiveness of other systems throughout the body, like the P450 system. When women undergo genetic testing and are told that they have “the BRCA1 gene,” that means that they have a mutation of that gene. So, by increasing BRCA1 the iodine/iodide treatment helps to protect your DNA and thus offers some protection from the development of cancer.

Additionally, this study found that many genes which influence growth, cellular reproduction, and differentiation (a measure of a cell’s maturity or specialization- typically the lesser the degree of differentiation, the more aggressive the cancer) were impacted by the addition of iodine/iodide. Iodine/iodide treatment up-regulated genes which are responsible for preventing uncontrolled cellular division (aka cancer).

Lastly, and I have to say that besides the cancer preventative effects of iodine. This is the coolest action. Iodine/iodide treatment showed some ability to inhibit breast cancer cell’s ability to become resistant to treatments such as Tamoxifen. Tamoxifen, a SERM (selective estrogen response modifier), is an estrogen blocking drug used to treat estrogen-positive breast cancers. Unfortunately, like most cancer therapies Tamoxifen can loose it’s effectiveness over time. This occurs because cancer cells can change their genetics in response to their environment. Like most chemotherapy, chances are that it will work initially, but that it may become less effective over time. So, now it seems that it might be a good idea for women taking Tamoxifen to take some iodine as well.

For those who are interested the whole article “Iodine Alters Gene Expression in the MCF7 Breast Cancer Cell Line: Evidence for an Anti-Estrogen Effect of Iodine” article can do so by clicking here.

So, if you want to prevent breast cancer, or if you already have breast cancer is then you might be asking yourself “How much, and what kind, of iodine should I take?” The RDA for iodine is 150 micrograms per day for adults. For most people this is probably a good dosage to take on a daily basis. Those with thyroid disease or who have a history of breast cancer should consider having their iodine levels checked. This can be done easily using a urine collection. Doctor’s Data is a lab which I have used which can provide this testing. For more info on Doctor's Data and how to obtain this testing please contact my office here.

Iodine can cause things like rashes, nausea, headaches, or allergic reactions. However, most of these side effects are seen when people take very high doses (greater than 30 milligrams per day) over a long period of time. Some physicians believe that it takes much higher doses to cause any significant side effects. One thing I have learned in practice is that we are all physiologically unique, and what is good for one person isn’t necessarily good for another. If you would like to start taking iodine I would suggest eating foods that contain it before taking a pill. Many people will undoubtedly think that they are getting enough iodine because they eat iodized salt. The truth of the matter is that maybe they are, maybe they're not. A study published in 2008 found that 53% of iodized salt products contained less then the FDA recommended level. You can see this article here.

If you like seaweed salad you’ll love this: kombu, arame, and kelp all contain lots of iodine. Certain types of fish also contain higher amounts of iodine. Haddock, cod, herring, halibut, and sardines are all good sources. My favorite seafood, shrimp, also contains a fair amount of iodine. Shrimp are some tasty little bugs aren’t they?

Healthy Regards,
Jake Psenka, ND

PS-If anyone has any ideas for future topics please let me know via email.