Jewish World Review Nov. 17, 2003 / 22 Mar-Cheshvan, 5764




Leech therapy; mattress firmness & low-back pain; update on lycopene & prostate cancer

By Robert A. Wascher, M.D., F.A.C.S.

http://www.NewsAndOpinion.com | Lycopene, a powerful antioxidant that is chemically related to Vitamin A and other beta-carotenoids, gives tomatoes, peppers and other fruits and vegetables their characteristic red color. Lycopene is found only in certain fruits and vegetables, including tomatoes, red and pink grapefruit, apricots, pink guava, red peppers and watermelon. However, the most common source of natural lycopene in our diet is derived from tomatoes and tomato products. Interestingly, cooked tomato products appear to have more "bioavailable" forms of lycopene than raw tomatoes, including tomato pastes and sauces, tomato juice, and even ketchup!

Several research studies have identified high levels of food-derived lycopene in the diet of patients with a decreased incidence of heart attack and prostate cancer, as well as several other cancers, including cancers of the breast, colon, rectum, stomach and esophagus. Although lycopene's ability to sop-up circulating free radicals throughout the body may play some role in its putative disease-preventive effects, scientists are discovering that lycopene probably exerts many of its beneficial health effects through other mechanisms, including alterations in the way that adjacent cells interact with each other, as well as immune system and hormonal modulation.

In this age of pervasive bottled herbal and dietary remedies, many people have wondered whether or not lycopene supplements, in pill form, are as effective as the lycopene that your body absorbs from lycopene-rich foods. Indeed, many scientists believe that there are other compounds in lycopene-rich fruits and vegetables that might facilitate the beneficial effects of lycopene on health, and that lycopene alone, in pill form, may not be as efficacious as lycopene derived form dietary sources. A new study in the Journal of the National Cancer Institute may provide some answers to this question.

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The study treated 194 rats with chemicals known to induce prostate cancer in these animals. The rats were divided into individual groups that received the following supplements in their diet: pellets containing whole tomato powder, pellets containing lycopene alone, or placebo pellets containing no lycopene or tomato powder. Rats in each of the three groups were also further subdivided into two groups each: one sub-group was allowed to eat at will, while the other sub-group was placed on a 20% diet restriction compared to the other sub-group. The dietary restriction portion of this study was performed because previous research has shown that calorie restriction may also be associated with a lower risk of developing prostate cancer.

The study found that the rats that were fed the tomato powder supplement had, on the average, a 26% lower likelihood of dying from prostate cancer when compared to the rats that were fed the placebo pellets. However, there was no significant difference in the risk of dying from prostate cancer between the rats who received the lycopene-only supplements and the rats that were fed the placebo pellets. Furthermore, when comparing the sub-groups of rats that ate what they liked versus those that were placed on restricted calorie intakes, the calorie-restricted rats experienced a significantly lower incidence of death due to prostate cancer than the rats that received more abundant chow (79% versus 65%). Interestingly, there appeared to be no interactions between caloric restriction and the lycopene status of each sub-group of rats, suggesting that the reduction in the risk of dying from prostate cancer due to calorie restriction occurs by a completely different mechanism than the risk reduction obtained by tomato powder.

The study's authors concluded that lycopene-rich tomato powder, but not isolated lycopene, reduced the risk of prostate cancer deaths in rats. This suggests, once again, that there are other substances in lycopene-rich fruits and vegetables, and in tomatoes in particular, that are likely to be important in protecting against prostate cancer, and against death due to prostate cancer. This study also appears to confirm previous observations that reducing dietary calories may also have a favorable effect on preventing prostate cancer and death due to prostate cancer.

Unfortunately for our pill and supplement-popping society, this study is one of many suggesting that nutrients with purported anti-cancer properties are most effective when they are consumed as part of a healthy and balanced diet, and are least effective (or non-effective) when taken as isolated supplements. Countless generations of moms have been, once again, vindicated by growing research findings that support eating a healthy and balanced diet rich in fruits and vegetables, and low in animal-derived foods.

MATTRESS FIRMNESS & LOW-BACK PAIN

When I was a kid, if you needed a new bed, you went out and bought the frame, as well as the box springs and mattress, and usually as a single unit. There might have been three or four major manufacturers of mattresses and box springs back then, and the extent of customization that was available then was, at most, a "firm" versus "soft" mattress. Today, there is a bewildering array of mattress textures and construction, and one generally buys the frame separate from the box spring and mattress.

The conventional wisdom has, for generations, been that people with chronic low-back pain should opt for a firmer mattress. The thinking on this issue has generally been along the lines of improving the support of sagging and aching spines with a firmer mattress, although it appears that little scientific research has been done to confirm this intuitive supposition.

In a study published in the current issue of the journal Lancet, 313 adults with a history of chronic non-specific low-back pain, and who complained of increased low-back discomfort while lying in bed, or upon arising from bed in the morning, were included in this study. All patients were without clinical evidence of nerve root compression symptoms, which are often seen in people with herniated spinal discs or other more serious spinal disorders.

The study volunteers were evaluated at the beginning of the study, and again after 90 days spent sleeping on either a "firm" or a "medium-firm" mattress. The study found that the patients who slept on a medium-firm mattress experienced significantly less pain in bed, less pain upon arising from bed, and less daytime low-back pain when compared to the patients who were randomized to sleep on a firm mattress. Chronic disability related to low-back pain symptoms was also reduced among the patients sleeping on the medium-firm mattresses. As someone who suffers from both non-specific "mechanical" low-back pain as well as herniated lumbar discs, my own anecdotal experience would certainly tend to support the findings of this study, although I have also found that especially soft mattresses also tend to make my lower back ache when I wake-up in the morning. Goldilocks had it right after all, it seems....

AND NOW FOR SOMETHING COMPLETELY DIFFERENT...

Leech therapy has experienced something of a renaissance in patient care over the past twenty years or so. The first recorded therapeutic use of leeches was in ancient Egypt more than 3500 years ago. Hippocrates subscribed to the theory of blood-borne pathogenic substances that caused an imbalance between the "good humors" and the "bad humors," resulting in a state of disease. By employing leeches to rid the blood of the bad humors (and, unfortunately, relieving the patient of his or her own blood in the process...), the physician could, in theory, restore a more harmonious balance between these opposing humors. The use of leech therapy continued through the Middle Ages, and into the 19th century. During the 1800s, in the United States and Europe, the scope of leech therapy was expanded to include the treatment of such diverse disorders as hemorrhoids (try visualizing that one...), large bruises, gum disease, headaches, obesity, laryngitis, kidney disease, mental illness, and eye disorders, among various other conditions. Indeed, so widespread was the use of medicinal leeches that the species very nearly became extinct during this period! By the early 1960s, the practice had all but died-out with the advent of our better understanding of disease-specific pathophysiology and therapy.

Advances in microsurgery in the 1980s, and especially in the reimplantation of limbs, fingers, and toes, brought about a renewed interest in the lowly medicinal leech (more properly referred to by its scientific name, Hirudo medicinalis). The saliva of the leech contains a powerful anti-clotting substance, hirudin, which facilitates the continued flow of unclotted blood between the host and the leech. A major cause of the loss of reimplanted limbs, and especially of reimplanted fingers and toes, is the increased pressure within small veins that are too tiny to be reconnected to the patient's circulation. When this "venous congestion" builds-up to a high enough pressure, the reimplanted digit will often die. Medicinal leeches, when attached to the reimplanted digit, relieve this venous congestion by sucking the excess venous blood out of the transplanted extremity. Other potentially beneficial substances in leech saliva include anesthetic compounds that allow the leech to obtain a blood meal without being detected by its host, and bacteria in its gastrointestinal tract that are thought to produce an antibiotic-like substance that can kill other disease-causing bacteria.

Anecdotal observations of an apparent reduction in the symptoms of osteoarthritis have also been previously noted! Follow-up studies in Europe have been done, and the placement of leeches on the arthritic knees of patients did appear to reduce the symptoms of arthritic knee inflammation in at least one German study. A new Canadian study in the current issue of the Annals of Internal Medicine looked at this issue in a study that included 51 patients with chronic knee arthritis.

The patients were divided into two treatment groups. One group of 24 patients received a single treatment involving the application of 4 to 6 leeches to the inflamed knee, while the remaining 27 patients were treated by applying an anti-inflammatory cream (topical diclofenac) to their arthritic knees daily for a period of 28 days. The patients were then surveyed at 3, 7, 28 and 91 days after initiation of either therapy. At day 7, the patients who had received leech therapy reported less knee pain than the patients who received the anti-inflammatory cream. However, after day 7, there was no difference in knee pain reported by the two groups of patients. When the scientists looked at joint stiffness and function, as well as overall knee symptoms, they discovered that the patients who had received leech therapy reported less severe symptoms in these categories, up to day 28, when compared to the patients who had been treated with diclofenac cream.

This is an interesting little study, although the vastly different treatments employed in the two patient groups increases the likelihood of bias being introduced in the study's results. As there is no way to simulate leech therapy in the group of patients who were randomized to receive "non-leech therapy," and as the researchers (and patients) clearly knew which patients received the cream and which received the leeches, it is difficult to objectively determine the effects, if any, of leech therapy over the topical anti-inflammatory treatment based upon this study.

JWR contributor Dr. Robert Wascher is an oncologic surgeon, professor of surgery, oncology research scientist, and author. He lives in Honolulu with his wife and two daughters. Comment by clicking here.

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© 2003, Dr. Robert A. Wascher