Three main features are said to distinguish this state from ’sadness’ or ‘ordinary depressive moods’: [i] it has to be a sustained depression of mood lasting for weeks or months; [ii] its severity must be great enough to interfere with normal functioning; and [iii] the depression will have had a definite onset with a distinct change from normal to depressive thinking [R L Souhami and J Moxham. Textbook of Medicine, 3rd ed, Edinburgh: Churchill Livingstone, 1997, pp 189-190]. Unmelancholic patients are sometimes bewildered, or more often affronted, when they are told they suffer from clinical depression because they present with sleep disturbance, or constipation, or a slowing of thought and movement, or have some unexplained pain, or feel chronically fatigued. It may seem grotesque, yet on occasion even criminal behaviour (e.g. shop-lifting) has been taken as a reason for foisting the pass-key diagnosis of clinical depression on a patient.

Often overlooked seem to be some of the rather more obvious explanations. An organic illness (e.g. diabetes, hypothyroidism, or hypoglycaemia), the side-effects of recreational or prescription drugs (e.g. methyldopa, phosphatidyl choline, procainamide, or propranolol), alcoholism, ‘caffeinism’, or sugar-dependence, the symptoms associated with so-called masked food allergies, the toxic effects from some environmental exposure (e.g. the widely-used solvent ‘dioxane’), the distress of withdrawal due to the avoidance of addictive substances (e.g. giving up tobacco smoking), or the systemically depressing effect of gut fermentation products in circulation before detoxification by the liver, are some of the many other possible causes for a “severe and sustained change from normal to depressive thinking”. Hormonal changes (e.g. post-natal, menopausal, p.c.o.-syndromal, or from taking oral contraceptives) can also lead to just such a state. This is, however, usually acknowledged.

When such causes and any genuine psychogenic triggers have been excluded, what is the course of action? To begin with, two laboratory tests are quite useful: [i] The overnight dexamethasone suppression test (half of patients with endogenous depression have suppression test values >138 nmol/L); and [ii] the 5-hydroxyindoleacetic acid test (for which the patient should be drug-free for 72 hours prior to test). Two other tests are really for major depressive disorders: [i] the serotonin test; and [ii] the thyrotropin-releasing hormone stimulation test.

NATUROPATHIC MEDICINE

Naturopathic medicine maintains that virtually any nutrient deficit can result in this state [Ross Trattler. Better Health through Natural Healing, Wellingborough: Thorsons Publishing Group, 1987, pp 127-130]. However, there is a recognized behavioural downturn resembling clinical depression associated with a deficiency in each of the following eight vitamins: ascorbic acid (”C”), biotin (”H”), cyanocobalamin (”B12”), folic acid (”M”), niacin (”B3”), pantothenic acid (”B5”), pyridoxine (”B6”), and thiamine (”B1”) [L Mahan & M Krause. Food, Nutrition and Diet Therapy, Philadelphia, PA: W B Saunders & Co Inc, 1984]. Brain metabolism involves a highly complex interplay of different factors, all of which are modulated by enzyme systems both within and outside the brain. The basic working materials for these systems are derived from the diet. Maintaining an awareness also of trace and toxic elements (which should always be tested for) in the management of clinical depression can lead to effective, non-toxic, therapeutic intervention in certain cases. A zinc, magnesium, iron, manganese, or chromium deficiency, a potassium depletion, and/or the excess of vanadium, copper, aluminium, lead, or mercury, and either too much or too little calcium can be associated with depression and sometimes with more serious psychiatric problems. [Stephen Davies & Alan Stewart. Nutritional Medicine: The Drug-free Guide to Better Family Health, London: Pan Books Limited, 1987, pp 396-400].

The vitamin-like co-enzyme tetrahydrobiopterin is essential for the proper functioning of neurotransmitter synthesis. Many patients with endogenous depression (meaning without any external cause) have been shown to have a reduced formation of tetrahydrobiopterin [J Blair, C Morar, C Hamon, et al. Tetrahydrobiopterin Metabolism in Depression, Lancet, 1984, i: 163]. Whilst it is not readily available commercially, supplementation with vitamins M, C and B12 (folic and ascorbic acids, and cyanocobalamin, respectively), even though there may be no corresponding deficiency, can stimulate the production of tetrahydrobiopterin in humans [R Leeming, J Harpey, S Brown & J Blair. Tetrahydrofolate and Hydroxycobalamin in the Management of Dihydropteridine Reductase Deficiency, J Ment Def Res, 1982, 26: 21-25; and H Curtius,. A Niederwieser, R Levine, et al. Successful Treatment of Depression with Tetrahydropterin, Lancet, 1983, 1: 657-658].

Eleutherococcus senticosus (so-called Siberian Ginseng) has unvaryingly shown its capacity to increase the sense of well-being in a variety of psychological disturbances, including clinical depression, insomnia, hypochondriasis, and a variety of neuroses. It improves the balance of monoamines in the brain, adrenals, and urine [N R Farnsworth, et al. Siberian Ginseng (Eleutherococcus senticosus): Current Status as an Adaptogen, Econ Med Plant Res, 1985, 1: 156-215].

Taking this should also make the regular following of an exercise program enjoyable, because the energy metabolism is very quickly corrected by Eleutherococcus senticosus. This is, perhaps, just as well since naturopaths, osteopaths, and chiropractors will generally prescribe an exercise program for clinical depression. Exercise alone has been demonstrated to have an enormous impact on the patient’s improved capacity to handle stressful situations and generally to lift moods straight away [R Dishman. Medical Psychology in Exercise and Sport, Med Clin North Amer, 1985, 69: 123-143]. Shiatsu may help to improve a deficiency in lung energy, which is often associated with a clinical depression where, for instance, there is hyperventilation or there are panic attacks [Ray Ridolfi. Alternative Health: Shiatsu, London: Optima/Macdonald & Co (Publishers) Ltd, 1990, pp 78-79]. Anxiety, nervous tension, or clinical depression, when there is some anger, grief, or jealousy in the background, can be helped by rose (Rosa centifolia or Rosa damascena) aromatherapy oil as inhalant. Only very little is needed. [Thomas Bartram. Bartram's Encyclopaedia of Herbal Medicine, London: Robinson Publishing Ltd, 1998, p 143; Robert Tisserand. Aromatherapy, London: Mayflower Books/Granada Publishing Ltd, 1979, p 70; and Shirley Price. Practical Aromatherapy, 2nd revised edition, Wellingborough: Thorsons Publishing Group, 1987, pp 132-133]. In hydrotherapy so-called dispersive measures are used with extreme effectiveness in clinical depression. This refers to arm or foot baths, or to the sitzbad, with lavender (Lavandula spica); by all accounts they seem to drain away the depressive feelings very quickly [Gerhard Leibold. Practical Hydrotherapy, Wellingborough: Thorsons Publishers Ltd, 1980, p 75; and British Herbal Pharmacopoeia, Part Two, Cowling: British Herbal Medicine Association, 1979, pp 105-106]. Although massage has been around since the beginning of time and is evident in the animal world too (kittens being licked by their mother giving them reassurance, for instance), there has been little research on the effectiveness of massage in the area of mental health. At the Touch Research Institute, University of Miami School of Medicine, a variety of such studies are in progress. Preliminary results of pilot studies show reductions in anxiety levels, as well as a measurable decrease in depression [David di Domenico, Touching the Mind: Massage and Mental Health, in Lynette Bassman (editor), The Whole Mind: The Definitive Guide to Complementary Treatments for Mind, Mood, and Emotion, Novato, CA: New World Library, 1998, pp 377-388].

With acupuncture the treatment of clinical depression, which may arise from several sources, is individualized and appropriate treatment is given. Should there be lack of free-flowing Chi due to a Liver imbalance in a patient with a giving disposition who feels anger, resentment, guilt, or jealousy, the points to be needled would be different from those for the strongly religious patient with diarrhoea and churning rumination from the Spleen, or the sad, grief-stricken Lung patient, or the one with a lack of joy from the Heart, or the depressed apathy associated with lack of ambition with a Kidney weakness (capital letters are used for the organs as these are energetic concepts rather than the narrow physical understanding of Western mainstream techno-medicine) [Stephen Gascoigne. The Manual of Conventional Medicine for Alternative Practitioners, vol II, Dorking: Jigme Press, 1994, p 363; and Summary of research on the effects of acupuncture on the nervous system is published in: Shanghai College of Traditional Medicine, Acupuncture: A Comprehensive Text, Seattle, WA: Eastland Press Inc, 1981, pp 536-539].

Kava kava, a non-fermented beverage made from the root of the pepper plant (Piper methysticum) is widely consumed in Melanesia, Micronesia and Polynesia. The efficacy in patients with clinical depression and an anxiety syndrome was investigated in a randomized double-blind placebo-controlled study extending over four weeks. After only one week the treatment group revealed a significant reduction in anxiety symptomatology compared with the control group. This difference between the two groups increased in the course of the study, demonstrating the efficacy of Kava kava in patients with anxiety disorders [E Kinzler, J Kromer, & E Lehmann. Wirksamkeit eines Kava-Spezial-Extraktes bei Patienten mit Angst-, Sopannungs-, und Erregungszustaenden nicht-psychotischer Genese. Doppelblind-Studie gegen Plazebo ueber vier Wochen, Arzneimittelforschung, 1991, 41: 584-588]. The active principles in the Kava root are a number of lactones (known as kava-pyrones), kavaine, dihydrokavaine, methysticin, dihydromethysticin, and yangonin. However, it should be noted that in the longer term, copious Kava kava consumption also affects the skin, causing peculiar unpleasant ichthyosiform (fish-scaly) eruptions. This is known as kava-dermopathy, and may be caused by Kava’s interference with the cholesterol metabolism. Captain James Cook first reported this effect on members of his Pacific expeditions. It is strange that this was never described in the medical (dermatology) literature until 1994 [P Ruze & S A Norton. Kava Dermopathy, J Am Acad Dermatol, 1994, 31: 89-97].

Another herbal mood-lightener is Hypericum perforatum (St John’s Wort) which contains red hypericin, the flavone hyperoside, the aglycone quercetin, as well as choline, pectin and tannins. The red hypericin is a photosensitizing substance which means that irritating photosensitivity reactions can arise in patients who take Hypericum. It has also been combined with Rauwolfia serpentina (Indian snakeroot) which reduces blood pressure and the two, in a combination-preparation, are marketed under the trade name ‘Hyperforat’ (Klein, FRG). Of profound significance is that it has been shown that ‘Hyperforat’ induces well-reproducible specific inhibition of anaerobic glycolysis in brain tumours (glycolysis = the essential energy-yielding conversion of glucose to lactic acid in the tumours; and since molecular oxygen is not consumed in the process it is called ‘anaerobic g…’) [J Dittmann, H-D Hermann, & H Palleske, Arzneimittel-Forschung, 1971, 21: 1999].

Nux moschata (nutmeg), the dried seed kernel of Myristica fragrans, contains myristicin, a volatile oil with a hashish-like effect. If a drink is made from a number of ground-up nutmeg nuts, it can induce a state of euphoric intoxication similar to that achieved with Cannabis sativa var. indica. Yet even here there is a possible drawback: it may cause such an unpleasant stomach irritation that one might not want to try it again [H Friebel, Med Klinik, 1953, 42: 1569].

The highly nutritious seeds of Nelumbilis nuciferae (the lotus flower) have definite antidepressant effects. They are known in Chinese Medicine as lian zi, in Japanese Medicine as renshi, in Korean Medicine as y*ncha. The actions and indications (consonant with what was said about acupuncture in clinical depression earlier): For Spleen deficiency; tonifies the Spleen; to stop diarrhoea. For Kidney deficiency; tonifies the Kidneys, to stop uterine bleeding. Nourishes the Heart and calms the spirit; to stop palpitations with anxiety, irritability, and insomnia; especially useful for problems due to lack of communication between Kidneys and Heart. Constituents are: raffinose, oxoushinsunine, N-norarmepavine, calcium, phosphorus, and iron. Contraindicated where there is constipation or pronounced abdominal distension [Dan Bensky & Andrew Gamble. Chinese Herbal Medicine Materia Medica, revised edition, Seattle, WA: Eastland Press Inc, 1993, pp 385-386].

My personal experience with clinical depression has been that the very best results - without adverse reactions or contraindications - in cases of clinical depression are achieved with a French homoeopathic combination remedy, called ‘L.72 drops’ [Lehning, France]. This combination remedy has undergone an extensive controlled double-blind trial. In the study female patients between the ages of 20 and 60 suffering from nervous depression were given either the homoeopathic L.72 combination remedy (of ten component drugs) or the benzodiazepine Diazepam. Result: After 30 days of treatment, the homoeopathic combination remedy was found to be fully as effective as diazepam on so-called thymo-affective parameters (thymo- = of the mind and/or the emotions), on hot flushes, tachycardia, shortness of breath, intestinal problems, micturition frequency, dyspareunia and dizzy spells; there were no weight changes; there was a lowering of the pulse rate, a marked increase in the number of hours of sleep; there were no cases of addiction and no potentiation of the effects of alcohol, even though 10% of the large sample was, as it happened, alcohol-dependent [Drs Depis, Fineltan, Hamazaoui, L'Homme & Magonnier. Random Trial of L.72 (a Homoeopathic Speciality) against Diazepam 2 in Cases of Nervous Depression. A Balance Sheet of 60 Random Observations of a Female Population, Age 20-60 published by Dr B Heulluy, Paris: Centre for Therapeutic Research and Documentation, 1988].

HERBAL REMEDIES

The alleviation of all these distressing peri-menopausal phenomena by the rhubarb-root extract ‘Phytoestrol’, the trade-mark of a standardised phyto-oestrogen available in the U.K., is very well documented [G Wilcox et al. Oestrogenic Effects of Plant Foods in Post-Menopausal Women, Br Med J, 1990, 301: 905-906; Kaldas, R S, & C L Hughes. Reproductive and General Metabolic Effects of Phyto-Oestrogens in Mammals, Reprod Toxicol, 1989, 3: 81-89; and Gerster, G. Die Anwendung von Rhaponticin im Licht der modernen Endokrinologie, Zschr angw Phytotherapie, 1981, 111(81): 1-8.].

But there is much more good news about memory loss, the sense of dissociation, and the dreadful loss of cognitive competence that so many menopausal women experience, along with a disturbing emotional disequlibrium (which is also distressing to their partners and husbands):

Phytoestrogens have been stimulating considerable interest in the circles of orthodox medicine, since they have been shown to have anti-viral, anti-carcinogenic, anti-fungal, anti-oxidant, anti-mutagenic, anti-hypertensive, and anti-inflammatory effects. Dr Margaret C P Rees of the John Radcliffe Infirmary, Oxford, UK referred in some detail to the information given to 4000 delegates at the 8th International Medical Congress on the Menopause in Sydney, Australia about all these benefits, as well as on the cardiovascular and skeletal systems, with no adverse effect on breasts [J Wordsworth. Congress Highlights, J Brit Menopause Soc, March 1977, p. 26-27].

At the same Congress, Dr Jennifer Wordsworth, Consultant in Family Planning and Reproductive Healthcare, Sheffield, UK quoted four studies of pre-menopausal women who had undergone a surgical menopause. She said that the human brain is a key target organ for oestrogen. The hippocampus and hypothalamus have high concentrations of oestrogen receptors, which is of particular importance in memory performance. Cognitive skills are adversely affected by the menopause and these were maintained by supplementation in the women who had had hysterectomies. The verbal memory performance was maintained and the ability to learn new material was enhanced as compared to the women taking placebo. In addition, perception, sense of well-being, problem-solving ability, and language fluency improved in the treated groups. She also pointed out that the phytoestrogens appear to have a clinically relevant cholinergic and serotonergic neuromodulatory role in old age by lowering the risk of Alzheimer’s disease. When former users do develop dementia, the age of diagnosis is later and there are fewer deaths attributable. She also quoted one study showing that it reduced the severity of Sleep Apnoea Syndrome [SAS], and since SAS increases the risk of cardiovascular disease and fatal accidents, and occurs quite frequently in postmenopausal women there are significant health implications.

The point was also made that Tamoxifen, which is widely used to reduce the recurrence of breast cancer, brings on many peri-menopausal symptoms and increases endometrial stimulation, which could well increase the risk of endometrial cancer. [Wordsworth, J, M C P Rees & P Roberts. From the 8th International Congress on the Menopause, Sydney, December 1996: Congress Highlights; Phytoestrogens; and The General Practitioner's Perspective, J Brit Menopause Soc, March 1997, 26-27.]. Isn’t it eminently sensible, then, to use phytoestrogens with their established anti-carcinogenic and anti-osteoporotic effects?

Eighty menopausal women formed part of a double-blind trial in which Cimicifuga racemosa (Black Snake-root or Black Cohosh) [8 mg/day for 3 months] was administered to group A, conjugated oestrogens [0,625 mg] to group B, and placebo to group C. The r4esults was that the results for A wre significantly superior to groups B or C on all menopausal symptoms [Therapeuticon, 1987, 1: 23-31].

OSTEOPATHY FOR THE MENOPAUSE

A randomized clinical trial involving 30 menopausal patients compared the effects of osteopathy (once weekly for ten weeks) with sham treatment. Significant improvements were reported with osteopathy on a number of menopausal symptoms, particularly hot flushes and depression [C Cleary & J P Fox. Menopausal Symptoms: An Osteopathic Investigation, Compl Ther Med, 1994, 2: 181-186].

DIETARY AWARENESS IN THE MENOPAUSE

Positive evidence here, particularly for soy, is very well established [Menopause, 1997, 4:89-94; Obstet Gynaecol, 1998, 91:6-11; Menopause, 1999, 6:7-13; Menopause, 2000, 7:105-111].

ACUPUNCTURE FOR THE MENOPAUSE

In a sham-controlled randomized clinical trial acupuncture provided relief from menopausal symptoms and reduced blood pressure lasting less about two months [K Kraft & S Coulon. Effect of a Standardised Acupuncture Treatment on Complaints, Blood Pressure and Serum Lipids of HypertensivePpost-menopausa Women: A Randomized Controlled Clinical Study, Forsch Komplementaermed, 1999, 6:74-79].

OVERWEIGHT

Corpulence is a synonym for this state in which the weight is greater than 10% above ‘normal’ weight relative to height; obesity is more than 20% and where, additionally, the body fat percentage is greater than 30% for women and 25% for men. Thus a muscular athlete may be overweight, but have a very low body-fat percentage. Hence body weight alone can not be used as an index of obesity.

The successful programme for combating obesity is consistent with the basic tenets of naturopathic medicine, namely all of the following: proper diet, correct mental attitude and adequate exercise.

PHYTOTHERAPY

One double-blind randomized controlled trial assessed 70 obese subjects who received one of three different Ayurvedic herbal formulations (depending on their constitutional body-type: Vata, Pitta or Kapha) or indistinguishable placebo for 3 months [Paranjpe P, Patki P, Patwardhan B. Ayurvedic Treatment of Obesity: A Randomised Double-blind, Placebo-controlled Clinical Trial. J Ethnopharmacol, 1990; 29:1-11]. All patients entered into this controlled trial were at least 20% in excess of their ideal body weight and not diabetics. The paper reports that, even without exercise, patients in the treatment group experienced a significant weight loss compared with those in the placebo group.

In a double-blind randomized controlled trial Maté (a tea) extract (Ilex paraguariensis) was reported to induce a rise in respiratory quotient which indicates an increase in the proportion of fat oxidized [Martinet A, Hostettmann K, Schutz Y. Thermogenic Effect of Commercially Available Plant Preparations Aimed at Treating Human Obesity. [Phytomedicine, 1999, 6: 231-238.

ACUPUNCTURE

This has the reputation, deservedly, of helping to attenuate addictive urges. So, can it curb the appetite for food ? In a randomized controlled trial 60 overweight patients, who were considered gourmands, were treated with either electro-acupuncture or sham acupuncture twice daily for 4 weeks [Richards D, Marley J. Stimulation of Auricular Acupuncture Points in Weight Loss. Aust Fam Physician, 1998;,27(suppl 2):S73-77]. The paper reports that the number of patients, who lost weight, as well as the mean weight loss overall, was significantly larger in the acupuncture group. Two other sham-controlled randomized trials of good quality, including more than 200 subjects, which assessed appetite/hunger, yielded convincingly positive results [Wiener Klin Wochenschr, 1997, 109:60-62].

FOOD SENSITIVITIES

Overweight may result from cravings for certain frequently eaten foods to which people have become sensitized, or may have always been hypersensitive to. Avoidance of those foods precipitates a variety of mental and physical symptoms, which militates against their avoidance. In that situation, any weight reduction diet that happens to include such foods will become exceedingly difficult until the ‘masked’ food allergen(s) have first been avoided for about two weeks, during which a diuresis will often occur, that itself results in weight loss. The most common culprits are cow’s milk, cane sugar and the wheat/rye/barley group [T G Randolph. Masked Food Allergy as a Factor in the Development and Persistence of Obesity, J Lab Clin Med, 1947, 32:1547]. It is with these cravings that acupuncture can also help.

NUTRITIONAL SUPPLEMENTATION

There is evidence from a controlled study that following a high fibre weight reduction plan may increase annual bone loss significantly. The loss of bone density was noted to be from the lumbar spine in post-menopausal women. It seems that this bone loss is irreversible, even if the weight is regained. In other words, repeated cycles of high fibre weight loss and gain may well increase the risk of spinal osteoporosis [A Avenell et al. Bone Loss Associated with a High Fibre Weight Reduction Diet in Post-menopausal Women, Eur J Clin Nutr, 1994, 48(8):561-566].

Chromium is known to modulate the body’s sugar metabolism and to reduce sugar-cravings. Several double-blind trials have found that supplementation with chromium promoted the loss of body fat in obese people whilst preserving lean muscle mass. Ninety days after overweight patients randomly received either a chromium supplement or placebo, the patients in the chromium group lost significantly more weight (7.79 versus 1.81 kg respectively) and fat mass (7.71 versus 1.53 kg, respectively), and had a greater reduction in percent body fat (6.3% versus1.2%, respectively) without any loss of the fat-free mass [G R Kaats et al. A Randomized, Double-masked, Placebo-controlled Study of the Effects of Chroium picolinate supplementation on Body Composition: A Replication and extension of Previous Studies, Curr Therapeut Res, 1998, 59(6):379-388].

Obese patients supplemented in two double-blind studies with 5-hydroxytryptophan had significant weight loss, within six weeks, without dietary changes: They reduced their carbohydrate consumption and experienced early satiety [F Ceci et al. The Effects of Oral 5-Hydroxytryptophan Administration on Feeding Behaviour in Obese Adult Female Subjects, Neural Transm, 1989, 76(2):109-117; and C Cangiano et al. Eating Behaviour and Adherence to Dietary Prescriptions in Obese Adult Subjects Treated with 5-Hydroxytryptophan, Am J Clin Nutr, 1992, 56:863-867].

EXERCISE AND DIET

A 6300 kilojoules (1500 calories) per day diet, adequate in protein, and reasonably high in ordinary vegetable fibre as well as rich in complex carbohydrates coupled with daily exercise with the heart rate maintained in the 50-60 percent intensity range for about 20 minutes is indicted [M T Murray & J E Pizzorno, Jnr. Encyclopaedia of Natural Medicine, Prima Publishing: Rocklin, CA, 1990, p446].

BREAKFAST

Overweight or obese people have less satisfactory breakfast habits than people who are ‘normal’ in weight [R M Ortega et al. Differences in the Breakfast Habits of Overweight/Obese and Normal Weight School Children, Int J Vitam Nutr Res, 1998, 68(2):125-132]. In a controlled study, moderately obese women who ate breakfast were more successful at losing weight than those who did not. Analysis of behavioural data suggested that eating breakfast helped reduce dietary fat and minimized impulse snacking [D G Schlundt et al. The Role of Breakfast in the Treatment of Obesity: A Randomized Clinical Trial, Am J Clin Nutr, 1992, 55:645-651].

WHAT IS IT?

Prostatic cancer is the most common cancer in elderly men. It is generally androgen-depedent. The management of early stage disease in Orthodox medicine is with surgery and/or radiotherapy. For more advanced cases, and in metastatic disease, a mainstay of treatment is suppression of androgen secretion and/or action; GnRH analogues (Buserelin, Goserelin, or Leuprorelin) are prescribed. Yet these pharmaceutical agents are known to cause a transient worsening of the disease. For the prevention of these ‘flares’ the anti-androgens Cyproterone acetate (100 mg 2 or 3 times daily) and/or Flutamide (250 mg 3 times daily) are usually additionally prescribed [R L Souhami & J Moxham. Textbook of Medicine (3rd ed), London: Churchill Livingstone, 1997, p 774]. Impotence commonly occurs.

SHOULD I SUSPECT THAT I HAVE (OR MY PARTNER HAS) PROSTATE CANCER?

Any, or all, of the following ten symptoms may be present, although it could also be totally asymptomatic:

• Painful or burning urination
• Painful ejaculation
• Blood in urine or semen
• Erectile problems
• Stiffness or aches in the hips, low back or thighs
• Weak or interrupted urine flow
• Difficulty starting to urinate
• Difficulty in holding back urine
• Frequent urination, especially at night
• Inability to urinate

These symptoms are not specific to prostate cancer only; amongst other things, infections may cause them too (like Chlamydia, Mycoplasma, Ureaplasma, etc: many of these can be excluded by blood tests). Moreover, the last five symptoms (6 - 10) are also found in benign enlargement of the prostate (known as benign prostatic hyperplasia, or BPH).

IS THERE A CONSTITUTIONAL PREDISPOSITION TO
PROSTATE CANCER?

In a study of 4000 men by the U.S. National Institute of Health, male-pattern baldness is associated with a greater risk. That is because both conditions involve the organism’s reaction to the principal male hormone: The same testosterone receptors are found on hair follicles and on the prostate [E Hawk, R A Breslow & B I Graubard. Male Pattern Baldness and Clinical Prostate Cancer in the Epidemiological Follow-up of the First National Health and Nutrition Examination Survey, Cancer Epidemiol Biomarkers Prev, 2000, 9:523-527].

WHAT IS ENTAILED IN AN INVESTGATION?

There would first be a digital rectal examination (or DRE, in which a gloved finger rectally probes the prostate). That is usually followed by a blood test that checks the level of a protein called prostate-specific antigen (PSA). This is, unfortunately, not very reliable: on average, it produces 35% false negatives. But that reliability improves markedly, if there has been no sexual activity for 48 hours prior to the blood being taken. There is, however, another blood test, which measures an enzyme called telomerase in the semen. The enzyme allows cancer cells to by-pass fixed controls on cell division, so that cells can undergo an unlimited number of divisions, as cancer will cells always want to do. The diagnostic procedure will then move on to the obligatory ultra-sound scan.

HOW CAN YOU TELL THE DIFFERENCE BETWEEN BPH AND
PROSTATE CANCER?

I have found the best non-invasive method in natural medicine was the taking by the patient of the herbal tincture of Serenoa serrulata consistently under professional guidance for at least three weeks. In BPH, it generally reduces the urination urgency and approximately halves the frequency of nightly urination in that time, whereas in prostate cancer it has little or no effect. In any event, this is certainly the remedy of choice for BPH and should always be part of the regimen for prostate cancer, too.

SUPPORT THROUGH NUTRITIONAL SUPPLEMENTATION

One of the most effective support nutrients is lycopene. This is the carotene that creates the red colouring in tomatoes. It is the major carotene in the diet of most Europeans. About 80% of lycopene consumed in the European Union comes from tomatoes. Yet paw-paw, pink grapefruit, red paprika, rose-hip, strawberries, cranberries, water-melon, galia-melon, pimiento, peri-peri, guava, harissa, plums, damsons, raspberries, bell peppers, peaches, cherries and apricots all contribute, to a greater or lesser extent, as well. The amount of lycopene in the fruit/vegetable obviously, varies significantly. It depends on the type of fruit/vegetable and how ripe it is. In the reddest strains, lycopene concentrations may be close to 60 mg per kg; but there may be as little as 5 mg/kg in the yellowish strains of the same fruit/vegetable. Lycopene is, fortunately, relatively stable during cooking and food-processing. Lycopene is a more a potent scavenger of free radicals, exerting anti-cancer effects in this way, than any other dietary carotene, and if it is eaten with pumpkin-seed oil, its absorption is improved [P H Gann, J Ma, E Giovannucci, E Willert, et al. Lower Prostate Cancer Risk in Men with Elevated Plasma Lycopene Levels: Results of a Prospective Analysis, Cancer Res, 1999, 59:1225-1230]. Lycopene supplementation, together with alpha-tocopherol (vitamin E), seems to have a measurable therapeutic effect in prostate cancer. Twenty-six men with diagnosed, clinically localized cancer were randomly assigned to receive 15 mg of lycopene and vitamin E twice a day, or no supplementation, for three weeks before prostatectomy. The PSA levels decreased by 18% in the lycopene group, whereas they increased by 14% in the control group [M Pastori, H Pfander, D Boscoboinik & A Azzi. Lycopene in Association with Alpha-tocopherol Inhibits at Physiological Concentrations Proliferation of Prostate Carcinoma Cells, Biochem Biophys Res Commun, 1998, 250:582-585]. If vitamin E levels are adequate, I generally recommend 30 mg of lycopene supplementation daily to decrease the growth of prostate cancer, furthermore, I add vitamin E supplementation to this.

There are a number of rigorously conducted studies showing both the protective effects, as well as the reduction in the further development of established prostate cancer, by the introduction into the diet of, or supplementation with: soy, omega-3 fatty acids, and selenium [B K Jacobsen, S F Knudsen & G E Fraser. Does High Soy Milk Intake Reduce Prostate Cancer Incidence? The Adventist Health Study (United States): Cancer Cases and Control, 1998, 9:553-557; A E Norrish, C M Skeaff, G L Arribas, S J Sharpe & R T Jackson. Prostate Cancer Risk and Consumption of Fish Oils: A Dietary Biomarker-based Case-control Study, Br J Cancer, 1999, 81:1238-1242; and L C Clark, B Dalkin, A Krongrad et al. Decreased Incidence of Prostate Cancer with Selenium Supplementation: Results of a Double-blind Cancer Prevention Trial, Br J Urol, 1998, 81:730-734].

Other essential supplements in prostate cancer are calcium D-glucarate, indole-3-carbinol, and ground linseed (called ‘flax-seed’ in the U.S.). Men who have been prescribed anti-hormonal drugs, ought to take extra calcium and engage in weight-bearing and resistance exercise in the gym to prevent osteoporosis.

DIET AND LIFE-STYLE

Avoiding tobacco and cannabis smoke and excessive intake of alcohol, as well as a regular exercise program have been associated with a reduced risk of prostate cancer. There are now so many convincing studies linking diet to prostate cancer that William Fair and his colleagues suggest that prostate cancer ought, perhaps, to be considered a “nutritional disease” [W R Fair, N E Fleschner & W Heston. Cancer of the Prostate: A Nutritional Disease?, Urology, 1997, 50:840-848]. Dietary factors are known to change sex hormone levels, detoxication mechanisms, and the whole anti-oxidant
status generally.

The bottom line is: the risk increases with -

• Diets that are low in selenium, vitamin E, soya isoflavonoids, and lycopene; and
• Diets which are high in heterocyclic amines (abundant in grilled and broiled meats), saturated fatty acids, as well as milk and egg products.

WHAT IS IT?

I don’t think any condition has undergone more name changes over the past 90 years than I.B.S. At various times, in the medical literature, it has been referred to as ‘spastic colon’, ‘functional bowel disorder’, ‘dyspeptic diarrhœa’, ‘gut hyper-reactivity’, ‘spastic constipation’, ‘anxiety- and GI-syndrome’, ‘mucous colitis’, ‘functional bowel syndrome’, and, recently ‘dysfunctional gut syndrome’ is beginning to displace ‘irritable bowel syndrome’. This makes one suspect that no-one seems entirely sure of what I.B.S. really is. The symptoms associated with I.B.S. generally seem to include abdominal distension (bloating) and some discomfort - particularly after food, borborygmi (bowel rumblings), mucus in the stools, constipation alternating with diarrhœa, decreased memory and concentration, fatigue or lethargy, and poor quality of sleep. The probability of I.B.S. increases the more of these symptoms are present. I.B.S. must be distinguished from conditions that may mimic I.B.S: colorectal cancer, cœliac disease, infective diarrhœa, diverticular disease, carcinoid syndrome, gallstones, appendicitis, and one of the two inflammatory bowel diseases. There are specific diagnostic procedures to exclude such other conditions.

CAN DIET HELP?

The 'stone age' diet or 'elemental' diet [L & A Chaitow, Stone Age Diet, London: Macdonald Optima, 1987], which is free of grains, red meat, cow's milk products, refined sugars, and all processed foods, has been shown to induce a dramatic remission in this and related illnesses [G Zoli, et al. Randomized Controlled Study Comparing Elemental Diet and Steroid Treatment in Crohn's Disease, Alimentary Pharmacol Ther, 1997, 11(4):735-740].

WHICH NUTRITIONAL SUPPLEMENTATION SHOULD I CONSIDER?

Ginger (Zingiber officinale) was shown gently to reduce colic spasms, flatulence, nausea and diarrhœa in a double-blind randomized clinical trial [Lancet, 1982, i:655-657]. Rosemary (Rosmarinus officinalis), peppermint (Mentha piperita) and balm (Melissa officinalis) have been demonstrated to have a calming effect on intestinal spasms and to reduce flatulence [H B Forster, H Niklas & S Lutz. Antispasmodic Effect of some Medicinal Plants, Planta Medica, 1980]. Carraway seed (Carum carvi), fennel (Fœniculum vulgare), and probably dill (Anethum graveolens) have a similar effect [R F Weisz. Herbal Medicine, Ab Arcanum: Gothenburg, 1988, pp 67 & 68]. The globe artichoke (Cynara scolymus) has a long history in helping with liver detoxification and treating gallbladder spasms that occasionally accompany I.B.S. [HH Hammerl. Wiener medizinische Wochenschrift, 1973, 1223:601; H Dierel. Wiener medizinische Wochenschrift, 1972, 122:188; and E Fröhlich. Subsidia Medica, Wien, 1973, H.3:5 (with an extensive list of further references)]. Dandelion has comparable effects [R F Weisz. Herbal Medicine, Ab Arcanum: Gothenburg, 1988, pp 94 & 96]. I.B.S. sufferers who are too busy to do anything else should at least be taking either artichoke or dandelion whole-plant juices on a daily basis.

WHAT ABOUT "CANDIDA" OR FUNGAL-TYPE GUT DYSBIOSIS?

There are three species of yeast or fungus that can invade the gut and settle there:

• Candida albicans
• Geotrichum species
• Torulopsis glabrata

The difference is evident from responses to dietary manipulations. For example, it seems the last two will ferment white potatoes, maize and rice, as well as the other grains, whereas Candida albicans only appears to ferment wheat, rye, barley and oats.

IS THERE A SET OF SYMPTOMS THAT POINTS TO 'CANDIDA' OR A 'CANDIDA-LIKE' CONDITION?

• Yes, the clinical symptoms that usually accompany this, are:
• Cravings for sweet foods
• Chronic fatigue or lethargy
• Poor co-ordination
• Sleepy after meals
• Difficult to lose weight
• Increasing weakness
• Brittle or flaky nails
• Loss of libido
• Panic attacks
• Constipation
• Diarrhoea
• Abdominal bloating with food
• Burning pressure in stomach after eating
• Indigestion or trapped wind
• Belching and wind
• Mucus (sliminess) in stools

Sometimes there are other yeast infections present too, such as:

• Vaginal thrush
• Peri-anal or other Candida infection of the skin
• Oral thrush
• Fungæmia (presence of fungi in the blood) [M A Krupp & M J Chatton. Current Medical Diagnosis and Treatment, Lange Medical Publishing: Los Altos, CA, U.S.A., 1989, pp 100, 121, 353, 747 & 1000]

CAN AN INTESTINAL YEAST OVERGROWTH OR A BACTERIAL GUT DYSBIOSIS ACTUALLY BE MEASURED?

The Gut Fermentation Profile can do that [A Hunnisett, J Howard & S Davies. J Nutr Med, 1990, 1:33-38]. Abnormalities of bacterial fermentation or a possible yeast overgrowth are indicated by the results of this blood test.

CAN A 'LEAKY GUT' BE TESTED FOR?

Yes, by means of the Gut Permeability Probe [K K Eaton, M Howard & J McLaren-Howard. J R Soc Med, 1995, 88:63-66]. A drink containing PEG 400, a mixture of eleven sizes of molecules, is taken. The different sizes of molecules pass through the gut wall and into the circulation with differing levels of ease. All the urine passed over the next six hours is collected. The quantities of each molecular size of PEG in the urine collection are measured and from this an accurate absorption profile can be reconstructed.

IS THE BREATH HYDROGEN TEST USEFUL IN THE OF GUT FUNCTION?

Hydrogen is generated by bacterial action in the gut. The normal fasting level is low but increases are seen after the digestion of fermentable carbohydrate. If bacterial action occurs in the stomach the hydrogen increase is detected in a matter of minutes. This can also be helpful in detecting Helicobacter Pylori (a bacterial infection associated with stomach ulcers).

IS THE CANDIDA ANTIBODY TEST USEFUL?

Only to establish whether you may be hypersensitive to the Candida albicans yeast organism, though it may not be in your gut at all. In other words, it does not tell you whether, in fact, you have a yeast overgrowth [G F Kroker. Chronic Candidiasis and Allergy. In: J Brostoff & S J Challacombe (eds): Food Allergy and Intolerance, W B Saunders: Philadelphia, PA, USA 1987, pp 850-872]. Stool cultures should also not be relied upon for a definitive exclusion of a ‘candida’ diagnosis [J E Pizzorno, Jr & M T Murray. Textbook of Natural Medicine (loose-leaf), Bastyr University: Kenmore, WA, U.S.A., 1995 (and later), pp IV:Candid-1to Candid-6]. They are very useful for investigating parasitological aspects.

WHAT COMMON PREDISPOSING CONDITIONS ARE THERE?

There are two common predisposing conditions:

Hypochlorhydria (reduction in stomach acid production) Decreased pancreatic exocrine function (too few pancreatic enzymes)[H C Gaier, K K Eaton, M Howard, J McLaren Howard & L Reid. Gastric Acid Production, Pancreatic Secretions and Blood Levels of Higher Alcohols in Patients with Fungal-type Dysbiosis of the Gut, J Nutr & Env Med, 2002, 12(2):107-112]

Digestive secretions, such as gastric hydrochloric acid, pancreatic enzymes, and bile, inhibit the overgrowth of Candida and prevent its penetration into the absorptive surfaces of the small intestine. The pancreatic enzymes, for example, are largely responsible for keeping the small intestine free of parasites (be they unwanted bacteria, yeasts, protozoa, and intestinal worms) [E Rubinstein, Z Mark, J Haspel, et al. Antibacterial Activity of the Pancreatic Fluid, Gastroenterol, 1985, 88:927-932] and help the body break down immune complexes [K Ransberger. Enzyme Treatment of Immune Complex Diseases, Arthritis Rheum, 1986, 8:16-19].

HOW ARE THESE DETECTED?

I do it by means of clinical observations: A low stomach acid production can manifest itself through a tendency to nausea (e.g. morning queasiness), excessive eructations (burping), an uncomfortable pressure sensation in the pit of the stomach, some hyperventilation and/or occasionally by œsophageal reflux. People with a low production of pancreatic enzymes and/or stomach acid often suffer from panic attacks. The reason for this is that the outlet of the stomach into the small intestine (the pylorus) opens only when the contents of the stomach has reached a particular, and always the same, level of acidity. With too little stomach acid, it can take an exceptionally long time before the pylorus opens. That means the stomach distends as fluids and foods enter but cannot leave it (hence the nausea, the pressure sensations, the burping to relieve, the reflux - a burp behind some material, etc). The distended stomach presses on the cardio-vascular system right next to it. This produces palpitations and a state of anxiety, which we call panic attacks.

WHAT IS A SUCCESSFUL THERAPEUTIC APPROACH?

There are six important steps in the successful control of an intestinal yeast overgrowth with increased gut permeability:

• Eliminate the use of antibiotics, steroids, immune-suppressing drugs, and birth control pills (unless there is an absolute medical necessity)
• Follow the ‘Gut Dysbiosis and Fermentation Diet’ that supports the actual treatment (this can be downloaded by clicking here.)
• Where needed restore normal digestive secretion by supplementing with pancreatic enzymes, ‘HCl + Pepsin’, and substances which promote bile flow
• Support liver function (which has constantly had to detoxify alcohols produces within the body)
• Support immune function (which has probably been compromised through is increased gut permeability)
• Use nutritional and herbal supplements which eliminate unwanted gut bacteria, help control yeast overgrowth and correct degraded intestinal permeability [J E Pizzorno, Jr & M T Murray. Textbook of Natural Medicine (loose-leaf), Bastyr University: Kenmore, WA, U.S.A., 1995 (and later), pp IV: Candid-1to Candid-6].

HOW LONG DOES TREATMENT USUALLY TAKE?

On average, it takes ten weeks from test to finish, but it sometimes takes a bit longer.