Very small quantities of the trace mineral selenium are essential to human health. Selenium is required for the synthesis of the protective enzyme glutathione peroxidase, which protects cell membranes against damage by oxidants, including those in cigarette smoke. Selenium also seems to make platelets less sticky, decreasing the risk of strokes and heart attacks. It may also boost cellular immunity.

There is now a large body of evidence to suggest that in countries with high levels of selenium in the soil, cancer rates are low. Studies show that healthy people have higher selenium blood levels than cancer patients. And there is a substantial body of evidence to suggest that selenium supplements, either in the diet or added to the drinking water, offer protection against a variety of forms of cancer.

Studies on the protective effects of selenium have generated a great deal of excitement among researchers. It has been the most widely studied mineral in recent years. High selenium levels in the diet have been found to inhibit the induction of a variety of cancers (skin, liver, colon, and breast) in experimental animals, while low selenium levels may be an additional cancer risk factor. Selenium also helps detoxify some of the toxic heavy metals in cigarette smoke, such as mercury and cadmium.

A study led by Dr. Walter Willett of the Harvard School of Public Health found that people who came down with certain types of cancer had low selenium blood levels several years prior to the discovery of their cancers.

Dr. Gerald Schrauzer, a long-time selenium researcher at the University of California in San Diego, believes that the evidence that selenium can help protect against cancer is strong enough to suggest that virtually everyone should be sure they are receiving adequate amounts of this mineral.

The best dietary sources of selenium include organ meats (extremely high in selenium), seafood, beef, pork, lamb, chicken (very high in selenium), broccoli, cabbage, celery, cucumbers, onions, mushrooms, radishes, brewer’s yeast, and grains. Selenium content of vegetables may vary over 100-fold depending on the region in which they were grown.

Selenium supplements are available in both inorganic and organic forms. Some researchers believe that the organic forms have fewer toxic effects. In addition, the absorption of inorganic selenium, particularly sodium selenite, may be decreased in the presence of vitamin C. The National Cancer Institute currently recommends a dietary intake of 50 to 200 micrograms (nor milligrams) of selenium per day, including the selenium you get in foods, as a cancer prevention measure. [The symbol for micrograms is u The symbol for milligrams is mg.]

Selenium toxicity can occur if doses larger than 200 micrograms per day are taken regularly. Symptoms of selenium toxicicy include fragile or darkened fingernails, a metallic taste in the mouth, a metallic or garlicky smell to the breath, nausea, and dizziness.

Thus, it would seem a prudent pro-health measure for everyone ? smokers especially ? to make sure they get enough selenium. But even enough the evidence that selenium may help prevent cancer is very encouraging, smokers should not think of selenium supplements as a “magic anti-cancer pill.” It is extremely unlikely that selenium could completely reverse the harmful effects of tobacco smoke.

Vitamin B-12

This vitamin helps detoxify the cyanide found in tobacco smoke. Smokers excrete more B-12 and thus have lower serum levels. This smoking-produced B-12 deficiency is thought to be responsible for a disease called tobacco amblyopia. Tobacco amblyopia can produce dimming of vision in the central part of one’s visual field. In some cases complete vision loss can occur. Tobacco amblyopia is treated with large doses of vitamin B-12.

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Vitamin E

Vitamin E is an anti-oxidant that can protect experimental animals against some toxic substances. Vitamin E can help block the formation of nitosamines from substances found in tobacco smoke. Vitamin E also seems to protect both lung tissue and the vitamin A in your body from the effects of other oxidants in tobacco smoke. Vitamin E-deficient rats are more sensitive to damage by cigarette smoke.

Large amounts of vitamin E can help protect experimental animals from polluted air, probably because it protects the unsaturated fatty acids in the lung tissue from oxidation. Vitamin E also potentiates the tumor-inhibiting ability of the mineral selenium. Vitamin E may also help inhibit a precancerous breast condition in humans.

Vitamin E is a free radical scavenger. It neutralizes free radicals which could cause damage to other cells and tissues if vitamin E did not “soak them up.” Vitamin E may also protect against free radical damage to the cardiac muscles.

Vitamin E is generally considered safe in doses under 600 IU. Possible side effects of this vitamin include nausea, gas, diarrhea, fatigue, skin disorders and slow healing of cuts or burns.

Persons with high blood pressure, those taking anticoagulant drugs, and those with bleeding or clotting disorders should consult their physician before taking vitamin E supplements. Vitamin E supplements should be taken as part of a balanced vitamin/mineral preparation that includes selenium. Vitamin E should not be taken at the same time as birth control pills or inorganic iron supplements, as both can interfere with vitamin E activity.

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Vitamin A is available in two forms: fully formed vitamin A (technically known as Tecinol), and several pre-vitamin A substances, most notably beta-carotene, which are converted to vitamin A inside your body. Preformed vitamin A can have toxic effects at relative low levels. but beta-carotene is relatively nontoxic because it is converted into the active form very slowly. Beta-carotene is found in dark yellow, orange and green fruits a vegetables such as carrots, broccoli, asparagus, apricots and cantaloupe. One simple way for smokers to increase the level of vitamin A in their diet is to add carrots to their snack time menu.

Vitamin C

Vitamin C, also known as ascorbic acid, is an active antioxidant and can block the formation of some cancer-causing substances, especially the nitrosamines. These carcinogenic substances can be formed ? after you eat smoked, cured or pickled foods which contain nitrites. Tobacco products also contain nitrosamines. Vitamin C may also block the formation of other cancer-causing substances.

Vitamin C is also required for proper functioning of white blood cells in fighting infections, but smoking decrease the vitamin C levels inside these cells. The vitamin C levels of the white cells are frequently diminished during infections and during periods of environmental, physical or psychological stress. There is some evidence to suggest that high levels of vitamin C help reduce the duration of colds.

Smoking Breaks Down Vitamin C Smoking one cigarette breaks down roughly the same amount of vitamin C as you would get from an orange. As a result, smokers have 30 percent to 50 percent less vitamin C in their blood streams than nonsmokers.

A number of studies suggest that the diets of many American ? smokers and nonsmokers alike ? maintain low levels of this vitamin. Smokers take in less vitamin C than nonsmokers, even though they have a greater need for it. Smokers who do not eat breakfast are even more likely to be deficient in vitamin C intake.

Thus health-concerned smokers who don’t already eat plenty of vitamin C-rich foods may be well advised either to add more vitamin C to their diets or to consider taking vitamin C supplements. Fresh fruits and vegetable especially cirrus fruits, green pepper cantaloupe and broccoli are the best sources of vitamin C. One of the most convenient and least expensive ways to take vitamin C is in granular, rather than tablet, form. Granular vitamin C is a grainy powder. It is usually taken dissolved in water or juice.

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The question of whether to take vitamin supplements is a sticky one indeed. Some researchers pooh-pooh the need for vitamin supplements and insist that it is possible to obtain all our nutritional needs by eating healthy foods. It is undoubtedly better to get our vitamins and minerals from the foods we eat.

But the sad fact is that most Americans do not choose foods that provide the recommended levels of many vitamins and minerals from their diets. In the end, the supplement-or-not-to-supplement question is one each of us must answer for ourselves.

In addition to the guidelines listed above, smokers who are members of the following groups may have other special needs for vitamins and minerals:

• women using oral contraceptives
• pregnant women
• postmenopausal women
• people on weight-loss diets
• runners and other athletes
• those who drink significant quantities of alcoholic beverages
• hospitalized patients
• those exposed to high levels of environmental pollutants
• older people

Vitamin A

Vitamin A is probably the single most important nutrient for keeping the tissues lining the bronchi, trachea and lungs healthy. If smokers are deficient in vitamin A, the cilia that normally cleanse the lungs and bronchial passages are more susceptible to injury by tobacco smoke and the goblet cells, which secrete mucus, are more likely to die.

Numerous animal experiments have shown that vitamin A protects animals from carcinogenic substances found in cigarette smoke. In addition, some animal studies have shown that vitamin A may help prevent cancers of the skin, bladder and breast.

Tobacco Smoke Inactivates Vitamin A

Vitamin A is broken down at a faster rate in smokers, probably because some of the substances in tobacco smoke inactivate this vitamin. Several studies have shown that persons with low blood levels of vitamin A are more likely to come down with cancer.

One study showed that heavy long-term smokers who were given a six-month course of vitamin A showed a decreased level of pre-cancerous changes in their bronchi. And while the results of some studies have been less conclusive, a Norwegian study found that heavy smokers with low vitamin A levels had three times as much cancer as heavy smokers who had adequate blood levels of vitamin. Another study suggests that vitamin A may also have a protective effect against cervical cancer.

American Cancer Society Recommendations The American Cancer Society now recommends a diet high in vitamin A to help prevent cancer. And Michael B. Spom, chief of the lung cancer branch at the National Cancer Institute, has stated, “No human population at risk for development of cancer should be allowed to remain in a vitamin A deficient state. Considering the relatively trivial cost … this is certainly a goal which should be met for the entire population.”

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While it is already known that high blood pressure is a risk factor for cardiovascular disease, new findings show that it may also cause a decline in cognition in older adults.

In a study published in the December issue of Hypertension: Journal of the American Heart Association, researchers compared the cognitive skills of 107 older adults with moderately high blood pressure, and 116 older adults with normal blood pressure. The average age of the participants was 76, and all participants were well-matched for other factors known to influence cognitive function, including age, education level, depressive disorder and psychotropic prescription medication without prescription. The participants completed various tests to define their reaction time and long- and short-term memory abilities.

Researchers found that the participants with high blood pressure had problems with short- and long-term memory, and, on average, were ten % slower in reaction time than participants with normal blood pressure. They believe that, while the decline in cognition may be too mild to disrupt everyday function, it may increase the risk for developing dementia or impaired mental ability later.

Researchers believe that the results of this study show a link between high blood pressure and cognition, and speculate that treating high blood pressure may prevent dementia. The incidence of dementia doubles every five years, starting at 2.8 percent at ages 70 to 74, to 38.6 percent at ages 90 to 95.

The FDA asked its Oncologic Drugs Advisory Committee to consider whether changes are needed to the agency’s policy on giving severely ill patients special access to cancer therapies that are not yet approved.

The panel will not make suggestions until its next meeting in March, said committee chairperson Stacy Nerenstone of Hartford Hospital’s Helen & Harry Gray Cancer Center.

Currently, a patient who is not eligible for a clinical trial of an experimental cancer prescription drugs can seek treatment with the same therapy through an individual investigational new drug (IND) application. The application must be approved by the drug company, and the FDA has to agree with the company that there is adequate evidence of safety and efficacy.

Grant Williams, medical team leader at the FDA’s Division of Oncology Drug Products, said several hundred patients a year get individual INDs. Many also get access to products in development through expanded access programs, in which pharmaceutical companies make their treatment available to hundreds or thousands of people at once while they complete clinical trials.

But drug makers often balk at making their products available through “compassionate use” programs, especially the individual IND. Several patients said they were stonewalled when they asked for individual access, with no clear policy explained.

“Companies must be clear and honest with the public about their policies,” said Robert Erwin, director of the Marti Nelson Cancer Research Foundation. He said there are many valid reasons why drug makers might deny access, but that they should not blame the FDA or do so without explaining the reasons to the patient.

Robert Spiegel, chief medical officer of Schering-Plough, said his company has made five drugs available through these programs. But, he said, Schering and other companies worry that opening up access will hurt their ability to get patients into clinical trials of the experimental product. They are also concerned that such programs will stress their capacity to provide the drug, and may compromise their ability to ensure safety.

With increasing media coverage of new therapies, some companies are being inundated with requests. Gerard Kennealey, vice president of oncology clinical research at AstraZeneca Pharmaceuticals, said the company has received 7,000 phone calls since May, when there was a spurt of upbeat stories about its non-small cell lung cancer drug Iressa.

“We stopped counting when we got calls from 12 Senators’ offices,” said Kennealey, noting that celebrities and politicians were among the many people pleading for the drug.

AstraZeneca set up an expanded access program, and now has 200 patients enrolled. But, said Kennealey, the company has been careful to limit distribution only to non-small cell patients, and only to those who had failed other treatments, and weren’t eligible for other trials.

The National Breast Cancer Coalition said expanded access programs were the only legitimate, fair, way to make experimental therapies available, but that they should not be the norm. Jan Platner, director of administration and programs for the Coalition, said individual INDs in particular tend to undermine research, and that there is no fair way to grant them. They also contribute nothing to scientific knowledge, she said.

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Both DeLapp and Dr. Janee Steinberg, medical director of the Advanced Cosmetic Laser Center in West Fort Lauderdale, Fla., say they have also had success with hypnosis.

“There’s lots of documentation for hypnosis that our bodies have energy we can tap into to fight infections,” Steinberg said. “For instance, I treated a 2 year old who had warts all over her eyes, face and mouth. I couldn’t bear the thought of putting her through the discomfort of surgery, so I decided to start with hypnosis. I told her I was giving her a special cream. She was to put it on her warts each night and say, ‘Warts, please go away.’ She surprised herself and me when she came back two weeks later and all the warts were gone. They have not recurred.”

Steinberg has also had positive results with Cantharone, the juice of the blister beetle.

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Unfortunately, the TV spots featuring Carter leave one with the incorrect impression that we know little about what causes the disease. While there apparently is a genetic component to pancreatic cancer leaving certain families at risk, what was not communicated in the Carter/Lustgarten ad is the reality that cigarette smoking is by far the leading controllable risk factor associated with the development of this form of cancer.

About 27,000 Americans are diagnosed each year with pancreatic cancer — and approximately the same number die annually from it. This type of malignancy is one of the deadliest forms of cancer.

Smokers are considered to be at twice the risk of nonsmokers, and the heaviest smokers at three times this risk (the Lustgarten Foundation Web site acknowledges this fact). Indeed, epidemiologists now estimate that 30 percent of the cases of pancreatic cancer can be causally linked to smoking (Individuals with cystic fibrosis or pancreatitis associated with heavy alcohol ingestion, are also at increased risk).

Interestingly, despite his family history, Carter has to date avoided pancreatic cancer — and he has never smoked. However, his sister, Ruth, brother, Billy, and mother, Lillian, were all cigarette smokers.

The tobacco industry is quick to argue that smokers are fully responsible for the health consequences of smoking — and “know all the risks.” But how many consumers are aware that smoking is a highly significant cause of pancreatic cancer and that this condition is almost always fatal?

If public service ads such as the one President Carter has done continue to communicate the message that the risks are largely unknown, we will miss an opportunity to give Americans the information they need to modify their lifestyle to reduce the risk of this deadly disease.

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“A lot of the controversy springs from the fact that we haven’t actually proven most of the claims for adding hormones,” said Love. Further, studies have shown that by adding hormones a woman is increasing her chances of getting cancer, especially of the breast, and of getting blood clots.

Why take something that could give you cancer, asks Seaman, the co-founder of the National Women’s Health Network, a member-supported organization that is a longtime advocate for women’s health. Based on her studies of problems associated with hormone use since the 1940s, she calls their inclusion other than on a short-term basis “unjustified.”

For his part, Thomas, in his practice as a reproductive endocrinologist, said, “I do see the benefits of hormone replacement therapy,” including for prevention of the problems of heart disease and osteoporosis.

What women need to make a decision, he said, is copious amounts of information and a balanced discussion of the pros and cons. He is currently working on a consensus paper that identifies whether women who are members of minority groups are getting adequate information on the use of hormones.

Thomas said about a quarter of the women in menopause are taking hormone replacement medication. About 50 percent of women who start hormones stop taking them within a year. Of those that continue, about two-thirds are women who are seeking estrogen because they no longer have ovaries that are producing any estrogen at all.

Lifestyle Changes
It’s important to stress that it’s never too late to begin making lifestyle changes to prevent serious medical conditions like heart disease and osteoporosis, said Marks, including the following:

Do not smoke.

Eat well: healthy foods and sufficient calcium intake.

Exercise: Walk, move your body.

Take care of your spirit: Reduce stress and do things you enjoy.

Alternative Treatments
Some of the areas in which women have chosen alternative methods include vitamin and mineral supplements, herbs and acupuncture.

The public is increasingly combining conventional medical treatments with alternative or complementary therapies, said Mark. She has formed a task force of federal agencies to look at this issue, specifically through CAMPS, a comprehensive study to assess what women 45 and older are thinking and doing in regard to menopause. The data that’s been gathered is now in the process of being analyzed.

“I think it’s important that we study not only the efficacy, but the safety,” Mark said. Over the past year, the NIH has created the National Center for Complementary and Alternative Medicine, and it is expected that high-quality studies will be generated on how good and how safe alternative techniques are for menopause as well as other conditions.

For now, she said, there is not enough information available to know about interaction between alternative and conventional therapies.

Evaluating the Options
As new research comes out on any of the issues of menopause, Mark said, one study may refute another, thanks to better design or other variables. “It’s an evolving process,” she said, and women need to understand the information generated in light of who they are as individuals.

One study that it is hoped will provide guidance is a large, randomized, controlled study undertaken by the Women’s Health Initiative to look at hormone replacement therapy and heart disease, osteoporosis and Alzheimer’s disease, said Love. However, it will not be completed until 2008.

In the meantime, women and the medical profession have a number of studies on hormone therapies, many of which seem to have conflicting information. One of the problems is that many of the studies, to date, have been based on observational data rather than randomized, controlled data, the methodology that guides the medical profession to identifying the gold standard in treatment.

One recent study published in the January 2000 issue of JAMA, The Journal of the American Medical Association, looked at more than 46,000 post-menopausal women. It compared the rates of breast cancer between those who took estrogen alone in hormone replacement and those who took estrogen plus progestin. Progestin had been added to the hormone mix several years ago in order to protect the uterus from the cancer-causing properties of estrogen.

One promising area of research is the use of SERMs, selective estrogen receptor modulators, or hormones that interact with specific parts of the body without having the potential of negative effects on other parts.

Love said the key to grasping what is best to consider doing in menopause and beyond is to understand, “This is a work in progress. We are finally doing studies that answer the questions.”

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The average age of menopause in the United States is 51.2 years, Thomas said.

Post-Menopause
This is the condition that remains for the rest of a woman’s years, and given current life expectancies, most likely that means a full third of her lifespan. Hormones continue to be produced in the body, though at a reduced level.

What Are the Symptoms of Perimenopause/Menopause?
Symptoms, said Love, are what make you think “you’re going crazy.” One of the defining aspects of perimenopause and menopause is “change and unpredictability. Your body is reshuffling and rebalancing and, in doing so, you don’t know what it’s going to do when.”

About a third of women have no symptoms, she said, another third have some symptoms, though not badly enough to do much about them, and another third are suffering and need some form of treatment. The most common symptoms include: hot flashes, night sweats, insomnia, weight gain, vaginal dryness and mood swings. However, there are many different symptoms that a woman may experience. In her book on hormones, Love lists about 40 of them.

Treatment Options
Do Nothing
You don’t have to do anything different as you experience menopause. Some women have no symptoms. Some who do have symptoms can control them through their usual coping mechanisms. In fact, said, Thomas, about 75 percent of women choose not to treat menopause medically.

Hormone Treatment
This has become the hottest topic of menopause. In the past 60 years, medical science has created the capability to add hormones, such as estrogen and progesterone, to the body through medication. The questions include: Is it necessary? Is it risky? What are the benefits?

There are two reasons generally given to take hormones. One is to relieve the symptoms of perimenopause and menopause. The other is to add higher levels of estrogen with the intention of protecting the body from some of the diseases associated with aging.

To frame the discussion, Love said it’s important to understand that the ovaries continue to make hormones well into a woman’s 80s, but at a lower level than during the child-bearing years. And given the needs of an older woman’s body, “That lower level may well be adequate.”

Since the body naturally stops making high levels of estrogen, by taking hormone medication, you are not so much “replacing” hormones as adding them. The vast majority of women do just fine with the levels of hormones their body produces naturally, Love said. Some, however, may want hormones to get over the hump of symptoms that are too difficult to deal with and can’t be eliminated by other means. The ovaries of some women may not be making enough hormones to sustain their needs in the post-menopausal period, or they may not have ovaries if they were removed in a hysterectomy.

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