Adirondack Sports September 2023

SEPTEMBER 2023 23
NON-MEDICATED LIFE
Potential Benefits of
Sulforaphane
By Paul E. Lemanski,
MD, MS, FACP
Medicines are a mainstay of
American life and the healthcare
system not only because they
are perceived to work by the individuals
taking them, but also because
their benefit may be shown by the
objective assessment of scientific
study. Clinical research trials have
shown that some of the medicines
of Western science may reduce the
risk of Type 2 diabetes, heart attacks,
strokes, cardiovascular death, and
even some cancers.
In the first 110 installments of the
Non-Medicated Life, a healthy diet and
lifestyle has been shown to accomplish
naturally for the majority of individuals
most of the benefits of medications in
the prevention of the chronic medical
conditions mentioned above. With
respect to a healthy diet, certain foods
may have a disproportionate benefit.
This may be true for cruciferous
vegetables and their most active and
well-studied ingredient sulforaphane.
The cruciferous vegetables include
arugula, bok choy, broccoli, Brussels
sprouts, cabbage, cauliflower, collard
greens, kale, radish and watercress.
Epidemiological data suggests that
cruciferous vegetables may reduce
the risk of all-cause mortality and the
risk for certain cancers. For example,
while observed for some time, a study
published in 2011 in the American
Journal of Clinical Nutrition, showed
individuals in the top 20% of vegetable
consumption had a 16% reduction in
Editor’s Note: This is the 111th in a
series on optimal diet and lifestyle
to help prevent and treat disease.
Any planned change in diet, exercise
or treatment should be discussed
with and approved by your personal
physician before implementation. The
help of a registered dietitian in the
implementation of dietary changes is
strongly recommended.
all-cause mortality. Of interest, individuals
in the top 20% of cruciferous vegetable
consumption reduced all-cause mortality
risk by 22%.
In another study, men who consumed
three-to-five servings a week of cruciferous
vegetables had a 40% reduction in
their risk for prostate cancer as compared
to men eating less than one serving a
week. In another study, smokers consuming
four servings of cruciferous vegetables
per month had a 55% reduction in
lung cancer risk. Studies have also shown
women consuming cruciferous vegetables
once a week reduced risk for breast
cancer by 17% and by up to 50% in those
consuming cruciferous vegetables on a
daily basis.
While such reductions are impressive,
such epidemiological or population-based
studies do not establish causality.
For establishment of causality,
randomized prospective clinical trials are
needed, and finding the possible causative
substance for the observed benefit
would aid the design and completion of
such trials.
Starting over 30 years ago Dr. Paul
Talalay and the Johns Hopkins’ Cullman
Chemoprotection Center attempted to
identify the active ingredient responsible
for the benefit seen in epidemiological
studies. Ultimately, the lab identified a
substance from broccoli called sulforaphane
and set out to study it for efficacy
and possible mechanisms. To date, thousands
of research studies have been completed
investigating sulforaphane and its
potential benefit in human health.
Broccoli plants do not contain sulforaphane.
Rather they contain the precursor
of sulforaphane, called glucoraphanin,
and an enzyme called myrosinase. The
precursor and the enzyme are stored in
small vesicles in close proximity to one
another within the broccoli floret. When
an animal or human chews the plant,
the vesicles are broken and the glucoraphenin
is acted upon by the myrosinase to
produce sulforaphane. The sulforaphane
has a disagreeable taste to many animals
and some humans and the plant may use
this property to protect itself from being
eaten. While this may help the plant, what
is its connection to possible cancer prevention
in humans?
Cancer is a multistep process of damage
to DNA ultimately resulting in uncontrolled
cell division and dissemination
called metastasis. Damage to DNA may
come from a variety of sources including
ionizing radiation, ultraviolet radiation,
viruses such as HIV, HPV and Hepatitis B,
as well as exposure to certain compounds
called carcinogens. Carcinogens may be
artificially made compounds but also
may be naturally occurring. For example,
a naturally occurring fungus growing on
moldy peanuts and tree nuts produces a
toxin called aflatoxin that increases the
risk of liver cancer.
Thankfully, the liver which is the
major detoxifying organ in the body, can
act upon both ingested drugs and carcinogens
to modify them and, when potentially
unhealthy, help enhance their excretion
and thus body cells’ exposure time.
The liver has two enzymatic systems for
drug and carcinogen processing: Phase 1
biotransformation enzymes and Phase 2
conjugation and detoxification enzymes.
Phase 1 enzymes can actually take prodrugs
(and pro-carcinogens) and process
them to active drugs or carcinogens. Phase
2 enzymes can combine carcinogens and
cocarcinogens with substances that make
them water soluble and thus able to be
eliminated from the body via urine.
Sulforaphane appears to influence
both Phase 1 and 2 enzymatic systems. It
decreases activity of Phase 1 enzymes and
increases activity of the Phase 2 enzymes,
thus reducing the formation of carcinogens
and cocarcinogens and increasing
their elimination from the body. Reducing
carcinogen exposure in this way, may thus
help prevent the development of cancer.
In addition, sulforaphane may
have a direct effect on DNA by protecting
tumor suppressor genes, portions
of DNA that help control cell
growth. In a study of men with diagnosed
prostate cancer who showed
evidence of recurrence after prostate
surgery, 60 milligrams of sulforaphane
a day (equivalent to what results from
ingesting approximately 140 grams of
broccoli sprouts) slowed the rate of
rise of tumor marker Prostate Specific
Antigen (PSA) by 86%. (Please note:
although safe in moderate dosing,
the adjunctive use of high-dose sulforaphane
described above in cancer
patients as with all patients should
first be discussed with your oncologist,
urologist, or primary care physician to
determine any possible contraindications
to use). While slowing the rise
of this tumor-marker would seem to
indicate a slowing of cancer growth,
further studies are needed.
In summary, vegetables in general
and cruciferous vegetables particular
appear to lower all-cause mortality
including cancer. One of the mediators
of this benefit appears to be
sulforaphane, a substance derived
from the mastication of multiple cruciferous
vegetables, but especially
broccoli florets and broccoli sprouts.
Sulforaphane activates enzymes in the
liver that deactivate carcinogens and
increase their elimination from the
body. It may also have direct effects on
protecting DNA.
Sulforaphane is representative of
a number of naturally occurring substances
that may lower cancer risk and
be used adjunctively
with traditional
Western medical
treatments to
potentially improve
outcome once cancer
is diagnosed.
Paul E. Lemanski,
MD, MS, FACP
(plemanski3@gmail.com) is a boardcertified
internist practicing internal
medicine and lifestyle medicine in
Albany. Paul has a master’s degree
in human nutrition, he’s an assistant
clinical professor of medicine at
Albany Medical College, and a
fellow of the American College of
Physicians.