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Category Archives: Information & Resources
Total Health Massage FAQs
Top Ten+ Most Frequently Asked Questions
- What exactly is a massage? What is a therapeutic massage? What is massage therapy?
- Who is the Total Health Massage Therapist?
- Why should I get a massage? What are the benefits?
- Are there times when massage is not recommended?
- Where do I go for a massage?
- What happens during my first appointment?
- Do I need to get undressed for a massage?
- When do I get undressed? Do I get undressed with the massage therapist in the room?
- What should I expect during the session?
- What should I wear when I get a massage?
- How long is a massage session?
What exactly is a massage? What is a therapeutic massage? What is massage therapy?
Massage, also referred to as therapeutic massage or massage therapy, is defined as the manual manipulation of soft body tissue, such as connective tissue, muscle tissue, tendons and ligaments with the intent being an enhancement of health and well-being. States and organizations that have governing authority over massage therapists all have similar definitions in describing massage therapy.
There are many techniques and modalities in massage therapy, which may address specific conditions or symptoms. For the most part they consist of routines using a combination of stroking, kneading, tapping, friction and/or vibrating to improve muscle tone, restore flexibility of joints, enhance blood and lymph circulation, as well as help with relaxation and stress reduction. A wide range of pressure is practiced in the Total Health Massage; our experienced Therapist works closely with you to determine the appropriate level for each area of your body with just the right amount of touch to help the body let go of its localized areas of tension.
Depending on the modality or technique used, the Total Health Massage may consist of deep or light pressure and may be stimulating or sedating. Certain modalities such as sports massage use techniques with the intention of enhancing athletic performance or alleviating sports related injuries, while others such as geriatric massage, prenatal massage or infant massage have techniques appropriate for a specific population.
The Total Health Massage therapist is Joe Fox, licensed and certified in a wide variety of therapeutic massage styles as well as other wholistic and natural health disciplines, in practice since 1978. Joe believes in Nature’s power to heal with natural remedies, and that your health is in your own hands and Joe can be your guide to heal yourself. He works with a wide range of people of different ages and “occupations” and uses his Total Health Therapeutic Massage in a wholistic fashion for prevention, remedy, relief of stress and pain, and for personal and professional development.
Joe sees that the tensions in the body may be the result of everyday or compounded stress, overworking of the tissues from sports, play, work, or injury. The body may need to be taught how to become well and how to let go of its ingrained physical habits and contributing mental and emotional tendencies. For this reason the Total Health Massage is best done regularly and preferably before you think you need it. Of course, if you do really need it right now Total Health Massage is the natural remedy. We always recommend you try a Total Health Massage at our introductory rates to see how it benefits you.
- Massage and other forms of bodywork can help to reduce muscular tension, which results in less pain.
- Massage improves blood and lymph circulation.
- Massage helps to lower blood pressure.
- Massage increases joint flexibility and improves posture.
- Massage helps to reduce anxiety and stress levels and improves concentration.
- Massage promotes quicker healing of injured muscles.
- Massage helps to reduce muscle tightness.
- Massage lessens depression.
- Massage reduces spasms and cramps.
- Massage relieves generalized or chronic pain.
- In some cases, massage reduces or eliminates the need for medication.
- Massage enhances immunity.
- Massage improves quality of sleep.
- Massage boosts your personal and professional development.
An experienced Massage therapist will know how to work with the following situations, but, of course the choice is entirely up to you, if…
- If you have had recent surgery.
- If you have open sores.
- If you are experiencing acute pain.
- If you have an active inflammation, such as with rheumatoid arthritis.
- If you have an active bacterial or viral infection.
- If you are undergoing chemotherapy or radiation treatments.
- When you are drunk, taking mind-altering drugs or otherwise impaired.
- If you have untreated, high blood pressure.
- If in doubt, check with your primary care physician first, but, of course, the choice is entirely up to you.
Your appointment should be made with a licensed and certified massage therapist, educated at a reputable massage school. Our very experienced Total Health Massage Therapist is licensed and certified in many natural health disciplines, and began his career in 1978. Total Health Massage is offered primarily in your home or workplace throughout SoCal or in the Total Health Studio, if you prefer. Our fees are reasonable and are based on the distance to your location. Our massage therapist brings the massage table to your home or office and sets up in a comfortable space; the Total Health Studio is in a quiet natural setting in SW Riverside County.
During the course of your Total Health Massage, the Therapist will have questions about your general health, diet and exercise habits, medications you are taking, recent surgeries and any ailments or limitations you may have. You may be asked about your activity levels, what type of work you do and your reason for scheduling a massage. As an ongoing client, our Therapist will want to know about all medications as well as herbal and nutritional supplements you are taking.
For some types of massage, such as traditional Swedish massage which uses vegetable oil, you would need to get undressed. Some people choose to leave on certain articles of clothing such as underwear or socks, at your discretion. For other modalities, such as pressure-point, sports or chair massage, you remain fully clothed. However, before the massage, the Total Health Massage Therapist should advise you regarding this matter and instruct you to only disrobe to your own level of comfort.
Legal regulations require the client to be covered with draping (for those modalities requiring you to undress), with a sheet or large towel, except for the body part being treated. So even though you are undressed, you are covered during the massage session.
Our massage therapist will bring you into the treatment area and then leave the room, closing the door and allowing you to get undressed in private. Once you are undressed you should get onto the massage table and cover yourself with the towel or sheet provided. If this is your first massage, our Therapist will provide you with instructions, such as whether you should lie face down or face up on the table.
It depends on the type of massage you will receive. Our massage therapist will discuss this with you. The massage therapist should ask about your expectations and health information to decide the best form of treatment.
- If you choose a traditional Swedish massage, you will be asked to go into the treatment room, disrobe to your own comfort level, lay on a padded massage table and cover yourself with a sheet or towel. Depending on what your needs are, the massage may include the use of broad, flowing strokes on the arms, hands, legs, feet, back and shoulders. State laws forbid the massaging or touching of private areas.
- If you are receiving pressure point or sports massage, you will be asked to wear comfortable clothing. The session may consist of appropriate pressure tense areas of the body as well as gentle stretches.
- The massage therapist will use his or her body, including fingers, hands or forearms, for a seamless flow of acupressure manipulations as well as helping you learn stretches and poses you can do on your own.
- Each form of bodywork may have its own instruction, which should be explained in full by your massage therapist.
- A massage therapist should ask for feedback with regard to your comfort level during the massage.
- A massage should never hurt or produce any bruising.
- Whether your Total Health Massage is Swedish or Acupressure, it will generally include your neck, back, shoulders, arms, hands, legs and feet. It may or may not include your face, and may include the abdomen with your permission. The massage will not include your private areas.
It is important to wear comfortable clothing when you go to get a massage.
- For a Swedish massage you will need to get undressed to the level of your own comfort. This is done with the massage therapist out of the room. He or she will instruct you to cover yourself with the provided sheet or towel for modesty.
- If you are receiving a massage using acupressure techniques, most likely you will be keeping your clothing on. Wear something loose and comfortable, preferably made from natural fabrics like cotton, and that have some give to allow for assisted stretching.
If you are unsure as to what type of clothing to wear for the specific technique your massage therapist will be using, ask before you go to the appointment
A massage session can be as short as 10 or 15 minutes for a mini- or demo-massage (given to multiple clients), or as long as an hour or so for the full body massage. In the Total Health Studio or for multiple clients in the same outcall location you may opt for a half-hour session. Depending on the condition of your body and your responses to the treatment , a one-hour appointment may be anywhere from 50-70 minutes of actual massage.
Allow at least 15 minutes before and after your appointment to relax, and for undressing/dressing. Being rushed afterwards may reduce some of the positive results of your massage session. The OutCall Total Health Massage is the ultimate way to receive your massage for this very reason.
Total Health Fx Health Radio Interview on Blog Talk Radio
Joe and Kathi Fox of Total Health Fx had a great health radio interview on Blog Talk Radio on February 7, 2013. Listen to the 1/2 hour audio replay below as they discuss alternative health solutions using the healthy choices of massage therapy, healthy eating and healthy living, how to take your health into your own hands.
Total Health Fx ‘s Joe and Kathi Fox had a great interview on Blog Talk Radio. Check out the audio replayListen to internet radio with Robbie Motter on Blog Talk Radio
Total Health Fx provides wholistic natural healthcare alternatives for prevention, remedy, and wellness, since the late ‘80’s. After a decade of serving at destination health centers teaching personal natural health and training practitioners, Total Health Fx has been providing therapy and health consultation to individuals and families throughout Southern California. Joe and Kathi Fox, Certified Natural Health Practitioners and owners of Total Health Fx, offer therapeutic massage and nutritional consultation as primary services. Joe is a Licensed Massage Therapist; Kathi holds a Ph.D. in Naturopathy. The Total Health services are available ala carte or as part of a Wholistic Synergy Program. The “Food for Health” Co-op offers healthy foods at wholesale prices.
Joe and Kathi are very accommodating people. Services are available in their Riverside County studios or by outcall in the local area; massage therapy serves a wide area from Los Angeles to San Diego on a regular basis. Introductory rates are available for the first month of services and custom program packages.
Total Health Fx gives people the tools, therapy, and understanding of how to be healthier. Consistency is the key to the goal of Total Health. Although a single massage is a nice treat, regular treatment offers progress to the ingrained habits of the body. Although many seek a “magic pill” for natural health, a well-founded plant-based diet will cleanse and nourish the body for Total Health. For those wanting nothing short of Total Health, the services offered by Joe and Kathi Fox will get you there.
Total Health Massage Partners with Hands for Heroes™
Hands for Heroes™, Hands for Healing
Joe Fox of Total Health Massage is pleased to partner with Hands for Heroes™ to provide veterans healthcare, veterans benefits, and veterans services. Total Health Massage utilizes therapeutic hands for healing as medical massage for healing physical pain and healing trauma.
“Hands for Heroes™ is a nationwide organization of caring healthcare professionals who have donated their time and skills to provide therapeutic bodywork and medical massage for our Nation’s Veterans Healthcare.
“Joe Fox, Licensed Massage Therapist, of Total Health Fx has joined with Hands for Heroes™ to provide therapeutic bodywork and medical massage at no fee basis for their initial treatment to our Veterans Healthcare and will provide a predetermined number of bodywork sessions each month to help Veterans in dealing with the stress encountered while on duty, as well as physical complaints common to our service men and woman.
A “Hands for Heroes Partner™, as a healthcare professional makes a significant contribution to the healing of our service men and women and their families. Hands for Heroes™ founders encourages you to support Joe Fox of Total Health Massage in his therapeutic practice healing our returning service men and women.”
Veterans seeking veterans healthcare from Joe Fox of Total Health Massage in the Southern California area may contact him directly or by commenting below; all communications are confidential.
Total Health Massage Gift Certificates
Total Health Massage Gift Certificates are the ideal way to show care and appreciation for family, friend, co-worker/employee for any occasion. We appreciate your trust in us in purchasing a Total Health Massage Gift Certificate and price them at our introductory rate as we do for all of our new clients in their first month of service. All Total Health Massages are done on an out call basis to home or workplace, with the exception of the Southwest Riverside area which has the additional option of in-studio massage. View photos of the Total Health Massage. They will love the Total Health benefits of massage.
Introductory Rates Available for Gift Certificates in All Our Service Areas
use the following to purchase Gift Certificates or Introductory Massage Appointments:
SouthWest Riverside County
$60/hr. [wp_cart:Total Health Massage Gift Certificate-SW R'side:price:60.00:shipping:1.00:end]
San Diego/Orange/Inland Empire
$70/hr. [wp_cart:Total Health Massage Gift Certificate-SD/OC/IE:price:70.00:shipping:1.00:end]
Los Angeles County
$80/hr. [wp_cart:Total Health Massage Gift Certificate-LA:price:80.00:shipping:1.00:end]
Genetically Modified Food: Effects on Our Health Safety and Environment
Genetically modified food also known as genetically modified organisms is a big issue, especially in light of their effects on our health safety and our environment. Politics aside, here we are taking a look at genetically modified foods and the consequences on our health and the environment. We don’t know for certain which of our foods have been modified . We don’t understand how they have been modified… have our plant-based foods been genetically engineered with genetic material from humans, animals, fish, birds, insects, or amphibians? I certainly hope not, not in this plant-based body!
“Genetic Engineering is often justified as a human technology, one that feeds more people with better food. Nothing could be further from the truth. With very few exceptions, the whole point of genetic engineering is to increase sales of chemicals and bio-engineered products to dependent farmers.” David Ehrenfield: Professor of Biology, Rutgers University
The Institute for Responsible Technology asks, “Is the FDA protecting us? No. The Food and Drug Administration policy on genetically modified organisms (GMOs), released in 1992, falsely claims that the agency had no information showing that GM foods are substantially different… FDA scientists repeatedly warned of possible allergies, toxins, new diseases, and nutritional problems; they urged long-term safety studies. But the FDA official in charge of policy was Michael Taylor, Monsanto’s former attorney, later their vice president, and now the US Food Safety Czar. The FDA ignored their scientists, and doesn’t require a single safety test. Instead, companies such as Monsanto, which have been found guilty of hiding toxic effects of their other products, get to decide if their GMOs are safe for us to eat. And the superficial studies they do conduct are widely criticized as rigged to avoid finding problems. The laboratory techniques are imprecise and bear no resemblance to natural breeding. The technology is based on outdated scientific assumptions and can lead to massive collateral damage in the plant. The DNA of GMOs, for example, can have hundreds or thousands of mutations, and the activity of up to 5% of their natural genes can be significantly changed. Even the inserted gene can be damaged or rearranged, creating proteins that trigger allergies or promote disease.
GM foods on the market
The Institute for Responsible Technology notes the six major GMO crops are soy, corn, canola, cotton, sugar beets, and alfalfa. Each has added bacterial genes, allowing plants to survive an otherwise deadly dose of weed killer such as Roundup. Farmers use considerably more herbicide on these crops, causing higher herbicide residues in our food. The second most popular trait is a built-in pesticide, found in GM corn and cotton. An inserted gene from soil bacteria called Bt (Bacillus thuringiensis) secretes the insect-killing Bt-toxin in every cell. The other GM crops are Hawaiian papaya and a small amount of zucchini and yellow crookneck squash, which are engineered to resist a plant virus.
The Institute for Responsible Technology lists these concerns:
- GMOs: unnatural, imprecise, prone to side-effects
- Growing Evidence of Harm from GMOs
- GMOs and allergic reactions
- Bt corn and cotton linked to allergies
- GMOs may make you allergic to non-GM foods
- GMOs, reproductive problems, and infant mortality
- Bt crops linked to sterility, disease, and death
- Functioning GM genes remain inside you
The American Academy of Environmental Medicine (AAEM) urges physicians to advise all patients to avoid genetically modified (GM) food. They state, “Several animal studies indicate serious health risks associated with GM food.” These include:
- Immune problems
- Accelerated aging
- Faulty insulin regulation
- Changes in major organs and the gastrointestinal system.
- What are some of the advantages of GM foods?
- What are genetically-modified foods?
- How prevalent are GM crops?
- What plants are involved?
- What are some of the criticisms against GM foods?
- How are GM foods regulated and what is the government’s role in this
- How are GM foods labeled?
- Pest resistance
- Herbicide tolerance
- Disease resistance
- Cold tolerance
- Drought tolerance/salinity tolerance
- Unintended harm to other organisms
- Reduced effectiveness of pesticides
- Gene transfer to non-target species
- Human health risks
- Unknown effects on human health
(An outline extracted from the full article)
Deaths and Near-Deaths
1. Recorded Deaths from GM
2. Near-deaths and Food Allergy Reactions
POTATOES - A study showed genetically-modified potatoes expressing cod genes were allergenic.
PEAS - A decade-long study of GM peas was abandoned when it was discovered that they caused allergic lung damage in mice.
SOY - In March 1999, researchers at the York Laboratory discovered that reactions to soy had skyrocketed by 50% over the year before, which corresponded with the introduction of genetically-modified soy from the US. It was the first time in 17 years that soy was tested in the lab among the top ten allergenic foods.
Cancer and Degenerative Diseases
3. Direct Cancer and Degenerative Disease Links
4. Indirect, Non-traceable Effects on Cancer Rates: combining chemical food additives into chemical cocktails caused many times more toxic effects
Viral and Bacterial Illness
5. Superviruses: Viruses can mix with genes of other viruses and retroviruses
6. Antibiotic Threat Via Milk
7. Antibiotic Threat Via Plants
8. Resurgence of Infectious Diseases
9. Increased Food Allergies: The loss of biodiversity in our food supply has grown in parallel with the increase in food allergies. Each new food item produced contains many new potentially allergenic proteins.
10. Birth Defects and Shorter Life Spans
11. Interior Toxins: “Pesticidal foods” have genes that produce a toxic pesticide inside the food’s cells.
12. Lowered Nutrition
13. No Regulated Health Safety Testing
14. Unnatural Foods: “a profound difference between the types of expected effects from traditional breeding and genetic engineering.” ”Pleiotropic effects occur in genetically engineered plants.There is “something tangibly different about the food that is material with respect to the consequences which may result from the use of the food.”
15. Radical Change in Diet: Ten companies now own about 40% of all US seed production and sales. Also 60% of all hard cheeses in the US are processed with a GM enzyme. The current result is that approximately two-thirds of all processed foods in the US already contain GM ingredients - and this is projected to rise to 90% within four years according to industry claims. In short, the human diet, from almost every front, is being radically changed – with little or no knowledge of the long-term health or environmental impacts.
“Genetic Engineering is often justified as a human technology, one that feeds more people with better food. Nothing could be further from the truth. With very few exceptions, the whole point of genetic engineering is to increase sales of chemicals and bio-engineered products to dependent farmers.”
David Ehrenfield: Professor of Biology, Rutgers University
General Soil Impact
16. Toxicity to Soil
17. Soil Sterility and Pollution
18. Extinction of Seed Varieties
19. Superweeds: It has been shown that genetically modified Bt endotoxin remains in the soil at least 18 months and can be transported to wild plants creating superweeds potentially disturbing the balance of nature.
20. Plant Invasions
21. Destruction of Forest Life: GM trees or “supertrees“ are being developed which can be sprayed from the air to kill literally all of surrounding life, except the GM trees. There is an attempt underway to transform international forestry by introducing multiple species of such trees. The trees themselves are often sterile and flowerless.
22. Terminator Trees: These super deadly trees are non-flowering, herbicide-resistant and with leaves exuding toxic chemicals to kill caterpillars and other surrounding insects – destroying the wholesale ecology of forest life.
24. Animal Bio-invasions: Fish and marine life are threatened by accidental release of GM fish threatening local fish supplies.
25. Killing Beneficial Insects: Studies have shown that GM products can kill beneficial insects
26. Poisonous to Mammals: In a study with GM potatoes, spliced with DNA from the snowdrop plant and a viral promoter (CaMV), the resulting plant was poisonous to mammals (rats) – damaging vital organs, the stomach lining and immune system.
27. Animal Abuse “supercrippling”
28. Support of Animal Factory Farming: Rather than using the best of scientific minds to end animal factory farming - rapid efforts are underway to develop gene-modified animals that better thrive in disease-promoting conditions of animal factory farms.
29. Genetic Pollution: Carrying GM pollen by wind, rain, birds, bees, insects, fungus, bacteria – the entire chain of life becomes involved. Once released, unlike chemical pollution, there is no cleanup or recall possible.
30. Disturbance of Nature’s Boundaries: Genetic engineers argue that their creations are no different than crossbreeding. However, natural boundaries are violated – crossing animals with plants, strawberries with fish, grains, nuts, seeds, and legumes with bacteria, viruses, and fungi; or like human genes with swine.
31. Unpredictable Consequences of a Gunshot Approach“wedging foreign genetic material in an essentially random manner…causes some degree of disruption…It is impossible to predict what specific problems could result.”
IMPACT ON FARMING
Small Farm Livelihood and Survival
32. Decline and Destruction of Self-Sufficient Family Farms
33. General Economic Harm to Small Family Farms
34. Losing Purity: At the present rate of proliferation of GM foods, within 50-100 years, the majority of organic foods may no longer be organic.
35. Mixing of GM and non-GMO crops
36. Losing Natural Pesticides
Control and Dependency
37. Terminator Technology: Plants are being genetically produced with no annual replenishing of perennial seeds so farmers will become wholly dependent on the seed provider.
38. Traitor Technology: Traitor technologies control the stages or life cycles of plants – when a plant will leaf, flower, and bear fruit. This forces the farmer to use certain triggering chemicals if he is to yield a harvest
39. Less Diversity, Quality, Quantity and Profit: One of the most misleading hopes raised by GM technology firms is that they will solve the world’s hunger.
40. Fragility of Future Agriculture: With loss of biological diversity there inevitably develops a fragility of agriculture.
41. Lower Yields and More Pesticides Used With GM Seeds
42. Monopolization of Food Production: The rapid and radical change in the human diet was made possible by quick mergers and acquisitions that moved to control segments of the US farming industry.
43. Impact on Long -Term Food Supply: If food production is monopolized,the future of that supply becomes dependent on the decisions of a few companies and the viability of their seed stocks.
ECONOMIC, POLITICAL AND SOCIAL THREATS
46. Health/Environmental/Socio-Political Reasons: The lack of labeling of genetically modified food violates and harms your right to know what is in our foods – given the list of health, environmental, and socio-political reasons to avoid GM ingredients. Even if GM foods were 100% safe, the consumer has a right to know such ingredients – due to their many potential harms.
47. For Religious Dietary Reasons: Previously if someone wanted to avoid foods not permitted by certain religions, the process was simple. With transgenic alterations, every food is suspect – and the religious and health-conscious consumer has no way of knowing without a mandated label. The lack of labeling makes it impossible for religious people to observe dietary customs.
Total Health Food Co-op Price Comparisons
Here you will find prices comparing several food items available through the Total Health Food Co-op’s catalog from United Natural Foods, Inc. (UNFI) and several local health food and grocery stores. The food items selected are healthy foods, wholesale foods and discount foods. In summary, recent Total Health Food Co-op research shows the best prices more often and with more availability of all products than comparable stores. Download the Total Health Food Co-op Price Comparisons and view in Excel. Also see Total Health Food Co-op instructions, ordering and delivery dates. and more about Total Health Fx
Breast Cancer Survival May Improve With Vegetable Consumption
In another boon for broccoli, researchers have found that eating the green vegetable may improve outcomes after a breast cancer diagnosis. A new study points to the positive role that all cruciferous veggies — like cauliflower, brussels sprouts, kale and cabbage — can play in improving survival and recurrence rates associated with breast cancer.
In the study, presented Tuesday at the American Association for Cancer Research’s annual meeting, researchers looked at data from more than 4,800 breast cancer survivors in China who had been diagnosed with breast cancer between 2002 and 2006. The women’s cancers ranged from stage 1 to stage 4.
Overall, researchers with the Vanderbilt Epidemiology Center and Shanghai Centers for Disease Control and Prevention found that higher consumption of cruciferous vegetables in the years following diagnosis was tied to better outcomes. Women who ate the most reduced by 62 percent their risk of both overall mortality and breast cancer-specific mortality, as compared to women who consumed the least. Those who consumed the most vegetables also reduced by 35 percent the risk of their breast cancer coming back. Researchers compared relative quantities of the vegetables in women’s diets and have not determined at what quantities the beneficial effects are derived.
“Cruciferous vegetables, such as cauliflower, cabbage, bok choy, turnips and broccoli, contain high amounts of glucosinolates, which are hydrolyzed to bioactive compounds including isothiocyanates (ITCs) and indoles,” said Sarah Nechuta, a research fellow in Vanderbilt University’s epidemiology center and a researcher on the new study, who explained that she and her fellow researchers attempted to control for other factors that might influence women’s outcomes, including demographics, exercise and additional dietary behaviors.
“These bioactive compounds have many anti-cancer properties that may influence cancer development, progression and survival,” Nechuta added.
This is not the first time that the cabbage family has been tied to decreased breast cancer risk.
“An association has also been established with colon cancer and prostate cancer,” explained Emily Ho, an associate professor in nutrition and exercise sciences at Oregon State University. “There is pretty strong evidence from studies that compounds found in cruciferous vegetables may have cancer-fighting properties.”
The new study is, however, among the first to look at the role that cruciferous vegetables can play aftera cancer diagnosis.
But Ho cautioned that many questions about the connection between vegetables and cancer risk remain.
“There are still a lot of unanswered questions about what, exactly, is in [cruciferous vegetables] that is protective,” she said. Researchers do not understand exactly what the underlying mechanisms are and what impact these vegetables may have at the tissue level, she said. Furthermore, research has not yet made it clear whether supplements could have the same potential effect as vegetables themselves seem to have.
Nechuta also cautioned that it should not necessarily be assumed that similar results would be achieved in the United States, where the types of cruciferous vegetables women eat may be different than those in China.
“Commonly consumed cruciferous vegetables in China include turnips, Chinese cabbage [or] bok coy and greens, while broccoli and brussels sprouts are the more commonly consumed cruciferous vegetables in the United States and other Western countries,” Nechuta said in a statement. In an email to The Huffington Post, she said that future studies with direct measurements of various bioactive compounds are needed in order to understand the possible link between cruciferous vegetables and breast cancer intake.
In the meantime, Ho said people would do well to follow fruit and vegetable consumption guidelines.The American Cancer Society, for example, recommends that individuals consume at least two and a half cups of fruits and vegetables per day to lower cancer risk, pointing out that those foods with the most color — which are dark green, red, yellow and orange — provide the most nutrients.
“If you try and include cruciferous vegetables as some of those servings,” Ho said. “It probably won’t hurt and it certainly might help.”
American Journal of Clinical Nutrition, Vol. 87, No. 3, 753-760, March 2008
© 2008 American Society for Nutrition
ORIGINAL RESEARCH COMMUNICATION
Cruciferous vegetables, the GSTP1 Ile105Val genetic polymorphism, and breast cancer risk
Background: Cruciferous vegetables are the primary source of isothiocyanates and other glucosinolate derivatives that are known to induce phase II detoxifying enzymes, including glutathione S-transferases (GSTs).
Objective: We investigated the independent and combined effects of cruciferous vegetable intake and the GSTP1 Ile105Val genetic polymorphism on breast cancer risk.
Design: Analyses included 3035 cases and 3037 population controls who were participating in the Shanghai Breast Cancer Study and for whom diet and genetic data were complete (87% of cases and 85% of controls).
Results: With the use of multivariate logistic regression, the GSTP1 Val/Valgenotype was significantly associated with greater breast cancer risk (OR = 1.50; 95% CI: 1.12, 1.99). The association was significantly greater in premenopausal women (OR = 1.69; 95% CI: 1.17, 2.43) than in postmenopausal women (OR = 1.20; 95% CI: 0.74, 1.92). Total cruciferous vegetable intake was not significantly associated with breast cancer risk, although subjects reporting greater turnip (Pfor trend < 0.001) and Chinese cabbage (P for trend = 0.049) intakes had a significantly lower postmenopausal breast cancer risk. Women with the GSTP1 Val/Val genotype and low cruciferous vegetable intake had a breast cancer risk 1.74-fold (95% CI: 1.13, 2.67) that of women with the Ile/Ile or Ile/Val genotype. This effect of low cruciferous vegetable intake and the Val/Val genotype was seen predominantly among premenopausal women (OR = 2.08; 95% CI = 1.20, 3.59).
Conclusions: Cruciferous vegetable intake consistent with high isothiocyanate exposure may reduce breast cancer risk. Cruciferous vegetable intake also may ameliorate the effects of the GSTP1 genotype.
Key Words: Cruciferous vegetables • GSTP1 genetic polymorphism • breast cancer risk • gene-diet combined effect
Cruciferous vegetable are an especially rich source of glucosinolates, which may be converted by plant myrosinase and the gastrointestinal microflora to isothiocyanates, indole-3-carbinol, and other compounds believed to have anticancer properties. These agents may affect carcinogenesis through several mechanisms, including the induction of apoptosis and a shift in estrogen metabolism to favor metabolites with lower estrogenic activity (1, 2). In addition, isothiocyanates induce multiple phase II conjugating enzyme systems (3, 4), including glutathione S-transferases (GSTs), through nuclear transcription factor–E2–related factor 2–enhanced transcription (5, 6). The overall effects of cruciferous vegetable intake appear to be a reduction in systemic oxidative stress (7) and a suppression of mutagenic and carcinogenic activity (8). Indeed, cruciferous vegetable intake has been inversely associated with the risk of lung, stomach, colorectal, bladder, and other cancers (9, 10). However, despite strong biologic plausibility, the relation between cruciferous vegetable intake and breast cancer risk is unclear. Several studies found no association between total or cruciferous vegetable intake and breast cancer risk (10–13). In contrast, case-control studies from Sweden (14), the United States (in premenopausal women) (15), and Shanghai (16) reported a reduction in breast cancer risk associated with cruciferous vegetable intake.
The capacity of cruciferous vegetable intake to affect breast cancer risk may depend on the inherent metabolic activity. GSTs target a broad range of electrophilic compounds for conjugation with glutathione, which leads to a reduction in organic hydroepoxide concentrations (17). The role of GSTP1 in breast carcinogenesis remains unclear (18). A transition from an A to a G nucleotide position 313 leads to an Ile105Val amino acid change and, perhaps, also to greater thermal stability. Substrate specificity also may differ by GSTP1genotype: the GSTP1 Val allele is reported to have greater in vitro activity toward 1-chloro-2,4-dinitrobenzene (19). This may suggest an effect of the hydrophobic substrate–binding site. Several studies have reported an association of the GSTP1 Val/Val genotype with greater breast cancer risk (20–22), although subsequent studies reported mixed or conflicting results for the GSTP1 Val/Val polymorphism with respect to breast cancer (23–28). These inconsistencies in the relations between GSTP1 genetic polymorphism and breast cancer suggest that the effects of the GSTP1 genotype may depend on environmental factors such as cruciferous vegetable intake.
GSTs catalyze the conjugation of glutathione with isothiocyanates (electrophilic compounds) to facilitate membrane transport and excretion of isothiocyanates (29), thus, perhaps, first increasing the availability of isothiocyanates but ultimately reducing their systemic concentrations. A previous study by our group (30) found that urinary isothiocyanate concentrations are higher in Shanghai women with the GSTP1 Val/Val genotype than in those with other genotypes, which suggests that GSTP1 genotypes may affect the persistence of isothiocyanates in the body. Three earlier studies reported a combined effect of the genetic polymorphisms of GSTM1/T1/A1 and cruciferous vegetable intake on breast cancer (15, 16, 31). However, the combined effect of the GSTP1 Ile105Valpolymorphism and cruciferous vegetable intake on breast cancer risk has not been investigated. Thus, the goal of the present study was to investigate the relation among cruciferous vegetable intake, the GSTP1 genotype, and breast cancer risk.
SUBJECTS AND METHODS
The Shanghai Breast Cancer Study (SBCS) is a population-based case-control study conducted in Shanghai, China. Detailed study methods were reported elsewhere (32). Cancer cases between 25 and 64 y of age were identified through a rapid case-ascertainment system, supplemented by the population-based Shanghai Cancer Registry, which provided a virtually complete ascertainment of incident breast cancer cases diagnosed by pathologists among urban Shanghai residents. From 1996 through 1998 (SBCS I), a total of 1598 eligible breast cancer cases were identified, of which 1455 (91%) completed in-person interviews. Characterization of tumors as estrogen receptor (ER)–or progesterone receptor (PR)–positive or –negative in SBCS I found that 52.8%, 10.8%, 10.5%, and 25.9% were defined as ER+/PR+, ER+/PR–, ER–/PR+, and ER–/PR–, respectively. Most cases (82.2%) were diagnosed with stage I or II cancer; 10.8% had stage III/IV cancer, and 7.0% had cancer of unknown stage (33). Controls were randomly selected from the general population of Shanghai by using the Shanghai Resident Registry, a population registry containing demographic information on all adult residents of urban Shanghai. The inclusion criteria for controls were identical to those for cases save for the cancer diagnosis. Of the 1724 eligible women, 1556 (90%) completed in-person interviews. To enhance the statistical power of the study, we recruited a second set of cases and controls between April 2002 and February 2005 (SBCS II) by using a protocol similar to that described above, although the age range of SBCS II was expanded to ages 20–70 y. A total of 1997 (84%) cases and 1918 (70%) controls were recruited to SBCS II, and information on ER/PR status will be reported in the future. Participants in SBCS II tended to be somewhat older, more educated, and more likely to be postmenopausal than were participants in SBCS I, perhaps because of the greater age range, but, overall, the participant characteristics in SBCS I and SBCS II were highly comparable.
A questionnaire was administered by in-person interview to elicit detailed information on demographic factors, menstrual and reproductive histories, hormone use, dietary habits, disease history, physical activity, tobacco and alcohol use, and family history of cancer. Current weight, circumferences of the waist and hip, and height while sitting and standing were also measured for all participants. In SBCS I, blood samples for research were obtained from 1193 (82%) cases and 1310 (84%) controls; in SBCS II, 1933 (97%) cases and 1857 (97%) controls who completed the in-person interview also donated a blood sample and buccal cells.
Genomic DNA was extracted from buffy coat fractions or buccal cells by using the Puregene DNA Isolation Kit (Gentra Systems, Minneapolis, MN) or the QIAmp DNA Mini-kit (Qiagen, Valencia, CA) according to each manufacturer’s protocol. DNA concentration were measured by using the PicoGreen dsDNA Quantitation Kit (Molecular Probes, Eugene, OR). Five to 10 ng of genomic DNA was used for each polymerase chain reaction (PCR). Quality-control (QC) samples (ie, water, CEPH 1347–02 DNA, and blinded and nonblinded DNA samples) were included in the genotyping assay.
For the SBCS I samples, the GSTP1 Ile105Val polymorphism (A313G, rs1695) was determined by the PCR-restriction fragment length polymorphism method reported previously (21). The PCR products were digested by using BsmAI restriction endonuclease. The PCR product with the G allele was digested to 2 fragments (148 and 41 bp), whereas the PCR product with the A allele remained undigested (189 bp). Genotyping was successfully completed for 1129 (95%) cases and 1236 (94%) controls in SBCS I.
For the 1897 (98%) cases and 1801 (97%) controls in SBCS II, the GSTP1 Ile105Valpolymorphism (rs1695) was assessed with the use of the ABI PRISM 7900 Sequence Detection System [Applied Biosystems (ABI), Foster City, CA] in the TaqMan genotyping assay with primers and probes obtained from ABI. The primers were 5′- CCTGGTGGACATGGTGAATGAC-3′ and 5′- TGGTGCAGATGCTCACATAGTTG –3′. The probes were VIC-CTGCAAATACATCTCC and FAM-CTGCAAATACGTCTCC. The TaqMan assay method was described previously (34). Briefly, the final volume for each reaction was 5 µL; it consisted of 2.5 µL TaqMan Universal PCR Master Mix, 0.6 µL of each primer, 0.2 µL of each TaqMan probe, and 5 ng genomic DNA. The PCR profile consisted of an initial denaturation step at 95 °C for 10 min and 40 cycles of 92 °C for 15 s and 60 °C for 1 min. The fluorescence level was measured with the ABI PRISM 7900HT sequence detector (Applied Biosystems). Allele frequencies were determined by using ABI SDS software (version 2.2; Applied Biosystems).
Genotyping was successfully completed for 1846 (95%) cases and 1727 (93%) controls in SBCS II. The laboratory staff was blind to the identity of the subjects. QC samples were included in the genotyping assays. Each 384-well plate contained 4 water, 8 CEPH 1347–02 DNA, and 8 blinded QC DNA samples. We genotyped the GSTP1 Ile105Val polymorphism in 45 DNA samples of the Chinese participants used in the International HapMap Project and 24 DNA samples used in Perlegen Sciences human genomic datasets as an additional QC step. The genotypes of the samples generated from the present study were compared with data downloaded from the International HapMap Project (Internet:http://www.hapmap.org) and Perlegen Sciences (Internet:http://genome.perlegen.com). The concordance rates for the QC samples were 98.3% and 100% for SBCS I and II, respectively. The rate of concordance between the data generated in our laboratory and the data from the above databases was 100%. GSTP1 genotypes did not significantly differ from Hardy-Weinberg equilibrium.
Habitual intakes of cruciferous vegetables were measured by using a validated food-frequency questionnaire (35). During the in-person interview, each participant was first asked how often each food item or food group was consumed and then asked how many liangs (1 liang = 50 g) of each food were eaten per unit of time (ie, d, wk, mo, or y) during the past 5 y. Five cruciferous vegetables common in Shanghai were listed as separate items on the food-frequency questionnaire, including Chinese greens (bok choy), green cabbage, Chinese cabbage (nappa), cauliflower, and white turnip. From this information, we calculated the average intake (in g/d) of each cruciferous vegetable. Furthermore, we estimated dietary isothiocyanate exposure by using previously published isothiocyanate concentrations for cruciferous vegetables grown in Singapore and cooked in boiling water (36). The report showed considerable variation in potential isothiocyanate contribution across the cruciferous vegetables analyzed, ranging from 4.9 µmol/100 g wet weight in bok choy (Braccica chinensis) to 81.3 µmol/100 g wet weight in watercress.
Separate analyses in SBCS I and II were comparable, and thus we pooled the SBCS I and II data for these analyses. Study participants were classified into 5 categories by quintile of the intake of each cruciferous vegetable. The lowest quintile served as the reference group in the analyses. Odds ratios (ORs) and 95% CIs summarizing the association between breast cancer risk and cruciferous vegetable intake or GSTP1 genotype were calculated by using unconditional logistic regression after adjustment for age, education, family history of breast cancer, age at menarche, body mass index (BMI; in kg/m2), age at first live birth, regular exercise, total energy intake, and study stage (SBCS I or II). Stratified analyses were performed to investigate any interaction or combined effect between the GSTP1 genotypes and cruciferous vegetable intake. We also repeated analyses after excluding the contribution of bok choy intake, because bok choy was frequently consumed in this study population but may have a lower isothiocyanate content than other cruciferous vegetables. Tests for interaction were performed by comparing the model with and without interaction terms by using a likelihood ratio test. All statistical tests were based on 2-sided probability. Statistical analyses were carried out with SAS software (version 9.1; SAS Institute, Cary, NC).
Breast cancer cases and controls were of a similar age and did not significantly differ in reported intakes of energy, total vegetables, fruit, or cruciferous vegetables. Significant case-control differences were observed with regard to education, family history of breast cancer, age at menarche, menopause status, age at menopause, age at first live birth, BMI, waist-to-hip ratio, regular exercise, and intakes of red meat, poultry, and fish (SBCS I and II combined; see Table 1).
Total cruciferous vegetable intake was not significantly associated with premenopausal (P for trend = 0.859) or postmenopausal (P for trend = 0.142) breast cancer risk. On the other hand, estimated isothiocyanate exposure was significantly associated with lower breast cancer risk among women in quintile 5 (OR = 0.82; 95% CI: 0.70, 0.96; P for trend = 0.007), particularly the postmenopausal women (OR = 0.68; 95% CI: 0.53, 0.87; P for trend < 0.001). Turnip consumption was significantly associated with lower breast cancer risk among quintile 5 premenopausal (OR = 0.81; 95% CI: 0.67, 0.97; P for trend = 0.065) and postmenopausal (OR = 0.65; 95% CI: 0.52, 0.83; P for trend < 0.001) women, whereas Chinese cabbage was significantly associated with lower breast cancer risk among quintile 5 postmenopausal women (OR = 0.76; 95% CI: 0.60, 0.96; P for trend = 0.049). We removed bok choy from our total cruciferous vegetable intake score and found that intakes of the remaining cruciferous vegetables were significantly associated with lower postmenopausal breast cancer risk [from quintile 1 to quintile 5: OR = 1.00 (ref), 0.98, 0.77, 0.77, 0.83, and 0.76, respectively (95% CI: 0.58, 0.97); P for trend = 0.014]. We also found no association between total cruciferous vegetable intake minus bok choy and premenopausal breast cancer (data not shown).
The GSTP1Val allele was prevalent among 18.4% of controls. The GSTP1 Val/Valgenotype was associated with a significantly greater risk of breast cancer (OR = 1.50; 95% CI: 1.12, 1.99). The GSTP1 genotype x menopausal status interaction was not significant (P = 0.729); however, the association of GSTP1 genotype and menopausal status was significant in premenopausal women (OR = 1.69; 95% CI: 1.17, 2.43). Significant associations between the GSTP1 Val/Valgenotype and breast cancer were found in SBCS I (OR = 1.70; 95% CI: 1.09, 2.65 in all women; OR = 2.00; 95% CI: 1.16, 3.46 in premenopausal women), whereas associations identified in SBCS II were consistent with data from SBCS I but were not significant (OR = 1.35; 95% CI: 0.93, 1.97 in or all women; OR = 1.50; 95% CI: 0.92, 2.45 in premenopausal women).
The combined effect of total cruciferous vegetable intake and GSTP1 genotype on breast cancer risk. The GSTP1 Val/Val genotype combined with low cruciferous vegetable intake was associated with a 1.74-fold (95% CI = 1.13, 2.67) greater risk of breast cancer than was seen in women with the Ile/Ile or Ile/Val genotype and high intake of cruciferous vegetables. TheGSTP1 genotype was not significantly associated with breast cancer in women with high cruciferous vegetable intake. This association of the GSTP1 genotype and cruciferous vegetable intake was predominantly seen among premenopausal women (OR = 2.08; 95% CI = 1.20, 3.59), although tests for an interaction effect were not significant (Table 4). The combined effect of isothiocyanate estimates or cruciferous intake minus bok choy and the genetic polymorphism of GSTP1 Ile104Val were similar.
We examined the association among GSTP1 genotype, cruciferous vegetable intake, and breast cancer risk in a population-based case-control study of women living in Shanghai, China. Postmenopausal breast cancer risk was inversely associated with white turnip and Chinese cabbage intakes but not withGSTP1 genotypes. In contrast, the GSTP1 105Val homozygous substitution was significantly associated with a higher risk of premenopausal breast cancer. Women with the GSTP1 Val/Val genotype and low intake of cruciferous vegetables had a greater risk of breast cancer than did women with the Ile/Ile or Ile/Valgenotype and high intake of cruciferous vegetables; this greater risk was predominantly seen in premenopausal women.
Reports from Sweden and the United States (in premenopausal women) suggested a lower effect of high cruciferous vegetable intake on breast cancer risk (14, 15). Smith-Warner et al (11) found that broccoli and Brussels sprout consumption was associated with a 14% reduction in the risk in postmenopausal women. The associations between overall cruciferous vegetable intake and breast cancer risk seen in the present study were more consistent with the modest and nonsignificant associations observed in prior European Prospective Investigation into Cancer and Nutrition analyses (12). Nonetheless, we found white turnip and Chinese cabbage intakes to be inversely associated with breast cancer risk, predominantly among postmenopausal women. Turnip is consumed more regularly in Shanghai than in the West (36), and 66.3% of participants in this study reported consuming some amount of turnip. Wang et al (37) suggested that different cruciferous vegetables may not represent unique exposures because the glucosinolate profile varies across species. Similarly, Jiao et al (36) estimated turnip isothiocyanate concentrations to be ≈17-fold those of bok choy, which is a more widely consumed cruciferous vegetable in the Chinese population. Accordingly, associations between estimated isothiocyanate intake and breast cancer risk tracked well with associations between turnip intake and breast cancer risk, and total cruciferous vegetable intake was also associated with postmenopausal breast cancer when the intake of bok choy was excluded from the total cruciferous vegetable intake. Thus, our results suggest that turnip or other cruciferous vegetables with a high isothiocyanate content may reduce postmenopausal breast cancer risk. We cannot address the potential for systematic errors associated with applying isothiocyanate concentrations derived from cruciferous vegetables in Singapore (36) to our study population in Shanghai.
The GSTP1Val allele frequency of 18.4% in controls is more prevalent than that typically observed in white populations, which is usually ≈5–10% (20, 24, 38, 39). Zimniak et al (19) reported that the GSTP1 Val104 isoform differs in affinity for electrophilic substrates. Several earlier studies found no significant overall association between the GSTP1 Ile105Val polymorphism and breast cancer risk (23–26), and the GSTP1 Val allele has been associated with a lower risk in Finnish women, both premenopausal and postmenopausal (27), and in postmenopausal Korean women (28). However, we found the GSTP1 Val/Val genotype to be significantly associated with greater breast cancer risk, a finding that is consistent with the findings of other studies (20, 22) and previous analyses by our group (16, 21). The risk association with this polymorphism was more pronounced among premenopausal women, which is consistent with the common belief that genetic factors play a more important role in breast cancer diagnosed in young women than in that diagnosed in older women. Discrepancies between the results of the present study and those of earlier studies cannot be easily explained by the genetic variability associated with ethnicity or race alone, and they suggest that environmental factors such as cruciferous vegetable intake may affect the genetic predisposition to breast cancer associated with GSTP1genotype.
Dietary isothiocyanates induce GST enzyme activity (17, 40) and are associated with a reduction in indexes of systemic oxidative stress (7, 8). However, GSTs also conjugate isothiocyanates, and low GST activity could allow the protective effects of isothiocyanates to be exerted to a greater extent at the target tissue level. Overall, the results of epidemiologic studies to date most clearly support a combined GSTM1/T1-isothiocyanate effect on lung cancer risk, with more limited evidence for an effect on colon cancer risk (41). Limited data also suggest a GST-isothiocyanate effect on breast cancer risk (15, 16, 30). In the present study, high cruciferous vegetable intake reduced the strength of the association between theGSTP1 genetic polymorphisms and premenopausal breast cancer risk. We previously showed that urinary isothiocyanate concentrations are higher among Shanghai women with the GSTP1 Val/Val genotype than among those with other genotypes (30). Persons with the GSTP1 Val/Val genotype may excrete isothiocyanates more readily than those with another GSTP1 genotype, which may reduce the availability of isothiocyanates in the body and contribute to breast cancer risk. In such a situation, a low cruciferous vegetable intake would have the greatest effect among women with the GSTP1 Val/Val genotype. In contrast, higher cruciferous vegetable intake and isothiocyanate exposure may compensate to a degree for the greater isothiocyanate excretion observed with the GSTP1 Val/Val genotype.
These results could be affected by sources of bias that are common to case-control studies (eg, recall bias), although our rapid recruitment protocol was designed to minimize such sources of bias. Moreover, selection bias associated with diet or genotype is less likely, because of the high participation rates and population-based study design. Myrosinase activity and isothiocyanate availability may be affected by the method of food preparation (42, 43). Turnips are often consumed in an uncooked state in Shanghai, whereas most cruciferous vegetables are consumed after light cooking or stir-frying or in soups. It is unlikely that cooking methods vary substantially between cases and controls. Despite the pooling of data from 2 large studies, data within specific strata for analyses investigating the effects of cruciferous intake by genotype were sparse, and the observed patterns should be confirmed in other studies. Urinary isothiocyanate concentrations as a biomarker of cruciferous vegetable intake and internalized isothiocyanate exposure were not available for this analysis, but they will be investigated in the future. Nonetheless, this population-based study includes a sample size large enough to allow detection of relatively small associations and to explore combined gene-diet effects after adjustment for potentially confounding factors. Furthermore, total cruciferous vegetable intake was considered in a large number of subjects with high cruciferous vegetable intakes, and the evaluation included various cruciferous vegetables not as commonly consumed in other populations.
In summary, the cancer-preventive potential of cruciferous vegetable is believed to derive, in part, from the effects of isothiocyanates and other glucosinolate derivatives on phase II enzyme activity (2, 36). Greater intake of cruciferous vegetables with a higher isothiocyanate content was associated with lower postmenopausal breast cancer risk. In addition, we found that the GSTP1 Val/Valgenotype was associated with a greater breast cancer risk, and premenopausal breast cancer risk was attenuated among women with a high cruciferous vegetable intake. This may suggest that a genetic predisposition to breast cancer related to GSTP1 genotype could be modified by cruciferous vegetable intake.
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Massage Therapy is ranked as one of the most commonly used complementary
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