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Is Pineapple a Placebo? When to Worry About PSA Level

Dear Dr. Roach: I am in my mid-80s and have arthritis in both knees and hips, as well as in my spine, neck and hands. My doctor and I agreed on six 500-mg tablets of Tylenol a day rather than a prescription drug. This has not done too well.

A friend of mine suggested that I take 8 ounces of pineapple juice a day. I have been doing this for several weeks. This has almost alleviated the pain from the arthritis.

My question: What is in the pineapple juice that does this? — S.I.

Answer: I looked this up, and some publications suggested that the enzyme bromelain in pineapple juice is the effective component. This doesn’t make sense to me since enzymes, being made of protein, are themselves digested quickly in our stomachs and not absorbed into the body. So, I don’t know what in the pineapple juice is helping.

It’s possible there is something in the juice we don’t yet understand that helps joints. It’s also possible that this is a “placebo effect” — when we believe something will help, it does. The placebo effect is powerful, and accounts for much of the apparent effectiveness even of prescription drugs. It honestly doesn’t matter.

Eight ounces of pineapple juice shouldn’t cause side effects in most people, although for diabetics, it is a fair bit of sugar. I think I would stick with what’s working for you.

Dear Dr. Roach: Our local doctor referred my husband, who is 70, to a urologist more than a year ago for possible determination of prostate cancer. During this year, my husband returned to the urologist for tests. He did not have a biopsy. The urologist indicated that the test showed a PSA of 6.8. He suggested radiation, surgery, keeping a watch as he has been doing or do nothing. We understand that a normal reading would be between 0-4. Which of these alternatives would you recommend? These numbers mean little to us. — B.B.

Answer: A PSA level of 6.8 in a 70-year-old man suggests the possibility of prostate cancer. The urologist’s options are all reasonable for diagnosed prostate cancer in a man like your husband, although ideally you should have had some guidance on the risks and benefits of each option.

What I don’t understand is why the urologist is proceeding as though there is a clear diagnosis. Without a biopsy showing cancer, you don’t have a diagnosis. A biopsy is not only necessary to be sure of the diagnosis, but it can help to tell how aggressive the cancer is (although not as well as we would like).

There are newer tests coming that may be able to help guide treatment of prostate cancer, but for right now I would not recommend radiation or surgery without a biopsy. Some men are sure they would not get treatment even if there were cancer there, but I strongly recommend having all the knowledge you can before making a decision. I recommend a second urologic opinion to discuss biopsy.

Dear Dr. Roach: I have taken cholesterol medications in the past, and they give me leg cramps and pain. I need to take medication, but am hesitant to do so even though my doctor recommends treatment. Does Vytorin have the same side effects as the other statins? — P.L.

Answer: Vytorin contains two medicines: One is the same medicine as Zocor (simvastatin), so it can cause muscle aches. The statin least likely to cause it is pravastatin (Pravachol). Sometimes even the same medicine doesn’t cause aches when you try it again.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.