Richard G. Petty, MD

Antioxidants May Raise Cancer Risk?

Regular readers will know that I have for some years now been raising a red flag the wholesale promotion of antioxidants.

The trouble is this: antioxidants are supposed to help rid us of some of the free radicals that have been implicated in a small number of diseases, and may also play a role in some of the physical aspects of aging. However, free radicals are also some of the major cancer killers in the body, so eradicating them – even if it were possible – hardly seems like a good idea.

According to an analysis of a dozen studies including more than 100,000 patients in the Mayo Clinic Proceedings taking antioxidant supplements do not reduce cancer risk.

In fact smokers who take beta carotene supplements could be increasing their risk of smoking-related cancer and death.

Different antioxidants have different effects, and their effects may also vary depending on the part of the body involved.

The researchers looked at 12 trials that compared antioxidant supplements with placebo on cancer incidence and mortality. Antioxidant supplements did not reduce the risk of cancer. When they looked separately at beta carotene, they found the nutrient actually increased cancer risk by 10 percent among smokers. There was also a trend toward a greater risk of dying from cancer with beta carotene supplementation.

Selenium supplements reduced cancer risk by 23 percent among men, the researchers found, but had no effect on women. While vitamin E had no anti-cancer effect overall, supplementation with the nutrient was tied to a 13 percent lower prostate cancer risk.

A large study looking at vitamin E supplementation for prostate cancer is currently underway. While future studies of beta carotene and vitamin E for cancer prevention are very unlikely to show effectiveness, it would be worth doing further studies on selenium.

The moral of the story: we should be going for a balanced diet and a balanced life in general rather than putting our hopes in an over-simplified nutritional message.

Judah Folkman R.I.P.

I just heard that Judah Folkman just passed away at the age of 74. That is a name that is not widely known outside the scientific world, although a couple of years ago an excellent book –Dr. Folkman’s War - was written about him and his work.

His major work and his enduring legacy was in the field of angiogenesis: the production of new blood vessels. In the 1960s he came up with the idea that a way to kill tumors was to starve them of the blood supply that they need to survive. He was initially ridiculed, but history is now proving him correct. I got to know him twenty years ago after publishing a paper in which I described the discovery of a growth factor that is involved in the production of new blood vessels at the back of the eye in people with diabetes. Judah was very supportive and we had many good discussions about the potential role of angiogenesis not only in tumors and diabetic retinopathy, but also in diseases like rheumatoid arthritis and psoriasis.

Last November, at the 12th Annual Society for Neuro-Oncology Meeting in Dallas, researchers from the University of Virginia and several other leading brain tumor centers in the United States presented data on the successful use of an inhibitor of angiogenesis in the treatment of glioblastoma multiforme (GBM), the most common form of primary brain cancer. It is hard to treat, and if it recurred after surgery, radiation and/or chemotherapy there was often not much to be done.

Building on Judah’s work, they wanted to see if they could inhibit vascular endothelial growth factor (VEGF) that has an important role in the disease. VEGF fosters the growth of a tumor by stimulating the growth of new blood vessels to feed it. According to earlier studies, bevacizumab (BV) (Avastatin), a humanized monoclonal antibody that specifically targets VEGF, in combination with irinotecan (also called CPT-11) could have a role in recurrent glioblastoma multiforme. The researcher was an attempt to establish the clinical benefit of BV, both alone and in combination with CPT-11, in a multicenter, randomized phase II trial.

The results were very promising, substantially exceeded the pre-specified thresholds set for this work.

They looked at 6-month progression-free survival (PFS) defined as no clinical or MRI tumor growth and the objective response rate (ORR), which measures tumor shrinkage. Secondary endpoints included safety and survival. Response assessments were conducted by an independent radiographic facility that did not know which patients had been treated. All patients were followed for 24 weeks to determine efficacy and safety.

When taking BV, 35.6 percent of patients on average had a 6-month survival with no progression of their cancer, and an objective response rate of 21.2 percent on average.

The combination of BV and CPT was even more effective, with results of 51 percent and 34.1 percent, respectively.

The investigator group found similar results when they evaluated the patients. Those results showed that 44.7 percent of patients on average had a 6-month survival with no progression of their cancer, and an objective response rate of 38.8 percent on average. The combination therapy yielded results of 60.9 percent and 46.3 percent, respectively.

The surviving patients have remained in the study and are still being treated and followed, so we shall be seeing some longer-term results in the future.

In the United States bevacizumab has already been approved for the treatment of metastatic colon cancer and most forms of metastatic non-small cell lung cancer.

This is very encouraging research and a fitting tribute to a genuine medical pioneer.

Unhealthy America

The Milken Institute has released an impressive study that shows the heavy economic burden chronic disease places on our nation. “An Unhealthy America: The Economic Burden of Chronic Disease” shows the current treatment costs of seven chronic diseases - cancers, diabetes, heart disease, hypertension, stroke, mental disorders and pulmonary conditions – as well as the economic impacts of lost workdays and lower employee productivity. It gives a breakdown across all 50 states and the nation as a whole. The study finds that the annual economic impact on the U.S. economy of the most common chronic diseases is more than $1 trillion, and projects that the figures could reach nearly $6 trillion by the middle of the century.

Though some of the blame for this burden can be blamed on stress and environmental factors, much more of it is a direct consequence of our lifestyle choices interacting with our genes. Most of us are failing to renew, refresh and replenish ourselves, and it is important to recognize that whenever we start debating the costs of health care in the United States.

Integrated Health is based on tailored systems to help people care for themselves by going way beyond diet and exercise, and addressing the psychological, social, cultural, subtle and spiritual components of health and wellness. Healing, Meaning and Purpose is a detailed roadmap for creating the life that you deserve, and we are going to be rolling out a new series of teleseminars and workshops in the New Year.

Fat and Cancer

It is not every day that a medical story hits the front page of USA Today, but today one has, and for a very good reason.

The World Cancer Research Fund (WCRF) has just published a report that we have been eagerly awaiting for several years. It is the most comprehensive analysis ever published on the link between cancer and diet, weight and physical activity. Researches at nine academic institutions across the world looked for every relevant study published since records began in the 1960s. They initially found half a million, and in the end 7,000 of them were judged to be the most relevant and robust for inclusion in the report.

It includes 10 recommendations from a panel of 21 world-renowned scientists that represent the most definitive and authoritative advice that has ever been available on how the general public can prevent cancer. UNICEF and the World Health Organization were among the official observers of the report's process.

A key finding is that maintaining a healthy weight (a BMI of 20-25) is one of the most important things you can do to prevent cancer. The number of types of cancer where there is "convincing" evidence that body fat is a cause has risen from one to six since the last WCRF report was published in 1997, including colorectal cancer and post-menopausal breast cancer.

Prof Sir Michael Marmot, who was Chair of the Panel, said that,

“We are recommending that people aim to be as lean as possible within the healthy range, and that they avoid weight gain throughout adulthood.

"This might sound difficult, but this is what the science is telling us more clearly than ever before. The fact is that putting on weight can increase your cancer risk, even if you are still within the healthy range.

"So the best advice for cancer prevention is to avoid weight gain, and if you are already overweight then you should aim to lose weight."

Other findings in the report include:

There is "convincing" evidence that processed meats, including ham and bacon, increase the risk of colorectal cancer. People who consume them are advised to do so sparingly.

The evidence that red meat is a cause of colorectal cancer is stronger than ever before. People should not eat any more than 18 ounces (500g) of red meat a week.

This figure is for cooked meat, and is the equivalent of between 15-30 ounces (700-750g) of non-cooked meat.

Here is something that is almost a first, at least for a cancer report. It has made a breastfeeding recommendation: mothers are advised to breastfeed exclusively for six months and to continue with complementary breastfeeding after that. This is because of "convincing" evidence that breastfeeding protects the mother against breast cancer and "probable" evidence that it protects the child against obesity later in life.

Dietary supplements are not recommended for cancer prevention. The evidence that alcohol is a cause of cancer is stronger now than ever before.

Professor Martin Wiseman, Project Director of the Report, said:

"This report is a real milestone in the fight against cancer, because its recommendations represent the most definitive advice on preventing cancer that has ever been available anywhere in the world.

"When individual studies are published, it is impossible for the public to put them into context and know how seriously they should be taking the findings. But the great thing about this report is that it does this job for them.

"If people follow our recommendations, they can be confident they are following the best advice possible based on all the scientific research done up to this point. These recommendations are not based on one study but are based on 7,000." 

In the United Kingdom, plans are afoot to establish a Cancer Reform Strategy. Professor Mike Richards, the British Government's Clinical Director for Cancer, had this to say:

“The WCRF report is the most authoritative and exhaustive review done thus far on the prevention of cancer through food, nutrition and physical activity.

"For those of us wanting to lower our risk of developing cancer, the Report provides practical lifestyle recommendations. The Report also provides public health goals. Both will form an important element for the forthcoming Cancer Reform Strategy."

These are the main recommendations:

• Limit red meat
• Limit alcohol
• Avoid bacon, ham, and other processed meats
• No sugary drinks
• No weight gain after 21
• Exercise every day
• Breastfeed children

Have you seen those infomercials where someone tells you that there is some conspiracy by shadowy people who don’t want you to know the truth about diet, exercise and cancer?  Next time remember this research. If some expensive supplement or the juice of an exotic berry from the Himalayas could really reduce the risk of cancer, these studies should have noticed something by now.

Broccoli and Skin Cancer

This one is going to launch a thousand gags on the late night talk shows, but it is actually quite serious.

Despite what you hear on some of those infomercials, there is a strong link between ultraviolet radiation (UVR) and many kinds of skin cancer. You can even use ultraviolet radiation to induce cancerous change in cells cultures in a Petri dish.

In an article from Johns Hopkins University published in the Proceedings of the National Academy of Sciences damaging effects of UVR can be significantly reduced by the topical application of a broccoli extract called sulforaphane that comes from broccoli sprouts. Sulforaphane was first identified over 15 years ago, and it has been shown to play a role in preventing the development of several types of tumors that can be induced by cancer-causing chemicals. It may also have a role in fighting some established tumors.

The research involved both animal and human studies, and showed that the level of erythema (skin reddening) caused by UVR is substantially reduced when this extract is applied to the skin.

The broccoli extract is not acting like a sunscreen; it does not absorb the UVR, neither does it stop it from entering the skin. Instead it enters the cells and switches on the production of several enzymes that protect cells from UV damage. The result is that the protective effect is sustained for days after the extract has been removed.

The advantage of this is that it is much longer-lasting than any sunscreen - several days, in fact. The scientists said the protection is still there when no extract is present on/in the skin.

The researchers first tested sulforaphane on mouse models of skin cancer, and then on six healthy human volunteers.

Each of the volunteers had small patch of skin exposed to a pulse of UVR. Some of the patches were treated with the broccoli extract while others were not.

At the highest UVR dosages, UVR-induced redness and inflammation was on average 37% lower when the extract had been applied, and the protection was sustained for at least three days. They also found that protection varied greatly depending on the person - protection ranged from 8% to 78%.

These variation may be due to the volunteers' different skin types, dietary habits and genetic differences.

In these trials, the conventional sunscreens did not provide significant protection.

This research is important for several reasons:

• The research re-emphasizes the importance of recognizing inter-individual differences. An approach that works for one person may not help another
• There are many times in life when we cannot do much to prevent something bad happening to us: radiation, stress or somebody being mean. The new approach s not just to prevent exposure, but also to work on resilience: how can we stop ourselves from having a bad reaction? The whole of us, from our cells to our soul?
• It is inevitable that people will start telling you that broccoli is the way to protect yourself against skin cancer, and I am just waiting for the advertisements to start coming in. Do not be fooled! This research involves a specific extract applied to a precise area of skin. As far as we know, it does not apply to eating broccoli

Emotion and Cancer Survival

There is some research coming out in the December issue of the journal Cancer from some researchers at the University of Pennsylvania School of Medicine and other colleagues. The results surprised me, particular since I know some of the authors, and they are first rate investigators.

For over thirty years, most research studies have claimed to find an association between emotions, attitudes and beliefs, and the chance of survival form several types of cancer. Entire psychological wellness and psychotherapy programs have been designed around that premise.

The study suggests that emotional wellbeing has no effect on the chances of surviving head and neck cancer. People with negative emotions had the same survival rate as people with positive emotions.

Patients from two Radiation Therapy Oncology Group clinical trials completed a quality of life questionnaire known as the Functional Assessment of Cancer Therapy-General (FACT-G) at the start of the trials. So these assessments were added on to studies of different cancer treatments. One trial was looking at what is known as “dose fractionation strategies” and the other was looking at combined chemotherapy and radiation treatments.

The FACT-G questionnaire included a collection of items called the Emotional Wellbeing Scale. This was assessed against overall survival.

There were 1,093 at the start of the trials, of whom 646 died during the period of the study. One of the reasons for trusting the data is that this large sample together with the consistency in the treatment the patients received have made this study one of the most statistically robust ever conducted.

Emotional state did not predict survival, and the results did not change when the researchers took into account possible effects such as interactions between emotional wellbeing and the methods of the study, gender, the primary site of the cancer, or the stage of the cancer.

There are several important points:

• The study only included head and neck cancer patients. These are often very traumatic cancers, but they do not usually involve the endocrine system. Some of the best data on emotions and survival come from studies of breast cancer, which often involves disturbances of hormones that may themselves have an impact on mood and survival. And mood can have a big impact on hormones
• The patients in the study had to keep coming to appointments, and to follow instructions, so they may not be representative of all people with head and neck cancer

But the most important thing is this: before critics jump off the deep end, let’s be very clear.

The study is not saying that having an optimistic or positive emotional outlook does not bring benefits to cancer patients. All it is saying is there is no evidence that it prolongs life.

Psychotherapy, art therapy, bibliotherapy and many others can all provide a great many emotional and social benefits.

They may not add anything to the years that a persons lives, but they may add greatly to the life in those years.

Tomatoes and Prostate Cancer: What to Do? What to Do?

In June a new study on tomato intake and prostate cancer was  published in the journal Cancer Epidemiology Biomarkers and Prevention and it really put the cat among the pigeons.

I am sure that you have heard a bit about the studies that seemed to show a protective effect of tomatoes on prostate cancer, and those studies have lead to large advertising campaigns by the manufacturers of the phytochemical lycopene, which is though to be a key component of the protective effect. Lycopene has attracted particular attention because it happens to be concentrated in some of the cells of the prostate gland.

Then along comes this study suggesting that lycopene offered no protection against prostate cancer in a group of 28,000 men.

It is just the latest in a long line of research into the effects of lycopene-containing foods, and as I said, the majority of previous studies have suggested that tomatoes and tomato-based products offer some measure of protection against prostate cancer.

One of the key points that is so often not discussed, is that loading up on any one food or food supplement is not a good idea and certainly not supported by the research. For foods to be effective in humans, they may well have to be in their natural form, and the strongest evidence shows that diets high in a variety of different fruits, vegetables, whole grains and beans are associated with lower risk of developing heart disease, cancer and several other problems.

It is certainly true that in the laboratory, tomato components have stopped the proliferation of several types of cancer cells including breast, lung, and endometrium. In animal models, consumption of large amounts of compounds extracted form tomatoes has been linked to large decreases in prostate cancer risk. 

The best known study recruited 47,894 men and evaluated their diets for six years. The data showed that those who ate the most tomato products – raw, cooked tomatoes, tomato sauce, pizza and tomato juice - had a 35% lower risk of early prostate cancer and a 53% lower risk of advanced prostate cancer than men who ate the least of these foods.

We are all eagerly awaiting the publication by the American Institute of Cancer Research and its international affiliate organizations on November 1st of this year, of the most comprehensive assessment of the scientific literature on diet, physical activity and cancer risk ever undertaken.

That report, Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective, will synthesize data from thousands of studies and provide guidelines for the public and for the scientific/medical community. It is bound to be controversial, but hopefully it will provide answers to questions about nutrition and cancer that are based on a thorough review of the available science.

(You can find out more about the WCRF/AICR Expert Report here. I am looking forward to reading the report and I shall be taking you through the highlights as soon as I get a copy)

Let me re-iterate one of the principles of Integrated Medicine, that is so very important when considering the impact of nutrition on health:

Combinations are Key for they create a powerful synergy.

Whole Grains

Every day of the week I talk to people who say that they do not have time to eat a healthy diet or hunt for the right type of victuals, and so off they go to the health food store to buy some capsules.

How many advertisements have you seen for some capsule or powder that gives you all the nutrients and fiber that you need? But think about that for a moment: does that make sense? For millions of years our far-distant ancestors co-evolved with the plants and minerals around them. So does it make sense that we can pull out one dietary component and ignore the rest? Or that the berries of some plant growing thousands of miles from early humankind could contain some magic potion that will solve all of our problems? That would imply a rather capricious Universe that only wants you to find that essential something when you have the money and the wherewithal to find.

Back when the world was new – well, come to think, it was 1974 – I was impressed to see some early data that showed dramatic differences between the exquisitely balanced nutrient profile of an orange compared with commercially prepared orange juice. A few years later we even did a bit of research on the subject.

This topic has re-emerged with some new research that has received justified plaudits from experts at the American Institute for Cancer Research. The study has indicated that whole grain fiber rather than fiber from other food sources, is associated with lower risk of colorectal cancer.

The study was recently published in the American Journal of Clinical Nutrition and found that consumption of whole grains was associated with lower risk for colorectal cancer. The same study found no significant link between consumption of fiber from other food sources and colorectal cancer risk.

Researchers at the National Institutes of Health analyzed survey results from a huge prospective cohort study called the NIH-AARP Study involving more than 291,000 men and 197,000 women aged 50 to 71.

The scientists analyzed the participant's intake of fiber from many different food sources, but only fiber from whole grains was associated with lower risk of colorectal cancer. In the study, those subjects who ate the most whole grains had a 20 percent lower risk of colorectal cancer than those who ate the least.

The observed protective effect of whole grain consumption was stronger for rectal cancer, with a 35 percent lower risk.

Experts have been following the conflicting and often contradictory findings on fiber and colorectal cancer for years.

Much of the previous research simply measured the participants' total fiber intake. The trouble is that so much of the American diet is now made up of heavily processed grains in foods like pasta, cereals and breads, so “Fiber” is a really mixed bag. So it seemed that it might be helpful to distinguish between different food sources of fiber. 

Let’s have a quick refresher course. All grains, from the familiar, like wheat, oats, rye, corn, to the less well known such as barley, bulgur, millet, quinoa start out as kernels. The bran is the outermost layer of the kernel, and that is where most of the fiber is found. The germ lies at the center of the kernel, and that is where most of the vitamins, minerals and fatty acids reside. In between the brain and the germ lies the endosperm, which contains a few vitamins and minerals and most of the starch.

Because the refining process removes the bran and germ, the main component of white bread and other products made from refined grains or white flour is starch. Whole grain products are darker and chewier than refined grain products is because all three layers of the kernel are ground together to make whole grain flour. This provides the kernel's full complement of protein, fatty acids and a range of phytochemicals. Most importantly, perhaps, the fiber content of whole grains can be as much as four times that of refined grains.

The evidence connecting consumption of whole grains to reduced risk for cancer, cardiovascular disease, stroke and diabetes comes chiefly from population studies and laboratory work. Only recently have researchers begun to identify specific ways a diet high in whole grains promotes health.

In February 2006 a study also published in the American Journal of Clinical Nutrition found that a high whole-grain intake had a number of objective effects on physiological markers - homocysteine, plasma markers of glycemic control (fasting insulin, hemoglobin A1c, C-peptide, and leptin), lipids (total cholesterol, triglyceride, HDL cholesterol, and LDL cholesterol), and inflammation (C-reactive protein, fibrinogen, and interleukin 6 – that may be associated with both diabetes and cardiovascular disease almost all improved and none became worse.

The evidence for whole grains specifically lowering cancer risk is less strong. However, in 2003 European Prospective Investigation into Cancer (EPIC) prospectively examined the association between dietary fiber intake and incidence of colorectal cancer in 519,978 individuals aged 25 to 70 years, recruited from 10 European countries. The data showed that high consumption of fiber (from fruits, vegetables and whole grains) reduced risk for colon cancer by 25 percent.

Although most experts have been recommending “whole grain foods” for years, this new study finally proves that the fiber that we get from whole grains is different from the fiber we get from "starchy" foods like white bread and processed cereal, and that these differences are not only important for the vascular system and diabetes, but also for cancer risk.

Red Meat and Breast Cancer

There is an important study that was published in the April issue of the British Journal of Cancer, but which I haven't seen reported in the United States.

The researchers did a survival analysis to assess the effect of meat consumption and meat type on the risk of breast cancer in the UK Women's Cohort Study. Between 1995 and 1998 a cohort of 35,372 women was recruited, aged between 35 and 69 years with a wide range of dietary intakes, assessed by a 217-item food frequency questionnaire. The researchers also took into account smoking, weight, fruit and vegetable intake, class, education and use of hormone replacement therapy.

The results showed that eating even small amounts of red meat daily can increase the risk of breast cancer by 56 per cent in older women.

As little as 2oz (57g) of beef, lamb or pork a day showed an effect. Post-menopausal woman who ate larger amounts, 3.6oz (103g), of processed meats such as sausage, bacon or ham had an increased risk of 64 per cent.

Even younger, pre-menopausal women had a slightly raised risk if they ate red meat daily.

Earlier analysis from the study found that pre-menopausal women who had the greatest intake of fibre cut their breast cancer risk by half.

The Leeds work supports other studies. In November, a study from the United States found that women who ate the largest amounts of red meat had a rising risk of breast cancer. But different studies have presented conflicting views.

One reason why red meat may contribute to a raised risk of breast cancer is that it is a rich source of saturated fat. The women who ate the most meat were also more likely to be fatter.

The publication of the study in the United Kingdom generated a great many negative comments from the meat industry.

One spokesperson, on hearing that as little as two ounces may be enough to increse the cancer risk said,

"Two ounces is absolutely tiny. I have never heard such rubbish. It's a tiny amount. This is ridiculous, it's silly."

I doubt very much that it is "silly," though it is a surprise that the study has not attracted more attention.

The best way to look at this data is not to say that everyone should become vegetarian, but to recommend that women should:

• Eat a balanced diet
• Limit alcohol consumption
• Exercise regularly
• Keep and maintain a healthy weight
• Try to maintain a regular sleep schedule

It’s Not Just Kissing

Once upon a time Marilyn Monroe is supposed to have said, “So what’s wrong with sleeping with lots of people? You can’t get cancer from it.”

The quotation may be apocryphal, but the facts are not: we now know full well that there are viruses that can be sexually transmitted that may in turn increase the risk of getting cervical cancer. Hence all the talk about Gardasil, the new vaccine against some of the main culprits: strains of the human papillomavirus (HPV) types 16, 18, 6, and 11. HPV types 16 and 18 cause about 70% of HPV-related cervical cancer cases.

It was only a matter of time before someone put two and two together and asked the question whether the viruses might be involved in cancer if they end up in other parts of our anatomy.

After all the revelations concerning a former President, it seems that over the last ten years there has been a sea-change in attitudes. According to surveys, many young people now regard oral sex as nothing more significant than kissing.

On many levels, that is sad.

Anyone able to see the larger picture will be upset to see that complex matters of human relationships, feelings of self-worth and transcendence are being reduced to a branch of gymnastics. This is not at all a puritanical view: any kind of sexual activity is complex and multi-faceted. And now there is some new evidence to suggest that oral sex with multiple partners can carry a substantial risk of developing cancer of the throat.

According to a study published in the New England Journal of Medicine people who have oral sex with 5 or more partners during their lifetime have a much greater chance of having throat cancer, The researchers suspect that the cause is a well known strain of the human papillomavirus (HPV) that is linked to a number of anogenital cancers.

Dr Maura Gillison and a team of collaborators from the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland conducted the research.

Scientists already knew that HPV was doing something at the molecular level to help trigger a type of throat cancer known as oropharyngeal squamous-cell carcinoma, but consistent epidemiological evidence was still missing.

The researchers recruited 100 patients with newly diagnosed oropharyngeal cancer and 200 control patients without cancer in a hospital-based case controlled study. They used a statistical method called logistic regression to look for links between results from the patients' blood and saliva samples and lifestyle variables such as their sexual behavior, consumption of alcohol and smoking habits. Getting honest and accurate lifestyle data is always tough, particularly when asking about sex, so this data was collected using an anonymous questionnaire.

The results showed that:

• Patients who had a lifetime number of 6 or more oral-sex partners were 3.4 times more likely to have oropharyngeal cancer
• Those who had 26 or more vaginal-sex partners during their lifetime were 3.1 times more likely to have oropharyngeal cancer.
• The link became stronger as the number of lifetime oral and vaginal sex partners went up.

Oropharyngeal cancer was linked with oral infection with HPV type 16 (HPV-16), with any of the 37 types of HPV, and with having been exposed in the past to HPV. That was determined by measuring for antibodies to the HPV-16 L1 capsid protein. The statistics were impressive. What is known as the odds ratio for these three events were found to be 14.6, 12.3 and 32.2 respectively.

DNA from HPV-16 was found in 72 per cent of tumor specimens and 64 per cent of patients tested positive for presence of one or more cancer-related proteins produced by HPV-16. (These are known as oncoproteins E6, E7, or both).

The results suggested that once the link with HPV is present, there is no added risk from tobacco use and alcohol consumption, usually regarded as the highest risk factors for this type of throat cancer.

The researchers suggest that HPV "drives" the cancer and once the cell is sufficiently disrupted to cause cancer, the impact of tobacco and alcohol is unlikely to contribute any more risk.

The researchers concluded that:

"Oral HPV infection is strongly associated with oropharyngeal cancer among subjects with or without the established risk factors of tobacco and alcohol use."

In an accompanying editorial, Dr Stina Syrjänen from the University of Turku in Finland suggested that this study raises important clinical and public health issues.

For instance:

• Should heavy smokers and drinkers be screened for HPV-related throat infection?
• Should throat cancers with a suspected HPV origin be treated differently form those with no HPV link and most likely caused by smoking and drinking?
• And the question that must be in the minds of many currently focused on the HPV vaccination debate: would HPV vaccination give people protection against some throat and mouth cancers?

Breast Cancer and the Gang of Four

People of a certain age will remember the ominous "Gang of Four" who were primarily blamed for the events of the Cultural Revolution in China.

Now new research published in the journal Nature has exposed an equally ominous "Gang of Four," but this time it is a set of four genes is responsible for the lethal spread of breast cancer.

A team in New York with researchers now working at the Hospital Clinic de Barcelona and the Institute for Research in Biomedecine in Spain, has identified four key genes in human breast cancer cells that play a role in metastasis, or the spread of the cancer, to the lungs.

A number of genes are already known to contribute to the spread to the lungs. But Prof Joan Massagué and colleagues at Memorial Sloan Kettering Cancer Centre, New York, now show how four co-operate to promote the formation of new tumour blood vessels, the release of cancer cells into the bloodstream, and the penetration of tumour cells from the bloodstream into the lung.

The gene set comprises EREG, MMP1, MMP2 and cyclooxygenase (COX2). (That is the same COX2 that you will have heard about as a target for some arthritis and anti-inflammatory medicines. It is the abnormal activation of all four that enables the breast cancer to invade the lungs. Although shutting off these genes individually can slow cancer growth and metastasis, the researchers found that turning off all four had a dramatic effect.

Prof Massagué said:

"The remarkable thing was that while silencing these genes individually was effective, silencing the quartet nearly completely eliminated tumour growth and spread."

In experiments on human breast tumours implanted in mice, the researchers also found that they could reduce the growth and spread of the disease by simultaneously targeting two of the proteins produced by these genes, using drugs already on the market.

"We found that the combination of these two inhibitory drugs was effective, even though the drugs individually were not very effective," said Prof Massagué. "This really nailed the case that if we can inactivate these genes in concert, it will affect metastasis."

The researchers now want to test combination therapy with the drugs - cetuximab (Erbitux) and celecoxib (Celebrex) - to treat breast cancer metastasis.

The other two genes are matrix metalloproteinases (MMP1 and MMP2) that are involved in the formation of new blood vessels.

A second study, also published in Nature, reports that investigators in Texas have isolated 87 genes that seem to affect how sensitive human cancer cells are to certain chemotherapy drugs.

The study highlights a new way to screen for alterations in cancer cells that make them specifically sensitive to treatments, so that they may leave normal tissue relatively unharmed.

This is important work that unlocks  another piece of the mystery of at least one type of cancer.

It will not be the whole story: we still need to find out why tumors can spread to other organs and how environmental factors, including states of mind, may have an impact on the spread of tumors.

And it is yet more evidence that inflammation is one aspect of the spread of tumors.

The Causes and Consequences of Insulin Resistance

I have spent so much time talking about insulin resistance becuase it is one of the greatest medical threats facing the world.

It is estimated that approximately 33% of the adult population of the United States is insulin resistant, and if left untreated many will develop diabetes, hypertension and an array of other problems. It is an epidemic that is expected to swamp most health care systems around the world, yet sadly it may in most cases be preventable.

There is an enormous literature on insulin resistance. As of this afternoon there are almost 33,000 scientific papers on the subject.

I created this graphic to try and summarize the key points about insulin resistance: the main factors that may cause it, as well as the most important medical consequences.

(Click on the graphic to expand it.)

The Main Causes of Insulin Resistance are:

• Aging
• Intra-abdominal obesity
• Inactivity
• Glucose intolerance
• Genetics
• Fetal malnutrition
• Cigarette smoking
• Some medications

The Main Consequences of Insulin Resistance are:

• Type 2 diabetes mellitus
• Hypertension
• Arteriosclerosis
• Polycystic ovarian syndrome
• Non alcoholic fatty liver disease
• Disturbances in the function of the vascular endothelium
• Elevations of triglycerides and cholesterol
• Disturbances of clotting
• Disturnaces in kidney function
• DIsturbances in one type of heart rhythm
• Elevated uric acide levels
• Some malignancies

This is probably not a complete list, but it gives you a very good idea of the reasons for looking for insulin resistance. Many - but not all - experts now recommend measuring insulin resistance in people at high risk of developing any of these medical problems.

We have good evidence that lifestyle changes can prevent the development of many of these dire consequences, so it is certainly something worth discussing with your health care provider.

Colon Cancer: Improving the Chances of Cure

I was very pleased to see how many people have read and downloaded the advice about reducing your risk of colon cancer. I was also very happy with the announcement this morning that Tony Snow’s cancer has not spread to his liver.

People who develop cancer of the colon can often be cured of their original tumors, but some grow back and then they can be more difficult to eradicate. Most relapses occur within 2.5 to 3.0 years. If a tumor has not returned within five years, many doctors consider that the patient has been cured.

The risk of getting a tumor and of it recurring is greater if there is some “predisposing factor,” including a positive family history for colon cancer, familial polyps of the colon or inflammatory bowel disease. The risk of recurrence is also higher in people who get the illness before the age of fifty. We are beginning to see the emergence of genetic tests that can help predict people at high risk of developing colon cancer. People with any of these factors should get particularly careful screening.

Over the last ten years several new drugs for the treatment of colon cancer have been approved by the Food and Drug Administration:
Avastin (Bevacizumab)
Camptosar (Irinotecan)
Eloxatin (Oxaliplatin)
Erbitux (Cetuximab)
Vectibix (Panitumumab)

None is a cure, but they may help in people whose disease has spread to other organs. Most are used in combination with older and often more toxic chemotherapies.

Colorectal cancer is the number two cause of cancer-related death in the United States. It is estimated that there will be 153,000 new cases this year that will ultimately result in 52,000 deaths. The earlier that the disease is caught, the better the chance of a cure. The American Cancer Society has published these five-year survival figures:
Stage 1 - Limited to the colon                            93%
Stage 2 – Spread through the wall of the colon    72-85%
Stage 3 – Spread to local lymph nodes                44-83%
Stage 4 – Spread to other organs                         8%

Bear in mind that even the most gloomy figures are only based on current treatments: we do not know what the future holds.

The data are also for people who have only had conventional treatments. Integrated Medicine suggests using conventional treatment as well as addressing the psychological, social, subtle and spiritual aspects of the illness. We have little empirical data that such a comprehensive approach works better than conventional medicine alone, but clinicians around the world have accumulated a great deal of experience to indicate that this kind of comprehensive approach helps not only with survival, but also in quality of life and in comprehending the meaning and purpose of the illness.

Blueberries and Colon Cancer

I have been delighted to see how many people have read and downloaded my Twelve Tips to Reduce Your Risk of Colon Cancer.

There is some new research that was just presented at the shows tha there is a compound in blueberries called pterostilbene that may help protect against the development of colon cancer.

Researchers from Rutgers University and the US Department of Agriculture presented their findings at the meeting of the American Chemical Society in Chicago.

Pterostilbene is a natural antioxidant that mops up free radicals that may, in excess, trigger the growth of some cancers. Similar antioxidants have already been identified in grapes and red wine. Work in mice suggests that pterostilbene may also lower cholesterol levels. The compound also reduced inflammation and the rate of cell division in the bowel both of which are considered to be cancer risk factors.

Pterostilbene is also found in cranberries, sparkleberries, lingonberries and grapes.

It is an extremely good idea to add blueberries to your diet. Do not overdo it! I worry when people extol the virtues of some super-food or super-drink that is supposed to abolish all of your free radicals. Despite the claims of at least one medical correspondent on Fox New, there is usually no evidence that they do so. And in any case, you do not want to abolish all your free radicals: they are key cancer killers.

You want to balance and modulate the free radicals in your body, and blueberries, together with four other portions of fruit and vegetables a day are one excellent way of doing so.

Anti-inflammatories and Colon Cancer

I just had a very good question after I published my list of Twelve Tips to Reduce Your Risk of Colorectal Cancer.

Dear Dr. Petty,

“That’s a great list, but I am wondering why you haven’t included aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs)? I thought that they had been shown to reduce the risk of colon cancer.”

This is an excellent question, and I deliberately omitted mention of anti-inflammatories because the research suggests that they may cause more harm than good.

There is a report in today’s edition of the Annals of Internal Medicine from the United States Preventive Services Task Force, a highly regarded and independent panel of experts in primary care and prevention, that confirms that screening for colorectal cancer is still important and everyone over 50 should have it. But they urge caution on taking preventive drugs, saying that on balance the health risks of aspirin outweigh the benefits when it comes to preventing colon cancer. This advice holds even for those people with a family history of the disease, as long as they have only an average risk of colon cancer. (20 per cent of people who get colorectal cancer also have a close relative with the disease, with proportionally more cases among African Americans than other races.)

They found good evidence that high doses of aspirin (i.e. 300 mg a day or more) and possibly ibuprofen protect against colorectal cancer but this comes with increased risk of intestinal bleeding, stroke and kidney failure.

In low doses - under 100 mg a day - the Task Force says that good evidence supports the notion that aspirin protects against heart disease. However, at this dosage it will have no preventive effect on colorectal cancer.

The US Preventive Services Task Force regularly reviews the available research evidence and issues advice based on what they regard the strength of the evidence to be. They use a grades to help guide practice. For example a grade A recommendation is equal to "strongly recommends", while a B is just "recommends", and C is "no recommendation for or against".

In this case the Task Force has issued a grade D "recommends against" to the routine use of aspirin and NSAIDs to prevent colorectal cancer.

So for now I recommend following the Twelve Tips that I published yesterday.

Twelve Tips to Reduce Your Risk of Colorectal Cancer

Colon cancer, or, more accurately colorectal cancer, includes cancerous growths in the colon, rectum and appendix. It is the third most common form of cancer and the second leading cause of death among cancers in the Western world. Colorectal cancer surpasses breast and prostate cancers as a leading cause of cancer deaths in both men and women.

And the key point is that with early screening and a few simple dietary modifications, you can dramatically reduce your risk of getting it.

These are the 12 Tips to Slash Your Risk of Colorectal Cancer

1. Receive regular colorectal cancer screenings beginning at age 50 if you are at normal risk
2. If you are at higher risk due to a personal or family history of colorectal cancer, other cancers or inflammatory bowel disease have a discussion with your health care provider about screenings before age 50
3. Eat between 25 and 30 grams of fiber each day from fruits, vegetables, whole grain breads and cereals, nuts, and beans
4. Eat a low-fat diet: colorectal cancer has been associated with diets high in saturated fat, particularly fat from red meat
5. Eat foods with folate, such as leafy green vegetables
6. Try to drink at least 80 fluid ounces of pure water a day unless you have a medical reason for not doing so
   
7. Drink alcohol in moderation: 2 units of alcohol or less each day
8. If you smoke, here is another good reason for quitting. Alcohol and tobacco in combination are linked to colorectal cancer and other gastrointestinal cancers
9. Exercise for at least 20 minutes three to four days a week. Moderate exercise such as walking, gardening or climbing stairs may help reduce your risk
10. If you get any persistent symptoms such as blood in the stool, a change in bowel habits, weight loss, narrower-than-usual stools, abdominal pains or other gastrointestinal complaints, it is essential to report them to your health care provider
11. Maintain a healthy weight. Obesity may increase the risk of colorectal cancer
12. Maintain a good intake of calcium and vitamin D:  this combination has been shown to reduce the risk of colorectal cancer

For more information, I recommend visiting the Web site of the American Cancer Society.

I keep their details in the "Resources" section on the left hand side of this blog.

Prayer and Healing

We have already talked a little about the associations between active, healthy spirituality and psychological and physical well-being.

Yet another study has highlighted the connection, showing that breast cancer patients who pray in online support groups can obtain mental health benefits.

Researchers from the University of Wisconsin-Madison Center of Excellence in Cancer Communications Research did the study that was that was funded by the National Cancer Institute.

The research looked at message transcripts from 97 breast cancer patients participating in an online support group that was integrated with the Comprehensive Health Enhancement Support System (CHESS) "Living with Breast Cancer" program, a computer-based health education and support system. The patients were recruited from Wisconsin and Michigan.

Surveys were administered before group access and then again four months later. Text messages within the computer-mediated support groups were analyzed using a text analysis program that measured the percentage of words that were suggestive of religious belief and practice (e.g., pray, worship, faith, holy, God). Writing a higher percentage of these religious words within the online support groups was associated with lower levels of negative emotions and higher levels of self-efficacy and functional well-being, even after controlling for patients' pre-test levels of religious beliefs.

One of the researchers had this to say:

"From a psychological standpoint, there are a variety of reasons why cancer patients may benefit from prayer - whether on the Internet or elsewhere. In reviewing the messages, some of the most common ways study participants used religion to cope with their illness included putting trust in God about the course of their illness and consequently feeling less stressed, believing in an afterlife and therefore being less afraid of death, finding blessings in their lives and appraising their cancer experience in a more constructive religious light."

And that is, of course, one set of explanations for the findings.

Or perhaps, as we have seen before, there is a growing body of research to indicate that prayer is effective.

We just have to expect it to be effective. And isn’t that faith?

“Prayer, like radium, is a luminous and self-generating form of energy.”
--Alexis Carrel (French-born American Surgeon, Experimental Biologist and, in 1912, Winner of the Nobel Prize for Medicine or Physiology, 1873-1944)

"Too often we see prayer as a last resort rather than as our first thought. People will say, “I guess all we can do now is pray!” like that's the last thing, horrible thing to do. And your friend says, “Has it come to that?! Is it so hopeless that all we can do is pray?”
--Rick Warren (American Evangelist and Author, 1954-)

“Though God knows all our needs, prayer is necessary for the cleansing and enlightenment of the soul.”
-- John Sergieff of Kronstadt (Russian Priest who, in 1882, Established the House of Industriousness, 1829-1909)

“Man often thinks that, as God is the knower of the heart, there can be no need of any recital or gesture in prayer: but that it would surely be sufficient if he were to sit in the silence and think of God. But this is not so; it is according to the extent of a man’s consciousness of prayer that his prayer reaches God.”
--Hazrat Inayat Khan (Founder of the Sufi Order of the West, 1882-1927)

“Through prayer, the love of God grows and assumes a form which is called supreme devotion. Forms vanish, rituals fly away, books are superseded, images, temples, churches, religions and sects, countries and nationalities - all these little limitations and bondages fall off by their own nature from him who knows this love of God.”
--Swami Vivekananda (Indian Hindu Mystic and Spiritual Teacher, 1863-1902)

“Prayer is part of man's original nature. He can never be satisfied with merely meditative religion, and naturally and involuntarily inclines to move on to the religion of prayer.”
--Toyohiko Kagawa (Japanese Christian Anti-War Campaigner, 1888-1960)

“All true prayer somehow confesses our absolute dependence on the Lord of life and death.”
Thomas Merton (French-born American Trappist Monk and Writer, 1915-1968)

“There is a relationship between prayer and action. Receptive prayer results in an inner receiving, which motivates to right action.”   
-- “Peace Pilgrim”  (a.k.a. Mildred Norman, American Peace Activist, 1908-1981)

Juices, Cardiovascular Disease and Cancer

There was an important study that came out a few months ago in the International Journal of Food Science and Nutrition.

Investigators from Dundee in Scotland decided to look at the health benefits of fresh fruit juice. While it is widely accepted that fruit and vegetables lower the risk of some cancers and of most cardiovascular diseases, the role of pure fruit and vegetable juices has never been clear. In fact many textbooks have said that 100 percent juices play a less significant role in reducing risk for both cancer and cardiovascular disease than whole fruits and vegetables since they contain less fiber, and it had been assumed that it was the fiber that was the key to their value.

The researchers analyzed a variety of studies that looked at risk reduction attributed to the effects of both fiber and antioxidants. They found that the positive impact offered by fruits and vegetables is derived not from just the fiber but also from antioxidants which are present in both juice and the whole fruit and vegetables. Juices are comparable in their ability to reduce cancer and cardiovascular risk compared to their whole fruit/vegetable counterparts.

This research  goes a long way in demonstrating that fruit and vegetable juices may play an important role in reducing the risk of various diseases.

A study published in the American Journal of Medicine in September found that consuming a variety of 100 percent fruit and vegetable juices was associated with a reduced risk for Alzheimer's disease. Japanese American individuals who drank three or more servings of fruit and vegetable juices per week had a 76 percent lower risk of developing Alzheimer's disease than those who drank juice less than once per week. That finding seemed robust, even taking into account other potential variables. So I think that we may be able to add juices to our strategies for reducing the risk of developing Alzheimer's disease as we get older.

There is another point of importance. Some of the fad diets claim that fruit juices should be avoided at all costs, since they can cause the release of insulin, and insulin is bad. Those proclamations have usually come from people with a limited background in biochemistry or metabolism. The research shows that they were not correct. The key is balance, and as part of a comprehensive nutritional approach, juicing can be very helpful.

And a final point: careful use of juices has long been one of the "secret" components of our system of weight management.

“Drinking freshly made juices and eating enough whole foods to provide adequate fiber is a sensible approach to a healthful diet.”
--Jay Kordich (American Health Expert, Author and Lecturer, 1921-)

“If people would only stop putting into their bodies the things that are creating their physical problems, and eat a predominantly raw vegetarian diet, along with raw vegetable juices, almost all physical problems would soon disappear from the face of the earth!”
--Reverend George M. Malkmus
 (American Minister and Originator of the Hallelujah Diet, 1934-)

Checking Data

Following my brief piece on the sun and some of its potentially adverse effects, someone was kind enough to leave this comment:

"Don't forget that skin cancer is cured by melatonin and vitamin A.
Reference 1
Reference 2

I am extremely grateful that he wrote, because it gives me the opportunity to illustrate the point about checking the data. The person who wrote was obviously motivated by a desire to help, but he had been given some information that was not correct.

I pulled out both of these papers and discovered that they said something rather different.

The first paper in the Indian Journal of Medical Sciences is quite a good review article about melatonin. There are several reasons for us to be interested in melatonin, and I actually plan to write a brief review about it as soon as I have finished analyzing the literature. There is indeed some experimental work to suggest that melatonin may modulate and in some cases arrest the growth of some malignant cell lines (1. 2. 3.) But we are still a long way from being able to say that melatonin is a viable treatment option for melanoma.

The second paper does not talk about melanoma treatment at all: it is a paper about the possible use of Vitamin A as protection against cancer in sun-damaged skin.

As I mentioned in my piece about the new open access journals, our next task is to help people learn how to interpret the data in all of these papers. I am on the review and editorial boards for several scholarly research journals and it is amazing how often the article summary does not tally with the data in the paper.

And also how often people cite articles that they cannot have read. Within the last 24 hours, the editor of a well-known journal asked me to review a research paper that had been submitted for publication. There was very interesting data in the paper, but the author had made at least one error in his citations. He accidentally claimed that a piece of research had discovered one thing, when the research had actually said something quite different. I happened to know that because I wrote the original paper!

This problem of misinterpreting data keeps coming up, and I’m sure that we may all have missed something at some time. It’s sometimes hard to analyze all the ins-and-outs of a piece of research.

You may have heard about a bit of a scandal over a book on gender differences that was just published. I liked reading the book, but I was worried about some of the references about hormonal effects on behavior. I know this literature very well, and some of the statements and inferences were a bit questionable. Now several experts have been checking some of the citations about gender differences in language that were used by the author. They discovered that some were just plain wrong.

Have you ever heard that one about, “Women talk more than men?” It always sounded pretty silly. And of course, if something sounds silly it probably is. Does it matter? If someone is going to write a popular book, good luck to them: I actually think that scientists have a duty to make their work accessible to the public.

But if they quote a lot of papers to give themselves an air of authority, they really have to make sure that they are not misleading anyone. If some references are wrong, then it’s difficult to be sure which ones we can trust.

We cannot have one set of rules for a book written for professionals and another for the general public. Each must be created with the utmost care, clarity and attention to detail.

My last book and CD series – Healing, Meaning and Purpose – cites over 800 books and websites, all carefully checked by yours truly. I did this just so that people can follow up on what I say. That way my books, articles, papers – even this blog – become portals to a world of ideas and information that you can use to improve your life.




Here Comes the Sun: To Screen or Not To Screen?

I have been worried to see some people - all, I think, without scientific training - proclaiming that there is no need to protect ourselves against the sun because there is no evidence that sulight causes any health problems.

Ultraviolet radiation (UVR) from the sun has been part of the environment since the first cells began to form. When we discuss the effects of UVR on human health and the environment, the range of UV wavelengths is often subdivided into:

• UVA (400–315 nm), also called Long Wave or "blacklight"
• UVB (315–280 nm), also called Medium Wave
• UVC (< 280 nm) also called Short Wave or "germicidal”

The key questions are these:
Can sunlight cause health problems?
Do the benefits of sunlight outweigh their risks?”

UVB is required for the conversion of 7-deoxycholesterol to vitamin D, (the sunshine vitamin!) which is critically important in the maintenance of healthy bones, although there may also be another mechanism by which vitamin D is generated in the body. As we have seen research is making clear that vitamin D has other potential roles in the maintenance of human health. Low levels of vitamin D have been linked to:

• Rickets
• Osteomalacia
• Osteoporosis
• Maintaining the integrity of cell membranes
• Type 2 diabetes mellitus
• Schizophrenia
• Multiple sclerosis
• Pre-eclampsia (hypertension and accompanying problems during the late stages of pregnancy)
• Some types of cancer
• Fibromyalgia-like pains
• Immune deficiency: Africa Americans do not generate enough of a protein needed to ward off tuberculosis. Why? Because the protein needs vitamin D to be activated, and dark skin is inefficient at absorbing and converting UVR. It may also be that we see epidemics of colds and flu in the winter because that is when we have low levels of vitamin D, which allows the viruses to overwhelm our immune defenses.

This does not necessarily mean that taking extra vitamin D will ward off all of these problems.

In the days before the Industrial Revolution, unless we lived in the frozen North, we had no trouble in getting the amount of vitamin D that we needed. In most of the United States, during the summer months, 10-15 minutes outdoors at midday will generate around 10,000 international units (IU’s) of vitamin D in an average fair-skinned person. This is far in excess of the government’s dietary recommendations of 200 IU’s/day in people up to age 50, 400 IU’s up to age 70 and 600 IU’s in people over 70. Not surprisingly many experts – me included – believe and have provided evidence that these daily requirements are much too low. (Have a look at the comments here.)

Of course many of us do not spend much time outside and don’t take in as much in the way of vitamin D containing foods - such as milk and salmon – as we should. I’ve seen evidence to suggest that we in Atlanta are probably at the Northernmost point in the United States were we could hope to get enough sunshine and therefore vitamin D from modest winter exposure to the sun.

Recent data has suggested that if you spend no time at all in the sun, then you may need as much as 4,000 IU’s of vitamin D/day, though that figure has not yet been widely accepted.

Exposure to UVR, whether of solar or artificial origin, also carries potential risks to human health. UVR is a known carcinogen and excessive exposure, at least to the solar radiation in sunlight, increases the risk of cancer of the lip, basal cell, and squamous cell carcinoma of the skin and melanoma, particularly in fair-skinned populations. There is also evidence that solar UVR increases risk of several diseases of the eye, including cortical cataract, some conjunctival neoplasms, and perhaps also melanoma of the eye.

We have good data for the existence of a threshold amount of UV-B exposure that may lead to the formation of cataracts. The amount needed to cause cataracts depends in part on the amount of pigment in the eye, so albino rats get cataracts with much lower exposures to UV-B.

So what to do?

Sunlight has a definite benefit in preventing or treating many clinical problems and it is no surprise that after 3000 millennia we are adapted to make use of the sun’s largesse. What is less easy to understand is why an excess of sunlight can cause so many problems, unless it is our hairlessness and environmental change that has lead to a loss of the ozone layer.

Some years ago it was suggested that sunscreens may themselves cause skin cancer, but the data has shown that to be false. Indeed modern sunscreens almost certainly reduce melanoma risk.
So how do we balance the positive and negative effects of sunlight? A recent review precisely reflects my own thinking:

• We need some sunlight
• Depending on where you live, you need only a few minutes each day
• Sunscreens confer protection on the skin without blocking all the health benefits
• If you have a medical reason for avoiding sunlight, then your health care provider should measure your vitamin D status.

 

Rethinking Cancer

Over the last thirty years, there has been a gradual change in the way in which we conceptualize biological processes. Although the lion’s share of research is still dedicated to biochemical processes involving DNA, RNA and the cell membrane, other important concepts are being quite widely accepted. They include:

• Fetal imprinting
• Epigenetic control
• Self-organization
• Self-regulation
• Coherence over time
• Information exchange with the environment
• Symbiosis
• Morphogenesis

One way of thinking about this is to describe cells, organs and bodies as coherent information-rich processes. And when things go wrong, it is because these processes have gone awry. Information medicine is designed to bring the system back into coherence and harmony.

I have spoken before Integrated Medicine and in the next posting I am going to talk more about the difference between Integrated, integrative and integral medicine. But at this point suffice to say that Integrated Medicine is information medicine based on an understanding of these principles.

Several years ago I presented a paper at a closed meeting where I introduced the term “adult dysmorphogenesis,” to describe the way in which some disease processes – such as arteriosclerosis, arthritis and Alzheimer’s disease - could be better understood not as degenerative conditions, but as deranged information systems. These in turn disrupted the normal self-organizing principles of the body that lead it to constantly correct and repair itself. Part of my reasoning was that we were constantly seeing apparently irreversible conditions like broken down joints being repaired by information medicines like acupuncture and homeopathy.

With that background I was very interested to read an important paper in the journal Theoretical Biology and Medical Modelling.

The paper begins by highlighting three odd observations:

1. Throughout the animal kingdom cancer hardly ever occurs in tissues that have a strong ability to regenerate
2. In animals in which cancer occurs frequently, its incidence rises with age. If it occurs in a young animal it usually occurs in a tissue that has already been damaged
3. In animals that have a strong ability to regenerate and repair organs, these mechanisms remain fairly efficient throughout life. In animals with weak regenerative and repair mechanisms, they tend to become less efficient with age.

The authors propose that when an organ is damaged it receives a signal to start undertaking repairs. The cancer cell is the one cell in an organ that is able to respond to the signal telling it to start to proliferate. It is the one cell that is trying to restore function. So simply removing a cancer might not work if the organ remains damaged: new tumor cells would simply keep emerging.

This paper is a good complement to another in the same journal. This one is a bit more mathematical, but also views cancer as a dynamic systems problem.

Ideas like this have come and gone before, but I have not seen them so well presented before, and they open up some new ways of thinking about a set of problems that is altogether too common.

Moving away from thinking that cancers are all simply the result of mutated or messed up DNA toward the idea that they may owe just as much to the environment in which they grow makes very good sense.

Spicy Foods as Cancer Killers

Several news services have picked up a very important piece of research in the February 16th issue of the journal Biochemical and Biophysical Research Communications.

In a nutshell, they have shown that capsaicin, an ingredient of jalapeno peppers, triggers cancer cell death by attacking mitochondria, the energy producing organelles in the cell. Some of the reports were a little confused and confusing and also missed out some critical pieces.

So first, a bit of revision, this is a graphical representation of what a mitochondrion looks like:

The mitochondrion is the primary producer of energy in the cell, converting molecules derived from food or stores into adenosine triphosphate (ATP) and several other less important molecules. ATP is the energy "currency" throughout the body. In recent years we have discovered that there are a number of diseases that are a result of faulty mitochondrial metabolism.

One of the biggest problems about most forms of chemotherapy for cancer is that the treatments often damage normal cells as well as the malignant ones. Therefore a great deal of research has aimed at identifying differences between normal and malignant cells.

Over the last ten years, increasing evidence has shown that mitochondrial dysfunction is a key feature of many types of cancer as well as part of normal aging. This has lead to the idea that we might have a new therapeutic target if cancer cell mitochondria are different from those in normal cells.

This new study showed that the family of molecules to which capsaicin belongs, the vanilloids, bind to proteins in the cancer cell mitochondria to trigger apoptosis - programmed cell death - without harming surrounding healthy cells. Capsaicin was tested on cultures of human lung and pancreatic cancer cells.

As the lead researcher Timothy Bates has said, "We believe that we have in effect discovered a fundamental 'Achilles heel' for all cancers."

This is extraordinarily interesting, not least because capsaicin is already in use for the topical treatment of peripheral neuropathy and some inflammatory conditions of the skin including psoriasis. The amount of capsaicin used in the experiments was similar to amounts that could probably be ingested safely. So now the next step if to see whether these observations can be translated into a viable treatment option for cancer, and if so, which types.

What the research does not say is that eating a lot of spicy food will help prevent or treat cancer.

The reports that I have seen have failed to mention that one of the reasons for doing this research was that  some spices have been used in traditional Chinese and Indian medicine for many centuries for the treatment of several conditions, and some of the investigators are engaged in the Nottingham UK–China Collaboration on Complementary and Alternative Medicine.

How many more treasures are waiting for us in the archives of traditional medicine?

And how many have already been lost as plant and animal species become extinct?

Reducing Your Cancer Risk

“The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease.”
-- Thomas Alva Edison (American Inventor, 1847-1931)

I am sure that you will agree that prevention is better than cure. And this is a good time of the year to review where you are in your life and what you want or need to do for yourself and your loved ones.

According to a study reported in the Lancet in November 2005 more than one third of cancer deaths are attributable to nine modifiable risk factors.

To evaluate exposure to risk factors and relative risk by age, sex, and region, the investigators analyzed data from the Comparative Risk Assessment project and from new sources, and they applied population-attributable fractions for individual and multiple risk factors to site-specific cancer mortality provided by the World Health Organization.

Of the seven million deaths from cancer worldwide in 2001, approximately 2.43 million (35%) were attributable to nine potentially modifiable risk factors. Of these deaths, 0.76 million were in high-income and 1.67 million in low- and middle-income nations; 1.6 million were in men and 0.83 million deaths were in women.

Smoking, alcohol use, and low consumption of fruits and vegetables were the leading risk factors for death from cancer worldwide and in low- and middle-income countries. In low- and middle-income regions, Europe and Central Asia had the highest proportion (39%) of deaths from cancer attributable to the nine risk factors studied.

For women in low- and middle-income countries, sexual transmission of human papilloma virus (HPV) was also the leading risk factor for cervical cancer. Smoking, alcohol use, and overweight and obesity were the most important causes of cancer in high-income countries.

Between 1990 and 2001 mortality from cancer decreased by 17% in those aged 30 to 69 years and rose by 0.4% in those older than 70 years, according to the authors, but this decline was lower than the decline in mortality rates from cardiovascular disease for men and women. The decline in mortality in men was largely due to reduction in mortality from lung, prostate, and colorectal cancers, while in women, lung cancer increased in the 1990s, and death rates for breast and colorectal cancer decreased. An article published almost ten years ago in the journal Cancer Epidemiology, Biomarkers, and Prevention, it was estimated the worldwide attributable risk for cancer to infectious agents as 16%.

The nine factors were:

1. High body mass index
2. Low fruit and vegetable intake
3. Physical inactivity
4. Smoking
5. Alcohol abuse
6. Unsafe sex
7. Urban air pollution
8. Indoor use of solid fuels
9. Injections from healthcare settings contaminated with hepatitis B or C virus

This all makes good sense, but it is good to see high quality research in reputable journals confirming what we suspected. The research also gives us further compelling reasons for taking a good look at our lifestyles and hopefully the motivation to do something to improve them. And in the case of air pollution and injection of contaminated products, to be active in getting things cleaned up.

“Keep your own house and its surroundings pure and clean. This hygiene will keep you healthy and benefit your worldly life.”
-- Sathya Sai Baba (Indian Spiritual Teacher, c.1926-)

“Length of life does not depend so much on a good physical constitution as it does on the best use of the six non natural things, which if we rule aright, we shall live long and healthy lives: to divide the day properly between sleep and waking; to adjust our air to the needs of the body; to take more or less food and drink according to our age, our temperament and whether we live an active or inactive life; to take exercise or rest according to the quantity of food and whether we are lean or fat; to know ourselves and be able to rule our emotions and subject them to our reason.  Whoever handles these wisely will live long and seldom need a doctor.”
--Giorgio Bagliivi (Italian Physician, Pathologist, Researcher and Author of De Fibra Motrice, 1669-1707)

“The best doctor prevents illness, a mediocre one treats illnesses that are about to occur, and an unskilled one treats current illnesses.”
--Chinese Proverb

Multiple Sclerosis and Vitamin D

I have commented before that the increasing rates of multiple sclerosis as we move away from the equator has lead to speculation that it might have something to do with lack of sunlight and therefore reduced production of vitamin D in the skin.

A lack of vitamin D may also explain the increased rates of both type 1 and type 2 diabetes, as well as cluster headache at higher latitudes.

Vitamin D is not a single vitamin, but is instead a group of fat-soluble prohormones as well as the metabolites and analogues of these substances. There are two major forms of vitamin D: D₂ (or ergocalciferol) and D₃ or cholecalciferol. Vitamin D₃ is produced in skin exposed to sunlight, specifically ultraviolet B radiation. Very few foods are naturally rich in vitamin D, and most vitamin D intake is in the form of fortified products including milk and cereal grains.

It used to be that we all made plenty of Vitamin D simply by being outside in the sun, but our time outside has been steadily falling since the beginning of the Industrial Revolution, and there are the increasing concerns about exposure to sunlight and some skin cancers.

Vitamin D is involved in many critically important chemcial reactions in the body, and Vitamin D receptors are found in cells in most organs in the body, including the brain, heart, skin, gonads, prostate, and breast. Apart from its effects on regulating calcium and phosphorus, Vitamin D is involved in maintaining the integrity of cell membranes and in modulating the immune system. There is some evidence that a modest increase in Vitamin D intake may reduce the risk of colon, breast and ovarian cancers.

There is a risk of overdosing with Vitamin D. The U.S. Dietary Reference Intake Tolerable Upper Intake Level (UL) of vitamin D for childern and adults is 50 micrograms/day (2000 IU/day). In adults, a daily intake of 2500 μg/day (100,000 IU) can, over a period of weeks and months, produce toxicity  and, if taken for years, as little as 50 to 75 μg/day (2000 to 3000 IU) can produce toxicity.

In this week's issue of the Journal of the American Medical Association, there is an important report that endorses everything that we have been saying. Researchers from several prominent institutions in the United States have examined the hypothesis that higher levels of 25-hydroxyvitamin D are associated with a lower risk of multiple sclerosis.

The study confirmed the hypothesis: the risk of multiple sclerosis (MS) fell as blood levels of the vitamin rose.

The researchers uncovered 257 cases of MS among more than seven million military personnel who had given blood samples to the US Department of Defense.

Amongst white personnel, there was a 41% decrease in MS risk for every 50 nanomoles per litre increase in 25-hydroxyvitamin D, the key form of the vitamin found in the blood.

Those whose vitamin level was in the top 20% had a 62% lower risk of MS than those whose level was in the bottom 20%.

The researchers found no such association among black and hispanic personnel, but this could be a reflection of the smaller size of these sample groups.

This new research ties in with other work that has shown that Vitamin D supplements can prevent or favourably affect the course of a disease similar to MS in mice, as well as evidence that if you live in the Northern Hemisphere, being born in May is associated with a lower risk of MS than if you were born in the winter. If you are born in May, your mother will probably have been exposed to more sunlight - and therefore have produced more Vitamin D - during the later part of pregnancy when the final development of the nervous system takes place. Or alternatively you may have had a heathy dose of sunlight in the weeks immediately after your birth.

It is most likely that the Vitamin D helps by modulating the immune system and suppressing autoimmune reactions caused by specialised T helper 1 cells attacking myelin, the insulating material that sheathes most nerves. It is these attacks that are thought by most experts to play a key role in the development of MS.

If confirmed, the finding suggests that many cases of MS could be prevented or its severity reduced by increasing our levels of Vitamin D.

The data also confirm a point that we have made before: we should not be aiming to "boost" our immune systems, but to "modulate" them.

If you see an advertisement for some potion that is supposed to boost your immune system to help you ward off colds, the flu or something more serious, be suspicious: if the seller does not know the  difference between boosting and modulating, it would be best to move on.

Hormone Replacement Therapy, Breast Cancer and Causality

It seems a remarkable "coincidence" that they very day after writing about breast cancer screening, we should hear the news about a sudden fall in the rates of breast cancer amongst a certain proportion of the population.

Researchers from the M.D. Anderson Cancer center in Houston presented their data at a meeting of the San Antonio Breast Cancer Symposium. They recorded a 7% drop in new breast cancer cases in the US in 2003, ad an even bigger fall – 12% - in cases of hormone-dependent breast cancer among women aged 50-69. This is the first time that breast can cancer rates have fallen since 1945.

The decrease was most striking for women with so-called estrogen-positive tumors, which account for 70% of all breast cancers. It is the growth of these tumors that may be fueled by estrogen.

The scientists believe that the fall could be linked to the fact that millions of women gave up hormone replacement therapy (HRT) following reports questioning its safety. Around 14,000 fewer US women were diagnosed with breast cancer in 2003, compared with the previous year. The number of American women on HRT had halved by the end of 2002 in the wake of a large study was halted in 2002 after evidence emerged indicating that the therapy was associated with an increased risk of developing breast cancer.

The data are striking, but they need to be confirmed. That being said, there was a different type of study in last month’s issue of the Journal of Clinical Oncology. Researchers found an even larger drop in breast cancers in some parts of the State of California where there had been some of the highest rates of HRT use in the nation.

If the figures are correct – and they will have to confirmed - they could be explained by existing tumors stopping growing, shrinking or disappearing so that they could not be detected.

When I was a full time endocrinologist I saw a great many women who suffered terribly with menopausal symptoms, but I always declined to use HRT because of my take on the research data. I used dozens of alternatives, and if they failed, I had plenty of colleagues who were happy to use HRT, but I was always uneasy about using it.

There is also another important point: epidemiology can never prove causality. We have a plausible link, but no direct proof that a fall in the use of HRT is responsible for the fall in breast cancer.

Let me give you another example. Few people doubt the link between cigarette smoking and lung cancer, but no causality has ever been proven. Typhoid can cause a horrible illness, but all that the epidemiologist can do is to suggest an association between the bug and the pattern of an outbreak. It requires a microbiologist to prove that the bacterium Salmonella Typhi is the cause of the symptoms.

A number of years ago I became involved with the Oxford Causality project. It was fascinating, because not only did we call into question the issue of uni-causality in medicine – one cause for one illness – but some scientists and philosophers – such as Roy Bhaskar and Rom Harre even went so far as to suggest that “laws” of nature are better thought of as “habits” of nature. Clearly there are laws and there is causality. I throw a stone into a pond and there should be a plopping noise and then the ripples spread out. If there were no laws, then atoms could disintegrate. But at the deepest levels of nature, it no longer appears that we live in a clockwork universe in which free will is an illusion.

This is not just of theoretical importance, I recently received some interesting correspondence after I mad some comments about how self-cutting, if ignored, could lead to the development of borderline personality disorder. One correspondent thought that this implied causality, but I do not think so. “Disorders” are best viewed as deviations from a norm and they usually appear in bits and pieces. For example, some people with bipolar disorder may have had problems years before the illness had declared itself. The first signs were there, but they could have evolved along a dozen different pathways. Some people with borderline personality disorder have had varying degrees of distress since childhood, but back then it was impossible to say for sure what was wrong.

It is usually a mistake to try to find one cause for a problem. It is equally a mistake to try and diagnose a problem prematurely. We sometimes need to wait and see how things will evolve.

Screening for Breast Cancer

An important report came out in the middle of October that doesn't seem to have been reported in much detail by the mainstream media in the United States.

It concerns screening for breast cancer. This is a most important issue: breast cancer is the most common form of malignancy in women and it carries a high morbidity and mortality. Though there can be a genetic component, there are also a number of important environmental factors. Some of those for which there is decent evidence include:

• Circulating levels of estrogens and androgens
• Late first pregnancy
• Having no children
• Not breast-feding
• Alcohol consumption
• Post-menopausal weight gain
• Exposure to artificial light

There is an array of other potential risk factors, but the point is that with so many potential risk factors, it is difficult to idenify everyone at high risk of developing the disease. 

Therefore mass screening for breast cancer has been the accepted practice for many years now, and it has undoubtedly saved many lives.

But the new research - a review of studies covering half a million women - raises some important questions for women as well as clinicians.

The investigators found that for every 2,000 women who had mammograms, one would have their life prolonged but 10 would have unnecessary treatment due to false positive tests and over-dagnosis.

Dr. Peter Gozsche the director of the Nordic Cochrane Center, who led the research, said that the new research indicated that many women were being treated for slow-growing tumors that might never have affected them if they had not been picked up during the screening.

There remains no question that screening does save lives, but the new research indicates that - if it is replicated - we need to re-think the risk/benefit ratio about screening and the actions that we take if screening turns up an abnormality.

But it also should not scare people away from being screened.

It is also a good reminder that there are many potentially modifiable risk factors for breast cancer, and that is the best place to direct your attention.

Renal Cell Carcinoma and Bread

Renal cell carcinoma (RCC) is the most common type of kidney cancer, and accounts for 2 percent of all adult cancers. It has been known for some time that diet plays a role in RCC risk, but attempts to identify which foods have harmful or beneficial effects have been inconclusive.

The smart money has been on foods that elevate insulin levels, because RCC is one of the cancers associated with obesity, and some RCC cell lines grow when exposed to insulin or insulin-like growth factors.

A new study by researchers form the Institute of Pharmacological Research "Mario Negri" in Milan, conducted a large case-control study of 2301 Italians. They found a significant association between high bread consumption and renal cell carcinoma. Eating a lot of pasta and rice may also raise the risk, while eating many vegetables may lower the risk. The study published online October 20, 2006 in the International Journal of Cancer, the official journal of the International Union Against Cancer (UICC), and is available via Wiley InterScience.

The researchers enrolled 767 adults diagnosed with RCC and 1534 controls who did not have the disease between 1992 and 2004. Two controls were matched to each case by gender, age range, and location. The researchers collected sociodemographic information, height, weight, lifestyle habits and personal and family medical history from each participant. They also administered a 78-item food frequency questionnaire which asked about the average weekly consumption for each item over the previous two years. They then performed statistical analyses to discover odds ratios (OR) with a 95 percent confidence interval.

They found a significant direct association was observed for bread consumption and a higher RCC risk. A modest non-significant risk increase was also observed for pasta and rice. On the other hand an increasing intake of poultry, processed meat, and all vegetables, both raw and cooked, all reduced the risk of RCC.

These findings confirm our guess about insulin and/or insulin-like growth factors. This association between elevated cereal intake (bread, pasta and rice) is most likely due to the high glycemic index  of these foods, leading to an over-production of insulin and insulin-like growth factors.

The inverse relationship between vegetable consumption is consistent with previous studies and may be related to their content of vitamins, micronutrients or elements such as carotenoids, flavonoids and phytosterols.

This is not a perfect study: it is limited by the fact that the interviewers who gathered each participant's information and administered the food questionnaire were not blind to who was who. But its big strengths include the sample size and the reproducibility and validity of diet information.

This study is important and speaks to the point that we have made before: a balanced diet is key, and your body does not want to be exposed to constant variations in glucose or insulin.

It also confirms all the advice that we have been offering you about what and when to eat. Click on the links to review what I have said before!

Integrated Medicine and Cancer

There's a very interesting and important piece of research from the School of Social Work at the University of South Florida in Tampa.

The title of the paper is “Patient-physician communication regarding use of complementary therapies during cancer treatment,” and it discusses something with which I’ve been very involved for many years.

The paper uses the terms “complementary and alternative medicine,” though the same principles apply to the far more sophisticated and comprehensive approaches of Integrated Medicine.

Studies from the United Kingdom, Germany, Holland, France and the United States have estimated that as many as 80% of adult cancer patients use at least one form of Complementary and Alternative Medicine (CAM) during or after conventional treatment. I’ve discussed before the pitfalls of trying to use unorthodox medicine in place of conventional medicine. In Europe some of the practices of Integrated Medicine, particularly acupuncture, homeopathy and massage, are used to help people cope with the rigors of chemotherapy and radiation therapy, rather than to treat the tumors themselves. Many people claim that they can use homeopathy or some herbal remedies as the sole treatment for different types of cancer. But I won’t endorse them unless they can show me some data.

We already know that patients frequently do not tell their oncologists about their use of unorthodox medicines and physicians consistently underestimate the numbers of their patients using them. The purpose of this study was to assess newly diagnosed cancer patients' and oncologists' communications with regard to unorthodox medicines. They looked at people with two types of cancer: 106 had breast cancer and 82 had prostate cancer. All the patients in the study were receiving regular conventional medical treatment.

In line with previous research, 84% reported that they were using at least one unorthodox therapy. The most popular were exercise, vitamins, prayer, and nutritional supplements.

But here was the surprise for the investigators: The oncologists surveyed were generally enthusiastic and supportive of patients' use of these therapies. In addition to those therapies popular with patients, at least half the physicians supported massage, journal writing, support groups, acupuncture, biofeedback, and art therapy.

This was no surprise to me at all. I spent most of my clinical career in tertiary referral centers, and I’ve worked with the best of the best. The vast majority was extremely supportive of anything that would help. Every one of them was a skeptic who would say, “show me.” But once they had been shown, they would be very helpful. After all, who doesn’t want to help people get better?

It has always been so noticeable that the biggest critics, not skeptics, but critics, have been people who were less secure. Often not the “Best of the best,” they would carp and complain that “we don’t do things that way,” and “I don’t see how it could work, so I’m sure that it doesn’t.”

What this new piece of research showed was that discussions the use of unorthodox medicine were relatively rare and were most likely to be initiated by the patients. When the topic was discussed, both patients and doctors said that it usually enhanced their relationship.

What do I take away from this study?

If you, a friend or loved one has cancer, or any other type of illness for that matter, consider using something else in addition to your regular medical care. Not as a replacement, but in addition. The regular treatment will be helping the physical side of the illness, but you also need help with the psychological, social, subtle and spiritual aspects of what is going on in your life.

And guess what? Chances are that if you have a good oncologist, or any other type of conventional clinician working with you, he or she will probably be very supportive of anything that you do.

I once said at a very large meeting that if I needed to put a bone through my nose and do a dance to get someone better, I’d do it.

And I’m not the only one.

What Integrated Medicine does is to put all the cards on the table from the very beginning. We tell people that we are going to be helping guide them toward physical, psychological, social, subtle and spiritual health. They need to be able to derive meaning and purpose from what’s happened to them, rather than just cussing at their misfortune.

And then using the experience to grow as individuals and to help others.

The Integrated Practitioner will also be working with the way in which this person’s challenge is changing them. If a practitioner is not changed by the person in front of him or her, they are working only as a technician and not as a healer.

There’s nothing wrong with that, but everyone needs to be clear about what the practitioner is bringing to the table, and what their expectation is for the person who has come to see them with a problem.

For now, if you are not working with an Integrated Practitioner, do tell your health care provider if your are doing something else to help yourself.

Chances are that he or she will be very supportive.

Prostate Cancer, Shift Work and Vitamin D

One out of six American men will develop prostate cancer and more than a third of them will experience a recurrence after undergoing treatment, putting them at high risk to die of the disease.

A study from Japan in this month’s issue of the American Journal of Epidemiology, reports prospective research that examined the association between shift work and the risk of prostate cancer incidence among 14,052 working men. Compared with day workers, people who worked rotating shifts were significantly at risk for prostate cancer whereas fixed-night work was associated with a small and non-significant increase in risk. This report is the first to reveal a significant relation between rotating-shift work and prostate cancer. Previous research has found that shift work may be linked to an increased risk of breast and colon cancer.

It’s important not to jump off the deep end: we are long way from saying that sleep disturbance is linked to prostate cancer. But it is another piece of evidence suggesting a link between environmental factors and genes, since there are a number of genes that may increase a man’s risk for prostate cancer.

However, there have now been several reports that disturbances in normal body rhythms might be linked to some cancers and this report adds to that evidence. It has never been shown that the actual sleep disturbance itself is responsible for the slight increase in risk seen in these studies. It could also be that people with abnormal sleep patterns are more likely to be doing something else, for instance smoking or eating junk food that would interfere with sleep and increase people’s cancer risk.

But here’s something to think about: shift workers have been found to have reduced secretion of the sleep-inducing hormone melatonin. Melatonin has also been shown in some studies to have some potential anti-cancer effects. The studies are controversial and certainly not conclusive, despite what one or two melatonin manufacturers may say. But something that is true is that reduced secretion of melatonin has been linked to increased production of sex hormones, which play a role in regulating prostate tissues. Under normal circumstances, secretion of the hormone is low during daytime, increases soon after the onset of darkness, peaks in the middle of the night, and gradually falls until morning. In shift workers the melatonin cycle becomes disrupted.

There has been some recent evidence that maintaining adequate levels of vitamin D may reduce a man’s risk of prostate cancer.

Another study, this time on pancreatic cancer and led by Northwestern University in Illinois has indicated that taking the US Recommended Daily Allowance (RDA) of vitamin D (400 IU/day) reduces the risk of pancreatic cancer by 43%. It is published in this month’s issue of Cancer Epidemiology Biomarkers & Prevention. This does not mean that we should start taking vitamin D supplements to reduce our cancer risk. But it ties in with research indicating that some exposure to sunlight might actually reduce the risk of some cancers. But all things in moderation: malignant melanoma and basal cell carcinoma of the skin have been increasing with increased exposure to sunlight.

Aging, Skin and Cancer

There’s a very interesting paper in this month’s issue of the journal Developmental Cell, based on research conducted at the Oregon Health & Science University in Portland, Baylor College of Medicine in Houston and Leiden in the Netherlands.

The investigators have found a pathway through which a gene's over-expression causes stem cells in the skin to switch from creating hair follicles to creating sebaceous glands. This discovery may not only provide us with new ways of treating hair loss and oily skin, but it may help us to prevent and treat some cancers.

Skin cells turn over very quickly: just think how fast a graze gets covered over. Epidermal stem cells give rise to the outer layer of the skin that serves as a barrier for the body, as well as generating the follicles that produce hairs and sebaceous glands. These glands produce oils to lubricate the skin. In aged skin, a protein called Smad7 is overproduced, which triggers hair loss and sebaceous gland growth.

This is the first study definitively to link Smad7 over-expression and the pathological changes that occur in aged skin.

Here’s the twist: Smad7 shuts down signaling of another group of genes called Wnt. It binds to a Wnt signaling protein known as Beta-catenin and degrades it with an enzyme called Smurf2. (I don’t known why they decided to call it’s call it Smurf: it looks like ponderous chemical humor to me!) Wnt signaling is critical for organ development, but if Wnt signaling is too active, it also causes cancer.

Enhanced Beta-catenin signaling contributes to many types of cancer, including colon, lung and brain. Perhaps inducing over-expression of Smad7 or delivery of Smad7 directly to tumor cells would provide a therapeutic approach because of the boost in Beta-catenin degradation.

And finally, impaired Beta-catenin signaling contributes to neurodegeneration, such as that found in Alzheimer's and Parkinson’s diseases, retinal degeneration, some bone density defects and aging. For these diseases, blocking Smad7-mediated Beta-catenin degradation may offer a therapeutic approach.

Free Radicals, Aging and Small Hairless Creatures

I’m accused of many things.

Apart from the oft-repeated falsehood that I was the inspiration for Hugh Laurie’s brilliant characterization of the cranky Dr. Gregory House (I definitely was not!), I have been accused of having a fixation with mole rats. Well, that one is partly true: they are fascinating little creatures.

But let me start at the beginning. Over the last three decades, free radicals have entered the national vocabulary. In the 1983 James Bond movie, Never Say Never Again Edward Fox orders Sean Connery to enroll in a health clinic in order to "eliminate all those free radicals."

Free radicals are found in nature: they can be derived from combustion and some other chemical reactions and they are generated in the atmosphere by the action of ultraviolet radiation with chlorofluorocarbons. But most found in the human body don’t come from the environment: they are generated by biological processes. The majority are extremely short lived, but a few special types can hang around for hours.

An excess of free radicals has been linked to an array of illnesses, including:
Some cancers
Diabetic vascular disease
Parkinson’s disease
Schizophrenia
Alzheimer’s disease
Emphysema
Age-related changes in the skin
Macular degeneration

This list just names a few: many other illnesses have been laid at the door of free radicals. You will often see people talking about “oxidative stress,” to describe the damage done by an excess of free radicals. There is a theory that normal aging may be a result of the gradual increase in the production of free radicals in the body

There is something to all this: I did some research on the role of free radicals in diabetic vascular disease in the 1980s, and made some interesting discoveries. It has recently been shown that an excess of free radicals in the wrong place can play a part in generating insulin resistance.

The trouble - as with so many apparently simple ideas - is that many of the popular concepts about free radicals are over-stated or even wrong.

We first have to ask ourselves, “If free radicals are so bad, then why does the body produce them at all?”

The answer is that free radicals play a crucial role in a number of important biological processes, including the killing of bacteria by a group of white cells known as granulocytes. They are also thought to be key cancer killers and prime mediators of normal communication between cells.

Yet they have been pilloried: thought to be the key to so many illnesses when, in fact, they are intimately involved in normal biological processes: if you had no free radicals you would probably die quickly and unpleasantly. We know that because there is a group of rare, fatal illnesses in which children cannot generate free radicals.

Rather than focusing on ways to eliminate free radicals, we should be dealing with ways to balance them.

Our bodies are loaded with sets of enzymes whose task is to mop up excessive numbers of free radicals. The most important of these are superoxide dismutase, glutathione peroxidase, glutathione reductase and catalase.

When you see an advert or article extolling the virtues of some product because it abolishes free radicals or “reactive oxygen,” you know that you are dealing with some nonsensical marketing. Not science.

Fortunately, despite the marketing hype, it’s virtually impossible to obliterate all the free radicals in your body: Some must remain in your system or you will run into all kinds of medical problems.

Let me give you two examples of research that has shown first the good side of a producer of free radicals and second, one of the reasons why we know that there is more to aging than free radicals.

A study from France looked at a dye called mangafodipir that is used in MRI scanning. It was found to increase the cancer-killing ability of some chemotherapy drugs, while at the same time protecting normal cells. Mangafodipir was found to help promote the production of hydrogen peroxide while at the same time, through different biological mechanisms, protecting healthy cells from damage.

The second piece of research concerns my mole rats. I’ve talked about them before. They are extremely long lived: most reach the age of 25-30. And they seem never to get cancer. There are very few species that are spared from cancer: sharks rarely get the disease and there are some simpler organisms that also seem to be spared. So these mole rats have attracted the attention of researchers. What is more, they have very high levels of DNA damaged by oxidation so by rights they should get cancer and age prematurely. The fact that they don’t is leading to a whole new line of thinking about aging and illness.

So the message should be this: oxidative stress may be a factor in illness and aging, but your aim should be to modulate the free radical systems in your body, not to obliterate a key cancer killer.

Eat a diet that is rich in antioxidants
Don’t try and avoid stress: you can't. Learn to manage it
Take regular physical exercise
Avoid environmental toxins such as smoke, excess sunlight, pesticides and radiation

Acupuncture and Acupressure for Chemotherapy Induced Nausea and Vomiting

During the years that I served on the Research Council for Complementary Medicine, one of the most successful pieces of research that we funded was an investigation by the late Professor John Dundee into the use of acupuncture to treat and to prevent post-operative nausea, and chemotherapy-induced nausea and vomiting.

Those early trials helped us learn a lot about how to do trials in acupuncture, and over the years this work has progressed in a number of enters around the world. The Cochrane Collaboration in Oxford has just published a systematic review of the use of acupuncture and acupressure for the treatment of chemotherapy induced nausea and vomiting. Acupuncture was shown to reduce vomiting on the first day after chemotherapy compared with those who did not receive acupuncture: 22% compared with 33%. Acupuncture did not help with nausea but acupressure did. Though acupressure did not help with vomiting.

This shows once again that acupuncture and acupressure almost certainly work by different mechanisms.

For many years, the department of oncology at the Royal Postgraduate Medical School in London used an array of complementary practices. Not to treat the cancers, but to make it possible for people to tolerate the chemotherapy and radiation therapy.

I recently spoke to a woman who had an illness that would only respond to a certain antibiotic. She was very involved with natural medicine, and did not like taking it. But treatment by world-class homeopaths, naturopaths and acupuncturists had not helped her. My solution was to use the antibiotic, but to also use acupressure, homeopathy, a precisely designed diet and some qigong. With that combination she sailed through the conventional treatment, the organism that was causing her problems has gone, and she has re-built her resilience. That is integrated medicine in action.

Technorati tags: Acupuncture Acupressure Chemotherapy Nausea Vomiting Integrated medicine

What is Your Risk of Developing Breast Cancer?

When I was first practicing in the United States I was stunned when a research coordinator - who was with me as I examined a young woman – complained that it embarrassed her that I asked the patient about breast cancer screening. I had been trained and then practiced for many years in the United Kingdom, where it would have been deemed negligent if I had not asked the question. As I was taught a long time ago, “When you see a patient, man, woman or child, that may be their only contact with a doctor, so take the opportunity to do as much screening and education as you can.” I still take that to be good advice. We have good data that if women did regular breast self-examination and men checked their testicles, that we would each year catch many cancers at the stage when they are still easily treatable.

I was reminded about all this as I read the shocking results of a study that will be coming out in the European Cancer Journal this month.

In a survey of over 10,000 female students from 23 countries, hardly any knew about any of the major risk factors for developing breast cancer. We have obviously done a lousy job a teaching young people about a disease that may in large part be preventable.

This is desperately important. About 30% of illnesses you cannot help: they are the result of genetic mutations, accidents and so on. But 70% of all illnesses are thought to be the result of lifestyle choices.

Breast cancer is a good example. Yes, there are undoubtedly some cases that are largely genetic: genes have been identified in some families that strongly predispose women – and some men – to the disease. But they are uncommon: probably no more than 5-10% of cases. It is likely that the majority of people with the illness do have a genetic predisposition. But the impact of family history is usually small. And remember that biology is not destiny. Lifestyle modification may indeed significantly reduce your risk.

These are the Major Breast Cancer Risk Factors:
1.    Age
2.    Family history (slight risk)
3.    Starting periods at a younger age
4.    Late menopause
5.    Using hormone replacement therapy
6.    Using the contraceptive pill (small)
7.    Alcohol
8.    Obesity

Please do note that this is not the whole list of risk factors. Perhaps the most comprehensive list is here.

Cutting the Risk:
1.    Breastfeed
2.    Having several children, and having them young
3.    Stay in shape
4.    Eat and drink healthily
5.    Don't smoke

The take home message for everyone is this: lifestyle can strongly influence the risk of developing breast cancer. You cannot change everything, but stopping smoking, cutting down on alcohol, reducing weight and taking regular exercise are in the reach of almost everyone.

Technorati tags: Breast cancer Education Risk factors Health screening

Cytokines and Weight

Anyone who has ever had a sick child knows that one of the surest signs that he or she is recovering is a return of appetite. From a biological perspective, this is an attempt by the body to make up for any losses that took place during the illness. The major mediator of this effect is one set of a group of chemicals known as cytokines.

Cytokines are glycoproteins that behave like hormones and neurotransmitters, serving as chemical messengers between cells. There are many families of cytokines, including leptin, that we have met before. In recent years most of the attention of researchers has been directed not at the cytokines themselves, but at their receptors, whose activity is far more subtle.

Cytokine receptors are involved in the regulation of cell growth and repair and have important roles in immune responses. Apart from their role in feeding behavior, cytokines have roles in fatigue, fever, sleep, pain and stress. Some key cytokines: interleukin (IL)-1,  IL-6 and IL-8 are dysregulated in fibromyalgia.

At a meeting of the 6th International Congress of Neuroendocrinology in Pittsburgh last month, researchers from the Centre National de la Recherche Scientifique (CNRS) at the Pasteur Institute and the University of Lille, France, presented evidence that The cytokine interleukin-7 (IL-7) is not only involved in immune function, but also prevents obesity-prone mice from getting fat. This is the converse of those cytokines that cause weight gain. IL-7 interacts with the regions of the hypothalamus involved in appetite control. This is yet another piece of evidence indicating that the immune and neuroendocrine systems are closely inter-linked.

This is not really a surprise. One of the big problems I people with many chronic illness, particularly cancer, is that they tend to lose appetite and weight. Sometimes they lose a great deal of weight even while maintaining a decent diet. The anorexia of cancer is caused by many factors working on the signaling pathways in the hypothalamus that modulate energy homeostasis. Research has shown that cytokines are major mediators of weight and appetite loss in cancer patients, by working on two systems known as melanocortin and neuropeptide-Y. It also seems likely that the weight loss that happens with stress, depression and chronic inflammation are all mediated by specific cytokines. These same cytokines increase the risk of developing heart disease. A recent study from Ireland has shown that treatment with an SSRI antidepressant reduces measures of systemic inflammation.

It may be that this new insight into the relationship between inflammation and weight will offer up some more solutions for the problems of obesity, but we are going to need to be alert to the possibility that anything that modulates cytokines may increase the risk of vascular disease.

The more that we learn, the more that we understand about the miraculous checks and balances that keep us healthy.

Technorati tags: Cytokines Leptin Cancer cachexia Weight control Inflammation

How Not to Use Complementary Medicine

There is a report in the British Medical Journal that the Amsterdam Medical Disciplinary Tribunal has struck one doctor from the medical register and suspended two others for their exclusive use of unorthodox approaches in the treatment of a famous Dutch actor and comedian named Sylvia Millecam, who sadly died of breast cancer in 2001 at the age of 45.

After being diagnosed, the patient was recommended to have surgery and chemotherapy, but instead sought unorthodox treatment. Although the patient wanted this type of treatment, the legal case was that the doctors failed to give a reasonable assessment of the chance that their treatments would help, or made it clear that the only treatment that had been proven to help the course of the illness is the conventional route. One of the doctors was also judged to have caused her unnecessary suffering by withholding conventional palliative care as she deteriorated.

Not surprisingly, this case has attracted a lot of interest in Europe, where alternative, complementary and integrated approaches to health care are far more commonly used than in the United States. Many alternative practitioners feel that conventional medicine simply “suppresses” the underlying cause of the illness, and that there is no need to use orthodox and unorthodox together.

The approach that I have been advocating for many years is that if the individual warrants it, to use conventional and unconventional approaches together. But to see them as working on different dimensions of the person: what I call integrated medicine, though the term “integrative” is more popular in the United States. There is nothing very integrated about using St. John’s Wort instead of Prozac. That is just an alternative, which may be appropriate for certain individuals. And everything gets tailored to the individual: a man came to see more for acupuncture, but left with a prescription for a medicine. Once the medicine had done its part, some acupuncture was a very helpful adjunct. And there have been many folk where we have worked the other way round: acupuncture or homeopathy, and sometimes also a medicine. Whatever it takes to help people get to where they need to be.

In an ideal world, Ms. Millecam would probably have had surgery, but also psychological and energetic work, and perhaps some other remedies and spiritual counseling to support her through the process. Would it have enabled her to live longer? Perhaps, but the point is that the integrated approach would have aimed to help her quality of life and to help her to find the meaning and purpose of what she was going through.

She may have declined all this, but the problem was that enthusiastic doctors were using their approaches in place of regular evidence based medicine, without making it clear to Ms. Millecam what she was letting herself in for. Yes, a mentally competent individual has the right to decide whether or not to have a course of treatment, but he or she must be given all the options, so that he or she can make an informed decision. It was all rather sad and probably avoidable.

Technorati tags:integrated medicine

Sheryl, Lance and Kylie

I was very sorry indeed to hear that the amazingly gifted singer Sheryl Crow, who is only 43 years old, is facing a challenge with cancer. She is, of course, by no means the first. Cancer is not something that just hits the older people in the population. Two recent examples: Lance Armstrong who even now, after years of treatment and triumph is only 34, and Kylie Minogue, who is 37. Those two are apparently doing very well indeed, and have used their celebrity to publicize the importance of health screening and of looking at all the options in treatment.

Because of the kind of work that I do, I know of many other well-known people who have dealt with similar problems, and are doing extremely well, but who have chosen to maintain their privacy. Most forms of cancer are no longer the death sentence that they once were.

For more than two decades, I have been heavily identified with holistic medicine, which has gone through more names than the artist formerly known as Prince: alternative, complementary, integrative and integrated. So people are often surprised that I am also an expert in conventional medicine. “After all,” I am asked, “If integrated medicine is so great, then why bother with conventional medicine at all?” The answer is that the best way to treat anyone is by an integrated approach that treats the five principle dimensions of a person: physical, psychological, social, subtle and spiritual.

I regularly receive mailings from people and organizations claiming that they can cure all types of cancer using all sorts of unusual approaches, from nutrition to detoxifications and methods for getting rid of parasites. I have never recommended these approaches because the evidence is so flimsy, and we have data to show that there are indeed treatments that can improve survival and quality of life. But what I am very keen on is using conventional treatment as well as these less orthodox approaches, which are precisely tailored to the individual.

The United States Department of Health and Human Services has Task Forces that make screening recommendations, and I thought that it would be a good idea to make a note of some of their recommendations:

• Breast Cancer: Mammography every 1-2 years over age 40. Interestingly, the Task Forces don’t recommend routine breast self-examination, although many European countries do.
• Cervical Cancer: Screening every three years after age 21 or after becoming sexual active.
• Colon Cancer: “Regular” screening for everyone over age 50
• Prostate Cancer: They do not recommend routine PSA screening, but certainly clinical examination.

All of these recommendations get ramped up if an individual has a family history of a specific cancer and breast and colon cancer screening should start earlier in African Americans.

So I wish the very best to Sheryl, Lance and Kylie. And if you have been following my posts about spirituality and healing, it is, I think, highly likely that if enough of us think kindly of them, it will help them heal.

Technorati Tags: Sheryl Crow, cancer screenings, breast cancer

The Four Percent Solution

In this week’s edition of the Journal of the American Medical Association, is a study of 11,701 American over the age of 50, who participated in a national health survey in 1998 funded by the National Institute on Aging. The researchers analyzed participants' outcomes during a four- year follow-up and examined the health characteristics that seemed to predict death within four years.

These were the questions that were asked, and this is a bit like golf: you want to have the lowest score possible. Zero would be best. The score is supposed to tell you your chance of dying within the next four years.

1. Age: 60-64 years old = 1 point; 65-69 = 2 points; 70-74 = 3 points; 75-79 = 4 points; 80-84 = 5 points; 85 and older = 7 points.

2. Male or Female: Male = 2 points.

3. Body-Mass Index: Less than 25 (normal weight or less) = 1 point. (BMI = weight in pounds divided by height in inches squared, multiplied by 703.)

4. Diabetes: 2 points.

5. Cancer (excluding minor skin cancers): 2 points.

6. Chronic lung disease that limits activities or requires oxygen use at home: 2 points.

7. Congestive heart failure: 2 points.

8. Cigarette smoking in the past week: 2 points.

9. Difficulty bathing/showering because of a health or memory problem: 2 points.

10. Difficulty managing money, paying bills, keeping track of expenses because of a health or memory problem: 2 points.

11. Difficulty walking several blocks because of a health problem: 2 points.

12. Difficulty pushing or pulling large objects like a living room chair because of a health problem: 1 point.

Score:

• 0 to 5 points = less than a 4 percent risk of dying;
• 6-9 points = 15 percent risk;
• 10-13 points = 42 percent risk;
• 14 or more points = 64 percent risk.

So what should we make of this?

The first thing is that the study is just looking at the physical aspect of life. It asks nothing about diet or family history. It also says nothing about psychological and spiritual factors that can buttress health and well-being.

So what should it mean if somebody gets a high score? Does it mean that they should expect the end and stop reading long novels? Absolutely not! A high score should be a very good indicator that you should have a talk with your health care provider and get to work on all the reversible factors on the list. And as I have pointed out before, a positive psychological outlook and regular spiritual practice have been shown to extend the length and quality of your life.

It is not given to us to know the length of our lives and plenty of people live on and on despite breaking all the rules while others die young despite a lifetime of temperance. I had an aunt who smoked heavily throughout her adult life, yet lived to be well over ninety, while one of my former students died of lung cancer in his thirties, having never smoked a single cigarette.

Genes and lifestyle are important in determining our life span, but so are the quality and integrity of our relationships, our own sense of meaning and purpose, the clarity of the subtle systems of the body and our spirituality.

So use this study not as a death sentence, but as a wake-up call.

Technorati tags: health quiz, aging, longevity

Mapping the Genes of Disease

Many of us have been wondering if the so-called genetic revolution is ever going to bear fruit? When are we going to see some practical benefit from billions of dollars and the years of research by thousands of scientists?

On December 13th 2005, Dr. Francis Collins, the head of the National Institutes of Health’s Genetics Program, announced a bold $100 million pilot project to try to begin to unravel the genetic makeup of some common cancers. The plan is to try and speed the understanding of the diseases, so that new treatments may be developed.

We have already discovered numerous genes that can play a role in initiating cancer: in causing a cell to become malignant, to keep it growing and then to spread. Some tumors run in families, but many do not. And even in families with strong histories of cancer, it is by no means inevitable that an individual will develop the disease. As I have said many times, "biology is not destiny."

This new program is to be applauded: understanding the genetic component of cancer is an essential step toward better treatment, but it is equally important to recognize that an understanding of the biochemistry of the disease is but one aspect of understanding it. We also need to consider environmental and psychological factors, which all come into play. I have known some of the more militant geneticists who insist that the whole of human health and wellness will be comprehensible in terms of genes: why some people smoke all their lives and do not get lung cancer, while some non-smokers die of the disease in the forties. Or why some people have high-risk cancer genes, but that these are balanced by genes that endow them with a robust psyche that prevents them from succumbing to the disease.

I have had endless discussions with some, and although I respect their position, I think that they have only half of the answer. One of the big breakthroughs in recent years has been the understanding that genes in the brain do not so much determine your personality, but instead they give you a predisposition to how you react to changes in your environment. Genes are a lot less fixed than we used to be taught.

So this initiative is great, but don’t think that it is going to come up with all the answers.

For this we also need to be aware of the psychological, social, subtle and spiritual aspects of illness. For it is by considering all of these and understanding that illness has meaning and purpose for us, that we can achieve health and healing.

Technorati tags: genetics, cancer, healing and meaning