Tag Archive for: cancer

What Research Delays Can Cost

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In 1911, a physician named Peyton Rous discovered that a microbe, found in a tumor in chicken, was able to infect other chickens causing the same cancer. His findings were thought to be ridiculous because cancer wasn’t caused by a microbe—so his research stopped. Those microbes were called viruses in later years.

Move forward to the 1950s, when a scientist named Ludwig Gross picked up the research and established that viruses caused cancer in several species of animals. What he did not prove was how that was possible. The problem was that it went against the central dogma: DNA could result in the production of RNA, but RNA could not go backward and interfere with DNA. Without knowing how that could happen, it wasn’t possible to establish that viruses caused cancer in humans.

In the early 1970s, David Baltimore, Renato Dulbecco, and Howard Temin discovered a piece of the virus that could retroactively insert itself into the cell DNA and make it a cancer cell. They called that reverse transcriptase, and it led to the term retroviruses. In 1975, the researchers won Nobel Prizes for that discovery.

Now the science turned to finding a retrovirus in humans. Robert Gallo discovered just such a retrovirus in two different humans and submitted his paper to the Journal of Virology. It was rejected on September 15, 1980.

During the early 1980s, there was a disease that seemed to be impacting primarily gay men; at that time, catching the virus was almost always a death sentence. Dr. Gallo turned his attention to this new virus and co-discovered what became known as the human immunodeficiency virus, or HIV for short, the virus that causes acquired immunodeficiency disorder, also known as AIDS. That was in 1984—four years after Gallo demonstrated that a retrovirus caused a form of blood cancer, leukemia, in humans.

Those lost years delayed the test for HIV, also discovered by Gallo. By 1995, there was a blend of drugs that could arrest HIV and today, while there is no vaccine yet, HIV is blocked by drugs that stops it from replicating itself.

Four years were lost because science stopped. More correctly stated, science didn’t stop, but those scientists who would have been attracted to the research problem didn’t take up the search because there was limited funding for that type of research. Ryan White, a teenage hemophiliac from Indiana, died on April 8, 1990, from AIDS. If you don’t remember him, you may remember Freddie Mercury who died of AIDS on November 11, 1991. Maybe they would have lived if science hadn’t slowed for four years, as would hundreds of thousands of others.

And imagine how far ahead we might be if 114 years ago, scientists had admitted they didn’t know everything and followed up on the research by Dr. Rous. How many lives could have been saved? What major diseases could have been cured?

That’s the price for delaying research. But what about research that is started based on the dogma of the person who dictates where research dollars are spent? I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Revisionist History. Malcolm Gladwell. The Obscure Virus Club provided the basis for the HIV and AIDS timeline. Every scientific article and fact were independently verified by the Memo writer.

Research Update: Cancer and Diet

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A recent paper used an interesting approach to treat pancreatic cancer using a high-fat diet. That flies in the face of the typical approach: “If it was ever alive, don’t eat it.” In other words, a vegan diet. I’ve reviewed fasting prior to cancer treatment, which demonstrated improved outcomes for those who fasted, but this diet is radically different.

The Study

This study was all about finding the weakness in a defensive mechanism and attacking it.

Researchers were studying the mechanism that cancers use to get energy. The thought is that cancers use sugars and carbs, but cancer’s need for fuel to grow isn’t that limited. Researchers were studying how cancers switch to using fat as a fuel when there are no carbs available. Just like with the keto diets, the liver, and subsequently cancer cells if present, switch to using fat as a fuel in the form of ketone bodies. The protein that stimulates this switch is called eIF4E.

Researchers were able to find a current chemotherapy drug called eFT508 that blocked the ability of eIF4E to turn on the fat metabolism pathway. However, that didn’t stop the cancers from growing—they used other fuels such as carbs. But when they first treated the cancers with the chemotherapy drug that prevented the cancer from using fat as a fuel, then put them on a high-fat diet, the tumors all shrank.

In this study, the type of cancer was pancreatic cancer, one of the deadliest. This was a rodent study, but the chemotherapy drug is already approved for use in humans. Clinical trials are surely to follow in humans.

The Bottom Line

The authors speculate that cancers have more than one weakness that can be exploited with a combination of dietary and pharmaceutical interventions. Their breakthrough came almost 15 years after discovering what blocked the fat metabolism pathway. To me, this is one of the most exciting studies I’ve read in a long time. Just remember that this was one potential treatment for one type of cancer, but it represents hope.

I’ll be back in a week with a new Memo. If you’re here in the U.S., enjoy the final holiday of the summer—but don’t forget to eat your fruits and vegetables.

What are you prepared to do today?

        Dr. Chet

References:
1. https://medicalxpress.com/news/2024-08-fasting-ketogenic-diet-reveals-vulnerability.html
2. https://www.nature.com/articles/s41586-024-07781-7

How VILPA Can Reduce Cancer Risk

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We’re going to switch from mortality to morbidity: in this case, the objective is to reduce the risk of getting one of thirteen types of cancer. This was interesting for all kinds of reasons, but mostly because researchers specifically looked at subjects who claimed they didn’t exercise regularly. The data were part of a sub-study of subjects that included wrist accelerometry data. The participants reported no leisure time exercise and one or fewer recreational walks per week; they used a seven-day trial of wearing the accelerometer before the study to be sure.

The purpose of the study was to test the relationship of unplanned vigorous activity to the diagnosis of cancers, especially those associated with the lack of physical activity such as breast and colon cancer. The researchers wanted to determine the dose of vigorous activity required to reduce the risk by 50% compared to maximal risk. They termed the activity Vigorous Intermittent Lifestyle Physical Activity or VILPA for short.

What would count as VILPA? Walking up several flights of stairs, running to catch a bus, or fast walking through an airport to catch a flight. Even roughhousing with the kids might qualify.

Study Results

There were 22,398 participants with a mean age of 62. Over the six-plus years of follow-up, there were 2,356 new cancer events with 1,084 diagnosed physical-activity-related cancers.

They analyzed the data to find out how much VILPA per day was beneficial. One-minute bouts and two-minute bouts revealed the same dose-response curve. The more one- to two-minute bouts of VILPA, totaling at least 4.5 minutes per day, the lower the risk of developing cancer, especially a physical-activity-related cancer.

Less May Be More

We’ve looked at the amount of weight training that helps reduce blood pressure, the minimal number of steps needed to reduce mortality from CVD, and now, how to reduce the risk of some cancers by intense burst of exercise. There seems to be no doubt that some exercise, even in one-minute intervals, can be beneficial.

The Bottom Line

Nowhere in these research papers did they suggest that this was the way to train athletes—they all wanted to find the minimum to show how it could be beneficial. Even if you have little time to exercise, you can probably fit in a few one- or two-minute sessions; you could wait until it’s put into an organized program, or you could just do it right now. As long as your doctor says you can exercise, take the clothes off the exercise bike, jump on, and pedal as fast as you can for a minute. Do that a few times a day. There’s your VILPA workout.

If your only goal is to reduce the risk of disease, this is the way to begin. Based on the most recent research, you might find you like the way you feel and begin to do a little more. Who knows? But you must begin somewhere, and it all depends on one question:

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Oncol. doi:10.1001/jamaoncol.2023.1830

Chemicals in Our Water

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Here’s one for you to mull over. We’ve been exposed to this chemical group since the 1940s. It’s not just one chemical such as TCE from Saturday’s Memo; there are thousands of forms of these chemicals. Based on samples from large groups of people, over 98% of us have them in our bodies; they’re found in rainwater all over the world. At this point, we don’t really know what diseases or conditions can result from this group of chemicals. On top of all that, it’s slow to eliminate from the body and gets worse as we get older.

The chemical group is perfluoroalkyl and polyfluoroalkyl substances, more recognizable by its acronym PFAS. This non-flammable group of chemicals is found in many products including fire retardants, stain repellents—and until recently removed—cookware covered with Teflon. You may have seen the story of how Teflon production affected West Virginians in the movie “Dark Waters.” Here in west Michigan, we’re battling PFAS released into the water supply years ago by a shoe manufacturer.

The major concern is that PFAS are in our water supply everywhere and will be there for a long time, even it were banned today. What surprised me is how little is known about the effects on our health.

There is some association with several forms of cancer such as testicular and kidney cancer. These epidemiologic studies of PFAS and cancers have been informative, but not entirely conclusive. Along with other chemicals known as hormone-disrupting chemicals, PFAS may affect fertility, contribute to miscarriages, and be a factor in early-onset puberty. It may increase non-alcoholic fatty liver disease in women. There are some associations but no overwhelming smoking gun at this point. Even with no definitive link to diseases, we don’t want them in our body. The problem is that there’s no known way of speeding up their elimination from our body. It can take years.

You may be thinking that this was less than satisfying. Yes, it was, but it doesn’t mean there’s nothing we can do; that’s how I’m going to finish up this look at chemicals on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Environ Res. 2021 Mar; 194: 110690.

PSA: Sharing the Decision

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PSA screening is controversial because it may or may not indicate prostate cancer without additional testing and it may or may not indicate mortality from prostate cancer. As I said, many elderly men will die with prostate cancer but not of it. How do you know what to do? A recent study may provide some guidance.

Regular PSA Testing and Mortality

The Veterans Administration can be a challenging bureaucracy, but it’s one entity that can provide medical information on millions of subjects. Researchers wanted the answer to a simple question: Do higher rates of PSA testing yield a reduction in metastatic cases of prostate cancer?

The survey population included male patients getting a PSA test at 128 U.S. Veterans Health Administration facilities across the system from 2005 to 2019. The reason those years were chosen is that the U.S. Preventive Services Task Force (USPTF) had modified guidelines for PSA screening to recommend less frequent use of the test for men over 70. Over those years, there was a decrease in annual testing by 10% to 15% in non-VA healthcare facilities, and that was matched in the VA system. The USPTF recommended against screening all men, and PSA testing again fell in all age groups.

The data showed that as PSA testing decreased, the rates of metastatic prostate cancer increased. Drilling down into the data, those VHA facilities with higher rates of PSA screening had lower rates of metastatic prostate cancer.

Shared Decision-Making

The researchers were diplomatic in their conclusions. They simply presented the findings and suggested that the physician and patient should jointly decide on the course of action. Should we test? When do we proceed with a biopsy? What do we do if it’s benign? If it’s malignant? And a whole bunch more.

The Bottom Line

The researchers easily could have recommended that everyone gets tested and everyone gets a biopsy if the PSA is too high, but PSA testing is not precise enough. Some men have prostate cancer with PSA less than 4.0 and some do not have it with PSA over 10. The best course is having a discussion with your urologist and coming to a joint decision that satisfies you both. It’s also not a bad idea to get a second opinion, of whether you agree with the plan or not.

One thing for sure: always do the screening test again, regardless of whether it’s PSA, cholesterol, or HbA1c. For the most part, tests are accurate and reliable, but there’s always the possibility of a mistake; one test does not a diagnosis make. Retest, discuss, and plan a course of action with your healthcare professional.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Oncol. doi:10.1001/jamaoncol.2022.4319

Controversy: PSA Testing

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Medical testing is a blessing at times, a curse at others, and a source of controversy in the medical profession itself. I recently wrote about colonoscopies and why they provide information other colon health tests do not. The PSA (protein specific antigen) screening for prostate cancer has also been controversial. Here’s why.

If the PSA exceeds a specific number (another point of controversy), especially if a digital rectal exam reveals an enlarged prostate, more tests follow. The prostate biopsy takes samples of the prostate to see if cancer is present. If not present, the PSA was a false positive that resulted in a much more expensive test that probably increased the anxiety of the individual.

But wait—there’s more. Even if cancer is diagnosed, it may or may not indicate treatment. That’s because many prostate cancers are very slow growing, especially in elderly men, and will not impact how long they live. They may die with prostate cancer but not of prostate cancer.

How do you decide whether testing PSA is necessary? A new study may provide some direction, and I’ll cover that Saturday.

The Insider conference call is tomorrow night, and the topic is important: a recent study and the medical press that followed have indicated your ability to purchase dietary supplements may be under attack. If you’re an Insider, you don’t want to miss this call. If you’re not, purchase your Insider membership by 8 p.m. ET Wednesday night to get the latest information as well as all the other benefits of membership.

What are you prepared to do today?

        Dr. Chet

Science Says Coffee Is Good

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Research is based on curiosity; in order to do good research, you have to ask good questions. Researchers in the coffee study asked: Will a little sugar negate the benefits from drinking coffee? We don’t know whether this was the initial question or if researchers wanted to find out whether artificial sweeteners might have negative effects that altered the benefits of plain coffee.

Turns out artificial sweeteners did not have an impact on the mortality of those who used it over the seven years of the observational study. If you drink from one to 4.5 cups of unsweetened or sweetened coffee, there’s a reduction in mortality from CVD and cancer.

If artificial sweeteners did have an impact on mortality, the headlines would have been bigger than they were. Last week’s look at the safety of melatonin for kids led me to ask the author “Why melatonin?” Multiminerals in gummy form generally contain iron, and that can be toxic to toddlers in high quantities. So why not start looking there and then examine other nutrients? To date, I haven’t gotten an answer.

What Do We Mean by “Coffee?”

I explained how I drink my coffee earlier in the week. However for today’s coffee drinkers, there could be high-sugar flavors added as well as whipped cream and other assorted milks. It seems like a science unto itself to know how to order some of the “coffees” available today, let alone fill those orders. Based on what I read in the Methods section, the questionnaire they used didn’t go into that kind of detail. Extra sugar and fat from elaborate coffees may have a negative impact that won’t be determined in this study.

The Bottom Line

This was an observational study, so there’s no cause and effect implied. Still it’s good to know that the cup o’ Joe isn’t doing any harm and may actually be good for you. Now, about those tea drinkers…

What are you prepared to do today?

        Dr. Chet

Reference: Ann Internal Med. 2022. https://doi.org/10.7326/M21-2977

Coffee: One Sugar Please

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I have a strong relationship with coffee. I began drinking coffee when my mother put coffee in a bottle with a little sugar for me when I was a toddler. These days, a mother would get reprimanded by somebody if she did such a thing, but in the 1950s there weren’t the variety of drinks for children that are available today; milk, orange juice, and Kool-Aid, that was about it.

When I talk about coffee now, I don’t mean the fancy kind with steamed milk and espresso and other ingredients. I drink strong coffee, eight to ten ounces per mug, with exactly one teaspoon of sugar. I drink only Sumatra roast and use a Turkish grind, which is more like powder than grounds; I get the most flavor out of the beans when I brew it that way. I sit back and drink it, savoring every sip. (And yet somehow I married a woman who thinks the only thing coffee is good for is dipping a biscotti.)

The benefits of coffee have been established in prior studies of coffee drinkers compared to non-coffee drinkers. Coffee seems to reduce mortality from cardiovascular disease and cancer. No one seemed to separate the drinkers who used sweeteners from those who didn’t, and that’s why a recently published study caught my attention.

Researchers examined data from over 170,000 subjects in the U.K. Biobank Study; their purpose was to see if adding sweeteners to coffee, either sugar or artificial sweeteners, impacted the mortality of the subjects. I won’t make you wait until Saturday: the coffee sweetened with sugar had the same reduction in mortality as the unsweetened coffee. What about artificial sweeteners? I’ll talk about those on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Ann Internal Med. 2022. https://doi.org/10.7326/M21-2977

How C-Reactive Protein Can Predict Cancer Risk

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High-sensitivity C-reactive protein (hs-CRP) is a measure of inflammation in the body. This blood test looks for inflammation that’s not apparent; with severe infection you have a fever, but other types of inflammation may go unnoticed. This is subtle because you don’t feel anything. On top of that, CRP hasn’t been shown to be diagnostic for any disease. It still may not be, but a recently published study demonstrated that there’s a chance that if CRP changes over time, that may be indicative of some forms of cancer.

The Study

The researchers examined the relationship between CRP trajectory patterns and new-onset cancers among 52,276 participants over eight years; CRP trajectories were developed from 2006 to 2010 to predict cancer risk from 2010 to 2019. The study was restricted to the population who participated in physical examinations in 2006, 2008, and 2010, and had their CRP measured each time.

If you can think of a variable, they tested for it, as well as collecting demographic information that allowed them to consider confounding variables in the statistical analysis. The subjects were tracked for the next eight years to find out who developed cancer and what type of cancer they developed.

The Results

During the extensive and complicated statistical analysis, four CRP trajectory patterns emerged:

A low-stable pattern (43,258 subjects)
A low-stable pattern was associated with a low risk of new cancers.

A moderate-increasing pattern (2,591 subjects)
Subjects in the moderate-increasing CRP trajectory pattern were associated with an elevated risk of any form of cancer, but especially lung, breast, leukemia, bladder, stomach, colorectal, liver, gallbladder, or extrahepatic bile duct cancer.

An increasing-decreasing pattern (2,068 subjects)
Subjects in the increasing-decreasing trajectory pattern were associated with an elevated risk of any form of cancer, but especially lung, breast, bladder, pancreatic, and liver cancer. This pattern was also associated with decreased risk of colorectal cancer.

An elevated-decreasing pattern (4,359 subjects)
Subjects with an elevated-decreasing trajectory pattern were associated with increased risk of leukemia and decreased risk of esophageal and colorectal cancer.

The Bottom Line

Here’s what we know now: inflammation is definitely one of the hallmarks of cancer. Regular assessment of CRP over many years may now be predictive as a risk factor for cancer but not diagnostic. There’s more research to go, but this study is a step in the right direction.

The good news is that it’s another risk factor that can be changed through lifestyle: Eat less. Eat better. Move more.

What are you prepared to do today?

        Dr. Chet

Reference: Int J Cancer. 2022. 10.1002/ijc.34012

Three Ways to Really Reduce Your Cancer Risk

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In the last Memo before Spring Break, I said I’d cover ways to reduce your risk of getting cancer that really work. Every cancer website has lists, ranging from 10 to 15 recommendations. I’m going to give you my top three ways to reduce the risk of cancer of the items you can control. You can’t control your age or your genetic risk factors, but there are many elements of your health you can control if you work at them.

I’m not including smoking cigarettes or other tobacco products. That’s a no-brainer and shouldn’t even be mentioned, because no one should smoke. (I’m not saying that from my perch on Mount Olympus; I smoked when I was young and foolish, and quitting was one of the best decisions I ever made.)

Dr. Chet’s Top Three Ways to Prevent Cancer

  1. Eat more vegetables and fruits every day and the wider the variety, the better. They don’t have to be organically farmed; you just have to eat eight to ten servings per day. That seems like a lot, and I’m not perfect at it, but you get a new chance every day. Here’s a tip: weigh your produce instead of measuring it. Find out what constitutes a serving in grams or ounces. You may find out that a large banana is actually two servings. Do supplements matter? Yes, but the important point is to eat the fruits and veggies first, then add a multivitamin as backup.
  2. Exercise for 30 to 45 minutes per day. The fitter you are, the lower your risk of cancer. It doesn’t all have to be aerobic; yoga and strength training count as well.
  3. Reduce your weight until you achieve as close to a normal BMI (under 25) as you can; you’ll find all the info you need in the Body Mass Index article on the Health Info page at drchet.com, including how to adjust your target for your body type. We talked about caloric restriction in February, and that’s a way to slowly reduce your weight. My theory is that the older you are, the more movement matters, so if you are doing well at Numbers 1 and 2, you’re well on your way to accomplishing Number 3.

Those may sound very familiar: Eat less. Eat better. Move more. The reason these are my top three is that they reduce inflammation in different ways.

On Thursday, I’m going to cover a study on the relationship between a test for inflammation and cancer.

What are you prepared to do today?

        Dr. Chet