Monday, December 31, 2012

What Can You Eat If You Have Cancer?

The other day, I saw a patient who had been diagnosed, a number of years ago, with metastatic breast cancer (it had already spread to the lymph nodes in her arm).  She was advised to undergo chemotherapy, but decided instead to undergo a rigorous process of fruit and vegetable juicing. Here she was now years later standing in front of me with no apparent evidence of cancer.  What is the take away from this story? For me, there is none. Anecdotal stories of cures from cancer by food alone offer no compelling scientific evidence. Perhaps the surgeon had effectively removed all the cancer and that is why the patient had no recurrence?  Perhaps she had a very slow growing tumor that continues to spread but goes undetected?  Maybe the fruits and vegetables actually did make a difference? Nevertheless, there can be little doubt that eating healthy foods helps ward off diseases, but the question remains: can you depend on them for a cure?

The problem is that cancer is a confounding disease and can act dissimilar from one person to another even when it is of a similar histology (micro-anatomy) such as squamous, adeno, or sarcoid types of cells. Also, our bodies immune responses to cancer is also different because of our diverse genetic make-ups. That's why we sometime hear of someone being diagnosed with cancer and then passing away a few short months later, while others with similar cancers enjoy many more years of life. It is also true that certain cancers, such as pancreatic cancer, are often discovered very late in their course and often portend very poor short-term outcomes.  Ultimately, the staging (how extensive it is and if it has spread beyond its primary location) of a cancer really does make a difference. The sooner you find cancer, the more effective interventions usually prove to be.

Yesterday, I spent time reviewing various websites that proffer advice on how to eat properly when one has cancer.  What I found was frightening and I am sure very confusing for someone searching for the right answers. The government based sites recommended eating meat and milk products to maintain strength while virtually every other site discouraged consumption of such food materials because of their links to causing and propagating cancer.  The government sites seem to offer their information on the basis of what the government considers healthy eating.

There can be little doubt of the sway of the Dairy and Cattle Associations on the government's recommendations. This is well established.  Nevertheless, a person with cancer is left guessing which set of directions to follow. Unfortunately, I profess some uncertainty in answering this very question. However, I will try.

Based on everything I have read to date, meat and dairy products seem more problematic than helpful when dealing with cancer.  Fruits, vegetables, nuts, beans, seeds, whole grains, and wild Salmon seem more helpful than problematic.  Sugar, other than the natural fructose found in in fruits (don't confuse with high fructose corn syrup, which is horrible), seems universally bad.

Given the choice between conventional therapies and home grown remedies, I would choose both.  My relative battling cancer has made that very choice. He is being bombarded every day with a heavy dose of juicing which includes pomegranates, papaya, berries, apple, citrus fruits, collard greens, turmeric, cinnamon, etc., while also taking prescribed medicine. He is getting the best of both worlds.

As a side note, the person who prepares his food got carried away one day and tried to sneak some very healthy sardines into his smoothie. Suffice it to say, it did not go well. There are limits to what kind of foods can be combined together at one time and still be palatable.  Cancer patients with taste buds need to at best enjoy their food like everyone else, and at worse, not detest it.  There are ample good recipes for combining healthy ingredients; while some experimentation is encouraged, it is advised to not get carried away such as by throwing blueberries and sardines together.

For example, while recently traveling, I got to enjoy a smoothie of my own. There was an airport kiosk offering a smoothie they called "Habit." It contained fresh squeezed orange juice, whole banana, fresh pineapple, raw kale and spinach, and nothing else other than ice. There was no sugar of any type added and I must tell you it was delicious. I understand why they call it "Habit" because I could get use to drinking one of those smoothies every day.

By the way, on another note, this morning I received an email from Harvard Medical School titled "The Top Health Headlines of 2012." The fifth headline was "Do vitamins and other supplements live up to their promise?"

I read the accompanying article and here is a quote from it worth noting:

"Despite their popularity, there is no evidence that multivitamins enhance health or prevent illness. In fact, both the U.S. Preventive Services Task Force and a National Institutes of Health State-of-the-Science Conference concluded that multivitamins do not offer protection against heart disease or cancer."

Now the truth be told, I don't agree with everything I read from Harvard Medical School because sometimes the information provided is outdated or simply wrong. Therefore the information provided is merely offered as another view about the ubiquitous multivitamins and dietary supplements.  As always, consult with your physician before initiating taking any pills.

In summation, although no one can tell you definitively what foods can stop cancer once it develops, it seems prudent, if you or someone you know find him or herself in that situation, to eat like we ate thousands of years ago when meat and dairy were in short supply, and we lived off the land and ate fresh oily fish.

Wednesday, December 19, 2012

Are Dietary Supplements and Multivitamins Addictive?

The Merriam Webster dictionary definition of addiction is a "compulsive need for and use of a habit-forming substance characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly: persistent compulsive use of a substance known by the user to be harmful."

Psychology Today defines it as "a condition that results when a person ingests a substance (alcohol, cocaine, nicotine) or engages in an activity (gambling) that can be pleasurable but the continued use of which becomes compulsive and interferes with ordinary life responsibilities, such as work or relationships, even health."

Pursuant to such definitions, one who takes multivitamins and supplements would not classically be deemed an addict because he or she doesn't know that such pills may be harmful and typically would not experience physiological withdrawal symptoms from the use of such products.

Yet, I would like to offer an alternative definition of addiction.  My definition is the compulsive use of a substance in the absence of any evidence that the product enhances health or that it is not harmful. Furthermore, my definition includes the use of such a product as a crutch and substitute for otherwise engaging in healthy behaviors such as a health promoting diet, physical activity, stress management, etc.

Under my definition, we have an epidemic of supplement addictions in the U.S.

Over the past year, I have been giving lectures to over a thousand people on why supplements and multivitamins are mostly worthless and may be harmful. Yesterday evening, I gave this presentation to a group of about 70 people. As often happens with this lecture topic, I was peppered with questions both during and after the presentation.

Despite citing specific very large studies that demonstrate potential harms related to the use of such products, I was asked repeatedly if there was definitive proof that taking such products is absolutely harmful. One audience member went so far as to state that she had been taking such products for years and had suffered no apparent harm so why was I certain in my pronouncements. Certain audience members shook their head in agreement challenging me to refute this apparent fact.

As the intensity of the pro-supplement voices rose, I took a deep breath, composed my thoughts and answered as follows. First, I reminded the audience of Mark Twain's quip that "It's not what we know that gets us into trouble. It's what we know for sure that does." I explained that that I could not state with absolute certainty, given the biological diversity of people, that all multivitamins and supplements were equally worthless and/or harmful to everyone.

People have different medical histories, use different prescriptions, engage in different lifestyles, eat different diets, and have different genetic predispositions. Such diversity often challenges and complicates the application of research results to any given individual. Furthermore, some people may actually suffer from a deficiency that for one reason or another can't be addressed simply by regular food. By the way, this is extremely rare.

I also explained that sometimes the evidence of harm can be many years in the making. The development of a mesothelioma, a cancer, may not be evident until thirty years after exposure to a single strand of asbestos. Also, many of the diseases that afflict most western civilization inhabitants such as heart disease, stroke, dementia, etc. do not develop for many decades after steadily engaging in unhealthy behaviors. Even most sugar addicts and cigarette smokers don't develop diabetes and lung cancer respectively for many years of use. (True, some never develop it.)

Yet, something more nefarious was underfoot. I felt like I was suddenly challenging certain people's religious or political beliefs. There was palpable angst in the audience. Then it hit me. Instead of sharing my facts about such products, I should be asking questions.

"Hold everything," I said to the audience, "Why has the burden fallen on me to produce evidence that such products demote health, are harmful, shorten life, etc.?" I further queried, "Why are you not demanding proof of benefit and of no harm prior to spending your hard earned money on products that offer no such evidence?" Why are you blindly following advice from people who have a pure profit motive in getting you to buy their products?"

I shared with the audience an encounter three weeks prior at another such lecture when a Shaklee representative (Shaklee is a multilevel marketing supplement distributor) chimed in from the audience that based on a landmark study it performed, Shaklee offers such proof that it's products are worth the money spent on them.

I've since obtained the study to which he was referring. It is a ridiculous study confabulated by Shaklee to produce desired results. Basically, Shaklee compared selective data they gathered from their affluent product users to data collected by the government from many poor and elderly citizens.  It is not a valid comparison and the study was essentially a worthless (not for Shaklee) piece of marketing propaganda. No surprise there.

The bottom line is that the supplement industry has sowed so much confusion that even doctors no longer know which products are valid, when they are necessary, how much to recommend, etc. As Consumer Reports published in September 2012, there are now 55,000 products for sale and over $100 billion of nutritional products sold each year.

The weight and consistency of the marketing has been so effective that people are no longer asking the most basic of questions. Will this product help or hurt me? Is there any scientific validity to the use of this product for the reason I am taking it? Is it worth the money I am spending?

Since 1994, the law of this land is that supplement product companies need offer no proof of effectiveness to market their products--and so they don't. But like lambs to the slaughter, people continue to line up sheepishly and buy millions of these pill bottles of uncertain value. It is estimated that somewhere between 50 to 80% of Americans now take one form or another of supplement.

The value of these products, now occupying only 80 years of our 150,000 year chronicle (millions more if you include early man), may be the single biggest hoax in mankind's history.

Taking invalidated, potentially harmful supplements may not seem like an addiction to you, but it sure does to me.

Saturday, December 8, 2012

It's Never One Thing

It would be an understatement to state that I have become fascinated with all aspects of longevity and disease prevention. Over twenty thousand studies and a dozen books later, my search for the quintessential answer to a long and healthy life goes on.  The body of knowledge is so vast and the hours are so short that I suspect that I shall never fully grasp all the intricacies of what allows any single person to optimize his or her longevity and minimize susceptibility to disease. While scrutinizing certain cultures that appear more successful at longevity may offer some clues, even among their members you will find those that die far younger than others despite similar lifestyles.

However, one thing has become abundantly clear to me: a long and disease free life is never dependent on just one thing.

This statement is made with the caveat that obvious detriments to health, such as consuming lethal poison or jumping off a perilous cliff, offer certain consequences.  Nevertheless, when one removes from the list such immediate threats to continued living, it becomes crystal clear that a host of factors contribute to the life we live and the day we die.

Foremost, but often not close to the most important factor, is the role that genetics plays. This is the influence least under our control as we obviously have no role in choosing our parents. But numerous studies, and in particular, the Swedish Twin Studies (that began in the 1870's, involving tens of thousands of identical twins who happened to grow up separately with varying lifestyles who developed different diseases and died at vastly different ages),  have demonstrated that genetics plays no more than a 15 to 30% role in our overall longevity and disease development. Of course, those born with Down's syndrome, hemophilia and other genetic disorders would argue otherwise and they would be right. But for most people, genetics at most represents a predisposition for diseases whose ultimate manifestations are under our control.

So what does matter? For one, but not alone, it is environmental factors. Which? That's the $64,000 question. Is it processed foods, gluten, pesticides, household chemicals, pollution, contamination, etc., or could it be some mix and match of all of them?

Anyone who tells you they know with certainty is either delusional or just flubbing.

The reason no one can tell you the absolute answer is that it is often different for different people. For example, there are smokers who live to 100 and others that die far earlier. Some obese individuals have heart attacks in his or her 30's while others survive into their 90's.

More importantly, no one can do better than hypothesize because the scientific method can never be applied to such a multivariate question. The gold standard of scientific inquiry into a population's health would require a double-blind, randomized controlled study where all confounding variables are controlled. Unless we could snugly place people in a bubble, we could never firmly establish a definitive working conclusion.

Nevertheless, scientists slog on trying to make sense of what they can. They can show a strong correlation between smoking and lung cancer, alcoholism and cirrhosis of the liver, obesity and heart disease, etc. What they can't do is tell you if you simply avoid or consume one particular food then your longevity is guaranteed to be positively or negatively impacted, respectively.

For example, I think there is a strong basis in science to call sugar a human poison, albeit a slow acting one. My patients are cautioned to avoid it and to go to great lengths to minimize their exposure to it. Nevertheless, I don't believe that avoiding sugar alone guarantees a long life.

I often tell my audiences that if they eat plenty of fruits and vegetables, nuts and beans and seeds, whole grains and wild fish--they are going to die.  I suspect they expect a different conclusion than the one proffered, but it's the truth.  Long before processed foods even existed, people died and some at relatively young ages from a myriad of other factors--infections foremost among them.  Food allows you to live by providing essential nutrition, but it doesn't guarantee health. Healthy eating doesn't offer protection against many simple infections like chickenpox and viruses or more esoteric infections like tuberculosis and tetanus.  These sometimes life-threatening ailments often depend on passing exposure to these pathogens.

So what else matters? The mind.

Many an otherwise healthy person has been befallen by stress, anxiety, depression or any other number of mental health issues. Such factors may have a genetic or familial disposition. Some may be purely situational. Sometimes it's both. The connection between the mind and body is well established. It facilitates innocuous placebos to work and allows real, measurable systemic diseases to develop in the absence of any other factors.

I have witnessed this first hand. Learning about my family member's cancer brought back my heartburn which I thought I had banished forever. No diagnostic medical test, and I've had plenty of them searching for a clinical reason, has shown any other identifiable cause for this phenomenon. I know it is because of stress.  Despite eating, sleeping, and living well, I have struggled to control my own guttural reaction to difficult news. I know that I must learn to manage my reaction to difficult news and I strive everyday to naturally manage my stress to relieve my symptoms.

This is why I know that the complex human body forged over 150,000 years to it's current form, and millions of years earlier in prior forms, is at once and always will be a very vulnerable and fragile system, highly complicated and efficient-- a veritable miracle of nature subject to forces sometimes beyond our control.

Although many would have you believe by the titles of their books such as "Why We Get Fat" or "Wheat Belly" that your health depends on one thing, I will tell you that it's simply not true.  No pill, prescription or supplement, no food described as super or otherwise, no exercise routine, done in the gym or in nature, will guarantee health.  Alternatively, certain vices like smoking and excess alcohol, consumption of certain processed foods, a sedentary lifestyle, poor sleep, great stress, etc. while expected to have a detrimental effect on your health, don't always factor in your death.

Your health depends on a combination of factors that affect both your body and mind.  Ignoring any of these factors shifts the odds against you for a long and healthy life.

But please take note, it's never one thing.

Saturday, December 1, 2012

Is Dr. Oz Nuts Over Ice Cream? or The Worst Food Advice Dr. Oz Ever Gave!

Many readers of this blog know of my disdain for Dr. Oz's reckless proclamations on his nationally televised show. From Green Coffee Extract for weight loss to two baby aspirins at night for unknown pain, I find such advice irresponsible and dangerous. After watching numerous shows and finding much to object to, I simply stopped watching.

Occasionally, I am reminded of his showmanship when a patient presents to MDPrevent with a heaping batch of worthless supplements in tow. The patients are often surprised when I surmise before even asking that they are a fan of Dr. Oz. "How did you know? they ask. The answer is simple because many of the products they are taking are among the worst of his recommendations, offenders like Raspberry Ketones, Sage Leaf Extract, Glucomanan, etc.  I am always delighted to relieve them of the expense and chicanery of such products.

So after stopping to waste valuable time watching his show, I thought I had finally effectively distanced myself from Oz. It was not meant to be.

Last week, I came across a magazine cover on an airport newsstand. The large picture of frozen food colorfully displayed on the cover immediately caught my eye and the name below ultimately proved too intriguing to pass by.  I say ultimately because I first ignored it and took a seat at my terminal only to shortly thereafter return to the newsstand to peruse the article behind the cover. (Yes, I actually read it standing there as I could not bring myself to pay for such anticipated nonsense.)

In the December 3, 2012 issue of Time magazine, I read an article written by Dr. Oz's titled 'Give (Frozen) Peas a Chance--and Carrots Too."  The article starts innocently enough with Oz explaining that frozen vegetables retain the same nutrition as their fresh counterparts. On this point, the science supports the good doctor. As I kept reading, his other assertions also seemed hardly controversial.  Then it came and couldn't believe it.

Mid way through the article, Dr. Oz shares a personal story of how he and his father use to drive together to the ice cream store when he was a child.  During these wonderfully memorable rides, he writes how he learned much of what he knows about his father. Accordingly, he has fond memories associated with eating ice cream. This is not surprising.

Almost all patients I care for relate some positive (or negative) association with certain foods. Some enjoy steak because it represents a positive correlation to family dinners celebrated over some good news.  For me, it's watermelon. It reminds me of returning from romantic dates on Saturday nights and enjoying a sumptuous slice of cool watermelon alone and undisturbed in the kitchen.

For Dr. Oz, it is clearly ice cream. On the surface there is nothing wrong with that. In fact, it's a very nice story and sentiment.  Except he feels that his sentimental story warrants telling his readers that they should therefore consume ice cream (albeit in reasonable quantities).

There can be no doubt that Dr. Oz is aware of the epidemic of obesity that is ravaging our country. 36% are obese, two-thirds are overweight, over half die from heart disease, 8% have diabetes, etc. At the center of this huge problem is sugar, the very kind one would find in the ice cream touted by Dr. Oz.

In my clinical experience as well as in countless studies, many people clearly identify themselves as addicted to sugar and sugar has been demonstrated to cause the same areas of the brain to light up as drugs do for drug addicts and alcohol does for alcoholics. Recent studies also closely correlate sugar consumption with cancer stimulation and growth (by stimulating insulin release which then binds to insulin receptors on the cancer surface to signal uptake of such sugar to meet the energy needs of the cancer cells trying to multiply).

A recent article in Mother Jones magazine chronicles the efforts of the sugar industry over the past five decades to squelch negative publicity about the dangers of sugar and to confuse the populace about its perils.  Sugar and related simple carbohydrates are also primarily responsible for the development of diabetes and high triglycerides.  You don't have to be a doctor, let alone a cardiovascular surgeon, to know of the dangers of sugar even in small amounts for certain people and in larger amounts for virtually everyone.

Now don't even get me started on the fat content of the full fat cream used in most ice creams or the hormones, antibiotics (despite the law), and cornstarch fed to the cows that produce the milk used to make such products. And what about the food additives and coloring added for a myriad of flavors that range from cookie dough to maple walnut?

"Everyone knows that ice cream isn't good for you — it's a splurge," says Jayne Hurley, a senior nutritionist at the Center for Science in the Public Interest. "But most people don't realize how much of a splurge it is."

In 2009, the Center for Science in the Public Interest commissioned a study that looked at saturated fat and calories in some of the most popular treats from Baskin-Robbins, Cold Stone Creamery, Friendly's, Ben & Jerry's and TCBY. Most of the information in the nutritional analysis was provided by the companies.

(The following is excerpted from an article that appeared on a CBS News website in 2009.)

"Among the findings in "Living Large: The Scoop on Ice Cream Shops":

A chocolate-dipped waffle cone at Ben & Jerry's has about 320 calories and 16 grams of fat. Add one scoop of Chunky Monkey ice cream and the total surges to 820 calories and 26 grams of saturated fat — roughly as much as a one-pound rack of ribs.

Cold Stone Creamery's regular-size "Mud Pie Mojo" — coffee ice cream, roasted almonds, fudge, Oreo cookies, peanut butter and whipped topping — has a saturated fat and calorie level equal to two personal pan pepperoni pizzas from Pizza Hut.

At 1,270 calories and 38 grams of saturated fat, eating a Haagen-Dazs "Mint Chip Dazzler" sundae is like eating a T-bone steak, a Caesar salad and a baked potato with sour cream."

This appears to be the same type of ice cream that Dr Oz is advocating that people eat when they go to the store for this dangerous treat.  He just says don't eat too much. Right.

(By the way, for further proof if his unreliability, on a website in which Oz has an ownership stake, a video is posted featuring him with the label, "Ice cream is delicious, but it is packed with fat and calories. In this video, Dr. Oz presents his concoction for a healthier ice cream treat.")

Folks, I don't care what sentimental attachment Oz has for ice cream. I hope you agree that it is reprehensible to tell a population struggling with weight problems to continue to eat one of the foods most closely related to avoidable chronic diseases such as heart disease, diabetes, strokes, cancer, etc.--even in small amounts. Most people can't control such urges and studies have demonstrated that faced with such willpower choices, willpower will often fail them. One study even demonstrated that when confronted with flavorful food, the body will release a hormone that will stimulate people to eat even when they are not hungry.

On further thought, maybe it's a good thing if Oz keeps eating ice cream. Then I may not have to waste time educating others of the danger of taking health advice from him on TV, on the web, or in print.

That's not true. I really don't mean him or anybody harm so I hope he knows better and just keeps his mouth shut when it comes to eating and giving advice about ice cream. It wasn't the first time he made such a blunder, but for all our sakes and particularly those who hold him in great esteem and follow his every pronouncement, let's hope it's the last.