The Cancer Paradox

Modern medicine has decreed aggressive screening and treatment for cancer. In spite of shaky grounds for screening and the futility of many treatment plans most patients meekly agree to whatever a physician recommends about cancer. Most treatment programs including surgery, radiation and drugs are very expensive. With newer drugs cost is often astronomical, perhaps leading to poverty for patient and family. In spite of this most agree to whatever is ordered by their doctor not even pursuing a second expert opinion which I think is crucial for any major medical decision.

Contrast this to best treatment for more common, life threatening conditions like diabetes and heart disease. Physician recommendations of procedures and drugs are often followed. The by far best treatment of lifestyle change is either not offered or rejected even though results are better than standard cancer treatments and the cost is negligible, often negative. This I call "the Cancer Paradox."

Why this illogical, expensive disparity? Most of the fault is with our medical system, starting with miseducation of physicians which is then compounded by strong financial incentives to over diagnose and over treat. Advice to take expensive drugs which offer little chance of success and likelihood of serious side effects is presented to the patient as an absolute. Advice to change diet or other lifestyle is an option to be considered if it is mentioned at all. Furthermore, lifestyle change requires an excellent support system with education, cooking classes, social and psychological professionals for the patient and family, but these are mainly non-existent. There's no profit in such systems and money drives medical center and physician resource allocation.

What's the answer? Unfortunately, it's to find or create such a support system for yourself, family and friends. The internet has many possibilities as long as you're careful to avoid the charlatans promoting fad diets, supplements and foods. Good luck!

                         Extreme Variety

Over 30 years ago Larry Smarr, professor of computer science at UCSD, first proposed the idea of super computer centers based at universities and convinced the National Science Foundation to fund these centers. He also developed systems allowing the internet to be created, but more recently his work has focused on another of his brainstorms, Calit 2, which explores advanced digital technology for medical practice. The structure and work of Calit 2 has been so successful that top level computer scientists have left much better paying jobs to join Smarr in his work.

In addition to computer applications Smarr has studied medical research, concluding that lifestyle was the critical variable for good health and longevity. Optimally, this is patient controlled as he demonstrated in the management of his own Crohn's disease. Exercise, sleep and relaxation are all important features of best lifestyle but diet is the most critical. Smarr has concluded that the gut microbiota are key to many aspects of health including his own Crohn's. Maintaining a wide variety of "good" gut microbes requires the right food. Smarr attempts to eat 32 varieties of whole plant food regularly, often incorporating them into smoothies. He comments- "Although I am not a vegetarian, I am a follower of what Thomas Jefferson once said: "I eat meat only as a condiment to the vegetables which constitute my principal diet."" Smarr cites Michael Pollan's classic book,  In Defense of Food, as an excellent analysis of the best approach to diet. He limits animal products to a maximum of 10% of his diet.

https://www.theatlantic.com/magazine/archive/2018/03/larry-smarr-the.../550883/

https://en.wikipedia.org/wiki/Larry_Smarr

                           Starchivore

Dr. John McDougall has coined the term "starchivore" to describe his diet regime which is based on the observation that populations that eat little animal products and refined oils rarely suffer from heart disease, diabetes, cancer or auto-immune disease. Many excellent epidemiological studies have confirmed this. McDougall advocates a low protein, low fat diet which includes some fruit and vegetables but is mainly "comfort foods": potatoes, yams, rice, pasta, whole grains and other starches. Small amounts of salt and sugar are okay to increase palatability. Initially he taught that a few lower fat animal products were acceptable but in recent years he advocates staying vegan.

McDougall designed his medical practice around this diet which he created based on work of Pritikin, Kempner and Burkitt. He has successfully treated many thousands over the last 40+ years, first in private practice in Honolulu and later through clinics; 10, 5 and 3 day programs in Santa Rosa, CA; many books and an active free internet site which has access to many talks given at his "Advanced Study Weekends" plus patient interviews describing dietary success treating various chronic diseases and obesity. Deb and I  attended his 10 day program and found it a powerful, instructive and pleasant experience. We've also attended many of his weekend and travel programs, befriending many "McDougallers." The seed for many of my blogs was from his programs.

McDougall just announced his retirement from active practice; his Advanced Study Weekends and travel programs ended last year, but 3, 5 and 10 day treatment programs under the supervision of his colleague, Dr. Anthony Lim, continue as does his excellent educational website( link is on right side of this blog's home page.)

                         Nutritarian

Much writing and study of diet revolves around what not to eat: too many calories, fats, carbs, protein, refined oils, or some combination of these. Some research and advice centers more on what to eat. One of the most prominent of this group is Joel Fuhrman, a New Jersey family practice physician who has devoted his career to promoting diet as the principal way of maintaining health and treating many diseases.

Fuhrman has had a family practice for decades where he has treated thousands using his dietary approach, "nutritarianism," which is to eat a large variety of vegetables, fruits, legumes, nuts and seeds- the more variety the better. Sharing meals with him is fun since he eats huge quantities of very low calorie foods which includes a few starches but emphasizes salads and smoothies. His salad building technique is amazing: after filling his large plate with a variety of greens he takes another plate, puts it on top of his greens, presses down crushing them into a smaller volume and then adds another layer of greens. His comment is that otherwise he can't get enough on his plate.

I've known Joel for more than ten years, visited his practice in Flemington, NJ, and attended multiple conferences where he was the only presenter. He is a remarkably energetic, enthusiastic scholar who knows as much about nutrition literature and research as anyone I've met on my odyssey searching for dietary truth. Initially, when I first met him he indicated that a small amount of animal products, especially eggs, were a reasonable part of a good diet but over the years he's evolved to a diet which does not include any animal products. Fuhrman has many books to his credit plus DVD's and very successful PBS shows. He's an engaging, enthusiastic speaker. Concepts he espoused years ago have become more mainstream and accepted over the years (eg intermittent fasting.) He maintains an active website which includes a good way of linking with others about dietary issues and questions. Unfortunately this requires dues to participate. He also sells many products, various supplements and foods, in addition to his books and DVD's. These products all seem to be highest quality but I have an issue with too much supplementation which is well shown to be wasteful and occasionally harmful. 

                                M and M

In medicine we have M and M conferences. Often we'd have preferred that this meant we sat around and ate M and M's, since the subject matter was morbidity (serious illness) and mortality (death) in patients under our or our colleagues' care. The purpose was to understand what went wrong and what we could have done to prevent it.

Much of medical science revolves around the same theme: cause and prevention of death and disease. Eleven years ago, around the time of my 66th birthday, reading and study made it obvious to me that much M and M was due to changeable lifestyle and that modern medical practice paid little heed to this while emphasizing drugs and procedures for patient care. My wife Deb and I changed our own diets since this was by far the major cause of M and M. We had no health problems at the time but felt that we wanted to share this information and couldn't preach what we didn't practice. If you've read many of my prior blogs you know that the dietary change was to cut out or minimize animal products, refined oils, refined carbohydrates and added salt, effectively eliminating most processed foods.

I've recently swapped emails with a high school classmate whose wife has dementia. His observation  that many older people in his retirement community have poor quality of life in their "golden years" led him to muse that perhaps early death was a better option. But what if you can have both low M(ortality) and low M(orbidity)? Several excellent large epidemiological studies make it clear that this is so. Not only do you live longer with good diet but the quality of your last years is much better. It is very reasonable to dread final years with dementia or taking drug after drug for cancer, advanced heart disease, diabetes. Life in a hospital, extended care facility or making regular rounds of doctors' offices is no one's choice for the golden years, but that is the path made very likely by ignoring sound dietary guidelines. Another friend of mine died earlier this year after several miserable years of chasing health from doctor to doctor. A few months before he died he said, "Jack, I sure wished I had taken your advice about diet years ago."

                            Epigenetics

1. 
   

   Epigenetics is a relatively new field which examines the effect of events outside our inherited DNA code on how our genes control our life and health (gene expression.)

   
   

   "epigenetics has transformed the way we think about genomes"

   
   

   The April 5, 2018 New England Journal of Medicine has a long article on this subject which includes information about epigenetics and inflammation and epigenetics and the microbiome, subjects of my most recent blogs.

REVIEW ARTICLE

The Key Role of Epigenetics in Human Disease Prevention and Mitigation

• Andrew P. Feinberg, M.D., M.P.H.

The epigenome consists of nuclear information, heritable during cell division, that controls development, tissue differentiation, and cellular responsiveness. Epigenetic information is controlled by genome sequence, environmental exposure, and stochasticity, or random chance. As such, epigenetics stands at the interface of the genome, development, and environmental exposure.

All cells of the body have essentially the same DNA, yet different organs and tissues serve vastly different functions and also retain their identity as their cells divide. This cellular identity is epigenetic information, or information that is added onto the genes themselves.

Feinberg goes on to say: "The use of sequencing alone to assess disease risk is even more limited because sequencing studies cannot easily capture the role of the environment, which is thought to account for 80% of disease risk in humans. For example, a Western diet is the leading cause of type 2 diabetes and a major cause of cancer." He could add auto-immune disease, vascular disease and dementia. Our diet controls most of our health events. Inherited genetic pattern is much less important. 

                       The Microbiome

The media is filled with stories about the microbiome, a very hot research topic which thousands of scientists worldwide are pursuing. The microbiome is defined as the genome(gene pool) of the micro-organisms which populate the body. Most of these are bacteria in the bowel, especially the colon. The importance of the microbiome was not appreciated until the last couple of decades during which time it has been discovered that our bowel organisms control our overall health and well being. It has been estimated that up to 90% of all disease is related to problems with the microbiome.

A poor quality microbiome leads to a "leaky gut" in which unhealthy materials enter through the bowel wall. Close association with auto-immune and heart disease, dementia, cancer and obesity have been documented. Experiments with lab animals have shown radical personality change by modifying bowel organisms. Taking bowel organisms from people with irritable bowel syndrome and giving them to lab animals causes the same syndrome in the lab animals plus anxiety.

The major determinant of a healthy bowel flora is what is eaten. The foods listed in the prior blog on inflammation have the same effect on bowel flora. Refined vegetable oils, dairy, refined carbohydrates, meat and eggs damage bowel flora. Whole grains, legumes, fruits and vegetables improve it. Again, the recurrent theme "you are what you eat" is confirmed.

The army of researchers working on the microbiome receive funding to find a drug or patentable superfood which will improve the microbiome. Fast and processed food companies plus the drug industry support these efforts when every scientist in this field knows that a diet emphasizing whole plant foods and whole grains resolves the problem. Again business interests are controlling behavior and obscuring the obvious inexpensive solution to a poor quality microbiome. We are being manipulated by for-profit businesses.