The Los Angeles Times “Booster Shots” blog reports that research published in Cancer Epidemiology, Biomarkers & Prevention suggests that “drinking four or more cups of caffeinated coffee may protect against endometrial cancer.” Continue reading
In two previous blogs (“Thirty percent of breast cancers could be prevented by lifestyle changes” and “Three Healthy Habits Cut Breast Cancer Risk, Study Finds“) I’ve discussed the association between cancer risk and lifestyle choices. Continue reading
Congrats to the new Surgeon General, for taking an even stronger stand on tobacco in her recent report, “How Tobacco Smoke Causes Disease.: The Los Angeles Times and Orlando Sentinel write that the report has found that “ANY exposure” to tobacco smoke can cause immediate damage to the human body.
“There is NO safe level of exposure to cigarette smoke,” Surgeon General Regina Benjamin said.
“Inhaling even the SMALLEST amount of tobacco smoke can also damage your DNA, which can lead to cancer.”
The report also finds almost NO difference between being a light smoker and a heavy smoker.
“That’s because of the inflammatory processes occur at very, very low doses,” said cardiologist Dr. Stanton Glantz.
The AP notes that the report “is the 30th issued by the nation’s surgeons general to warn the public about tobacco’s risks,” but “is unusual because it devotes more than 700 pages to detail the biology of how cigarette smoke accomplishes its dirty deeds — including the latest genetic findings to help explain why some people become more addicted than others, and why some smokers develop tobacco-caused disease faster than others.”
CNN says that the report “links smoking directly to 13 different cancers including esophagus, trachea, stomach, pancreas, kidney, bladder, cervix and acute myeloid leukemia.”
It also “ties smoking to more than a dozen chronic diseases like stroke, blindness, periodontitis, heart disease, pneumonia; reproductive problems like diminishing fertility; chronic obstructive pulmonary disease (COPD), asthma and other respiratory illnesses.”
The Washington Post “Checkup” blog reports that Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, called the report “a stark reminder of how lethal and addictive smoking truly is.”
In the advertisements for aspirin you see every day on TV and in magazines, they have for years called it a wonder drug. Now, more and more of us doctors are finding that is truly the case. In past blogs I’ve told you, “Low-dose aspirin reduces risk of developing and dying from colon cancer,” and “Single Dose of Aspirin Effective in Relieving Migraine Pain.” And, millions of people take 81 mg of aspirin every day for heart health.
Now, a new study in The Lancet indicates that “aspirin may be much more effective than anyone knew at helping prevent cancer deaths.”
The stunning finding came while researchers were studying 25,000 people taking daily aspirin to prevent heart disease. It turns out aspirin was doing something else, reducing the death rate from cancer as well.
In fact, in the trials where people have taken aspirin four, five, six, seven years on average, the risk of dying of cancer was reduced by about 25%.
So, you may ask, “Should everyone take low-dose aspirin?”
The American Cancer Society said no and that “it would be premature to recommend people start taking aspirin specifically to prevent cancer,” considering that “even low dose aspirin can lead to dangerous internal bleeding. Still, evidence that it might help fight cancer is intriguing for doctors.”
Even so, in the Lancet study, daily aspirin use appeared to lower the risk of death from cancer by 21% in randomized trial participants. It’s important for me to point out that the findings, by themselves, do not prove that aspirin prevents cancer or even cancer death and that the role of aspirin as a chemoprevention agent needs clarification by further studies.
Nevertheless, researchers at Oxford reached the conclusion that a daily low-dose aspirin could significantly lower cancer deaths. They came to that conclusion after examining “the cancer death rates of 25,570 patients who had participated in eight different randomized controlled trials of aspirin that ended up to 20 years earlier,” the New York Times reports.
“Participants who had been assigned to the aspirin arms of the studies were 20 percent less likely after 20 years to have died of solid tumor cancers than those who had been in the comparison group taking dummy pills during the clinical trials, and their risk of gastrointestinal cancer death was 35 percent lower. The risk of lung cancer death was 30 percent lower, the risk of colorectal cancer death was 40 percent lower, and the risk of esophageal cancer death was 60 percent lower.”
Only “one-third of people in the analysis were women — not enough to calculate any estimates for breast cancer,” the AP points out.
And, “there appeared to be no benefit to taking more than 75 milligrams daily — roughly the amount in a European dose of baby aspirin and a bit less than the baby aspirin dose in the US.”
In addition, “aspirin was not found to [significantly] influence the risk of death from pancreatic, prostate, bladder, kidney, brain, or blood cancers,” the Los Angeles Times reports.
Yet, lead investigator Dr. Peter M. “Rothwell noted that most of the subjects stopped taking aspirin at the end of the study – or, alternatively, many in the control group began taking it — potentially confusing the results.” He added that “‘it’s likely that if people had carried on taking aspirin,’ the benefit would have been greater.”
Rothwell also said that “healthy middle-aged men and women may benefit the most from taking aspirin over a long period,” and medical guidelines “may be updated on the back of these results,” Bloomberg News reports.
Meanwhile, an 80-year-old expert at Cardiff University “who has published 300 research papers over 50 years” said, “The man on the street knows betting odds.” Peter Elwood, “who has been taking aspirin since 1974 and wasn’t involved in the study,” maintained that “people should ‘evaluate the risks for themselves.'”
But increasingly, my patients, when evaluating the risks and benefits of daily 81-mg aspirin, are choosing to take it.
An easy-to-remember formula for good health (0, 5, 10, 30, 150) is proposed in a wonderful editorial in American Family Physician titled “Preventive Health: Time for Change.” The author suggests this formula to physicians to “help patients achieve healthy lifestyle goals”:
- 0 = no cigarettes or tobacco products
- 5 = five servings of fruits and vegetables per day
- 10 = ten minutes of silence, relaxation, prayer, or meditation per day
- 30 = keep your BMI (body mass index) below 30
- 150 = number of minutes of exercise per week (e.g., brisk walking or equivalent)
The editorial is penned y Colin Kopes-Kerr, MD, from the Santa Rosa Family Medicine Residency in Santa Rosa, California:
It is time to make a decision. Which will be our health promotion strategy—primary prevention or secondary prevention?
Traditionally, the only one available to us was secondary prevention. Medicine consisted of a one-on-one physician-patient relationship, and taking care of patients meant minimizing the impact of any diseases the patient had. We did not have the time or tools to do anything else. More recently, we have been able to reduce a patient’s mortality by 20 to 30 percent by treating heart disease with a statin or beta blocker. These two medications have had the most dramatic effects in secondary prevention.
But now, the way we practice medicine has changed. We have a real choice to make. According to recent literature, primary prevention appears to work better than any other strategy in medicine. So why do some physicians not implement primary prevention? Despite the literature, maybe physicians are not getting the news. We need to keep repeating the message to physicians and patients that primary prevention is simple and effective. Next, we need to take a look at our own behavior as physicians and determine if it makes sense in the context of primary prevention.
There are 10 major studies on the effects of primary prevention.(1–15) These studies demonstrate very large correlations between specific healthy lifestyle behaviors and decreases in major chronic diseases (e.g., diabetes mellitus, heart disease, stroke, cancer) and all-cause mortality.
Although these studies offer a complex array of data to sift through, the elements of a healthy lifestyle are clear: not smoking, regular exercise, healthy diet, healthy body weight, and reduced stress.
Although exercise guidelines vary, I ascribe to the U.S. Department of Health and Human Services’ Physical Activity Guidelines for Americans, which recommends at least 150 minutes of brisk walking or the equivalent per week.(16) For the diet criterion, the Atherosclerosis Risk in Communities study illustrates that merely consuming five servings of fruits and vegetables per day is associated with the same benefits as consumption of a Mediterranean-style diet.(11) A standard of five servings of fruits and vegetables is much easier to remember and adhere to.
There is strong support for at least one weight-related variable in a healthy lifestyle. This may include body weight, body mass index (BMI), waist circumference, or waist:hip ratio. The INTERHEART study showed waist:hip ratio to be the most predictive of cardiovascular disease.(6) However, unlike BMI calculation, measurement of weight:hip ratio has not yet become standard in U.S. practices. I use BMI as the metric, and a value less than 30 kg per m2 as the cutoff between a healthy and unhealthy lifestyle. The goal is to move away from this outer limit toward a more ideal parameter, such as less than 25 kg per m2.
The final variable of a healthy lifestyle, which has strong support from the INTERHEART study, is stress reduction.(7) The INTERHEART study offers useful suggestions for measuring stress—perception of severe stress at home or at work, financial stress, or major life events.(7)
The minimal lifestyle intervention that would be beneficial is not defined. However, 15 to 20 minutes of silence, relaxation, or meditation appears to be a common interval.(17) To be more inclusive of patients, I set the criterion to an even less restrictive amount, about 10 minutes per day.(17) This is enough time to produce a change in biorhythms and is achievable for most patients.
Information alone does not lead to behavior change, however. Motivational interviewing or brief negotiation is a new framework that can close the gap between knowledge of available lifestyle interventions and changing behaviors. The framework has already been proven markedly effective for tobacco, drug, and alcohol addiction.(18) Few physicians have received the training necessary to implement motivational interviewing or brief negotiation. Resources for learning about these skills include the Kaiser Permanente Medical Group Web site and the book Motivational Interviewing in Health Care: Helping Patients Change Behavior.(18)
In terms of health, we can have it all. We have the requisite tools to convert knowledge into healthy behaviors. This newfound power to reduce diabetes, heart disease, stroke, cancer, and all-cause mortality with primary prevention strategies should impel us to change how we counsel patients. Research is needed to explore why some physicians are not making this change.
Address correspondence to Colin Kopes-Kerr, MD, at email@example.com. Reprints are not available from the author.
Author disclosure: Nothing to disclose.
- Stampfer MJ, Hu FB, Manson JE, et al. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000;343(1):16–22. View here
- Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345(11):790–797. View here
- Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA. 2009;302(4):401–411. View here
- Knowler WC, Barrett-Connor E, Fowler SE, et al.; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. View here
- Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA. 2004;292(12):1433–1439. View here
- Yusuf S, Hawken S, Ounpuu S, et al.; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infraction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–952. View here
- Rosengren A, Hawken S, Ounpuu S, et al.; INTERHEART Investigators. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):953–962. View here
- Chiuve SE, McCullough ML, Sacks FM, et al. Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid-lowering and antihypertensive medications. Circulation. 2006;114(2):160–167. View here
- Chiuve SE, Rexrode KM, Spiegelman D, et al. Primary prevention of stroke by healthy lifestyle. Circulation. 2008;118(9):947–954. View here
- Kurth T, Moore SC, Gaziano JM, et al. Healthy lifestyle and the risk of stroke in women. Arch Intern Med. 2006;166(13):1403–1409. View here
- King DE, Mainous AG III, Geesey ME. Turning back the clock: adopting a healthy lifestyle in middle age. Am J Med. 2007;120(7):598–603. View here
- Khaw KT, Wareham N, Bingham S, et al. Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study [published correction appears in PLoS Med. 2008;5(3):e70]. PLoS Med. 2008;5(1):e12. View here
- Ford ES, Bergmann MM, Kröger J, et al. Healthy living is the best revenge: findings from the European Prospective Investigation into Cancer and nutrition–Potsdam study. Arch Intern Med. 2009;169(15):1355–1362. View here
- Lee CD, Sui X, Blair SN. Combined effects of cardiorespiratory fitness, not smoking, and normal waist girth on morbidity and mortality in men. Arch Intern Med. 2009;169(22):2096–2101. View here
- Djoussé L, Driver JA, Gaziano JM. Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA. 2009;302(4):394–400. View here
- U.S. Department of Health and Human Services. 2008 physical activity guidelines for Americans. View here.
- Dialogue Partner. View here
- Rollnick S, Miller WR, Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York, NY: Guilford Press; 2008. View here
CNN/Health.com reported, “Millions of Americans already take fish oil to keep their hearts healthy and to treat ailments ranging from arthritis to depression.”
Now a new study appearing in Cancer Epidemiology, Biomarkers & Prevention suggests that fish oil “supplements may also help women lower their risk of breast cancer.”
In fact, “postmenopausal women between the ages of 50 and 76 who took fish oil were … less likely to develop certain types of breast cancer than women who didn’t,” researchers at the Fred Hutchinson Cancer Research Center found.
However, consider this information very preliminary. My friends at the Natural Medicines Comprehensive database say this:
You can read more about the study here.
You can also read my blog on how to take the right kind and amount of fish oil here.
Just in time for the holiday weekend, a recent study has found that putting rosemary, turmeric, or fingerroot on meat before grilling seems to inhibit the production of cancer-causing (carcinogenic) compounds.
Here are the details from HealthDay News: Researchers report that adding certain spices to your burgers before tossing them on the grill this summer will not only add to the flavor of the meat, but they can also cut the risk of cancer long associated with the cooking of beef.
Scientists at Kansas State University (KSU) found that three spices in particular — fingerroot, rosemary and tumeric — seem to direct the greatest amount of antioxidant activity towards preventing the formation of heterocyclic amines (HCAs).
HCAs, they note, are the cancer-causing compounds that are produced when foods such as beef are barbecued, grilled, broiled or fried.
Specifically, the three spices appeared to cut back on HCA production by upwards of 40 percent, the team observed, thereby significantly reducing the HCA-associated risk for developing colorectal, stomach, lung, pancreatic, mammary and prostate cancers.
“Cooked beef tends to develop more HCAs than other kinds of cooked meats such as pork and chicken,” KSU food chemistry professor J. Scott Smith noted in a news release.
“Cooked beef patties appear to be the cooked meat with the highest mutagenic activity and may be the most important source of HCAs in the human diet.”
Therefore Smith and his colleagues looked into the HCA-inhibiting potential of six spices: cumin, coriander seeds, galangal, fingerroot, rosemary and tumeric.
Of all those investigated, rosemary came out on top as the strongest protector against HCA.
The authors suggested that consumers integrate these spices into their menus when appropriate, noting that some, such as rosemary, come in an extract form that has demonstrated HCA inhibition of 61 percent to 79 percent.
They pointed out that spicing allows for the sort of high-temperature cooking (above 352 degrees Farenheit) that is typically recommended for safe grilling, while at the same time blocking the increased HCA production that is known to occur when the flames intensify.
Smith and his team plan further research to see what other marinades and powders might do by way of HCA curtailment — they noted that earlier work has shown that marinating steaks with particular herbs and spices effectively lowers HCA production.
Fish oil (omega-3 fatty acids) have been shown effective in treating high levels of triglycerides and in preventing primary and secondary cardiovascular disease. Now comes a new study showing that the fatty acid found in fish oil (EPA) has shown promise in the prevention of colorectal cancer in patients with familial adenomatous polyposis. The study was a randomized study. Although the study was performed in patients with a genetic predisposition to colorectal cancer, the benefits might also extend to non-inherited, or sporadic, colon cancer. Here are the details from MedPage:
An omega-3 polyunsaturated fatty acid significantly reduced both the number and size of rectal polyps in patients with familial adenomatous polyposis, a randomized trial found.
Six months of treatment with the free fatty acid formulation of eicosapentaenoic acid (EPA) led to a decrease in mean number of polyps from 4.13 at baseline to 3.61, a 12.4% decrease, according to Nicholas J. West, MBBS, of St. Mark’s Hospital in London, and colleagues.
In contrast, six months of placebo treatment resulted in an increase from 4.50 polyps at baseline to 5.05, which represented a 9.7% increase, the researchers reported online in Gut.
Familial adenomatous polyposis is an autosomal dominant disorder in which affected individuals are predisposed to colorectal cancer, and prophylactic removal of the colon is recommended.
In younger patients, the procedure generally undertaken is colectomy with ileorectal anastomosis, but the remnant of rectal tissue remains susceptible, so patients must undergo routine endoscopic surveillance.
In the past, patients also were given chemoprevention with cyclo-oxygenase (COX)-2 inhibitors, but the recognition that these drugs have cardiovascular toxicity limits their long-term use today.
Strong preclinical evidence suggests that certain polyunsaturated fatty acids are active against colorectal cancer, but typical fish oil supplements are associated with adverse effects such as dyspepsia.
So a new, enteric-coated, free fatty acid formulation which is released and absorbed primarily in the small intestine was used to evaluate the potential efficacy of EPA for prevention of colorectal cancer in post-colectomy patients.
A total of 55 adult patients with familial polyposis were randomized to receive 2 g EPA per day or placebo.
After six months the difference between the change in polyp number between the EPA and placebo groups was −1.06 (95% CI −1.78 to −0.35, P=0.005), with an overall decrease of 22.4% (95% CI 5.1 to 39.6%, P=0.012).
In addition, the sum of polyp diameters decreased by 12.6% in the EPA group and increased by 17.2% in the placebo group — an overall difference of 29.8% in polyp size (95% CI 3.6 to 56.1, P=0.027).
Video endoscopy determined that EPA treatment was associated with a modest improvement in the global rectal polyp burden (+0.09), compared to overall worsening with placebo (−0.34). The difference was statistically significant (P=0.011).
There also was a mean 2.6-fold increase in rectal mucosal EPA levels associated with the active treatment.
Two patients in the placebo group withdrew because of abdominal pain, nausea, and rash, while one patient in the EPA group withdrew because of nausea and epigastric discomfort.
The most common adverse event in both groups was diarrhea, which may reflect a post-colectomy lack of physiologic control of fecal water, the investigators suggested.
Nausea was reported by nine patients receiving EPA and by three receiving placebo.
Patients reported no bleeding episodes, and there were no serious adverse events attributable to the treatment.
The antineoplastic activity demonstrated in the study “is almost certainly a combination of regression of existing adenomas and prevention of de novo tumor growth,” the researchers concluded.
Comparison of these findings with those from previous studies of chemoprevention in familial polyposis with the COX-2 inhibitor celecoxib found that the magnitude of effect was “remarkably similar.”
The authors said the data also suggest a role for EPA in chemoprevention of sporadic colorectal neoplasia.
The mechanisms by which EPA inhibits neoplastic activity remain uncertain, although both COX-dependent and COX-independent mechanisms of action have been described, including antioxidant effects and alteration of T cell and colonocyte membrane ‘lipid raft’ functions.
Aside from antineoplastic activity, omega-3 polyunsaturated fatty acids have beneficial cardiovascular and antiplatelet properties.
“Therefore, it is possible that EPA [free fatty acid] treatment may combine [colorectal cancer] chemopreventative efficacy with cardiovascular benefits, which is a particularly attractive therapeutic strategy for middle-to-old age populations relevant to secondary prevention of sporadic colorectal neoplasia,” the investigators asserted.
Readers of this blog know that, in general, I’m in favor of healthcare professionals checking vitamin D levels as part of routine exams. I do this on all adolescents and adults. And, I’ve blogged more on the topic of vitamin D this year than any other topic. So, I’m trying to post less on the topic, but this and the next too blogs were too important not to mention to you.
The subject of this blog is based upon an abstract of an amazing study titled “Vitamin D Supplementation and Cancer Prevention.” It is authored by Thomas L. Lenz, PharmD, and published in the American Journal of Lifestyle Medicine (2009;3:365-368):
It is estimated that approximately 1 billion people worldwide have blood concentrations of vitamin D that are considered suboptimal.
Much research has been conducted over the past 30 years linking low vitamin D serum concentrations to both skeletal and nonskeletal conditions, including several types of cancers, cardiovascular disease, diabetes, upper respiratory tract infections, all-cause mortality, and many others.
Several observational studies and a few prospectively randomized controlled trials have demonstrated that adequate levels of vitamin D can decrease the risk and improve survival rates for several types of cancers including breast, rectum, ovary, prostate, stomach, bladder, esophagus, kidney, lung, pancreas, uterus, non-Hodgkin lymphoma, and multiple myeloma.
Individuals with serum vitamin D concentrations less than 20 ng/mL are considered most at risk, whereas those who achieve levels of 32 to 100 ng/mL are considered to have sufficient serum vitamin D concentrations.
Vitamin D can be obtained from exposure to the sun, through dietary intake, and via supplementation.
Obtaining a total of approximately 4000 IU/d of vitamin D3 from all sources has been shown to achieve serum concentrations considered to be in the sufficient range. However, most individuals will require a dietary supplement of 2000 IU/d of vitamin D3 to achieve sufficient levels as up to 10,000 IU/d is considered safe.
Vitamin D3 is available as an over-the-counter product at most pharmacies and is relatively inexpensive, especially when compared with the demonstrated benefits.
What am I doing in my practice? As mentioned above, I check a vitamin D level as part of my annual exam. I do this on all adolescents and adults.
If the vitamin D level is below 50, I suggest supplementing with vitamin D and rechecking.
I give my patients two options:
- OTC vitamin D, 2000 IU per day, and recheck the level in 4-6 months, or
- Prescription vitamin D, 50,000 IU per week for 12 weeks and then recheck the level.
In my latest book, 10 Essentials of Happy, Healthy People, I teach people how to utilize these ten essentials that are necessary to live a happy and highly healthy life. Under The Essential of Self-Care, teach what I call “The 10 Commandments of Preventive Medicine. Here’s the seventh installment of this ten-part series. Continue reading
In my latest book, 10 Essentials of Happy, Healthy People, I teach people how to utilize these ten essentials that are necessary to live a happy and highly healthy life. Under The Essential of Self-Care, teach what I call “The 10 Commandments of Preventive Medicine. Here’s the sixth installment of this ten-part series. Continue reading
Looking for ways to cut your risk of developing cancer? Here’s a list of 10 diet and activity recommendations highlighted this week in Chicago at the annual meeting of the American Dietetic Association (ADA) that can dramatically reduce your risk of developing cancer.
More Information: Continue reading