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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Other findings in the report include:

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

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

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

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

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

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

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

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

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

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

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

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

These are the main recommendations:

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

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

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

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

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

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

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

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

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

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

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

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

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

This research is important for several reasons:

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