Ian Gawler Blog: Research, daily life and cancer

Groups, mushrooms, CD47, surgeons, PSA tests, mistletoe and coconut oil.
What do they have in common? They all feature in important research that throws light on what might make for a good choice if you or someone you love has cancer – or wants to avoid it. So this week, some compelling reading that just might help to save a life.

Plus Ruth and I start our tour of New Zealand next week, so more details of the talks and retreats, but first

Thought for the day
If I die
I want to be the healthiest person ever to die of this disease
                           One of the women in my Friday cancer group

Yes, that dot in the middle is me speaking at the Happiness and its Causes Conference in Perth last week; some highlights next week.

1. Attending a therapeutic group halves the risk of recurrence and the risk of dying from breast cancer
This study is a few years old now, but very significant all the same.

After a median of 11 years of follow-up, this study involving 227 women showed that those women provided with a psychological intervention via small groups that included strategies to reduce stress, improve mood and alter health behaviours, were found to have around halved the risk of both breast cancer recurrence (hazards ratio [HR] of 0.55; P=.034) and death from breast cancer (HR of 0.44; P=.016).

Follow-up analyses also demonstrated that women in the groups had a 50% reduced risk of death from all causes (HR of 0.51; P=.028) during the time of the study.
The authors concluded that psychological interventions can improve breast cancer survival.

Reference: Andersen BL et al, Psychologic Intervention Improves Survival for Breast Cancer Patients - A Randomized Clinical Trial.  Cancer. 2008; 113:3450-3458

2. Psychological and behavioural variables can have profound effects on cancer. 
In a related study, a meta-analysis (analysis of a large number of studies) revealed stress-related psychosocial factors to be associated with a higher cancer incidence in initially healthy people, poorer survival in patients diagnosed with cancer, and higher cancer mortality.1

Reference: Chida Y, Hamer M, Wardle J, Steptoe A. Do stress-related psychological factors contribute to cancer incidence and survival? Nat Clin Pract Oncol. 2008;5:466–475. [PubMed]

3. CD47: The cancer breakthrough I believe may really happen
Many of those who attend my workshops may remember I have been speaking hopefully of CD47 for some time. Here is an update.

CD47 is a kind of protein that is found on the surface of many cells in the body. It tells circulating immune cells called macrophages not to eat these cells. The body uses the CD47 protein to protect cells that should be protected and to help dispose of cells that are aged or diseased.

Unfortunately, some cells that should be destroyed are not. Researchers at Stanford discovered that nearly every kind of cancer cell has a large amount of CD47 on the cell surface. This protein signal protects the cancer against attack by the body's immune system.

Stanford investigators have discovered if they block the CD47 "don't-eat-me" signal through the use of anti-CD47 antibodies, macrophages will consume and destroy cancer cells. Deadly human cancers have been diminished or eliminated in animal models through the use of anti-CD47 antibody.

For the last year, many people have been working to make clinical trials in humans possible. Stanford is hopeful that the first human clinical trials of anti-CD47 antibody will take place in mid-2014, and clinical trials may also be done in the United Kingdom. Stay tuned; this one just might work!

4. Mushrooms – cook them and reap the rewards!
Some will know that mushrooms have been under something of a cloud (OK – bad pun ) and even on the Gerson banned list. I have never been able to find a satisfying rationale for this avoidance and more recent research indicates that maybe the problem was eating them raw, while cooking them seems quite beneficial.

In 2009 a study of 2,018 women correlated a large decrease of breast cancer in women who consumed common white button mushrooms (Agaricus bisporus). Women in the study who consumed fresh mushrooms daily were 64% less likely to develop breast cancer, while those that combined a mushroom diet with regular green tea consumption reduced their risk of breast cancer by nearly 90%.

Some studies have revealed that raw A. bisporus - along with some other edible mushrooms - contain small amounts of carcinogens. However, this research also noted that when cooked, these compounds were reduced significantly.

Reference: Zhang, M et al;  "Dietary intakes of mushrooms and green tea combine to reduce the risk of breast cancer in Chinese women". International Journal of Cancer 124 (6): 1404–1408.

HERE IS THE INVITATION

Pause,  focus on the scene below,  take a deeper breath or two,  bring yourself into this present moment     :-) 

then read on

Photo taken near the river at the Gawler Foundation's Yarra Valley Living Centre where we conducted the training /retreat with Dr Nimrod Sheinman recently and where Ruth and I will lead next year's pre-Easter retreat Meditation in the Forest

5. Would you travel to save your life? Surgeons and survival
A fairly well kept secret is that when it comes to cancer surgery, particularly the more complex, complicated surgery, your surgeon’s experience levels can drastically affect your chances of long-term survival. This is an excellent thing to know BEFORE you might ever need it. Tell anyone you care for about it!

This proposition has been further validated recently by a well-funded Swedish prospective cohort study in which all patients who underwent eosophagectomy between 1987 and 2005 were followed until 2011.

Results demonstrated that surgeons who performed above the Swedish median number of operations per year had a 20% reduction in mortality. The median number was about 10 operations per year. What that means is that if you had been operated on by a surgeon who was doing more than 10 esophagectomies per year, you would have had a 20% reduction in mortality.

What should we make of this? Seek an experienced surgeon if you need a tricky operation.

Reference: Derogar M et al. Hospital and surgeon volume in relation to survival after esophageal cancer surgery in a population-based study. J Clin Oncol. 2013;31:551-557.

6. Are PSA tests more trouble than they are worth?
Here we go! This is really going Out on a Limb! PSA testing for prostate cancer seems to ignite untold passions in many of those involved, but speaking in The Age recently, health reporter Julia Medew pointed out

“PSA tests are controversial because they can cause "overdiagnosis" of prostate cancer that is so slow-growing it was never going to cause men harm. It is now estimated that for every man thought to be saved by the test, another 12 to 47 will be diagnosed with cancer that will not kill them. Many will have surgery and other interventions that can lead to sexual impotence and incontinence.”

A recent Australian review has called into question one of the major studies that is used to support PSA screening and in doing so, adds more caution to taking that test.

Here is the Abstract of the paper so that if you are interested you have some facts.

Major clinical trials using prostate-specific antigen (PSA) as the screening test to detect localized early-stage prostate cancer and to attempt to change its natural history with early intervention have yielded conflicting interpretations.

The US Prostate, Lung, Colorectal, and Ovarian (US PLCO) cancer screening trial concluded that PSA-based screening conferred no meaningful survival benefit, whereas the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the GOTEBORG clinical trial (GOTEBORG) trials claimed statistically significant life-saving benefits.

These divergent outcomes have not provided physicians with clarity on the best evidence-based treatment. To determine the extent to which these divergent outcomes are clinically meaningful, we evaluated these data and those of a long-term prospective cohort study in the context of the clinically documented harms of androgen deprivation therapy (ADT) (hormone treatment).

We noted the unheralded fact that in both European trials far more patients received hormonal treatment in the control than the prostatectomy arm, whereas hormonal therapy in the US trial was balanced between arms. We examined this imbalance in ADT treatment and prostate cancer–related deaths in the contexts of contamination, stage migration, and attribution of cause of death, all of which impinge on data interpretation.

The ERSPC and GOTEBORG data are compatible with the hypothesis that ADT treatment contributes differentially to an increase in prostate cancer deaths in control patients. If so, the claim of a reduction in prostate cancer deaths in the screened cohort requires reappraisal.

The conventional interpretation that PSA screening and radical treatment intervention are the major contributors to the results of these two studies needs more rigorous scientific scrutiny, as does the role of ADT treatment of nonmetastatic disease.

Reference: Haines I, Miklos G et al; Prostate-Specific Antigen Screening Trials and Prostate Cancer Deaths: The Androgen Deprivation Connection JNCI J Natl Cancer Inst, Vol 105; 20, 1534-1539.


To read The Age report: CLICK HERE: 

7. Mistletoe doubles survival in advanced pancreatic cancer
Advanced pancreatic cancer is a tough disease and while over the years I have seen a number of people actually survive for long periods following our approach, often the side-effects of any medical treatments are outweighed by any benefits. This then is an interesting study as although the times were still disappointingly short, the mistletoe injections almost doubled survival. Also, mistletoe has been one of those controversial treatments often labelled as "alternative", so it is good to see it being evaluates scientifically and that it does seem to have some efficacy.

Abstract: The unfavourable side-effects of late-stage pancreatic cancer treatments call for non-toxic and effective therapeutic approaches. Over 12 months, we compared the overall survival (OS) of patients receiving an extract of Viscum album Mistletoe (VaL) or no antineoplastic therapy.

Findings: We present the first interim analysis, including data from 220 patients. Patients in both groups received best supportive care. Median OS was 4.8 for VaL and 2.7 months for control patients (prognosis-adjusted hazard ratio, HR = 0.49; p < 0.0001). Within the ‘good’ prognosis subgroup, median OS was 6.6 versus 3.2 months (HR = 0.43; p < 0.0001), within the ‘poor’ prognosis subgroup, it was 3.4 versus 2.0 months respectively (HR = 0.55; p = 0.0031). No VaL-related adverse events were observed.

Conclusion: VaL therapy showed a significant and clinically relevant prolongation of OS. The study findings suggest VaL to be a non-toxic and effective second-line therapy that offers a prolongation of OS as well as less disease-related symptoms for patients with locally advanced or metastatic pancreatic cancer.

Reference: Tro ̈ger W. et al., Viscum album [L.] extract therapy in patients with locally advanced or metastatic pancreatic cancer: A randomised clinical trial on overall survival, Eur J Cancer (2013), http://dx.doi.org/10.1016/j.ejca.2013.06.043
 

RELATED BLOGS
Let your food be your medicine - more dietary research

Multi-vitamins and cancer

Who needs prostate surgery?

NEWS UPDATE
I am being asked in workshops why coconut oil melts at room temperature, around 22 -24C, yet Prof George Jelinek in his guest blog on coconut oil (Coconut oil- are you nuts?) says the simple, obvious reason not to use coconut oil is that it contains saturated fats that are solid at body temperature - 37C.

At first glance this may seem confusing, but here is the detail, and again, I quote George:

The explanation for this melting point of the oil is pretty simple. Coconut oil is a complex mixture of fats; while 88.7% is saturated fat, there are also mono- and poly-unsaturated fats in the oil, as with other oils.

So the melting point of the oil depends on the relative proportions of the various fats making up the oil, and is lower than the individual melting points of the saturated fats referred to in the blog because of the lower melting points of some of the other shorter chain saturated fats, mono-unsaturated fats, and poly-unsaturated fats.

However, coconut oil does not get absorbed whole, but rather as the individual fatty acids, and it is the melting point of each of those individual fatty acids that is the important factor when they are incorporated into cell membranes.

By way of example, butter melts at 32-35C despite being composed of 63% saturated fats, most of them with melting points higher than body temperature, yet no-one would recommend it for good health.

NOTICEBOARD
Ruth and I will be presenting a range of public talks, workshops and retreats around New Zealand
in November/December.

There are a range of events in Auckland, Rotorua, Christchurch and Nelson.

We are delighted to be including our first meditation retreat in New Zealand (which quite a few Aussies have also booked for already!) - December 2 -8.

Please do let anyone you may know in NZ about the visit -  all the details are on my new public Facebook page: Dr Ian Gawler,    or the website.

Coconut oil - are you nuts?

Is coconut oil safe? What if something you believed to be true was incorrect? I love being constructively challenged, and recently have had a series of passionate people object to me stating in workshops that coconut oil is best avoided.

So I thought it best to go to the Oracle, the best informed expert on things fatty I know, my old friend and colleague Professor George Jelinek, author of Overcoming Multiple Sclerosis and Recovering from Multiple Sclerosis. George also has a terrific website: overcomingmultiplesclerosis.org

Also this week, more important meat research, along with news of the coming Melbourne workshops and an important message for those already booked for Meditation in the Desert, but first

Thought for the day
The human mind is not capable of grasping the Universe.
We are like a little child entering a huge library  .....
The child knows that someone must have written those books.
It does not know who or how
                                        Albert Einstein: cited in The Next Thousand Years by A Berry

So here is George’s guest blog answering the question: Is coconut oil safe?

Bhoy oh Bhoy! Is coconut oil the next big thing?

I love Danny Bhoy. I saw his ‘Dear Epson...’ comedy show in Melbourne on Thursday. Danny Bhoy is endearing and very funny. But he is also perceptive. His show is about letters he has written to companies that have misled him with their claims.

Like Clinique with its ‘Aging Reversal Cream’ that he smothered on from head to toe trying to get back from his 39 years to being a teenager. The packet did say ‘clinically proven’ after all, and he was as excited as a puppy about being young again.

This led him to the story of one drunken night as a young man when he fell asleep (read lost consciousness) and woke to find his cat had peed on his head. Realising many years later that he had retained a full head of hair, he felt that is was evidently clinically proven that cat pee prevents baldness!

This started an old scientist in the audience, namely me, thinking about the latest claims for coconut oil, after reading a recent testimonial that said ‘Coconut oil assists with a whole host of ailments from parasites, atherosclerosis, cholesterol, HIV, digestive and nutrient absorption disorders to heart disease; you name it, it helps.’

I have to say when reading this I could not help but think of the cat pee. In medicine, we use a hierarchy of evidence to determine whether something works or not in disease in humans. Suffice to say, the reason there is a lot of debate about coconut oil is that there is not a lot of evidence; if there was, there would be no need for debate.

In the absence of high quality evidence from clinical trials, it is wise to look at the chemistry of what is going on when eating various fatty foods to see if there is a problem with coconut oil. Not widely known or acknowledged is that the major issue with dietary fats is their melting points.

Fatty acids are the building blocks of the membranes, or outer envelopes, of our bodily cells. The composition of our membranes mirrors exactly our dietary patterns of fatty acid intake. Saturated fats, mostly found in meat, typically have high melting points; this is easy to see when you put a chop on the barbecue and the fat only melts when the temperature is really high. When it cools down again, the fat is solid, white and sticky.

So if we eat principally saturated fats, our cell membranes end up hard and sticky. This is a real problem. Most common Western diseases reflect these hard, sticky, brittle properties of cell membranes; think clots in the heart, high blood pressure from hard arteries, strokes and deep venous thrombosis.

Unsaturated fats, including the monounsaturated fats like olive oil, and the polyunsaturated fats like fish and vegetable oils, have lower melting points. You can see that they are liquid at room temperature. Membranes containing these fats are soft, pliable and non-sticky; we know that populations where these fats predominate in the diet have low rates of the common Western diseases.

So the key issue is whether the melting point (MP) of the fat we eat is below that of body temperature (37C); if the MP is below 37C, the fatty acid will be liquid and behave that way in cell membranes. We also know that with saturated fats, the shorter the fatty acid chain, the lower the melting point.

Many who promote coconut oil say that it is composed primarily of medium-short-chain fatty acids, and thus has a totally different effect on the body from typical long chain fatty acids.

So what fats are in coconut oil? Well, we know that one third of raw coconut flesh is made of fat. That fat is 88.7% saturated fat. What are the components of that saturated fat? Well, lauric acid (12 carbon chain) makes up exactly 50%: it has a MP of 44.2C; myristic acid (14 carbon chain) makes up 20%: it has a MP of 53.9C; palmitic acid (16 carbon chain) makes up 10%: it has a MP of 63.1C (see www.netrition.com). Hmmm....

So is coconut oil safe? I guess I could use the logic of Danny Bhoy’s cat, and say that, having not eaten coconut products at all in the 14 years since my diagnosis of multiple sclerosis (MS), and having had no relapses or deterioration of any sort since, not eating coconut products is clinically proven to protect you from the effects of MS; or I could say that my reading of the scientific literature, which kept me away from these products, as well as other saturated fats, in the absence of better evidence provides enough rationale for me to avoid coconut and its oil. That, among many other health decisions I took, have combined to keep me well. Decide for yourself if you think taking coconut oil is worth the risk.

Many thanks George, I think I will stick to the flax seed oil along with some olive oil,; and I will continue to suggest avoiding coconut oil.

NEWS
1. Meditation in the Desert – Who are you?
A couple of people have recently paid to attend this retreat by Bank transfer without leaving any details of who they are! If you have paid and received a receipt, no problem. If you have paid and not heard from us, we do not know who you are!! So please email Angela at info@insighthealth.com.au and make contact.

2. Melbourne Workshops approaching rapidly, booking soon recommended.

Saturday May 11th : Meditation and the Power of the Mind
Sunday May 12th : Living Well, Being Well

Bring the family, invite a friend or two, inform your colleagues!
Also, maybe you know someone living in Melbourne who would benefit/like to attend.
For full details and to book, LINK HERE

3. Interview with Verity James
Recently In Perth, I was interviewed as part of a fundraising event for the Cancer Support WA group and the WA launch of my new edition of You Can Conquer Cancer. Verity James is a well-known and much loved WA identity, having been a long-term presenter for ABC radio and contributing to many community events. I very much enjoyed interviews with her in days gone by, and for this event she conducted a lengthy interview/ conversation with me that some may find worth a listen. Click here.

4. Eating meat - more than a mouthful.
In the new edition of You Can Conquer Cancer, I point out that one reason meat consumption is not so healthy as plant based proteins is due to the metabolic products contained in meat and produced by the digestion of meat.

According to a recent study, people who eat meat produce more artery-clogging  by-products than people who follow vegan and vegetarian diets. Researchers followed 2,595 heart patients and categorized them as omnivores, vegans, or vegetarians and found that those who consumed the most carnitine, present in animal products, increased their risk for heart disease by producing more artery-clogging metabolites.

This study lends insight into other components of meat products, besides saturated fat and cholesterol, that may elevate the risk of heart disease.

Koeth RA, et al. Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med. Published online April 7, 2013.