HORSEMAN #3: CANCER

This week, as promised, I continue to share Dr. Attia’s advice on the four horsemen.? In this article we will explore his thoughts and research on cancer, which he refers to as the runaway cell.? For me this is the most frightening of the four killer chronic diseases because it usually involves lots of pain and suffering.

My mother died of cancer.? She succumbed when she was 57.? It was a painful and terrible experience which changed my life and lead me to a lifelong curiosity about health and disease and ways to live healthier; most probably leading me to Dr. Attia’s work.? I am also sure that most, if not all of you reading this article, know of a friend or family member who has, or has succumbed to, cancer.

As Dr. Attia notes:

“Cancer is the second leading cause of death in the United States, right behind heart disease. Together, they account for almost 50% of American deaths.? The difference is that we understand the genesis and progression of heart disease fairly well, and we have some effective tools with which to prevent and treat it.? As a result, mortality rates from cardiovascular disease and cerebrovascular disease have dropped by two-thirds since the middle of the twentieth century.? But cancer still kills Americans at almost the same rate as it did fifty years ago. …

Cancer, like heart disease, is a disease of aging, i.e., it becomes exponentially more prevalent with each decade of life.? But it can be deadly at almost any age, especially middle age.? The median age of a cancer diagnosis is 66, but in 2017 there were more cancer deaths among people between 45 and 64 than from heart disease, liver disease, and stroke combined.”

CANCER STAGING

Cancer staging is a process that helps doctors understand the extent of cancer in the body, such as how large the tumour is and if it has spread. ?The stage of cancer helps doctors plan the best treatment for you and understand how serious your cancer is.

Most types of cancer have four stages: stage I to IV. Some cancers also have a stage 0. ?Here is a general description of cancer stage groupings:

• Stage 0:???????? Carcinoma in situ, abnormal cells growing in their normal place.
• Stage I: ???????? Cancers are localized to one part of the body.
• Stage II:???????? Cancers are locally advanced.
• Stage III:??????? Cancers are also locally advanced.
• Stage IV:??????? Cancers have spread to other organs or throughout the body.

The big problem is our ability to detect cancer at an early stage remains very weak and by the time it’s detected it has probably already been progressing for years and possibly decades.? We discover tumours only when they cause other symptoms, by which time they are too advanced to be removed or have already spread (metastasized) to other parts of the body and at this stage, we lack effective treatments.

The following summarises the options available today:

• Many (though not all) solid tumours can be removed surgically. ?Combining surgery and radiation therapy is effective against most local, solid-tumour cancers.
• Surgery is of limited value when cancer has spread. ?Metastatic cancers can be slowed by chemotherapy, but they virtually always come back, often more resistant to treatment than ever.

WHAT IS CANCER

Dr. Attia advises that cancer cells are different from normal cells in two important ways:

• “They don’t grow faster than their noncancerous counterparts; they just don’t stop growing when they are supposed to.? They stop listening to the body’s signals that tell them when to grow and when to stop growing.

• “They metastasize, travel from one part of the body to a distant site where they should not be, enabling a cancerous cell in the breast to spread to the lung.? This spreading is what turns a cancer from a local, manageable problem to a fatal, systemic disease.? Therefore, even when we treat a local cancer successfully, we can never be sure that it’s entirely gone.? We have no way of knowing whether cancer cells may have already spread….? It is this metastatic cancer that is responsible for most cancer deaths.”

Unfortunately, the medical profession does not know what causes cancer to spread. The other major hurdle to finding a cure for cancer is that, as Dr. Attia advises:

“… cancer is not one single, simple, straightforward disease, but a condition with mind-boggling complexity….? No two cancer cells are alike—each tumour has more than 100 different mutations, on average, and those mutations appear to be random.”?

CHEMOTHERAPY

The primary flaw of modern chemotherapy is that it is still not specific enough to target only cancerous cells and not normal healthy cells.? Hence the horrible side effects patients suffer.

Once the cancer spreads, surgical removal of the tumour will not solve the problem.? Dr. Attia notes:

“We need to treat metastatic cancers systemically rather than locally.? …We must use chemicals to kill the cancer cells, which is easy.? The problem is that these poisons will also kill every normal cell in between, killing the patient in the process. The game is won by killing cancers while sparing the normal cells.? Selective killing is the key.

But this is the primary flaw of modern chemotherapy:? It is systemic, but still not specific enough to target only cancerous cells and not normal healthy cells.? Hence the horrible side effects patients suffer.? Also, those cancer cells that do manage to survive chemotherapy often end up acquiring mutations that make them stronger, like cockroaches that develop resistance to insecticides. …

Ultimately, successful treatments will need to be both systemic and specific to a particular cancer type.? They will be able to exploit some weakness that is unique to cancer cells, while largely sparing normal cells (and, obviously, the patient).? But what might those weaknesses be?”

CANCER METABOLISM

Dr. Attia notes that there are two qualities of cancer that may lead to new treatments:

1. “Many cancer cells have an altered metabolism, consuming huge amounts of glucose—they devour it at up to forty times the rate of healthy tissues.
2. They seem to have an uncanny ability to evade the immune system, which normally hunts down damaged and dangerous cells—such as cancerous cells—and targets them for destruction.”

Cancer cells fuel their own proliferation by consuming glucose, as opposed to the more normal and efficient oxygen, turning the same amount of glucose into a little bit of energy and a whole lot of chemical building blocks—which are then used to build new cells rapidly.

THE LINK BETWEEN CANCER AND METABOLIC DYSFUNCTION?

Obesity and type 2 diabetes seem to be driving increased risk for many types of cancers, including oesophageal, liver, and pancreatic cancer.? Excess weight is a leading risk factor for both cancer cases and deaths, second only to smoking.

Dr. Attia points out that:

“In the 1990s and early 2000s, as rates of smoking and smoking-related cancers declined, a new threat emerged to take the place of tobacco smoke. ?Obesity and type 2 diabetes were snowballing into national and then global epidemics, and they seemed to be driving increased risk for many types of cancers, including oesophageal, liver, and pancreatic cancer.? The American Cancer Society reports that excess weight is a leading risk factor for both cancer cases and deaths, second only to smoking.

Metabolic therapies, including dietary manipulations that lower insulin levels, could potentially help slow the growth of some cancers and reduce cancer risk.

Globally, about 12% to 13% of all cancer cases are thought to be attributable to obesity.? Obesity itself is strongly associated with 13 different types of cancers, including pancreatic, oesophageal, renal, ovarian, and breast cancers, as well as multiple myeloma.? Type 2 diabetes also increases the risk of certain cancers, by as much as double in some cases (such as pancreatic and endometrial cancers).? And extreme obesity (Body Mass Index (BMI) ≥ 40) is associated with a 52% greater risk of death from all cancers in men, and 62% in women.

I suspect that the association between obesity, diabetes, and cancer is primarily driven by inflammation and growth factors such as insulin.? Obesity, especially when accompanied by accumulation of visceral fat … helps promote inflammation, as dying fat cells secrete an array of inflammatory cytokines into the circulation.? This chronic inflammation helps create an environment that could induce cells to become cancerous.? It also contributes to the development of insulin resistance, causing insulin levels to creep upwards.”

Therefore, metabolic therapies, including dietary manipulations that lower insulin levels, could potentially help slow the growth of some cancers and reduce cancer risk.

As Dr. Attia advises:

“We don’t want to be anywhere on that spectrum of insulin resistance to type 2 diabetes, where our cancer risk is clearly elevated.? To me, this is the low-hanging fruit of cancer prevention, right up there with quitting smoking. ?Getting our metabolic health in order is essential to our anticancer strategy.”

Next week I will share Dr. Attia’s research and advice on the promise of new treatments and the importance of early detection in the fight against this killer.? Again, I strongly urge you to read Outlive and I hope that these excerpts will help convince you to do so.

Have a disciplined week as you work to build your financial freedom and improve your health span.? If you find this advice helpful, please share with your friends and colleagues.? As usual, I look forward to your questions and comments.? Be safe.? Take good care, and if you can, help someone in need.

Cheers, Nigel

Nigel Romano, Senior Director, Moore Trinidad & Tobago, Chartered Accountants