Free Radicals, Aging and Small Hairless Creatures
I’m accused of many things.
Apart from the oft-repeated falsehood that I was the inspiration for Hugh Laurie’s brilliant characterization of the cranky Dr. Gregory House (I definitely was not!), I have been accused of having a fixation with mole rats. Well, that one is partly true: they are fascinating little creatures.
But let me start at the beginning. Over the last three decades, free radicals have entered the national vocabulary. In the 1983 James Bond movie, Never Say Never Again Edward Fox orders Sean Connery to enroll in a health clinic in order to "eliminate all those free radicals."
Free radicals are found in nature: they can be derived from combustion and some other chemical reactions and they are generated in the atmosphere by the action of ultraviolet radiation with chlorofluorocarbons. But most found in the human body don’t come from the environment: they are generated by biological processes. The majority are extremely short lived, but a few special types can hang around for hours.
An excess of free radicals has been linked to an array of illnesses, including:
Some cancers
Diabetic vascular disease
Parkinson’s disease
Schizophrenia
Alzheimer’s disease
Emphysema
Age-related changes in the skin
Macular degeneration
This list just names a few: many other illnesses have been laid at the door of free radicals. You will often see people talking about “oxidative stress,” to describe the damage done by an excess of free radicals. There is a theory that normal aging may be a result of the gradual increase in the production of free radicals in the body
There is something to all this: I did some research on the role of free radicals in diabetic vascular disease in the 1980s, and made some interesting discoveries. It has recently been shown that an excess of free radicals in the wrong place can play a part in generating insulin resistance.
The trouble – as with so many apparently simple ideas – is that many of the popular concepts about free radicals are over-stated or even wrong.
We first have to ask ourselves, “If free radicals are so bad, then why does the body produce them at all?”
The answer is that free radicals play a crucial role in a number of important biological processes, including the killing of bacteria by a group of white cells known as granulocytes. They are also thought to be key cancer killers and prime mediators of normal communication between cells.
Yet they have been pilloried: thought to be the key to so many illnesses when, in fact, they are intimately involved in normal biological processes: if you had no free radicals you would probably die quickly and unpleasantly. We know that because there is a group of rare, fatal illnesses in which children cannot generate free radicals.
Rather than focusing on ways to eliminate free radicals, we should be dealing with ways to balance them.
Our bodies are loaded with sets of enzymes whose task is to mop up excessive numbers of free radicals. The most important of these are superoxide dismutase, glutathione peroxidase, glutathione reductase and catalase.
When you see an advert or article extolling the virtues of some product because it abolishes free radicals or “reactive oxygen,” you know that you are dealing with some nonsensical marketing. Not science.
Fortunately, despite the marketing hype, it’s virtually impossible to obliterate all the free radicals in your body: Some must remain in your system or you will run into all kinds of medical problems.
Let me give you two examples of research that has shown first the good side of a producer of free radicals and second, one of the reasons why we know that there is more to aging than free radicals.
A study from France looked at a dye called mangafodipir that is used in MRI scanning. It was found to increase the cancer-killing ability of some chemotherapy drugs, while at the same time protecting normal cells. Mangafodipir was found to help promote the production of hydrogen peroxide while at the same time, through different biological mechanisms, protecting healthy cells from damage.
The second piece of research concerns my mole rats. I’ve talked about them before. They are extremely long lived: most reach the age of 25-30. And they seem never to get cancer. There are very few species that are spared from cancer: sharks rarely get the disease and there are some simpler organisms that also seem to be spared. So these mole rats have attracted the attention of researchers. What is more, they have very high levels of DNA damaged by oxidation so by rights they should get cancer and age prematurely. The fact that they don’t is leading to a whole new line of thinking about aging and illness.
So the message should be this: oxidative stress may be a factor in illness and aging, but your aim should be to modulate the free radical systems in your body, not to obliterate a key cancer killer.
Eat a diet that is rich in antioxidants
Don’t try and avoid stress: you can’t. Learn to manage it
Take regular physical exercise
Avoid environmental toxins such as smoke, excess sunlight, pesticides and radiation
Acupuncture and Acupressure for Chemotherapy Induced Nausea and Vomiting
During the years that I served on the Research Council for Complementary Medicine, one of the most successful pieces of research that we funded was an investigation by the late Professor John Dundee into the use of acupuncture to treat and to prevent post-operative nausea, and chemotherapy-induced nausea and vomiting.
Those early trials helped us learn a lot about how to do trials in acupuncture, and over the years this work has progressed in a number of enters around the world. The Cochrane Collaboration in Oxford has just published a systematic review of the use of acupuncture and acupressure for the treatment of chemotherapy induced nausea and vomiting. Acupuncture was shown to reduce vomiting on the first day after chemotherapy compared with those who did not receive acupuncture: 22% compared with 33%. Acupuncture did not help with nausea but acupressure did. Though acupressure did not help with vomiting.
This shows once again that acupuncture and acupressure almost certainly work by different mechanisms.
For many years, the department of oncology at the Royal Postgraduate Medical School in London used an array of complementary practices. Not to treat the cancers, but to make it possible for people to tolerate the chemotherapy and radiation therapy.
I recently spoke to a woman who had an illness that would only respond to a certain antibiotic. She was very involved with natural medicine, and did not like taking it. But treatment by world-class homeopaths, naturopaths and acupuncturists had not helped her. My solution was to use the antibiotic, but to also use acupressure, homeopathy, a precisely designed diet and some qigong. With that combination she sailed through the conventional treatment, the organism that was causing her problems has gone, and she has re-built her resilience. That is integrated medicine in action.
Technorati tags: Acupuncture Acupressure Chemotherapy Nausea Vomiting Integrated medicine
What is Your Risk of Developing Breast Cancer?
When I was first practicing in the United States I was stunned when a research coordinator – who was with me as I examined a young woman – complained that it embarrassed her that I asked the patient about breast cancer screening. I had been trained and then practiced for many years in the United Kingdom, where it would have been deemed negligent if I had not asked the question. As I was taught a long time ago, “When you see a patient, man, woman or child, that may be their only contact with a doctor, so take the opportunity to do as much screening and education as you can.” I still take that to be good advice. We have good data that if women did regular breast self-examination and men checked their testicles, that we would each year catch many cancers at the stage when they are still easily treatable.
I was reminded about all this as I read the shocking results of a study that will be coming out in the European Cancer Journal this month.
In a survey of over 10,000 female students from 23 countries, hardly any knew about any of the major risk factors for developing breast cancer. We have obviously done a lousy job a teaching young people about a disease that may in large part be preventable.
This is desperately important. About 30% of illnesses you cannot help: they are the result of genetic mutations, accidents and so on. But 70% of all illnesses are thought to be the result of lifestyle choices.
Breast cancer is a good example. Yes, there are undoubtedly some cases that are largely genetic: genes have been identified in some families that strongly predispose women – and some men – to the disease. But they are uncommon: probably no more than 5-10% of cases. It is likely that the majority of people with the illness do have a genetic predisposition. But the impact of family history is usually small. And remember that biology is not destiny. Lifestyle modification may indeed significantly reduce your risk.
These are the Major Breast Cancer Risk Factors:
1. Age
2. Family history (slight risk)
3. Starting periods at a younger age
4. Late menopause
5. Using hormone replacement therapy
6. Using the contraceptive pill (small)
7. Alcohol
8. Obesity
Please do note that this is not the whole list of risk factors. Perhaps the most comprehensive list is here.
Cutting the Risk:
1. Breastfeed
2. Having several children, and having them young
3. Stay in shape
4. Eat and drink healthily
5. Don’t smoke
The take home message for everyone is this: lifestyle can strongly influence the risk of developing breast cancer. You cannot change everything, but stopping smoking, cutting down on alcohol, reducing weight and taking regular exercise are in the reach of almost everyone.
Technorati tags: Breast cancer Education Risk factors Health screening
How Not to Use Complementary Medicine
There is a report in the British Medical Journal that the Amsterdam Medical Disciplinary Tribunal has struck one doctor from the medical register and suspended two others for their exclusive use of unorthodox approaches in the treatment of a famous Dutch actor and comedian named Sylvia Millecam, who sadly died of breast cancer in 2001 at the age of 45.
After being diagnosed, the patient was recommended to have surgery and chemotherapy, but instead sought unorthodox treatment. Although the patient wanted this type of treatment, the legal case was that the doctors failed to give a reasonable assessment of the chance that their treatments would help, or made it clear that the only treatment that had been proven to help the course of the illness is the conventional route. One of the doctors was also judged to have caused her unnecessary suffering by withholding conventional palliative care as she deteriorated.
Not surprisingly, this case has attracted a lot of interest in Europe, where alternative, complementary and integrated approaches to health care are far more commonly used than in the United States. Many alternative practitioners feel that conventional medicine simply “suppresses” the underlying cause of the illness, and that there is no need to use orthodox and unorthodox together.
The approach that I have been advocating for many years is that if the individual warrants it, to use conventional and unconventional approaches together. But to see them as working on different dimensions of the person: what I call integrated medicine, though the term “integrative” is more popular in the United States. There is nothing very integrated about using St. John’s Wort instead of Prozac. That is just an alternative, which may be appropriate for certain individuals. And everything gets tailored to the individual: a man came to see more for acupuncture, but left with a prescription for a medicine. Once the medicine had done its part, some acupuncture was a very helpful adjunct. And there have been many folk where we have worked the other way round: acupuncture or homeopathy, and sometimes also a medicine. Whatever it takes to help people get to where they need to be.
In an ideal world, Ms. Millecam would probably have had surgery, but also psychological and energetic work, and perhaps some other remedies and spiritual counseling to support her through the process. Would it have enabled her to live longer? Perhaps, but the point is that the integrated approach would have aimed to help her quality of life and to help her to find the meaning and purpose of what she was going through.
She may have declined all this, but the problem was that enthusiastic doctors were using their approaches in place of regular evidence based medicine, without making it clear to Ms. Millecam what she was letting herself in for. Yes, a mentally competent individual has the right to decide whether or not to have a course of treatment, but he or she must be given all the options, so that he or she can make an informed decision. It was all rather sad and probably avoidable.
Technorati tags:integrated medicine
Sheryl, Lance and Kylie
I was very sorry indeed to hear that the amazingly gifted singer Sheryl Crow, who is only 43 years old, is facing a challenge with cancer. She is, of course, by no means the first. Cancer is not something that just hits the older people in the population. Two recent examples: Lance Armstrong who even now, after years of treatment and triumph is only 34, and Kylie Minogue, who is 37. Those two are apparently doing very well indeed, and have used their celebrity to publicize the importance of health screening and of looking at all the options in treatment.
Because of the kind of work that I do, I know of many other well-known people who have dealt with similar problems, and are doing extremely well, but who have chosen to maintain their privacy. Most forms of cancer are no longer the death sentence that they once were.
For more than two decades, I have been heavily identified with holistic medicine, which has gone through more names than the artist formerly known as Prince: alternative, complementary, integrative and integrated. So people are often surprised that I am also an expert in conventional medicine. “After all,” I am asked, “If integrated medicine is so great, then why bother with conventional medicine at all?” The answer is that the best way to treat anyone is by an integrated approach that treats the five principle dimensions of a person: physical, psychological, social, subtle and spiritual.
I regularly receive mailings from people and organizations claiming that they can cure all types of cancer using all sorts of unusual approaches, from nutrition to detoxifications and methods for getting rid of parasites. I have never recommended these approaches because the evidence is so flimsy, and we have data to show that there are indeed treatments that can improve survival and quality of life. But what I am very keen on is using conventional treatment as well as these less orthodox approaches, which are precisely tailored to the individual.
The United States Department of Health and Human Services has Task Forces that make screening recommendations, and I thought that it would be a good idea to make a note of some of their recommendations:
- Breast Cancer: Mammography every 1-2 years over age 40. Interestingly, the Task Forces don’t recommend routine breast self-examination, although many European countries do.
- Cervical Cancer: Screening every three years after age 21 or after becoming sexual active.
- Colon Cancer: “Regular” screening for everyone over age 50
- Prostate Cancer: They do not recommend routine PSA screening, but certainly clinical examination.
All of these recommendations get ramped up if an individual has a family history of a specific cancer and breast and colon cancer screening should start earlier in African Americans.
So I wish the very best to Sheryl, Lance and Kylie. And if you have been following my posts about spirituality and healing, it is, I think, highly likely that if enough of us think kindly of them, it will help them heal.
Technorati Tags: Sheryl Crow, cancer screenings, breast cancer
The Four Percent Solution
In this week’s edition of the Journal of the American Medical Association, is a study of 11,701 American over the age of 50, who participated in a national health survey in 1998 funded by the National Institute on Aging. The researchers analyzed participants’ outcomes during a four- year follow-up and examined the health characteristics that seemed to predict death within four years.
These were the questions that were asked, and this is a bit like golf: you want to have the lowest score possible. Zero would be best. The score is supposed to tell you your chance of dying within the next four years.
1. Age: 60-64 years old = 1 point; 65-69 = 2 points; 70-74 = 3 points; 75-79 = 4 points; 80-84 = 5 points; 85 and older = 7 points.
2. Male or Female: Male = 2 points.
3. Body-Mass Index: Less than 25 (normal weight or less) = 1 point. (BMI = weight in pounds divided by height in inches squared, multiplied by 703.)
4. Diabetes: 2 points.
5. Cancer (excluding minor skin cancers): 2 points.
6. Chronic lung disease that limits activities or requires oxygen use at home: 2 points.
7. Congestive heart failure: 2 points.
8. Cigarette smoking in the past week: 2 points.
9. Difficulty bathing/showering because of a health or memory problem: 2 points.
10. Difficulty managing money, paying bills, keeping track of expenses because of a health or memory problem: 2 points.
11. Difficulty walking several blocks because of a health problem: 2 points.
12. Difficulty pushing or pulling large objects like a living room chair because of a health problem: 1 point.
Score:
- 0 to 5 points = less than a 4 percent risk of dying;
- 6-9 points = 15 percent risk;
- 10-13 points = 42 percent risk;
- 14 or more points = 64 percent risk.
So what should we make of this?
The first thing is that the study is just looking at the physical aspect of life. It asks nothing about diet or family history. It also says nothing about psychological and spiritual factors that can buttress health and well-being.
So what should it mean if somebody gets a high score? Does it mean that they should expect the end and stop reading long novels? Absolutely not! A high score should be a very good indicator that you should have a talk with your health care provider and get to work on all the reversible factors on the list. And as I have pointed out before, a positive psychological outlook and regular spiritual practice have been shown to extend the length and quality of your life.
It is not given to us to know the length of our lives and plenty of people live on and on despite breaking all the rules while others die young despite a lifetime of temperance. I had an aunt who smoked heavily throughout her adult life, yet lived to be well over ninety, while one of my former students died of lung cancer in his thirties, having never smoked a single cigarette.
Genes and lifestyle are important in determining our life span, but so are the quality and integrity of our relationships, our own sense of meaning and purpose, the clarity of the subtle systems of the body and our spirituality.
So use this study not as a death sentence, but as a wake-up call.
Technorati tags: health quiz, aging, longevity
Mapping the Genes of Disease
Many of us have been wondering if the so-called genetic revolution is ever going to bear fruit? When are we going to see some practical benefit from billions of dollars and the years of research by thousands of scientists?
On December 13th 2005, Dr. Francis Collins, the head of the National Institutes of Health’s Genetics Program, announced a bold $100 million pilot project to try to begin to unravel the genetic makeup of some common cancers. The plan is to try and speed the understanding of the diseases, so that new treatments may be developed.
We have already discovered numerous genes that can play a role in initiating cancer: in causing a cell to become malignant, to keep it growing and then to spread. Some tumors run in families, but many do not. And even in families with strong histories of cancer, it is by no means inevitable that an individual will develop the disease. As I have said many times, "biology is not destiny."
This new program is to be applauded: understanding the genetic component of cancer is an essential step toward better treatment, but it is equally important to recognize that an understanding of the biochemistry of the disease is but one aspect of understanding it. We also need to consider environmental and psychological factors, which all come into play. I have known some of the more militant geneticists who insist that the whole of human health and wellness will be comprehensible in terms of genes: why some people smoke all their lives and do not get lung cancer, while some non-smokers die of the disease in the forties. Or why some people have high-risk cancer genes, but that these are balanced by genes that endow them with a robust psyche that prevents them from succumbing to the disease.
I have had endless discussions with some, and although I respect their position, I think that they have only half of the answer. One of the big breakthroughs in recent years has been the understanding that genes in the brain do not so much determine your personality, but instead they give you a predisposition to how you react to changes in your environment. Genes are a lot less fixed than we used to be taught.
So this initiative is great, but don’t think that it is going to come up with all the answers.
For this we also need to be aware of the psychological, social, subtle and spiritual aspects of illness. For it is by considering all of these and understanding that illness has meaning and purpose for us, that we can achieve health and healing.
Technorati tags: genetics, cancer, healing and meaning
