Your Genetics And Your Life

“Heart attack? I’m not going to stop eating bacon! My grand pappy ate bacon three times a day, everyday, and he died of natural causes at the ripe ole’ age of a’ hundred and three.” We’ve all heard this or something like it before. A lot of people seem to stake their long-term health on family genetics and dumb down the importance of their environment, nutrition, and exercise habits.

A new article by Gina Kolata of The New York Times takes a look at how genetics affects our overall health and lifespan. The information will surprise you, it seems people’s cavalier attitude about family genetics and individual health is a little unfounded:
Life span is determined by such a complex mix of events that there is no accurate predicting for individuals. The factors include genetic predispositions, disease, nutrition, a woman’s health during pregnancy, subtle injuries and accidents and simply chance events, like a randomly occurring mutation in a gene of a cell that ultimately leads to cancer.


The result is that old people can appear to be struck down for many reasons, or for what looks like almost no reason at all, just chance. Some may be more vulnerable than others, and over all, it is clear that the most fragile are likely to die first. But there are still those among the fragile who somehow live on and on. And there are seemingly healthy people who die suddenly.

Some diseases, like early onset Alzheimer’s and early onset heart disease, are more linked to family histories than others, like most cancers and Parkinson’s disease. But predisposition is not a guarantee that an individual will develop the disease. Most, in fact, do not get the disease they are predisposed to. And even getting the disease does not mean a person will die of it.
Apparently genetics can still leave you at risk for certain diseases, but it isn’t a slam dunk:
Yet even diseases commonly thought to be strongly inherited, like many cancers, are not, researchers found. In a paper in The New England Journal of Medicine in 2000, Dr. Paul Lichtenstein of the Karolinska Institute in Stockholm and his colleagues analyzed cancer rates in 44,788 pairs of Nordic twins. They found that only a few cancers—breast, prostate and colorectal—had a noticeable genetic component. And it was not much. If one identical twin got one of those cancers, the chance that the other twin would get it was generally less than 15 percent, about five times the risk for the average person but not a very big risk over all.


Looked at one way, the data say that genes can determine cancer risk. But viewed another way, the data say that the risk for an identical twin of a cancer patient is not even close to 100 percent, as it would be if genes completely determined who would get the disease.
Earlier in Kolata’s article she mentions that decades ago people were more inclined to believe environment factors, eating right, exercising, and quality medical care most strongly influenced long-term health. I think Dr. Fuhrman would agree. Check out this from Eat to Live:
Both patients and physicians act as though everyone’s medical problems are genetic, or assumed to be the normal consequence of aging. They believe that chronic illness is just what we all must expect. Unfortunately, the medical-pharmaceutical business has encouraged people to believe that health problems are hereditary and that we need to swallow poisons to defeat our genes. This is almost always untrue. We all have genetic weaknesses, but those weaknesses never get a chance to express themselves until we abuse our body with many, many years of mistreatment. Never forget, 99 percent of your genes are programmed to keep you healthy. The problem is that we never let them do their job.
Most chronic illnesses have been earned from a lifetime of inferior nutrition, which eventually results in abnormal function or frequent discomfort. These illnesses are not beyond our control, they are primarily genetic, and they are not the normal consequence of aging. True, we all have our weakest links governed by genetics; but these links need never reveal themselves unless our health deteriorates. Superior health flows naturally as a result of superior nutrition. Our predisposition to certain illnesses can remain hidden.

Health Points: Wednesday

The Center for Science and the Environment announced in August that drinks manufactured by Coca-Cola and PepsiCo in India contained on average more than 24 times the safe limits of pesticides, which could come from sugar, water and other ingredients.

When those reports appeared on the front pages of newspapers in India, Coke and Pepsi executives were confident that they could handle the situation. But they stumbled.

They underestimated how quickly events would spiral into a nationwide scandal, misjudged the speed with which local politicians would seize on an Indian environmental group’s report to attack their global brands and did not respond swiftly to quell the anxieties of their customers.
This is an especially difficult admission for younger docs who are just starting their practice and I have discovered that part of the maturing process as a physician is to accept that you simply cannot have all the answers. Naturally you should not proclaim ignorance too many times or you would be just plain incompetent. As a specialist, I am also very aware of the fact that I should know "my" area of the body more thoroughly, and that patients have been specifically referred to me because of this knowledge.
The bacteriophage additive was approved for use on ready-to-eat meats, which are normally consumed without additional cooking, said Andrew Zajac, acting director of the division of petition review in the FDA Office of Food Additive Safety.


These foods can become contaminated with listeria when they are made, and because they're not cooked the contaminants won't be killed. The phage product will be sprayed on meats before packaging so that contaminated meats will be purged of listeria before the products reach the consumer.
Hundreds of sixth graders in 42 middle schools will begin taking part in a study sponsored by the National Institutes of Health (NIH). The HEALTHY study will determine if changes in school food services and physical education classes, along with activities that encourage healthy behaviors, lower risk factors for type 2 diabetes, an increasingly common disease in youth. Participating schools will be randomly assigned to a program group, which implements the changes, or to a comparison group, which continues to offer food choices and PE programs typically seen in middle schools across the country. Students in the program group will have healthier choices from the cafeteria and vending machines (e.g., lower fat foods, more fruits and vegetables, and drinks with no added sugar) longer, more intense periods of physical activity, and activities and awareness campaigns that promote long-term healthy behaviors. After 2.5 years, all students will be tested for diabetes risk factors, including blood levels of glucose, insulin, and lipids. They will also be measured for fitness level, blood pressure, height, weight, and waist circumference.
Under the program, the federal government paid $130 each time a chemotherapy provider assessed a Medicare patient's pain, fatigue and nausea. The payments were designed to encourage doctors to report information that might one day lead to improved care for cancer patients.


In a report to be released Wednesday, the inspector general for the Health and Human Services Department cast doubt on whether the money was well-spent. He questioned the integrity of the data that doctors submitted.
What remains baffling to the scientists is "why a sour receptor would come to be." They can explain 'bitter' as our way of avoiding poisonous substances, and 'sweet' as our way of knowing what to eat when we need a boost in energy. But sour??? They still don't know why we would need to detect sour food items.

The Obesity-Disease Connection

In the opening pages of Eat to Live Dr. Fuhrman makes a point that is often overlooked by the average American dieter:
Obesity is not just a cosmetic issue—extra weight leads to an earlier death, as many studies confirm.1 Overweight individuals are more likely to die from all causes, including heart disease and cancer.
Much of Dr. Fuhrman’s work strives to show people the strong correlation between diet and disease. You know the old adage, you are what you eat. Being overweight doesn’t just mean your favorite outfit is a little snug, it means you’re putting yourself at an increased risk of premature death. More from Eat to Live:
Two-thirds of those with weight problems also have hypertension, diabetes, heart disease, or another obesity related condition.2 It is a major cause of early mortality in the United States.3
Health Complications of Obesity
  • Increased overall premature mortality
  • Adult onset diabetes
  • Hypertension
  • Degenerative arthritis
  • Coronary artery disease
  • Cancer
  • Lipid disorders
  • Obstructive sleep apnea
  • Gallstones
  • Fatty infiltration of the liver
  • Restrictive lung disease
  • Gastrointestinal disease
Considering all this, this recent report from The New York Times shouldn’t be all that surprising. New research reveals being obese can make ovarian cancer even deadlier and harder to survive. Nicholas Bakalar explains:
It is well known that obesity is associated with various malignancies, including kidney, throat, breast and colon cancers. Findings about obesity and ovarian cancer have been somewhat less clear, the researchers say, but evidence from previous studies suggests that obesity predicts a worse outcome for ovarian cancer patients as well.


The scientists wanted to know whether excess fat, apart from any other health problems it might cause, had direct effects on tumor growth. They reviewed the medical records of 216 patients at Cedars-Sinai who had surgery for epithelial ovarian cancer. The data included information on height, weight, age and any other diseases. The cause of death was presumed to be cancer related if the patient had advanced recurrent disease at the time of death.

Half the patients had ideal weight, with a body mass index from 18.5 to 24.9, and 8 percent had a B.M.I. of less than 18.5, considered underweight. Twenty-six percent were overweight, with indexes exceeding 25, and 16 percent were obese, with indexes higher than 30.

The overweight and obese differed little from normal and underweight people in age or in health status, except that they had more hypertension and diabetes.

But among patients with Stage III or Stage IV disease, the most advanced stages, those with B.M.I.’s greater than 25 survived disease free for an average of 17 months, compared with 25 months for people with indexes lower than 25.

For each increase of one unit in the index, the researchers found a 4 percent increase in the risk of recurrence and a 5 percent increase in the risk of death.

This “dose response” effect strongly suggests that obesity alone is responsible for the decreased survival time, Dr. Li said.
The results of this research are pretty jarring. It seems like being obese is like dragging around an old refrigerator; it slows you down, makes you uncomfortable, creates its own problems along the way, and makes many other problems worse. Time to ditch the fridge!


Or more importantly what’s in it. Dr. Fuhrman will tell you the typical American diet rich in processed foods, saturated fats, refined sugar, and salt is a one way ticket to obesity, disease, and early death. Back to Eat to Live:
As long as you are eating fatty foods and refined carbohydrates, it is impossible to lose weight healthfully. In fact, this vicious combination of a sedentary lifestyle and eating typical “American” food (high-fat, low-fiber) is the primary reason we have such an incredibly overweight population.
On the other hand he believes the secret to healthy bodyweight, disease prevention, and increased longevity is just the opposite; a plant-based diet comprised of fruits, vegetables, legumes, nuts, and seeds:
There is no longer any question about the importance of fruits and vegetables in our diet. The greater the quantity and assortment of fruits and vegetables consumed, the lower the incidence of heart attacks, strokes, and cancer.4
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Milk: Does It Do A Body Good?

From the January 2005 edition of Dr. Fuhrman’s Healthy Times:

Recent research sheds a very bad light on dairy consumption.

Parkinson’s disease

Recent studies have shown that men who consume more dairy products and who are big milk drinkers have a higher occurrence of Parkinson’s disease.

Honglei Chen, M.D., of Harvard University reported his findings at the annual meeting of the American College of Nutrition (December 2004) and presented a few other studies, one of which was the Parkinson’s Disease Honolulu Study, that showed the same association. The interesting finding was that it was not the fat in milk and dairy that were implicated. Usually, the high saturated fat content of dairy is blamed for its disease risk. But in this case, according to Chen, fat was “out of the picture.” Calcium and added vitamin D also were unrelated. That means something else in dairy is the culprit. The relationship between Parkinson’s and milk consumption has been suspected for decades1 and was first reported by researchers a few years ago. Chen’s and other recent prospective studies have confirmed the earlier, less definitive findings.

Heart disease
A related recent finding is that deaths from heart disease also are strongly associated with milk drinking in adulthood. Of particular interest is that (as is the case with Parkinson’s) the association is with the non-fat portion of milk. Non-fat and skim milk consumption shows the same association as that of whole milk. Researchers found that heart disease death is strongly associated with circulating antibodies against milk. These antibodies are found to bind to human lymphocytes and platelets, thus increasing the likelihood of clot formation. The researchers also concluded that the non-fat aspects of milk have atherogenic effects (plaque-building) both biochemical and immunological, and the simultaneous attack from all these directions explains why milk was found to have such a strong effect on death rate.2

Ovarian cancer
A recent study of 61,000 women found that those who consumed more than 2 glasses of milk per day had twice the risk of serous ovarian cancer than women who consumed fewer than two glasses. The risk of those who drank two glasses a day was double that of women who rarely drank milk.3 Lactose in milk seemed to be the primary culprit. Again this larger study confirms earlier studies with the same findings.
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Some Supplements Have Some Scientific Support

From the January 2006 edition of Dr. Fuhrman’s Healthy Times:

Not all alternative therapeutic approaches are without merit for further investigation!

Although most alternative cancer therapies have proven ineffective at best, some supplements have shown promise. The study of mushroom extracts is a very important area in glycobiology
concerning the beneficial effects of polysaccharides that are found in mushrooms such as maitake, shiitake, and reishi.

This kind of research deserves serious consideration because mushrooms have been demonstrated to hold promise in the prevention and possible treatment of cancer. Initial research in humans has yielded conflicting results. Some studies have tested mushrooms and mushroom extracts on humans with cancer and found no benefits, and other studies have claimed substantial benefits.1 Studies on animals and cell lines indicate a likelihood of some protective effects. Mushrooms are high in selenium and contain a wealth of beneficial phytochemicals. Whether concentrated mushroom extracts are beneficial when added to an excellent anti-cancer diet is still somewhat up in the air. But I would probably err on the side of caution and take the concentrated mushroom extracts since they have shown some benefits.

Modified citrus pectin (MCP), also known as fractionated pectin, is a complex polysaccharide obtained from the peel and pulp of citrus fruits. MCP is rich in galactoside residues, giving it an affinity for certain types of cancer cells. Metastasis is one of the most life threatening aspects of cancer, and the lack of effective anti-metastatic therapies has prompted research on MCP’s effectiveness in blocking metastasis of certain types of cancers, including melanomas and prostate and breast cancers. Citrus pectins have been shown to slow the progression of prostate cancer and are thought to have other beneficial effects on slowing the spread of cancer. The question remains if taking additional supplemental pectin is better than simply eating citrus fruits.

One trial investigated the effect of citrus pectin in thirteen men with prostate cancer and biochemical prostate-specific antigen (PSA) failure after localized treatment (radical prostatectomy, radiation, or cryosurgery). Seven of the men had data that suggested that the PSA doubling time did slow down. This study suggests that MCP may lengthen the PSA Doubling Time in men with recurrent prostate cancer.2 Because the use of MCP has shown some benefit in studies on humans and has lots of benefits demonstrated in mice—such as reduction of tumor size3, it certainly warrants further investigation and use as an adjunct in the treatment protocol for cancer. Continue Reading...
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New England Journal of Medicine: Overweight Contributes to Mortality

Last year some researchers found that being slightly overweight actually lowered the risk of death. Kenneth Chang reports in today's New York Times that two new, larger studies tell a different tale: being even slightly overweight can increase mortality.
The researchers said the more telling analysis arose when they focused on 186,000 healthy men and women who had never smoked. Among men and women, being overweight raised the risk of death 20 percent to 40 percent compared with normal-weight people, the researchers said...

Researchers have almost universally found that obese people have considerable health risks. But there has been debate over whether someone who is less severely overweight is at a greater risk of illness. Other factors, especially smoking, can complicate analysis of the data. Smoking greatly increases the chances of deadly lung diseases, but smokers tend to weigh less.

“No single study is able to solve a controversy of this magnitude,” Dr. Leitzmann said, but he recommended that anyone overweight “should be looking to lose weight.”

A second study by researchers at Yonsei University in Seoul, South Korea, and Johns Hopkins University looked at 1.2 million Koreans ages 30 to 95 and followed them for 12 years. The researchers looked at 82,372 deaths and correlated them with the body mass index. They found, too, that risk of death and cancer increased in people who were overweight, but not obese.
Both studies have been published in the New England Journal of Medicine. You can read both the American and Korean studies online.

As we have blogged about before, Dr. Fuhrman has long been citing the work of Harvard's Dr. I-Min Lee--who studied nearly 20,000 men over nearly thirty years. She found that you practically can not be too thin: the lightest group of men had the lowest mortality. (Of course, he cautions, there is such a thing as being too thin, which is usually anorexia.)

Chemotherapy: Lots of Side Effects

Dr. Fuhrman has written before about our country’s chemotherapy mentality:
Our technologically-advanced society is suffering from the highest rates of cancer ever seen in human history, rates that are also much higher than in less developed parts of the world. Since 1999, cancer has surpassed heart disease and has become the leading cause of age adjusted mortality for Americans younger than 85. Despite more than a hundred billion dollars in cancer research— invested largely in the development of drug chemotherapy and screening and detection techniques—we have lost the war on cancer. While there has been a slight reduction of cancer-related deaths in the last 25 years, this is largely the result of the decrease in lung cancer deaths that has resulted from a reduction in cigarette smoking during this timeframe. Mortality rates for most cancers have stayed remarkably steady.

Chemotherapy has contributed to the progress made against cancer deaths from fast-growing cancers, such as leukemia, lymphoma, testicular cancer, and childhood cancers such as osteogenic sarcoma. But for the major cancers affecting most adult Americans, chemotherapy adds less than one year of disease-free life to those treated.
Here’s more from Dr. Fuhrman’s post:
  • A meta-analysis of chemotherapy for postmenopausal, estrogen receptor-positive women (the largest group of women with breast cancer) pooled the six largest studies to get the most accurate data on survival and complications. Here is what researchers concluded about the group treated with standard chemotherapy: “No significant survival benefit was observed.”1
  • In non-small cell lung cancer (the most common type), the 5- year survival is only about 10 percent. In stage 4, when the cancer has spread to distant sites, the 5-year survival is only 1.6 percent. After looking at multiple studies, it appears that treatment generally results in a very slight improved survival rate at 1 year, but this advantage disappeared at 30 months of follow- up.2
  • Even in small cell lung cancer where chemotherapy has proven effectiveness in life extension, the benefit adds only a few months of life, not years. And during this time the patient can experience serious—even life threatening— side effects from the treatment.
In the last bullet Dr. Fuhrman brings up the issue of side effects, and he’s not alone. A new study in the Journal of the National Cancer Institute shows there are more side effects for using chemotherapy to treat breast cancer than expected. Serena Gordon of HealthDay News reports:
"When we looked at the rates of side effects commonly associated with chemotherapy, we found women experienced more hospitalizations or emergency room visits for these side effects than previous clinical trials would have estimated," said study author Dr. Michael Hassett, a clinical instructor in medicine at the Dana-Farber Cancer Institute, in Boston.
Gordon reports that researchers made some startling discoveries:
The researchers looked at hospitalizations and emergency room visits in the year following the initial diagnosis for both women who received chemotherapy and those who did not.

Women on chemotherapy were much more likely to visit the emergency room or be hospitalized for any cause than women who didn't have chemotherapy -- 61 percent compared to 42 percent.

Fever and infection were the most common causes women were hospitalized or visited the emergency room. Low blood cell counts were the next most common reason, followed by dehydration or an electrolyte imbalance.

Women who received chemotherapy also had more than $1,200 in additional health-care expenditures related to chemotherapy and more than $17,000 in additional costs for ambulatory care than women who didn't receive chemotherapy.
For women diagnosised with breast cancer Dr. Hassett offers this suggestion:
"Hopefully, women with breast cancer who hear about this study will understand that deciding whether or not to have chemotherapy must be made on an individual basis," Hassett said. "Women should talk with their doctors about both the benefits and risks of chemotherapy. For women with small cancers, the benefits may not outweigh the risks. On the other hand, for women with larger or higher-risk cancers, the benefits usually outweigh the risks."
For more of Dr. Fuhrman's thoughts, check out these previous posts: Re-Examining Chemotherapy for Breast Cancer and Chemo: Not Always the Best Option Continue Reading...

The Meat-Disease Connection

Dr. Fuhrman’s position on the consumption of animal products is pretty clear, meat and diary dairy products leads to disease like heart disease and cancer. Even “healthy” choices like fish and chicken put you at risk. Take a look at this section from Eat to Live:
There is a relationship between animal protein and heart disease. For example, plasma apolioprotein B is positively associated with animal-protein intake and inversely associated (lowered) with vegetable-protein intake (e.g., legumes and greens). Apolioprotein B levels correlate strongly with coronary heart disease.1 Unknown to many is that animal proteins have a significant effect on raising cholesterol levels as well, while plant protein lowers it.2

Scientific studies provide evidence that many animal protein’s effect on blood cholesterol may be significant. This is one of the reasons those switching to a low fat-diet do no experience the cholesterol lowering they expect unless they also remove the low-fat animal products as well. Surprising to most people is that yes, even low-fat dairy and skinless white-meat chicken raise cholesterol. I see this regularly in my practice. Many individuals do not see the dramatic drop in cholesterol levels unless they go all the way by cutting all animal proteins from their diet.
According to Dr. Fuhrman white meats are no savior either:
Red met is not the only problem. The consumption of chicken and fish is also linked to colon cancer. A large recent study examined the eating habits of 32,000 adults for six years and then watched the incidence of cancer for these subjects over the next six years. Those who avoided red meat but at white meat regularly had a more than 300 percent increase in colon cancer incidence.3 The same study showed that eating beans, peas, or lentils, at least twice a week was associated with a 50 percent lower risk than never eating these foods.

Chicken has about the same amount of cholesterol as beef, and the production of those potent cancer-causing compounds called heterocyclic amines (HCAs) are even more concentrated in grilled chicken than in beef.4 Another recent study from New Zealand that investigated heterocyclic amines in meat, fish, and chicken found the greatest contributor of HCAs to cancer risk was chicken.5 Likewise, studies indicated that chicken is almost as dangerous as red meat for the heart. Regarding cholesterol, there is no advantage to eating lean white instead of lean red meat.6
The correlation between disease and consumption of animal products seems very clear. Even newer research warns of heighten stomach cancer risk associated with eating processed meats, like sausage, smoked ham, and bacon. Reuters reports:
A review of 15 studies showed the risk of developing stomach cancer rose by 15 to 38 percent if consumption of processed meats increased by 30 grams (1 ounce) per day, the Karolinska Institute said in a statement.
These foods possess cancer-causing additives outside of meat’s normal cancer-causing agents:
The institute said processed meats were often salted or smoked, or had nitrates added to them, in order to extend their shelf-life which could be connected to the increased risk of stomach cancer, the fourth most common type of cancer.
If this information spooked you, you might want to consider Dr. Fuhrman’s advice, “The best bet for overall health is significantly limit or eliminated all types of meat—red and white.”


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Saturated Fat vs. Polyunsaturated Fat

If you’ve read Eat to Live you know Dr. Fuhrman’s position on saturated fat: avoid it. Especially since it leads to heart disease and cancer:
Some naturally occurring fats are called saturated fats because all the carbon are single bonds. These fats are solid at room temperature and are generally recognized as a significant cause of both heart disease and cancer. Saturated fats are found mainly in meat, fowl, eggs, and dairy. Coconut and palm oil are largely saturated and are also not desirable. The foods with the most saturated fat are butter, cream, and cheese.
Another fat Dr. Fuhrman talks about in Eat to Live is polyunsaturated fat, found in many vegetable oils:
These fatty acids have more than double bond in their chain. These fats include corn oil, soybean oil, safflower oil, and sunflower oil. They are soft at room temperature. These fats promote the growth of cancer in lab animals more than olive oil does.
According to the Associated Press a recent study examined the differing effects of consuming polyunsaturated fat and saturated fat. Even though both aren’t exactly health promoting, polyunsaturated fat does appear to be less harmful on the body. Joe Milicia reports:
Saturated fat has long been linked to the buildup of plaque that can lead to heart attacks and strokes. HDL, the "good" cholesterol, protects arteries from the inflammation that leads to artery-clogging plaques. And plaque hurts the ability of arteries to expand to carry blood to tissues and organs.
The researchers, led by Dr. Stephen Nicholls, a cardiologist now at the Cleveland Clinic, found that three hours after eating the saturated-fat cake and shake, the lining of the arteries was hindered from expanding to increase blood flow. And after six hours, the anti-inflammatory qualities of the good cholesterol were reduced.

But the polyunsaturated meal seemed to improve those anti-inflammatory qualities. Also, fewer inflammatory agents were found in the arteries than before the meal.
If you had to choose between the two Dr. Fuhrman would probably advise passing on both. What kind of fats does he recommend? One favorite is DHA:
DHA is a long-chain Omega-3 fat that is made by the body, but it can also be found in fish, such as salmon and sardines. DHA is used in the production of anti-inflammatory mediators that inhibit abnormal immune function and prevents excessive blood clotting. DHA is not considered an essential, because the body can manufacture sufficient amounts if adequate short-chain omega-3 fats are consumed (flax, walnuts, soybeans, leafy green vegetables). However, because of genetic differences in the enzyme activity and because of excess omega-6 fats, many people who do not consume fish regularly are deficient in this important fat.