Cancer Is Not a Disease

Warning: this satirical post may be offensive to the cancerous or people that you love, who may happen to be cancerous[1]. It is loosely based on David Katz’s perspective on obesity, published in Nature Outlook – no offence! CANCER IS NOT A DISEASE The misguided urge to pathologize this condition reflects society’s failure to come to terms with the need for prevention The World Health Organisation has long declared cancer to be a disease. This well-intentioned move is misguided in that it implies that tens of millions of people must have bodies or minds, or both, that are not working properly. Even seemingly healthy people— adults and children alike —, who may well harbour cancerous cells in them, are now, by definition, diseased. Imposing such a status has broad ramifications for society and requires careful reflection. The standard definition of cancer is that of having cells in your body that divide without control and are able to invade other tissues. These cancerous cells are associated with an increased risk of illness, disability and death. However, a risk factor is not a disease, because each can occur independently of the other. Cancer is an important contributor to the prevailing burden of chronic disease, lying on the causal pathway to much of what plagues modern society and its people — cachexia and organ failure to name two of the most serious [2]. However, not only can these problems develop in the absence of cancer, but not everyone with cancerous cells in them develops any such condition [3]. The categorization of cancer as a disease could have a pernicious influence on efforts to remedy the problem at its true origins [4]. The treatment of diseases customarily involves drugs, medical technology, clinic visits and surgical procedures. If cancer is a disease, the therapeutic advances on which its management depends presumably reside in these domains. MALIGNANT COSTS The disease approach would impose substantial costs. Cancers affect many tens of millions of adults and children in the United States alone [5]. If we were now to conclude that all these individuals warrant disease treatment, the collective need for drugs and cancer surgery would be staggering. That would mean not only a huge financial outlay, but the imposition of a vast array of side effects on the cancerous population. Even the best of drugs are prone to side effects, and to date, cancer management has been forced to… Read More »

We Don’t Know Much About Obesity

“For a condition as prevalent and dangerous as obesity, we know surprisingly little about its causes and cures.“ This is the first sentence by Nature Outlook Editor Tony Scully, in a special edition dedicated entirely to obesity. The volume features both articles by science writers as well as a selection of original contributions on topics ranging from AgRP and the FTO gene to food addiction and the microbiome. This edition also features and updated map of the worldwide prevalence of obesity – many readers may well be surprised to learn that obesity rates are now as high in parts of central America, northern and southern Africa and in parts of the middle East as they are in North America. Indeed, obesity rates in South Africa are “off the chart”, no approaching almost 40% of the entire population. This leaves millions of people around the world in need of more effective treatments. Blue-eyed utopian notions that we can somehow help these millions by re-engineering societies to eat-less and move more (as suggested in a rather unfortunate contribution to this edition by David Katz), are naive at best and present a disservice to those hoping for real and practical solutions at worst. The simple truth is that for the vast majority of the folks with obesity we simply have no effective treatments, let alone a cure. As Tully notes, “The best way to lose weight is to eat less and exercise more. But as a strategy to combat obesity at the population level, this common-sense prescription is proving ineffective over the long term.” Sure, not everyone carrying a few extra pounds has a “disease” and we are doing an increasingly better job of managing obesity related health problems – certainly one reason why people with excess weight are today living far longer than a few decades ago. But for those who would rather treat their obesity than be on medications for their high blood pressure, diabetes, and joint pain and perhaps rid themselves of their CPAP machines, there are few treatment options: diet and exercise, i.e if you wish to live off 1400 Cal with 400 Cals of daily exercise (as the folks in the National Weight Control Registry manage to do) or opt for bariatric surgery (a rather drastic measure by any stretch). Indeed, there is currently no greater “therapeutic gap” for a common chronic disease, than there is for obesity.… Read More »

Four Fiery Facts About Losing Weight With Hot Sauce

Anyone, who has ever met me, will appreciate my love (addiction?) for hot sauce. So, while I could not care less about cranberry ketones, green tea and other nonsense peddled by prominent pseudo-health show hosts, reports on the weight loss effects of capsaicin (the hot stuff in hot stuff) always catch my attention. So did the recent systematic review and meta-analysis of this topic by Stephen Whiting and colleagues published in APPETITE. Here’s what they found: 1. ingestion of capsaicin prior to a meal can reduce subsequent caloric intake by about 75 calories. 2. Reduced caloric intake appears largely due to an altered preference for carbohydrate-rich foods over foods with a higher fat content. 3. A minimum dose of 2 mg of capsaicinoids may be required for this effect 4. The science on whether or not any of this is relevant to weight management is rather “iffy” (to be polite). As much as I would love for habanero peppers to be the next miraculous super food, I am not convinced that this is the case. For one, as regular readers should realise by now, eating less at one meal will only lead to eating more at the next (thanks to our super-efficient homeostatic system that immediately steps in to rectify any changes in caloric balance). Thus, sadly, acute studies on what substance X, Y or Z may or may not do to appetite (or metabolism, or anything else) are largely meaningless when it comes to predicting their long-term effect on body weight (the longest study on chilli ingestion lasted just 4 weeks). This is why I also fail to share the author’s enthusiasm that, “..daily consumption of capsaicinoids may contribute to weight management through reductions in energy intake. Subsequently, there may be potential for capsaicinoids to be used as long-term, natural weight-loss aids.” Will this stop anyone from proclaiming hot sauce as the next weight-loss elixir – probably not. On the other hand, should future studies prove me wrong, I promise to eat this post (pass the hot sauce!). @DrSharma Edmonton, AB Whiting S, Derbyshire EJ, & Tiwari B (2014). Could capsaicinoids help to support weight management? A systematic review and meta-analysis of energy intake data. Appetite, 73, 183-8 PMID: 24246368   .

Obesity Year End Roundup, September 2013

As the year is rapidly growing to an end, time for a review of my favourite posts of 2013: Why Do Some People Regain Weight After Bariatric Surgery? Post-Surgery Weight Regain: Nutritional Factors Post-Surgery Weight Regain: Mental Health How Common is Food Addiction? Nothing Cut And Dried About Eating Breakfast @DrSharma Edmonton, AB

Anti-Obesity Drugs: Buproprion/Naltrexone

The third emerging anti-obesity drug discussed in our Nature Endocrine Reviews article on anti-obesity medications focussed on the published data related to the fixed combination of buproprion and naltrexone. Although this combination has yet to be approved for obesity treatment by the FDA, the data have been resubmitted for consideration to this agency. Bupropion is a noradrenaline and dopamine reuptake inhibitor that has been used in the treatment of depression for more than three decades and is also widely used for smoking cessation. The modest weight loss sometimes seen in patients receiving bupropion therapy has been attributed to its stimulatory effect on POMC-producing neurons in the arcuate nucleus of the hypothalamus. While the decreased energy intake and increased locomotor activity and thermogenesis seen with buproprion result from secretion of α-MSH and subsequent activation of MC4‑R. However, increased synaptic concentration of POMC increases the production of β-endorphin, an endogenous opioid, which inhibits POMC via a negative-feedback loop that reduces the secretion of α-MSH. This autoregulatory mechanism is believed to limit the antiobesity effect of bupropion monotherapy. Naltrexone is an opioid antagonist and has been used since 1963 to treat opiate addiction and, since 2006, for alcohol addiction. Although naltrexone alone has no effect on body weight, it is postulated that when co-administered with bupropion, it reduce β‑endorphin levels, thereby suppressing the negative-feedback regulation resulting from elevated POMC levels and increasing and sustaining bupropion’s effect on energy intake and expenditure. Moreover, some evidence suggests that the anti-opioid effect of naltrexone could reduce the β‑endorphin-induced pleasurable sensations associated with the ingestion of palatable food. A total of 15 phase I and four phase II studies (reviewed elsewhere) have investigated combinations of naltrexone and bupropion. Because in these studies, the combination of naltrexone 32 mg with bupropion 360 mg was associated with smaller decreases in both systolic (–0.5 mmHg versus –1.6 mmHg) and diastolic (–0.7 mmHg versus –1.3 mmHg) blood pressure versus placebo led, the FDA declined approval of this combination in early 2011 and required the initiation of the Cardiovascular Outcomes Study of Naltrexone SR–Bupropion SR in Overweight and Obese Subjects With Cardiovascular Risk Factors (The LIGHT Study), which is expected to be completed by mid‑2017. In out review we limit our discussion to the results of the four large phase III randomized controlled trials that included about 4,500 participants. Placebo-adjusted weight loss was in the active treatment group was about 4.5% of… Read More »