How Vitamin C Can Stop Leukemia

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Three recent studies related to cancer diagnosis and treatment, including alternative treatments, contain solid, meaningful research. That’s this week’s focus.

The first study was published in the journal Cell. The title is the best way to describe the paper: “Vitamin C May Encourage Blood Cancer Stem Cells to Die.” The biochemistry in this paper is complicated, but here are the main points. In some forms of leukemia, there are genetic mutations which prevent cancer stem cells from maturing and dying. These stem cells should naturally die, but the mutation aids production of an enzyme that causes the stem cell to mature.

In a study on mice engineered to have that same mutation, researchers found that an infusion of vitamin C caused the cancer stem cells with the mutation to be turned on, producing the enzyme and causing the cancer stem cells to die. That keeps the bone marrow healthy as they produce all types of blood cells.

This is fascinating research but it’s just an initial phase; it doesn’t apply to every form of leukemia or every type of cancer. But this is the type of research that may result in better treatments in the future.

I know many of you have seen the headline on vitamin B6 and B12 and lung cancer; I have the paper and am reviewing it. I’ll write about it next week, so don’t throw out your B vitamins or energy drinks just yet.

What are you prepared to do today?

Dr. Chet

 

Reference: Cell, DOI: 10.1026/j.cell.2017.07.032.

 

The Bottom Line on Loneliness

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Loneliness is a terrible thing. My father-in-law missed my mother-in-law from the day she died until the day he did. He was never without people in the assisted-living residences where he lived; the staff was wonderful and we visited him often, but he was terribly lonely. He lived to 94 and it was a good life, but the last three were unarguably his worst—even getting shot at in World War II was better. One of the reasons I shed no tears when he died was because I knew he was finally where he wanted to be: with his Ruthie.

For those of us still alive and in no hurry to leave this world soon, loneliness, social isolation, and living alone are things we may have to confront. The longer we live, as Dad did, the greater the possibility we might have to face these issues. But how great is the risk? Let’s take a look.

 

The Studies

The critical thing to understand is that meta-analyses can tell us something about a large group of people, but they can’t tell us anything about ourselves. While the total number of subjects is impressive, there are no hard comparable numbers to examine. Not reported was how they assessed loneliness and social isolation in each of the 70 studies. This was a presentation, not a paper. When it becomes a peer-reviewed paper, that may help us examine details, but for now we just don’t know.

One thing they didn’t assess due to the nature of the study was the risk for people who were lonely, isolated, and obese. If the logic holds true, they should be at the highest risk.

These studies raise questions. One of the commentaries suggested that this study hadn’t considered the effect of mobile devices. Does it make people feel part of a social group to be interacting on Facebook and Twitter, as well as texting? Or does that make them feel more alone?

 

The Bottom Line

While the science is not the strongest, it raises some significant issues. What will happen to your social fabric as you age? Most people prepare for financial wellness, but how about social wellness? Where are you going to be and who might be with you? Should you move to your retirement destination or into assisted living earlier so you’ll have more energy to make friends before your health deteriorates? Is staying in your home the best option? My mother-in-law was much happier after moving into a nursing home because she finally had a big group of friends and lots of activities—and of course Dad visited almost every day.

And this is an issue for younger people as well. If you feel lonely and isolated, it’s time to reach out; reconnect with family and friends and find new activities that will help you meet new people.

Just as you eat well and exercise for your body, it may be time to prepare your mind for your social situation as you get older. It’s also an important issue to explore with your parents. I’ll keep doing my part to get and keep you healthy, and I’ll continue to be in touch three times a week.

What are you prepared to do today?

Dr. Chet

 

Reference: www.sciencedaily.com/releases/2017/08/170805165319.htm.

 

Loneliness Is Worse than Obesity

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Let’s take a look at the second study on loneliness by the same research group and presented at the 2017 American Psychological Association Convention. In this study, researchers analyzed 70 studies in a meta-analysis; simply put, it’s a way of combining data from many studies to get a more robust statistical look at an issue. In this case, the number of subjects was over three million from countries all over the world.

What they found was that social isolation, loneliness, and living alone were all independently associated with early mortality similar to obesity and other physical risk factors. The researchers called for more research to find out how to address these factors. Their concern was that as the population of the world ages, this could become a greater public health issue.

How at risk are you? Is this a real concern? What can you do about? I’ll finish this up on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: www.sciencedaily.com/releases/2017/08/170805165319.htm

 

The Link Between Loneliness and Mortality

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Have you ever felt alone even though you were surrounded by dozens of people? That can happen to anyone at times but when it happens on a regular basis, can it impact your health? Could it even be worse than being obese? Recent research suggests that it just might be.

Before we get to the studies, let’s define some terms.

  • Social isolation is a physical lack of contact with other human beings.
  • Loneliness is a subjective feeling of being lonely no matter how many people are around.
  • Living alone is just what it says: you live alone. Up to 25% of the adult population lives alone in the U.S.

Researchers did two meta-analyses on the relationship between social isolation, loneliness, and living alone. In the first study, people with more social connections had up to a 50% reduction in early mortality. That in and of itself is interesting, but it’s what they reported in the second study that was more profound. I’ll cover that on Thursday.

What are you prepared to do today?

Dr. Chet

 

Reference: www.sciencedaily.com/releases/2017/08/170805165319.htm

 

Essential Tests: Melanoma Screening

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You may not want to show a lot of skin at the beach, but one place you should show skin is in the privacy of your doctor’s office. The first year results of a study on Full Body Skin Examination (FBSE) have just been published and based on the results, you should have this exam every year during your physical.

The observational study was conducted by a large healthcare group in western Pennsylvania that had their physicians conduct FBSE during routine physicals with the patient’s permission. A total of 335,735 patients had physicals with their primary care physicians; 53,196 patients had FBSE, the rest did not. In the screened group, 50 melanomas were diagnosed; 109 were found in the unscreened group. Although the reports didn’t say how the melanomas were found in the unscreened group, I’m guessing it was obvious to the doctor or the patient asked about it.

The important points are this: there was a higher percentage of melanomas diagnosed in the screened group. The more significant point is that the depth of the tumors was much thinner. That translates to less complicated treatments and better survival rates.

This week’s memos were written to encourage you to get tests, some simple, some complicated, that will help you stay on top of your health. Without knowing your blood pressure or body fat, you wouldn’t know what your risk is. No one wants to be surprised with a diagnosis of type 2 diabetes or even something as serious as a stroke. Prevention is a whole lot better than treatment. Take an inventory of what you need to have checked and schedule your physical today. Form a working partnership with your doctor; that’s a key way to keep your health at its best.

What are you prepared to do today?

Dr. Chet

 

Reference: JAMA Oncol. 2017;3(8):1112-1115. doi:10.1001/jamaoncol.2016.6779

 

Essential Tests: Blood Pressure

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How many times have you had your blood pressure checked in the doctor’s office and it was higher than normal? That’s a common occurrence. It even has a name: White Coat Syndrome. But is your blood pressure really higher only at the doctor’s? Do you check it regularly? If you don’t, you really don’t know. That’s why the second test I think you should also do on a regular basis is your blood pressure. It’s simple and easy and if you keep track, you’ll find a pattern. It’s the pattern that’s important.

Your BP will naturally be higher during exercise or as part of the stress response, but it should come down to normal when the workout or stress is over. However some stressful situations last a long time; you don’t know what your BP is during those times unless you monitor it. Based on the 7th Joint Task Force on BP, for every 20 mm Hg systolic (the top number) or 10 mm Hg diastolic (the bottom number) increase in BP, there’s a doubling of mortality from both ischemic heart disease and stroke (1).

But those are the extreme responses. Even if your BP is 6 mm Hg higher on either, there’s damage occurring inside your arteries. Everyone wants to know how to prevent Alzheimer’s disease by taking a supplement, but that’s not what I’d try first. Exercise and diet can do more to lower your BP than almost anything else, and thus reduce your risk of all diseases associated with HBP including Alzheimer’s.

To monitor your BP, either get a home monitor machine or take it at a pharmacy that has a free monitor. The critical part is that you monitor it regularly on the same device. While that device might have a slight error, taking it repeatedly on the same machine will provide a pattern and that’s the critical part. That way you’ll know when you go to the doctor whether a high reading is just White Coat Syndrome or not. We’ll finish up on Saturday.

What are you prepared to do today?

Dr. Chet

 

References: www.heart.org

 

Essential Tests: Bones and Body Fat

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After Saturday’s Memo, the logical question is: “How do I really know if I’m overfat?” This weeks Memos are going to be about tests. No, you don’t have to study for these tests. I’m talking about medical tests to talk about with your healthcare provider.

At this point, the best way to test for body fatness is using dual-energy X-ray absorptiometry (DEXA). This process uses low-beam radiation and can identify the three main tissues that make up our body: bone mass, lean mass, and fat mass. Yes, DEXA is the same technology that’s used to determine your bone mass to test for osteopenia and osteoporosis. Instead of just doing the wrist and pelvis, the entire body is scanned to determine body composition.

If you want to know your bone health and your body composition, check out the medical services in your area. There’s one hospital that offers DEXA for both purposes in Grand Rapids. If you’re over 40, it’s a great idea to do both tests. The bone scan will most likely be covered by insurance while you may have to pay for the body composition. The cost is about $100 in this area. If you want the most accurate method for bone mass and body composition, check out the DEXA availability in your area.

The goal is to use this information to improve your health. Reducing body fat and increasing bone mass both end up using a similar strategy: Eat less. Eat better. Move more. On Thursday another simple test that’s too often ignored.

What are you prepared to do today?

Dr. Chet-

 

Normal BMI but Still Too Fat

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Last week the health headlines shouted “Study Shows Over 90% of All Americans Are Overfat!” The rate of overweight as assessed by Body Mass Index (BMI) is already 70%; now scientists want to say even more people are too fat? What’s going on? I’ll explain what overfat means first and then tell you about the study behind it.

For the most part, the greater the BMI, the greater the risk for cardiovascular disease, prediabetes, and hypertension. For those of you who aren’t sure of your BMI, check out your BMI in the Health Info section of our website. And if you think you’re just big boned, we show you how to prove it.

But there are people who have a normal BMI under 25.0 but still may be overfat. Considering Waist Circumference in addition to BMI may help but that could still miss some people. How? They may have lost muscle mass; the subtle loss of lean muscle with a gain of fat could lead to overfatness. That increases their risk for the diseases I mentioned earlier.

Here’s the most common example of someone who has a normal BMI but is overfat: a very sedentary elderly person who looks slim, but has very little muscle. As the saying goes “use it or lose it” and they’ve lost it.

A clinician from Arizona has taken it upon himself to redefine the terminology associated with excess body fat. He claims that overfatness gets missed in too many people. The problem he sees is that people who could begin treatment with diet, exercise, and medication if necessary are being missed. He outlined his arguments in a paper published in January 2017 (1), but it was his paper published in July that lead to headlines (2).

He and his co-authors examined the BMIs of people in countries all over the world. Using prior studies that estimated the number of normal-weight people who are overfat, ranging from 9.7% to 20%, he then applied that to the normal-weight populations (as assessed by BMI) in the top 30 developed countries in the world. That’s how they derived the headlines of over 90% overfat—not just in the U.S. but also New Zealand, Iceland, and Greece as well. To be fair, this applied only to males. Don’t rest on your laurels, ladies. All the same countries were greater than 80% for females.

 

The Problems

There are three with his approach in my opinion. First, adding another definition to replace BMI doesn’t really help people or their physicians as he implies. Confirming a person with normal BMI is overfat would require a more advanced exam or assessment of body fat. I’m not sure that’s practical.

Second, I looked at his work from every direction and couldn’t get the numbers to work. If 70% of Americans are overweight or obese and you add 20% of the remaining 30%, it adds up to 76% not 90%. Even if the numbers worked, the statistic would apply to a physician’s total number of patients. There would be no way to identify who is overfat without additional testing.

Third, there’s another group that needs to be addressed, and that would be those who are overweight according to their BMI but are metabolically healthy. In fact, that’s a significant problem today. Even after losing over 30 pounds, my BMI is still in the overweight category. By every test of metabolic fitness—blood pressure, cholesterol, HbA1c, or insulin—I’m at no additional risk of heart disease, yet I’m still classified as “at risk” due to my BMI. I think that’s a greater issue and will be more so as healthcare gets debated. Is your BMI over 25? You’ll pay more, even if your test results are stellar.

 

The Bottom Line

I agree with the concept that the author put forth: there are people with normal BMIs that are overfat, and they’re at greater risk for CVD and metabolic diseases. But new definitions aren’t necessary. What is necessary is identifying who is at risk. That will only occur when doctor and patient meet face to face. When was your last doctor’s appointment?

What are you prepared to do today?

Dr. Chet

 

References:
1. Front. Public Health 4:279. doi: 10.3389/fpubh.2016.00279.
2. Front. Public Health 5:190. doi: 10.3389/fpubh.2017.00190.

 

Chelation Therapy: Too Soon to Judge

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The results of the study on chelation therapy in subjects with diabetes showed a reduction in cardiovascular incidents during the follow-up time. No single event dominated, ranging from heart attack to stroke to death, but overall there were fewer incidents. Subjects who did not have diabetes did not experience a benefit in v incidents during the same follow-up time.

That led the researchers to speculate why. They couldn’t come up with any specific reason other than the chelation must involve a mechanism that was not yet identified. They carefully suggested that while the results were positive, this study could only suggest that larger clinical trials were necessary and the findings do not constitute enough evidence to be recommended as a treatment.


Should You Do It?

Here a few more things to consider:

  • The cost: each session costs $90 to $150 and there should be at least 30-40 of them. Add office visits and the total price could be around $5,000; none of it is covered by insurance.
  • All the subjects continued to use their typical medications for diabetes, cholesterol, and blood pressure. This was not replacing traditional treatments, it was in addition to the treatments.
  • The investment of time was significant at three-plus hours once a week or on whatever schedule the patient and doctor agree upon.


The Bottom Line

This study demonstrated a small cardiovascular benefit to the patients, reducing the risk of a cardiovascular event from 35% to 25%. In my opinion, the results are too small to justify the cost of money or time.

I know people who swear by chelation therapy, and I’m happy it worked for them, but there’s too much we don’t know. Nobody tracks what is actually changed in the body during chelation. Where do the heavy metals go? What if someone doesn’t process metals the same way to eliminate them? At this point, there are more questions than answers.

Here’s an idea. Spend the money on more vegetables and fruit for your diet. Invest the three hours per week in additional exercise. Both of those things will give you a better return on your investment than chelation therapy.

Eat less. Eat better. Move more.

What are you prepared to do today?

Dr. Chet

 

Reference: Circ Cardiovasc Qual Outcomes. 2014;7:15-24

 

Update on Chelation Therapy

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One of the questions asked during Tuesday’s Conference Call was about chelation therapy for helping with memory. I didn’t find any research to support that outcome, but a couple of studies have been published on chelation therapy with cardiovascular disease (CVD). One paper was from the Trial to Assess Chelation Therapy or TACT study.

Chelation therapy is used to eliminate heavy metals with the goal of reducing the metals that can be toxic to the body. While it’s been used for decades, the research hasn’t demonstrated a clear benefit.

For the TACT trial, researchers recruited over 1,700 subjects. In this paper, they used a sub-group of subjects from the original study who had diagnosed diabetes and had a heart attack more than six months before the study began. Half the diabetic subjects received chelation with EDTA (ethylene diamine tetraacetic acid) as well as some vitamins and minerals. The other half were infused with just saline solution. All subjects were given low doses of vitamins and minerals.

Subjects were infused once per week for 30 weeks and then biweekly and bimonthly until 40 sessions were completed. Each chelation session lasted three hours. With the investment of time, did the chelation therapy result in fewer cardiovascular events over the next five years? We’ll see on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: https://doi.org/10.1161/CIRCOUTCOMES.113.000663