I remember the day that my mother was diagnosed with cancer. It was 1982 and it was the first time that I heard words like mycosis fungoides, chemotherapy, and survival prognosis. The vision of her at our kitchen table, trying not to reveal her fear, and eating ice cream in a “since I’ve got cancer and might die” kind of way is engrained in my memory forever.

She was given a topical chemotherapy agent, nitrogen mustard, that was made from a chemical warfare agent known as mustard gas. It was so potent that we had a special “clean-up” kit, she could not have any physical contact during treatment, and even had to sleep alone. My mom was a nurse, a compliant patient, doggedly determined to drive the disease into remission. Although it periodically flared, she managed it for 35 years.

Lung cancer killed her instead.

I was angry. She was only 70 and she never knew about her great-grandson that would be born a year later, the little boy that she always wished for. I wasn’t angry at her death as much as I was furious about her smoking habit that led directly to developing lung cancer and the fact that she knew the risks of smoking. I sat with her as she died, the oxygen machine whirring in the background as she took two final, slow breaths. That vision is also permanently etched in my memory…. of her tiny, frail body, ravaged by the cancer, finally at peace.

It wasn’t what I had expected. When I received the call that she was going home to hospice and that I needed to return to be her caregiver, I was bracing myself for a long, miserable, heart-wrenching decline like we had experienced with my step-grandfather about ten years prior. He was also a smoker and my memories of his lung cancer include graphic images of his coughing up copious amounts of bloody mucus into his oxygen mask and of being strapped to his hospital bed because the pain medications were making him convulse and get his arms and legs stuck in the bars. My mom died after only 3 weeks on hospice, at home, in her own way and it was beautiful.

My father has a type of chronic leukemia called myelofibrosis. I remember the day that I took him to Seattle for a bone marrow biopsy and again used words like “progression” and “prognosis”.  He has been “beating the odds” for about eight years now and last week we got the good news that his platelet count (a critical determinant in myelofibrosis) was the lowest it had been in a few years, indicating stabilization if not outright improvement.

So…. here’s where I got angry again. His oncologist/hematologist is a super nice guy, bright and personable and I like him a lot. He is a young doctor and patiently listens to my dad’s stories and I think he honestly cares and has good intentions. However, despite the significantly improved test results, he recommended starting a “new” chemotherapy drug called Jakafi that is targeted for myelofibrosis. I understand, to some degree, the logic of trying to further lower the platelet count through pharmaceutical intervention but side effects for Jakifi include severe anemia, dizziness, headaches, and a decreased ability to fight infections. My dad has a recent history of falling, pneumonia, and several bouts of sepsis (a potentially fatal infection) so it seems like he would be at an even higher risk if he took the new medication. At his age, he is more likely to die from complications stemming from one of those three factors than he is from the cancer. Why put him through such a thing if he was improving on his own through natural methods? Dad is almost 80 years old and has congestive heart failure among other issues. I don’t think profit is why the oncologist was attempting to prescribe the new drug. He was simply following the accepted “standard of care”, acting in accordance with his medical training, and trying to use all his available tools to help an elderly patient with cancer.

The professional monograph about Jakifi on drugs.com states, “Following interruption or discontinuance of therapy, disease symptoms generally return to pretreatment levels within approximately 1 week”. This implies that the drug doesn’t actually do anything but make you more susceptible to infections and anemia while masking one aspect of your blood count temporarily. I understand the effects of having a high platelet count and the risk of stroke. I’m not convinced that chemically lowering it while increasing other serious risks is something that makes sense, especially since his count is decreasing.

Well, unless you are making money. A Viewpoint article in the Journal of the American Medical Association (JAMA) by Dr. George W. Sledge noted:

“Therapeutic success has long-term consequences. For example, an aromatase inhibitor for early breast cancer may cause an osteoporotic fracture years later. A patient may experience infertility or cognitive disorders as a consequence of chemotherapy. A patient with advanced non–small-cell lung cancer, previously doomed to premature death, may enter prolonged remission with treatment with a checkpoint inhibitor, only to encounter challenges related to treatment-activated autoimmune disease. The oncology clinic has hereby become an entry portal to numerous specialties.”

If we don’t die from cancer… we might get to live with a further “challenge”. So…we can develop a highly lucrative, long-term illness as a result of our “therapeutic success”. Then our oncologist can refer us to other specialists who can prescribe more medications for our “consequences” which, as we know, will also have side effects.

Standard dosing of Jakifi is twice daily and since “disease symptoms generally return to pretreatment levels” it means taking it for duration of your lifetime. At Dad’s age, that could mean a few days or another 15 years. Jakifi costs about $13670 a month, or $450 each day. No wonder the good young doctor is encouraged and taught to prescribe it.

“More than 60 new therapeutic indications in hematology-oncology were approved in 2018. It is impossible for a general medical oncologist to become familiar with the use of new indications at the rate of one per week.”

Since the development rate of new therapies is so rapid, they cannot be taught in medical school or simply through continuing education. This is where Pharma steps in with “teaching” the doctors about the latest and greatest (and most expensive) developments, and, as we saw in the prior post, incentivize them with financial rewards. Even if a doctor is not accepting their funding, they are probably listening to the educational portion…. from the viewpoint of the company selling the product.

According to the National Cancer Institute (NCI):

“Historically, cancer has been one of the most costly medical conditions to treat in the United States. Compared to a decade ago, cancer patients are receiving increasingly expensive chemotherapy and biologics, both alone and in combination. The use of expensive supportive agents and hematopoietic growth factors has also increased. The cost of newly introduced chemotherapy and supportive drug-based treatments is growing, and prices higher than $10,000 a month for individual drugs and biologic agents are common.”

”Cancer patients with health insurance are paying higher premiums than in the past. They are also paying more for copayments, deductibles, and coinsurance.”

And this does not reflect the cost to taxpayers because many cancer patients are unable to work or rely on programs such as Medicare, Medicaid, and the VA health system. The NCI refers to the monetary expenses of cancer as “financial toxicity” and reports that some patients find it more stressful than the illness itself.

In addition to being unsustainably expensive, cancer is the second leading cause of death in the United States.

In a both heartbreaking and appalling report, The Lancet recently revealed,

“Cancer trends in young adults, often under 50 years, reflect recent changes in carcinogenic exposures, which could foreshadow the future overall disease burden.

The risk of developing an obesity-related cancer seems to be increasing in a stepwise manner in successively younger birth cohorts in the USA.

Incidence significantly increased for six of 12 obesity-related cancers in young adults (25–49 years) with steeper rises in successively younger generations.

Our findings are consistent with a previously reported increase in gastric non-cardia cancer among young adults and is thought to reflect, in part, increased prevalence of autoimmune or atrophic gastritis related to exposures to antibiotics and acid-suppressing drugs.”

Evidently, cancer isn’t just a disease for old people anymore.  Why is cancer increasing among young adults? This study looked at obesity-related cancers but is that the only factor?

“Numerous epidemiologic and occupational health studies support the importance of lifestyle factors and exposure to known or suspected carcinogens in the development of cancer. In fact, it is estimated that 15–20% of cancer cases are driven by infectious agents, 20–30% of cancer cases are largely due to tobacco use, and 30–35% cases are associated with diet, physical activity, and/or energy balance (e.g., obesity).”

If you did the math on that one, it’s about 85% with the remainder coming from toxins like asbestos, benzene, Roundup, and other chemicals, ultraviolet radiation, alcohol, and unknown agents. Our genetics can play a role, but they are not destiny. Not every person with a gene variant has it express as cancer and there are studies that prove epigenetics, (outside influences like diet and chemical exposure) are a more significant contributor. My dad smoked for 40 years, was overweight, had a very stressful job with shift work and altered sleep patterns, and ate a diet that included many processed foods. These lifestyle factors undoubtedly played a role in his developing cancer and heart disease.

If we look at this from a historical and anthropological view, while there were instances of cancer, it was extremely uncommon.

 “In spite of a long history of palaeopathological study of human remains globally, the direct evidence of cancer from ancient human remains is still very rare. This remains the case despite the constantly growing number of remains available for study, and an increase in numbers of bioarchaeologists.

“Cancer, one of the world’s leading causes of death today, remains almost absent relative to other pathological conditions, in the archaeological record, giving rise to the conclusion that the disease is mainly a product of modern living and increased longevity.”

Nearly all recorded cases of cancer in archaeology are within the last few thousand years, a time when we had already transitioned to agriculture and cities to some extent. While there is a possibility that the statistics are skewed because of lifespan and that active tumors would not have been preserved, the evidence for lifestyle impact remains unquestionably solid. Even in paleolithic times we would have had exposure to infectious agents like viruses and bacteria, or toxins like smoke from indoor fires, but we certainly were not completely inundated by obesity, cigarettes, chemicals, antibiotic resistant microbes, processed artificial foods, unrelenting stress, and the compounding factors that we face daily. Cancer appears to be another example of mismatch theory. We are not living in a manner for which we are designed, and our bodies cannot handle the amount of toxins and detrimental lifestyle elements that we expose ourselves to constantly.

“Exposure to carcinogens that exist as pollutants in our air, food, water, and soil, also influence the incidence of cancer. Most exposure to toxic substances and hazardous wastes results from human activities, particularly through agricultural and industrial production.

“Considerable evidence indicates that maintaining a healthy lifestyle has the potential to reduce cancer-related morbidity. Up to one-third of cancer cases in the United States are related to poor nutrition, physical inactivity, and/or excess body weight or obesity, and thus could be prevented.”

So….as we previously discussed, rates of chronic illnesses are rising exponentially, cancer is increasing dramatically in younger adults (especially obesity-related forms), and the financial cost to deal with it is also termed “toxicity”, as if it’s an illness too.

“For the United States to prosper in the 21st century, controlling health care costs is critical—indeed, it is the single most important challenge facing health care. Greater rationing of care is inevitable if health care costs continue to increase. Controlling health care costs is the only way to ensure appropriate investment in other areas, such as education, the environment, and infrastructure, and to provide a more equitable, just, and fair distribution of the remarkable health care advances that have been achieved with even more on the horizon.”

Wait….” rationing of health care”? Yes. It already happens, right here in the United States. Those who struggle with poverty cannot afford the same insurance, co-payments, or treatments that more affluent patients can manage. (they are also less likely to have routine care and basic cancer screenings) Recently, a cancer patient confided to me that they were thrilled that their insurance approved a very expensive treatment. ($100,000) They had been prepared to pay out-of-pocket if the insurance company declined. How many of us have that ability? Do you mortgage or sell your home? Do you use the kids’ college funds? Cash out all your retirement funds?

So here we are again…. sick, fat, and faced with expensive medical care.

Or are we?

If approximately 90% of chronic illness and 85% (or more) of cancers are basically preventable or reversible through lifestyle changes like losing weight, quitting smoking, treating latent/opportunistic infections, improving our microbiomes, and reducing chemical exposure…. why aren’t we looking at that as the answer? It certainly can’t cost $13,670 a month like Jakifi…AND it might actually cure us.

We ALL have cancer…. whether we have an altered cell in our bodies or not. It impacts every single one of us, either directly through a friend or family member, financially, or indirectly through things like our infrastructure, environmental degradation, or lack of funding for schools as medical costs explode.

We have a choice.

“Throughout most of medical history, clinical knowledge was effectively owned by physicians. The physician received specialized training, attended medical meetings, and obtained information from journal articles. The sole source of information for the patient was the physician, who was—or was thought to be—the final arbiter of therapeutic decision-making.

This is no longer the case. Many patients are now informed by online summations of “best therapy,” some of which are based on scientific articles and conference proceedings.

In this data-rich environment, the previously held perception of the physician’s omniscience is no longer plausible.”

When we are given a diagnosis…we have the ability to explore options. I’m by no means saying don’t consult with your healthcare provider but we don’t have to flatly accept smearing our bodies in mustard gas and sleeping alone. We don’t have to agree to prohibitively expensive medications with massive side effects that secondarily induce chronic or degenerative disease as a means to delay death. There are other treatment options that can be very effective or that can be used in combination with modern medical therapies. A perfect example is the well-established fact that fasting as an adjunct with chemotherapy can improve effectiveness and lessen side effects.

Or maybe…. just think about what we do that increases our chances of developing cancer in the first place.

Exactly like our plague of chronic disorders, cancers are a modern blight and one that we don’t need to face in fear, but instead should examine with consideration to the causation of the vast majority. Inarguably, there are cancers that appear in people who “do all the right things” and “live clean” but they are still exposed to viral impacts and environmental toxins. The causes of cancer are multifold and there isn’t a single answer for resolving it but clearly diet and lifestyle choices are critical factors.

We have the opportunity and power to change the outcome and we deserve better than “therapeutic success”.

And we’ll get the bonus effect of a healthspan…. not simply a lifespan.

Addendum: My dad passed away in September of 2021 from heart failure. His cancer had remained stable. I sat with him the night before he died and he suddenly looked up and I could tell that he saw something in the distance. He said, “God, hold my hand” and those were the last words he spoke. I love you Pops.

https://www.drugs.com/monograph/jakafi.html

https://www.drugs.com/price-guide/jakafi

https://www.cancer.gov/about-cancer/managing-care/track-care-costs/financial-toxicity-hp-pdq

https://www.cancer.gov/about-cancer/managing-care/track-care-costs/financial-toxicity-pdq

https://www.cdc.gov/nchs/fastats/cancer.htm

https://www.thelancet.com/action/showPdf?pii=S2468-2667%2818%2930267-6

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5530583/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956457/

https://jamanetwork.com/journals/jama/fullarticle/2725150

https://jamanetwork.com/journals/jama/fullarticle

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4901417/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6257056/

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What is food? The Oxford dictionary describes it as,” any nutritious substance that people or animals eat or drink or that plants absorb in order to maintain life and growth” while Merriam-Webster states, “material consisting essentially of protein, carbohydrate, and fat used in the body of an organism to sustain growth, repair, and vital processes and to furnish energy”.

Humans are the only creatures that need a written definition.

Most of us know that we should avoid “fast food” and “eat better” or eat “clean” or think that our diet is “pretty good” but those are rather vague and distant concepts. What many of us don’t know, oddly enough, is what to actually consume. Cougars hunt prey that is suitable for a huge feline. Deer graze and nibble on grasses and plants. (or my tulips, roses, and entire garden) Birds look for seeds, insects, rodents, etc. But humans? We are the only animal that has to be told what to eat. That’s where the problem starts.

Granted, much of that isn’t our fault given the influence that the industrialized food industry has over our choices. We are taught in elementary school that “milk does a body good” but that didn’t come from our science class…it came courtesy of the National Dairy Council. The manipulation from industry is such a comprehensive topic that it would take an entire book to fully discuss it, so we are just going to acknowledge for today that there is a LOT of profit to be made in food and we are deliberately misled from a very young age.

In 2017, the latest year with complete data, typical US households spent $7729 on food, including $3365 that was for food “away from home” or dining out. That works out to about $21 a day for our food budget. Just for comparison, we spent $9576 on transportation costs including $4054 in vehicle purchases. In that light, it appears that we’d rather buy new cars than organic produce.

One of the influences that I see affecting human food choices is a form of ‘hard-wiring’ known as the Optimal Foraging Theory. Basically, it means that we (and all animals) instinctively look for foods that give us the most reward for the least amount of effort. We know that we expend more energy than we will receive walking five miles to pick one apple than to go half a mile to a large patch of berries or a tree laden with nuts. We also know when to leave that patch for the next or when to move to a new fishing hole and that if we have a chance to snag something large and nutrient dense, we need to jump on it. This was a beneficial trait before there was endless access to food.

Let’s combine that theory with our current fast food trends, industry altered foods that contain addictive substances, and frantic lifestyles.

So, I have $21 to spend on food. Am I going to drive through McDonald’s and grab a couple of things from the dollar menu and start chowing down in under 5 minutes….and probably even while driving… or go to the grocery store, park, shop, spend $10+, go back to my car, drive home, prepare and cook my food, and then finally eat it? This gets compounded by factors such as “food deserts” where healthy options aren’t available and by poverty, when you simply don’t have enough money to buy broccoli and chicken, so you opt for a couple of $.99 cheeseburgers for your kids.

For most of human history we were foragers and hunters. While we did start cultivating crops and farming about 10,000 years ago, even then, most humans still relied upon traditional methods for obtaining food. It wasn’t until a few hundred years ago that we really settled into cities on a broad scale and industrialized agriculture became the norm. Our bodies haven’t adapted to that change, much less  the recent novelties of online shopping, food delivery, drive-thru, and endless apps that enable the process. Increasing numbers of us don’t even bother to hunt and gather at the grocery store or farmer’s market, much less in our own garden or the wild.

So…. if I’m sick from eating an inappropriate diet, I’m overweight, I’m spending an increasing proportion of my income on prescriptions, I’m heavily influenced by a handful of food industry conglomerates that don’t care about my health but only about their profits, and I’m exhausted from dealing with it all…. what am I going to do? Of course I’m going to pull up my Walmart app and have some mind-numbing, cheap, pseudo-foods loaded into my car while I wait curbside. I don’t even have to get out.

Fortunately, humans also have culture and it tells us what is acceptable and what is taboo in our groups. We have the ability to override innate foraging tendencies and make informed, conscious choices. We have the power to ensure quality food for all and to eliminate the approximately 40% of our food that gets wasted. Changing food policy will positively impact our health, our environment, and potentially our entire economy.

Diet is our cornerstone. Clearly, all areas of health overlap and influence each other but our dietary choices are the largest single factor and distinctly impact overall wellness. It has the power to make us sick or make us healthy and resilient. As we saw in the previous post, lifestyle….and largely our diet…is a massive contributor to chronic diseases and additional financial burdens.

It is imperative to get our diet and food into alignment. That doesn’t mean that we can’t be increasing our movement or working on improving sleep quality at the same time, but we start with getting our diet in order.

You cannot out exercise a poor diet.

 You cannot out supplement it.

Your doctor cannot out medicate it.

You cannot escape it.

There are times that we are exposed to viruses, have an injury, or get an acute infection that impacts our health, but these occasions are somewhat rare, while most of us eat at least 3-4 times each day. You are choosing food multiple times daily. Each of these exposures is a chance to make your health better or worse. For most of us, what we eat is a choice. We didn’t accidentally eat two donuts at our company meeting. It wasn’t required that we gorge on pizza, wings, and chips because football was on TV. We didn’t need a Pepsi. It was a choice.

Humans require certain nutrients from dietary sources in order to be vibrant, happy, and avoid disease. As our consumption of processed foods has increased, our health has decreased dramatically. When we eat food fit for humans rather than chemically enhanced pseudo-food, we can fuel our physiological requirement for nutrition and avoid detrimental substances that damage our health.

So, what is food fit for human consumption? By its definition, it should be something that our body finds to be nourishing, providing vitamins, minerals, macronutrients like protein, carbohydrates, and fats and that doesn’t cause harm. Food is a language, a direct form of speaking to ourselves.

 “Food does not merely represent calories. Rather, food represents information, signals that influence and interact with multiple complex biologic pathways in our bodies,” Dariush Mozaffarian, Dean of the Friedman School of Nutrition Science and Policy at Tufts

Let’s look at this by examining two items of similar calorie counts. I love avocados so let’s choose one medium avocado and compare it to a small McDonald’s French fry. (as if anyone orders small….at least I’m admitting to eating the entire avocado). The fries have 230 calories and the avocado has 240. The fries have mostly fat and carbohydrates (29 grams) but they do have 3 grams of protein, 3 grams of fiber and a bit of vitamin C. The avocado is mostly healthy monounsaturated fat, 12 grams of carbs, 9 grams of fiber, and numerous vitamins and minerals including 750mg of potassium. So, what do they say to your body?

Let’s listen.

Well that avocado says,” Hi, I’m Avo… I’m full of nutrients but I’m only an avocado. My high levels of potassium can improve cardiovascular health and lower blood pressure and I’m full of fiber too, so you’ll feel satiated and have a happier colon.”

Those fries say, “Hi, we’re…. Potatoes, Vegetable Oil (Canola Oil, Corn Oil, Soybean Oil, Hydrogenated Soybean Oil, Natural Beef Flavor [Wheat and Milk Derivatives]*), Dextrose, Sodium Acid Pyrophosphate (Maintain Color), Salt. *Natural beef flavor contains hydrolyzed wheat and hydrolyzed milk as starting ingredients.”

Admittedly, I didn’t know what sodium acid pyrophosphate was and had to look it up. While it’s a common additive to baked goods and to “maintain color”, it’s so acidic that the FDA only declares it safe in small amounts and in a rodent study, high doses of it were hematotoxic and killed red blood cells. Doesn’t sound like food and why exactly are we putting in an agent to keep the potatoes white during extended storage so that we can deep fry them in a mixture of toxic and genetically modified oils to make them brown? I’m completely perplexed at why there is “natural beef flavor” in the vegetable oil and how they make “beef flavor” from wheat and milk.  And dextrose…. which is sugar. Did you know there was sugar in your French fries? And finally, let’s not ignore the seemingly innocent potatoes which are known to have some of the highest pesticide residues in any produce.

What kind of language do those fries speak? Certainly not one that your body will understand. Let’s break down that “vegetable oil”. There is a very high ratio of Omega 6 to Omega 3 in the Standard American Diet which increases inflammation, a common denominator of many chronic illnesses and vegetable oil is chock full of Omega 6. Evidence also suggests that vegetable oils like corn and soy can increase colon cancer, IBS, and contribute to obesity. When heated, canola, corn, and soybean oils form trans-fats, a type of fat that is recognized as causing heart disease and is now banned in most foods but since it’s an ingredient before the fries are cooked…they can still use it because the bad fats aren’t created until the heat is added. Reusing fryer oil compounds the amount of trans-fats. And again, “natural beef flavor” which really seems like it ought to come from natural beef but instead, is created from wheat and milk. Since at least 75% of the adult population does not have the gene to adequately process dairy…. yeah, we should put milk derivatives in French fries?

And we haven’t even begun to delve into how these GMO and non-organic foods are impacting our microbiome….and therefore our overall health, including increasing anxiety and depression.

If we are spending about half of our food budget on “food away from home” and much of what we do eat at home is also “processed/convenience” ….is it any wonder that we have such rapidly increasing rates of mismatch disorders like diabetes and cardiovascular disease? We simply are not able to translate the language of industrialized food, of chemicals…both in the “food” and that leach in from packaging materials like plastic wrappers, can liners, or cooking methods.

Our bodies understand the language of nature. We can speak this by eating food that not only provides the proper nutrients but also avoiding foods that physically harm us. The American Heart Association states that cocaine is the “perfect heart attack drug” because of physiological changes that happen after using it including hardening of the arteries and increased blood pressure. That sounds pretty scary if we associate it with an illegal drug, but we seem to be perfectly fine with eating those fast food fries that have exactly the same effects.

We need to be mindful of what goes in our mouths but it’s going to take a bit of effort. We might have to get out of the car but hey, if we park in the outer spaces, we can get a bit of walking/movement in our day too and compound the positives.

As for me…. I’m going to go have a little talk with my friend Avo.

 

https://www.bls.gov/news.release/cesan.nr0.htm

https://www.mcdonalds.com/us/en-us/product/small-french-fries.html

https://loveonetoday.com/nutrition/avocado-nutrition-facts-label/

https://www.sciencedirect.com/science/article/pii/S1382668918301571

https://www.nih.gov/news-events/nih-research-matters/how-too-little-potassium-may-contribute-cardiovascular-disease

https://www.ncbi.nlm.nih.gov/pubmed/27251151

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6356359/

https://www.ncbi.nlm.nih.gov/pubmed/27374582

https://www.heart.org/en/health-topics/consumer-healthcare/illegal-drugs-and-heart-disease

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