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Rapid Responses: Rapid Responses published:
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Are the goals achievable?
- Makarand K Oak (4 November 2007)
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Neutraceuticals and diet for cancer control
- Biji T. Kurien, Jobin T. Kurien and R. Hal Scofield (4 November 2007)
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Cassius Had A Lean And Hungry Look
- Dr. Herbert H. Nehrlich (5 November 2007)
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Life Style
- Ada Madjd (6 November 2007)
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When will science inform public policy?
- John C Oldroyd (6 November 2007)
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Confusion over drink sizes
- Dr Rachel Seabrook (7 November 2007)
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Diet and the risk of cancer..Colorectal cancer.
- NAZAR R DESSOUKI (10 December 2007)
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Makarand K Oak, Consultant Obstetrician and Gynaecologist Wishaw General Hospital ML2 0DP
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On a lighter note, I sometimes wonder if I live on the same planet as everyone else and particularly eminent scientists. For a starter, I do not even manage to eat five portions of any kind of food let alone fruits and vegetables a day. Now coming to drink, here again the governmen or some other health watchdog recommends two to three litres of fluids and preferably clear a day. Here again I am lucky if I get the time to drink little over a litre a day. I am certainly not a unique individual and there must be many like me so what risk do I and the like of me carry? The recommendation leaves the non-vegetarian population with the choice of white meat, which of course carries the risk of salmonella and as for the fish, the environmental lobby will be on our backs for devastating the fish stock. It is disappointing to see the material presented in a reputed journal. Competing interests: None declared |
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Biji T. Kurien, Senior Research Scientist Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA, Jobin T. Kurien and R. Hal Scofield
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As Dr. Key states in his editorial (1), important gains in cancer control can be made by reducing obesity and alcohol consumption. Here we wish to add (a) that there is no sufficient support (from population studies) (also suggested by Dr. Key) for the idea that eating more fruits and vegetables will help prevent cancer of the mouth, pharynx, esophagus, stomach, colonrectum,larynx, lung, ovary (vegetables only), bladder (fruit only), and kidney cancers as well as a lack of evidence for a cancer- preventative effect for all other sites (2) (b) about the importance of reducing red meat and increasing omega-3 consumption and (c) that the use of nutraceuticals, especially curcumin (clinical trials are being carried out using curcumin as a treatment for various cancers), and the potential use of capsaicin, gossypin, quercetin and resveratrol in the prevention of cancer is important. Red meat consumption has been linked to colon-rectal cancer 3 while a diet rich in omega-3 and selenium has been shown to be preventative in prostate carcinoma (3). Potential cancer protective agents either impede the initiation stage or act as suppressing agents that arrest or reverse the promotion and progression stages of cancer, presumably by controlling apoptosis, cell proliferation, differentiation or sensescence (4). Dietary chemopreventative compounds mainly include phenolic and sulfurcontaining compounds. Phenolic compounds are polyphenols and flavanoids, while sulfur-containing compounds are isothiocyanates and organosulfur compounds (4). Polyphenols include curcumin (from turmeric), epigallocatechin-3 gallate (green tea) and resveratrol (grapes). Flavanoids include quercetin (citrus fruits), gossypin (Hibiscus vitifolius) and genistein (soy). Isothiocyanates include sulforaphane (broccoli), phenethyl isothiocyanate (turnips, watercress) and allyl isiothiocyanate (Brussels sprout) (4). Clinical trials are under way using curcumin for the treatment of several cancers, including multiple myeloma, pancreatic cancer and colon cancer (5). Epidemiological data suggest that curcumin may be responsible for the lower rate of colorectal cancer in Asian countries (6). Capsaicin, the pungent ingredient of red and chili peppers, has been found to have a potential role in the prevention and treatment of multiple myeloma and other cancers (7). Quercetin is found in fruits and vegetables, including blueberries, onions, curly kale, broccoli and leek and in high doses have been found to reduce rat colorectal cancers (8). Care must be taken to see that results obtained from using dietary supplements have come from rigorously conducted clinical trials. Some results obtained from large-scale randomised controlled trials on the efficacy of beta-carotene to reduce cancer risk have been disappointing. For example, the and Beta-Carotene and Retinol Efficacy Trial (CARET) both showed increased risk of certain cancers and mortality with supplementation (9,10). In conclusion, control of cancers with nutraceuticals, like curcumin (11), and dietary control is therefore as important as other cancer prevention strategies. References 1. Key T. Diet and the risk of cancer BMJ 2007;335:897 2. Vainio H, Weiderpass E. Fruit and vegetables in cancer prevention. Nutr Cancer. 2006; 54: 111-142. 3. Divisi D, Di Tommaso S, Salvemini S, Garramone M, Crisci R. Diet and cancer. Acta Biomed. 2006; 77:118-123. Review. 4. Nair S, Li W, Kong AN Natural dietary anti-cancer chemopreventive compounds: redox-mediated differential signaling mechanisms in cytoprotection of normal cells versus cytotoxicity in tumor cells. Acta Pharmacol Sin. 2007; 28: 459-472. 5. Aggarwal BB, Banerjee S, Bharadwaj U, Sung B, Shishodia S, Sethi G. Curcumin induces the degradation of cyclin E expression through ubiquitin-dependent pathway and up-regulates cyclin-dependent kinase inhibitors p21 and p27 in multiple human tumor cell lines. Biochem Pharmacol. 2007; 73:1024-1032. 6. Kurien BT, Singh A, Matsumoto H, Scofield RH.. Improving the solubility and pharmacological efficacy of curcumin by heat treatment. Assay and Drug Dev Technol. 2007; 5:567-576 7. Bhutani M, Pathak AK, Nair AS, Kunnumakkara AB, Guha S, Sethi G, Aggarwal BB. Capsaicin Is a Novel Blocker of Constitutive and Interleukin- 6-Inducible STAT3 Activation. Clin Cancer Res. 2007; 13: 3024-3032. 8. Dihal AA, de Boer VC, van der Woude H, Tilburgs C, Bruijntjes JP, Alink GM, Rietjens IM, Woutersen RA, Stierum RH. Quercetin, but not its glycosidated conjugate rutin, inhibits azoxymethane-induced colorectal carcinogenesis in F344 rats. J Nutr. 2006; 136:2862-2867. 9. Bowen DJ, Thornquist M, Anderson K, Barnett M, Powell C, Goodman G, Omenn G; Carotene and Retinol Efficacy Trial. Stopping the active intervention: CARET. Control Clin Trials. 2003; 24:39-50. 10. Smigel K. Beta carotene fails to prevent cancer in two major studies; CARET intervention stopped. J Natl Cancer Inst. 1996 Feb 21;88(3- 4):145. 11. Kurien BT, Scofield RH Curcumin/turmeric solubilized in sodium hydroxide inhibits HNE protein modification--an in vitro study. J Ethnopharmacol. 2007;110:368-373. Competing interests: None declared |
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Dr. Herbert H. Nehrlich, Private Practice Bribie Island, Australia 4507
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The report on what causes cancer is confusing, to say the least. Here we go again with obesity, alcohol and meat. There is, in my humble opinion, not enough evidence to link meat consumption to cancer, nor is there a clear connection to obesity. Alcohol is a separate entity altogether. While it is generally believed that fat (as from meat) causes obesity, this has been shown to be naive and without foundation in fact. It is likely that not obesity, but the factors leading to malfunctioning in the body's systems, are behind the door that is standing ajar, waiting for cancer to enter. Why single out meat? Why not refined foods such as simple carbohydrates and man-made foodoids? The notion that alcohol is a significant cause of malignancy would need far more proof than was shown here. Epidemiological evidence alone would suffice in showing people that this is pure speculation as presented. An excess of anything is potentially harmful but to present a study that took years and the combined wisdom of some good minds only to come up with a silly conclusion that is both impractical and inconclusive is rather unhelpful. Fat men will die of cancer? Show me. Competing interests: None declared |
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Ada Madjd, GP Tehran-Iran
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Due to this very interesting article, once again and more than ever before, the role of life style becomes prominent in preventive medicine. Can the role of alcohol be due to its role in inhibiting lipase and causing accumulation of adipose tissue? Or this is something totally connected to alcohol itself that can make damages in DNA like smoking? Competing interests: None declared |
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John C Oldroyd, Research Fellow Cabrini Institute, 183 Wattletree Tree Rd, Malvern, Victoria 3144
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If science is to be believed at all, then the World Cancer Research Fund report, which reviewed 500000 studies over 5 years, must provide a strong evidence base. It concluded that alcohol consumption is linked to cancer. The ink was barely dry on the report when the Premier of NSW, Australia announced a reduction in alcohol licensing fees for small bars from $15000 to $500. This means alcohol can now be served without food in cafés. The purpose: to transform Sydney's drinking culture and create a "true cosmopolitan city". We need no encouragement to drink! There is a tsunami of alcohol related problems about to devastate young people in Australia [1]. Can governments please stand up to the alcohol industry and say no! [1] Alcohol Related Brain Injury Services. Accessed November 2007 http://www.arbias.org.au/information/overview.html Competing interests: None declared |
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Dr Rachel Seabrook, Research Manager Institute of Alcohol Studies, 1 The Quay, St Ives, Cambs, PE27 5AR
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A recent BMJ editorial[1] discusses the World Cancer Research Fund[2] report on diet and cancer. The author comments on the report’s recommendation on alcohol consumption, “that men should not drink more than two units of alcohol a day and women should not consume more than one unit a day,” that, “These recommendations are much lower than current government advice in Britain of up to three or four drinks a day for men and two or three for women.” This highlights a widespread confusion regarding units of alcohol and ‘standard’ drinks. The WCRF recommendation was actually framed in terms of ‘drinks,’ identifying a drink as containing between ten and fifteen grams of ethanol, whereas the British government advice is framed in units, where a unit, by definition, contains eight grams of alcohol. Whilst the UK unit has the advantage of being relatively simple to calculate (volume in litres multiplied by percentage strength), it does not correspond to a typical UK drink. One pint of beer at 4.2% (the average strength of beer sold in the UK in 2006[3]) contains 2.4 units of alcohol and a 175 ml glass of wine at 12% contains 2.1 units. Unfortunately, a unit is often taken as representing one drink, specifically, half a pint of beer, one (small) glass of wine or one (small, i.e. 25 ml) measure of spirits. The Department of Health leaflet, “How much is too much?” revised in October 2007, promises, “Information is provided on the number of units in popular alcoholic drinks, as well as advice and contact details for those wanting to cut down or get support.” It contains the advice to use smaller wine glasses as a means of lowering consumption, stating that a 125 ml glass of wine contains one unit of alcohol.[4] This would be true only if the strength of the wine was 8%; at a more typical 12% that glass would contain one and a half units. To make matters worse, the standard drink varies considerably across the world. The UK and Ireland have the smallest units, at 8 g, American standard drinks are 14 g, whilst the largest drinks are served in Japan, at approximately 20 g.[5] Furthermore, there is variation within each country on what constitutes a standard drink. For example, The WHO reports a standard drink in the USA to contain, “between 12 and 14 grams” of ethanol.[6] The WCRF report, published jointly with the American Institute for Cancer Research, is an international publication giving a ‘global perspective,’ and drawing on research from many countries. This may explain the wide range of ethanol content per drink (ten to fifteen grams) allowed for in the recommendation. In 1991, Miller, Heather and Hall published, “Calculating standard drink units: international comparisons,” in the British Journal of Addiction. In this article, they issue “a plea for consistency,” regarding the reporting of alcohol content. Given the ambiguity present in a report of the stature of WCRF/AICR report, and the confusion evident even in a BMJ editorial, it is surely time to heed that plea. ____________________________________________________________ [1] Key, T. Diet and the risk of cancer (2007) British Medical Journal 335, 897 [2] World Cancer Research Fund / American Institute for Cancer Research (2007). Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR [3] BBPA Statistical Handbook, 2007 [4] Department of Health (2006) 277506/How much is too much: adults. DH publications, p7. ww.dh.gov.uk/publications [5] ICAP Reports 14 (2003) International drinking guidelines. International Center for Alcohol Policies. icap.org/portals/0/download/all_pdfs/ICAP_Reports_English/report14.pdf [6] World Health Organization (WHO). International Guide for Monitoring Alcohol Consumption and Related Harm. Geneva: WHO, Department of Mental Health and Substance Dependence, 2000. Competing interests: None declared |
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NAZAR R DESSOUKI, CONSULTANT SURGEON ST BERNARDS HOSPITAL GIBRALTAR
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Diet is clearly implicated in the origin of colorectal cancer, with risk factors for the disease including reduced consumption of vegetables, fiber, and starch and increased consumption of red meat and animal fat. Several hypotheses have been developed to explain these associations. PMID: 10965515 [PubMed - indexed for MEDLINE] Competing interests: None declared |
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