Cancer- Should Money Be Spent on Prevention or Therapy?

[Bestwifeever]

I think part of the reason weight loss is difficult to maintain, especially after getting to a goal weight and reintroducing less restricted portions of carbs and fats, for example, is something called the thermic effect of eating, which I believe has been well proven, as explained here, for example:

Roughly 10 percent of the calories you burn each day get burned by the act of digesting your food. But not all foods are created equal: Your body uses more calories to digest protein (20 to 35 calories burned for every 100 calories consumed) than it does to digest fats and carbohydrates (5 to 15 calories burned for every 100 calories consumed). That’s why adding lean, healthy protein to each meal and snack will help you burn more calories. Even better, protein can dull hunger and protect against obesity, diabetes, and heart disease.

http://eatthis.menshealth.com/content/prime-your-metabolism?article=1&page=1

So if a post-weight loss diet includes more calories from fat and carbs, even if the total calorie count is the same as during weight loss, it is almost like adding more calories. Not that anyone would do this, but if one ate 2000 calories of only protein, up to 700 calories would be used in digestion. Eating 2000 calories of only fat and/or carbs, one would use up to 300 calories in digesting them--and effectively have 400 more calories for the body to metabolize for energy or to store for later. Or about 40 lbs a year weight gain if not burned up. This may be part of the reason why weight loss through low carb methods (or really any method) is difficult to maintain for people when the maintenance level changes the ratio of carbs/protein/fats even if the calorie intake is the same.

And if you look at old family photos going back generations, it is interesting to see the same body types repeating. As with many other things, choosing your ancestors may be the most important decision we can never make in terms of appearance, disease, and opportunity.

 

[NW-Bound]

I like proteins, particularly those coming from animals.

And about ancestors, is it possible that children raised by overweight parents tend to follow in the same trait because of the long-standing family diet?

 

[timo2]

Eh. I don't know if obesity causes cancer, per se, but it does make it much more difficult to detect in a lot of cases. It is something that is wholly controllable - yes, even diabetics - to some extent. It doesn't mean we shouldn't show compassion, but it does mean that the victim could've done something to help him/herself.

Don't forget that some people are doing the best they can as-is. There is no need to pull out the Herman Cain 'Blame Yourself' admonition. To assume that what you or I know to do is able to be performed by others defies the laws of probability.

 

[bld999]

My view is that risk factor discussion is much like treatment reccs. for populations in that what is good public health policy is not necessarily good policy for any individual patient. People can end up feeling ignored or picked on by an outlook or health protocol and thus object and push back. Discussion can get personal on an emotional level pretty quick.

@haha: I will admit to a small role in your disappointment with the tack of the thread, and thank you for the effort anyway. I think keeping this kind of stuff on an entirely academic and thoughtful footing in a public forum is somewhat wishful thinking, but kudos to the effort.

Research on disease risk factors and diet effects on humans is expensive and difficult, and while some stuff is pretty clear, I am always reminded of Einstein's quote: "as the circle of light increases, so does the circumference of darkness around it"
We have far to go on most of this stuff. JMO

 

[Katsmeow]

Duplicate post, please delete.

 

[Katsmeow]

Responding to several things at once:

I think part of the reason weight loss is difficult to maintain, especially after getting to a goal weight and reintroducing less restricted portions of carbs and fats, for example, is something called the thermic effect of eating, which I believe has been well proven

This addresses calories in and how it can vary depending on what you eat. I don't question that. The other part of the equation though is calories out. Many obesity researchers believe that the far greater factor in regaining lost weight in the reduction in metabolism that occurs after weight lost for most people, independent of what those people are eating. That is they burn enough fewer calories compared to similar others (only difference between the fact that the others had not lost weight) to allow significant regain each year.

When you lose weight using a LCHF diet your muscle mass is preserved for the most part. Increases in muscle mass are possible with proper exercise; however, most merely maintain their existing muscle mass.

I don't question at all that a person with more muscle mass will burn more calories than an otherwise identical person with less muscle mass. That said, most weight reduced persons with more muscle mass will burn fewer calories than an other identical person (who also has the same muscle mass) who never lost weight. So, yes, losing weight to preserve muscle mass is undoubtedly a good idea, but it doesn't prevent a reduction in metabolism as compared to the person who never lost weight.

I was talking about the same thing you are talking about - both issues. My question was simply inquiring whether you, personally, fit the lower metabolism model when you dropped to 116 and then drifted back up. If you lost your weight on LCHF and drifted back up while continuing to eat LCHF, I would agree that you may fit that model and may be SOL (other than thru tormenting yourself with hunger). But, if you lost the weight thru other means (e.g. calorie counting on a LFHC diet) or even lost the weight on a LCHF diet but then switched back to a regular diet and tried to maintain your weight with portion control, I would not agree that you have personally demonstrated a low metabolism issue.

You seem to wondering (or perhaps assuming) that following a lowcarb diet might mean that a weight reduced person following such a diet would not have the reduced metabolism seen in most people and that following a lowfat diet would cause such a reduced metabolism. I agree that that would be an interesting question to study. I don't think that has been the focus of the studies I've seen. FWIW, the study I posted about earlier:

MMS: Error

fed people a formula consisting of 40% fat, 45% carbohydrate and 15% protein, so really not lowfat and not lowfat either. It was 800 calories so that would be 90 carbs a day which would hardly be considered high carb.

Insofar as I am concerned personally, I am a mixed back. When I lost from 167 to 119 that was 20 years or so ago when people didn't pay as much attention to diet composition. I was following Weight Watchers then I wasn't particularly low fat and I wasn't particularly low carb. I didn't eat much sweets and mostly, but not always, ate whole grains.

That said, in 2011 I lost about 44 pounds, most of it lost while following a LCHF diet. And, then I started regaining. I was still in my weight loss phase so it wasn't a matter of deciding not to follow LCHF. After I had regained about 30 pounds I quit focusing so much on the low carb part although I am still not eating high carb (I am back on the losing trend again). I currently eat about 80 to 100 net carbs a day.

FWIW, I don't think that I am particularly carb sensitive. Also, I don't eat a lot refined carbohydrates and haven't for many years. I kept reading about all these people who went low carb and felt so much better and lost weight so much faster. That didn't happen with me even during the induction phase. I did lose about 10 pounds of water weight (everyone does this on low carb) but otherwise didn't find that I lost particularly faster on low carb and didn't feel any better (or worse).

Regardless - the main point I was trying to make in this thread is that obesity treatment is not easy. Most people who lose weight regain and I don't think it is just because of lack of willpower or being sloths. I personally believe that the real cure to the obesity epidemic is obesity prevention so that people never get the reduced metabolisms in the first place.

As much as I believe in obesity prevention, I don't think that it should come at the expense of cancer research and cancer treatment.

 

[kyounge1956]

(snip)And if you look at old family photos going back generations, it is interesting to see the same body types repeating. As with many other things, choosing your ancestors may be the most important decision we can never make in terms of appearance, disease, and opportunity.

Here's a study that perhaps reveals part of the reason those body types repeat. For some obese people, the deck was stacked against them before they were born.

 

[Amethyst]

I often read, in the context of weight-loss discussions, that some people - because of the effects of dieting - develop slower metabolisms than others, and thus have more trouble maintaining a healthy weight.

What I am wondering is, what is the effect of having a slower metabolism? Is it possible to change your body so it more efficiently extracts energy from food? Is the effect significant enough that it could have implications for people in countries where there isn't enough food?

In addition, when somebody has a slower metabolism, is there any effect on their ability to function? Does their whole system somehow slow down, so they don't react as quickly, can't move as fast, can't do as much physical work?

Amethyst

 

[nash031]

Don't forget that some people are doing the best they can as-is. There is no need to pull out the Herman Cain 'Blame Yourself' admonition. To assume that what you or I know to do is able to be performed by others defies the laws of probability.

I don't think I said anything about blaming yourself nor did I admonish anyone. As I said in my post, obesity is something that can be controlled to some extent. The fact is, we have a say in our body composition. Maybe not 100% due to genetics and other factors, but we get a vote. And we exercise that vote through the choices we make.

 

[nash031]

Here's a study that perhaps reveals part of the reason those body types repeat. For some obese people, the deck was stacked against them before they were born.

Predisposition doesn't necessarily dictate outcome.

When you look at those family photos of body types repeating, things like bone structure and height repeat. Then you get into nature vs. nurture. Certainly there is some effect of being raised by a family of overweight people that also predisposes someone to be overweight from the habits they learn - diet, exercise, etc. Those are behaviors that can be changed, even if it is extremely difficult to do so.

Anecdotally - my father's parents were average height/average build. Their two daughters were both obese, and married men who were obese. Some of their offspring are obese, some of them are not. My father and mother are not, and my sisters and I are not. My father and mother were active early in their lives and remain so today. My aunts and uncles were not. So to write off obesity as something that's uncontrollably dictated by genetics and upbringing is equally fallacious.

 

[Katsmeow]

I often read, in the context of weight-loss discussions, that some people - because of the effects of dieting - develop slower metabolisms than others, and thus have more trouble maintaining a healthy weight.

What I am wondering is, what is the effect of having a slower metabolism? Is it possible to change your body so it more efficiently extracts energy from food? Is the effect significant enough that it could have implications for people in countries where there isn't enough food?

In addition, when somebody has a slower metabolism, is there any effect on their ability to function? Does their whole system somehow slow down, so they don't react as quickly, can't move as fast, can't do as much physical work?

Amethyst

Amethyst in some of my prior posts in this thread I posted to what I think is one of the better articles about this:


http://www.nejm.org/doi/full/10.1056/NEJM199503093321001

Someone on another forum went to a talk given by one of the researchers on the article and he said, at the time (a few years ago) that as far as they could tell the lowered metabolism after weight loss is permanent. That is, they had tested people who had lost weight years before and they still had the lowered metabolism. I think, though, that this is one of the things that is still up in the air.

It is possible for the individual person to do things that increase metabolism, I think. For example, a weight reduced person who has higher body fat who works out and gains muscle and loses body fat might burn more calories than she burned before building muscle. But, she won't burn as many calories as someone with similar body composition who had never lost weight.

The main thing I've read about slower metabolism is simply burning fewer calories for the equivalent amount of work as someone who had never lost weight. I don't know if there is anything else.

 

[Amethyst]

It boggles my mind, that a person could tune their engine, so to speak, so as to accomplish the same amount of work, for fewer calories, and no loss of efficiency in other respects. It's as if you could train your car to go just as fast, but burn less gas.

Amethyst

Amethyst in some of my prior posts in this thread I posted to what I think is one of the better articles about this:


MMS: Error

.

 

[haha]

It boggles my mind, that a person could tune their engine, so to speak, so as to accomplish the same amount of work, for fewer calories, and no loss of efficiency in other respects. It's as if you could train your car to go just as fast, but burn less gas.

Amethyst

Odd that several million years of evolution would not have figured that one out, and applied it across the board without anyone ever needing to get fat to get this advantage. After all, starvation not obesity was the major human problem until the last ~60 years or so. It's a wonder that there are any descendants of people who did not have this trait.

Ha

 

[Meadbh]

It's a wonder that there are any descendants of people who did not have this trait.

Ha

Perpetuation of genetic traits only requires that carriers live long enough to reproduce, so this is not surprising. Elimination of adverse genes occurs when they result in disorders that are fatal early in life. Of course, modern medicine can prolong life to reproductive age in some of these disorders, which may perpetuate them. (E.g. cystic fibrosis). Also, new mutations pop up all the time.

 

[samclem]

A lower metabolic rate comes at a cost (reduced ability to withstand cold temperatures, reduced alertness, etc). So, any changes in metabolic rate in response to the environment (either at the individual level or as a species) would be a tradeoff.

 

[kyounge1956]

Predisposition doesn't necessarily dictate outcome.

When you look at those family photos of body types repeating, things like bone structure and height repeat. Then you get into nature vs. nurture. Certainly there is some effect of being raised by a family of overweight people that also predisposes someone to be overweight from the habits they learn - diet, exercise, etc. Those are behaviors that can be changed, even if it is extremely difficult to do so.

This study doesn't merely show the effect of learned behaviors. The children born while the mother was obese were genetically different--different genes were "turned on" or "off"--from the children born to the same mother after she lost weight as a result of bariatric surgery. The genes that are different in children born before and after weight loss due to surgery are "overwhelmingly involved in insulin sensitivity and glucose regulation..and in inflammatory processes". I suspect this means among other things, that the same behavioral choices will be less effective in controlling weight for the children born while the mother is obese than for those born after bariatric surgery.

Anecdotally - my father's parents were average height/average build. Their two daughters were both obese, and married men who were obese. Some of their offspring are obese, some of them are not. My father and mother are not, and my sisters and I are not. My father and mother were active early in their lives and remain so today. My aunts and uncles were not. So to write off obesity as something that's uncontrollably dictated by genetics and upbringing is equally fallacious.

I didn't say obesity was uncontrollable. But I do think this study suggests that it will be more difficult for the children born while the mother was obese to avoid becoming obese themselves, than for those born after she lost weight. That is what I meant by likening their situation to having the deck stacked against them. It's not impossible to win in a rigged game, but it is more difficult than in a fair one.

 

[haha]

Perpetuation of genetic traits only requires that carriers live long enough to reproduce, so this is not surprising. Elimination of adverse genes occurs when they result in disorders that are fatal early in life. Of course, modern medicine can prolong life to reproductive age in some of these disorders, which may perpetuate them. (E.g. cystic fibrosis). Also, new mutations pop up all the time.

I understand this very well. But it seems clear that more efficient energy metabolism would go a long way toward making someone survive to reproduce. For example, in a hunter gatherer society, the man who can go farther and longer on his food, and still have the gas to get his game will not only gain survival advantage but also sexual advantage The same is true of women, not least because it takes energy to get pregnant, and incubate and deliver a baby.

A lower metabolic rate comes at a cost (reduced ability to withstand cold temperatures, reduced alertness, etc). So, any changes in metabolic rate in response to the environment (either at the individual level or as a species) would be a tradeoff.

Do those who have experienced this phenomenon report reduced alertness, or inability to withstand cold?


Ha

 

[Katsmeow]

Do those who have experienced this phenomenon report reduced alertness, or inability to withstand cold?

I think I have reduced metabolism and I do not withstand cold at all well. I am constantly making the thermostat warmer. I don't know whether there is a connection at all. I am not actually sure how you would know if you had reduced alertness....

 

[haha]

I think I have reduced metabolism and I do not withstand cold at all well. I am constantly making the thermostat warmer. I don't know whether there is a connection at all. I am not actually sure how you would know if you had reduced alertness....

In light of this, do you or others with this condition tend to have lowered thyroid function? This would seem to explain a mechanism of this condition, at least to some extent.

Ha

 

[kyounge1956]

It's a wonder that there are any descendants of people who did not have this trait.

Perpetuation of genetic traits only requires that carriers live long enough to reproduce, so this is not surprising. Elimination of adverse genes occurs when they result in disorders that are fatal early in life. Of course, modern medicine can prolong life to reproductive age in some of these disorders, which may perpetuate them. (E.g. cystic fibrosis). Also, new mutations pop up all the time.

I understand this very well. But it seems clear that more efficient energy metabolism would go a long way toward making someone survive to reproduce. For example, in a hunter gatherer society, the man who can go farther and longer on his food, and still have the gas to get his game will not only gain survival advantage but also sexual advantage The same is true of women, not least because it takes energy to get pregnant, and incubate and deliver a baby.

One possible explanation is that other selective pressures were stronger or more recent than those in which more efficient metabolism would be the deciding factor. Another factor that may enter in is that the same gene may be both beneficial and harmful--mutated genes that cause illness and premature death in people with two copies, can protect against (a different) disease in those who have one mutant gene and one normal copy.

More efficient metabolism would be of survival benefit for a hunter-gatherer, but would it have helped someone in medieval times to survive the Black Death?

 

[Meadbh]

One possible explanation is that other selective pressures were stronger or more recent than those in which more efficient metabolism would be the deciding factor. Another factor that may enter in is that the same gene may be both beneficial and harmful--mutated genes that cause illness premature death in people with two copies, can protect against (a different) disease in those who have one mutant gene and one normal copy.

More efficient metabolism would be of survival benefit for a hunter-gatherer, but would it have helped someone in medieval times to survive the Black Death?

Exactly! The risk/benefit ratio of having the gene depends on the context. To wit: having sickle cell trait provides some protection against malaria. That's very helpful if you live in an African jungle. If you want to ski at Aspen, not so much. You become quite ill at altitude. (This happened to a Nigerian friend of mine). Likewise, if you are a Native American from the Pima tribe, your hunter-gatherer genes are well suited to protecting you from starvation at times when you are dependent on nuts and berries to survive. Take the same genes with you to McDonalds on a regular basis and you get Type 2 Diabetes.

Gene prevalence evolves over many generations to help people adapt to their environment. Change the environment radically, and things get out of balance until evolution leads to a new equilibrium. Globalization may not be good for you!

Meanwhile, we can't eliminate sickle cell genes, but we can certainly replace some of the carbs, saturated far and protein with nuts and berries.

 

[Katsmeow]

Exactly! The risk/benefit ratio of having the gene depends on the context. To wit: having sickle cell trait provides some protection against malaria. That's very helpful if you live in an African jungle. If you want to ski at Aspen, not so much. You become quite ill at altitude. (This happened to a Nigerian friend of mine).

Indeed. We adopted children from Vietnam, who have a blood disorder, Hemoglobin H disease. (They actually have very mild conditions which cause them no serious problems). Basically they are missing 3 of the 4 alpha globin genes that most people have. (If you are missing one you are a carrier, with minimal effect. Missing two is known as alpha thalassemia trait. Missing four is incompatible with life). To have hemoglobin H disease basically both of your parents need to have one or more missing alpha globin genes.

One reason all of the alpha thalasemias are so common in SE Asians is that they are protective against malaria. So, it is adaptive in Vietnam. Of course, not all that helpful in the US.

 

[Meadbh]

We have veered away from the original topic but this thread is very informative with good debate. Thanks to everyone who has contributed so far!

We now return to our regularly scheduled program.......

 

[kyounge1956]

OK, back to the regularly scheduled thread. Some months ago, I read The Truth in Small Doses: Why We're Losing the War on Cancer-and How to Win It. The author explains why the "War on Cancer", as currently conducted, has had so little success, and suggests a different way of tackling the problem.

Unfortunately, I don't recall exactly what his suggestion was! So I cheated and read the WSJ review of the book, which I quote below:

It is early detection that has been responsible for half the age-adjusted decline in death rates, Mr. Leaf says, yet the focus on new drugs eats up most of the resources. In fact, almost $300 billion in spending on research since the 1970s "has not stopped or substantially slowed the soaring cancer burden because of our nearly exclusive focus on trying to cure complex advanced cancer rather than pre-empt it from progressing."
That's a fairly extreme statement, given how many people have lived longer thanks to advances in cancer treatment. And the screening tests that are meant to detect cancer early on, like mammograms and PSA tests for prostate cancer, lack sensitivity and specificity, as Mr. Leaf acknowledges, leading to false positives and overtreatment. The solution, he says, is more tests like the colonoscopy and the Pap smear, which can detect irregular cells that aren't yet considered clinical cancer and guide their removal, interrupting the disease process before full-blown cancer develops.

Obviously, as someone with advanced cancer, I have a personal stake in finding better treatments. And pre-emption as suggested by Leaf isn't infallible. My father and my younger brother both died of colon cancer. I think my dad was screened as recommended, but the abnormal cells weren't detected until after they were fully cancerous; my younger brother was stage IV from his initial diagnosis in his early forties--well before the recommended age for a first colonoscopy. But to me it makes a lot of sense to get rid of suspect cells before they go fully cancerous, rather than to wait and treat them afterwards.

 

[Meadbh]

I agree. There is an interesting article in the New York Times today (Wednesday) about the pros and cons of screening for the BRCA gene in Israel. It examines the issue from the societal point of view.

http://www.nytimes.com/2013/11/27/h...e-leaves-many-conflicted.html?ref=health&_r=0