Ultra-processing the causes of cancer

Diet is one of the most basic human concerns. And why shouldn’t it be? The human body needs food and water to survive. But perhaps over the last few decades there has been a sort of over-focus on foods, fads, low-carb diets, low-fat diets, high protein-diets and others that have been taken a bit to extreme. And when you realise that another of the human obsessions (at least the media one anyway) is exercise – low-intensity? high intensity? intervallic? strength? – you realise that these two can be a deadly combination. While they purport to help you lose inches, the amount of column inches they generate is amazing!

It is no surprise to find the Guardian reporting that ultra-processed foods can be linked to cancer in a recent study done by French researchers. Ultra-processed foods are those that have undergone processing that relies on chemicals outside the normal realm of preservation. In the kitchen, we normally put salt on meat to preserve it, but an ultra-processed food could be one that is cooked and then preserved using special chemicals to allow it to be stored in a can and have a long shelf life.

The diets of 100,000 people were studied and those individuals who consumed the highest proportion of processed food were found to have increases in the overall rate of cancer.

But because the consumption of processed foods covered a wide umbrella, it was difficult to isolate the specific chemical purporting to create a rise in cancer.

The rise in cancer may not necessarily be linked to a specific chemical either.

Certain chemicals might work in combination to create an increased cancer risk. The chemicals themselves may be safe, but may interact in unknown ways.

Furthermore, it might be a lifestyle issue anyway – as those who eat more ultra-processed foods are more likely to live a more stressful or hectic lifestyle, consume a higher-fat diet, exercise less and be more likley to smoke.

The risk of cancer is minimised with a reduction in smoking, and increased in physical activity, and a healthy diet that includes minimising the consumption of alcohol and eating fruits and vegetables. It is also perhaps managed by a comfortable level of stress. We could take the combination of these factors to give a “lifestyle score” to assess the risk of developing cancer, instead of looking at individual factors and trying to determine their individual impact. While certain individual factors do have a pre-dominant influence when taken far beyond the boundaries of normal well-being – for example, a person who drinks excessively and then develops cancer can have his cancer retrospectively linked to his alcohol consumption – the examination of how factors combine within a smaller boundary is perhaps useful research for the future. For example, if a person does not exercise, but eats healthily, is he or she more likely to develop cancer than someone who eats healthily but has a stressful lifestyle?

It is these kinds of combinations that could form the basis for useful research in the future.

Dogs can sense fear – and seek release

What makes some people more susceptible to being bitten by dogs? A recent study suggests that dogs, with a sense of smell keener than humans, can sense fear in us. And this suggests that perhaps the sense of fear trips or triggers the dog into a fright or flight response that results in the human being bitten.

The Daily Telegraph reported that the best form of prevention against a bite from a dog could be to adopt a slight self-confident front, almost seemingly like a swagger, in order to convince the dog of a sense of confidence to override the inner sense of fear. However, this approach does not address how the dog might deal with the presentation of a confident person yet sense the underlying fear. It is like you meeting a person who you know is lying, yet smiling at you. What do you know? You revert to what psychologists might call the memory bank, the “type 2” kind of thinking which is more analytical, and less immediately responsive – but do dogs have that kind of ability to think and fall back on?

The research was carried out by researchers from the University of Liverpool in the form of a survey in a bit to understand why the likelihood of people being bitten by dogs seemed to be in a higher case of incidence for certain individiuals.

The results from the survey said that the likelihood of taking a nip from a four legged friend was almost 2.5 times more common than the current official figure, which estimates that 7.4 in 1,000 people get bitten by a dog every year in the UK. The figure is likely to be higher, because dog owners who get bitten by their own dogs are unlikely to report them for fear of getting their own dogs put down. Dog bites which also happen within the family – where the dog belongs to a family member – are unlikely to be reported for the same reason.

The results also showed that people who are nervous, men and owners of several dogs were more likely to be bitten.

This study was dependent on the date from questionnaires. This sort of information collection is a good way to obtain responses quickly. However, the limitations of this study include the fact that in this particular instance an assessment of behaviour is difficult, both in a recollection situation – having to do it in hindsight. Also there was the earlier reported case of perhaps dog owners not wanting to get their dogs taken in, and amending their queries.

The current guidelins for dog bit preventions suggest the following:

Never leave a young child unsupervised with a dog – regardless of the type of dog and its previous behaviour.

This is of course a good point, especially with attack dogs or more aggresive breeds. Even if the child is known to the dog, there have been many cases where dogs left alone with toddlers have seized the chance and attacked them. It is almost as if the removal of an adult boldens the dog into an attack it would not normally make, and being left alone with a young child heightens the fright or fight syndrome within a dog.

Another guideline is to treat dogs with respect – don’t pet them when they’re eating or sleeping. Dogs dislike being disturbed when they are meeting their basic needs, and the disturbance awakes and breeds aggressive responses that may evolve later.

A third guideline is to avoid stroking or petting unfamiliar dogs – when greeting a dog for the first time, let it sniff you before petting it. A good idea is to actually converse with the owner first so that the dog has already established you are friendly.

This study was carried out by researchers from the University of Liverpool and was funded by the Medical Research Council Population Health Scientist Fellowship. While the media reporting of the study was fairly accurate, The Guardian pointed out that people’s emotional stability was self-rated. In other words, if respondents were asked to rate their feelings, this may not be an accurate assessment – one person’s level of anxiety may not be the same as another’s.

So can dogs actually sense fear and anxiety? How does this explain the incidence of people being bitten by dogs? The answer to these questions can be answered best perhaps in two parts.

The first is the level of aggression in the dog. This depends of course on the genetic makeup, but also how it is treated. If its needs are met then it is likely that the level of aggression is typically lower than what it would be than if it were harrassed or disturbed persistently, which can build up latent aggression.

The second is the dog’s sense of fear. If a dog is often emotionally angered and there is opportunity to release this tension, even in a moment of madness, then this may result in biting as an emotional release.

So can dogs sense fear? Possibly. Does this explain their tendency to bite? Well, dogs that are treated well and genetically not prone to attacking will be less prone to nipping. Dogs that are not attack dogs but mistreated, or dogs that habitually have their attack responses nurtured, are more prone to biting, when the opportunity presents itself in the form of a less defensive target.

How the dangers of e-cigarettes extend beyond DNA damage

Studies done on laboratory mice suggest that e-cigarettes can be harmful to humans, although to a lesser degree compared to the traditional tobacco they are supposed to replace. This suggests that  cigarette smokers could do themselves some good in switching to e-cigarettes, although those who have yet to pick up the habit should avoid it because it can actually do the body harm – and is not zero-risk smoking as some might view it.

E-cigarettes have been growing in use over the last few years. Because they are aerosol-based, they use compounds to deliver nicotine to the user. This means they avoid the smoke associated with traditional tobacco cigarettes. In the latter, the burning of tobacco releases carcinogens, which cause cell damage and cancer when they are inhaled. The delivery of nicotine by aerosol in e-cigarettes avoids these, although the recent study proposes that this is not enough.

The most recent research into the use of e-cigarettes suggests that they still cause cancer because they damage string DNA and the body’s ability to repair itself.

Laboratory mice were exposed to the vapour of e-cigarettes for a period that simulated normal human consumption. The vapour of e-cigarettes contains both nicotine and solvent, and while the solvent itself had no effect on the mice, the combination of solvent and nicotine had the same impact as nicotine itself.

The limitations of the study were that it was unclear the vapour inhaled by the mice was equal to the amount a human being would, or pro-rated for the difference in mass! Furthermore, the impact on mice may not be comparable to those on humans.

The research does highlight, nevertheless, that there is a potential danger in e-cigarettes. While guidelines in 2016 recommended them as a safer alternative to tobacco, they are not 100% safe. Various groups of people such as the younger generation, for whom smoking is a perceived sign of maturity, think that just because there is no burnt substance, that they are perfectly safe. Unfortunately, the easy availability of these e-cigarettes, just like nicotine gum, means that rather than getting individuals off cigarettes, they may only be building up a lifelong addiction instead.

The higher cost of body embarrassment

If you were a bloke, would you avoid going to the doctor’s if it meant you had to strip off for the doctor to examine an area of your body you had concern about? Chances are men who have found a lump in their testicles might put off going to the doctor’s for a couple of days, drinking lots of water in the hope that it would go down, and if the lump remained, then work up the courage to make an appointment to see a doctor about it. Why put it off for a few days? It is probably down to the fact that it is slightly awkward and embarrassing to strip off to your private areas in front of someone else, despite the fact that doctors are professional and the health concerns are pressing. Despite the risk that the lumps may need to be operated on, some leave it late – and even a bit too late – because of the embarrassment.

But the embarrassment is not just down to men. Women put off going for tests and checkups because of the awkwardness around their perceived bodies. The BBC News website reported that women were avoiding smear tests to detect cervical cancer, with some either delaying making an appointment, or skipping screening altogether.

Cervical cancer accounts for an average of more than two deaths a day. Over 900 women die annually from it. Each day an average of nine women a day are diagnosed with it. All women aged 25 to 49 are invited for a screening test every three years. From the ages of fifty to sixty-four, this is reduced to once every five years.

Among those aged 25 to 29, more than one in three skip the cervical screening, a statistic that is worrying as the women more likely to get such cancer is the age group most likely to avoid the screening tests meant to catch it.

For what reasons do women avoid such tests?

One survey of around 2000 women found that their embarrssment about body shape was the most largely quoted reason for not attending. In other words, women were not comfortable with their own bodies in front of others. Other women also thought that they were healthy, being regulars of exercise or the gym, and thought that they were of a lower risk than others. A third did not believe that cervical screening reduces the risk of cancer at all. The results of the survey suggest that more importance needs to be placed on educating women of the benefits of screening.

The test only takes five minutes but perhaps one of the biggest barriers facing women was the awkardness if a male doctor or nurse was the one conducting the cervical screening. But women do have the option of asking in advance for a female to carry out the test, and many already do.

Jo’s Cervical Cancer Turst, the only charity in the UK dedicated to women suffers of this form of cancer, is working to improve detection rates and hence reduce the emotional impact of cancer on women and their families. The current screening is the greatest form of protection against such cancer, and helps save the NHS money by preventing the need for later surgery. The treatment of early stage cancer iis estimated by the charity to cost less than a tenth of later stage cancer.

It is not clear from the survery whether the women were representative of different regions, beliefs, or socio-economic groups. Women from certain cultures may find it more socially unacceptable to be naked in front of other individuals, let alone male doctors, and hence not attend screening for such reasons and are likely not to.

Appearance of the body shape and the vulva accounted for 84% or cervical smear absentees. Of these, 38% were also concerned that they might not smell normal, while 31% would not have gone had they not shaved or waxed their bikini area.

A senior nurse mentioned that nurses are aware of the awkwardness of showing an intimate part of the body to someone else but are sensitive to make the procedure less embarrassing so that women continue to have acceptable experiences that do not put them off screening for cancer. A chaperone is always offered and if women prefer to take a friend or partner with them that is fine too. It would be a great shame if women were put off seeking medical advice because of their embarrassment – it would be too great a price to pay for a small period of minimal inconvenience. The same goes for men and visits to their doctors too.

Ibuprofen and the fertile imagination

There is an astounding variety of painkillers available for purchase both in supermarkets, chemists, and corner shops. Just take a look at the shelf of your nearest Tesco or Sainsbury. You have various types of paracetamol, both made by pharmaceutical companies as well as in house versions of the supermarkets.

What is the difference between them and why are there so many varieties?

When pharmaceutical companies take on the decision to manufacture a new drug, they are given a twenty-year patent which covers the research into the product, testing and manufacturing, and sales. The period of twenty years, a monopoly as such, is to reward them for the time invested into the research. In the course of the research into the product, pharmaceutical companies must publish various forms of medical evidence and put it into public domain, so that if there is any medical evidence that points to the contrary, these can be debated both by the medical community and the pharmaceutical world.

The problem, if we can call it that, is that business is a very competitive world, and if research is put out in the open without any form of intellectual protection, any manufacturer can pounce on the research undertaken by someone else who has taken the effort and trouble to do it, and produce their product off the back of it. They would have saved the time and cost investment.

Imagine if a writer has taken the time to research a topic, organise his thoughts succinctly, and find a publisher. And when his book is published, someone else photocopies it, binds the copied pages and subsequently peddles it as their own.

Within the period of twenty years, a pharmaceutical company has to research, market and sell enough of the product to recoup the investment costs and profit. It is after the twenty period has expired that the other sharks enter the fray. This is where you get the supermarket brands of the product, which are cheaper because they don’t need to pay for research.

What is the difference between brand names and generics? They essentially do the same thing. But if the original company has done a good job in making the product synonymous with its own brand, then you might think they are better. If you take Neurofen for headaches, then you might think it better than Tesco ibuprofen, even though they both contain the same active ingredient.

But pharmaceutical companies have to reinvent themselves, to make varieties of the same product, otherwise they will lose their market share and eventually die out. If you realise that Neurofen is matched in ability by the cheaper Tesco ibuprofen, you would buy the latter, unless you are persuaded that Neurofen for Flus and Colds, or Neurofen Muscle Pain has something clinically formulated for that specific purpose.

So the shelves of supermarkets are stacked with different priced products with the same active ingredient, as well as different varieties of the same product.

Painkillers are a common medicine because there will always be a demand for pain management.

The availability of pain relief medicine means it is easy for the average individual to obtain them. There is the possibility of overdose, and while this may be a rarity, there is a higher likelihood that the greater availability may mean individuals are taking more doses than they should.

What are the long term health impacts of taking ibuprofen for prolonged periods?

One problem is that the body adapts and so the long-term resistance is affected. In certain groups such as the elderly, aspirin also increased the risks of stomach bleeding.

A clinical trial seemed to suggest it may impact on testosterone production and hence affect fertility.

Test subjects were administered 2 x 600mg doses of ibuprofen daily for six weeks, much higher than the average dose. The sample size was only a small group of 30, and half received ibuprofen, while the others received a placebo. It would have been better if the subject group had been greater, so that there could be more confidence in the test results, but because a test of such nature is to examine human resistance to what is essentially toxicity, it would have been unethical to involve a large group of participants. The research findings found that there was no impact on testosterone already in the body, but the pain relieving nature of ibuprofen, as a relaxant of sorts, had impact on the production of testosterone and appeared to slow down production.

How did these reports end up in the media? The tabloids had a field day, and you would undoubtedly have found one with the usual wisecracks about balls and other man-related genitalia, along the lines of “Ibuprofen shrinks your balls” or “Ibuprofen smalls your balls”.

Maybe instead of Ibuprofen for colds or fast relief, we need Ibuprofen for Dummies.

Your daily sausage roll may exact its revenge on you in good time

Ever wonder why people go on a vegetarian or a vegan diet? There are many reasons I can think of.

The most common one is that people are very much against animal cruelty. People who avoid eating animal-based products are against the farming of animals, because they are convinced that animals are treated inhumanely. For example, battery hens are kept in small cages in large densities. Imagine if you and your fellow co-workers were put together in a small room, without any desks, and told to make the most of it. You’d all be up in arms about the way you were treated. The only difference between you and hens is that hens can’t protest about it.

The transition to a vegan diet is not just about not eating animals, although this can be a factor too. Vegans are against the eating of animal meat because of the way farm animals are killed. Cows, pigs and chickens, the main farm animals that are killed to provide the common English foods such as the English breakfast comprising sausages, bacon and eggs, are – in the opinion of vegans – inhumanely killed, despite the best of measures.

Do you know how a chicken is killed before it ends up deep fried in bread crumbs and served with your chips and bottle of cola? There are two main ways. The first is by electric methods. First of all, the birds are shackled to a conveyor belt by their legs, upside down. Needless to say, they don’t willingly walk to the machine and pick their positions. There is a lot of fluttering about, human exasperation, and rough handling of the birds which may result in broken bones – who cares, right? After all, the bird is going to be dead soon – before the conveyor belt brings the birds upside down into a water bath primed with an electric circuit. The moment the bird’s head touches the water, it is electrocuted to death.

The second method involves gassing to death. Birds are transported in their crates and exposed to suffocation. This method is arguably more humane, supporters say, because the birds are not manhandled. But don’t be fooled into thinking the bird’s welfare is under consideration. It is a faster, less human-intensive way of killing the birds. Sling them in the box and gas them to death. No messing around trying to catch the flapping things. Avoiding the need to shackle them also saves time.

There is a third reason often quoted for going further in being a vegan. Cows produce vast amounts of methane and if everyone stopped eating beef, it would be better for the enviroment. In this instance, it is not so much for the animal’s welfare, but more for the sake of avoiding the environmental pollution by the animal.

There may soon be another fourth reason for avoiding meat. Processed meats – which have been preserved using methods such as salting, curing, smoking or adding preservatives – have been linked with cancer.

A study involving 262,195 UK women showed links of breast cancer and processed meat. Postmenopausal women who ate processed meat had a 9% higher chance of getting breast cancer than women who ate no processed meat. Those who consumed more than 9g of processed meat had a 21% chance of getting cancer in comparison to those who avoided it altogether.

The study is significant because the sample size is large – not just 100 women, or a small negligible figure whose results may bias findings, but over 250,000 women; more than enough to be taken seriously.

The women were all between the ages of 40-69 and free of cancer when they were recruited for the study before 2010. They were followed for a period of seven years and the results examined.

Process meats are thought to possibly cause cancer because the methods involved in processing the meat may lead to the formation of cancer-causing compounds called carcinogens.

What is not so clear is whether it was the eating of processed meats in isolation that caused the development of cancer. There are other factors that should be taken into account, of course, such as alcohol, exercise, work stress, lifestyle factors and body mass index. Certain ethnicities may also be prone to developing cancer because of other dietary factors such as cooking with oil, ghee or lard.

The results also did not suggest that the findings would be equally applicable to men.

Nevertheless, it would be a good idea, if you were an older woman, to avoid eating processed meat every day. Instead the consumption could be limited to once every other day, or eating it as an occasional treat. Or cut out the meat completely – a switch to a vegetarian or a vegan diet would not only be good for your health. You would be considering the environment too.

Health umbrella reviews mask the real issues

You have to wonder why the breakfast tea doesn’t get the same level of attention. Or perhaps whether in France, the humble croissant is elevated to the same status. Or maybe the banana could soon be the star of another media show. But unfortunately it is coffee that headlines tomorrow’s fish and chips papers.

“Drinking three or four cups of coffee a day could have benefits for your health”. As we have seen previously, this kind of headline bears the hallmarks of a media health report:

1) repackaging of common information requiring little or no specialist examination;

2) use of a modal auxiliary verb (could) to conveniently justify or disclaim an

attention-grabbing headline – which, by the way, is point number three.

The health reports in the media also incorporate:

4) a statistically small group of trial participants, whose results are then blown up in proportion as if to be representative of the 7 billion people on the planet.

5) Assumptions. A media report about health could simply include assumptions.

Why dwell on coffee? For starters, it is a commonly consumed drink and so any meaningful research would potentially have bearings on millions of people. It is common media practice to focus on common food and activities because of the relevance to daily life.

But if you examine this carefully, why not tea? Why not write about tea? While conspiracy theories may be slightly far fetched, it is possible that – unless it is a speciality tea – coffees cost more, and any potential health benefits would lead people to spend more, hence generating more for the economy in the forms of tax. Perhaps this is why media writers don’t waste too much ink on researching the potential life-saving benefits of bananas, even though they are widely consumed. The research isn’t going to drive people to buy bananas in bulk, and even so, the extra revenue generated from a low priced item isn’t going to raise much extra tax.

Are there any notable similarities or differences in style across different countries? One wonders whether Parisian newspapers, on a regular basis, churn out headlines such as:

“Eating two or more croissants a day could reduce your chances of heart disease.”

“Pan aux raisins linked with dementia”.

The research done was an umbrella review to potentially examine whether further research should be undertaken into researching the effects of coffee and its role in preventing liver cancer. An umbrella review meant that no actual research was undertaken, but that existing research was examined and analysed to glean insights.

The problem with umbrella reviews is that they are very generalised, no actual research is done, and they are only brief analyses of existing research. This means that first of all, an umbrella review could arrive at a particular conclusion, but in no way should that be taken as the final conclusion.

In fact, the findings of an umbrella review are only the preliminary to more detailed investigation. If an umbrella review suggested that drinking coffee could prevent cancer, then what it is saying is more research needs to be undertaken, and the media needs to be ethically responsible by not reporting “Coffee prevents Cancer”, because there are people that look at newspapers and television as the source of their information and assume just because it has been released in the public domain, it is truth. Who could conceive that newspapers spend time and resources to publish trivial information and that television is pure rubbish?

The second problem with umbrella reviews is that the outcomes are only as good as the original sources. If someone gave you a set of grainy photos, then asked you to make a collage with them, then your collage is going to be as good as the grainy photos will allow. If the original sources were not thorough or exact in their investigation, are any subsequent findings based on these merely just a waste of time?

The third issue with umbrella reviews is that under closer scrutiny, the overall picture is distorted by over focussing on small statistical variances, or sometimes minute errors are magnified and lead one down the wrong path.

If you took a picture on your phone and then blew it up to the size of a mural covering the side of your house, the picture becomes very dotty. You might see big patchy squares. But if you started looking for that big patchy square from the image in your phone… one has to wonder what the purpose of that is.

The fourth is that because umbrella reviews are a prelude to a more thorough investigation, their end results are slightly skewed from the outset. If an umbrella review is bound to provide a few avenues for later time-consuming research then it is fundamentally biased into having to provide one in the first place. Why, in that case, have such reviews in the first place? Some may point out that the flaw in the system is that umbrella reviews are relied on by those in academia and research to warrant the continued longevity of their positions. In other words, if researchers had nothing to research, they might be out of a job, so they best find something to stick their noses in.

Have you ever read the London newspaper Metro and come across some research news such as:

“Going to bed angry can wreck your sleep” (25 Sept 2017)

It is the sort of headline that makes you think “Why bother doing the research in the first place?”

It is likely that you have read a media report of an umbrella review.

What were the findings of the original coffee review?

Drinking coffee was consistently linked with a lower risk of death from all causes and from heart disease. The largest reduction in relative risk of premature death was seen in people consuming three cups a day, compared with non-coffee drinkers.

Now, when an umbrella review mentions drinking coffee is linked with a lower risk of death, it is important to be clear about what it specifically means. And what it is stating is that those who had a lower risk of death all happened to drink coffee. It might have nothing to do with the coffee itself. It might have been that they took a break to slow down a fast-paced lifestyle, and the taking of a break gave them a lower risk of death. By that logic of association, tea could also be linked with a lower risk of death.

Coffee was also associated with a lower risk of several cancers, including prostate, endometrial, skin and liver cancer, as well as type-2 diabetes, gallstones and gout, the researchers said. The greatest benefit was seen for liver conditions such as cirrhosis of the liver.

Again, to be clear, the above link means that those who were at lower risk of those cancers happened to drink coffee. But it is not necessarily stating the coffee had anything to do with it.

And coffee is such a commonly consumed drink, that it is easy to use it to draw links to anything.

If people who died from car accidents happened to drink coffee, an umbrella review might state that drinking coffee is linked with higher incidences of car accidents.

The findings can be summarised by a health analyst:

“Does coffee prevent chronic disease and reduce mortality? We simply do not know. Should doctors recommend drinking coffee to prevent disease? Should people start drinking coffee for health reasons? The answer to both questions is ‘no’.”

We should perhaps add a further third question: Did the umbrella review produce any actionable findings, and should it have been undertaken in the first place?

Probably not.