Discoveries, especially very innovative breakthroughs that take place at frontiers beyond the usual structure of big medicine, seldom make front pages. The press that they do receive may be falsely negative, purveyed by the naïve and by establishments who place the interest of shareholders and stakeholders above the common good. Embedded in the basalt of internet medical claims are diamond-class discoveries in cancer prevention.
Applying Research Methodology at the Frontiers
A key component of my profession as a physician scientist and editor of medical textbooks is to evenhandedly apply the scientific metrics of public health, epidemiology and preventive medicine. Through this diligent process, I can attest to several scientific breakthroughs that were delayed in the fringes of skepticism.
My passion for "diamond-mining" stems from my early-career mentors:
- As a medical student at Johns Hopkins I witnessed the value of critical thinking and being dog-bone tenacious about discovery, no matter how under-appreciated it was at first. One mentor was the first to submit a clinical research proposal on probiotics. There wasn't even a place for it then. Decades later while working at the FDA, I had to recuse myself from a meeting on probiotics in infant formula because of the same researcher's multidecade perseverance. He prevailed, and now probiotics are among other applications, and are studied for cancer prevention.
- Another research mentor invited me to participate in one of the first studies of Helicobacter pylori infection and gastric cancer risk in an endemic country.
- While I was serving as the station physician in Antarctica, a series of events took place that made my station an unanticipated observational study of vitamin D. Consequently, by 1997 I was convinced that vitamin D was a powerful and underutilized modulator of the immune system in keeping with the vitamin's recently identified roles in cancer prevention.
Very Early Detection
Discoveries in early detection are especially difficult to advance. Large population studies are needed and are usually only feasible by large, well-funded teams.
The greater challenge may be the perceived lack of need for earlier detection. A commonly held view among health-care professionals is, "Cancers come and cancers go. Detect them too early and you'll be unnecessarily treating many patients, disrupting their lives and subjecting them to harmful procedures for a condition which would have resolved on its own."
As I wondered what it would take to renew an inculcated medical structure's interest in early detection, a temblor struck. It did not originate from the center of the earth, but from the stars - the Hollywood kind. Movie stars are choosing prevention, even at shockingly great cost. Imagine medical grand rounds where Angelina Jolie defines patient choice. It might put the medical community on notice, changing the rubric to "Doctors come and doctors go. ..."
My personal temblor was one of excitement when Yoshiaki Omura, MD, ScD, invited me to attend his international symposium at Columbia University in 2011. He received his training in cancer diagnosis and treatment at the Columbia University Cancer Institute and is a distinguished adjunct professor at New York Medical College. Dr. Omura holds a 1993 US patent for his multidecade career work in early cancer detection. An objective university study in Japan found a true positive rate of approximately 30% not combined with any other screening methods – remarkable for a noninvasive technique requiring minimal cost and no patient discomfort. Thousands of practitioners worldwide have come to see his lectures, and his technique is being thoroughly studied at major hospitals in Japan.
Yet Dr. Omura's work is criticized, based not on the work but on a misrepresentation on the Internet, where anonymous bloggers make it sound as if one can simply take the Washington, D.C., metro to Crystal City, Virginia; be the first to fill out a few papers with an original idea; and receive the US Patent Office's seal of approval in the mail. Of note, the most forward-thinking inventions take more time to receive a patent because meticulous research is required to prove that the invention can work. Another requirement for receipt of a patent is that the technology can be transferred and learned by those in the field. Affidavits from physician scientists worldwide reviewed by the U.S. Patent office can be found at Dr. Omura's website Bi-Digital O-Ring Test (BDORT.org), as can the description of his patented invention. Opportunities for continuing education can be found at the International College of Acupuncture & Electro-Therapeutics (icaet.org).
Early Detection + Treatment = A Call to Action
Detecting cancer at a stage earlier than it can be corroborated by conventional diagnostics (i.e., breast imaging, serology, and colonoscopy), while fascinating, can only lead to prevention if treated. It's the sound of one hand clapping. However, early detection that informs a personalized treatment plan is an extraordinary tool for prevention. Dr. Omura's work has spurred me to identify such treatment plans.
A Meaningful Biomarker Coupled with a Biologic Treatment
Dr. Omura's method of cancer detection can sometimes be corroborated with a biomarker and corresponding treatment. The enzyme alpha-N-acetylgalactosaminidase, known as Nagalase, is produced by viruses and cancer cells to invade human cells. Nagalase can be measured in human serum, where it is a marker for viral infection and cancer. Nagalase inactivates the D3 binding protein (Gc protein) which signals human immune production of the macrophage activating factor (GcMAF). Dr. Nobuto Yamamoto of Japan first reasoned and demonstrated that if GcMAF production is impaired by viruses and invading cancers, administering GcMAF as a biologic treatment could potentially allow the immune system to regain control. GcMAF is currently in preclinical trials, and additional resources can be found at the website GcMAF.eu. At the very least, this intriguing area of research underscores the importance of vitamin D in cancer prevention.
When D is synthesized by the body from sunlight, its effects are not identical to those of vitamin D3 supplements. For most individuals, 400 IU daily is the optimal dose of supplemental D3 for cancer prevention. For all the interest in coffee and cancer prevention, and the emerging importance of a small amount daily, perhaps liquid vitamin D3 may be effectively delivered in a cup of morning brew. I'd name the study "D' common grounds."
Genetic Risk Potentially Reduced by Dietary Supplementation
Genetic screening can personalize cancer prevention. Gilbert's syndrome is a genetic (inborn) metabolic condition associated with decreased activity of UGT1A1. In contrast to most inborn errors of metabolism, Gilbert's syndrome is very common, with a prevalence of 1 in 10 Caucasian Americans and 1 in 7 African Americans and less in other racial groups. The most noted, and for some time only, known consequence was jaundice in newborn babies. However, with increased research and rise in environmental toxins, Gilbert's is associated with difficulty in eliminating carcinogens and certain synthetic drugs. Now published medical studies show epidemiologic data linking Gilbert's syndrome with increased risk of hormonal cancers.
Calcium-D-glucarate is a dietary supplement that promotes removal of environmental toxins and biochemically appears to ameliorate the metabolic blockages of Gilbert's syndrome, as well as broader use for elimination of environmental toxins. I am not aware of any clinical studies of risk reduction, but support of liver metabolic pathways in general is relevant to cancer prevention.
Expanded Medical Partnership with Dentistry
Dentistry is emerging as a field with several cancer-prevention tools. Cancer is associated with inflammation, which can be from nerve stimulation through pathways delineated by ancient medical practices. The nerves in teeth interconnect with the body through these meridians, so that a toothache, cavitation, or root canal promotes inflammation and carcinogenic potential in distant body parts.
Dr. Alireza Panahpour has focused his West Coast dental practice on treating patients with dental conditions exerting adverse effects on distant body organs. With a similar practice model, Dr. Mark McClure of National Integrative Health Associates in Washington, D.C., offers an interactive chart of teeth and meridians, found on the Internet at Nihadc.com/biological-dentistry/interactive-meridan-tooth-chart.html.
Periodontal disease is associated with heart disease because of the associated inflammatory pathway. Now a similar association between periodontal disease and cancer is being established. No dental work is completely accepted by the body, but some such as mercury amalgams and bisphenol-A, asbestos, and phthalate-containing appliances would be appropriately replaced.
Dr. McClure's colleague Dr. Lowell Weiner raises an important point about the jaw and the messages that it signals systemically, especially during sleep. Oral appliances can correct a cancer-related deficiency of a vital nutrient – oxygen. Sleep apnea can be treated by dentists, sometimes with higher patient satisfaction and adherence than through pulmonary medical approaches, depending on the underlying disturbance.
Removing a Specific Carcinogen
Dr. Omura's technique not only detects cancer at early stages, it can also detect asbestos, which is suspected in cancers besides mesothelioma, wherein it is the primary carcinogen. The same physical properties that make asbestos a fire retardant and insulator confer its carcinogenesis and its ability to be detected as tiny nanoparticles using Dr. Omura's technique. More can be found in Dr. Omura's chapter on asbestos in Advancing Medicine with Food and Nutrients, 2nd edition, which I edited.
Dr. Omura's interest in the herb cilantro was piqued when he found that cilantro promoted the excretion of asbestos from the body. He recommends eating cilantro and also taking a cilantro supplement to facilitate removal of heavy metals and asbestos, to prevent cancer. Cilantro is high in folate, a vitamin with established anticancer properties. This adds to the rationale to use it strategically in cancer prevention.
Tools exist to profoundly reroute a life journey from the cancer that would have been to the vibrant health that is. While I make no claims or endorsements of the efficacy of the cancer prevention tools presented here, each has demonstrated merit with scientific criteria. These discoveries may be the vitamin D, infection-induced cancer and the microbiome of the next decade. The research needed for these discoveries to reach their full potential is a forward-thinking investment that sparkles with the promise of vibrant health for many.
Ingrid Kohlstadt, MD, MPH, FACPM, FACN
Faculty Associate, Johns Hopkins Bloomberg School of Public Health
Executive Director, NutriBee National Nutrition Competition Inc.
Editor, Advancing Medicine with Food and Nutrients, CRC Press 2013