Restaurant menus
Following the U.S. Food and Drug Administration (FDA) rule introduced in 2012, restaurant menus today in about two-thirds of the largest restaurant chains have eliminated the highest caloric food items on their menus. In these 66 chains, higher calorie sandwiches, which have 52 to 71 more calories than their average items, were dropped. This is a healthy trend, but desserts, which are in carbohydrates, and soft drinks, which are toxic to the body, have remained unchanged. Low-carbs, low-fat, more vegetables and nuts are in. Indeed, long overdue.
COPD among non-smokers?
Chronic Obstructive Pulmonary Disease (COPD), which chronic tobacco smokers inevitably acquire after years of exposure (firsthand or secondhand) to the countless toxic agents in cigarettes, could also result from other causes, like environmental chemical pollution, and rarely, from a genetic disorder called alpha-1 antitrypsin deficiency, a hereditary condition. Unbeknownst to many, COPD could also be caused by GERD (Gastro-Esophageal Reflux Disease), where the valve between the stomach and the esophagus (food pipe) is incompetent (loose), allowing stomach hydrochloric acid (which normally helps in food digestion) to backup to the esophagus and higher up. The acid could also flow into the windpipe, frequently causing small coughs, and over the years, leading to inflammation in the respiratory track, leading to COPD, with lung congestion, bronchial spasm, some shortness of breath and wheezing, similar to asthmatic attacks. For this, metered dose inhalers (MDI) with bronchodilators, some with steroids, is part of the treatment, besides the use of Proton Pump Inhibitor (PPI) to reduce acid formation, abstention from spicy foods/alcohol, and sleeping with the head of the bed elevated.
Oral-cardiac health link
There is an intimate relationship between oral health and cardiac health. Any infection in the mouth, dental/oral, causes bacterial invasion and inflammatory processes that increase the risk for the development of heart attack and stroke. In the U.S., greater than 80 percent of Americans have undiagnosed periodontal or gum disease. This is the reason why it is vital to have maximal oral health by maintaining good oral hygiene and having dental checkup at least two times a year. As we have alluded to in this column in past articles, inflammation in oral cavity or any part of the body, evidenced by elevated C-reactive protein, is the cause of most major illnesses known to man.
Shotgun approach versus cancer
In view of the deadly nature of cancer in general, medical science and technology are unceasingly finding new and more effective ways to target cancer with this multi-pronged approach: pre-emptive recognition of genetic risks, prevention (lifestyle, vaccines), discovery of markers, early diagnosis, more precise targeted treatment, immunotherapy, and more accurate prognostication. This evidence-based approach is aimed at conquering this killer disease to allow victims to live longer or even attain total cure.
Genetics, genomics, mapping
The new frontier in screening tests for cancer are in the area of genetics and genomics. On such test searches for BRCA1 and BRCA2 genes, which predispose women to develop breasts and ovarian cancers, like in the case of renowned actress Angelina Jolie, who had her breasts and ovaries surgically removed as a prophylactic measure. Today, there is also a home test that detects changes in feces that identify colon cancer.
A great advance in cancer care is the mapping of the genetic blueprints of 33 cancer types. The DNA similarities would allow more precise target treatments of cancers, because greater success in the fight against cancer can be achieved if we can first classify them according to their genomic and molecular makeup. This would identify their vulnerabilities.
Biomarkers and liquid biopsy
Biomarkers are substances in urine, blood, and other body fluids that reveals cancer. These tests are: Liver cancer: alpha-fetoprotein (AFP); Prostate cancer: prostate-specific antigen (PSA); Thyroid cancer: Thyroglobulin (TG); and non-small cell lung cancer: ALK gene. Biomarker proteins for pancreatic cancer for its early diagnosis are still being investigated.
Standard biopsy is done on solid tissues or tumors. Liquid biopsy, newly approved by the FDA in 2016, is a blood test that could detect cancer DNA circulating in the blood stream. Besides revealing changes to the EGFR gene in the serum of patients with non-small cell cancer of the lungs, liquid biopsy for other forms of cancers are underway.
Anti-cancer vaccines
Like vaccination for the prevention of chickenpox, measles, etc., vaccines, which works with our immune system to prevent, or even treat, cancer are a welcome regimen in our fight against these killer diseases. Gardasil, the very effective vaccine against cervical cancer we reported in this column in 2006, has dramatically reduced Human Papilloma Virus (HPV) infection by 64 percent and correspondingly cervical cancer. The other two are the hepatitis B vaccine, which significantly prevent deadly hepatoma (liver cancer), and sipuleucel-T (Provenge) vaccine, which treats prostate cancer. Investigations worldwide are going on for vaccines against other types of cancers, like melanoma (skin cancer) and colon cancer.
Screening tests for cancers
Since most of our screening tests for cancer have potential side-effects, like radiation from mammogram or CT scans, false positive results from biopsies from gastroscopy/colonoscopy, more precise indications are needed to find out which individuals are more at risk and really need to be screened. If prevention does not succeed, finding cancers in their early stage before they spread is the next best strategy to get a possible cure, so screening tests are important.
Pills in your home against cancer
You may not realize it but, most likely, you have pills in your medicine cabinet at home today which could help in the prevention of colon cancer and heart attack. Some of you may have been taking it already. I am referring to aspirin (acetylsalycilic acid), first introduced in 1899, which, when taken in its 81 mg low-dose regimen once daily for at least 4 years could reduce deaths from heart attack by 25 percent and from colon cancer by 44 percent, if taken for ten years. The US Preventive Services Task Force states those 50 to 59 could benefit from this mini-dose aspirin therapy. There is also a group of medication that blocks estrogen receptors and lowers the risk for breast cancer. Drugs called aromatase inhibitors may also prevent breast cancer. Consultation with your physician is advised before taking any medication.
When it comes to warding off diseases, including heart attack and stroke, and especially cancer, a healthy lifestyle is at the top of the list of preventive measures at our disposal. The ball is in our court, our future largely in our hands.
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Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email: [email protected]
