But  doctor, can't I have just 1 cigarette per day?

Almost everybody realises these days that cigarette smoking increases the risk of heart disease, stroke and cancer, and do their best to stop. Nicotine is probably one of the most addictive of all substances in some people, and many find it almost impossible to stop, and cut down to one or 2 cigarettes per day, in the belief that this dramatically reduces the risk. If you smoke 20 cigarettes a day and cut down to one, the assumption is that you reduce your risk 20 times.

Unfortunately a recent paper in the British Medical Journal is bad news for these people. They reviewed over 200 studies between 1946 and 2015, involving over 3 million men and 2 1/2 million women, and looked at the risk of having a heart attack or stroke if they smoke 20 cigarettes a day, or just one.
In men compared to non-smokers, the risk of having a heart attack was increased by 150% with one cigarette, and 200% with 20.  In women it was 220% and 390%.

So it appears that much of the damage is done by just one single cigarette, and complete abstinence is the only answer if we want to reduce the risk of heart attacks.
The incidence of stroke is similar.

To quote the paper: "smokers who cut down the number of cigarettes believe they can benefit from large reductions in the risk of cancer and cardiovascular disease. The study shows clearly that there is no safe level of smoking for cardiovascular disease, and light smokers cannot assume that continuing to smoke does not lead to harm. Smokers need to quit completely rather than cut down."

Bariatric surgery – why aren't we doing more of this?

In the Western world obesity is an enormous problem, which we are tending to ignore - quite literally
the elephant in the room. Thousands of books and magazines discuss different diets to lose weight, almost all of them provide short-term but no long-term benefit. The fact that there are so many diets confirms that none are successful.
There is no debate that the major cause of this as we are eating far too much sugar, and medical advice in the past to not eat fat makes the profession equally as guilty as their patients. We are talking about taxing sugar, soft drinks, making them R16 etc. and while this may well make a difference in the long term, there are tens if not hundreds of thousands of people who are moderate to morbidly obese who have been left in limbo. If diets don't work, how can they possibly lose weight?
The medical profession and many others look at them and say "it's their fault"  they eat too much and don't do enough exercise. But losing weight and keeping it off is extraordinarily difficult. At the same time people with severe obesity developed diabetes, hypertension both of which lead to heart attacks, heart failure, strokes and possibly cancer. The cost of both the medicines to treat these diseases long-term is significant, and is a great deal more expensive than one single operation!

2 recent studies in the Journal of the American medical Association show just how effective bariatric surgery is.
In one study 932 people had an operation and the 956 were treated medically with intensive dieting advice, followed for 6.5 years.   High blood pressure was "cured" in 32% of the surgical compared to 12% the medical group. Only 2% of the surgical group developed high blood pressure over 5 years while 12% of the medical group did.
Diabetes was "cured" in 57.5% compared to 14.8% of those treated optimally medically, and only 0.3% developed diabetes compared to 7.5%.
In the second study looking at diabetes, of the 40 patients having gastric bypass, at 5 years 55% had their diabetes controlled against 14% of the intensive medical group.   They did however, not surprisingly, have more gastric surgical complications (66 vs 38 events).   So the surgery should only be done by skilled gastric surgeons.

50% reduction in diabetes and 32% reduction of high blood pressure - These benefits are huge, and will represent an enormous difference in medical costs over the years, save many lives, and reduce the misery of these patients.
Surprisingly compared to other studies there is an increased incidence of depression (8.9 compared to 6.5 in the medical group) on those who had the operation.

I believe bariatric surgery should be available to many more people, it will save lives, improve quality of life and saved medical expenses far outweighing the cost of the operation. Obviously people who have the operation should be followed up carefully, and any psychological problems discussed. I have a suspicion that many people after the operation are discharged as "cured".
It's also extremely likely that the bypass will affect the absorption of some nutrients, particularly vitamins and minerals, and these patients should be given good multivitamins and multi minerals, fish oils and probably calcium and magnesium on a regular basis. They also need to have their vitamin B12 checked, as the intrinsic factor created in the stomach is essential to absorb B12, and they may require B12 injections.

Hopefully in the future when we can cut down on the sugar this will no longer be a problem, but I think we do need to be holding out a helping hand to the current generation of obese people that the medical profession and food manufacturers have created.

Supplements and Cancer

Supplements which can help cancer.

I was recently asked by a patient's specialist to justify the supplements I suggested he could take to help in his fight against cancer.
I thought I might place the answer here on my blog as well:

In response to your doctor's letter re the value of supplements and cancer:

It is important to remind people, especially the medical profession, of reality. Requesting "need to justify this advice with clear evidence from medical literature for the use and the client scenario", suggests that "conventional medical treatment" has passed through the same rigorous process, whereas we know this is not true. For example in writing an editorial in the British medical Journal, Dr Richard Smith the editor states "only about 15% of medical interventions are supported by solid scientific evidence….This is because only 1% of the articles in medical journals are scientifically sound and partly because many treatments have not been assessed at all." (British Medical Journal, 1991:303:798) The vast majority of papers written to support the value of drugs are either initiated by, sponsored by or paid for by the pharmaceutical industry manufacturing the drug, and in many cases the articles are ghostwritten by the pharmaceutical industry. Fortunately these days the situation is improving as people are realising just what has happened in the past. As far as the newer anti-cancer treatments are concerned, and to some extent the older ones, the pharmaceutical industry is deeply involved in the studies and reports.

It has been quoted that to do a study that would be acceptable, costs about $2 million dollars, making it extremely unlikely that most nonpharmaceutical therapies will ever have "acceptable" scientific evidence, no matter how effective they are.

So accepting that the scientific evidence behind many drug treatments is poor, and the same can be said for complimentary therapies, the logical answer is to use what appears to be scientifically and logically the best therapies for the individual patient.

Having said that, I would like to justify my recommendations for additional treatment for your patient:

I believe that he should be being treated with what is potentially beneficial, should do little harm, and would not interfere with current medical therapy.

Optimal nutrition – Undergoing chemotherapy is an arduous time, and I don't think anybody would restrict the food intake of a cancer patient, with the possible exception of high levels of sugars. Unfortunately chemotherapy does blunt the appetite, may possibly affect absorption, and certainly makes it more difficult to receive all that the body requires. Many physicians suggest the patient should graze rather than have 3 large meals per day. It thus seems logical to add a quality multivitamin and multi mineral supplement to provide complete nutrition.

In addition to the chemotherapy and radiotherapy, the body's immune system is a major if not the major component in suppressing and hopefully killing the cancer. To optimise its function the immune system needs optimal nutrition.

While it is possible to provide supplements individually, it does seem much more logical to take a single multivitamin and multi mineral tablet.
Just to comment on a few of the contents of a multivitamin and multi mineral:

selenium – this has been shown to have anti-cancer effects in animals and also humans, and in the Arizona study (Journal of the American Medical Association 1996, December 24) of 1300 patients, half receiving supplementary selenium and half not, those taking selenium over 6 years have a 63% reduction in prostate cancer, and a 50% reduction in cancer deaths.. These deaths suggest that many of the patient's had cancer before they started selenium.

Multivitamins – In the women's health nurses study, women who took multivitamin tablets for more than 15 years reduce the risk of developing: a number of other cancers by between 50 and 70% (Annals of Internal Medicine 1998, October: 517)

Individual vitamins – while there is some cloud over vitamin A and beta-carotene in large doses, the B vitamins have many beneficial effects in patients receiving chemo. For example it is highly likely that B12 and folic acid would be beneficial in reducing the incidence or severity of peripheral neuropathy very common with chemotherapy, vitamin C is an antioxidant and given intravenously does seem to have anti-carcinogenic effects, but even orally in the production of collagen it is likely to be beneficial in strengthening the tissues and maybe even reducing spread.

Vitamin D has been postulated in many cases is having anti-cancer effects, (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470481/) unfortunately the amount of vitamin D allowed in tablets in this country are less than desirable, but nevertheless the amount of a good multivitamin tablet must have some beneficial effect.

Vitamin E is an antioxidant, provided it is not given in high doses which could potentially or theoretically affect chemotherapy, can reduce the side-effects of chemotherapy, as well as protecting the body from free radicals. Vitamin K has also been suggested as having anti-cancer effects .

As far as minerals concern, we have discussed the trace element selenium, but it is very likely that other minerals might also be beneficial in the routine amount found in a normal diet, which is what a multivitamin should be providing. Magnesium for example does relax smooth muscle, and can reduce cramps and possibly some of the other peripheral effects common in patients with chemotherapy and also cancer.

While it is possible for all of these to be achieved by taking the products individually, taking one or 2 good multi tablets a day does seem to be logical and practical.

Lycopene found in tomatoes this does appear to have a beneficial effect on prostate cancer, and the Harvard University study (Journal of the National Cancer Institute, 6th of March 2002, page 291) of 47,000 health professionals followed over 12 years those eating 4 to 7 servings of tomato sauce per week had 20% less prostate cancer, those having 10 servings per week had 45% less. This does suggest that lycopene has a beneficial effect upon the prostate, and it is likely to also be beneficial in the presence of cancer.
Lycopene is often taken with saw palmetto which is helpful for benign prostatic hypertrophy.  We do not know if it has and effect  on prostate cancer (but in animals it can increase the sensitivity of prostate cells to radiation.( https://www.mskcc.org/cancer-care/integrative-medicine/herbs/saw-palmetto)

Omega-3 fish oils are known to have numerous effects from the cardiovascular system through to the nervous system and are considered an essential oil. Eating a lot of fish will provide this, but usually provides a dose of mercury which in cancer patients would be undesirable. There is a small study in Sweden involving 11,000 men which showed a 2 to 3 fold increase in prostate cancer in those men who did not eat fish (Lancet 2001; 2 June: 1764) in addition it may also be beneficial in the peripheral nervous effect and other effects of chemotherapy.

Melatonin – this hormone is created in the pineal gland, and is very helpful for sleep, a problem often difficult in cancer patients. Apart from this beneficial effect, in the United States nurses study, those nurses who work night shifts (who are likely to have low doses of melatonin) for more than 30 years, had a 37% higher incidence of cancer, and in the review of 10 randomised trials (Journal of pioneer research, 2005, November, 39 (4): 360 to 6). Involving 643 patients, cancer patients given melatonin in high doses (10 to 40 mg at night, reduce the risk of death at 1 year by 34%.

Coenzyme Q 10 – one of the most debilitating symptoms of both cancer and particularly chemotherapy is the crashing fatigue which they develop. Coenzyme Q 10 which essentially carries the energy from the mitochondria in the cell to the nerves and myofibrils, may help with this. It certainly has been shown to improve energy in many other situations.

Turmeric or curcumin has been shown to have anticancer properties in animal studies some of them quite spectacular.  These are reviewed (http://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/complementary-alternative-therapies/individual-therapies/turmeric) and although there are no blinded studies, many people (including oncologists) believe that this product is a useful adjuvant to chemotherapy and other cancer treatments.,

Milk Thistle this contains a number of compounds including Silymarin.   It has been shown to directly destroy prostate cancer cells and slow their growth, as well as increase the sensitivity of cancer cells to some forms of chemotherapy (http://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/complementary-alternative-therapies/individual-therapies/milk-thistle-and-liver-cancer).

Frankincense – derived from boswellia tree has strong anti-inflammatory actions, and may possibly be beneficial in cancer, probably best put on the skin as aromatherapy.  Its uses are reviewed here (https://www.medicalnewstoday.com/articles/314366.php).

Low dose naltrexone – I am certainly no expert on this, but it is a very interesting development, and is being used by many of my colleagues. Naltrexone is used to assist patients coming off opioids and alcohol. This is usually at the dose of 50 mg and above. It works by blocking the opioid receptors. Low dose naltrexone (usually 0.5 to 1.5 mg taken at night blocks the receptors overnight. It is believed that this up regulates the receptor  sensitivity, and possibly even increases the number of receptors. During the day following this, the normal endorphans and similar hormones are thus potentially more active. This can reduce pain, and other symptoms without any obvious adverse effects. LDN is used in a number of situations including multiple sclerosis, lupus, inflammatory bowel disease, chronic fatigue syndrome , fibromyalgia, restless leg syndrome and depression. It has been suggested from animal studies  that it may also suppress tumour growth, although the mode of action has yet to be established. (Biochemical pharmacology 67, number 7 (April 2001: 7792786.)

While I would have no way suggest to Stephen that LDN is essential for his cancer, it might possibly reduce some side-effects symptoms.

As mentioned in my opening paragraph, the evidence for many therapies is not strong for the scientists, but in the situation where we are doing our best for our patients, logical therapies combined with Hippocrates "1st do no harm" philosophy is what most doctors try and practice.

In Stephen's case he has not been well served by the profession, he is very likely to get side-effects from both the cancer and the chemotherapy, and the above supplemental recommendations potentially may help him, but given in physiological doses, will do him no harm.

I would like to stress again that we need to be supporting our bodies a great deal more than we currently do.   Our immune system and body's defences have been ignored in much of our current medical therapies.

Dr Gerald's Website

Visits in the last week

www.drgeraldlewis.com is being used by lay people, patients and doctors from around the world.  On the site Dr Gerald has listed most of today's diseases, briefly describes the condition then

Another advantage of bariatric surgery – controlling high blood pressure.

With the worldwide increase in obesity, and the failure of almost all dietary plans to reduce it, bariatric surgery is now becoming an option that many are turning to. There is good evidence that bariatric surgery reduces obesity, and diabetes, in fact in many cases cures diabetes. When one looks at the long-term costs of the medical management, and drugs, the cost of the operation is usually a great deal less.

A recent small study from Brazil compared 49 patients with high blood pressure who had bariatric surgery, with 49 control patients who had optimal medical treatment. In those who had bariatric surgery, within a year they were 6 times more likely to have cut back on the number of blood pressure medications by about a 3rd, and half of the surgical patients did not need any blood pressure medication at all.

While bariatric surgery should not be considered as a method of treating high blood pressure, the small study does show the benefits of weight loss using this technique and may tip the scales in making a decision as to whether or not to proceed with the operation.

Sex very rarely causes heart attacks

There seems to be a fear that having sex can cause a cardiac arrest, probably aggravated by scenes in movies such as "something's gotta give" which makes patients and their partners more likely to avoid it.  This anxiety almost certainly reduces the pleasure in what is an important aspect of a relationship. We have known for a long time, and advise our patients, that if you can climb 2 flights of stairs, this is about equivalent to the cardiac exercise of sex (normal sex).

A recent study from the USA gives some very reassuring news. They studied over 4500 cases of sudden cardiac arrests, and only 34 cases were related to sexual activity within the preceding hour. 32 men, 2 were women. The average age was 60, with a range from 34 to 83. Interestingly a slightly increased number of patients survive their cardiac arrest, probably because of the presence of a "bystander" who could perform cardiac massage.

Although obviously from this information, provided they can climb 2 flights of stairs, sex is not something that should be avoided or worried about. Nevertheless with the new simplified form of CPR (chest compression is all that is necessary, mouth-to-mouth is no longer recommended), everybody should learn the CPR, in the very unlikely case of a cardiac arrest happening, in bed or elsewhere.

Dr, will I feel better ? 
Bringing the patient into the decision making process..

Until relatively recently, (and in many cases still recently), doctors have had an arrogance in their approach to advising patients – "trust me I know best". However with Google and other online advice, in many cases patients know a great deal more than the doctors over their specific condition.
In addition much of the advised that most doctors give is based on so-called blinded clinical trials – where the outcome in disease progress, repeat heart attacks etc., and mortality are the basis of their advice to their patients.

It is exciting to see that doctors are now looking at quality of life, and how the patient benefits and feels in them selves, rather than the hard end points of disease and death.
This is especially important in the treatment of cancer - "does having unpleasant chemo which may extend life for some weeks or months, really what is best for the patient and their relatives"," is having this major operation worthwhile,"– in medicine we tend to have the attitude of "if there is something we can do, we usually do it".
Unfortunately also private medicine there is the additional impact of financial remuneration for the doctor and the institution which we must do our utmost to exclude.

It is interesting now in cardiology they are also looking at what is best for making the patient feel better, even if not necessarily for longer. In a publication in the American College of cardiology, they reviewed quality of life comparing angioplasty and bypass surgery and although bypass surgery was possibly slightly better long-term benefit, in many cases the patient would prefer angioplasty rather than the recovery process of a major operation.

In the meantime I think it is important for patients to demand their rights, and asked the doctors for a genuine opinion, if I go ahead with this procedure, is it actually going to make me feel better?