Sugar and Cancer: sweet surrender? Taking the lid off the sugar controversy - by Robin Daly

This week's blog post is written by our founder, Robin Daly. He discusses the controversial topic of sugar and cancer...

In cancer, you don’t have to look too far to find divided opinions on most aspects of theory, causation, diagnosis, treatment and more, but few are more polarised or more hotly debated than the role - or maybe irrelevance - of dietary sugar.

Here’s what the two largest cancer charities in the UK have to say on the subject:

At No 4 in Cancer Research UK’s Top 10 Persistent Myths Debunked is ‘Cancer has a sweet tooth’.^[1]

And Macmillan state confidently that ‘Sugar in your diet doesn't directly increase the risk of cancer, or encourage it to grow.’^[2]

At the other end of the spectrum we have views such as Dr Mark Hyman’s. Hyman is the leading voice in the Functional Medicine movement that is now gaining significant traction in the US.

‘The number one thing you can do to prevent or control cancer is to control insulin levels with a high-fiber diet rich in real, fresh, whole foods and minimize or eliminate sugary, processed, insulin-raising foods.’^[3]

And top oncologist and advocate of Lifestyle Medicine Professor Robert Thomas wraps up an extensive review of all the science demonstrating a link between refined sugars and carbohydrates and cancer by saying:

‘In conclusion, although much of the evidence for the cancer promoting risks of sugar and high GI carbohydrate is from laboratory or large cohort trials, considering all the studies together its link to cancer is becoming increasingly convincing. Instead of the pro-sugar camp claiming that more trials are needed to prove the link, perhaps a more sensible approach is to assume there is a link, unless proven otherwise, as certainly no study to date has ever suggested sugar is healthy, and the problem is getting worse.^[4]

Where did it all start?

Back in the 1920s, Nobel prize-winning German scientist Otto Warburg discovered that one of the distinctive features of cancer cells is that they have damaged mitochondria. Mitochondria are the cells’ energy generators, and the damage means that cancer cells turn away from oxygen as an energy source and instead use fermentation. Fermentation is an inefficient process that doesn’t require oxygen, but that does need large quantities of glucose. This led Warburg to hypothesise that damaged mitochondria are the source of cancer, and that this provides a universal way of targeting cancers, by starving them of the steady supply of glucose they require.

This view of cancer as a ‘metabolic’ issue, was surpassed during the twentieth century by the somatic mutation theory, which lays the blame firmly on genetic defects. Although the gene theory has substantially failed to deliver on the targeted cures that were at one time considered a future certainty, the division between the two theories - in which both see each other as preoccupied with a side effect - lives on. It’s a testament to the power of marketing that, despite giving so little bang for the immense number of bucks invested, gene theory remains predominant, and sugar remains a facet of outdated metabolic theory.

The cautionary principle

Prof Thomas makes the point that, given the sheer volume of good evidence pointing towards dietary refined sugars and carbohydrates as both a source and driver of cancer, along with the catastrophic way that the grim reaper, cancer, is scything its way through developed nations around the globe, a zero-cost, safe intervention such as reducing intake of refined foods should be seen as eminently worth trying. Making utterly confident pronouncements about the absence of a relationship between sugar and cancer depends entirely on a totally suspect system that seeks to portray evidence as a binary ‘evidence/no evidence’ scenario, rather than as a more nuanced sliding scale of ‘more evidence’, ‘better evidence’.

All down the centuries, scientists have sought to equate scientific understanding with absolute certainty. Given the repeated experience of just how wrong science can be, a degree of uncertainty and even humility would, at this point, be both pragmatic and realistic. It’s well past time that scientists ditched the permanent ‘they used to think they knew, but now we know’ stance, for good. Clinging to increasingly untenable certainties is not just foolish, in public health it wreaks hell with people’s lives. The most obvious recent example of this is the ‘low fat’ myth that held sway for half a century and even now is a continuing mantra of organisations which have yet to find a way to reverse their position without completely losing face.^[5] Corporations are often nimbler than governments or charities when it comes to seeing the writing on the wall; protecting their bottom line is always a higher priority than sticking to dogma. Unilever, who have recently struck out in a new direction by buying Pukka, have sold off their margarine interests - which it describes as a ‘declining sector’ -  including major brands such as Flora and Bertolli.^[6]

Fuel for the feud

It’s also important not to overlook the role of business in perpetuating scientific ‘certainties’. Once a story takes hold - such as ‘fat is bad’ - the wheels of industry gear up and soon there is an avalanche of food products and medicines riding on it, generating huge profits, and a determination to keep everyone ‘on message’ for the marketing plan, whatever that may take. And so industry starts buying the science it wants, buying the scientists who are prepared to deliver the sales lines, and in no time ‘fat is bad’ is a religion with devotees around the globe. By this time, the resistance to a change of direction is, unsurprisingly, overwhelming.

The soil not the seed

The growing science of epigenetics is making it increasingly clear that just as we are deeply connected with and affected by our environment, our cells are intrinsically linked to and dependent on the microenvironment of the body. Mina Bissell, former Head of Life Sciences at Lawrence Berkeley Laboratory in California, performed a breakthrough experiment in which she demonstrated that a cancerous cell, when placed within a healthy extracellular environment, reverts to a normal healthy cell. And conversely, a healthy cell transplanted into a cancerous environment quickly becomes cancerous.^[7]

This understanding is starting to creep into the mainstream. Best-selling author and oncologist Siddhartha Mukherjee writes at length in the New Yorker, giving examples from nature of species that, in their native environment, are in step with everything around them; but move them elsewhere and they can quickly become a destructive menace.^[8]

Both Bissell and Muckerjee are giving indications that cancer is more about the health of the body than the state of a few genes, and absolutely no-one is currently arguing that refined sugars and carbs are good for your health.

Common sense

 So here’s a picture:

•        Refined sugars and carbs are bad for our health

•        In tandem with other lifestyle issues, they drive the body towards inflammation and encourage a cellular environment conducive to fermentation

•        Fermentation is the the method of choice for cancer cells to get their energy

Common sense conclusion: refined sugar is a bad idea if you want to remain cancer free, and it’s a bad idea if you have cancer, as you are supporting its preferred environment. In fact Mina Bissell has gone on to demonstrate in the lab that this is indeed the case - sugar promotes the inception of cancer and fuels it once the process is under way.^{[9] [10]}

Big messages

Public health messages seem, on the face of it, to be a good idea. But when they are conceived within an environment fuelled by business interests^[11] and in which scientists are clinging to certainties well past their ‘sell-by’ date, they can go horribly, horribly wrong. The results can be far worse than if the public had been left to their own devices. Millions of people, thinking they are making healthy choices, are being utterly misled. Big, simplistic messages are the supertankers of public health: nigh-on impossible to turn around.

Sugar and cancer is one such supertanker. You can already read the first attempts to ‘manage’ the turnaround, as the rhetoric inches away from ‘sugar definitely has nothing to do with cancer whatsoever’ towards ‘it’s complicated’. Meanwhile, a recent Daily Mail headline blares out in a singularly uncomplicated manner: ‘Revealed: How sugar feeds cancer and makes it harder to treat’.^[12] We are told the conclusion from a 9 year ‘breakthrough’ study (audible yawns from the Integrative and Functional Medicine camps) that ‘This link between sugar and cancer has sweeping consequences’.

What price for being ‘right’?

So far it has taken almost a century for one simple, but vital piece of information to make its way into the mainstream…. and it’s far from there yet. Cancer patients in leading hospitals across the land are still being exhorted to eat high-calorie junk food in order to keep their strength and weight up. This dogmatism looks set to kick the twenty-year refusal by doctors to wash their hands between procedures into absolute insignificance, in terms of the level of human suffering generated.

Eventually the science will force change, but of course, in reality, the science changes nothing. If it’s true that excess dietary sugar both causes and feeds cancer, then it is just as true right now, before sufficient science arrives to bludgeon the nay-sayers into submission. The effects on the lives of those with cancer is real and it is happening today on the cancer wards. If the cautionary principle were always to the fore - as of course it should always be when dealing with people’s lives - then avoiding sugar, along with many other simple precautions, would be routine, until such time as proved safe. And had this been the case, who knows, the Daily Mail might just have been able to announce the same ‘breakthrough’ a whole lot sooner - possibly even half a century or more sooner.

---

^[1] http://scienceblog.cancerresearchuk.org/2017/05/15/sugar-and-cancer-what-you-need-to-know/

^[2] https://www.macmillan.org.uk/information-and-support/coping/maintaining-a-healthy-lifestyle/healthy-eating/commonly-asked-questions-about-diet.html

^[3] http://drhyman.com/blog/2015/08/07/5-strategies-to-prevent-and-treat-cancer/

^[4] https://www.canceractive.com/cancer-active-page-link.aspx?n=3892&title=Sugar-intake-and-cancer-The-emerging-evidence-reviewed

^[5] http://doctoraseem.com/the-truth-about-fat-and-sugar/

^[6] http://www.bbc.co.uk/news/business-42365300

^[7] https://www.ted.com/talks/mina_bissell_experiments_that_point_to_a_new_understanding_of_cancer

^[8] https://www.newyorker.com/magazine/2017/09/11/cancers-invasion-equation

^[9] https://www.jci.org/articles/view/63146

^[10] http://healthinsightuk.org/2015/01/21/cancer-and-genes-have-we-got-it-badly-wrong/

^[11] https://www.wsws.org/en/articles/2017/11/28/suga-n28.html

^[12] http://www.dailymail.co.uk/health/article-4986706/How-sugar-feeds-cancer-makes-harder-treat.html#ixzz57ZlB1Hx9

Re-purposing old drugs for cancer: sometimes old ‘uns can be good ‘uns

Today's post is from our chairman Robin Daly who discusses how the re-purposing of drugs could unlock new potentials for treating cancer.

The re-purposing of old drugs for cancer is making headline news this year. So is this really ‘new’? Is it even ‘newsworthy’? Or is it simply yet another of those endless ‘cancer breakthrough’ stories so beloved of the media?

To answer the first question: this is far from a new idea. The incidental positive effects of some old, safe, tried and tested drugs on cancer has been noted for many years. For example, metformin, given to people with diabetes to control their blood sugar levels, has the striking effect of transforming their risk of developing cancer from higher than normal healthy people to lower. The thing that is new is the level of interest around this phenomenon.


You might have expected, given the appalling, runaway cancer statistics and the spiralling cost of treatment, that an observation such as this effect of metformin might have been heralded as potentially another groundbreaking medical breakthrough along the lines of Fleming spotting the mould in his petri dish that led to penicillin. But in the event, this, along with dozens of other similar observations, was noted as ‘interesting’ and relegated to a ‘footnote’ of medical history.

Fortunately, a few pioneering doctors have noticed these medical ‘footnotes’ and begun using these drugs as part of their integrative protocols to control cancer. One of the most instantly striking features of the drugs is their extraordinary diversity. Apart from metformin, they include an anti-parasitic drug called mebendazole; a statin, one of a class of drugs developed to lower the risk of heart attacks but increasingly seen to be ‘barking up the wrong tree’; an old antibiotic, doxycycline; and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. On the face of it, this is a
completely random collection of unconnected medicines. Certainly within the current orthodoxy of cancer as a genetic disease, caused by defects in the genes leading to changes in DNA and cell mutation, it’s hard if not impossible to make sense of it all.

This is where another old idea comes to the rescue: in 1924, the scientist Otto Warburg put forward the notion that cancer has essentially one root cause - damage to the cells’ energy generators, known as mitochondria1 (1).  Again, this looks like one of those breakthrough scientific observations - and indeed Warburg eventually received a Nobel Prize for making it - but all too soon it found itself relegated to the category of  an interesting observation, merely an effect of the basic genetic problem. But if we dust off Warburg’s theory and use it to illuminate these random pieces that appear to come from completely different jigsaws, we can start to see how they do in fact fit together in a way that makes complete sense. We can see how all these drugs have a disruptive effect on the ‘hallmark’ feature of all cancer cells - their damaged metabolism.

The reason for much of the recent media exposure is that a group of scientists and oncologists have launched a low budget trial in London* in which they are enrolling late stage patients with any type of cancer on a programme of four re-purposed drugs. This programme can be added to existing standard treatments. Very unusually, the trial facilitators take an active interest in all the ‘integrative’ approaches a patient may be using such as dietary interventions, oxygen therapies, vitamin C infusions or heat treatment (hyperthermia), and take careful note of these.

Since they are fully signed up to the metabolic theory of cancer, such non-toxic approaches make complete sense as additional ways of targeting cancer’s trademark metabolic features, whilst simultaneously supporting healthy cells. I understand that early results look very promising and that the trial is still open to further applicants.

How could we have overlooked such a potential goldmine of methods to control cancer? The combination of a statin and metformin alone has been observed to reduce cancer risk by a staggering 80% (2). There is a serious danger of the trial results making the best of cutting-edge cancer treatments look ridiculous - not to mention ridiculously expensive. The problem of course is that the main driver for healthcare innovation is business, and sadly health is only a secondary consideration for business. Their interest is in profits, and there are clearly no big bucks for the corporates in this particular goldmine. Out-of-patent drugs are cheap. The four drugs in the trial come in at less than £20 per month, hardly worth mentioning alongside something in the order of £5000-£20,000 per month for targeted gene therapy.

The obvious fact that we cannot afford to entrust the health of our nation to corporations must be assimilated and acted on by our government if we are to turn around the headlong long rush into multiple chronic conditions. For too long the food and pharmaceutical industries have been profiting at the expense of our nation’s health. To begin to turn the tide, we need strong government initiatives to drive unprofitable research into cheap solutions and to control the parameters of what is allowed into our food supply.

To return to the other two questions I asked at the outset: I’d say re-purposing of drugs  certainly is newsworthy. In fact I’d say it needs as much exposure as it can get to alert the public to the realities of 21st century ‘cancer research’. And as news, I think - I sincerely hope - it just might be a real ‘cancer breakthrough’ this time.

Read more blogs from Robin here

* Care Oncology Clinic: http://careoncologyclinic.com

1. Warburg, O. (1956) On the origin of cancer cells. Science 123 (3191), 309-314.
Warburg, O., Posener, K, and Negelein, E. (1924) Ueber den stoffwechsel der tumoren. Biochem Z 152, 319-344. OpenURL

2. Khurana, V., Sheth, A., Caldito, G. and Barkin, J.S. (2007) Statins reduce the risk of pancreatic cancer in humans: a case-constrol study of half a million veterans. Pancreas 34 (2), 260-265.
DeCensi, A. et al. (2010) Metformin and cancer risk in diabetic patients: a systematic review and meta-analysis. Cancer Prevention Research 3 (11), 1451-1461.

Play PharMADNESS

Many of us are aware that the current system for developing new medicines relies on private pharmaceutical companies who have a duty to maximise returns for shareholders.  But it isn’t always easy to understand how the conflict of interest between the needs of shareholders and patients can manifest itself in sub-optimal benefits for patients and lead to a sub-optimal use of public investment in medical research.

To highlight these issues and raise awareness of how the current profit-led system for medical R&D is letting down patients, the Missing Medicines campaign has produced a clever online game that puts you in the seat of a Big Pharma Exec, running your own pharmaceutical company.




The game asks you to make annual decisions on which drugs to invest in and how much you want to spend on key areas like R&D, marketing and legal matters.  By doing this it highlights in a very effective way the trade off between commercial and public health interests – a stark choice between making money and saving lives.

After playing a couple of turns of the game and producing large profits, you start to see the negative consequences of your decisions on patients; something which is explained further through some a number of videos.

Ultimately the game aims to raise awareness of the need to move away from the current profit-led approach to medical research.

To play the game now visit the PharMADNESS website.

Cancer Drug Benefits Overhyped

Today's blog is from John Piears, who lost his wife to cancer last year and went on to set up the Dying for a Cure campaign, to push for much needed reforms of the R&D system for developing and funding new cancer treatments

Barely a month goes by without a newspaper headline claiming that "A cure for all cancers is on the way" or hailing the latest "Major cancer breakthrough", but dig beneath the media hype and you'll discover the shocking reality that new cancer drugs for most cancers are only expected to improve patient survival by just 2.7 months on average, despite costing an estimated £2bn each to develop.

Re-purposing old drugs for cancer: sometimes old ‘uns can be good ‘uns

Today's post is from our chairman Robin Daly who discusses how the re-purposing of drugs could unlock new potentials for treating cancer.

The re-purposing of old drugs for cancer is making headline news this year. So is this really ‘new’? Is it even ‘newsworthy’? Or is it simply yet another of those endless ‘cancer breakthrough’ stories so beloved of the media?

To answer the first question: this is far from a new idea. The incidental positive effects of some old, safe, tried and tested drugs on cancer has been noted for many years. For example, metformin, given to people with diabetes to control their blood sugar levels, has the striking effect of transforming their risk of developing cancer from higher than normal healthy people to lower. The thing that is new is the level of interest around this phenomenon.

Like, Comment, Share: Top posts

Today's blog is a round up of your favourite posts from our Facebook page over the past three months. We love sharing the latest news, research and all the inspiring stories which come our way. Please 'like' us if you are interested in joining the conversation.

In case you missed them here are the top 5 posts which got you all talking over the past few months.

1. Why I'm saying no to a smear

An interesting, and in many ways controversial article from GP Dr Margaret McCartney explaining the reasons why she will not be taking parting in cervical and breast screening. She says 'I'm not against screening, but I am against unthinking screening' and presents a strong case for rethinking our current approach to screening for cancer.

2. I ate 40 teaspoons of sugar a day. This is what happened

A shocking (and hilarious) article from Damon Gameau, who after giving up sugar for three years, reintroduced 40 hidden teaspoons a day for 60 days to see how would it affect his health. No prizes for guessing that it wasn't an improvement...  His story features in the documentary 'That Sugar Film', a huge hit across Australia.