A blog reader, thank you!, sent me a study titled Dietary Fish Intake and Risk of Leukaemia, Multiple Myeloma, and Non-Hodgkin Lymphoma, published in “Cancer Epidemiology, Biomarkers & Prevention” in April 2004. The full study is available online, so I won’t load the post up with details that you can read for yourself, right here: http://tinyurl.com/5wugks.

 

But, as always, a quick overview. The study is based on questionnaires, which always makes me wary, since there could be a million other unmentioned factors involved. But I decided to have a look at it anyway, since the findings might be relevant to us.

 

The researchers examined a total of 4175 controls, 914 leukemia cases, 287 myeloma cases, and 1408 NHL cases; these were participants in a study carried out between 1994 and 1998 in Canada. Interestingly, compared to controls, myeloma folks were older and less likely to have ever smoked. I have never smoked in my life, but I found this mention of non smoking rather puzzling. It almost seems to imply that smokers are more protected against getting myeloma…weird! As for the second point mentioned, I was diagnosed with MGUS in 1999, at age 38, then with SMM in 2005, at age 44 (okay, okay, so 44 is “older” compared to 38…!).

 

Now, for most of my life, my fish intake has been limited to occasional cans of tuna. Dreadful, I know. If only I could go back in time, I would eat tons of fish! Fact is, growing up, I simply didn’t like the taste of it…until I met Stefano, who is a gourmet cook…yes, the rather annoying but also wonderful type who can peer inside a nearly-empty fridge and come up with a scrumptious meal within minutes. Gotta love the guy. And boy, can he cook fish!

 

Anyway, back to the study. The Canadian researchers discovered that people who consumed greater proportions of their total energy intake from fresh fish had a significantly lower risk of each of the three types of cancer, and there was a significant dose-response for risk of leukemia and NHL. Furthermore, Those in the highest quartile for percentage of fat intake from fish were at lowest risk […].

 

Basically, the higher your weekly fish intake, the lower your risk of developing one of the LH cancers (=the three cancers combined).

 

Attention-grabber: There was no association between level of education and cancer status. Well, phew!, that is indeed comforting. Until now, I had been absolutely convinced there must be an association between my undergrad years at Harvard University, my subsequent grad school career and my myeloma… 😉

 

Discussion part of the study: The major conclusion of this paper is that increasing proportions of total energy and fat obtained from fresh fish seems to protect against the development of leukemia, NHL, and myeloma. For all cancer types, the strongest reduction in risk was associated with increasing proportion of total fat obtained from fresh fish. This supports the hypothesis that dietary fats provided by fish are the key to the protective effect of fish intake against LH and other cancers. Aha!

 

The study ends as follows: In summary, in a very large case-control study, we have found a strong protective effect of fresh fish intake for leukemia, myeloma, and NHL which is consistent with previous literature.

 

Okay, but here is a good question: how can we know if our freshly caught fish is contaminated or not? (Go read the part about the myeloma-attacked Japanese village on p. 5.) Indeed, for that matter, how do we know that anything we eat isn’t contaminated? Does the label “organic” (biologico, in Italian) really protect us enough? But I am getting off track, and besides, the implications of that question would provide enough fodder for an entirely separate post.

 

Interesting titbit: Animal studies have found that consumption of fish oils increases survival of animals with cancer. I glanced at the particular animal study (full text: http://tinyurl.com/67cwaw) listed in the bibliography, and it implies that fish oil, i.e., not fish fillets or whole bits of fish, was given to dogs with lymphoma. Fish oil…

 

That is why I will stick to my free-from-contamination (!) daily fish oil capsules. But, about once a week, I will also eat fish caught by a small fishing cooperative off the coasts of Tuscany. At least, contaminated or not, the fish is fresh!

This morning Stefano suggested that we drive to the medieval Tuscan town of San Gimignano, which we haven’t visited in years.

 

Well, I didn’t need much convincing (none, in fact!). It was a perfect day for such an outing, sunny and glorious. Besides, this little trip gave me an opportunity to take a few photos for the blog! 😉

 

I had forgotten how breathtaking San Gimignano is, even though only 14, some websites say 15 (I have to say that I didn’t count them) of its original 72 13^th century towers are still left standing. But those 14 or 15…aaah, what a sight!

 

We walked all over the place and had a fabulous time popping in and out of countless arched alleys and walking on the ramparts of the town’s 14h century fortress (Rocca di Montestaffoli). A lovely day. 

Another study on curcumin’s function as an iron chelator was published in “Blood” last month (abstract: http://tinyurl.com/5fhhwd). The interesting part is that these Wake Forest University NC researchers wanted To test whether the chelator activity of curcumin is sufficient to induce iron deficiency in vivo, using mice whose diets contained graded concentrations of both iron and curcumin for 26 weeks. Well, after reading the full study, I have reached a couple of conclusions. But first, the study…

 

As we can read in the abstract, the researchers found that curcumin has the potential to affect systemic iron metabolism, particularly in a setting of subclinical iron deficiency. This may affect the use of curcumin in patients with marginal iron stores or those exhibiting the anemia of cancer and chronic disease.

 

Hmmm, doesn’t sound too good, eh. Well, now for the full study (grazie Sherlock!).

 

As usual, it begins with info on how curcumin has been used traditionally, how human Phase I clinical trials of curcumin have yielded good results, such as almost no toxicity, and so on. It then discusses how curcumin works—inhibition of NF-kappaB and so on. Skip, skip. Skip.

 

Then the study mentions a 2006 study, which I discussed in a previous post (see my Page on curcumin and iron). In a nutshell, liver cells treated with curcumin showed a decrease in ferritin, raising the possibility that the chelator activity of curcumin might be sufficient to induce systemic iron depletion, potentially triggering or exacerbating subclinical or clinical iron deficiency.

 

The first thing that the researchers did was put groups of mice on either high or low iron diets. Then curcumin was added to the mix, up to the equivalent of 8-12 grams a day. No toxicity from the curcumin was observed, by the way. So far, so good.

 

Results: the addition of curcumin had no effect on the hematocrit, haemoglobin, serum iron or transferrin saturation of the “high-iron” mice BUT it did have a dramatic effect on the “low-iron” mice. All the above-mentioned values declined; the higher the curcumin dose, the lower the values.

 

However, before we freak out and toss our precious bottles of curcumin into the rubbish bin, let me say that the Discussion part of the study makes a few interesting points.

 

1. Compared to other chelators used for the treatment of iron overload, curcumin has a moderate chelator activity.

 

2. Indian diets are traditionally low in bio-available iron. This is important, since Indians consume quite a bit of curcumin via the spice from which it is extracted–turmeric. So, theoretically, Indians should be an anemic population en masse with their large consumption of turmeric and low iron intake, right? Hmmm…I doubt that that is the case…

 

On the negative side, the mice with the iron-deficient diet ended up with iron deficiency anemia, including a decline in serum iron, decreased hematocrit, decreased transferrin saturation and appearance of hypochromic red blood cells. “Hypochromic” red blood cells means “paler than usual” red blood cells = anemia (Werriam Webster definition: marked by or being red blood cells with deficient haemoglobin).

 

Then we read that Curcumin also decreased iron levels in the bone marrow and spleen. And that curcumin-mediated changes in the liver were extensive: curcumin reduced liver iron, activated IRP, repressed ferritin, blablabla.

 

This sounds really scary, but hey, after all I have been on a high dose of curcumin for almost three years, and I am not anemic. Yes, my haemoglobin is on the low end of normal but is still hanging in there. I just checked, and, as far back as 2005, my Hgb has never been super high. So, without meaning to sound flippant, I say, no big deal. My serum iron, though, took a plunge in February, after our (Sherlock’s and mine) failed Biocurcumax experiment. So far, it hasn’t recovered, and for the past three set of tests has been slightly below the normal range. I will keep an eye on it.

 

At any rate, at the end of the study, the researchers make a few important points: There are two important implications of these results. First, iron chelators have been shown to exert anti-tumor effects, both through the formation of redox-active iron complexes and by iron depletion. Thus, reduction in systemic iron resulting from the use of curcumin in the setting of a low iron diet may contribute to the anti-cancer activity of curcumin. Second, curcumin may have the potential to contribute to the development of anemia in patients with marginal iron status. This may be an important consideration when curcumin is used to treat patients with marginal or depleted iron stores or those exhibiting the anemia of cancer and chronic disease.

 

So if you are healthy but trying to prevent the development of cancer and your iron levels are normal or high, don’t worry about taking curcumin. However, you have to be more cautious if you are a cancer patient with low iron levels. Problem is, if we, the low-iron myeloma folks, add an iron supplement to our daily intake, we may end up inhibiting curcumin’s anticancer activity (again, see my Page on curcumin and iron)…sigh. Catch-22.

 

My own conclusions. Driving to work this morning, I decided to wait until I get my test results in mid December before taking any action on the iron front. I will begin taking an iron supplement in December if I see that my Hgb, serum iron and ferritin levels keep dropping compared to my July tests. If I do start taking iron, though, I will wait at least 12 hours before swallowing my curcumin, so as to minimize any possible interference.

 

In yesterday’s post I forgot to mention that a couple of weeks ago I came across a bottle of curcumin (in my medicine cabinet) that turns out not to be the C3 Complex curcumin that I usually take. No idea where it came from, my parents must have brought it with them last spring. Anyway, each capsule contains about 850 mg of curcumin, which means that I have to take only 10 capsules a day, not 16 (bonus!). And each capsule has a bit of bioperine in it, which is good. So I decided, what the heck?, and began taking this new curcumin. That was about ten days before I had my blood tests. 

 

But the big decision of the past few days is that I have decided to begin taking feverfew, in its capsule form. The parthenolide content is rather low, but I hope it WILL work anyway. This weekend I am going to do some research on when and how to take it (at the same time as I take my curcumin or not?), etc.

Next tests in January. My parthenolide tests. Exciting! 🙂

UPDATE: after reading this post, Sherlock wrote me a private note reminding me that her Hgb is the same as it was one year ago (=before she began taking curcumin). However, get this: her serum iron and transferrin have actually gone UP since 2007. Now that is interesting. (Hmmm, my transferrin is high, incidentally…food for thought.)

The only value that has decreased in a year’s time for Sherlock is her ferritin. So, curcumin may have a different effect on different people. After all, we are not mice! 😉

I zoomed into the Careggi hospital lab at 6:30 a.m. this morning. Even that early, I had 50 people in line in front of me. By 7:45, though, that number would have risen to almost 150…yikes. It’s a popular lab!

 

Unfortunately, since I am having some specific things tested (a few vitamins and my parathyroid hormone, e.g.), I won’t get my test results until mid December. Without those specialized tests, I would have had my results in 10 days. Bummer, since I am seeing my haematologist on November 26^th and my endocrinologist on the 29^th. Oh well. Can’t have everything!

 

Next week I am having a flu shot. If your immune system is compromised, ask your doctor about having a flu shot this year. And here is a word of caution. I always make sure that my vaccine doesn’t contain any mercury, i.e., that it is thimerosal-free, even though the percentage of mercury is supposed to be tiny. (Thimerosal is a mercury-based preservative.) Still, a percentage is a…percentage.

 

It’s a controversial topic, some studies report that the mercury contained in flu shots exits the body quickly without causing any damage, others that it can accumulate in the brain…well, my reason for choosing the no-mercury option is that I think we already have enough toxins in our food and environment…I just don’t see the point in adding any more, even if the risk might be (!) minimal. Might be…

 

Might not be…

 

Nothing much else going on right now. I am settling back into my regular, post-election life—reading and monitoring new (or not so new, sometimes) studies/research and so on. Life is good.

 

Yesterday, in the spirit of change, I changed my blog header image. It’s a portion of a lovely photo I took last month on a Cape Cod (Massachusetts, U.S.A.) beach.

Well, there is not much that I can add to what has already been written in the comments to my previous post. Just a few random items.

 

Unlike my cousin and aunt and half the world, it seems!, I didn’t stay up last night, figuring that we wouldn’t have any reliable election results until at least mid morning (Italian time). But as soon as I woke up this morning, my first thought was to turn on the TV, where I saw the headlines: “Obama presidente.”

 

Presidente??? Still bleary-eyed, I thought “wait, that’s not possible, it’s too SOON!”

 

But it wasn’t. I began watching CNN International, Sky News and Fox News. It really happened.

 

I laughed, I cried (with joy, obviously), and laughed again.

 

And when I turned on my computer, I found cheery messages from my students, family members and friends. One of my Italian friends phoned earlier to congratulate me, as though I myself had run for President and won. 😀

 

Special reports on the U.S. election have substituted regular TV programming here in Italy. I am simply blown away by the celebrations going on all over the world, not just in the United States. Unprecedented.

 

This is an amazing day. I am so proud. So happy.

And tomorrow I am going to have my blood tests. I want to take advantage of OHF, the Obama Happiness Factor. I am sure that OHF will kill at least a few of those evil myeloma cells…!

This morning I woke up thinking about the issue that nobody wants to bring up under normal circumstances, much less during a presidential election: cancer.

 

I asked myself: simply based on health status, would I be running for President right now? Well, after all, my cancer is inactive, so far, at least. Hmmm. So here are my morning ruminations…mainly but not exclusively from a health perspective (when I use italics, I am pretending to be…someone else). Just for the sake of argument, of course.

 

Let’s say that between 1993 and 2002 I had four cases of malignant melanoma. The one removed in 2000 was a particularly nasty one.

 

Let’s say that, in April 2008, my doctors had found and removed six adenomas–growths with the potential to turn malignant–from my large intestine.

 

Let’s say that they had also removed a basal cell carcinoma (considered to be highly curable) from one of my legs, in May 2008.

 

Okay, my doctors have pronounced me “cancer-free” and fit to run for President. Off I go.

 

But wait a sec…why in the world would I even remotely desire to run for President??? The stress of a prolonged presidential campaign could cause a recurrence of the cancer. I certainly do not want put my family through hell again, do I?

 

Out of curiosity, this morning I did a quick search on a possible connection between stress and malignant melanoma. Well, quelle surprise, I found quite a number of studies on this topic. The following, e.g., shows that stress inhibitors hold back the invasion of malignant melanoma cells: http://tinyurl.com/6gx3aq Another one on stress and malignant melanoma: http://tinyurl.com/5bb24s And here (on page 212, see also the bit on “anger,” to which Sen. McCain is no stranger): http://tinyurl.com/5t6399

 

Of course, I am not saying that cancer patients should crawl into a hole and isolate themselves from the rest of the world. Hah. That would be sooo silly. But why make matters potentially worse? I don’t get it. Not in this case, certainly. But let’s go on, for the sake of argument. 

 

Let’s say that I am elected President of the United States and that my cancer rears its ugly head again, due to the overwhelming stress of a prolonged presidential campaign. To take the argument a step beyond the obvious consequences for me and my family, what would happen to my beloved country? Shudder…

 

As a cancer patient, I have a lot of empathy for Sen. McCain. In fact, I would have loved to hear him speak openly about his melanoma during the campaign. But he didn’t, or if he did, I must’ve missed it.

 

Indeed, from what I saw while I was in the States, and from what I continue to see over here in Italy (except when I watch Fox News), his campaign has been based more on shockingly reprehensible, angry and hypocritical mudslinging than on addressing the issues that concern us all. There are heaps of mudslinging examples from which to choose…but this morning I received a private note from a blog reader supporting Sen. McCain’s most recent attack on Sen. Obama. I have already responded privately, but now I will do so publicly.

 

The attack concerned Sen. Obama’s acquaintance with a highly esteemed Middle Eastern scholar, Columbia University Professor Rashid Khalidi. His impressive credentials are available online, I won’t bother repeating them here.

 

But I do have an interesting bit of news: since 1993, Sen. McCain has been chairman of the International Republican Institute (IRI). Tax returns show that in 1998 IRI gave $ 448,873 to the Center for Palestinian Research and Studies (CPRS), an organization co-founded by Prof. Khalidi. I kid you not. The 1998 IRS form is available online, just click on this link, go to p. 14 and look for “CPRS”: http://tinyurl.com/6nt6tx  

 

 

The worst case scenario is that Sen. McCain and his script writers are suffering from a severe case of memory loss. The best (?) is that they are not able to do even a minimally acceptable amount of research.

 

Either way, I am not at all impressed. I hope U.S. voters won’t be, either.

 

HAPPY

 

HALLOWEEN,

 

EVERYONE!!!

One of my July blood tests, the folate, or folic acid, test (I will use the two terms interchangeably), turned out to be quite low. When my family doctor saw that result, he told me that I should probably take a folic acid supplement. I followed his advice for a while. But recently I read some studies that made me stop taking it, while I do more research and ponder the matter.

 

First things first. Folic acid is a type of the water-soluble B-9 vitamin found the fruit and vegetables we eat–dark green and leafy veggies, nuts and seeds, lightly-cooked beans (folic acid is very susceptible to heat), oranges and grapefruit, etc.

 

Healthy cells need folates, which are essential for cell division…but, and here we get to the crux of the matter, cancer cells do, too. As we know, cancer cells divide and grow very rapidly. For this “divide and prosper quickly” process, they need folates. They gobble ’em up.

 

Now we will get into some technical stuff. DHFR (=dihydrofolate reductase) is an enzyme that is essential for cancer growth. Some chemotherapy drugs, such as methotrexate, target DHFR. When DHFR is inhibited, you see, cancer cells are not able to use folic acid to keep dividing, which means that tumour growth is slowed down (did I just hear a “wow!”? That was my reaction, too).

 

In sum, as I understand it, no DHFR=no folic acid=slowed tumour growth.

 

There is an obvious consequence, though: DHFR inhibitors can cause folate deficiency. And folate deficiency hinders not only cell division (and DNA synthesis, incidentally), but also the production of red blood cells, which means that folate-deficient folks could develop a sort of anemia called “megaloblastic anemia” (for a lot of info on this particular topic, see: http://www.emedicine.com/med/TOPIC1420.HTM) 

 

So let me get this straight. If I don’t take a folic acid supplement, I risk developing megalobummer anemia. Not good. But if I do take a folic acid supplement, I will be feeding my myeloma cells. Hey, that’s a no-win situation.

 

And now we get to the second part of this post. What does folate deficiency have to do with EGCG?

 

Last week, I happened to come across a 2005 Spanish study (abstract: http://tinyurl.com/5g4o48; full study: http://tinyurl.com/a8crc) showing that people with a folate deficiency should probably not drink a lot of green tea or take too much EGCG in its supplement form. Furthermore, the study linked high levels of green tea consumption to birth defects caused by folic acid deficiency: specifically, spina bifida and anencephaly. Therefore, pregnant women and women even remotely thinking about conceiving should not drink green tea.

 

It seems, in fact, that EGCG behaves like the above-mentioned DHFR inhibitors (except that the green tea extract doesn’t attack healthy cells, only cancerous ones). Yes, it blocks folic acid. And it is precisely its folate-inhibiting activity that makes EGCG so successful in the fight against cancer cell growth. Makes sense, given what we know. But let’s not forget that healthy cells need folates, too. So green tea is good for you only in certain situations, not in others. Caution is the name of the game, as usual.

 

The EGCG-folate issue reminds me of the curcumin-iron “catch-22” situation. Curcumin is an iron chelator (in fact, I am about to read a recent “Blood” study on this very topic, so stay tuned), meaning that it “sucks” iron out of our blood. This is brilliant if you have high serum iron and are at risk of developing cancer. But let’s not forget that the “A” in the myeloma CRAB acronym stands for Anemia. 

 

And here’s the “catch”: anemic curcumin-taking cancer folks who take an iron supplement risk inhibiting the anti-cancer activities of curcumin. So even though my serum iron is low, I have not added an iron supplement to my daily intake. I don’t want to swallow anything that might prevent curcumin from doing its job. For now, I am just trying to obtain a bit of iron from my diet (=red meat once a week, sigh, together with a salad with lots of lemon juice, since vitamin C helps us absorb iron from our food…). I will probably do the same for folic acid. That is, get it from my diet. Period.

 

Anyway, this folate dilemma presents me and perhaps others in my situation (=low folic acid folks) with a tough choice. To take or not to take a folic acid supplement? And how about drinking green tea or taking EGCG capsules?

 

It doesn’t help matters to know that low folic acid intake has been associated with high homocysteine levels, which increase the risk of heart disease and other undesirable conditions.

 

No easy solution, here.

I want to read scientific studies. I want to write about my research and amusing daily happenings. I want to keep myself stable until a cure is found for myeloma. I want to spend time with my family and friends. I want to be a good English teacher. I want to laugh and enjoy life. I want more time. I want lots of things.

 

I don’t want to write about politics. With yesterday’s post, I was actually trying to move away from politics. But recent comments “force” me to post again on this topic. And I am not going to promise not to write about it again…only to break my promise. I am sure Keith or Rachel will inspire at least one more political post at some point this week. 😉

 

Hmmm, besides, it is MY blog, right? 😉

 

And what is a blog but an electronic diary? That’s how I use it. I never plan my posts. If I read something that inspires or enrages me or makes me happy, then that is what I post about. And it just so happens that right now I am thinking, reading, hearing and seeing A LOT about the upcoming U.S. presidential election. That won’t change until after the election. Then life will presumably return to normal. Presumably.

 

Okay, let’s get into some political stuff. Let’s say that the Democrats had a candidate similar to McCain, and the Republicans someone like Obama. Well, guess what? I would have voted Republican. Surprised? Well, when I was a U.S. resident, I voted occasionally for decent Republican candidates in local elections. I have always voted for the better person.

 

Oh, and I don’t just watch Jon Stewart, Keith Olbermann and Rachel Maddow. I also watch Fox News, which I can get here in Italy, too.

 

So you see, I am not a mindless follower of the party line. I listen to both sides of an argument and make up my own mind. Always have, always will.

 

Nobody can tell me what to do, except for my cats. 🙂

 

A final consideration. If Sen. McCain is elected, I would never be able to move back to my own country. Not that I plan to, but I wouldn’t mind having the option…you never know. But under a McCain administration, I would never get health coverage due to my pre-existing condition. Under Sen. Obama’s plan I would instead not be denied coverage for having myeloma. Another point in the latter’s favour.

 

U.S. cancer patients need to think long and hard before casting their vote next week. Consider the folks who will be diagnosed with cancer before or without having good insurance coverage. What will happen to them? What will happen to you?

This weekend Stefano and I watched three movies. Erm, uhm , I am a bit embarrassed to admit that we watched the new “Hulk” movie and “Iron Man.” What can I say? Mindless entertainment! 😀

 

But we also watched “I Am Legend” (2007). That wasn’t completely mindless. The plot, in a few words…

 

At the beginning of the movie, during a T.V. interview, a scientist (played by Emma Thompson) talks about her cancer treatment, a genetically modified measles virus. With a smile on her face, she admits that “yes, we have cured cancer” (or words to that effect). That got my attention, as you can imagine.

 

But something soon goes wrong. The modified virus mutates into a deadly airborne strain that ends up killing 90% of the world population. Of the remaining 10%, 9% are turned into light-phobic zombies and only 1% remain healthy, thanks to their natural immunity to the virus. But life is not a bowl of peaches and cream for the healthy survivors, who are hunted down by the hungry, screeching, enraged zombies at nightfall. Lovely, huh?

 

At any rate, by the year 2012, a U.S. Army virologist (superbly played by Will Smith) is the last human being left in New York City. The movie revolves around him, his dog, his daily experiments to find a cure for the virus, and his trips through a scary devastated Manhattan on a quest for food and supplies.

 

But that’s enough. I won’t spoil the movie or the end for you. Now that I think about it, I almost didn’t make it to the end. Be warned: those zombies are freaky scary. And I not easily freaked out: I have watched plenty of horrifying horror flicks in my lifetime. So why did I find this one particularly disturbing?

 

Well, because it made me think about the manipulation of viruses. This stuff is going on right now in laboratories around the world. I myself have written at least one post on adenovirus delivery systems (October 14, 2007). This movie brought up a lot of questions for me: are we going too far in our quest for a cure for cancer and other diseases? Are new, worse?, monsters being created in order to defeat old monsters?

 

Would you rather have cancer or be an angry hungry zombie? Hmmm…

 

Coincidentally, I came across a Science Daily article reporting on a real-life scientist, the virologist and cancer biologist Dr. Patrick Lee, who discovered that “I Am Legend” is based on his own research and development of a reovirus, a virus used to target cancer cells: http://tinyurl.com/59wx5l (interesting article, please have a look when you have a snippet of time).

 

Okay, sure, “I Am Legend” is science fiction, but does it really present us with an unlikely scenario, or an “impossible” scenario, as Dr. Lee declares? I wonder…