On My Youngest Daughter Ai Hsing (Front) Graduation Day

On My Youngest Daughter Ai Hsing (Front) Graduation Day

Wednesday, May 30, 2018

Does Garlic Cause Cancer When Heated



I write this comment below to a request and question via Whatsapp on a video narrated  in Chinese Mandarin. It was sent to me for advice by a friend called Sister Sonia Soon from Bahhma Kimaris on behalf of her sister and someone else from a cancer society (CanSurvive) in Malaysia

They solicited my opinion that garlic when overcooked causes cancer


Dear sister Soon

Thank you sister Soon for soliciting my personal view once again on this video claim

This video in Chinese Mandarin emphasizes on overheating the garlic (Allium sativum) that it claims can cause cancer, but it says garlic is cancer-protective if eaten uncooked.

If you were to solicit my opinion on this, let me tell you a lot of foods containing complex starches such bread when toasted, cakes, traditional kuih, coffee (after roasting its beans), potatoes chips, pop corns, fried rice, fried mee, fried rice noodles and any foods containing starches (almost all foods do) when cooked above 120 degrees Celsius produces  this acryloyl group called acrylic amide or acrylamide or prop-2-enoyl  in short

We are not too clear on the mechanism how this substance is formed when almost all starchy foods,  not just garlic alone, are heated to above 120 0 C. Food scientists  think this may be a by-product of Maillard reaction.


Maillard reaction:


Maillard reaction is a chemical reaction between amino acids and reducing sugars that gives food its brown colour and distinctive flavor when foods like bread, buns, and cakes are heated at a high temperature. It is a non-enzymic browning reaction, a very well-known reaction in food chemistry.

This reaction does not occur when starchy foods are boiled such as in boiled potatoes and rice. But in fried or baked goods, acrylamide may be produced by the reaction between asparagine (an amino acid from protein) and reducing sugars (fructose, glucose, etc.) or by reactive carbonyls at temperatures above 120 °C.

Unfortunately some later studies  showed that  acrylamide was also present  in black olives, prunes, dried pears for reasons not clear to us.


The Decomposition of Acrylamide:


However, we also know that acrylamide decomposes in the presence of acids, bases, oxidizing agents, iron, and iron salts. This means that even if starchy foods are baked, acrylamide may not be present if they are cooked at high temperatures in the presence of vinegar (acetic acid), lime juice (citric acid) or if baking powder (sodium bicarbonate, a mild alkaline) has been added.

The baking powder itself will decompose into carbon dioxide and sodium carbonate which is even more alkaline than baking powder. This may block the formation of acrylamide, but we need studies to show this.

But even if acrylamide is present, this compound can decompose even without heating into ammonia, and with heat, it decomposes into carbon monoxide, carbon dioxide, and oxides of nitrogen after some time. Again we need to conduct studies on this.


Discovery of Acrylamide:


Acrylamide was discovered in April 2002 by a scientist in Sweden when she found the chemical in starchy foods, such as, French fries (potato chips), and bread that had been heated higher than 120 °C, but  was not found in food that had been boiled or in foods that were not heated.
The discovery of acrylamide in some cooked starchy foods provoked worries about the cancer-causing effects of these foods.


However as today (Friday, June 1, 2018), food scientists, nutritionists, toxicologists, and medical scientists are still uncertain whether or not acrylamide in foods put us all at risk of developing cancer.


Tumors in Experimental Animals:



In experimental animals, exposure to acrylamide was shown to causes tumors in the lungs, thyroid, adrenal glands, and testes.

This concern is not just through ingestion, since acrylamide can easily be absorbed by the skin and distributed throughout the body.

It was demonstrated that the highest levels of acrylamide after exposure were found in the blood, non-exposed skin, liver, the kidneys, in the testes, and spleen.

The mechanism how the carcinogenicity of glycidamide is triggered in animal models is through a gene called cytochrome P450 which transfers its metabolism into a genotoxic metabolite called  glycidamide.

However, people who worked in food manufacturing industry and were exposed to twice the average level of acrylamide do not exhibit higher cancer rates. 


Detoxification of Acrylamide:


Interestingly, acrylamide and glycidamide can also be detoxified by conjugation with glutathione (an antioxidant produced by the body) to form isomeric glycidamide-glutathione conjugates, and these  are subsequently  metabolized to mercapturic acids and excreted harmlessly in the urine.


Neurotoxic Effect:


Acrylamide has also been found to have neurotoxic effects in humans who have been exposed. Animal studies also show the same neurotoxic effects.

Nonetheless, we cannot translate experimental results based on animal studies into human.  First of all, human life span is far longer than smaller animals like rats, rabbits and guinea pigs.

Secondly, the dose normally given to animal models are far higher and fed continuously than those consumed unintentionally by human in their daily diet.

What we are unsure of is the accumulative effects of acrylamide in humans even at low doses, but over a long period of our  life span. So far we have no evidence on its correlation with cancer in humans


Nutrigenetic:


Thirdly, how our human body reacts to acrylamide and other substances may not necessary be the same as those in animals. There are a lot of other factors such as nutrigenetics to be considered.

Nutrigenetics is a sub-specialization of the science of nutrition on how nutrients have variations in  genetic responses, and thus the onset of disease and their outcome such as cancer.

Food substances such as acrylamide may influence gene expression and gene behavior and also their epigenetics. The branch of molecular medicine called epigenetics refers to external modifications to DNA that turn genes "on" or "off."

These modifications do not change the DNA sequence, but may trigger off disease like metabolic syndrome and cancers, and the way we respond to acrylamide or other poisons are different from individuals to individuals, not just among human or among animals, but even among individual humans.

In short, you and I are entirely different even though we share almost exactly the same genome, and we respond to disease, their treatment including cancer and their outcome differently.


Absorption through Skin:

  
Acrylamide has been found to be a skin irritant. Thus being a chemical irritant, this may act as a tumor initiator on skin tissues, giving an increased risk to skin cancer. Clinical presentations of acrylamide exposure include dermatitis in the exposed area, and subsequent peripheral neuropathy.

But what we are concern is not so much  the presence of acrylamide in heated garlic, but by the loss of a lot of valuable suphur-containing allicin and other functional active components in garlic,  one of the most important medicinal principle is ajoene when garlic is cooked at home,  or processed into pills by other means through food technology

Allow me to briefly explain  this in a simple language for the benefit of my gentle lay readers.


Ajoene:


Ajoene has medicinal properties. It is an antioxidant that is able to block the formation of free radicals like superoxide. Ajoene also acts as an antithrombotic agent that prevents platelets in the blood from forming blood clots. This means that regular consumption of raw garlic reduces the risk of heart disease and stroke in humans due to blood clots

Ajoene processes anti-viral properties against a number of viruses such as those that cause vesicular stomatitis, para-influenza, vaccinia virus, human rhinovirus, and herpes simplex.

It was shown that when cells are infected by a human immunodeficiency virus (HIV), ajoene in garlic was able to block the integrin-dependent processes as shown by Tatarintsev AV, et al.

Ajoene also exhibits broad-spectrum antibacterial and antifungal properties, and garlic has been used traditionally as a natural antibiotic and fungicide against many types of infections since ancient times by all civilizations for thousands of years.


Phyto-dynamics:


The mechanism how ajoene acts as natural antibiotics is its ability to inhibit genes expression controlled by quorum sensing.  Quorum sensing is a communication system used by pathogenic bacteria like Pseudomonas aeruginosa to synchronize the expression of specific genes involved in pathogenicity.


Cancer therapeutics:


In cancer therapeutics too, ajoene has been found to exhibit anti-leukemia properties against acute myeloid leukemia and it was found to decrease basal-cell carcinoma tumor size by inducing apoptosis (induced cell suicide)

This was shown that ajoene was able to effectively inhibit tumor cell growth by targeting the microtubule cytoskeleton of cancer cells and through other phyto-pharmaco dynamics.
  
Like its action against pathogenic microorganisms, in cancer management where gene expression, epigenetic, and nutri-genetic are of paramount importance to our understanding on the biology of malignant growth and their spread, garlic and other natural medicines are of current interest to  scientists in their search for cancer treatment.


Garlic Pills vs. Raw Garlic:


Unfortunately this extremely useful cancer fighting and cardio-protective sulphur-containing ajoene in garlic was found to be absent in all 20 brands of garlic pills manufactured by 20 different countries

This strongly suggests to us that when foods are processed by extraction, heating, cooking or by other means, a lot of valuable nutrients and medicinal properties are lost.

Hence, as a general rule, wherever, and whenever possible, bearing in mind hygiene, digestibility, toxicity and other factors when some foods are consumed raw, plant-based foods generally are best consumed raw or lightly cooked such as in blanching of vegetables where most of the nutritive, medicinal and health-protective properties are retained

By lim ju boo


Tuesday, May 15, 2018

Speed of black ants


Just fancy this:


This morning I was eating breakfast in my kitchen, and for a long time as usual, noticed red or black ants crawling over certain areas in the kitchen especially along the white-tiled wall that was just right in front where I was sitting


I then wondered as I always do about tiny creatures, how fast black ants “crawl” since I often notice they actually move quite fast for their small size.


I then decided to conduct a very small and very informal post-breakfast study on their speed similar to a research paper.  But here I make it very simple, very informal and friendly to read for non-scientists, and non-researchers


Materials and method:


I marked out exactly 2 meters on the white wall along the path of the black ants, and made 12 measurements on their velocity across these two points.


The ants were then killed by a sweep of  the flame from a  blow torch lasting less than one second on each point along the line of sweep to minimize contraction of the ants’ size due to crinkling of the ant’s protein molecules when subjected to heat.


The ants’ sizes were then measured under a low power (50 X) microscope fitted with a measuring scale on the eye piece and their natural sizes corrected for magnifications


Here are the results:

Measured Data:

Size of kitchen black ants (cm): 3.6, 3.5, 3.0, 3.2, 3.4, 3.6,
3.2, 3.7, 3.1, 3.3, 3.2, 3.4, 3.3, 3.3, 3.5, 3.4

Sampling Technique: Randomized:


1.       Sampling size (n): 16
2.       Mean size:  3.375 mm (3.375 x 10-3 meter)
3.       Sample Standard Deviation: +/- 0.195
4.       Time taken to “crawl” 2.0 meters was 10.2 seconds (mean of 12 measurements)
5.       Velocity of crawl in a straight line: 19.6 cm per second = 0.7058 km per hour


Results and Discussion:

Olympic 100 Meters Sprint Record:


The current Olympic men’s world record for a 100 meter sprint is 9.58 seconds. This was set by Jamaica's Usain Bolt in 2009. This translates to 37.57 km per hour over a short distance.  He was 1.95 m tall compared to the ants which were just 3.375 mm in size.


He was thus 577.77 times larger than the size of the ants


Had the black ants in my kitchen reached the size of Usain Bolt, my ants would have run 407.79 times faster than Usain Bolt. This truly would be far outside this world’s record.  


Now let us compare with a latest version of the AirBus jet plane. One of the latest models made by AirBus is the A350-1000. It is 73.88 meters long, or 21,890 times longer than the black ants.

Its new wing design allows it a cruising speed of Mach 0.89 or 1,098.97 kph


If those ants crawling along my kitchen wall were to reach the size of A350-1000, their velocity would be 15,450 kilometers per hour. This is more than 14 times faster than the latest model of this commercial jet plane.


Mr. Atom Ant:


The Earth radius is 6378.1 kilometers. This translates to 40,075 km in circumference (calculated or measured). The velocity of Space Shuttle is 27,870 km/h orbiting the Earth at a minimum height of 304 kilometers above sea level or 6,682 from the center of the Earth. This means its minimum circuit is 41,984 km round above the Earth.


This also means the Space Shuttle will go round the Earth once every 90.38 minutes.

Should my kitchen black ants be now be bloated up to also the same size as an A350-1000 AirBus jet, and then decide to go up into space to the same height as the Space Shuttle, it would be able yo circle the Earth once every 2.717 hours or 163 minutes, making the Space Shuttle 1.8 times faster. Still, that is  an awesome speed for Mr. Black Ant 

Of course we are fully aware that ants cannot fly like a plane, nor can they hurtle into space and circle the Earth like a space craft. Furthermore, we are only assuming that when the ants were bloated up to the size of a man or to a  plane its speed will be magnified proportionally. That may not be true. In all probability their speed may slow down tremendously instead because of an increased mass, let alone we need to consider the aerodynamic shape of the ants as their speed increases, causing a drag, loss of energy and slowing down a body considerably

Of course we are just discussing this under a hypothetical scenario just for academic interest far from being practical. I understand that very well.

Yet we always describe ants as “crawling” on the wall and floor. This very simple and informal study shows they “fly” far faster than a jet plane,  not ”crawl”


Do we make sense when describing small creatures?  Think this over.


Thank you for reading


-          Lim jb

Tuesday, April 17, 2018

The Physiological Role of Lutein in Vision and Disease


LIM JU BOO 
BSc Post Grad Dip Nutr MSc MD PhD FRSPH

Fellow
Royal Society of Medicine
London


Chemistry of Vision:


Rhodopsin or visual purple is a sensory protein-containing pigment found in the rod cells of the retina requiring retinol or vitamin A for its synthesis.

In the event of vitamin A or carotene  deficiency (carotene is a precursor of retinol or vitamin A), the synthesis of rhodopsin is compromised, resulting in night blindness, and in severe cases lead on to xeropthalmia and keratomalacia and total blindness.


Hence the importance of an adequate intake of vitamin A or fruits and vegetables containing carotene which can be converted into retinol (vitamin A) by the body

However, retinol is not the only nutrient that ensures good vision in the dark in particular.


Lutein and Carotenoids:


There are other carotenoids that are also involved in good vision in both in the day and at night , one of which is lutein, the other zeaxanthin.


Lutein is a one of the carotenoids that acts as an antioxidant responsible for protecting the eyes. This phytochemical is found abundantly in most brightly colored fruits and leafy vegetables and in plant-based foods that have deep orange or yellow colours.


Many colorful fruits and vegetables such as kale, spinach, broccoli, water cress, kangkong, sayur manis, including mangoes, water melons, citrus fruits, in fact in most tropical fruits, and even egg yolk are rich not just in carotenes, the precursor of retinol, but are also abundant  in lutein and zeaxanthin.


Green tea too contains lutein and zeaxanthin in good amounts besides the catechins, a subgroup of the flavonoids, as well as  vitamins C and E,


So does a Chinese herb called Gou Qi Zi (Wolfberries) which has very high levels of zeaxanthin, lutein, polysaccharides and polyphenols, all of them  have been shown to improve eyesight, prevent macular degeneration and diabetic retinopathy.



Their rich presence in most colorful fruits, vegetables, teas, berries and herbs protects the eyes from oxidative stress and vision loss.


Like retinol, lutein and zeaxanthin cannot be synthesized by the human body and hence they must be obtained by the consumption of plant-based foods rich in these sources. However, lutein may also be  giving by lutein supplements.


Although it is best to source lutein naturally through foods rich in them,  other antioxidants supplements or fortified foods may also be used to help increase levels of lutein, zeaxanthin and carotene levels in order to confer the full potential of lutein in terms of disease prevention, bioavailability, metabolism and dose-response relationships


When foods rich in lutein or lutein supplement is consumed, scientists and nutritionists believe this is easily transported throughout the body, especially to the parts of the eyes called the macula and the lens where it is wanted most. Nutritional and food scientists know that there are more than 600 different types of carotenoids found in nature, but only less than two dozen find their way into the eyes.


Of these, approximately 20, lutein and zeaxanthin are the only two left that are deposited in high quantities into the macular portion of the eyes.  The macula is the central area of the retina which is the light sensitive, and it is in this area that lines the inner portion  of the eye that  gives us the ability to see an optimal “20/20”vision  and visualize the full range of colours.


Oxidative Radical Damage:


Furthermore, the antioxidant properties of lutein to block off free radical damage caused by blue light from smart phones or from other sources have been reported in the journal Nature.


A diet lacking lutein and other carotenoids may increase the risk of developing age-related vision loss or disorders related to macular degeneration and cataracts formation


Nutritionists and medical researchers are aware that lutein protects healthy cells like rods and cones in the eyes and skin cells, and its ability to arrest the growth of malignant cells.


One of the most important parts of the eye is the lens. The function of the lens is to collect and focus light onto the retina. This is exactly why the lens has to remain clear and transparent for light to enter. It has to be free from the cloudiness which is indicative of the formation of cataracts.


Energy of Light:


The main reason why the lens becomes cloudy is due to oxidation of the lipids in the lens by ultraviolet light and blue light which are shortwave ends of the light in the electromagnetic spectrum.

The shorter the wave length or the higher the frequency, the greater the penetrating and destructive powers of the electromagnetic spectrum including light as given in the Max Planck equation:


E = hv

where,  E = energy delivered, h = Max Planck constant, and v = the frequency


Thus blue light and ultra violet of the Sun can energize molecules in the eyes, the skin  and other tissues liberating highly destructive free radicals to the cells, especially the DNA, initiation molecular lesions on the sites where the light or radiation is turned on.


However the presence of antioxidants like lutein and zeaxanthin is able to block off these highly distractive free radicals that may ultimately lead to vision impairment, both to the lens and to the retina.


Even for those who may, or may not have existing eye and vision problem other than short or long sightedness, including plenty of lutein in their diet or in supplements can prevent  vision impairmemt Thus it is important to ensure we have adequate lutein intake.


Preventative measures are the best ways to ensure that our vision and eyes remain  intact and healthy even till old age. It is thus strongly advised that both the young and the old should ensure adequate consumption of foods rich in lutein, or the use of supplements so as to minimize the risk of oxidative damage to the eyes.



Cancers and Heart Disease:


Even though lutein, zexanthin and other carotenoids are extremely crucial for vision and the eyes, their benefits is also extended to other areas of the body.


For instance, lutein is also used in the prevention of skin disorders, several types of cancer including colon or breast cancer, type 2 diabetes as well as minimizing risk factors associated with coronary heart disease.


Macular Degeneration:


Lutein may be considered a natural treatment for macular degeneration (AMD), which is probably the most common cause of blindness among older adults in countries where vitamin A intake is adequate but where lutein is deficient.  


Estimates show that more than 25 million people worldwide are affected by age-related macular degeneration or cataracts, especially people aged 55 and older living in areas where exposures to ultra violet rays of the sun is highest such as in snow covered mountains of Tibet or in the tropical sun like in Malaysia.


For instance, the incidence of AMD in the United States is predicted to triple by 2025 according to the American Optometric Association


Mechanism of Action:


Lutein protects the eyes by blocking off a portion of the short-wavelength UV light or blue light that have the most damaging effects on the most delicate parts of the eyes such as the retina and the macula.


Researchers at Harvard University have found that supplementing with 6 milligrams daily of lutein can lower the risk for macular degeneration by an average of 43 percent.


Cataract & other Studies:


Similarly, other studies have demonstrated that a higher dietary intake of lutein and zeaxanthin along with vitamin E is associated with a significantly decreased risk of cataract formation. While the research is still in its early stages, it is suggested that taking lutein three times weekly for up to two years may confer an improvement in vision in older people who already have cataracts or at risk.


Other benefits of lutein intake or its supplements include a reduction in  eye fatigue, glare and light sensitivity especially those who plays with their smart phones constantly especially in the dark. It assists the lens and retina to remain intact while strengthening the eye tissues.


Individual Variations:


However, the requirements of lutein like for all other nutrients differ from individual to individual.  No one person is biologically the same. It’s likely that even for those with a relatively high intake of antioxidant-rich foods, their blood levels might be correspondingly high in the various nutrients, and yet their levels in the tissues within their eyes and at retinal levels may still be too low.


Scientists have now devised ways of measuring macular pigment levels of lutein in the eyes to determine the risk for retinal disease. By determining the macular pigment optical density test (MPOD), nutritionists and specialist doctors can now formulate more precise dietary recommendations for lutein and other protective nutrient requirements based on individual responses, genetic predisposition and lifestyle requirements


Skin Cancers:


It was shown that carotenoids including lutein and zeaxanthin are not just present in the eyes, but also in the skin. It is postulated that lutein may be able to filter out high-energy wavelengths of visible light such as blue light and ultraviolet radiation by slowing down the rate of free radical damage and oxidative stress. A few animal studies have shown that lutein provide significant protection against light-induced skin damage, such as signs of aging, the loss of skin elasticity, and potentially skin cancer.



Lowers risk of diabetes:


It was also demonstrated in some animal studies that high levels of lutein and other carotenoids within the blood are associated with a better control of blood sugar. This may be translated to a lower risk of diabetes and its complications.


For instance, a 2000 study conducted on diabetic rats found that oral supplementation with lutein and omega-3 fatty acid or DHA was able to normalize all diabetes-induced biochemical lesions in the experimental group.


Compared to the control of rats not given lutein and DHA, diabetic rats taking the supplements showed   lower oxidative stress rates and less damage to the retina of the eyes, even though they were under hyperglycemic conditions.



Lowers Risk of Cancer:


There was some evidence that people who obtain more lutein in their diet have lower rates of breast, colon, cervical and lung cancers. However, we do not know exactly how lutein and cancer formation is linked currently, even though correlational studies have shown that adults with higher levels of lutein in the blood experience a reduction of developing several forms of common cancers.


Thus it may be possible lutein could offer as a part of a natural cancer treatment because of the fact that foods rich in lutein such as broccoli,  kale, spinach,  leafy green vegetables and all highly colored fruits  with high antioxidants scores  can  lower inflammatory diseases due to oxidative stress.


But more research is still needed to help us fully understand the role lutein and other carotenoids have on cancer, immune response, hormonal and cardiovascular functions, independent of other nutrients and phytochemicals that are found in fruits and vegetables.


One possibility is their epigenetic influence on how genes express themselves in the presence of lutein and carotenoid-rich foods.
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Cardiovascular Protection:


A few  observational studies have demonstrated  that xanthophyll carotenoids including lutein can reduce the risk of cardiovascular events and  coronary heart disease and stroke However as in previous studies that show potential cancer-protective effects of lutein, we are not quite  sure as yet at this moment in time how lutein could be cardiovascular protective?  


One such possibility is lutein anti-inflammatory and antioxidant properties may inhibit inflammatory response which currently scientists and cardiologists believe is the primary cause of heart and vascular diseases.  This hypothesis is currently replacing the out-of-fashion high cholesterol theory.


Studies conducted at the University of Southern California suggest that low levels of lutein within the blood might contribute to the thickening of artery walls. This elevates the risk for arteriosclerosis development and clogging of the carotid arteries that can result in cerebrovascular accident or stroke.


The USC’s observational studies show that populations with the highest levels of lutein in the blood experience less plaque formation in their arteries, as opposed to the other group with lower levels of blood lutein.   It was shown that the lesser lutein-rich plant foods they consumed, the more clogged their arteries. Perhaps more studies are needed to confirm this observation.
 

Another interesting observation is that after the researchers tested effects of lutein on human arteries that were surgically removed, there were fewer white cells present within the arteries after lutein supplementation was added compared to the controls. We know that the presence of white cells is suggestive of   an inflammatory response, and a subsequent blockage of the arteries which has no link to high or low blood cholesterol levels.


This may suggest the actions of free radical damage prior to atherosclerotic plaques and lesions.




Monday, April 2, 2018

The Contribution of Scientist in Medicine


The Contribution of Scientists in Medicine


I wrote an article in this blog "Are Doctors Clinicians or Technocrats?" just  hours ago. 

Here, in this small article, I thought I should continue my thoughts that medical scientists should not be left out with their hard earned scientific data for the advancement of medicine


What I wrote earlier,  of course does not mean clinical practice should only be confined by just looking at the history of the patient, by just looking at the signs and symptoms, do a  clinical examination.

All these methods  are very subjective depending entirely on the clinical acumen of the doctor but without any concrete objective measurements and without any data,  and then just prescribing the treatment.

This approach in modern medicine would be grossly wrong if medical technology can come to the  aid of the doctor with their advanced objective measurements and investigations.


Clinical Data Just as Important:


Clinical data can then be collected to look at the extent of the chemical and physiopathology, which would also be very valuable for follow-up treatment and monitoring
It would be utterly unacceptable if lab technology if available to confirm a diagnosis, but denied to the patient especially if they are cheap and  cost effective


Furthermore, there are many things in medicine we do not know, such as how do we defeat cancer yet not wanting to consult our scientists colleague who have the expertise in  molecular biology, genetics and epigenetics, who can study malignant cells express themselves, the behavior of their  genetic codes, codons and switches and their highly complex signaling pathways…etc., etc.


But to understand disease,  we need to call in our scientific counterparts working silently in research laboratories, and through their R & D develop rapid diagnostic procedures and drugs that may eventually give the tools to  clinicians to effectively manage cancer and many other unsolved and difficult diseases


Scientific Medicine:


But if we do not wish to use scientific methods but  confine our practice to just history taking, and physical examination, medicine will immediately come to a standstill for everybody –  for  the doctor, the patient and  worse of all,  the public.


Then there will be many, many diseases like autoimmune disorders like SLE, lupus, polycystic ovary syndrome, multiple sclerosis, cystic fibrosis, Crohn's disease, motor neuron disease, and even the entire range of reemerging  infectious and communicable diseases becoming  unresolved, if not growing bigger and bigger a threat


The Contribution of the Scientist


If the doctor does not wish to bring in the scientist as part of the health-care provider, but only himself as the stand alone contributor, then how is he going to treat the patient?
Where then can he get the medication because all the drugs including vaccines and diagnostics are the inventions of the scientist in his research into R & D. This includes the medical engineers who invented and developed all those different types of scans and imaging machines


It is the drug scientists who not just formulate and model the drug or the vaccine, but they were actually the ones who study their actions on body as well as its chemistry of the pathology.


They are also the ones who study their therapeutic action, their toxicities, work out the dosage, their interactions with other drugs or nutrients, their indications and contraindications, pharmacodynamics (mode of action), their pharmacokinetics (absorption, distribution, retention time, mode of excretion, etc.), and teach the doctor how to use the drug besides educating them on the precautions, etc. etc.


The doctor won’t know these because the drugs are not designed or invented by them. They are just the end-users together with the patient


Drugs like TV Sets


This is exactly like a consumer who buys a television set, a house computer, a smart phone, a microwave oven, a washing machine. All the consumer needs to know is how to use them by following the manual that comes together with the product. It is not their responsibility how the gadget works or manufactured, and even if told, he is hardly likely to understand either because pharmacology is not their field with just two months lectures about drugs during their medical training


All he is interested is how to use them by reading and following the manufacture’s pamphlets enclosed with the drug.


Hence if a doctor refuses to acknowledge most of the credits  to be given to his scientist colleague, then he will stand alone forever taking only  medical history,  looking for signs and symptoms, palpating and percussion the patient body, and auscultating the patient for heart murmurs, lungs for rales, rhonchi, stridor and pleural rubs, and elsewhere for bruits and bowel sounds. 

This he will do round and round in circles forever getting nowhere for him, or of any benefit to the patient

He has no choice if he wishes to use other methods to diagnose and treat the patient,  he must give due credit to the scientist who work brought to him all the lab diagnostics and scans available for him to proceed further,  much more than mere clinical examinations round and round, benefiting no one.


Treating the Disease, the Person or the Patient:


Unfortunately, the doctor does not study or research into disease. His role is merely to diagnose and prescribe the medication, but the medication is actually administered by the nurse. Sadly he treats the disease but not the patient as a person. He looks at everything from the medical point of view and forgets the patient is actually a person, and not a biochemical machine, but  with social and spiritual needs which must also be holistically treated, and not  just by  giving the medicine

The medical scientist on the other hand, only studies the disease, its chemistry and pathology, but does not treat the patient, let alone treat the patient as a person. He is only interested in research to give something new for the doctor to use, like a manufacturer producing a smart phone or a television set,  and sell it to a user  to use it  Both are grossly guilty of their short coming 


The Clinician- Scientist Partnership:


Thus clinicians, no matter how competent  they may be, must give way to scientific methods of investigation in order for medicine to advance. They just cannot confine their practice using just  clinical methods  without lab investigations. Then  they will get nowhere, and all of us in society will also suffer too because there is no way to diagnose a complicated case effectively, and no treatment can then be offered


Clinicians have no choice but to work hand-in-glove with medical scientists and researchers who actually are the frontiers of their scientific and medical knowledge. The scientists impact these knowledge to them through their publications in learned scientific and medical journals provided the doctors read them.


But all these scientific research in medicine and medical sciences must be able to be translated from bench into bedside through the middle party called translational medicine, and emerging field of medicine so that a medical graduate will turn into not just a clinician, but a clinician-scientists capable of handling complex scientific research.

At the moment it is the scientists, not the doctor who does  99.99 percent of the research work in medicine. However, neither the clinician nor the medical scientist can work separately, ignoring each other valuable work.  


Both are to be given equal tribute in the health care profession, because the doctor cannot work stand alone. Many other health care partners are also involved in a holistic approach to fight disease, pain and sufferings


The Nobel Prize in Medicine or in Physiology:


In fact all the prestigious Nobel Prizes in Medicine or in Physiology are awarded mainly to the scientists these days. They are actually the ones who work silently in their research laboratories except during clinical trials when both may emerge in public, else only the doctor and the patient are in view 


The Nobel Prize in Physiology or Medicine is widely considered to be the highest accolade in modern healthcare. Once a year, the Nobel Assembly at the Karolinska Institutet in Sweden announces a prize to recognize the significant medical contribution of up to three healthcare researchers.

The Royal Society of Medicine in London bemoans:


In a paper published by the Royal Society of Medicine in London, it was reported:
“We studied the overall trend in prizes and awardees to note that the proportion of clinicians receiving this award has been diminishing year on year. In the past 100 years of awards to medical scientists (excluding war periods where Nobel Prizes were not awarded to individuals); over 79% of Nobel Prizes in the first 30 years were awarded to clinicians. This contrasts significantly with the last 30 years, where only 26% of prizes have been awarded to clinicians”

  
(J R Soc Med. 2011 Sep; 104(9): 387–389).

Thus we can see the advancement of medicine has  now been taken over by medical researchers and medical scientists instead of by medical doctors and clinicians unlike 3 decades ago. The scientists  are deservingly  recognized as the actual frontiers  and contributors  of medical knowledge and medical advances  only possible by their hard work hiding behind the screens and  corridors of the health care profession



The Scientist Contribution:


In fact they contributed 99.99 percent of the advances in medicine by developing new diagnostics, new range of drugs, all the various scans and imaging techniques from X-rays to ultrasound, CT down to MRI and PET scans – all of them are developed by medical scientists and researchers,  and none by clinicians.


So did medical scientists find out causes of various diseases and how to prevent them? Very few of these studies came from medical doctors


The highest accolade in the form of Nobel Prizes in Medicine or in Physiology are praiseworthily given to the research scientists for their immense contribution to medicine


But if we were just to depend history taking and clinical medicine without any drugs formulated and designed by the pharmaceutical chemists, studied by the toxicologists, molecular biologists and evaluated by the pharmacologists, then absolutely no disease can be treated by the doctor. They will have nothing to offer?


The Long Dark Tunnel


The health-care industry is like a long dark tunnel
Hidden all along the sides of this tunnel are the unsung and unseen heroes, the medical researchers, scientists, inventors, and discoverers working silently towards the end of this tunnel just for two recipients to benefit their hard and unsung work


 At the end of this tunnel you will see a very bright light where you will see only two persons who are recipients  sitting in the open of a  bright glare. One is the doctor, the other the patient. The doctor gets the most limelight


But each year, the Nobel Prize Committee for Medicine or Physiology will call out just one or two most glaring contributors hidden somewhere at the side of this tunnel to come out to receive this world’s most prestigious Prize in Medicine to be in the real glare


There the tunnel is opened completely, not just at one spot at the end of this tunnel, but in broad daylight for the entire world to see the real hero


Ironically, more and more of these unsung heroes hidden in this dark tunnel are now being called out into the open to receive this most converted and glaring Prize and the doctor and his patient at end of the tunnel are asked to retreat into darkness and oblivion  



Obviously the medical community has to acknowledge and give way to the clinician’s scientific counterpart in order for them to progress for the benefit of the public. None can stand alone, as the scientific world is now multidisciplinary requiring expertise from various scientific disciplines    


lim ju boo BSc PG Dip Nutr MD PhD FRSPH
Fellow, Royal Society of Medicine
London                  

Sunday, April 1, 2018

Are doctors clinicians or technocrats


Dear Prof Dr. Andrew

Thank you for agreeing with me.


A lot of diseases are Iatrogenic, caused by all these annual medical check-up, unnecessary investigations, unnecessary medications prescribed by the doctors themselves.
Let me give my frank view who makes a competent doctor.


By merely taking the medical history of a patient, and asking him a lot of questions, a competent doctor with very good clinical acumen would already be able to analyze and differential diagnose a patient’s illness without resorting to all those unnecessary and expensive lab tests, imaging and scans which to me all these images are just shadows on a film with no definitive diagnosis.  I only agree lab examinations provide some data of blood levels of a pathology which is not possible with just clinical examination


Thus,  I am not saying lab support is unnecessary. What I am trying to drive home to doctors is that these  blood, urine and serological-immunological tests  should be reserved for difficult cases where the clinical presentations  may mimic other conditions or disorders sharing the same signs and symptoms unless the signs and symptoms are presented as a group typical of the classical features (syndromes) of a specific disease.


In which case lab tests (biochemical, serological, haematological, microbiological, nutritional, molecular-biological assays…etc., etc.) may be necessary to confirm, or to monitor the progression of a disease or a treatment. These tests are just adjuncts to clinical examinations.


A physical examination is thus extremely important to diagnosis besides history taking. What about doctors who work in rural environment and among primitive societies where sophisticated lab technology and molecular-biological assays are completely not available? They will be sunk if they do not have the clinical skill


History taking and physical examinations are all non-invasive. They are cheap, reliable, and traditionally used since medicine was practiced by all cultures and civilizations long, long before all these sophisticated medical technology was invented by scientists in research laboratories to help the doctors.


History taking, listening carefully what a patient tells you (the patient is our mentor) and just some basic but relevant clinical examinations would already give a doctor with competent clinical acumen  almost 90 percent accuracy in his diagnosis without resorting to all those scans and elaborate lab investigations which are just  adjunct to support a diagnosis.


 I only respect a clinician who is a good diagnostician using  just his hands, ears, and eyes to assess (palpate, percuss and auscultate) without using all those unnecessary lab examination as “diagnostic clutches” This is my frank opinion on who makes a competent  clinician and a first class diagnostician

   
Just ask ourselves how did doctors diagnose well before all these sophisticated medical technology was developed by the scientists to help the doctors?  Yet these “ancient” doctors can make brilliant diagnosis, and also document and publish papers to describe the features, pathology, causes, outcome and prognosis of any disease s so accurately and so beautifully and have their description  published in standard textbooks of clinical medicine which even today modern doctors and medical students  read, learn and get their training


They  all learn from  these books written by doctors in the 18th Century where all these lab tests and imaging technology were not available? They must be genus to describe, diagnose and treat disorders almost the same way doctors do today except they do not need lab tests 


The text books they wrote,  such as Sir Stanley Davidson textbook on The Principle and Practice of Medicine is not much different from the current Oxford or Price Textbooks on Medicine (just to quote two examples among hundreds of modern medical textbooks)


In fact the modern textbooks merely expand existing chapters of the older books without altering the  original  content. How did these “non-technological” doctors describe the pathology and diagnosis so many diseases  so accurately decades before all these lab tests, radiological and histology examinations became available? They must be genus, and we need to salute them.  Currently doctors need technological clutches to help them diagnose.  They “must” have all those lab data, without them they are sunk.  


 Ask ourselves this question that even today; despite impressive medical imaging and molecular medical tests, just history taking and physical examination remain indispensable in many contexts. Before the 19th century, the history and physical examination were nearly the only diagnostic tools the physician had, which explains why tactile skill and ingenious appreciation in the exam were so highly valued in the definition of what made for a good physician.


Even as late as 1890, the world had no radiography or fluoroscopy, only early and limited forms of electrophysiologic testing, and definitely no molecular biology to help doctors as we know it today.
Ever since this peak of the importance of the physical examination, reviewers have warned that clinical practice and medical education need to remain vigilant in appreciating the continuing need for physical examination and effectively teaching the skills to perform it; this call is ongoing, as the 21st-century literature shows.


To me, this is what makes a very competent, and an extremely skillful doctor who is an excellent diagnostician by using just his eyes, ears, hands and his brilliant analytical brain to differential diagnose even a mixture of complicated disorders. Can we do that?   


The rest who depends on lab and medical technological support are all brainless robots
This is my view Professor Dr.  Andrew.  I am sure you agree as an eminent medical-surgical specialist from prestigious John Hopkins School of Medicine


A Non Robot 

Wednesday, February 14, 2018

Asparagus and Cancer



Food may influence cancer spread


“Over to you my dear beloved uncle JB Lim, How true is this report by scientists from the University of Cambridge, England about asparagine in asparagus and cancer spread,  as reported by BBC”
From Niece Lim Ai Lian

……………………………………….

My dearest niece Ai Lian


Thanks for the report to solicit my comment and explanation on this site from your Whatsapp to me:




First of all let me tell you Nutrition is a very difficult and dynamic subject, and especially in the area of Nutrition and Cancer.


There are a tremendous wealth of knowledge we already know about natural substances present in fruits, vegetables, spices and herbs and how they can affect our health and our outcome of disease including cancer.


Scientists learn about them through an inundation of their scientific discoveries, and yet there are much more information about the medicinal values of tens of thousands of natural substances in foods that remained undiscovered.


New discoveries on food and nutrition are published every 10 minutes worldwide. This makes our understanding how natural substances in foods affect our health very difficult to understand if not confusing with conflicting scientific disclosures being published
   

Nutrition is an extremely broad field of study, and nutritional science is also a specialty of medical sciences and their applications under dietetics plays an extremely important part in therapeutic medicine


Despite of the avalanche of our knowledge about plant-based foods, yet  if you were I ask me for instance, whether  durians, mangosteens, Psidium guajava (guava), Averrhoa bilimbi (camias), Averrhoa carambola (star fruit), Nephelium lappaceum (rambutan), Achras sapota (sapodilla or ciku), Lansium domesticum (langsat), etc, etc, if consumed regularly could  block, prevent, reverse or cure cancer, or use to treat hypertension, diabetes or any other disease, the answer I am going to give you is: 


“I do not know”


We already know that fruits and vegetables high in potassium and low in sodium as well as rich in antioxidants of various molecular weights are very useful in the control of hypertension and many chronic diseases where free radical damage to the cells, tissues, organs and systems are involved 



 But their medicinal values are far more than their uses in managing mere hypertension, diabetes or the prevention of cancer. They contain thousands of phytochemicals and antioxidants that act collectively and in different ways unknown even to research nutritionists, practicing dieticians and food scientists



Then we ask, what about vegetables like Bambusa sp. (bamboo shoots), Sechium edule (chayote), Allium fistulosum (spring oinion), Sauropus androngynus (sayur manis), Amaranthus gangeticus (Chinese spinach), and thousands of other tropical vegetables, etc.?



Can these too have a therapeutic or medicinal properties that could prevent or even reverse renal diseases like glomerulonephritis and nephrotic syndrome, or able to restore re-establish normal sinus rhythm in heart block? What about their role in liver and bile duct disorders like Gilbert's syndrome, sclerosing cholangitis? We are giving examples of course, not specific diseases where diet plays a paramount importance.



Again we do not know without studies. These are only questions we ask which food acts prophylactically and therapeutically.  



Scientists who conduct research on food and nutrition would normally only observe and record their effect instead of trying to explain how they work



It is not that they cannot explain, it is just that it would be exceedingly difficult, considering that there are several possibilities with tens to hundreds into thousands of unknown active principles found in naturally in fruits, vegetables, herbs and spices



So which one ingredient among the thousands of phytochemicals is actually working, or do they act synergistically? We have little answers


Even if we manage to identify and isolate their bioactive principles, it is hard to explain their mechanisms?


This is the dilemma challenging the most brilliant scientific brains how food substances act as a medicine.


Indeed Hippocrates had advised doctors in his days and even for doctors and patients today very correctly and appropriately about the therapeutic values of foods when he advocated:



“Let Food Be Thy Medicine”



Hippocrates never said let medicine be thy food. This of course was put into his mouth by pharmaceutical people today and modern doctors who want to replace food with drugs for their own survival.



In order to explain how food substances work as a medicine, it would involve a very deep understanding of food chemistry, biochemistry, metabolic pathways, molecular biology, genetic switches, epigenetics, among other medical-scientific disciplines



These are highly complex and specialized areas of studies. Without these integrated knowledge it is almost impossible to explain how food substances can affect health and disease like cancer.



Nutrition is indeed very complex and complicated trying to explain

  
Any attempt to explain their mechanisms would require a team of scientists from various fields working together to unravel its dynamics. So, researchers try to avoid giving an explanation as far as possible except demonstrating an effect on the body or on a disease.



You can clearly see that even scientists from the University of Cambridge conducting above study as reported by BBC did not try to explain much except mentioning that cancer spread may depend on the amino acid asparagine. But how asparagine works they remain silent.  



It was also shown earlier and independently by Prof Charles Swanton, Cancer Research UK's chief clinician that the drug L-asparaginase is used to treat acute lymphoblastic leukaemia, which is dependent on asparagine, and that the development of lymphoma and intestinal cancer were also slowed down in the absence of amino acids serine and glycine.



We already know that amino acids in which proteins are derived are very crucial in all cell and body growth and development.  Hence we can see nutrition and food substances do influence the outcome of disease including cancers.



Food as a medicine as Hippocrates of Cos (cica 460 BC) works differently from how pharmaceutical drugs act.



It is a breeze for any scientist in pharmacology to explain how drugs work. They can explain in great detail how they work because drugs are specially designed and modeled by them.  They then educate a doctor how they work (pharmacodynamics), and how to use them, their dosage, and explain the kinetic of their absorption, distribution, retention time, and mechanisms of  excretion.



They also inform the doctors their clinical applications (indications), contraindications, toxicities, adverse drug reactions, and the dosages because they study the chemical pathology of a disease and work on them during the formulations and conduct clinical trials on them. So these scientists know best.  These information are all clearly summarized in their literature (pamphlets) enclosed in the package.



Hence it is not a problem for a pharmacologists or a scientist working in a drug industry to explain how a drug works, their biochemical and clinical efficacy because they are the experts who study the chemistry of the disease (pathology) first, and they are the person who actually designed the drugs to block, substitute, replace or to mimic the body’s chemistry, or slow down the chemical pathology.



They then manufacture the drug and sell them to the doctors and teach the doctors how to use them with all the dosage, precautions, etc. given to the doctors.


All these information are given in their literature for the doctors. That’s not a problem for these medical scientists to explain.  That is because drugs are something they designed, formulate and developed themselves.



 But how are we to know what’s inside a food (other than the usual carbohydrates, proteins, vitamins, minerals and trace elements) especially for fruits, vegetables, spices and herbs.



There are hundreds to thousands of little known substances called phytochemicals in them, and even though we already know a lot, but there are lots more we do not know



These natural substances too possess therapeutic properties like pharmaceutical drugs except they are designed and put there as natural medicines by God for our existence on this planet, and they have been made used of by man for thousands of years by all civilizations.



These natural medicines are NOT designed and formulated as a single compound for a specific use, or only for a specific disease as done by pharmaceutical chemists and their therapeutic actions studied by the pharmacologists.



Natural medicine are designed and put there by God for all purpose. We just can’t match God in His formulation.



It is not that scientists are unable to explain how many naturally occurring medicines works to block cancer. It is just that it would be extremely difficult to explain considering that there may be several possible explanations involving chemical, biochemical, metabolic pathways, cell action, molecular and gene expressions, their switches and their epigenetics involvement…etc.,



But in this case about an amino acid slowing down some form of cancers, we are talking about just one food principle namely, asparagine. This is a non-essential amino acid. The expression “non-essential amino acid” does not imply that this amino acid or other non-essential acids are not required or essential to the human body. They are absolutely essential for growth, repair and development of the human body.



They are only non-essential because the body can synthetize them,  and hence they need not come from food sources


So maybe this makes it much easier for me to answer your question



First of all, let it be known that asparagine is found not only in asparagus, but also in most legumes, soya beans, nuts beef, eggs, sea foods, like fish and shell fish, milk and dairy products like cheese and even in potatoes.



Now bear with me, as I need to introduce just a tiny bit of biochemistry. Asparagine enters into the common Kreb’s Cycle and changes into oxaloacetic acid as with all other nutrients before entering the brain for its function. This makes this amino acid very important for our survival. We just can’t block it just to prevent cancer.

  

But what is more important is that, asparagine is encoded by the codons AAU and AAC, and its alpha-amino acid is then used in the biosynthesis of other proteins.



Codons are genetic codes responsible for amino acid translation and their production as in gene expressions.


This step is very crucial if we now try to explain how asparagine works in cancer development



First, all cells inclusive of cancer cells need to genetically express their special proteins through these codons in order to survive and spread.


Without these special proteins expressions with the help of asparagine, the cells including cancer cells die. This step is crucial in our understanding. In short, blocking off asparagine or avoiding foods rich in asparagine may slow down existing cancers, but at the same time seriously compromise our other  biochemical and physiological functions.



Hence avoiding asparagus and all foods rich in asparagine may not answer in preventing or slowing down cancer.



In any case, as I have already mentioned, asparagine is a non-essential amino acid, meaning even if you avoid foods with this amino acid, the body will still be able to synthesize it for its vital requirements. So you are back to square one again, solving nothing.



However, my feeling in forwarding my hypothesis how asparagine works is that, it may have helped in the synthesis of the various types of proteins cancer cells need. Proteins are nitrogen in composition and without a nitrogen base, no protein can be expressed by cancer genes, and they cannot spread.


But it also affects the rest of the body functions   

This is the probable the answer I offer you.



But if you are not satisfied with my explanation you should contact those researchers at the Cancer Research Institute in Cambridge, the UK for a better explanation.



Obviously they know more than I do because they were the medical scientists who conducted the study.



They may have another alternative explanation.



Lim jb