CHAPTER ONE
INTRODUCTION TO THE PROBLEM
Statement of the Problem
Nutritional aspects of preventative and acute models of care for cancer remain on the periphery of Western scientific research. Nutrition is viewed primarily as an ancillary modality used to re-mediate the negative effects of traditional cancer procedures including radiation and chemotherapy. While some recent research suggests a direct link between nutrition and genetic models of preventative and acute cancer care, this research will remain outside the mainstream of most scientific research in the United States.
An integrated assessment of the role of nutrition in acute and preventative models for cancer care will shed significant probable light upon its role in the prevention and treatment of cancer. Such assessment must incorporate findings from studies using Western scientific, traditional Chinese medicine (TCM) and alternative research paradigms. The problem studied will include the conflicts between the western scientific, TCM and alternative medicine regarding the role of nutrition in cancer prevention and treatment.
In addition, the intellectual assessment of the problem will include an analysis of existing research in both western scientific, oriental and alternative medicine regarding the role of nutrition in the prevention and treatment of cancer. The analysis will also seek to reconcile conflicts in findings and conclusions between western scientific, oriental and alternative research.
Background and History of the Problem
In his 1971 State of the Union Address, President Richard Nixon announced a “war” against cancer. He sternly announced that:
“the time has come in America when the same kind of concentrated effort that split the atom and took man to the moon should be turned toward conquering this dread disease” (National Cancer Institute, 2009).
On December 1971, the National Cancer Act was signed into law by Nixon, and since then, the Federal Government had spent almost two trillion dollars funding cancer research to find a cure (Cutler, 2008).
Despite massive government funded research and significant private funding of cancer research, cancer mortality levels increased approximately eight percent between 1972 and 1990. Cancer mortality rates decreased approximately 13 percent for the period of 1990 and 2004, but Cutler (2008 ) argues that this is due to preventative research focusing on lifestyle changes and scientific advances in cancer screening techniques. Cancer treatment regimens have remained largely unchanged in the past twenty years. Chemotherapy and radiation treatment protocols have resulted in small improvements in cancer mortality, but often at prohibitive costs.
On the other hand, the role of nutrition in cancer prevention and treatment remains a marginal topic in most Western scientific studies. The National Cancer Institute (2009) website defines nutritional therapy as a way of helping cancer patients in getting adequate nutrients for body weight and strength maintenance, tissue break down and infection prevention (NCI 1, 2009).
Nutrition is presented as a factor for mitigating the effects of medical treatment for cancer. While the NCI states that nutrition has a vital role in many aspects of both cancer development and treatment, it was not stated how the so-called “aspects” of nutrition may include an acute care role for foods that are used to treat, re-mediate or prevent cancer. The NCI classifies acute and preventative models of cancer care based on nutrition as either complimentary or alternative medicine.
Complimentary and alternative medicines are a group of various medical and health care practices, products or systems that are not considered as part of conventional medicine (NCCAM, 2009). While alternative medicines are used in replacement of conventional medicine, complementary medicines are used together with conventional medicine. In Western science, nutrition is often considered as a complementary aspect for cancer care. The NCI acknowledges that nutrition is sometimes promoted as an alternative care, but largely dismisses that it is a stand-alone alternate model for cancer care. In addition, NCI accepts the possible use of nutrition as a complimentary form of treatment (NCCAM, 2009).
Western scientific research exploring both preventative and acute care models featuring nutrition occurred mainly in Europe and Asia. Some American researchers published Western scientific studies involving nutrition’s role as alternative and complimentary factors in preventative and acute care models. However, most of the American research from the previous years ties nutrition to genetic factors, also known as “nutritional genomics”.
According to Ozdemir et al. (2009), nutritional genomics is the integration of genomics and nutritional science, which examines the relationship of nutrition science, food and possible health outcomes. NG (nutritional genomics) represents a Western scientific perspective on nutrition, and contrasts with alternative and oriental medical perspectives that fall outside “scientific” investigative parameters. It is a hybrid of complimentary and alternative medicine that represents a shift in scientific paradigms, favoring a more serious consideration of nutrition in the prevention and treatment of cancer (Ozdemir et al., 2009). The most significant gains against cancer mortality have been achieved through preventive practices (life style changes and screening technologies and protocols), while acute treatment methods remain largely unchanged for the past twenty years (Ozdemir et al., 2009; Cutler, 2008). Therefore, nutritional acute care models for cancer treatment represent a new approach that may advance cancer treatment protocols.
Purpose of the Study
The study will demonstrate the advantages of nutritional models of preventative and acute care as a “stand-alone” paradigm for cancer treatments. Nutrition remains on the periphery of cancer treatment and prevention paradigms in Western medicine. This is partially due to the fundamental differences between Western, TCM and alternative medical paradigms. By identifying differences in each paradigm, and presenting findings of research in ways that are valid to all three philosophies, the role of nutrition can then be accepted and expanded into all current cancer research.
Significance of the Study
Current Western scientific research regarding the role of nutrition in preventative and acute models of cancer care continue to present an ancillary role (NCI 1, 2009). Diet is primarily viewed as either secondary or tertiary force in the development of cancer, and a secondary element for helping cancer patients cope with the effects of chemotherapy and radiation therapy.
Nutrition as a “stand-alone” model of care for cancer is well established in TCM, which follows principles of energetic physiology: the idea that energetic force within and surrounding the body controls biochemical and cellular activity, and that electromagnetic forces are the primary dynamics of physiology (Wheat & Currie, 2008). This orientation toward energy balance and alignment is the basis for all TCM conceptual frameworks. Using the concepts and terminology of TCM provides a perspective of nutrition that is quite different from the meanings of the term suggested in English. Nutrition, in TCM, defines how food and comestibles autonomously manipulate the body’s energy fields and energy waves to produce health and wellness (Wheat & Currie, 2008).
Western concepts of research require different paradigms for physiological functions, they are far more mechanistic than TCM. When Western scientists discuss acupuncture, for example, they are likely to focus on the physiological, biochemical and molecular effects of acupuncture, and ignore its energy aspects. This is generally well-known to practitioners of alternative and oriental healing methods – offering a partial explanation as to why Western science has lagged far behind TCM in considering the role of nutrition in cancer prevention and treatment.
Most of the mainstream Western scientific thinking has a long tradition of refusing to accept alternative theories, which challenges accepted norms of science. The reliance on reductionist thinking and the scientific method has sometimes caused science to lag in accepting new and novel theories of science and medicine. Paradigm shifts in scientific thinking almost always require lengthy periods of time to gain general acceptance by the scientific mainstream.
Therefore, nutrition must be thoroughly investigated as an important factor in preventing and healing cancer. This can only be accomplished by presenting theories and criticisms of nutritional paradigms for preventative and acute treatment models for cancer and objectively weighing the evidence of each side.
Research Questions
What are the fundamental TCM, alternative, and Western scientific concepts of nutrition as related to the prevention and treatment of cancer?
What elements of nutritional genomics can be applied to TCM and alternative medical paradigms for the prevention and treatment of cancer?
What are the current research trends in TCM, alternative and Western scientific medicine regarding nutrition and the prevention and treatment of cancer?
How can all three models be used to form a complimentary model of preventative and acute care for cancer?
Scope, Delimitations and Limitations of the Study
Scope – The scope of the study will integrate existing literature on theoretical and practical investigations into the role of nutrition in the prevention and treatment of cancer. The body of literature will include studies following paradigms of Western scientific, TMC, and alternative models of medicine. Each of these paradigms will be examined as both alternative and complimentary models for cancer prevention and treatment. There are no restrictions on the framework or structure of research.
Traditional scientific studies will be examined along with anecdotal studies – although each study will be critically reviewed for the vigor and rigor of its methodology. The studied literature will be limited to printed source materials either in printed formats or electronic formats, and scientific studies and source materials will only be used for this study. Although a significant body of first-person and third-person material exists concerning the role of nutrition in the prevention and treatment of cancer, such anecdotal materials will be excluded from the literature used for this study.
Delimitations – The focus of this study is on the role of nutrition in the prevention and treatment of cancer. Its role in the prevention and treatment of other physical and mental illnesses will not be considered in the absence of any ties to the research question. The use of nutrition in re-mediating depression, for example, could be discussed in relation to nutrition therapies used with cancer patients who experience depression or lethargy during the course of treatment regimens. However, the breadth of nutrition related topics will be limited to the discussion of cancer itself.
Limitations – Limitations include access to all literature published regarding the research topic. While most research is available through search engines and library databases, some journals do not provide complete access to search engines without special financial arrangements or some journals may limit access of articles, or subscriptions to journals, to specific professional groups or members of private associations.
Not all scientific research is published in journals. Seminars and professional forums are often venues for the presentation of research findings that may not be published as peer-reviewed. While there are search engines and databases dedicated to cataloging such presentations, access to these databases can be limited and there is no certainty that all papers presented at such venues will be entered into search engines and databases. It is possible to “triangulate” research to locate such studies. By reading the available published literature and checking all sources cited in studies, certain source material can be identified and specifically sought out using extraordinary search techniques.
The final limitation to the assessment and analysis of existing research on nutrition and cancer involves translation issues with articles not published in English. Although English is the most common language for scientific publication, it is not the only language. This is especially true for TCM and alternative medical research. A significant segment of nutritional research in TCM and alternative medicine is conducted in Europe and Asia, and many findings are published in languages.. Many non-English language articles do contain an English language version of the abstract. This minimizes some of the difficulty of accessing non-English language research. However, the publication of non-English language research lacking abstracts available in English remains a significant factor in limiting access to all available research.
Translations of articles also poses problems for assessing the value of research, since there is no concrete way of knowing how accurate a translation may be of a non-English language article.
Definition of Terms
Alternative Medicine – It is a medicinal practice that does not conform to Western scientific paradigms of medicine and healing. It is often presented as an alternative to Western scientific-based healing practices and methods. It may or may not involve the non-Western scientific paradigms such as spiritual healing and the manipulation of body energy.
Biofield – The energy fields surrounding all living things, which are the basis for TCM and alternative medicine paradigms of physiology.
Cancer – A diseases distinguished by massive, uncontrolled growth of cells that invade and destroy adjacent tissues, and, through the process of metastasis, can spread through other organs and tissues of the body.
Complementary Medicine – The practice in which Western scientific paradigms combines with alternative medicine paradigms to create a modality that fuses elements of each group into a treatment practice.
Genome – The complete genetic sequencing on one set of chromosomes. It is a term used to describe the complete genetic sequencing of organisms from a single cell to complex living organisms.
Nutrition – The process by which living organisms obtain food and use it for growth, metabolism, and repair. In medicine and healing practice, nutrition also refers to the healing or medicinal aspects of food, vitamins, minerals, chemical and biochemical affects of food and comestibles on illnesses and in the maintenance of good health.
Qi – In Traditional Chinese Medicine, Qi refers to the active force that is a principle part of all living things. For the purposes of this study, it can be translated to English as “energy flow,” although it is sometimes translated as “air” or “breath.”
Traditional Chinese Medicine (TCM) – Sometimes used interchangeably with Traditional Oriental Medicine (TOM) or Eastern Medicine. TCM focuses on the role of Qi, which unifies body and mind through channels and meridians in the body. Unlike western scientific medicine, TCM views the body, mind and spirit as a unified entity. It engages a variety of treatment modalities including, but not limited to, acupuncture, the five element theory, and the use of foods and comestibles to correct disharmony within the body.
Western Scientific Medicine (WSM) – The practice of healing based upon scientific principles developed over the past two centuries, primarily in Europe and the United States. Its healing approaches are based upon scientific paradigms of research focusing on the isolation and identification of pathogens of disease, and the development of medicines and practices to counteract the pathogens. It rests upon a framework of reductionist science, and often clashes with the principles of TCM. It is difficult, for example, for WSM to accept or even understand fundamental TCM diagnoses such as “cool with dampness” or a need to “tonify” particular organs.
CHAPTER TWO
REVIEW OF LITERATURE
Introduction
The current body of literature regarding nutrition’s role in the prevention and treatment of cancer represents a sharp divide between Western scientific medicine (WSM) and TCM paradigms. Most research is presented in frameworks dedicated to either WSM or TCM models of care, few research is offered as a model for complimentary care. When Western research approaches what seems to be a complimentary model of care using nutrition for the prevention and treatment of cancer, the research nearly manages to present a reductionist explanation for oriental paradigms of biofields and energy. This is true for the field of nutritional genomics, which examines that role nutrition can have on the genome.
Nutrition is also subject to broadly different definitions in WSM and TCM. In WSM, nutrition is expressed as the product of food intake. Taking this to its logical extreme, the WSM views nutrition as “you are what you eat” (NCI 1, 2009). Interaction between foods, comestibles and the body are restricted to specific mechanical and biochemical reactions. An over intake of fats will lead to obesity and the complications of obesity. The relationship of nutrition to the body’s health is mechanical and subject to scientific testing following the scientific method.
TCM views nutrition as affecting the unified mind, body and spirit that is human life. The mechanistic function of WSM is ignored, and the unified approach to life incorporates nutrition as it affects the Qi. This may explain the relative small number of complimentary models of care for the prevention and treatment of cancer (Wheat & Currie, 2008). Existing research regarding nutrition and cancer in WSM is specific to a few types of cancer, particularly breast, colorectal and lung cancer. WSM literature has an expansive discussion of nutrition as a palliative model for patients undergoing or recovering from chemotherapy and radiation therapy for all types of cancer, but is generally not viewed as having as substantial healing effect on cancer.
Most WSM studies of nutrition as a factor in preventing/treating cancer are criticized for the common methodology of subject-maintained records to determine nutrition practices of study participants. Large studies of subjects cannot practically resort to direct observation of their eating habits and foods consumed during the course of the study. The most common method of recording subjects’ consumption of food and liquids during nutrition studies is the use of a food journal/food diary. As the name suggests, subjects record all aspects of food and liquid intake, including the portion size and the means used to prepare the food or liquid prior to consumption. Subjects are required to enter all food and liquids consumed during their participation in a study.
Critics of this method argue that subjects may intentionally or unintentionally fail to record all food and liquid consumed during a study for a variety of reasons. The tedious nature of recording all food and liquid consumed, as well as measuring and recording portion sizes and preparation steps can cause subjects to estimate portion size or simply ignore preparation steps. Reflexivity is also viewed as a negative factor in utilizing the methodology It is the tendency of a subject to report results that he or she believes a researcher wishes to find. Subjects may also neglect to record eating foods that they may feel ashamed to admit eating (e.g. excessive sweets, foods with high fat content).
General Studies of Nutrition and Cancer
Hatcher et al (2004) argue that studies involving nutrition and cancer may not be based upon a clear and precise notion of the food being consumed. The authors insist that foods are not simply a product of genetic structure and growing environment per se (soil components, levels of sun exposure and rainfall). A study of a food’s preventative qualities for cancer, such as garlic or spinach, may be affected by the nature of plant development, and this could cause inconsistent research findings if a wide variety of plants are used from disparate locations (Hatcher et al., 2004).
Leung et al. (2008) suggest that regional differences most likely do not play any role in the effectiveness of food in cancer prevention and treatment. The authors demonstrate that the isoflavone genistein, found in soy plants, can inhibit polycyclic aromatic hydrocarbons (PAH) from binding to DNA. PAH are considered as cancer initiators found in both environment and food, which are isolated from tobacco smoke, overheating cooking oil, barbecued meat and diesel fuel (Leung et al., 2008). The Environmental Protection Agency (EPA) lists PAH as a toxic substance and a factor in determining whether a location is designated a toxic cleanup site under EPA guidelines.
Cell cultures were exposed to high levels of PAH and then treated with a preparation of genistein, while the cellular activity was studied using real-time florescent technology. Cells treated with genistein demonstrated a significant resistance to cellular damage ordinarily associated with exposure to PAH. The authors note that previous research into the protective nature of genistein in breast cancer development is “controversial” (Leung et al., 2008). However, previous studies did not follow as rigorous a methodology as the present study. Genistein is shown in this study to offer “a protective effect on DNA integrity” against recognized cancer inducing chemical actions caused by PAH (Leung et al., 2008).
Schulz et al. (2008) report on finding from the European prospective Investigation into Cancer and Nutrition (EPIC) – Potsdam Study. The EPIC-Potsdam study involved 23,153 subjects from the German city of Potsdam. Four “healthy factors” were monitored in the subject population: never smoked, had a body mass index (BMI) under 30, performed 3.5 hours of physical exertion or more per week, and maintained “healthy dietary principles”, determined through food journals maintained by subjects (Schulz et al., 2008).
Schulz et al. (2008) analyzed food journals of 15,351 female subjects for a period of six years. All participants began the study cancer-free, and after six years, 137 had developed breast cancer. A review of the food diaries of the 137 women who developed breast cancer demonstrated common dietary patterns that included “low consumption of bread, fruit juices, and high consumption of processed meats, fish, butter and other animal fats” (Schulz et al., 2008). These dietary factors were adjusted for other covariates present at the beginning of the study such as menopausal or overweight status.
The authors suggest that total fat intake, rather than selective fractional fat intake, contributes to the development of breast cancer among women, although the 137 subjects who developed breast cancer shared additional dietary habits such as low intake of fiber and beta-carotene (Schulz et al., 2008). Previous studies have often conflicted with one another, and the authors attribute this to an emphasis on fractional fat intakes, especially when specific types of fat have been found to act in a preventative manner regarding breast cancer. However, the high intake of fat remains only an indicator of nutritional patterns that may foster the development of breast cancer. A weakness of the authors’ study remains an absence of any discussion regarding the potential flaws of using food diaries maintained by the subjects without significant verification methods in place to monitor true compliance with journal protocols.
Brandi et al. (2005) suggest that juices from several varieties of Brassica oleracea (kale, cabbage, brussels sprouts, broccoli, cauliflower, kohlrabi, and collard greens) can block the development of breast cancer. The effect of DNA synthesis common to the onset of breast cancer was significantly reduced or eliminated by the presence of juices obtained from varieties of Brassica oleracea. The authors acknowledge that they have no genuine understanding of how Brassica oleracea juice function as a preventative agent for breast cancer, and they have not identified specific molecular or chemical aspects of the juice. The research is more of a note than an exhaustive study. However, the findings continue to suggest that nutrition plays a key element in reducing or preventing breast cancer (Brandi et al., 2005).
Jevning, Biedebach, and Anand (1999) discuss the possible link between cruciferous vegetables and the reduction of C-16, a form of estrogen that promotes uncontrolled cell division, which can eventually lead to cancer. The authors explain that women who have a family history of breast cancer have elevated levels of C-16 in their blood. Authors state that the 4-hydroxy tamoxifen, an anti-estrogenic drug, decreases c-16 levels in the blood and lowers the incidence breast cancer. In the 1970s, cruciferous vegetables were found to contain I-c-3, a chemical compound that is believed to contribute to their anti-breast cancer effect on animals. Studies are being conducted to determine whether cruciferous vegetables decrease the risk of breast cancer by lowering levels of C-16 in the bloodstream. The authors state that a diet high in fiber may be beneficial in preventing breast cancer (Jevning, Biedebach, and Anand, 1999).
Ottoboni & Ottoboni (2007) discuss a study that was conducted by the federally funded Women’s Health Initiative, a program designed to address heart disease, breast cancer, colorectal cancer, and osteoporotic fractures in postmenopausal women. The study evaluated three different approaches thought to aid in the prevention of these diseases: hormone therapy, calcium plus vitamin D supplementation, and dietary modification. Women who participated in the dietary modification trial were asked to lower their fat intake to 20% of their total daily calories, and to eat five or more fruit/vegetable servings and six or more grain servings a day. The diet groups were monitored via periodic questionnaires and clinical visits, and also participated in a behavioral modification program. At the end of the study, it was found that a low-fat dietary intervention did not reduce the risk of heart disease, breast cancer, colorectal cancer, or osteoporotic fractures in postmenopausal women. The authors then describe the lipid hypothesis, which proposes a connection between cholesterol level and coronary heart disease, and reference scientific data and writings that prove that it is not a valid theory. In spite of the evidence, many nutritionists continue to recommend that their clients adopt a low-fat diet, which they believe has a positive effect on an individual’s general health (Ottoboni & Ottoboni, 2007).
Tsai et al. (2008) examined the relationship between the consumption of garlic and other allium vegetables (onions, scallions, and chives) and a reduced risk of mammary tumors. A total of 34,388 randomly selected postmenopausal women residing in Iowa were followed for fifteen years, and their garlic and allium vegetable consumption was monitored via food frequency questionnaires (FFQ). A nested case-control study was used to supplement information not found in the original FFQ. At the end of the study, a high frequency of garlic and other allium vegetable consumption, defined as two or more cloves/shakes per week, was not found to be associated with lower breast cancer incidence.
Tsai et al. (2008) acknowledge that no specific monitoring protocols were followed over the curse of the study to determine the accuracy of the FFQ, and no safeguards were designed to counter the possible presence of reflexivity or compliance with the FFQ protocols. There was also no rigid definition of what constituted garlic. For purposes of the study there was no difference in the type of garlic consumed. Thus, if a large segment of the study population consumed commercially grown garlic, produced with the use of commercial fertilizers and chemical treatments, rather than organically grown garlic, the results could be skewed by the presence of carcinogens found in the growing process.
The issue of FFQ used over a period of fifteen years suggests that there are multiple opportunities for the data to be compromised. The authors grudgingly acknowledge this possibility. The study’s primary value is to represent typical methodological flaws in long-term nutrition studies utilizing self-reporting instruments to establish nutrition patterns. The study was published in 2008, and this may explain why the methodology is so lax, given that the study began almost seventeen years ago (Tsai et al., 2008).
Mattisson et al. (2005) suggest that all studies with self-reporting instruments are subject to being compromised by the failure of subjects to maintain accurate records. The likelihood of compromised information is increased when multiple entries are required. Authors state that bias in self-reported dietary intake is common, and the most troublesome areas of this self-reported intake include energy intake associated to energy expenditure (Mattisson et al., 2005).
The authors examine the findings of the Malmo Diet and Cancer Cohort (MDCC). The MDCC was designed to test the accuracy of self-reporting instruments in energy intake and energy expenditure. Mattisson et al. (2005) attempted to compensate for misreported data by excluding misreported dietary journal information, and comparing levels of postmenopausal breast cancer in the new data against the previous findings. Data was collected from 11, 726 women to reanalyze the risk of breast cancer once statistical adjustments had been made to account for misreports of energy intake.
After adjustments, the authors found that high alcohol intakes were associated with an increased risk of breast cancer, but that the associations between energy-adjusted fiber intake and relative fat intake and risk of breast cancer were similar to those obtained when all women were included. However, findings are compromised, somewhat, by the authors’ acknowledgement that self-reporting food intake and energy expenditure journals and diaries are, at best, suspect methods of data recording. The authors note that the accuracy of food intake and energy expenditures can be verified through the use of doubly labeled water as a biomarker for calculating metabolic rates. Accordingly, the precise measurements of an individual’s physical activity level (PAL) remain a goal rather than a realized standard of practice (Mattisson et al., 2005).
Maskarinec et al. (2003) discuss several methods and measures of compliance for ensuring that women adhere to long-term dietary study regimens. The authors asked 220 women who did not have cancer, did not consume more than five soy products per week, and were not taking oral contraceptives, to incorporate two servings (approximately 50 mg of isoflavones) of soy per day into their diets. During the two-year study, through measurements of urinary isoflavone excretion levels, self-reported soy intake log books, and randomly repeated 24-hour recalls, the authors concluded that the majority of the participants in the study were compliant with the study protocol. This high level of compliance was achieved by offering a wide variety of soy food choices, making soy food products easily accessible to the participants, and the development of a strong relationship and support system between the participants and the dieticians involved in the study. The authors also credit their initial screening methods, which are highly effective in determining the level of commitment of a potential study participant, with the high level of compliance (Maskarinec et al., 2003).
To sum up, Brandi et al. (2005), Schulz et al. (2008), and Leung et al. (2008) present evidence that nutrition plays a preventive role in the development of cancer, but none of these studies suggest or examine the role nutrition may play in treating cancer once it has developed. While Leung et al. (2008) and Schulz et al. (2008) present valid evidence that nutrition can influence the development or lack of development of cancer, neither study discusses nutrition as a means of retarding or eliminating the presence of cancer in the body.
Nutrition in Cancer Treatment
Lee et al. (2000) studied various types of alternative breast cancer therapies employed by women belonging to four ethnic groups: Latino, White, Black, and Chinese. The authors identified 163 African American, 160 Chinese, 141 Latino, and 141 white women who were diagnosed with primary breast cancer through the regional tumor registry of the Northern California Cancer Center. Thirty-minute telephone interviews were conducted in order to determine the factors that influenced each woman to implement her alternative therapy of choice. Data was entered into a personal computer and Chi-square tests were used to compare women who employed alternative therapies with those who did not. The authors found that dietary therapies were the most common form of alternative therapies employed, and psychological methods were the least commonly employed.
African Americans most often used spiritual healing; Whites used dietary methods; Latinos overwhelmingly used dietary therapies; and Chinese most often used herbal remedies. Forty-eight percent of the women used at least one form of alternative therapy, and more than 90% found the alternative methods to be helpful. Women with late-stage breast cancer were more likely than those with early-stage breast cancer to use alternative methods (Lee et al., 2000).
The authors suggest that since the majority of the women who participated in the study had early-stage breast cancer the “…prevalence estimates of use of alternative therapy…are probably conservative,” but that another study would be needed to verify this (Lee et al., 2000).
Thompson et al. (2002) conducted a descriptive study to determine the dietary intake patterns of women who are participating in the Women’s Healthy Eating and Living before and after they were diagnosed with and treated for breast cancer. To be eligible to participate, participants must have:
…completed conventional therapy for primary operable invasive breast cancer within the past 4 years, [be] between the ages of 18 and 70 years at the time of diagnosis, [be] accessible by telephone, and have completed a physician evaluation within 3 months of randomization to confirm no evidence of disease recurrence.
Data was collected from lifestyle questionnaires as well as participation in 4 days of telephone dietary recalls. Statistical analysis system software was used to analyze the data and the authors found that the majority of women increased their consumption of vegetables, fruit, and whole grains after being diagnosed with breast cancer and decreased their consumption of cheese and red meat. Women who were over 60 years of age were less likely to change their food intake patterns after diagnosis, and age was found to be the “strongest predictor of food preferences” (Thompson et al., 2002). The study found that ethnicity did not play a significant role in dietary change, which contradicts the findings of Lee at al. (2000). Limitations of the study include recall bias, the use of a lifestyle questionnaire, which is not considered a valid research instrument, and the use of scheduled as opposed to unscheduled recalls.
Leadbeater (2004) demonstrates that cancer patients consider nutrition as a key factor in treating cancer whether or not their physicians include nutrition a treatment protocol. Leadbeater (2004) cites an online survey showing that fifty percent of all respondents report changing their diets once they were diagnosed with cancer, but that only five percent of those changing their diets consulted a physician for guidance on nutritional issues. Leadbeater (2004) uses the survey to support her position that women must become aware of the link between nutrition and breast cancer, especially in postmenopausal women.
However, the study offers a valuable example of how nutrition’s role in the prevention and treatment of cancer remains prominent despite the lack of absolute scientific evidence linking nutrition to the prevention and treatment of cancer. The link between what is consumed and general health is presented as a given, and the fact that science has yet to definitively link nutrition and cancer is largely viewed as a flaw of science. Lee et al.’s (2000) observation that women most likely employ alternative therapies once they are diagnosed with cancer is supported by Leadbeater (2004).
Leadbeater (2004) states that while there is no definitive evidence that a change in diet can help women manage or avoid breast cancer, there have been studies that show a positive relationship between healthier eating and a lowered risk of breast cancer. Several of the many alternative cancer diets are listed, as well as a guide for healthy eating that includes fruits and vegetables and regular exercise.
Advantages of Complimentary and Alternative Research
Cutler (2008) examines the cost of advances in reducing cancer mortality and evaluates the cost effectiveness of the ‘war” on cancer. He notes that cancer mortality rates have declined thirteen percent for the period 1990 – 2004, but most of this decline resulted from reductions in mortality for four types of cancer: breast, colorectal, lung and prostate cancer. Seventy-one percent of the reductions in mortality rates for these cancers result from advances in screening processes and life style changes. Twenty-one percent of the reduction in mortality is credited to medical advances, and all of the advances listed involve new drug therapies.
Cutler (2008) suggests that the current cost of developing new drug therapies for cancer is not cost-effective for society. He points out that prolonging life is not the same thing as preserving a good quality of life. He also compares drug development policy in the United States with drug development policies in the United Kingdom (UK). The UK national health insurance program follows policies and guidelines set by the National Institute for Health and Clinical Excellence (NICE). NICE requires that cancer drug therapies be subjected to a cost benefit analysis prior to receiving approval.
Cutler (2008) notes that drug testing protocols in the United States almost always test drugs “in metastatic settings,” and that the efficacy of a drug therapy may be enhanced when used against cancer cells that have not yet become metastatic. But the significant expense of researching cancer drug therapies, and the dramatic gains obtained through simple life style changes and increased preventative screening methods and technologies, suggest that alternative and complementary treatments for cancer should be explored as cost effective alternatives to drug therapy and as complimentary modalities to early screening and life style changes.
Nutritional Genomics
Ozdemir et al. (2009) argue that nutritional genomics represents an increased understanding of the “relationships between food, nutrition science, and health outcomes” which have been recognized for centuries. It examines the genome in relation to nutrition. This is not limited to the genomic response to the consumption of nutrients, vitamins and enzymes in food. Nutritional genomics (NG) considers all aspects of the nutrition sphere, including the physical mechanisms of consumption.
NG also studies the genomic affect of particular food types and groups, and studies how genes respond to specific nutrients (Ozdemir et al., 2009). By focusing that genome environment interaction is a conceptual thread that forms an interdisciplinary and complimentary paradigm to approaching the role of nutrition and cancer, NG promises to be the first genuine attempt to merge WSM and TCM paradigms regarding nutrition and cancer.
Summary
The literature on nutrition and the prevention and treatment of cancer demonstrates the current state of conflicting findings within WSM research. Nutrition, as the mainstream research of WSM, remains a secondary topic for palliative care, although research pointing to nutrition and preventative and acute models of cancer care are acknowledged, the methodological reliance upon FFQ and self-maintained records of nutritional habits remains a point of contention regarding the validity of data collected. Some areas of WSM, such as nutritional genomics, suggest that complimentary models of medicine utilizing alternative modalities involving nutrition are growing in scientific acceptance.
CHAPTER THREE
METHODOLOGY
Introduction
The intellectual assessment of current research in TCM, WSM, alternative medicine and models of complimentary medicine involving TCM and alternative medicine modalities is based upon a reading and analysis of existing literatures. Limitations of this study are already discussed in the limitations section. The objective of the methodology is to gather as much information as possible and then filter gathered information through the research questions.
It is not a fixed process. As information is gathered and analyzed, findings may lead to additional discoveries requiring further review of the literature, and a possible expansion of literature reviewed to include new topics. The research questions will also serve as the fundamental guide for discovery and analysis of information.
Methodology
The primary tool for locating information relating to the research questions will be public and proprietary Internet search engines. Information gathered will be subjected to a hierarchy of vetting, which follows guidelines for peer-reviewed literature. Research published in peer-review journals will be given the highest priority, but the peer-review process will not be limited to Western scientific publications only.
TCM journals have a peer review process that mirrors the process of Western scientific journals: acknowledged leaders in a field review the work submitted to determine if it meets set professional standards for research.
Books will be reviewed in a similar fashion. While a high priority will be given to books dealing directly with research, certain books dealing with anecdotal and first-person experience with nutrition and cancer will be studied and used to compare and contrast findings with scientific research.
Brick and mortar and electronic libraries will be used to review catalogues for books or periodicals that suggest relevance to the research questions. No interviews will take place as part of the normal framework of research.
Summary
If all of the methodologies will be utilized properly, a thorough analysis of all available literature regarding nutrition, diet and cancer can be gathered. Therefore, extensive research for locating information must be done during the entire process.
References
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