Strike Deadly Pancreatic Cancer: Healing Pillars from Bottleneck to Potentials

By Hui Xie-Zukauskas

Pillars for P. Cancer Therapy_Cancer Prevention DailyCancer. The word itself can send shivers down your spine. How about pancreatic cancer? Consider these three facts:

  • A grim reality: Pancreatic cancer is a rare and deadly cancer. Estimated 66,440 people in the US will be diagnosed with and approximately 51,750 Americans will die of pancreatic cancer in 2024 (per American Cancer Society). Data also predicts the disease to become the second leading cause of cancer deaths by 2030.
  • A growing concern: Pancreatic cancer diagnoses in young adults (under 45) are on the rise. As its increasing incidence, it’s a public health problem too.
  • A glimmer of hope: Yes, let’s explore it as evolving breakthroughs combat this terrible disease!

First, let me briefly emphasize what makes pancreatic cancer extremely fatal. It is because of its key characteristics such as:

  • Asymptomatic nature in early stages (if any signs, vague or nonspecific)
  • No routine screening test available
  • Invasive early and rapid spread
  • Limited effective treatments
  • Therapy-resistant, with high rate of recurrence
  • Poor prognosis, with a 5-year survival rate about 10% or low long-term survival.

For the focus here, the most common type of pancreatic cancer (85% overwhelmingly) is pancreatic ductal adenocarcinoma (PDAC); its nature remains aggressive and multifaceted.

However, the mainstays for pancreatic cancer treatment are surgery, chemotherapy, and radiation therapy, which appear to reach a “bottleneck” status with unsatisfactory clinical results. Also sadly, most cancers have already metastasized at the time of diagnosis.

Despite its complexity, genetic research and scientists’ unwavering effort have propelled discoveries!

A hallmark of pancreatic cancer is KRAS mutation. KRAS is a tumor-promoting gene, and mutated in ~95% of pancreatic cancer patients. Studies indicate that KRAS mutation likely initiates human pancreatic cancer, and drives tumor growth and progression. Even so, targeting KRAS through pharmacological interventions—especially with single agent inhibitors in the past—has confronted an “undruggable” challenge.

Yet, researchers are unlocking new opportunities in various paths, with transformed treatments encompassing but not limited to:

  • Targeted therapy: Innovative therapies—such as the use of siRNAs (small interfering RNA) through nano-delivery, anticancer vaccine, and immune T-cell therapy—are driven against KRAS mutation. Additionally, a subgroup of pancreatic patients harboring BRCA1/2 mutation can benefit from platinum-based chemotherapy and Olaparib (a PARP inhibitor). Next-generation sequencing technology will facilitate genomic mapping of cancer cells to identify more treatment targets.
  • Immunotherapy: In the past, most pancreatic cancer didn’t respond to immunotherapy, likely attributed to its immuno-suppressive tumor microenvironment. Now, studies and clinical trials are ongoing to alter tumor microenvironment, and make tumors active immunologically or cytotoxic T-cells respond.  
  • Liquid biopsy: This is an emerging, non-invasive, and less costly clinical tool to detect cancer biomarkers or “signatures” from blood circulating tumor DNA (ctDNA) or circulating tumor cells, etc. It shows promises for early detection, treatment precision and monitoring, and offers prognostic value in pancreatic cancer.
  • Combined therapies: In addition to a targeting approach, combined drugs to simultaneously block multiple abnormal pathways in PDAC, or a combination of immuno- and chemotherapy, can also improve survival and/or quality of life in cancer patients.  

Still today, early detection is crucial, because pancreatic cancer is curable at an earlier, localized, and surgically resectable stage.

If you experience persistent abdominal pain, unexplained loss of appetite or weight, or any concerning symptoms, don’t hesitate to see your doctor. For those with a hereditary risk, consult with oncologists to keep updated on helpful or applicable genetic development.

Finally, with a glimmer of light, a glimmer of joy for the positive impact on cancer patients, it also creates an urgent need for our awareness and actions. Spread words and modify lifestyle!

 

Image Credits: slidemodel.com; CancerPreventionDaily

Beyond Colon Cancer: The Hidden Cancers Threatening Young Lives

By Hui Xie-Zukauskas

Lower Cancer Risk_Sm_for LIIn recent years, there has been a concerning rise in cancer incidence and mortality among individuals aged 15–39. Notably, colorectal cancer (CRC) has shown an uptick in cases among those under 50, both in the US and globally. This underscores the urgent need for preventive measures to mitigate cancer risks and elevate awareness.

While it might be perplexing to see the unexpected rise in cancer among the younger population, considering that traditionally cancer primarily affects older adults, the reasons behind this trend are complex and fascinating. Let’s delve into this in simpler terms.

Cancer is caused by mutation, i.e., a permanent change in the DNA sequence of an organism. Mutations can result from damage to DNA and errors in DNA repair.

Imagine DNA as a blueprint for building a magnificent LEGO castle. Each LEGO brick represents a specific unit of DNA called a “base pair”. DNA damage is like the LEGO bricks get chipped or break due to various factors, DNA repair by enzymes works as repair crews identify damaged bricks and replace them with new ones. When the damage is too severe or the repair crew is overwhelmed, the building plan (DNA) can be disrupted and structural crises in the castle (cell malfunctions) take place.

We know that most of cancer risk in aging adults can be attributed to randomly acquired mutations in proliferating tissues or susceptible cell types. In contrast, cancers in younger individuals result from the presence of genetic predisposition or the exposure to carcinogens (cancer-causing agents) or both, which all impact DNA damage and repair, genomic integrity, and then accelerate cancer growth in a young body.

To illustrate further, its origins have three key elements: inherited genetic predisposition, environmental carcinogens (including cancer-causing viruses), and developmental mutations—the latter can vary greatly depending on mutational rates in various cell types. Importantly, the interplay between each element and among these factors can also contribute to the variation in cancer risk among different cells, tissues and age groups.

Colon cancer is not the only type of cancer with a high prevalence in young people. Other cancers include:

  • oropharyngeal cancers (more in adolescent and young cancer survivors),
  • breast cancer,
  • cervical cancer,
  • skin cancer, melanoma and
  • pancreatic cancer – its genomic feature distinctly involves the well-known tumor genes (including breast cancer’s BRCA1 and BRCA2).

I’d like to highlight some harmful environmental factors more relevant to young people, and mostly also apply to a broader population.

  • Traumatic brain injury (resulting from car accidents, sports, falls, bast injuries but leading to long-term chronic neuro-inflammation in the brain and link to CNS tumors)
  • Oncogenic pathogens or carcinogenic viruses – such as Infections by the human papilloma virus (HPV), causing cervical and oropharynx cancers; Infections by the Epstein-Barr virus (EBV), causing lymphomas and nasopharyngeal cancer; Merkel cell polyomavirus, causing Merkel cell carcinomas; Human T-cell lymphotropic virus, causing leukemias; and Fusobacterium, associated with colorectal cancer.
  • Hazard environmental exposures – Sunlight/UV damage, causing skin cancer; air-borne radon or tobacco smoke, or air-borne asbestos, causing lung cancer.
  • E-cigarettes – potential risk for oral cancer
  • Food-borne pre-carcinogens and/or carcinogens: generated by chemical or physical food processing, including N-nitroso compounds (NOCs), polycyclic aromatic hydrocarbons (PAHs), heterocyclic aromatic amines (HCAs), and acrylamide. Moreover, some fungi- and plant-derived substances pose a cancerous potential. Their mechanisms of action and relevance to human biology can be classified as either genotoxic (DNA-reactive) or epigenetic (effects other than DNA reactivity).

It’s essential to remember that adolescents and young adults diagnosed with cancer face a risk for early death. This risk, influenced by factors such as age at diagnosis, race, ethnicity, lower socioeconomic status and cancer type, is multifaced and requires adequate healthcare with careful monitoring.

Next, let’s move to colon cancer, especially early-onset CRC, with an emphasis on risk factors.

Modifiable risk factors

These include obesity, type-2 diabetes, heavy sugar and red meat diet, physical inactivity, smoking, high alcohol consumption, inflammatory bowel disease (IBD), and frequent antibiotic use.

Non-modifiable risk factors

Particularly for early-onset CRC, being male, black or Asian, having IBD, or a family history of CRC are among non-modifiable risks.

Based on recent scientific evidence, early-onset CRC is associated with a genetic predisposition, mainly attributed to sporadic mutations in some genes (e.g., APC, KRAS, BRAF, TP53) that trigger uncontrolled cell growth and subsequent tumor formation.

However, one overlooked group is individuals younger than 50 years (<50 years) who do not usually undergo screening if they are at average-risk (defined as those without a personal or family history of CRC, without a personal history of IBD). Currently, there are little data regarding risk factors for CRC at average-risk young adults who are also asymptomatic.

Act to lower cancer risk

Armed with a comprehensive awareness and an inner-warrior mindset, act swiftly in the specific domains to impede or prevent cancer development within your young body.

  1. Live a healthy lifestyle. Eat a plant-based diet, stay active, avoid smoking, limit alcohol, and practice sun-safety.
  2. Maintain a healthy weight.
  3. Get screened for early detection.
  4. Get cancer risk assessment and genetic counseling. (for high-risk individuals)
  5. Get the HPV vaccination. Protect yourself from sexually transmitted infections.

Finally, cancer in young people disrupt crucial life stages such as education, career development and family planning. Early diagnoses can have long-term consequences in every aspect of individual’s well-being. Furthermore, the rising cancer burden in young people poses a significant public health challenge. Thus, the unexpected vulnerability in young people demands our attention and dedication to this troubling shift.

 

Image credit: Matt Cole, Mis wanto at Vecteezy

Navigating Stress and Surprise

By Hui Xie-Zukauskas

v2_Navigate Stress & Surprise_travel_unsplashHave you heard “Surprise Travel in 2024” as an emerging trend? Where does “surprise travel” concept come in?

We live in a fast-paced, hyperconnected, and stimuli-bombarded world, and experience unwelcomed stress that impacts our physical and mental wellbeing. Chronic stress ranges from personal tragedy and job loss to financial or health burdens, not to say work deadlines or workplace issues, information overload, and constant notices and responses.

Beyond major life stressors, micro-stressors are ubiquitous, i.e., small, everyday annoyances like traffic jams, unexpected errands or inconveniences such as long lines, etc.—insignificant but impactful. Also, worth mentioning is social media exhaustion fostered by hazardous, oversaturating digital environment and human digital behavior. Accumulated stress, whether chronic or micro-, can deplete our emotional reserves and overwhelm us.

In a nutshell, stress and increased cortisol levels elevate blood pressure, promote weight gain, weaken the immune system, and contribute to various chronic illnesses such as cardiovascular disease, cancer, and mental health issues like depression.

Certainly, we benefit from time-off with planned vacations as conventional wisdom tested. However, surprise travel may serve as a novel or potent antidote to the constant influx of information and stressors.

About Surprise Travel

Surprise travel involves booking a trip (with a travel agency) without knowing a destination until shortly before departure or even after arrival at an end point. That can be thrilling adventures for some (e.g., millennials) but anxiety over uncertainty for others (e.g., family, solo travelers).

For thrill- or adventure-seeking enthusiasts, a spirit of spontaneous excitement and a sense of venture exploration can break the monotony of daily life, and enliven the trip with indelible memories. Other benefits beyond the elements of surprise or curiosity stem from enhanced mindfulness, reduced decision-making fatigue, boosted problem-solving and sustained relationships through cherished moments with loved ones. Plus, an opportunity of personal growth can be hidden in the package. Obviously, concerns about safety or accessibility cannot be ignored.

On the other hand, for meticulous orchestrators or cautious travelers, uncertainty/unknown, logistical challenges and potential for discomfort can build debilitating fear or overwhelming anxiety. These folks prefer predictability and control, so unexpected situations become understandably tough to embrace yet demanding. Unforeseen expenses (such as hidden costs, exceeding budgets, etc.) can also be a deterrent, making leisure and wellness travel less appealing.

After all, the positive elements of surprise travel, leisure travel, or even weekend getaways and downtime help us break free from negative thought loops, information overload, and digital or social media exhaustion; and combat the adverse effect of stress.

Surprise travel is just one way to mitigate stress. Take a deep breath. Close your eyes for a minute, think – whether a type of travel that suits your needs would improve heart rate, blood pressure, sleep quality, stress level, and psychological well-being?

Look ahead to 2024

The bottom line is – Remember that the key is to effectively manage stress and prioritize your well-being. To boost your wellness—whether your take a well-planned trip or try the surprise travel—make sure you return home feeling refreshed, rejuvenated and recharged, ready to face the day-to-day challenges with newfound spirit.

Prioritizing your well-being will undoubtedly enhance your physical and mental vitality. Whether you crave thrills, meticulous planning, or a balanced approach, explore and find your own surprise stress-buster in 2024!

Image credit: Unsplash

Cardiovascular Disease (CVD) on the New Spotlight

By Hui Xie-Zukauskas

Heart Care Blog_Pixabay & VeezeeIt’s Black Friday, Cyber Monday, or Holiday shopping time. I’m fascinated by some new, popular products on the market. They seamlessly integrate into our daily lives or functions, through hand-free and hassle-free items or other products that make routine tasks more effortless, efficient, and enjoyable.

Equally fascinated by emerging technologies in medical science, I’d love to share some tremendous discoveries and developments that have transformed clinical landscape of therapeutics. But first off, critically important is putting cardiovascular diseases (CVD) on the spotlight. Why?

Based on the World Heart Federation, CVD is the world’s number one killer, causing over 20.5 million deaths each year (resulting from heart attack, stroke, and heart failure). However, there is hope—80% of premature deaths from CVD are preventable! Not to say, medical breakthroughs make CVD and some of its risk factors treatable.

Here I’d focuses on the conditions that are harmful to your heart, but sometimes overlooked.

1.      Obesity    

Overweight and obesity affects more than 70% of US adults and more than 50% of people worldwide, contributing to numerous health consequences. Overweight and obesity are independently associated with an increased risk of CV events. This holds true after excess weight-associated cardiometabolic risk factors (such as hypertension, dyslipidemia, and type 2 diabetes) are accounted for (Khera et al., 2023; Lincoff et al., 2023; Drozdz et al., 2021).

Whether obesity as a disease that individuals are predisposed to develop as a result of genetics, biology and the living environment or as a condition due to complex factors, it’s important to double our awareness and effort to prevent or treat obesity for tackling CVD. For those who want to understand more about it, I’d recommend a Weight and Health video from New England Journal of Medicine. It eloquently and effectively delves into obesity from pathophysiology and the impact of weight bias or stigma, to therapy including benefits and risks of promising new medications.

Since weight gain usually takes place gradually, weight loss unlikely occurs quickly. So, monitor this significant risk factor closely, make small lifestyle modifications consistently, and seek medical treatment if needed.

Having emphasized on overweight and obesity, by no means I diminish or minimize other common risk factors or detrimental conditions such as high blood pressure, high cholesterol, high blood sugar, smoking, alcoholism, poor diet, physical inactivity, and stress, in addition to the uncontrollable (age and genetics). It’s very possible that an individual may have multiple risk factors as these conditions are often interlinked and interact. All of that make regular check-up, lifestyle modifications, and early intervention crucial for the prevention of CVD.

2.      Climate change coupled dual threats—extreme heat and poor air quality

Global climate change affected environmental disaster is real! As we all see, extreme heat events are becoming more frequent, more intense, and longer. High temperatures stress the CV system by making the heart work harder and by putting extra strain on vital organs like lungs and kidneys. Exposure to poor air quality, especially to high concentrations of fine particulate matter smaller than 2.5 µm (PM2.5) is also independently associated with CV morbidity and mortality. When inhaled deep into the lungs, these fine particulates can irritate the lungs and blood vessels around the heart.

Recent findings showed that co-exposure to extreme heat and poor air quality synergistically increase the risk of fatal heart attack. In an analysis of 202,678 heart attack deaths between 2015–2020 in Jiangsu province of China, up to 2.8% of heart attack deaths were attributed to combination of extreme heat and high levels of PM2.5 (exceeding WHO target value of 37.5 µg/m3). Women and older adults were more vulnerable to the greater risk.

3.      “Athlete’s Heart” and exercise intensely

In January, the Bills’ 25-year-old Damar Hamlin suffered cardiac arrest on the field during Monday Night Football, which captured the national spotlight. Sudden cardiac arrest is the leading cause of death in young athletes. According to Rakesh Gopinathannair, MD, specialized in clinical cardiac electrophysiology, intensive endurance training can cause a distinct pattern of functional and structural changes of the CV system, including heart muscle thickening and ECG changes. This results in so-called “athlete’s heart”. So, it reminds us to be more attentive to heart health among young athletes and ensure the readiness of life-saving equipment and teams involved.

I would also expand this issue to the non-athletic population, in particular a small percent of “fitness-fanatics” who exercise excessively. Without doubt, exercise reduces your risk of CVD, cancer, and all-cause mortality. However, excessive exercise or rigorous yet unproven fitness routines can negatively impact your heart health.

Most commonly seen is atrial fibrillation (AFib; a heart condition of an irregular rhythm and often abnormally fast rate). This is because strenuous exercises put extra demands on the heart and cause damage to the CV system. It has been proven not only by scientific/medical research but also by people in real life. I know some folks—a family member, a neighbor, and a few doctors including cardiologist who admitted their heart problems were the fault of their own (i.e., exercised in extreme intensity, volume, and frequency when they were young). It all comes down to the benefits’ gain from proper exercises without overdoing it when the risk kicks in. A 30-minute walk is just as good as 30-minute intense cycling, depending on an individual. Adequate exercise is always better than none. If you have any concerns about your heart health, don’t hesitate to consult with your doctor or a healthcare professional.

The bottom line is—in the holiday season and the years ahead, don’t just indulge in hand-free, hassle-free gadgets to satisfy your convenience, do pay attention to your heart and keep it “hazard-free” for your wellbeing and life.

 

Image credits: Pixabay; Andres Ramos / Vecteezy

Walking Matters

By Hui Xie-Zukauskas

People Walking_SmSometimes, ordinary acts can be the solutions to challenging and complex problems.

A professor, a man in his late 60s, walked down the farmers’ market every day, whether on freezing winter days or hot, humid summer ones. He would stop at a few booths and buy some vegetables, fruits, nuts, or meat. He would also pass by other sellers, smiling and greeting them as friendly acquaintances. This was a daily stop for the elderly man on his way from work to home (an extra 20–30-minutes added to his 20-minute walk each way). He stayed with this routine for decades and in doing so, outlived many of his colleagues and friends. He lived into his 80s even though he had a family history of cancer and had poor health during his youth and middle age.

A tiny lady walked around local department stores virtually every day after she finished her accounting job that demanded sitting for long hours. Sometimes she bought clothing or necessities for her children, whereas at other times she was just window shopping or walking along. Her relatives were always puzzled about what attracted her to those stores where they had the same merchandise almost every day. They didn’t realize that her “go shopping” was simply her daily “relaxation activity routine.” A result of her spending decades in that home-workplace-department store route was that the lady has lived well up into her 90s.

I witnessed these real-life anecdotes because this man and woman are my parents.

These stories reflect at least one simple thread – Walking matters. Daily walking can bring substantial health benefits!

Cancer touches each of us so much, so deep, and there is no cure for it currently despite medical and technological advances, as is the case for some other debilitating chronic diseases.

Of course, the best cure would be prevention! As everybody knows, “An ounce of prevention is worth a pound of cure.”  Of various risk factors, physical inactivity is a major one. However, it is increasingly common in our modern life. As the saying goes, “sitting is the new smoking.”

To prevent cancer, heart disease and improve one’s overall health, the American Heart Association recommends that all adults to get at least 150 minutes exercise per week with moderate intensity. The American Cancer Society has also advised on being physically active: particularly, adults should get 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity activity each week (or a combination of these).

I’ve seen that a majority of people don’t meet these guidelines based on my experience in public health. I also understand how difficult it is for many busy folks to fulfill this goal due to the demands of their work and family life. Accordingly, for years, I’ve shared some practical ways for daily exercises.

Today, I would make it even simpler—if time is a problem—by suggesting to start small in terms of walking and its feasibility. If it’s really challenging for you to exercise 30 minutes a day and 5 days a week, how about walking ~20 minutes a day and 7 days a week? Or alternatively, any combination that may fit your schedule? Cumulativeness counts too and is better than nothing. You may divide 30 minutes into a 10- or 15-minute walk first thing in the morning, and 10 minutes of walking-oriented activities during the day (for examples, running up stairs, parking farther away from a destination, or walking to a local store). Then ideally, add 5-10 minutes more of activity (say dancing, jumping, gardening, or playing with the kids).

There is no need to reiterate the well-documented, numerous health benefits of walking at this time. While I’m stressing not to underestimate the power of walking, it’s important to engage in various physical activities, along with a balanced diet, weight control, adequate sleep, and living a healthy lifestyle for your overall well-being.

Doing nothing is like waiting for a miracle that much likely won’t happen soon. So, simply getting up from your chair to get moving is your best regime and the first step in disease prevention.

Happy walking!

 

Climate Change Threatens Children’s Health – So Let’s Give a Holiday Gift to Our Children

By Hui Xie-Zukauskas

Climate Crisis for unhappy snowman_Pixabay+CPDI credit a recent Double Take Video from New England Journal of Medicine for inspiring this article on the holiday season. The instructional video focuses on Climate, Pollution, and Children’s Health. In about seven minutes, it eloquently highlights five key ways in which climate change causes a long-lasting negative impact on children’s well-being. I highly recommend everyone to watch it – a link is here.

When we face the reality of climate change, we realize that it has severe implications for human and planetary health, and certainly is a threat to children’s vulnerabilities. A growing body of research has shown that climate change has detrimental effects on children’s health through multiple pathways. So most unfortunately, climate change will have adverse impacts on children born today throughout their lifetime—their nutrition, health, education, and life.

Children are not little adults. They are at a higher risk for health hazards because of various reasons, including but not limited to

  • The way their bodies metabolize toxins during development,
  • The physiological fact that they breathe, eat, and drink more, relative to their body mass (or on a per pound basis), than adults do,
  • Their having less developed natural defenses (from skin and the blood-brain barrier to system and organ functions),
  • Thermoregulation – that is, they regulate their body temperature differently from adults,
  • Unique activity patterns and behaviors.

Understandably, children at varying developmental stages also respond differently to environmental extremes and stressors such as air pollution, UV exposure, increased frequency and severity of heat waves, and contaminated food or water.

Previously, I’ve talked about why the climate crisis is a health crisis and how climate change can impact cancer risk, and I’ve shared some ideas for taking “greener” actions combined with lifestyle modification on a daily basis. Now, let’s give extra attention to children.

As the global climate crisis intensifies, children are likely to bear the consequences of negative impacts over their life course if we don’t take action now. Worth mentioning is that disadvantaged children suffer from a disproportionally high and unjust health burden from climate change. As a result, the long-term impact of multiple physical and psychosocial stressors on children’s health may endanger their future.

Key Takeaway Point 

Climate change is a critical and huge problem. It cannot be solved by any one person. However, the solution can be achieved by collective efforts—from policy levels and organizational involvement to the practices of each of us. To this end …

This holiday, I’m giving my voice as a gift to this vulnerable population—not only my children but also all children in the world—for an important endeavor and a lasting purpose, in order to meet the challenge of climate crisis.

Please join me in taking action in whatever way you can and, consequently, promoting a harmony on earth where the coming generations can enjoy their holidays like us and, more importantly, for their long-term well-being.

Image credit: Pixabay; CPD

How Your Sleep Quality Affects Your Health and Your Quality of Life

By Hui Xie-Zukauskas

Sleep & QoL_Pixabay & CPDGetting adequate sleep is a critical part of the daily cycle of renewing bodily functions. Yet, many folks experience sleep deprivation; and those that do often tend to brush off its signs. Such signs include tossing around on the bed or staring at the ceiling at night, still feeling exhausted after sleep and having frequent mood swings, and undergoing reduced alertness and concentration during daytime.

Poor sleep quality is not a minor issue. In fact, it’s an alarming one due to its being a possible underlying contributor to serious health problems and its adverse effects on your overall quality of life.

So, I’d like to zero into the topic of sleep disorders, particularly obstructive sleep apnea (OSA) and how common and serious it is.

First, let’s glance at OSA prevalence.

Sleep apnea is a serious sleep disorder, often underdiagnosed and undertreated. Obstructive sleep apnea (OSA) happens when there is intermittently reduced or stopped airflow despite ongoing ventilatory effort. This is caused by the blockage or collapse of the upper airway during sleep. In other words, your breathing stops and starts repeatedly.

About one billion people suffer from OSA worldwide. The overall prevalence in the US population amounts to 20 to 30 percent in men and 10 to 15 percent in women.

Second, what are risk factors of OSA? 

  • Old age
  • Obesity
  • Men (more commonly affected than women)
  • Large tonsils (potentially narrow the airway)
  • Certain populations (e.g., individuals with hypertension or atrial fibrillation)
  • Changes in body hormone levels (women after menopause)

Also consider that sleep trouble could be reflective of lifestyle or behavior issues. A healthy lifestyle and sleep hygiene can assist you with a good night’s sleep. I’ve highlighted some practical tips previously.

Third, what are the possible severe consequences of OSA?

Poor quality of sleep, especially OSA, can negatively impact your well-being—not only your daily behaviors (e.g., fatigue, slow or suboptimal performance, being easily irritated, and increased caffeine or alcohol intake) but also various health problems. OSA is a respiratory condition. However, it is more and more accepted as a systemic disease. Let me briefly emphasize OSA’s possible, detrimental long-term effects on health.

1. Cardiovascular diseases

OSA can sneakily contribute to numerous cardiovascular disorders, including coronary artery disease, myocardial infarction or heart attack, stroke, arrhythmias, heart failure, diabetes, and hypertension. About 80 percent of individuals with drug-resistant hypertension also have OSA, which shows how complex OSA’s causes are and how chronic illnesses can be intertwined with OSA. So, be aware that unscreened and untreated OSA may potentially trigger preventable cardiovascular disease.

2. Cancer

Growing evidence shows that OSA is significantly associated with a higher cancer incidence and with mortality in various types of cancer. Individuals with OSA are more likely to develop cancer, and the severity of OSA results in a higher risk.

It’s not clear how OSA potentially promotes tumor malignancy; however, hypoxia, hypoxia-reoxygenation cycles—as the hallmark of OSA—can have an impact on tumor biology at least through systemic inflammation and subsequent activation of diverse cellular pathways to advance tumor progression. I’ve explained how poor sleep quality and OSA may contribute to cancer development in the book Key Strategies for Cancer Prevention.           

3. Other chronic and systemic illnesses

Though a sleeping body is at rest, that body is still carrying on dynamic processes and integral functions. Poor sleep reduces circulating monocytes and natural killer cells, resulting in a weakened immune system. Patients with OSA are at higher risk for depression, mood swings, and cognitive delay. Moreover, OSA is also linked to disrupted hormonal balance and periodontal disease, etc..

I hope that by this point, you’ve gained new insight into the very important health issue of getting quality sleep and have gotten ready for action. Next time, don’t stop at an answer of “Yes” or “No” to the question of whether you had a good night’s sleep? Examine the question further (for yourself and your loved ones): How good or efficient is your sleep? What is the time it takes for you to fall asleep after turning off the lights? How long is your estimated sleep duration? How often or how long are you waking up at night? Do you have any gasping or breathing difficulty?

If you have trouble with these answers or wonder if you have a sleep disorder, it’s time to consult your doctor.

Key Take-home Message:

Improving your sleep quality is closely linked not only to improved health outcomes, but also to improved quality of your life.

 

Image Credit: Pixabay, CPD

Artificial Sweeteners: What Helps and What Hurts

By Hui Xie-Zukauskas

Past-Present-Future on AS & CancerWhen it comes to artificial sweeteners, do you have mixed feelings? Are you confused about its link to cancer risk or not? Well, you’re not alone.

All over scientific literature, this topic remains intensely controversial. I summarized where we are on an association between consumption of artificial sweeteners and risk of cancer in a flowchart illustration here.

Briefly, little or no evidence from past decades shows common artificial sweeteners have a cancer-causing (i.e., carcinogenic) potential, except a link to bladder cancer in animals but inconsistent results in humans. The US FDA also approved the safety of several artificial sweeteners as food additives.

However, this view has shifted in recent publications. Especially, a large epidemiological study (102,865 adults, follow-up nearly 8 years) found that participants who heavily consumed artificial sweeteners—aspartame and acesulfame-K—showed a 13-15% higher risk of cancer (e.g., breast, obesity-related cancer), compared with non-consumers (Debras et al. PLoS Med. 2022). Keep in mind that obesity is linked to more than ten types of cancer. Meanwhile, the International Agency of Research on Cancer (IARC) would place a high priority in the near future to evaluate the possible carcinogenic effect of aspartame on humans, as recommended by its advisory group.

So, what do you do? How the renewed awareness influences your choice on a healthy and palatable diet?

Artificial sweeteners exist in a wide variety of food (especially those packaged or processed), drinks, drugs, and hygiene products. Therefore, virtually everybody uses or ingests artificial sweeteners, knowingly or not.

An immediate concern is about unanticipated or undesirable consequences from its regular consumption, along with confusion, or worse, disinformation.

But this is more complex than what one may think.

To help clarify it, let’s examine what helps and what hurts in critical areas, so that you can strike a balance between benefits and risks, and make wise choices.

What helps –

Artificial Sweeteners packs_SmWe all have a sweet tooth, and often add a little amount of sugar to enhance our food’s flavors and pleasure.

Artificial sweeteners—as sugar substitutes—are calorie-free and nutrient-free. With their sweet taste or perception, these food additives may affect certain health outcomes. For instance, they are used as a strategy to reduce calorie intake in weight loss programs, though controversies exist. Furthermore, as for whether these sweet alternatives are advantageous, there is little evidence based on long-term studies to demonstrate that.

What hurts – 

Aspartame Structure_SmAfter all, artificial sweeteners are synthetic chemicals hidden in packaged foods and soft drinks, which are different from natural sugar contained in fruits and vegetables.

Excessive sugar intake can negatively impact human metabolism and health. Likewise, excessive consumption of artificial sweeteners is undoubtedly risky.

Of potentially grave concern is those pregnant women and young children who consume aspartame-containing foods and beverages in a large quantity, because research reveals that offspring of rodents exhibit increased incidence of leukemia and lymphoma after fetal or prenatal exposure to aspartame. And there is a clear dose-response correlation between aspartame exposure and occurrence of blood or lymphatic malignancies. Obviously, aspartame is a carcinogen in rodents.

Paradoxically in dietary intervention to counter weight gain, artificial sweeteners might not be as efficient as expected, or at least need to be considered cautiously.

First, we know that sugar is a driver of inflammation and weight gain, and artificial sweeteners are also inflammatory foods. After reviewing more than 100 studies that investigated aspartame in both higher (>40 mg/kg/d) and safe (<40 mg/kg/d) dosages, and ascertaining its harmful effects on various cells, tissues and organs, the authors concluded “aspartame use could not only exacerbate existing systemic inflammation but also cause inflammation if healthy individuals ingest it on a regular basis” (Choudhary & Pretorius. Nutr Rev. 2017).

Chronic, low-grade inflammation is a significant risk factor for the development of many diseases including cardiovascular diseases, diabetes, cancer, neurological disorders (e.g., Alzheimer’s), and arthritis, right? So is malnutrition (or micronutrient deficiency). Malnutrition is associated with not only lower body weight but also obesity.

Taken together, it’s important to understand adverse effects of artificial sweeteners and their metabolites. For individuals with or susceptible to inflammatory bowel disease, it’s critical to avoid or at least limit artificial sweeteners, processed foods, and sugar-sweetened beverages.

Again, lifestyle with a healthy diet is an integrative, effective solution. If you eat more veggies, fruits and less processed foods, you easily curb added sugar or artificial sweeteners without loss of nutrients. For example, you may sprinkle fresh fruits (such as pineapples, oranges, or watermelon, etc.) or dried fruits (such as raisins or dates) onto your salad (or other dish) as a sweet addition—not only making it palatable but also supplying antioxidants (i.e., a bonus). Alternatively, use a tiny amount of honey or maple syrup, when necessary, which is relatively healthier than artificial sweeteners.

So, take-home points:

Enjoy nutrients-dense foods and reduce sugar intake overall. Specifically, eat plenty of fruits and veggies for natural sweetness, and engage in more physical activity to prevent inflammation.

 

Image Credits: CancerPreventionDaily, Pixabay

Key References: click here

4 Takeaways for Colon Cancer Smart plus Prevention Tips

By Hui Xie-Zukauskas

Colon Cancer Prevention_Cleveland Clinic HealthImagine your colon functions fairly well for years. Unaware was that healthy cells in the inner lining of your colon developed changes in their DNA (i.e., mutation), and formed polyps that may start cancer, a couple of which reside on the left side of your colon. You are either asymptomatic or unchecked by mistaking cautionary signs as normal. Fortunately, one day these polyps (varying 0.4 to 10 mm in size) showed up on your colonoscopy and the surgeon successfully removed them, thus stopping the cancerous growth.

Unfortunately, millions of people had their polyps growing in size from tiny (about a match head) to giant (≥25 mm or almost 1 inch), from benign lumps progressed to malignant tumors that invade adjacent tissues or distant organs. Then we all know the sad ending.

How should you be aware that you need a colon cancer screening (when or based on what)? What’s new about colon cancer pertinent to you and your loved ones?

I summarized 4 takeaways from updated research findings here. In addition, I’m highlighting proven preventive measures in a memorable poetry style.

So, let’s dive in the takeaways.

1.      Risk factor you might have overlooked

Primary risk factors for colorectal cancer can be categorized as:

-          non-modifiable ones that you can’t control, such as age, taller height, family history, personal history of inflammatory bowel diseases or polyps (pre-cancerous growth), etc., and

-          modifiable ones that are more lifestyle or diet behaviors related, including tobacco smoke, heavy intake of alcoholic beverages, obesity/overweight, high consumption of red or processed meats and dairy fats, and physical inactivity.

A recent, large study (based on 47 observational studies involving 280,644 colorectal cancer and 14,139 colorectal adenoma cases) indicated that taller individuals had a 14% higher risk of colon cancer and 6% higher odds of adenomas (a type of benign tumor). Note that taller stature has been linked to an increased risk of several other cancers.

The findings are intriguing and supported from other perspectives. For example, Laron syndrome (LS) is a rare genetic condition, characterized with congenital deficiency of insulin-like growth factor-1 and dwarfism. Patients with LS do not develop cancer.

This is significant yet overlooked because current cancer screening guidelines do not define height as a risk factor or relevant specifics that one should get screened. So, it’s up to doctors’ recommendations or an individual’s choice.

2.      Age for colon cancer trending younger (under age 50)

In contrast to falling or steady rates of colorectal cancer incidence in older adults, a concerning trend is the rising occurrence of young people (< 50 years old) with colorectal cancer. Simply blaming obesity and diabetes in this population might be too early, because new studies shed a light from various angles. Gut microbiome may play a role in carcinogenesis as bacteria alter inflammatory and immune environment. High consumption of sugar-sweetened beverages in adolescence and young adulthood may also contribute to an increased risk of early-onset colorectal cancer.

In addition to reinforcing awareness, an immediate outcome improvement can be done by early screening. Multiple societies and the United States Preventive Services Task Force have updated their recommendation—individuals should initiate screening for colorectal cancer at age 45, instead of age 50.

3.      Obesity as a strong and sustained risk

Obesity and/or being overweight is a well-known, independent risk factor for more than ten cancers, and with obesity comes a worse prognosis. We also know that gut microbiota imbalance can influence cancer, and there are identified colon cancer-promoting bacteria. Recent studies showed that changes in gut microbiota composition occur in patients with colon cancer, particularly among those having a BMI >25 kg/m2.

Cumulative history or effects of excess weight is another issue, as an investigation newly published on JAMA Oncology (online March 17, 2022) emphasized a greater role of cumulative lifetime excess weight in colon cancer risk. The researchers defined “cumulative lifetime exposure” as the subjective numbers of years lived with an overweight condition or obesity, and found that excess weight effect at all ages (between 20 and 70 years) studied is clearly associated with an increased colon cancer risk. In other words, the longer one is carrying excess body weight, the more likely he/she will develop colon cancer.

4.      Polyps’ vulnerability and risk critical to screening methods

Although not all polyps will become cancer, many cancers, especially in colon, start from polyps. Vulnerability and/or risk of polyps turning to cancer depend on their size, shape, number, and microscopic characteristics or pathology.  The larger in size and the more in number the polyps, the greater likelihood they are on the road to cancer. The good news is that polyps can be safely and successfully removed during the colonoscopy.

That’s why colon cancer screening is critical. There are several screening tests with variable specificity and sensitivity—from at-home, stool-based kits (e.g., fecal immunochemical test or FIT, Cologuard DNA test), a new blood-based biomarker test to sigmoidoscopy and colonoscopy. Of all, colonoscopy is still the gold standard, and a preferred test strategy.

However, consider as an early intervention, even starting with at-home kits, is better than doing nothing. Understandably, the cost associated with different preferences may be involved in the decision-making, that’s why your voice to ensure life-saving screening should be raised loudly.

At the end, colon cancer is a most common but preventable cancer!

I draw your attention to the effective, preventative strategies below in a poetry style.

Title: Reminder of Colon Cancer Prevention

Imagine your colon cool and smooth,

With a regular bowel move;

To steer away from cancer growth,

Your brain and action are your tools.

 

Rainbow dish stands a golden rule,

More water, veggies and fruits,

Less red and processed meats,

No smoke, alcohol, and junk foods;

Stay lean and burn fat,

Walk, run, or yoga, whatever you choose.

 

Let your motion get annoying pounds removed,

Let your screening discard any malign root;

Enlighten your disease prevention and a long life,

Keep a good, positive mood!

 

Image Credit: Cleveland Clinic Health Essentials

An Active and Long Life Springs from Your Vascular Health (Part 2)

By Hui Xie-Zukauskas

Continued on Strategies to control risk factors for stroke – 

Norm & Artheroma Arteries_AHAFundamentally, atherosclerosis (particularly in carotid artery) is the primary cause of a significant portion of ischemic strokes. Cardiovascular risk factors can facilitate the progression of atherosclerotic plaque.

Atherosclerotic disease can be asymptomatic initially because it develops over time. When a plaque grows larger enough to reduce blood flow supplying to vital organs (usually >70% stenosis or narrowed vessel), ischemic symptoms may occur. However, it doesn’t mean that smaller plaques (30-40% stenosis) are stable without rupturing to cause a blockage.

How do you prevent or slow down atherosclerosis and stroke by reducing risk factors?

First, before I lay out key preventive strategies, let me quickly draw your attention to some risk factors for stroke, especially those modifiable and those beyond conventional cardiovascular risks. They include:

  • 3 Highs (high blood pressure, high blood lipids, and high blood sugar)
  • Atherosclerotic disease and/or other cardiovascular disease
  • Obesity
  • Smoking and alcohol abuse
  • Unhealthy lifestyle such as poor diet and physical inactivity
  • Atrial fibrillation
  • Sleep apnea and other sleep problems
  • Chronic kidney disease
  • Sickle cell disease
  • Illicit drug use (marijuana, cocaine or heroin)

Illicit drug use can increase the risk of all types of strokes. Cannabis or marijuana use has been linked to vasospasm, ischemia, and increased hemorrhagic incidence in the brain, likely due to the vasoactive properties of delta-9-tetrahydrocannabinol (THC), a key component of these plants.

  • COVID-19 infection

Acute ischemic stroke and intracerebral hemorrhage are known neurological complications in patients with COVID-19, frequently in individuals 50 years or younger with asymptomatic COVID infection. The possible mechanisms include that blatant inflammatory response and “cytokine storm” associated with COVID cause endothelial injury; that the disease causes arterial and venous clots, thus resulting in poor outcomes.

  • Socioeconomic factors (e.g., lower income with inequality in health care, etc.)

Certainly, there are risk factors out of your control, such as age, gender, family history, a history of stroke, transient ischemic attack (TIA) or heart attack, and race. Note that black people have twice the risk as white, particularly young black population.

Here are 8 Key preventive strategies to put into actions:

I’d also like to stress that the point is not just knowing to have a healthy diet or exercise more, but to know important reasons behind and why these strategies work on targets to avert stroke.

1.      Lower your blood pressure (BP).

As stroke doesn’t discriminate (by) age, neither does high blood pressure. High blood pressure is a leading cause of stroke. Young people should never disregard their elevated blood pressure, especially those with a family history of stroke or hypertension and black women.

High blood pressure is also the most significant controllable risk factor. Better BP control works, because evidence shows that tight BP control (systolic <130 mm Hg) was associated with a 42% lower incidence of stroke compared with standard control (130–139 mm Hg).

I’ve notified the danger of high BP, including to watch BP in young people. If you haven’t done so yet, please check out this article – Hypertension can be asymptomatic but potentially fatal.

If you have hypertension but with difficulty to manage it, try to figure out where you can target; for example, whether medication not working or side effect issues, whether your diet is healthy, you exercise enough or you have adequate support.

2.      Lower your blood cholesterol. Critically, lower your bad cholesterol (LDL).

LDL increases plaque formation or growth in the arterial wall, and high cholesterol can also cause blood clots due to fatty deposits’ suddenly breaking off; if the blood supply to the heart or brain is significantly blocked, heart attack or stroke occurs. Avoiding or limiting diet high in saturated fat and trans fats, along with physical activity, can minimize the risk for stroke.

3.      Lower your blood sugar, control your weight, and prevent diabetes.

Diabetes is an independent risk factor for stroke, and with combined overweight, its damaging impact on health piles up over time. Again, diabetes is controllable. Obesity and excess bodyweight pose an increased risk for diabetes, hypertension, heart disease and stroke.

4.      Lower your stress level.

Cumulative psychological or mental stress is associated with increased inflammation in the body, and more significantly, with mortality, cardiovascular disease, and stroke.

Depression has a direct or indirect link to a number of illnesses including Alzheimer’s disease, and cardiovascular events. Studies also showed that stroke survivors who experienced high and persistent levels of stress negatively affected the brain repair process and recovery outcome.

5.      Quit smoking.  Non-smokers should encourage people around you to do so.

This sounds repetitive or nothing new, but this is one of the most valuable things you can do to save lives of people for whom you love and care.

Smoking increases inflammation in the body and plaque buildup in the blood vessels, and makes the blood thicker to facilitate clot formation, leading to heart attack and stroke. Needless to say, toxicities from smoking (e.g., nicotine and carbon monoxide, etc.) ravage your cardiovascular system, thus paving the road to stroke.

Don’t overlook second hand smoking and e-cigarette smoking either.

6.      Practice a healthy lifestyle.

Poor diet and physical inactivity contribute to several cardiovascular risk factors and metabolic disorders, thereby presenting an increased risk for stroke. So, get more active, get a nutrients-rich diet, get bodyweight controlled, and get social. Equally important, have a well-balanced life including relationship, financial, and psychological wellbeing.

7.      Take seriously alcohol and drug abuse.

Alcohol influences on stroke are not uniform. While low to moderate alcohol consumption (£2 drinks daily for men or £1 for women) may reduce stroke risk, even low alcohol consumption escalates the risk of hemorrhagic stroke.

As mentioned above, regular substance use (e.g., cocaine, heroin, phencyclidine (PCP), amphetamines, and cannabis/marijuana) sets an increased risk for stroke, which is a common predisposing factor for stroke among young individuals.

8.      Recognize warning signs of acute cardiovascular events (heart attack and stroke).

Young folks (those under 50) may think this is too early for you. Not anymore! Learn those signs seemingly not related to heart. For instance, sudden poor vision in one or both eyes are reported in 66.1% of stroke patients, and pain or discomfort in the arm or shoulder, 53.8%.

Take-home message:

Stroke is dangerous and deadly. Greater awareness, better control of modifiable risk factors all help prevention and timely treatment.

To reduce atherosclerotic plaque development, know your critical numbers (blood pressure, cholesterols and sugar), monitor them, and keep them at healthy levels, while maintaining a healthy weight through diet and exercise routine. More importantly, take these measures as early in life as possible.

 

Image credit: heart.org