As I type these words, I’m hurtling through the sky somewhere over the North Atlantic on my way to the US from Germany. I just woke up from about a two hour nap, during which I was flat on my back and got to stretch my 6’2” frame to the max without hitting the end of my little cubicle. Yes, cubicle. I’m kicked back in business class in a medium-sized jumbo jet fending off the flight attendant’s offers of a multitude of libations and snacks. What a contrast to the first time I flew to Europe when I was a kid in 1969, off for a libidinous summer abroad. Then I was crammed into the last row, window seat of a Boeing 707, a small tube of a plane (but the largest around at the time), which didn’t have the avionics of a little Cessna trainer plane you could buy today.
In the last 48 years, like most industries, commercial aviation has improved in virtually every aspect. Consequently, my trip today is much different than the one in 1969. Sadly, however, were I to come down with cancer today, I would discover that, for the most part, treatments now wouldn’t be much different or any more effective than they were in 1969. Or even 1959. And that’s an awful realization, since as cancer is on its way to overtaking heart disease as the leading killer, sooner or later everyone is going to come into contact with the ravages of it up close and personal.
What do aviation and cancer have in common? Not a lot, but cancer has been on my mind because before I left on this trip about a week ago, I finished an extraordinary book on cancer by Travis Christofferson called Tripping Over the Truth: How the Metabolic Theory of Cancer is Overturning One of Medicine’s Most Entrenched Paradigms.
I have received more emails from people asking me my opinion of this book than any other book I can think of. I read it a couple of years ago when the first edition came out, so when I heard a new, updated version was soon to be available, I snagged a review copy from the publisher. I thought the first edition of the book was pretty good, but the new, revised edition is an absolute gem that should be read by everyone. But before I get to the book, let me tell you about my family’s close encounter with cancer.
A Typical Case of Cancer Treatment Today
On New Year’s Day in 2012, my wife MD and I were in Little Rock, Arkansas visiting her sister, Rose. A great cook who loves to throw dinner parties, she put together a small group of friends to join us at her house for a New Year’s spread. As usual, it was excellent. MD and I left the next day, but before we did, MD’s sis complained that she had an upper respiratory infection. MD checked her over and gave her a prescription for an antibiotic.
They talked a couple of days later on the phone, and Rose said she was much improved. But shortly she had a relapse and asked MD to call her in another round of medication. This went back and forth – her getting better then worse – for about a month. Rose was a long-time smoker, and in light of this lingering respiratory condition, MD had been badgering her to get a chest X-ray. When she finally did, she was ecstatic, as most smokers are when they get the normal-chest-x-ray news. But despite her normal chest film, she continued her cycle of upper respiratory infections, each one getting a little worse than the one before. And now she was becoming hoarse. MD finally insisted that her sister go to a physician there who could actually examine her, instead of simply listening to her symptoms over the phone. So, she made an appointment.
By the time she had her appointment in early March, she was seriously ill. She couldn’t sign in at the receptionist’s counter, not because she was so sick, but because her brain wasn’t working. She couldn’t figure out how to write her name. The doc checked her over and sent her immediately for a head scan, which came back showing five large masses, which were compressing her brain and creating her cognitive difficulties. Though there might have been other possibilities, when we got the news MD and I figured they were metastatic tumors, which often go to the brain. Her sister, of course, was then scheduled for the full cancer workup.
When the results came back on March 6, they were pretty grim. She had a chest full of cancer, but not so much in the lungs. It was mainly in the lymph nodes of her mediastinum (the central part of the chest) and hilum (at the base of the lungs) and also in an adrenal gland and, of course, her brain. A biopsy showed highly undifferentiated adenocarcinoma. Cell typing showed the primary came from the lung. Not a diagnosis anyone wants to get.
Due to the location of the tumors, surgery wasn’t an option, so she was spared the ‘slash’ part of the ‘slash, burn, and poison’ treatment protocol for cancer.
Since she was so ill, she was hospitalized. She lost her voice, which the oncologist thought was due to the cancer impinging on the nerve that makes the vocal cords work. He blasted her with a couple of doses of a potent chemotherapeutic cocktail that quickly knocked the cancer back enough so that she could speak and swallow, though her voice was a croaky whisper.
MD had dropped everything and hopped a plane once she learned the diagnosis. I came a week or so later. MD stayed in the hospital with her sister while she went through the first blast of chemo and saw first hand the wretchedness of it. The unremitting nausea and vomiting and all the rest.
I want to digress here for a bit to let you know that until MDs sister’s cancer diagnosis, I had never had any actual day to day exposure to the disease. (MD had some, with other family members, but never as up-close and day-to-day as this one.) We had both diagnosed plenty of it in our careers, but we always referred the cases on to oncologists to take care of. We knew a fair amount about cancer on an academic level. We could both have told you the prognosis of most any cancer you might name, and we understood on an intellectual level the misery cancer and cancer treatment bring about. But knowing it on an intellectual level and living it every day on a gut level are two different things. It was eye opening to both of us.
Rose began a multi-week course of radiation therapy for the tumors in her brain and chest. MD schlepped her over to the treatment center five days a week for six weeks of treatment that left her exhausted, nauseated, and cost her her hair. She also took massive doses of steroids to prevent swelling of her brain after the insult of the radiation.
After the radiation, the chemotherapy began. And it was a nightmare from day one. She experienced almost every bad thing that can be experienced with chemotherapy. As she struggled on with her treatments, MD and I had to leave for a bit. We left her sister in the capable hands of their nephew, who had been there from the start, helping MD throughout the weeks of treatment with all the ferrying around.
Rose ended up having problems while MD was away (a deep vein thrombus that required placement of a vena cava filter and a bleeding gastric ulcer) and she had to be hospitalized. MD rode herd on her hospitalization from afar, because her sister’s oncologist was MD’s medical school classmate, so they spoke almost daily. She slowly improved and fought on.
At the end of the course of therapy, she had another total body scan. This one on May 12 showed pretty much a complete regression of the tumors in her head and a major regression of the nodes in her chest. All that was left was some scarring where the tumors had been in her head. Things looked pretty hopeful.
On June 2, a few days before we were planning to head back to Little Rock, the oncologist told MD that her sister was doing so well he planned to move her out of the hospital to a kind of halfway house rehab center. She was pretty weak and needed someone there with her. Rose was torqued because she wanted to go home. Which was under discussion because MD and I would soon be coming back and living there with her for a while.
The next morning — the morning of the day before we were headed back — MD got a call from the oncologist, who told her he was on his way to the hospital, because her sister was having some shortness of breath. A couple of hours later, MD got another call. The oncologist told her that he did a chest x-ray and that her sister had lymphangitic spread of the cancer throughout her lungs, which is pretty much a terminal stage event. He said that he had talked to Rose, explained the situation, and told her all he could do was make her comfortable and he told MD to come back quickly. He texted her chest x-ray to MD and me. It was horrific.
MD called her sister and told her to hang on, that we were coming. We tried everything to get a flight out that would get us there that day, but the only thing we could find was a red eye flight out of LAX that would get us there at 8 am, which we booked. As our ride was coming to pick us up to take us on the two hour ride to LAX, MD’s nephew called and told us her sister had just died.
It was June 3, 2012. Just three months after her diagnosis and six months after the New Year’s dinner party at which she seemed totally normal. Not quite a year after the photo above was taken.
MD was the executrix for her sister’s estate. When she gathered all the medical bills for this three month treatment period, they totaled a little over $400,000.
I’ve gone on at length about MD’s sister’s illness to give those of you who haven’t lived cheek by jowl with someone with terminal cancer a better understanding of how devastating this disease can be. And how, in most cases, the treatment is worse than the disease. If MD’s sister hadn’t gone through this long and expensive process, she might have lived one miserable month instead of three. Or she might have lived six months. Was it worth it?
I can’t speak for Rose, but having lived there on the front lines with it, it doesn’t seem so to me.
The War on Cancer
On December 23, 1971, as a Christmas present to the American people, President Richard Nixon signed into law the National Cancer Act, allocating $1.6 billion ($9.7 billion in today’s dollars!) to declare the War on Cancer. One of the observers cheering loudest was Senator Edward (Ted) Kennedy, one of the act’s biggest supporters. Confidence was high that with the massive funding involved and America’s can do spirit, cancer might be vanquished by 1976, the US Bicentennial.
Thirty-eight years later Senator Kennedy himself succumbed to brain cancer. He died on August 25, 2009 after having gone through the same kinds of horrendous treatment Rose did. Despite the billions of dollars spent on cancer research, Senator Kennedy ended up getting the same treatment and experiencing the same dreadful outcome he would have gotten had he developed his brain cancer before December 23, 1971, the kick off of the War on Cancer he so supported.
How come the multi-billion dollars thrown at cancer research hasn’t gotten us any closer to a cure than we were when Nixon signed the bill? Could it be for the same reason all the money spent to promote low-fat diets ended up making us fat and diabetic? Have the ‘experts’ been on the wrong track?
In Tripping Over the Truth, Travis Christofferson makes the case that the cancer research industry has been on the wrong track. While they’ve been fruitlessly throwing billions of dollars at the genetic theory of cancer, the real cause of most cancer is not genetically derived. Instead he posits that cancer is a disease of deranged cellular metabolism.
Dueling Cancer Theories
I’m sure if I dug in and pored through all the literature, I could find dozens of offbeat theories of how cancer gets its start. There are doubtless many people who have published their own theories of the initiating factors causing normal cells to undergo the transformation into malignant cancer cells, but the two theories accepted by the greatest number of people are the genetic theory and the metabolic theory. The vast majority of cancer researchers are believers in the first theory, the so-called Somatic Mutation Theory.
The Somatic Mutation Theory of Cancer
In 1914, Theodor Boveri, a German cell biologist, kicked off the Somatic Mutation Theory of Cancer (SMT) by publishing the first paper discussing the role of chromosomal abnormalities and their role in cancer. The main premise of the SMT is that cancer arises in a single somatic cell (any cell other than a reproductive cell – could be skin, lung, bone, brain, etc.) due to an accumulation of multiple DNA mutations over time. This single cancerous cell grows and replicates in an uncontrolled fashion due to other mutations in genes controlling growth and the cell cycle.
Should this theory be true, it would mean that if the specific mutations were known, then therapies could be designed to treat them. Countless dollars have gone toward discovering these mutations and trying to match them with specific cancers. But, unfortunately, there has been minimal success. Researchers have identified an enormous number of specific mutations, but there is little, if any, correlation between these mutations and types of cancer. Consequently, the treatments for the vast majority of cancers rely on surgery, radiation, and chemotherapy (slash, burn and poison) in combinations mostly unchanged over the past 50 years.
The typical outcome of these treatments: misery on the part of the patient, shrinking of the cancer, and little to no prolongation of life.
The Metabolic Theory of Cancer
After World War I another German scientist, Otto Warburg, started studying cancer. He found a unique feature of cancer cells: they fermented glucose in the presence of oxygen. In normal cells, under anaerobic conditions (i.e., without oxygen), glycolysis (the metabolism of sugar) proceeds and results in the production of lactic acid. When oxygen becomes available, anaerobic glycolysis is shut down in normal cells (the Pasteur effect), but Warburg found that cancer cells continue to produce lactic acid even in the presence of plenty of oxygen, a phenomenon now called the Warburg effect.
As Christofferson writes:
As Warburg continued his experiments, he found that cancer’s defective metabolism presented itself without exception in all types of tumor cells. Now he could be sure. To him, this reversion was the prime cause into which all other secondary causes collapsed. The shift from aerobic to anaerobic energy generation was the signature difference between cancer cells and normal cells. Nothing was more fundamental to a cell than energy creation. Nothing could be further reduced.
Years later, Warburg made another critical observation that hinted at why cancer cells were fermenting in the first place. He showed that when normal, healthy calls were deprived of oxygen for brief periods of time (hours), they turned cancerous. No other carcinogens, viruses or radiation were needed, just a lack of oxygen.
This led him to conclude that cancer must be caused by “injury” to the cell’s ability to respire. He contended that once damaged by lack of oxygen, the cell’s respiratory machinery (later found to be the mitochondria) became permanently broken and could not be rescued by returning the cells to an oxygen-rich environment. He reasoned that cancer must be caused by a permanent alteration to the respiratory machinery of the cell. It was a simple, elegant hypothesis. Warburg would contend until his death that this was the prime cause of cancer.
Let’s take a minute to go over what he means by the “cell’s respiratory machinery.” Respiration is more or less defined as taking in oxygen, which is used to fuel metabolism (in the same way that oxygen is required to burn a fire in your fireplace), and releasing carbon dioxide and water. We do this constantly. We breathe in oxygen-containing air and breathe out carbon dioxide and water vapor (and make urine). Cells do the same thing.
Cells take in oxygen and produce carbon dioxide and water. But not all metabolic processes use oxygen all the time. Glycolysis, as we discussed above, can operate without oxygen. Other pathways that generate ATP (the cellular energy currency) can also operate without oxygen. The part of our metabolic process that cannot work without oxygen is located on the inner mitochondrial membrane and is called oxidative phosphorylation. The metabolic pathways that can work either in the presence of oxygen or not are called substrate level phosphorylation and represent about 12 percent of total energy produced. Oxidative phosphorylation produces 88 percent of total energy, the obvious lion’s share.
When the respiratory part of the energy production process becomes damaged, then the substrate level phosphorylation is left to come up with all the energy required for the cell to function, or the cell dies. Usually the cells die, but when they don’t, they become cancer cells.
Damage to the respiratory function of the cell can then lead to instability of the genome as the cancer develops. The instability of the genome can then lead to additional respiratory impairment, which then leads to more genetic instability, etc.
A major difference between the SMT and the Metabolic Theory of Cancer is what precedes what. Those who are supporters of the SMT believe the genetic instability arises first and causes the respiratory dysfunction. Those who favor the Metabolic Theory believe as described above: the initial insult is to the cell’s respiratory system with the genetic instability following as a consequence.
In Tripping Over the Truth you’ll learn the history and background to these two competing theories and why the Metabolic Theory is the odds on favorite for taking the cancer sweepstakes. It’s a book loaded with an unforgettable cast of characters, many of whom are less than savory. For example, James Watson of double-helix fame even slithers into the story by trying to purloin the work of a young researcher, who may have hit upon a real cure for cancer.
The new edition of this book is absolutely gripping. I thought it on par with some of the best mystery novels I’ve ever read, which is a lot to say for a non-fiction book on cancer. I read it over a few days, and when I wasn’t reading, I was thinking about it. I couldn’t wait to get back to it. I thought maybe it was just me, but I blathered on about it so much, MD wanted to read it. She felt the same way. She stayed up half the night polishing it off.
I believe the book is hugely important and should be read by everyone, because sooner or later cancer is going to cross everyone’s path one way or another. The book is a must-read for anyone with cancer or who has a friend or loved one with cancer.
It’s an important book, not just because it tells the story of the Metabolic Theory, but because it dispels a lot of myths I’ve heard bandied about on Facebook and Twitter.
It Must be True. I Read it on Twitter
Since most cancerous cells must ferment glucose for energy, it means that if they don’t get glucose they can’t survive. Since the cancer cells can’t really use ketones or fat, because these substances require the broken part of the respiratory process to metabolize, it makes sense for cancer patients to go on high-fat, ketogenic diets. Which is true. Tripping Over the Truth tells many miraculous stories of sufferers of cancer of one kind or another being jerked from the jaws of death and allowed to live many more years by switching to a ketogenic diet. But too many people seem to think a ketogenic diet is the total answer. It makes sense. The cancer needs sugar to survive. Deprive it of sugar, and you’re cured. Unfortunately, it isn’t that simple.
Physicians who are treating cancer based on its being a metabolic rather than a genetic disease use many of the same therapies that oncologists use treating cancer as if it were a genetic disease. The best outcomes are those in which everything available is arrayed against the cancer. Especially the ketogenic diet.
A ketogenic diet, the mainstay of the program, makes the cancer cells more vulnerable to the radiation and chemotherapeutic agents while at the same time making the surrounding normal, non-cancerous tissue healthier, more robust and better able to withstand the assault of the poisonous drugs. Other treatment modalities such as hyperbaric oxygen add to the treatment armamentarium. From the limited number of studies, it appears that patients respond much better to therapies underpinned by the ketogenic diet than chemotherapy alone.
Reading about the virtues of the ketogenic diet in beating back cancer and enhancing the health of normal cells can’t help but make you a believer in the notion that a ketogenic diet would be a great way to prevent cancer.
One of the great virtues of this book is a description of many of the therapeutic modalities that have been used along with the ketogenic diet and a list of physicians who treat cancer as if it were a metabolic disease.
I feel heartened, because even the mainstream is starting to change. I had lunch a few weeks ago with my son and a friend of his, who had undergone surgery a couple of months before for esophageal cancer. When diagnosed out of the blue (both he and his gastroenterologist thought he had an ulcer), he headed off to MD Anderson Center in Houston, the most mainstream of the mainstream, to get a course of chemotherapy to shrink the tumor so that it could be operated on. After his chemo, he underwent surgery to remove and reconstruct the cancerous part of his esophagus. When he went back to his surgeon on a follow up visit, he asked what he could eat. The surgeon told him, “Pretty much anything…except sugar. Sugar is poison; it feeds the cancer.” If that’s what they believe at MD Anderson, they’ve come a long way and there is hope for the future.
I’m going to send this guy a copy of the book. I suggest you do the same for anyone you know with cancer.
If you want a much more technical description of the Metabolic Theory of Cancer, you can read the book that inspired Travis Christofferson to write Tripping Over the Truth: Thomas Seyfried’s encyclopedic Cancer as a Metabolic Disease. It’s pricy (~$125 on Amazon) and is written for a scientific audience. It’s a terrific book, but it is highly technical and unless you’re used to reading this kind of material, I wouldn’t spend the money. But if you’re a person who relishes technical reading, by all means pick this one up
Cancer as a Metabolic Disease is an in depth, extremely technical argument that cancer is a metabolic disease. Tripping Over the Truth is the story of the development of the hypothesis.
You can also read Dr. Seyfried’s paper Cancer as a Metabolic Disease written in 2010. It is still fairly technical, but much less so than his book of the same name.
MD and I have discussed many times how much we wish we had the information in Tripping Over the Truth before Rose’s diagnosis. But it wasn’t in print then. I remember learning about Dr. Seyfried’s book and purchasing it immediately. As you can see from the notice on my Amazon account, that was exactly ten days after Rose died.