Aristotle, Blood Sugar, and Surviving Cancer: Does A = B = C?
Aristotle, Blood Sugar, and Surviving Cancer: Does A = B = C?
Recently, there has been another addition to the array of medical papers revealing the detrimental effect of elevated blood sugar in patients undergoing treatment for cancer. This paper showed that patients with an episode of elevated blood sugar while receiving chemotherapy and radiation therapy for the treatment of glioblastoma multiforme (an aggressive and fatal brain tumor) experienced a survival that was half that of the other patients.1
Two other major papers in the past several years have revealed a significant impairment in patient survival after surgery for high grade gliomas (brain tumors) with elevated blood sugar.2,3 Adding fuel to the fire is the fact that after brain surgery (or from the tumors themselves), patients with gliomas often require steroids to reduce the pressure caused by these lesions, as the brain is a tight place with minimal empty space. A potent increase in blood glucose is an unfortunate side effect of these steroids.
This has been shown in other cancers as well, including lung cancer.4 And yes, these patients often receive steroids to offset the potential reactions that can result from a common chemotherapy drug employed during treatment called Taxol.5
Candy and Cancer Centers
Many cancer centers have bowls of candy for their patients in the waiting room — something that continually irks me to no end. It is even worse for Breast Cancer Awareness Month, when pink sugar cookies are commonly found, well, everywhere. I often tell my patients to avoid these candy trays, especially my patients receiving steroids, as their blood sugar is already experiencing a roller coaster of ups and downs.
If high blood sugar is bad for cancer patients, and steroids raise blood sugar, shouldn’t we limit carbohydrates, and especially sugar, in the diet during these treatments?
What Does Aristotle Think of All This?
This whole argument brought me back to Aristotle. The famous Greek philosopher and scientist focused much of his time on deductive reasoning and syllogism. In other words, he would perform logical arguments (sometimes with himself) to provide conclusions to problems that were otherwise difficult to solve. This seems like the kind of reasoning that could help us solve some of the current issues with diet and cancer, as it seems that dietary studies aren't going to be conducted anytime soon.
The most common of Aristotle’s categorical syllogism, is:
If A = B
And B = C
Then A = C
Unfortunately, science does not always work out this way, especially when it comes to diet. These thoughts and hypotheses must be tested in a scientific fashion, and ideally in a randomized trial. However, due to financial and political reasons, these trials often don't take place.
A Does not Necessarily Equal C, but it May
Returning to the article discussed above, the authors again found that patients with an elevation in their blood sugar levels during treatment lived half as long as those with lower blood glucose levels.1 They also concluded that elevated blood sugar levels may play a role in reducing survival through elevating the expression of DNA damage or increased activity of antioxidant systems. More data toward high blood sugar and worse survivals, yet, in the paper the authors actually follow their findings by throwing caution against attempting to combat these findings with diet.
In this case and based on their data, it is unclear if A = B and B = C, then A = C. However, they even go as far as warning against trying to combat elevated blood sugar through diet by questioning its safety. This was a step too far, and under the guidance of Dr. Rainer Klement, we wrote a response describing our dismay. Our rebuttal even went as far as stating that “the burden of proving any clinically harmful effect rests upon those who warn against their usage.”6
Why are we so Scared of Attempting to Treat Disease with Diet?
According to Maimonides, the Spanish philosopher and physician:
“No disease that can be treated by diet should be treated with any other means.”
Yet it seems like nowadays this adage has changed to:
“No disease should even be attempted to be treated with diet.”
I continue to have trouble putting my finger on the source or reason for the constant negativity towards applying diet for disease treatment (or disease avoidance for that matter). For instance, telling patients to avoid carbohydrates or sugar during chemotherapy or radiation therapy when steroids are given to reduce blood sugar spikes almost seems like common sense. Yet, this advice often receives a negative response, or the typical “that doesn’t even matter,” even though we know that elevated blood sugar causes radiation therapy to work less effectively at killing cancer cells.7
Can we say with 100% certainty that stabilizing your blood sugar during the treatment of cancer can help you to live longer or beat it? Absolutely not.
Can we say with 100% certainty that avoiding sugar and carbohydrates during the treatment of cancer can help you to live longer and beat the cancer? Absolutely not.
Can we say that patients with higher blood glucose levels during the treatment of brain tumors appear to live significantly shorter? Absolutely.
So does A = B = C? Maybe. Maybe not.
Do we want to chance it? I have an easy answer to that, but it seems like most people do not agree. I think it at least deserves to be answered in a study — but I’m not holding my breath.
To Your Health,
Dr. Colin Champ
1. Mayer A, Vaupel P, Struss H-G, Giese A, Stockinger M, Schmidberger H. Strong adverse prognostic impact of hyperglycemic episodes during adjuvant chemoradiotherapy of glioblastoma multiforme. Strahlenther Onkol. 2014;190(10):933-938. doi:10.1007/s00066-014-0696-z.
2. Derr RL, Ye X, Islas MU, Desideri S, Saudek CD, Grossman SA. Association between hyperglycemia and survival in patients with newly diagnosed glioblastoma. J Clin Oncol. 2009;27(7):1082-1086. doi:10.1200/JCO.2008.19.1098.
3. McGirt MJ, Chaichana KL, Gathinji M, et al. Persistent outpatient hyperglycemia is independently associated with decreased survival after primary resection of malignant brain astrocytomas. Neurosurgery. 2008;63(2):286-291; discussion 291. doi:10.1227/01.NEU.0000315282.61035.48.
4. Luo J, Chen Y-J, Chang L-J. Fasting blood glucose level and prognosis in non-small cell lung cancer (NSCLC) patients. Lung Cancer. 2012;76(2):242-247. doi:10.1016/j.lungcan.2011.10.019.
5. Bookman MA, Kloth DD, Kover PE, Smolinski S, Ozols RF. Short-course intravenous prophylaxis for paclitaxel-related hypersensitivity reactions. Ann Oncol. 1997;8(6):611-614. http://www.ncbi.nlm.nih.gov/pubmed/9261533. Accessed December 24, 2014.
6. Champ CE, Klement RJ. Commentary on “Strong adverse prognostic impact of hyperglycemic episodes during adjuvant chemoradiotherapy of glioblastoma multiforme.” Strahlenther Onkol. 2014. doi:10.1007/s00066-014-0788-9.
7. Klement RJ, Champ CE. Calories, carbohydrates, and cancer therapy with radiation: exploiting the five R’s through dietary manipulation. Cancer Metastasis Rev. 2014:1-13. doi:10.1007/s10555-014-9495-3.