Questions & Answers

My family has had pancreatic, cancer of uterus, breast cancer, and leukemia.  Am I doomed?

You should get a referral to a genetic counselor to evaluate your family history and genetic risk.  This is a lot of cancer in the family, but a lot depends on whether they are all on one side of the family or not, and the age of onset.  Breast and uterine cancer are very common, so they are not necessarily inherited risk.

Patricia Ganz, MD, 11/20/2020


Are there legitimate institutions that study emergency, nonconventional treatments for terminal patients that have exhausted all other treatment options? Can hard, criminalized drugs kill tumors without killing patients? Can induced comas help fight tumors?

Lot of questions here:  Most cancer centers funded by the NCI have experimental treatments of various sorts. They can also obtain compassionate use of some drugs that are in the development pipeline.  That is for active cancer treatments.  If you are referring to comfort care at the end of life, many institutions use integrative and complementary therapyies.
Criminalized drugs do not have a role in cancer treatment as far as I know, and coma does not play a role in treatment.

Patricia Ganz, MD, 11/20/2020


Regarding heredity: father’s sisters has cancer, grandmother had colon cancer—is that important?

It depends on the age of onset and types of tumors.  Best to get a consult from a cancer genetic counselor.

Patricia Ganz, MD, 11/20/2020


What diet adjustments can be made to promote gut microbe diversity?

It is pretty simple:  eat the largest variety of fruits and vegetables on a daily basis.  There are hundreds of different fiber molecules contained in different vegetables and fruits, and thousands of different phytonutrients (in particular polyphenols), so the more variety of plant based foods you eat, the more you incentivize your gut microbes to diversify in order to be able to metabolize this food. 

Emeran Mayer, MD, 11/20/2020


Is UV needed for your body to produce Vitamin D?

I often hear people say, “I need to lay out in the sun because I need to get vitamin D.” To that, I’d say, there are many different ways of getting vitamin D. Yes, the sun is one way of doing this, but it’s not good for your melanocytes. Why tempt fate when you can take a supplement?

Delphine Lee, MD, 11/20/2020


How closely correlated are one’s cancer risk and the ingestion of acrylamides?

The debate on the potential carcinogenic effect of dietary acrylamide remains open. There were a total of 32 publications on this topic reviewed in 2015. The summary relative risk (RR) of cancer sites for the highest versus lowest level of intake and for an increment of 10 µg/day of dietary acrylamide were examined. No meaningful associations were found for most cancers considered including  oral and pharyngeal, esophageal, stomach,  colorectal, pancreatic, laryngeal, lung, breast, endometrial,  ovarian, prostate, bladder and for lymphoid malignancies. The RR was of borderline significance only for kidney cancer (RR = 1.20; 95% confidence interval, CI, 1.00-1.45). All the corresponding continuous estimates ranged between 0.95 and 1.03, and none of them was significant. Among never-smokers, borderline associations with dietary acrylamide emerged for endometrial (RR = 1.23; 95% CI, 1.00-1.51) and ovarian (RR = 1.39; 95% CI, 0.97-2.00) cancers. Therefore, dietary acrylamide is not related to the risk of most common cancers. A modest association for kidney cancer, and for endometrial and ovarian cancers in never smokers only, cannot be excluded.

David Heber, MD, 11/19/2020


Does periodic fasting help the epigenetics that lead to an increased risk of cancer?

Intermittent fasting is part of normal physiology and does move about 40% of genes to support fasting metabolism every night while you are sleeping. Intermittent Fasting as a diet plan only helps by eliminating late-night eating after dinner which could help maintain normal body weight.  Obesity and overweight including abdominal obesity have been associated with an increased risk of common forms of cancer.

David Heber, MD, 11/19/2020


How do you identify thyroid cancer and type of test to plan ahead?

Screening for thyroid cancer is not recommended unless you have an inherited genetic risk or have had radiation to the neck in the past.

Patricia Ganz, MD, 11/20/2020


Is leaky gut syndrome a real thing? Should we take probiotic supplements every day?

Leaky gut is NOT a disease or a disorder.  It refers in lay terms to a situation where gut microbes come into close contact with the gut associated immune system. This can occur either if the mucus layer covering the inside of your gut is thinned or compromised, and/or if the tight connections between the cells lining your gut have been loosened.  Both situations can result from a diet low in fiber, high in sugar and fat, as well as from chronic stress.   In the great majority of people the condition is asymptomatic, but it can result in the activation of the gut associated immune system.  Probiotics alone will not help, but switching to a largely plant based diet, and a positive mindset and stress reduction are the best way to address it.

Emeran Mayer, MD, 11/20/2020


Fifty years ago President Nixon declared the war on cancer.  Has there been adequate research money, or does the research process just take so much time that money is not the issue?

We can always use more money for research, but overall, cancer funding is quite high due to federal and philanthropic organizations.  The research just takes a long time to mature and be translated into new treatments.

Patricia Ganz, MD, 11/20/2020


What is the current scientific thinking regarding whehter cell phone use contributes to brain cancer?

The short answer is that, at this time, there is no definitive evidence that the use of cell phones causes brain cancer or cancer in any other tissue (eg, salivary glands).  The concern for cell phones potentially causing cancer is based on the exposure of cell phone users to radio waves.  Three early clinical studies yielded contradictory results: one reported increased incidence of cancer in cell phone users while two others did not find any association between cell phone use and cancer.  A very large ongoing study known as the COSMOS study was started in 2010 and is following participants for over 30 years.  Hopefully, this study will provide an answer to the question.  While awaiting results, it is important to note that the FDA stated that  “based on this current information, we believe the current safety limits for cell phones are acceptable for protecting the public health.”

 Joaquin Madrenas, MD, PhD, 11/20/2020


Has Dr. Heber updated his great book?  I have the original and wonder if it is still current?

"The  What Color Is Your Diet?" is in 11 languages and is still current. Appendix 1 which includes my recommendation of 1 gram of protein per pound of lean body mass and its relationship to resting energy expenditure remains the main message I am launching around the world through my Instagram site @drdavidheber and my website I have edited and written many of 24 chapters in a new book to be published in 2021. It is heavily referenced and entitled "Nutrition and Cancer: Prevention, Treatment, and Prevention of Relapse" (CRC Press, Taylor and Francis). 

David Heber, MD, 11/19/2020


In addition to a healthy diet, any thoughts on whether regular consumption of probiotics may be helpful for cancer prevention?

To my knowledge, no such benefit of probiotics has ever been demonstrated.

Emeran Mayer, MD, 11/20/2020


Since we're all spending so much time at home, do we still have to replenish sunscreen on our face every two hours if we're sitting near a window?

Typical car, home, and office windows block most UVB rays but a smaller portion of UVA rays.  Even if you don’t get sunburned sitting in the sunlight behind a window, the UV rays that get through can theoretically still damage your cells.  Tinted windows help block more UVA rays, but this depends on the type of tinting.  In addition to causing DNA damage that can lead to mutations and skin cancer, UV light also contributes to photoaging, so it is not a bad idea to wear sunscreen if you are exposed to UV rays.  As my dentist tells me, you don’t have to floss your teeth, only the ones you want to keep!

Delphine Lee, MD, 11/20/2020


Are there any vitamins someone could take to help protect the skin?

Nicotinamide (vitamin B3) has protective effects against ultraviolet damage caused by sun exposure, which enhances DNA repair and reduces UV‐induced suppression of immunity.  Randomized controlled clinical trials have also shown that nicotinamide reduces the development of new non‐melanoma skin cancers in patients at high‐risk.

Delphine Lee, MD, 11/20/2020


How much of the development of the current front runner vaccines (Moderna, AstraZeneca & Pfizer are funded by public funding (e.g., NIH grants)?  Will the pricing eventually reflect this collaboration?  Or should we expect the initial dose to be discounted, then subsequent doses be inflated?

There are 5 COVID-19 vaccine development programs that have received substantial funding from the U.S. government as part of “Operation Warp Speed”.  These vaccine development programs include (in order of stage of clinical trials:  Moderna / NIH; AstraZeneca / Oxford; Pfizer /BioNTech; Johnson&Johnson; and Merck).  Most of these efforts reflect public/industry or industry/industry interactions.  There are also U.S./International collaborations reflected in this list.  As part of U.S. government funding, vaccine development programs typically must adhere to U.S. government policies on making the vaccines available to U.S. citizens as a priority, and at a cost that is different from that if the companies were to have funded their development without U.S. government aid.  For example, as part of the Pfizer/BioNTech funding agreement, the U.S. government secured 100 million doses (i.e. vaccine for 50 million Americans) at a cost of about $40 for the vaccination regimen (2 doses).  Whether the cost of vaccines will inflate after the pandemic “crisis” period is over remains to be determined.     

 Michael Yeaman, PhD, 8/1/2020


Can you clarify why recent blood donation would exclude a potential subject from participation in the vaccine trials?

The SARS-CoV-2 virus that causes COVID-19 disease is known to cause abnormalities in blood coagulation in some infected patients.  This effect, known as coagulopathy, can lead to blood clots and blockages to small blood vessels essential to delivering oxygen and nutrients to tissues.  For individuals donating or receiving blood products, some of the vaccines being tested require a waiting period (often up to 3 months) before they could receive the vaccine.  The reasoning is that individuals who have less blood volume (e.g. having donated blood) or have received other’s blood products (e.g. blood donation recipient) may have a slightly higher risk of adverse outcome.  A key aspect of all the vaccine trials is safety, so out of an abundance of caution individuals who have donated or received blood products are restricted from participating in some of the trials for at least some period of time, even if risks of adverse outcome from the vaccine are extremely remote.

 Michael Yeaman, PhD, 8/1/2020


I have heard that one can get infected through the eyes.  Is it as important to protect your eyes as it is your nose and mouth?

Yes, cases of people contracting COVID-19 infection through the eyes have been reported.  The CDC now recommends that eye protection should be worn by health care providers who interact with patients in areas with moderate to substantial community transmission.

 Scott Filler, MD, 7/31/2020


Is research being done on how long immunity lasts, either from having had COVID-19 or receiving a vaccine?

Yes, research is being done on finding out how long antibodies against the SARS-C0v2 virus last, as well as whether they are neutralizing or not.  Research is also examining the development of memory T cells in the presence and or absence of antibodies against the virus.  The emerging evidence suggests that immunity is developed, both in terms of antibodies and T cells, and that there is some degree of cross reactive immunity with other coronaviruses.  How long will immunity last is still unknown.  For other coronaviruses, immunity usually lasts between 1 to 1.5 years.

 Loren G. Miller, MD, MPH, 7/31/2020


Is it possible that something that appears as a second round of infection is merely the first with a slight remission?


 Scott Filler, MD, 7/31/2020


I take Ocrevus for MS and I’m wondering if it might help me by tamping down my immune response in the event I’m exposed to COVID.

This medication targets B cells expressing CD20 molecules on their surface.  How the medication works is uncertain but it is likely that it down-regulates the function of these cells.  B cells are the cell type responsible for the production of antibodies. Thus, the use of this medication down-regulates immunity and it has been linked to an increase risk for infections, including COVID-19.

 Joaquin Madrenas, MD, PhD, 7/31/2020


If we come down with this, what medicines help it heal?  Why hasn't there been more information on how to handle the disease when someone first gets it?

Currently, the best studied drugs for treating COVID infections are remdesivir and dexamethasone.  Unfortunately, remdesivir can only be given intravenously and so it is not practical to give it to patients who are at the initial stages of infection, before they become very sick.  Dexamethasone works best in patients with severe disease.  Scientists are working on new treatments that can potentially be given to patients as soon as they are diagnosed with COVID, but these treatments are still in development.

 Scott Filler, MD, 7/31/2020


Is it known to what degree a congenital heart defect would make someone high-risk for COVID-19 complications?

It is prudent to say that a person with a congenital heart disease might be at risk for severe COVID-19 but as of July 30, 2020, there is no firm evidence of the magnitude of the risk for severe COVID-19 in a person with congenital heart disease. 

 Joaquin Madrenas, MD, PhD, 7/31/2020