The Problem With Research Article Abstracts – Or, How The Rooster Crows To Make The Sun Rise…
By Nurse Mark
Our patients tend to be a well-informed and intelligent group – naturally, they chose Dr. Myatt for their physician! This is a good thing most of the time – but sometimes our patients cause themselves needless worry and alarm when they get out into the great, big, wild, wooly, and unchecked World Wide Web. Newsgroups, support groups, “infomercial” websites, self-appointed “experts” – all clamoring for attention. It can be a confusing, even misleading place out there, much like a carnival midway sometimes: “Hurry, Hurry, Hurry! Step Right Up And Get Your Cure! Today Only Folks – Just For You…”
This question was sent to us by one of our patients, a noted Scientist and a quite brilliant fellow who more than six years ago was told by his conventional doctor to tidy up his affairs as he had weeks, perhaps months at best to live. We are thrilled that he is not only still “with us” but that he is fit and healthy and confounding his conventional doctor.
He is also, like many prostate cancer patients, keenly interested in his condition and deeply determined to learn as much as possible about it. And therein lies the problem.
Dear Dr Myatt,
I hope you have had a very pleasant weekend.
As you know, I have been making a Supershake every morning for breakfast and one of its ingredients is Flaxseed Oil.
I also receive many emails from well informed sources, who are members of a special interest group focused on PCa. (Prostate Cancer) This surfaced the paper below and the associated comment.
You will appreciate that this gives me some concern about the flaxseed oil, which is stated to comprise mainly the alpha-linolenic acid.
Can you provide some published material to rebutt the proposition that this is “bad for PCa”?
This patient goes on to provide us with this link to a Journal article:
from the International Journal of Cancer and quotes the information that was sent to him, highlighting in red selected portions of the text: [edited for brevity - see full abstract at URL above]
Risk factors for prostate cancer incidence and progression in the health professionals follow-up study.
[...] for fatal prostate cancer, recent smoking history, taller height, higher BMI, family history, and high intakes of total energy, calcium and alpha-linolenic acid were associated with a statistically significant increased risk. [...] Tomato sauce (inversely) and alpha-linolenic acid (positively) intakes were strong predictors of advanced cancer among those with low-grade cancers at diagnosis[...]
An associated comment (presumably of the person from the support group who found and forwarded this information)
“It’s the alpha linolenic acid that is the ALA that is not good for prostate cancer. Alpha lipoic is OK.“
Interestingly, this abstract does contain a gem of information that appears to have been under-appreciated:
[...] The complexity of the clinical and pathologic manifestations of prostate cancer must be considered in the design and interpretation of studies.
Wow – How Very True!
Dr. Myatt responded to this fellow with the story below:
Once upon a time, a man decided to do research to find out what makes the sun rise in the morning.
Every day, a half hour before sunrise, he dutifully awakened and sat outside in a lawn chair, recording his observations.
Every day for that entire year, whether it was cloudy or clear, he heard a rooster crow in the distance. Sometimes ten minutes before the sun came up, and other times five minutes before the sun came up, but the rooster always crowed.
After a year of observation, the man was confident that he had solved the mystery of sunrise. He published a scientific paper titled “Sound Correlates to Sunrise: What Makes the Sun Come Up?” The abstract (a pseudo-scientific term for “article summary”) said something about “cock’s crowing unequivocally associated with first light of dawn.”
The article title and abstract were quoted in numerous internet forums. The media picked up on the article, and headlines read “Rooster’s Crowing Responsible for Sunrise.” Because the article had been published in a scientific journal — The Journal of Improbable Results —- everyone knew that the information must be trustworthy.
People started to panic. What if something happened to the Rooster? Would the sun stop rising every morning? Was it a special rooster, or perhaps a particular breed of rooster, that caused sunrise? Should the rooster be a protected species? Would we experience another ice age if anything happened to the rooster? Or worse, would life as we know it cease to exist without the rooster bringing the sun up each day?
The stock market fluctuated drastically as a result of this report. New companies were formed to develop alternate technologies in case the sun failed to rise. Cryonic research was started to preserve the rooster should anything happen to him. And many people lived in fear of the worst, which seemed reasonable in view of these new findings.
Of course, very few people actually read the research paper itself. Why bother when the abstract clearly stated that “cock’s crowing unequivocally associated with first light of dawn”? Besides, scientific journal articles are usually only accessible through a paid subscription to the journal, or at least a pay-per-view of the article.
Several people did actually read the full article, but they had no background in improbable results research and so didn’t understand what they were reading.
One specialist read the article and began to laugh uncontrollably, for it was clear to her that the entire panic was unwarranted. First, the study was “observational,” not interventional. Just because the rooster crows before sunup doesn’t “prove” that the crowing causes sunup. And she found that no studies had been done (or even planned), to silence the rooster and see if the sun would come up without his help.
Although she tried to explain to her worried constituents that the reports of the study were far over-blown and not necessarily accurate, the mass hysteria created by headlines and “abstracts” was too great, and most people chose to remain in a state of panic and confusion rather than systematically evaluate the evidence.
And so it is with the headline and abstract you forwarded to me she continued…
First, do you suppose that the person who posted this abstract read the article? Seeing as how the abstract is “ahead of print” and the article is a “pay-per-view,” I’m betting NOT. Further, unless one knows how to read and interpret medical science (not just any science), they still might not know what they were looking at.
Do you suppose the person posting this article even knows what study the “conclusion” is drawn from, or if it is a viable conclusion? Again, I’d bet money that this is not the case.
The study from which this sweeping statement is drawn is called the “Health Professionals Follow-Up Study,” a project that has been going on since 1986. Over 50,000 male medical professionals (doctors, dentists, veterinarians) have been receiving surveys for the past 20+ years, and that’s the study. Like the “rooster and sunrise study,” it is an observational study only. Individuals and groups seeking grants related to this study must continue to “make something” of the results in order to continue receiving funding. There’s always a “rooster article” to be found in any set of data!
Now, here’s the “inside scoop” (the one few bother to look into before they post an abstract on a forum, or read an abstract and get their knickers in a knot about a single sentence of illogically-drawn “conclusion”…)
So what is the True story about ALA’s and Prostate Cancer?
ALA’s and flax seed oil are being declared guilty by being at the crime scene, rather than actually being the criminal. (Sort of like saying that white blood cells cause infection because you almost always find them at sites of infection; or saying that flies cause garbage because…)
To fully understand this, let’s use both common sense AND biochemistry (both of which I find often lacking when someone posts an “abstract” with one sentence highlighted on a forum….)
First, the Common Sense (Oh, NO! NOT common sense! Don’t make me go there!)
For all but the most recent of human existence, we have eaten foods with an omega-6 fatty acid (linoleic acid and arachidonic acid) to omega-3 fatty acid (DHA, EPA, and alpha-linolenic acid) of about 1:1 to 2:1. Over the last 50 years, however, that ratio has changed to 20:1 or even 30:1 and in some cases as high as 50:1.
Modern diets now include HUGE amounts of highly refined Omega-6 oils extracted from plants (corn oil, safflower oil, cottonseed oil, peanut oil, and soybean oil) and used for cooking. These oils are all high in the omega-6s fatty acids but also contain some amount of O-3 fatty acids. At the same time, we have dramatically decreased our intake of omega-3 fatty acids (found primarily in whole grains, beans, seeds, and seafood). The Omega-3′s we DO eat are typically “secondary” to the omega-6′s in food, and are cooked or highly refined.
Biochemical side-note: Omega 3′s and Omega 6′s (polyunsaturated oils) are dramatically altered when heated. THEY ARE NOT THE SAME SPECIES of oil once they are heated, and their health benefits literally evaporate with cooking. SO… talking about Essential Fatty Acids is really an incomplete discussion without addressing whether or not the oils are the “parent oils” (unheated) or whether they are damaged EFA’s. But I digress with science… back to common sense…
In this same 50-year period that our intake of parent EFA’s (both O-6 and O-3, but especially O-3) has dramatically decreased, the rates of prostate cancer have soared. (The incidence of prostate cancer in Uruguay, one of the more frequently-referenced “ALA’s are associated with prostate cancer” studies, has increased nearly 80% in the past 50 years. It should be noted that the diet in Uruguay is largely comprised of meat (a major dietary source of ALA), dairy, a lot of food fried in refined cooking oils such as canola (a major dietary source of ALA, and remember that heating ALA makes it an entirely different “beast”) and virtually no flaxseed or unheated cold-processed flax oil.
Common sense would tell us that we’ve been doing something wrong over the last 50, especially in regard to prostate cancer. Here are some things that have changed in our oil consumption:
1.) We get most of our Omega-3 fatty acids from foods that are quite high in Omega-6 fatty acids, thereby altering the 1:1 or at most 2:1 ration of O-6 to O-3 that used to comprise a “natural diet. As a result, yes, we’re getting more O-3 (especially ALA) but a LOT MORE O-6. It is important to understand that all fat-containing foods have a variety of different types of fats, not just one type. For example, Canola oil is considered a high Omega-3 fat, but it actually contains omega 3s, 6s, and 9s. Meat contains both saturated fats and also unsaturated omega-6s and 3s.
2.) Most of the Essential Fatty Acids (both O-6 and O-3) that are consumed today have been heated or chemically extracted. These polyunsaturated oils are quite fragile, and heating and refining them makes them a completely different “species” of oil. If we are not consuming “parent” (undamaged) EFA’s, then we are comparing apples to oranges.
3.) Refining oils removes many of the associated nutrients (phytochemicals) and fiber. Remember that I originally advised you to use ground flax seed meal instead of flax oil, or second best, high lignan flax oil. Lignans are a special class of fiber with potent anti-cancer properties.
4.) Vegetable oils (even ones that are uncooked) go rancid quickly. Again, a rancid EFA is an entirely different “species” than an undamaged “parent” EFA.
Ah, but listen to the untutored who take every sentence from a “scientific study” (to use the term loosely) and you’d think that eating raw, natural O-3 ALA’s in the form of flaxseed was single-handedly responsible for the rise in prostate cancer. What a serious perversion of the truth!
Next, Let’s Look at the Medical Science
In spite of a few spurious “rooster and sunrise” studies to the contrary, the vast majority of scientific studies show a positive outcome using flaxseed and Omega-3 parent oils in cancer patients.
A Duke University Medical Center study found that flaxseed and a low-fat diet helped men reduce the risk of prostate cancer (1, 2). The conclusions of the study were that even short-term changes to a high-fiber/flax supplemented diet resulted in prostate cancer cells that didn’t divide as quickly as those in people not on the diet. “I really didn’t think we’d have results like we did, because this was a diet and not drug intervention,” said Wendy Demark-Wahnefried, associate research professor in the department of surgery at Duke.
A Kaiser Permanente study concluded that it was not total fat intake per se which relates to prostate and colon cancer but instead the type of fat, plus increasing exercise, that was associated with lower cancer risk. The “type of fats” recommended are from uncooked plant sources (which would be “parent” O-6′s and O-3′s). The American Cancer Society guidelines concur with these recommendations (3).
A Korean study found that the ratios of serum O-3 to O-6 were highly correlated with prostate cancer. Men with prostate cancer also had significantly higher levels of O-6 acids than did men with BPH and those with normal prostates. The researchers concluded that omega-6 polyunsaturated fatty acids have a tumor-promoting effect while omega-3 acids have a protective effect. (4).
And While We’re On The Subject of Biochemistry….
The Fate of ALA in the body is that it is converted to DHA and EPA, two forms of fat which have a HIGH correlation with protection from cancer. Aye, but here’s the rub:
O-6 and O-3 (and O-9, for that matter) all use the same delta-6-desaturase enzyme for their conversion. When O-6 levels are high, O-3 is not so readily converted to DHA and EPA. Since DHA and EPA are protective substances, high O-6 can interfere with conversion. (A probable mechanism whereby high O-6 levels increase cancer proliferation, by interfering with the body’s use of protective O-3).
Trans fats, high insulin levels and damaged polyunsaturated oils all interfere with the desaturase enzyme.
And Now the Particular Study That This “Rooster Crowing Causes Sunrise” Abstract Was Taken From…
The “Health Professionals Follow-Up Study” has been ongoing since 1986. A group of 50,000+ male health professionals (doctors, dentists, veterinarians, etc.) have been sent questionnaires every two years since 1986. That makes this “study” an observational one (like getting up to watch the sun rise), not an intervention study. As we discussed, finding white blood cells at the site of an infection is not proof that WBC’s cause infection (we know they don’t, but instead are attempting to “clean up” infection). The rooster crowing before sunrise does not prove that His Nibs’ noise brings the sun up, either.
There is NO PLACE in the Men’s Healthy Study questionnaire that asks about specific foods that contain largely ALA, or ALA supplements or flaxseed. You can view the actual questionnaire here: http://www.hsph.harvard.edu/hpfs/pdfs/04L.pdf
If you want to see the food and supplement questions they have asked about over the years (the form is sent every two years), access it here: http://www.hsph.harvard.edu/hpfs/hpfs_qx_diet.html
Higher levels of ALA as ascertained in this study are from meats (a specific question on the form), especially fried meats. This, of course, also increases intake of O-6. And remember, a cooked polyunsaturate bears no resemblance to a “parent” EFA, questions which aren’t touched on in this study.
The Bottom Line (and Many Medical Scientists Concur)
If you look at all of the evidence, both historical and scientific, (plus use some common sense) there is not one shred of “proof” that “parent” Omega-3 fatty acids as derived from flax seed and flax oil contribute to increased prostate cancer risk. In fact, just the opposite is true. The real risk is from highly processed vegetable oils (yes, containing ALA), that bear little resemblance to parent Omega-3 oils (native ALA’s).
Not only do these heat and chemically-processed ALA’s bear no resemblance to parent ALA’s, they do not help to improve the highly imbalanced O-6:O-3 ratios characteristic of our “evolved” diets.
But isn’t it better to be safe than sorry and avoid ALA’s? I don’t believe so. As I mentioned earlier, that would be like blaming white blood cells (WBC’s) for infections, and seeking to eliminate them instead of (or in addition to) the offending bacterium. Blaming the white blood cells and then trying to get rid of them — “Maybe it’s true and maybe it’s not, but just to be on the “safe side” we should get rid of the WBC’s at the site of an infection,” is NOT a benign mistake.
The big problem with “warnings” about flax and flax oil is that they condemn a valuable component of cancer prevention and treatment based on faulty information and also let the real killers (highly refined O-3′s and O-6′s plus an imbalanced O-3:O-6 ratio) go Scott-free.
If you’re concerned about flax oil, you can always rely solely on fish oil for your DHA and EPA’s. However, you’ll be missing out on the cancer-protective lignans (a type of fiber that is difficult to obtain in sufficient quantities outside of flax seed).
1.) Pilot study of dietary fat restriction and flaxseed supplementation in men with prostate cancer before surgery: exploring the effects on hormonal levels, prostate-specific antigen, and histopathologic features. Urology. 2001 Jul;58(1):47-52.
2.) Pilot study to explore effects of low-fat, flaxseed-supplemented diet on proliferation of benign prostatic epithelium and prostate-specific antigen. Urology. 2004 May;63(5):900-4.
3.) Dietary fat and cancer.Am J Med. 2002 Dec 30;113 Suppl 9B:63S-70S
4.) Comparison of fatty acid profiles in the serum of patients with prostate cancer and benign prostatic hyperplasia. Clinical Biochemistry, Vol. 32, August 1999, pp. 405-09.
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