Low carbohydrate diet

The advocates of low-carb diet received a scientific boost recently.

An American trial, published recently in the British Medical Journal, compared the effects of low-carb-high-fat diet with high-carb-low-fat while keeping total calories and protein intake constant.

This elegantly done trial shows that carbohydrates are bad for weight loss. A diet with a combination of low-carb-high-fat content was the winner in this trial and it promoted energy loss and helped maintain weight loss.


Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial.


Are Vitamin and Food supplements safe and helpful?


medical tablets pharmacy cure

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A British man recently ended up needing a liver transplant after taking green tea capsules. (1).(2).

Many people do not realise that supplements can be useless or even harmful. 

Firstly, Dietary supplements may not always be helpful. Even though the Public Health team in England recommend vItamin D supplements, a large study published recently  – found that Vitamin D supplements do NOT prevent fractures or falls in General population. (3) (4).

Secondly, Dietary supplements can be harmful. For example , a cancer prevention trial involving 35,533 North-American men reported that  “Dietary supplementation with vitamin E significantly increased the risk of prostate cancer among healthy men”. (JAMA 2011; 306: 1549).  Another cancer prevention trial in Finland involving 29,133 male smokers unexpectedly found a “higher incidence of lung cancer among the men who received beta carotene dietary supplements”. (NEJM 1994;330:1029 )

On the other hand, Vitamin are essential nutrients. Vitamin deficiency can be severely harmful to health. Vitamin D deficiency is common in colder parts of northern hemisphere. Vitamin D supplements are used in treatment and prevention of osteoporosis (5). Vitamin B12 deficiency is common in Vegans and Vitamin B12 supplements are used. (6).

So there is no clear cut answer ….

Always consider the possibility that “dietary supplements may actually have harmful as well as possible beneficial effects”. 

yellow health medicine wellness

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  1. BBC News – Are supplements safe and do they work? https://www.bbc.com/news/health-45992725
  1. Daily mail: Green tea supplements may cause liver damage, warns EU watchdog. https://www.dailymail.co.uk/health/article-5629791/How-healthy-healthy-EU-warns-green-tea-supplements.html
  1. Public Health England recommends vitamin D supplements in autumn and winter.  BMJ 354 doi:10.1136/bmj.i4061
  1. Guardian : Vitamin D supplements don’t help bone health, major study concludes. https://www.theguardian.com/society/2018/oct/04/vitamin-d-supplements-dont-help-bone-health-major-study-concludes
  1. Vitamin B12 and Health: http://www.lnds.nhs.uk/Library/Vitamin_B12_and_HealthOct2018LNDS123.pdf
  1. National Osteoporosis Guideline Group: https://www.sheffield.ac.uk/NOGG/mainrecommendations.html

Gout: Should you blame your diet or should you blame your parents and ancestors?


Gout is caused by excess Uric acid in blood. It is known for a long time that certain diets increase Uric acid levels in blood.

For Centuries, the common perception is that Gout is mainly caused by poor diet. But this myth has been busted by a recent study published in British Medical Journal.

The study found that

“Seven foods were associated with RAISED serum urate levels (beer, liquor, wine, potato, poultry, soft drinks, and meat (beef, pork, or lamb) &

Eight foods were associated with REDUCED serum urate levels (eggs, peanuts, cold cereal, skim milk, cheese, brown bread, margarine, and non-citrus fruits)”.

But poor diet was NOT found to be the MOST important cause of raised Uric acid levels in this study.

The “Genes” handed down by parents and other ancestors were found to be responsible for raised Uric acid levels and Gout in a significant number of people.

So it’s not you but your parents at fault if you are unlucky to have Gout !!


Major Tanya J, Topless Ruth K, DalbethNicola, Merriman Tony R. Evaluation of the diet wide contribution to serum urate levels: meta-analysis of population based cohorts BMJ 2018; 363 :k3951


Can Vitamin D control prostate cancer?

Vitamin D is also known as the “sunshine vitamin” because it’s produced in your skin in response to sunlight. Vitamin D is critical for bone health and general health.


Low levels of vitamin D in blood have been linked to cancer and other diseases.

But taking Vitamin D supplements to control an existing prostate cancer is controversial.

vitamin D

In  the lab, Vitamin D can stop prostate cancer cells growing and spreading.

One human trial suggested better outcome when high strength vitamin D is combined with standard chemotherapy.  But a second trial involving prostate cancer patients showed an unexpected and unexplained increase in death rate in patients taking Vitamin D with chemotherapy.

So the answer is “no” – Vitamin D cannot be used to control prostate cancer.

Related Links:

1. Sung V. 1,25-Dihydroxyvitamin D3 decreases human prostate cancer cell adhesion and migration. Mol Cell Endocrinol. 2000;164:133–143.

2. Moffatt KA. Growth inhibitory effects of 1α, 25-dihydroxyvitamin D3 are mediated by increased levels of p21 in the prostatic carcinoma cell line ALVA-31. Cancer Res. 2001;61:7122–7129.

3. Double-blinded randomized study of high-dose calcitriol plus docetaxel compared with placebo plus docetaxel in androgen-independent prostate cancer: a report from the ASCENT Investigators. J Clin Oncol. 2007 Feb 20;25(6):669-74.

4. Another Clinical Trial Failure – Ascent-2 https://malecare.org/another-clinical-trial-failure-ascent-2/

5. Randomized, open-label phase III trial of docetaxel plus high-dose calcitriol versus docetaxel plus prednisone for patients with castration-resistant prostate cancer. J Clin Oncol. 2011 Jun 1;29(16):2191-8.




Can Pomegranate fruit control prostate cancer?


Some lab studies have indicated that pomegranate fruit is active against prostate cancer. Unfortunately, three separate patient studies have shown only minor activity  in the form of “slowing down of PSA rise”

So “Eat fresh fruit or Drink fresh juice” if you relish it like any other fruit or juice. If there is any effect on prostate cancer, it would be unexpected bonus. But don’t compel yourself to eat or drink it for therapeutic benefit !

Bear in mind that the pomegranate juice or fruit can interfere with some other medications. And I will also state the obvious that “pomegranate is not an approved cancer treatment”.

Links for further reading:

1. Daily Mail. Pomegranate juice ‘can help fight prostate cancer’. http://www.dailymail.co.uk/news/article-393368/Pomegranate-juice-help-fight-prostate-cancer.html

2. Guardian: Consider the pomegranate.  https://www.theguardian.com/lifeandstyle/wordofmouth/2011/feb/01/consider-pomegranate

3.Phase II study of pomegranate juice for men with rising prostate-specific antigen following surgery or radiation for prostate cancer. Clin Cancer Res. Jul 1 2006;12(13):4018-4026.

4. A randomized phase II study of pomegranate extract for men with rising PSA following initial therapy for localized prostate cancer.Prostate Cancer Prostatic Dis. 2013 Mar;16(1):50-5.

5. A double-blind, placebo-controlled randomised trial evaluating the effect of a polyphenol-rich whole food supplement on PSA progression in men with prostate cancer—the U.K. NCRN Pomi-T study. Prostate Cancer Prostatic Dis. 2014 Jun;17(2):180-6.

6. Is pomegranate juice a potential perpetrator of clinical drug-drug interactions? Review of the in vitro, preclinical and clinical evidence. Eur J Drug Metab Pharmacokinet. 2013 Dec;38(4):223-9. doi: 10.1007/s13318-013-0137-x.



What causes prostate cancer?

The short answer is “bad luck“.


The fact is that we do not know the exact cause of prostate cancer in most patients .

So, at present, we have to say it’s “bad luck” if one develops prostate cancer.

Many things have be shown to be associated with increased risk of prostate cancer.

father son

Sometimes prostate cancer runs in the family and abnormal genes are passed from one generation to other. So it’s “bad luck” if you have inherited the abnormal genes. One cannot change their genes.

Western men are at increased risk compared to the Asians.  Afro-Caribbean men are at much higher risk of developing prostate cancer compared to Caucasians.


Many other factors such as bad diet, obesity, unhealthy life style, smoking, hormones, & inflammation have been suggested as possible risk actors but none of the them have been conclusively proven as the cause of prostate cancer.





How to communicate that the disease is mild even though symptoms are disabling?

women s white long sleeved top

Beth McHugh makes a strong argument for doctors “not to explicitly discuss disease severity scale”.


(1) A valid informed consent would then become difficult

(2) Not discussing severity, is not a practical option for patients with certain illness.

My BMJ eLetter on this topic…

Risk categorisation will continue to be the norm in future as genomic data leads to personalised medicine.

England’s 100 000 Genomes Project

Can milk cause cancer?

blur calcium close up dairy

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A vegan group’s recent advertisement claimed that “cow’s milk contains 35 hormones, including oestrogen … some of these are linked to cancer”.

Advertising Standards Authority (ASA) in U.K banned the vegan group’s advert  as it found the groups claims misleading.

Does the evidence stack up?

First of all, I have to emphasize that “Human Mothers milk” is the best nutrition a new born baby can have…even though it might have various natural hormones.

But “mass produced diary milk” is a different matter.

A large observational study from ” Central Sweden”  found that “High milk intake was associated with higher risk of death and higher fracture incidence in women”. The paper was published in the prestigious BMJ journal in 2014. I suspect the substances used in mass production of diary milk might be the culprit rather than natural milk itself.

So the jury is out on this question. In the mean time, moderation is the key as Cows’ milk does contain many beneficial substances.  Switching to sugary, fizzy drinks or other artifically produed milk alternatives is not sensible either.

Related Links

Milk intake and risk of mortality and fractures in women and men: cohort studies

BMJ Letter: S Sundar. Milk and mortality: the potential effects of modern milk production

Telegraph: Vegan group’s advert wrongly linking cow’s milk to cancer is banned.

Independent: Vegan group’s advert wrongly linking cow’s milk to cancer gets UK ban

Living with cancer…


A cancer diagnosis turns your life upside down. But “Living with cancer” should not bring your professional life to a cliff edge.

Continuing to offer your professional knowledge and expertise not only helps you financially but also boosts your self esteem. But working full time is not an option nor feasible for many cancer patients.

Asteriid,a unique charity, launched by David Shutts, aims to help millions of people living with cancer.

Read the inspiring story of David Shutts at BBC website.

How do you get work when your cancer won’t go away?“.

BBC TV news also featured the pioneering Charity Astriid on its Morning bulletin on 11th May 2018.

To know more about Astriid, please visit: https://www.astriid.org.uk/s/ 

Can alcohol cause cancer?


Can alcohol cause cancer?

Yes,  worldwide, 1 in 20 cancers are attributed to alcohol .

How much drinking causes cancer?

“Even modest use of alcohol may increase cancer risk, but the greatest risks are observed with heavy, long-term use”

“The more that a person drinks, and the longer the period of time, the greater their risk of development of cancer, especially head and neck cancers”

Are light drinkers at risk ?

Risk of cancer is present at  even at low levels of consumption.  Hence, the World Cancer Research Fund/AICR makes the following recommendation: “If alcoholic drinks are consumed, limit consumption to two drinks a day for men and one drink a day for women.” They also recommend that, “for cancer prevention, it’s best not to drink alcohol.”

Is wine less risky than spirits?

No,  the risk is present “regardless of the specific type of alcoholic beverage (ie, beer, wine, or spirits/liquor)”

Which cancers can arise due to alcohol?

Alcohol is causally associated with Mouth, Throat, Gullet, Liver, Breast and Bowel cancers.


  1. Alcohol and Cancer: A Statement of the American Society of Clinical Oncology. http://ascopubs.org/doi/full/10.1200/JCO.2017.76.1155
  2. Alcohol is a direct cause of seven ​​forms of cancer, finds study . https://www.theguardian.com/society/2016/jul/22/alcohol-direct-cause-seven-forms-of-cancer-study



New test for Prostate cancer


Research team from Dundee University are developing  a new scan for diagnosis of prostate cancer.  The technique is non-invasive. This novel scan uses an ultrasound process called shear wave elastography (SWE) to detect prostate tumours.

The team’s leader, Professor Ghulam Nabi claims “Our new method is far more accurate and also allows us to identify the difference between cancerous and benign tissue in the prostate without the need for invasive surgery.”

This exciting project was funded by Prostate Cancer UK with support from the Movember Foundation.

The raw data from the paper abstract does call for caution. The test was done in patients who are already known to have prostate cancer. The test was not use to diagnose the cancer. It was a single centre study which usually calls for caution. How well the scan would perform in ” real world” patients who are yet to be diagnosed with prostate cancer remains to be seen.

Early results from about 200 patients are very promising indeed. The test has enormous potential if it is proven to work in a large scale, multi-centre trial.


  1. The Guardian: https://www.theguardian.com/society/2018/apr/22/prostate-cancer-ultrasound-diagnosis-test.
  2. Daily Mail: http://www.dailymail.co.uk/health/article-5643999/Dundee-scientists-new-non-invasive-ultrasound-detect-prostate-cancer.html.
  3. BBC: http://www.bbc.co.uk/news/uk-scotland-tayside-central-43864875.
  4. Pubmed: https://www.ncbi.nlm.nih.gov/pubmed/29605444


Image credit: Anon




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This blog will be a commentary on health related news with particular focus on clinical studies involving the cancers I treat. (my profile: https://sundar.uk ).

Disclaimers first:

  1. This blog cannot provide personal medical advice. Medicine is incredibly complex and nothing is absolute, and everything depends on individual circumstances. So always consult your own oncologist.
  2. Remember modern medicine is ever changing and the “only thing that is permanent is change itself”. That’s why new evidence sometimes completely contradicts conventional wisdom and practice.  Don’t be surprised if scientific studies contradict each other.
  3. To avoid anyone inadvertently disclosing personal or confidential information, comments will be disabled.
  4. The views expressed here are strictly personal and the views do not in any way whatsoever reflect the views or policies of the many professional organisations I am associated with.