Stool DNA Test for CRC Is Improving

by Caroline Helwick
San Francisco—New-generation stool DNA testing for colorectal cancer (CRC) screening offers “extraordinarily” high detection rates for cancers and precancers that are likely to progress, said David Ahlquist, MD, professor of medicine, Department of Gastroenterology and Hepatology at the Mayo Clinic, Rochester, Minn., who helped develop this approach and presented recent findings at the 2012 American Society of Clinical Oncology (ASCO) Gastrointestinal Cancers Symposium.

The broad application of stool DNA testing in longitudinal screening programs is to prevent CRC through high precancer detection. In an invited lecture at the ASCO meeting, Dr. Ahlquist said this claim is “not too bold and not hyperbole.”

Stool DNA testing detects tumor-specific DNA alterations in cells that are continually being shed into the stool from precancerous and cancerous lesions. The test detects lesions on both sides of the colon with equal accuracy and reveals flat or serrated polyps likely to be missed by both fecal occult blood tests and colonoscopy. Stool DNA testing is noninvasive, involves no diet or medication restrictions, does not require bowel preparation and is done at home using a stool sample.

“It is user-friendly, affordable and offers individuals unlimited access by mail,” Dr. Ahlquist said.

The test is being developed by Exact Sciences, a molecular diagnostics company in Madison, Wis.

Dr. Ahlquist and colleagues published the results of a multicenter, blinded study that measured the new test’s effectiveness in the February issue of Gastroenterology (Ahlquist DA et al. 2012 142:248-256). The study included 678 individuals, 253 of whom had CRC and 130 who had advanced adenomas. The investigators found that the test detected 85% of nonmetastatic CRCs and 64% of adenomas 1 cm or larger. Lesions were detected in the proximal and distal colons with equal accuracy, 87% and 83%, respectively, for cancerous lesions and 55% and 53%, respectively, for adenomas 1 cm or larger.

Dr. Ahlquist noted that this detection sensitivity rate increases over time with repeated tests, much in the way that cervical cancer screening becomes more beneficial as it is employed sequentially over time. Additionally, detection sensitivity increased as adenoma size increased: 64% for adenomas 1 cm or larger, 77% for those larger than 2 cm, 86% for those larger than 3 cm and 92% for those larger than 4 cm. (Less than one-third of adenomas smaller than 1 cm were identified).

“This is most important,” he said. “As a polyp grows, the risk for transformation to cancer increases, and the sensitivity of this test increases in proportion.”

Stool Test Versus Plasma-based DNA Test

Dr. Ahlquist and colleagues also recently compared the stool DNA test with a commercially available plasma test for methylated Septin 9 (SEPT9); they found the stool DNA test to be superior (Ahlquist DA et al. Clin Gastroenterol Hepatol 2012;10:272-277). The stool DNA test detected 82% of large adenomas and 87% of CRC, whereas the plasma test detected 14% and 60%, respectively. False-positive rates were almost four times higher for the plasma test (7% vs. 27%, respectively).

Final validation of the stool DNA test’s accuracy is under way in a multicenter study, the results of which should support FDA approval, Dr. Ahlquist said.

“The data are very impressive. I’m surprised and delighted at how good the test is,” said Richard Goldberg, MD, physician-in-chief at The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Institute of Ohio State University Medical Center, in Columbus.

“I was a bit surprised that the methylation was so good because of the heterogeneity of CRC evolution,” added Dr. Goldberg, who chaired the ASCO meeting’s steering committee.

Dr. Ahlquist noted, “We did deep sequencing of the CpG island and found within the island there were certain base sequences that were never methylated in normal tissue but highly methylated in cancerous and precancerous lesions. We redesigned the capture and the primer sequences to yield a very specific approach. One of the criteria we applied was no methylation—zero—in normal tissue.”

Dr. Ahlquist added that an optimized multimarker panel includes DNA screening plus fecal immunochemical testing for hemoglobin. In a case–control study of 78 cases and 278 matched controls presented in an industry seminar at the 2011 annual meeting of the Association for Molecular Pathology, the assay showed 98% sensitivity for cancer and 64% sensitivity for adenomas greater than 1 cm at a specificity of 91%.

The assay also will be affordable, Dr. Ahlquist said.

“The goal has been for this to be an everyman’s test. I would like to see it cost less than $300,” he said. “And this will be just the tip of the submerged iceberg,” he added. “The reduction in false-positives and the effect of cancer prevention are all enormous downstream cost burdens that could be lightened with this approach.”

Dr. Goldberg noted that, if the test pans out and is used as a substitute for widespread screening, the cost savings would be substantial.

“This is potentially a very exciting development,” Dr. Goldberg said.

Management Revenue Group, LLC

“Large enough to serve; Small enough to care!”™
http://www.mrg-llc.com

"Gut"-Throat Competition: U-M Research On Digestive Tract Bacteria Yields Surprising Findings

From tiny villages in developing nations to suburban kitchens in the United States, dangerous strains of E. coli bacteria sicken millions of people each year - and kill untold numbers of children.

http://news.yahoo.com/gut-throat-competition-u-m-research-digestive-tract-190807302.html

H. Pylori - Friend or Foe in Cancer risk http://agajournals.wordpress.com/2010/06/30/h-pylori—what-makes-it-a-friend-or-foe-in-cancer-risk/

http://agajournals.wordpress.com/2010/06/30/h-pylori—what-makes-it-a-friend-or-foe-in-cancer-risk/

True Story: Doctor Says “Don’t Eat Wheat Ever Again”

True Story: Doctor Says “Don’t Eat Wheat Ever Again”

Insanity: Managing Symptoms and expecting a cure…

We all fool ourselves from time to time in order to keep our thoughts and beliefs consistent with what we have already done or decided.  This is called the consistency principle.  Once we have made a choice or taken a stand, we will encounter personal and interpersonal pressures to behave consistently with that commitment. Those pressures will cause us to respond in ways that justify our earlier decision.  “managing symptoms” never cured any underlying cause…

How doctors fool themselves

The consistency principle is hardwired into us as a valued social trait. A high degree of personal consistency is associated with personal and intellectual strength.  Lack of consistency is often perceived as indecisiveness, confused, two-facedness, and even untrustworthy.  Consistency makes life easier.  Once we navigate our way through an issue, stubborn consistency allows us to "not think about the issue" anymore.  We no longer have to sort through information or weigh pros and cons. We simply act consistent with our earlier decision and expend our energy thinking about "new" things and most of the time this actually works quite well for us.

It only becomes a problem when we stubbornly lock into an erroneous position.  Here is 1 of MANY examples:

Statin drugs

Statin drugs are a great myth that doctors buy into en masse even when conclusive data proves they don't work except in very limited circumstances.  What's worse is they are nowhere near as safe as promoted.  For a long time, scientists have known that cholesterol-regulating drugs can cause structural damage to muscles.  They were convinced it only affected a small number of people. Maybe 10-15% of patients develop muscle pain and weakness, but after they stop using the drugs, only one in 50 report continual or debilitating pain.

This is the "rare but serious muscle side effect" that is quickly mentioned at the end of Lipitor ads.  More recent studies have found these side effects are anything but rare. A 2009 Canadian Medical Association Journal study found that the standard CPK test used by doctors to establish muscle damage is highly inaccurate and dramatically underestimates the scope of the problem.  This study found that more than half of all people who use statin drugs show structural damage to muscles when more accurate biopsy analysis is used.   50% does not qualify as "rare." According to a 2006 study published in the Journal of Pathology, virtually all patients who take statin drugs experience muscle damage, even if they don't have pain.

And yet doctors continue to hold onto the myth that statin drugs are relatively free of side effects.  As a side note, supplementing with CoQ10 will eliminate most of the muscle damage.  If your doctor recommends using statin drugs and does not insist that you also supplement with CoQ10; consider finding another doctor.

But muscle damage is not the biggest problem with statin drugs -- nor connected with the biggest myth doctors have bought into.  A study sponsored by Merck and Schering-Plough, the manufacturer of Vytorin, found that after several years on two types of cholesterol-lowering medications, patients reduced their cholesterol levels, but they reaped no significant health benefit at all unless they already had heart disease. The bottom line is unless you’ve had a heart attack, statin drugs will not provide a single health benefit; they will not extend your life one single day.

Doctors continue to prescribe Statins like candy.  In 2010, AstraZeneca received permission from the FDA to sell Crestor as a "preventative" measure to an additional 6.5 million people -- none of whom actually have cholesterol or heart problems. That's right, the FDA authorized doctors to pitch you a solution that doesn't work, that causes muscle damage to virtually everyone using it -- just as a preventative…that doesn't actually prevent anything. And the medical community accuses the alternative health community of not being science based!!??

What can be done about it?

We could go on and on. While the list of examples is not endless, it certainly is large. The purpose of this is not to beat up on mainstream medicine but to offer insight as to why so many of the untenable health positions they maintain are so hard to let go of.  Also, that given that awareness, you will be able to apply a mental speed bump before automatically giving in to the advice of authority figures.  Just because doctors rank high on the pecking order of “Authority Figures”; it does not necessarily make their positions correct. As we have seen, they are very human and can hold onto absurdity in the service of consistency. In fact, they are more likely to do so than most because admitting a mistake would undermine that authority.

H2Blockers and Antacids cure nothing; they stop you from producing acid which is critical to optimal health.  GERD or acid-reflux is not a disease; it’s a symptom.  You don’t have too much acid, you have too little.  How can we prove that?  INCREASE your acid level when you experience GERD, Heartburn or acid-reflux and see what happens.  The sensation evaporates.  Big Pharma is in the business of being a “legal” drug pusher and they don’t sell cures for anything.  They sell pills to manage symptoms.  If they had a pill that “cured” anything then it would have to cost a fortune as they would only sell you one and you would be cured.  When your physician has run the course of what they know to do from a diagnostic standpoint and they haven’t found the “Cause” of your symptoms then they do what they have done consistently: put you on pills to manage your symptoms.

It is up to you to break that program automatically running in your head with respect to your wellbeing that grants them a wisdom in "all things" related to health that they do not necessarily warrant. Use your discrimination and only accept what you're told when the evidence truly warrants it.  If it "feels" wrong, it probably is wrong no matter how many authorities say otherwise.  Do your own research and seek out your own answers being ever mindful of the motivations of the people providing the information.  Remember, “managing symptoms” never cured any underlying cause…

Management Revenue Group, LLC

“Large enough to serve; Small enough to care!”™
http://www.mrg-llc.com

Acid blocking medication: a good or bad idea?

Is offsetting bad lifestyle and food choices with acid blocking medication a good or bad idea?     

   It’s probably a bad idea, but that is not going to stop Americans from doing it or pharmaceutical companies from advertising for it.  Research is finding that in the decades to come some of these people may suffer from unresolved anemia, bone loss, depression, impaired detoxification, and other chronic problems. Big Pharma doesn’t mention that in the commercials — all you see is a smiling fat man finishing off a plate of BBQ ribs and assuring us not to worry because he takes drug X.

Prescriptions and over-the-counter (OTC) medications have become the mainstay of therapy in acid-related, upper gastrointestinal disorders.  I think there are some people who need these medications, but I have a strong feeling many people could get relief with some diet and lifestyle changes – much more work than popping a pill.  As a nutritionist, I am concerned with the nutritional implications of blocking stomach acid long term. There are many nutrients that depend on a low-acid environment for absorption. Here are three nutritional areas I think about when someone uses acid blocking medication.

Minerals – Reduced mineral absorption due to acid blocking medications is well documented and has sound theoretical support from basic chemistry.  The dissociation of calcium complexes from food and the liberation of calcium salts are dependent on a low pH.   Research has noted increased risk of hip fractures in elderly women on long-term Proton pump inhibitors (PPI) intake.  In a study with 13,556 hip fracture cases and 135,386 controls, the risk of hip fracture was increased in patients on long-term high-dose PPIs and increased with duration of treatment. They even found significant associations after just one year of PPI treatment.  Suppression of gastric acid has also been shown to reduce intestinal absorption of zinc and other minerals.  Zinc is essential in enzyme functions and amino acid breakdown.  The consequences of inadequate mineral absorption could be significant to overall health.

Anemia – In patients with refractory anemia, once gastrointestinal blood losses have been excluded, intestinal mal-absorption should be the next area to be investigated.  Acid is important for absorption of dietary iron.  Hypochlorhydria also affects the absorption of vitamin B12.  It is protein bound and released in the presence of acid and pepsin. Thus, patients with increased stomach pH are at risk of both iron deficiency and megaloblatic anemia.  So if you have a patient with unresolved anemia, don’t forget to ask if they are taking acid blocking medication.

Amino acids – Lastly, acid secretion facilitates protein and lipid digestion.  Pepsinogen, the most potent protease (an enzyme that breaks down protein), is activated under acidic conditions below a pH of 4.  So hypochlorhydric patients may have impaired digestion of proteins.  Earlier research simply looked to see if there was a decrease in muscle mass, but newer research is looking at the effect of low levels of individual amino acids.  The possible lowering of tryptophan, tyrosine, and phenylalanine in the blood may be a precipitating factor in depression in hypochlorhydric patients.  It’s also important to think about the other functions of amino acids, such as building proteins and detoxification.  In patients who take acid blocking medication, it is advised to test for these nutrients instead of doing a diet assessment, because they may get enough nutrients but may not absorb them efficiently.

Performing a red blood cell mineral test can identify your mineral status; checking methylmalonic acid (MMA) can identify a functional need for B12; performing a plasma amino acids test can show levels of individual amino acids.  Besides nutritional concerns, there are many others such as bacterial overgrowth, acid sensitive feedback regulations, effects on hormones, and increased risk of intestinal infections.

Management Revenue Group, LLC

“Large enough to serve; Small enough to care!”™

for more information email CustomerService@mrg-llc.com

   

Killing Me Slowly With His Pills

FDA NEWS RELEASE: PPI Warning

For Immediate Release: May 25, 2010
Media Inquiries: Elaine Gansz Bobo, 301-796-7567, elaine.bobo@fda.hhs.gov
FDA: Possible Fracture Risk with High Dose, Long-term Use of Proton Pump Inhibitors

The U.S. Food and Drug Administration today warned consumers and health care professionals about a possible increased risk of fractures of the hip, wrist, and spine with high doses or long-term use of a class of medications called proton pump inhibitors.           

Yes folks, that right; the pills you pop based on the constant ads you are bombarded with have serious negative side effects!  In fact, here is the warning directly from one manufacturer’s website:

The following instructions are taken directly from www.Prilosecotc.com:              

14-Day Course of Treatment:  Swallow 1 tablet with a glass of water before eating in the morning;  take every day for 14 days; do not take more than 1 tablet a day; do not chew or crush the tablets; do not crush tablets in food ; do not use for more than 14 days unless directed by your doctor

Repeat 14-Day Courses (if needed): You may repeat a 14-day course every 4 months; do not take for more than 14 days or more often than every 4 months unless directed by a doctor

But you say, “This can’t apply to me because my physician prescribed these pills.”  Folks, when the physician runs out of diagnostic tools to help them determine what is the ROOT CAUSE of your SYMPTOMS, the physicians have no other choice but to push drugs and try and manage your symptoms.

By eliminating the acid in your stomach, they are effectively stripping you of your mainline, internal defense against Bacteria, Parasites and Fungi.  Stomach acid is also a critical component in the process of digestion and absorption of essential nutrients.

The paradox:

Having sufficient stomach acid keeps the valve to the esophagus closed so it cannot be harmed by stomach fluids. When the stomach produces acid it also produces bicarbonate of soda.  Bicarbonate of soda is what protects the stomach lining from being damaged by the acid. Therefore, it stands to reason that IF the stomach is not producing sufficient acid it also won't be producing enough bicarbonate of soda to protect the stomach/esophagus and this will allow ulcers to form.

So what can you do?  If you are going to have an Endoscopy (this is where the physician goes in for a look see from the top) then demand that the tissue sample they are testing is sent to TZAM Diagnostics.  That lab does PCR testing for H. pylori.  Their Multiplex PCR test is astoundingly better than any other testing option; it finds what the other miss.

If you have already had the “look see” from the top (and/or from the bottom) and you are now on pills; demand that your physician (Gastro or Primary) orders the MetaMetrix 2100 Profile.  This is another patented PCR based test that looks at ALL of the Bacteria, Parasites and Fungi that might infect your Digestive System.  If your issue isn’t H. pylori then there is something “bugging you” and this test will help identify that for nearly everyone.  It’s non-invasive (done on stool) and has helped over 100,000 people find out what is keeping their lives turned upside down.

Remember, pills for symptoms promote the status quo.  What you need is a cure for the cause…

Management Revenue Group LLC - "Large enough to serve, Small enough to care"
customerservice@mrg-llc.com