The population of India is now over a billion with an estimated 1.5 million cases of cancer diagnosed per year. The population of the United States is 295 million, and yet 1.5 million cancers will be diagnosed this year. The accompanying Table shows that the incidence of breast cancer in the US is 660/million while in India, it is 79/million. Similarly, in the US, prostate cancer accounts for 690 cases/million, while in India, it is 20/million. What is more surprising is that in a country where large numbers of people smoke, and where pollution control is not as good as that in the developed countries yet, the incidence of lung cancer in India is 30/million compared to 660/million in the US. Only Head and Neck, and endometrial cancer rates are comparable between the two countries, the former probably related to the chewing of pan and betel nut in India.



The cause of this discrepancy has been debated, and is felt to be multi-factorial including the genetic predisposition of the subjects, their life-styles, a uniqueness of the geography or the environment or any combinations of the above. The weakest factor in this list of possibilities is that of genetic predisposition. While some diseases are clearly more common in or restricted to certain races ( for example, Jews of Eastern European, or Ashkenazi descent carry the Tay-Sachs gene at a rate ten times that of other Americans), cancer incidence is associated with individual or familial pre-disposition rather than racial predisposition. It has also been suggested that there may be serious under-reporting of cancer cases from the third world countries, making the statistics unreliable. Frequently, patients from the remote and rural parts of the country either do not seek treatment at all, or succumb to the disease before a diagnosis is made, many more preferring homeopathic and Aryuvedic remedies. However, differences are also apparent between Asians and Americans living in the US as shown in the example of cancer statistics for males in Massachusetts:



Similarly, the incidence of cancer differs among the female population:



It is conceivable that cancers unique to an older age group such as prostate or certain hematologic malignancies may not be as common in India because the percentage of the aged population is comparatively lower, but this does not explain the well documented difference in the incidence of childhood leukemias.

Two thirds of all cancers are related to diet. Associations between the two are difficult, if not impossible, to prove because of the formidable number of variables involved. Problems with the American diet are being increasingly appreciated because of the epidemic of obesity. Meats and poultry obtained from animals that have been fattened up on hormones or chemically preserved foods may be factors that contribute to the early onset of puberty in girls, and increasing incidence of chronic diseases like diabetes and cancer. However, another possibility is that Americans not only consume (in large amounts) what is damaging, they also do not eat what could potentially neutralize and protect them against the carcinogenic effects of the former. That protective effect for Indians may be provided by their diet which is rich in spices. Garlic, onion, soy, turmeric, ginger, tomatoes, green tea and chillies that are the staples of Indian cooking have been shown to be associated with a lower risk of a variety of cancers ranging from colon, GI tract, breast, leukemias and lymphomas.

The benefits of spices have been known for millennia. As Alexander the Great was returning home after conquering the known world, the last such place being India, he fell ill and unexpectedly died in Babylon. The University of Maryland researchers have now successfully proved that he died of typhoid. Upon his death, a fight broke out between the Macedonians who wanted to take their native son home for burial and Ptolemy, Alexander’s powerful General, who was heading the conquered Egyptian territory and who wanted to bury him in Egypt. It took almost a year to build a chariot suitable enough for transporting the body out of Babylon, and during this time, Alexander’s body had to be preserved. Interestingly, even though the secrets of mummification were now known to the Greeks because of the conquest of Egypt, the body was actually preserved in spices, white pepper and honey.

Sir Thomas More was beheaded by the order of King Henry VIII and his head was cooked in water before being impaled on a spike and displayed on London Bridge where it stayed for a month, taken down only as more heads began to arrive, eventually being returned to his daughter. Margaret More kept the head with the greatest reverence as long as she lived, carefully preserving it by means of spices. To this day, it stays in the custody of one of his relatives. Since 1500s, the vault containing the head was last opened in 1837, and it was still in reasonably good shape.

Spices have been used for ages as food preservatives. Mothers knew millennia ago that meat spoils quickly in hot climates, and their children died if they ate left-over food. Being a rich source of protein for their children, meat was a precious commodity, especially in hunting gathering days and needed to be preserved. Mothers learnt through experience that adding spices could accomplish this goal. Geographically speaking, the number of spices in food has been shown to be directly proportional to how hot the weather is. In contrast, food is either chemically preserved or frozen in the Western countries. Spices kill germs, and are therefore highly effective as preservatives.

The precise mechanism by which spices prevent the development of cancer is not well understood. Spices are some of the best natural anti-oxidants, and may be acting by protecting the cells from DNA damage. There is a documented association between germs and cancer; estimates are that ~15% of cancers globally are caused by micro-organisms. It is possible that many cancers are initiated by pathogens and spices prevent this from happening by killing off the germs. More importantly, natural substances like onion, garlic, ginger, turmeric, red chilly, tomatoes, and black pepper have now been scientifically proven to interfere with the very intracellular signaling which accounts for the excessive proliferation and loss of maturation in cancer cells. The bio-chemical properties of these substances are being widely investigated now, with over 1000 papers published in highly respected medical journals on curcumin and ginger in the last few years alone. In summary then, spices may act to prevent the various stages of cancer initiation and development through a combination of their anti-oxidant, anti-pathogen and anti-proliferative properties.

Plants of the ginger (Zingiber officinale Roscoe, Zingiberaceae) family, one of the most heavily consumed dietary substances in the world, have been shown to inhibit tumor promotion in mouse skin. The substance called [6]-gingerol is the main active compound in ginger root and the one that gives ginger its distinctive flavor. A review of recently published studies indicate that among a host of other activities, gingerol induces apoptosis (cell death) in leukemia cells, can prevent the development of colon cancer cells, protects against radiation induced lethality and acts as a blood thinner via platelet activation inhibition (similar to an aspirin-like effect).

Curcuma longa or turmeric, responsible for the yellow color of curry powder, is a herb belonging to the ginger family and curcumin is its most active component. Turmeric has been widely used in India for centuries as a panacea for a variety of ailments. In summary, curcumin has been found to interfere with key cellular signaling pathways to arrest the unchecked proliferation of cancer cells, induce apoptosis, sensitize them to radiation therapy, and stop the formation of new blood vessels, a mechanism by which cancer cells are known to spread. These are the very effects desired to achieve growth arrest and eventual regression in a malignant process.

At least 9 clinical studies with curcumin have now been reported in humans in diseases ranging from cancer to rheumatism, uveitis, inflammatory diseases, leukoplakia, metaplasia of the stomach, and as cholesterol-lowering agents. All studies show that curcumin is extremely well tolerated in doses ranging from 4-8 grams/day, although up to 12 Gm/day have also been administered. Clinical responses of varying degrees have been reported in almost all of these clinical trials. Similarly, gingerol has been widely used for its biologic and chemopreventive effects for centuries, with more controlled clinical trials in recent years.

While spices may prevent cancer initiation and expansion, could they also be of therapeutic benefit in already established tumors, especially if given in very high doses? The intuitive answer is that the earlier the treatment is instituted in the course of the disease, the higher the probability. Two obvious possibilities are the pre-malignant conditions marked by abnormal morphology called dysplasias, or established malignancies such as low grade lymphomas and chronic leukemias where the course is so slow that a watch-and-wait policy is usually practiced. Over the ensuing years, the diseases change character, becoming progressively more lethal, at which time intervention is undertaken with aggressive and toxic approaches like radiation and chemotherapies. A good place to start may be the use of these natural substances in such conditions, especially in the earliest stages of disease evolution. The benefit from natural substances is likely to take time, a luxury which cannot be afforded in the case of rapidly growing malignant diseases, therefore the sooner this intervention occurs, the better.

We were curing malaria long before we knew what caused it. It was an empirical observation that victims of malaria who chewed on the bark of the Cinchona tree improved dramatically which led to the extraction and isolation of quinine. If we wait for a complete understanding of every abnormal signal and molecule in a cancer cell, then effective therapies may be a long way off. On the other hand, taking an observation such as the role of diet in preventing cancer can help develop some novel therapies as well as define preventive measures. As evidenced by the campaign against smoking, it will take a long time to bring about the social change required in making major lifestyle adjustments such as alterations in diet. While such changes are essential in the long run, it may be advisable to combine the best of what the East and West offer by using the natural substances to treat earlier stages of cancers and use the latest DNA microarray technologies and the results of the Human Genome Project to understand the precise mechanism of action of these spices.

Studying age old Eastern remedies, or “complimentary” medicine runs the risk of being branded as voodoo. Upon hearing of my current interest in treating cancers with Masala after so many years in cancer research using the most sophisticated scientific tools, a beloved family member in Pakistan remarked in wonder, “But I thought you went to America to become a rich doctor, not a witch doctor!”

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The War on Cancer