Dr Gopee

Plenty of fruits around: and keep eating them, despite… 

— Dr R Neerunjun Gopee 

Here we go again, I told myself, as I read the following excerpts from an article in the Independent Online UK two days ago titled ‘Simply eating your five a day will not protect you against cancer” (emphasis on ‘not’ is author’s). Here’s the excerpts:

‘It has been a shibboleth of healthy living for decades: eat more fruit and vegetables to beat cancer. Now, scientists have found that the anti-carcinogenic properties of such a diet are weak at best.

In one of the largest and longest studies into the link between diet and the killer disease, scientists surveyed the fruit and vegetable consumption of almost 400,000 men and women in 10 European countries including the UK over almost nine years, during which they developed 30,000 cancers.

They found that eating an extra 200g of fruit and vegetables each day, equivalent to two servings, reduced the incidence of cancer by about 4 per cent. The finding confirms the pessimistic view of a growing body of scientists over the last decade: that the protective effect of fruit and vegetables against cancer is very limited.

It represents a dramatic reversal from 20 years ago, when as high as 50 per cent potential reductions in cancer risk were suggested. The World Health Organisation in 1990 recommended five servings of fruit and vegetables a day.

…But there is still good evidence that fruit and vegetables protect against heart disease and stroke: in the same population of men and women …there was a 30 per cent lower incidence of heart disease and stroke among those eating five servings a day compared with those eating less than one and a half servings.

Separate studies have shown that increasing fruit and vegetable consumption reduces blood pressure, a major cause of heart disease.

…were researchers misled over the decades?’ Apparently no, for ‘Paolo Boffeta of the Mount Sinai School of Medicine in New York, who led the study published in the Journal of the National Cancer Institute (JNCI), said other factors linked with a high fruit and vegetable consumption, such as lower alcohol intake, not smoking and having higher levels of physical activity “may have contributed to a lower cancer risk.”’

But ‘it remains possible that specific foods have preventive effects against specific cancers.’

The authors of the study admit to an issue with methodology that may have had bearing on the earlier conclusions, which were based on a technique known as case-control studies, where there is a problem of recall of what was previously eaten. Since the 1990s these have been replaced by prospective studies, which means recording in real time what the subjects are eating and following them up for a given period to see if they develop more cancers than those who have less servings.

Pretty confounding for the doctor, as it is: one can imagine what effect this has on the layman’s psyche. So what are we to do, concretely?

Well, the bottomline is, and will always remain that we do not and will never know everything about any given condition or situation. Do we know all the factors inside our bodies and outside – in the environment – that cause or give predisposition to the diseases that we most hear about these days and that are not caused directly by microbes, such as heart disease, high blood pressure, diabetes, cancer, depression and so on? The answer is a plain no – and that is why they are called multifactorial, that is the result of several factors, many of which have to do with the where, what, how, why of the way we live our lives. Together these constitute what we call our lifestyle.

This year’s World Health Day, which fell on 7 April, was about urbanisation and its effects on the health of populations. Getting stuck daily in a traffic jam and, in addition to the stress that this generates, being exposed to atmospheric pollution resulting from vehicular traffic is clearly a vastly different lifestyle from working near one’s place in a rural environment with less pollution and more fresh air around. This is just one example out of the myriads that exist about what affects our lives. Besides these possible causative factors, how they actually lead to disease is not fully understood. That is why we get surprises all the time – and no one can explain exactly why they happen, save to hear remarks such as ‘he/she was so well, never expected this,’ when news of some mishap about an acquaintance is received.

All this said, I must make it clear that I have absolutely no doubt that only serious scientific studies can help us to progress, and the fact that science questions and keeps revisiting its own premises is itself an indication and a guarantee that nothing is taken for granted for long and everything is constantly under scrutiny. This is the only way we can learn and make midcourse corrections as it were when new knowledge comes our way. Admittedly this may disturb for a while, but we have to accept that there is no other or better way to live one’s life than one based on sound logic, values and principles.

The realistic attitude, therefore, is that we must have a consistent, reasoned and reasonable approach in everything we do, especially as regards our health. And in the long run the middle path is always the best. For we know that excess is always harmful. As far as fruits are concerned, no normal person will go about eating them telling himself ‘I am eating orange because it contains x amount of vitamin C, melon because it has got such minerals’ and so on and so forth. The consumption of fruits depends on personal preferences, availability, cost, cultural factors amongst others.

Since before the year changed we have been having an abundance of local fruits – mango, pineapple, litchi, water melon, ‘solo’ papaya. For a couple of weeks recently stalls were full of avocado and atte, and currently there’s juicy jamblons, jamalacs and guava to tempt us. Do I care what mineral or vitamins they contain? Of course I do – but not when I have my teeth deep into a juicy guava! Then, the vitamins and minerals can wait – or can get on with their work inside my body for all I care. Life would become a living hell if one were to try remembering numerical contents of this and that instead of enjoying what is at hand – enjoyment also being a critical component of the lifestyle.

The only mystery for me and others I have talked to is: why do the seasonal fruits disappear as suddenly as they appeared in the market, and last for such a short time?

That is the reason why we doctors give general guidance for the population at large, to consume preferably a variety of what is available currently, and it’s only when there is a disease state in a given individuals that nutritionists are called upon to give specific dietary advice.

And best is to remember the poet’s words –

Season of mists and mellow frutifulness,
Close bosom-friend of the maturing sun;
To bend with apples the moss’d cottage trees,
And fill all fruit with ripeness to the core…

Enjoy your fruits – they all contain goodness, one way or another!

RN Gopee

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