0xWTF
4 days ago
Hi, your friendly, local pathologist here. I'm the kind of doctor that diagnoses liver diseases, cancer, lots of infections, inflammatory processes, benign tumors, and runs the lab that a lot of other doctors use the results from to inform a lot of their other decisions.
If you really want to learn about this stuff, Robert Weinberg's The Biology of Cancer is where to start. It introduces concepts starting where a high school student could understand and carefully walks through the history of our development of knowledge until, by the end, the pithy chapters are helping novel concepts for real science flower in your brain all on their own. It's the best book of biological science I have ever read. 10/10, will read again.
hobo123
4 days ago
Pathology... reminds me of all those studies with accident victims all over the world (and often as early as the 70s - today's numbers are likely much worse) that show 30% or half the population being liver-toxic in vitamin A (in all age groups). Lots of health problems are simply downstream from that.
Melatonic
4 days ago
Why would that many people have so much vitamin A ?
pieter_mj
4 days ago
It needs to be balanced with vitamine D not taken as a supplement but by having it (an all metabolic products downstream) produced by being outside in sunlight providing a natural dose of UVA & B. If vitamine A is not balanced by D, it can be considered to be toxic. 90% Indoor living as is the case nowadays in many developed countries is deadly.
hobo123
4 days ago
Consuming lots of dairy (including fortified), lots of colorful veggies every single day year round, maybe adding multivitamins, fortified flour. Then there's the liver hype in some circles.
theoreticalmal
4 days ago
“High intake of provitamin carotenoids (such as beta-carotene) from vegetables and fruits does not cause hypervitaminosis A.”
From Wikipedia
jodrellblank
4 days ago
Your Wikipedia page references a paper in footnote 21 which says:
> "In developing nations, however, 70–90% of vitamin A is obtained from provitamin A carotenoids in plant foods"
and
> "Whereas retinoic acid can be produced from excentric cleavage of β-carotene in humans (31), it is generally considered a minor contributor to circulating concentrations, at least in normal, healthy persons"
Google tells me that "Two pathways have been suggested for the conversion of carotenoids to vitamin A in mammals, central cleavage and excentric cleavage".
Carotene conversion cannot both be "a minor contributor" to body levels of Vitamin A and also the main way billions of people get Vitamin A. So my guess is the Wikipedia page has mistakenly taken 'excentric cleavage' to be the only conversion method. Still, ignoring carotenes entirely, the referenced paper also says:
> "observational studies suggest that more than 75% of people may be routinely ingesting more than the recommended dietary allowance (RDA) for vitamin A"
yorwba
4 days ago
The entire paragraph containing your first quote:
> "Dietary vitamin A is obtained from preformed vitamin A (ie, retinyl esters from animal foods, fortified foods, and pharmaceutical supplements) as well as from provitamin A carotenoids from plant sources. Preformed vitamin A is efficiently absorbed and utilized by humans at absorption rates of 70–90%. Up to 75% of dietary vitamin A in Europe, the United States, and other industrialized nations is preformed vitamin A (1, 2), which is largely derived from multivitamins, fish liver oil, and the fortification of foods such as milk, butter, margarine, breakfast cereals, and some snack foods. In developing nations, however, 70–90% of vitamin A is obtained from provitamin A carotenoids in plant foods. These are absorbed much less efficiently, at rates of 20–50%, depending on each person’s vitamin A status and other dietary and nondietary factors (3, 4). The cleavage of provitamin A carotenoids to retinal is a highly regulated step, and vitamin A toxicity from provitamin A sources is largely impossible. In contrast, absorption and hepatic storage of preformed vitamin A occur very efficiently until a pathologic condition develops."
jodrellblank
4 days ago
Indeed, but they neither explain nor cite what they mean for it to be "highly regulated" or how/why that means toxicity is largely impossible.
If you take "the cleavage of provitamin A carotenoids" and Ctrl+F for 'cleavage' or 'carotene' in that paper, the only other mentions are this:
> "An acute elevation of retinoids other than retinyl esters—eg, retinoic acid—occurs after the ingestion of a large amount of vitamin A, possibly because the intestinal absorptive capacity is overwhelmed, which leads to the oxidation of retinol to retinoic acid by the intestinal enterocytes (30) and to the rapid formation of retinoic acid from retinol in certain cells (5). Whereas retinoic acid can be produced from excentric cleavage of β-carotene in humans (31), it is generally considered a minor contributor to circulating concentrations, at least in normal, healthy persons."
That is, they only seem to be talking about excentric cleavage and not central cleavage. My limited understanding is that beta-carotene is roughly two retinoic acid molecules chained together, and cleaving them in half is what makes two retinoic acid molecules, and that non-central-cleaving would be different. See skeletal formula on right for these two pages:
https://en.wikipedia.org/wiki/%CE%92-Carotene
https://en.wikipedia.org/wiki/Retinoic_acid
(You can also wonder if beta carotene can produce 90% of circulating vitamin A in developing countries, whether getting lots of beta carotene in developed countries can raise the base level in the body, which then leads to easier overdose from preformed vitamin A)
jodrellblank
4 days ago
Vitamin A is in eggs, dairy (butter, milk, cream), in meat fats like pork and grain-fed beef, in salmon, in liver, in cod liver oil. Vitamin-A precursors (carotenes) get converted into Vitamin A in the body, they are in red and orangey fruits and vegetables such as carrot, tomato, chili, chili-powder spice, bell pepper, sweet potato, apricot, mango, butternut squash, grapefruit, watermelon, papaya, passion fruit, cantaloupe, pumpkin, also in dark greens like kale, collard greens, spinach.
Carotenoids are used as a natural food colouring, beta-carotene is E160a, e.g. I've seen it in Red Leicester cheese, yellow custard powder, red jelly, in glace cherries. American law requires vitamin A fortification in reduced-fat dairy. Companies optionally fortify it in things like wheat flour, or breakfast cereal. Retinoids are in beauty and moisturising skin creams and sun tan lotions, and sometimes used as extreme acne medication.
Things that have been promoted for "good health" for decades, such that someone who wants to avoid it needs to deliberately choose an awkward diet of non-colourful foods like potato, rice, onion, parsnip, coconut, apple, pear, cucumber, zucchini, black beans, white beans, lean meats or carefully chosen meat fats, breads made from un-fortified flour, avoiding many restaurant, take-away, or processed foods and "eat the rainbow" variety of fruit and veg.
Grant Genereux has proposed that overflowing the liver's ability to store and process Vitamin A / retinoids leads to them circulating in the blood, that they can enter cells bypassing the normal methods, can cause damage which makes cells denature and burst, which triggers an immune system response to try and find an attacker, which gets misdiagnosed as the immune system causing the damage. And has proposed this as a mechanism which explains some of the 25 - 50 million Americans having unexplained auto-immune diseases.
Proposing that retinoic acid builds up inside body cells over years and decades even whan taken ordinary 'safe' levels, not enough to trigger hypervitaminosis A or acute symptoms but chronically accumulating until the body has so much of it stored that cell damages releases retinoids into the bloodstream which enter nearby cells, denature some of them, releasing their stored retinoids, causing a domino effect which we know as an auto-immune flare-up. And that it's a matter of luck where the concentration is higher whether that makes a skin rash or a kidney or joint or thyroid inflammation, or just generally high "inflammation".
It's an interesting hypothesis with a lot of specific testable claims and specific proposed mechanisms, mixed with quite a lot of conspiracy theorising and less-testable claims.
jodrellblank
4 days ago
I'm past the comment edit window, but incidentally these two Harvard pages[1,2] say that:
- the recommended daily vitamin C is 90mcg for men and 75 for women, the upper limit is 2000mcg. That's a safety margin of 22x, and exceeding the upper limit may cause diarrhoea and gastrointestinal distress.
- the recommended vitamin A is 900mcg for men and 700 for women, and the upper limit is 3000mcg. That's a safety margin of 3.3x, and even that upper limit has "some evidence that this much preformed vitamin A might increase the risk of bone loss, hip fracture, or some birth defects".
- "Sometimes people take cod liver oil for vitamin D but may not be aware it is also very high in vitamin A, beyond the RDA at 192%"
That is, even without any alternative views on it, it's much easier to go above the safe levels, easier to do accidentally, and the risks are more serious.
mikeodds
4 days ago
How could I determine if I’m in/out of this group
hobo123
4 days ago
Possibly if you have many symptoms that sound like isotretinoin or tretinoin side effects (the latter is active vitamin A, the former just a twisted form of it).
As for measuring: there might be spillover of retinyl esters (storage form in the liver) into serum, but that's nothing that's commonly measured. (Serum retinol levels do not correlate with liver levels AT ALL.)
cj
4 days ago
At least for isotretinoin, that would look like: dry skin, chapped lips, dry eyes, dry nostrils, dry mouth, photosensitivity, body aches in the morning.
It can also raise liver enzyme values and change lipid values.
(I recently finished a round of Accutane, basically high dose vitamin A)
tefkah
4 days ago
What are accident victims?
lepton
4 days ago
People who died in an accident, think car accident or fell off a roof. Otherwise healthy people who didn’t die of a disease.
FiatLuxDave
4 days ago
I'm about halfway through this book and I can second the recommendation.
agumonkey
4 days ago
Any other similar books ?
harhargange
4 days ago
Hi Doctor. My sibling recently was diagnosed with liver Mets. Is it really incurable? Docs here refused surgery in 36F
naijaboiler
4 days ago
In general, we don’t do curative surgeries for metastatic cancers. The thinking is that it is has spread that much away from where it started, there little point going to cut out where it started alone. Are we then to cut out every place it has spread to and every how it got to those places.
We do do palliative surgeries if warranted but the intent there is not to cure, but to relieve some symptoms and transiently improve quality of life.
Please direct any specific questions you have about your sisters case directly to her doctors
harhargange
4 days ago
Surely. Since the conversation was already going i asked. Thank you very much for your opinion.
airstrike
4 days ago
My grandpa and his dad were both pathologists, so I always appreciate seeing one in the wild.
Thanks for the rec, I'm buying it just so I can explore their world a little bit.
bookofjoe
4 days ago
Retired anesthesiologist here. I'm buying Weinberg's book based on your review as soon as I finish this comment. Thanks!
collyw
3 days ago
Do we really understand cancer? Rates seem to keep going up and up, despite billions being poured into research.
user
4 days ago
jbs789
4 days ago
Thank you
blini-kot
4 days ago
>flower in your brain all on their own
almost like... cancer itself
BrtByte
4 days ago
[dead]
tty456
4 days ago
[flagged]
nikanj
4 days ago
A paperback is $235.62.
What is it printed on??
arijun
4 days ago
The internet archive has a copy of the epub, but I have no idea if it’s a legal copy or piracy:
https://archive.org/details/the-biology-of-cancer-3rd-editio...
Tagbert
4 days ago
The method of printing is not the major cost differential in a book. Hardbound or softbound, the production costs don’t differ all that much. That is why ebooks are not substantially cheaper than a printed book.
bgilroy26
4 days ago
When kids have to buy a textbook for school the price goes way up
diseasedyak
4 days ago
Stretched dodo hide, tanned and prepared by blind monks.
ChoGGi
4 days ago
Cheaper material than this
https://www.amazon.ca/Hyperart-Thomasson-Akasegawa-Genpei/dp...
igleria
4 days ago
the hopes and dreams of the publisher, author probably sees a very small %
psychoslave
4 days ago
Same as Necronomicon, surely.
KellyCriterion
4 days ago
Well, this one should have left copyright long ago and you can reprint it everywhere? :)
arijun
4 days ago
Isn’t copyright duration like 70 years? How could it have left copyright (one of the editions were published in 2013)?
KellyCriterion
4 days ago
https://en.wikipedia.org/wiki/Necronomicon
I meant this Sci Fi book
lukan
4 days ago
I always thought invoking demons was more occult fantasy genre and not science fiction, but it is a matter of perspective I suppose.
KellyCriterion
4 days ago
You are right, but since Im a Philistine, I would put bock genres in the same bucket - excuse me :-D
bookofjoe
4 days ago
paperback $127.30 here: https://www.amazon.com/Biology-Cancer-Robert-Weinberg-dp-039...
ebook $100.64 here: https://www.vitalsource.com/products/the-biology-of-cancer-r...
Razengan
4 days ago
Liver cells
pieter_mj
4 days ago
Does SV40 cause cancer? Did and does SV40 inadvertendly inside the Polio Vaccine in the late 1950ies and 60ies cause cancer? Does the Pfizer proces 2 SV40 promotor in the Covid Vaccine cause cancer? Is SV40 DNA (or its fingerprints) found inside actual cancer tissue these days? What type of research is performed on it? Does DNA contamination in general cause cancer? I don't know if you're friendly enough to address these isssues. Probably not.
sjmcmahon
4 days ago
Not the GP poster, but some answers:
> Does SV40 cause cancer?
Yes, in a range of animal models at least.
SV40 can 'immortalise' cells, turning off regulatory functions which prevent uncontrolled division, which is an important part of carcinogenesis. This has been shown to contribute to cancer in experimental systems.
> Did and does SV40 inadvertendly inside the Polio Vaccine in the late 1950ies and 60ies cause cancer?
The evidence suggests not significantly, although it's impossible to rule out for some unlucky individuals.
The SV40-exposed cohorts rates of cancers don't differ that greatly from unexposed groups, so we can say with certainty that the rate is much less in humans than seen in laboratory systems. There were suggestions of differences for some cancers, but these are heterogeneous and often confounded, and the general consensus now seems to be the effect was small if not zero. I don't think there's a definitive answer on why - possibly the exposure was sufficiently low or the virus was not effective at infecting humans to significantly affect the carcinogenic processes.
> Does the Pfizer proces 2 SV40 promotor in the Covid Vaccine cause cancer?
Certainly not by the mechanism intact SV40 causes cancer.
That depends on the production of particular SV40 proteins which interfere with cell functions, which aren't present in that promoter.
> Does DNA contamination in general cause cancer?
In general, no.
Cells are constantly exposed to both native and foreign DNA fragments, and have plenty of mechanisms for dealing with them. Even if fragments were somehow incorporated and expressed, most are not inherently carcinogenic.
pieter_mj
4 days ago
Thanks, at least you seem to be aware that there was a process 1 (PCR) and 2 (Plasmide DNA template), and that the inclusion of SV40 promoter in the real production process 2 was intentionally hidden by Pfizer. Difference between 1 and 2 should have been enough in itself to shut that vaccine down.
>Certainly not by the mechanism intact SV40 causes cancer.
There are researchers that claim this makes it an even more virile cancer causing agent.
sjmcmahon
3 days ago
> There are researchers that claim this makes it an even more virile cancer causing agent.
This is exceedingly vague, but also seems to fall into "extraordinary claims" territory.
We know the proteins SV40 expresses that immortalise cells, and we know their targets. Moreover, we know that delivering the proteins independently of SV40 can still immortalise cells, but SV40 mutated to disable those proteins can't.
The claim that the promoter by itself is a stronger cancer causing agent requires it to have an entirely different mechanism of action, but also one which isn't activated by all the other ways DNA fragments containing promoters can get into cells - like, say, everyday viruses. At first glance it doesn't pass the sniff test.
lazyasciiart
4 days ago
> I don't know if you're friendly enough to address these isssues. Probably not.
A fantastic closing if the goal is to make people not answer your questions. I don't know if you're friendly enough to explain why you made your comment so hostile. Probably not.
pieter_mj
4 days ago
Actually I am, it seemed to me the 'friendly' MD is not here to (try to) answer questions, he is just the typical self-assigned gatekeeping credentialist you see on these threads that come to stop any meaningful conversation.
lazyasciiart
3 days ago
Oh, so you thought you’d just act obnoxious enough that every reader would see you as the obstacle to meaningful conversation, to make him look reasonable.
Glemmlko
4 days ago
You are ignorant and disrespectful and i'm higly disappointed from human to human.
"friendly enough to address these issues".
He is not part of some research group who is researching this type of topic. You assume he is a bad faith actor with your "probably not".
Either accept the status quo / research on this topic, or do the research yourself but don't take some potential conspiricy shit to hn by cheap shooting someone else with your 'probably not'.
And if you really struggle with this type of things, get help.
pieter_mj
4 days ago
>You assume he is a bad faith actor with your "probably not".
Admittedly yes. However, this does not make me ignorant.
The type of questions I wass asking should have been an indication that I'm interested and researching.
Glemmlko
3 days ago
You are on hacker news. You have a computer and internet, potentially something to do with computers.
You are fully capable of doing proper research yourself especially when you are that interested in this.
You assume that a random doctor on HN can answer you a Pfizer specific 'secret' thing you can't find out yourself?
Come on...
user
4 days ago
UberFly
4 days ago
PURCHASE OPTIONS: Ebook Courseware $94.95, Paperback with Courseware Access $235.62 (FREE SHIPPING!)... Take your adverts someplace else.
fc417fc802
4 days ago
What's your objection exactly? Those are standard prices for even semi-modern technical books.