
Helpless to Prevent Cancer? Actually, Quite a Bit Is in Your Control - hvo
http://www.nytimes.com/2016/07/06/upshot/helpless-to-prevent-cancer-actually-a-lot-is-in-your-control.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=second-column-region&region=top-news&WT.nav=top-news
======
MicroBerto
I recently wrote an article discussing how increased fruits and vegetables can
prevent mortality from _cardiovascular diseases_ , yet not cancer.[1]

My conclusion was that cancer is best prevented by _removing_ negatives from
life, not necessarily adding positives. ie avoid anything from stress to
pollution to sunburn to obviously smoking. Interestingly, organic food doesn't
seem to matter in the cancer equation, given the data we have.

Yet there's one thing you can ADD to reduce cancer: exercise. Preferably
moderately hard to strenuous.

[1]
[https://blog.priceplow.com/vegetables](https://blog.priceplow.com/vegetables)

~~~
rsync
"My conclusion was that cancer is best prevented by removing negatives from
life, not necessarily adding positives."

I'm also skeptical that adding foods/vitamins/supplements will prevent cancer.

However, there is one area that _adding_ things seems to be very beneficial,
and that is adding things that promote regular bowel movements.

There have been studies of heavy coffee drinkers and their reduced risks of
colon cancer. Everyone is looking for some mysterious phenol or antioxidant
from the coffee as a magic elixir, but I think it should be obvious that
coffee as a laxative is the agent here.

There's also the age-old rule of thumb: an apple a day keeps the doctor away.
It's not the apple, it's the fiber.

~~~
gmarx
When I was young the idea that high fiber reduces colon cancer risk was very
high profile and based on pretty stupid studies. Later when more rigorous
studies failed to find an association, no one noticed. It's like antioxidants
and a host of other "eat this and you'll live forever" studies/stories.

Regular bowel movements are their own reward!

------
roldie
>A bigger concern to me is that people might interpret these findings as
assigning fault to people who get cancer. You don’t want to get into
situations where you feel as if people don’t deserve help because they didn’t
try hard enough to stay healthy. Much of cancer is still out of people’s
control.

Although only one paragraph, I'm glad the author addressed this.

All of these tips and lifestyle changes are great but this doesn't make those
of us with loved ones with cancer feel any better. By all accounts she has
done everything to qualify as "low risk," but still got cancer.

It's still an odds game. Better odds don't guarantee anything. It's unfair,
frustrating, and infuriating.

~~~
randomgyatwork
I agree, a woman who worked for my mom died of lung cancer, she never smoked
once in her life.

~~~
Declanomous
Lung cancer is most closely associated with smoking, but lung cancer can be
caused by many air contaminants. Radon is the second leading cause of lung
cancer, causing 21,000 deaths each year. About 2,900 of those people are non-
smokers.[1]

Cancer can be caused by things other than mutagens though. There is a certain
rate of transcription errors when cells divide, and these errors can build up
in the same way mutations from radiation, etc. build up. Things that kill
cells and force them to divide speed up cell division, and can cause cancer
that way. For instance, acid reflux and drinking can both cause esophageal
cancer.

You can also get cancer from just being extraordinarily unlucky.

[1] [https://www.epa.gov/radon/health-risk-
radon](https://www.epa.gov/radon/health-risk-radon)

~~~
randomgyatwork
Thanks for giving me something to worry about.... But seriously, I had no idea
that was a thing, thanks for bring it up.

------
fauigerzigerk
I'd like to see a statistic that accounts for the fact that we all eventually
die from _something_.

If we measure success only by how many people eventually die from a particular
disease, then increasing life expectancy doesn't count as success at all.

Dying from cancer at the age of 90 should not be counted the same as dying of
cancer at the age of 45.

So the statistic I want to see would count cancer free years.

~~~
barrkel
The NHS in the UK uses the concept of QALYs to measure the effectiveness of
interventions: Quality Adjusted Life Years.

If you have to avoid a certain activity, or take up a certain activity, in
order to enhance your longevity, doing or not doing something you'd rather do
(or not) may still affect your quality of life.

------
rhondapatrick
It's amazing just how badly this study was distorted by generalized
clickbaitism. It chafed me sufficiently enough to put out a video on the
subject at the time[1]. The hype really wasn't even necessary... the
underlying findings were plenty interesting enough already: that there is an
association between stem cell division rate of specific tissues and overall
cancer risk. This, however, in no way implies that cancer is _only_ due to bad
luck.

Science ended up printing a follow-up actually clarify things, perhaps feeling
themselves that the interpretation by the public at large got out of hand a
little bit[2].

[1]
[https://www.youtube.com/watch?v=iiH4m7NvV98](https://www.youtube.com/watch?v=iiH4m7NvV98)

[2] [http://www.sciencemag.org/news/2015/01/bad-luck-and-
cancer-s...](http://www.sciencemag.org/news/2015/01/bad-luck-and-cancer-
science-reporter-s-reflections-controversial-story)

~~~
nchelluri
IMO, the author does clarify this sufficiently,

> In other words, this study argued that the more times D.N.A. replicates, the
> more often something can go wrong. Some took this to mean that cancer is
> much more because of “bad luck” than because of other factors that people
> could control.

> Unfortunately, this simple explanation is not really what the study showed.
> Lung cells, for instance, divide quite rarely, and still account for a
> significant amount of cancer. Cells in the gastrointestinal tract divide all
> the time and account for many fewer cancers. Some cancers, like melanoma,
> were found to be in the group of cancers influenced more by intrinsic
> factors (or those we can’t control), when we clearly know that extrinsic
> factors, like sun exposure, are a major cause.

as well, he only opens with that and aims to debunk the bad luck hypothesis by
means of the other two studies. which again I personally have no idea about :)

------
apolretom
> Over all, though, about 25 percent of cancer in women and 33 percent in men
> was potentially preventable.

This article is a rather optimistic spin on these numbers. I'd have said "a
large majority of cancer cases--75% in women and 67% in men--were not
preventable"

~~~
chias
Oh, I don't know. On the one hand, part of me agrees with you.

On the other hand, when someone tells me that they've optimized a compiler and
it can now compile 3% faster I get really excited and pull their repo, I don't
turn around and say "you mean 97% as slow" and keep complaining about how long
compilation takes and how nothing can be done about it. Show that there are
steps you can take to cut it by 33% more than we currently know how and you'll
be a god among programmers.

~~~
sn41
I agree with your basic point - but doesn't "3% faster" usually mean that it
runs faster in all cases? So the "97% as slow" does not seem to be clear.
Maybe it should be said as the improvement is not significant enough according
to some numerical threshold?

~~~
benmanns
I think it's closer to "I boosted conversion rates on our sign up page by
33%."

Sure, not every visitor signs up still, but some group of people found the new
copy compelling enough to sign up - with no new, very expensive feature
development.

------
l1feh4ck
To guys out there who still smoke. Please quit. It can be done.

~~~
bbarn
I think as a culture (speaking here in the US) we've made quitting smoking out
to be much harder than it actually is. One of the problems with this massive
marketing campaign saying things like "You can quit with help!", etc.. is it's
focusing on how difficult it's supposed to be.

After 20 years or so of being a smoker, I just decided I didn't want to be
embarrassed about the way I smelled in elevators anymore, and quit. I was a
competitive cyclist, despite being a smoker, so it wasn't helping me in those
social situations either.

When I did stop, it was hard for about a single day. Irritation and not being
sure what to do with your hands are the biggest "withdrawal" symptoms you'll
have from quitting. If I'd known just how easy it is to stop, I would have 10
years prior.

So yes, listen to the above poster. It won't kill you to quit, it will kill
you not to. If you honestly think you can't, it's a very simple problem to
solve. There are really only three components to quitting. Nicotine addiction
(easy to taper off with substitutes like gums, switching to vaping with
decrementing nicotine levels, etc), Habit (the act of smoking,
vaping/e-cigarettes/gum chewing/going on walks instead can help replace this)
and the social pressure, which is usually smoking with your smoker friends or
partner. Fun fact, they all want to stop too, even if they don't say so. Get
them to quit with you, and if one or more refuse or abandon, ignore them and
be selfish with your health.

All that said - the "pain" of cold turkey lasts a day and all the anecdata
that I've collected seems to make it the most effective way to stop.

~~~
piva00
I quit cold turkey after 7 years of smoking and I'm really glad that I did.

So with that I can say: the pain of quitting doesn't last only a day, it's
good you didn't experience depression, I never had depression before or after
that but I was clinically depressed for 3 weeks, I was apathetic about life in
general, would wake up and not feel motivation to do anything, I'd do them
anyway because it was a routine (eat, shower, work) but I really felt I'd
never be happy as I was before.

It began to fade after the first week, during the second week I'd still feel
urges to have a cigarette after a coffee or lunch, or just when I was bored.
Third week was easier and by the end of the first month I was over the initial
withdrawal symptoms.

But again: it's not "just a day", it's not really "omg, this is so easy, I'm
over it". I had to constantly remind myself to NEVER had a drag, I got drunk
during the third week and it was a pretty good feeling to deny a cigarette a
friend wanted to share.

I was a 2 pack a day smoker during the last year of smoking, that might have
impacted how much the withdrawal symptoms lasted or how strong they were.

It's on of the best things I've done in life, it also gave me a huge boost of
confidence to do other stuff, my mindset nowadays is "I quit smoking cold
turkey, I can do almost anything when I commit to".

~~~
bbarn
It's not to say I didn't have urges.. doing something for almost 20 years,
anything, is hard to let go of. But that nail biting aggravated irritableness
lasted about a day for me.

Part of it may be that because of the whole bike racing thing, I had had
several occasions where I'd been through weekend long periods I couldn't
really get to smoke, or had to make due with patches or gums. I would also
immediately light up when I got away from those friends. Those times, I'd also
tried white-knuckling through weekends, been just as irritable, but it kept
going for days like you said. When I mentally made the switch to not smoking
anymore though, it was different, much easier than those 3 day weekends ever
were.

I've heard lots of people say the same thing to me, once you do it, you know
it's done. You're not just holding off for a few days or seeing how long you
can go, you're just mentally done with it. Or maybe I just tricked myself and
it worked. :)

------
serg_chernata
This is great, and I think it should be fairly easy for everyone to follow in
small measure at the very least. I'm not minimizing the struggles of those who
can't control their weight or eating habits. I simply believe that people
often pick something like a "diet" as their primary focus and then skip the
workouts or continue to indulge in alcohol. I find it much easier to succeed
when I attack the problem from more angles and try to make changes in all of
these aspects to my routine. If one fails, I can still reap the benefits from
the other changes I've made.

------
pmiller2
I wonder what the psychology behind believing heart disease is preventable vs
cancer being unpreventable.

~~~
coldtea
No deep psychology needed.

With hearts, you open up and you see clogged arteries, for example. It doesn't
get much simpler than "too much fat is bad for your heart".

With cancer? It could be anything. And there are tons of different types,
seemingly hitting all kinds of people, fat smokers and lean non-smoking vegans
alike.

~~~
nostrademons
I've heard recently that the causality for heart disease actually goes the
opposite way than everyone assumed. The body's response to inflamed arteries
is to lay down a layer of fatty plaques to protect the arteries from further
damage. The fat deposition is the effect of the inflammation, not the cause,
and now researchers are trying to understand just what the real cause is.

...which just goes to show how complicated causation vs. correlation is in
real science. It was a pretty obvious conclusion that clogged arteries would
cause heart disease...except that it's both obvious and wrong.

~~~
teslabox
> I've heard recently that the causality for heart disease actually goes the
> opposite way than everyone assumed.

This "Assumption" would be a good case study of the infection of common
knowledge with charlatanism.

Better scientists than Ancel Keys already knew that polyunsaturated oils were
not appropriate for human consumption. Soybean oil and Linseed oil were used
to make paint & stain, because they're good 'drying oils'.

But Dr. Key's theory was picked up by the mass media and used to demonize
butter, and to promote garbage like "I Can't Believe It's Not Butter"...

People are easy to swindle.

------
nchelluri
Interesting article. I don't know that I'd take too much to heart given some
of the obvious caveats the author has been nice enough to make explicit, but
it sounds like I'd be hard pressed to argue the suggestions contained within.

For the tl;dr crowd:

\- written by a physician

\- people often think that heart disease is controllable by our actions
whereas they feel that cancer is not

\- > people can’t change many risk factors of heart disease like age, race and
family genetics

\- > A more recent study published in Nature argues that there is a lot we can
do. [about cancer]

\- > Using sophisticated modeling techniques, the researchers argued that less
than 30 percent of the lifetime risk of getting cancer was because of
intrinsic risk factors, or the “bad luck.”

\- > [another study] identified four domains that are often noted to be
related to disease prevention: smoking, drinking, obesity and exercise

\- if you limit that stuff, and not meaning 0 smoking, but "having quit within
the last 5 years", no more than 1 drink a day (women) or 2 drinks a day (men),
your BMI is >= 18.5 and <= 27.5 (BMI is such a shit and antiquated metric,
IMO, incidentally), and perform 150mins/wk moderate intensity excercise or
75mins/wk vigorous intensity exercise, then you're in the low risk group. so
the barrier to entry is not super high.

HOWever:

> No study is perfect, and this is no exception. These cohorts are
> overwhelmingly white and consist of health professionals, who are not
> necessarily like the population at large. But the checks against the
> national data showed that if anything, these results might be
> underestimating how much cancer is preventable by healthy behaviors.

[...]

Optimistic conclusion, for a skeptical cheapskate like myself,

> As we talk about cancer “moonshots” that will most likely cost billions of
> dollars and might not achieve results, it’s worth considering that — as in
> many cases — prevention is not only the cheapest course, but also the most
> effective.

Hard to fault this article. I'm glad you posted it, thank you.

~~~
amock
What's wrong with BMI for something like this? It's such a simple measure and
it seems to be useful for predicting health issues. From what I've read body
fat percentage is what really matters, but accurately calculating that takes
expensive equipment. [http://www.nytimes.com/interactive/projects/cp/summer-
of-sci...](http://www.nytimes.com/interactive/projects/cp/summer-of-
science-2015/latest/how-often-is-bmi-misleading) seems to indicate that BMI
does a pretty good job, although it may be too generous on the high end.

~~~
sosborn
> It's such a simple measure and it seems to be useful for predicting health
> issues.

It is good for predicting in general populations, but can easily fall apart
with individuals. It doesn't take into account what the makeup of your mass
is. Muscle is denser than fat, so a muscular man and a fat man of the same
height and weight would have the same BMI, but vastly different health
profiles.

~~~
coldtea
> _It is good for predicting in general populations, but can easily fall apart
> with individuals._

While it can "easily fall apart with individuals", the difficulty lies in
finding an individual to measure that will make BMI fall apart.

And that's because the huge majority of us is of the kind of complexion and
body type where BMI works well.

So, sure it can give false positives, but for a quite small fraction --
besides any other rough medical heuristic does the same (e.g. signs of having
the flu can also be caused by 200 other reasons).

~~~
peteretep

        > the difficulty lies in finding an individual to
        > measure that will make BMI fall apart
    

I'm 5'11 with a 36 inch waist. This gives me a waist-to-height ratio of 0.507,
which has me just under or over the healthy cut-off, depending on who you
ask[0].

I was 212lbs this morning, giving me a BMI of 29.6, which has me at the border
of "Overweight" and "Obese Class I (Moderately obese)", and is high risk.

I don't think you'd think I was a weird shape if you looked at me.

[0] [https://en.wikipedia.org/wiki/Waist-to-
height_ratio](https://en.wikipedia.org/wiki/Waist-to-height_ratio)

~~~
parfe
>A WHtR of over 0.5 is critical and signifies an increased risk

Both measures put you in an at risk categories. Why doesn't that concern you?

~~~
peteretep
It does, which is why I know exactly how much I weighed this morning.

------
known
95 per cent of the targeted cancer cells die within two hours with new
treatment that involves injecting a chemical compound, nitrobenzaldehyde, into
the tumour and allowing it to diffuse into the tissue;
[http://sakshipost.com/index.php/lifestyle/editor-s-
picks/840...](http://sakshipost.com/index.php/lifestyle/editor-s-
picks/84095-new-method-can-wipe-out-cancerous-tumours-in-two-hours.html)

------
xchip
Summary: reduce alcohol, don't smoke, stay fit.

Yet another super long article that the bottom state the obvious.

~~~
baytrailcat
Yea, no shit. This is pretty much common-sense advise by now. I was hoping for
some new insights with respect to things like cell-phone usage, pesticides,
low-carb diets, fasting or those so-called "anti-inflammatory" diets.

------
erikb
At least in my section of this world people don't feel out of control about
cancer. Trying to avoid things that "give you cancer" seem to be normal, even
in lesser educated groups. Can't imagine it's so different in the US.

------
mathgenius
Here's what it would take to really prove the causative effects claimed in the
article: pick a bunch of random people and then force them to either drink or
not, exercise or not, smoke or not.. etc. There's no way anyone is ever going
to do this experiment, and I just find the claims made in the article somewhat
dubious as a result. On the other hand, they are likely to be right (yes?) and
probably it's better to make such claims than not to. But hey, if you are a
sedentary type, if you smoke, if you drink, what is causing those behaviours?
Just forcing some exercise doesn't change those deeper causes (what ever
bio/emoto/chemico causes), and may very well make the person absolutely
miserable or worse.

------
WorldMaker
Obviously the easy way to prevent cancer is to just stop aging. We just need
to unlock the means to micro-manage the cellular mitosis of all the trillions
of cells in our bodies. Easy.~

------
known
[https://en.m.wikipedia.org/wiki/French_Paradox](https://en.m.wikipedia.org/wiki/French_Paradox)

------
retrogradeorbit
Two books on the subject I would recommend to the interested. One is "The
China Study" and the other is "Cancer-Gate".

------
elchief
BMI is so bad.

I'm 6'0 and the last time I was under BMI 25 I was a triathlete. The only way
I could be <25 would be to exercise 3 hours a day and eat 1200 calories. F-off
and die

I did quit smoking though:

\- Really wanted to \- Picked a good mental argument against it ($100k CAD
over 20 years) \- Picked a quit date \- Patch + zyban + nicotene lozenges

If you live in British Columbia, the government will pay for your patches or
lozenges (hint: ask a friend)

~~~
maccard
I'm 6'1 and I had a BMI of about 26 until recently - I was definitely pudgy. I
also claimed that BMI was worthless until I dropped a few pounds and realised
that it was right and I was just making excuses.

If you're an athlete, or a bodybuilder, or particularly tall or small, it
won't necessarily fit you. but if you're of normal-ish stature (ie 5'4 to
6'3), and don't keep track of your weight, it's probably bang on.

~~~
sgt101
I've had a BMI of 27 for most of my adult life. I used to do competitive sport
and trained for sessions a week 45 weeks a year, I got to 40 and couldn't cut
it anymore so I quit. My bmi stayed at 28... I looked at a photo of me at age
28 about eight months ago and compared myself to that. The photo showed muscle
bulk and tone, the mirror showed a big belly. I've adopted what I call the
beer, bread and biscuits diet (as in NO) and avoid alcohol four days a week
altogether. I've lost six kg, six more to go!

------
reasonattlm
If peak cancer years are two or more decades in your future, I'd argue that
the best thing you can do today is donate to research programs that are likely
to change the economic landscape of cancer research. You should also not get
fat, not smoke, and all the other things that require no money, but research
is much more transformative. You want the future to be no cancer, not less
cancer.

Why economic transformation in cancer research? The cancer research community
suffers from a high level strategy problem: the majority of treatments are
only applicable to a small number of cancer types, out of the hundreds of
known types, and the majority of new technology platforms under development
will be just as expensive to adapt to a different type of cancer as to build
in the first place. A much more efficient approach is needed, as there are
only so many researchers and only so much funding in the world.

This is much on my mind because I'm helping to raise funds for one such
project right now. It involves taking on the less well-supported but still
necessary part of building a universal cancer treatment platform, one that can
target all cancers. This could be built for about the same cost as one of
today's highly specific single-cancer treatments. Obviously that is an
immensely better path forward.

The approach is to block telomere lengthening: all cancers must lengthen their
telomeres in order to grow, and abuse a small number of target mechanisms in
order to do so. These mechanisms, telomerase and alternative lengthening of
telomeres (ALT), are very fundamental to cellular biochemistry. If they are
turned off, it is expected that there is no way for a cancer to evolve around
that dead end. Many of today's cancer therapies, in addition to being very
specific, also leave room for a cancer cells to evolve a different way of
conducting business that renders them immune.

A number of research groups are working on sabotage of telomerase, but next to
no-one is working on ALT. It is known that telomerase cancers can turn into
ALT cancers, so it is probably the case that both doors have to be slammed
shut to have a truly effective universal cancer therapy. So I'm helping a
fundraiser to use an ALT assay to scan the standard drug candidate library for
compounds that act to suppress ALT, something that should greatly advance that
part of the field, both by identifying more lines of investigation, and by
finding potential therapies for ALT cancers. Since ALT doesn't happen in
normal cells, completely suppressing ALT should be a pretty safe treatment if
an approach with limited side-effects can be identified. The telomerase
blocking will need more work on compensating or targeting for other effects,
since stem cells require it. But that is still a lot less work than producing
one therapy per cancer type.

~~~
Aelinsaar
> _This is much on my mind because I 'm helping to raise funds for one such
> project right now_

After two paragraphs about how the only way to save yourself is to give
generously? Ya don't say...

~~~
reasonattlm
You see the argument for this approach to cancer as being less valid because
in addition to making it, I have chosen to act on it? Strange thought process.

~~~
Aelinsaar
I see that the answer to the question of, "Cui bono" is "You".

~~~
reasonattlm
I don't run this research. It is a non-profit initiative. I have donated
myself. I'm persuading other people to do so as well because I think it is a
good idea, an important idea, and very necessary for the strategic reasons
noted above. The benefit I'm going to get out of it is that my odds of
surviving future incidence of cancer increase should it succeed. But then the
same is true of everyone else.

------
davidf18
A lot of cancer is self-inflicted such as smoking cigarettes. Even though they
know smoking is bad for them and they've had relatives that have died from
tobacco, teens continue to use it and become addicted to smoking.

In NYC, cigarettes cost $12-$14 per pack it is against the law to buy
cigarettes until age 21. Countries that have universal healthcare such as
Canada, UK, France all have tobacco taxes that exceed $5 per pack. Our US
Federal tax is about $1.

The high cost of tobacco and the increase age for buying tobacco (now the same
as drinking alcohol which is also 21) helps to prevent teens from becoming
using and becoming addicted to tobacco.

~~~
dghughes
I was thinking the other day you don't see very many or any smokers or obese
people in old age homes do you?

The majority of my family on my father's side who are smokers have died of
heart disease, strokes, lung damage.

Even at my workplace 9 of 10 people who died were smokers. I think the buddy
system where they need to smoke in groups just enforces their denial.

I've seen the "scared straight" situation many times where a middle aged
smoker suddenly decides to quit only to be diagnosed a month later with
cancer. Only now it's e-cigarettes instead of quitting so they can still be
addicted to nicotine but quit cigarettes.

I like to tell them there are worse things than cancer which has a possibility
of a cure or surgery. My dad has IPF a scarring of lung tissue and there is no
chemo or surgery to cut it out or slow it down. It occurs from many years of
small amounts of lung damage in my dad's situation it was blue collar work
welding, paint fumes, wood dust, grinding dust etc.

------
grnadav1
lol vegans have FAR LESS cancer
([http://m.huffpost.com/us/entry/2250052.html](http://m.huffpost.com/us/entry/2250052.html))
but nooo, I won't go vegan - those peoplz ares crazies!!!11

~~~
Joof
Is it because they are vegan or because vegans live healthier lifestyles?

~~~
geomark
Exactly. If there was strong evidence for causality I would make a real effort
to go vegan. But I suspect it's about being thin and having a high fiber diet,
which doesn't require being vegan.

~~~
retrogradeorbit
There is strong evidence.
[https://en.wikipedia.org/wiki/China%E2%80%93Cornell%E2%80%93...](https://en.wikipedia.org/wiki/China%E2%80%93Cornell%E2%80%93Oxford_Project)

It's the ratio of plant protein to animal protein in the diet. So no you don't
need to go hard vegan. But yes, it is the diet and there is hard evidence.

~~~
pkroll
Criticism of "The China Study" pretty much ends my confidence in it:
[https://rawfoodsos.com/2010/07/07/the-china-study-fact-or-
fa...](https://rawfoodsos.com/2010/07/07/the-china-study-fact-or-fallac/)

~~~
geomark
Thanks for that link. It's an excellent analysis of the actual data from the
study. I'm part way into reading it and right away the author has thrashed
some of the claims of the original study. It appears that even some of the
basic claims of correlation aren't even correct.

Added: Schistosomiasis infection is such a huge cofounder for colorectal
cancer rates that it is ridiculous to have claimed dietary cholesterol from
animal sources as the cause.

