New Paper Describes Cuomo’s Paradox:
Dietary Habits Which Prevent Disease May Worsen Survival After Cancer or Heart Disease Diagnosis
A paper recently published is challenging conventional assumptions surrounding diet and disease. Raphael E. Cuomo, Ph.D., professor and scientist in the UC San Diego School of Medicine Department of Anesthesiology, evaluated findings across numerous studies in his latest paper, The nutritional epidemiology risk–survival paradox, published in The Journal of Nutrition.
The paper introduces a newly described phenomenon demonstrating that nutritional exposures commonly seen as detrimental to health, such as obesity, moderate alcohol consumption, elevated cholesterol and certain antioxidant supplements, can paradoxically predict better survival in some individuals who develop cancer or cardiovascular disease.
Cuomo spoke with the School of Medicine to share a bit more about the study.
What sparked your interest in this topic?
Repeated findings showed that dietary exposures linked to disease risk were associated with better survival once disease was present. This paper formalizes the general principle, which the scientific community has named “Cuomo’s Paradox,” that nutritional factors which help prevent cancer or cardiovascular disease can be neutral or even show the opposite association with survival after diagnosis.By definition, a paradox is contradictory. This research is challenging how we think about nutrition and longevity with regards to chronic illnesses. Should we be thinking differently about how we define what is healthy?
Healthy should be defined relative to a person’s stage in life and goals. Cuomo’s Paradox reframes health as prevention versus survival. My research has uncovered pre-diagnosis versus post-diagnosis as a core variable in nutrition. It became clear to me that prevention advice and survivorship advice must be separated.
There are so many factors that impact health for individuals. Is it possible that people who survive longer are just healthier in other ways—and that’s why we see these somewhat surprising results?
It's always important to consider when other factors might be influencing the results, but even when studies account for things like smoking, age, existing health problems and treatment, we still see patterns that line up with Cuomo’s Paradox.
Are there any ongoing studies that might give us clearer answers about these findings?
Big health databases that track heart failure patients already have the information needed to explore Cuomo’s Paradox using methods that mimic clinical trials. Researchers should also consider running practical nutrition studies that look at how diet affects survival. This principle will help to guide targets that differ before and after diagnosis.
Why is this important for patients today? Does it apply to individuals with diabetes or hypertension?
Millions are living with advanced cancer or heart disease; Cuomo’s Paradox gives clinicians a rationale to individualize recommendations for patients rather than copy prevention rules. There is less evidence that this applies to those with diabetes or hypertension. The boundaries of this paradox have yet to be uncovered, though I expect that it will have applications outside of cancer and cardiovascular disease.What safeguards are needed if guidance shifts?
Pair any stage-specific target for novel dietary guidelines with safety labs and secondary morbidity tracking. Cuomo’s Paradox seeks longer and better life, not narrow gains at new costs.What single message should readers remember?
The behavior that helps you avoid disease may not be the behavior that helps you live longer after diagnosis. That is the essence of Cuomo’s Paradox.— Joyce Pritchett
Communications Specialist, UC San Diego School of Medicine