In 1974, an influential paper was published decrying physician-induced malnutrition as the skeleton in the hospital closet. The fact that many patients in hospitals were malnourished, with the editorial board of the Journal of the AMA described as shocking. Even a single case is one too many, yet still to this day the issue persists. If anything, people with serious illness would seem to need even more nutrition, and less, yet underfeeding persists, involving as many as 50% of hospitalized patients. The ethical principle of justice requires that every patient be fed enough, given that hospital malnutrition has been associated with increased risk of disease and death. But is it cause and effect?  You don't know until you put it to the test. But would it be ethical to randomize patients to remain starved? I mean, wouldn't nutritional support obviously help? It turns out, no. Not one but 22 randomized controlled trials involving thousands of malnourished patients found that sure, you can plump them up. However, there seemed to be little effect on clinical outcomes. In fact, sometimes they can actually make things worse. Maybe your body is losing your appetite on purpose. Ever since, Hippocrates, fasting has been offered as a treatment for acute end chronic diseases based on the observation, then when people get sick, they frequently lose their appetite. So maybe that's part of our body's wisdom, and we shouldn't force it. Okay, but that was 2400 years ago. What have we learned since? Along with fever, decreased food consumption is indeed one of the most common signs of infection, often regarded as an undesirable manifestation of sickness, but it's actually an act of beneficial defense mechanism. Now, obviously chronic under nutrition can impair our defenses, but data suggests that in the short term, immune function can be enhanced by lowering food intake. Some of the data are crazy, like 95% alive versus 95% dead after the same infection, but that was in mice starved for 48 hours. Obviously, you can't randomize people to a fatal infection, but what they showed is that the blood from starved mice was nearly eight times better at killing off the invading bacteria in a petri dish.  Why can't we just test people like that? Indeed we can. Researchers fasted people for two weeks on an 80 calorie a day diet and their white blood cells showed the same kind of boost in bacteria killing activity, a boost in antibody production, and natural killer cell activity increased by an average of 24%. Now that's especially interesting because our natural killer cells don't just help clear infections, but also kill cancer cells. In fact, that's how they measured natural killer cell activity by pitting them against K562 cells. Those are tumor cells, human leukemia cells.  So fasting is said to improve anti-cancer immunosurveillance, or more poetically stimulate the appetite of the immune system for cancer. So why isn't fasting used more to treat cancer? Until recently, fasting therapy was not considered to be a treatment option in cancer, related to the fact that a common therapeutic goal and palliative cancer treatment is to avoid weight loss and to counteract the wasting syndrome known as catechia, which is the ultimate cause of death in many cancer cases. Tumors are voracious, rapidly expanding, needing lots of energy and protein and so metabolically reprograms our body to start breaking down to feed it. It does this by triggering inflammation throughout the body. It's not just that people lose their appetite. The fundamental difference between weight loss observed in cancer catechia, and that seemed in simple starvation, is the lack of reversibility with feeding alone. For example, here's the weight of a cancer patient that started to drop. No wonder they were only taking in a few hundred calories a day. So in addition to giving them about 100 grams of protein a day, they stuck a tube into a vein and infused up to 4,000 calories a day, but it didn't matter. They continued to lose weight. Therapeutic nutritional interventions to correct or reverse catechia have met with little success. The best treatment for cancer catechia, therefore, is to treat the cause and cure the cancer. In fact, maybe forcing extra nutrition on cancer patients could be playing right into the tumor's hands. Like in pregnancy, when the fetus gets first dibs on nutrients, even at the mother's expense, the tumor may be first in the feeding line. Maybe our loss of appetite when we get cancer is even a protective response. But in the 1960s, TPN was born—total parenteral nutrition, where people no longer had to eat. You could infuse all the nutrition people needed straight into their veins, and the modern era of nutrition support was born. It became widely accepted and implemented. Growing into a multi-billion-dollar industry, so should it be routinely given to malnourished cancer patients? The answer is not as obvious as one might think. When it was put to the test in dozens of randomized trials, the results were both disappointing and surprising. Parenteral nutrition didn't just fail to provide any benefit to these patients, it caused harm. Not only did it appear to provide zero survival benefit, there was an increase in complications and infections, and a decrease in tumor response to chemotherapy, presumed to be due to all those extra nutrients stimulating tumor growth. Similarly, oral nutrition interventions in malnourished patients with cancer, like giving them bottles of inshore, found no survival advantage. Despite the lack of demonstrated benefit, the knee-jerk reaction of many oncologists to the idea of cancer patients fasting is the concern that they're not eating enough already. But you don't know until you put it to the test, which we'll explore next.


Hi everybody, Joe for jazzy's case breaks dot com here. Happy Monday coming out to a 2015 Panini National Treasures Collegiate Multisport one box random number block break number 28. You see us do a lot of this format For teams as a filler. This is just in a whole entire box One of these box or a whole entire box will be in that random number block format big thing and all the Instructions are right here in case you're wondering if you're new to it big. Thanks this group right here for getting in on it Thanks for the film There are the numbers right there. Let's roll it randomized names numbers one and a four five times each one two three four and five Got at a down to Aaron one and a four five times for the numbers one two three four and five After five we got one down to five Alright Ed with one at a with one and seven at P with zero Nick with eight Eric with four Nick with six Travis with three at P with nine Eric with two and Aaron with five To order these numerically Now remember zero gets any and all redemptions, but as you know with an old product like 2015 Those are most likely going to be expired, but we'll still send those to you anyway All right, we're gonna pause the video when we come back We're gonna see if there's any trades don't want the one box break stick around. We'll be right back All right, welcome back. No deals were done here on Monday the 13th Thanks everyone for making this happen. I appreciate it So remember we mark those boxes so we know they're from the same case one two three For the top box four five six for the bottom box Four one two three four five six so this will be saved for next time In fact that last box is already loaded up on Jasper's case breaks calm. So if you want to finish that off tonight I'm down to do it Should be able to it's not a bad price point Fun little break a little blast from the past Got the nice little pop those old wooden NT case boxes to Base card in the bottom right there Let's see what we got we're gonna lead off with Randy Gregory 76 out of 99 going to Nick. Oh when a Nick oh and the And that number right there number we're six Tim Tebow 22 out of 99 going to Eric and the number two nine out of 15 Frank Thomas Ruby That's pretty cool. Ed P with the number nine And trust me Ed. She'll like it too The bigger No randomizers on quad relics six out of 99. That's for Nick. Oh Brandon Ashley Ronde Hall is Jefferson Stanley Johnson and TJ McConnell. It's a nice quartet here. I feel like But three of the four guys are still getting regular minutes in the league I'm not sure what Brandon Ashley is up to out of 99 Brandon Gibson Relic 55 out of 99 That is for Aaron and the number five Our first autograph is five out of 25 Sierra Burdick that goes to Number five that'll be for Aaron She in the lead She is not in the WNBA. She's currently playing for Valencia But she did bounce around between the dream Liberty stars aces Mercury links Seattle 34 out of 99. That's Brian Bennett Eric with the number four. I don't think he's around the league What about Jordan Matthews was in the league for a little bit still might be kicking around somewhere 68 out of 99 Jersey not a graph Jordan Matthews Nick Ozer number eight There's Sean Manion RPA Two-color patch not a graph 77 out of 99 at Aaron's at a with number seven Sean Manion might be kicking around as a backup somewhere and this is a cool of you one. He's still in the league Out of 25 colossal patch auto Andrew Ben and Tendi I look like the what the R of Arkansas right there. That looks awesome. He's still playing It'll be for Nick. Oh and the number eight.  All right, and the last one is the book to 99 It's Carson Fulmer 60 out of 99 that goes to ed P and the number zero Jersey and Autograph in a nice little book in his Vanderbilt gear Now, yeah, I feel like that 20 that pitching staff was really I think Walker Bueller might have been on that staff, too Anyway, there it is one box break. It's a fun little one blast from the past break 28 The last box is in the store right now. So check it out on Jaspy's case breaks calm. I'm Joe I'll see you next time for the next one


All right, Howie Long, let's get back to a game we talked about earlier, Washington getting a win and moving into first place in the NFC East. Yeah, and we said that division was wide open and it's in balance for Carolina, 18 rushes, 40 passes. That's not the identity of who the Panthers are, 81 yards on the ground, three turnovers, that was the key to the game particularly early on. They had their opportunities down the stretch to maybe pull it off at the end, but to no avail. I think Carolina, you had third and five. Why are you trying to go through the end zone both times? Go for the first down. Well, you may have that route there to get the first down, but his read said it was covered and he was forced deep. I don't think he necessarily, Camus just went deep. I think his progression took him deep because I think the other, I think it was covered, I think Washington did a heck of a job on him. Well, I'm calling the play to get the underneath done. I get it first down, I have four more downs to go. Show me when you look at Washington though, one thing I did like about the Redskins today is that if you were over 30, you were helping that team win. Alex Smith, Vernon Davis led the team of receptions would have touched down. Adrian Peterson, when they needed him down the stretch especially, we saw that Adrian Peterson of old, ran hard, ran tough. He knew where he needed to get to pick up these first downs and he got it done. And look at the staff line. We were doing it, it was just 1982, 21 for 36, 163, two touchdown zero and a substance for Alex Smith. And letting your running back run for 97 yards, which is what Adrian Peterson did, they got the win to go to three and two. All right, you know what? Let's get back to the Atlanta Tampa game. Boy, at the end, Tampa almost pulled out the miracle Tony Gonzalez, but Atlanta wound up holding on the win. Matt Ryan, the way he's playing with all the injuries too. Calvin really goes down today. Mohamed Sanu goes down today and what does he do? He just picks up, keeps always gonna go to the old faithful guy in Julio Jones, but Austin Cooper, the tight end, he came out and played really, Hooper, I'm sorry, he came out and played really, really well. And Matt, you do what you gotta do. This is what winners do. Obviously I played with Matt, he's a champion. He's never ever gonna give up. He's always gonna be in the game when you got a guy like him. He's one of those guys that can go for big chunks of yardage, 354 yards, three touchdowns and they got the win.  Those are nice ball, easy to catch. Eight those are nice ball, nice. Cause some quarterbacks or a hard ball. Julio another 143 yards receiving and still no touchdowns. That hasn't had one since week 11, I think last year. But if you look at the stat line of this game with the quarterback, they both threw 41 balls. Jamies 30 completions, Matt 31 completions. Jamies for more yards. The only thing is two turnovers, red zone turnovers. Hurt you every time. You can't win turning the ball over. Yeah, and their offense has to, we talked about in the pregame because of their defense and where they are physically, that offense has to be great. Matt has to be great. Even though two wide receivers go down, as you mentioned, he does go to Hooper, which is another facet of that offense that hasn't been used, but he's a good player. You can see how good this team could be. If they could just get the running back. Yeah, Devonte and Freeman didn't get a ball in the youth.  Well, this is how most pro, this is how you're supposed to grip it. And this is how you're supposed to have your finger down below it like this. And when you throw it, the nose comes out down. And the revolutions roll it back up and square it up. So back. So that was the wrong one. I was taught to throw with my fingers and keep a pocket. So the ball always had the nose up, which I thought was easier to do. Okay. And if you're a Rams fan, your heart is very warm after that three point win today to stay undefeated, six nothing. You know, it's a fascinating offense, obviously. You know, the play calling, the bells and the whistles, the motions, change of tempo, the jet sweeps, all that. But when the weather's bad, you're at mile high, you're on the road, it's loud. You need someone to dictate terms. This guy is special. And we knew he was special from the minute he got to the Rams, but with this expanded offense, Tony, it just makes them really difficult to defend. Yeah. It's like he's the MVP of the league right now. You can put that argument up and then putting up points like this and makes the other teams of offense one dimensional.


Jets flying in and out of Royal Australian Air Force Base in Townsville, Australia rely on precise radar readings and accurate weather forecasts. For these, they turn to MAX4, who for the first time have deployed a new system that allows them to be fully functioning in eight hours. Our submarines have been doing an outstanding job with this new system. We prepared hard for this deployment. We trained hard for this deployment and it's really showing off and paying off with the abilities of my Marines, how they are learning the gear and explaining the gear and training on the gear. They're performing outstanding. Watson says being able to deploy and set up so fast is what really makes them an asset to the Marine Corps. That's the Marine Corps model. We're first in, first out. I mean, that's what we do as Marines. We're the first to fight and that gives us even more firepower to get into the fight, get deep into the fight and we're very mobile. So wherever the combatant needs us, we're able to get there and go. Watson also said it's been nice working with an ally that speaks the same language, but added it doesn't matter if they speak English or Chinese, MAX4 is ready to go. We're prepared to go wherever we need to go.  It doesn't matter because we prepare to do our job no matter where we are in the globe. Watson said they can have their new system torn down and ready to go in three hours. Reporting from Royal Australian Air Force Base in Townsville, Australia, I'm Corporal Bradley Hansen.