Protection Against Chronic Diseases

We have recently suggested that the practice of dietary approaches to the prevention of chronic diseases like cancer beget more frugal medicine and can serve rich and poor alike. Dietary delivery of protective phytochemicals makes good sense and chemoprevention by whole foods, or simple extracts of whole foods, presents unprecedented opportunities to solve unmet global problems. They are intuitively the most logical, sustainable, ethical, and responsible way to deal with the epidemic of chronic and degenerative disease. They may also be among the most cost-efficient, certainly compared to treatment of frank disease. This is a frugal and realistic strategy that is economically sustainable in the U.S. and in the underserved and economically deprived populations that are already moving toward more chronic illnesses.

Copyright 2014 Jed W. Fahey

A very straightforward starting point for this paradigm shift is for physicians to prescribe preventive diets for their at-risk patients. The food system in the U.S. can readily facilitate the delivery of such diets, but our medical and graduate schools must do a far better job of teaching new physicians and biomedical scientists about human nutrition and the role of diet in disease prevention, and those newly trained professionals must in turn be proactive with their patients and counselees. They must make prevention as much the order of the day as cure. Food—chemopreventive diets—should be, and can be, the daily “multivitamin” of our immediate future.

The challenge for the next decade(s) and for new health professionals is how to convey the learnings directly to their patients and to the general public. Social scientists, the entire spectrum of stakeholders in the food industry (e.g., from farmers to retailers), medical, nursing, and public health schools, government (e.g., regulatory and research branches), and primary and secondary school educators will all need to become invested and involved. The new drivers of this revolution will be not the drug companies but the food and agricultural interests because they will stand to profit greatly from introduction of new foods, new plant cultivars, and the reintroduction of “old foods” into new markets. They should thus be expected to provide a larger share of the funding for chemoprevention research as well as for effective public outreach. The road to longer healthspan will of course be rocky, but we cannot afford to ignore a strategy of diet-based prevention without putting our health care system in even more severe jeopardy than it already is.

Excerpted from: Fahey JW and TW Kensler (2013) American Medical Association Virtual Mentor 15(4): 311-318.

I recently talked about many of these things in a 44 minute podcast on SmartDrugSmarts.

Related Publications

Lynch R, EL Diggins, SL Connors, AW Zimmerman, K Singh, H Liu, P Talalay, JW Fahey. (2017)  Sulforaphane from broccoli reduces symptoms of autism: A follow-up case series from a randomized double-blind study. Global Advances in Health and Medicine 6:1-7.
Axelsson AX, E Tubbs, B Mecham, S Chacko, HA Nenonen, Y Tang, JW Fahey, JMJ Derry, CB Wollheim, N Wierup, MW Haymond, SH Friend, H Mulder, AH Rosengren.  (2017) Sulforaphane reduces hepatic glucose production and improves glucose control in patients with type 2 diabetes. Science Translational Medicine 9(394). with supplementary materials
Dinkova-Kostova AT, JW Fahey, RV Kostov, TW Kensler.  (2017)  KEAP1 and done? Targeting the NRF2 pathway with sulforaphane.  Trends in Food Science and Technology 1-13. [Article].
Fahey JW.  (2017)  Moringa oleifera: A review of the medical potential.  Acta Horticulturae ISHS 1158: 209-224. DOI: 10.17660/ActaHortic.2017.1158.25. [Abstract]
Leone A, G Diorio, W Sexton, M Schell, M Alexandrow, JW Fahey, N Kumar.  (2017)  Sulforaphane for the chemoprevention of bladder cancer: Molecular mechanism targeted approach.  Oncotarget doi: 10.18632/oncotarget. 16015. [Article]
Fahey JW, KL Wade, SL Wehage, WD Holtzclaw, H Liu, P Talalay, E Fuchs, KK Stephenson. (2016) Stabilized sulforaphane for clinical use: Phytochemical delivery efficiency.  Molecular Nutrition and Food Research doi: 10.1002/mnfr.201600766. [Article].
Kerns ML, L Guss, JW Fahey, B Cohen, JMC Hakim, S Sung, RG Lu, and PA Coulombe. (2016) Randomized, split-body, single-blinded clinical trial of topical broccoli sprout extract assessing the feasibility of its use in keratin-based disorders. Journal of the American Academy of Dermatology doi: 10.1016/j.jaad.2016.10.009. [Article]
Wise RA, Crinert G, Sethi S, Rayapudi S, Sudini KR, Sugar EA, Burke A, Thimmulappa R, Singh A, Talalay P, Fahey JW, Berenson CS, Jacobs MR, Biswal S.  (2016)  Lack of Effect of Oral Sulforaphane Administration on Nrf2 Expression in COPD: a Randomized, Double-blind, Placebo Controlled Trial. PLOS One 11(11): e0163716. doi:10.1371/journal.pone.0163716. [Article]
Bauman JE, Y Zang, M Sen, C Li, L Wang, PA Egner, JW Fahey, DP Normolle, JR Grandis, TW Kensler, DE Johnson.  (2016) Prevention of carcinogen-induced oral cancer by sulforaphane.  Cancer Prevention Research 9(7): 547-557. [Abstract]
Liu H, P Talalay, JW Fahey.  (2016)  Biomarker-guided strategy for treatment of autism spectrum disorder (ASD).  CNS & Neurological Disorders – Drug Targets. 15: 602-613. [Abstract]
Benedict AL, EV Knatko, RV Kostov, Y Zhang, M Higgins, S Kalra, JW Fahey, SH Ibbotson, CM Proby, P Talalay, AT Dinkova-Kostova.  (2016)  The multifaceted role of sulforaphane in protection against UV radiation-mediated skin damage. In Juurlink B. (ed.) Broccoli: Cultivation, Nutritional Properties and Effects on Health.  Nova Publishers, NY. [Link]
Johnson TL, AT Dinkova-Kostova, and JW Fahey.  (2016)  Glucosinolates from the Brassica Vegetables and their Health Effects. In Caballero B, Finglas P, and Toldrá F (eds) The Encyclopedia of Food and Health vol. 3, pp. 248-255. Oxford: Academic Press. [Link]
An SS, W Mitzner, W-Y Tang, K Ahn, A-R Yoon, J Huang, O Kilic, HM Yong, JW Fahey, S Kumar, S Biswal, ST Holgate, RA Panettieri Jr., J Solway, SB Liggett. An inflammation-independent contraction mechanophenotype of airway smooth muscle in asthma. Journal of Allergy and Clinical Immunology. DOI: [Abstract]
Knatko EV, M Higgins, JW Fahey, AT Dinkova-Kostova.  (2016)  Loss of Nrf2 abrogates the protective effect of Keap1 downregulation in preclinical models of cutaneous squamous cell carcinoma.  Scientific Reports (Nature) 6: 25804. doi:10.1038/srep25804. [Article]
Brown RH, C Reynolds, A Brooker, P Talalay, JW Fahey. (2015) Sulforaphane improves the bronchoprotective response in asthmatics through Nrf2-mediated gene pathways. Respiratory Research 16: DOI 10.1186/s12931-015-0253-z. [Abstract]
Fahey JW, WD Holtzclaw, SL Wehage, KL Wade, KK Stephenson, P Talalay.  (2015)  Sulforaphane bioavailability from glucoraphanin-rich broccoli: Control by active endogenous myrosinase. PLOS ONE  doi 10.1371/journal.pone.0140963 [Article].
Singh K, SL Connors, EA Macklin, KD Smith, JW Fahey, P Talalay, and AW Zimmerman.  (2014)  Sulforaphane treatment of autism spectrum disorder (ASD). Proc. Natl. Acad. Sci. USA. 111(43): 15550-15555. [Article]
Egner PA, J-G Chen, AT Zarth, DK Ng, J-B Wang, KH Kensler, LP Jacobson, A Muñoz, JL Johnson, JD Groopman, JW Fahey, P Talalay, J Zhu, T-Y Chen, G-S Qian, SG Carmella, SS Hecht, TW Kensler. (2014)  Rapid and sustainable detoxication of airborne pollutants by broccoli sprout beverage: Results of a randomized clinical trial in China.  Cancer Prevention Research (June 9. pii: canprevres.0103.2014 Epub ahead of print). [Abstract]
Tsuji PA, KK Stephenson, KL Wade, H Liu, JW Fahey. (2013) Structure-activity analysis of flavonoids: Direct and Indirect antioxidant, and anti-inflammatory potencies and toxicities. Nutrition and Cancer 65(7) 1014-1025. [Abstract]
Kensler TW, PA Egner, AS Agyeman, K Visvanathan, JD Groopman, J-G Chen, T-Y Chen, JW Fahey, P Talalay. (2012) Keap1-Nrf2 signalling: A target for cancer prevention by sulforaphane. Topics in Current Chemistry 329: 163-178. [Abstract]
Egner PA, J-B Wang, Y-R Zhu, LP Jacobson, D Ng, A Munoz, JW Fahey, J-G Chen, T-Y Chen, G-S Qian, JD Groopman, TW Kensler. (2013) Prevention of liver cancer in Qidong, China: Lessons from aflatoxin biomarker studies. Progress in Chemistry 25(9): 1454-1461. [Abstract]
Fahey JW, TW Kensler. (2013) Frugal medicine: Health-span extension through green chemoprevention. American Medical Association Virtual Mentor 15(4): 311-318. [Article]
Bhattacharya A, Y Li, KL Wade, JD Paonessa, JW Fahey and Y Zhang. (2010) Allyl isothiocyanate-rich mustard seed powder inhibits bladder cancer growth and muscle invasion. Carcinogenesis 31(12): 2105-2110. [Abstract] [Full Article]
Rodriguez-Cantu, L, J Gutierrez-Uribe, J Arreola-Vucovich, R Diaz de la Garza, JW Fahey and S Serna-Saldivar. (2010) Broccoli (Brassica oleracea var. italica) sprouts and extracts rich in glucosinolates and isothiocyanates affect cholesterol metabolism and genes involved on lipid homeostasis in hamsters. Journal of Agricultural and Food Chemistry 59(4): 1095-1103. [Abstract]
Egner PA, JG Chen, JB Wang, Y Wu, Y Sun, JH Lu, J Zhu, YH Zhang, YS Chen, MD Friesen, LP Jacobson, A Muñoz, D Ng, GS Qian, YR Zhu, TY Chen, NP Botting, Q Zhang, JW Fahey, P Talalay, JD Groopman and TW Kensler. (2011) Bioavailability of sulforaphane from two forms of broccoli sprout beverage: Results of a short term, cross-over clinical trial in Qidong, People’s Republic of China. Cancer Prevention Research 4(3): 384-395. [Abstract] [Full Article]
Suganuma H, JW Fahey, KE Bryan, ZR Healy and P Talalay. (2011) Stimulation of phagocytosis by sulforaphane. Biochemical and Biophysical Research Communications 405(1): 146-151. [Abstract] [Full Article]
Kensler TW, D Ng, SG Carmella, M Chen, LP Jacobson, A Munoz, PA Egner, JG Chen, GS Qian, TY Chen, JW Fahey, P Talalay, JD Groopman, J-M Yuan, SS Hecht. (2012) Modulation of the metabolism of airborne pollutants by glucoraphanin-rich and sulforaphane-rich broccoli sprout beverages in Qidong, China. Carcinogenesis 33(1):101-107. [Full Article]
Fahey JW, P Talalay, TW Kensler. (2012) Notes from the field: “Green” chemoprevention as frugal medicine. Cancer Prev Res 5(2):179-188. [Abstract] [Full Article
Fahey JW, SL Wehage, WD Holtzclaw, TW Kensler, PA Egner, TA Shapiro, P Talalay. (2012) Protection of humans by plant glucosinolates: Efficiency of conversion of glucosinolates to isothiocyanates by the gastrointestinal microflora. Cancer Prev Res 5(4):603-611. [Abstract]
Dinkova-Kostova, AT, SN Jenkins, JW Fahey, L Ye, SL Wehage, KT Liby, KK Stephenson, KL Wade and P Talalay. (2006) Protection against UV-light-induced skin carcinogenesis in SKH-1 high-risk mice by sulforaphane containing broccoli sprout extracts. Cancer Letters 240: 243-252. [Abstract]
Tang, L, Y Zhang, HE Jobson, J Li, KK Stephenson, KL Wade and JW Fahey. (2006) Potent activation of mitochondria-mediated apoptosis and arrest in S and M phases of cancer cells by a broccoli sprout extract. Molec. Cancer Therapeutics 5(4): 935-944. [Abstract] [Full Article]
Munday, R, Y Zhang, JW Fahey, HE Jobson, CM Munday, J Li and KK Stephenson. (2006) Evaluation of isothiocyanates as potent inducers of carcinogen-detoxifying enzymes in the urinary bladder: Critical nature of in vivo bioassay. Nutrition Cancer 54(2): 223-231. [Abstract]
Shapiro, TA, JW Fahey, AT Dinkova-Kostova, WD Holtzclaw, KK Stephenson, KL Wade, L Ye and P Talalay. (2006) Safety, tolerance, and metabolism of broccoli sprout glucosinolates and isothiocyanates: A clinical phase I study. Nutrition and Cancer 55(1): 53-62. [Abstract]
Zhang, Y, R Munday, HE Jobson, CM Munday, C Lister, P Wilson, JW Fahey and P Mhawech-Fauceglia. (2006) Induction of GST and NQO1 in the urinary bladder by an extract of broccoli (Brassica oleracea italica) sprouts. Journal of Agricultural and Food Chemistry 54: 9370-9376. [Abstract]
Fahey, JW and TW Kensler. (2007) Role of dietary supplements/nutraceuticals in chemoprevention through induction of cytoprotective enzymes. Chemical Research in Toxicology. 20: 572-576. [Abstract] [Full Article]
Dinkova-Kostova, AT, JW Fahey, KL Wade, SN Jenkins, TA Shapiro, EJ Fuchs and P Talalay. (2007) Induction of the phase 2 response in mouse and human skin by sulforaphane-containing broccoli sprout extracts. Cancer Epidemiol. Biomarkers Prev. 16(4): 847-851. [Abstract] [Full Article]
Cornblatt, BS, L Ye, AT Dinkova-Kostova, M Erb, JW Fahey, NK Singh, MS Chen, T Stierer, E Garrett-Meyer, P Argani, NE Davidson, P Talalay, TW Kensler and K Visvanathan. (2007) Preclinical and clinical evaluation of sulforaphane for chemoprevention in the breast. Carcinogenesis. 28(7): 1485-1490. [Abstract] [Full Article]
Talalay, P, JW Fahey, ZR Healy, SL Wehage, AL Benedict, C Min and AT Dinkova-Kostova. (2007) Sulforaphane mobilizes cellular defenses that protect skin against damage by UV radiation. Proc. Natl. Acad. Sci. USA 104: 17500-17505. [Abstract] [Full Article]
Kensler, TW, J-G Chen , PA Egner , JW Fahey, LP Jacobson, KK Stephenson, X Ye, JL Coady, J-B Wang, Y Wu, Y Sun, Q-N Zhang, B-C Zhang, Y-R Zhu, G-S Qian, SG Carmella, SS Hecht, L Benning, SJ Gange, JD Groopman and P Talalay. (2005) Effects of glucosinolate-rich broccoli sprouts on urinary levels of aflatoxin-DNA adducts and phenanthrene tetraols in a randomized clinical trial in He Zuo Township, Qidong, PRC. Cancer Epidemiol. Biomarkers Prev., 14(11): 2605-2613. [Abstract] [Full Article]
Fahey, JW, KK Stephenson, AT Dinkova-Kostova, PA Egner, TW Kensler, and P Talalay. (2005) Chlorophyll, chlorophyllin and related tetrapyrroles are significant inducers of mammalian phase 2 cytoprotective genes. Carcinogenesis 26: 1247-1255. [Abstract] [Full Article]
Fahey, JW, A Munoz, Y Matsuzaki, H Suzuki, P Talalay, M Tauchi, S Zhang, C Hurt and A Yanaka. (2004) Dietary amelioration of Helicobacter pylori infection: Design criteria for a clinical trial. Cancer Epidemiol. Biomark. Prevent. 13(10): 1610-1616. [Abstract] [Full Article]
Fahey, JW, AT Dinkova-Kostova, and P Talalay. (2004) The “Prochaska” microtiter plate bioassay for inducers of NQO1. Chapter 14 in Methods in Enzymology, Vol. 382, Part B, pp. 243-258 (Eds.) H. Sies and L. Packer, Elsevier Science, San Diego, CA. [Abstract]
Dinkova-Kostova, AT, JW Fahey, and P Talalay. (2004) Chemical structures of inducers of nicotinamide quinone oxidoreductase 1 (NQO1). Vol. 382, Part B, pp. 423-448. in Methods in Enzymology, (Eds.) H. Sies & L. Packer, Elsevier Science, San Diego, CA.  [Abstract]
Fowke, JH, JR Hebert and JW Fahey. (2002) Urinary excretion of dithiocarbamates and self-reported Cruciferous vegetable intake: Application of the ‘Method of Triads’ to a food-specific biomarker. Pub. Health Nutr. 5(6): 791-799.   [Abstract] [Full Article]
Fahey, JW. (2002) Dietary phytochemical delivery: Glucosinolates/ isothiocyanates. Nutrition Today 37(5): 214-217
Talalay, P and JW Fahey. (2001) Phytochemicals from cruciferous plants protect against cancer by modulating carcinogen metabolism. J. Nutrition 131:3027S-3033S. [Abstract] [Full Article]
Shapiro, TA, JW Fahey, KL Wade, KK Stephenson and P Talalay. (2001) Disposition of chemoprotective glucosinolates and isothiocyanates of broccoli sprouts. Cancer Epidemiol. Biomark. Prevent. 10:501-508. [Abstract] [Full Article]
Fowke, JH, JW Fahey, KK Stephenson and JR Hebert. (2001) Using isothiocyanate excretion as a biological marker of Brassica vegetable consumption epidemiological studies: evaluating the sources of variability. Pub. Health Nutr. 4(3):837-846.  [Abstract] [Full Article]
Fahey, JW and KK Stephenson. (1999) Cancer chemoprotective effects of cruciferous vegetables. HortScience 34(7):1159-1163.
Fahey, JW and P Talalay. (1999) Antioxidant functions of sulforaphane: A potent inducer of Phase 2 detoxication enzymes Fd. Chem. Toxicol. 37(9-10):973-979. [Abstract]
Shapiro, TA, JW Fahey, KL Wade, KK Stephenson and P Talalay. (1998) Metabolism and excretion of cancer chemoprotective glucosinolates and isothiocyanates of cruciferous vegetables. Cancer Epidemiol. Biomark. Prev. 7(12):1091-1100. [Abstract] [Full Article]
Fahey, JW and P Talalay. (1995) The role of Crucifers in cancer chemoprotection. In: Phytochemicals and Health, Eds. DL Gustine & HE Flores, pp 87-93. American Society of Plant Physiologists.
Talalay, P, JW Fahey, WD Holtzclaw, T Prestera and Y Zhang. (1995) Chemoprotection against cancer by Phase 2 enzyme induction. Toxicology Letters 82/83:173-179. [Abstract]