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I really wanted to like this book. After all, for years I have complained about the lack of recognition paid by orthodox physicians and medical journalists to the role of nutrition in cancer prevention. Now it seemed that all my concerns would be addressed all at once – a book on this very subject, written by an orthodox physician – who also happens to be medical corespondent for NBC, the highly respected American TV news network. To add to the lustre the book has reached No. 1 on the New York Times best seller list. The thought of all this made me feel quite satisfied. I must admit that I didn't feel so satisfied after I read the book.

It would seem that The Breast Cancer Prevention Diet is well-meaning and truly committed to the agenda of helping women make an informed choice. The book contains information that could well save many lives. Dr Arnot draws conclusions from numerous research studies, and comes up with a diet and lifestyle plan that heavily promotes the use of soy foods, flaxseed, olive oil, fish oils and lots and lots of vegetables and fruit. At the same time it warns the reader of high-risk foods (e.g. hydrogenated fats, fatty red meat, etc.) and high-risk lifestyle factors (e.g. being over or underweight). The book also tries to explain breast cancer mechanisms and discusses the main drugs being used in treatment and prevention.

Unfortunately, the book is full of flaws, both in terms of content and factual accuracy. The messages it tries to get across are often overstated, occasionally misleading and at times downright contradictory.

One of the things that bothered me the most was how incomplete this book is. Some of the most significant issues regarding breast cancer were de-emphasised or even omitted. A case in point is the antioxidant trace mineral selenium, long recognised as the most significant micronutrient marker in breast cancer. Richard Passwater Ph.D., one of the world's leading authorities on this subject, is a colleague of mine so it has become sort of a habit when I pick up any book on cancer to turn to the index and see how much space the book allocates to selenium. Shockingly, I found no reference to selenium in the index of The Breast Cancer Prevention Diet – I thought it must have just been a typographical error, but I read every page of the book and, sure enough, selenium is not mentioned even once! Actually, it is surprising how inexhaustively antioxidant nutrients in general are discussed, especially considering the amount of research into free radical pathology in cancer.

Another glaring weakness in content is the lack of discussion about HRT. Although it is mentioned on occasion, the space allotted to it seems unjustifiably small and incomplete. This is not due to the fact that the book is totally dedicated to nutrition, as he frequently discusses other types of drugs, and in far more depth.

Dr Arnot's sweeping statements and potentially damaging oversimplification of some very critical issues are also cause for concern. One of the worst examples occurs in the discussion on fats. While he rightly points out the evidence that excessive omega 6 fats in the diet represent a major risk factor in breast cancer, his directive is to totally avoid omega 6 fats and replace them all with omega 3 and 9 fats. He writes at one point, "There is a simple bottom line. You do want to give up saturated fats, trans fats and omega 6 fats." Dr Arnot doesn't qualify this with a warning regarding the implications of essential omega 6-derived prostaglandin deficiencies if the reader follows his advice literally (especially those readers who are not at high risk of breast cancer in the first place).

Mixed messages abound as well. He uses the term polyunsaturated to classify the omega 6 fats that he wants the reader to completely avoid – yet he energetically promotes the consumption of the omega 3 fatty acids EPA and DHA, which also are polyunsaturated. One of the most glaring anomalies stems from a scientifically unsupportable comment regarding supplements containing nutritional antioxidants. Dr Arnot states, "The only effective way of ingesting those antioxidants is through a diet high in fruits and vegetables." However, at another point in the book, he clearly directs the reader to take a supplement of indole 3 carbinol, which just happens to be a nutritional antioxidant.

What I did find interesting was Dr Arnot's frequent and often effective use of research (and occasional sound bites from researchers) to support his point of view. However, he occasionally falls into the trap of apportioning too much weight to the most recent studies to make a point, rather than basing his judgement and resulting recommendations on the totality of the published research on a particular subject. As a result, there are occasions when his conclusions fly in the face of the scientific consensus. This was especially misleading in the case of his warning about vitamin E, citing a recent work suggesting that it might increase the risk of breast cancer – yet he fails to mention that the consensus of previous studies has shown vitamin E to be associated with a lower risk.

From the standpoint of readability, I am sure that Dr Arnot's down-to-earth use of language will be very reassuring and appealing to many readers who otherwise would find the subject daunting or distressing. At times the book does try a little too hard to be conversational – which at times can be a distraction – nevertheless, Dr Arnot is generally good at distilling difficult concepts into a form suitable for the layperson, without being patronising.

As flawed as this book is, the majority of the information is valid and if followed, is likely to reduce the risk of breast cancer and benefit health overall. Considering this, as well as the fact that there is so little written on the subject (especially by people with Dr Arnot's lofty status), if I was asked to recommend The Breast Cancer Prevention Diet the answer would be a qualified yes. Presumably its most creditable legacy will be that it triggered more (and hopefully better) books to be published in this urgently important area of health.

* Stephen Terrass is the Technical Director of Solgar Vitamins UK.

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