Day 035 - 12 Oct 94 - Page 54


     
     1        However, individuals living in areas with a high risk of
     2        colon cancer do not have a higher faecal bile acid
     3        concentration or total faecal bile acid output compared
     4        with those living in areas with a low risk, neither do
     5        cases of large bowel cancer have higher faecal bile acid
     6        outputs or concentrations compared with controls.   Other
     7        factors modulating the solubility of free bile acids may
     8        be involved."  Is there anything in that passage about
     9        bowel cancer with which you disagree, Dr. Barnard?
    10        A.  Perhaps the most noteworthy point here is that the
    11        secondary bile acid which are what are of principal
    12        concern are, for some reason, omitted from the discussion.
    13
    14   Q.   The which?
    15        A.  Secondary bile acids.
    16
    17   Q.   No, I do not think so.
    18        A.  Did I miss that?
    19
    20   Q.   I think you probably missed it.
    21
    22   MR. JUSTICE BELL:  Yes, about eight lines up "In bowel cancer",
    23        the end of that sentence.
    24
    25   THE WITNESS:  I see.
    26
    27   MR. RAMPTON:  They state, which I believe I have is common
    28        ground, one of the few pieces of common ground between us,
    29        Dr. Barnard, that secondary bile acids have been shown to
    30        act as tumour promoters?
    31        A.  Yes.
    32
    33   Q.   That I understand is what you tell us too.
    34        A.  Yes, what I was trying to get at was that I would
    35        agree with that sentence which says that "in bowel cancer
    36        it has been proposed that the concentration of faecal bile
    37        acids", and so forth, where they make the point that
    38        secondary bile acids may act as tumour promoters.  The
    39        point I am concerned about is that there is in the
    40        subsequent discussion as to bile acid concentration,
    41        either in international comparisons or in case-controlled
    42        studies, they make no mention of secondary bile acids;
    43        they focus only on total faecal bile.
    44
    45   Q.   One of the processes by which it is thought that certain
    46        kinds of fibre and starch may modify or decrease the risk
    47        of bowel cancer is that they do indeed modulate the
    48        solubility of free bile acids?
    49        A.  What seems to be happening, or one of the very
    50        important things, is that the bacteria themselves are 
    51        altered such that the bile that is coming downstream, if 
    52        you will, is altered, is chemically altered. 
    53
    54   Q.   It is the fermentation of the fibres or starches in the
    55        bowel which may enable the bacteria to perform that
    56        function; is that right?
    57        A.  That is one proposed ----
    58
    59   Q.   That is one proposed theory amongst others?
    60        A.  Yes.

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