Molecular Pathway Linking Colon Cancer To A High Fat Diet (And Obesity)

By Attributed to Charles Mellin - WgF1LrUvFdNysA at Google Cultural Institute, zoom level maximum, Public Domain, https://commons.wikimedia.org/w/index.php?curid=13334241

A study has shown a molecular pathway linking obesity and a high fat diet to colon cancer.  Excerpts from the article (italics) with some of my own comments inserted:

Scientists in the U.S. have identified a molecular pathway that appears to play a key role in the link between a high-fat diet (HFD) and the development of colorectal cancer. The research, led by the Cleveland Clinic’s Sheerlarani Karunanithi, and Matthew Kalady, suggests that it may one day be possible to develop drugs that reduce tumor growth associated with obesity and a diet that is high in fat. 

Or people can lose weight and eat lower-fat diets.  What's wrong with that approach?

Their research is published today, in Stem Cell Reports, in a paper titled, “RBP4-STRA6 Pathway Drives Cancer Stem Cell Maintenance and Mediates High-Fat Diet-Induced Colon Carcinogenesis.”

The Cleveland Clinic team’s review of published research indicated that high expression levels of two vitamin A signalling proteins—serum retinol binding protein (RPB4), stimulated by retinoic acid 6 (STRA6)—in colorectal cancer tumors is associated with poor prognosis, increased tumor metastasis and recurrence, and resistance to cancer therapy. The RBP4-STRA6 pathway triggers the JAK2-STAT3 signaling cascade…

That is useful information - perhaps the greatest utility is motivation to lose wright and change diets, as there is now more concrete evidence linking unhealthy eating habits and an unhealthy weight to colon cancer.

...Our data clearly indicate that RBP4-STRA6 pathway is necessary for the optimal expression of stem cell markers such as NANOG, SOX2, and LGR5, and thereby for maintaining the colon CSC pool,” the authors conclude in their published paper. "We have known the influence of diet on colorectal cancer,” commented Matthew Kalady, M.D., colorectal surgeon, and co-director of the Cleveland Clinic Comprehensive Colorectal Cancer Program. “However, these new findings are the first to show the connection between high-fat intake and colon cancer via a specific molecular pathway. We can now build upon this knowledge to develop new treatments aimed at blocking this pathway and reducing the negative impact of a high-fat diet on colon cancer risk."

One could reasonably reduce the risk of a high-fat diet by no longer eating the high-fat diet.

“The interesting finding here is that the high fat diet-induced effects appear to also involve the stem cell program, which is interesting for tumor growth and has implications on therapies, as tumor stem cells are also therapeutically resistant...” 

It would seem therefore if high-fat diets maintain colon cancer stem cells - cells that can "fuel" the tumor and which may be more resistant to therapy - then one can ask: should colon cancer patients be given nutritional programs that take this into account?

There's nothing wrong with developing new therapies, but those therapies should be in addition to healthy eating, not a substitute for it.

More Against Red And Processed Meat

By 4028mdk09 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=25399566

Is enhanced mortality associated more with red meat/processed meat consumption or with saturated fatty acid (SFA) consumption?  Is it the meat or the saturated fats?  A recent study says meat:

Among highly educated persons, aged >45 years, a high consumption of red, total, and red + processed meat was related to increased all-cause mortality, compared with those with low consumption, whereas no significant associations were found for SFA intake. Dietary guidelines should specifically limit meat consumption and not relying only in limiting SFA intake.

And:

…replacing 100 g of vegetables, fruits & nuts or cereals by 100 g of red meat resulted in higher mortality risk.

For older individuals eating more meat, there was some effect of more SFA consumption:

In these participants, SFA intake was non-significantly associated with mortality. However, isocaloric replacement of monounsaturated fat or carbohydrates by SFA resulted in significantly higher mortality risk. 

But overall this particular study provides data pointing the finger at red meat/processed meat.  Given the consistency of this finding with that of previous studies, it looks for now that excessive consumption of red meat/processed meat is a major dietary health risk.  Looking at all studies, SFA risk is more equivocal; this study does not show, overall, a significant risk, but other studies have showed such a risk.

Limiting red meat/processed meat consumption would seem to be a prudent dietary priority.  Limiting SFA may be a good idea as well, depending upon context and whatever other dietary recommendations a person has from their physician, etc., but the meat situation would seem more important at this point.  Who knows what further studies will say about SFA.

Dried Fruit And Nuts For Type 2 Diabetes

Figure 1

Role of nutrients from nuts and dried fruits in glucose and insulin metabolism, and cellular and molecular mechanisms related to T2D/IR. CHO, carbohydrate; CMF, cellular membrane fluidity; GI, glycaemic index; IR, insulin resistance; MUFA, monounsaturated fatty acid; PUFA, polyunsaturated fatty acid; T2D, type 2 diabetes. http://www.mdpi.com/2072-6643/9/7/673/htm (Figure from the open access paper)

Of course, diabetics need to follow the instructions of their physicians; however, we present this article for readers' interest.  It suggests that eating nuts and dried fruit (DF) can be beneficial for diabetics; some of the possible mechanisms are outlined in the figure (above) from the paper.  The fiber and relatively low glycemic index, healthy fats, minerals, and various bioactive compounds alter gene expression, microRNAs (RNA that control gene expression), and microbiota and so helpfully "modulate glucose and insulin metabolism." From the conclusion:

Undoubtedly, the specific composition of nuts and dried fruits means that they can be used to efficiently counteract metabolic diseases such as type 2 diabetes. Their unique profile of macronutrients, micronutrients and other bioactive compounds may explain the beneficial effects observed in clinical and epidemiological studies. However, the exact mechanisms by which they modulate glucose and insulin metabolism and influence T2D have yet to be fully discovered. They contain fiber, fat, minerals and other bioactive molecules that modulate several gene mechanisms at the cellular and molecular level. This may explain some of their beneficial effects. However, further basic and translational research is needed in order to extend their positive health benefits and to find novel mechanisms and targets to explain their contribution to the management of type 2 diabetes.

What about the sugars in the dried fruit?  The authors claim:

Carbohydrate Content—Glycaemic Index of Nuts and Dried Fruits

It should be noted that nuts are relatively low in CHO (approximately 15% of the total energy) whereas DFs have a high amount of CHO (60–80%). Nuts have a low glycaemic index and therefore increase the blood glucose level less and require less insulin secretion, thus favoring the control of T2D. However, because DFs are high in carbohydrates and fiber, their specific GI has been the object of considerable study. The GI of raisins was first evaluated in three heterogeneous groups of subjects (aerobically trained, sedentary or pre-diabetic) and was described between 49 and 69, therefore corresponding to the low-to-moderate GI foods [110]. However, later studies have reported that raisins are in the low GI category in healthy subjects (a GI of 49.4 and an insulinemic index of 47.1) [15]. This suggests a favorable postprandial glucose and insulin response [112], that could be explained by the high proportion of fructose that DFs contain.

Overall, the inclusion of both nuts and DFs in a balanced diet may reduce the overall glycaemic index of the diet, with benefits to glycaemic and insulinemic control in both healthy and T2D subjects.

Fructose of course can cause problems but when combined with the high fiber in the dried fruits that is obviated.

Cancer Field Effect

Here is a paper on the cancer field effect, an idea that states than an entire area of a tissue can be altered in some way to predispose that area to develop cancer. Of interest is the possibility that diet, lifestyle (including smoking), etc. can alter the tissue microenvironment to create a "field of susceptibility" to cancer. Hopefully such research can fulfill the promise of "personalized prevention and treatment strategies for precision medicine;" however, until then, controlling diet and lifestyle to prevent cancer, to the best of your ability, is the optimal behavior modification to do.

The term 'field effect' (also known as field defect, field cancerization, or field carcinogenesis) has been used to describe a field of cellular and molecular alteration, which predisposes to the development of neoplasms within that territory. We explore an expanded, integrative concept, 'etiologic field effect', which asserts that various etiologic factors (the exposome including dietary, lifestyle, environmental, microbial, hormonal, and genetic factors) and their interactions (the interactome) contribute to a tissue microenvironmental milieu that constitutes a 'field of susceptibility' to neoplasia initiation, evolution, and progression. Importantly, etiological fields predate the acquisition of molecular aberrations commonly considered to indicate presence of filed effect. Inspired by molecular pathological epidemiology (MPE) research, which examines the influence of etiologic factors on cellular and molecular alterations during disease course, an etiologically focused approach to field effect can: (1) broaden the horizons of our inquiry into cancer susceptibility and progression at molecular, cellular, and environmental levels, during all stages of tumor evolution; (2) embrace host-environment-tumor interactions (including gene-environment interactions) occurring in the tumor microenvironment; and, (3) help explain intriguing observations, such as shared molecular features between bilateral primary breast carcinomas, and between synchronous colorectal cancers, where similar molecular changes are absent from intervening normal colon. MPE research has identified a number of endogenous and environmental exposures which can influence not only molecular signatures in the genome, epigenome, transcriptome, proteome, metabolome and interactome, but also host immunity and tumor behavior. We anticipate that future technological advances will allow the development of in vivo biosensors capable of detecting and quantifying 'etiologic field effect' as abnormal network pathology patterns of cellular and microenvironmental responses to endogenous and exogenous exposures. Through an 'etiologic field effect' paradigm, and holistic systems pathology (systems biology) approaches to cancer biology, we can improve personalized prevention and treatment strategies for precision medicine.

The Yin to FGF19's Yang

At left, FGF19.

By Emw - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=8767926

I recently wrote about the potential benefits of FGF19. However, in biology, many things are “double edged swords” and the same things that can promote useful growth in one context can, in another, promote cancer.  Abstract:

Fibroblast growth factors (FGFs) and their cognate receptors, FGF receptors (FGFRs), play critical roles in a variety of normal developmental and physiological processes. Numerous reports support a role for deregulation of FGF-FGFR signaling, whether it is at the ligand and/or receptor level, in tumor development and progression. The FGF19-FGFR4 signaling axis has been implicated in the pathogenesis of several cancers, including hepatocellular carcinomas in mice and potentially in humans. This chapter focuses on recent progress in the understanding of the molecular mechanisms of FGF19 action and its potential involvement in cancer.

This is why various cutting edge treatments must always take into account potential side effects. Now, of course, there is a difference between normal and deregulated FGF signaling and it may be possible to use FGFs in therapy responsibly: the point is that all possibilities, both positive and negative, need to be considered and evaluated.

The American dream: code blue

America, its lifestyle and opportunities have been the dream for many.

America became my own salvation when the communist bloc in Eastern Europe began to fall apart, and there were no jobs, food was scarce, and electricity was sporadic. At that time, I had a newly-minted MS degree, very little English and no prospects for work. So, I studied English on my own, took the required standardized tests (for the first time in my life) and applied to PhD programs in the U.S.

I was lucky - I was accepted in one out of the three universities I applied to. I petitioned to waive my application fee; I hardly had the money to cover the fees for the standardized tests. My parents borrowed money for my airfare and for my first month of expenses in the U.S. After the first month, I had to support myself with my stipend for the work I did in the graduate school.

Looking back, I believe that America saved me from the prematurely aged, toothless and nervous wreck I could have become in my own country. The reality in a disintegrating socialist country killed many. It killed my best friend. Sometimes I doubt that I would have survived, if I had stayed home.

America gave me a PhD degree, job, and family. America gave me opportunities and hopes.

However, would America give the same to my child? What does America offer to the young generation today?

Today, college is a barrier that everyone needs to jump over, but once on the other side, there are not too many opportunities to apply the college degree to. Instead, the graduates are staring at an ugly debt.

And even when one finds a job, how many college-degree jobs are stable today? I think, none. Even my present job is about to expire within the next few years, as academia contracts into a quasi-online model that employs adjuncts, teaching assistants and an exorbitant number of administrators. This would be the end of my career as a PhD graduate.

When I look back at my parents’ trajectory, I perceive that their stories could have been the most extreme example of the American dream. The irony is that they grew up and lived in a socialist country, not in the U.S.

My father was born and raised in a remote, small village in the middle of nowhere. I wanted to visit the place a few years ago, and I was told that there were only a few houses left. His parents may or may have not attended elementary school. After leaving the village and joining the workforce at age of 14, my father survived on very little until the political changes in the country pulled him from the bottom and gave him opportunities. The socialist system helped him finish high school and vocational school, and eventually, brought him into a military academy in the USSR. My father became a skillful and knowledgeable electrical engineer, he rose to the rank of colonel and was given a high-responsibility position in the Ministry of Defense. He was considered for a general and a leader of a military factory next. However, by that time the stress and speed of rising took their toll. My father gave in to a psychosis-ridden burnout and was unable to function at his high-ranked position.

Despite this ending, my father’s story is this of tremendous success – his journey was this from a speck of a village, through numerous towns and jobs, and finally to the capital. He put lots of effort, work, diligence and determination on this path. But he was also helped by the system. If my father was to go to a grad school in the U.S. today, he would not have had a chance! You see, candidates like him are considered an unacceptable risk for the schools. Candidates like him are not offered any scholarships. Back then – more than 50 years ago, my father paid not a single penny for his education. The education in the socialist countries was free.

My mom was raised in a family that was more stable financially; however, her parents also did not have too much of a formal education. My mom graduated from a specialized college to become a highly accomplished teacher in science. Again, the education was free.

Despite their education, my parents received the standard socialist salaries – at that time everyone was receiving more or less the same amount of money for being a medical doctor, colonel, teacher, or janitor. My mom and dad never got a penny from their own parents; however, they were able to establish a home and raise two children. Both my brother and I received free education and obtained masters’ degrees. At the time of graduation, we did not have a penny of debt.

Of course, whereas the socialist system was good and helpful to some, to others, the same system turned out to be cruel and unforgiving. I met some of these people - they had been raised in affluent families, they were smart, well educated, and talented. And yet, when the socialist system was established, these people found themselves under attack. After all, their mothers, fathers and/or grandparents have served the monarch! These people were banned from certain schools, they were not given jobs. Every system has its own flaws, the socialist system had plenty.

And yet, when I look at the future of this land of opportunities, I see only shrinking ones. For me, for my husband, for my child, for the majority of the population.

I do not see the solutions that great leaders should offer the greatest nation in the world.

Where is the grand vision?

Our children are the future of this country. Our priority in visioning should be to take good care of them, give them opportunities to learn, find their interests, realize themselves and be able and free of debt to apply their talents where their hearts are.

We should also make sure that these children grow up in stable families, families in which mom and dad have jobs.

FGF19 Against Muscle Wasting

https://i.ytimg.com/vi/uKMVIfas12k/hqdefault.jpg

Muscle wasting occurs in a variety of diseases as well as aging (sarcopenia). This study shows that a growth factor called FGF 19 increases muscle size in mice and increases human muscle cell size in culture.  In addition, mice with induced muscle wasted were helped by FGF19.  Therefore, this has possible clinical applications for various human disorders.  Abstract:

The endocrine-derived hormone fibroblast growth factor (FGF) 19 has recently emerged as a potential target for treating metabolic disease. Given that skeletal muscle is a key metabolic organ, we explored the role of FGF19 in that tissue. Here we report a novel function of FGF19 in regulating skeletal muscle mass through enlargement of muscle fiber size, and in protecting muscle from atrophy. Treatment with FGF19 causes skeletal muscle hypertrophy in mice, while physiological and pharmacological doses of FGF19 substantially increase the size of human myotubes in vitro. These effects were not elicited by FGF21, a closely related endocrine FGF member. Both in vitro and in vivo, FGF19 stimulates the phosphorylation of the extracellular-signal-regulated protein kinase 1/2 (ERK1/2) and the ribosomal protein S6 kinase (S6K1), an mTOR-dependent master regulator of muscle cell growth. Moreover, mice with a skeletal-muscle-specific genetic deficiency of β-Klotho (KLB), an obligate co-receptor for FGF15/19 (refs. 2,3), were unresponsive to the hypertrophic effect of FGF19. Finally, in mice, FGF19 ameliorates skeletal muscle atrophy induced by glucocorticoid treatment or obesity, as well as sarcopenia. Taken together, these findings provide evidence that the enterokine FGF19 is a novel factor in the regulation of skeletal muscle mass, and that it has therapeutic potential for the treatment of muscle wasting

Dismantling Administration

 Representative of a typical administrator. By Source, Fair use, https://en.wikipedia.org/w/index.php?curid=19854440

Related to this, take a look at this article. I’ll reproduce some parts of it, and then link to another article, and then make some comments at the end.

The number of non-academic administrative and professional employees at U.S. colleges and universities has more than doubled in the last 25 years, vastly outpacing the growth in the number of students or faculty, according to an analysis of federal figures. 

The disproportionate increase in the number of university staffers who neither teach nor conduct research has continued unabated in more recent years… 

…Universities have added these administrators and professional employees even as they’ve substantially shifted classroom teaching duties from full-time faculty to less-expensive part-time adjunct faculty and teaching assistants, the figures show… 

…Part-time faculty and teaching assistants now account for half of instructional staffs at colleges and universities, up from one-third in 1987, the figures show. 

During the same period, the number of administrators and professional staff has more than doubled. That’s a rate of increase more than twice as fast as the growth in the number of students. 

It’s not possible to tell exactly how much the rise in administrators and professional employees has contributed to the increase in the cost of tuition and fees… 

…But critics say the unrelenting addition of administrators and professional staffs can’t help but to have driven this steep increase. 

At the very least, they say, the continued hiring of nonacademic employees belies university presidents’ insistence that they are doing everything they can to improve efficiency and hold down costs. 

“It’s a lie. It’s a lie. It’s a lie,” said Richard Vedder, an economist and director of the Center for College Affordability and Productivity. 

“I wouldn’t buy a used car from a university president,” said Vedder. “They’ll say, ‘We’re making moves to cut costs,’ and mention something about energy-efficient lightbulbs, and ignore the new assistant to the assistant to the associate vice provost they just hired.”… 

...The ratio of nonacademic employees to faculty has also doubled. There are now two nonacademic employees at public and two and a half at private universities and colleges for every one full-time, tenure-track member of the faculty. 

Centralization has been promoted as a way to reduce costs, but Vedder points out that it has not appeared to reduce the rate of hiring of administrators and professional staffs on campus—or of incessant spikes in tuition… 

…“It’s almost Orwellian,” said Vedder. “They’ll say, ‘We’ll save money if we centralize.’ Then they hire a provost or associate provost or an assistant business manager in charge of shared services, and then that person hires an assistant, and you end up with more people than you started with.” 

In higher education, “Everyone now is a chief,” he said. “And there are a lot fewer Indians.” 

And if that is not enough, how about this: 

By contrast, a major factor driving increasing costs is the constant expansion of university administration. According to the Department of Education data, administrative positions at colleges and universities grew by 60 percent between 1993 and 2009, which Bloomberg reported was 10 times the rate of growth of tenured faculty positions. 

Even more strikingly, an analysis by a professor at California Polytechnic University, Pomona, found that, while the total number of full-time faculty members in the C.S.U. system grew from 11,614 to 12,019 between 1975 and 2008, the total number of administrators grew from 3,800 to 12,183 — a 221 percent increase. 

As a faculty member, I can attest to this. Faculty are downsized concurrently with a relentless expansion of administration and staff. Faculty are held accountable to how they spend every microsecond of their workday, and at the same time incompetent administrators have lower and lower responsibility and accountability as they rise in the academic hierarchy. 

The more administrators talk about “tight budgets” and “cost cutting measures”, the more administration and staff they hire, the more expensive out-of-state meetings they attend, the more of their buddies are invited to come and “train the faculty,” and the more fluff and nonsense they waste money on. Much of what administrators do is self-serving: they use the authority of their positions to the advantage of administration (of which they are part) at the expense of faculty and, above all, students (who have to pay, via tuition, for this bloated administrative infrastructure). 

What about the excuse that all these administrators are required because of the expansion of regulations? Guess what – more self-serving behavior. Who do you think are making up all these regulations? Academic administrators working for government and for accreditation agencies. Where do these people come from? Look at the situation in which people switch back and forth between government positions and corporate lobbyists – it is the same principle in academia. It’s the same general pool of parasitic, self-serving administrators that fill the academic administrative posts and also fill the positions in government and accreditation agencies dreaming up more regulations to justify even more administrative hiring. 

What about the “demands of students and their families?” If only those students and families understood how little the students actually benefit from a school having more Deans, Vice Deans, Associate Deans, Assistant Deans, Presidents, Vice Presidents and all of their respective staffs! That’s just another excuse…have you noticed that American academic performance continues to decline despite our expansion of ever-more administration to “help” “students and their families?” In the end, the administrators are not really helping the “students and their families” – they are helping themselves. And why are students ill-prepared for college in the first place (one excuse often cited for hiring more administration)? One reason is that these scenarios play out at the public school level as well; anyone who has a child in American public schools understand how much time is wasted with non-academic fluff at the expense of a rock-solid education.

If all of this administration could be justified by the fact that American education was a well-oiled machine that would be one thing. But that’s not the case. The administrators ultimately cause problems requiring hiring even more administration to fix. Work creating even more work, a feedback loop that will continue until colleges end up having more administration and staff than they do students (faculty have already been out-numbered long ago). It’s like a metastatic cancer and it can only end up by killing off the host. 

Solution? Faculty and students need to form an alliance to promote the best interests of their institutions and the students who attend those institutions against the self-serving behavior of runaway administration. A stand needs to be made or the student-faculty foundation is going to crumble under the weight of the gigantic administrative superstructure, whose sheer mass is much-too-much to handle.

Alternative Treatments For Musculoskeletal Pain

Physical therapists.  Citations for pictures at end of post.

Here is a refreshing article suggesting that instead of just prescribing medication, doctors should suggest exercise therapy and "psychosocial interventions" - a change from the 'quick fix" attitude of just popping a pill to solve very problem.  The conclusion of the abstract:

This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most promising treatments is needed.

Citations for pictures:

By _US_Navy_100723-N-7214P-020_Machinist's_Mate_Fireman_George_F._Avinger_practices_cone_drills_during_physical_therapy_in_the_Comprehensive_Combat_and_Complex_Casualty_Care_facility_at_Naval_Medical_Center_San_Diego.jpg: U.S. Navy photo by Mass Communication Specialist 1st Class Anastasia Puscian_US_Navy_090508-F-7885G-021_Staff_Sgt._Hugo_Reiner,_a_physical_therapy_craftsman_aboard_the_Military_Sealift_Command_hospital_ship_USNS_Comfort_(T-AH_20),_makes_a_wrist_brace_for_Teresa_De_la_Pena_during_a_Continuing_Promise_200.jpg: U.S. Air Force photo by Airman 1st Class Danielle GrannanUS_Navy_070917-N-8704K-072_Lt._Gwen_Smith,_attached_to_Military_Sealift_Command_hospital_ship_USNS_Comfort_(T-AH_20),_performs_physical_therapy_for_Marcus_Pryce_at_the_Arima_Health_Facility.jpg: U.S. Navy photo by Mass Communication Specialist 2nd Class Joshua Karsten_US_Navy_070706-N-8704K-101_Lt._Gwen_Smith,_attached_to_Military_Sealift_Command_hospital_ship_USNS_Comfort_(T-AH_20),_performs_physical_therapy_with_the_help_of_translator_Zoela_Armstrong_at_the_Paul_Brown_Arena.jpg: U.S. Navy photo by Mass Communication Specialist 2nd Class Joshua Karsten_US_Navy_081610-A-6522B-002_Physical_therapist_Lt._Cmdr._Mitchel_Ideue,_Officer_in_Charge_of_Inpatient_Services_at_Landstuhl_Regional_Medical_Center,_in_Landstuhl,_Germany,_gives_Army_Sgt._Charlie_McCall_a_physical_therapy_trea.jpg: U.S. Navy photo_US_Navy_091003-N-8960W-011_Gunner's_Mate_2nd_Class_Patrick_Cornwell_undergoes_an_exam_by_Lt._Cristi_Zohlen_to_document_his_shoulder_pain_in_the_physical_therapy_clinic_aboard_the_aircraft_carrier_USS_Nimitz_(CVN_68).jpg: U.S. Navy photo by Mass Communication Specialist Seaman Apprentice Robert Winn_US_Navy_020128-N-6077T-008_CVN_74_crew_member_receives_medical_treatment_aboard_ship.jpg: U.S. Navy photo by Photographer’s Mate 1st Class Kevin H. Tierneyderivative work: Jnyles (talk) - _US_Navy_100723-N-7214P-020_Machinist's_Mate_Fireman_George_F._Avinger_practices_cone_drills_during_physical_therapy_in_the_Comprehensive_Combat_and_Complex_Casualty_Care_facility_at_Naval_Medical_Center_San_Diego.jpg_US_Navy_090508-F-7885G-021_Staff_Sgt._Hugo_Reiner,_a_physical_therapy_craftsman_aboard_the_Military_Sealift_Command_hospital_ship_USNS_Comfort_(T-AH_20),_makes_a_wrist_brace_for_Teresa_De_la_Pena_during_a_Continuing_Promise_200.jpgUS_Navy_070917-N-8704K-072_Lt._Gwen_Smith,_attached_to_Military_Sealift_Command_hospital_ship_USNS_Comfort_(T-AH_20),_performs_physical_therapy_for_Marcus_Pryce_at_the_Arima_Health_Facility.jpg_US_Navy_070706-N-8704K-101_Lt._Gwen_Smith,_attached_to_Military_Sealift_Command_hospital_ship_USNS_Comfort_(T-AH_20),_performs_physical_therapy_with_the_help_of_translator_Zoela_Armstrong_at_the_Paul_Brown_Arena.jpg_US_Navy_081610-A-6522B-002_Physical_therapist_Lt._Cmdr._Mitchel_Ideue,_Officer_in_Charge_of_Inpatient_Services_at_Landstuhl_Regional_Medical_Center,_in_Landstuhl,_Germany,_gives_Army_Sgt._Charlie_McCall_a_physical_therapy_trea.jpg_US_Navy_091003-N-8960W-011_Gunner's_Mate_2nd_Class_Patrick_Cornwell_undergoes_an_exam_by_Lt._Cristi_Zohlen_to_document_his_shoulder_pain_in_the_physical_therapy_clinic_aboard_the_aircraft_carrier_USS_Nimitz_(CVN_68).jpg_US_Navy_020128-N-6077T-008_CVN_74_crew_member_receives_medical_treatment_aboard_ship.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=14511419

Life with courage or failure by default

The Sleep of Reason Produces Monsters. (Capricho No 43). Found in the collection of State Hermitage, St. Petersburg. Photograph: Heritage Images/Getty Images

Imagine yourself at the end of your life: what would your biggest regret be?

Mine would be that I have lived a life of fear. My fear is this of being a failure and causing disappointment.

I always wanted not to fail. But I never wanted to succeed.

I always wanted not to disappoint. But I never wanted to make someone proud of me.

My entire life has been marked by fear. Or lack of courage.

Recently I was listening to Simon Sinek (again). This time the talk was about leadership. Simon believes that a great leader is not defined by charisma or vision, but by courage.

Does this apply to all of us? Maybe.

Even if we do not lead anyone at work, we still need to manage our own life trajectory or this of our families. If we do not have courage, then we would fail at least on a personal, if not professional, level.

To a great extent, courage depends upon our financial situation. Do you have enough to live, if your courage brings a failure? If the answer is yes, then you could afford to be courageous.

At the other end of the spectrum – if you have nothing to lose, courage is also easily achievable.

The best example is this by J.K. Rowling. During her Harvard Commencement, she talked about the benefits of failure.

The biggest revelation was that when one hits rock bottom, the fear of failure fizzles away.

When there is nothing to lose anymore, courage emerges. Rowling said, “rock bottom became solid foundation, on which I rebuilt my life”. And further, “Failure, is inevitable unless you live so cautiously that you might as well have not lived at all. And this is a failure by default.”

Is my entire life a failure by default? Am I ever going to gather the courage I need to taste a real life, life without fear? The next years will put me to the test. At present, I am stuck in the middle between having too little to be courageous, and having too much to lose.