A medical phenomenon known as Cuomo’s Paradox is challenging conventional wisdom about disease and survival.

Named after the biomedical scientist Raphael E Cuomo, this term refers to an unexpected phenomenon where factors like alcohol consumption, high cholesterol, or obesity, typically known to increase the risk of serious diseases, are sometimes linked with improved survival rates once a person is diagnosed with the disease.

Obesity, moderate drinking, and diets leading to high cholesterol are recognized as significant risk factors for chronic illnesses such as cancer and heart disease.

However, it’s often observed that patients already diagnosed with such diseases who maintain these behaviors may have a survival advantage over slimmer non-drinkers with the same conditions.

This risk-survival paradox, studied by Cuomo’s team at the University of California San Diego School of Medicine, suggests that strategies beneficial for healthy individuals, like weight loss and avoiding fatty foods, might actually reduce the lifespan of those who are ill.

The objective for healthy individuals is to prevent illness by managing their weight, regulating cholesterol levels, and either limiting alcohol intake or abstaining altogether. Cuomo’s findings suggest that once someone is ill, the body’s priorities may shift towards combating the disease and surviving.

For those battling cancer or heart disease, body fat and cholesterol may provide vital energy reserves needed to endure the significant metabolic stress caused by illness. Cholesterol is also crucial for rebuilding cells damaged by the disease or its treatments.

And while alcohol is a known carcinogen, moderate intake has been linked to better heart disease survival. It also appears to improve cholesterol levels, reduce blood clot formation and increase insulin sensitivity, which may benefit an already-diagnosed patient. 

Pictured above is biomedical scientist Raphael E Cuomo. A counterintuitive medical finding, termed Cuomo’s Paradox, reveals that factors like obesity or alcohol, which increase the risk of developing a disease, may actually be linked to living longer after a diagnosis is received

Cuomo described the paradox in The Journal for Nutrition and offered two possible explanations. 

First, it may be a false signal. A severe, advanced disease like cancer or heart failure causes the body to waste away, leading to weight loss and plummeting cholesterol levels.

Therefore, low weight and low cholesterol levels might not be the cause of poor survival. Instead, they are a symptom of the aggressive disease process that is already underway. 

Doctors are not recommending that patients gain weight after a diagnosis, however. 

The observation is that patients who are already overweight or obese at the time of their diagnosis often show better survival rates compared to normal-weight or underweight patients with the same disease.

The second possible explanation is that there may be real biological mechanisms at play. Body fat serves as a store of energy that the body can tap into to meet the demands of fighting their disease. 

These energy reserves also help patients tolerate the side effects of treatments like chemotherapy and radiation and reduce the risk of becoming dangerously malnourished and weak, a condition called cachexia.

Similarly, high cholesterol is a clogging agent that increases a healthy person’s risk of developing heart disease.

Age-adjusted deaths per 100,000 people due to heart disease have been steadily declining since 1950. Death rates have plummeted from almost 600 per 100,000 in 1950 to around 160 per 100,000 deaths in 2018

Cancer diagnoses, particularly colorectal cancer, are likely to continue ticking up in part due to major disruptions to preventive healthcare during the Covid pandemic. Nearly 130,000 cancers were missed in 2020 and 2021, or nine percent less than the expected number

But in a patient who is already battling cancer or another chronic illness, fatty molecules in the blood, including cholesterol and lipids, are sources of energy for the body to tap into and use in its fight against advancing disease.

Cholesterol is also a vital component of cell membranes. To heal damaged tissues resulting from disease, radiation, or chemotherapy, the body requires a sufficient amount of cholesterol to rebuild healthy cells.

It also helps control the production and release of hormones like estrogen and cortisol, which regulate the body’s response to illness, maintain muscle mass, and manage inflammation.

Alcohol is classified by the World Health Organization as a class 1 carcinogen, a substance that has been proven to cause cancer in humans based on sufficient evidence.

But Cuomo’s Paradox reveals that for patients already diagnosed with cardiovascular disease, moderate alcohol consumption has been consistently linked to better survival in observational studies.

Alcohol can increase levels of high-density lipoprotein (HDL), which helps remove ‘bad’ cholesterol from the arteries, slowing plaque buildup.

Moderate intake can also make the body more sensitive to insulin, reducing the risk of type 2 diabetes, a significant risk factor for heart disease.

Factors like obesity, often linked to disease risk, are paradoxically associated with better survival outcomes in some patients after a diagnosis, suggesting nutritional needs shift once illness strikes (stock)

Alcohol can also make blood platelets less ‘sticky,’ which reduces the formation of blood clots that can cause heart attacks and strokes.

According to the paradox, the stress of withdrawal or the loss of a perceived benefit, such as antioxidants in red wine, could theoretically do more harm than good in heart disease patients.

This does not mean that being overweight, drinking or having high cholesterol is beneficial for someone without a disease.

It means that rigorously enforcing prevention guidelines in sick, weakened patients might be ineffective and could even undermine their strength and well-being. Each patient’s care must be tailored to their individual needs.

Nutritional guidance should also not be abandoned. Instead, it should be tailored to the specific stage of a patient’s health journey, Cuomo said, rather than based on standard prevention advice, such as reducing cholesterol or losing weight.

Cuomo said: ‘Healthy should be defined relative to a person’s stage in life and goals. Cuomo’s Paradox reframes health as prevention versus survival. My research has uncovered pre-diagnosis versus post-diagnosis as a core variable in nutrition.

‘It became clear to me that prevention advice and survivorship advice must be separated.’