Prostate Cancer Registry - coming very soon

In 2021 Prostate Cancer Research began work on developing the first-of-its-kind prostate cancer registry in the UK. As I've noted in this blog earlier it seems extraordinary that this sort of research has not been going on for years....how can we possibly fully understand treatments and their efficacy without collecting this data.

At last it is coming - all credit to Prostate Cancer Research - they write: "We believe that a prostate cancer registry will revolutionise prostate cancer diagnosis, treatment and care by putting real people at the centre of research. It will bring together personal experience with clinical records in a safe and secure way with the potential to transform future research and connect patients with personalised medicines of the future." 

What is great is that they are including data like lifestyle and complimentary approaches to cancer as well as conventional - plus putting patients at the heart of it all. It sounds like in international circles this approach is pretty groundbreaking.

You can Pledge your support (already over 3,000 people have) at: https://www.prostate-cancer-research.org.uk/pledge/

Hear more in their Webinar that I caught earlier this month: https://www.prostate-cancer-research.org.uk/registry-update/

 

Shared Decision Making?

I just joined a Webinar on Shared Decision Making with the Patients Association earlier this morning - it was recorded so I think it will be available to watch and there are various downloadable resources. No mention of Integrative Care but I guess the more shared decision making, the more opportunities there will be, at least amongst those patients who have come across Integrative medicine?

We so need more of this as reserach shows one in seven people have post decision regret! I think that was mostly surgery but I've certainly come across quite a number of people who would have liked to understood better their choices. We also know from Kelly Turner's research (and others) that having more control over our health is good for our health. In some ways it seems extraordinary that we are even having this conversation!

There was a Citizen’s Jury in 2019 with NHS Scotland that looked at shared decisions -  this has led to a number of campaigns to boost shared decision making. A badge was created for clinicians to show their support - apparently very positive feedback from patients.

One of the resources that has been created is the 'Our Health - Our Knowledge' - a short web course designed to help people who are thinking about choices in healthcare. That includes patients, family members, carers, healthcare students, healthcare professionals, and policy makers. Patients are expected to be offered choices in treatments. See: https://www.ourhealthourknowledge.org

This Patients Association blog with online resources has a suggestion for Patient Reference Groups to have a look at this - I've already copied to our Gloucestershire Group: https://www.patients-association.org.uk/blog/our-health-our-knowledge-online-resource-for-patients-launches 

You can join other Patients Association webinars this week; 'Patient Partnership Week': www.patients-association.org.uk/Event/join-us-for-a-week-of-patient-partnership

To finish I note that this blog has been rather slow of late - partly have been busy with the charity Yes to Life and partly just life....I have at leats a hundred blogs in my head so hope to find some time for at least a few of those! In the meantime do check out Yers to Life's blogs at: https://yestolife.org.uk/blog/

BPA; what are the issues?

In 2018 it was reported that since the 1970s more than 78,000 chemicals have been approved for commercial use. Only 1,000 have been formally examined and considered for their carcinogenic potential - and of those the World Health Organisation consider 120 as ‘known’ carcinogens, 81 as probable carcinogens and 299 as possible carcinogens (i). See my previous blog at: https://myunexpectedguide.blogspot.com/2022/01/a-look-at-environmental-toxins.html

One of those chemicals which has been widely used is Bisphenol A (BPA) and it has been linked to cancer. It is a synthetic chemical used since the 1950s in making millions of plastics items including food packaging. By 2008 it was found in 93% of Americans urine. Research has linked it to cancers, hormone disruption and other serious health problems. It seems that when BPA enters the body it latches onto the body’s oestrogen receptors and tricks the body into thinking it’s oestrogen – thus increasing oestrogen levels for both men and women as well as disrupting the natural balance between our hormones. Not great stuff!

A review in 2019 (ii) concluded; “Recent findings support a causal role of BPA at low levels in the development of cancers and in dictating their response to cytotoxic therapy.”

In 2020 a study (iii) found that people who had higher levels of bisphenol A in their urine were about 49% more likely to die during a 10-year period. Even as long ago as 1996 research was indicating concerns around endocrine disruption - sadly since then the list of endocrine disrupting chemicals (which includes BPA) has been steadily growing (iv).

Michael Greger of Nutrition Facts writes (2019)(v): “As the world’s oldest, largest, and most active organization devoted to research on hormones concluded, ‘even infinitesimally low levels of exposure—indeed, any level of exposure at all—may cause [problems].”

Not just plastics

A research review paper in 2018 (vi) noted: “Occurrence of BPA in breast and commercial milk represents a public health concern” and that “infants and children are particularly vulnerable to the effects of BPA exposure.”

While another 2018 report found that 93% of till receipts have BPA or bisphenol S (BPS) which were readily transferred onto the skin when handling them. Thankfully BPA has been banned in till receipts in the UK since January 2020. It seems BPS is still in some UK till receipts, although most major supermarkets are now using alternatives. So largely good news particularly for many shop workers who handle many till receipts in a day(vii).
 

Action on BPA – and alternatives

An EU ban on BPA in baby bottles only came into force in 2011 and in food packaging in 2020. It is hard trying to find out the extent of BPA use today; it is certainly being used in new products and of course in products that were made before the bans. Also while there are moves to reduce exposure to the public it seems there is little being done in terms of the impact on those workers, largely women, in the plastic industry.

Banning BPA may still lead to problems as in some cases it is being replaced by other unregulated chemicals like BPS which some argue could be worse than BPA.

BPS and bis­phenol F (BPF) are the two most common replacements for BPA. Research in animals shows that both chemicals disrupt hormone balance comparably to-and sometimes worse than-BPA. Research also suggests that high levels of BPS may promote weight gain. The good news of the replacement BPS is that it may be less likely to leach into your food or beverage when heated in the container, as opposed to BPA, which is very sensitive to heat.

BPA-free does not mean chemical free. I have personally moved away from storing food in plastic where possible but many foods still arrive plastic wrapped especially supermarket products – even many of the organic ones are shrink wrapped. I remember that it was only a year ago that I came to understand that many canned foods had a BPA lining. I was horrified to find that research from the US in 2016 found that people who had consumed one can of food had 24% higher concentrations of BPA in their urine (within 24 hours after consumption) than people who had not consumed canned food.  

Some companies have gone BPA free like Biona and some Mr Organic products – plus an increasing number of products can be found in jars for a price. However too many companies are not talking the issue seriously and it can be hard to find food labelled as to whether it is free from BPA, BPS or BPF - and of course this doesn’t answer the question about how safe the new liners are?
 

What can you do?

We don’t fully know the impact of the replacements so to avoid these chemicals in your food here’s a list that I’ve pulled together that may help us make better choices;

-       if the container or plastic has a number 3 or 7 recycle code, it more likely contains BPA or BPS so that is one to avoid.

-       Choose food and drinks packaged in glass rather than aluminium and plastics

-       Tetra Pak - many non-dairy, beans and tomato products come in these and they are BPA and BPS free

-       choose BPA-free cans where possible

-       dried organic beans are less likely to be contaminated with chemicals than those from cans also sprouted beans can take much less time to cook

-       use glass and stainless steel for food storage at home

-       age increases the leaking of BPA from plastics so take care to throw away old or damaged plastic containers

-       use bees wax wraps or other non-plastics to cover food

-       never heat food in any type of plastic container

-       silicone maybe safer than many plastics but has not been researched well and food-grade silicone can have many additives and colourings added which are not usually listed

-       use a wooden shopping board; plastic has been shown to have more bacteria than wood and there is a risk of small plastic particles becoming dislodged and mixing with the food

-       some takeaways are fine if you bring your own containers

-       getting an organic box delivered or more regular shops at the farmers market could help reduce supermarket plastic wrapping

-       avoid plastic coffee makers and if using filters use non-bleached paper

-       Use unbleached parchment paper for baking and wrapping food. Parchment is often coated with silicone that is considered inert and safe; but as noted above research is limited

-       Aluminum foil can be used to wrap foods but best used with dry foods; acidic foods like tomato sauce can increase the likelihood of it leaching into foods.

Do you have any suggestions to add to this list?

It’s worth noting again that we’ve have only looked at BPA here – as the 2018 report at the beginning of this blog suggests we need to look much wider – for example others like phthalates are also known to mimic and disrupt hormones while many others have other effects.
 

Notes

(i)            ‘Anti Cancer Living’ by Dr Lorenzo Cohen and Alison Jefferies (2018)

(ii)           https://pubmed.ncbi.nlm.nih.gov/30848227/

(iii)         https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2769313

(iv)         https://link.springer.com/article/10.1007/s11356-009-0107-7

(v)          https://nutritionfacts.org/2019/11/05/why-hasnt-bisphenol-a-bpa-been-banned-completely/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726844

(vi)         https://www.sciencedirect.com/science/article/abs/pii/S0278691518300863

(vii)       https://saferchemicals.org/2018/01/17/new-report-9-out-of-10-receipts-contain-toxic-bpa-or-bps/

 

Exposing the bias; the role gender plays in cancer

For too long our health community has not acted sufficiently on the disproportionate impact of cancer on the lives and livelihoods of women, and the impacts this creates for societies. The International Agency for Research on Cancer note for example that worldwide two thirds of cancer deaths under 50 happen to women (i). In this blog I will look at some of the shocking biases faced by women when it comes to cancer.

Of interest in terms of gender you may also want to see a previous blog on the Yes to Life website where we looked at how men don’t do Complementary Medicine(ii) particularly when it’s looking at the mind-body stuff.

What got me writing this blog was a book by Caroline Criado Perez, ‘Invisible Women, Exposing data bias in a world designed for men’ (2019)(iii). Before reading this book I was aware of some of the bias but the story it tells is truly totally shocking. The book shows us how, in a world largely built for and by men, we are systematically ignoring half the population. Perez exposes what she describes as the “gender data gap – a gap in our knowledge that is at the root of perpetual, systemic discrimination against women, and that has created a pervasive but invisible bias with a profound effect on women’s lives”.

There is so much in this book that I can only point to a few of the facts that highlight some of the problems we face relating to cancer. I’ll start with work-related cancers then look at drugs and how because they have never been tested on women they can have very different outcomes to those planned by medical teams.

 
Work-related cancers

In terms of the workplace 8,000 people die every year from work-related cancers. We have seen, for example, the numbers of breast cancers rise in the last 50 years but it has not been researched what is behind this rise. In contrast dust disease amongst miners has been well research. Rory O’Neill, professor of occupational and environmental policy research at Stirling University commented in Perez’ book; “You can’t say the same for exposures, physical or chemical, in ‘womens’ work.”

The data studies that do exist rely on data from studies done on men, mostly 70kg Caucasian and aged 25 to 30 – and the research is done as if this data also applies to women. Perez writes: “This is ’Reference Man’ and his superpower is being able to represent humanity as a whole. Of course, he does not.”

In fact women tend to be smaller and have thinner skin which can lower the levels that make exposure to toxins more safe. A higher percentage of body fat can also impact as that is where chemicals can accumulate. This means that exposure to radiation and many commonly used chemicals could quite likely be outside a safe range. Add to this that the chemicals are usually tested in isolation and on the basis that there is only one exposure. This is just not how any of us are likely to come into contact with chemicals in the home or at work.

A shocking example is the nail salons where many of the chemicals that have been linked to cancer, miscarriages and lung diseases are not only absorbed through womens’ thinner skin but also their fumes are breathed in. Recent studies show air quality in salons exceeds occupational exposure limits that are based on ‘Reference Man’. Many  of the chemicals are endocrine disrupting chemicals which can have significant impacts with even small doses – and been shown to be linked to Hodgkin’s disease, multiple myeloma and breast and ovarian cancers.

Other examples of women using many chemicals are home and hotel cleaners. There is also no account that many might be exposed to some chemicals at work and different ones at home or in a second job. Even those products deemed safe may well be problematic when exposed with other chemicals at the same time.

Every now and then there are headlines about commonly used products which suggests they are not tested often enough. “Always” menstrual pads were found in 2014 to include a number of chemicals including styrene, chloroform and acetone – all either carcinogenic or reproductive and developmental toxins.

In a previous blog I’ve noted other examples like in 2016 Johnson and Johnson’s baby powder and other talc products for feminine hygiene were determined by a Missouri state court to cause ovarian cancer (iv). Last year 75 hand sanitiser brands were recalled in the States as they contained toxic ingredients. We've also just seen last December dozens of Pantene and Herbal Essences dry shampoo sprays recalled for a cancer-causing chemical (v).


Shift-related cancers

In the UK the Health and Safety Executive note that around 2,000 women develop shift-related breast cancer every year. Shift work includes early, late and night shifts at work. Yet this is not listed on the state prescribed disease list and not one of the women is compensated by industrial disease pay outs. Asbestos related ovarian cancer, the most common gynaecological cancer in UK women, is also missing, despite having Industrial Injuries Advisory Council’s top cancer risk ranking. It is also absent from HSE’s occupational cancer body count (vi).

Drugs don’t work?

Perez covers many other aspects of bias but one of the chapters I found particularly concerning relating to cancer was the one entitled ‘The Drugs Don’t Work’. It starts by looking at how doctors are trained. The assumption has been that there is no difference between male and female bodies other than reproductive function and size. She suggests this bias goes back to the Greeks and Aristotle arguing women’s bodies were ‘mutilated male’ bodies(vii).

Today doctors don’t argue that (!), but the male body persists. For example;

-      a 2008 study of textbooks found male bodies were three times more often used to illustrate ‘neutral body parts’,
-      women being excluded from medical trials (viii),
-      a study of courses found huge under-representation of women in medical school curriculums.
-      researchers have argued against the use of women in studies as they can complicate the picture with for example greater fluctuating ‘atypical’ hormones! (ix)

Perez notes that “researchers have found sex differences in every tissue and organ system in the human body, as well as in the prevalence’, course and severity’ of the majority of common human diseases.” This includes differences in lung capacity, fundamental workings of the heart and a host of differences in diseases.

At a most basic level, as mentioned above, women tend to have a higher body fat percentage than men, which, along with the fact that blood flow to fat tissue is greater in women (for men it’s greater to skeletal muscle) can affect how they metabolise certain drugs.” Other sex differences include kidney enzymes, bile acid composition, intestinal enzyme activity and more.

One example quoted is that women develop higher antibody responses to vaccines. A 2014 paper proposed there should be different versions of the influenza vaccines for men and women (x). Other examples include differences in outcomes of diseases like strokes, depression, Parkinsons’ and brain ischaemia, plus cell differences in responses to stress. Yet despite this evidence progress and change seems incredibly slow.

In 1960 my Mum was prescribed the thalidomide drug for morning sickness when she was pregnant with me. Drug manufacturers already knew as early as 1959 that it affected foetal development. It was only taken off the market in 1962 with over 10,000 children having thalidomide-related disabilities. Our family GP when the case came to light commented that he couldn’t understand why I was not amongst those who were disabled as my Mum had had such a high dose. Of interest is that this case led to the FDA in 1977 excluding women of childbearing potential from drug trials; again the acceptance of the male norm went unquestioned.

Women are clearly not just smaller men, but it seems this is still not being taught – or properly considered when prescribing medication.


Chemotherapy drugs

In 2018 a paper (xi), not mentioned by Perez that I came across, entitled ‘Sex Differences in Cancer’ highlighted a host of differences between men and women, genetic, molecular and hormonal plus differences in the efficacy and toxicity of chemotherapy. Again the vast majority of research has only been done on men, yet the research has shown some  clear differences. In particular the paper notes the following chemo drugs have different impacts: 5-fluorouracil, Paclitaxel, Doxorubicin, Cisplatin, Bevacizumab and Rituximab.

The paper concluded: “Chemotherapy has been used without consideration of sex differences, resulting in disparity of efficacy and toxicity between sexes. Based on accumulating evidence supporting sex differences in chemotherapy, all clinical trials in cancer must incorporate sex differences for a better understanding of biological differences between men and women…. Further studies are needed to provide greater insight into sex differences in cancer and improve treatment outcomes with anticancer agents.”

 
Heart disease

Another example of differences is in the death rates from heart disease - they are way higher in women than men. Again this is likely to be that conventional medicine doesn’t always recognize the core biological, psychosocial, hormonal, and metabolic differences between women and men. On top of that, current cardiometabolic diagnostic criteria are based on clinical trials done in men, which means many of the factors that are specific to women get overlooked. One factor is likely to be that women are more susceptible to the damaging effects of insulin resistance than men, yet it seems not enough is being done to tackle this issue.


Highest standards not being used

This bias towards women is clearly hugely problematic but we must also remember that many treatments are not fully tested even on the so-called ‘Reference Man’. In August 2022 a Cochrane Review (recognized worldwide as the highest standard in evidence-based healthcare) found that only one in 20 medical treatments have robust evidence to support their use. Additionally the risks and harms of these treatments are rarely measured (xii).

It is hard to draw conclusions other than most of these treatments are more about benefiting Big Pharma rather than the health of those being prescribed such treatments?


Diet and exercise differences

In 2011 the World Cancer Research Fund found that half of studies looking at diet and cancer that included both men and women did not separate the data by gender. This clearly makes it hard to establish dietary guidelines for both sexes (xiii). Women who face more muscle mass loss should probably eat more protein but these studies can’t tell us if this is right.

Similarly research into exercise is largely male-based. Studies show that resistance training, for example, is good for reducing heart disease but papers warn against this if you have high blood pressure as it can increase artery stiffness (xiv). However a 2008 paper found the advice is not gender-neutral (xv). Resistance training lowers blood pressure to a greater extent in women and they don’t suffer from the same increases in artery stiffness. This is possibly good news as blood-pressure drugs developed using male subjects don’t work with women as effectively but the resistance training might just do the trick?

Evidence is also mounting for how men and women experience pain differently. Womens’ pain sensitivity changes through her menstrual cycle. Even basic drugs like Paracetamol and morphine work differently. It also seems that women have to experience pain longer before having treatment.

Perez has many other such examples. She writes: “None of this should surprise us, because despite obvious sex differences, the vast majority of drugs, including anaesthetics and chemotherapeutics, continue with gender-neutral dosages, which puts women at risk of overdose.


Time for change

Perez argues that part of the answer lies in closing the female representation gap. When women are involved in decision-making and research then women are considered.

Awareness is growing that we face a huge problem.

Last year The Lancet Commission on women and cancer was established to explore the relationship between gender, power and cancer (xvi). In particular they are looking at three main areas:

-      Women as cancer patients; for example the disparities in access to diagnosis and care often affect women more than men. I have written to them to see if they will cover some of those disparities highlighted by Perez (no reply yet).
-      Women in cancer caregiving roles; women are more often caregivers and this impacts on earnings and more.
-      Women as health care providers; for example women are underrepresented in the workforce especially in the higher tiers of cancer care and face salary disparities in comparison to men.

The Commission’s work is due to be published next year. It cannot come soon enough.

Also last year there was a part acknowledgement of the problem and the government called for evidence (xvii) to help inform the development of the government’s Women’s Health Strategy. The forward to the call notes: “This ‘male by default’ problem of the past must be put right. Despite living longer than men, women spend a greater proportion of their lives in ill health and disability, and there are growing geographic inequalities in women’s life expectancy. This makes levelling up women’s health an imperative for us all.”

This week the results of the call for evidence, which saw over 100,000 submissions, are published (xviii). Some of the challenges include that doctors’ routinely dismiss women’s debilitating health problems as “benign” which research suggests have contributed to gynaecology waiting lists rising by 60% to more than half a million patients.

Some of the actions promised by the Government seem limited when compared to the size of the challenges I’ve touched on in this blog - like mandatory training for doctors to better treat female medical conditions, more mobile breast screening and updated guidance around endometriosis. However this is a start and will hopefully lead to further improvements.

Personalised care

To wrap up this blog that is already too long I wanted to mention one of the other books I’ve come across; ‘Am I Normal? The 200-Year Search for Normal People (and Why They Don’t Exist)’. This book is just out by Sarah Chaney and she questions the standards that have emerged from sexist and racist scientific endeavours. She goes onto challenge why we ever thought ‘normal’ might be a desirable thing to be. Indeed she argues normal does not, in fact, exist.

So while we do need to close the female representation gap it seems more than clear that what we need overall is a more personalised approach to our health. We are all not the same and using ‘Reference Man’ or any other idea of ‘normal’ is fraught with problems.

6/9/22 update; See also Tedx talk on pain: https://www.ted.com/talks/sheetal_decaria_the_bias_behind_your_undiagnosed_chronic_pain


Notes:

(i)            https://www.rti.org/insights/feminist-approach-womens-cancer

(ii)           https://yestolife.org.uk/where-are-the-men/

(iii)         https://carolinecriadoperez.com/book/invisible-women/

(iv)         https://yestolife.org.uk/a-look-at-environmental-toxins/

https://nutritionfacts.org/video/friday-favorites-talcum-powder-and-fibroids

(v)          https://edition.cnn.com/2021/12/20/business/procter-and-gamble-dry-shampoo-recall/index.html

(vi)         https://www.hazards.org/compensation/meantest.htm

(vii)       https://medium.com/lessons-from-history/misogynist-aristotle-viewed-women-as-mutilated-deformed-men-a2715d7e20e4

(viii)     https://www.theguardian.com/lifeandstyle/2015/apr/30/fda-clinical-trials-gender-gap-epa-nih-institute-of-medicine-cardiovascular-disease

(ix)         https://pubmed.ncbi.nlm.nih.gov/17197669/

(x)          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157517/

(xi)         https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029678/

(xii)       https://www.sciencedirect.com/science/article/abs/pii/S0895435622001007 It is also worth noting that Systematic Reviews do not seem to address sex/gender differences as the data is more often not available. See 2014 paper: https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-3-33

(xiii)     http://genderedinnovations.stanford.edu/case-studies/colon.html#tabs-2

(xiv)     https://physoc.onlinelibrary.wiley.com/doi/pdfdirect/10.1113/EP085369

(xv)       https://pubmed.ncbi.nlm.nih.gov/18573479/

(xvi)     https://womenandcancercommission.org

(xvii)   https://www.gov.uk/government/consultations/womens-health-strategy-call-for-evidence/womens-health-strategy-call-for-evidence

(xviii)  https://www.gov.uk/government/publications/womens-health-strategy-for-england and https://www.theguardian.com/society/2022/jun/02/dismissal-of-womens-health-problems-as-benign-leading-to-soaring-nhs-lists

New magazine by and for cancer community launched

Flourish Magazine is a joint venture between integrative cancer care charity Yes to Life and creative health charity Artlift and funded by National Lottery Awards for All, aiming to explore the benefits of an integrative and creative approach to living with cancer. It features a range of creative responses, expert information and interviews in each themed edition that offer support and represent the diversity of the cancer community.

This is a project I've been working on for many months after being inspired by Cancer Hive's magazines - it has been great to work with Artlift - and we are now working on the second issue - do download a copy of the first to see how you can submit something or click here.

The first issue of Flourish Magazine features a range of creative submissions, features and interviews around the theme of ‘Nourish’ - with several Stroud folk getting entries.

Download Flourish at: https://yestolife.org.uk/news/launch-of-the-new-flourish-magazine-2/

The magazine is created with the support of a steering group that includes people living with cancer and partners Macmillan, Macmillan Next Steps and Gloucestershire Health and Care NHS Foundation Trust. We will have a few print copies available across Gloucestershire - probably too few as we are already getting requests.

Our Creative Editor

Before finishing this news item I wanted to celebrate Natalie Beech, our Creative Editor of the magazine. Natalie has gone more than the extra mile to develop this project. I have loved how she has navigated sensitive issues and challenges and brought heaps of energy and creativity to this project. Here's what she wrote:

"When I began work on the magazine, it was clear to me that there is no ‘one size fits all’ when it comes to cancer and that it was important the content of the magazine reflected this. A cancer diagnosis is a life changing moment for all involved, its impact rippling beyond the person receiving it to our friends, family and colleagues, but how we feel and respond to it will be different for each individual. Whether it’s a support group, a massage, exercise, food or a creative activity like art or writing, cancer in all its bleakness can offer the opportunity to discover how best to nourish ourselves through difficult times.

"Through an open call for submissions on this theme, we painstakingly whittled them down to this final selection, which features everything  from the hilarious to the heartbreaking, because of course, how we experience cancer is as complex and unique as we are. Some of the pieces are therefore challenging and we felt it was important not to shy away from this, but have provided content warnings so that readers can choose what they feel able to engage with".

Scary dairy?

For the dairy industry there must be some disappointment that the word ‘scary’ rhythms so well with dairy. Certainly on many dairy farms the practices are more distressing than those of meat production - and those practices can be pretty poor (i). Indeed the internet is awash with info videos with titles like ‘Scary Dairy’ telling us it is time to reconsider dairy (see link).

If you want to check out ‘good’ milk then find those smaller farmers like Stroud Micro Dairy with a real consideration to the animals and environment. However this blog is not covering those issues other than to say how animals are treated has a huge part to play in the quality of food they produce - instead I wanted to explore more whether dairy has an impact on prostate cancer.

As a child we had glasses of milk at home and school and as an adult with some years largely vegetarian I loved cheese. However, it was not until my cancer diagnosis that I reconsidered it.

So what do folks say?

The NHS Eatwell Guide recommends having some dairy as part of a healthy, balanced diet. In Canada the federal government have updated their guidelines and their new Canada Food Guide advises Canadians to eat more vegan foods and less meat. They have cut the proportion of dairy and also largely removed cheese from the guidelines (see right).

Cancer Research UK (ii) always take a fairly conservative view in terms of research and like the Dietician I saw at the hospital after my diagnosis, says: "There is not enough good evidence to prove that milk and dairy can cause cancer."

Cancer Research UK also write: “Eating and drinking milk and dairy can reduce the risk of bowel cancer. But there is no proof it increases or decreases the risk of any other cancer type”. They note, however, studies have found an increased risk of both prostate and breast cancer in people who have large amounts of dairy; “But there’s not enough good evidence for this”.

Cancer Research UK call for more research - and clearly it is needed - however as Michael Greger of Nutrition Facts points out there have been many studies (iii). For example 32 studies found an increase in prostate cancer linked to dairy. In Greger’s 7 minute video he looks at some of that research pointing out the increase doesn’t seem to be connected to calcium; non-dairy calcium sources were protective of cancer but dairy was not. It seems the insulin-like growth factor I (IGF1) in dairy is more likely one of the key factors.

One study Greger quotes shows that consuming three or more product of dairy a day after prostate cancer diagnosis had a 76% higher risk of mortality and a 141% higher risk of prostate cancer-specific mortality compared to men who consume one dairy product or less per day. He goes on to show that advanced prostate cancers thrive by up-regulating a growth enzyme called mTOC1; dairy protein boosts mTOR1 signalling higher. This makes sense as the weight gain of calves in the first year of cow’s milk feeding is nearly 40-times higher than that of breast-fed human infants. Pregnant cows release “uncontrolled bovine steroids into the human food chain”. Could this all play a role in prostate cancer?

In the 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) report “Food, Nutrition, Physical Activity and the Prevention of Cancer” it stated that there is probable evidence that diets high in calcium increase risk and limited suggestive evidence that milk and dairy products increase risk. They gave no recommendation for dairy as the prostate cancer risk conflicted with the evidence noted above by Cancer Research that there is a decreased risk with bowel cancers.

A 2011 study looked at other studies and confirmed that milk and total dairy products but not cheese or other dairy products are associated with a reduced risk of colorectal cancer. However the picture is confusing as people who drink milk exercise more, eat less meat, smoke less and have other better health behaviours. The conclusion was that it was likely to be the calcium binding with bile acids to reduce cell proliferation and promote cell differentiation. This explains why cheese wasn’t a factor and could increase colorectal cancer by increasing bile acid levels in the colon.

As noted earlier we need more research. However there are too many reports for me linking dairy to an increased risk. Indeed as I started writing this blog a new study (8th June 2022) (iv) at Loma Linda University of 28,000 North Americans, concluded: “Men with higher intake of dairy foods, but not nondairy calcium, had a higher risk of prostate cancer compared with men having lower intakes. Associations were nonlinear, suggesting greatest increases in risk at relatively low doses.” The results had minimal variation when comparing intake of full fat versus reduced or nonfat milks; there were no important associations reported with cheese and yogurt.

In his video Greger concludes that if you want to take a precautionary approach then it is best to obtain calcium through green leafy vegetables, legumes and non-dairy milks. I am with him on that and we no longer have dairy milk in this house.

What about other dairy products?

Dairy of course includes a whole host of other products some of which may have benefits and some may have less impact on cancers than others - but there isn’t enough research.

Organic pastured-fed butter is surely better than processed margarines? And organic kefir and yogurt’s are full of probiotics which can be key support for the microbiome? Goat and sheep milks are said to be easier to digest and better than cow’s milk? Some suggest unpasteurised (or raw milk) is better, others see risks?

Ghee (or clarified butter) is treated with low heat, and retains more nutrients than standard butter. The Ayurveda tradition see it as having spiritual and medicinal properties and even preventative of cancer; it is certainly gaining traction as a healthier alternative to standard butter. Organic and grass fed being favoured - it is also a useful fat that can be used at higher temperatures. See a useful article on dairy by Truly Heal here (v).

Lactose intolerance?

A further factor to consider is that each of us is different. Most infants, for example, can digest lactose, however people can begin to develop lactose malabsorption (a reduced ability to digest lactose) after infancy. It is estimated that about 68 percent of the world’s population has lactose malabsorption; this is more common in some parts of the world (like Africa and Asia) than in others. Whereas in northern Europe, many people carry a gene that allows them to digest lactose after infancy, and lactose malabsorption is less common. In the United States, about 36 percent of people have lactose malabsorption; lactose malabsorption causes lactose intolerance, not all people with lactose malabsorption have lactose intolerance.

Genetic or allergy testing can be helpful. My DNA apparently shows that I am ‘likely tolerant’ of lactose. However my hair analysis shows a ‘high reactivity’ food sensitivity to all dairy. That is not an allergy but rather a sensitivity; having food sensitivity may be uncomfortable and cause symptoms that, whilst annoying, embarrassing or even debilitating, do not have the potential to be life-threatening like those caused by food allergy. Fortunately I don’t seem to have any obvious symptoms.

Where did this leave me? Well, confused but while being largely vegan I am not afraid to occasionally have some of these dairy products.

Berries and dairy - don’t do it!

To finish I thought this was worth a mention - before diagnosis I had berries and yoghurt - and more recently occasionally organic sheep yoghurt for breakfast with those berries - we know how good blueberries are for tackling cancer! I was however rather disappointed to read this; Three Harvard studies following more than a 100,000 women for more than a decade found that those consuming the most anthocyanins (the brightly coloured pigments found in blueberries and other berries) had an 8% reduction in risk of developing high blood pressure (vi). 

Indeed just 11 blueberries or 6 strawberries daily made that difference. However the moment dairy (milk or yoghurt) was added and researchers found it blocked the absorption of the berries nutrients and appeared to eliminate the blood pressure-lowering benefits of the berries. 

So no more strawberries and cream? Sadly milk in tea also prevents vascular protective effects of the tea.

All this is food for thought.

Notes

(i) https://www.theguardian.com/commentisfree/2017/mar/30/dairy-scary-public-farming-calves-pens-alternatives

(ii) https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/cancer-myths/can-milk-and-dairy-products-cause-cancer

(iii) https://nutritionfacts.org/video/dairy-and-cancer

(iv) https://news.llu.edu/research/new-study-associates-intake-of-dairy-milk-with-greater-risk-of-prostate-cancer

(v) https://www.trulyheal.com/have-you-been-told-to-avoid-dairy/

(vi https://nutritionfacts.org/2022/05/17/blueberry-blocking-effects-of-yogurt/

Looking for creative submissions for a new magazine by and for the cancer community

Over a year ago I was totally inspired by 'The Cancer Hive' magazine - The magazine was all about seeking to change the conversations around cancer, make it less of a taboo, but also support people who are living with it. I tried to get them involved in another project but they said go ahead and create something yourself.....well just over a year on and we are launching our own version.....

Yes to Life, the charity I have been working with and the Glos-based Artlift charity have today launched a call out for artwork, photography, writing & more for the first edition of Flourish, a magazine by and for people living with or beyond cancer. We have a Creative Editor in place and are sending out news releases and lots of social media.

The first issue is on the theme of 'Nourish' and we are after works that explore the benefits of an integrative and creative approach. You can see more at: https://www.wigwam.org.uk/post/looking-for-creative-submissions-for-a-new-magazine-by-and-for-the-cancer-community

See more about The Cancer Hive here. 

Exercise is a dirty word for some, but...

Here I take another look at exercise in a blog that first appeared on Wigwam Cancer Support Groups blog - a Yes to Life charity project.

There are many people that embrace and love a lifestyle rich with exercise, but there are many, who like me, have never liked the word or the idea of ‘exercise’. The US ‘Peanuts’ cartoonist Charles M. Schulz once said; “Exercise is a dirty word. Every time I hear it I wash my mouth out with chocolate.” Yes give me a bar of that organic raw 90% cacao chocolate any day.

It is clear that I’m not alone in responding to the word with a negative reaction. Was it an experience at school? Or perhaps something to do with the picture of exercise in gyms with sweat, lycra and dumbbells? For some exercise might be associated with a negative reinforcement; we exercise to reduce shame around our health or weight. Yet shame is linked to poorer motivation and wellbeing and can lead to repeated failures to embed more activity in our lives. For others it might be pain or not having found the ‘right’ exercise?

There are no doubt many reasons for a negative view of exercise - and some of those will be contributing and reinforced by the fact that for many of us, our lifestyles are becoming more sedentary. Our muscles, bone strength and density are much less than a hundred years ago. In the UK obesity affects more than one in four adults and one in five children (aged 10 to 11) while nearly two thirds of adults are ‘overweight’ and one third of children. 

A 2015 report by the Academy of Medical Royal Colleges, 'Exercise – the Miracle Cure’ (i), said, that regular exercise can assist in the prevention of strokes, some cancers, depression, heart disease and dementia, reducing risk by at least 30%. Many of us know this on some level, yet we still find exercise hard.

Cancer and exercise

You can see in the box below a whole host of benefits from exercise not least significant reductions in both cancer progression and reoccurrence. It is worth looking at some of the research and there is lots of it. Back in 2012 Macmillan published an evidence review entitled; "The importance of Physical Activity for people living with and beyond cancer”. To give a flavour it is worth noting three research papers, all had the highest level of research for a patient-oriented outcome (ii) and since then the evidence has only grown.

Some of the research

Breast cancer: a systematic review of six studies indicated a reduced mortality risk of 34% related to leisure-time physical activity. A subsequent review supported these findings. Results of the two largest studies suggested that women reaching the equivalent of the recommended minimum levels of physical activity (ie 150 minutes of moderate-intensity activity per week) had over 40% lower risk breast cancer-specific mortality, and breast cancer recurrence, compared with women active for less than one hour a week.

Colorectal cancer: results of two studies suggested that the risk of cancer mortality was reduced by about 50%, by performing the equivalent of six hours of moderate intensity physical activity per week.

Prostate cancer: findings from two studies indicated a lower risk of prostate-specific mortality of approximately 30% and a lower rate of disease progression of 57% with three hours per week of moderate intensity physical activity (eg brisk walking).

Exercise needs to be a higher priority

One of the things that now so surprises me, following my diagnosis, was the complete failure of my medical team to talk about exercise - and from talking to others this is still the experience of most people. Researcher, exercise physiologist, and chair of the Clinical Oncology Society of Australia (COSA) Exercise Cancer guidelines committee, Dr. Prue Cormie, has said - what many others have also said in different ways: “If we could turn the benefits of exercise into a pill it would be demanded by patients, prescribed by every cancer specialist and subsidised by government. It would be seen as a major breakthrough in cancer treatment.”

There are over two million people living with or beyond cancer in the UK. Many of those have never been told about the huge impact exercise can have on their diagnosis. It is time this was made a priority by our health services. Many other countries are ahead of us, like Belgium where when you are first diagnosed you get taken down to the gym for an assessment and tailor-made plan. While in Germany after an operation patients get proper rehab - indeed they call it ‘die Kur’ literally ’the cure’. Love that!

How much is enough?

There is considerable debate about the definition of exercise and how much is enough. Macmillian have a useful general guide on ‘Physical Activity and Cancer’ (Jan 2019). Their chart (see right) is a good place to start and includes details about the weekly 150 mins aerobic activity, muscle strength, balance and stretching work(iii). However it is important to get advice as I was merrily increasing my aerobic exercise only to find many months later that strength exercises are critical for improvements in some cancers. Why did no one share that information?

There is other interesting and growing research; here are some I found interesting: 

High Intensity: The benefits of short bursts such as 2-4 minutes, of high intensity exercise(iv). A 2016 Canadian study looked at previously sedentary individuals who did strenuous exercise three times a week for 12 weeks; they did bouts for ten mins total with only three twenty-second episodes of flat-out exertion. These people were found to have similar improvements compared to those who exercised forty-five minutes a week for the twelve weeks. 

Rebounding. Chris Wark, of Chris Beat Cancer, notes that ‘rebounding’ (bouncing on a mini-trampolines) can give those with cancer some of the best exercise as it is not so hard on knees and also pumps the lymph system (v). I can actually quite enjoy this!

Before and after treatments. In Gloucestershire for the last four years, a number of us have been working with the health authority to try and enable more people with cancer to have access to information and support around exercise (vi). We have seen an exercise rehabilitation project start to roll-out and now at last a prehabilitation project is being launched (vii). This is where components of rehabilitation are introduced to patients prior to undergoing intensive medical intervention in order to optimize function and improve tolerability to the intervention. Both these projects are small and miss many people, but are a start. 

During treatment. Some exercise during radiotherapy and chemo seems to significantly improves outcomes (viii). Indeed even pharmaceuticals are getting interested as some of their chemo drugs seem to be working better when combined with exercise. One study I found fascinating was at the University of North Carolina where they have found that curative chemo caused an increase in molecular age that was equivalent to fifteen years of ageing. Incredibly exercising is being found to neutralise this ageing impact from chemo.

Finding out more? One of the best videos I’ve seen for those wanting a great overview is the 'Industry-Presented Webinar: Exercise as Medicine for Cancer’ with Professor Robert Newton (ix). While those wanting a general introduction they need go no further than a previous forum on Wigwam with Lizzy Davis (x). Certainly is well worth getting advice for your own particular situation - indeed just as too little exercise can be a bad thing so can too much exercise.

Being more than an active coach potato?

In recent years research suggests that how much time we spend sitting is likely to be just as important as how much time we spend exercising. There is even a new term to describe those who exercise, but spend the majority of their days being sedentary; 'active couch potatoes’. A couch potato is someone who prefers to sit around and watch TV, this new term, an active couch potato, is someone who is inactive for most of the day, but manages to get in their 30 minutes of exercise most days. No doubt many of them (like I have been) are seated at desks for large parts of the day plus seated commuting, having meals and then watching TV at home.

Over the years, many studies have looked at the lifestyles of people in 'blue zones' where people live the longest in health. Researchers found various important factors including not smoking, a sense of belonging and purpose, eating a predominantly plant-based diet, but interestingly, exercise was absent in many cases. Further research has indicated that it is being sedentary that is the problem and that key to health is sustained, low-level activity (xi). 

The Lancet in 2016 found that “high levels of moderate-intensity physical activity (ie, about 60-75 min per day) seem to eliminate the increased risk of death associated with high sitting time”. While it also seems that aiming for 10,000 steps a day is a good idea, but 15,000 better resembles the distances likely covered by our prehistoric ancestors, and some of those ‘blue zone' centenarians.

The World Health Organization (WHO) have now identified physical inactivity as an independent risk factor for chronic disease development, and it is estimated to now be the fourth leading cause of death worldwide. 
Update 21/01/23: Positive news report here that a small piece of research indicates that 'a five-minute light walk every half-hour was the only strategy that significantly reduced blood sugar levels, reducing the blood sugar spike after eating by almost 60 per cent compared to sitting down.'

Visualisation

Have you come across Dr David Hamilton’s blogs (xii)? I so like them - and his new book 'Why Woo-Woo Works' (Sept 2021) is also excellent. One of the pieces of research he quoted that I particularly like looks at visualisation and how the brain doesn’t distinguish real from imaginary. One famous Harvard University study compared the brains of people playing notes on a piano with the brains of people who imagined playing the notes. The region of the brain connected to the finger muscles was found to have changed to the same degree in both groups of people, regardless of whether they played the keys physically or mentally. In another study imagining flexing the little finger for 15 minutes daily for 3 months was shown to increase muscle strength by 35%. 

Sports players have utilised this approach of imagining to good effect to increase muscle strength. The technique is also now seen as a ‘viable intervention’ to help people recover faster from a stroke. As David Hamilton writes (xiii): "The benefits rely on the fact that when a patient visualises movement, the brain processes it as if they really are moving, and so imagined movement becomes like extra physical practice as far as the brain is concerned”. 

I am guessing imagining can’t replace the importance of movement but it sounds like it can certainly enhance and can probably play a key role in recovery after treatment?

One more study of interest comes from 2017 looking at individuals who thought they were less active than other people their age. Incredibly they were more likely to die, regardless of their health status, body mass index and more. This is the so-called negative placebo effect, that Hamilton also writes about. So even when those perceptions are in our head this impacts on our health. 

Our relationship with exercise is complicated

I started this blog with the suggestion that exercise is something that many of us persistently struggle with - we also instinctively know it is important. It is not a fad or an add-on to our busy lifestyles, it actually keeps us alive. 

So how did I start to to think differently and build it into my daily routines? I guess that rather than seeing exercise as a challenge to fit in with my busy life, it was time to view it in what I was already doing. When children run and play in a playground they are not thinking about aerobic conditioning. It is all about having fun.

I’ve always enjoyed, gardening and regular walks, but now instead of meeting people for a coffee I will go for a walk together and have the coffee (can’t miss my espresso!), the rebounder has become a chance to catch up on podcasts while an exercise or yoga class has become a place to meet others - somehow in a group it all feels easier and more fun. My computer desk has a raiser that allows me to stand up in zoom calls, I no longer try to park nearest the shops I’m visiting and I take the stairs not a lift for my Mum’s flat. I can also perhaps thank my prostate for needing the loo more often; I rarely sit for as long as I used to without visiting the loo upstairs!

I guess there are dozens of ways we can incorporate more movement into our lives. A friend has one of those bikes that fit under a desk so you can peddle while sitting and working while another now has an electric bike to get to work on.

It has surprised me that much of the increased ‘exercise’ and movement has been easy-ish to fit with my life. I suspect one of the reasons for that is that I have taken on board a lot of what I wrote in a previous blog about changing or embedding new habits - in particular, one technique, ‘tagging’, where behaviours are tagged onto an existing behaviour. For example rebounding is now something I do every morning after brushing my teeth (xiv).

Lastly I seem to use the word 'movement’ more than exercise - they have different meanings but somehow movement has a softer, less threatening quality - 'almost lyrical’ as one writer suggested (xv). Anyhow this blog is already longer than I meant and it is time for me to go on one of those walks. Happy moving but don’t forget to also 'exercise' kindness to yourself….there may well be days when it is all too much.
Update 30.12.22: Great article on how to get motivated for exercise: https://www.positive.news/lifestyle/health/how-do-i-improve-my-motivation-to-exercise-10-science-backed-tips/

Notes

(i) http://www.aomrc.org.uk/reports-guidance/exercise-the-miracle-cure-0215/

(ii) Research has been graded using the Strength of Recommendation Taxonomy (SORT) which rates the body of evidence for a patient-oriented outcome on quality, quantity and consistency. This research quotes was all Grade A is 'Systematic review of RCTs (or cohort studies for prognosis outcomes), or high-quality individual RCTs/cohort studies with clear consistent results.’

https://www.macmillan.org.uk/documents/aboutus/commissioners/physicalactivity_evidencebasedreport.pdf

(iii) https://cdn.macmillan.org.uk/dfsmedia/1a6f23537f7f4519bb0cf14c45b2a629/1656-source/physical-activity

(iv) High-intensity exercise interventions in cancer survivors: a systematic review exploring the impact on health outcomes: https://pubmed.ncbi.nlm.nih.gov/29210001/

See for example this research into prostate cancer: https://www.health.harvard.edu/mens-health/exercise-may-slow-prostate-cancer-growth

(v) Chris Wark video: https://youtu.be/1dgvg5hCar0

And his blog: https://www.chrisbeatcancer.com/rebounding/

(vi) http://gloscancerexercise.org.uk

(vii) Prehabilitation is the Gateway to Better Functional Outcomes for Individuals with Cancer: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8765744/

(viii) Various examples in Pub Med including this one using exercise during radiotherapy treatment: 

https://pubmed.ncbi.nlm.nih.gov/32074040/ and https://pubmed.ncbi.nlm.nih.gov/28189100/

And here is one with High-intensity exercise during chemotherapy inducing beneficial effects 12 months into breast cancer survivorship: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6482129/

(ix) Industry-Presented Webinar: Exercise as Medicine for Cancer: https://youtu.be/mS7g9VVy-Pk

And a more recent video: https://youtu.be/1n-Z3LVT37I

(x) Scroll through to find link at: https://www.wigwam.org.uk/podcast-and-videos (You need to sign up free to get access). 

(xi) https://www.theguardian.com/news/2019/jan/03/why-exercise-alone-wont-save-us

(xii) https://drdavidhamilton.com

(xiii) https://drdavidhamilton.com/real-vs-imaginary-in-the-brain-and-body/

(xiv) https://www.wigwam.org.uk/post/the-challenge-of-embedding-new-behaviours

(xv) https://carlospattersoncoaching.com/movement-vs-exercise-is-movement-better-than-exercise/