Baldness and prostate health?!

Here's info I hadn't come across before....the connection between 'vertex baldness ie hair loss at the crown of your head and aggressive prostate cancer and benign prostatic hyperplasia (BPH). A study in the Journal of Clinical Oncology, 2014, found that men with moderate baldness at the front and crown of their head by age 45 were found to have up to a 40% higher risk of developing aggressive prostate cancer compared to their non-balding counterparts. This was supported by other studies.

The reasons for this seem to be linked to hormones...both conditions are influenced by dihydrotestosterone (DHT), a potent form of testosterone - although there is still little understanding about how this works. See more in this article here.

We still have lots to learn...another 'strange' connection is that there is some evidence showing that the taller people are during adulthood and the more people weighed at birth, the higher their risk of prostate cancer. Well I was a big baby and tall now but no sign of baldness.....

'Little we can do to prevent prostate cancer'

Cartoon by Russ

Professor Chris Whitty, Chief Medical Officer for the UK, in this video (see 39.42) says 'for example prostate cancer, there really isn't very much you can do to prevent it but you can identify the aggressive forms earlier.' 

This was a 'Distinguished Lecture Series' talk out two weeks ago looking at 'Health in an ageing society'. It is certainly true that unlike some cancers (eg breast and cervical), research into how to prevent prostate cancer remains poor. However we do know that there is strong evidence that being overweight increases the risk of being diagnosed with advanced prostate cancer. There is also growing evidence of other factors.

Whitty mentioned healthy lifestyles earlier in the talk but seems to ignore their role in prostate cancer? Cancer Research UK say 'Prostate cancer is not linked to any preventable causes. Your risk of developing it depends on many things. These include age and ethnicity.' Other factors they note are family history, faulty genes, obesity, being taller, hormone levels and pesticides.

It seems to me that some of the factors they identify are preventable and will reduce chances of getting cancer - indeed even the World Health Organisation note that 30-50% of all cancers are preventable. What we need is more concerted efforts to improve lifestyle factors like diet and exercise. We already know that even 20 mins of exercise a day can prevent the return of some localised prostate cancers.

Prostate cancers like many others are on the rise - indeed cancer rates have doubled in the last thirty years in the UK. Some cancers, for example, some child cancers, have more than trebled.

It is long overdue time to take this issue more seriously. Clearly one factor alone does not cause all cancers - it is way more complicated but we do know that many things do increase or may increase the risk of cancers. We urgently need more information available for people. Just for starters there is more than enough expert research to attach ’Precautionary labels’ to Phones, Masts, WiFi, certain chemicals, pesticides, many drugs, HRT, the contraceptive pill, and even dairy. 

Nutrition is another key area - I like this approach from the Alliance for Natural Health - see here. See also Canceractive's 15 simple steps to cancer prevention here. 

It seems to me we could do with a manifesto for cancer prevention - checking online I found Cancer Research UK had issued one this year - see here. Sadly it seems to be more of the same from them with, as far as I can see, no mention of exercise or nutrition, no mention of cutting chemicals, ultra-processed foods etc etc. 

Locally I still sit on the Cancer Patient Reference Group for NHS Glos that meets monthly or bi-monthly - we are making slow progress on introducing more info to patients re lifestyle changes they can make - plus some basic support with prehab and rehab exercise, nutrition and mental health support. This of course is to those already diagnosed - wouldn't it be great if we could reach people before they got cancer - of course we wouldn't stop all cancers but I think we could stop and turn back the ever increasing rates of cancer which will mean that soon one in two people will get cancer.

Of course this blog post shouldn't be read without reading my post from September about banning the word 'prevention'. See that here: https://myunexpectedguide.blogspot.com/2023/09/time-to-ban-word-prevention.html

Kelly Turner in a podcast on the key healing factors in radical remissions

A long while back I listed Kelly Turner's book as one of the ones that someone who is newly diagnosed could find very useful - I still think that! You can find her talking with the amazing Nasha on YouTube here and on Spotify here.

Chris Woollams on prostate cancer

This is a great introduction for those newly diagnosed and looking at treatment options but also a good reminder of things we can all be doing:

Time to ban the word “prevention”

I just read a BMJ opinion piece here that called for us to ban the use of the word prevention. I agree, but what can we use in it's place? Here's a very quick blog with some rather random thoughts....

The word 'prevention' is so tied up with the 'deficit model of health'. Our health is seen as the absence of sickness. And it is health professionals who determine when we are sick - but as the opinion piece notes health is so much broader; "it's about resilience, adaptability, coping, interdependence, and relationships with others, our community, the planet, and nature". Many of us living with cancer know this only too well!

The challenge is what can we replace the word with? We know that much of ill health is preventable - we know for example more than 50% of cancers could be prevented with the right measures...ban advertising of unhealthy products, introduce taxes on excess sugar and other items, more support to cut smoking, more sport at schools, improved open spaces, walking and cycling, more breast-feeding, etc etc.

Sadly our NHS seems to find any investment in more 'prevention' so difficult - in some quarters it has been dubbed our National Ill-health Service - indeed it has been a huge struggle to find funds to support a Cancer prehab and rehab project in Gloucestershire - yet in many other countries that has been standard practice. So why not more investment when the evidence is so compelling?

When NHS leaders have been asked about prevention, many will argue strongly for it but around half acknowledge they are ineffective at delivering their own prevention priorities. From this same report the leaders identify lack of funding, but other key reasons for non-delivery include a lack of integration of prevention into core services, combined with system capacity issues and the perception that prevention isn’t seen as part of the delivery organisation’s remit are identified as the main barriers to prevention delivery.

Indeed when you look at funding over recent years the picture is pretty bleak..... we've seen cuts to many services - see for example chart from the Kings Fund how this current Government has cut funding to the NHS - also the chart looking at pay to health workers.

Add to that the horrific cuts to Public Health grants - see chart below from the Health Foundation - this will also impact unfairly on more deprived communities where these grants tend to be more focused. The Health Foundation note: "Local authority public health interventions funded by the grant provide excellent value for money, with each additional year of good health achieved in the population by public health interventions costing £3,800. This is three to four times lower than the cost resulting from NHS interventions of £13,500. Interventions can also help reduce health inequalities."

It is notable how our NHS seems to be being run down despite the words of some of our politicians - some would argue this 'running down' is deliberate and aimed at increasing  privatisations in our NHS - see for example here. 

The Observer's recent investigation into pharmaceutical companies shows how spending on drugs is increasing - see here - and increasing at the expense of patients in some cases. Dr David Unwin, who has spoken at Yes to Life conferences, has championed a low-carb lifestyle that has been shown to reverse type 2 diabetes. He is quoted in the article saying drug industry funding risked distorting treatment; “With so many drug companies paying to advance the pharma agenda, there is an obvious imbalance. No one is pushing the lifestyle agenda and, over time, this is distorting medical practice to an alarming degree.” Indeed the more we have privatisation then the more there is less incentive for wellness.

I started out agreeing we should ban the word prevention but then have fallen into using it through the rest of this blog....how can we create wellness in ourselves and communities? What is the language that can convey the shifts we need?

The Case for Active Surveillance

So if your cancer is localised the evidence is growing for Active Surveillance. In a UK study of 1600 men published this March, Dr Freddie Hamdy showed that Active Surveillance was a safe alternative for most men. 

Men diagnosed with localised prostate cancer shouldn’t go straight to radiotherapy or surgery - this is especially so as we know the side effects of those treatment are not great. I sadly wasn't in the 'localised' group but am delighted to see that this research will hopefully save many from treatment side effects if only for some years.

The study (i) showed little difference in survival across the 15 year study period from 1999. Death from prostate cancer occurred:

3.1% of the ‘Active Surveillance’ group, 

2.2% of the surgery group,

2.9% of the radiation group. 

These differences were considered to be statistically insignificant. This reminds me of a 2002 study that Chris Woollams of CancerACTIVE shared - in that they looked at over 50 men killed in car accidents in California and found that over 60% were driving around with prostate cancer, didn’t know it and weren’t receiving treatment. In other words from initial diagnosis, treatment was rarely urgent.

The study also found that at the end of the 15 year study, the prostate cancer had spread in 

9.4% of the ‘Active Surveillance’ group, 

4.7% of the surgery group 

5% of the radiation group. 

However the spread did not equate to significant survival differences. Having said all this it is clear we should consult with our medical team to find the best way forward.

Notes

(i) https://www.nejm.org/doi/10.1056/NEJMoa2214122

Dental health and cancer

Here's another video worth watching that looks at dental health with Chris Woollams interviewing Dr Elmar Jung, an expert Holistic dentist - it is a great look at how our teeth can make us ill and what involvement dental complications have in cancer. It includes:

* Root canals * Amalgam fillings * How good breathing affects your teeth * How the nerves in your mouth affect organs in your body * Gum disease * Fluoride

From Chris Woollams YouTube where there are other usefulvideos: https://www.youtube.com/watch?v=zudasa0Ke_g

Modified Citrus Pectin - a key supplement

I've mentioned Modified Citrus Pectin previously - see here where there is a link to a great 10 minute video with Sam Watts talking MCP.
I took this supplement but it hasn't been part of my protocol in the last couple of years. A video from Chris Wark has reminded me that it is one of the most important supplements that those of us with cancer can take.

In the video Chris interviews Dr. Eliaz, one of the world's foremost experts on galectin-3 and modified citrus pectin (MCP). As the show notes write: "Galectin-3 is an essential survival molecule in your body that when over-expressed promotes inflammation, aging, and chronic diseases like cancer. Modified citrus pectin has been scientifically proven to block its harmful effects. By disrupting galectin-3 interactions, MCP creates an environment that is inhospitable to inflammation, fibrosis, hypoxia, infection, and cancer cell growth. Modified citrus pectin has also been found to be helpful with pain relief and is known to bind to heavy metals and help remove them from the body".

See video at: https://www.chrisbeatcancer.com/dr-isaac-eliaz-the-survival-paradox-galectin-3-modified-citrus-pectin-and-integrative-cancer-therapy

I like the Cancer Choices website, as that looks at some of these treatments at a glance. They look at the science and more and score each treatment on a number of factors. In this MCP doesn't get a great reading - see here: https://cancerchoices.org/therapy/modified-citrus-pectin/

However Chris Woollams lists it as one of his top ten supplements for people with cancer: https://www.canceractive.com/article/the-top-10-cancer-fighting-supplements See more on his views here: https://www.canceractive.com/article/Modified-Citrus-Pectin,-MCP-and-cancer

Urinary Incontinence

When I started my radiotherapy treatment Macmillan gave me a credit card that I could wave at folk to get urgent access to a loo. I never tested it to see if it worked!  Nevertheless radiation treatment certainly impacted on me - I am fortunate to not be among those that are having a whole range of more serious issues - although I am certainly going more frequently and with more urgency. Indeed it is said that post-surgery or radiation, almost every man experiences urinary incontinence.

This issue isn't talked about enough - one in three men over 65 have a urinary incontinence problem while one in 25 aged over 40 will have some urinary leakage every year. It can be hard to find good info, it was therefore great to come across this week a 30 min video with Consultant Urological Surgeon, Ms. Tamsin Greenwell - see below. 

Ms. Greenwell explains the link between prostate cancer treatments and urinary incontinence and shares practical advice on how to manage urinary frequency and urgency. Learn what to ask your doctor and get insights into effective treatments to regain control over your life - several of them I had not heard of - but also there is a mention of how acupuncture can help some. I like this straight-talking video from Malecare - they are one of the world's leading cancer patient support and advocacy nonprofit organizations. It is worth checking out some of their other videos too.

Prostate Cancer UK also have some good advice: https://prostatecanceruk.org/

Book of Cancer blogs just out

I've just seen that Yes to Life's new book is out..."Kitchen Cancer Talks. Shared Stories, Same Experiences" with a foreword from Patricia Peat. It will no doubt help to raise funds for the charity.

I've not seen it but I understand it has several of my blogs in the book along with many others from Yes to Life's Wigwam group members and supporters including nutritionists and even a Naturopathic Oncologist. While everyone’s story is unique to them, the experiences and emotions that accompany being diagnosed with cancer and the journey to find an integrative path will be recognized by many. The power of shared experiences enables us to see we are not alone in our thinking.

Robin Daly, the Chair and Founder off the charity writes: "These posts are simply too valuable to pass by as ephemera. The quality of the writing is consistently high, and the sheer breadth of the content results in an inspirational resource that you can dip into at any time. Open up anywhere and you are likely to be led into territory you’ve not explored, and to have new avenues to health and wellbeing open up."

Get book (£6 kindle and £20 paperback) at: https://www.amazon.co.uk/dp/B0C2RHK145?

‘Could this be the day the World changes (for people with cancer)’

The title of this blog post was by health author, Jerome Burne, taken from his blog on the Yes to Life website (i). The title makes a big big claim - but I think it really could be one of those moments in history. On 12th February, at a specially put together Yes to Life online forum with three panels of cancer experts (Scientists, Clinicians and Patient Experts) and an invited audience of some 200  cancer specialists, a new way of thinking about cancer was proposed.

Mark Lintern presented his findings that have resulted from eight years of intensive research into the origin and mechanisms of cancer. He had been hugely frustrated by the lack of understanding he encountered when dealing with his own and a friends cancer. It drove him to explore more - in what has been described as a ‘Herculean’ effort, he has come up with findings that could lead to an enduring change in the direction of cancer care, to potentially prevent cancers and to lead to groundbreaking new treatments.

In another blog by Jerome, 'Revealing the Dark Matter of Cancer’, he sets out to share the approach and how it came about. It is very worth a read: https://healthinsightuk.org/2023/04/12/revealing-the-dark-matter-of-cancer/

Cancer is widely regarded as a genetic disease. Mark, like many of us who have looked at the causes of cancer, couldn’t understand how changes to DNA were supposedly random and just the result of bad luck. Indeed these are the very words my oncologist used when I was diagnosed. It just didn’t sit right. One of the problems is that there are around 1,000 genes that can become cancerous when mutated, and it typically takes at least two different mutations within these cells for cancer to grow. That means there are a million potential mutation pairs, and it becomes hopeless to narrow down the possibilities when seeking new treatments.

There are other theories of cancer but the one that many integrative health professionals seem to favour (at least until now), is the metabolic theory. This approach looks at the abnormal energy use of cancer cells.  See a good description of the metabolic theory at: https://foundationformetaboliccancertherapies.com/metabolic-cancer-therapies and Prof Thomas Siegfried talking about this approach: https://youtu.be/APwnkpD_BfI

New paradigm

Mark looked at all this and info that seems to have been overlooked from other medical fields and he suggests that cancer can be caused by multiple factors that can trigger the infectious process of an opportunistic pathogen. There is effectively a battle between the pathogen, the cell and the immune system. A victorious immune system can remove the tumour. 

One of the ways of assessing new theories about cancer is how many of the so-called hallmarks of cancer – the changes a cancer makes to a cell – the theory can explain. This new pathogen theory comes out top. It can account for 9 out of the ten, more than both the genetic or metabolic approaches. Of course, Mark is now keen to see his theories tested, but already the reception from this first meeting to these ideas has been very positive.

Find out more

Mark Lintern shares his story of 8 years’ research into the mechanisms and origin of cancer in 6 Health Radio shows with Robin Daly, Chair and Founder of Yes to Life: 

https://yestolife.org.uk/radio_shows/through-another-lens-part-1/

Cancer Through Another Lens - Professional pre-release version

https://www.yestolifeshop.org/product-page/cancer-through-another-lens-professional-pre-release-version

Update 29.09.23: I liked this article as an additional perspective on cancer: https://www.anhinternational.org/news/opinion-cancer-as-a-survival-and-healing-mechanism/

Note

(i) https://yestolife.org.uk/could-this-be-the-day-the-world-changed/

Interview with Prof Rob Thomas

This is a great overview of prostate cancer treatments (and a bit about breast) - Chris Woollams of CancerActive interviewing NHS oncologist Robert Thomas; looking at treatment protocols, hormones, lifestyle and much more. I found it a great reminder but also some stuff I didn't know.

Understanding blood tests

There are many tests that are possible to monitor our health - indeed this blog has covered a fair few in terms of my own treatment. However a lot of those specialist tests are too expensive for many and not available on the NHS. For example my own health service has stopped doing Vitamin D for people with cancer despite it being an important part of the picture; indeed the health team now recommend Vit D supplementation.

Of course it depends lots on the type of cancer you have, but I heard recently Jo Gamble, Functional Medicine practitioner and nutritionist say if you were going for one test then go for a genomics test as that gives a great starting point. More of that in another blog post.

This blog is a bit of a cheat as it is not my blog but rather it links to Chris Woollams' Canceractive website - there in a blog from earlier this month, he does a great simple guide of those blood tests we get from our GPs - sometimes it can be a challenge to get these tests but they can often give a great overview of our health. See it at:

https://www.canceractive.com/article/understanding-your%20blood%20test%20results%20when%20you%20have%20cancer

However we should remember blood tests are only part of the picture - and it can be dangerous to try and self-diagnose from results - talk to your health team. Nevertheless it can be useful to do your own research - see for example my previous blog on low white blood cells: https://myunexpectedguide.blogspot.com/2019/09/low-white-blood-cell-count.html

Ultra-processed foods recommended by NHS App

Radiotherapy, Cheltenham Hospital

Hearing that an NHS App is now promoting ultra-processed foods was a shock. In this blog I look at that App plus an action you can take but first a closer look at UPFs, and some quite extraordinary revelations about our food. If you’ve not delved into this then steady yourself for quite a ride….sadly not room in this blog post to even touch on GMOs and other ‘new foods’ that are being developed.

How much do we eat?

Most of the food in the UK is Ultra-Processed food (UPFs) making up 65% of children diets. Dr Kiara Chang, who worked research at Imperial College, London, said to The Independent newspaper in February this year (i), that the average person in the UK relies on UPFs for more than half of their daily energy intake, with poorer people more vulnerable to taking the cheap and unhealthy option.

Apologies but can't find reference for this

Health risks

These foods have little or no nutritional value and their industrial processing and chemical ingredients often make them easier to eat without filling us up - so we crave more. We know UPFs carry serious health risks including heart, liver and kidney disease, depression, early death, obesity and cancer. Over 18,000 reports come up in Pubmed when searching for ultra-processed foods.

In terms of cancer the findings in the Imperial College research is that for every 10 per cent increase in ultra-processed food in a person’s diet, there was a 2 per cent increased risk of cancer overall, and a 19 per cent increased risk for ovarian cancer specifically. These links held true even after adjusting for factors that may alter the results, such as exercise, body mass index (BMI) and deprivation. Other cancers like colorectal are also linked to UPFs but interestingly the link is less clear with prostate cancer.

See Alliance for Natural Health’s article on UPFs health risks : https://www.anhinternational.org/2018/02/21/ultra-processed-food-dangers-need-cook-scratch/


Culture

Aggressively marketed UPFs have led to the development of a culture where UPFs are seen as acceptable and in some cases even healthy. We’ve also seen a shift to more vegan and other ‘healthy diets’ yet these are not always so healthy; processed vegan meals can be just as unhealthy with high fat, salt and sugar contents. There are now for example over 400 vegan cheeses on the market in the UK, some are great but many are packed with lots of unhealthy ingredients.

A 2019 study found over half of commonly eaten processed foods in the EU are too unhealthy to be marketed for consumption by kids (ii). And it seems to only be getting worse. In the States I read that Kraft Heinz are launching new prepackaged ultra-processed lunches as part of school lunch programs (iii).

Processed meats

Many of us will be aware of the controversy around red meats, bacon and processed meats. The WHO put them in the same carcinogen category as alcohol and tobacco despite being only a ‘probable’ carcinogen with the research linking it to thousands of deaths from colorectal cancer in the UK. Cancer Research UK also have a page warning us about the risks (iv).

Chris Woollams of CANCERactive writes about a study that was widely covered in the press, seemed to suggest these foods are not associated with cancer (v). It is not so straightforward as he shows. A new review of 25 studies last year involving nearly 2 million participants found ‘increased consumption of "total meat" and "processed meat" might be associated with a higher risk of prostate cancer’ (vi).

“Probable cause of cancer” means it is sensible to me to cut out processed meats or keep them to a minimum. It also seems important to go for organic, pasture-fed quality where possible. We can also keep an eye out for nitrites that can become cancer-causing chemicals when we eat them. Last year there were increased calls for alternatives to be used; certainly these are now available but it is still seems very hard to get organic nitrate free bacon (vii).

Time to get juicer out!

‘Serving Up the Food Industry’s Markets Secrets’

This is the sub-title of a book by investigative food journalist, Joanna Blythman entitled ‘Swallow This’ in 2015. I’ve got several of her books so when I saw this in a charity shop soon after it was published I hesitated thinking I surely know most of the stuff that is going on. 

Well I did buy it and the book blew me away - some of it no doubt is known to readers of this blog but I guess when it was all put together it made an impression on me. It also goes into how the chemical industry and food manufacturers are designing our food with enzymes, nanoparticles, protein isolates, cyclodextrins and more. Sadly this is the last book she has written although there are more recent articles in The Guardian by her. 

To give a flavour of the book here are a some of the stories she tells:

• Vitamin tablets derived from petrol.

• Supermarkets ready meals coming from the same manufacturers with, for example, the same tomato sauce that can be used in pizza, chilli, lasagna, soup, bolognaise and more.

• Manufacturers doing away with the unpopular E numbers and replacing them with a ‘Clean Label’ policy. Examples include E number preservatives relabelled as ‘fermented corn syrup’ which sounds more healthy or using the word ‘Extract’. Rosemary extract, for example is the same as E392 and has faced processing that deodorises (removes rosemary taste and smell) by using supercritical fluid-extraction or chemical solvents.

• Supermarket in-store bakeries that don’t have to give a complete list of ingredients (and don’t).

• ‘Fresh’ cut fruit sprayed in an acid solution to add 21 days to its shelf life.

• Commercial cooking oil is used for up to 12 days, kept ‘fresh’ by a cocktail of antifreeze and varnish. It doesn’t appear on the label of your chicken kiev because it’s classed as a processing aid rather than an additive.

• Processing to ensure pitta bread stays ‘fresh’ for six months.

• Food manufacturers use over 2,500 ‘approved flavouring substances’; 400 of these are under evaluation for safety testing that takes many years to complete. A typical strawberry flavouring in a milkshake uses around 50 chemicals while several chemicals are used to make up the taste of ‘aged’ or ‘mature’ cheeses.

• Stewing beef encased in plastic with gases to keep it looking ruby red.

• Adding water to meat products by tumbling minced meat in brine, then heat treating or cooking in plastic bags in steam, then this semi-liquid protein plus chemicals binds the meat pieces together to look like one joint.

• How colour cons us into thinking processed food tastes of something it doesn’t; when research showed certain colourings were strongly linked to hyperactivity in children the colourings were not banned. It was only after campaigns then the EU stepped in to insist products with those colourings must have a warning. Prominent independent food groups don’t accept that other E number colours (that are widely used) are safe.

• Other additions to our food include150 enzymes (more are being developed using genetic modification). They are so powerful that they are only needed in small amounts and don’t appear on labels as it is ‘assumed’ they are deactivated or used up in processing. Phospholipase, for example, that is used in bread comes from a pig’s pancreas. Andrew Whitley, an authority on artisan baking, observes ‘safety assurance has a short shelf life’.

• A chemical is often added to packaging like mayonnaise to ensure a slippery surface so it slides out.

I’ve looked BPA in a previous blog here: https://myunexpectedguide.blogspot.com/2022/07/bpa-what-are-issues.html


NHS App

Cheltenham Hospital Radiology 

The government seems unable to take this issue seriously and continues to ignore the health impacts of these foods. Astonishingly the NHS Food scanner app promotes ultra-processed foods as healthy! The Soil Association found products encouraging unhealthy snacking, artificially sweetened beverages and even energy drinks awarded the UK government’s Good Choice badge and promoted as healthy swaps by its NHS Food Scanner App. 

I guess I shouldn't be surprised when we know the NHS is unable to take food seriously with such poor nutrition from hospital meals and hospital shops selling hugely unhealthy foods.

This approach can only help the big food corporations - friends of those in Government - to continue to make massive profits at the expense of our children’s health.

The Soil Associations’ in their report ‘Ultra-processed foods - evidence review 2022’ outline the current situation: “In the past 12 months a torrent of new evidence has linked ultra-processed foods (UPFs) to adverse health and environmental outcomes. The evidence was already compelling. A 2020 review found 37 of 43 published papers had established a clear association between UPFs and poor health, while the first randomised control trial (RCT) in 2019 found a causal relationship with weight gain. This had prompted a policy response from national governments across the world, from Brazil to Canada to France, though not in the UK.” 
You can read their reports plus a huge list of the evidence including the massive impact UPFs are having on the environment: https://www.soilassociation.org/causes-campaigns/ultra-processed-foods/taking-the-biscuit/

The Soil Association picked out the products in the image (see left) as prime examples of ultra-processed products awarded Good Choice badges or similar endorsements and promoted as ‘good', 'healthier choice’ or 'High Five' swaps by the NHS Food Scanner App.

Take action

Join me in signing the Soil Association’s petition calling on Secretary of State for Health and Social Care, Steve Barclay, to:
•    Remove the UK government’s Good Choice badge from ultra-processed products, 
•    Introduce dietary guidelines to address ultra-processed foods, 
•    Introduce a percentage reduction target to reduce ultra-processed food consumption to more healthy levels by 2030 
•    Talk to families about their experience of ultra-processed foods, working to ensure that healthy foods are more accessible and affordable

https://act.soilassociation.org/taking-the-biscuit

Update 17th April 23: Check out Green in Lords on this topic on Radio 4 news: https://nataliebennett.org/latest/radio-4s-today-in-parliament-covers-the-house-of-lords-ultraprocessed-food-debate

Notes

(i) https://www.independent.co.uk/news/health/ultra-processed-foods-list-cancer-risk-b2274166.html
(iv) https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/diet-and-cancer/does-eating-processed-and-red-meat-cause-cancer
(v) https://chriswoollamshealthwatch.com/blog/the-truth-about-red-meat-bacon-and-processed-meats/
(vi) https://pubmed.ncbi.nlm.nih.gov/35198587/
(vii) https://www.theguardian.com/food/2022/jul/08/nitrites-in-bacon-scientists-mps-call-for-uk-ban-cancer-fears

(ii) https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213512

(iii) https://www.today.com/food/news/lunchables-national-school-lunch-program-rcna74798

Cancer Care Reviews, Pathways and more

I’d not heard of Cancer Care Reviews until very recently - yet all of us with cancer are meant to have them. Hence this blog to find out more about them….this is my first attempt to capture some of the key issues and look at where we are going in Gloucestershire. 

Research from a while back showed that one in three cancer survivors experience moderate to severe unmet needs at the end of treatment, and for 60% of people, these needs have not improved six months after treatment. It is research like this that led to The National Cancer Survivorship Initiative (NCSI) being set up in 2008 to develop and test a number of key interventions that together are called the Recovery Package.

Evaluations consistently pointed out that implementing elements of the package requires a shift in culture away from dependence on professionals towards empowering patients. It is great that this is recognised but we have a long way to go.


What is a Recovery Package?

These are a series of interventions that are aimed at improving our quality of life during and after treatment for cancer - helping us to self-manage the impact cancer and treatment can have on our lives - see Macmillan's paper on it here: https://www.macmillan.org.uk/documents/aboutus/health_professionals/recoverypackage/recoverypackagesharinggoodpractice.pdf 

If you are not offered these types of support but feel any of them would be useful, you could ask your healthcare team if they can arrange them. The recovery package has four parts:

• Holistic Needs Assessment

• treatment summary

• health and wellbeing events

• cancer care review

They may not always have these names - and in my own treatment I have only come across the first of these:

1. Holistic Needs Assessment (HNA); this is an assessment where we answer questions about our needs and what is important to us. The questions will be about all areas of our life. For example the HNA looks at physical, practical, emotional, spiritual and social needs. Then based on our needs and a discussion with us, the team creates a care and support plan. This can include advice and information on lifestyle, self management, local support and a referral to a specialist service.

Apparently you can have the HNA at diagnosis, the end of treatment, or whenever your needs change. You can also ask to have an HNA when you feel you need it. The HNA ensures that your team spots your needs early and find ways of helping you in the best appropriate way.

In terms of the Care Plan I see that Macmillan also recommend people with cancer should have a co-developed personalised prehabilitation care plan (PPCP) as part of an overall care plan (i); “Individualised exercise, nutrition and psychological support, should be integral to the care of all people with a cancer diagnosis”. 

Just after diagnosis things are not always easy to absorb, remember or understand. However I don’t remember ever having a conversation with anyone about the HNA except a brief phone call. I do remember the tick box HNA form that I have a copy of plus a very sparse Care Plan that was sent through - but certainly there was no talk of Prehab. Indeed as I’ve noted before when I asked my oncologist about exercise and diet he said I was pretty fit and to just keep doing what I was doing - that was without any conversation about what I was doing! 

Self assessment as to whether for example we are doing enough exercise or the right nutrition seems a poor way to do it. We may well know what is needed but for me I hadn't appreciated that in addition to aerobic exercise I needed to doing strength-bearing. This is the time when folks are open to discussions to make changes that support is crucial. If, for example, it is judged that this is not the right time then there should be a way for health professionals to pick up on it at a later date.

I have spoken to a number of folks locally who similarly had one of these HNAs - some remember their conversation but no one I have spoken to was asked about exercise or diet. This seems a hugely wasted opportunity to let people know how they can support themselves and make a real difference to health outcomes. 

2. Treatment Summary; this is a written summary of our treatment for us to take away usually after treatment is completed. A copy is also sent to our GP so we both know what has happened and what to expect after treatment. The summary should include details about the cancer treatment we have had, any tests or investigations we might need, side effects or potential signs and symptoms we need to be aware of and contact details for our healthcare team, in case we or our GP need to contact them. 

I am told that we may find the treatment summary useful if we want to tell others about our care. For example when applying for travel insurance. I have no memory of this but maybe one of my visits covered this - anyhow I will go and request a copy in my next visit!

3. Health and Wellbeing Events; different health authorities provide varying levels of support. Gloucestershire have a small number of talks like on Prehab or specifically on treatments like radiation. These events usually take place in a hospital and last a few hours. Macmillan list a range of talks that some health authorities give;

• claiming benefits and other financial support

• getting back to work or education

• eating well and leading a healthy lifestyle

• the possible long-term consequences of treatment

• the emotional effects that cancer and its treatment may have, and where to seek help if you need it

• being aware of signs and symptoms that may mean the cancer has come back, and who to contact

• local services and opportunities – for example, support groups or local physical activity groups.

This looks more comprehensive than Gloucestershire’s offer - Macmillan do have lots of info on these topics so do call them free on 0808 808 00 00.

Example of Cancer Care Review

4. Cancer Care Reviews; a discussion with your GP or practice nurse. The Quality Outcomes Framework requires all GPs to carry out a Cancer Care Review within six months of receiving a confirmation of a patient receiving a cancer diagnosis. 

The aims of the discussion are to check whether you have any concerns or need any information or support. They are also used to tell you what to look out for, what to do and when you might need to contact your healthcare team for advice. Macmillan have a useful page about these Reviews for professionals: https://www.macmillan.org.uk/healthcare-professionals/cancer-pathways/prevention-and-diagnosis/cancer-care-review

Again I have no memory of any meeting called this but my GP was very supportive throughout my treatment and I guess we covered some of these issues. Indeed unlike many GPs that I hear about from others with cancer, my GP was prepared to raise and discuss issues like the impact of treatment on sex life.


After treatment

There is lots I could write about what happens when treatment is complete - and for many that time can be one of the hardest times as it can feel like support ends and others think you are back to 'normal' - but more of that in another blog. In brief there are various options that continue to involve your healthcare teams input. Some folks might continue to see their oncologist or other member of the team, while some may be discharged and only come back if their situation changes. In my case I am now being monitored every six months with a PSA test and a call from an oncology nurse. 


Cancer Pathways

The above gives a flavour of what we can request. This ‘support’ is part of a Cancer Pathway that aims to give us access to high-quality diagnosis, treatment and care. These pathways are developed to support healthcare professionals at the front line of cancer diagnosis and care. They often include easy to follow flowcharts to guide healthcare professionals deliver best practice diagnosis, treatment and support.

Prostate Cancer UK have an excellent few pages on their website that looks at diagnostic, treatment and support pathways (ii). They aim for example to achieve an early diagnosis in men at higher than average risk of the disease. Their Prostate cancer pathway is in the process of being updated.

These pathways are one of the areas that I think can make a difference to care. At the moment in Gloucestershire - and across the country - we do not have clear pathways that are followed by all our health teams. Indeed this is one of the reasons I joined the Gloucestershire Cancer Patient Reference group a couple of years ago. We need significant improvements. A blog on that Reference Group is for another time - the group has just merged and we are developing new terms of reference but if you live in Glos and are interested in joining the group do get in touch. I have hopes that it will now be a vehicle where more real co-production is possible and we can see some further improvements.

As a representative of the Patient Reference Group I have recently joined (as a volunteer) the staff group looking at Prehab in Glos for a series of meetings. It is a privilege to be part of their plans and passion to build improved services. Some key areas are improving but resources are still not being prioritised and we are a long way off from a quality service….the Prostate Pathway for example is just starting to be looked at and much work will be needed to get health teams on board. 

Very old leaflet!

However here in 2023 more patients should at least be hearing about the Prehab offer from the NHS - that includes the offer of support re exercise, nutrition and in some cases mental health support.

Notes

(i) https://cdn.macmillan.org.uk/dfsmedia/1a6f23537f7f4519bb0cf14c45b2a629/1637-source/ten-tips-prehabilitation-tcm9-355561?

(ii) https://prostatecanceruk.org/about-us/projects-and-policies/best-practice-pathway

Ghee - and fats revisited

One of the areas of nutrition I’ve struggled to understand is ‘fats’. In this blog I want to take a more in depth look at ghee. There is much that contradicts in the world of fats and cancer; do click on the ‘Fats’ tag of this blog to see some of my previous discussions on this issue. In particular one blog in June last year I wrote about dairy (i) and some of the studies that indicate a possible increased risk regarding prostate cancer. In other previous blogs I wrote about Coconut oil (ii), Omega 3 and oily fish (iii) and a recent blog on olive oil (iv).

Saturated fats

Ghee is considered high in saturated fats. I thought it worth revisiting this issue as it is said by some that prostate cancer is driven by fats. There is some evidence to support this (v). However saturated fats are perhaps not as bad as they have been seen by many since the 1950s - indeed since then they have got the blame for a number of cancers - and indeed for heart disease when Ancel Keys argued that saturated fat raised cholesterol levels and this caused heart disease. In fact saturated fat consumption fell during this time just as heart disease and cancers were on the rise. The picture is more complicated.

A great article by Meleni Aldridge that delves more deeply into this topic can be found at the Alliance for Natural Health: https://www.anhinternational.org/news/get-fat-happy/ In that article she exposes the myths that fats make us fat, cause heart disease and more. As we know fats are essential for human health - indeed three quarters of our brain is made up of fats. 

In another article, “The Oiling of America” by Sally Fallon (vi), she looks at the history and links the rise in brain diseases, emotional disorders and neurodegenerative disorders to the timeline from when the public was asked to drop animal fats and replace them with vegetable fats. It seems it is more important to be aware of the particular fats you are eating.

Fats and cancer

As I mentioned in a previous blog (vii), Dr Geo Espinosa wrote (viii): “There is no conclusive association between eating fat, including saturated fat and prostate cancer. With two possible exceptions: Too much Omega 6-fatty acids and trans – fatty acids. Omega 6 fats are good for you but only when it is in the balance with omega 3-fats. The omega-6 to omega-3 ratio in the standard American (heart attack) diet is 20 or 30:1, omega 6 to omega 3. The healthier ratio is 2 or 1:1, respectively.”

Meanwhile in a paper by Stephen Evans, entitled ‘Cancer Control – The New Protocol’ (ix) he concludes: “There is some evidence that diets high in animal fat and saturated fat increase prostate cancer risk. However, some studies have also shown no association, while others have implicated unsaturated fats [Note from Evans – when I looked in depth at the studies, the saturated fats list included, for example, ice cream and cheese spreads – both of which are either high in sugar or nitrates and trans-fats – now known to be cancer instigators. That is, the definition of saturated fats in the prostate research was quite naive.”

Evans goes onto write: “The problem is not saturated fat – which even protects against cancer in certain cases. In fact, even trans fats that occur naturally – in the milk and meat of cows and other grass-fed animals – are known to protect against cancer. The real problem is with artificial trans fats, and other types of artificial foods. What I believe we may conclude is that non-trans-fat is not implicated in cancer.”

Update 28.01.24: I just read an interesting study where they heated a number of common oils including extra virgin olive oil (EVOO) to 240°C and then held the oils at 180°C for 6 hours,. The concluded: “EVOO yielded low levels of (unhealthy) polar compounds and oxidative by-products (compared with other oils). EVOO’s fatty acid profile and natural antioxidant content allowed the oil to remain stable when heated (unlike oils with high levels of polyunsaturated fats [PUFAs] which degraded more readily).”

https://actascientific.com/ASNH/pdf/ASNH-02-0083.pdf

Ghee

I mentioned previously that it doesn’t make sense to have lots of butter but it seems it is not as bad as some thought - especially if organic and grass-fed. However it is clear that better still is ghee. The beta-casein is removed, leaving the clarified butter fat with it’s fat-soluble vitamins. In a Western diet we are often deficient in vitamins A, D, and K2 - ghee is a great way to get those vitamins. Ghee has a modest amount of omega 3 and it's ratio of Omega 3 to 6 (roughly 1:3 or 1:2.5) is better than most vegetable oils including olive. It also has a high smoking point - unlike many other oils/fats it doesn’t have low oxidation levels that can create free radicals when heated - it is these free radicals that can lead to disease. So ghee is a great option to use when cooking and baking.

Ayurvedic doctor, Sam Watts sings the wonders of ghee (x). In terms of anti-cancer benefits he writes: “Given the ever-increasing prevalence of cancer around the world, we should all be adopting, as a key self-care priority, daily approaches into our lives that possess proven cancer inhibiting benefits. And ghee fulfils this criteria in a very significant way. For example, clinical research now shows that ghee is able to modify the functioning of our genes in a way that helps to prevent the excessive cell growth that is the root cause of all cancer formation whilst also helping to induce cell death (a process called apoptosis) in pre-cancerous and fully cancerous cells. Furthermore, ghee excels in its ability to detoxify and remove cancer promoting carcinogenic toxins and chemicals from the cells of the body which is a crucial weapon in our cancer preventing arsenal.”

Making ghee

There are a number of recipe variations but this one worked for a friend of mine. So far we have just bought ghee but this has inspired me to try making it….melt at least 250g of butter in a small sturdy saucepan over a low heat. You can use more butter but for the first time start with a smaller amount.

Within five to ten minutes, you start to see the milk solids separate from the melted butterfat and the water will evaporate. At this point you can turn up the heat to a medium so that the milk solids will continue to brown and the water evaporate. A layer of milk solids will form some white foam on the top which some recipes say you can scoop off.

Continue to cook for a further five to ten minutes until the milk solids have all gone brown. There is a great smell of toffee!

Turn the heat off and leave the pan for a few minutes to cool slightly.

Now strain the butter through a muslin (that lies in a metal sieve) into a heatproof bowl. This is now butterfat - the ghee - or ‘liquid gold’ as some have named it. Avoid getting any milk solids mixed in - you can leave some of the browned milk solids in the pan. 

Leave for some minutes to get the lasts drip into the bowl, then transfer to a jar. 

The water and milk solids have been removed so the ghee should last for three months at room temperature and up to one year refrigerated. In a freezer it will last much longer.

Finally…

In short, in terms of fats, I am left avoiding dairy but occasionally having a small amount of butter - and also an occasional goat or sheep yoghurt or cheese, a small amount of coconut oil, a fair bit of olive oil, some oily fish and an omega 3 supplement - and off course pasture-fed organic ghee.

Like with many approaches to cancer there is a need to continue to review and update as new evidence comes to light or something resonates. As always these blogs are my thoughts - I welcome comments, corrections and more - we still need further research to untangle all this about fats and prostate cancer. 


Notes

(i) https://myunexpectedguide.blogspot.com/2022/06/scary-dairy.html

(ii) https://myunexpectedguide.blogspot.com/2020/10/a-look-at-coconut-oil.html

(iii) https://myunexpectedguide.blogspot.com/2019/07/what-now-after-mineral-and-fatty-acids.html and https://myunexpectedguide.blogspot.com/2019/07/another-look-at-my-ethythrocyte.html
(iv) https://myunexpectedguide.blogspot.com/2023/01/olive-oil-and-cancer-im-still-learning.html
(v) https://pubmed.ncbi.nlm.nih.gov/14713748/ 
(vi) https://www.westonaprice.org/health-topics/the-oiling-of-america/
(vii) https://myunexpectedguide.blogspot.com/2019/02/the-mystery-of-fats-and-oils.html
(viii) http://drgeo.com/dietary-fat-does-not-increase-prostate-cancer-risk/ and https://pubmed.ncbi.nlm.nih.gov/18408140/
(ix) Cancer Control – The New Protocol (CTP9.6) Basic Principles, Strategies, and Interventions Steven Evans Therapeutics Research Institute Omaha, NE 68131 June, 2013
(x) https://www.mind-body-medical.co.uk/news/the-lowdown-on-ghee