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/

New film: Steve McQueen on black men and cancer

I've not managed to be very regular with these blogs - has been busy times - in part as have been helping develop more peer-to-peer support groups with Wigwam. However I did want to give a plug to this new film by Steve McQueen looking at the fact that black men are twice as likely to be diagnosed with prostate cancer and 30% more likely to die from the disease. You can also read more on this in Men's Health magazine here: https://www.menshealth.com/uk/health/a38880027/black-men-prostate-cancer/

See previous blog on Black Lives Matters with a brief look at prostate cancer and the role of racism - and previous blogs on this topic by clicking on BAME link.

Update 14.9.23: I came across this series of videos here.

A look at Environmental Toxins

Today it's a look at Environmental Toxins - of course people have written books on this topic and often books on aspects of this - so it is more of an introduction. As regular readers will know I've been helping a few hours a week to establish a series of Integrative Health Forums and some of the groups. What has been fascinating is that I've been able to join in some of the discussions - this blog is based a lot on my Wigwam Group blog here and their discussion that looked at environmental toxins.... 

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).

We know little about the other thousands of chemicals. What is the impact of each of those chemicals on one another? Do some change our internal biology that could lead to the onset of diseases? What is the accumulative effect?

The average adult uses 9 personal care products a day with 126 unique chemical ingredients (ii)! One in five adults are exposed to all the top seven carcinogenic impurities found in personal care products including formaldehyde. Women are hit harder with an average of 168 chemicals every day. 
Indeed many everyday products could be a concern - and their seem to be regular media stories raising concerns; 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 (update 6/9/22; Talc is to be withdrawn - see here). Last year 75 hand sanitiser brands were recalled in the States as they contained toxic ingredients. We've also just seen last month dozens of Pantene and Herbal Essences dry shampoo sprays recalled for a cancer-causing chemical (see here).
There are many examples of papers pointing to the impact of chemicals that are widely being used. A PubMed paper for example, from November 2020 looking at hand sanitisers notes that "it has been observed that overuse of alcohol based hand sanitizer results antimicrobial resistance, which can put more burdens on already struggling healthcare professionals. Repeated exposure of disinfectant, antibiotics or other genotoxic chemicals to microbes tends them to get mutations through natural process that make them resistant to survive from repeated use of hand sanitizer".
I remember a ground-breaking study in 2004 that still shocks; the Environmental Working Group commissioned five laboratories to examine the umbilical cord blood from ten babies and found more than 200 chemicals in each newborn. They report that they would have found more if they had tested for more.
In a blog back in June 2009 a blood test came back suggesting that my cancer may have been caused by a chemical found in moth-proofing carpets, air-fresheners and toilet bowl blocks - see that blog here. As I note then it is possible that that played a role in my cancer but I think it is far more complex than that.
It is easy to become paralysed by the overwhelming number of possible toxins in our environment. However we can become informed and thoughtful consumers. The list of chemicals is likely to grow and we are unlikely to know what impact many of them will have on ourselves. Many of us have adopted a precautionary principle so that until a chemical has been found to be harmless we will try not to use it. One example of this is if a product has the word ‘fragrance’ it may well have endocrine disrupters in it - so we just don’t use it.Toxins role in Cancer?
Professors Rosalie David and Michael Zimmerman looked at cancer prevalence by reviewing the remains of Egyptian mummies and data gathered since then. They concluded that “Cancer certainly existed in antiquity…but the rarity of that diagnosis in the tens of thousands of skeletal remains and thousands of mummies that have been examined supports our view that most cancers in our modern populations are due to man-made factors”.
There is increasing evidence for the impact of environmental factors on cancer. In a Nature article in Jan 2016 it was estimated 70-90% of cancers are caused by diet, lifestyle and environmental factors. While a Pubmed article (iv) by Schneiderman found 80% of cancer is related to the environment. Cohen and Jefferies in their great book ‘Anti-Cancer Living’, say research shows diet and sedentary behaviour in the US is around 30-35%, tobacco 30% worldwide, viral infections 15%, radiation up to 10%, alcohol 3.5%, but they acknowledge that environmental toxins are too hard to estimate.
Our homes and lives are certainly full of chemicals - and it is true that some of those will have an impact on our health. It is also true that we can’t realistically avoid them all but we can limit exposure.

Nutrition
There are varying reports about the possible impact of pesticides in our food. Amazingly we can lower pesticide levels in washed produce by 80% by avoiding the 12 most contaminated fruits and veg (most years these include apples, potatoes, tomatoes and strawberries). While the Journal of Environmental Research found 7 days on an organic diet led to dialkyl phosphate pesticide (DAP) levels dropping by 89% in urinary secretion. DAPs make up 70 to 80% of organophosphate pesticides.
There are also concerns regarding other foods including some processed foods, dairy, meat and more. This is a topic for another blog.
Of course what you eat can also help detox - foods like beets, lemon, chlorella, spirulina, broccoli sprouts, milk thistle and more - but again that is another blog.
Wigwammer thoughts

In the Wigwam group people shared various thoughts and ideas. To give a taste here are some of them; vinegar for cleaning, glass storage for food (as opposed to plastic) but also to avoid tinned food that has BPA liners, replacing toilet bleach with bicarbonate of soda, purifying water, getting an infrared sauna, being aware of Electromagnetic Fields (EMFs), mercury in food and fillings, some medications and treatments/screenings, radon, asbestos and more. 
Phew - you can see why this could be totally overwhelming and lead to panic.....but also crucial to remember the impact of stress! Over four years since my diagnosis and I am still learning and still trying to reduce the impact of chemicals on my immune system.

Previous Forum looked at Environmental Toxins
Leyla Mouddan, a Digestive Health educator and previously President of Association of Naturopathic Practitioners looked at a very basic framework for the everyday changes that increase immunity, exploring how our homes could be poisoning us - and what we can do about it - to access you need to sign up (free) to get access: https://www.wigwam.org.uk/podcast-and-videos

Air quality
There are over 36,000 premature deaths in the UK linked with air pollution (v) - more than from obesity or alcohol. The UK Government has breached EU limits on air quality and been found guilty twice in court. Cancer Research UK estimate 3,600 cases of cancer due to air pollution (vi).
One of the more common pollutants is benzene; it is known to cause cancer and is found in many products and places including cigarettes, glues, solvents, paints, pesticides, airports and petrol stations. Since learning this I’ve been far more careful now to avoid breathing in fumes when I fill up with petrol!
Update 11.08.22: "Researchers say they have cracked how air pollution leads to cancer, in a discovery that completely transforms our understanding of how tumours arise" - see https://www.bbc.co.uk/news/health-62797777

Outside air is one thing but inside our homes and work places can also be polluted and in many cases can be more polluted than outside. 
Indoor Air Pollution
This list is some from the one by Tony Davies from one of the Wigwam groups;

There is no safe level of tobacco consumption, a major cause of cancer, do not allow it indoors.

Open windows to air the home for a few minutes daily, do NOT use ‘air fresheners’ that can contain toxic chemicals eg: volatile organic compounds (VOCs) (respiratory irritants), benzene, formaldehyde, toluene, m,p-xylene, phthalates, and more.

The British Lung Foundation advise NOT to burn scented candles and incense in a confined space as they let off VOCs and other pollutants eg formaldehydes (linked to cancer);

Many plants produce a lot of oxygen and some remove toxins from the air - spider plants have been shown to remove formaldehydes and other toxins – all good to have in the bedroom. One of the Wigwam group sent this re houseplants that help clean air: “according to NASA Snake plants are one of the best houseplants for absorbing airborne toxins, including formaldehyde, nitrogen oxide, benzene, xylene and trichloroethylene. There are many websites with lists of plants that are good - here’s one: https://www.cancerdefeated.com/are-your-houseplants-%E2%80%A8really-purifying-your-air/ “

Keep humidity below 55% (hygrometers to measure this are cheap and readily available) to minimise chance of mould growth eg Aspergillus (black) which affects lungs and breathing - not something you want if going through chemo or have any form of lung problems. If mould does start to grow chlorine based bleach is itself a Xenoestrogen and thus carcinogenic and only kills spores on non-porous surfaces. Use vinegar, tea tree oil, hydrogen peroxide and then baking soda.

Try to avoid drying clothes on radiators, a significant source of humidity. Best practice is to dry them outside, otherwise use a tumble drier that vents or collects moisture.

A lot of this seems to be common sense but I think we can too easily get seduced into seeing chemicals as an easy answer.

Notes
(i) ‘Anti Cancer Living’ by Dr Lorenzo Cohen and Alison Jefferies (2018)(ii) www.ewg.org(iii) https://www.nature.com/articles/nrc2914-c3(iv) https://pubmed.ncbi.nlm.nih.gov/642654/(v) https://friendsoftheearth.uk/clean-air(vi) https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/air-pollution-radon-gas-and-cancer/how-can-air-pollution-cause-cancer and see BBC report: http://www.bbc.co.uk/news/health-2456444

A label is more than a label

We have talked lots in past about the placebo effect...the power of the mind...well I loved hearing about this test where participants had their hormone levels measured before and after consuming different types of milkshakes. One of the shakes was labelled as huge in calories - a super sized indulgent shake while the other was labelled as fat free and guilt free.

It was exactly the same milk shake. Yet the results show that the participants hormone levels reflected what they believed to have just consumed and were wildly different depending on which milkshake they had. This is more evidence that our mindset can meaningfully impact on our physiology. You can check out the research by Alia Crum et al at: https://pubmed.ncbi.nlm.nih.gov/21574706/

Gratitude

Research has shown how important the role of gratitude can be...increasing our resilience, directly impacting on our health (like lowering blood pressure and increasing immunity), opening up new opportunities, improved relationships and so much more.

A while back I came across Oliver Sacks' published essays before his death that were collected in Gratitude. This particular quote so resonates and couldn't resist posting here: “I cannot pretend I am without fear. But my predominant feeling is one of gratitude. I have loved and been loved; I have been given much and I have given something in return; I have read and travelled and thought and written. I have had an intercourse with the world, the special intercourse of writers and readers. Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.”

Image from the amazing Rukmini Poddar who wrote: "Choosing gratitude is not my default mode by a long shot. Really, being grateful is not something that comes easy for me and it’s a moment by moment choice. But having had a heavy heart the last two weeks is teaching me that there is always an option of being grateful despite it all. And that’s empowering." 

Rukmini Poddar is an artist, designer, and educator. Her passion lies at the intersection of emotional wellness and creative storytelling. See more at: https://dearruksi.com

Out-Witting Cancer exhibition

 

This new exhibition is in 'real life' in London with some of it online - see more - particularly the videos here: https://www.crick.ac.uk/whats-on/exhibitions/outwitting-cancer

I've only had a chance to look at the online info and it is very much a reflection of the current conventional approach - and gives some great insights to where research is going and how they are researching some cancers.

It does also just touch on broader topics like diet but not in any depth or, in my view, providing any useful info. However several of the videos are interviews with Karen Vousden from the Francis Crick Institute and Chief Scientist, Cancer Research UK - she studies the influence of the body’s metabolism – how cells change food into energy – on the development of cancer cells. She rightly points out that we do not understand
risk well, for example she suggests one sausage a week 'almost certainly' won't give you cancer but if people are told that eating a sausage causes cancer then they will not trust other messages. Indeed sensationalising risks are very unhelpful.

However we also don't know fully the impact of food on cancers; there is still loads to learn. So I think the comments around food might suggest to some not to worry too much about bacon, alcohol etc in moderation.....I certainly agree worry is counter productive but also think that we still need some care around changing the way we eat. There seemed to be no mention - maybe I missed it - about what we do need to be eating...people living with cancer (and indeed many other conditions) are long overdue advice and support around good nutrition....not to give it can only reinforce perceptions that many of us are eating well...the evidence however suggests otherwise. See my last blog on nutrition.

Similarly the info about treatment approaches are all conventional - with a focus on surgery, radiotherapy, chemotherapy and immunotherapy. As we know there is a whole world of lifestyle and complimentary treatments/approaches that are peer-reviewed and will impact beneficially on people living with cancer.