Register for Updates on Cancer and Lifestyle on 29th September in London

Medical charity the FPM is organising a one-day meeting on Updates on Cancer on 29th September at the Royal Society of Medicine, 1 Wimpole Street, London. 

Register online

Abstract submission online

Consultant Oncologist Professor Robert Thomas will discuss the evidence on benefits of lifestyle and nutrition after cancer, at a one-day meeting on Updates on Cancer on 29th September at the Royal Society of Medicine, 1 Wimpole Street, London organised by the FPM.

He said: “With 1:3 getting cancer and 3 million people living with the consequences of this disease at any one time in the UK, and the cost of care increasing, the case for developing effective, self-help initiatives has never been stronger.”

His talk “summarises the international evidence, which shows that physical activity, nutrition and other lifestyle strategies can substantially reduce the risk of relapse and minimise numerous late effects ranging from fatigue, weight gain, anxiety, hot flushes, arthralgia.”

He added that his talk will “highlight the biological processes that take place in the body after a healthy lifestyle, which can have direct and indirect anti-cancer effects. By looking only at the scientific evidence, it breaks down the myths behind which foods to avoid and which to eat more of. It discusses the risks the benefits, of mineral and vitamin supplements and highlights the potential benefits of boosting the anti-cancer polyphenols in our diet. It summarises the results of the world’s largest double blind randomised study of a polyphenol rich food supplement Pomi-T, developed and tested with the help of the UK government’s National Cancer Research Network (NCRN).”

Professor Robert Thomas is a Consultant Oncologist at Bedford and Addenbrooke’s Hospitals, a Professor of applied biology and exercise science Coventry University, a senior clinical tutor at Cambridge University. He is editor of the lifestyle and cancer website (Cancernet.co.uk) and designed the 1^st UK approved qualification in cancer rehabilitation. He wrote the evidence review for the UK’s National Cancer Survivorship Initiative, chairs the Macmillan Cancer Support Exercise advisory committee and directs an dynamic research unit, which has designed numerous studies which been published across the world. For these, and other, efforts to improve the long term wellbeing of patients he was awarded the British Oncology Association Oncologist of the Year, the Hospital Doctor Magazine UK Doctor of the Year and the Royal College, Frank Ellis Medal.

Southampton researcher Dr Lisa Loughney will discuss the benefits of exercise for people undergoing cancer treatment. 

Neoadjuvant treatment is treatment given as a first step to shrink a tumor before the main treatment e.g. surgery or radiotherapy.

In her 2016 paper on this theme she noted that neoadjuvant cancer treatment decreases physical fitness and low levels of physical fitness are associated with poor surgical outcome. She added that exercise training can stimulate skeletal muscle adaptations, such as increased mitochondrial content and improved oxygen uptake capacity that may contribute to improving physical fitness. She has therefore evaluated the evidence in support of exercise training in people with cancer undergoing the “dual hit” of neoadjuvant cancer treatment and surgery.

Dr Loughney works in the National Institute of Health Research’s Respiratory Biomedical Research Unit at the University Hospital of Southampton’s  NHS Foundation Trust.

Wendy French will discuss her Poet-in-Residency year at the UCLH MacMillan Cancer Centre.

Working with patients, sharing in their hopes and fears, tracking the everyday endeavours of a vital medical hub, Wendy French found herself drawn into lives in which blood tests, diagnosis, chemotherapy and hope become as much part of the human experience as cappuccino and Vivaldi on the radio.

Her residency resulted in publication of ‘Thinks itself a Hawk’. In the collection, one life, that of Zipora, a Jewish woman whose origins lay in the darkest days of the twentieth century, is chosen for particular attention for its power to place everyday experience in large frames, but also for the brightness with which it reminds us that everyday life is unique and important.

Wendy French was Poet in Residence at the Macmillan Centre UCLH from April 2014-2015. Her collaboration with Jane Kirwan resulted in the book Born in the NHS, published in 2013. She won the inaugural 2010 Hippocrates Poetry and Medicine prize for the NHS section in 2010 and was awarded the Hippocrates NHS second prize in 2011. She has two chapbooks and two further collections of poetry published, Splintering the Dark (2005), and surely you know this (2009). She previously worked twenty years with children and adults with mental health problems and was head of the Maudsley and Bethlem Hospital School. She has also worked with people with aphasia/dysphasia, helping them to recover their use of language through poetry.

This one day symposium will include further sessions on:

• risk factors for cancer
• evidence for effective strategies aimed at preventing cancer
• medical humanities to support patients undergoing treatment for cancer

Berlin: encouraging the healthy lifestyle - from exercise to wildlife

In Berlin for the 5th Forum on Companion Diagnostics, organised by the rapidly expanding Brandenburg-Berlin DiagnostikNet of biotech companies and affiliates.

The event has been hosted in the CoLaborator startup building on the former Schering, now Bayer campus. Outside, a volleyball court and all weather table-tennis tables - and a giant chessboard for those wishing to divert the mind.

In the city centre, tremendous buzz around the Brandenburg Gate with an international field

Kestrel with prey in the Tempelhofer Garten in Berlin

of runners, part of the international city move to encourage exercise through amateur runs. The latest field numbers I could find were 25,500 in Berlin for a recent Spring half-Marathon.

In the South of Berlin, an inspiring example of local democracy, Berlin citizens having voted to preserve the former Tempelhof airfield as a vast wild urban common land - the former site of the Berlin Airlift (or air bridge as locally known - Die Luftbrücke: 1948-1949).

This huge space is well worth enjoying while still protected wild city green land.
 

When I visited, the runways were in use by cyclists of all speeds, stylish rollerbladers, families with pushchairs, and general strollers.

There are numerous copses and tall grasslands rich in birdlife. Within 100 yards of the entrance, a kestrel catching an unlucky field rodent (above the old parachute drop training wires), sparrows nesting in an abandoned cargo plane, pied wagtail, goldfinch, wood warbler, swifts and skylarks, common nightingale, chiffchaff ...

Many good examples of making it as easy as possible at work and in leisure time to

Common Redstart in Berlin's Tiergarten

maintain a healthy active lifestyle. This is not only of course a key part of general wellbeing, but well-established to prevent serious diseases. Cardiovascular disease is the most obvious example. 

Healthy lifestyle is also well-evidenced as good for preventing cancers, and for providing clinical benefit in patients with cancer,  the focus of a one day Updates on Cancer Meeting being organised by the Fellowship of Postgraduate Medicine in London on Thursday 29th September, 2016.

Keeping weight in check - does the weight of the adviser matter?

A wide range of advisers - from family doctors to pharmacists - can be effective in providing lifestyle advice aimed at reducing risk of serious diseases of the heart, brain and circulation - including advice on diet and exercise aiming to help with weight loss.
However a new study, organised by the Royal Society for Public Health, suggests that people seeking advice on weight loss are less likely to take it seriously from someone who is overweight, whether from a health professional or another source, including hairdressers and celebrities.
In response to this report, the Royal Society for Public Health is recommending that NHS staff not only advise 'do what I say'  but also 'do what I do' when it comes to advise on weight loss – ie NHS staff and others involved in advice on reversing overweight should be aware of the importance of acting as role models to help the public at risk to engage in losing weight.
A major challenge for the NHS as "more than half its 1.3 million-strong workforce, are estimated to be overweight or obese".

See more on the study

Healthy heart charity CVRT and Hippocrates Initiative jointly launch Healthy Heart Poetry project by and for school children and young people

On behalf of the healthy heart charity the Cardiovascular Research Trust (CVRT), London-based poets Wendy French and Rebecca Goss will be editing a book of poems on the heart written by children for children of all ages. 

Entries are welcome from anywhere in the world from schools or individually from children and young people. 

Wendy said: “The aim is to bring to children, from an early age, awareness of the importance of keeping the heart healthy through diet and exercise. The idea for this came from a pilot poetry project in schools in and around London. Please do get your pupils writing! Our experience of this type of project in schools has shown that it can be very exciting both for pupils and teachers."

She added: "We would like as many children and older school students to enter as possible so we have a wide selection of poems to choose from. The book will be published in print and online by the Hippocrates Press for Poetry and Medicine. The book will be launched at a celebration in London on December 4th 2014, which children and older school students and their teachers will be invited to attend.”

The closing date for entries is 12 midnight GMT July 16^th 2014.

Poems may be entered on-line (see the Hippocrates website link) or sent to
Wendy French at 4 Myton Road, West Dulwich, London, SE21 8EB. 

Wendy has a quiz devised by the CVRT on the heart and can email this with lesson plan suggestions to teachers who are interested.

Kidshealth also has very helpful facts to help get started on the project.

The book will be divided into four sections, selected poems by primary children, selected poems by secondary school students, and a section devoted to heart healthy recipes supplied by anyone of school age. 

Medical professor Donald Singer said: “This looks a very interesting way to engage children and young people actively in understanding ways to prevent heart disease. I will be adding a section in the book on how to keep the heart healthy so that book could be used in schools for teaching about health as well as just for pure enjoyment of the poems."

See YouTube videos of examples of Healthy Heart Poetry by schools from the 2013 CVRT Healthy Heart Awards:

Little Red Balloon: from Chevening C.E. Primary School - read by Raphael Shirley

Heart or Else: heart poem from Chevening C.E. Primary School read by Raphael Shirley

Healthy Heart Poem during Assembly - performed by Year 6Ws at Dulwich Hamlet Junior School

You can read more about the Healthy Heart Poetry initiative on the Hippocrates website.

If you wish any further information or would like to help by involving your local school in the project, or in other ways, you can contact Wendy French on wendy.french6@btinternet.com 

Waistline and increased risk of premature death: what's so new?

@HealthMed The latest European Society of Cardiology Congress in Munich coincided with the last days of a Gallery of the Modern exhibition of caricatures by Munich satirist Karl Arnold:  amongst them a striking 1922 image of a stylish corpulent man said for 20 years not to have been able to see his feet. Then a social observation, it is of course now well recognized that the frankly obese are at high risk of diabetes, heart disease, stroke and other medical conditions.

At first sight surprising, that there should have been major interest from scientists and the press in new US research presented at the 2012 heart Congress linking a larger waistline to premature death; and not just from a beer belly, but for anyone with a body shape with above normal waist to hip circumference.  What’s so unusual? Surely everyone knows that being overweight increases risk of serious medical problems.

What did these American researchers do? They looked at the strength of the link between different measures of obesity and risk of early death. In the research, lead by Professor  Francisco Lopez-Jimenez from the Mayo Clinic, almost 13,000 American men and women were studied for around 14 years, within a cohort study: the Third National Health and Nutrition Examination Survey (NHANESIII). There were around 2500 deaths of which around 1100 were from cardiovascular causes. The researchers measured body-mass index (BMI), a general measure of fatness, and waist-to-hip ratio (WHR), a measure of central obesity. This meant they were able to include people not currently considered obese based on BMI, but who had a relatively large belly, as well as those overweight both based on BMI and abdominal girth. The surprising finding of the study was that, compared to subjects with normal BMI and WHR, the group with normal BMI but relatively high central fat not only had a high death rate (2.8 times for cardiovascular disease and 2.1 times for all causes), but their risk of premature death was much higher than participants who were obese based on BMI (1.4 times normal cardiovascular risk).

It is already well established that abdominal fat is particularly deadly in relation to risk of heart disease. This new NHANESIII research in addition reported that increasing waist-hip ratio is linked to earlier death from all causes, not just for heart disease. It also provided objective data of the graded increase in risk as abdominal fat and waist-hip ratio increases.

What messages to take from this study? Obvious questions include whether it is reliable and if so generalizable from US to European and other international populations. As a prospective observational study, the results are open to bias – i.e. factors co-incidentally present in the larger waisted people may have been responsible e.g. the type of diet causing the central overweight rather than distribution of the fat itself.

However the authors reported that their findings were similar after adjusting for other well-known risk factors for premature heart disease and death, such age, male gender, ethnicity, socio-economic factors, smoking, hypertension, and diabetes.  Furthermore, this new report from Munich supported the previous systematic review by the authors noting similar findings in patients with coronary artery disease: i.e. central obesity a much stronger link  than BMI to premature death.

Reasons for the observed health risks are thought to include major regional differences in types chemicals secreted by fat from different parts of the body. Unlike fat padding in other part of the body, abdominal (or visceral fat) makes chemicals that promote resistance to insulin, increasing risk of diabetes, an important risk factor for heart disease. This fat also makes inflammatory chemicals that can accelerate damage to arteries, leading to atheroma (deposits of fat and abnormal cells – from the Greek for ‘porridge lump’) in the arterial walls. This both reduces blood flow to vital organs, and increases the likelihood of a clot forming to cause critical narrowing or complete blockage of an artery, a major cause of heart attack and stroke. There is also  evidence that in contrast there may also be a protective metabolic profile associated with the presence of lower body fat.

These findings add to increasing concern about health risks from central overweight and stress the importance of preventive measures, even if BMI is within the normal range. Health professionals need to make the public aware of these risks and explain what preventive measures may help. The good news is that losing excess central weight is practical through a healthy, lower calorie diet, combined with regular aerobic exercise, reduces major risk factors for heart disease: reduces cholesterol, decreases blood pressure and reduces risk of diabetes, and lowers risk of heart and other serious diseases. Other reasons for benefits may include better metabolic profile from the increase in muscle mass with exercise, and the improved tissue nutrition resulting from generation of more micro-vessels.

Calculate your waist-hip ratio.

Calculate your BMI.

Helpful free software to help with exercise, diet and weight loss.

Romeo's 'Sick health'

@HealthMed One of Romeo's string of oxymorons [Romeo and Juliet Act 1, Scene 1: reflecting on his heart sickness for fair Rosalind], 'sick health' illustrates the challenge of preventing more conventional heart disease - with its long prodrome of apparent health masking the development of sub-clinical disease from unrecognized risk factors, which may however be reversible if identified and addressed.

Why don't more people engage? Many reasons, including fear of finding a problem if tested, difficulty accessing advice/health checks, lack of interest or knowledge of outcomes of 'treatment', lack of confidence in self-efficacy to achieve supporting or first-line life-style changes, in diet, exercise, weight, smoking cessation, alcohol intake ...

To find out more on challenges and solutions for success in behaviour change, look for sources on Theory of Planned Behaviour e.g. this referenced link from the University of Twente.

See my previous blogs on smoking and alcohol.

Stopping smoking: why and how?

Hip fracture risk and smoking

Smoking: literary warnings

Alcohol: literary warnings

Alcohol and the French paradox

US - European perspectives on potential impact of promoting cycling

As a response to my summer notes on 'city cycling', I was sent a link by @jenicarhee to a graphic (see below) on potential impact of regional schemes to promote cycling. Projected advantages include for health, environment and financial benefit. This approach lends itself to regular update on actual outcomes and imaginative ways to assess impact. See for yourself via: 'How bikes can save us [infographic]'.

City cycling: beyond the obvious benefits

Cycling sounds an attractive approach to better personal health, reduced carbon footprint and therefore a generally healthier urban environment. Rojas-Rueda and colleagues in a British Medical Journal paper have recently modeled the health risks and benefits of the Barcelona bike sharing scheme (Bicing), based on the over 180,000 Barcelona residents using the Bicing scheme.  They conclude there are greater health benefits than risks in Barcelona, and a large reduction in annual carbon dioxide emissions.
For Barcelona and elsewhere, bike-sharing appears to offer the opportunity to introduce regular cycling as a way for many in the population to return to, or increase exercise, on a sufficient scale for both public health and environmental benefits.
After Milan's earlier efforts to provide affordable and enjoyable city centre cycling - yellow bikes disappearing around Europe to Geneva and beyond - Paris (launched 2007) and London (launched July 2010) are also addressing the challenge of encouraging exercise and reducing car travel on city centre streets - with some extra effects on healthy mind and body. This includes 'water-cooler' bonding as initiates explain how to use the cycle pay columns or how to free a tricky bike. And more than intended exercise in several forms. Cyclists often need to return for a fresh hire after realising too late that their chosen cycle is faulty - punctured, chain off, saddle collapse syndrome, sticky wheels and so on (a Paris code is to reverse the saddle and or collapse the saddle support on a faulty bike); or moving from full cycle rack to next cycle station looking for a post at which to return a cycle at busier city locations. For the less pressed, this is another opportunity to meet fellow cyclists while waiting, and to compare notes on nearby velib station options. A peak time problem at busier sites is of course there being no bike available; more exercise, locating then walking to the next available station. Paris is trying hard - from the velib website at the end of August, 1233 locations were declared - enough hire and return capacity for this to be more than a tourist or freetime gimmick. The Paris website includes a colour-coded webmap: green for stations with available spaces, red for full cycle stations. The Paris Velib system leads the way globally in number of sites and available cycles. Paris also has the advantage of many wide pavements, and, in some areas, proper cycle lanes - although partnering these with buses and taxis is a source of recurrent adrenaline surge.
A reporting option on the booking terminal at cycle stations would be a good addition, so that the next hirer does not have the same problem; also helpful would be a less sticky webmap for locating alternative Velib stations: not a very mobile phone friendly website. And a review in Paris is planned of the economics of the scheme, with 80-90% of cycles reported in need of repair or replacement due to damage or theft; much less respected than the earlier  Lyon scheme (established May 2005, now with around 340 bike stations, and as for Paris, run as a partnership with advertising company JCDecaux).

© DRJ Singer

Provence, the Rhone estuary and the 'French paradox'

The ‘French paradox’, coined in 1992, refers to apparent unexpectedly low cardiovascular disease rates despite reported high exposure to factors predisposing to increased cardiovascular risk such as alcohol, cheeses high in saturated fats, and the stereotypical Gitane cigarette or modern equivalent. Obvious explanations for such a paradox include protective genetic factors, cardioprotective factors in the French lifestyle, and ascertainment bias in recording cardiovascular disease.
What insights are evident to explain the French paradox from visiting the Mediterranean reaches of the Rhone valley? Unlike for some northern European populations, the southern French are not averse to leafy green vegetables (the Provencal variant - ‘mesclun’), tomatoes, or other salad ingredients. And garlic and other alliums are popular in local recipes.
Cheese intake appears relatively low and goat and sheep’s cheese are popular. That raises an obvious question: does the species source of cheese matter for cardiovascular risk? Alcohol intake in public appears modest. That combined with evidence from Roger Corder and others for possible cardiovascular protective effects of certain red wines may contribute to reduced cardiovascular risk.
The typical local build is lean. However increasing numbers of young and older French men and women are developing abdominal obesity.
Smoking outdoors is still very prevalent, particularly among young women and men. There remains scope both for active and passive smoking to be continuing risk factors for increasing risk of cardiovascular disease.
What about access to health prevention and medical treatment? Every variety of doctor is available, with rooms in large and small towns, brass or marble plaques advertising their specialty, diploma – especially when from Paris, or even the gift of ‘expertise’. This health provision is complemented by a large number of pharmacies, and the newer vogue for parapharmacies, providing expertise and/or access to conventional, as well as plant-derived and other complementary remedies.
Do these other ‘remedies’ work? Certainly herbal and other plant extracts can have potent medical effects. For example, St John’s wort can reduce the expected clinical effects of treatment both by reducing absorption of drugs through activation of drug transporters in the gut, and by increase drug breakdown through activation of liver enzymes responsible for drug breakdown.
And grapefruit juice may lead to potentially serious interactions with over 50 prescribed and over-the-counter drugs, through reducing their breakdown, therefore leading to greater than expected effects of these medicines. Pomelos and Seville oranges may have similar actions.
The afternoon promenade is popular and there is ample opportunity for outdoor activity, whether from walking, more relaxed or extreme forms of cycling, riding the ‘wild’ Camargue horses, or active engagement in the local bull-friendly pursuit of trimming the bull’s fringe. This involves rapid evasive action from the charging bull, by leaps over high wooden barriers by the bull-trimmers (razeteurs). There is also ample opportunity to release aggression as a spectator, or as a participant in local bull- or horse-related spectacles.
Taken together, there are obvious dietary and lifestyle opportunities available in Provence to reduce cardiovascular risk. These are potentially offset by smoking, development of abdominal obesity and the degree to which exercise and alcohol feature in an individual’s lifestyle. And, at least for cardiovascular mortality, ascertainment is increasingly difficult, as fewer post-mortems are performed to verify cause of death.
The best strategy for cardiovascular prevention is effective public health advice, combined with effective management of cardiovascular risk factors by lifestyle and drugs, with advisors and members of the public well-motivated to adopt effective evidence-based measures to reduce cardiovascular risk. That of course begs several questions on existence or strength of the evidence base for cardio-protective effects of dietary factors, including different regional wines. These questions are key themes included within a Symposium on cardiovascular effects of ‘healthy foods’ to be held in London on Thursday 8th December 2011, with discussants including Professor Roger Corder (Wm Harvey Institute, London) and Professor KT Khaw (University of Cambridge).
For further details see my recent blog on 'What foods protect cardiovascular health?'

Exercise and cardiovascular health on Everest

Jesuit priest Father Jose Acosta, wrote of his crossing the Andes in the late 16th century problems with sickness and vomiting which he attributed to the "thinne air", so "delicate as it is not proportionable wth the breathing of man". In 1865 the first man to climb the Matterhorn, Edward Whymper, recently commemorated in London by a blue plaque, was an early student of sickess at altitude. In recent modern times, climber Charles Houston made a major contribution to research into mountain sickness, his interest inspired by his episode in August 1953 of unconsciousness high on K2. He crystallised key ideas on mechanisms in his 1980 book "Going Higher: Oxygen, Man and Mountains".  Speaking about his talk at the 14th July Symposium on 'Exercise and Cardiovascular Health’ organized by the Cardiovascular Research Trust, Professor Chris Imray commented: "increasing numbers of people travel to altitude for both leisure and work purposes. On ascent to altitude, there is a reduction in atmospheric pressure, and there is consequently a reduction in the inspired levels of oxygen. The resulting physiological challenge stresses the body both at rest and further during exercise.

The cardio-respiratory challenges and the subsequent responses of ascending to high altitude will be discussed in detail, as will the role of ‘altitude training’."

Professor Imray will present "unique data from the Caudwell Xtreme Everest expedition, including arterial blood gases and the response to exercise at extreme altitude ...".

These studies provide important messages for health and risk for climbers at high altitude. They raise interesting questions about impact on brain and heart function of working at high altitude for border guards who are not acclimatised to low oxygen levels. They also provide insight into the physiological challenges and pressure for emergence of survival genetic variants for populations historically living at altitude.

See the symposium website for the programme.

Exercise and cardiovascular health

The good news is that even mild activity can be helpful in keeping healthy and in reducing risk of joining the pandemic of cardiovascular disease in the 'developed' world and emerging epidemic of heart attacks and strokes in less developed countries.

At the elite end of the exercise spectrum, internationally competitive athletes benefit from positive feedback effects of exercise on the heart and circulation. 

And for patients with established clinical heart problems, exercise under medical supervision is now well recognised to help to complement medical and surgical treatments to aid recovery and reduce the risk of future heart disease.
Not a good idea though for the out-of-condition to go from none to extreme exercise. What advice should the health or sports professional consider ?
These themes form the programme for a symposium on 'Exercise and cardiovascular health' in London on the afternoon of Thursday 14th July 2011. 

Of interest to a diverse audience - sports professionals and health professionals and students looking for an update on benefits and risks of exercise, from prospective to the elite athletes interested in benefits of exercise for their health and performance, to people with heart conditions wanting to find out more about exercise and the heart. And as an interesting case study on extreme athletes, surgeon and Everest researcher and mountaineer Professor Chris Imray will be discussing exercise at extreme altitude. 

See the symposium website for the programme.