By Clive Lindley-Jones | June 29, 2016 12:17 pm
Do you have a Prostate, No? But perhaps you know (and even love) someone who does?
I loved my father. Well most of us do, what was sad for me to see was his growing girth and eventual demise from prostate and bladder cancer some fourteen years ago. I remember him when I was young as a slim, energetic man, who would run down the street and make me laugh, it was inevitably painful to see him suffering in his last years.
Sad but nothing new about that, you might say. True, but it may be that history, as well as my clinical knowledge, was one reason why my eye was caught recently by a small piece in The Week under the headline waist size and prostate cancer. Perhaps, for many, the link between the most common form of male cancer in the UK, we have around 130 new cases a day, and the size of your waist, might seem surprising.
Few people think of reducing their waist size specifically to avoid cancer. But for clinicians over many years now, one of the least expensive, but very cost effective tools in our offices, has been a simple measure tape with green, yellow and red sections indicating the good, not so good and bad sizes for our waists with one side for women and the other for men. In one small maneuver you can see where you lie in the healthy to unhealthy or even dangerous waist-size stakes. This has been a useful tool to bring to light, in a very simple and direct way to patients, the risks that visceral fat can have on our health.
This study, which was recently presented at the European Obesity Summit in Gothenburg, Sweden, carried out at Oxford University followed 141,896 men, typically aged 52, over 14 years: during this time 7,022 developed prostate cancer and of those, 934 died. What the research showed was that for every extra four inches a man had on his waist, he raised his risk of developing the most aggressive form of prostate cancer by 13% while his risks of dying went up by 18%.
It has been known for some time that a waist size can have a significant effect on health: You have a higher risk of health problems if your waist size is:
- more than 94cm (37 inches) if you're a man
- more than 80cm (31.5 inches) if you're a woman
Your risk of health problems is even higher if your waist size is:
- more than 102cm (40 inches) if you're a man
- more than 88cm (34.5 inches) if you're a woman
Around 1,000 people a week die in the UK from obesity-related conditions. While estimates vary, the cost of obesity accounts for possibly more than 20% of all health costs today and looks to rise exponentially in years to come. Knowing where you are on that colour code tape is a good start to add some warning for this common cancer as well as, it could be argued now we are on the skids financially, a patriotic step. As I am at that peak age for diagnosis of prostate cancer, I have another reason to think carefully about the disease, even though my waist size is under control.
The incidents of prostate cancer is highest in Australia and New Zealand and lowest in South Central Asia. So what is it in this increased waist size, (or apple shape as opposed to pear shape) that is driving these higher risks? According to the Harvard School of Public Health The fat surrounding the liver and other abdominal organs, so-called visceral fat, is very metabolically active. It releases fatty acids, inflammatory agents, and hormones that ultimately lead to higher LDL cholesterol, triglycerides, blood glucose, and blood pressure. Male hormones, or androgens, drive the development of prostate cancer. Two common androgens are testosterone and the more powerful, less friendly, dihydrotestosterone (DHT). It is possible that this increased viseral fat drives the production of DHT.
The Nurses’ Health Study,(yes I know nurses are more often women) one of the largest and longest studies to date that has measured abdominal obesity, looked at the relationship between waist size and death from heart disease, cancer, or any cause in middle-aged women. After following this enormous cohort of women for 16 years they found that women who had a waist size of 35 inches almost doubled their risk of dying from heart disease and cancer, and the higher the size the bigger the risk.
Food for Thought
OK, so we should lose that beer belly, anything else we can do? Well yes, if epidemiology studies on diet and disease are telling us anything. Why has there been a twenty-five fold increase in prostate cancer in Japan since world war two? Could it have anything to do with the sevenfold increase in egg consumption, a ninefold increase in meat consumption, and a twentyfold increase in dairy consumption?
Many things happened in Japan to change the rates of death, but it does appear that the rise of milk consumption is a significant factor. We have grown up with a cultural belief that milk is altogether a 'good thing', all sorts of phases link it to the positive in our upbringing, "The milk of human kindness", "mother's milk" tells us subliminally that this is a good thing. Fear of osteoporosis encourages us to increase our calcium intake and this is often linked to milk in many people's minds.
The truth turns out to be somewhat different. Not only do numerous rigorous scientific studies point to high intake of dairy appearing to increase total prostate cancer risk, but milk may, ironically, even increase bone and hip fracture rates, something that would seem to be counter-intuitive to our prevailing cultural conditioning.
Milk is not the only 'good' food associated with higher risks of prostate cancer, eggs, chicken and most animal proteins are associated with up to four times the risk of prostate cancer progression. Now I have been a life long vegetarian so avoiding meat, for me, is no sacrifice, however moving to a fully vegan diet and abandoning eggs and cheese is more of a challenge. But this is where the science seems to be taking us. Not that you will hear this from any government any time soon. That would lose too many farming votes and food industry cash. Sadly we cannot rely on the government as a reliable source of anything but the blandest of health advice. And anyway, such governmental health advice is not effective. What might be more effective is, following the likes of the Finnish example and concentrating on encouraging and introducing young children in school to a wide range of exciting and tasty vegetables so that they at least grow up with a healthier and more protective diet. Banging on about '5 a day' seems singularly ineffective. Perhaps the way forward is via taste and joy rather than advice and guilt.
This takes us to the A:V ratio. or the rate of Animal to Vegetable proteins in our diets. Many research studies have tried to test for this and, sure enough, the more we shift towards a plant-based diet, the lower the signs linked to prostate cancer, like PSA levels, are. It is looking very likely that the ideal A:V ratio is closer to zero than one. And this is not just for prostate cancer, it seems to apply too for cancer prevention in general.
Allen et al. reported in the International Journal of Cancer in 2013 on the largest study ever performed on bladder cancer that involved nearly 500,000 people in Europe, found that an increase in animal protein consumption of just 3% was associated with a 15% increase in risk of bladder cancer, the other cancer my father suffered from. On the other hand, an increase in plant protein intake of only 2% was associated with a 23% decreased cancer risk.
So while politicians will wail, with some justification, at the struggles of our National Health Service, behind the headlines, science is inexorably pointing to a dramatic change needed in our farming and food culture, if we are really to successfully deal with the growth of chronic disease and the ever rising cancer levels. This will take an ongoing revolution.
It seems almost impossible to imagine the kind of shift in habitual eating habits needed to make a dent in the drivers for our high cancer rates. We know that a very significant proportion of cancers are lifestyle and particularly food, related. But I am confident things will eventually change and fewer of us, like my father, will have to suffer unnecessarily due to our ignorance of what our eating habits are subtly doing to us, when all the time we thought we were doing the right thing. However it is going to take far, far too long, both for the chances of a whole generation, not to mention climate change, to get these kind of profound changes.
Never-the-less we can already see the small seeds of change in many of the millennial generation where things like veganism is rapidly becoming mainstream in certain circles. As only men have a prostate and men are very much the weaker sex when it comes to being able to change their diet for health reasons, see, Dr. Michael Greger's evidence based review of the literature on this things look grim, for the time being, for the mass of British men. As Greger says, a cancer diagnosis is often considered a 'teachable moment' in medicine. The only way the renowned Dr. Dean Ornish managed to make significant changes in men's diet was by delivering healthy cooked meals to their door. So if men won't change behaviour because of a risk of cancer, perhaps the very high risks of erectile dysfunction might be the way to go in encouraging change. I fear the type of major change we have discussed here, will only come with generation change. Smoking is slowly becoming an unacceptable activity, but that has taken nearly a lifetime and, for the more disadvantaged, it is still not eradicated.
With weight gain we seem to disrupt all sorts of hormonal messengers that are trying to keep the balance in our bodies. Chronic inflammation sets off confusion within.
Unwanted Growth & IGF-1
When we are small we need to grow, and so signals, such as insulin-like growth factor 1 (IGF-1) are sent through our hormones to encourage cells to grow more numerous. Every day we are turning over billions of cells and renewing ourselves all the time. However once we are adult we do not need to grow more numerous cells, just renew the ageing ones we have got. Extra cells can lead to tumors and the kind of growth we do not want. As I said in my November blog on fasting;
"Genetically engineered mice live 40% longer by reducing levels of growth hormone I.G.F.1. This is the ‘go-go’ hormone. With less of this the body has the time to slow down the production of new cells in order to fix the cells it already has so repairing damage. Protein when eaten builds cells but also locks us into the go-go mode and can encourage too fast a growth, leaving no time for repair. Eating less protein, less often, seems to help reduce IGF1 as well as the crucial glucose levels".
There is a rare form of dwarfism called Laron syndrome that has been studied a lot recently both in relation to cancer suppression and fasting. The body of those with Laron syndrome cannot produce enough IGF-1 to grow, however the good side is that small as they are, they seem almost immune to cancer. And it is our dietary choices that can allow us to turn down the helpful growth power of IGF-1 when we are fully grown. Evidence is mounting to show that both reducing our calorific, and specifically, protein consumption, perhaps through regular mild fasting, see my recent blog fasting-is-it-the-way-forward-november-2015/ can reduce our levels of IGF-1. After just eleven days of cutting back on animal protein, your IGF-1 levels drop by 20% and your levels of IGF-1 binding protein can jump to 50%. This binding protein helps to tie up excess IGF-1 and so protect your body from excess growth, from cancer.
What to do?
So what can we guys do to reduce our risks of prostate cancer? And what can you do to help the men in your life reduce their risks, and also help reduce your risks of other cancers like breast or bladder cancer? Remember that some like Dr. William Fair and his colleagues, from the Memorial Sloan Kettering Cancer Center in the USA, suggest that prostate cancer may be considered a 'nutritional disease.'
- Work towards reducing your A:V ratio. More plants fewer animals.
- Eat more cruciferous vegetables, broccoli, brussels sprouts, cabbage, cauliflower, or kale are helpful for glucosinolates and Indole-3-carbinol (I3C)
- Eat more grounded flax seeds for their cancer protective lignans.
- Eat more tomatoes, especially cooked, for their anti cancer effects of lycopene.
- Consider eating traditional East Asian soya products like tofu for their protective phytoestrogens called isoflavones.
- Oh yes, and work towards reducing that inflammatory waist size! (Back to my November blog on the 5:2 fasting diet)!
There are lots of things you can do to reduce the risk. The sooner started the better the effect. Good luck.
New Faces, new talents
Helix house will be getting some new faces working with us starting this summer. Watch out for some interesting, skilled people who will be joining us, offering their well honed talents in body work different from our own. You may well want to book a trial treatment from one or all of these well honed and experienced practitioners.
Alex graduated from Oxford School of Sports Massage with Level 5 BTEC Professional Diploma in Clinical, Sport & Remedial Massage. She worked at the Oxford University Woman’s Lightweight Rowing Club, and more recently at Eau-de-Vie - The Centre for Natural Health Treatments. She treats a diverse group of clients ranging from busy mums, office and manual workers, musicians, football players, cyclists, runners, power lifters to racing car drivers. She has just completed the core programme of the Visceral Manipulation (VM) at The Barral Institute in New York. VM is a gentle manual therapy which helps to release restrictions and unhealthy compensations that cause pain and dysfunction.
Bells Aris Bella has been working as a massage therapist in Oxford for the last 18 years and over time has enjoyed how her practice has grown and evolved. After first training at the Oxford School of Massage in holistic massage she became more drawn to helping clients in pain and discomfort, after all that is primarily why someone will seek treatment. This led her to train at JING Advanced Massage where she gained the tools and knowledge to really understand and help people in pain whether it be from a sporting injury or spending 8+ hours a day at a desk.
Through becoming a mother of 3 her interests extended to women’s health, firstly with pregnancy massage. As a doula as well as a massage therapist she has developed a deeper understanding of the pregnant body both in terms of the common aches and pains of pregnancy but also the ups and downs that a woman might go though at this time.
A natural step from pregnancy became helping women with menstrual and fertility issues. she came across Maya abdominal massage, a gentle non invasive technique aimed at the health of the uterus and pelvic region. She has become increasingly convinced at how this work supports women on many levels.
She continues to love the work that she does and feels that her experience gathered over the years along with an interest to learn more has helped her to give clients a comprehensive treatment.