So you’ve survived cancer – that’s only the beginning

Weight issues

Being overweight or obese is well known to raise your risk of cancer, along with a number of other disorders, so maintaining a healthy weight should be one of the primary aims when planning a life after cancer. However a recent study found at least 50 percent of survivors were overweight/obese, but there were few suggestions for doing anything about it (10). The benefits of weight loss can be seen from research involving overweight postmenopausal women. Losing weight brought down the level of various hormones that can raise cancer risk, such as insulin and the amount of oestrogen that was available to use. These women also had lower level of the hormone leptin that makes you feel hungry (11).

Metabolic syndrome

It’s now clear that one of the side-effects of hormone-blocking therapies used to treat both breast and prostate cancer is that they can increase the risk of metabolic syndrome – a combination of symptoms such as obesity, raised glucose level and raised blood pressure – making diabetes and heart disease more likely (12). Two recent studies have tried to address this.

Dr Michelle Harvie is a dietician at Manchester University andaa pioneering researcher into the benefits of alternate-day dieting schedules on breast cancer. She found a surprising effect from putting overweight women on a very low calorie diet for two days and then allowing them to eat normally for the rest of the week. They became more sensitive to insulin – a drop in insulin sensitivity comes with metabolic syndrome. This didn’t happen with women who followed a low calorie diet every day.

A slightly different approach reducing the symptoms of metabolic syndrome that come from blocking testosterone production in prostate cancer patients, has been tried by Dr Robert Laing a radiation oncologist at St Luke’s Cancer centre in Guildford. He has found that putting them on the diabetes drug metformin, which improves insulin sensitivity, plus a low glycaemic diet – none of the refined carbohydrates that boost blood sugar – was beneficial. Patients lost weight and the amount of fat in their blood dropped.

Keeping physically active

Exercise is the ultimate lifestyle panacea – good for everything, including life after cancer. Physically active survivors are likely to live longer, have an enhanced quality of life and lower levels of anxiety. The benefits are greatest for older women.

The American Cancer Society recommends at least 30 minutes – preferably 45-60 minutes – of moderate or vigorous aerobic activity for 5 days/week, along with muscle strengthening anaerobic resistance activity involving all major muscle groups 2 days/week (13). As an alternative regular 30 minutes cycling or muscle strength training has benefits (14 ).You are going to do 50% better if you have the benefits of exercise clearly explained before starting any regime because you are more likely to stick to it (15). Patients who exercise regularly report feeling better physically and emotionally (16).

Ongoing Fatigue and Pain

Exercise can also help with the severe persistent fatigue that affects 25% of survivors a year after their cancer treatment had ended. For best results the an exercise program needs to start two months after treatment has finished (17).

Pain is an even more common problem. Around 40% of patients undergoing chemotherapy develop muscle pain, nerve pain (neuropathy) and sensory disturbances and 60% of those are still suffering these symptoms many months later. N-acetyl canitine, alpha lipoic acid, fish oil and vitamin E have all been found beneficial in reducing symptoms (18).

Mike Wakeman

Mike Wakeman

Michael Wakeman is a pharmacist and healthcare consultant with master’s degrees in pharmaceutical analysis, nutritional medicine, and shortly clinical oncology. He has extensive experience in natural medicines research, is a regular contributor to health publications and in 2009 his research was selected to promote the Royal Pharmaceutical Society’s scientific conference. Email
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  • Interesting, but I spotted two errors: in the section on obesity the author claims that the hormone leptin makes you feel hungry. This is incorrect, leptin is the hormone secreted by adipose tissue that signals to the brain that the fat stores are full and is known as the satiety hormone. Low leptin increase hunger. Ghrelin, secreted by the stomach, is the hormone that makes you feel hungry. Second, the studies by Harvie et al. use a low carbohydrate diet for two days followed by a Mediterranean diet for 5. It is likely that the low carb intake is the key to lowering insulin resistance. The actual intake on the two days of low carbs is about 1000cals per day. Alternate day fasting (ADF) as studied by Krista Varady and colleagues also demonstrates decreases in insulin resistance. Fasting is akin to low carb as the lack of carb intake during fasting allows insulin levels to fall and as a result increases in insulin receptors occur.

    • Editorial

      Thanks for picking up leptin error – is of course saiety hormone. You may well be right on low carb – personally think it makes a lot of sense for a number of metabolic disorders but know there is still disagreements over differening effects of low carb, low calories and different dietary schedules. Fascinating area, maybe Mike has a view.

  • That’s an interesting discussion, Mike, and as you say, attention and funding majors upon bringing forth high-tech treatments. Cancer does respond positively to low carbohydrate diets, and several decades ago some proponents saw highly saccharine diets as being a risk factor for cancer.

    What are your thoughts about cancer rates as apply to humans in the context of time an place, and how do cancer rates compare across species, including those species who live wild, and those we have domesticated and brought into our homes?

    Are there factors present and common in aspects of the world we’ve largely shaped for ourselves, and perhaps rising in prominence within the last century, that you might reason could be capable of accounting for cancer rates?

  • An excellent article – most people could improve their health by walking more but some are reluctant. Walking for health is a scheme to help people with this gentle but effective form of exercise, walking in groups to give encouragement and mutual support. They have a website that provides more info.

  • Mike, what an excellent article, but you will be aware that the difficulty is getting the physicians to consider the value in nutrition when they only receive six hours tuition in nutrition in two years of their basic science part of the their medical degree. It is just as bad in the US where only six percent of graduating physicians have had any training in nutrition. Perhaps Mike there is an opportunity now with the new Academic Health Science Networks to get this ‘innovation’ promulgated. After all it was another pharmacist, the famous apothecary William Cookworthy who advised the naval officers in Plymouth that scurvy might be prevented and treated by supplying crews with fresh fruit and vegetables and in their absence sauerkraut which is rich in Vitamin C.

  • “Excellent read and very insightful. Certainly has given me more food for thought given my current academic learning curve. The piece flows really well and is supported by a diverse range of research. Would the inclusion of direct comments/experience from cancer survivors have given the literature more richness/depth?

    You could perhaps include local Macmillan Cancer Support and Information centres and the national website as additional resources. To highlight the referral criteria for most Community Macmillan Nurses across the UK care for patients with a 12 month prognosis or less. However, there are a range of service models who also see patients deemed ‘curative’ however in my experience this is generally not the case. Hospital based Macs do see patients across the disease trajectory and also use the ‘buddy/mentor’ programme”. An excellent concept Mike – in reality given the current economic climate in an era were GP led commissioning is upon us the evidence would need to ensure a both a positive health outcome for survivors and cost efficiency.

  • medical ozone!Please.

    • Editorial

      I discovered that this refers to: prof v bocci,uni siena “the use of ozone in medicine

  • Thanks for highlighting this important issue, Mike. Doctors have consistently underplayed the long term effects of cancer treatments, and the sufferers have all too often been ignored. RAGE – Radiotherapy Action Group Exposure has campaigned – and been rebuffed – consistently since the early 90s on behalf of women whose lives have been a misery as a result of the unintended consequences of radiotherapy.

    At Yes to Life, we know that still, a quarter of a century later, doctors describe radiotherapy as an almost completely benign procedure, and the fact that it could even kill you by promoting cancer is never mentioned. My daughter died of radiotherapy induced osteosarcoma, but even the circumstances of her death were ‘sanitised’ to keep the truth about radiotherapy below the radar – her death certificate said respiratory failure. This is rather like saying that someone who got shot dead, died from respiratory failure, rather than from being shot.

    Importantly, also, your article highlights the dire situation that cancer patients find themselves in on ending their treatment. They are sent off with nothing other than the hope they’ll avoid a recurrence, with no strategy and no idea what to expect in terms of long term after effects of treatment. In the 21st century, this archaic denial of reality, stemming from institutionalised problems in health services the world over surrounding empathy and simple human relations, needs to be called exactly what it is – complete absence of care coupled with pathological clinging to an increasingly untenable status quo. Dr Robin Youngson’s ongoing campaign against old style clinical detachment is In need of all the support it can get. We need nothing less than a revolution in the way that healthcare providers relate to the people who find themselves in need of care. Only then will the difficulties of these huge numbers of people start to be heard.

    All in all, a topic, or indeed range of topics that needs a lot more airspace. thanks Mike.

    • Radiation and Chemo will never give a good outcome as they merely have one pathway of killing aberrant cells. Cancer is a metabolic disease with multi pathways and thus the current conventional protocols are little more than an Emperor with only a jock strap.

  • I am a Medical Herbalist in Canada, trained out of the UK. I treat cancer and it has become a speciality for me personally. There are plenty of Medical herbalists in the UK who can not only treat cancer in its primary form but also when chemo etc are used both maximise its beneficial effect to the patient and minimise and/or remove the negative aspects. As Medical Herbalists are highly trained practitioners of biochemistry and phytochemistry they usually know more than the so called oncology professionals. Sadly the mandarins in the UK government continue to block this eminent profession which has been licensed since 1542. Every cancer patient should have a Medical Herbalist at part of the team and there would be far better outcomes with considerable cost reduction. As this is a general post I am not giving references but they are mostly all on Pubmed as it is MH is evidenced based medicine. Cancer is a metabolic endocrine disease driven in the first instance by excess circulating glucose for most cancers, now recognised as the Warburg effect. Cancer is a completely preventable disease but it is never treated as such because it is a huge money maker and the protocols are very ineffective for real health. Perhaps readers could start to educate the public

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