Dr Paddy Barrett: Exercise cuts certain cancer risks

May 18, 2024Apr 10, 2024 kaitiscotland3 Comments

Does Exercise Prevent Cancer?

Why exercise is one of the best tools we have for cancer prevention.

Let’s start with the simple fact that a lot of cancer diagnoses are simply down to ‘bad luck’.

You can do everything right and still get cancer.

This is a somewhat depressing fact, given its leading position as a cause of death.

The other leading cause of death, cardiovascular disease, is mostly preventable.

Cancer – Less so.

But that does not mean you cannot tilt the odds in your favour.

And regular exercise, it seems, might be a good way of doing so.

Regular exercise and high levels of physical fitness have been consistently associated with longer lifespans and a substantially reduced risk of dying from any cause¹.

If exercise reduces all-cause mortality, it seems safe to say that it is reducing cardiovascular and cancer deaths.

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Let’s look at cancer specifically.

Over a 10-year period, those in the highest fitness levels had an 11% reduction in the risk of cancer².

But this 11% figure masks the fact that not all cancers are impacted equally.

Exercise has little effect on some cancers, while it has a much bigger effect on others.

While the risk of gastric/stomach cancer is reduced by only about 5%, the reductions in other cancer types are even greater.

Breast Cancer – 13% Reduction
Oesophageal Cancer – 18% Reduction
Liver Cancer – 18% Reduction
Lung Cancer – 25% Reduction
Colorectal Cancer – 26% Reduction

The impact of exercise on cancer even extends beyond the original diagnosis and has been shown to reduce the likelihood of recurrence of cancer³.

Regular exercise in those who have already been diagnosed with cancer has been associated with:

A reduced chance of dying from a breast cancer diagnosis by 40% compared to those with breast cancer who did not exercise regularly⁴.
A reduced risk of death from colorectal cancer by 30%⁵.

The question is WHY exercise might be associated with such benefits with respect to cancer.

Regular exercise and high fitness levels are associated with lower rates of obesity.

Obesity is the second leading cause of preventable cancers after smoking⁶.

Please reread that line again.

It should hit you like a ton of bricks. If it doesn’t, you are not getting the magnitude of the problem that is preventable.

The likely driver of the cancer risk conferred by obesity is probably related to higher levels of insulin resistance and metabolic syndrome.

A diagnosis of metabolic syndrome significantly increases your risk of several leading cancers⁷:

Postmenopausal Breast Cancer – 52% Increased Risk
Hepatocellular Cancer – 81% Increased Risk
Colorectal Cancer – 30-40% Increased Risk
Pancreatic Cancer – 55% Increased Risk

But insulin resistance and metabolic syndrome are not the only drivers of risk.

Cancer As A Breakdown Of Immune Function

The hallmark of cancer is the uncontrolled replication of cells.

But the cells in your body are continually replicating.

The mechanisms of replication usually do an excellent job at producing exact copies of cells, but sometimes replication errors occur, which can lead to the development of cancer⁸.

The immune system’s job is to constantly search for these poorly replicated cells and destroy them.

In truth, we are probably creating very early cancerous cells throughout our lives, but because of our immune system, they do not get the opportunity to progress into fully formed cancers.

Natural Killer Cells are one of the key agents for targeting abnormal precancerous cells.

A properly functioning immune system then is essential for cancer protection.

Hereditary Cancers and The Role Of The Immune System

Lynch syndrome is a genetic colorectal cancer disorder where 60% of carriers go on to develop colorectal cancer over their lifetime⁹.

A recent study examined the question of whether regular exercise in such a high-risk group for cancer would impact the number of natural killer cells, which are important tools for destroying early cancer cells.

Those who did 45 minutes of high-intensity exercise three times per week for a year had significantly higher levels of natural killer cells¹⁰.

The higher levels of natural killer cells are likely to explain at least some of the protection regular exercise confers when it comes to cancer prevention.

Regular exercise also influences a variety of other cellular mechanisms that modulate cancer risk, including beneficial changes in¹¹:

Cell Growth Regulators – IGF1 & IGFBP3.
Suppression of RAS oncogenes.
Higher levels of proteins involved in cellular repair.
Enhanced activity of regulators of apoptosis and cellular growth.

Tilting Odds

The best way of not dying from cancer is to not get cancer.

Unfortunately, much of that risk is simply down to ‘Bad Luck’.

However, it is clear that regular exercise can play a crucial role in decreasing the odds of developing cancer, and the mechanisms by which it does so are becoming increasingly clear.

We need all the help we can get.

Keep the odds on your side.

Cardiorespiratory Fitness and Mortality Risk Across the Spectra of Age, Race, and Sex. J Am Coll Cardiol. 2022 Aug 9;80(6):598-609.

Association between physical activity and cancer risk among Chinese adults: a 10-year prospective study. Int J Behav Nutr Phys Act 19, 150 (2022).

Physical Activity Reduces the Risk of Recurrence and Mortality in Cancer Patients. Exerc Sport Sci Rev. 2020 Apr;48(2):67-73.

Physical activity in breast cancer survivors: A systematic review and meta-analysis on overall and breast cancer survival. Breast 2019; 44:144-152.

American College of Sports Medicine Roundtable Report on physical activity, sedentary behavior, and cancer prevention and control. Medicine and Science in Sports and Exercise 2019; 51(11):2391-2402

Cancer is a Preventable Disease that Requires Major Lifestyle Changes . Pharmaceutical Research, Vol. 25, No. 9, September 2008

Mendonça FM, et al, Metabolic syndrome and risk of cancer: Which link? Metabolism (2014),

Roles of the immune system in cancer: from tumor initiation to metastatic progression. Genes Dev. 2018 Oct 1;32(19-20):1267-1284.

Cancer risks by gene, age, and gender in 6350 carriers of pathogenic mismatch repair variants: findings from the Prospective Lynch Syndrome Database. Genet Med. 2020 Jan;22(1):15-25.

Exercise Training Reduces the Inflammatory Response and Promotes Intestinal Mucosa-Associated Immunity in Lynch Syndrome. Clin Cancer Res 1 November 2023; 29 (21): 4361–4372.

Why exercise has a crucial role in cancer prevention, risk reduction and improved outcomes, British Medical Bulletin, Volume 139, Issue 1, September 2021, Pages 100–119,

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As with all the material on this site it is not medical advice and is for general informational purposes only. None of the information provided constitutes the practice of medicine, or any professional healthcare services. No doctor patient relationship has been formed. Information contained on this platform is used at the readers own risk. Readers of this information should not delay or disregard in obtaining professional medical advice or treatment for any health related issue. The information presented is in no way a substitute for medical advice.

My comment: There is new research indicating that mitochondrial function greatly improves with exercise. It reduces the potential for DNA changes that can lead to cancer and in cellular degeneration. I didn’t write a specific blog about this as the scientific detail is overwhelming to me and I already keenly advocate exercise across all ages.

A ketogenic drink can improve brain metabolism and cognition in early dementia

Apr 30, 2024Apr 10, 2024 kaitiscotland1 Comment

Adapted from Alzheimer’s and Dementia 15(2019) 625-634

A ketogenic drink improves brain energy and some measures
of cognition in mild cognitive impairment

Melanie Fortiera, *, Christian-Alexandre Castellanoa et al.

Research Center on Aging, CIUSSS de l’Estrie – CHUS, Sherbrooke, Quebec, Canada.

Abstract Introduction:

Unlike for glucose, uptake of the brain’s main alternative fuel, ketones, remains normal in mild cognitive impairment (MCI). Ketogenic medium chain triglycerides (kMCTs) could improve cognition in MCI by providing the brain with more fuel.

Methods: Fifty-two subjects with MCI were blindly randomized to 30 g/day of kMCT or matching placebo. Brain ketone and glucose metabolism (quantified by positron emission tomography; primary outcome) and cognitive performance (secondary outcome) were assessed at baseline and 6 months later.

Results: Brain ketone metabolism increased by 230% for subjects on the kMCT (P ,.001) whereas
brain glucose uptake remained unchanged.

Measures of episodic memory, language, executive function, and processing speed improved on the kMCT versus baseline. Increased brain ketone uptake was positively related to several cognitive measures. Seventy-five percent of participants completed the intervention.

Discussion: A dose of 30 g/day of kMCT taken for 6 months bypasses a significant part of the brain
glucose deficit and improves several cognitive outcomes in MCI.

My comments: Providing a daily ketogenic drink seems to have been easy to implement and have a worthwhile positive effect on brain function in patients with early dementia. I would welcome more studies and information on how such drinks could be made commercially available out with the research setting.

Ketogenic diets can improve behaviour in autistic children

Apr 24, 2024Apr 10, 2024 kaitiscotlandLeave a comment

A modified ketogenic gluten-free diet with MCT improves behavior in children with autism spectrum disorder

Ryan W Y Lee¹, Michael J Corley², Alina Pang³, Gaye Arakaki⁴, Lisa Abbott⁵, Michael Nishimoto⁶, Rob Miyamoto⁷, Erica Lee⁸, Susan Yamamoto⁹, Alika K Maunakea¹⁰, Annette Lum-Jones¹¹, Miki Wong¹²

DOI: 10.1016/j.physbeh.2018.02.006

Abstract

Purpose: The ketogenic diet is a low-carbohydrate, moderate protein, high-fat diet that has emerged as a potential treatment for autism spectrum disorder.

Autism spectrum disorder is a neurodevelopmental disorder of social communication, and restricted, repetitive behaviors and interests in need of novel therapies.

An open-label clinical trial was done in Honolulu, Hawaii to test a modified ketogenic diet for improvement of core clinical impairments in children with ASD.

Intervention: A modified ketogenic gluten-free diet regimen with supplemental MCT was completed in 15 children ages 2 to 17 years for 3 months. Clinical (ADOS-2, CARS-2) and biochemical measures were performed at baseline and 3-months on the ketogenic diet.

Main outcome: Children administered a modified ketogenic gluten-free diet with supplemental MCT significantly improved core autism features assessed from the ADOS-2 after 3 months on diet (P = 0.006). No significant difference was observed in restricted and repetitive behavior score (P = 0.125) after 3 months on the diet protocol. Substantial improvement (> 30% decrease ADOS-2 total score) was observed in six participants, moderate improvement (> 3 units) in two participants, and minor/no improvement in seven participants. Ten participants assessed at a six-month time point sustained improvement in total ADOS-2 and social affect subdomain scores comparing baseline and 6 months (P = 0.019; P = 0.023), but no significant improvement in restricted and repetitive behavior scores were noted (P = 0.197). Significant improvements in CARS-2 items after 3 months of the modified ketogenic protocol were observed in imitation, body use, and fear or nervousness (P = 0.031, P = 0.008, P = 0.039). The percent change on ADOS-2 score from baseline to 3 months was associated with baseline high-density lipoprotein levels (ρ = −0.67, P = 0.007) and albumin levels (ρ = −0.60, P = 0.019). Moreover, the percent change from baseline to 3 months in ADOS-2 scores was significantly associated with percent change in high-density lipoprotein levels (ρ = 0.54, P = 0.049) and albumin levels (ρ = 0.67, P = 0.010).

Conclusions: A modified gluten-free ketogenic diet with supplemental MCT is a potentially beneficial treatment option to improve the core features of autism spectrum disorder and warrants further investigation.

My comment: Looking after a child with autism is very challenging. As the ketogenic diet shows promise and has a good track record for health outcomes over many years it may be worth a trial for parents or for those children living in institutional settings. If a child is also on insulin for type one diabetes careful reduction and adjustment of insulin doses will be required usually with professional help.

BMJ: GP patient group appointments disappoint

Apr 12, 2024Apr 4, 2024 kaitiscotland3 Comments

*Photo by SHVETS production on Pexels.com*

Adapted from BMJ 23 March 2024

A study published in BMJ Open reported on the analysis of 29 patient trials who were placed in group appointments in their General Practice. The participants had the same conditions as other group members.

These appointments have been seen as a way to make patient education and care more efficient. Given the constraints that Primary Care faces regarding health care professionals, this is perfectly reasonable. Group therapy, at least in theory, also allows patients to learn from each other and to support each other.

Unfortunately the outcomes were not any better for the group appointment attendees, except for lower diastolic blood pressure. There were no other statistically relevant changes. In addition, there was no difference in the use of medical services.

IDDT: What patients want from a doctor consultation and how to get it.

Apr 6, 2024Mar 15, 2024 kaitiscotlandLeave a comment

From Open Verse

Adapted from IDDT Newsletter March 2024

What can patients do to help ensure a good consultation with their GP or specialist doctor?

This was the aim of a diabetes support group. They brainstormed what they wanted to achieve and then discussed the way to get this.

The first step is preparation for your appointment.

What is the point of the consultation? Is it a first meeting, a review of progress, a follow up from a previous meeting? Think, What do I want to get out of this consultation?

Have a clear understanding of your problem if possible. Rehearse what you intend to say.

If you have a complex or worrying problem you may wish take a partner or friend with you to listen so that important information is not forgotten.

Prepare a list of questions you have for the doctor. Give it to them. This way they can figure out best how to answer comprehensively on what they can answer and tell you what they can’t answer.

During the consultation

Try to sit so you can face the doctor either side on or in front of them.

Keep it simple if you can and let the doctor know you have questions to ask, and when is it a good time to ask them.

Maintain eye contact with the doctor, encourage a two way conversation and demonstrate a desire to build a working relationship with the doctor.

Briefly summarise your symptoms.

Ask clarifying questions if you have any uncertainty such as, Why do you advise me to take these medications? Ask if there are alternative treatments.

Answer questions honestly eg if you haven’t been taking your medication as prescribed.

Be positive.

What patients want in a consultation.

Patients want to feel welcomed into the consultation. They want a doctor who shows interest, care and respect for them. A sense of humour may be appropriate.

They want to have eye contact and not just have a doctor who looks at a computer.

They want to be treated in an intelligent adult to adult way. They want the doctor to listen and to have a two way exchange.

They need the doctor to have their notes and be familiar with them.

The patient’s carer also needs to be involved in the conversation.

They need TIME to allow a relevant discussion. Often more than one issue is involved. Test results need to be explained and some patients will want specific information other than “normal” or ” a bit low”. They want options to be discussed and involved in implementing a course of action.

Patients dislike being contradicted over their experience and treatment history. They want their doctor to be frank when the doctor doesn’t know something. They welcome referral or a doctor speaking to someone with more expertise when necessary.

Some patients are very keen to have copies of letters and summaries of the discussion and action plans.

My comment: This patient group has a good structure of the ideal consultation and is similar to the sort of thing that doctors also want. In my experience there are often impediments achieving this. Such things are lack of scheduled time, interruptions, lack of continuity of doctor-patient relationships, difficulty getting notes and getting computers to work. It also helps if patients are focussed on one or at most two main issues and don’t bring a shopping list of everything that bothers them. It is helpful to involve the team of health care professionals so that things that concern eg a podiatrist or a pharmacist can be dealt with separately to the GP or consultant.

Rotavirus immunisation shown to reduce the onset of type one diabetes

Mar 25, 2024Dec 22, 2023 kaitiscotland3 Comments

Finland has been vaccinating children from rotavirus since 2009.

This has led to a 10 fold fall in the number of children getting a rotavirus infection by the age of 5.

There has also been a fall (they don’t say how much of a fall) in children being diagnosed with type one diabetes.

This supports the belief that rotavirus is a trigger for inducing islet cell autoimmunity.

Diabetes Care doi:10.2337/dc23-1203

Step counts: Aim for at least 2,600 a day and 8,000 if you can.

Mar 19, 2024Dec 21, 2023 kaitiscotland2 Comments

Adapted from BMJ Oct 14 2023

Advice about step counts are easy to understand and can be measured with smart watches or keeping your phone in your pocket.

A meta-analysis has concluded that even 2,600 steps will improve cardiovascular and total mortality.

Increasing this further increases the benefits till gains flatten out at 8,000 steps a day. Walking faster was better than walking slower.

A UK Biobank study showed that increasing physical activity protected against neuropathy and nephropathy in people with type two diabetes. Unfortunately retinopathy was not affected.

They found that walking for an hour and a half each week lowered neuropathy and nephropathy by between 20-30%.

Having type one diabetes ages your brain faster

Mar 7, 2024Dec 14, 2023 kaitiscotland2 Comments

Adapted from BMJ July 16 2023

A North American study has demonstrated that the brains of type one diabetics of middle age or older showed structural changes in brain volume and white matter compared to similar aged and demographically similar control subjects without diabetes. MRI studies were used.

The differences are the equivalent of 4 to 9 years difference in brain aging.

The study was published in Diabetes Care.

Protein from meat is more favourably absorbed than protein from plants

Mar 1, 2024Dec 14, 2023 kaitiscotland5 Comments

*Photo by Artem Savchenko on Pexels.com*

Adapted from Nutrients Volume 15 June 25 2023. Effects of consuming once equivalent portions of animal v plant based protein foods, as defined by the Dietary Guidelines for Americans on Essential amino acid bioavailability in young and older adults: Two cross over randomised controlled trials. Gavin Connolly et al. Department of Nutritional Science. Purdue University, West Lafayette, Indiana.

The 2020-25 Dietary Guidelines for Americans recommend that protein foods are consumed as part of a healthy dietary pattern. This includes animal based protein such as red meat, poultry, fish and eggs and plant based. These include soy products, beans, peas, lentils, nuts and seeds.

One ounce of protein equivalents are one whole egg, one ounce of meat, 0.25 cups of beans, or 0.5 ounces of nuts.

Protein foods differ up to three fold in metabolizable energy and macronutrient contents. For example, one ounce of pork contains 7g of total protein and one oz of almonds contains 3g of total protein. Protein quality can be defined as the ability of a dietary protein to provide adequate amounts and proportions of essential amino acids (EAA). These can then be used by the body to make proteins and maintaining and growing body tissues.

Animal proteins contain all the EAA whereas plant proteins, apart from soy lack one or more of them. This is why vegans and vegetarians are urged to eat a wide variety of plants.

Research has previously found that in young adults, animal protein sources resulted in better whole body net protein balance (anabolic response) compared to plant based foods. Up till the study presented in this paper the protein balance had not been assessed in older adults.

The study group of the young adults ranged in age from 22-39. The study of the older adults ranged from 55-75 years. BMI was 22-35, stable weight, not pursuing moderate to vigorous exercise more than 3 hours a week, not ill, non smokers, not diabetic, not pregnant or lactating, and willing to not exercise for 48 hours before the testing days.

Each participant completed four 300 minute trials. These were randomised, investigator blinded and of cross over design. The trial meals were two oz equivalent meals of 1. unprocessed pork loin, 2. scrambled whole eggs. 3.black beans and 4. raw sliced almonds. Blood samples were taken at various timed intervals on 8 occasions after the meals.

Of the young adults 30 completed the study. There were equal numbers of men and women. Average age was 26, average BMI 26.4. Ethnicity was mixed.

Of the older adults 25 completed the study. 15 women and 10 men. Average age was 64.2, BMI 26.1 and again there were mixed ethnicities.

The results showed that the pork and whole egg meals resulted in greater essential amino acid bioavailability compared to the beans and almonds. This was true for both the young and older adults. This was a similar result to a previous study where pork, whole eggs, beef sirloin, tofu, kidney beans, peanut butter and mixed nuts were compared.

There were no differences in the protein bioavailability between the younger and older groups.

My comment: Apart from the very sensible advice given to vegans and vegetarians about consuming a wide variety of plants, this study would demonstrate that eating enough plant protein, aiming for a bit more than you may expect from plant protein estimates, would be potentially helpful in maintaining healthy body composition.

The ketogenic diet shows promise to improve cardiovascular disease in varied mechanisms

Feb 24, 2024Dec 12, 2023 kaitiscotland2 Comments

Review

The Ketogenic Diet and Cardiovascular Diseases

Damian Dy ´nka , Katarzyna Kowalcze , Anna Charuta and Agnieszka Paziewska *
Institute of Health Sciences, Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, 08-110 Siedlce, Poland; damian.dynka24@gmail.com (D.D.); katarzyna.kowalcze@uph.edu.pl (K.K.); anna.charuta@uph.edu.pl (A.C.)

Correspondence: agnieszka.paziewska@uph.edu.pl
Abstract: The most common and increasing causes of death worldwide are cardiovascular diseases
(CVD). Taking into account the fact that diet is a key factor, it is worth exploring this aspect of CVD
prevention and therapy. The aim of this article is to assess the potential of the ketogenic diet in the
prevention and treatment of CVD. The article is a comprehensive, meticulous analysis of the literature in this area, taking into account the most recent studies currently available.
The ketogenic diet has been shown to have a multifaceted effect on the prevention and treatment of CVD. Among other aspects, it has a beneficial effect on the blood lipid profile, even compared to other diets. It shows strong anti-inflammatory and cardioprotective potential, which is due, among other factors, to the anti-inflammatory properties of the state of ketosis, the elimination of simple sugars, the restriction of total carbohydrates and the supply of omega-3 fatty acids.
In addition, ketone bodies provide “rescue fuel” for the diseased heart by affecting its metabolism. They also have a beneficial effect on the function of the vascular endothelium, including improving its function and inhibiting premature ageing.
The ketogenic diet has a beneficial effect on blood pressure and other CVD risk factors through, among other aspects, weight loss.
The evidence cited is often superior to that for standard diets, making it likely that the ketogenic diet shows advantages over other dietary models in the prevention and treatment of cardiovascular diseases. There is a legitimate need for further research in this area.
Published in 2023 Nutrients MDPI