18 June 2012

Ian Gawler Blog: Let your food be your medicine

Nutrition reduces the risk of developing cancer, along with its progression and recurrence for those who already have it - the top 10 recent research articles - including an answer to the soy question.

But first, how can we go past:

Thought for the Day

Let food be thy medicine and medicine be thy food

                 Hippocrates – commonly referred to as the founder of western medicine

I have had the good fortune to attend and speak at two major international nutrition conferences in the last month. The first was a combined effort from the CSIRO, the Australian Dieticians and ACNEM, a peak body for doctors interested in nutritional and environmental medicine. The second was convened by Metagenics and focused on the therapeutic application of nutrition in cancer medicine. One of the world-class speakers summed up and said that this conference was like drinking intellectually and emotionally from a fire hose!

The take home message? The volume of research in this field is staggering – even for me who attempts to keep up with it. Anyone who suggests nutrition is unimportant for people dealing with cancer is both ill-informed and dangerous. Ill-informed because the evidence base is comprehensive. Dangerous because they may cause vulnerable people to ignore or disregard a source of significant help – for their quality of life and their survival.

While there was a lot of talk regarding the importance and clinical application of epigenetics (and I will report on this later), for the next two weeks I will share some of the nutritional research that impressed.


1. One quarter of all cancers could be prevented by a healthy diet and exercise.
ESTIMATE FOR 2025:  About 170,000 Australians diagnosed with cancer -
an increase of 60% on 2007. 

43,000 of these cancers are preventable through improvements to diet and physical activity levels. 

It is likely that this is an underestimation of the true figure.

While the theoretical impact of primary prevention is substantial, motivating populations is difficult. Therefore, unless a concerted and significant effort is made to invest in and implement powerful preventive measures, the reduction of cancer incidence over the coming decades will probably be relatively small.

Baade P D et al, Med J Aust 2012; 196 (5): 337-340.

refer to Blog: 26 March 2012

2. Nutrition and lifestyle prevents breast cancer
Be as lean as possible
Be physically active - at least 30mins/day
Limit alcohol to one drink/day
Mothers breastfeed exclusively for up to 6 mths
     -- this will reduce the mother’s risk and reduce the child’s risk of becoming       overweight

Expect a 40% reduction in breast cancer.
                                                 Based upon 954 studies, AICR & WCRF 2009

3. Anti-inflammatory diet contributes to longevity.
Meta-inflammation is low-level, systemic inflammation. It is a major factor in most chronic degenerative diseases including cancer.
Modern nutrition is a significant “inducer” of meta-inflammation.
Egger, G, ACNEM Journal, Mar 2012, Vol 3 No 1 P12-14

It is well known that inflammation potentiates active cancers, therefore, when we adopt an anti-inflammatory diet (like the one in YCCC), we reduce inflammation and assist recovery.

4. Turmeric and pepper target breast cancer stem cells
Cancer stems cells are associated with cancer’s capacity to lay dormant and then reappear as a metastasis or secondaries. As far as I know, there are no drugs in current use that can impact significantly upon these cells, short of stem cell transplants. However, nature offers hope.

Turmeric (curcumin) and black pepper (piperine) separately, and in combination, have been found to inhibit breast stem cell self-renewal but are non-toxic to differentiated cells. This is another good reason to use these two regularly.

Kakarala, M et al, 2010, Br Ca Research & Treatment, Vol 122, No 3, 777-785

5. Research claims soy is safe for breast cancer
The soy question has to be one of the most contentious and relevant nutritional issues for women with breast cancer (especially if HER +ve) for some time. Here is a summary quoted in part from what is a very comprehensive analysis of available research:

Currently there is little evidence to suggest that any potential weak estrogenic effects of dietary isoflavones (as found in soy) have a clinically relevant impact on breast tissue in healthy women. Limited data suggest this is also the case for breast cancer survivors.

Findings from one rodent study showed that genistein may interfere with concurrent tamoxifen treatment, suggesting that breast cancer patients taking a tamoxifen-like drug may need to limit soyfood intake and avoid isoflavone supplements.

Currently there is no data to support the idea that soyfoods or isoflavone supplements improve the prognosis of breast cancer patients.

Available data on breast cancer recurrence and mortality provide some assurance for breast cancer patients that soyfoods and isoflavone supplements, when taken at dietary levels, do not contribute to recurrence rates; although more data are clearly needed to better address this issue.

Messina, MJ and Wood CE, Nutrition Journal 2008, 7:17


1. IAN’s NEXT WEBINAR IS ON MINDFULNESS: Tuesday 19th June at 8pm EST

All welcome to tune in – you just need to register via the Mindbody Mastery website via the link : www.anymeeting.com/mindbodymastery

2. Chocolate trialed as antihypertensive for kids

Not sure whether to laugh or cry about this one, what do you think?
In a study of the effects of daily consumption of dark chocolate on blood pressure (BP), Melbourne school children had a 97% ‘adherence’ rate – no problem getting them to eat it!

However, the seven-week pilot study, conducted by the Murdoch Children’s Research Institute, did not show any benefit of dark chocolate on either systolic or diastolic BP, according to results published in the Archives of Diseases in Childhood.

The researchers say a larger and longer trial – perhaps with a higher daily ‘dose’ of chocolate - will be needed to show any real effects.

And we cannot get funding for a lifestyle based cancer intervention study. Maybe we need to emphasis the program’s chocolate component!


Eating for recovery

Big Mac or a salad?


Eating well, being well

Eating for recovery

11 June 2012

Ian Gawler Blog: Over-medicalisation, mammography and PSA screening

This week, big questions posed by new research concern the over-medicalisation of our health and wellbeing. Key examples cast big doubts over the merits of mammography for 50 yo women and PSA blood tests for prostate cancer in healthy men.

Next come telling comments from the MJA re why they did not publish the controversial article on me, The Age has another go at the Foundation, while another massive review of evidence comes out connecting nutrition with breast cancer.

But first, please do not believe what I say, just because I said it!

Thought for the day: Arrive at your own truth.

At the end of my early workshops I would often say “Everything you may have heard today could be untrue”. Some people were understandably unsettled and required an explanation. Why did I say it? Because I see the truth in the quote that follows, and have always been guided by it. 

"Don't blindly believe what I say. Don't believe me because others convince you of my words. Don't believe anything you see, read, or hear from others, whether of authority, religious teachers or texts. Don't rely on logic alone, nor speculation. Don't infer or be deceived by appearances.

"Do not give up your authority and follow blindly the will of others. This way will only lead to delusion.

"Find out for yourself what is truth, what is real. Discover that there are virtuous things and there are non-virtuous things. Once you have discovered for yourself, give up the bad and embrace the good."

- The Buddha

If someone leaves a program I have presented and says something like “I am eating this way now because Ian said so”, they have really missed the point and I would be very disappointed. 

If they say “I heard what Ian said, have considered it, and have chosen to eat this way”, then I am happy.

Research claims over half breast cancers would amount to nothing if left untreated, and raises questions about breast screening

Writing in the prestigious British Medical Journal, academics from Australia and Canada, claim up to 54% of breast cancers detected in women in their 50s by breast cancer screening would never have manifested clinically.

The article goes on to identify the phenomenon of over-medicalisation, saying healthy people are increasingly harmed by a barrage of unnecessary tests, procedures and drugs. The tendency to over-screen, over-diagnose and over-treat has become rampant in modern medicine, and poses a “significant threat to human health”.

 “Screening programs are detecting early cancers that will never cause symptoms or death, sensitive diagnostic technologies identify ‘abnormalities’ so tiny they will remain benign, while widening disease definitions mean people at ever-lower risks receive permanent medical labels and lifelong treatments that will fail to benefit many of them.”

ADHD, chronic kidney disease, gestational diabetes and prostate cancer were also key areas for concern, they said. Even asthma is over-diagnosed in up to 30% of cases, the authors said.

The article was timed to promote a new international conference called Preventing Overdiagnosis, that will aim to better assess the problem and begin working on solutions.
Click here for the reference: BMJ 2012; online.

Healthy men do not need PSA screens

Controversy has raged for some years about men being routinely screened for prostate cancer using blood PSA tests. I remember cringing while being a part of an SBS TV Insight program where Prof Alan Coates suffered the most vitriolic and personal attack from a prominent and highly emotional politician really suffering from prostate cancer and abusing Coates mercilessly for suggesting the scientific evidence did not support routine PSA testing. Coates was CEO of the Cancer Council of Australia at the time and he endured ongoing professional and personal criticism for his stance.  

However, recently the prestigious US Preventive Services Task Force (USPSTF) has added to this debate, claiming that PSA-based screening could not be widely recommended, due to the “inevitable” risk of over-diagnosis and harms of treatment.

It acknowledged that some men would continue to demand PSA tests, and that some doctors would continue to offer them, but said this should only occur through fully informed, shared decision making. The USPSTF said community and employer-based screening should be stopped altogether. It based its recommendations on an extensive literature review.

“The mortality benefits of PSA-based prostate cancer screening through 11 years are, at best, small and potentially none, and the harms are moderate to substantial,” said the final statement, published in the Annals of Internal Medicine.

The Prostate Cancer Foundation of Australia branded the recommendations “unhelpful”, and not directly applicable to Australia.


1. The Medical Journal of Australia explains why it did not publish 

- with direct quotes

First: I did not give my permission and they value patient rights

Second: The article "presented supposition, nothing new in the way of facts".

Finally:  The Editor, Annette Katelaris summarised, and again I quote "patient consent, accountable editorial processes and an articles validity, significance and potential to advance medical practice are primary considerations in the MJA's editorial decisions...  These principles were applied in the MJA's final decision not to publish the article".

Conclusion: The Journal of Internal Medicine Journal obviously has different standards that allowed them to publish.

The letter that provoked the response, along with the editorial, will be linked to on my website soon.

2. Good nutrition may reduce the progression or recurrence of breast cancer.

Following on from last week’s blog on nutrition and cancer, comes news of a major work citing 353 references put together by Natalie Ledesma from the University of California, San Francisco.

Link here for the full work which makes for compelling reading:

Here is Natalie’s summary:

Good nutrition may reduce the incidence of breast cancer and the risk of breast cancer progression or recurrence. There are many studies in progress to help further understand how diet and cancer are related. We do know, however, that improved nutrition reduces risk of chronic diseases, such as diabetes, obesity, hypertension and heart disease, and also enhances overall quality of life. It is estimated that one third of cancer deaths in the U.S. can be attributed to diet in adulthood.

3. The Age is at it again!

A personal account has been published in the Medical Journal of Australia by a Melbourne psychiatrist who attended the Gawler Foundation’s 12 week non-residential cancer program. Writing under the strident headline “Doctor denounces Gawler program's 'harsh' healing”, health editor Julia Medew quotes and comments on the patient’s concerns regarding the rigours of the dietary approach, perceived guilt around the cancer prone personality, and the suggestion her group leader said there was no evidence chemotherapy works.

Join the link, read and decide for yourself.

I wish the psychiatrist good health and a long and happy life. Discussion, feedback and constructive criticism is always welcome, even when it turns up for the first time in a medical journal.

Comments from the Foundation’s CEO, Karin Knoester and the oncologist from Peter Mac seem worth quoting directly.

“Ms Knoester said although no independent evaluations had shown the Gawler programs were an effective cancer treatment, there was evidence that nutrition, exercise, meditation and positive thinking could all on their own help people overcome illness.

Deputy Head of Oncology at Peter MacCallum Cancer Centre, Associate Professor Michael Jefford, said he got the impression from patients that the Gawler Foundation's staff were ''overvaluing'' their therapies while telling people conventional treatments were less effective and more toxic than they really are.

''There is very good evidence for the efficacy of chemotherapy … so to say it doesn't work is blatantly wrong,'' he said. “There is also good evidence that chemotherapy improves quality of life … so to say it's toxic is incorrect.''

My comment. 

1. The Morgan study of 2004 reviewed the 5 year increased survival benefits of chemotherapy for the major 22 cancers at an average of 2.3%. Modest efficacy overall, although chemotherapy does have major benefits for a number of the less common cancers, including some of those that affect children. (I know of no more recent comprehensive review since that of Morgan in 2004. It was not very popular in oncology or the popular press at the time, but not refuted, apart from Prof Boyer who claimed on ABC radio he could “massage” the figures up to 5 - 6%!).

2. There is good evidence that chemotherapy impacts adversely on some people’s quality of life and that most chemotherapy is given with palliation in mind, not cure. Therefore the equation of pluses and minuses has to be considered carefully when making decisions regarding this form of treatment. No doubt good oncologists inform their patients of the risks and benefits, encourage open dialogue and assist in the making of good clinical choices.

3. If chemotherapy is not toxic, why is it called cytotoxic therapy? I wonder if Professor Jefford was quoted accurately.

People who do choose to have chemotherapy will benefit from a healthy, therapeutic lifestyle that is highly likely to reduce the risk of side-effects, improve survival and improve quality of life. The two, chemotherapy and a therapeutic lifestyle, work well together. This should be a co-operative venture.


Nobody expects the Spanish Inquisition

TB or not TB - The Age gives me a voice

04 June 2012

Ian Gawler Blog: Research to live for

People sometimes say ”I have been dying to meet you”. Bit weird really.

This blog presents new research relevant to living. A major review of the literature pointing to the extension of life benefits gained through diet and exercise for people diagnosed with cancer.  Then we discuss a new syndrome to watch out for called Faecal Encephalitis that leads to a raft of distressing, disgraceful symptoms.
But first:

Thought for the day
How brief this life
So little time to prepare for eternity
                                                                     Paul Gauguin

Diet and exercise extend life

It is disturbing how often I still hear from people diagnosed with cancer whose highly educated specialists have told them that what they eat will not matter. While one would imagine simple common sense would dictate that was flawed advice, there is often the follow up "There is no evidence at all to support changing your diet after a cancer diagnosis".

Clearly wrong. And clearly ignorance that is dangerous. A recent, major review of the scientific literature has examined the role of diet and physical activity in breast, colorectal, and prostate cancer survivorship and confirmed the benefits. While it is both astounding and disappointing that the amount of research investigating how much therapeutic nutrition can add to cancer survival is quite small, the indications are steadily growing.

The evidence for exercise increasing survival is stronger, and you may wonder why that is. The benefits of exercise were stumbled upon some years ago and have attracted a good deal of recent research, support and uptake in the mainstream. I cannot help but wonder if exercise offends few and so people research it happily, whereas the vested interests involved with nutrition are vast, complex and obstructive. Whether it be the food lobby groups like the meat and dairy industries, the processed food and fast food conglomerates, or just the general malaise amongst the population who seem reluctant to really grapple with the connection between lifestyle, healing, health and wellbeing; food is far more challenging as a research topic than exercise.

Be that as it may, here is a summary of what was said in this extensive review of current research, along with the quote to cite if anyone in the future is so stupid as to say what you eat when diagnosed with cancer does not matter, or there is no evidence:

Link here to the article in the British Journal of Cancer
QUOTE:  Davies, N J, Br J Cancer. 2011 November 8; 105(S1): S52–S73.
Published online 2011 November 3. doi:  10.1038/bjc.2011.423

Evidence that poor diet and low physical activity relate directly to the incidence of cancer is well documented, but owing to increased cancer survivorship, an understanding of these lifestyle factors after a cancer diagnosis is of crucial importance.

Evidence was initially gathered from pre-defined searches of the Cochrane Library Database and PubMed from March 2006 to February 2010. Another search of 2011 literature was conducted to update the evidence.

Evidence from observational studies suggests that a low-fat, high-fibre diet might be protective against cancer recurrence and progression. There is more support for physical activity, with a dose response for better outcomes.

Cancer survivors would like to have a more active role in their health care and to know how to look after themselves after diagnosis, including what diet and lifestyle changes they should make. The challenge is in integrating lifestyle support into standardised models of aftercare.

Faecal Encephalitis
This is a dangerous new condition that is particularly harsh on those in the ambit of the sufferers.

Faecel Encephalitis occurs when faecal material builds up to critical levels in a person’s system, leading to a toxic overload of their brain and mind. This leads to inflammation of the brain and disgraceful behavior. Symptoms can be severe and include chronic resentment, irrational behavior, poor judgment, loss of values and distortion of the truth.

Apparently the condition can result from chronic constipation causing a back log and auto-intoxication, although a more common problem is having the head stuck so far up someone else’s backside there is a direct faecal overload. Usually the “other person” is someone perceived to be in authority or power.

The condition needs to be differentiated from the more common and more recognized problem of being “full of sh*t”, which is a far more benign problem and while regrettable, is of little concern in daily life.

Treatment of Faecal Encephalitis is quite difficult as it seems those afflicted by the condition loose the capacity for self awareness and do not recognize they have a problem. It may be more useful to focus on helping family, friends and colleagues of those affected as they often suffer unduly.

1. Brisbane workshops June 14 – 16

Where: The Relaxation Centre, 15 South Pine Rd, Alderley, Brisbane, 4051

Bookings & Info: Click here for the link and go to the 14th -17th on the calendar
or call The Relaxation Centre on (07) 3856 3733.

2. Israel workshops etc July 18 - 28

It will be a great pleasure to be back in Israel once more where I have been invited to make a variety of presentations. If you know anyone in Israel who may be interested, please forward the details.

i) Wednesday July 18th, 19:30-22:00, Evening Talk 
The Art of Living and Dying: contemplation, meditation and healing
Seminar Hakibutzim, Tel-Aviv
Sponsored by Tovana, Israel Insight Meditation Association

ii) Friday July 20th, 09:00-14:00, Master Class Workshop for Health Professionals 
An Integrative Approach for Major Illness - Applications of Meditation and Mind-Body Principles
Rabin Medical Center
Sponsored by the Integrative Medicine Department, Davidoff Cancer Center, Beilinson Hospital

iii) Friday July 27th, 09:00-16:00, One Day Workshop for the General Public
Health, Healing and Well-being: the Healing Power of the Mind 
Beit Rishonim, Bitan Aharon
Sponsored by Taatzumot Association

iv) By Invitation Only:
Wednesday July 18th, 16:00-18:30: A meeting with leading Dharma teachers,
Saturday July 28, 19:00-22:00: An evening with leading integrative therapists and physicians.

For more information or registration:
Dr. Nimrod Sheinman, In Israel: 0544-797466, nimush@zahav.net.il