Stay in the Game... Check Your Balls!

Testicular cancer accounts for a small % of all cancers in Canada- only 1.1% . However, in 2006, the Public Health Agency of Canada reported that steadily increasing rates were alarming; in the last 3 decades alone, incidence has increased by 59%. Testicular cancer is often referred to as a young man's disease and is currently the most common type of cancer, and leading cause of cancer death, in men in their 20s and 30s!

Because men in the at-risk age-group remain largely unaware of testicular cancer, its symptoms, the importance of TSE, and the role of early detection on survival rates, I developed a Social Marketing Campaign and Public Service Announcement (PSA) for an assignment. Thought I'd share my PSA with you (Thanks for your help guys!). (The website on the PSA doesn't really exist).

What causes testicular cancer?

It's not well understood what causes testicular cancer, but risk factors include a family history, cryptorchidism (undescended testicle), previous testicular cancer, age (15-49 years old), and race (incidence is 4 times higher in Caucasians than African American, for example). Nonetheless, many men will develop testicular cancer without any of these risk factors.

Testicular Self Exams (TSE)

Testicular cancer is one of the most curable types of cancer when detected before it has spread (the cure rate is 99%). So, testicular self examination (TSE) would be the obvious recommendation.

Controversy:

Recommending TSEs is still a bit controversial- critics state that population-wide recommendations shouldn't be made until it can be proven that TSE reduces mortality. Given the low incidence though, this is probably not possible.

Both the American Cancer Society and the Canadian Cancer Society suggest that early detection can improve treatment and recommend that TSE be part of regular routine medical exams. However, research shows that not all health care providers perform testicular exams, or even talk to their patients about performing TSE. Moreover, men tend to delay going to the doctor, possibly delaying early diagnosis. Half of testicular cancer patients are currently diagnosed in advanced stages.

Other critics state that recommending regular TSEs would lead to a number of false-positive results, resulting in patient anxiety. This, however, has been refuted, and TSEs have been reported to be highly effective and sensitive in cancer detection.

How to Perform a TSE

According to the Testicular Cancer Resource Centre, and the Sean Kimerling Testicular Cancer Foundation, self exams should ideally be done once a month, either in front of a mirror after a warm shower, or in the shower - the warm water relaxes the skin of the scrotum. The thorough exam should take about 3 minutes.

Gently examine each testicle with both hands.

Place your index and middle finger under the testicle with the thumb on top. Gently roll the testicle between your thumb and fingers. You shouldn't feel any pain. It's normal for one testicle to feel a bit larger than the other.

Find the epididymis, a soft, tube-like structure behind the testicle that collects and carries sperm- once you're familiar with this structure, you won't mistake it for a suspicious lump. Cancerous lumps are usually found on the sides of the testicle but can also show up on the front.

What to Look For

See a doctor as soon as possible if you:

Have any pain in your testicles or scrotum.
Detect any hard lumps, nodules (smooth rounded masses), or abnormalities
Notice any swelling
Detect a significant loss of size in one testicle
Detect a significant enlargement of a testicle
Feel a dull ache in your lower abdomen or groin
Feel heaviness in the scrotum
Notice collection of fluid in the scrotum
Have pain or discomfort of the breasts.

When in doubt, see a doctor.

For more information:

http://www.tctca.org/
http://www.seankimerling.org/index.php/self-exam
http://tcrc.acor.org/tcexam.html

And for great PSAs!
http://www.carpetestes.org/

Dinner with Roger Ebert

What would you miss most, or remember most, if you couldn't eat or drink?

Film critic Roger Ebert was diagnosed with thyroid cancer in 2002. He later underwent surgery and treatment for cancer in his salivary glands, and near his right jaw.
These surgeries resulted his inability to speak, eat or drink- he has a feeding tube.

In his very touching blog entry, Nil By Mouth, Roger Ebert tells his story of losing the ability to eat, drink, and speak... something that most of us just couldn't imagine.

Storytelling

I've been reading, in class, about the use of storytelling (aka the narrative) as a way for caregivers to better understand their clients, and as a way for individuals to understand, control, make sense of what's happening to them; as a way to cope, to heal. Another purpose of storytelling is to make the personal public- to connect with others, to share, to get others thinking and talking ("personal narratives energize public narratives"). Kind of describes a blog, right?

As you read Roger Ebert's story (or my summary, below), think about the role of storytelling:

If you have a journal or a blog (and blog about your life)... why? What does it bring to you?

If you don't write down your story- keep a journal, for example- do you think doing so would help you... cope with, understand, have control over.... certain situations in your life?

If you were to see a new health care provider- a doctor, dietitian, therapist etc.- would you feel more comfortable and honest telling them why you're there, or presenting them with a story? Which would represent you best?

Roger Ebert's Story (as summarized by me):

Ebert writes that he was never told that he might lose the ability to eat, drink or speak during his first surgery, and while subsequent surgeries were supposed to 'fix the problem', they failed... and, he recalls, "it gradually became clear that it wouldn't ever be right again. There wasn't some soul-dropping moment for that realization. It just...developed. I never felt hungry, I never felt thirsty, I wasn't angry because the doctors had done their best. But I went through a period of obsession about food and drink".

In his hospital room, he recounted his fantasies of drinking Root Beer to his brother-in-law and his wife, telling them that, for the first time in 60 years, he remembered, with complete clarity, driving with his father to the A&W Root Beer stand.

His brother-in-law, a religious man, interpreted Ebert's "story" in terms of his own faith, saying:

"Could be, when the Lord took away your drinking, he gave you back your memory".

Ebert states that: "those were the words I needed to hear. And from that time I began to replace what I had lost with what I remembered".

But while he could remember clearly the meal he regularly ordered at Steak n' Shake or the tastes and texture of the amazing "cheap" candy he used to buy, what he missed most about not eating was not the food, but the loss of dining. He ends his story:

"It may be personal, but for me, unless I'm alone, it doesn't involve dinner if it doesn't involve talking. The food and drink I can do without easily. The jokes, gossip, laughs, arguments and shared memories I miss. Sentences beginning with the words, "Remember that time?" I ran in crowds where anyone was likely to break out in a poetry recitation at any time. Me too. But not me anymore. So yes, it's sad. Maybe that's why I enjoy this blog. You don't realize it, but we're at dinner right now".

Telling People to Eat Fruits and Vegetables Isn’t Enough Anymore

While the role of a Dietitian has always been pretty clear to me, it has been put into question recently (I guess that's what happens when you go back to school...).

Dietitians, as stated by Dietitians of Canada (the “nation-wide voice of Dietitians”) , are trained to advise on diet, food and nutrition.

Simple, right? We study nutrition for 3-4 years , making us experts in the field of nutrition, and therefore able to advise, counsel and educate our clients on what food choices can best help them meet their health needs and goals.

Well, some argue that this is kind of presumptuous: who are dietitians to blindly tell you that you should be eating fruits and vegetables to decrease your cancer risk? What makes them the expert of you?

This is Hogwash...Right?

Firstly, on a one-on-one basis, a good Dietitian wouldn’t assume that she's an “expert of you” and wouldn’t simply tell you what to eat. She’ll get a good picture of what’s going on in your life first: learn about your culture and how you eat, ask about your health and learn about your family and their health, ask you what your health and nutrition concerns are, how you’re coping financially, etc. She’ll ask you lots of questions and use this information when making her suggestions.

At the public health level though, we have to use our expertise to educate the public about what they should be eating, right? In this case, it makes sense to send the message “increase your fruit and vegetable intake to decrease your cancer risk”.

Not so, according to some. Not holistic enough. Still too presumptuous.

I admit, I thought this was all hogwash... until I read an article called ‘Public Health Nutrition and Food Policy”.

It basically says that campaigns that target the individual, telling them to eat more of this, less of that, exercise more, weigh this much, etc., miss the mark. By putting the onus on the individual, we’re not dealing with the bigger issues like:

Why is broccoli more expensive than a hamburger? Why is it that we don’t really know where our food comes from? Why do very few Big Food corporations monopolize all our food and control their prices? Why is it that in 2 of the richest countries in the world, 15% of American households (17 million), and 9% of Canadian households (1.1 million) worry about where their next meal is coming from? Why are there are 800 million people hungry on this planet and 1 billion overweight?

So what’s a Dietitian to do?

While we still need to advise, educate, and promote good nutrition, and interpret new related research, our role is bigger than that. We need to get involved at the policy level.

Easier said than done, I know.

As a start, if you're Canadian, asking the Federal government to regulate trans fats in foods is one way to get involved in policy (See yesterday's post!). Hopefully I'll learn of more ways we can get involved that I can share with you... and let me know if you know of any.

Tomatoes: Lycopene, Cancer & Heart Attacks

Tomatoes are rich in the antioxidant lycopene that's been linked to reduced rates of cancers, especially lung, stomach and prostate cancers.

A study by the Harvard School of Public Health showed that men that ate 10 or more servings of tomato-based foods a week had a 45% reduced prostate cancer rate.

Lycopene is bound inside cell walls, making it difficult for the body to extract it from raw tomatoes. This explains why cooked tomatoes (ie tomato sauce) seem to be more protective than raw tomatoes or tomato juice- the heat seems to release the lycopene.

Lycopene is also fat-soluble so cooking tomatoes in oil (ie. tomato sauce!) enhances the absorption of the antioxidant.

What's causing some confusion is a study conducted at the Ohio State University on about 200 rats (a good model for human prostate cancer, supposedly). Some rats were fed diets containing whole tomato powder and others were fed rat food fortified with pure lycopene (and, consequently, received more lycopene than the tomato powder group). Reserachers caused prostate cancer in these rats.The rats fed the pure lycopene actually had more tumors and a significantly greater risk of death!

What this study suggests is that there seems to be other components in tomatoes that have a protective effect- the whole food is beneficial whereas isolated lycopene may not be.

It seems that tomatoes may also protect the heart. An Itailan study looked at the diets of 507 heart attack victims and of 478 controls- one of the items on the food frequency questionnaire was pizza. Surprisingly, regular pizza eaters (eating about 500g or just over 1/2lbs pizza a week) were 40% less likely to suffer a heart attack than those who never ate pizza!

Maybe the pizza eaters were eating less high saturated fat hamburgers. Remember that real Italian pizzas are not like the North American meat-lovers-pepperoni-3 cheese- stuffed crust ones- they have a thin crust and are dressed with olive oil, a lot of tomato sauce and some cheese. Another possibility that Dr. Schwarcz proposes is that the tomatoes may be responsible: That yellow stuff around the seeds of tomatoes contain flavonoids that have anti-clotting properties... possibly reducing the risk of heart attacks!


Bottom line: Aim to treat yourself to tomatoes, processed tomatoes or tomato products cooked in oil every day. Stay away from lycopene supplements until more research is done.

Red meat linked with death

A study published in March’s Archives of Internal Medicine looked at the meat intake of half a million Americans aged 50-71 for 10 years.

After controlling for age, race, BMI, education, smoking history, alcohol intake, caloric intake, fruit and vegetable intake, vitamin intake, hormone therapy and physical activity, researchers found that the more red meat and processed meat people ate, the higher the mortality risk- in fact, they had a 20-40% increased risk of death. They also had a higher risk of heart disease and cancer.

The participants that ate the most meat were more likely to be of white (non-Hispanic) ethnicity, married, smokers, have a higher BMI, higher caloric, fat and saturated fat intake, have lower education and physical activity levels and lower intakes of fibre, fruits and veggies. Remember, that all these factors were controlled for though.

So, how much meat were they eating? The subjects that are the most meat were eating about 160g red meat or processed meat per day- the equivalent of about a 5 oz steak a day. The ones getting the least meat were eating just under 1 oz a day.

This study adds to what we’ve already known: red meat and processed meat are major sources of saturated fat which have been associated with high blood cholesterol, heart disease and cancer. Meat has also been shown to be a source of cancer-causing agents which are formed during high-temperature cooking. Processed meats also contain carcinogenic nitrosamines.

Since it's pretty clear that eating a diet rich in red meat and processed meat puts your health at risk, try to limit your intake- there are so many delicious vegetarians options available now... try them! Also replace your red meat with beans and lentil-based meals, fish and/or white meat as often as possible.

Vitamin supplements undo benefits of exercise

First, some facts:

Exercise has loads of health benefits including decreasing your risk of insulin resistance and type 2 diabetes by making your body’s cells more sensitive to insulin.

The more sensitive your cells are to insulin, the easier it is for the glucose (sugar) that’s in the foods you eat to get used up by your body. When your cells become insensitive or resistant to insulin, the glucose doesn’t get used up by your body but instead stays floating in your blood, causing high blood sugar. You body cries out for the glucose it needs to function causing your pancreas to over-compensate and produce even more insulin. This combination of insulin-resistance and insulin over-production by the pancreas leads to diabetes and/or obesity, increased risk of heart disease.

Inhaling oxygen produces free radicals. These free radicals attack the body causing you to age and also causes illnesses like heart disease and cancer and, eventually, death. 2-3% of the oxygen consumed by our cells is converted into free radicals.

When we exercise, we use lots of oxygen, increasing free radical production and all the stuff that goes with that.

Antioxidants are those highly publicized substances found in plant foods like fruits and vegetables that neutralize free radicals.That's why eating a diet rich in fruits and vegetables is good for you!

The Study:

It seems logical that taking supplemental antioxidants, like Vitamins C and E, would reduce the harmful effects of the free radicals produced during exercise and promote longer life and better health, right?

That’s what German researchers thought when they decided to observe 40 young healthy men (half were pretty sedentary and half exercised about 6 hours a week)- randomly assigned, half took a combination of 1000mg of vitamin C (btw, the recommended intake is 75mg and 90mg/day for women and men respectively) and 400 IU of vitamin E (recommended intake is 33 IU/d)- these amounts are commonly found in over-the-counter supplements- for 4 weeks while the other half didn’t. Both groups exercised, supervised, 85 minutes a day, five days a week for the 4 weeks of the study (workouts included biking, running and circuit training).

What they Found:

The exercisers NOT taking the antioxidants did have more free radicals floating around in their bodies but had a significant increase in insulin sensitivity (a good thing), as predicted. However, there was no increase in insulin sensitivity in those taking the antioxidants... but there were less free radicals.

It seems that the supplemental antioxidants prevent the health benefits of exercise when it comes to diabetes prevention. According to the authors, the free radicals produced during exercise are actually a good thing as they activate the body’s defense systems against exercise-induced stress, allowing it to use carbohydrates (glucose) more efficiently, thus helping to prevent diabetes and possibly other diseases. Taking supplemental antioxidants blocks this process and therefore health promoting effects of exercise.

Bottom Line:

Antioxidants like Vitamins C and E found in food protect our body from damage and help prevent diseases like cancer- this doesn’t change. However, taking high doses in supplemental form can be harmful.

As I’ve said before, if you're healthy and eat a balanced diet that includes a variety of fruits and vegetables, you don’t need supplements!

Previous blog entries that drive this point home: Vitamin Supplements Can Kill You & Get Rid of your Multivitamin and Eat Real Food!

Foods That Fight Cancer- Part 3

Cancer Fighting Menu

We’ve seen already that the authors of the great book Foods that Fight Cancer: Preventing cancer through diet, Richard Béliveau and Denis Gingras, leading cancer researchers, recommend you eat ½ cup cruciferous vegetables (particularly broccoli and brussel sprouts) daily as well as 2 cloves of garlic and ½ cup onions most days of the week. According to their research, they’ve found that these foods, as part of a healthy diet, contain important anti-cancer compounds.

The authors also recommend you eat 1 tsp of turmeric a day.

Turmeric is a yellow spice and a staple in Indian cuisine. In fact, Indians consume 1.5-2 grams of the spice a day, on average! Turmeric is actually responsible for the yellow colour of prepared mustard in North America, but the quantity is so small that we’d have to eat 4kg mustard a day to consume as much turmeric as the average Indian. Not appealing.

Cancer rates in India are about 1/3 of that of the United States, lung and colon/rectum cancer rates in India are negligible compared to the States. Although no epidemiological study has looked at the link between turmeric and this huge disparity, the spice is almost exclusively consumed in India and its primary active ingredient, curcumin, has been studied in labs and found to have very strong anti-cancer potential. Giving the compound to lab animals that were introduced to carcinogens prevented the appearance of tumours. Curcumin is thought to have the greatest impact on colon cancer.

What is important to note is that a molecule found in pepper (black pepper and long pepper, not chilli pepper), piperine, increases the absorption of the turmeric’s curcumin by a factor of 1000. So, add 1 tsp turmeric and ½ tsp pepper to your curries, pastas, soups, salad dressing for a little flavour and a little cancer prevention. Curry powder is also great as it contains both turmeric and pepper.

Enjoy 1/2 cup blueberries, blackberries, raspberries and strawberries a day.

Berries contain a high number of phytochemical- anti-cancer compounds produced by plants. For example, raspberries, blackberries and strawberries have a high level of

ellagic acid that has been found to interfere with the development of cancer.

Blueberries contain a very high level of the phytochemical anthocyanidins, followed closely by raspberries, strawberries and cranberries, that is thought to be responsible for the antioxidant potential of berries. It has also been found to impede cancer cell growth, leading to cell death.

Enjoy berries year round- buy them frozen in the winter, ensuing that no sugar has been added, and defrost them to use in cereal, yogourt, make shakes with them or have them as a dessert topping... or as a dessert!

Drink 3 cups of green tea a day.

According to the authors, “green tea is by far the more important contender in the dietary cancer prevention race”.

Catechins are the main polyphenols (class of phytochemicals) found in green tea and are responsible for its anti-cancer properties, especially the catechin called EGCG.

The authors warn that just because the package says ‘green tea’, the product may not have a high amount of EGCG as it’s affected by cultivation area, season, processing etc. In general, Japanese green teas (especially Sencha-Uchiyama , Gyokuro and Sencha) contain a greater amount of the catechin than Chinese teas.

Brewing period- the time that the leaves are steeping in boiling water before drinking- is another important factor to consider. A longer brewing time (8-10 minutes) is favoured as it allows the catechins to be extracted. A bad quality tea brewed for a short time can have up to 60 times less catechins than a better quality tea brewed for a longer time.

As a result of the large variations in polyphenol compositions of green teas, it’s been hard to study. New studies are looking at the amount of polyphenols, rather than green tea, ingested. Nonetheless, the current research suggests that green tea is beneficial in cancer prevention, particularly bladder and prostate cancers, as well as breast and stomach cancer. Animal studies have shown that EGCG prevents the development of cancer triggered by carcinogens, specifically skin, lung, breast, esophageal and colorectal cancers.

Apart from choosing Japanese teas that contain a higher amount of anticancer compounds, and brewing it for at least 8-10 minutes, aim to drink freshly brewed tea, avoiding thermoses, and spread out your 3 cups of tea to get the most benefit.

More of the menu to follow... stay tuned!