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(To read Dr Perring's Personal Account of Prostate Cancer click HERE)
I have resisted writing a ‘fruit and veg’ polemic till I had something more specific to say than ‘eat 5 portions a day’. This instruction from the chief medical officer to us all has the merit of offering a yard-stick against which to judge our usually inadequate diet but does nothing to remedy the underlying difficulty of managing our unsuitable lifestyles. I am probably typical of many of us who find eating takes second place to a schedule of meetings, commuting, and a social life with alcohol, while eating at home is a quick trip to a Supermarket selecting the next meal for ease of preparation on a momentary whim. The other point of resistance to my writing on this subject has been that I don’t like the pushy way of selling that puts product sales before an evaluation of its medical worth. However, in this instance I do believe ‘Juice Plus’, which is marketed under franchise, offers a fundamental advantage over taking separate named vitamins. I will now elaborate on this. A vitamin is defined as a carbon-containing compound needed by the body in small amounts to maintain tissue and metabolic function. Historically we have been used to thinking of a small number of selected vitamins and minerals (about 25), which have been identified as essential at a minimum level in our diet for adequate nutrition. Deficiency ‘syndromes’ were recognised: rickets from too little vitamin D, pellagra from not enough niacin, and scurvy from lack of vitamin C. Minimum amounts of many vitamins were identified on the basis of what was required to avoid developing symptoms rather than from a consideration of optimal levels for health. We are still encouraged to replace these vitamins, or minerals, when measurement shows them to be low or when, as is the case with selenium, there is a deficiency in the soil effecting the whole population. However, while there may be two dozen identified vitamins and as many minerals, there are 12,000 phytonutrients (plant-based nutrients) in fruit and vegetables which we utilise to advantage in our bodies. There is no way, and indeed no need, for us to take these as individually selected items when they are readily available in the food sources from which they are derived. The easiest way of ingesting them is directly from their source, namely the vegetables and fruit which were the principle component of our remote ancestors’ diet when we grazed the plains of Africa. Nowadays the simplest way to take these is in the form of a freeze dried capsule or powder. That way we obtain all the phytonutrients of an ideal diet without the elaborate demands of purchase, preparation, cooking and consumption. I hasten to add I have nothing against the enjoyment of good food well prepared, but it separates the need for good nutrition from the social and hedonistic aspects of eating which otherwise prevails. Incidentally, when cooking, a lot of nutritional value from vegetables is lost in their overcooking and in the juices that we discard. The science behind Juice Plus Fruit and vegetables provide a large range of antioxidant phytochemicals working synergistically (together) that protect the body’s cells against attack by excess free radicals – damaging molecules which arise from pollution of our air and water, processed food, cigarette smoke and also as a normal consequence of exercise and sunlight. Furthermore there is increasing evidence that phytochemicals, unrelated to their antioxidant action, enhance cell communication, regulation of cell growth, detoxification, anti-clotting effects and hormone regulation. The largest organ in the body is the endothelium, that is, the lining of the blood vessels. Anti-oxidants protect the endothelium and ‘Juice Plus’ has long-lasting effects on the flow of blood through blood vessels. A meal that includes fatty meat, say roast lamb or beef, reduces blood flow and increases blood viscosity. Both effectively reduce tissue oxygenation. Vitamin C and olive oil taken just before a fatty meal will protect the blood vessels from damage. It is the cardiovascular system that is principally at risk from endothelial damage and a high fruit and vegetable intake has been shown to decrease blood pressure and levels of glycated haemoglobin (a measure of long-term blood sugar). Energy levels are thereby maintained and risk of later diabetes reduced. Immune function tends to deteriorate with age – auto-immune disease and food allergies are more common (eg rheumatoid arthritis or allergy to gluten in bread, etc) while cellular immunity to infections, measured by the number of lymphocytes (NK cells) in the blood, reduce while the incidence of cancer increases. A high fruit and vegetable intake (in studies using Juice Plus) showed protection with increased NK and beta cells. Other studies have shown improved bone density, retained lean body mass and successful weight control. Two significant benefits to eyesight in older people are protection from macular degeneration and delay in cataract development. Macular degeneration, the leading cause of blindness in older people, is due to cumulative damage of the macular at the centre of the retina. Symptoms start as a blurred spot in the centre of the field of vision and spreading gradually outwards to restrict the field of vision. Cataract is the gradual clouding of the lens by a disc of protein that focuses light on the light sensitive retina. It is due to wear and tear, metabolic or physical in nature. Children with attention deficit disorder improve with dietary measures, particularly with a high fruit and vegetable intake and accompanying reduction in simple sugars and food additives. They are often given Ritalin which may improve their symptoms, though the long-term effects of this drug in children are not known. My personal observation after several months on Juice Plus has been that my energy is now more evenly distributed throughout the day and I have not been affected this winter by a cold as I often am. I take it as a vanilla flavoured drink in the morning and two capsules in the evening. From the perspective of good nutrition I add omega-3 oil, as part of the ‘Univite’ supplementation package which I have taken for some years. With one ‘square’ cooked meal a day this regime is also reducing my weight. That’s a bonus! (For anyone interested we are now stocking ‘Juice Plus’ and it costs per day about the same as a Starbuck’s coffee) The Rise and Fall of Sexual Medicine It is a doubtful privilege of age to look back and say this or that has changed – custom has it this is likely to lead to criticism of the present. Now, with the passage of time it is my turn to look back on medical practice as it was, say, 30 years ago. The specialty I now recall, with affection, is Sexual Medicine and I worked as a Lecturer teaching this subject in two weekly sessions at Southampton University. The department of the University was called Human Reproduction and it was run by a kind and forward–looking man called Professor John Dennis. It was the era of the St Louis Doctors Masters and Johnson, with their explorative attitude to couples’ private sexual life and we were able to set up at Southampton what was one of the first clinics in the UK to follow the ‘M and J’ programme offering ‘conjoint’ (couple) therapy by co-therapists (two therapists). We gave one to one interviews with each partner and ‘cross-over’ interviews, after which we all met together weekly. After the couple had been physically examined and a plan of treatment devised, there were homework assignments with regular discussion of the ‘dyad’ with the (same) therapy team. And, of course, the therapists had supervision meetings with colleagues. Amongst other techniques we taught ‘sensate focus’ exercises (a sort of attentive touching exercise with one partner the recipient and the other the ‘giver’). In all there were often twelve sessions of treatment. We reckoned we got a rating of about 75% substantial success over a 4-month therapy course. Fast forward to the present job I started recently at the Royal Surrey
hospital in Guildford. Students there tell me they have minimal training with only two
sessions of teaching on sexual matters in the syllabus (these were final year students),
which are given within the department of genito-urinary medicine (sexual infections
department) at Southampton University. The clinic where I see patients has two nurse
practitioners that see a handful of patients with sexual problems; one treats men’s
erectile problems and manages post-operative complications to sexual function. Both are in
the urology department. Of the eight or so teaching programmes in the UK which offered courses in psychosexual counselling in the 80’s only two or three still continue to function which include Relate and the Institute of Psychotherapy. Where have all the patients gone? Are they treated by GP’s in the well-reported 10-minute sessions that is all they have available for their patients. And what of the sexual symptoms that used to be considered worth helping? I see little reporting today of these in general medical literature. Have I lost my perspective, or am I right in my judgement that there is a decline in the service, retrenchment in the system and downgrading of importance attached to sexual function in healthcare generally?
(Read on
for Dr Perring's article
PROSTATE CANCER In the spirit of what I believe Optimal Health is about I would like to share my recent experiences with you, if only to underline the need for men to monitor the state of their prostate for symptoms of its dysfunction – particularly benign prostatic hypertrophy (BPH) and cancer. Recent publicity including a personal account by the Times medical correspondent, Thomas Stuttaford, who was himself a prostate cancer patient, has led to this aspect of male function being talked about openly. However, cancer of the prostate is increasing in frequency and is now the second most common cancer in older men. Factors accounting for this are partly genetic – which, at the moment, we can’t do anything about - and, significantly, to do with diet and lifestyle, about which we can act to reduce risk. In my case there is a family history of prostate cancer and since my older brother’s diagnosis with this condition I have monitored my own symptoms. Initial investigation showed pre-cancerous signs and after 5 years of ‘watchful waiting’ a second biopsy of the gland last January early cancer was clearly present. I had a radical prostatectomy four weeks ago and am happy to say the cancer was removed completely. So how do I feel, as a Doctor, about becoming a Patient? I was scared about being in hospital so demonstrably in the hands of others. No more a Doctor telling others what to do, but placed by circumstance firmly in the category of Patient and worse, in the hands of a Surgeon, with all the uncertainty that implies. The decision to have surgery was one that I welcomed since the tumour still appeared to lie within the glands capsule and could therefore be removed in its entirety. Prior to surgery I took anti-oxidants, and supplements to increase T-killer cells (which attack the cancer) and isoflavones to counter vascular proliferation and shrink the tumour’s size. On the afternoon before the operation I checked in to the hospital ward and surrendered myself to the pre-surgical routines. I was introduced to ward staff, shown to my bed and personal TV and given a menu – an ethnic masterpiece befitting the multiculturalism of Camden. A junior nurse checked my BP, pulse and temperature, and a junior Doctor took my medical history. Then nothing! Time passed. I was not exactly ‘alone and palely loitering’, but conscious of isolation and very unaccustomed inactivity. The bed was comfortable, views of Hampstead Heath spread like a map twelve floors below. I dozed, then slept. Morning came early. No longer was I waiting in the wings, it was all action. As if in a play, unsure of my part, I was stage-managed through consent forms, into an operating gown, onto a trolley, through miles of corridors, flat on my back with nothing to see but hospital ventilation pipes, to the anaesthetic room - and all this before 8.00am. The operation was to be under spinal rather than a general anaesthetic, so I remained awake and free to talk. Catheters went into both arms and my neck, electro cardiac leads placed onto my chest and a needle into my back. There was a warm sensation in my legs which became heavy. I could feel pressure, but definitely no pain, and no sense of an incision. At some point I felt both faint and nauseous. I heard someone say ‘his blood pressure’s dropping, put in more blood’ and I felt better. I thought a bit about my life and all the things I still wanted to do. Maybe I was sedated for I didn’t feel anxious, and I talked, but about what I have no idea. Two hours in theatre passed very quickly and I don’t remember being wheeled up to Intensive Care. Twenty-four hours later I still had no pain, thanks to the continuing spinal anaesthetic, but with a clearer head I became aware of a urinary catheter complete with stopcock and bag attached to my left leg. It went where I went for the next 12 days. Slowly, other drips and attachments were removed and by the next day I could get up and move around, eat, sleep, go and have a shower and get in touch with the outside world. Visitors came and went – including the surgeon. He said ‘I got all the cancer out. No glands were involved. There was cancer tissue at the margin of the (prostate) capsule on one side but I expected as much and cut widely at that point’. I felt a surge of relief - actually, inside me I went ‘wow’ - even though I hadn’t thought I was worrying about the outcome of the operation. Three days after the operation, still a bit wobbly on my feet, I was allowed to go home. By losing an organ, be it the prostate in men or a breast in women, the dream of a fully functioning body goes too. Certainly my adult self has had no illusion of perfection for many years, but as a psychoanalyst might say it is the remnant of one’s persisting infant within that may remain brittle and fears injury the most. Losing my prostate happened so fast there seemed little time to adjust to its implications, but adjust one must as a necessary preliminary to getting on with life. And that is just what I have been doing. I am reminded how precious a gift life is. So what can I, as a Doctor, usefully pass on to you about my experience as patient? In general the experience of surgery seemed immeasurably improved over what I remember from my days as a medical student: very little pain, a short hospital stay, mostly competent and friendly staff. Also, perhaps less agreeably, there was noise, bustle and rush. Conspicuously, there were staff from every corner of the globe: my most attentive care-takers were from Malaysia and Macedonia. Specifically, to monitor prostate problems, let me remind you: If there is a family history of prostate disease be more rigorous in observing its function. Cancer can occur rarely from the age of 35 years onwards. Having a first degree relative with cancer increases the cancer risk sevenfold. The Prostate Specific Antigen (PSA), which measures prostate activity should, I believe, be monitored annually after the age of fifty. When the PSA is increased, there are herbal or synthetic products which will reduce prostate activity and the prostate’s uptake of the male hormone dihydrotestosterone (DHT). Benign Prostate Hyperplasia (BPH) is much more common than cancer and does not lead to its development. Symptoms of enlargement, due to constriction of the urethra where it passes through the gland, are reduced urinary stream, a dribble at the end of urination and a need to get up to urinate at night. It is this obstruction to the urethra by overgrowth of prostatic tissue that necessitates the operation of trans urethral resection of the prostate. (Coring out the central area of the prostate to improve urinary flow.) The lifestyle factors to which I referred above include weight control, adequate exercise, a balance between the excessive demands of life and relaxation, and good nutrition. Good nutrition, increasingly recognised but still obscure as a science means, put simply, as much variety as possible, good quality food, a lot of vegetables and fruit, and only limited amounts of animal fats and dairy products. Also, most of us eat too much carbohydrate - bread, potatoes, pasta and sugar – and unrefined food is nearly always better for us than its refined alternative. We now know there is usually a lead-time of many years between the initial mutation of a cell into a form which is cancerous and the clinical presentation of symptoms due to the cancer. It is particularly during this early phase of a cancer that good nutrition and a healthy lifestyle (adequate exercise and avoidance of excessive stress) will keep the tumor’s development at bay. We also now know that the evolution of a cancer requires a cascade of events to occur, any of which provide opportunity for therapeutic intervention. It is probable that most individuals over 80 will have multiple tumours within their body in a quiescent form. Our capacity to live and survive with cancer activity contained within us by a well-maintained immune system justifies efforts to look after our own health and assists us in maintaining good function late in life. It is all a part of healthy ageing. Dr Michael Perring |
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