Tag Archives: Health

Cancer and Exercise.

English: Nutrigenomics: bring disease, cancer,...

English: Nutrigenomics: bring disease, cancer, diet and genetics together (Photo credit: Wikipedia)

Recent press articles in the UK have trumpeted the alarming fact that “Half of the UK population will get cancer in their lifetime,” but if one reads further through the reports there was also another eye-opening claim:  “Exercise is so effective in the prevention and rehabilitation of cancer, that if it were a drug; it would be a wonder drug.”

Why am I not surprised? In my mind, these findings lead me to imagine a situation in which it is suddenly realized that that food (even in minute portions) is now the new wonder drug to cure  famine!

The tragic reality is that the vast majority of the population suffers from exercise hunger or acute chronic exercise deficiency. Inactivity is now the 4th preventable cause of death. Based on a survey of 153,000 people, only 5% of UK adults meet the minimum physical activity recommendations. (NHS Sport & Exercise Medicine Sept. 2011) and only 3% do not smoke, have normal weight, eat 5 fruits and/or vegetables per day and exercised sufficiently. (Ach. Intern. Med. 165:854, 2005). On the other hand, regular exercisers are up to 50% less likely to be affected by serious illness, including cancer. (NHS Sport & Exercise Medicine Sept. 2011).

45% of the US population has at least one chronic disease (including cancer). By 2025, it is estimated that the proportion will increase to 49%, or about half the population! Behavioural risk factors for chronic disease include physical inactivity, an unhealthy diet and smoking. (WHO).

In spite of the fact that the intimate details of the preventive and curative aspects of exercise are not widely known, efforts are being made to develop special training regimes and specialized coaches for specific medical conditions. The ACSM/ACS (USA) offers courses for a “Certified Cancer Exercise Trainer”, with requirements that include a Bachelor’s Degree. (American College of Sport Medicine).  In principle, this is a development I welcome, though much more research is necessary.

I am, however worried that, it is readily forgotten that exercise must be combined with diet in order to achieve the desired results. Diet should be tailored and timed to the training regime. Certain dietary components that were present in the mid-Victorian diet contain enzymes that induce cancer cell arrest. (J.R.S.M. 101(9):454 2008). These components and avoidance of the carcinogens present in many modern foods should be incorporated. I’m convinced that reduced energy expenditure or lack of exercise and the increased consumption of processed and less nutritious foods are the main causes of the dramatic continuing increase in chronic disease.

A specified training regime, for cancer patients, administered by a certified cancer exercise trainer together with a diet, tailored to the exercise regime as well as being anti-carcinogenic seems a valid prescription.  Sadly, the recommendation is often just a short walk.

Perhaps the cancer patients are often so weak that even a 30 min. walk is very demanding or the knowledge of exercise and it’s inter-relationship with nutrition is sparse. Either way, both are disturbing.


Causes of Knee Osteoarthritis.


Knee (Photo credit: mariandy_gizfel)

I have talked about the extraordinary and disturbing number of knee joints that are being replaced by artificial joints. There are 600,000 knee replacements every year in the US at a yearly cost of $9 Billion. They have doubled over the last decade. (OECD iLibrary 2011). They are expected to double again in the UK over the next 2 decades! (Lancet 380:1768 2012).

Age is a factor. 70% of those 65+ show radiological evidence of osteoarthritis in at least one knee or hip joint. (J. Orthop. Res. 7:15 2012)

But one of the major causative factors is obesity. 69% of knee operations may be attributed to obesity in Croatia (Ljec. Vjesn. 131:22 2009). If all overweight and obese people were to reduce weight by only 5Kg., or until their  BMI was within the normal range, 24% of OA knee surgical cases could be avoided.! (Int. J. Obes. Relat. Metab. Disord. 25(5):622 2001). Some surgeons do not operate until the patient has reduced his BMI. A BMI of 40 is considered inoperable!

Another major cause of osteoarthritis of the knee, which is rarely discussed, is inactivity. The synovial fluid of the joints is viscous and cannot function unless the joint is put under pressure. 40% of men with knee osteoarthritis are couch potatoes (Northwestern Univ. News Aug. 2011). Lower extremity muscle weakness is a risk factor for knee osteoarthritis (Arthrit. & Rheum. 41(11):1951 1998). Low muscle strength is strongly associated with knee pain, (Ann. Rheum. Dis. 57:588 1998) and muscle weakness may be an im portant factor in the pathogenesis of osteoarthritis. (Rheum. Dis. Clin. N. Am. 25(2):283 1999).  Such patients require not only rehabilitation after the operation  but “prehabilitation”, to increase necessary muscle strength,  before the operation!

Age-standardised disability-adjusted life year...

Age-standardised disability-adjusted life year (DALY) rates from Osteoarthritis by country (per 100,000 inhabitants). (Photo credit: Wikipedia)

Man is the most destructive animal that has ever existed on the planet and efforts are being made to protect animal and plant species. However there seems little effort to protect the human species from the man made destruction of human health.

We are already at a point where we have to be treated to give us sufficient minimal health in order that we can be treated.

Fluoridation of Drinking Water in Switzerland

English: Putting toothpaste on a toothbrush. T...

English: Putting toothpaste on a toothbrush. The toothpaste is Crest Pro-Health Clean Cinnamon, 0.454% stannous fluoride, 0.16% w/v fluoride ion. Deutsch: Zahnpasta auf eine Zahnbürste auftragen. Русский: Выдавливание зубной пасты из тюбика на зубную щётку (Photo credit: Wikipedia)

I was in general practice as a dental practitioner from 1954 to 1984 and during this period witnessed the enormous and dramatic gains in oral health. Before the Second World War, it was very rare for anyone over 40 to have any teeth left. Everyone over 40 was toothless. Dentists were having to pull the remaining teeth and make full dentures. My best friend, in England, lost all his upper teeth before the age of 20, which was not unusual.

In some countries, even after the war, young women would have healthy teeth removed and full dentures made, as these were inevitable, in order to save their future husbands dental expenses, and thus be more attractive! Today dentists are filling few teeth and are now in the cosmetic business, working in “Smile Clinics”, with patients having beautiful teeth, well into old age.

There are no federal laws forbidding the practice fluoridation of drinking water Switzerland, however it is impossible to fluorinate the public drinking water.  The reason for this is that the water supply in Switzerland is extremely diverse, from lakes, rivers and especially springs and is not centralized.

As an older dentist I feel that fluoride was mainly responsible for the rapid and dramatic advance in oral health. As water fluoridation was not feasible in Switzerland, fluoride was added to salt as well as to milk.

English: Photo of mild dental fluorosis, or ev...

English: Photo of mild dental fluorosis, or evidence of trauma to deciduous teeth while permanent teeth were still forming. (Subject never had braces, which can be another cause for white dots or rings in the center of the teeth.) The condition appears here as white spots on both central incisors (front teeth) and upper left canine tooth, and less noticeably in the upper left lateral incisor. (Photo credit: Wikipedia)

Pregnant mothers and young children were given fluoride pills. Systemic fluoride was considered most important as the fluoride is thus incorporated into the developing tooth enamel making it more resistant to tooth decay rather than fluoridation of the tooth surface.

Dental clinics for school children were set up. Dental hygienists visited schools and gave toothbrush instruction with fluoridated toothpaste, rinsing instruction with fluoridated mouth washes and distributed fluoride pills. In addition dentists gave regular fluoride treatment. Inspite of the considerable amount of fluoride given in various forms to the public, in my 30 years of practice I never saw a case of dental fluorosis, mottled enamel or skeletal fluorosis or any condition that would suggest that the fluoride given was detrimental to health. Academic support was given by the University of Zurich which became well known for its preventive research. In fact the systematic, statistical research on the effects of the preventive measures in Switzerland received international acclaim in the field of caries prevention.

Today, fluoridated salt and non-fluoridated salt are available, fluoride is no longer added to the milk and pregnant mothers and children are no longer pressurized into taking fluoride pills.  Although Switzerland did not, in contrast to it’s neighbors have fluorinated drinking water, the population was certainly subjected to far more fluoride than any of the surrounding countries. The amount of fluoride could be huge as it was uncontrolled.  At the same time research showed that dental health in Switzerland increased dramatically and was superior to that of the surrounding countries.

To summarise; my practice experience has led me to believe that fluoride administered in the recommended dosage does not have a negative effect on health and that fluoride, together with other factors was responsible for the dramatic advances in dental heath.

Jumper’s and Runner’s Knee

English: Medial view of the knee showing anato...

English: Medial view of the knee showing anatomical features. (Photo credit: Wikipedia)

In my one of my previous blogs the content referred to the dramatic increase knee replacements, mainly due to osteoarthritis, which creates a huge burden on health systems.

The causes are multifactorial, which include previous injury, obesity and possibly genetic influences. (Dr. Sofat, RFS Newsletter 46:4 2013).

Age is also a factor with the majority of people over 60 showing evidence of osteoarthritis in at least one joint. At over 65 (a shocking) 70% of hips or knees show radiological evidence of osteoarthritis! (J. Orthop. Res. 7:15 2012)

But the increased number of knee replacements cannot be explained by population growth and obesity epidemic alone. The recent increase is likely to be related to the growing prevalence of sport-related knee injuries. (J. Bone Joint Surg. Am. 94(3):201 2012)

Injury:   An injury in younger years can lead to osteoarthritis in later years. Kneeling for long periods can cause injury. Housemaid’s Knee (Bursitis), (swelling in front of the kneecap) or Clergyman’s Knee, (swelling below the kneecap), seem to be relatively harmless (Mailonline May 2013).

Jumper’s Knee:  Jumping causes sudden pressure to the knee joint of 9-11 times body weight.  20% of jumping athletes have Jumper’s Knee (Performance, June 2009). In volleyball the prevalence of jumper’s knee is high, up to 40-50%!  Symptoms increase slowly and are often unreported especially as athletes with tendon pain perform substantially better in jump tests compared to asymptomatic controls!  “Jumper’s Knee Paradox”. (B.J.S.M. 47(8):503 2012)

Runner’s Knee: Whereas in jumper’s knee, high stresses on the knee are the main causative factor, runner’s knee is caused by repeated micro-trauma. (Angelfire March 2002).    25-65% of runners suffer from runner’s knee. There is a significant increase with increasing duration per week, but training pace has no impact on the incidence of chronic knee lesions. (Eur. J. Radiol. 58:286 2006).  In Singapore up to 50% of runners have runner’s knee (HealthXchange).  However, long distance running per se does not increase the risk of osteoarthritis. (J. Am. Osteopath. Ass. 106(6):342 2006).

English: Jogging at Cranny Good for your healt...

English: Jogging at Cranny Good for your health, but sore on the joints. (Photo credit: Wikipedia)

Jogging is excellent and popular exercise, but decades of jogging especially after 50 can cause problems. Not only overuse, but muscular imbalance can be a source of injury. (Walk Jog Run May 2012).  Cross training has been seen to be beneficial as prevention of injury.   Barefoot running reduces joint movement and work done at the knee and may provide potential benefits for the management of knee pain and injury. (Br. J. Sports Med. 47:387 2013)

It is unfortunate that sport related knee injuries are too often ignored, thus compounding the damage.  While the percentage of jumpers and runners that develop jumper’s knee or runner’s knee are disturbing and sport related knee injuries are on the increase, early injuries, although important, are nevertheless not the major cause of knee osteoarthritis in later life.

Contrary To General Opinion

University of Birmingham Medical School, England.

University of Birmingham Medical School, England. (Photo credit: Wikipedia)

Professor Janet Lord made an interesting presentation at the first AgeWell Conference at the University of Birmingham 2010, entitled “How to maintain a healthy immune system in old age”.

She was quoted as saying that, “the immune system declines with age”. However I have experienced exactly the contrary.

I am very nearly 94 and have experienced a dramatic improvement in my immune system during the last 3 years. Previously I suffered a cold just once a year- usually in November. During the last 3 years I have not had a cold nor suffered any complaints, or illnesses whatsoever.  I no longer have a doctor.

Contrary to general opinion I believe that high intensity training and muscle building in old age are essential factors for successful aging.

A New Profession? Try Orthopaedic Surgeon.


Total Knee replacement : AP view (Xray).

Total Knee replacement : AP view (Xray). (Photo credit: Wikipedia)

Should you consider a new profession then an orthopaedic surgeon specializing in knee replacements could be a very good idea. Consider the facts:

There was an extraordinary 400% increase in the number of total knee replacements from 1971 to 2003 as compared to an increase of (only) 55% in the number of hip replacements in the same period!

The number of primary knee replacements are expected to increase nearly 8 times from 450,000 to 3.48 million by 2030! But that is not all.  An increasing number of the artificial joints will have to be replaced or “revised”. From 2005 to 2030 it is estimated that the increase in revisions of total knee replacements will come to an amazing 600% compared to hip replacement revisions of (only) 137%!  (Renaissance Orthopaedics Jan. 2008).


More and more younger patients are involved. In 1999, 30% of knee replacements were for those under 65. In 2008 the number was already 41%.  There is a higher rate of failure and earlier revisions in younger patients. (Am. Acad. Orth. Surg. Now April 2012).  After only 5 years, 8% of the replacements in the under 55 age group had failed! (Acta Orthop. 81(4):413 2010).

What are we doing to our knees?  Overweight and obesity obviously put more strain on the knees. But population growth and obesity cannot explain the rapid growth of total knee replacements in the last decade ( J. Bone Joint Surg. 94(3):201 2012). The major causes seem uncertain.

Almost certain seems to be the expected shortfall of orthopaedic surgeons which is projected to be so dramatic that  by 2016, 72%  of those patients that require total knee replacements  will, (in the US), be unable to obtain them! (AAOS Ann. Meeting 2009)

All This Nothing We’re Doing Is Actually Killing Us

All this nothing we’re doing is actually killing us.

via All this nothing we’re doing is actually killing us.

English: On overweight man's waistline.

English: On overweight man’s waistline. (Photo credit: Wikipedia)

High praise indeed- and supporting this argument the Economist published a special report on “Obesity” (Dec. 15th 2012). Roughly 1/3 of the world’s adult population is either overweight or obese. It is estimated that this number will increase to 2/3 of the world’s adult population by 2030 (Jiang He at Tulane University).

This could have devastating consequences for the human race. What was not mentioned is the fact that obesity shrinks the brain.  It has been estimated that 4% of the brain mass is lost with overweight and a staggering 8% with obesity. What would the future for our grandchildren look like, with only a third of the world’s population having normal brains?

S.O.S. – “Save Our Sanity!”