Dr Catherine: It's frustrating that I think a lot of people in the in the cancer sort of healthcare professions feel that people have got enough on their plates and don't want to burden them with something extra like, now, now we're going to talk to you about lifestyle. But they don't realise that actually a lot of people who are going through a cancer journey feel very helpless and very out of control and desperate to do anything they can. They feel very passive and like they're part of a sort of just on a rollercoaster being taken in a direction where they have absolutely no agency. And so for a lot of people who come across our services and start to engage, I think that feeling of actually getting back into the co-pilot seat, you know, you are the centre of your own health creation team really as a as a as a patient and you should always feel that way and it upsets me that people often feel like they cancer is such a scary and high-tech condition and and there's a whole industry around it that people feel I'll just leave it to the experts.
Dr Rupy: Welcome to the Doctor's Kitchen podcast. The show about food, lifestyle, medicine and how to improve your health today. I'm Dr Rupy, your host. I'm a medical doctor, I study nutrition and I'm a firm believer in the power of food and lifestyle as medicine. Join me and my expert guests where we discuss the multiple determinants of what allows you to lead your best life. A multi-disciplinary approach in cancer care is a positive and empowering experience where people can choose what they would like to be doing. Every tool and approach adds on synergistically to provide better support. And this is what my guest, Dr Catherine Zallman, GP and medical director of Penny Brohn UK Cancer Charity, firmly believes in. Catherine trained to registrar level in medical oncology before qualifying as a GP in 1995. She completed a fellowship in integrative medicine at the University of Arizona in 2010 and works part-time as an NHS GP and as a GP cancer lead for the local clinical commissioning group. She's been on the podcast before. It was one of the most popular episodes we had on the series around cancer and all the different elements of improving one's resilience to cancer. And today we're going to be adding to that discussion by talking about the impact of the pandemic on services, but also looking at the next generation of lifestyle medicine practitioners, one of which is her son, who makes a surprise appearance right at the start. We talk about the general principles of an anti-cancer diet, medical tests informing, not directing treatment, the rainbow of exercises and why moving has anti-cancer benefits, and building resilience and how for some people, cancer is actually an opportunity to start thinking about what makes their life richer. I've really been inspired by some people's perspective that cancer gives them. It's not necessarily a good thing, but the ability of one to look at something as emotionally draining as cancer in a positive light, I think is just absolutely remarkable. Like I said, there is a special guest appearance from Catherine's son, Luke, and his friend Louis, who were helping out during this conference that we were speaking at. And I had the absolute pleasure of co-hosting one of the days with Catherine, who always seems to have a smile on her face. And Luke and Louis are big fans of the podcast who wanted to say hi, so you you'll hear from Luke right at the start. Remember, you can download the Doctor's Kitchen app for free to get access to all of our recipes. You can download it and get a free 14-day free trial. Android users bear with me, I am still building one for you guys. And in the meantime, you can subscribe to the Eat, Listen, Read newsletter. Every week, I give you a recipe to eat, something to listen to, something to read or watch, and something just mindfully curated to help you live a healthier, happier life and hopefully put a smile on your face as well. On to my podcast with Dr Catherine Zallman. So, Catherine, I see you've brought someone with you.
Dr Catherine: Yes. I've snuck in my son who has been a student volunteer at the conference. And Luke's a first year nutrition and psychology joint honours student, Newcastle.
Dr Rupy: Great.
Dr Catherine: So really excited about all of this. Yeah, I feel very, very excited to be seeing the next generation of of kind of clinicians and people interested in this space coming and being part of it all.
Dr Rupy: Absolutely. So not only are you doing incredible work, but you're also helping inspire the next generation within your own household as well.
Dr Catherine: Well, all I have to do is just show him your cookbook.
Dr Rupy: So Luke, tell us a bit about yourself. How's the conference been so far?
Luke: The conference has been great. It's my first time at any kind of convention or conference like this. It's been a bit of a whirlwind, kind of helping out with the different people, but it's been super exciting to see everybody with such a collective interest in lifestyle and nutrition medicine. Yeah, really striving for the change we desperately need to see.
Dr Rupy: Yeah. So how old are you?
Luke: I'm 20 years old.
Dr Rupy: You're 20 years old. And when did you first start getting into this? Because you got you're interested in it from a very young age from the from the start.
Luke: Well, as mum will tell you, it wasn't always that way. The teenage years was kind of like my anti area to anything lifestyle medicine. At one point, mum said my religion was Bristol City FC and KFC. And so we've had quite a sharp turnaround. But towards the end of school, I kind of started, yeah, moving away from certain people and getting into, it was actually Wim Hof, I would say, that kind of really set me off down that path. There's a YouTube channel called Yes Theory and they went on this adventure with him and I was like, okay, this looks pretty cool. They're all like opening up and like talking. And then I would say it kind of just snowballed and then I was travelling in 2021 and I listened to episode 72 of Doctor's Kitchen podcast, which was my mum, and I was like, oh yeah, this is cool. And then it's really just snowballed since there. I've got all your books, won't shut up about you to my friends.
Dr Rupy: But yeah, that's been my journey. You and your other friend here, Louis, who's behind the camera and behind the mics at the moment, we couldn't fit all of you in here, sorry. But he's also into it. So I guess it's this, you're not an outlier. This is actually something that a lot of younger people are interested in.
Luke: Totally. I mean, at Newcastle University, I thought I was pretty lucky to stumble across the lifestyle medicine society. As far as I was aware, that wasn't a thing. And there's also Nutritank. So it's growing amongst young people, a desire to kind of go through this. And ultimately, so with the lifestyle medicine, I'll be there's cook-alongs, there's sunrise swims, and it's not just like boring stuff about talks. I mean, talks are interesting, but it's about bringing people together. And that's what I love about lifestyle medicine is these kind of ripple effects that Rangan Chatterjee talks about, which act on so many different levels and kind of bring you together. So I find it's a really good catalyst for getting closer with my friends and making new friends as well.
Dr Rupy: Amazing. So you're you're studying nutrition at the moment, but it's not just nutrition, is it?
Luke: No, so I do a psychology and nutrition joint honours at Newcastle University.
Dr Rupy: And that sounds pretty novel. Is that I haven't come across that before.
Luke: As far as I'm aware, there's three courses across the UK that offer that specific joint honours. And there's 10 people on my course in total. So yeah, it is and it's it is a joint honours. It's not this carefully curated degree, but I was just super excited to find it at that blend.
Dr Rupy: Yeah, yeah. And what do you hope to, what were your expectations going into that degree before you started and where do you hope to take it?
Luke: I don't really know what my expectations were, but it drew me in. I'm quite like a, I've got varying interests with different things and I think they both act on the kind of lifestyle medicine principles, mental health and nutrition. And then I kind of do my lifestyle stuff outside of that. In terms of ambitions, there's there's lots of different things spreading out in front of me. My head's is a bit in different lots of different places, but I know for example, there's a food waste charity in Newcastle that I volunteer at a lot called the Magic Hat Cafe. And the Magic Hat Cafe. So what are they going to pull out of their magic hat this time? Usually Amazon deliver all sorts of different things. And that acts on food waste, but they also get like refugee and asylum seekers in and it starts so many different conversations and so many different things. So that's a place where I feel an insane amount of purpose. And I guess I'm just trying to narrow it down about that.
Dr Rupy: Yeah. Where do you think we're lacking at the moment? I mean, you just mentioned there's only 10 people in your course. So clearly, you know, there needs to be more opportunities and stuff for students to get involved in this. But where do you think the gaps are currently in our education? And after listening to all these talks, because you've been stewarding and helping with the mics and stuff like that, where where do you where do you feel that you should be having a bit more?
Luke: Well, I think it's it's first of all, I must say that this conference is kind of light and day between or day and night between what I'm getting taught on my course. I was on my first lecture, I was kind of like pretty quickly coming to the terms that not going to cover gut health at all, not really going to touch on how food affects mood and that kind of thing. So I would say even in nutrition, first of all, medical, they don't get taught about it that much, but even on the nutrition course, a lot of it is guided by industry and not so much about health science and nutrition and wellness within food. So and some of the models are a bit outdated in terms of looking at everything on much more of a macronutrient. But in terms of where we're lacking, a lot has been mainly female presence at this conference and also in just the whole space in general. So I think that's an area, how do we get it targeted towards men and how do we involve, make it a more well-rounded picture?
Dr Rupy: Yeah, yeah, absolutely. And in terms of your generation, I talk about this as if I'm like 60 years old or something, but you know, I've got a lot of patients who are younger and stuff, struggling with mental health, struggling with sort of belonging to a tribe. It sounds like you're you're sort of developing that. How do you personally look after your mental health and how do you feel that your peers might also be doing the same thing or even thinking about it?
Luke: So certain things which I do to look after my mental, I wouldn't say it's always like, oh, I'm feeling a bit of a dip, therefore I'll do this or do that. I just sometimes notice after certain activities, that really perked me up a little bit. And so some of that is volunteering, which I get involved with at Newcastle University, where there's a charity called Nest, which works with immigrants and asylum seekers. It's just like a reading session, just like human connection for me is a big one that kind of recharges me and I even if I go in in a crap mood, I'm like, I walk out with a smile on my face like 100% of the time. And also physical exercise, cooking with friends is a huge one as well, preparing, sharing food with friends. That's I love that and a bit of yoga and to mention a few.
Dr Rupy: That's great. Catherine, how proud are you?
Dr Catherine: It is, it is amazing. And and like Luke says, it wasn't always like this. And there were moments where I thought, has some of the stuff that I've tried to communicate actually put him off and and actually gone against against all of this because actually, so I think it is a really, you know, I'm I'm really inspired that he's found places in the university where he can begin to find that he's not alone in this because I think our overall culture is definitely people come out of school really just ready to party and and don't, you know, I think I think when you were saying where's the gap, I do feel like we're we're not taught enough about how how delicately balanced this whole system is and listening to some of the talks today around some of the deficiencies in your in your early 20s can really set you up big time for problems later down downstream. And I feel just very, very, well, immensely proud and really grateful that Luke seems to have stumbled on this and that it's making him so happy and excited and giving him this this future to look forward to because I think that's just what we need as you say. We really badly need it.
Dr Rupy: Absolutely, yeah. There's many parallels. My mum was the reason why I got into nutrition myself as well, actually. She was the one really battling against my own sort of ingrained beliefs that the only way was sort of the conventional medical route and like taking pills and having interventions. And whilst they're really important, I was really losing or I didn't have any sort of the lifestyle piece. So it's nice to see that the new generation are always piecing this together. So the future's bright, hey?
Luke: Well, I've got a lot to be grateful for as well. It's not gratitude isn't one way. So yeah, thank you to you too.
Dr Rupy: Oh, that's so lovely. I mean, I can't overstate the importance of my mum, but yeah. Thank you. Oh, that's very sweet. Right, well, we'll let you slink off because you've probably got loads of work to do, but yeah, it was a pleasure chatting to you.
Luke: Thank you, it's been a pleasure.
Dr Rupy: It's funny, I don't know if you know, Luke messaged via the newsletter feedback form that I have on my regular feedback form. And people don't realise that I respond to as many messages as I can. And I sent him a message, not knowing that he was your son. And I think he sent one back saying, oh, by the way, I'm Catherine's son, I'm going to see you at the conference. I just thought it was so sweet.
Dr Catherine: Oh. You didn't say that crazy woman.
Dr Rupy: No, I didn't say that. So look, the last time you were on, we talked about Penny Brohn. I've I've worked with you guys in the past. It's a wonderful, wonderful organisation. I always direct people towards your your work. Let's talk a bit about how things have progressed. We were on the pod well over a year and a half ago now, I think. What's what's been going on in the meantime?
Dr Catherine: Well, obviously the pandemic has had a huge effect. You know, the cancer population and the cancer community were initially sort of named as extremely vulnerable. And so lots of people just retreated into their houses, treatment was very disrupted, diagnosis was really disrupted, tests were really disrupted. So there was a lot of extra stress in in the whole area. We obviously closed our building and went fully online to begin with and we're just trying to support people and really amazingly we within a matter of a couple of weeks, we got a lot of our services running online so that we were able to offer that community and and sort of professional support to people going through a very, very difficult time. So it's been wonderful and actually in some ways, although we miss the very the sort of intimacy of the face-to-face contact, one of the upsides has been that we've been able to reach a whole load of people who would never have physically made it to our building and never been able to access our services. So people have we've we've had people from countries, you know, across the globe, but more importantly, we've had people kind of zooming in from their chemotherapy chair or sometimes from their hospital bed or sometimes with supporters and with family who would never have all been able to come together. So in some ways, it's been it's been a real journey of exploration and a real positive experience and there are definitely people who have come across us who would never have found us. And the actual numbers of people that we're seeing have increased year on year, which has been brilliant because the other thing that of course really affected us as a charity is our fundraising activities, which were all sort of in-person group events. And so we've had a real shortfall in in our funding and have had to sadly lose an awful lot of really experienced, wonderful staff. But actually the efficiency of doing it online has meant that we've still been able to support growing numbers of people. So I think it's it's been a real mixed mixed time for Penny Brohn and you know, I think for some people with cancer, it's been a really terrible time. Trials that they were on were cancelled, opportunities for second opinions or for even just the normal uninterrupted cancer treatment has has been really difficult. But for others, there has been this kind of reaching out to sources of support. A lot more has gone online. And in fact, some people in the cancer community were saying that actually as lockdown eased and people were going back out, that was almost more difficult for them because during the pandemic, they were kind of saying, well, welcome to my world because I've been on treatment, I've had to be isolating myself anyway. Now everybody's in that situation, there's so much more available. And as people who haven't necessarily been so vulnerable have kind of gone back to work, gone back to meeting people physically, that's produced a sort of it was fear of missing out, but then it turned into fear of going out kind of. So I think it's it's a really interesting time. And as a charity, I think we we've in many ways gone from strength to strength and developed new things. And we are now just at the point of beginning to kind of bring back some of our face-to-face services because you know, you've been to the centre, it's such a beautiful place.
Dr Rupy: I was going to say, yeah.
Dr Catherine: The gardens, the actual environment is such a sort of therapeutic and healing environment that we really, really want to bring people back and we are starting to, we've just finished doing our sort of second pilot residential retreat, which is people come to us for three days and spend two nights as a as a group of people working together to build their resilience and to learn how to support themselves and each other.
Dr Rupy: Absolutely. I I I remember that vividly and I think it would have been a real loss for your clients coming there and you know, not being able to experience those walks in the garden or the, you know, the the centres you've got there, the exercise room, the I believe there was a I remember when we had our first session with one of the nutritionists there, it was in a in a painting area. And just like, you know, the smell and yeah, it was.
Dr Catherine: And a wonderful cookery demonstration room as well, where people can actually really smell and taste and and actually experience the food being created rather than just being told this is a good thing to eat. It's actually seeing it come to life in that.
Dr Rupy: So we're gradually bringing that that back, but it is a real tension because we don't want to lose the the benefits of the online services as well.
Dr Catherine: I was going to ask you about that. So you must have found like a lot of companies, a lot of organisations, the benefits of going online as well in in such a way that you can scale up your activities. What what sort of services have you found have actually maybe not improved, but been just as effective communicated via Zoom or Skype or whatever your online tele platform is?
Dr Rupy: Yeah, well, we tend to use Zoom just because I don't know. We're not sponsored by Zoom. But one of the wonderful things is that of course, if you're inviting an external speaker to come in person, they have to travel, you have to pay their travel expenses. We've been able to get, I run a fortnightly webinar called the resilience room and we really kind of incorporate any of the aspects of whole person health that can help somebody become a bit more resilient after a diagnosis of cancer. So we touch on some of the physical things, we've looked at, we've looked at physical activity, we've looked at exercises to prevent and manage lymphoedema, we've looked at sexual dysfunction, but we've also touched on some of the psychological things, the spiritual things, some of the emotional things, some environmental things. And we've managed to get really national experts to come and share their wisdom with our our clients. And sometimes we've had over 100 people joining a Zoom session, being able to participate in that community, ask questions and and really meet the experts. And that would never have happened in person. So we've had this incredible program and people have been so generous. People, you know, right across the country, sometimes we've had international speakers who've given their time. So that's been a real wonderful thing. We've also managed to, you know, doing exercise in your own home has been fantastic. So we run at least two or three weekly exercise classes specifically designed for people with cancer. So they know that they're going to be led by somebody who's aware of some of the difficulties, who's aware of some of the cautions, yet they don't need to come and be public. Some people can switch their cameras off and be there if they're if they're feeling that they're not in a very public mood that day. So there's all sorts of advantages in a way that we hadn't really anticipated and that have been that have been very helpful.
Dr Catherine: Yeah. Let's let's dive into some of those activities and also the importance of the multi-disciplinary team because I mean, that's just essential to Penny Brohn. That's what I think of. I think of all these different specialists and and the information sharing and and meeting people where they're at as well. So when I say this, there's no judgment, but certainly, you know, you're encouraging exercise, better diet, mindfulness therapy because there is evidence base behind how that can improve reducing recurrence and also improving one's experience of treatment as well. How how let's dive into one of those sort of topics. Which one would you like? The nutrition element or the exercise?
Dr Rupy: Well, I'm so glad that you've kind of listed them all together because I think that's the unique bit about Penny Brohn is that actually we can start wherever the client wants to start and and it's not like you have to start with nutrition or you have to start with exercise. We can really help people do a bit of a holistic assessment of where they're at and what might be the easiest and most beneficial gains that they can make given their particular situation. You know, they might be on treatment and feeling very fatigued, in which case doing a lot of physical activity might be quite difficult, but actually getting some emotional support or maybe some nutritional support around that time could be really beneficial. Some other people really want to start off with the psychological side of things because they're just in a state of shock and can't really start to do anything else until they can help be helped to process some of that. And some of it is about just getting people out of their isolated little bubble where they think, is it me going mad? Is everybody feel like this? And actually just getting them into into a group. And you're absolutely right that I think one of the one of the things I'm proudest of at Penny Brohn is this multi-disciplinary approach where as a as a a team of practitioners, so we have doctors, we have counselors, we have nutritional therapists, we have exercise specialists, we have wellbeing practitioners who come from a variety of different complementary therapy backgrounds. We have art therapists and music therapists. So we can all work together to kind of make sure that whoever you are, you will find something that that feels interesting, appropriate and really importantly enjoyable to do. And so that you can start, you know, a cancer journey is often filled with a lot of things that you'd really rather not be doing. And we can start to feel like what would you like to be doing? We can start to bring back some of that positive experience, having a a nice experience of being touched, you know, through reflexology or through a massage, having an experience of being able to talk things through with a supportive group of other people who understand what you're going through. And that's that's been wonderful. But we can do a deep dive. I think each of them has their merits. And and the other thing is that I think when you do a little bit of each, then actually you start to get what I'd call a real synergy there that actually each one adds up to more than the sum of the parts if you see what I mean. So and I think it stops us diving down into one rabbit hole because I don't know, you might have had this experience, but sometimes when people get very excited about nutrition, they can they can sort of everything else can go out the window and it can and then it can especially in the cancer field, it can start to become super stressful where people are thinking I it's, you know, I might be doing the wrong thing. Is there somebody doing something better? Had I better do spend another couple of hours trying to, you know, Google search the the right thing and then you get confusing and conflicting advice. And I know that you've spoken about let's let's try and make it simple. Let's bring it back to basics. And I think that's so important. And let's also take the weight. It doesn't your nutrition doesn't have to be perfect. It doesn't even have to, you know, we don't even need to focus on that today if there's something more important or something more enjoyable or more sustainable that you can do. And any area that you can increase your resilience in a tiny bit, I keep saying it will feed into the same pot. You know, it actually if if all you can do today is actually ring a friend or or take your dog for a walk or read a nice book that brings a smile to your face, that's resilience building and that's fine. Or just, you know, write three things that you're grateful for. All of those things count. And then maybe tomorrow you'll do something different and that will that will help too.
Dr Catherine: Absolutely. Yeah. Before we actually go into nutrition and and exercise and the different various modes and what might be more effective than another, I think some people might be listening to this and thinking this just sounds like such an idyllic place. And I would love to have my treatment there or I would have loved to have access to this information, let alone like the the the centre itself. Where are the frustrations and the barriers for you as to why this isn't just the norm in terms of cancer therapy? I mean, it sounds very expensive from from my perspective. It sounds very labour intensive. It sounds very inaccessible for just thinking about the the waiting list of cancer patients right now to to get their conventional treatment, let alone the added benefits of all the the the elements that you've just mentioned.
Dr Rupy: Well, this is another of my passions is that I think integrative cancer care doesn't need to be expensive. Imean, I know there are an awful lot of expensive tests you can do and expensive supplements that you can buy and expensive treatments that are unfortunately only available in the private sector. But actually, there is huge gains and the evidence is really strong around things like being a bit more physically active, being a bit less sedentary, being, you know, practicing some mindfulness techniques, breathing in a different way, improving your diet in ways which actually can mean that your food is cheaper rather than more expensive. So cutting out some of the processed things, going back to basics, but it doesn't need to be expensive, you know, very, very sort of niche products at all. It can be simple vegetables, fruits, whole grains, those sorts of things which actually end up for many, many people once you know how to prepare them, actually a lot cheaper. So I think it's it's frustrating that a lot of people think it's expensive and often it really isn't. It's frustrating that I think a lot of people in the in the cancer sort of healthcare professions feel that people have got enough on their plates and don't want to burden them with something extra like, now, now we're going to talk to you about lifestyle. But they don't realise that actually a lot of people who are going through a cancer journey feel very helpless and very out of control and desperate to do anything they can. They feel very passive and like they're part of a sort of just on a rollercoaster being taken in a direction where they have absolutely no agency. And so for a lot of people who come across our services and start to engage, I think that feeling of actually getting back into the co-pilot seat, you know, you are the centre of your own health creation team really as a as a as a patient and you should always feel that way and it upsets me that people often feel like they cancer is such a scary and high-tech condition and and there's a whole industry around it that people feel I'll just leave it to the experts. And actually the evidence is just that taking that step to take a little bit more control actually has really positive beneficial effects on your experience and your outcomes as well. So, so I think there's a frustration that I think if it's done in the right way, people don't need to feel burdened by it. In fact, it can feel like a real a real positive and a real gift in a sense to be able to be directed and because what we know is that if people are told when they ask their specialist, is there anything I can do to help myself? And they're basically told, no, not really, just turn up, turn up to your appointments, take the medicine. We know that they go off and do it themselves anyway. They will be doing Dr Google or they will be reading, you know, newspaper articles or magazine articles and they might put things together in a way which actually really aren't helpful for them or which may risk undoing some of the or working against some of the treatments they're on. So it's much better to have it in the open and have it discussed. So I'd love to encourage more more people working in the cancer space, more cancer nurses, more oncologists, more surgeons, more cancer support workers to think about referring people to to outside organisations who can support them and and who have got that quality and that skill and that experience of working with cancer patients because there are a lot of people out there who who say they can work and support people with cancer but maybe don't have that experience. So I can understand their their reticence to kind of just refer to anybody. But there are now organisations, a growing number of organisations who really do have the skills and the expertise and who can work alongside and who work respectfully alongside whatever treatments people are having to make sure that any advice we give actually just helps those treatments work more effectively rather than undermines them in any way.
Dr Catherine: Yeah, absolutely. And I think, you know, people have had an experience where they feel patronized or it's a quite naive sort of viewpoint that you just turn up to your appointments, you just come for your therapy, you go home and rest, you don't need to exercise, you don't need to change your diet. Make sure you maintain your weight. Here's some whipped cream sort of thing with added sugar. And, you know, I spoke with Sheila Dylan actually, who's very bravely shared her journey with cancer over the last few years actually in the food program. She did a show on it in 2013. She was diagnosed, I believe in 2011, and she had the similar experience when inquiring about food. And obviously, she's an investigative journalism journalist. She's done a deep dive into the research. She came across a whole bunch of books as well, one of which was anti-cancer. I wonder if there are some principles that we could talk about when it comes to changing one's diet for one that might be anti-cancer or cancer supportive during treatment and to prevent recurrence. And also, let's start off with that actually, start before I dive into too much nuance.
Dr Rupy: Yeah. Well, I think the general principles of an anti-cancer diet are really the general principles of a healthy diet that that suits you and your individual constitution, just like we'd be talking about a diet, you know, for preventing cardiovascular disease, preventing dementia, preventing other sorts of inflammation because at the bottom of it, really we're talking about a good anti-inflammatory, whole food, plant-rich diet with as as little as possible in terms of processed foods. And by that, I mean the the sort of ultra-processed foods. I think people often read that as, well, I can't buy a ready meal, but actually there's ready meals and ready meals and there's, you know, a fresh made up soup that's that's contains, you know, ingredients that as as one of my heroes, Michael Pollan would say that your grandmother would recognise. If if everything on the label is actually comes from a plant or is something that you would recognise, then great. That that doesn't count as a as a processed food in my book. So and and just and and thinking about portion sizes so that we're not that that the balance of things on our plate means that that we're getting, you know, I you know, in an ideal world, if fiber isn't a problem and you haven't been told to go on a low residue diet, then at least half the plate being those kind of colourful veggies and and whole grains and fruits. And then there are some specific herbs and and spices that have that we know have the research tells us is are very active anti-inflammatory, anti anti-angiogenesis, which is the kind of cancer sometimes feeds itself by creating new blood vessels. And there are some very powerful foods that that um sources of of chemicals that will that will damp down those processes. So things like the chemicals contained in broccoli, in turmeric, in ginger, garlic, these are all wonderful things to include. And but many, many spices, really, you know, the other thing about our our Penny Brohn healthy eating plate is that we have an area right in the middle for herbs and spices and just saying that actually they are so nutrient dense and so rich in many of the polyphenols that that we're finding new research is turning up all the time, you know, the the anthocyanidins from your purple berries, the resveratrol from your grape skins and your a little bit of red wine, a little bit of dark chocolate. These these are these, you know, eating eating in this way is actually really pleasurable. There's no need for any deprivation or sense of sort of punishment about it. It's it's really what can we add in to the diet to make it really to make it really nourishing and really enjoyable.
Dr Catherine: Yes, absolutely. And all those sort of elements as you're as you're mentioning them, I'm just imagining the chapter of my book from me to be illness on on specifically looking at oncology and angiogenesis. And I think those are fantastic general principles of whole food, minimally processed and adding lots of herbs and spices because of all those different effects that you mentioned. That's a great sort of blanket or sort of target for for most people to try and achieve. Do you think, as we're at the personalized medicine conference here, do you think there is a role for metabolic oncology where one's diet can be personalized according to their individual blood sugar responses, perhaps, an introduction of certain types of probiotics or symbiotics, if you like, to optimize their their gut flora so that can potentially have an impact on whatever treatment regime they're on, they're on. Are there are there more targeted sort of ways that you see being introduced going forward?
Dr Rupy: It's a really good question. And I think I think at the stage, obviously I work for a charity and one of our one of our absolute aims is to make our advice accessible to all and not dependent on financial or other sort of social determinants. So I know that there are an awful lot of tests out there and unfortunately most of them cost an awful lot of money. And when I and I think if you're really stuck and if you're doing, if you've got the basics covered, so I think, you know, one of the things that we didn't mention in that description of that basic diet and it's if we say cut out some of the ultra process foods, then we obviously, I think, you know, trying to reduce the added sugars and the and the and the refined carbs is obviously part of that. But if people are doing that already and still and and they're covering some of the other basics because I think sometimes people, like you said, go down that nutritional rabbit hole and they feel that my diet's pretty good, but I just want to make sure it's even more perfect. And so whereas actually what they're they're not sleeping very well and they're and they're super stressed. And so I think rather than encourage people to deeply personalize that if they're already doing the good basics, if we can see when we do that holistic assessment that there are some other big areas which are maybe less less well developed. Sometimes there's not much you can do about those. Sometimes people are just have a super stressful life and there's not much they can change and that's fine. Then let's optimize the nutrition. But if it's something that we can address that maybe is just a bit less comfortable or it's a bit a bit of a kind of monster under the bed that you think, oh, this is, you know, I'd rather just focus on nutrition because I feel safe and good with nutrition. Then then I might encourage somebody rather to spend their attention and their energy looking at some of the maybe more psychological things, maybe really turning to them themselves and really starting to think, you know, do I actually love myself? Is there is there how do I show that love to myself and what what how do I nourish my spirit? That's maybe the so that's an area that often gets a bit neglected. People think of it as a bit of a luxury item. But for me, it's a real fundamental cornerstone. So having said that, I suppose I have so so I guess what you're hearing from me is I have a kind of ambivalent relationship with some of the tests, but I think and one of the other reasons is partly the expense, but partly because I think really interpreting them is still an art, not a science. And I think you you really need, I think the great practitioners who use these tests take a helicopter view and actually often actually make recommendations that aren't based on the tests, make make recommendations that are informed by the tests, but that are based on the other things that they notice or that actually the patient tells them. So I think yes, personalize, but my my my encouragement is to help people find the time and the space to actually listen to their bodies because I think actually our bodies tell us more intelligently and more accurately what's going on than any test that's available right now. So if we can if we can start to think, well, actually, you know, I feel really good when I eat this way. That's probably more reliable than saying, oh, you know, your serum rhubarb has shifted two points because sometimes the abnormalities on a test like that are significant, sometimes they're really not significant. And I think we can go chasing all sorts of of of kind of red herrings if if we're not careful. So I think yes, absolutely, we need to personalize cancer care. But for me, that doesn't necessarily mean lots of high-tech tests. I think personalizing for me means what matters to you? What are the what are your goals and what is what are the great things in your life and what are the things that are not going so well? And how can we shift the balance so that we're we're really tipping you much more towards the things that are going to nourish you and sustain you. And and that to me is real personalization, but first starting with that kind of what matters to you and helping people be brave enough to to articulate that, to even ask that question to themselves because it's not something we we tend to ask in medicine, is it? I mean, there is I must say that, you know, NHS England have got a big what matters to you campaign and and they have a personalized care institute which is designed to kind of get these this way of thinking out there, but actually, unless you know about it, it's hard to, you know, it hasn't yet penetrated the grassroots, has it? It hasn't penetrated to the average A&E department or the average primary care.
Dr Catherine: No, of course not. No, no. And you can understand why because we're currently firefighting as well. And so like this advent of personal, why why does that matter to me? You can understand the rationale and that way of thinking. But I love the way you you you talked about, you know, tests informing, not directing. And I think personalized care is also collaborative care. And I think the idea of being more intuitive or introspective is something that perhaps is a little bit lost on, well, I guess it was lost on me for the last few years. I don't think introspection and trying to encourage people to be a lot more intuitive about how they feel after a meal or after an activity was something I really thought about. But now I'm diving a bit more into the research, it kind of makes sense. I mean, we have these incredible baroreceptors, chemoreceptors, all these different sensors, you know, more high-tech than any D2C company technology that you can buy online to direct, you know, how your microbes are, how diverse they are, and what your blood levels are. We have to really encourage ourselves to be a lot more intuitive because that's basically what our ancestors were going on and they were right about a lot of things.
Dr Rupy: And and I don't think it means you you don't you don't be rigorous or you don't be scientific about it. You're just an n equals one study and you can, you know, I think try something out, be, you know, write it down, see how you feel, you know, see what what other circumstances are changing at the same time, you know, get get some corroborative evidence from your partner, family, friends, how how am I, you know, how is, am I just kidding myself that I'm feeling better or looking better? What do you think? So I think we can be quite rigorous about it. But I think there's a danger that these tests again put put our health in the hands of other experts and it all gets very complicated again. And I think yes, if we're if we're really stuck and we're coming up against a barrier that we're just not able to shift, but when you when I talk to people who've who've had these tests and and spoken to practitioners, often the advice is back to that generic kind of, you know, breathe better, sleep better, you know, and and and so it's really important not to lose sight of those the importance of those things in in the high-tech. And it's it's super interesting, isn't it?
Dr Catherine: Oh no, I find it fascinating. Yeah.
Dr Rupy: Really fascinating. But I also it's it's heartening and I think quite a lot of the speakers at today's conference have have have said, you know, actually, you know, we still don't quite know the significance of these things. We're finding out these correlations, we're finding out these profiles, but actually trying to then turn that into solid advice on on a on a sort of rigorous basis. I think we're still a few years maybe, maybe maybe a few decades, I'm not sure, but the progress is being so fast.
Dr Catherine: Yeah, yeah. But you never know. With with exercise on that note, we we've ticked off nutrition to an extent. Exercise, if you know, if I had a patient or I had a colleague and I guess it really depends on the type of cancer we are talking about and the stage and you know, the the pre-existing activity levels of that individual. But which exercises do you feel have the biggest impact or the biggest bang for buck, let's say. And I know it's very hard to to say, oh, it's Pilates 100%, you know, everything is contextual, but which ones do you think in general would have.
Dr Rupy: Well, it's a really good question. And I think again, I would say we need to personalize our exercise prescriptions too. And and be quite dynamic and fluid because we want to start off where people are and not give them some kind of unreachable target. This is this is what you should be aiming for because a lot of people they'll that will put them off.
Dr Catherine: Because you know, the current NHS guidelines, you know, 75 minutes or 150 minutes, it's out of reach for a lot of people. Absolutely. Let alone if you've you know, had major surgery and you've had, you know, a course of chemotherapy and you've got chemo brain and so, so I think we've got to be really, really careful to personalize it and but I think what one of the things that is really clear is that it's again, that mixed, almost I think a rainbow of exercise. So we know that cardiovascular, cardio-respiratory fitness plays a big part, but we also know that muscle strength is hugely important. And so exercises that that either combine those two or different exercises that touch those things. We know that kind of creative movement, so some of the kind of dance therapies or things more like Tai Chi and Qigong have had fantastic research evidence around improving mental health, but also improving physical health, improving reducing side effects. So I really like this idea of a combination approach, but it nearly it absolutely does need to take into account some cardiovascular fitness and some muscle strength. Now, a lot of people with cancer will also end up having problems with, you know, potential late complications with bone health. And so there's thinking about bone health in your exercise prescription and program as well. So we really want to be doing some weight bearing exercises as well. And we want to be thinking about balance and flexibility to reduce the risk of falls. So a lot of this is actually, you know, it is there are different types of exercise for different for different things. And there are a few, you know, you've mentioned Pilates, yoga is one of the the most studied in the cancer field. And and some types of those yoga and Pilates actually incorporate a whole range of those things. So they're great because they almost are a rainbow of exercises and some of them then will include some mindfulness or some breathing practices as well. So that's great. But actually, if yoga or Pilates isn't your thing, you can do it in other ways. And there are so many benefits of nature exposure as well. So actually doing something that takes you outdoors, if that's walking your dog, if that's going for a swim, if that's if that's going for a jog or a run or a hike somewhere, that that has those added benefits. And so I think again, it kind of comes down to what do you like doing and what are you going to carry on doing and what can you see yourself gradually building a healthy and sustainable and enjoyable relationship with.
Dr Catherine: Yeah, yeah, it's a very similar concept in food as well. I mean, consistency, I think is the biggest factor rather than the actual type of diet, the quality of diet. And I think, you know, even though you might argue weight bearing exercises or doing squats is great, if you don't like doing that and you can't bear to do it and you'd much rather do something else like a walk or a run, and you're going to be a lot more consistent with that, that's definitely going to have more of an effect. I did want to talk about resilience. I think this is a really important topic, particularly when you're going through something as emotionally draining as as cancer, let alone physically draining. You've got a really lovely slide that we're going to put on our show notes as well here. I wonder if you could talk a bit about the way in which you approach the whole person, the mind, the emotions, the body, the spirit. We've talked a lot about the body here, but not really much about the other three.
Dr Rupy: And it's fundamental. So we we talk about our approach as an approach that can really help you build whole person resilience. And I think of resilience as our capacity to respond constructively in the face of challenge. And sometimes that can be a kind of like aiming to bounce back to where you were, although we really talk, you know, and many people who've been on a cancer journey themselves would say that you don't bounce back to the old you. There is a kind of new normal that that that can emerge after a after a cancer experience and helping people to to feel as strong and replete and sort of well resourced in in in themselves. And it really does help to break that down and think we some people think of resilience as physical fitness and it and that is a part of it, but actually there's your emotional resilience, there's your mental resilience, and there's the kind of we call it, we call it spirit at Penny Brohn, but often people think of it as kind of your purpose or your meaning or your connection to things that are outside of you that matter to you. And you know, love is a big word there as well. But the more topped up you can feel with things that you love, things or people or places, actually that that prepares you for for future challenges and for challenges along the way. And so and we know that those are really important aspects of resilience. And then we can also build our sort of community resilience and the relationships, build resilience into those relationships, having good open conversations and connection with the the people closest to us, but also with our wider communities. We can try and put ourselves in in spaces and places that that help us be resilient as well. And we can try and also sort out some of the practical issues, so money and work and help help us find our our our way of best relating to those sorts of things. And we won't be, again, I think the lovely thing is that we can, as long as we're aware of all those aspects of resilience, we don't have to do them all and we don't have to do them all at once and and we can start where we where we want to, but they all do feed into that same same bucket of resilience as I as I the same tank which which really fuels us. And it is incredible that some people when, you know, the cancer is the opportunity for them to start thinking about this sort of thing in a way that maybe they've never thought before. And sometimes, it doesn't not always at all, but sometimes people do really say, if it wasn't for the cancer, I would never have done X, Y or Z, which has made my life so much richer, so much which has made me feel so much better. It's taken me in a new direction because I suddenly see the value of these sorts of things. So I think resilience is a great word. It it doesn't it doesn't necessarily mean being like a a rubber ball which bounces back to its old shape. In fact, sometimes it is, I I've I've read the work of Chris Johnston who's written a wonderful book called Seven Ways to Build Resilience. And one of his metaphors is that sometimes you, you know, you drop a vase, you break it and you can kind of put it back into a new shape which actually is even more beautiful than the original vase. So it's not about rigidly sticking to to old old forms and old patterns, but it's about creating new patterns and and being courageous enough and well supported enough, I think, to do that.
Dr Catherine: Yeah. It's like you're communicating with me telepathically here because I was literally just thinking about Kintsugi, which is that Japanese art form of breaking the the vase and then patching it up with gold lining so it looks even more beautiful and incredible. I haven't actually done that. I need to do that because I'd love to have one of those vases. But I think the enriching experience of doing it myself would be awesome. And I'm so glad you said that about certain patients' experiences of it being not necessarily net positive, but certainly enriching thereafter. You most most people think about cancer as something gravely negative and whilst it is horrific, some people if you have that growth mindset can really look at it in a different light. And as you were talking about all these different things, you know, one's diet, one's movement, one's psychology, one's ability to be resilient. These are things that I think most people need to think about regardless, you know. You know, looking at this diagram, financial issues, time restrictions, the the loss of sort of the emotional buoyancy. Honestly, I I I think that there is a lot that people can learn from listening to this and actually learning a lot more about resilience regardless of a diagnosis at all.
Dr Rupy: I completely agree. And it was really interesting actually, when the COVID pandemic sort of really hit and and a lot of our community came online, in some ways they felt better prepared for COVID because they felt I'm already looking after myself and I'm already actually doing a lot of things which I know will help build my resilience. And really interestingly, the cancer community, although in the initial phases, they were kind of like this might be one of the high risk factors, actually it didn't turn out to be half as high risk as some of the other actual lifestyle illnesses like blood pressure and obesity and things. So I wonder whether that is, you know, related, but certainly in terms of, you know, psychology, people were already taking vitamin D, had already looked into some of, you know, were already exercising, were knew how to exercise indoors. So it's it I think you're absolutely right. And I think the we all come at it through different lenses, but actually, you know, there've been some fascinating talks here, you know, integrative approaches to rheumatology, integrative approaches to mental health, but many of the principles have been very, very similar around how to how to give our bodies the optimum conditions to find that resilience that we need in in 21st century living because actually at one of the big things is that, you know, we're living a life that really genetically and biologically we weren't designed to live. So we've actually got to work more actively than maybe our ancestors did to keep that resilience up.
Dr Catherine: Absolutely. Catherine, you're such a legend. I absolutely love you. I love your energy and I just think the work you're doing is amazing and I just can't wait to just continue to support your work and and see what you're going to be up to next. So I really appreciate you coming on.
Dr Rupy: Thank you so much. And you know, Rupy, I mean it's the inspiration that people like you give to, you know, the communities out there is just phenomenal. And I think it's really lovely. It's great that you're you're reaching out into communities, you're you're, you know, using your platform to kind of champion these things because I think it it makes so much of a difference. I can't tell you how how heartening it is when people hear it just from one place, it's a bit difficult to trust. When they start hearing it from multiple different angles and everybody starts saying the same things. And I I love that about your approach is that you're always trying to find the common ground and and and sort of although you you get nice and geeky and and interested in in the new developments, it's always okay, so how do we bring this back to actual real people in their lives? And that's just fantastic. So thank you so much for all the work you do.
Dr Catherine: Oh, thank you. I appreciate that. That's so lovely of you to say. Thank you.
Dr Rupy: Thank you so much for listening to my conversation with Catherine. She is a breath of fresh air and I love just her energy and how she always appears to be beaming and brimming with a smile. You can find out more about Penny Brohn, a fantastic charity, and if you want to donate, there's a donation page as well. The links of which are all on the show notes and you can find more at the doctorskitchen.com as well. If you're looking for more information about cancer and all the previous episodes, just go to the doctorskitchen.com/podcast and type in cancer in the search bar and you'll find all of our podcasts on cancer therapies as well as anti-cancer diets and all the other elements that you can do within the lifestyle realm to improve your well-being. I really hope you enjoyed today's podcast and I will see you here next time.
