Kate Middleton is having ‘preventive chemotherapy’ for cancer. What does this mean?
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Catherine, Princess of Wales, is undergoing treatment for cancer. In a video thanking followers for their messages of support after her major abdominal surgery, the Princess of Wales explained, “tests after the operation found cancer had been present.”
“My medical team therefore advised that I should undergo a course of preventative chemotherapy and I am now in the early stages of that treatment,” she said in the two-minute video.
No further details have been released about the Princess of Wales’ treatment.
But many have been asking what preventive chemotherapy is and how effective it can be. Here’s what we know about this type of treatment.
It’s not the same as preventing cancer
To prevent cancer developing, lifestyle changes such as diet, exercise and sun protection are recommended.
Tamoxifen, a hormone therapy drug can be used to reduce the risk of cancer for some patients at high risk of breast cancer.
Aspirin can also be used for those at high risk of bowel and other cancers.
How can chemotherapy be used as preventive therapy?
In terms of treating cancer, prevention refers to giving chemotherapy after the cancer has been removed, to prevent the cancer from returning.
If a cancer is localised (limited to a certain part of the body) with no evidence on scans of it spreading to distant sites, local treatments such as surgery or radiotherapy can remove all of the cancer.
If, however, cancer is first detected after it has spread to distant parts of the body at diagnosis, clinicians use treatments such as chemotherapy (anti-cancer drugs), hormones or immunotherapy, which circulate around the body .
The other use for chemotherapy is to add it before or after surgery or radiotherapy, to prevent the primary cancer coming back. The surgery may have cured the cancer. However, in some cases, undetectable microscopic cells may have spread into the bloodstream to distant sites. This will result in the cancer returning, months or years later.
With some cancers, treatment with chemotherapy, given before or after the local surgery or radiotherapy, can kill those cells and prevent the cancer coming back.
If we can’t see these cells, how do we know that giving additional chemotherapy to prevent recurrence is effective? We’ve learnt this from clinical trials. Researchers have compared patients who had surgery only with those whose surgery was followed by additional (or often called adjuvant) chemotherapy. The additional therapy resulted in patients not relapsing and surviving longer.
How effective is preventive therapy?
The effectiveness of preventive therapy depends on the type of cancer and the type of chemotherapy.
Let’s consider the common example of bowel cancer, which is at high risk of returning after surgery because of its size or spread to local lymph glands. The first chemotherapy tested improved survival by 15%. With more intense chemotherapy, the chance of surviving six years is approaching 80%.
Preventive chemotherapy is usually given for three to six months.
How does chemotherapy work?
Many of the chemotherapy drugs stop cancer cells dividing by disrupting the DNA (genetic material) in the centre of the cells. To improve efficacy, drugs which work at different sites in the cell are given in combinations.
Chemotherapy is not selective for cancer cells. It kills any dividing cells.
But cancers consist of a higher proportion of dividing cells than the normal body cells. A greater proportion of the cancer is killed with each course of chemotherapy.
Normal cells can recover between courses, which are usually given three to four weeks apart.
What are the side effects?
The side effects of chemotherapy are usually reversible and are seen in parts of the body where there is normally a high turnover of cells.
The production of blood cells, for example, is temporarily disrupted. When your white blood cell count is low, there is an increased risk of infection.
Cell death in the lining of the gut leads to mouth ulcers, nausea and vomiting and bowel disturbance.
Certain drugs sometimes given during chemotherapy can attack other organs, such as causing numbness in the hands and feet.
There are also generalised symptoms such as fatigue.
Given that preventive chemotherapy given after surgery starts when there is no evidence of any cancer remaining after local surgery, patients can usually resume normal activities within weeks of completing the courses of chemotherapy.
Ian Olver, Adjunct Professsor, School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Keep Inflammation At Bay
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How to Prevent (or Reduce) Inflammation
You asked us to do a main feature on inflammation, so here we go!
Before we start, it’s worth noting an important difference between acute and chronic inflammation:
- Acute inflammation is generally when the body detects some invader, and goes to war against it. This (except in cases such as allergic responses) is usually helpful.
- Chronic inflammation is generally when the body does a civil war. This is almost never helpful.
We’ll be tackling the latter, which frees up your body’s resources to do better at the former.
First, the obvious…
These five things are as important for this as they are for most things:
- Get a good diet—the Mediterranean diet is once again a top-scorer
- Exercise—move and stretch your body; don’t overdo it, but do what you reasonably can, or the inflammation will get worse.
- Reduce (or ideally eliminate) alcohol consumption. When in pain, it’s easy to turn to the bottle, and say “isn’t this one of red wine’s benefits?” (it isn’t, functionally*). Alcohol will cause your inflammation to flare up like little else.
- Don’t smoke—it’s bad for everything, and that goes for inflammation too.
- Get good sleep. Obviously this can be difficult with chronic pain, but do take your sleep seriously. For example, invest in a good mattress, nice bedding, a good bedtime routine, etc.
*Resveratrol (which is a polyphenol, by the way), famously found in red wine, does have anti-inflammatory properties. However, to get enough resveratrol to be of benefit would require drinking far more wine than will be good for your inflammation or, indeed, the rest of you. So if you’d like resveratrol benefits, consider taking it as a supplement. Superficially it doesn’t seem as much fun as drinking red wine, but we assure you that the results will be much more fun than the inflammation flare-up after drinking.
About the Mediterranean Diet for this…
There are many causes of chronic inflammation, but here are some studies done with some of the most common ones:
- Beneficial effect of Mediterranean diet in systemic lupus erythematosus patients
- How the Mediterranean diet and some of its components modulate inflammatory pathways in arthritis
- The effects of the Mediterranean diet on biomarkers of vascular wall inflammation and plaque vulnerability in subjects with high risk for cardiovascular disease
- Adherence to Mediterranean diet and 10-year incidence of diabetes: correlations with inflammatory and oxidative stress biomarkers*
*Type 1 diabetes is a congenital autoimmune disorder, as the pancreas goes to war with itself. Type 2 diabetes is different, being a) acquired and b) primarily about insulin resistance, and/but this is related to chronic inflammation regardless. It is also possible to have T1D and go on to develop insulin resistance, and that’s very bad, and/but beyond the scope of today’s newsletter, in which we are focusing on the inflammation aspects.
Some specific foods to eat or avoid…
Eat these:
- Leafy greens
- Cruciferous vegetables
- Tomatoes
- Fruits in general (berries in particular)
- Healthy fats, e.g. olives and olive oil
- Almonds and other nuts
- Dark chocolate (choose high cocoa, low sugar)
Avoid these:
- Processed meats (absolute worst offenders are hot dogs, followed by sausages in general)
- Red meats
- Sugar (includes most fruit juices, but not most actual fruits—the difference with actual fruits is they still contain plenty of fiber, and in many cases, antioxidants/polyphenols that reduce inflammation)
- Dairy products (unless fermented, in which case it seems to be at worst neutral, sometimes even a benefit, in moderation)
- White flour (and white flour products, e.g. white bread, white pasta, etc)
- Processed vegetable oils
See also: 9 Best Drinks To Reduce Inflammation, Says Science
Supplements?
Some supplements that have been found to reduce inflammation include:
(links are to studies showing their efficacy)
Consider Intermittent Fasting
Remember when we talked about the difference between acute and chronic inflammation? It’s fair to wonder “if I reduce my inflammatory response, will I be weakening my immune system?”, and the answer is: generally, no.
Often, as with the above supplements and dietary considerations, reducing inflammation actually results in a better immune response when it’s actually needed! This is because your immune system works better when it hasn’t been working in overdrive constantly.
Here’s another good example: intermittent fasting reduces the number of circulating monocytes (a way of measuring inflammation) in healthy humans—but doesn‘t compromise antimicrobial (e.g. against bacteria and viruses) immune response.
See for yourself: Dietary Intake Regulates the Circulating Inflammatory Monocyte Pool ← the study is about the anti-inflammatory effects of fasting
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How To Eat To Lose Belly Fat (3 Stages)
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Belly fat is easier to gain than it is to lose, and it’s absolutely something that needs more attention in the kitchen than in the gym. Here’s one way of doing it:
By the numbers
First note: this video is by a man, and judging by the numbers mentioned, assumes that the viewer is also a man. An end goal of 10% body fat is a little on the low side for men, and would be dangerous for women. The magic 15% mark that he mentions as being a point where various metabolic things change, is more like 20% for women. All assuming normal hormones, of course, since it is hormones that direct this.
Healthy body fat percentages are (assuming normal hormones) in the range of 20–25% for women and 15–20% for men.
With that in mind…
The idea of this approach is to lose enough weight that your body gets rid of even the most awkward bits (e.g: visceral belly fat, which will often be the last to get used) before, if desired, then maintaining at a slightly higher body fat percentage.
- Stage 1: count calories (we don’t usually recommend this at 10almonds, but he does, so we’re reporting it here) and use your weight in pounds multiplied by 12 to give your daily calorie target. Make the majority of your diet foods that have a large volume:calorie ratio, such as fruits and vegetables, in order to feel full without overloading your metabolism. He has an interesting method of calculating a protein target; instead of the usual “1g/kg of body weight”, he says 1g per cm of height. Doing this consistently should get you to 15% body fat (so, 20%, for women).
- Stage 2: start counting fat intake too, and aim for 20–25% of your daily calories as fat. Continue, aside from that, with what you were doing in Stage 1. Doing this consistently should get you to 12% body fat (so, about 17%, for women). Being under the usual healthy level for a while should allow your body to start getting rid of visceral fat.
- Stage 3: track everything, levelling up your precision (no more “this little thing doesn’t count”), and planning ahead when it comes to social events etc. Doing this consistently should yet you to 10% body fat (so, about 15%, for women). This stage has a good chance of making most people miserable, so if that happens, consider the benefits of going back to the healthier 15% body fat (men) or 20% (women).
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Visceral Belly Fat & How To Lose It ← without calorie-counting! We prefer this 😉
Take care!
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Chai-Spiced Rice Pudding
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Sweet enough for dessert, and healthy enough for breakfast! Yes, “chai tea” is “tea tea”, just as “naan bread” is “bread bread”. But today, we’re going to be using the “tea tea” spices to make this already delicious and healthy dish more delicious and more healthy:
You will need
- 1 cup wholegrain rice (a medium-length grain is best for the optimal amount of starch to make this creamy but not sticky)
- 1½ cups milk (we recommend almond milk, but any milk will work)
- 1 cup full fat coconut milk
- 1 cup water
- 4 Medjool dates, soaked in hot water for 5 minutes, drained, and chopped
- 2 tbsp almond butter
- 1 tbsp maple syrup (omit if you prefer less sweetness)
- 1 tbsp chia seeds
- 2 tsp ground sweet cinnamon
- 1 tsp ground ginger
- 1 tsp vanilla extract
- ½ tsp ground cardamom
- ½ tsp ground nutmeg
- ½ ground cloves
- Optional garnish: berries (your preference what kind)
Method
(we suggest you read everything at least once before doing anything)
1) Add all of the ingredients except the berries into the cooking vessel* you’re going to use, and stir thoroughly.
*There are several options here and they will take different durations:
- Pressure cooker: 10 minutes at high pressure (we recommend, if available)
- Rice cooker: 25 minutes or thereabouts (we recommend only if the above or below aren’t viable options for you)
- Slow cooker: 3 hours or thereabouts, but you can leave it for 4 if you’re busy (we recommend if you want to “set it and forget it” and have the time; it’s very hard to mess this one up unless you go to extremes)
Options that we don’t recommend:
- Saucepan: highly variable and you’re going to have to watch and stir it (we don’t recommend this unless the other options aren’t available)
- Oven: highly variable and you’re going to have to check it frequently (we don’t recommend this unless the other options aren’t available)
2) Cook, using the method you selected from the list.
3) Get ready to serve. Depending on the method, they may be some extra liquid at the top; this can just be stirred into the rest and it will take on the same consistency.
4) Serve in bowls, with a berry garnish if desired:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Grains: Bread Of Life, Or Cereal Killer?
- Which Plant Milk?
- If You’re Not Taking Chia, You’re Missing Out
- Our Top 5 Spices: How Much Is Enough For Benefits?
- Sweet Cinnamon vs Regular Cinnamon – Which is Healthier?
Take care!
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Get Past Executive Dysfunction
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In mathematics, there is a thing called the “travelling salesman problem”, and it is hard. Not just subjectively; it is classified in mathematical terms as an “NP-hard problem”, wherein NP stands for “nondeterministic polynomial”.
The problem is: a travelling salesman must visit a certain list of cities, order undetermined, by the shortest possible route that visits them all.
To work out what the shortest route is involves either very advanced mathematics, or else solving it by brute force, which means measuring every possible combination order (which number gets exponentially larger very quickly after the first few cities) and then selecting the shortest.
Why are we telling you this?
Executive dysfunction’s analysis paralysis
Executive dysfunction is the state of knowing you have things to do, wanting to do them, intending to do them, and then simply not doing them.
Colloquially, this can be called “analysis paralysis” and is considered a problem of planning and organizing, as much as it is a problem of initiating tasks.
Let’s give a simple example:
You wake up in the morning, and you need to go to the bathroom. But the bathroom will be cold, so you’ll want to get dressed first. However, it will be uncomfortable to get dressed while you still need to use the bathroom, so you contemplate doing that first. Those two items are already a closed loop now. You’re thirsty, so you want to have a drink, but the bathroom is calling to you. Sitting up, it’s colder than under the covers, so you think about getting dressed. Maybe you should have just a sip of water first. What else do you need to do today anyway? You grab your phone to check, drink untouched, clothes unselected, bathroom unvisited.
That was a simple example; now apply that to other parts of your day that have much more complex planning possible.
This is like the travelling salesman problem, except that now, some things are better if done before or after certain other things. Sometimes, possibly, they are outright required to be done before or after certain other things.
So you have four options:
- Solve the problem of your travelling-salesman-like tasklist using advanced mathematics (good luck if you don’t have advanced mathematics)
- Solve the problem by brute force, calculating all possible variations and selecting the shortest (good luck getting that done the same day)
- Go with a gut feeling and stick to it (people without executive dysfunction do this)
- Go towards the nearest item, notice another item on the way, go towards that, notice a different item on the way there, and another one, get stuck for a while choosing between those two, head towards one, notice another one, and so on until you’ve done a very long scenic curly route that has narrowly missed all of your targetted items (this is the executive dysfunction approach).
So instead, just pick one, do it, pick another one, do it, and so forth.
That may seem “easier said than done”, but there are tools available…
Task zero
We’ve mentioned this before in the little section at the top of our daily newsletter that we often use for tips.
One of the problems that leads to executive function is a shortage of “working memory”, like the RAM of a computer, so it’s easy to get overwhelmed with lists of things to do.
So instead, hold only two items in your mind:
- Task zero: the thing you are doing right now
- Task one: the thing you plan to do next
When you’ve completed task zero, move on to task one, renaming it task zero, and select a new task one.
With this approach, you will never:
- Think “what did I come into this room for?”
- Get distracted by alluring side-quests
Do not get corrupted by the cursed artefact
In fantasy, and occasionally science fiction, there is a trope: an item that people are drawn towards, but which corrupts them, changes their motivations and behaviors for the worse, as well as making them resistant to giving the item up.
An archetypal example of this would be the One Ring from The Lord of the Rings.
It’s easy to read/watch and think “well I would simply not be corrupted by the cursed artefact”.
And then pick up one’s phone to open the same three apps in a cycle for the next 40 minutes.
This is because technology that is designed to be addictive hijacks our dopamine processing, and takes advantage of executive dysfunction, while worsening it.
There are some ways to mitigate this:
Rebalancing Dopamine (Without “Dopamine Fasting”)
…but one way to avoid it entirely is to mentally narrate your choices. It’s a lot harder to make bad choices with an internal narrator going:
- “She picked up her phone absent-mindedly, certain that this time it really would be only a few seconds”
- “She picked up her phone for the eleventy-third time”
- “Despite her plan to put her shoes on, she headed instead for the kitchen”
This method also helps against other bad choices aside from those pertaining to executive dysfunction, too:
- “Abandoning her plan to eat healthily, she lingered in the confectionary aisle, scanning the shelves for sugary treats”
- “Monday morning will be the best time to start my new exercise regime”, she thought, for the 35th week so far this year
Get pharmaceutical or nutraceutical help
While it’s not for everyone, many people with executive dysfunction benefit from ADHD meds. However, they have their pros and cons (perhaps we’ll do a run-down one of these days).
There are also gentler options that can significantly ameliorate executive dysfunction, for example:
Bacopa Monnieri: A Well-Evidenced Cognitive Enhancer For Focus & More
Enjoy!
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Sweet Cinnamon vs Regular Cinnamon – Which is Healthier?
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Our Verdict
When comparing sweet cinnamon to regular cinnamon, we picked the sweet.
Why?
In this case, it’s not close. One of them is health-giving and the other is poisonous (but still widely sold in supermarkets, especially in the US and Canada, because it is cheaper).
It’s worth noting that “regular cinnamon” is a bit of a misnomer, since sweet cinnamon is also called “true cinnamon”. The other cinnamon’s name is formally “cassia cinnamon”, but marketers don’t tend to call it that, preferring to calling it simply “cinnamon” and hope consumers won’t ask questions about what kind, because it’s cheaper.
Note: this too is especially true in the US and Canada, where for whatever reason sweet cinnamon seems to be more difficult to obtain than in the rest of the world.
In short, both cinnamons contain cinnamaldehyde and coumarin, but:
- Sweet/True cinnamon contains only trace amounts of coumarin
- Regular/Cassia cinnamon contains about 250x more coumarin
Coumarin is heptatotoxic, meaning it poisons the liver, and the recommended safe amount is 0.1mg/kg, so it’s easy to go over that with just a couple of teaspoons of cassia cinnamon.
You might be wondering: how can they get away with selling something that poisons the liver? In which case, see also: the alcohol aisle. Selling toxic things is very common; it just gets normalized a lot.
Cinnamaldehyde is responsible for cinnamon’s healthier properties, and is found in reasonable amounts in both cinnamons. There is about 50% more of it in the regular/cassia than in the sweet/true, but that doesn’t come close to offsetting the potential harm of its higher coumarin content.
Want to learn more?
You may like to read:
- A Tale Of Two Cinnamons ← this one has more of the science of coumarin toxicity, as well as discussing (and evidencing) cinnamaldehyde’s many healthful properties against inflammation, cancer, heart disease, neurodegeneration, etc
Enjoy!
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Small Changes For A Healthier Life
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
I am interested in what I can substitute for ham in bean soup?
Well, that depends on what the ham was like! You can certainly buy ready-made vegan lardons (i.e. small bacon/ham bits, often in tiny cubes or similar) in any reasonably-sized supermarket. Being processed, they’re not amazing for the health, but are still an improvement on pork.
Alternatively, you can make your own seitan! Again, seitan is really not a health food, but again, it’s still relatively less bad than pork (unless you are allergic to gluten, in which case, definitely skip this one).
Alternatively alternatively, in a soup that already contains beans (so the protein element is already covered), you could just skip the ham as an added ingredient, and instead bring the extra flavor by means of a little salt, a little yeast extract (if you don’t like yeast extract, don’t worry, it won’t taste like it if you just use a teaspoon in a big pot, or half a teaspoon in a smaller pot), and a little smoked paprika. If you want to go healthier, you can swap out the salt for MSG, which enhances flavor in a similar fashion while containing less sodium.
Wondering about the health aspects of MSG? Check out our main feature on this, from last month:
I thoroughly enjoy your daily delivery. I’d love to see one for teens too!
That’s great to hear! The average age of our subscribers is generally rather older, but it’s good to know there’s an interest in topics for younger people. We’ll bear that in mind, and see what we can do to cater to that without alienating our older readers!
That said: it’s never too soon to be learning about stuff that affects us when we’re older—there are lifestyle factors at 20 that affect Alzheimer’s risk at 60, for example (e.g. drinking—excessive drinking at 20* is correlated to higher Alzheimer’s risk at 60).
*This one may be less of an issue for our US readers, since the US doesn’t have nearly as much of a culture of drinking under 21 as some places. Compare for example with general European practices of drinking moderately from the mid-teens, or the (happily, diminishing—but historically notable) British practice of drinking heavily from the mid-teens.
How much turmeric should I take each day?
Dr. Michael Greger’s research (of “Dr. Greger’s Daily Dozen” and “How Not To Die” fame) recommends getting at least ¼ tsp turmeric per day
Remember to take it with black pepper though, for a 2000% absorption bonus!
A great way to get it, if you don’t want to take capsules and don’t want to eat spicy food every day, is to throw a teaspoon of turmeric in when making a pot of (we recommend wholegrain!) rice. Turmeric is very water-soluble, so it’ll be transferred into the rice easily during cooking. It’ll make the rice a nice golden yellow color, and/but won’t noticeably change the taste.
Again remember to throw in some black pepper, and if you really want to boost the nutritional content,some chia seeds are a great addition too (they’ll get cooked with the rice and so it won’t be like eating seeds later, but the nutrients will be there in the rice dish).
You can do the same with par-boiled potatoes or other root vegetables, but because cooking those has water to be thrown away at the end (unlike rice), you’ll lose some turmeric in the water.
Request: more people need to be aware of suicidal tendencies and what they can do to ward them off
That’s certainly a very important topic! We’ll cover that properly in one of our Psychology Sunday editions. In the meantime, we’ll mention a previous special that we did, that was mostly about handling depression (in oneself or a loved one), and obviously there’s a degree of crossover:
The Mental Health First-Aid That You’ll Hopefully Never Need
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