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What does Get Your Oomph Back include?

Blog post written by Carolyn Garritt, author of ‘Get Your Oomph Back – A Guide to Exercise after a Cancer Diagnosis’,  now officially launched.

 

There are many tools described in the book. Often the best starting point is simply to walk – outdoors if possible. Walking mindfully and seeking out nature (in an urban environment as well as the countryside) can feel really soothing and, as long as the walk is brisk, it can help to restore physical fitness as well as a sense of wellbeing.

If you’re not able to stay on your feet for long, then marching in a chair, and chair-based exercises in general, can elevate the heart rate more than many people imagine. You can get properly out of puff at home if that’s what you need to do, for now. There’s a chair-based cardio routine in the book.

In the book I also talk about Nordic walking – using poles – which I boldly describe as ‘perfect exercise’. It is very clever – it elevates the heart rate, gives the lungs space to work, improves the posture, protects the joints, strengthens the bones, supports the balance (pain and numbness in your feet is a common side effect of chemo). It helps reduce the risk of, and manage, a condition called lymphoedema, helps rebuild upper body strength and uses 95% of your body’s muscles.

And yet – perhaps most importantly – it feels really nice. The poles propel you along, so walking can feel more manageable. The fact that it’s outdoors, in nature, it’s low-cost and highly sociable, just seals the deal. Possibly my most used and useful type of activity.

Strength training

In the book there’s a lot of information about strength training – often overlooked, and definitely one aspect of exercise that folks are unsure about. Strength training – using weights, resistance bands or our own bodyweight – can help us to feel less tired after cancer treatment. Most people feel they lose some strength while they’re on the injury bench, and if we’re out of action for a while we can lose muscle mass.

Building (or rebuilding) stronger muscles is known to reduce our risks of cancer returning. It can also make everyday activities seem more manageable. Many of the people I’ve worked with (regardless of their age) have found that they can’t climb stairs as easily as they could before. There’s some specific information in the book about how to tackle stairs.

Do what you enjoy

One important theme throughout the book is that we should, I believe, do what we love when it comes to exercise. If you don’t love any type of exercise at all, there are some suggestions about how you might find acceptable, even likeable forms of activity. In my mind, nothing is out of the question – I’ve trained people to play croquet and to tackle ultra-marathons. And pretty much anything in between.

There’s definitely scope to get into, or return to, team sports, such as football, rugby and/or basketball, after a cancer diagnosis, and there are now organisations that run group-based activities specifically for people with a cancer diagnosis, such as the wonderful Active Ostomates.

Parkrun

In the book I also talk about parkrun which is, in my view, community, grassroots exercise at its very finest.

Running (slowly) is without doubt the exercise I love most. There’s a ‘couch to 5k’ running or walking programme that incorporates a monthly trip to parkrun.

Boxing

Boxing features too because it is a superb stress-buster. It helps sharpen our hand-eye coordination, which can be a bit foggy after treatment, and if done properly it works the whole body. (You don’t have to spar or hit actual people – I’m talking about using pads, mitts or a punchbag.) You do have to really think on your feet and stay light on your toes, yet it can be for anyone. My oldest trainee boxer is 84.

Combining boxing with using a skipping rope is one way to push ourselves and strengthen our hearts, lungs and bones as we go.

Yoga

Yoga, particularly restorative yoga, is another tool described. It’s important for people to find ways to relax (not easy, I know) and also to stay flexible as this can help deal with some of the aches and pains associated with taking cancer drugs.

Making time

Too much? I know that the idea of exercising can feel overwhelming. Fair enough. If you know you’re short of time or energy (or enthusiasm), then the book contains several cunning ways to incorporate movement into your daily routines. It can be as simple as getting off the bus a stop early and then walking, or taking the stairs rather than the lift. These actions can all add up to a more active day.

How am I doing?

And so, 18 months down the line, how am I doing? I know I’m not as fit as I was before, but I’m working on it and I’m doing my own strength training rather relying on what I do for a job to keep me strong. I’m less anxious about the cancer coming back, for sure. The drug I’m going to take for 5-10 years (tamoxifen) does make me tired and achy but I’m figuring out ways to minimise that.

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The books that informed my diagnosis and treatment of CFS/ME

Blog post by Dr Sarah Myhill, author of several HHB works including ‘The Energy Equation’, ‘The Infection Game’, ‘Ecological Medicine’ and ‘Diagnosis and Treatment of CFS/ME’.

 

Medical practice is called such for good reasons – doctors do not know all the answers and are practising! The patients present daily with medical dilemmas and the good doctor interposes her/himself between the theory of science and the art of treatment. As the famous physician, Sir William Osler, put it: He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.

So, what books do I take to sea with me? I determine the worth of such by the extent to which a book impacts on my clinical practice. There are two common ways – the first is to supply the intellectual imperative to put in place the necessary changes. This is vital as lifestyle changes are difficult and if I cannot inspire my patients with good science then they will not change their ways. After that it is about the road map. For me, since the 1980s the great challenge has been the treatment of patients with chronic fatigue syndrome and ME. There was no doubt they were pathologically ill, but why? What were the mechanisms? Could the pathology be biochemical and so not ‘seen’ by pathologists? Could there be something wrong with energy generation within cells?

What doctors learn about mitochondria

Medical students learn about those cellular energy generators – namely, mitochondria – during the ‘theory’ years. I was one of them. I mugged up the subject the night before, courtesy of black coffee and chocolate biscuits, regurgitated those short term memories onto the exam paper next morning and forgot. The reason to forget was simply that mitochondria appeared to have no application to the ‘practical’ years which ensued.

Power, Sex, Suicide by Nick Lane | Waterstones

 

Professor Nick Lane’s book

How wrong was that?! It is now difficult to find a pathology in which mitochondria are not involved. Professor Nick Lane’s Power Sex Suicide: Mitochondria and the meaning of life detailed the what, why and how of the role of mitochondria in the natural world. They supply energy to all living organisms such that the difference between life and death is mitochondria. No energy means no life. Lane’s book reads like a detective thriller – a real page-turner which had me enthralled as so much pathology suddenly fell into place.

 

The Sinatra Solution

 

 

Dr Stephen Sinatra’s book

The Sinatra Solution: metabolic cardiology then provided the practical reality of how to treat mitochondrial pathology. Stephen Sinatra was a traditional cardiologist using the conventional tools of drugs, pacemakers and surgery to treat heart disease, but none of these tools addressed the underlying pathology which progressed unremittingly. Sinatra now works by identifying the underlying causes of heart disease, and starts by treating the mitochondrial lesions. In doing so he has reversed pathology and cured patients. Great news for patients, bad news for Big Pharma whose mantra is: ‘A patient cured is a customer lost.’ By applying the Sinatra Solution to my CFS patients, I started to reverse their pathology. I watched their symptoms melt away. I began to see patients really recover. Not just recover but go on to live well. The really good news is that I can now also tell my patients that their best years are ahead of them – once recovered by addressing the mitochondrial lesions they are further protected against not just heart disease but cancer and dementia.

 

Look after your mitochondria and they will look after you.

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Have a Heart that Exercises your Power of Choice

Blog post written by Dr Trevor Griffiths, co-author of ‘Emotional Logic’.

 

I discovered the other day, to my great surprise, that men are as emotionally literate as women, but they simply handle their emotional energy in a different way. Those people who say that men are rational and women emotional are like the dodos of old, unable to fly and heading for extinction.

If you doubt what I am saying, please check out the string of books produced by the award-winning neuroscientist, Antonio Damasio. He found that people, men and women equally, need their emotions to make decisions whenever a choice is needed between equally rational options. The reason is: your emotions are gender-neutral, non-verbal information about your heart-level values. They are like the lights on a car dashboard, or blips on a radar screen, telling you that something is changing out there and needs attention. But they need interpreting to make the right decisions for action.

 

Emotions tell us about our values

Believe it or not, men have values! The thing is, though, that men tend to simply act straight away on the values-driven emotional movements within their hearts, their inclinations, not bothering to name their emotional feelings. Women (however you define gender) tend to be better at naming and talking about those inner movements. But there is one thing that men and women truly do share equally here. They both have heart-level values that move them. And they both, in different ways, tend not to be good at shifting their conversations from talk about feelings or behaviour onto naming their values and agreeing action plans that could build more responsive relationships around them. They tend to get stuck in a rut, a bit mindlessly, with either their feelings or their behaviours. That’s not good. So I wanted to find a way to change that.

 

By recognising our values we can make action plans rather than simply reacting

It so happens that my wife was quite pleased with my discovery of this. She’s a GP, and started using the method I came up with in her work. Cutting a long story short, we ended up writing a book together about what happened, getting permissions to tell the anonymised stories of how the emotional card-sorting tool and the Loss Reaction Worksheets transformed the way she handled common mental illnesses, and suicidal thoughts, and self-harming or compulsive behaviours for both men and women. I then added some chapters about how I had used the method in various community settings, at what I call the rough end of emotional literacy, where accumulating unrecognized grieving can lead to violence or other outbursts that irritate the law. In both settings, private and public, the same truths emerged. Accumulating hurts affect physical, mental, and social health equally. And learning a bit about healthy emotional adjustments to change reversed the harm.

 

The power of emotional literacy is gender-neutral but men and women tend to handle their emotional energy differently

If men are willing to learn how their heart-level loss emotions are there to protect their values, in other words for good reasons, they could harness their energy to make better decisions. They could then also become more responsive in their relationships around guess-checking someone else’s values. It opens a whole new way of talking that brings reasoning and emotions into a healthy partnership. Doing so usually sorts out the symptoms that often trouble people quietly in their hearts, or trouble them noisily outwards, removing their peace and driving them and perhaps others scatty. It is all so correctable with a bit of understanding and self-respect for naming values!

“So, what’s important to you in this situation?” Or, even better, “So, what did you miss when things went wrong?” Or, closer still to the point of this blog, “Listen, I’m on your side, okay. What are you worried you might have lost in this situation? Perhaps we can find a way to get that back together?”

 

Caring for your emotional heart is as important as caring for your physical heart

E-motions are energy in motion! They e-motivate people to act, either moving towards the signal or away from it. Either way, when you are next out taking some exercise to protect your physical heart, and choosing how to watch your diet, then try choosing also to exercise your increased power of choice by revising what you have learnt about naming your hidden heart-level values. You could learn to use the Emotional Logic method to do this, activating it as you face new situations. It has opened doors to people on all five continents to see themselves and life differently, and to get on better than before.

 

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How I Successfully Reversed My Type 2 Diabetes and Hypertension

Blog post written by Dr Eugene Kongnyuy, author of ‘No Pills, No Needles’.

 

Ten years ago, I was diagnosed with both type 2 diabetes and high blood pressure (hypertension). My GP prescribed Metformin for my diabetes and Ramipril for my hypertension. I was shocked and devastated because as a physician I had always thought that these two conditions were incurable. The diagnosis was like a death sentence to me because I knew its implications. Nonetheless I asked myself: ‘If diabetes and hypertension are caused by unhealthy lifestyle, shouldn’t it possible to reverse them if one switches to a healthy one?’ I decided that I would self-experiment through trial and error. I didn’t follow any complicated research rules. I was the patient and the researcher. My aim was to find out what could successfully reverse my diabetes and hypertension so that I could stop taking medicines.

Intuitively, I followed three simple steps: I ‘try’ something, I ‘track’ my blood sugar and blood pressure, and I ‘tell’ whether or not it works. Over five years, I tried out over 70 different things involving different diets and lifestyle changes.

 

Reversing my diabetes

After 29 unsuccessful trials (over two years), the 30th trial successful reversed my diabetes (but not my hypertension). The trial consisted of stopping eating lunch, which made me lose 10 kg. The first week was difficult because lunch was more than a meal to me – it was an opportunity to socialise and have informal discussions with my colleagues. Missing lunch meant missing the fun and merrymaking with friends. However, with strong willpower, I managed not to eat at lunchtime. I joined my friends during lunch but drank water instead of eating. In three months, I then lost those 10 kg of weight and my BMI (Body Mass Index) dropped from 26.1 to 22.8. My blood sugar went down to levels I had never seen before. I stopped taking Metformin and the diabetes was gone. A series of laboratory tests with my GP confirmed that the diabetes had been reversed.

It was in fact the weight loss that reversed my diabetes – missing lunch simply helped me to lose weight. A recent study, published in the Lancet and involving 685,616 adults, revealed a BMI of 23 or higher significantly increased the risk of diabetes (see reference 1 below). The findings of this study are consistent with my personal experience – weight loss is the centre-piece of diabetes reversal.

 

Reversing my hypertension

After reversing my diabetes, I continued with self-experiments with the hope of finding a cure for hypertension. After five years of self-experimenting (70 trials in total), none of the things I tried proved able to reverse my hypertension and I felt disappointed. Then one day I was challenged by my sister-in-law, Charlotte, who was (and still is) running for 150 minutes a day to lose and maintain her weight. I went out for morning exercise with her. That day, I realised I needed to do more.

Over a month, I gradually increased my daily exercise from zero to 1 hour per day. That was a turning point in my life because I hated exercise and I still believe no one hates exercise as much as I did then. Six months after starting 1 hour per day of regular exercise, I took my blood pressure (BP) and it was very low. I stopped the BP medicine and my hypertension was gone. One hour of regular, moderate- to high-intensity exercise per day may be what you need to reverse your own high BP. Moderate to vigorous exercise, especially of a type that makes you sweat, is the centrepiece for the prevention or reversal of high blood pressure.

 

Reverse lifestyle diseases with lifestyle changes

Diabetes and hypertension are lifestyle diseases and can be reversed by adopting the appropriate lifestyle. It’s not easy to change our lifestyle. Some of the things that worked for me include strong willpower, support from family and friends, and making exercise fun – I play music (a motivational fitness song) when exercising. With behaviour change, ‘start small, think  long-term’.

There are other benefits to weight loss and exercise, apart from reversing diabetes and hypertension. I’m physically stronger and regular exercise boosts my self-esteem, makes me concentrate, sleep and feel better. It helps me to combat stress and I feel better mentally.

Over the years, I have kept with 1 hour of exercise per day while tracking my BP and blood sugar, and I have learned a lot more. I have also continued practising my ‘no lunch’ strategy. My blood sugar and BP have remained within  the normal ranges. I have continued to learn from personal experience. Initially I wasn’t thinking of sharing this experience. It was the arrival of the Covid-19 pandemic, which showed a higher mortality rate amongst people with diabetes, that pushed me to decide to share my experience. If it worked for me, it can work for many, and the methods I used to explore my own health can be applied by anyone to find out what works for them. You will find all my lessons in my book ‘No Pills, No Needles – how to reverse diabetes and hypertension by finding out what works for you’.

 

References

  1. Teufel F, Seiglie JA, Geldsetzer P, Theilmann M, Marcus ME, Ebert C, et al. (2021). Body-mass index and diabetes risk in 57 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 685 616 adults. Lancet 2021; 398(10296): 238-248.
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How to Get Your Oomph Back by Carolyn Garritt

Blog post written by Carolyn Garritt, author of ‘Get Your Oomph back – A Guide to Exercise after a Cancer Diagnosis’, launching on 25th November. Available for pre-sale now. 

At the start of the pandemic, I was working as a personal trainer specialising in exercise for people with cancer, a job I had adored for more than seven years. I was fit, and mostly worked outdoors, one-to-one or with groups. As the realities of coronavirus became clear I knew I wouldn’t be working much, but I imagined I’d use the time to update my website, do the bookkeeping, and finish that book (about exercise and cancer) that I’d been writing for, well, ages.

And then, three weeks into lockdown, I found a breast lump. Quite by accident, after I had been shadow boxing, holding weights, with a couple of clients online. I thought I had just inflamed one of my pectoral muscles.

I was wrong.

 

The diagnosis

Going through a cancer diagnosis felt odd, almost dreamlike. Doing it at a time of global crisis just made the whole thing even more surreal, and it felt incredibly strange to be facing decisions as a cancer patient after years of working with them. It was suddenly happening to me too.

I was very lucky as I already had a network of support through my work. I was also fortunate because I knew a great deal about the side effects that I might encounter, and I knew what I could do to promote my own recovery.

 

Why exercise is so important

Research has shown – convincingly – that being active after a cancer diagnosis is really, really helpful in aiding rehabilitation and in improving our outlook for the future. In fact, exercising after cancer can help reduce the risk of it coming back by between 30% and 40%. That’s huge, and it has often been said that if exercise was a pill, it would be prescribed to every patient. For those living with secondary or advanced cancer, exercise can help to slow down the cancer’s progression, again, just as drugs can.

More immediately though, exercise can help us to feel better. Clinical studies have shown that exercise can help combat most of the commonly experienced side effects of cancer treatment:

Fatigue – Anxiety and depression – Hot flushes and night sweats – Weight loss / weight gain – Pain and joint stiffness – Bone thinning – Lymphoedema

 

Exercise to improve treatment side effects

Cancer treatment can be completely debilitating, and the side effects often drag on for months. Research shows that 95% of people find that they experience fatigue. For those living with cancer, life can become cyclical, as you go through endless treatment cycles and experience the associated ups and downs.

There’s also the anxiety – will it come back? Did the treatment really work? Will my next scan be okay?

 

Why my new book?

The reason I started to write my book was because I found in my work that increasingly people knew, or had been advised, to try to be more active after a cancer diagnosis, but they were often unsure what to do. What would work, what was safest, and when, during their cancer ‘journey’, could they start? Get Your Oomph Back aims to answer these questions and more.

There is a solid and growing body of evidence to show that exercising can help alleviate some of the anxiety, tiredness, pain and body changes that frequently accompany cancer treatment. In many ways it made writing the book very easy as I could find loads of really helpful, robust knowledge to call upon.

 

I’m really pleased to say that my book is being published in November. I still haven’t caught up with the bookkeeping!

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The Bowel Cancer Recovery Toolkit published in Chinese – a first for Hammersmith Health Books

Blog post written by Sarah Russell, author of The Bowel Cancer Recovery Toolkit.

Over a decade has passed since I had my own stoma surgery. And if someone had told me that 10 years later I would have a book translated into Chinese and I would be training ostomy nurses in China on Zoom, I would never have believed them.

Life really does take an incredible path sometimes. Here’s the timeline of how I went from ‘patient’ to ‘global expert’…

11 years ago

I went through abdominal surgery to remove my bowel and have a stoma formed, after suffering a life-threatening bowel perforation. I would need to use a colostomy bag fo

r the rest of my life. In most cases stoma surgery is life saving and life changing, and that was certainly true for me. I underwent 5 major operations over 18 months and it would be fair to say it was a difficult time. I had 2 young children and was a competitive athlete at the time. The surgeries floored me and I remember wondering if I would ever be able to go cycling or running ever again.

Lying frail in my hospital bed I asked about exercise, abdominal rehabilitation and whether I could run and do sports again now I had a stoma. My questions went unanswered. Nobody seemed to know what to do.

9 years ago

I managed to rehabilitate myself, get fit, retrain my abdominal muscles and return to running, cycling and the life I loved. To date I’ve completed 37 marathons and have just run a 50 mile ultra-marathon in the UK.

But in doing so realised there was a huge gap in patient support, nurse/surgeon education and knowledge about rehabilitation and exercise after stoma surgery. Despite my best efforts this hasn’t changed much, and we are still very much scratching the surface.

 

6 years ago

I started working with ConvaTec as their global exercise specialist and through our research in the UK, found that people who had their stoma due to cancer were reluctant to return to exercise and had very low levels of physical activity. I then trained in cancer rehabilitation to add to my MSc in sport/exercise science and 20 years of fitness rehabilitation qualifications.

 

4 years ago

I was working with a colorectal cancer patient (who was a keen runner and triathlete) and wanted to find an inspiring book for her to read about returning to exercise. I looked and couldn’t find one. So thought ‘Oh I’ll write a book then. That won’t be too hard’.

I contacted Hammersmith Health Books who took it on without a moments hesitation and then patiently waited whilst I wrote and re-wrote the book. It turned out writing a book is quite hard.

 

2 years ago (in 2019)

The Bowel Cancer Recovery Toolkit was finally published.

Let me tell you, if you’ve never published a book, it’s a terrifying process. Waiting for the first reviews on Amazon is utterly nerve wracking.

I hoped that people would find it comforting, useful and helpful. Which thankfully they have. Not only that but nurses and doctors have given it rave reviews and recommend it to their patients. That’s all I wanted and it makes me really happy to be able to help others. Read the reviews here.

During this time I continued to work with ConvaTec as a consultant and we developed an innovative nurse training course and the me+recovery training programme for patients.

For the first time patients could access professional advice on rehabilitation after stoma surgery and nurses could attend an RCN accredited (the only one of it’s kind in the world) course to teach them about abdominal exercises and safe activity for their patients. To date we’ve trained 350 UK nurses and many more around the world.

 

And so now today..

My book has just been translated and published in Chinese (a first for Hammersmith Health Books). I honestly find this mind blowing, but probably unsurprising. As it’s clearly something that’s desperately needed.

Each year there are around 380,000 people diagnosed with colorectal cancer in China (with a population of 1.3 billion) and cases are rising quickly in people under the age of 30.  It’s not a dissimilar picture in the UK, with around 45,000 cases each year and a sharp increase in younger people being diagnosed.

Even since publication of my book, the role of exercise in bowel cancer is becoming more and more important. Evidence is building to show that physical activity has a huge part to play in both prevention of cancer in the first place, but also in the role of recurrence. We now know that being physically active could reduce the risk of developing cancer (and it recurring) by around 30%.

If there was a pill that could offer the same thing, everyone would have it prescribed as a miracle treatment.

The exact mechanism as to why exercise is so effective isn’t yet fully understood, but it’s thought the anti-inflammatory effects of exercise combined with faster transit time through the bowel are the key physiological factors.

Having worked with thousands of patients, healthcare professionals and nurses over the last 6-8 years, I’m now hugely passionate about exercise and movement at all stages of bowel cancer prevention and diagnosis:

  • As part of a healthy lifestyle to reduce the risk of developing bowel cancer
  • As ‘pre-hab’ – getting fit for surgery
  • As rehab – after surgery – aiding recovery and reducing risk of parastomal/incisional hernia
  • As part of a healthy lifestyle AFTER a diagnosis of bowel cancer – improving mental wellbeing, confidence, physical strength and lowering risk of recurrence
  • For people with terminal bowel cancer, potentially prolonging life and helping with symptom control

All of this is covered in the book, along with advice on diet after surgery and specific abdominal exercises after stoma surgery.

Of course each person will interpret the advice and information differently, exactly as they should. But the ethos of the book is for each individual to focus on their own recovery and develop the confidence to exercise safely in their ‘post cancer body’ regardless of wherever they live in the world and wherever they are on their cancer recovery journey.

 

And finally…

The most recent part of this story (and it’s certainly not over yet) is the most incredible and ambitious project put together by ConvaTec to deliver the me+recovery training programme to a global audience.

In August 2021, we delivered online training (via Zoom) for stoma nurses in China, Japan, New Zealand, Australia, Singapore, Malaysia and South Africa – all at the same time.

It comprised 4 x 3 hour sessions to a group of 60 nurses with simultaneous translation into Chinese and Japanese. With me sat at home in my little studio in East Sussex. And due to the time differences, some of the nurses were up in the middle of the night. That’s commitment.

It was incredible. The cultural differences and the clinical approaches were fascinating and so very different. But the outcome was that every single nurse involved wanted to do better for their patients. They wanted to learn how to help them rebuild their confidence, return to exercise and know how to do safe abdominal exercises after their surgery.

I didn’t think it could work.  But it did. I’ve never experienced anything like it and it was an honour to be part of it.

In the book I write ‘My goal in writing this book is to try and help people, and to support, educate and encourage, and to start to change understanding and practice’.

And thanks to both ConvaTec and Hammersmith Health Books, that’s starting to become a reality.

Little by little we can start to change clinical practice around the world, give people better advice and enable people who receive a bowel cancer diagnosis to recover with confidence and live their best life.

 

For more information about me+recovery from ConvaTec Your home of stoma care advice, support and lifestyle tips. (convatec.co.uk)

For more information about my private practice www.sarah-russell.co.uk and my clinical Pilates www.theostomystudio.co.uk

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Raising awareness of Polycystic Ovarian Syndrome (PCOS) for PCOS Awareness Month

Blog post written by Rohini Bajekal, co-author of upcoming release ‘Living PCOS Free’, launching in February 2022.

This September is PCOS Awareness Month. Despite PCOS being the most common endocrine condition to affect women of reproductive age and those AFAB (assigned female at birth), with at least 1 in 10 affected, most people have never heard of it. Depending on how hard one looks for the condition, up to 3 in 4 of those with PCOS remain undiagnosed.

PCOS is the number one cause of anovulatory infertility and those with the condition are at greater risk of a number of long-term conditions, including type 2 diabetes, gestational diabetes, cardiovascular disease, metabolic syndrome and endometrial cancer.

PCOS is a chronic condition so, while there is no “cure”, making positive lifestyle changes can go a long way in managing PCOS and its symptoms, including insulin resistance, both in the short-term and longer term. Lifestyle modifications can tackle the underlying insulin resistance. All national and international guidelines recommend lifestyle and behavioural changes as the first line of management for PCOS, even before medications.

Knowledge is power and education is key. Raising awareness of what to look out for allows those with PCOS to access early help, support and advice. This may be through campaigns such as PCOS awareness month, workshops and education in schools or even by opening up the conversation between friends, family and colleagues.

Living PCOS Free is a practical guide which shows readers how to manage PCOS using proven lifestyle approaches alongside conventional medicine. Dr Nitu Bajekal, AKA ‘The Plant Based Gynae,’ dispels misinformation and tackles irregular periods, infertility, acne, weight gain and more.

For the diagnosis of Polycystic Ovarian Syndrome, any two out of three of the criteria below have to be met (Rotterdam criteria, 2003).

  • Ovulatory dysfunction (oligo- or anovulation: not producing eggs on a regular basis)
  • Clinical symptoms or biochemical (lab) evidence of androgen excess: (Increased levels of androgens including testosterone)
  • Polycystic ovarian appearance in one or both ovaries on pelvic ultrasound scan (specific features such as number of follicles, volume of ovary)

There are some common symptoms of PCOS, but it is important to mention that not everyone with the condition will have all the symptoms and vice versa (these symptoms may have other causes) so it is important to get a proper diagnosis:

  • Infrequent periods or missed periods are the most common sign of PCOS (oligomenorrhoea/amenorrhoea). NB: Pain is not a feature of PCOS. Painful and/or heavy periods or painful sex may be signs of endometriosis, fibroids and/or adenomyosis, all of which can affect fertility. Missed or infrequent periods could be a result of other conditions such as hypothalamic amenorrhoea resulting from calorie restriction (disordered eating, for example, or over-exercising).
  • Excess facial/body hair (hirsutism)
  • Acne (often adult and/or cystic)
  • Scalp hair loss (alopecia)
  • Unwanted weight gain
  • Insulin resistance
  • Fertility problems

There are several less well-known symptoms including:

  • Eating disorders, especially binge eating disorders without purging, unlike bulimia. (This may be missed, especially in those from different ethnic groups or those with excess weight. Referral to a therapist, dietitian specialising in medical nutrition therapy or another specialist, such as an endocrinologist or dermatologist, may be needed.)
  • Excessive daytime sleepiness
  • Breathing problems (sleep apnoea, snoring)
  • Acanthosis nigricans (darkened skin: behind the neck, underarms, groin).
  • Psychological issues such as depression and anxiety, which must be addressed.

 

Lifestyle matters and nutrition is the cornerstone

A plant-predominant dietary pattern

Given the commonality of PCOS among those with type 2 diabetes, and the higher risk of other serious health conditions, people with PCOS should be advised to focus on predominantly whole plant foods, including whole grains, beans, fruit, vegetables, nuts and seeds, herbs and spices. These foods are full of fibre and micronutrients that are nourishing and absorbed slowly, helping to normalise blood sugars. We know this works very well in people with type 2 diabetes and metabolic syndrome. Living PCOS Free is packed with tasty and nutritious plant-based recipes with gluten-free and oil-free options.

Exercise

Regular movement in a form that you enjoy is key. Aerobic exercise and resistance training, including high intensity interval training (HIIT) are all recommended to help improve insulin sensitivity in women with PCOS. Aim for 300 minutes of exercise per week (approximately one hour a day) and try to exercise outdoors in natural light.

Sleep

Ensure a regular sleep routine with seven to nine hours of restorative sleep.

Stress management and reduction

Consider exercise, meditation, mindfulness, community work, psychotherapy or yoga to help manage stress and lower cortisol levels which make insulin resistance worse.

Positive social connections

Build or join a community, whether online or offline; ensure you have a support network or a friend you can trust and confide in. Loneliness is a source of chronic stress and is associated with an increased risk of heart disease, high blood pressure and type 2 diabetes.

Avoid or limit risky substances

Eliminate risky substances such as drugs and tobacco and limit alcohol (people with PCOS are at higher risk of non-alcoholic fatty liver disease), which has no health benefits.

Living PCOS Free features an easy-to-follow 21-day plan by Nutritionist Rohini Bajekal, illuminating case histories and plant-based recipes.

https://nitubajekal.com/pcos/

https://nitubajekal.com/pcos-nutrition/

 

Dr Nitu Bajekal MD FRCOG Dip IBLM

Consultant Obstetrician and Gynaecologist

Lifestyle Medicine Physician

 

Rohini Bajekal Nutritionist and Lifestyle Medicine Professional

 

About the authors

Dr Nitu Bajekal, MD is a Senior NHS Consultant Obstetrician and Gynaecologist in the UK with over 35 years of clinical experience in women’s health. Her special interests include Lifestyle Medicine, PCOS, endometriosis, period problems, menopause, precancer, complex vulval problems and medical education. She is a keyhole surgeon with experience in laparoscopic procedures, including robotics.

Rohini Bajekal MA Oxon, MSc Nutrition, Dip IBLM, is a Nutritionist and Board-Certified Lifestyle Medicine Professional based in London. Rohini is passionate about PCOS and has personal experience of living with this condition.

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Dr Raymond Perrin’s Voyage of Discovery

Blog post written by Dr Raymond Perrin, author of The Perrin Technique 2nd Edition and The Concise Perrin Technique.

 

The background to The Perrin Technique

In 1989 a cyclist came into my clinic complaining of back pain. He also told me that he had been suffering with myalgic encephalomyelitis (ME) for 7 years and had been out of cycling for all of that time. I explained to him that, as an osteopath, I could help his back problems but couldn’t do much for his ME/chronic fatigue syndrome (CFS), which in those days was also known by the terribly derogatory name of ‘yuppie flu’. We were trained to believe that ME was very much a psychological disorder and that, with tender loving care and more exercise and time out of the office, the young upwardly mobile professionals so often affected would return to their healthy former selves. How wrong we were!

With treatment to the cyclist’s postural problems, his back pain diminished but amazingly so too did his ME symptoms and within a few months he was totally symptom free and able to return to his beloved bicycle.

 

The Perrin Technique: The theory

After helping this patient, I embarked on over three decades of clinical research into ME/CFS, including a doctoral thesis into the cause and treatment of this disorder that continues to baffle most clinicians, scientists and patients. In the early days of my research, I came up with a theory that formed the basis of my PhD thesis and my first book, The Perrin Technique, published by Hammersmith Press in 2007; this theory was that ME/CFS was due to a physical disturbance of the lymphatic drainage of the brain and spinal cord. This, I hypothesised, led to a build-up of toxins within the central nervous system, leading  to a disturbed autonomic nervous system (the nerves that control automatic functions of the body such as blood flow, the heart and gut function).

At the time, my theory that this autonomic dysfunction caused a reversal of lymphatic flow from the brain and spine, leading to toxic overload of the brain, went completely against medical and scientific thinking, as according to all the main authorities there was no lymphatic drainage of the central nervous system to go wrong in the first place. It was recognised that we had the lymphatic system to take away larger molecules that could not drain directly into the blood, but this was deemed unnecessary in the brain as the there was a natural protection, known as the ‘blood-brain barrier’, that stops large particles entering the brain, and so blood vessels in the brain were thought to be sufficient to flush any small particles away. We know very differently now!

 

The Perrin Technique: The facts

Join me in my voyage of discovery in The Perrin Technique 2nd Edition in which I describe how scientific breakthroughs over the past 14 years have  finally caught up with my original theory; we now have irrefutable proof of the existence of the lymphatic drainage of the brain (AKA the ‘glymphatic system’) and masses of evidence showing how  this drainage can be disturbed by a combination of physical, emotional, immunological and/or environmental stressors, leading to ME/CFS and fibromyalgia (FMS), and how a reversal of neuro-lymphatic  drainage can lead to physical diagnostic signs. In my 2nd Edition I include many references to the supporting scientific papers and to my own published research.

The Perrin Technique 2nd Edition also explains why every patient with ME/CFS or FMS is different and detail over 100 symptoms with an explanation of why patients suffer from each of these, such as :

Hyperosmia (changed sensitivity to smell): This is a common symptom of ME/CFS and FMS. The olfactory pathway is one of the main neuro-lymphatic drainage points in the cranium. The increased neurotoxicity and/or inflammation in this region will result in irritation of olfactory nerves leading to a heightened sensitivity to smell in some patients, with others finding a lessening of their senses and in some a total loss of smell and taste (see anosmia).

In addition, I discuss many other conditions that can occur together with ME/CFS and FMS and consider other therapies that may be of benefit together with The Perrin Technique as part of the jigsaw-puzzle of recovery.

 

Two Perrin Technique books

With the publication of The Concise Perrin Technique this month (August 2021) there will be two up-to-date books describing how to reverse problems with neuro-lymphatic drainage using manual techniques. The core of both books is a comprehensive game plan for helping patients return to health plus a step-by-step guide for manual practitioners to carry out the required treatment. Both books also answer many practical frequently-asked questions such as: What are the dos and don’ts for patients with ME/CFS and FMS?

However, I am acutely aware that ME/CFS and FMS can badly affect the cognitive ability of sufferers and that many of my patients find reading and comprehension difficult or impossible tasks, especially when it comes to long texts. Consequently, I have written The Concise Perrin Technique as a short, more focused guide to the Perrin Technique aimed specifically at patients who simply want to know the key facts about ME/CFS and FMS, how to diagnose these conditions and how to treat the underlying problem, without using scientific and medical language and long explanations.

Both The Perrin Technique 2nd Edition and the new The Concise Perrin Technique show how successfully to beat ME/CFS, FMS and other similar, emerging conditions, including Long-COVID. Correcting neuro-lymphatic drainage may also help many other neurological disorders – further research is underway.

If you wish to comprehend the underlying science and gain an in depth understanding of issues related to ME/CFS and FMS, then The Perrin Technique 2nd Edition is waiting to be read; if you want just the basics of the Perrin Technique and how to put these into practice, then The Concise Perrin Technique is for you.

 

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Young people and the importance of healthy eating  

Blog post written by Hanna Purdy, author of ‘Could it be Insulin Resistance?’

Insulin resistance and its corresponding effects, such as obesity, are alarmingly common issues in young people. In addition to excess weight, it is less commonly known and acknowledged that the effects of insulin resistance can also manifest as depression, anxiety and other mental health issues. This is due to the interconnection between the enteric nervous system, a collection of millions of nerve cells lining the gastrointestinal tract, and the central nervous system. This gut-brain axis means that our diet has a substantial influence over our moods. Therefore an unbalanced gut microbiome, hormonal imbalance and chronic inflammation, which are all effects of an unhealthy diet, go hand in hand with insulin resistance and negatively influence our mental as well as physical health. These effects are highly damaging to developing children and young people.

 

What is insulin resistance?

To briefly outline this concept, insulin resistance is where our cells are not responding to the effects of insulin in the way they should. The main cause of this is the overconsumption of sugary and starchy foods, as well as eating too frequently (e.g. snacking throughout the day). As a result, too much insulin is produced in the body, a hormonal problem also known as metabolic syndrome. A diet consisting of an excess of sugar and starch and a lack of integral micronutrients can also have an adverse effect on the good bacteria in our gut, causing abdominal problems such as IBS as well as mental issues such as depression. An excess of insulin and a deficiency of good bacteria can affect other hormones in the body, causing problems such as early puberty, acne and PCOS.

Children and young people are especially vulnerable to the consequences of insulin resistance, and therefore it is vital that parents are educated as to its cause and effects, as well as how to reverse it.

 

Educate your young people on insulin resistance

A common misconception held by both adolescents and adults is that you need to eat less to lose weight. It is important to understand that weight loss does not work that way, and under-eating can only do harm. It is essential for children and young people to eat the necessary nutrients (e.g. proteins, healthy fats) and the right amount of food to fuel their bodies. Excess weight is the result of too much insulin in the body, not too many calories, and exercising more does not solve this problem either. We also need to have an understanding of the micronutrients we get from our food, and why they are needed.

Education is one of the most important things if you want to bring about a lifestyle change, as cutting out sugar and starchy carbohydrates may be challenging. Educating your children and young people is very advantageous, as building an understanding of the topic of insulin resistance and healthy eating could motivate them to opt for healthier foods themselves. The WHY is very important. Simply making them eat more healthily “just because” will not help create long-term changes.

 

Learn to cook a wide variety of tasty and healthy meals

The first thing that comes to mind when thinking about healthy meals is salad. It might be worth reminding young people that healthy meals can actually be delicious and tastier than fast food when cooked right. You can eat all your favourite foods if you just make them yourself, from good ingredients. A fun way to get creative is to make alternatives to your favourite junk foods and desserts. There are many websites online that provide delicious recipes for you to follow and tweak to your liking (and there are some in my book Could it be Insulin Resistance? also). Personally, I find that the healthier alternatives taste better and they make you feel great. Here’s an example recipe from my book:

Chilli con carne

For 4 people

Ingredients:

  • olive oil
  • 500g beef mince
  • 1 onion, finely chopped
  • 1 red pepper, finely chopped
  • 1 yellow pepper, finely chopped
  • 2-3 cloves garlic, finely chopped, or grated
  • 400g can chopped tomatoes
  • 2 tbsp tomato purée
  • 1-2 tsp chilli powder
  • 2 tsp paprika
  • 1 tsp ground cumin
  • salt
  • black pepper
  • sour cream
  • grated cheddar cheese for serving

Method:

  1. Heat a drizzle of olive oil in a pan
  2. Add the mince and cook until it is brown
  3. When the meat is nearly cooked, add the onion and peppers and continue cooking for another 5 minutes
  4. Add the garlic, tomatoes, tomato purée and all the spices, including salt and pepper, according to your taste
  5. Simmer for 15-20 minutes. Serve with grated cheese and a spoonful of sour cream on top as well as a green salad

 

Replace fizzy drinks with water, kombucha and herbal tea

Soft drinks such as Coke or Pepsi can be very addictive. Kombucha is a great alternative. Not only is it pleasing for the taste buds, but it also provides probiotics, which are essential for gut health. If you can’t obtain kombucha, then herbal tea with some honey should suffice.

Now, if you think that replacing sodas with diet sodas is better, you have been misinformed. There are many articles on the Internet that provide valuable insight on the subject, but in short, diet sodas are very harmful to the body, containing artificial sweeteners as they do. Don’t forget, fresh water is always the best alternative for hydration.

 

Please read my book,Could it be Insulin Resistance?’, for more information on this topic.

 

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A sneak preview from upcoming release ‘Green Mother’

We have something a little different but equally as visually stimulating for you on our blog. A sneak preview of some beautiful illustrations from upcoming release ‘Green Mother’ by Dr Sarah Myhill and Michelle McCullagh with Craig Robinson. Launching later this year.

A family watering the garden
A mother breastfeeding
Children splashing in a puddle
A child splashing