Change of Address!

The Anti-Cancer Challenge has moved to the website of my new book, Zest for Life, The Mediterranean Anti-Cancer Diet.

Same format, same themes, more frequent posts -- please keep reading and commenting, and do tell your family and friends about this resource.

Cancer cells love sugar, and they're not fussy

Pancreatic cancer cells use the sugar fructose to help the tumor grow more quickly, researchers have discovered. Published this month in Cancer Research, these findings serve as a powerful reminder that anyone wishing to curb their cancer risk should start by reducing the amount of sugar they eat.

Since fructose makes up a large proportion of western diets (high-fructose corn syrup accounts for more than 40 per cent of caloric sweeteners added to foods and drinks), a research team at UCLA's Jonsson Comprehensive Cancer Center wanted to study its effect on cancer cells.

The researchers added fructose to one set of human pancreatic cancer cells in petri dishes and glucose to another set of cells. After letting the cells interact with the sugars, both fructose and glucose were found to increase cancer cell growth at similar rates, but through different metabolic pathways. This is the first time a link has been shown between fructose and cancer proliferation.

"In this study we show that cancers can use fructose just as readily as glucose to fuel their growth," said Anthony Heaney, the study's lead author. "The modern diet contains a lot of refined sugar including fructose and it's a hidden danger implicated in a lot of modern diseases, such as obesity, diabetes and fatty liver." While this study was done on pancreatic cancer, these findings may not be unique to that cancer type, Heaney said.

Americans in particular consume large amounts of fructose, mainly in high-fructose corn syrup, a mix of fructose and glucose that is used in soft drinks, bread and a range of other processed foods. High-fructose corn syrup is about 45% glucose and 55% fructose. People also get fructose from sucrose, known as table sugar, which is 50% glucose and 50% fructose.

It has been known for decades that cancer cells thrive on glucose. Moreover, foods that cause a sharp rise in blood glucose (i.e. foods with a high glycemic index (GI) ranking) trigger the secretion of insulin and insulin growth factor (IGF-1), two hormones that also promote cancer growth.

Many health-conscious eaters have therefore shifted to foods with lower GI rankings - an excellent idea if this involves replacing refined, processed starches with natural, whole carbohydrates rich in fiber, protein, fat and micronutrients. However, some people have also switched to fructose-rich sweeteners because these have low GI rankings. Indeed, popular ‘low-carb' weight-loss diets such as the Montignac diet promote the use of pure, crystallized fructose as a sweetener.

More recently, a fashionable sweetener widely touted as a natural and healthy alternative to other sugars has taken the health food community by storm: agave syrup. True, it has a low GI ranking and is ‘natural' to the extent that it is derived from a plant (albeit after intense processing). However, some brands of agave syrup contain as much as 90% fructose.

In the light of the UCLA study, agave syrup may therefore not be helpful for dietary cancer prevention. Indeed, cancer patients would probably be better off avoiding it. Indeed, "efforts to reduce refined fructose intake or inhibit fructose-mediated actions may disrupt cancer growth," the study states.

According to the American Institute for Cancer Research (AICR), commenting on the study on its blog, "the findings are interesting, but more research is needed before it can be used to make recommendations on public health." This is only one study, they note, and it is a cell study. This means that its findings may not necessarily be replicated in animals or humans.

However, the study does highlight that adding sugar to our diet raises cancer risks. "A healthy diet will always include some sugar, as it naturally occurs in nutritious foods like fruit and milk," the AICR writes. "The key is to limit added sugars of all types, rather than focusing on glucose versus fructose or sucrose."

With obesity in the US continuing to rise, "Americans need to cut back on added sugar, no matter where it comes from. Reducing added sugar will help people get to and maintain a healthy weight, and that is one way research clearly shows that we can prevent pancreatic cancer," says the AICR. The WCRF/AICR in its 2009 policy report found that 28% of pancreatic cancers could be prevented if Americans maintained a healthy weight.

In my next post I'll take a look at practical ways to rein in our desire for sugar. It's not as hard as you think!

Mediterranean diet may lower breast cancer risk

Further evidence of the Mediterranean diet's anti-cancer effects has just been published, cheering those of us who believe that this style of eating may be one of the best forms of dietary cancer-prevention around.

In a study that appeared recently in the American Journal of Clinical Nutrition, researchers found that among 14,800 Greek women tracked for a decade, those who stuck most closely to the region's traditional diet were less likely to be diagnosed with breast cancer than those who least closely followed Mediterranean eating patterns.

The link was observed only among women who were past menopause: those with the closest adherence to the Mediterranean diet were 22% less likely to develop breast cancer during the study than those who adhered least to this style of eating.

As I wrote here recently, I believe that Mediterranean-style eating is a key component of lifestyle cancer prevention. Best of all, you don't have to live in a Mediterranean country to reap the benefits of the Mediterranean diet: this term simply describes a pattern of eating that is rich in fresh vegetables, fruits, olive oil, fatty fish, nuts, seeds, garlic, herbs and spices and relatively low in dairy and meat.

The wide variety of fresh plant foods that characterizes this diet provides a vast array of cancer-fighting compounds. These are largely absent from modern western diets which comprise a large proportion of highly processed factory foods rich in sugar, refined starches and industrially transformed vegetable oils. These types of ‘foods' are thought to provide a fertile ground for cancer cells to grow and spread.

The Mediterranean diet may be breast-cancer protective in several ways. For one, studies (this one or this one) have found that women who closely follow the diet tend to have lower levels of estrogen, a hormone that fuels the growth of the majority of breast cancers.

Moreover, cell studies conducted in laboratories (this one or this one) indicate that the fats in the Mediterranean diet - olive oil and the omega-3 fats in oily fish - may slow the growth of cancer cells.
The Mediterranean diet is also typically rich in flavonoids (in particular, flavones, flavonoids and resveratrol), substances with important antioxidant properties. Antioxidants protect body cells from free-radical damage that can eventually lead to disease, including cancer.

But why should the Mediterranean diet may offer greater protection to postmenopausal than to premenopausal women? According to the study, most younger women who develop breast cancer tend to have a genetic predisposition to the disease, whereas in older women, lifestyle and environmental factors may be more important contributors to risk.

That's not to say that younger women don't also derive benefits from Mediterranean-style eating. As far as I'm concerned, the earlier we can get healthy eating patterns in place (ideally in childhood!), the better armed we are against illness in later life - and not only cancer, but also cardiovascular disease, obesity, diabetes, fertility problems and depression.

A vast body of research going back to the 1950s suggests that the Mediterranean diet offers substantial protection against all these conditions. And when paired with other healthy lifestyle habits - regular physical activity, adequate rest, not smoking, and avoiding excessive alcohol intake - the protective effects are even greater.

Strawberries: not just good, but good for you!

Summertime is strawberry time, and I am enjoying it to the full. For I have discovered that the best strawberries don’t come from the supermarket, but from a local farm not three miles from my home.

In the past, strawberry season was an exercise in frustration. Keen to avoid the early berries from Spain (grown in hothouses, tended by underpaid African migrant laborers, sprayed with pesticides and harvested before maturity) I would wait impatiently for the local berries to appear on the supermarket shelves. However, the season being short and hostage to the vagaries of the local weather, the long-awaited berries rarely made it to my supermarket, or only brioefly and at exhorbitant prices. Before I knew it, strawberry season was over and my plans for a freezer full of pureed strawberries had to be shelved until the following year.

A few weeks ago, as I was selecting beautifully fragrant strawberries at the local farmers’ market, the enterprising young grower selling them told me I could come and pick them myself – at half the price he was charging at the market! My family and I went for a short drive to the strawberry farm and as we got out of our car, a beauteous scene unfolded before our eyes: row after row of ruby-red, ripe strawberries glistening in the afternoon sun.

We were handed two wooden crates and set about filling them in the company of the friendly farm dog. Within ½ hour we had picked 8 kilograms of sweet, aromatic mara des bois strawberries, probably the most fragrant of all strawberry varieties, with a flavor resembling the sweet, spicy miniature forest berries you sometimes discover on particularly successful country walks. (They remind us why the Italian name for strawberry is fragola – essentially meaning ‘fragrant.’)

Best of all, the berries had not been treated with any chemicals; to rein in the weeds, the farmer had covered much of his field with black plastic sheeting into which he had cut holes for the strawberry bushes to grow through.

Strawberries are the very incarnation of nutrient-dense food: low in calories (1 cup only contains 43 calories) and brimming with nutrients. Eating just 10 medium-sized strawberries (1 cup or 140 grams) gives you 82 mg of vitamin C – or 136% of the recommended daily average! Strawberries are also rich sources of fiber, potassium, manganese and folic acid.

Strawberries (and other berries, such as raspberries, blueberries, cranberries and blackberries) are also one of our staunchest allies for dietary cancer prevention. A large body of research has established the anti-cancer potential of berry fruit phytochemicals. These include anthocyanins (pigments that impart the attractive colors to berry fruits and colorful vegetables), quercetin (a compound also found in onions, apple skins and tea), proanthocyanidins (common to green tea, grape skin and seeds, blueberries, cranberries, dark chocolate, etc.), tannins (particularly ellagitannins, found in strawberries, black raspberries, red raspberries, blackberries, muscadine grapes, some nuts and oak-aged beverages) and other plant chemicals.

Their cancer-protective effects are multiple: berries contain powerful antioxidants (notably ellagic acid, particularly prevalent in strawberries and raspberries) that protect our cells from free-radical attacks which can lead to cancerous changes. Berry compounds have been shown in laboratory experiments to inhibit cancer cell proliferation and to promote the detoxification of carcinogens. They can even induce apoptosis (cell death when a cell is no longer needed) and reinforce the cancer-destroying effects of certain chemotherapy drugs.

Interestingly, organically grown strawberries appear to have stronger anti-cancer effects than conventionally grown ones. Swedish scientists recently found that extracts of organic strawberries contained higher levels of vitamin C and phenolic compounds than their conventional cousins. Tested on human colon cancer and breast cancer cells, both types of strawberry extract  reduced cell growth,  but the organically grown ones were more effective at inhibiting proliferation than the conventionally grown ones.

If you can’t obtain organically grown strawberries but have a garden (even a small one will do), strawberries are easy to grow, even for beginners, and are very rewarding. Not only can they carry up to three flushes of fruit throughout the summer, but they are also perennial, meaning that they  flower and carry fruit every year, year after year. They reproduce by producing runners with nodes along them that are the beginning of new strawberry plants, so if you take good care of your strawberries and feed them and trim them when appropriate, they will reward you generously. Detailed information on planting and caring for strawberries can be found here.

So let’s enjoy strawberries while the season lasts! Most often I eat them as they come off the bush, or perhaps cut into creamy ewes’ milk yogurt along with a finely chopped mint leaf and a smidgen of acacia honey. Strawberries elevate any morning smoothie to a feast (I usually add banana and a spoonful of almond butter to make it more filling), as well as lending a lovely burst of color and freshness to porridge or muesli in the morning. To make the season last a little longer, I also puree them and freeze them in ice-cube trays or containers, to enjoy when fresh strawberries have become a distant dream.

To ring in the changes, I recently came up with a savory strawberry sauce that’s delicious with chicken or duck; if you would like to try it, I have posted it on my website.  

My year of not taking supplements

We took the children to the circus last weekend. When it came to the Flying Sandros, a terrifying trapeze act, I was on the edge of my seat. For during the third jump, a daring reverse triple salto, the catcher’s and the flyer’s hands missed each other by a nanosecond and the flyer came crashing down into the net. Thank goodness for safety nets!

For the last 12 years, I have had my own dietary safety net: nutritional supplements. When I stopped taking them 79 days ago for my Anti-Cancer Challenge (in line with the World Cancer Research Fund’s recommendations, upon which the Challenge is based) I felt like a trapeze artist working without a net, for this is the first time in over ten years that I am supplement-free.

Over the past ten years I have swallowed approximately 50,000 supplements pills. At my peak intake nine years ago, my husband would joke that if you shook me, I’d rattle. For a while, my daily regimen included a high-dose multi-vitamin and mineral supplement, extra vitamin C to boost my immune system, a herbal combo to support my liver, a formulation to stabilize my blood-sugar, probiotics to aid my gut flora, magnesium to help me relax at night and digestive enzymes and hydrochloric acid capsules to assist me in digesting and assimilating my food.

After moving to France from the UK nine years ago I scaled back my supplement intake. When I ran out of my British supplements and couldn’t find easy replacements (in France there aren't entire shops dedicated to the sale of supplements as there are in the US and the UK) I noticed that I felt no worse-off, even after several months of supplement-deprivation. Moreover, as I discovered irresistible fresh, locally-grown food at greengrocers’, farmers’ markets and bistros I quickly lost interest in the encapsulated astronaut fare I had leaned on for years. I was happy to invest the $4-5 a day I was saving on supplements in delicious, fresh and healthy food.

According to the WCRF, some 35% of Britons and 50% of Americans regularly take supplements. In France, that number stands at a modest 20% but it is rising. Many of us see supplements as a sort of top-up health insurance, a safety net for when we don’t get around to eating well. Let’s be honest: isn’t it reassuring to think that if we take multivitamins and minerals, probiotics and omega-3 fatty acids in capsule form, it’s OK to give the real foods that contain these – fruits, vegetables, yogurt, nuts, oily fish – a miss occasionally?

Sporadic dietary transgressions are fine, of course. The problem is, ‘occasionally’ often becomes ‘regularly’ and before we know it, we rely increasingly on supplements to provide our nutrients. For instance, many people who do not eat fish (alas, there are many!) will struggle to obtain enough omega-3's or selenium from their diet.

In terms of cancer prevention – the remit of this blog – supplementation does not appear to deliver great benefits; in fact, in some cases, for instance in smokers taking beta-carotene supplements, they may actually increase risks. That’s why the WCRF concluded in its 2007 Expert Report: “For otherwise healthy people, inadequacy of intake of nutrients is best resolved by nutrient-dense diets and not by supplements.”

“Nutritional supplements contain forms and concentrations of nutrients that don’t occur in nature,” says Dr Rachel Thompson, science programme manager in charge of nutrition at the WCRF, adding that “supplements don’t contain fibre or the many bioactive components found in food and which are important for health.”  Indeed, it is increasingly understood that the different vitamins, minerals, proteins, fats and plant chemicals bound up together in natural foods reinforce each other’s actions in synergistic ways that supplements cannot replicate.

To be sure, many nutrients have been found to offer cancer-protection, but these should ideally come from food, not pills. For instance, according to the WCRF the mineral selenium (found in Brazil nuts, whole grains, fish, crustaceans and meat) probably protects against prostate cancer, calcium (from kale, spinach and other green, leafy vegetables, nuts & seeds, canned whole sardines, tofu and dairy products) is thought to act against colon cancer and vitamin E (from plant oils, seeds, nuts & whole grains, berries and green leafy vegetables) may cut prostate-cancer risk.

Granted, swallowing a pill takes a lot less time than preparing a healthy meal. However, healthy, nutritious food is a lot tastier and need not be time-consuming, as my previous post shows. So let’s prioritise real food over laboratory nutrients. For optimal nutrition, the food we eat should be as fresh as possible (ideally, locally grown in rich, healthy soil and eaten as soon as possible after harvesting), highly varied and carefully prepared. Long-distance transportation, long-term storage and overcooking can significantly reduce nutrient levels in foods.

There are exceptions where supplements are advisable. In people who have marked nutrient deficiencies or heightened nutritional needs, or who have trouble eating, digesting and absorbing food, supplementation is important. People over 50 who have difficulty absorbing vitamin B12 should supplement this. Moreover, women planning to conceive should take folic acid. Vitamin D is recommended for people who are not exposed to sufficient sunlight or those (such as the elderly or people with dark skin) who do not synthesise adequate vitamin D from sunlight. However, do not self-administer supplements; if you think you need extra nutrients or have difficulty digesting and absorbing the nutrients in your food, consult a doctor or nutritionist.

I will report over the next few months on my year without supplements. For now, anyway, I’m feeling fine without my nuritional safety net - indeed, last week I was the only member of my family to escape a spring cold that was doing the rounds.

Picture credit: Five female trapeze artists performing at the circus. Published by Calvert Litho Co., Detroit, Michigan; obtained from the Library of Congress.

When fast food is health food

Working in my home office today I felt a pang of hunger around lunchtime. I sloped off into my kitchen in search of a quick bite so as not to interrupt my train of thought. (I confess, I was planning to grab a not-very-Mediterranean cheese sandwich; quick, tasty, but not exactly packed with plant-food goodness...)

As soon as I entered the kitchen, my eyes lit on an avocado idling on the counter. It was heavy and firm-yet-yielding -- in other words: perfectly ripe. This sight got my juices flowing and my mind wandering: hmm, what could I do with an avocado that really had to be eaten now? It certainly didn’t go with cheese sandwich, so I’d have to think of something else.

Then I remembered some left-over salmon puree in the refrigerator (canned Pacific salmon mashed with home-made mayonnaise and plain yoghurt, spring onion, parsley and lemon juice). Yes, that would go nicely in the avocado’s hollow.

No sooner had I opened the fridge to retrieve the salmon puree than I spotted a tomato on the vegetable shelf, sitting very still, no doubt hoping I wouldn’t spot it. I did spot it though and out it came. Just as I was about to chop it all up and dump it in a chipped breakfast bowl (part of me still wanted to rush) I remembered four lonesome asparagus spears left over from last night’s dinner and shunted to the back of the fridge. This had to be fate. No more rushing; the time had come for an impromptu feast.

I put away the chipped bowl, took a white china plate out of the cupboard and arranged on it the quartered avocado, a blob of salmon puree, the tomato quarters and asparagus spears, drizzled them with home-made olive-oil dressing (I always keep some in the refrigerator), sprinkled it with dried pepper flakes and a few leaves of parsley. I even found some pine kernels nestling at the bottom of a nearly-empty jar and so while I was arranging my plate, I toasted these lightly in a small, dry pan and scattered them over the plate.

This meal took only seven (yes, 7!) minutes to assemble; that’s my definition of fast food. It was infinitely more nutritious – and delicious! – than the cheese sandwich it replaced. And it helped me 'get out of my head,' sit down on my terrace and savour my meal listening to birdsong, a light breeze on my face -- rather than gobbling it down in-between office tasks.

Yes, there are days when I *do* eat the cheese sandwich, when there are no perfect avocadoes or salmon purees waiting to be discovered. But there are many ways of rustling up basic, delicious and healthy meals in a matter of minutes by keeping healthy supplies in pantries, refrigerators and freezers and not yielding to the temptation of the fast-but-suboptimal snack.

A few things that make healthy impromptu feasts easier:

• A supply of canned fish (especially sardines or mackerel), tomato concentrate, pesto or tapenade in one’s pantry (delicious on toast as a base for sardines or sliced tofu, or to liven up salads or soups).
• A stock of plain yogurt, home-made mayonnaise and salad dressing, goat’s cheese or feta (tastes great crumbled over salads or soups).
• Some longer-lasting items in the vegetable drawer (e.g. tomatoes, cucumbers, washed lettuce in a zip-lock bag, some parsley – washed, dried and kept fresh in an airproof container, carrots, vacuum-packed beets).
• Herbs and spices, nuts and seeds ring in the changes and liven up any dish.
• Left-overs! I generally cook a little more than we need for dinner so that I can eat the rest the next day, either cold or briefly reheated in a small saucepan.

So next time we think we don't have time to prepare healthy food,  let's hunt around and see what pleasant surprises our refrigerator may hold!

Family feasts for body and soul

As my family and I gathered around our dinner table yesterday evening, the Mediterranean Spirit was among us.

Three generations – my three children, their parents and visiting grandparents – sat down for a shared meal of chili con carne* that my 13-year-old son had prepared. Before we began to eat, each gave thanks for something they felt grateful for: the fine weather, the delicious meal, a good day at school. When it came to the chef’s turn, my son said: “I am thankful that we are all together, and for this nice atmosphere.” Amen to that!

In my last post, I sang the praises of the Mediterranean diet – its healthy vegetables and fruits, fish, herbs, garlic and olive oil. However, the health benefits of Mediterranean-style eating go far beyond mere molecules: taking time to prepare and savor good food in the company of people we love also has immeasurable benefits.

Indeed, possibly the most life-affirming aspect of the Mediterranean food culture is the central role of conviviality: the pleasure of sharing food with others, of celebrating communal culinary traditions and life at large. Without it, the Mediterranean diet would be just another health-food prescription; conviviality, at its heart, makes it a lifestyle.

The word ‘convivial’ derives from Latin, where it means quite simply ‘the act of living together.’ We are drawn to conviviality by our need for safety, companionship and comfort. But in today's hyper-efficient, fast-paced world, we often sacrifice that which made us human – our fundamental need for food – and the communality that was born of this need. Instead, we rush from one task to the next and eating becomes just another chore to be slotted into our busy schedules.

Over the long term, this modern way of eating cannot provide us with the biological or emotional sustenance we need to thrive. For a truly anti-cancer way of life, let's rediscover the joys of eating calmly, at a table, using cutlery and plates, ideally in the company of people we are fond of.

Shared, leisurely meals are about much more than fuelling our bodies, they are “uniquely human institutions where our species developed language and this thing we call culture,” Michael Pollan argues in an impassioned plea for a return to more traditional eating habits (In Defence of Food, Penguin Books 2008). “The shared meal elevates eating from a mechanical process of fuelling our body to a ritual of family and community, from mere animal biology to an act of culture.”

In recommending the Mediterranean diet, I want to move beyond the ‘food-as-medicine’ paradigm, where our diet is seen merely as an amalgamation of molecules that support bodily functions (a mechanistic view popular in Anglo-Saxon countries). Instead, I espouse the more holistic ethos prevalent in Mediterranean cultures where food is also a source of spiritual nourishment, of pleasure, comfort and vitality – a celebration of life in the fullest sense.

Although modern eating patterns have been making inroads into Mediterranean countries, many retain a rich and joyful food culture. Indeed, French bistros at lunchtime throng with office workers enjoying a leisurely meal and engaged in lively conversations not pertaining to work. On Sundays, three-generation families gather around many a restaurant table for two to three hours’ eating, relaxing and laughter. These groups often include babies and toddlers who learn from an early age that eating with others is an occasion for joy and communality.

Sociologists have compared habits of conviviality in Mediterranean and Anglo-Saxon countries and their results make fascinating reading. In an international survey of people’s attitudes to food and eating, respondents were asked to describe what, to them, constituted a ‘healthy diet’ (Fischler C, Masson E. Manger – Français, Européens et Américains face à l’alimentation. Odile Jacob (Paris), 2008).

Whereas primary health-concerns for the Americans and Britons surveyed touched on scientific concepts such as 'proteins,’ ‘carbohydrates’ and ‘fat,’ Italian and French respondents overwhelmingly focused on the notion of pleasure.

There was also a great divergence in respondents’ attitudes to conviviality: when asked what constitutes a healthy diet, French and French-speaking Swiss participants spoke spontaneously of ‘family meals’ or ‘eating with friends.’ In the French-speaking focus group, the word ‘family’ came up 39 times, ‘friends’ 51 times, ‘convivial’ 72 times and ‘sharing’ 38 times.

This is in striking contrast with the Anglophone groups, where ‘family’ was mentioned eight times, ‘friends’ four times and ‘sharing’ only three times. Lastly, while Anglophones and Germans valued ‘conviviality’ on special occasions, the French, in particular, said they treasured conviviality as an ordinary, day-to-day event.

In addition to their attachment to conviviality, the French and Italian respondents were also found to adhere most closely to strict rules about meal times (three times a day, at fixed times), portion sizes (modest), table manners (no phones, no TV), in-between-meals snacking (forbidden), second helpings (frowned-upon), dietary variety (essential), eating environments (tables, real dishes and cutlery, not cars, sidewalks or desks).

Thus, ‘Mediterranean’ anti-cancer eating, as I see it, isn’t just about eating healthy food. It’s also about consciously developing a health-promoting attitude to food which nourishes body and soul.

Call me a hopeless romantic, but to me, healthy nutrition is about eating natural food grown nearby under open skies, moistened by rain, ripened by the sun and brimming with essential nutrients, simply prepared and enjoyed in a relaxed mood, ideally in the joyful company of fellow-humans. This celebration of the senses and the grateful, guilt-free acceptance of pleasure is one of the best things we can do for our health.

*If you think that ‘chilli con carne’ has no cancer-prevention virtues, let me assure you that my son’s stew contained only 60 grams (cooked) of grass-fed beef per person, supplemented with copious amounts of red kidney beans, five red and yellow peppers, two large onions, 6 cloves of garlic, four large tomatoes, tomato concentrate, generous amounts of cumin, coriander and paprika powder, a pinch of red pepper flakes, raw cocoa powder and a lavish scattering of fresh cilantro. Alongside it we ate steamed quinoa, a tasty, low-glycemic alternative to rice, low-salt tortilla chips (a small bag between 7 people, which yielded 8 chips each. Boy, did the children savour those!), and cubed fresh avocado to scatter over the stew. Bursting with flavour and nutrients, the dish contained little meat, yet it satisfied even the most rabid meat-eater in my family.

Every month I publish two Mediterranean-diet-inspired recipes on my website (click 'my recipes' tab on left menu). They are tasty, simple and affordable -- why not give them a try?

Eat, drink and be healthy!

Want to know a health prescription that's (a) tasty, (b) simple, (c) affordable, (d) thought to protect against cancer, heart disease, depression, dementia and infertility (among others!) and (e) stood the test of time? Look no further: it's the Mediterranean diet!

The traditional Mediterranean diet has garnered much academic and media attention in recent years, but it's no fad diet - in fact, it's been around for millennia. It is rich in protective plant foods, healthy fats and fish and eschews the refined carbohydrates, industrial fats and large quantities of red and processed meat that characterize the typical Western diet.

Over and above merely biochemical considerations, the Mediterranean diet embodies freshness, diversity, simplicity, conviviality and joie de vivre. As a nutritionist, I believe that healthy food should be enjoyable; if it feels like a chore, we won't persist eating that way for long. As a hedonist, the Mediterranean diet pushes all my pleasure buttons - and not just mine, as the huge popularity of Italian and French cuisines around the world illustrates.

From a purely biological perspective, the traditional Mediterranean way of eating is probably the closest thing to the perfect anti-cancer diet. For almost every food that is thought to have anti-cancer properties - such as garlic, onions, tomatoes, leeks, citrus fruit, cabbage, berries, green tea, mushrooms, olive oil, oily fish, nuts, seeds, lentils, beans, aromatic herbs and spices - is an integral part of the traditional Mediterranean diet.

In addition, the region has given birth to a rich food culture that celebrates conviviality, diversity and freshness - all of which boost the healthiness of the food we eat. (Incidentally, when I refer to the ‘traditional' Mediterranean diet, I mean a style of eating that prevailed until the 1950's, after which western eating patterns began making inroads into the Mediterranean way of eating - with regrettable consequences, as we shall see in a separate post.)

In relation to cancer, it is unclear whether the Mediterranean diet actually prevents the formation of tumors, or whether its protective role lies in hindering micro-tumors from developing into full-blown, life-threatening cancer. Whatever the mechanism, scientists estimate that up to 25% of colorectal cancers, 15% of breast cancers and 10% of prostate, pancreas, and endometrial cancers could be prevented if the populations of highly developed Western countries did nothing more than adopt a Mediterranean diet.

The more closely people adhere to the Mediterranean diet, the greater its anti-cancer effect. According to a study conducted in Greece, strict adherence to two elements of the Mediterranean diet - for example, a high consumption of vegetables and a low intake of meat - causes a 12% reduction in the incidence of all cancers. The study shows that the more elements of the Mediterranean diet are incorporated, the greater the protection; thus, simply adhering to four elements of the Mediterranean diet - for instance, by adding a high intake of fruits and legumes to the two measures described above - may reduce cancer incidence by up to 24%.

When combined with other healthy life-style habits, the Mediterranean style of eating can confer even greater protection. A large-scale European study found that people eating a Mediterranean diet who hadn't smoked for 15 years or longer, had regular physical activity and drank a moderate amount of alcohol, were 65% more likely to outlive their peers who had none of these healthy habits, and were 60% less likely to die of cancer.

You might be wondering how to adopt a Mediterranean diet without moving to Greece or Italy (albeit perhaps a tempting thought...). The good news is: you can eat this way wherever you live! Based on ingredients that are easily available everywhere, simple to prepare and delicious, Mediterranean-style eating can be transported to any part of the globe and adapted to local conditions.

During the Anti-Cancer Challenge, I have decided to adopt a traditional Mediterranean Diet following these principles:

The Mediterranean Diet: My Top-10 Tips

1. High intake of vegetables and fruits
2. High intake of olive oil, moderate intake of saturated animal fats
3. High intake of legumes
4. High intake of whole grains
5. Frequent use of aromatic herbs and spices
6. Moderate-to-high intake of fish
7. Moderate consumption of dairy products, mostly as cheese and yoghurt
8. Low consumption of meat and meat products, especially red meat
9. Moderate red wine consumption with meals
10. Enjoyment: taking time to prepare meals and sharing food and drink with others in a convivial atmosphere

Although I do not plan to turn this into a cooking blog, I do hope, over the coming months, to share my passion for Mediterranean food and cooking with you and plan to offer some practical suggestions that may inspire you to adopt Mediterranean eating habits. (If you are interested in Mediterranean-diet-inspired recipes, check out my website, where I publish a tasty new recipe every month.)

WCRF to advise on Anti-Cancer Challenge

Good news: the World Cancer Research Fund (WCRF) has agreed to act as scientific adviser to my Anti-Cancer Challenge. With the help of this highly respected and well-resourced organization, I will be even better equipped to provide reliable and useful information to readers wishing to improve their chances of preventing or overcoming cancer through simple lifestyle changes.

“We are pleased to advise Conner throughout her Challenge,” says Dr Rachel Thompson, science programme manager in charge of nutrition at the WCRF.  “A third of the most common cancers could be prevented by eating healthily, being physically active and maintaining a healthy weight. Unfortunately many people are not aware this. This is why we are pleased that Conner has launched the Anti-Cancer Challenge. We hope her initiative can help raise public awareness about the links between diet and cancer and show how our recommendations can be incorporated into everyday life.”

Regular readers of my blog will have noticed that I frequently refer to the WCRF for information and recommendations. That’s because I consider this organization to set the gold standard for cancer prevention.

WCRF International, founded in 1982, is a not-for-profit umbrella association unifying a global network of cancer charities dedicated to funding research and education programmes into the link between food, nutrition, physical activity, weight maintenance and cancer risk. The national charities under WCRF International’s umbrella are based in the US (American Institute for Cancer Research), the UK (World Cancer Research Fund UK), the Netherlands (Wereld Kanker Onderzoek Fonds), Hong Kong (World Cancer Research Fund Hong Kong) and France (Fonds Mondial de Recherche contre le Cancer).

The WCRF is best known for its landmark Expert Report “Food, Nutrition, Physical Activity, and the Prevention of Cancer: a global perspective” (WCRF/AICR 2007), preceded by “Food, Nutrition and the Prevention of Cancer: a global perspective” in 1997.  The 2007 report is the most comprehensive investigation published to date on the links between food, nutrition, physical activity and cancer prevention and is based on the in-depth analysis of over 7,000 scientific studies published on cancer prevention over the last 50 years. A panel of 21 renowned scientists reviewed the research evidence and drew conclusions that led to the WCRF’s recommendations for cancer prevention, which in turn underlie my own Anti-Cancer Challenge exercise and diet plans.

In February 2009 the WCRF/AICR published “Policy and Action for Cancer Prevention,” a companion publication to the 2007 Expert Report that provides advice and guidance for key groups, such as governments and employers, on what can be done to influence and change people’s lifestyle choices, as they relate to their risk of cancer. All three reports are rather voluminous but quite accessible to lay readers with an interest in health and public policy.

Somewhat less visibly, the WCRF also funds research into cancer prevention; to date, the WCRF global network has funded over £64 million (some $97 million) of research. To see the studies the WCRF has helped fund, click here.

For people seeking hands-on practical advice, the WCRF network supplies a wealth of information free of charge on its websites. The content varies from one country’s website to another, but all the material is equally useful so do consult them all regularly. On the UK website, for instance, you can find an informative blog, tasty recipes and useful information booklets. The US website also offers a frequently-updated blog and research updates you can subscribe to, and more recipes. It may take more than one rainy afternoon to digest all the information available!

For those who do not have any rainy afternoons to spare, I aim to condense some of that information, supplemented with material of my own, on this blog by posting practical advice on healthy eating and exercise. For my Anti-Cancer Challenge, I have put together diet, fitness and sleep guidelines that I plan to follow for a year; to join me in the Challenge, simply click to download these guidelines, print them out, stick them on your refrigerator and off you go!

Do share your thoughts, ideas, suggestions or general feedback with the rest of us – if we all chip in, this blog can become a valuable resource helping people around the world keep themselves and their loved ones healthy.

My Anti-Cancer Eating Plan

Our media rarely stop buzzing with reports about anti-cancer foods. Each time a study suggests that a particular berry, nut or spice may have anti-cancer properties, journalists hail it as a new wonderfood and everyone rushes out to buy it.

As a nutritionist, I welcome information that heightens the public’s awareness about healthy eating. However, when recommendations are contradictory they can become counterproductive.

After years of being told to eat five fruits and vegetables each day, health-conscious eaters were stunned to learn recently that these foods apparently offer only scant protection from cancer. (I will address this in a separate post.) Similarly, while some research suggests that soy food has a cancer-protective effect, other investigations haven’t backed this up. Indeed, some observers warn that soy foods, which contain estrogen-like compounds, may actually stimulate estrogen-sensitive tissues and could thereby promote, rather than prevent, cancer.

It’s not surprising, therefore, that many people feel overwhelmed when trying to figure out what they should eat to help prevent – or recover from – cancer. Indeed, some are so confused by contradictory reports that they stop believing anything they read in the press and revert to their old eating habits, as a recent survey showed.

When putting together my Anti-Cancer Eating Plan, therefore, I decided to base my program on the most unambiguous and reliable data I could find: the World Cancer Research Fund’s Expert Report published in 2007, which analyzes tens of thousands of studies into the food-cancer link and offers practical recommendations based on the findings.

At first sight, the WCRF’s recommendations may seem a little conservative. For instance, their researchers could not find clear evidence that soy, green tea or turmeric – widely touted as anti-cancer foods – are in fact cancer-protective. At best, the WCRF concluded, “there is limited evidence suggesting that pulses, including soy and soya products, protect against stomach cancer and prostate cancer”. Green tea and turmeric were mentioned only in passing. Note: the WCRF report does not say that we should not consume these foods; it simply notes that there is not enough evidence to say that they offer protection from cancer.

What appeals to me about the WCRF’s recommendations, however, is that they are realistic and achievable for almost anyone. For whilst anti-cancer diets involving exotic, unfamiliar or expensive ingredients may suit some people, most of us when faced with excessively challenging dietary change give up and go back to our previous eating habits. Smaller but realistic steps in the right direction may be more effective and sustainable than drastic changes that don’t last. Besides – to some people, implementing just one or two of the WCRF’s recommendations (below) will feel plenty drastic!

My Anti-Cancer Challenge Eating Plan will thus be based on the following dietary recommendations issued by the WCRF:

• Avoid sugary drinks and limit consumption of energy-dense foods (particularly processed foods high in added sugar, or low in fiber, or high in fat)
• Eat more of a variety of vegetables, fruits, whole grains, and pulses such as beans
• Limit consumption of red meats (such as beef, pork and lamb) to no more than 500 g (cooked weight) per week, and avoid processed meats
• If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day
• Limit consumption of salty foods and foods processed with salt (sodium); do not eat more than 6 g salt per day (about 1 teaspoon)
• Don’t use supplements to protect against cancer (exceptions being women planning to conceive (folic acid); vitamin-D-deficient people, and people whose low appetite (illness) or low calorie needs (the elderly) restrict their nutrient intake (a good multivitamin).

Other suggestions and practical tips from the WCRF include:

• Balance your plate: 2/3 of your plate should be of plant origin and 1/3 of animal origin.
• Fish is a healthy alternative to red meat; eat it regularly. Some limited evidence has shown it may help to protect against bowel cancer. 
• Poultry (chicken, turkey, duck – skinless where possible) and other lean meats such as rabbit and venison are healthy alternatives to red meat.
• Cooking methods: baking, boiling and steaming are healthy cooking methods; other high-temperature cooking methods may alter the make-up of foods, especially meat. It is prudent not to consume burned or charred foods frequently or in large amounts.

In order to tailor the Anti-Cancer Challenge Eating Plan to my family’s needs I added a few more items:

• Dairy foods: The calcium in milk may protect against bowel cancer, but milk consumption has been linked to an increased risk of prostate cancer. Moreover, my daughter is allergic to cow’s milk. Therefore I limit cow’s dairy and consume only goat’s and ewe’s milk cheese and yoghurt.
• Foods rich in omega-3: This essential fatty acid is thought to have anti-inflammatory and anti-cancer properties. I eat omega-3-rich foods daily; these include oily fish (sardines, mackerel, salmon, anchovies, herring), ground flax seed, green leafy vegetables, and eggs, meat and dairy from animals fed an omega-3-rich diet. I avoid large fish (tuna, shark, swordfish) because of their potential contamination by mercury or other marine pollutants.  
• Green and white tea: epidemiological studies and laboratory studies in animals and on human cancer cells suggest that green tea may protect against cancer. Since I enjoy its taste, I drink two to three large cups of green or white tea daily.
• Vegetables and fruits: I eat a wide variety of vegetables and fruits, including all members of the cabbage and onion families, mushrooms, red and blue berries, citrus fruit, sea vegetables and carotene-rich vegetables & fruits (e.g. tomatoes, carrots, melon, winter squash, etc). I eat at least 5 portions a day, but I'd like to increase that to 8 a day in the course of the Anti-Cancer Challenge.
• Herbs and spices: I make copious use of fresh kitchen herbs that I grow in my garden or buy at the market (parsley, thyme, coriander, chives, basil, rosemary, oregano) and which are rich in anti-oxidants. I use many different spices such as turmeric, pepper, chili, cinnamon, coriander, cumin, cardamom, paprika, saffron and ginger. The copious use of herbs and spices is a great way of boosting the flavor of many dishes without needing to use salt.  
• I eat seasonal, locally-grown foods: In order to obtain the freshest produce, protect the environment and support the local economy, I buy most of my food (about 75%) at the nearby farmers’ market and directly from local producers. If it’s not in season (e.g. tomatoes in January, cabbage in July) I don’t eat it. I grow some vegetables in my own vegetable patch.
• About 80% of the meals I eat are prepared at home, from scratch: I do not buy prepared meals or processed ingredients except for plain vegetables in jars or cans (e.g. tomatoes, lentils, beans) and occasional condiments (e.g. pesto, ). All meals are eaten at a table, with all family members sharing the same meal. The television is off while we eat and I do not eat in front of the computer or while driving.

Overall, I am happy to say that I already do most of these things. I rarely eat red meat (about 150 g per week at most) and consume lots of vegetables and fruits and small amounts of whole grains. I drink only red wine (a glass with dinner on weekends), and use very little salt in my cooking. 

Not taking supplements will be interesting; for the past 10 years I have taken a pretty high-dose multivitamin supplement and fish oil capsules, and I am curious to see whether not taking these will make any noticeable difference to my health and well-being. No longer being able to rely on the "health-insurance effect" of my supplements will make it imperative that everything that enters my mouth is as nutritious as possible - no room for "empty calories". 

Do you have any dietary cancer-prevention advice that you would like to share with readers? All suggestions welcome!

Food for Life

A keen cook and a self-confessed glutton, I have always been passionate about the selection, preparation and enjoyment of food, though for a long time, the accent was on "pleasure" rather than on "health".

My brush with cancer 10 years ago made me realize that a healthy diet isn't an optional extra but a vital necessity. And so I began eating as though my life depended on it.

While my health has indeed improved, I have been particularly pleasantly surprised to discover how enjoyable a healthy diet can be! To me, fresh, natural food, simply prepared, is incomparably more satisfying and pleasurable than the fatty, crispy, gooey treats I used to delight in. Hold the onion rings - I'll have some crunchy spears of asparagus drizzled with olive oil and lemon juice and dusted with light parmesan shavings, thank you. (What's more, I'll save on antacids!)

Most people, when they think of cancer, rarely think about food. Many hold the fatalistic belief that cancer is largely programmed by our genes and that there's nothing we can do about it (in fact, at most 15% of cancers can be attributed to genetic causes). Even those of us who are aware that life-style plays a critical role in cancer usually think of smoking, alcohol consumption or sun exposure as the main risk factors.

But few consider food as a factor that may contribute to causing cancer. And yet, it is increasingly understood that diets rich in sugar and refined carbohydrates, unhealthy fats, red and processed meat and deficient in nutrient-rich vegetables, fruits, nuts, seeds, herbs and spices, may increase our cancer risk.

Once cancer has been diagnosed, most people embark on the recommended medical treatment: surgery, chemotherapy, radiation therapy or a combination thereof. Very few doctors recommend dietary measures as part of conventional cancer treatments. Medical students are taught only the bare essentials of nutritional science.

Nevertheless, nutrition plays a crucial role, both in preventing and in overcoming cancer. In its landmark Expert Report, the most comprehensive report ever produced on the links between lifestyle and cancer risk, the World Cancer Research Fund (WCRF) estimates that up to 30% of all cancers could be prevented by eating an optimal diet, getting regular physical activity and maintaining a healthy body weight.

Some experts even suggest that some of the commonest forms of cancer, such as breast-, colorectal and prostate cancer, could be reduced by 60-70% and lung cancers by 40-50% if people ate an anti-cancer diet. Even cancer patients undergoing treatment may find this type of diet helpful, some studies suggest.

A healthy diet is certainly not a stand-alone treatment for cancer, nor is it a fool-proof tool for prevention. Modern medical approaches are an essential part of any cancer therapy. Nonetheless, what and how you eat before, during and after cancer treatment can have a crucial impact on its outcome.

Meanwhile, for those of us who are healthy but worry about becoming ill - without prevention, about one in three women and one in two men will develop some form of cancer during their lifetime, the U.S. National Cancer Institute predicts - it's important to know that changes in diet can very much tip the odds in our favor.

By the way, healthy eating isn't just for cancer patients. There are benefits to everyone in a diet that boosts general health and well-being. Thus, an "anti-cancer" diet can potentially help prevent or relieve a long list of other medical conditions, including diabetes, heart disease, dementia, arthritis and even depression.

In addition to helping improve overall health, the anti-cancer diet I follow has no known negative side-effects. In my experience, if there are any "side-effects," they are increased energy, fewer colds and sore throats, clearer skin, better digestion and a happier disposition. Fine with me!

In my next post I will unveil my Anti-Cancer Challenge eating plan for the remaining 11 months of this project, so watch this space.

Month One : Progress Report

It’s been just over a month since I began the Anti-Cancer Challenge. Here’s my first progress report.

(If you have recently joined the Challenge, you can consult my Fitness Plan here and my Sleep Plan here; there are also links to these pdf documents in the right-hand column. I plan to post my Diet Plan this week.)

1.    Exercise 

As planned, I have been exercising every day for about 30 minutes. On some days I have done shorter, more intense workouts, and have thrown in other additional activities such as lawn mowing (very tiring when you don’t know how your new lawnmower’s automatic traction works… My 12-year-old showed me after I had nearly finished mowing our rather expansive lawn!). The only interruption to my exercise routine (past two days) came from stepping on a rusty nail and driving it through my shoe and foot while lawn-mowing (ouch!).

I still struggle to make time for my workouts at the start of the day – I often get distracted by other seemingly important and urgent matters (work, housework, phone calls and other procrastination techniques) and don’t get around to exercising much later in the day, at which point I feel much less energetic. Over the next month, I aim to exercise first thing in the morning, no matter what my house or e-mail cue look like, so I can shower and move on to other things without a guilty exercise deficit hanging over my head.

What has come as a very pleasant surprise is discovering just how invigorating even short spurt of physical activity can be! Not only do I feel proud of myself whenever I have managed to overcome my resistance and moved my body. At a physical level, too, I feel more energetic, more bouncy and resilient. Instead of increasing my desire for food, as I had expected, I’ve noticed that my appetite seems to be curbed for at least 2-3 hours after exercising – quite unusual for a habitual snacker like myself. (Perhaps also because I feel good about myself and don’t need to boost my morale with the help of chocolate…)

Another positive surprise is the fact that little exercise can go a long way. A mere 20-30 minutes’ activity each day (indoor rowing, jogging, weights exercises – all done at moderate intensity) has made a palpable difference to my body shape: certain clothes that felt very snug no longer do so, and I feel stronger and less easily winded. My arms, especially, feel stronger, and the wobbly under-arms I was beginning to fret about as the t-shirt season approached (my son recently called them “Mama’s jelly-arms”) have firmed up. Phew!

2.    Sleep

Writing down all my good intentions was the easy part; now I have to actually put them into practice! I have found it very challenging to get seven hours’ sleep this last month for two reasons:  overwork (I have an exceptionally heavy workload and it will take at least another three months until this abates…) and my children’s two-week school vacation. With more work to do in less time, I have been playing catch-up at night.

I have, however, managed to push my bedtime forward slightly from 1 or 2 a.m. closer to midnight, and the extra 1-2 hours’ sleep have already made a noticeable difference. I have noticed, for instance, that I drink less coffee (1 cup a day instead of 2-3) and have fewer starch- and sugar-cravings. I have also felt a little more mentally organized which I attribute to the mind-soothing effects of sleep.

Alas, I have been waking up quite frequently in the early morning hours to do a spot of nocturnal pondering (mostly work-related). Over the next month, I will try to get a better handle on managing my thoughts and to-do lists during daytime hours to give my mind a break at night (see this post).

3.    Diet

As I haven’t yet published my Anti-Cancer Diet Plan there’s little to report on this front. However, I have been enjoying daily doses of delicious spring vegetables (crisp asparagus, squeaky spring onions, spicy young carrots, tender spinach, pungent garlic shoots) these last two weeks which has felt invigorating and cleansing. I love coming out of winter and eating fresh spring greens; to me, their emergence from the wintry soil symbolizes hope, vigor and resilience.

More details about anti-cancer eating will feature in my Anti-Cancer Challenge Diet Plan, which I will unveil later this week.

My Anti-Cancer Sleep Plan (I'm yawning already...!)

As I sit here at 11.37 p.m., writing, nibbling on a square of dark chocolate and enjoying the peace and quiet of my hushed home, I know that getting regular, restorative sleep will be a formidable challenge for me - harder than exercising daily or eating healthily. Yet, only this morning, when I awoke grumpy and bleary-eyed after yet another late-night work session, I swore that something had to change, and fast.

Having spent the last few posts discussing the importance of sleep for cancer-prevention, it’s about time I stopped talking and started acting! So here’s my Sleep Plan for the remainder of the Anti-Cancer Challenge (330 days to go):  

• I will sleep for seven hours each night. That seems realistic, and is “only” two more hours than I usually accord myself – I should be able to squeeze those out of my busy schedule!  If I still feel groggy on seven hours’ sleep, I will try to extend my sleep duration.
• To make sure that I actually get these seven hours, I will count backwards from my planned wake-up time; thus, if the alarm is set for 6.25 a.m. (my usual weekday wake-up time), I have to switch off my light at 11.30 p.m. (Actually, that doesn’t sound quite as draconian as I had feared!)
• I will give myself 60 minutes’ winding-down time before lights-out. This may include reading in bed for half an hour – nothing work-related, but instead, relaxing fiction or poetry to help me “get out of my head”.
• Some of that winding-down time may also be spent jotting down any items on my “small stuff” list so they don’t keep me up during the night.
• I keep a Sleep Journal for the first few weeks to help me keep track of my sleep hygiene until my new betimes become a habit.
• I will not check emails after dinner (last week an annoying email that arrived at 11 pm kept me up most of the night!); I can read or shop on-line when the kids are in bed, but I commit to switching off my computer at 10.30 p.m. at the latest.  
• I will go straight to bed when I feel tired. Often, when I start to yawn of feel heavy-lidded, I override my body’s cues and push through the fatigue (frequently with the help of chocolate and bread…), making it doubly hard to get to sleep later. 
• I will spend 30-60 minutes daily under open skies and exposed to unfiltered daylight to stimulate adequate melatonin secretion at night (see this post). Outdoors activities such as gardening, exercising, playing with my kids or sitting on the terrace doing nothing (gasp!!) will feature more often in my otherwise house- and car-bound life.  
• I will exercise daily. I don't know whether these is scientific proof that exercise promotes sleep, but I have noticed that it helps reduce my stress levels and shouldern tension, which may make me feel more relaxed when it’s time to go to bed.
• I will avoid heavy meals in the evening, and when I drink wine, I will limit it to one glass (alcohol consumed before bedtime can distrupt sleep). 
• I keep potentially sleep-disrupting stimulants and sugar to a minimum (no coffee after lunch).
• If I am about to “fall off the wagon”, I remind myself that regular sleep allows me to be a happier, healthier woman with fewer wrinkles and stable weight, a more patient, energetic and resourceful mother and a congruent health practitioner who practices what she preaches.
• And if I do stray occasionally, I won't lose sleep over it. Slips happen.

There – that should get me started! I'd love to hear how some of you make sure that you get the sleep you need - any suggestions?

Next week I will unveil my anti-cancer eating plan, the third cornerstone of the Anti-Cancer Challenge. Meanwhile, have a restful weekend!

Lie back and think of -- nothing!

When I go to bed at night I switch off my light, lower my head on my pillow and wait for Morpheus to cradle me in his sweet embrace. (No, not my husband – this is Morpheus, the Greek god of dreams.)

But while my body is willing, my head won’t follow. For as soon as I want to let go of the day’s cares, I am assailed by half-finished thoughts and an army of to-do-list items marching through my weary mind.

First, I pass review of the Small Stuff: for instance, rescheduling the cat’s vet appointment. This reminds me that I have to make a doctor’s appointment for my son. And book dental check-ups for the twins. Since I’m on appointments, I make a mental note to confirm a birthday-party invitation for my daughter, which in turn reminds me that I have to buy a birthday present for her little friend. Oh, and order that DVD my older son wants for his birthday. For the next five minutes I reel off a list of dozens of things I need to do in the next few days. I grow increasingly tense wondering whether I’ll be able to remember them all by the time the alarm rings the next morning.

This leads on to Medium Stuff: my book that awaits publication, blog posts requiring writing, cooking classes demanding preparation, recipes that want testing, tax declarations, work and family administrivia (and not-so-trivia) that are running late. By now, I’m feeling downright anxious.

From here, it doesn’t take a big step to get to the Big Stuff: the state of the economy, my children’s future, my ageing parents, climate change, and eventually – inevitably – Life, Death and Forgiveness. The script is depressingly familiar, and yet each time it fills me with fear and loathing.

At this point, sleep has become an entirely unrealistic proposition. I get up, pad downstairs and read a boring book to lull myself to sleep. This can take up to an hour. The next morning I’m so tired I feel I need a coffee just to find the coffee!

I have one or two nights like this each week; either my thoughts prevent me from getting to sleep in the first place, or I awake in the middle of the night and the unrelenting cycle of nocturnal ponderings begins anew.

I don’t consider myself to be a particularly tormented soul; it’s mostly a function of having a very busy life and not sorting out my mental clutter before I go to bed. As part of my sleep challenge, therefore, I want to find ways of calming my pointless night-time chatter. Because, let’s face it, night-time ruminations aren’t Quality Thinking Time: I rarely get any real problem-solving or creative thinking done, and in the bright light of day many of the concerns that kept me up at night seem ridiculously small and perfectly manageable. So here’s what I’ll do.

Small Stuff first: I will keep a note pad next to my bed, and before settling in for the night, I will write down any niggling concerns that I haven’t been able to attend to during the day. When I can think of no more items to add to my list, I tell myself: “That’s all for today. You can stop thinking now.”

Medium Stuff: I will keep a comprehensive list on my computer (Microsoft Outlook has a to-do-list-function that includes deadlines and reminders) of the important and/or urgent jobs that need doing and consult it every morning when I begin work, aiming to deal with at least two items before attending to anything else. (I already do this – kind of. For while I often add items to my list, I rarely get around to doing them – just writing them down feels like they’ve been taken care of...)

Big Stuff: this is the most complex nighttime cogitation-fodder, and that which has no Easy Answers. Here’s where taking quiet time to think – and to “not-think” (i.e. meditate) – may help bring some peace.

Talking to loved ones about unresolved conflicts or worries is also important – something I keep putting off, but that keeps coming back to haunt me. So I will schedule time to talk with them, trying to say what needs to be said in the hope of bringing greater clarity and peace to our relationship and to my frazzled mind. And in case my approaches fall on deaf ears, learning to accept things I can’t change and not dwelling on them also strikes me as useful.

Liberating snatches of Quiet Time during the day to “let dangle the soul” (“die Seele baumeln lassen”), as German writer Kurt Tucholsky put it so evocatively, will be a challenge. But my mind has a way of getting what it needs, and if I don’t give it time during the day, it will steal it from me at night.

Turns out (as usual) I was trying too hard

I am the sort of person who tries too hard, and for many years this has been undermining my health and happiness.

When I cook, I strive for the perfect meal. When I write, I want the ultimate piece of prose. When I speak a foreign language, I seek flawless pronunciation. And when I exercise, I expect high performance and constant improvement.

See how I set myself up for failure?  Because, being human, I often don't meet my objectives. And so when I burn the cabbage-and-carrot stir fry, as I did last night, write a less-than-riveting blog post or mispronounce a word in French, I feel bad and put myself under pressure to do better next time.

A case in point is exercise. For many years I have made sporadic attempts to get fit. Since jogging seemed a cheap and universally popular form of exercise, I made several attempts at learning to like it. I would don my running shoes and pound some pavement, but invariably, within 10 minutes or so, I would start to suffer stitches, aching joints and pant like an exhausted greyhound.

Immediately I would be assailed by negative messages from deep down inside: “You’re hopelessly out of shape, you’re weak-willed and at this rate you’ll never get fit, slim and healthy!” I would limp home dejected and eat a butter croissant to make myself feel better. It would take at least a week before I could muster the courage to try exercise again, this time choosing a “safer” option like swimming or cycling (avoiding all elevations).

Now that I have vowed to exercise daily as part of the Anti-Cancer Challenge, and in fresh air when the weather permits, jogging once again has become an obvious choice; but as I contemplated my running route this morning, I felt the familiar dread of not being up to the task. So I decided to take a new approach to jogging by using my heart beat monitor for guidance.

Bearing in mind that my target range for “vigorous exercise” is 130 to 140 heartbeats per minute (bpm), I decided to keep within those parameters. Amazingly, it was one of the most enjoyable workouts I have ever had! Want to know why? It’s simple: all these years I had been running too fast and pushing myself too hard!

When I left the house, the heart rate monitor indicated about 85 bpm. A few minutes’ brisk walking raised it to 120 bpm, and after a few minutes of steady, comfortable shuffling, I was at 145 bpm – and it felt perfectly comfortable!

Granted, the fact that a modest exertion pushed my heart rate to 145 bpm suggests I’m not terribly fit. But the point is, running any faster would have pushed my heart rate well above my target zone, i.e. well above my comfort (and possibly safety) level!

So looking back, I realize I had always been jogging too fast, which had the undesired effect of making me feel more exhausted and demoralized than if I had just stuck to a realistic performance target and actually enjoyed myself!  For – who would have thought! – this morning’s run was such a positive experience, it left me wanting more!

How do my heart monitor’s teachings translate into the other domains of my life? Perhaps it’s telling me I should aim for more realistic results, rendering me less vulnerable to disappointment and allowing me to derive more joy from cooking, writing and speaking French. Sometimes, less is more.

Keeping track of lost snooze-time

As regular readers of the Anti-Cancer Challenge know, I am planning to get more, and better-quality, sleep during the next year (and beyond, hopefully).

I have been feeling decidedly groggy these last few months due to working late, or tossing and turning in bed because I hadn't given myself time to wind down before bedtime. And upon researching the subject of sleep I have become increasingly aware that that insufficient or disrupted sleep may increase our risk of disease: not only cancer (see this recent post), but also diabetes, heart disease, a weakened immune system, inflammation and weight gain.

Fatigue can even kill: driving while tired has similar effects to being drunk at the wheel. The American Academy of Sleep Medicine estimates that one in every five serious motor vehicle injuries is related to driver fatigue, with 80,000 drivers falling asleep behind the wheel every day and 250,000 accidents every year related to sleep. 

Not surprisingly, sleep is also vital for our emotional well-being; conversely, sleep deprivation is thought to increase the risk of depression, stress and anxiety and exacerbate pre-existing mental illness. I certainly have noticed that I relate more easily and joyfully with the people around me when I have slept enough: I am less easily irritated, more patient and altogether more positively inclined toward my fellow-beings.

However, in our fast-paced world it is often hard to get sufficient sleep. Some of us work late into the night (that would include me), others while away the hours surfing the internet to shop, book holidays or catch up on their reading (ditto), and others again seek entertainment from movies or video games which are so stimulating they then find it hard to wind down and get to sleep.

However, many of us are not aware that we're not getting enough sleep. We think being tired and craving coffee and starchy foods - especially in the afternoon - is a normal fact of modern life. And those of us who do realize we should sleep more often don't know where and how to carve out the extra snooze-time.

In order to chart my sleep behavior and find out where I can make improvements, I have designed a weekly Sleep Journal. Those of you joining me on the Anti-Cancer Challenge and seeking to improve your sleep can print it off here. 

You may think I am obsessed with charting. Admittedly, the Sleep Journal comes hard on the heels of the Fitness Diary and heralds the advent of - you guessed it! - the Food Log!  In the arena of weight-loss, however, journaling has been shown to be effective in helping people shed pounds, and so I have decided to apply the same logic to sleep-loss, or rather, gain!

Before we can change our behavior, we need to know first of all what exactly our behavior is! Once we understand where and why we waste precious sleep time (maybe it's not always as important as it seemed at the time?) and discover what our optimal sleep duration is (some of us need more than others), we can leave the journal behind. But for the next few weeks, this document will be my faithful companion!

Sleep: the missing link?

When I launched the Anti-Cancer Challenge I had an intuitive sense that it should include regular, restorative sleep, even though it's not a risk factor many people associate with cancer.

For one, my body has begun telling me that it isn't too happy with my irregular sleep patterns. It's not just that I feel a little tired during the day - that, I can live with. But I have noticed that I'm more prone to colds and infections during prolonged periods of sleep deprivation - when working night after night to meet a deadline, say - than when I'm getting  7+ hours of sleep a night.

Moreover, when I'm missing out on sleep repeatedly, my menstrual cycle shortens and I experience more noticeable PMS symptoms. At first I put this down to approaching menopause, but then I noticed that whenever I managed to sleep more regularly, my cycle would revert to its previous clockwork regularity.

Talking with the people around me, I gather that quite a few of us struggle to get restorative sleep. In many cases, the problem may lie with too muc exposure to artificial light, both at night and during the day.

Prior to the industrial era, humans were exposed to bright, full-spectrum sunlight during the day and to complete darkness at night, and their body clocks closely matched this natural cycle. Since the advent of electric light some 120 years ago, however, our exposure to natural light has been significantly replaced by artificial lighting. Moreover, westernized societies are 24/7 communities where many of us are being exposed to artificial light during the night both at home and particularly in the workplace, thus disrupting our natural circadian rhythms.

Exposure to light at night interferes with melatonin, a hormone involved in a multitude of bodily processes including cardiovascular function, bone metabolism, hormone balance and cancer development and growth. Melatonin is produced in the pineal gland at night, when it's completely dark. When we are exposed to light at night, however, melatonin production is suppressed and this in turn may increase cancer risk though a variety of complex mechanisms.

Studies have shown that melatonin inhibits the development and growth of experimental models of breast cancer, whereas exposure to constant light stimulates mammary tumors in laboratory animals. Epidemiological studies back this up; they show that women working night shifts have a significantly elevated risk of breast, endometrial and colorectal cancer, while male night-shift workers are at a significantly increased risk of developing prostate cancer, presumably due to their increased exposure to light at night. (Read this excellent review for more details.)

Highlighting the seriousness of the problem, the World Health Organization's International Agency for Research on Cancer (IARC) concluded in 2007 that "shift work that involves circadian disruption is probably carcinogenic to humans."

But it's not just night-time exposure to light that's a problem. As a reader of my Psychology Today blog "Nourish" helpfully pointed out, nocturnal melatonin production is also strongly influenced by how much daylight we are exposed to. A Japanese study found that spending one's day in dim indoor lighting leads to a weaker increase in melatonin levels at night than being exposed to bright outdoor sunlight. Thus not only shift-workers, but anyone leading an indoor and in-car lifestyle, like me, may be affected.

On the other hand, sleep duration - number of hours slept - is less clearly linked to cancer risk; indeed, epidemiological investigations have yielded ccnflicting results. While a Finnish study indicated that women sleeping 9 hours a night or longer were 31% less likely to develop breast cancer than women reporting 7-8 hours of sleep per night, a British study found no significant difference in the breast cancer risk of those sleeping 9 hours or more and those getting less sleep, and a third study actually detected a small increase in the breast cancer risk among women reporting more than 9 hours of sleep.

Conventional wisdom holds that 8 hours of sleep are "normally" required for optimal rest, but not all experts agree. "The fixation on sleep duration is unhelpful," comments Kevin Morgan, Professor of Gerontology at Loughborough University. "Sleep needs vary enormously from one person to another." As he sees it, the best criterion to measure sufficient sleep is "whether we feel restored by our sleep and are able to do what we need to do throughout the day." Age and gender also influence how much sleep we need, he says, making it impossible to set a "correct" number of hours people should sleep each night.

So where does all this leave people like me, who are not exactly shift workers but do spend a large portion of their nocturnal hours bathed in artificial light? David Blask of the Tulane University School of Medicine, New Orleans, speculates that non-shift working individuals who are not melatonin-deficient but who are chronically sleep-disturbed or deprived for other reasons may be at greater risk of developing cancer "due to the independent effects of immune suppression induced by sleep deprivation," though he notes that this hypothesis needs to be tested through more research.

What does this mean for my sleep challenge? I am still piecing together the puzzle, but initial conclusions are emerging. One is that sleep disruption and night-time work may have a negative effect on my immune system and overall hormone balance - as witnessed by the symptoms described above. In addition, daytime exposure to full-spectrum light is something I should increase from current near-inexistent levels. (Lighter, warmer spring and summer weather should help.)  I don't plan to sunbathe - another cancer risk! - but exercising outdoors rather than in my living room would be a good place to start.

Moreover, sleeping in a fully darkened bedroom should help stimulate melatonin production. And while sleep duration may not be directly relevant, I will try to increase mine a little for I do not currently meet Professor Morgan's criterion of feeling "restored and able to do what I need to do throughout the day."