Ian Gawler blog: Body weight and cancer

After last weeks recipes, lets go “Out on a Limb” again and tackle a vexed issue – body weight and cancer. What is the effect of too much or too little weight?

The context is the rising epidemic of a new form of disability called obesity. Today, around 34% of Americans are obese while a further 30% are overweight. Australia has similar statistics and along with the USA and Britain is among the countries with the fastest growing obesity rates.

Obesity means being roughly 30lbs or 13.5 kgs over a healthy weight. It is a significant risk factor for cancer, as well as heart disease, diabetes, MS and other diseases.

Treating obesity, according to mainstream medicine requires a multipronged approach including strong policy measures, lifestyle counselling and individual management. Disturbingly, lap band surgery (which shrinks the size of the stomach) is becoming one of the most common treatments for obesity.

But that is just the context. We all know about it. Lets tackle the other end of the spectrum – weight loss associated with cancer.

One of the most common questions I am asked about food is “will this diet cause me to lose weight?”

Here is the simple answer. A healthy, well balanced diet, whether intended for maintaining good health or to facilitate healing, must by definition lead to a healthy, well balanced body. As such, a good diet must support healthy weight.

I suggest that the diet put forward in “You Can Conquer Cancer” (YCCC) is a healthy, well balanced diet. After nearly 30 yrs of experience I can say that people who follow these suggestions consistently tend towards a healthy body weight, commonly a little on the lean side. It is well known being lean has huge health benefits when compared to the risks associated with being overweight or obese.

On this diet, those who are underweight tend to put it on; those overweight tend to lose it. When you consider around 60% of the population are overweight or obese, most initially do lose weight on this diet – and that is a good thing!

The recurring problem I find among people with cancer is the fear of weight loss. This fear seems to be fed (pun intended) by many doctors and other health professionals, including dieticians. Why?

Maybe it is because weight is easy to measure and is taken fairly reasonably to be a good measure of overall health. Put on a few pounds when you have cancer – that’s good. Lose a few pounds – that’s bad. And this despite the 60% who will benefit from losing some weight.

But there is another crucial issue – cachexia. Cachexia is the medical term for weight loss (specifically muscle mass) resulting from disease, in this case, the cancer itself. Cachexia is recognised as having multifactorial causality and is actually one of the most common and problematic signs of advancing cancer. However, in my experience, further difficulties often come from the way blame is assigned for it.

Over the years I have observed numerous people with advanced cancer and cachexia who were on what I considered to be a sound diet (following YCCC). They were losing weight because of their illness, yet some health professionals blame the diet for the weight loss, not the disease. Further, these same professionals often recommend patients to eat lots of high protein, high fat, high caloric foods, frequently encouraging them to consume junk food. While it can be helpful to modestly increase protein intake, care is required. High protein, high fat and high caloric intake are all risk factors for cancer. There cannot be many diseases where the risk factors are recommended for those working on recovering from that disease.

Prof Dan Nixon was a mainstream Oncologist before he researched the treatment of cachexia. In a landmark study he force fed (willing) people with advanced cancer and was shocked to find they died much quicker than those on standard diets. The rational that explains this outcome is strong if somewhat complex. It is to do with glucose metabolism and the impact of insulin on immune function and healing.
Dan Nixon went on to become a world authority on cancer nutrition.

So what to do?

1. Consider this: body weight is a function of several things including:

. Intake – what we eat.

. Digestion – which can vary amongst individuals and be diminished by old age and disease.

. Metabolic factors – some have racey, inefficient metabolisms (and lose weight easily); some slow and efficient (and gain weight easily). Cancer can affect metabolism.

2. The 3 factors above inform what to do:

. Intake – ensure adequate amounts of good quality food. If appetite is low, graze. Often when not well, a large meal can be off putting, but you can consume a lot by nibbling throughout the day. Consider adding more juices and smoothies. Make sure protein levels are adequate but not excessive.

. Digestion – consider supporting it by:

- chewing well so that all you swallow is like well mashed ripe bananas. Physical digestion starts in the mouth.

- boosting stomach acid with fresh ginger.

- aiding bowel flora with yoghurt or supplements

- if necessary, eat more easily digestible foods such as soups, juices and even white rice rather than brown.

- eat with gratitude and calm; breath, relax and smile.

. Output – paradoxically perhaps, exercise aids healthy metabolism and body weight – again, mostly through the insulin axis. Even when not so well, regular exercise (3-4 or more days per week) that is within manageable limits is highly recommended and supported by good research.

. Metabolic factors – for those with cachexia, it still makes sense to eat well. Remember that being on the lean side makes reasonable sense, but certainly if someone is really underweight it makes just as good sense, and in fact it is imperative to get good professional advice. The recommendations here are very general and intended to stimulate thought and discussion rather than being for specific advise.

But to be blunt – there is more chance of recovering on a good diet than a crappy one. As well, if I thought I actually was close to dying, I would be even more attentive to what I was eating (and I eat pretty well anyway!) as my experience is that a good, healthy diet minimises side effects and makes the process physically easier.

The fact is that when I was close to dying of cancer 35 yrs ago, I was very particular about what I ate and I was fortunate to recover. In my mind there is no doubt the diet was an important part of that recovery.

Good luck and enjoy your food.

RESOURCES:

Books: You Can Conquer Cancer: Ian Gawler
             Taking Control of MS: George Jelinek
             The Cancer Recovery Eating Plan: Dan Nixon
              Life over Cancer: Keith Block

CDs:      Eating Well, Being Well: Ian Gawler
              Eating for Recovery: Ian Gawler

Related Blogs: Good food prepared quickly
               Big Mac or a salad?
               Eating for recovery
               What food goes into your tank?

Programs: The Gawler Foundation.

Ian Gawler blog – Good food prepared quickly - : - Free spirit pasta and vegetables

People often ask me how long does it take to prepare really healthy meals? The truth is that once you know how, it can be really quick.

Here then is my all time favourite quick food recipe. Ruth and I both cook this regularly. It is yummy, really healthy and takes about 20 – 30 minutes from its beginning to presentation at the table.

A. The principles:

1. There are an infinite number of variations with this recipe:

i) Use any form of healthy pasta or noodles (we eat a lot of buckwheat or soba noodles).

ii) More variety comes with using whatever vegetables are fresh from your garden or what looks good in the organic shop and is in season for your area.

iii) There are 5 basic sauces; each can be varied a good deal.

iv) There are high protein options for further variety.

2.  It is called  ‘Free Spirit” because no quantities are given.

You get to experiment. With the vegetables, use about equal volumes of each one that you do use. With the sauces, add more or less herbs, ginger etc to suit your own taste. Do not sweat on the details. Use what feels good on the day. It is very easy to produce something that tastes terrific!

B. Start with the right attitude:

It takes no longer to enjoy cooking this recipe. It always helps to be grateful for the food you prepare and do get to eat; some like to say a formal grace. Food preparation can be an excellent time to practice relaxation in daily life. Cooking can also be a great focus for mindfulness – meditation in action.

C. What you need for this recipe:

1. Two saucepans – medium sized, stainless steel (or anything else other than aluminium) with lids, and a stainless steel strainer for the pasta.

2. Seasonal vegetables – around 5 -6 varieties (more or less as you like) of whatever is ripe from the garden or fresh from the organic shop, and a good vegetable cutting knife.

3. Be aware of roughly how long each vegetable takes to cook. You add the slowest to cook first and finish with the quickest. Here is a rough guide to cooking times and the order in which to add them to your pot:

i) Long cooking times: Onions, potato, sweet potato, pumpkin, egg plant, leek.

ii) Medium cooking times: Brussel sprouts (best cut in half if big), carrot, cauliflower, broccoli.

iii) Zucchini, squashes, silver beet, cabbage (best cut fine), spinach.

Tomatoes are best added early so they break down well, especially if you are using fresh ones for a sauce.

D. The Preparation:

1. Check your attitude, relax and smile.

2. Heat two saucepans:

To one saucepan, add ¼” (1cm) water. Add the lid and begin to heat flat out. This is for the vegies and sauce.

For the other, ¾ fill it with water, add the lid and place on medium heat. This is for the pasta.

3. Prepare the vegetables:

Clean and then dice each vegetable into cubes about the dimension of your thumbnail. Start with whatever takes the longest to cook (usually onions), add it to the pot with the small amount of water and replace the lid. At this point, the water in this pot should be boiling, so now turn it down to a moderate heat. Continue to add the other vegetables in order; just as quickly as you finish cutting each one.

If you use potato or pumpkin, dice them into small cubes so they do cook quickly. Experiment with this as well as the softer vegies like broccoli and zucchini so they do all finish cooking at the same.

4. Optional high protein – one of the following can be added if you choose:

i) Tofu – cut into small cubes and add towards the end of the cooking.

ii) Beans - either fresh; dried, pre cooked in a separate pot, and added once all the vegetables are cooking; or from a can

iii) Canned tuna – add towards the end of the cooking.

iv) Fresh fish or seafood – can be made into a full marinara sauce, or you can add just fresh fish about halfway through the vegetable cooking so that it steams in time to be cooked as all else is. Then you simply and gently break the cooked fish into small pieces and stir through the vegies.

5.Prepare the sauce – there are 5 basic variations; each of which is added and gently stirred through the vegies at the time indicated:

i) Naked sauce:

Simply have the vegies as they are, eg no sauce.

ii) Tomato base sauce – there are 2 ways to do this:

a) Fresh tomatoes – the preferred version if time and fresh produce permit – add as many tomatoes as you like once the onions are cooking, or use as the first ingredient if no onions are used. With the latter method, another variation is to use minimal water in the vegetables’ saucepan, start with the tomatoes and rely on the liquid from them to help with cooking all the vegies and avoiding having them sticking to the saucepan or burning.

b) canned or bottled tomatoes – add as much as you like once all the vegetables are cooking and the pasta is under way.

iii) Herbs – add to taste using the following instructions:

a) Ginger, garlic or tumeric – add after the first 2 or 3 vegies.

b) Any other herbs – add once all the vegies are in their pot. Of course, basil goes well with tomatoes, as does oregano; but again, be free spirited and experiment.

iv) Pesto – commonly is used on its own without vegetables, but experiment – it does go surprisingly well with some vegies.

v) Miso – pre mix a tablespoon or two of miso with a little warm water and add once the vegies are cooked.

6. Preparing the pasta:

Once all the vegetables are cooking, the water in the other saucepan should be boiling. Experiment with the heat levels on your stove to get this timing roughly right.

Add your chosen pasta and cook to its particular specifications.

7. Use your free time:

While the vegies and pasta complete their cooking, tidy up and wash the gear used for preparation. Relax and smile; maybe check on the vegies, stir if you like or if it is needed!

8. Serving:

i) Once the cooking is complete, turn off both saucepans.

ii) Drain the water from the pasta. Remember to rinse them if they are soba noodles.

iii) Add the noodles to bowls. Add 1 -2 tablespoons of good oil –preferably flaxseed, alternatively olive- and gently mix it through. Add the vegies with their sauce on top and serve.

9. At the table:

If you choose to, add low salt, organic tamari to taste.

Give thanks (say grace formally or informally).

Relax, smile and chew well. Enjoy!

10. Timing:

Once you are familiar with what to do, all this usually takes less than half an hour. It is quick and easy and really healthy.

Free spirit pasta and vegetables.

Enjoy!

Feel free to share this with a friend. Try it yourself and let me know your favourite variations.

Related Blogs:

Big Mac or a salad?  29 Nov 2010

Food 101 - What fuel goes into your tank?  18 Oct 2010

2011 - Ideas and treats

2011 was the year I turned 60 and stood back from my usual activities to review and reflect. The blog of 13/12/10 summarises something of this ongoing process. Now for some personal thoughts on the future; and in this blog a few modest suggestions.

The question is, how to be most helpful? How to help the most people possible? My own focus for helping people is through healing – healing the body, healing the emotions, mind and spirit.

There would seem to be three primary avenues for healing – conventional medicine, complementary and alternative medicine, and lifestyle medicine.

Over my 30 yrs in this field, I have observed some real progress. Meditation, for example has gone from alternative, to complementary, to mainstream. Great progress. But some aspects of things like nutrition still seem more on the alternative end of the spectrum, and lifestyle medicine itself seems under-recognised and under-valued. There is much to do.

My focus for the years ahead will be on working in this arena of lifestyle medicine and hopefully contributing to its ongoing development. The appeal is that lifestyle medicine focuses on what a person can do for themselves – diet, exercise, meditation etc, etc. It complements all else. It is cheap to teach, easy to learn. You can take it anywhere, do it any time. It has very few side-effects except chronic good health and its research base is strong. Perhaps its big downside is that financial support for it is limited. Currently this is a non-corporate venture – with no pills or products to sell, just techniques that empower all who learn them to better manage their own health.

For myself, lifestyle medicine neatly divides into 3 broad areas:

1. Healing – and I remain committed primarily to working within the cancer field; although lifestyle medicine has direct relevance to all illnesses and to disease prevention.
2. Wellness – and I wish to continue my long-term passion in this field too.
3. Spirituality – which is really about finding long-term, sustainable happiness – the area that underscores all that I am interested in.

For the immediate future, writing is a commitment. The blog will continue. I have just completed a major rewrite of my old “Imagery” book that will be released in May as “The Mind that Changes Everything”. Next comes an extensive rewrite and update of “You Can Conquer Cancer”. Along with this, I continue to explore avenues for using the new technologies usefully, and I will begin to present workshops again later in the year. More on this later.

I welcome feedback or suggestions for “You Can Conquer Cancer” – elements you feel need more or less coverage along with feedback and stories you can offer.

Also, if anyone has interest or energy for these plans and share in the vision of taking personal health empowerment to more people through a lifestyle-based approach, please do contact me, either through the comments section below or writing to PO Box 575, Yarra Junction, Victoria 3797, Australia. (I still prefer letters to emails although I seem to be doing more of the latter these days!)

Three suggestions for 2011:

1. New Year’s Resolutions are just that – resolutions! Definitions are so useful: “resolution: determination, firmness or steadfastness of purpose. The act or an act of making up one’s mind, a positive intention”. (The Oxford). Most New Year’s Resolutions fail because they lack most or all of the above. On the surface there can be all sorts of excuses, reasons, evasions; but in essence we change habits and we begin things anew when we put our mind to it and make a firm inner commitment. Think about it. It really is all in the mind.
2. A Suggestion: Adopt the habit of gratitude. Research shows it to be a powerful antidote to depression. Experience proves it to build inner peace and wellness – a positive, healthy state of mind. Each evening as you get into bed, dwell on three things from your day you can be grateful for. And if during the day you find yourself lapsing into feelings of gratitude for even the most ordinary of things, that would be OK too.
3. Treat yourself:

•  Listen to Margaret Throsby interview Bruce Lourie, Canadian environmentalist who has a lot of important things to say about the chemicals in our lives, the effects they are having, and what we can do to minimise the damage.
• Watch George Jelinek on the ABC’s 7.30 Report discussing the very positive research findings published on our MS programs.

As there is a steady influx of new people reading the blog, it may be helpful to point out a couple of related posts from earlier times, so here goes:

1. 2010 in Review - 13/12/10
2. Meditation and Satisfaction – 5/10/10
3. In the Beginning – 4/10/10

Ian Gawler Blog – Love and its Conditions

Christmas is the time when we celebrate the birth of Jesus Christ. Christ quite literally represents the embodiment of pure love, unconditional love.

Now there are many forms of love in this world of ours. There is love for a parent, for a child, for a lover, an animal, a thing, a cause etc.

These worldly loves often have an element of the relative about them. Relative in the sense that there are conditions: I will love you if… (you love me back, make me laugh, look after me...etc). I will love you when… ( you have a better job, loose some weight, do not get so angry…etc). I will love you if…etc, etc.

It is easy to observe many people are confused by these different aspects of love. This was often apparent after people came to any of the Foundation programs, particularly the residential ones.
The fact is that these programs reliably bring out the best in people. Participants quickly come to really care for each other. The staff consistently put their own issues aside and really care for the participants, People begin to feel something of that unconditional love.

As an aside, it is my sense that it is just this, the experience of unconditional love, that often explains the wonderful, positive and often profound transformations that occur during the programs in the physical, emotional, mental and spiritual health and wellbeing of participants.

But then, as these people  head home, often they experience the confusion that many others feel independently of attending such a program. If pure love is unconditional, and I want to love all, how do I manage the difficult people in my life?

The key resides in understanding the difference between relative and absolute. This is one of the great gifts of examining our minds. When we do so, we realise there is relative and there is absolute. On the absolute level we all have an intrinsic goodness, an intrinsic purity. In Christianity we say we are made in God’s image. Cannot get much purer than that. In Buddhism we say that in their essence, everyone has Buddha nature – again that notion of fundamental goodness and purity.

Yet on the relative, worldly level it is clear peoples’ actions, emotions and thoughts can be complex and often problematic. The fact is some relationships can be very difficult, even quite toxic and there may well be a need to discriminate about whom we hang out with!

Now it is true that difficult relationships can teach us so much about ourselves, about patience, tolerance, compassion etc. And enduring some relationships can lead to healthy outcomes for all. However, in some situations it can be clear that to remain in a relationship will only create more problems and it may well be the loving thing to avoid such a relationship.

Personal awareness requires discrimination. It is not about suffering endlessly, it is not about neglecting the treatment of illness or the working on difficulties. It is about right action. Working as much as possible from a position of unconditional love, recognising the fundamental goodness in all and so having a deep respect and real compassion for all, while at the same time recognising the limitations of others and ourselves. Doing the best we can and making every effort to continue to learn and to be a better person. To be increasingly comfortable with our own capacities and those of others.

Christmas then is a perfect time to contemplate the place of love in your life. To consider when for you love is unconditional, when it is more like a deal with its conditions, and when it is better avoided. Christmas often brings families together in a way that these issues are brought to the fore, so be gentle on yourself and others, take time to contemplate and meditate and may you experience something of the true meaning of Christmas – unconditional love.

Next Blog: I had pre-empted writing something about 2011 for this post, but love just took over! So there will be a short break until the New Year and then, all being well, some thoughts on the year to come.

May you have a joyful Christmas and a meaningful 2011.
  

Ian Gawler Blog - MINDFULNESS REVISITED

This week we have two guest contributors – Dr Craig Hassed and Paul Bedson. Both are friends and colleagues; Craig lectures at Monash Medical School and has regularly presented at Gawler Foundation cancer programs for around 10yrs. Paul and I worked together for many years and co-authored "Meditation an In-depth Guide". Both are experienced authorities on mindfulness and meditation and have responded to my blog: “Go with the flow or intervene”(see the blog below of 16/11/10), where I suggested there was potential confusion in the way mindfulness was being currently defined and used as a word.

But first some practicalities. Next week we are upgrading the database for my blog and website so it becomes easier for you and more efficient for us. You will receive email notification of this. If you choose to be removed from the database do nothing. However, importantly, if you choose to continue to be on it, you will need to confirm by simply clicking on the link provided.

Here then is Dr Craig Hassed on mindfulness and meditation:

"In regard to the question and answer, there is a lot in what you say but it would be my view that you have not accurately portrayed mindfulness and have drawn a false distinction. The reason for saying that is because all of what you say about discernment and getting to know our minds ('selves') better is exactly what mindfulness teaches us.
The short and apparently one dimensional definition from Jon that keeps getting cited does not provide a full account of all that mindfulness offers. That is probably why Jon's books on the subject are 500 pages long and not just one line.
Mindfulness meditation is the cornerstone in how to live mindfully - i.e. consciously and with discernment. It is exactly because it teaches us much about ourselves that it helps so much with conditions like depression, and fosters things like emotional regulation and self-awareness.
To say that mindfulness is just paying attention is true on one level - like saying that an elephant is a big animal with four legs and a trunk. It doesn't tell us anything about its functions - i.e. what the elephant can do.
The'non-judgmental' attitude, I believe, nearly always gets misrepresented. The judgments of the ego - e.g. deeply personal, biased and reactive - and seeing the dream-world we tend to live in within our own imaginations, are just the kinds of thought processes that one begins to see more clearly and objectively through the practice of mindfulness meditation. The judgment of inner wisdom, which is impersonal, objective and arises from equanimity, and which we could call discernment (or buddhi in Sanskrit),
and the capacity to be more in touch with the reality of the present moment, are strengthened and stabilised through mindfulness meditation and mindful living. One cannot make rational decisions without it.
The point you make about cocooning oneself from major challenges that one is not yet strong enough to deal with is a valid point. Like weight lifting, leave the heavy weights alone until you are trained to lift them.
So, sorry Ian, I can't really agree with the main theme of your blog. There are, I believe, similar false distinctions made between 'mindfulness meditation' and 'stillness meditation' - as if mindfulness does not help to bring one to stillness - which I have often heard mentioned by various people."

And here is what Paul Bedson has to say:

"In places I have some different emphasis to you:
I don't distinguish mindfulness from meditation, after all we have written a book on meditation using mindfulness. Nor do I distinguish meditation from living in the world ("coming out of the cocoon").
Mindfulness into Stillness meditation connects us with the inner cocoon of awareness, stillness and spaciousness that are our true nature. Connecting with this cocoon actually liberates the mind from some of the distinctions between self and other, inner and outer. The inner cocoon then opens us to the outer world, it travels with us to remind us that we are not separate, it provides us with resources of wisdom and compassion to be in the world.
Formal meditation helps to reconnect us with the inner cocoon which opens into life. The distinction between inner and outer is misleading and can be healed through meditation .
When you say "meditation is a way of getting to know the mind" it sounds a bit like a cognitive process.....I think of meditation as a way of abiding in our true nature. Out of that abiding insight comes as some illusions start to dissolve (healing comes out of the abiding as well). The Masters did not need to learn the wisdom teachings, or to learn discrimination. Their teachings are tools to guide us to the experience of our true nature (not tools for understanding)".

The issue for me remains as one of definition. Words are used to convey concepts. There is no doubt that the word for mindfulness, the concept of mindfulness, falls short of the experience. The best way to know mindfulness, as with meditation, is to practice it. Yet words are important and as linguists know, they change with time and usage. Linguists know that if a word is used incorrectly long enough its new and inaccurate meaning becomes correct through usage.
There is nothing wrong with this; this is how language progresses. The point again is that it does seem to me that mindfulness is being used increasingly as a generic word to cover a whole lot of things that its traditional definition and the commonly quoted one of Jon Kabat-Zinn does not include.
What more traditionally was called meditation, these days is commonly being called mindfulness. While this may be politically useful in arenas where mindfulness is a more acceptable word than meditation, in my view it creates more than just a language problem; it helps to foster a misguided conception of what mindfulness is, and potentially generates confusion in beginners and the experienced alike.
Because words do have power, I believe there may be the need to come up with a new modern definition of mindfulness, or else a new word to describe all this other stuff that goes with it.

Your comments are most welcome.

Next week, some personal reflections on the year as 2010 draw to a close, and some thoughts and plans for 2011.

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