Robert O Connor
Nutrition: What’s driving the nutritional problem in cancer? | FENS Symposium
Hello, and welcome to the safefood podcast.
I'm Dr Aileen McGloin, Director of Marketing and Communication at safefood. And this is a special edition of the Nutrition podcast series, where we're bringing you a recording from a symposium hosted by safefood, at the 2019 Federation of European Nutrition Society's conference in Dublin.
The symposium asked, "What advice does the public believe?", and outlines the challenges for researchers, policymakers, and practitioners. Each one of the four contributors is available to listen to individually. There is also a separate podcast where all speakers are featured in full. This is Dr Robert O'Connor of the Irish Cancer Society.
Thanks very much to safefood, for the invitation to speak here today.
Just to say at the outset, I should have added as well I've no conflicts of interest in giving this talk, I don't receive any funding, nor support from any outside agencies aside from the charity.
So, what's driving the nutritional problem in cancer? And I think hopefully my talk will intersect with some of the others as well. So I'll hit some of maybe the top-line elements. And obviously I am going to focus on nutritional aspects, but there's a lot of other challenges with misinformation in cancer.
So, I suppose we sometimes have a sensation that nutritional misinformation, and use of certain words, et cetera, is a relatively recent phenomenon. It's not. And food and drinks advertising has always had health claims made. It's not too long ago, that we would have had ads like this, for alcohol, for Guinness.
What we are seeing I suppose, is an increase in advertising, an increase in advertising spend, especially TV and social media. And social media is obviously a very new avenue for a lot of advertising spend.
And what we're also seeing is an increase in what I might call ‘scientification’ of nutritional marketing claims. So in the past, and I'll give some examples in a minute, we would have seen terms like ‘healthy’, although I defy anybody to define what is actually healthy, because healthy really depends on what your own state of health is. ‘Healthy’, ‘natural’, ‘nourishing goodness’ and ‘wholesome’. And we still see those.
But increasingly now we see much more sciency terms like, ‘Boosts the immune system’, ‘gives energy’, ‘has anti-cancer properties’, ‘is a superfood’. And ‘superfood’ is a particular red flag to me 'cause anybody who claims anything is a superfood is telling you a lie straight out.
So this all started back in the Bible, a long time ago. Don't want you to read through all of this, but it's actually probably an example of the first clinical trial that was conducted. And it was basically a comparison of a meaty diet versus a vegetable-based diet. It was thought the meat diet would be better, lo and behold, two weeks later, they found in the small cohort that they tested, that actually the folks with the pulses, which is the vegetable diet, had fairer countenances and fatter flesh than children who ate the King's meat.
So, I suppose over the 20th century, and even before then, we saw a variety of different aspects as commercialisation of food production and food sales grew.
And so we saw... I said some of these things. Cheery Oats was the precursor for what we now know Cheerios, corn, various different aspects of a normal diet have been promoted more with the health aspect, rather than just saying, ‘Go out and eat our products’. Things became maybe a little bit more palatable and that's part of the reason I suppose, that things came in, in terms of regulation. The top one here is a claim about beer and its impact for the baby and the mother, pick-me-up. ‘Kids need the energy candy gives.’ I don't think that one would go down too well. Certainly not with Healthy Ireland anyway and not with us, Cancer Society. ‘Vitamin doughnuts’. Most doughnuts actually do contain trace elements of vitamins. So there's nothing actually wrong in that, but the implication of them being good for you. And 7Up and milk, and I tweeted this the other night and actually several people went off and experimented on this. Apparently it's not that bad. But you know, calling it ‘wholesome’, I think, goes beyond the boundary now that we would find acceptable.
If we move into the more recent times, we see food companies being admonished and having regulatory oversight for claims like yogurts that are scientifically proved to help support your kids defences. If your kid isn't immunocompromised, that's really a very difficult, let's go back one.
We've got things... High-sugar-containing children's targeted foodstuffs that are, again, using sciency stuff, vitamins and minerals, giving a perception there.
And even in foods that we would regard as being healthy, fruits and vegetables, we see a huge focus now on trying to make completely false claims. Mangos do not prevent cancer, they simply don't. But we see this came from an Irish supermarket, three or four weeks ago, I think. Some of you in Ireland will know there was a bit of a media storm about this.
So these are very real things. We've also got the growth of what I call ‘shockumentaries’. So Pete Evans will be a particular person of focus. Some of you may have seen the Netflix documentary. I literally couldn't watch any more than two minutes. It hurt my eyes. The misrepresentation that was in there. Thankfully, some people have picked this up, but this this program is still available, and it's still seen by some people as a Bible for nutritional information.
Even today, within Ireland, our own food promotion organisations are cottoning onto this. This is big business, and they're talking about, ‘Let food be your medicine.’ Food is not medicine for a healthy person. It simply isn't. And claiming that, is trying to get an advantage over your food over somebody else's.
Now nutritional science is probably one of the more challenging sciences, because a lot of associations, where other sciences you can do much more causative-type examinations. But it has certainly contributed to vast amounts of prevention of ill health.
If we compare and show some data in a second, but if you compare where people were at the start of the 1900s, and at the end of it, there's no question that, that understanding of nutrition has contributed vastly to improvements in health. Not the only contribution, improvements in cleanliness, improvements in medicine, and in training, etc, and education have helped as well.
Our lifespan has increased incredibly dramatically. Much more so than at any other stage in human evolution. So over the last hundred years, so if you were an average person, this is UK data, but it's similar in Ireland, if you were a person born around 1900, your life expectancy was just over 45. Just over 100 years later, your life expectancy is over 80. And in Ireland now that's up to around 84 years of age, and it's matching a global, and even in underdeveloped countries, the average life expectancy now is well beyond 60.
But along with that, we've also seen a massive change in the diseases that impact people and in our perception of those diseases as well. If you were born in 1900, if you didn't die, maybe in an early...in childbirth, or an early childhood infection with one of the big ones, TB, flu, etc, there were so many different things queuing up to impact you. We've had a lot of improvements in nutrition making you more resilient to several of these diseases, but also the advent of antibiotics and other medical interventions, meaning that today, cancer and heart disease are the major killers.
If you look left and look right of you today, one of you will develop a life threatening malignancy in your lifetime. Just to put that in context: for every hundred people that die, 30 of them will die from a cardiovascular disease, and about 31 will die from a malignancy. So these are much bigger in terms of their impact now, much bigger in the psyche of people.
Food is a very lucrative, but it's a very crowded commercial space. I just took this from from Ibec, who's an industry body in Ireland. The sector has nearly a 30 billion turnover. 30 billion euro turnover, and groceries alone is 15 billion Euro in Ireland. Ireland is a small country. That's the 26 counties. That's just over four and a half million people. So this is a very, very large amount of money, but it's very difficult to kind of get in there.
Moving on, I suppose we've got issues around democratisation of health information and misinformation. You can get anything out there. We can go on our phones, and many of you will be on your phones looking at different things. And people talk about this Doctor Google phenomenon, but it's a very real phenomenon now. So you can go anywhere, you can put something in, and often this leads people to misunderstand their state of health and what they have. So this simply says, "He's gone on the internet and he's found 8346 life-threatening illnesses. He looks perfectly well, he's sitting up there in a chair.
So we get a perception of things. We've got easy access to research. Anybody can go onto PubMed or other sources of research, and they can basically find out information, even if they aren't channelled to that by somebody who's trying to misuse the information.
So for example, Resevratrol, which is an element of grapes and certain other fruits, and found in red wine, and there's been lots of claims for it, including this misinformation here, that it could have an impact on cancer. It can't have an impact on cancer. You would have to drink a bath-load of wine to get the active amount, and it breaks down in the body incredibly quickly. So you would need to continuously fill your body full of wine, and can anybody see a health problem with that, where cancer wouldn't really be relevant?
But you can go on there and you look at that, and unless you're a trained scientist, you won't know that these are in-vitro studies, the concentrations are not relevant to those that you see, etc.
So this is a challenge, because the general public are not trained in research understanding. And anybody who goes on Google thinks that they can do research. Most of you will know of this, but if you haven't, you certainly should know about it, the Dunning-Kruger effect. And we're all guilty of it. I am guilty of it as well, where we know so little of what we don't know.
So, many of us start out we have an interest in a topic, we read something we think, "That's all there is to know. ‘Nutrition, sure isn't it really easy.’ That was meant to get a joke and a laugh in the current environment, because if it is really easy, I don't know where I'm going wrong. And then as we start to study it, investigate it, and listen to other opinions, etc., we start to realise, actually, we do learn a bit more, but actually what we don't know starts to increase. And unfortunately, this is a very common phenomenon out in the real world, the scientific world, and causes real challenges.
We've got significant media issues. So our media has changed utterly from where it was maybe 20, 25 years ago. We have a continuous news cycle. We can check it on our phones 24/7, we turn on Sky News, BBC News, wherever our source. So there's a vast demand for information.
You don't go back onto your app unless you feel there's going to be something new there. So that has to be fed all the time. There's a lot of focus then on clickbait. Nobody wants to pay for their newspaper anymore. And the companies that set up the apps, etc, obviously get their money by advertising revenue. And they know what drives people to click on particular things. And I've seen this with articles that we've had, where certain phrasing of the article drives people and their interest.
We're largely seeing the death of the newspaper, not completely gone, but the rise of apps and social media means that people don't pay for their news. And this is just an illustration that now half of Americans, more than half Americans get their news from social media. So nobody actually sits down and formulates it. They just get their stuff on their Facebook feeds, their Twitter feeds, etc. We've seen a huge rise in the influencer phenomenon.
And we've also seen a huge rise in people talking about cancer. When I was a child, relatives died from cancer and you did not know that they died from cancer. No one spoke about it. Now everybody who gets cancer goes on, and they will go on media, go on social media, and we talk a lot more about it. Now that's a good thing in some ways, but it also over-emphasises the relevance of it. We're seeing a lot of evolution in marketing opportunities. And just by way of illustration here, we see an excellent guide from the American Cancer Society. It's really good. It looks well, but this is the kind of stuff that people actually want to pick up when they go down to their supermarket. And this is why these things actually continue to sell well.
Dr. Oz and his thyroid detox, and you're going to lose 42 pounds by Easter. Just crazy stuff. But it's a lot more marketing and a lot more spin than the evidence-based information.
We've always had the health food claims. But now we've got various other people able to monetise those aspects. So, how you cook the food. People and chefs, can make money out of that and their perceptions of it. Books about food and health, rather than just books about cooking. Seminars about food and health, we were involved in one case, where a particular person was charging 1,200 euro for three-month seminar series on a keto diet, okay? You didn't even have to go to it, it was an online thing, so they kept using the same content over and over again. Advertising revenue can be drawn into these things.
And now we also have hospitals and clinicians promoting these. There's little, if any, professional sanction from any of these people, so they don't get called out on it. And there are very significant conflicts of interest. And even in this meeting, I have to say, I've been quite disturbed at seeing some of the conflicts of interest around some of the sponsors of the meeting, and no-one yet having called it out.
On the other side unfortunately, there's very little access, certainly in Ireland, very little access to nutritional professionals. And RRSpin, I know, have been calling out for this, we in the cancer society have been calling out for this and been doing a lot of work in the background, specifically in the cancer space, probably more in the acute setting to be honest, because that's where, really, there's such a deficit, but we do need to work in that community setting as well.
So for example, data show that... sorry I'll go back, that nine in 10 cancer patients regard nutrition as either extremely important, very important, or somewhat important. We've got very confused messaging to people around what is important in terms of diet. So meat and cancer is a very good example. We've got excellent data from the World Cancer Research Fund, advising limitations, etc. Then a couple of weeks ago, we had a report out from the Annals of Internal Medicine and that was converted into headlines like this: "Sausage, bacon, and steak do not give you cancer", new study reveals. Now that's not what the what the study said, but that's what's coming up in people's minds. If you're a member of the public, how are you meant to interpret that information, and what its impact will be for you and your family? It really is very, very frustrating.
Our expectations, as I finish up, our expectations, I think, have also changed. Again with this Dunning-Kruger thing, we think that disease is easy. There's a lot of mistrust now of institutions and professional bodies. This concept of modern life being toxic. And that there's an easy fix somewhere. There's some sort of diet I can take, even if there isn't, I'll just do it and sure what harm can it do. And people who claim that they can cure your disease by following their mantra.
So, there's an expectation, I suppose, that we won't see disease or we won't see ill-health until some notional period into the future.
So to finish up, the impact of this, and there has been some research on it, although not as much as as we've needed, and I won't go through all of the detail, but basically, depending on the types of adjustments between complementary and alternative diets, we can see an increase of two- to five-fold, incurable cancer death rates. That's a massive impact, potentially, in cancer treatment. Much bigger than any drug.
I've worked with some dietitians in some of these areas. And just wanted to cite one case-study here, which I think is a very good example. And it was in this paper with Una Gryphon and myself. So I won't go through the details, but this lady has a re-sectable or essentially potentially curable pancreatic cancer. Caught it relatively early. But she went off and decided because of her research that she would do natural therapies and no-sugar diet, supplemented doses etc. She lost a quarter of her body weight as a result, her cancer progressed, and ultimately she passed away, and she was unable to really keep with her chemotherapy and treatment as a result.
Those are everyday examples the dietitians tell me about. This is a typical example now, of the kind of cancer patient pantry that we're seeing. You see turmeric in there, various vitamins, some of which we know actively work against cancer treatment and can actually promote cancer, but again, are being mis-sold. So to finish up, what's going on? I suppose we're seeing health claims for food and marketing there. They've been constant. We're seeing increased sophistication and much more actors in this space, lack of enforcement of legal regulation as opposed to industry body regulation.
And we're seeing poor nutritional education, especially in children, poor education of healthcare professionals who often are at sea in how to deal with these things, poor communication with patients, which is on us and groups like us, the Cancer Society, poor understanding of nutritional research, and I suppose, nutritional research, and researchers themselves need to learn that just because something correlates and graphs nicely, does not mean that one causes the other. And this is a very common thing I see in research and literature, and that I would review. Professional body regulation and also marketing of unproven facts.
So the take home... the nutritional problem in cancer is an issue around exploitation, poor basic education, poor protections, poor regulation of professionals who go into the ‘bad camp’ as it were, lack of factual communication.
And one thing I want to leave you with is lack of marketing of the facts. So, Coca Cola, and this may be a little bit of an obscure example, you go out tonight and you want to have a drink of a cola. Which one of these you're going to go for? The one on the left or the one on the right? You're going to go for the one on the left. They're both identical black liquids, both carbonated, both taste nice, etc.
So is there a lesson here for how we combat nutritional misinformation and cancer? And do we need to market our facts? We're reasonably confident of the facts, but do we need to market those facts in the same way that the bad actors in this situation are marketing their views?
So thanks very much for your attention.
That was Dr. Robert O'Connor of the Irish Cancer Society.
This was recorded at a FENS symposium at the convention centre in Dublin.
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Until the next time, goodbye from me, Aileen McGloin, and all the safefood team.