When food expert Sheila Dillon had cancer diagnosed, she investigated the role of diet in the disease. By Helen Rumbelow
The food servers on the chemotherapy ward that day didn’t know it, but they were about to start a one-woman revolution. They wheeled their trolleys around the ward, administering mildly carcinogenic ham sandwiches to patients. One sat with a needle in her arm and vowed that as soon as she was better, she would use her influence to fight. She would fight doctors, the NHS, British culture — because she believes that almost everyone has got it wrong when it comes to the link between food and disease.
“I was horror-struck by it. Everything about that day on the ward, that snack trolley, said ‘food does not matter’. ”
Sheila Dillon is the sound of Sunday lunchtime. When I meet her for breakfast, her face is unfamiliar, but just hearing her faint Lancashire accent is to be instantly transported, her voice the cosy aural gravy that pours out of the BBC Radio Four Food Programmeon which she has appeared for 20 years. Listeners won’t find the show this Sunday cosy at all: it’s angry, it’s personal, and it lays down the gauntlet to the British medical establishment.
Dillon had multiple myeloma, a form of bone cancer, diagnosed more than a year ago. As someone who has devoted her life to the importance of food, she wanted to know how much we can control our risk of exposure to cancer through diet. After speaking to some of the most respected doctors in the world, she concluded that there was a lot we could do to minimise our risk. But we are rarely told about this.
At every turn, she said, the official advice about nutrition was “non-existent”, and worse was the institutional food being served to patients. Why, she asks, are cancer consultants too fearful, too cautious, too ignorant or too busy to give dietary advice when we know that what we eat makes such a difference? Why, when the experts rate food choices alongside smoking as one of the biggest causes of cancer, are hospitals not taking it seriously? Why did she have to trawl through published studies to find the best possible anti-cancer diet, when most of her fellow patients were left with the last packet of crisps? When was Britain going to take this seriously? Hippocrates, the Ancient Greek physician, said: “Let medicine be thy food and let food be thy medicine.”
Dillon says: “I asked one of the specialist nurses what I should eat. She looked surprised by my question [and said] , ‘There’s no need to worry about it’. Why no advice on nutrition, why no attention to the hundreds of academic papers written on the subject over the past decade?
“It makes me angry. I looked at my cancer and the lack of any consideration about food. I think food is a great pleasure but it’s serious, we ingest it, it becomes us. If you buy a slice of ham, the slice of ham becomes part of you. It’s obvious, we’re built from food, we are ourselves food. How you can not think that matters when you talk about your health is barmy.”
But a lot of doctors don’t think that it does matter. Dillon herself interviewed a prostate cancer surgeon who cheerfully told his patient, “Eat what you like! Have red meat! There’s no evidence of a link with diet.” Another is referred to on the programme as saying that worrying about food when you have cancer is like “blowing out the candles on your birthday cake when the house is on fire”.
Dillon, well known to her millions of listeners as a calm and rational advocate for food, is this morning quite different, visibly passionate and full of righteous anger. In this programme, her personal and professional life fuse. “I feel too strongly about it,” she says. The problem is that the best advice that most people get in Britain is “eat your five a day”. This won’t hurt but, amazingly, studies have found no link between the consumption of five fruit and vegetable items a day and levels of cancer.
Dillon refers me to the medical profession’s pre-eminent expert on diet and disease: Walter Willett, the Harvard epidemiologist behind the Nurses’ Health Study, which assessed risk factors for cancer and cardiovascular disease, and who has published almost 1,000 studies on the theme.
Diet of course causes cancer, we can see that in how easily immigrants change their risk when they adopt the food of their host nation, Willet said.
And the effect is huge. More than 30 years ago, Sir Richard Doll, the late British scientist who confirmed the link between smoking and cancer, estimated that a third of cancers were dietary in origin. Willett has confirmed that experts now know that he was right. That accounts for about 100,000 preventable cases of cancer diagnosed every year in the UK, which could have been avoided through healthier eating.
It’s just that we are only now figuring out which kinds of food are important. The “five a day” campaign was intended to cut cancer rates, but it’s been a blind alley. Willett said that, of course, vegetables are good for you, particularly, in the case of prostate cancer, lycopene (a carotene and phytochemical found in tomatoes and watermelon). Also, foods high in folate (essentially greens and beans) offer protection against colon cancer. But the effects of eating any fruit and vegetables were negligible on cancer. The most important anti-cancer change you can make is to avoid being overweight and to drink no alcohol at all, he said. Few patients in the UK are ever told this. Willet said that obesity now accounts for as many cancers as does smoking.
You should also avoid processed meat (those hospital ham sandwiches: beware), and limit red meat in general. Willett himself used to eat red meat three times a day, now he does so only a couple of times a year, so convinced is he by the evidence. He also had another category of “interesting but unresolved” areas of study, relating to the consumption of milk, soya and Vitamin D.
None of this, of course, is filtered through to the average cancer patient, or anyone who believes themselves to be at high risk of cancer. Professor Margaret Rayman is the director and founder of the first and only evidence-based “nutritional medicine” course, which trains doctors in nutrition for prevention and management of disease at the University of Surrey. She has devised a diet for prostate cancer patients, with references in the scientific literature for every ingredient. Rayman shakes her head in despair at the ignorance of the doctors interviewed by Dillon, saying that they don’t take food seriously enough.
I ask if this is because doctors are trained to wait for a “gold standard” of evidence, for fear of misleading patients? Almost every day, a news report comes out about either the amazing or the dastardly cancer properties of certain foods, so much so that the doctor and author Ben Goldacre has joked that “the Daily Mail does have an ontological programme to divide all inanimate objects into ones that will either cause or cure cancer”.
Dillon says: “When I was being treated, I went through the various booklets given out by the cancer charities, and in them you’re treated as if you’re an idiot. They say ‘The effects of green tea haven’t been proved’.
Well, actually, there are quite a lot of interesting results on green tea. I think a cancer patient is able to look at those studies and think, ‘Well, there’s an indication it’s a good addition to my diet without being damaging.’ We are capable of understanding that this is not conclusive evidence.
“In some ways if you don’t get any decent medical advice, you’re more vulnerable to something bonkers.”
For example, a patient may search for answers on the internet and find a crazy solution that is clearly inappropriate.
She says: “Doctors do sometimes talk a lot about the gold standard of medical evidence, but a lot of medicine is practised without it, it’s more ‘Let’s have a go’. I think what’s going on here is that we are pushing up against cultural attitudes about food in Britain.”
Dillon’s medical treatment has been successful, her cancer has all but disappeared. She’s changed her diet. She makes sure that she eats lots of greens every day, she doesn’t drink much milk, and she peppers her meals with the turmeric spice that is undergoing promising research. She knows that these small interventions are not conclusively proven, but while she “wonders if the cancer is hovering, waiting to come back”, she can’t wait that long. I have to report though, that she has said all of this while finishing off a latte and a croissant. That doesn’t look very anti-cancer, I say. And she laughs, because she wants everyone to enjoy their health and their food just the same.