THE OVERLOOKED ROLE OF PHYSICAL ACTIVITY
IN THE PREVENTION AND TREATMENT OF CANCER.

By Dr. Martin Collis

Physical activity is the friend of the body/mind. Inactivity is an ally of disease. In the past few years we have seen with inconvertible clarity the fact that lack of movement is linked to many of the major diseases that kill and disable us. The truth knocks on our doors, whispers in our collective ear, shines from the print of our books and computers and we say, "Go away, I'm looking for the truth." We recline on our Lazy Boys, our fingers read the buttons of the remote control like Braille and hour and after hour we watch murders and mayhem and the 24/7 tabloid tattoo of CNN with sports scores and regional temperatures scrolling beneath. We await the next 'medical miracle' which will save our bloated bodies and the popular press gives us hope.

We read that Dr. Saunders Williams of the Duke University School of Medicine has developed a pill that builds strength and endurance in the muscles of mice. Using the Mice and Men approach it is not hard to extend the premise of this research so that we will soon have muscle pills for the human species to be washed down with beer or soft drinks while changing channels.

So reads another headline about the same story, and people live their lives in pursuit of the loophole and die of heart disease, stroke, diabetes and cancer.

The beneficial relationship between exercise and cancer is less clear than between the exercise and heart disease, stroke and diabetes. It's not hard to see why. There are many different cancers whose etiology is complex and often unknown. We do know that cancers can be triggered by genetics, cigarette smoke, stress, asbestos, fiberglass, diesel fuel, sunlight, radiation, preservatives, pollution and pesticides. There was an old rock song that featured the lyric, "Everything causes cancer." and at times it seems that way. With multiple cancers and multiple causes it's not surprising that it has been challenging to see a statistically clear positive relationship between:

1. Physical activity and the prevention of cancer.
2. Physical activity as part of a successful treatment regimen for cancer.

Another reason for the lack of clarity is the way in which many research studies have chosen to measure or record 'physical activity.'

In the past two years I've participated in three important conferences that concerned the linkage between physical activity and cancer.

In point form here is a summary of some of the current knowledge and thinking regarding the relationships between exercise and the prevention and treatment of cancer.

Data from Analysis of Multiple Studies.

• There is a 40% to 50% reduction in colon cancer incidence in active compared with sedentary individuals.
• There is a 30% to 40% reduction in breast cancer incidence among women engaging in three or more hours/week of regular vigorous activity.
• There are less strong associations (about 20%) between inactivity and prostate cancer.
• In 1997 the American Institute for Cancer Research combined with the World Cancer Research Fund to study 4,500 scientific studies involving associations between diet and physical activity level on one hand and cancer risk on the other. The findings of the 16 scientists who conducted the study indicated a general association between inactivity and increased overall cancer risk. Obesity, often linked to inactivity, increased the risk of cancer of the kidney, endometrium, breast, bladder, colon and rectum.

Data from Large Number Individual Studies.

• In the Harvard Alumni Study of 5,398 women, non-athletes had 2.5x as many cancers of the reproductive system (uterus, ovaries, cervix and vagina) as athletes and 2x as many breast cancers.
• Barlow, Blair et al. followed 22,000 men for 10 years and found unfit subjects were 2.6x more likely to die of cancer than fit subjects.
• In the journal 'Cancer' 2002; 94 Fairey and Courney note that a majority of studies show significant positive changes in immune system markers with regular exercise. They state that this may well point to exercise as a method for reducing the risk of cancer recurrence and improving survival times."

Writing for 'Well' I try to avoid citing long lists of studies, but in this case I think it is important to show that there are convincing data showing that physical activity is a significant factor in cancer prevention. The truth is that regular physical activity is almost certainly more beneficial than the studies indicate.

Most of the larger number epidemiological studies use questionnaires to assess people's physical activity level. In the past many of the questions regarding exercise have been vague and the answers hard to classify. People overestimate the amount of exercise they do, or to put it bluntly, people lie to themselves and the researchers. There have now been a number of studies in which subjects responded to a questionnaire about their physical activity and then had their cardio-respiratory fitness (CRF) objectively measured on a treadmill or cycle ergometer. In every study I have seen correlation between exercise and disease jumped when actual measured data were used. In some cancer studies the results went from showing no relationship between physical activity and cancer prevention (questionnaire responses) to a strong statistical relationship. (Objective measure of CRF). In the April 2002 Tufts Health and Nutrition Letter there is a report on a study by Dr. G. Duncan in which he says, 'people think they are pushing themselves harder than they are.' In this study, the subjects wore heart rate monitors and were also asked questions about their exercise intensity. Almost half the participants, who averaged in their late 40's, thought they exercised at least 'moderately.' But only 15% actually did.

The American Cancer Society estimates that if everybody exercised and controlled their weight, the number of Americans who die of cancer would drop by about one third. About an equal number of new cases would be prevented.

Physical Activity and Cancer Treatment

Cancer can be like high speed aging, and the treatment of cancer can be so debilitating that it becomes a risk factor itself. Chemo and radiation therapy can leave the patient nauseous, bone tired, with their immune system compromised and their hemoglobin way down. My wife, Nancy, works with many cancer patients whom she describes as 'being blindsided by fatigue.' Not surprisingly, people in this condition often take to their beds and try to eat easily digestible foods. But bed-rest can compound the problems the body is already facing with the cancer treatments. After 72 hours in bed, glucose tolerance can look like diabetes, blood coagulation increases, leading to dangers of clotting, muscles atrophy and osteoporosis begins. Also, the mind is getting a message from the body, which is immobile and horizontal, that there are major problems. It is important that physicians council their patients on the value of maintaining some form of physical activity during treatment if possible. The fatigue can be ameliorated by the use of Eprex and other drugs that elevate hemoglobin. Drugs such as Neupogen, which helps increase the white blood cell count, can boost the immune system.

The research on exercise as part of cancer treatment is not extensive, but is growing. Schwartz et al. in an article titled 'Fatigue, Breast Cancer and Chemotherapy' reported that far from increasing fatigue, exercise seemed to do the opposite. They note that, "Exercise seemed to change the perception of fatigue and its intensity.' These findings were echoed in the May 2002 'Consumer Reports on Health' in an article titled 'Exercise Fights Chemo. Fatigue.' A study, at the Oregon Cancer Center, of women undergoing breast cancer treatment found women felt 14 – 35% less fatigued on the days on which they did the recommended 15 – 30 minutes moderate exercise. Roanne Segal's work at the Ottawa Regional Cancer Center now has good data on the effectiveness of exercise during treatment, and she makes some interesting distinctions with different exercise regimens for different types of treatment.

1. Cytotoxic therapies – Cardio-vascular fitness.
2. Intensive radiotherapy – Flexibility.
3. Hormone based treatments such as Tamoxifin - Programs to improve body composition.

These are not exclusive to each type of treatment, but remind us that one exercise program does not fit all. Courneya and Friedenreich summarized 24 empirical studies and noted that physical activity led to improvements in cardio-respiratory fitness, muscle strength and body composition. People were less fatigued and nausea was more manageable. Quality of life improved, as did self-esteem, general morale and ability to deal with depression.

The ever macho and remarkable Lance Armstrong in his book 'It's Not About the Bike' says, "During those first weeks of chemo I had to keep moving. 'Move' I told myself. I would get up, throw up, put on my Walkman and walk." It is worth noting that during treatments Armstrong refused hospital food saying that his body needed only high quality nutrition in order to fight cancer. The finest line in the book is his comment about the importance of belief. He wasn't religious but said, "I believed in belief for its own shining sake."

One of my heroes, George Sheehan, a physician/runner, who died of prostate cancer that metastasized into the bone, wrote about his cancer in 'Going the Distance.' (Which he referred to as 'my death book'?) "The patient's responsibility is to follow a lifestyle that will add hours to their day. To follow a program that gives meaning and purpose to their final years, no matter how few they may be."

The Goldilocks Principle

How much exercise is appropriate to help prevent cancer? Not too little, not too much, but just right. Too little exercise, as we have pointed out, is associated with sickness. Too much, or exercise at too high an intensity, could possibly cause DNA damage and an increase in free radicals, both of which are associated with cancer. (I should add that the benefits associated with a high performance lifestyle far, far outweigh the rather remote possibility of cancerous cell damage.) The American Cancer Society Guidelines suggest the following.

• Adults: engage in at least moderate activity for 30 minutes or more on 5 or more days of the week; 45 minutes or more of moderate to vigorous activity on 5 or more days per week may further enhance reductions in the risk of breast and colon cancer.
• Children and adolescents: engage in at least 60 minutes per day of moderate-to-vigorous physical activity at least 5 days per week.
• During treatment do what you can, but try to do something despite your tiredness.

The Mechanisms. Why does exercise reduce the incidence of cancer?

The mechanisms by which regular exercise prevents cancers are not clear-cut. There are many cancers and there are probably many reasons why exercise plays a role in cancer prevention and recovery. The most simplistic is that the human body/mind is designed to move and that opportunistic disease flourishes where there is little movement. (This is simple, but as Schweitzer reminded us, we can progress from naïve simplicity to profound simplicity.) Physical activity is a known stress reducer (Remember the 3 A's Activity Absorbs Anxiety). Exercise increases immune cell function (e.g. T lymphocytes, natural killers cells, and macrophages). Exercise helps weight control and overweight is associated with cancer. The strong relationship between exercise and a decrease in colon cancer might be associated with enhanced transit time in the gut, lower insulin levels and altered bile acid metabolism.

There is much we don't know and much to be learned, and we certainly can't wait to take action until, 'all the information is in.' It never will be. Since Richard Nixon declared his 'War on Cancer' in 1971 some 30 billion dollars has been spent. (If 30 billion over 30 years sounds like a lot of money, it is less than the fast food industry spends in one year on promotion. Is it any wonder we're struggling to influence people's lifestyle and eating habits.) I didn't like Richard Nixon and I don't like military metaphors in dealing with a disease like cancer. Jeanette Rankin's famous comment is that, "You can no more win a war than you can win an earthquake." Decreasing the incidence and deaths from cancer requires finesse, patience and cultural shifts, not a war. One of the challenging questions is, how to make the most effective use of the billions of dollars obtained to help lead to a major decrease in both the incidence of cancer and deaths from cancer. There are four major areas where money can be spent namely, basic research, diagnosis, treatment and prevention. A figure one often hears is that more than 70% of cancers have their origins in lifestyle. This being so, I feel there is a strong case to be made for allocating a greater percentage of the cancer dollars to programs of prevention, lifestyle and public health.

Like the wars in Vietnam and Afghanistan and the War on Drugs, the War on Cancer can drag on and yield some statistics, which are hard to justify at first glance. In 1971, the year the war was declared, 335,000 Americans died of cancer, 25 years, and $25 billion later in 1996, 547,000 Americans died of cancer. (Close to the number of Americans that died fighting for their country in the 20th century.) It is often said that more people make a living from cancer than die from it. There has probably been far too much emphasis on discovering 'the magic bullet' and the big money corporate cure rather than helping create an environment and a cultural lifestyle which is not a good host for cancer.

Cancer is the number one cause of death in children from 1 – 14 years and in women aged 35 – 75. In the past half century breast cancer has increased 60% and prostate cancer 200% and the overall incidence of cancer seems to be growing in all age groups.

The news is not all bad however. Although the incidence of cancer is up, deaths from cancer have been declining for the past few years since 1998. This reflects earlier detection and more effective treatment. There are now about 8 million cancer survivors in the U.S.A. and since 1971 overall survival rates have nearly doubled. Childhood leukemia and Hodgkins disease have been major success stories. With the decrease in smoking, lung cancer is on the decline, a decline that will continue if we make smoking less and less socially acceptable. There are real breakthroughs in understanding the molecular and genetic processes of the cancer cell.

Leading epidemiologist, J.C. Bailar of University of Chicago, sums things up by saying, "I think it's foolish to think that some day we'll find cures for cancer. We cannot base national strategy on that kind of hope." He feels we must make prevention a top priority, while continuing work to try to pin point causation.

I agree with Dr. Bailar about the primacy of prevention and identifying the causes of cancer, but I feel he is a bit cavalier in his comments about discovering cures. Thirty five years ago as a student at Stanford I remember being puzzled by one of my old professors, Nobel Laureate Joshua Lederberg, who spoke briefly of the possibility of viruses being used to treat cancer. There have always been rumors about people whose tumors regressed when they had the flu or other viral infection, and now there seems to be growing substance to the paradoxical situation in which one disease fights another, although the principle of antibiotics is not too dissimilar from this. Work is now going on at the Ottawa Regional Cancer Center, Stanford University, Harvard and Duke, and many other institutions in which animals with cancerous tumors are being infected with a variety of viruses from herpes to the common cold. Speaking of tumor cells, Dr. Bell of the University of Ottawa notes, "They have thrown out genes that inhibit their growth, but at the same time they've thrown out their anti-viral programming."

Human trials are now underway. Michael Wosnick, director of research at the National Cancer Institute of Canada noted, "all logic says it should work." Dr. Bell has said, "I think we're going to find out that some viruses are going to be good at targeting some cancers, and that other viruses will get other cancers." The drawback of using viruses to attack tumors is that it has to be an on-going treatment and the patient will experience symptoms from the virus. However, that seems to be a price worth paying if cancer can be transformed from a killer into a manageable chronic disease.

As Emily Dickinson told us.

"Hope is the thing with feathers
That perches on the soul
And sings the song
Without the words
And never stops at all."

I believe that many of the answers lie outside the walls of the hospitals and research labs and that any initiative to rein in cancer will be doomed to failure unless we provide enormous human and fiscal resources to address lifestyle and environmental issues. My local bank sponsors a fundraiser for breast cancer titled 'Run for the Cure', which is an interesting double entendre. You can run 10K and raise some money for research, or jog on your own and literally run away from a sedentary disease inducing lifestyle.

The final word is that exercise does not stop with the cure, or when cancer goes into remission. Having been struck by the 2 by 4 of a cancer diagnosis and recovered, now is the time, not to 'put your affairs in order' but to put your life in order. Become the person you want to be, eat well, look very carefully at stressful jobs and situations and above all, move. As I've noted before, the key word in the human potential movement is 'movement.' Buy a bike, join a fitness club, get a pedometer for a step by step recovery. The possibilities are limitless. In the Fall 1999 edition of 'Well', Dino Asproloupos wrote about 10 teams of breast cancer survivors who were paddling in the Alcan Dragon Boat Festival in front of 40,000 spectators. The group known as 'Abreast in a Boat' has been featured on TV and many magazines and has helped re-shape the way physicians prescribe physical fitness activities to breast cancer survivors.

Funny how he always suggests exercise.

C.A.N.C.E.R.

There are many similarities between the lifestyle and mindset for cancer prevention and cancer treatment. These can be summed up by the acronym C.A.N.C.E.R.

C. Choice
Whatever the situation, you can choose to react or respond. The choice might be between a rock and a hard place, but it is still a choice. You can choose to accept a situation or you can choose to try and change it. You can always choose to nurture your sense of humor, which is a built in survival device.

A. Attitude
Attitude is the paintbrush of the mind. Success in real estate is defined as 'location, location, location'. Success in life is attitude, attitude, attitude.

The greatest discovery of my generation is that human beings can alter their lives by altering their attitudes of mind.
- William James

N. Nutrition
Eat plenty of natural complex carbohydrates and fiber (e.g. fruits, vegetables, grains and nuts). Go for a rainbow diet with multiple colors everyday. Numerous health enhancing phytonutrients are found in colored fruits and veggies. (see 'Well' Spring 2001 or 'The Little Book of Lifestyle Artistry.')

C. Control of Stress
We are good at being human doings, but need to be human beings as well. Seek relaxation through meditation or massage, yoga, progressive muscle relaxation, or whatever turns you off. Don't just do something, sit there. ("Calm Down" is a superb breath centered guided meditation CD by Nancy Wardle, MD)

E. Exercise
Make sure purposeful movement is a part of your day. I really like the 10,000 steps concept (see 'Well' Spring and Summer 2002, '10,000 Steps' articles). Exercise is the generic medicine, what sort of play you choose is just your brand preference. (see 'Well' Spring 2000 'Exercise' article)

R. Relationships
Loneliness is a major risk factor for cancer and many other diseases. Find ways to give and receive love, and make sure you have a loving relationship with yourself. If you find yourself spending a lot of time with negative and depressed people, consider weeding your social garden. As Dean Ornish notes, "There is a scientific basis for the healing power of intimacy.

Fund Raising for Cancer.
From the Ridiculous to the Sublime.

There has to be a better advertising placement for raising money to "conquer" cancer than a matchbook cover. But this old matchbook reminded people "every 3 minutes someone dies of cancer" and "guard those you love."

A few months back I addressed the staff of the Bone Marrow Transplant and Leukemia Unit of Vancouver General Hospital. One of their many successful patients was Adella Krall whose daughter, Diana, is one of the great jazz divas in the world. In one of those 'everybody wins' situations, each year Diana gives an exclusive performance to raise funds for the BMT Unit. Diana gets to support her mother, Adella was able to provide financial support for the hospital and people like Nancy and me get to spend a pretty special evening listening to Diana in a very intimate setting. I am always amazed at how a middle class white girl from Nanaimo can inhabit those bleak, desperate songs that make up some of the standards of jazz. But when Diana sang "Cry Me A River" she was tapping into some of those universal feelings of pain we've all experienced. The BMT Unit was able to raise over a quarter of a million dollars, and best of all, Adella was able to sit and listen to her daughter.

As a sad addendum to this, Adella Krall died very recently at age 60. I knew her when she was a teacher in Nanaimo and had a good conversation with her at Diana's evening. She was first diagnosed with multiple myeloma in 1996 and seemed to respond well to her bone marrow transplant and went back to teaching for a while, but she had a relapse in 2000 and underwent a second transplant in Sept. 2001. Cancer is a roller coaster disease in which apparent gains can be suddenly snatched away. We all wish she could have lived longer, but here is little doubt her treatment gave her a bonus six years and enabled her to watch her daughter grow into a beautiful woman and world star. Now there will be an extra poignancy when Diana sings 'Cry Me A River'.

One of my favorite detective writers is T. Jefferson Parker who has experienced the trauma of cancer within his own family. His new novel 'Black Water' features a spurious cancer cure, but in a previous novel 'Summer of Fear' he writes some very compelling segments about someone facing the reality of cancer.

"It was cancer. And I'll tell you something - I hate it. I even hate the word cancer, the way it hisses off our tongues, so eager to be said. I didn't create it, no matter what these…these…these bliss ninnies try to make me believe. They're selling snake oil in a New Age wrapper, that's all. They're in the cancer business, the phony-hope trade. I'll take the rap for almost anything - I'm a Mexican and a Catholic, right? But I refuse to take the blame anymore for this. I'm going to win; I'm going to beat this thing. Damn those people, those…parasites. Russ, what is it with this country? We think we control the whole world and everything on it - and beyond that, the moon, all the way from the heavens down to the metastatic level of the cells in our bodies. Where did we ever get so arrogant to believe that? Did it do any good? What did it get us but a place stripped of the people and animals who used to live here, a sky full of satellites and floating junk, a nation full of people who believe they can cure cancer by eating right? How can we be so arrogant to believe that cancer is our own fault? I want to live, Russ. I'm going to beat this thing. But I'm not going to accept responsibility for what's happened. I feel invaded. I feel cheated. I love you and I love life, but I hate what's happened to me. I'm going to fight with the tools I've got - love and hate. That's what I've got for weapons. You know what cancer is? Cancer is little cells growing where they shouldn't. Nobody knows why they start or how to stop them, but nobody can cure a cold, either. Cancer is not a symptom. Cancer is not a metaphor. It is not a theme. Mailer said that cancer is the growth of madness denied. Mailer is full of shit. The only thing cancer is for sure is bad luck. It's a vicious little bastard and I want it out of me. This is not a journey into myself to discover my secret desire to die."

I don't necessarily agree with all the sentiments, but it's a good reflection of the anger, frustration and desperation that cancer can provoke in a person.

Major Sources

1. Draft of proceedings of the 'Physical Activity and Cancer Conference' in Dallas, TX. Principal author Rachel Ballard-Barbash.
2. Proceedings of 'Living Well With Cancer Conference' in Vancouver, BC.
3. Proceedings of 'Promoting Nutrition and Physical Activity to Reduce Cancer Risk' in Atlanta, GA.
4. American Institute of Cancer Research press release, August 14, 1999.
5. Websites of American Cancer Society, National Cancer Institute, and Canadian Cancer Society.

THE SLOW FOOD MOVEMENT

By Dr. Martin Collis, Ph.D.

"If a thing's worth doing, it's worth doing slowly." - Mae West

"Why do the French enjoy escargots? Because they don't like fast food!" A bad pun, but a reminder that there are viable alternatives to the homogenization and standardization of foods and the gulp and run style of eating promoted by fast food franchises. The way many people eat has changed more in the past 40 years than in the previous 40 thousand. In the name of expediency, progress and profit margins we are consuming meats from animals raised on anti-biotics, pesticide drenched fruit and vegetables and genetically modified 'Franken foods.' As Eric Schlosser points out in his must read book, 'Fast Food Nation' (see a summary of this book in 'Recommended Reading', Fall 2001 edition of Well), now out in paperback, the taste of your fast food will probably not come from the food itself, but will be 'enhanced' and 'modified' by a 'flavourist.' Writing in my local newspaper, the Victoria Times Colonist, Pam Frier notes that, 'Processed food that's been canned, frozen and dehydrated is essentially food devoid of flavor. A mammoth "replace-the-taste" industry has evolved as a result."

The Silicon Valley of the flavor replacement industry is found among the plastics factories and pharmaceutical companies in the industrial desert of New Jersey. With a little amyl valerate, benzyl isobutylute, dipropyl ketone and a few more selected chemicals you have a 'strawberry' flavored milkshake. Want that "deep fried in beef fat" taste for a McDonald's french fry that's fried in vegetable oil, no problem. There is even a machine called a universal TA-XT2 Texture Analyzer, which is essentially a mechanical mouth to help develop the appropriate 'mouth-feel.' If the creaminess or crispiness isn't quite acceptable to its sensors it's easily 'texture-corrected' with the addition of appropriate fats, gums, emulsifiers and stabilizers.

This bland leading the bland fast food culture has evolved from the convenience of occasional meal replacement to a mainstream source of nutrition for millions of people and plays a major role in the obesity epidemic. It is not surprising that resistance to the 'instant gratification', 'more is better', eating mind-set has led to the formation of the Slow Food movement.

I became aware of the Slow Food movement when I saw an advertisement for cheese and honey tasting at a festival on Vancouver Island, promoted by the local chapter of the Slow Food movement. I visited the Slow Food web site at www.slowfood.com and discovered that what I was seeing in my hometown was a local manifestation of a global movement. The birth of Slow Food was triggered by the appearance of a McDonald's in Rome's Piazza di Spagna in 1986. This prompted Carlo Petrini to create an organization for those who love food and know that love takes time.

There is nothing precious or pretentious about Slow Food. It is about appreciating and enjoying one of life's great pleasures. (Remember there are more books written about food than sex.) This can mean helping maintain regional cuisine, supporting retail outlets and restaurants who show concern for the quality, variety and uniqueness of their food and participating in an initiative called the Ark of Taste which is attempting to identify and catalogue products and dishes that are in danger of disappearing.

It is easy to appreciate that higher yields from grains, more milk from faster developing livestock and pest resistant plants might be part of the fight against hunger in the world. The Slow Food movement is there to remind us that bigger, faster and more is not always better and that diversity is part of the picture. An example of this, is the Slow Foods' championing of the Piedmontese cow in Europe. The Piedmontese cow produces superb cheese and high quality beef but was disappearing because of the popularity of the Holstein cow which produced more milk and was ready for slaughter more quickly.

Slow Food supported a group of 16 farmers to raise Piedmontese cows and encouraged them to use organic and natural methods to raise and feed the animals. When mad cow disease struck, the Peidmontese offered a safe alternative to the speed produced beef. For as we subsequently discovered mad cow disease had its origins in the feeding and living conditions of some cattle.

Because the cows take longer to mature Piedmontese beef costs about $0.50 a pound more than speed beef. But in addition to buying safety and flavor you get many other health benefits.

• Standard beef contains around 11 grams of fat per 100 grams, whereas Piedmontese beef contains about 1 1/2 grams of fat.
• Piedmontese beef is about 100 calories per 100 grams compared to 250 calories for standard beef.
• The beef from a naturally raised Peidmontese cow has less fat and cholesterol than most fish.

As Bob Dylan once noted, "Hunger pays a heavy price to the falling Gods of speed and steel."

Fast food is a totally dollar driven industry and it's challenging to market healthy food to a nation exposed to billions of dollars of promotion for the cheap gratification of adult pablum. However, there is always a market for quality and as the wellness and slow food movements gain momentum so do the opportunities to market good food. A notable success story is Whole Foods Market Inc. who have spread throughout the US and has just arrived in Canada with an outlet in the Yorkville area of Toronto.

	My experience in the US Whole Foods stores has been generally very positive. I've enjoyed walking among the produce, which is displayed like a Cezanne still life. The breads are more like a Parisean boulangerie, some crusty as an old Brit and as variable as the passengers on a New York subway.

One thing I like about Whole Foods is that they treat their employees well, offering a variety of creative benefit packages. This is in direct contrast to a number of fast food giants who've lobbied furiously to keep the minimum wage as low as possible and then looked for loopholes to pay some employees even less.

"Well" Goes to Provence
Slow Food and Slow Mood

On behalf of our 5000 plus 'Well' readers, Nancy and I went to the cradle of Slow Food, the Rhone Valley in Provence, where vineyards carpet the landscape, with the vines linking arms in an endless one legged vine dance and the air is stained with the scent of honeysuckle, broom, wild thyme and roses; and poppies turn fields in magic scarlet carpets. The shops and markets shut at mid-day and re-open around 3:00pm and food and wine are a way of life, the locals do not need to be reminded of Paul Simons' "Slow down you move too fast." We stayed in a neighbouring village to Patricia Wells, a high priestess of Provencal cooking. Her philosophy of food sounds like a Slow Food manifesto. "Keep it fresh, keep it simple, respect the seasons and allow the integrity of the ingredients to shine through. (e.g. Don't drown the meal in 'special sauce'.) Her 4 'f's' are, "food, family, friends and feasts."

I'm a surprising person to be writing this piece, as I come from the American male school of cooking, where I didn't necessarily go to fast food joints, but I liked my food fast. My modus operandi of cooking was 'double the temperature, halve the time.' The microwave was my friend. However, I married a 'foodie' who knows chefs like I know soccer players and she is my gastronomic guide. We dined in little restaurants among the vineyards, where we ate marinated mussels, each of which were tied up and presented like little gifts and foie gras which defies description. (Using words to describe food is like using music to describe architecture.) But it was the cheeses and breads, the tomatoes and croissants which were the daily delights. We were living among people who shop for bread twice a day and take 2 1/2 hours for lunch. Nancy and I shopped at the markets almost every day and I played the role of sous chef. What a remarkable species we humans are who can take the necessities of food and drink and turn them into pleasures and treasures and ultimately to art forms.

A Market Driven Economy

Deconstructing the Mystery of French Markets

Through the eyes of an economist, logistics expert, town planner or any bureaucratic bean counter, the typical French market is inefficient, nonsensical and a formula for failure. The formula goes like this: take a town with streets narrower than aisles at Wal-Mart and minimal parking and fill it with hundreds of stalls. They are attractive and feature fresh food and an endless variety of other merchandise from necessities to objects d'art. This attracts thousands of people who come into town with their cars, children and shopping baskets. The market stalls take up most of the available space, so parking has to be innovative and some distance from the action. By 9:00 am the town is filling up and lines are forming at the more popular stalls. Each individual purchase can take as long as buying a week's worth of groceries at Safeway. There are no shopping carts, as there is no room, and no credit cards accepted, this is strictly a cash and carry enterprise. Yoked by their baskets the customers move from stall to stall checking off items from their lists. Towards mid-day the town is clogged with customers and you have that magic merchandising shopper/vendor interface where cash is flying over the counters. The markets respond to the customer feeding frenzy by closing down, not for lunch, but for another time, another town, another day. Show's over. This means that the café's and bistros are instantly full, so most people trudge off in search of their cars and a crowded drive home.

Then why do the markets work so well? The markets flourish because much of France is a cuisine driven culture, whereas North America is a convenience driven culture, where shelf life is more important than self-life. Many North Americans eat to live; millions of French citizens live to eat. For lovers of food and wine the markets have their own form of convenience. The convenience of having the 10 best producers of olives and olive oil in the region to select from. The convenience of being able to taste test 20 different cheeses and to talk to the person who created them. There are no degrees of separation between the producer and the purchaser, because the producer literally stands behind their product and will sell it to you. Quality and price are controlled by competition; if the peppers and tomatoes on one stall are substandard or expensive, there will be plenty of alternatives a few steps away.

Each market is an event, with energy, entertainment and a sense of community and communication. Ask a supermarket employee for help with a product and they'll direct you to the appropriate aisle, ask someone at the market and you might be invited to their farm or vineyard. After a wine tasting at the Uzes market we were invited to the vineyard of third generation vintner Luc Reynaud who is producing some astounding wines. Luc was preparing for bottling the next day, but took the time to take us out into his fields and explain how the leaf structure and method of staking different varietals provide optimal growing conditions for the sugars and tannins in his grapes. If you ever find wine labeled Domaine Reynaud buy all you can get.

Could this concept be successful in mainstream North America? Not a chance! Producing and marketing products this way is too labor intensive, you can't franchise fruit stalls, you'd need multi-story parking for all the S.U.V.'s (which barely exist in France). There would be pages of bylaws and city ordinances to prevent the placement of a market in the middle of town (not to mention hostility and litigation from nearby stores and franchises) and even if you could overcome all these problems, the customers would not, and in some cases could not, walk for a couple of hours carrying their shopping. So the markets will remain another part of l'exception francaise.

As an aside, I couldn't help noticing that overweight and obesity were radically less among the market customers than you would typically see in a North American supermarket. This was not a fat free population but they looked pretty good. Food I'm sure was a factor in this, but there is one other possible reason. When I checked my pedometer at lunch after a morning in the market I had already walked over 8,000 steps and burned about 400 calories.

Conclusion

Ultimately, the answer is not fast food or slow food but good food. The leisurely pace of the Rhone Valley cannot be exported to the USA, each country and culture must seek its own nutritional salvation. The overall numbers in North America are bad but here are signs of hope, the organic islands are getting bigger in the supermarkets, juice bars and vegetarian restaurants are multiplying and there's a growing realization that good nutrition need not be bad business. The Japanese style boxed lunch called Bento is now gaining popularity in North America. Bento is typically a healthy mix of veggies, sushi, rice and sometimes grilled meats. Individually people could use Aretha's solution of a little R-E-S-P-E-C-T for their marvelous body/minds and be more conscious of what they eat and drink.

The reduction in smoking has been a North American success story and it's been relatively easy to demonize the big bad cigarette manufacturers. But taking on the fast food empires is a lot harder. People don't have to smoke to live, but they do have to eat. No research could show that a few hamburgers and fries were bad for your health, so what we're dealing with is a dosage problem. Taxation of fast foods is a hot discussion topic in recent editorials, and a number of US states are funding wellness initiatives by taxing soft drinks. In Europe an increasing number of countries are banning junk food ads from children's TV programming. But it's difficult to legislate common sense and it's impossible to legislate cultural preferences. Until people figure out that they don't want to be fat, diabetic and vulnerable to chronic disease and that they can change their lives by better food selection and increased physical activity, little change will occur. Until parents understand that one of the great gifts they can give their children is an appreciation for good food and exercise (this is best achieved by example) we will continue to breed ever- increasing numbers of bloated kids. As long as we sit our kids in front of TV screens and allow their developing minds to absorb 10,000 fast food messages a year they, and we, will have problems. If low cost and high convenience are the dominant criteria in our food choices our health care system will buckle under the weight.

Bon appetit.

"Finally, a food label I can understand! Each serving contains 10 grams of fat and 5 grams of thin."

"Slow Food' Registration Form: Annual subscription fee: individual $60USD, $90CAD and couple $75USD, $110 CAD
www.slowfood.com

Recommended reading:

"Best of Slow" (www.chelseagreen.com)

"Utne Reader" June 2002 edition (www.utne.com)

At Speakwell we're proud of our employees, and it's exciting to us when former members of the Speakwell family succeed in their chosen fields.

Dino Asproloupos

Dino is completing the International MBA program at York University in Toronto, ON. (http://www.yorku.ca) Following Martin's footsteps as a speaker, Dino won 1st prize ($6,000 US) and a scholarship for his recent presentation at the 32nd Annual International Students' Symposium in St. Gallen, Switzerland. The audience was made up of business and international leaders from around the world, including the President of Estonia, the Secretary General of NATO, CEOs of Nestle, Greenpeace, Deutsche Bank, Oracle, Zurich Financial and 250 graduate students from around the world (http://www.isc-symposium.org).

Guy LeMasurier

Guy is completing his Ph.D. at Arizona State University East Campus and managing the Physical Activity Center (http://www.east.asu.edu/reccenter). He was Graduate Teaching Assistantship of the year in the Exercise and Wellness Department at ASU East. Guy received, for the 2nd year, the graduate academic scholarship and recently presented the theme of his Master's thesis at the American College of Sports Medicine National Conference in St. Louis titled, The Dose-Response Relationship Between Short Duration High-Intensity Exercise and Excess Post-Exercise Oxygen Consumption (EPOC). (http://www.acsm.org). Guy also published his first paper with Dr. Charles Corbin in the International Journal of Physical Education titled Health-Based Physical Education 2002.

More Thoughts on 10,000 Steps

By Martin Collis, PhD

"The length of my walking is the length of my writing," Charles Dickens said, no wonder 'Well' is more voluminous than most online webzines. My 10,000 steps are a daily stimulus to unlocking and unblocking the thoughts stored in the protein stacks of my mind. I love my little pedometer, which is with me every step of my way and dutifully records the 'walk of life.'

"Every step you take
I'll be watching you."
- Sting

The concept of a pedometer is not new and there were research models as far back as the 1920's. While in New York I found a matchbook from the 1950's, which featured a pedometer. I don't know how accurate it was, but you can't beat the price at $3.99.

The 10,000 steps concept originated in Japan as a business slogan for the promotion of walking and the use of pedometers. In the Jan/Feb. 2002 ACSM Health and Fitness Journal, Cara Sidman writes, "In Japanese, 'manpo' means 10,000 steps, and Yamasa produced a pedometer called the Manpo-kei (which literally translates to '10,000 step meter')." Early estimates suggested that 10,000 steps would roughly equate to the burning of 300 calories, which I felt was low. In order to check the accuracy of my pedometer, a Yamax Digiwalker, and find out the actual caloric cost of 10,000 steps, Speakwell went into the lab and with the help of graduate student, Ben Sporer, and technician, Holly Murray, conducted a simple experiment on the treadmill. The subjects were myself weighing in at 188 lbs. (85.5kg) and Trina Rickert at a trim 125 lbs. (57kg).

We found the following:

1. The pedometers were accurate in recording the number of steps we took.

Martin estimated his stride at 3.0 ft (0.91m) and Trina at 2.5 ft (0.76m). In fact both Martin and Trina's stride length averaged out to around 2.75 ft (0.84m).

2. Pedometer Actual

Obviously it is important to get a good estimate of stride length and Ben suggests the following technique. Using a 400m track, you do one lap for warm-up and then count the total number of strides on a second lap. Divide 1312.3 (the number of feet in 400m) by the number of strides in 400m to calculate your stride length in feet (make adjustments depending whether or not your pedometer is metric).

3. The most interesting statistic to me was the caloric cost of 10,000 steps. Energy expenditure was calculated using measured oxygen consumption and respiratory quotient, as well as with the energy expenditure table of McCardle, Katch and Katch for walking at 3.5 mph (5.6kmph).

Not perfect, Martin's pedometer reading was slightly high and Trina's significantly underestimated the caloric cost of her steps. But this is near enough for day to day living.

Rule of Thumb. Caloric Estimate for 10,000 Steps

One of the positive things about being heavy is that you burn more calories getting from A to B than the lightweights. My average heart rate for the walk was 72 beats per minute (bpm) and Trina's was 114 bpm as she worked a little harder with her shorter legs.

NOTE. When I jog my stride lengthens and, unless I adjust the pedometer, it will underestimate the distance traveled and calories burned.
Cara Sidman's ACSM Journal article expresses some concern about the lack of scientific validation of the 10,000 step concept. "It has not been scientifically shown to elicit health benefits for all people." Maybe not, but I would bet my house that if we could get all North Americans averaging 10,000 steps a day for a couple of years the incidence of heart disease, stroke, diabetes, cancer and many other chronic diseases would plummet. (I should note that I liked Cara's article, which is well researched and full of useful information about pedometers.)

If you don't own a pedometer you can estimate your steps on a walk by counting them for a minute and seeing how many minutes you walk.

If you'd like to own a pedometer which shows number of steps, distance and calories burned, we have them for sale at Speakwell. Just go to the order form on Well-Mart or call toll-free 1-866-721-6940 to place your order. THIS MAKES A GREAT GIFT, PARTICULARLY TO YOURSELF.

People often have no idea of how long it takes to walk off the calories of some typical popular food and drinks.

Watch out for the dressing and spreads, which sometimes accompany healthy sounding foods. Tim Hortons' donuts range from 220 - 380 calories, so why not have a "Tim's Own" Garden Vegetable Sandwich? The reason why not, is that the sandwich, in addition to shredded lettuce, tomato and cucumber, comes with a bunch of cream cheese and "special creamy dressing." (information from Nutrition Action)

I have a regular route, which I jog or walk on a daily basis. In any given week I probably see more than a hundred people walking their dogs and I am something of an anomaly exercising with no dog in tow. I would guess that dogs, and the fact that people walk them on a regular basis, do more for the health of Canadians and Americans than billions of dollars of medication. I used to think that Lassie was the only dog that saved lives, but there's millions of them. It's an odd culture where walking is an unusual activity. I was recently approached by security at the Toronto Airport wanting to know what I was doing walking round an empty parking lot. The security officer didn't seem very convinced by my 10,000 steps explanation, so I told him I had a heart condition and my doctor had told me to walk everyday. "O.K., carry on sir."

Globesity: Fats and Figures

B.M.I. Body Mass Index or Body Mass Inflation?

• The average person in the UK is 28lbs. heavier than the average person 100 years ago.
• In the USA, hospital costs linked to childhood obesity have more than tripled since 1981, and days spent in hospital for obesity related diseases have more than doubled.
• The number of overweight children has more than doubled in the past 20 years.
• UCLA researchers found that obesity increased health care costs an average of US$395 each year, whereas smoking increased health care costs by US$230. Obesity raises a person's health care costs 36% and their medication costs by 77%. In dollar terms the consequences of obesity are more serious than smoking.

The scientific definition of Obesity is a Body Mass Index of 30 and the definition of Overweight is a Body Mass Index of 25.

• In the past 4 years in the USA the number of men who weigh more than 300lbs. has increased 50% to one in 80, and the number of women over 300lbs. increased 67% to one in 200.

• Stomach stapling surgery increased 29% in 2001 at a cost of over 1 billion dollars.
• 300,000 people die annually from obesity related causes and many more from diseases associated with obesity.
• There is now a special industry making monster beds and wheelchairs to accommodate huge hospital patients. With cutbacks in staffing many nurses are suffering back injuries trying to manoeuvre their patients.
• Dr. Rafael Bangoa of the World Health Organization reports that in an increasing number of areas in Africa including Egypt, Morocco and Zambia more children are overweight than malnourished in a classic feast or famine situation.
  

"Five foot seven, 204 pounds … I'd say you could put on another five or six pounds."

• Food companies produce 3,800 calories of food a day for every American, up from 3,300 calories in 1970 (still too much). Chances are many people are consuming 500 calories a day more than their parents did at a comparable age. (From Marion Nestle's new book 'Food Politics.')

Fast Food Industry Growth Since 1980

• More than 11,000 new food products came onto the market in 1998. More than two thirds of them were candy, snacks, baked goods, soft drinks, ice creams, and similar items ('Food Politics')
• The money spent promoting one major new junk food product often exceeds the total spent in a year to educate the public about healthy eating.
• Portions continue to get bigger. In oxymoron like fashion Lean Cuisine now offer "Hearty Portions" which are 50% larger and Weight Watchers have also been advertising larger portions. The latest edition of the old standby 'The Joy of Cooking' offers the same brownie recipe and ingredients as it did in the 60's and 70's. Except that now instead of yielding 30 brownies you only get 16. People just want bigger brownies.
• The common 7-ounce muffin is the caloric equivalent of 7 slices of bread, plus the added fat and sugar.
• Americans can now get a tax deduction for obesity treatment if they have been diagnosed by their physicians as 'obese.' It doesn't apply to diet foods, but you can deduct the cost of joining and attending approved weight loss programs.

• The 1990's saw a phenomenal 1,384% increase in exclusive agreements between schools and soft-drink bottlers in the USA. 240 school districts in 31 states have sold exclusive rights to one of the big three soda companies (Coca-Cola, Pepsi, Dr. Pepper) to push their products in schools.
• One item of good news is that the promoters of fast food are beginning to get nervous. There is a group which styles itself The Center for Consumer Freedom (CCF) representing food outlets and tavern operators nationwide. The CCF recently spent $200,000 US to run three 60 second spots on radio stations in the Washington area. The ads directed listeners to the CCF web-site which essentially suggests that groups like Center for Science in the Public Interest (CSPI which publishes 'Nutrition Action') are anti-consumer interest and just want to take your pleasures away by taxation or other means. There is a full section titled "CSPI NOT" saying CSPI is "not science in the public interest." The web-site says, "The anti-consumer crowd may seem to take tiny footsteps on the way to controlling your food and beverage options but it's essential to track these 'baby steps'." The web-site is full of headlines such as "More absurd fat tax proposals" or "Fast Food Nation Book is Full of Fluff." In their cartoon section they ridicule the Surgeon General. It's a rather paranoid web-site which suggests that government organizations are really just there to take away your freedoms and pleasures. What really scares them is the concept of taxing junk food, which makes me think it might be a very good idea. Check out the web-site for yourself at www.consumerfreedom.com/index.cfm . Here are two examples from the CCF website.
  

"You Are Too Stupid... to make your own food choices." The Center for Consumer Freedom ran this full-page national ad in U.S. News & World Report to alert consumers that their freedoms of food choice could be the next thing to be taken off the menu.

• It's not surprising that the CCF is concerned about the Center for Science in the Public Interest (CSPI). The CSPI whose magazine 'Nutrition Action' we rated so highly in the Spring edition of 'Well' is the one group which seems to have the resources, knowledge and focus to actually bring about legislative changes. Currently they are taking a lead role in proposed changes to food labeling and the taxation of nutrient poor foods. These are just two of many initiatives they have for leveling the playing field so that the producers of nutrient poor foods don't have an overwhelming fiscal advantage. The CSPI places tremendous importance on creating an environment where it is easier for children to make healthy choices abut food and physical activity.
• According to the Canadian Fitness and Lifestyle Research Institute (CFLRI) only 43% of parents regularly play active games with their children (2000 survey).
• The CFLRI noted that one in five adolescents aged 13-17 reported having no physical education at all in school. About half of children aged 5-12 received physical education only once or twice a week.
• Insurance concerns make school playgrounds and gyms increasingly unavailable.
  "Where do the children play?"

Good reading: "Fixing a Fat Nation" by Tom Farley and Deborah Cohen.
www.washingtonmonthly.com/features/2001/0112.farley.cohen

As usual Dave Barry has his own perspective on problems associated with body image and weight loss. See article 'Never Turn Your Back'. Some of his books include:

Dave Barry: Hits Below the Beltway

Dave Barry's Guide to Life

Dave Barry Turns 50

Cancer Case Study

By Nancy Wardle, MD

One of my patients likes to say that he is four years, a few months, weeks, and days past his expiry date. Told some time ago, after being diagnosed with metastatic colon cancer, that he needed to get his affairs in order, he decided that this meant starting to live what time was left to him differently. He began to understand and practice one of my favourite definitions of health, namely that health is "not just the absence of pain or illness, but rather, living the best life possible, whatever the circumstances." He, rather indelicately, pointed out that he'd gone through life controlling things and, "By being and asshole. But they've taken it out, so now I have to find a different approach."

His medical team, alopathic and complementary, were in charge of helping him eradicate much, if not all, cancer from his body. He was in charge of doing whatever he could, not necessarily to "beat" his cancer, but to move beyond his fear of it and its impact on his life. That meant moving out of a normal and understandable state of fear based reaction, into a more 'how can I best handle this' responsive state. This was especially important when it came to dealing with one of the more persistent and difficult consequences of multiple surgeries, chemotherapy and radiation ….. fatigue. More than pain and more than nausea, his profound loss/lack of energy interfered with his efforts to live well.

"Fatigue makes cowards of us all." Vince Lombardi

Cancer patients consistently report that of all the problems they face, fatigue is the greatest and can be even more debilitating than pain and/or nausea.
Several things helped him. First, as Martin has written about in his essay, medication to increase hemoglobin and white blood cells gave him the necessary building blocks to physically exert himself. Secondly, the information that physical activity was a valuable healing tool, validated by research, gave him confidence to make appropriate demands on his recovering body. Thirdly, his willingness to see clearly the ongoing changes that had been imposed on him, allowed him to be more self-caring.

For him, and for others like him, living well with cancer started with the awareness that, until he accepted the diagnosis, he couldn't defy the prognosis. At the moment of acceptance, his experience with cancer became what psychologist, Lawrence LeShan, calls a 'turning point'. This signified that he was ready to take up the challenge and respond to the unique call to action on his own behalf: mentally, physically and spiritually.

Accepting his fatigue did not mean he liked it, and dealing with it on a daily basis and moving through it required a shift in perspective. His life became a progression of little victories, getting out of bed and to the bathroom one day, (an early mantra was, 'mind over mattress'), next extending his range to the kitchen and then to the garden. He had to 'show up' and live in the moment each day, learning to pace himself and gradually push his recovery boundaries. This was a new life, not to be compared to his physical performance in his previous pre-cancer life. New ways of inhabiting his body/mind and living well presented themselves, yoga replaced his old timers hockey games and he found wisdom in an old admonishment 'walk, don't run'. He learned to use the breath to release, renew and fuel his body. Rest became reasonable and honourable because it allowed for improved recovery. Through setbacks and achievements, recurrences and remissions, he decided to follow Auden's advice and "stagger on, rejoicing" or as he liked to say, "I looked at it this way, if I was vertical that meant I was six feet up, not under."

Acronyms

Adroitly Created Representations Of Notions, You Might Say.

C.A.N.C.E.R.

There are many similarities between the lifestyle and mindset for cancer prevention and cancer treatment. These can be summed up by the acronym C.A.N.C.E.R.

C. Choice
Whatever the situation, you can choose to react or respond. The choice might be between a rock and a hard place, but it is still a choice. You can choose to accept a situation or you can choose to try and change it. You can always choose to nurture your sense of humor, which is a built in survival device.

A. Attitude
Attitude is the paintbrush of the mind. Success in real estate is defined as 'location, location, location'. Success in life is attitude, attitude, attitude.

The greatest discovery of my generation is that human beings can alter their lives by altering their attitudes of mind.
- William James

N. Nutrition
Eat plenty of natural complex carbohydrates and fiber (e.g. fruits, vegetables, grains and nuts). Go for a rainbow diet with multiple colors everyday. Numerous health enhancing phytonutrients are found in colored fruits and veggies. (see 'Well' Spring 2001 or 'The Little Book of Lifestyle Artistry.')

C. Control of Stress
We are good at being human doings, but need to be human beings as well. Seek relaxation through meditation or massage, yoga, progressive muscle relaxation, or whatever turns you off. Don't just do something, sit there. ("Calm Down" is a superb breath centered guided meditation CD by Nancy Wardle, MD)

E. Exercise
Make sure purposeful movement is a part of your day. I really like the 10,000 steps concept (see 'Well' Spring and Summer 2002, '10,000 Steps' articles). Exercise is the generic medicine, what sort of play you choose is just your brand preference. (see 'Well' Spring 2000 'Exercise' article)

R. Relationships
Loneliness is a major risk factor for cancer and many other diseases. Find ways to give and receive love, and make sure you have a loving relationship with yourself. If you find yourself spending a lot of time with negative and depressed people, consider weeding your social garden. As Dean Ornish notes, "There is a scientific basis for the healing power of intimacy."

Send us a favourite acronym of yours

Acronym:		Name:
Phrase:		Email:

My Favorite Things

A mixed bag this issue.

1. Amazon.com

I like its web site, I like the suggestions they make based on my past book purchases. I like the fact that you have an option to buy new or used books and CD's. (Book publishers don't like this.) I like the customer service and I like the CEO, Jeff Bezos. Bezos went from poster boy to piñata when Amazon stock went from over $100 US to just over $5.00 post 9/11. But he's stuck with his business model and built an organization with whom it's tough to compete. They owe a lot of money, but are edging towards profitability and I'm betting they succeed. Another thing I like about Bezos is that his Seattle office is on the 11th floor and he never uses the elevator.

2. Robin Williams HBO Special

This will be aired on July 14th and is a sure-fire winner. Laughter is a big part of wellness, which will make this a very healthy show. While in New York, Nancy and I paid big bucks to see Robin Williams' first stand-up in 15 years. Describing his performance in the New Yorker (8 April 2002) John Lahr wrote, "As a spectator, you have to hang on tight; there are no signposts for the emotional-intellectual switchbacks and no rests. Williams is the ringmaster of his own haunted internal world and the whirlwind of the extraordinary is his natural climate."

We bumped into Robin and his wife while shopping in Soho. I told him we had tickets to see him that night and he thanked us profusely for coming to see his show instead of watching the Oscars on TV. (The Oscars could surely benefit from his talent.) I wish I'd remembered to thank him for "Dead Poet's Society", my favorite of his 40 odd films, but that happens in those brief brushes with fame. As we left the store, ever in character, he held the door open for us saying, "And thank you for shopping Casa Armani."

Robin is now a regular at Glide Church in San Francisco (see the "Georgia On My Mind" article in the Summer 2000 edition of 'Well').

3. The 2002 World Cup

Albert Camus, the French existentialist said, "What I know most surely about morality and the duty of man, I owe to soccer." Amen to that. Growing up in London soccer was my lifeline, and the first poem I ever wrote aged 10 began.

"It matters not the words I say
My thoughts are often far away
At a football match
On a Saturday."

America does not 'get' soccer like the rest of the world, it's too hard to control, it's not media friendly with time-outs for commercial breaks and it's become a sort of shorthand for happy suburban families, rather than the passion of the masses. Evidence of this is already emerging, after Senegal beat France the President of Senegal declared a national holiday, but after U.S.A. upset favoured Portugal, Bush didn't even manage a phone call, but said he was "aware" of the result. Despite the fact that the USA has qualified as one of the final 32 teams, few people could name even one player, or the coach. This would be unthinkable in the other 31 countries. I have been in no North American sports arena where the passion of the fans even remotely approached the intensity of a soccer crowd, who need no cheerleaders, marching bands or amplified sound effects to orchestrate their songs, chants and other-worldly roar.

I will be getting up at strange times to see the major games live from South Korea and Japan, and envying Steve Nash and some friends who have tickets for the all England games. For me a defining moment will be 4:30 am (West Coast time) on June 7th when England walks onto the field against Argentina. The 8,000 English supporters who have travelled to Japan will be singing "God save our gracious team" and my goose-bumps will be being shared with millions of others. England v. Argentina at football attracts much more interest than the Falklands War. (The Argentine military actually used the football song 'Vamos vamos Argentina' to try to boost their morale.) It's easy to go on about the history which includes the brawl in '66 ('Britania Waives the Rules.'), the 'Hand of God' goal by Maradona in '86, and two huge controversies involving clashes between Spice boy, soccer genius David Beckham and Argentine defenders.

It will be riveting stuff with strategy, passion, despair, exultation, and skills so sublime they can make you weep. Soccer is not called 'the beautiful game' without reason.

Organized sport is one of the great achievements of our species and soccer with its minimal equipment and simple rules is the ultimate game. (In the rest of the world soccer is called football, but this leads to confusion in North America. The word 'soccer' is derived from the 'soc' in association football, which is the correct terminology for the 'beautiful game.')

Late Note. As the excitement mounts, even George W. Bush called Mexican President Vicente Fox prior to the start of the USA vs. Mexico game.

4. 'Stupid White Men' by Michael Moore I've always liked Michael Moore who's smart, abrasive and not even close to being politically correct. I own his first documentary, 'Roger and Me', about the decline and fall of Flint, Michigan and his efforts to talk about this to Roger Smith, the CEO of General Motors. 'Stupid White Men' has topped the non-fiction best-sellers list for weeks and is worth reading for the first chapter alone, 'A Very American Coup' about the Florida election. Moore's new documentary 'Bowling for Columbine' has been the surprise hit of the recent Cannes Film Festival, and got huge coverage in the French press while I was there.

5. New Zealand Sauvignon Blanc I'm not a wine expert and won't give you a bunch of trendy adjectives to try to do with words what can only be done by taste buds. There seems to be ideal growing conditions for the sauvignon blanc grape in New Zealand and they've won over the world with their aromatic, crisp and fruity wines. There are plenty of good ones to choose from including the various 'Bay' wines, Oyster Bay, Hawkes Bay, and Cloudy Bay. Stoneleigh, Matua Valley and Marlborough are 3 others that come to mind. If I had to pick a favorite it would be the Cloudy Bay 2001, with Oyster Bay 2000 or 2001 a close runner-up at a few dollars cheaper.

Poetry

Wild Geese You do not have to be good. You do not have to walk on your knees for a hundred miles through the desert, repenting. You only have to let the soft animal of your body love what it loves. Tell me about despair, yours, and I will tell you mine. Meanwhile the world goes on. Meanwhile the sun and the clear pebbles of the rain are moving across the landscapes, over the prairies and the deep trees, the mountains and the rivers. Meanwhile the wild geese, high in the clear blue air, are heading home again. Whoever you are, no matter how lonely, the world offers itself to your imagination, calls to you like the wild geese, harsh and exciting - over and over announcing your place in the family of things. Mary Oliver

 

The Journey One day you finally knew what you had to do, and began, though the voices around you kept shouting their bad advice -- though the whole house began to tremble and you felt the old tug at your ankles, "Mend my life!" each voice cried But you didn't stop. You knew what you had to do, though the wind pried with its stiff fingers at the very foundations, though their melancholy was terrible. It was already late enough, and a wild night, and the road full of fallen branches and stones. But little by little, as you left their voices behind, the stars began to burn through the sheets of clouds, and there was a new voice which you slowly recognized as your own, that kept you company as you strode deeper and deeper into the world, determined to do the only thing you could do -- determined to save the only life you could save. Mary Oliver

 

In her own words… In your dedication to your own life's work, whatever it may be, live as though you had forever, for no amount of careful and devoted doing is too great in carrying out that work to which you have set your hands. Cultivate in your work and your life the art of patience, and come to terms with your inevitable human limitations, while striving also to extend the boundaries of your understanding, your knowledge and your compassion. These words are easily said; they are not easily lived. Learn from those who are older than you are; learn from your contemporaries; and never cease to learn from children. Try to feel, in your heart's core, the reality of others. This is the most painful thing in the world, probably, and the most necessary. In times of personal adversity, know that you are not alone. Know that although in the eternal scheme of things you are small, you are also unique and irreplaceable, as are all your fellow humans everywhere in the world. Know that your commitment is above all to life itself. Your own life and work and friendships and loves will come to an end, because one day you will die, and whatever happens after that, or if anything happens at all, it will not be on this earth. But life and work and friendship and love will go on, in others, your inheritors…It is up to you, now… Margaret Laurence 1926-1987

 

Quotations

Speaking Engagements

April 3 & 4 - Kern County Public Health Department - Bakersfield, CA

April 8 - Pacific Sport Seminar - Victoria, BC

April 14 - Focus Conference - Victoria, BC

April 28 & 29 - Recreation Conference - Slave Lake, AB

May 1 - Ohio Department of Health/WIC - Columbus, OH

May 3 - Surrey Teachers Association Secondary Convention -Surrey, BC

May 24 - Workplace Health, Safety & Compensation Commission of New Brunswick - Saint John, NB

June 1 - BC Human Resources Management Association Conference - Nanaimo, BC

June 8 - Dietitians of Canada Annual Conference - St. John, NB

June 13 - Canadian Elevator Contractors Association - Victoria, BC

June 18 - Center for Curriculum, Transfer & Technology -Victoria, BC

June 26 - Seaside Health Promotion Conference - Seaside, OR

July & August - Summer holidays and back to work in September!

August 13 - Intermediate Unit 1 Inservice - Coal Center, PA

September 7 (on hold)- Correctional Service of Canada - Saskatoon, SK

September 20 - Concrete Reinforcing Steel Institute Conference - Victoria, BC

September 27 - Transcona-Springfield School - Winnipeg, MN

October 18 & 19 - Early Childhood Educators' Conference - Cranbrook, BC

October 22 - Western Canada Educational Administrators' Conference - Kananaskis AB

October 24 - Victoria Quality Council - Victoria, BC

November 5 - Workplace Health, Safety & Compensation Commission of New Brunswick - St. John, NB

November 6 - Saskatchewan Credit Union Central - Saskatoon, SK

November 14 - Assoc. of Washington Cities - Sea-Tac, WA

February 3 - Victoria & District Dental Society - Victoria, BC

February 18 - Health Excellence & Fitness Symposium - Pensacola, FL

February 21 - School District #43 Professional Development Day - Coquitlam, BC

Visions of Wellness

Nancy salutes the sun at Tofino, on Canada's West Coast.

In addition to caring for her patients, Nancy is in demand as a speaker
and last week was a typically busy week:
Wednesday, June 5th - World Breast Cancer Conference presentation,
Thursday, June 6th - Chapters of Hope presentation at Indigo Bookstore,
Friday, June 7th - Fanny Kiefer Show on CBC TV.

Cartoons

from The Journal of Medical Humour Stitches.

Grins

Never Turn Your Back on Your Mirror

By Dave Barry, The Miami Herald

Resisting Temptation

Yoga at Your Desk