Deep Dive
Shownotes Transcript
When it comes to weight loss, no two people are the same. That's why Noom builds personalized plans based on your unique psychology and biology. Take Brittany. After years of unsustainable diets, Noom helped her lose 20 pounds and keep it off. I was definitely in a yo-yo cycle for years of just losing weight, gaining weight, and it was exhausting. And Stephanie. She's a former D1 athlete who knew she couldn't out-train her diet, and she lost 38 pounds.
My relationship to food before Noom was never consistent. And Evan, he can't stand salads, but he still lost 50 pounds with Noom. I never really was a salad guy. That's just not who I am. Even through the pickiness, Noom taught me that building better habits builds a healthier lifestyle. I'm not doing this to get to a number. I'm doing this to feel better.
Get your personalized plan today at Noom.com. Real Noom users compensated to provide their story. In four weeks, the typical Noom user can expect to lose one to two pounds per week. Individual results may vary.
Welcome to The Referral. I'm Dr. Curran, a surgeon in the NHS, and this is your weekly fix for all things health, science, and actionable tips to improve your life. Today, I'm going to be discussing the emperor of all maladies, cancer. Why do we get cancer, and will we ever be able to beat cancer? Over the past few years, there have been some breakthroughs in cancer science and cancer treatments.
And today I'm fortunate enough to be joined by Professor Peter Johnson. He is the cancer guy. He's the chief clinician at Cancer Research UK and a professor of medical oncology at the University of Southampton. He's also the clinical director for cancer in NHS England. And those changes appear to be capable of inducing cancers at different rates. Why people who live on our planet
predominantly fiber-based diet are much less prone to bowel cancer than people who live on a high fat diet. Later on, I'll be answering your questions in CrowdScience. And remember, if you've got a question you want me to answer on this show, get in touch via the referralpod.com. You can hear even more science and even more myth-busting about your queries in CrowdScience Extra. Just visit the referral show page on Apple Podcasts and hit the try-free button to begin your free trial today.
You'll then unlock the extra episode, which sits right under this one on the feed. And remember, if you're sitting there quietly just listening and haven't yet asked your own question, get in touch via the referral pod.com. Professor Peter Johnson, thank you so much for joining me today. You are a professor of medical oncology. You have dedicated most of your adult life to cancer research and cancer advancement as well.
Tell me a little bit about what a daily life looks like for you if there exists such a thing. So I'm a medical oncologist with a particular interest in cancer immunology and I'm a clinical academic so I divide my time between clinical work looking after people with cancer and in my case that's a specialization in lymphoma as
As I've gone on, I've become more and more narrow in my interests. I used to treat lots of different sorts of cancer and more recently just lymphoma. And at the same time, we run a large program of research in trying to understand how the immune system can be taught to recognize cancer and how to combat it. And whilst that was, for a large part of my career, a bit of a niche specialty and a
that people thought sounded interesting, but they weren't sure it was ever going to work. In the last decade, we've seen an explosion of knowledge
and application in the clinic, which has been really exciting to see. Yeah, I mean, you've mentioned that immunotherapy and how it was a niche thing. And now almost every few weeks, I seem to read headlines, sometimes sensationist headlines about a groundbreaking new cancer therapy. And it all seems to be based on monoclonal antibodies, cancer vaccines, and some form of
immunomodulation to improve either responsiveness to cancer therapy or finding a way to limit cancer evasion against the immune system. What are some of the, you could say, groundbreaking things within the last couple of years we've seen in immunology that's helped with cancer treatment? I mean, if you look at the history of medicine and by medicine, I mean systemic treatment of illnesses, there are two things which have enabled us to make progress historically. One is small chemical entities, drugs,
And the other is vaccination or some means of bringing the immune system to bear on an illness. And vaccination, of course, derives from the original general experiments of using cowpox to prevent people from getting smallpox.
So the idea that you can bring the immune system to bear on an illness goes back a very long way. And indeed, the idea that you can bring the immune system to bear on cancer has a long history as well, well over a century. The difficulty with modulating immunity is that it's an infinitely complex system. So one of the things that the COVID pandemic has taught everybody is an enormous amount about the immune system. Everybody who's
about COVID and what vaccinations to prevent virus infections might do has heard the terms T-cells and B-cells. So our immune system consists largely of neurons
lymphocytes, these are a particular sort of white blood cell, they come in two broad strains, the T cells, which are very good at recognising things like cells infected with viruses and directly killing those cells, and B cells, which are the cells in the immune system which go on to make antibodies. So when I vaccinate you against COVID,
Two things happen. Firstly, you produce T cells which recognize the little bit of the COVID virus that I vaccinated you against. And secondly, you go on to produce B cells which make antibodies which stick to cells infected by the COVID virus. So the immune system is fantastically good and fantastically well evolved over millennia.
for us to fight infectious diseases. What we can also do is tune the immune system to recognize and fight cancers. And in exactly the same way as a cell infected by a virus has little bits of virus protein visible on its surface,
So a cancer cell, which has developed mutations in the course of its development from being a normal cell in the lining of your bowel to being a cancer cell, as it develops those mutations, those little mutations are expressed as little bits of protein on the cell surface as well. So we can use the immune system, which we've mainly developed over the centuries to protect us from infectious diseases, to also attack cancers, which they're not
primed to do naturally, but we can artificially co-opt the immune system into doing that. Do you think there's a bit of
evolutionary game theory at play here. You know, in the same way that, for example, populations and ecology and animals in the environment evolve to avoid or get better at killing other, you know, their prey, in the same way that as we evolve our treatment, radiotherapy, chemotherapy, immunotherapy against cancer cells, they become better at evading those treatments. But at the same time, they're in this double bind where they become more resistant to
chemotherapy or radiotherapy, but because they are better at evading something else, they become worse and they expose their Achilles heel at another thing. For example, immunotherapy, which allows many patients to be given treatment with two things, you know, chemotherapy and immunotherapy, for example. So people think of cancer as one thing, but we have lots of different sorts of cancers. They arise in different tissues of the body.
and they grow in very different ways. And if I look at two cancers from the same organ but from two different people, two types of breast cancer, and I look at the genetic changes within those cancers, they will be unique to each particular person. So cancers are very individualized things. They develop in very individual ways.
And as the cells go from being nice, normal, well-behaved cells which know when to grow, when to divide and when to stop to being this chaotic, uncontrolled growth spreading around the body, going and living in places where they shouldn't live, that process of evolving from normal to malignant happens.
is of course all the time under the selection pressure of the immune system. So we generate tiny cancers all the time or we generate changes in cells all the time which might lead on to cancer. Most of the time our immune system spots it, takes them out and nothing ever happens. They never develop. So by definition something which has already turned into a cancer which is capable of spreading around the body has got out under the radar, has escaped that surveillance
and is able to grow despite the controls of the immune system. So it's already evolved in a way which has protected it from immune suppression. And our job in trying to treat it is to work out how you restore that suppression, how you restore the recognition.
Oh hello strangers, I'm Alice Fraser, your guide to the galaxies, goblins, dungeons and dystopias. We'll be hurling ourselves into a weekly hero's journey through realms unknown into the dark but sensual heart of all our favourite speculative fictions. We'll navigate the wild realms created by brilliant authors, filmmakers, game designers and more. New episodes drop every week on your
podcast app or on YouTube. Do not resist the call to adventure, chosen one. Join me for Realms Unknown. My dad works in B2B marketing. He came by my school for career day and said he was a big ROAS man. Then he told everyone how much he loved calculating his return on ad spend.
My friend's still laughing at me to this day. Not everyone gets B2B, but with LinkedIn, you'll be able to reach people who do. Get $100 credit on your next ad campaign. Go to linkedin.com slash results to claim your credit. That's linkedin.com slash results. Terms and conditions apply. LinkedIn, the place to be, to be.
And your point about all cancers being different, the biologies of even same types of cancer in two different people being different, for example, you know, even the same type of lobular breast cancer in two different patients will be completely different on a genetic basis. How deep into bespoke cancer therapy are we now?
in 2023, instead of just saying, you have this type of chemotherapy for both these patients, looking into the specific genetic sequence of those cancers, and almost on a genetic level providing treatment for that. Are we there yet?
So we've come a long way in cancer treatment without knowing the very specific changes that take place in people's cells. Surgeons cure enormous numbers of people with early cancers by doing essentially the same operation. Everybody with bowel cancer will get the same sort of operation. Similarly, chemotherapy and radiotherapy, which are, you know, radiotherapy is shining a beam of intense radiation on a cancer in a particular place. And again, that doesn't take any account of the biological characteristics of the cancer. Right.
chemotherapy similarly is a form of mild poison which stops the cells from dividing or kills them in various ways. As we've had the explosion of knowledge and our ability to see into the molecular changes within individual cancer cells, so we're starting to understand much more about what the precise determinants are of success. The analogy might be
Cartography, for example. In the Middle Ages, we had these rather beautiful medieval maps, things like the Map of Mundi, where they drew dragons around the edge and the geographical outlines of the countries bore a vague resemblance to the shape of the country. But it was more a work of art than a work of precise science. Whereas now you have satellite images which can show you whether the garden shed is open or not.
So the level of gaze and the precision of gaze that we've developed through technological changes has made an enormous difference to our ability to understand cancers at a molecular level. And would it be fair to say that
not necessarily all cancer needs to be treated. I mean, it sounds like a controversial statement, but a recent long-term study looking at active surveillance versus more aggressive measures such as radiotherapy and surgery in prostate cancer, for example, suggested, you know, there was no significant difference in mortality in several years follow-up between just watching and waiting and close surveillance and actually intervening with quite intense treatments for prostate cancer, for example.
This, again, varies enormously from cancer type to cancer type. And prostate cancer is a very good case in point where there are a lot of people who die of prostate cancer. So it's not a benign situation. It does spread around the body and there are plenty of people who die from it. Conversely, there are a lot of people who, as we get older, we all of us have more and more changes in our cells. There are a lot of people who have cancer cells within their prostates who...
who will die of something else before the prostate cancer ever turns into anything nasty. And one of the jobs of biology is to try and understand how to tell in advance which is which so that we can really intervene quickly for the people who really need the treatment and we can leave alone the people who don't. What role do you see the microbiome having in changing the course of cancer treatment, either improving it or making someone sicker?
more resistant to a particular type of therapy? I think the microbiome is a good case in point, and it's a long way from my area of expertise. But it's clear that there are levels of complexity over and above what takes place in cancer cells. The microenvironment, the organismal environment, of which you should also include the microbiome,
And certainly we can see that changing the diet from a very Western diet, rich in saturated fats, to a much more fiber-based diet, such as you might get in sub-Saharan Africa, for example, has an enormous effect in a very short space of time on the bacterial content of the gut. Not surprisingly, if there's a lot of fat for them to live on, then you'll get the sort of bacteria that like a lot of fat. If there's only fiber for them to live on, you'll get a lot of bacteria that are happier in that environment.
And those changes appear to be capable of inducing cancers at different rates, should I say. And we've wondered for a long time about why people who live on a predominantly fiber-based diet are much less prone to bowel cancer than people who live on a high-fat diet. And it looks like the microbiome is a potential determinant of that. We are really just at the beginning of our understanding of this. When you look at the...
bacteria that live in the gut. There's thousands of them in any one person's gut. And trying to, again, understand all this massive information and try and pull some rules out of it so that you can really go, not just do observational work, but actually say, okay, if A, then B.
We haven't got that yet in the study of the microbiome, but it's pretty clear that skewing of the microbiome certainly has an influence on the likelihood of developing some types of cancer and the rise of bowel cancer in a much younger group of patients than we've seen previously over the last decade is potentially related to that.
Also, if we look at the effects of treatments using the immune system to fight cancer, we can also see that probably those are affected by the microbiome and the gut at the same time. And that probably has to do with the levels and the particular types of immune activation that are existing. And you mentioned there that, you know, a rise in things like bowel cancers in younger people. I read a statistic recently that people born in the 1990s
are at double the risk of colorectal cancer and quadruple the risk of rectal cancer than people born in the 1950s. That was a report, I think, from the American Cancer Society a couple of years ago,
Why is that? Is that because of changes in dietary factors leading to a change in the microbiome? Or is there some other unseen hidden basis for that? Yes, again, not my field specifically. And the straight answer is we don't know. You have to...
think that it probably has a lot to do with diet and the way that our diets have changed over the last 50 years. And that seems the most likely culprit and the most likely explanation for it. But there's a huge amount of work going on to try and dissect this out at the moment and try and understand what has driven this really quite striking increase in bowel cancer at a younger age, people under the age of 50, which pretty much
previously was pretty uncommon, where we're seeing increasing numbers of cases now coming through. And obviously, with our evolving diagnostic tools now compared to 10, 15 years ago, over the last few years, we've seen a rise in the number of these multi-cancer early detection blood tests, for example, the GALERI test, which claims to be able to detect 50 cancers just from a blood test. Now, I see this as a sort of
poison chalice. There's obviously the blessing there, which is, wow, we can detect these cancers early before something happens. But also the kind of double-edged sword there is, okay, in an asymptomatic person, we detect their risk of cancer or potentially early cancer, and we then subject
them to a gauntlet of potentially unnecessary investigations, often which may be very invasive. And then we get down this slippery slope of we find things that we shouldn't have found, which never would have harmed them. And we're now just giving them more tests and more procedures just on the base of one single blood test, which may not have ever harmed them.
I think you have to recognize that not knowing is not going to be helpful. Knowing may be helpful or unhelpful, but unless you have the information, unless you've done the experiment and investigated what happens to people, you're never going to be in a position to change the natural history of these things. Two, three hundred years ago, most people didn't live long enough to be old enough to develop cancer. We've changed. We've changed our...
the population in ways through public health, through the suppression of infectious diseases, through increasing the suppression of cardiovascular disease to allow us to live long enough to get a whole different pattern of diseases to those we saw previously. And we're still finding our way into which ones are the biggest threat to us and which ones can be safely watched.
And I think we still have a huge amount of work to do, even in prostate cancer, which we've been investigating for a long time to understand which ones are likely to grow fast and which ones can safely be observed. And only by finding them and observing them and working out what their natural history does would we be able to do this. So I'm not a fan of the ignorance is bliss school of thought.
At the same time, we have to be super careful about medicalizing the population and turning healthy asymptomatic people into subjects of intensive medical investigation. So there's a middle course to steer between these two. I mean, on that point of, you know, trying to avoid medicalizing a healthy asymptomatic population, I recently saw, you know, this influencer in America, Kim Kardashian, who was
promoting and doing an advert on social media, on her social media to her hundreds of millions of followers about a full body MRI scan. And, you know, she was recommending this as a life-saving treatment where you can do a full body MRI scan, okay, full body MOT and pick up things which you wouldn't have picked up.
Now, that seems to be the steroid version of the cancer blood test, where you would find things that routinely shouldn't need to be picked up at all. What are your thoughts on a routine screening, full body screening for just an asymptomatic population in their 20s or 30s? I think it's really important for healthcare systems in general that we go on the basis of evidence and that we do things for which there's good evidence of benefit.
And until there's good evidence of benefit, we should do the research. We should work out what works. And I wouldn't jump into embracing those kinds of technologies without some really clear evidence that it's helpful to people. I can completely understand why people want to do that.
But at the same time, it's really important that we do it in a very measured and careful way. And recently I saw you were quoted talking about the seven-minute anti-cancer jab, which is all over the headlines. It's gone from being a hospital-based intravenous infusion, which would take an hour or maybe longer in some patients, to now having a subcutaneous under-the-skin seven-minute injection.
How much of an impact can that have on cancer services in the UK and potentially over the world if it's ever rolled out worldwide?
So monoclonal antibodies, we've always tended to give intravenously because that was how they were originally developed. And these antibodies which stick to the cancer cell surface and allow the immune system to recognize and target it, which we've been using for 25 years, have been transformative in my own area of lymphoma. And the likelihood of surviving lymphoma has gone up massively since we introduced actually just one antibody targeting B cells, which is what
most lymphomas in the West are. And you can see the point of inflection in the mortality curve for the population as a whole with the introduction of this one treatment, which is pretty remarkable that if you think about medicine and mortality, and we'd seen a continuously rising mortality rate for lymphoma until that antibody was introduced. And then it started to go down again, despite the fact the incidence has continued to go up as our population ages.
So that's pretty remarkable for a piece of medical technology. If you want to be able to deliver that in out-of-the-way places where you don't have a big specialist nurse population, where you may not have access to all the disposables and all the things that you need for lots of intravenous treatments, giving it under the skin makes complete sense. So the ability to take this sort of treatment into remote settings, into less economically fortunate settings...
is incredibly important. So I think that was the original motivation behind developing subcutaneous treatments with long-legged. You get a much more smooth absorption. So if you give an antibody intravenously, you get a huge spike of it, and then it goes off into the tissues. If you give it subcutaneously, you don't get that huge spike, but you get the same area under the curve, the same overall exposure to the drug.
So that's proven to be something which originally designed for less well-off economies, but which has actually been incredibly helpful for our service where...
as we have increasing numbers of people coming through and we're under, you know, pressure for capacity to look after them, if you can get people to have a subcutaneous injection, which takes a few minutes rather than sitting attached to a drip for an hour, that's massively helpful for being able to treat more people. What we'd really like to do is people giving it themselves, of course, which is the next step. REI Co-op presents a mini mindfulness break.
Take a deep breath in. Picture yourself on a mountain. As you hold your breath, look down at your skis, freshly waxed thanks to your REI membership, carving through powder like a knife to warm butter. Breathe out slowly. Let the air leave your lungs like you'd leave your local co-op with all the gear, clothing, classes, and advice you could hope for. Make time to opt outside. REI.com.
Since you're new to H&R Block, we'll look at your returns from the last three years for any money your last guy might have missed, for free. I could get money back from last year? You could. We'll find any mistakes. Could have really used that two years ago when I dated that mistake for five months. Don't leave money on the table. Switch to H&R Block and get a free second look review. Second look is included at no additional cost with the purchase of tax preparation. Results vary. All tax situations are different. Fees apply if you have us file an amended return.
One of the things I like to do on this podcast is debunk myths. And, you know, when it comes to cancer, I think there's an endless list of myths that people are trying to propagate. Now, the myth I hear a lot on social media is that, you know, every time you hear something like this seven minute jab or the Carty cell therapy, which was talked about last year,
It seems to then disappear and no one hears about it. And then there's these conspiracy theorists online say Big Pharma wants to suppress any breakthroughs in cancer because, you know, more money is made from treating disease than curing it. What are your thoughts on that take from a conspiracy theorist? It isn't a worldview that I recognize at all. I think if we could find ways to
to really highly effectively treat cancer in a very short space of time. We'd all take it. I'd be very happy to be not having to look after people with very advanced cancer, which has gone beyond the point of being treatable. If we had more effective treatments, then that would be great and we could all do other things with our spare time. The fact of the matter is, you know, we have, as our population gets older and cancer becomes more common, an enormous number of people who need our help
And also, as we're all getting older and getting cancer at more advanced stages, we have other illnesses as well. So treating a lymphoma in somebody who's 40 years old and otherwise incredibly fit is reasonably straightforward. I wouldn't pretend it's easy for the person involved, but it's, from the medical point of view, reasonably straightforward.
Doing the same thing in somebody who's 85 who's got, you know, had coronary artery disease and has got a bit of chronic bronchitis and might be diabetic is a completely different proposition. So the other illnesses which we acquire as we get older at the same time as our risk of cancer goes up has made this enormously more complicated than it used to be. So this is not about...
people suppressing fantastic treatments. These treatments that you hear about go from being the latest thing to something we're routinely doing. And there are...
tens, maybe even hundreds of thousands of people having subcutaneous antibody treatments now as a result of the change in the technology to be able to do that. Similarly, something like CAR T-cells, which is taking somebody's own T-cells out, putting a construct in which allows them to stick to something on a cancer cell surface and recognize it and kill it, is something which we do for thousands of patients a year now in the UK. We've been rolling that out over the last...
five years or so. And there's no doubt there are quite a lot of people alive who've had lymphoma in particular, who would not have been alive if they hadn't had CAR T-cell treatment. I mean, it has been remarkably effective for people whose other types of treatment have failed them. And another common thing I hear, and usually I feel it's a result of
fear and lack of trust in the medical system. And it's a lot about you can cure cancer or avoid cancer purely with dietary changes. If only that were the case. I think there's no doubt that there are a lot of factors in our lifestyle which predispose us to get cancer, the far the biggest of which is cigarette smoking, where we know the dominant risk is really very high.
But dietary changes, as we were saying earlier, probably have played a role in the increase of some types of cancer. And if we can start to understand really what those are and to move away from the dietary features that make us more likely to develop cancer, that can also help. Being overweight, not taking enough exercise, we know all of those things actually contribute to our cancer risk. So there's lots of things we can do that are in our hands.
But at the same time, quite a lot of cancer is random damage to the genome, which comes down to really bad biological luck that these cells develop these abnormalities, develop more abnormalities, get away from our immune systems and evolve in such a way that they turn into full-blown malignancies. And not all of that is driven by our lifestyles or the way we live. Some of that is just the way that cells are as they get older and acquire more damage. Yeah, I agree. I mean, you know, obviously, if you're living a good lifestyle with a
high-fiber diet, activity, good sleep, clearly you would have a significant reduction in your risk of cancer. But then again, I feel that also...
points the finger at people who get cancer and then they're blamed for their lifestyle, where actually they may have been doing everything right, but they just get a cancer because it's sheer bad luck. Exactly. And everybody knows of people who've lived well into their 90s despite smoking 20 cigarettes a day, and equally people who get lung cancer at a terribly young age despite never having smoked. So this whole thing is...
probabilistic. There are things we can do to help and reduce our risk, but nothing will completely emanate it, unfortunately. Just before you go, you had a question for me. Yeah, I mean, you're training as a surgeon, and I'm interested to
know what you think about the march of technology and how that's going to change the working lives of surgeons for the future. I mean, we see lots of innovation. Surgeons have always been really good at thinking of new ways of doing things and innovating. And we see, for example, robotic surgeries is really taking off in certain areas. I think 96% of prostate operations are now done by robotic surgery.
And I'm interested to know how you think that's going to change the life and the training of surgeons in the future. Yeah, it's a really fascinating question because you can clearly see that the modern surgical trainee, and I'm talking about maybe surgeons who have trained from the year 2000 onwards, right?
who were in the sort of laparoscopic era of training, minimally invasive surgery, where most of the operations they do, whether it's a hernia operation, appendix removal, gallbladder operation, bowel cancer operations now, mostly done laparoscopically. These surgeons, the bulk of their cases will be done laparoscopically, but we can never discount the fact that a small percentage of cases, if something goes wrong or it's just technically difficult, you will need to do a big open surgery. Right.
It's very difficult to acquire the open surgical skills to the same level of proficiency as you are with your laparoscopic skills because you're just doing that every day. So now with robotic surgery and maybe a surgeon in 2040 who's done all his training only robotically, how can then that surgeon, if something happens and there's a catastrophic major hemorrhage,
Would they have the skills to quickly open and do things? I don't know, because the sort of older generation surgeons who could do a little bit of everything...
They're now diminishing and we are getting to this super specialized surgeon who just focuses on one thing. So it's worrying in a way, but obviously fantastic that we're developing these novel techniques. But I do worry about the, you know, retainment of broad range of skills. Feels like something where we really need, and I know the College of Surgeons and the surgical associations are thinking hard about this, is how do we make sure that we've got enough
trained surgeons that really can deal with not when things go well but when things don't go well and of course it's not something where you can send for somebody from 20 miles away you need somebody there right now and I think making sure that we retain those skills among our surgeons as a medical oncologist I've always had a degree of scalpel envy the
medical oncologists are kind of people who would have been surgeons if they had the dexterity, but still like this kind of therapeutic inclination of the way that we work. And I think it's really important that we retain those really high level skills that the surgeons have and can
work in ways which keep people safe and make sure that not only can we do the everyday stuff that goes well, but also deal with the emergencies. I think, you know, the field in which you're in, hopefully at the rate it's expanding, eventually you may be able to slowly start putting surgeons out of jobs. That's the holy grail, maybe one day. It will be lovely, but I think we're going to need surgeons for a very long time to come. So I think you're safe. Okay. Thank you so much, Professor Johnson, for joining me.
Just before we go, we have a listener question. This one is from Carly in London. Carly asks, I've had quite an emotional time recently and I found myself in tears much more than I would like for various reasons. My question is, do you need to drink more water when you've been crying? Does it dehydrate you?
Secondly, why do you get a headache after you've been crying quite intensely? So thank you very much for that question, Carly. There's quite a few bits to unpick here. Number one, the amount you cry is very, very, very unlikely to dehydrate you. The tears serve many purposes. You've got different types of tears. You've got emotional tears, which you're describing. You've also got reflexive tears and tears which just lubricate your eyeballs.
and this is all part of your bodily fluid which it accounts for. Now, if you are very dehydrated to the point where you literally cannot cry, you cannot produce tears, you cannot produce sweat, then yes, you may need to drink more water, but it doesn't work the other way where you cry so much, you can actually dehydrate yourself and lower your total fluid content in your body. That is, I don't want to say impossible, but
very, very improbable. And your second question about getting a headache, there's an emotional reason you've been crying intensely and that can play a part in giving you a headache, whether it's stress related, anxiety related, there are lots of obvious causes for your headache.
And finally, if you're crying intensely, you're contorting your face, you're closing your eyes, you're scrunching your eyes. So all of these muscles around your face and head are being contracted and this can lead to this type of muscular headache. So Carly, I'm really sorry that you've been crying for whatever reason, but thank you for taking the time to ask this question.
And hopefully that can assuage some of your queries and conundrums. And in this week's episode in Crowd Science Extra, I'm also answering a question from Zahid in Nottingham who asks about getting involved in clinical trials. Zahid has celiac disease and he's wondering how he can get involved in any clinical trials to try new medication or otherwise. If you want to find out, check out the Crowd Science Extra episode.
And that's a wrap for today's episode, but no doubt I'll be covering cancer in the future because there is so much to talk about and cutting edge science to bring to you. Thanks for listening to this episode of The Referral. Yes, I am a real doctor, but I'm not your specific medical doctor. So if you need specific medical advice, contact your own healthcare professional. And remember, nothing on this show is intended to provide or replace specific medical advice that you'd otherwise receive from your own doctor.
This has been a Sony Music production. Production management was Jen Mystery. Videos by Ryan O'Meara. Cameras, James Lloyd. Studio engineer was Matias Torres. Music by Josh Carter. Grace Lakewood and Hannah Talbot were the producers. And Gaynor Marshall and Chris Skinner are the executive producers.