BPA - Join the Revolution

You may remember my one-woman investigation into the fact that those of us who eat food out of tins (and who doesn’t – apart from me?) are being bombarded with an oestrogenic substance called Bisphenol-A.

Spurred on by the Breast Cancer Fund’s Kick the Can campaign, I have pledged to eat no tinned food in July. For me, it was easy: no BPA infested tinned food has passed my lips for over a year now. But for most of us, avoiding tinned food falls into the ‘too-hard basket’ of life. Don’t despair, Lily is here to give you some support.

Lily’s top tips for avoiding tinned food:

Fruit:

I get a weekly delivery of fresh, organic fruit from Riverford Organics. Then I cook up a variety of compotes (rhubarb; blackcurrant and apple; gooseberry; mixed berries etc) using agave syrup to sweeten them. I store the compotes in glass jars in the fridge. Fabulous for an instant breakfast or dessert with yoghurt or ice cream.

Buy organic fruit in summer whilst it is cheap and plentiful, then freeze it. Also make home-made sorbets and keep them in the freezer.

Fresh and dried fruits are great to keep around the house for quick snacks.

Beans:

Dried beans, the upside: they taste much better than tinned beans. The downside: most beans have to be soaked overnight before cooking. Lentils are the exception.

Sainsbury’s now do a great range of organic beans (butter beans; black beans; canellini; lentils) in BPA-free Tetra Paks. Posher brands come in glass jars.

Organic frozen peas and broad beans cook in seconds and are available from most supermarkets.

Vegetables:

Most vegetables in tins are completely flavourless. Steaming fresh veg usually only takes a minute or two.

I buy sweetcorn cobs with the papery leaves still on. These act as a natural wrapper. Just bung a cob in the microwave for 4 minutes (7 minutes for 2 cobs) then peel away the leaves and hairy flax. Eat the corn as is with butter, salt and pepper or cut the niblets off with a sharp knife to add to salads.

Tinned meat:

Are you crazy? Don’t eat that sh*t. Sometimes I have a ‘cooking Sunday’ when I make some organic chicken or lamb casserole and then freeze portions that can be reheated for a quick snack. If you simply can’t cook then go for a good quality, preferably organic, ready meal, but take it out of the plastic tray before heating. Reheat ready meals in a stainless steel or cast-iron saucepan or a ceramic oven dish or microwave them in a Pyrex or ceramic bowl (cover with unbleached kitchen paper).

Tinned fish:

Anchovies and tuna fish are both sold in glass jars. Frozen prawns are great for adding to curries, pasta and stews.

Soup:

Buy soup in Tetra Paks – or make your own.

Tomatoes:

Again, tomatoes are available in Tetra Paks. Tomato paste can be bought in glass jars. Tomato sauce is easy-peasy to make at home and freeze.

So get on board with Lily and Ernest Hemingway (above), sign the pledge, kick the can and please let us all know how you get on.

BPA - A Canalily Investigation

In past posts I have drawn attention to concerns about Bisphenol-A. Apparently it is an endocrine disruptor that mimics oestrogen in the body. If you’ve been with me up to now (come on, keep up!) you will know that, in the context of breast cancer, this is not a good thing.

I have read that the lining of tins is made of plastic and known to leach Bisphenol-A. In general, plastic will release far more chemicals when heated. Tins of food are heated to high temperatures when they are sealed, in order to kill bacteria.

In August 2009 a group of French Senators tabled a bill that proposed to ban BPA in all food containers. The proposal was watered down and in June this year they approved a proposition to ban BPA in babies’ bottles. Yes, that’s right, BPA is in babies’ bottles and no, I didn’t know that either.

In March the Danish government banned BPA in all materials that are in contact with food intended for children aged 0-3.

Last month the Canadian Government declared Bisphenol-A to be toxic.

Last week the European Union banned it from babies’ bottles. The move has been greeted with a great deal of moaning from the plastics industry.

Surely what is not good for babies is also not good for me?

From:      Canalily

Subject:   Tinned Foods

To:          Sainsburys, Waitrose, Tesco, Marks & Spencer, Coles, Woolworth's

Dear Madam or Sir,

As a breast cancer survivor I am increasingly concerned about the leaching of possible endocrine disruptors into food. It has come to my attention that the plastic linings of food tins may contain Bisphenol-A.

Unfortunately, there is no way to tell if the tin is lined with plastic until one opens it.

Would you be so kind as to send me a list of the foods that you sell in unlined tins?

With kind regards

Canalily

From:      ASDA

Subject:   Tinned Foods

To:          Canalily

Hello Lily,

Thanks for contacting us.

I understand your concerns about Bisphenol A in food as you have survived breast cancer.

However, I am unable to provide you with a list of foods because of the volume of products we sell.

If you are worried about any particular food please let me know and I will speak with the technical team about it.

Once again, thanks for contacting us and if I can be of further assistance, please do not hesitate to get in touch.

Kind regards

ASDA Service Team

Am I understanding this right - Asda sell so many products that they don’t have time to keep up with the safety of what’s in them?

From:      Sainsbury’s

Subject:   Tinned Foods

To:          Canalily

Dear Lily,

Thanks for your email. I can understand your concerns about Bisphenol-A, especially in the circumstances.  I hope you are keeping well now.

I’ve spoken to my colleague and I’ve not been able to get a list for you.  We are aware of the potential health issues but I can assure you that we do follow guidance issued by the FSA.  I’m sorry I can’t give you any more information at this time. If you require information about specific products please call 0800636262 with the barcode and we will be happy to assist you.

We’re grateful to you for taking the time to contact us, and look forward to seeing you in store soon.

Kind regards

Customer Manager

From:      Marks & Spencer

Subject:   Tinned Foods

To:          Canalily

Dear Ms Canalily

Thank you for taking the time to contact us with your concerns over our food packaging.

Bisphenol-a is a chemical that M&S have been monitoring for a number of years.  We would like to assure you that Bisphenol-a is not used in all plastics as indicated in your email.  In fact there are very few instances where bisphenol-a is used, which is often misrepresented by the media.  It has been known for the media to have to retract statements they make on this subject, certainly this was the case in 2008 when the media reported, incorrectly, that the chemical was used in HDPE plastics (milk bottles).

Marks and Spencer use four main plastic types (PET, PP, PE and small amounts of PS) and we can confirm that the chemical is not present in these plastics.

The areas where the chemical are used are poly-carbonates (the material that baby bottles are made from). Its other main area of use in the food packaging is within the plastic coating on the inside of grocery cans.

We have independently reviewed all the experimentation on the research carried out to date and we can conclude that none of this work is able to form any direct link to human health effects.  Our own studies are backed up by all the main food regularity bodies (FDA, EFSA, FSA), who have concluded that the chemical does not present a concern to human health. 

Where we know the chemical to be used, we also know that it is food safe and there is no current technological alternative that can be used.  We monitor the chemicals use and carry out random independent testing on the levels found in food and to this date we have not had a positive result.  In other words, where the chemical is used in can linings, it has not then be found to actually migrate into food.

As the chemical continues to be of concern to the public, we are of course working with the can manufacturers and chemical companies to reduce and ideally replace its use.  In the meantime, we can assure you that all Marks and Spencer packaging complies with relevant EU legislation and where possible we take a leading standards approach on chemical safety, through our own independent testing and monitoring programme as well as setting limits on chemicals that are higher than legislative limits.

I hope you will find this information useful.

Thanks again for taking the time to get in touch.

Please be aware that this email is from a ‘no reply’ email address.

If we can assist any further, please visit the help pages of our website.

https://www.marksandspencer.com/contactus

Here you will find answers to some of our frequently asked questions. If after using this facility you still need assistance, please use the contact us link that will appear in the bottom right hand corner. To contact us directly please select the ‘in store service and feedback’ option under ‘email us’.

Kind Regards

Marks & Spencer Customer Services

From:      Canalily

Subject:   Tinned Foods

To:          Marks & Spencer

Dear Sir,

Thank you for your prompt reply.

You have, however, missed the point of my enquiry.

I did not write to ask about the safety of BPA. As you say, there is controversy in this area. Some think it safe, others do not.

Having had breast cancer, I prefer to adopt the precautionary approach. It is my intention to buy only those tinned goods that do not contain any BPA. Hence my question is: which tinned foods stocked by M&S do not have plastic linings that may contain BPA?

With kind regards

Canalily

From:      Marks & Spencer

Subject:   Tinned Foods

To:          Canalily

Dear Ms Canalily

Thank you for contacting us further about the lining of our tinned products.

I am unable to answer this question right now but will speak to our technologist for our tinned products. I appreciate your precaution with plastic lining and although he may not be able to provide an actual list of products excluding this; I will source further information that may prove useful to you.

On receipt of this information I will be in touch further. Thank you for your continued patience and I apologise for any inconvenience this causes.

Kind Regards

Marks & Spencer Customer Services

From:      Marks & Spencer

Subject:   Tinned Foods

To:          Canalily

Dear Ms Canalily,

Following on from my previous correspondence, I have now received a response from our technologist.

He has informed me all of our cans are lacquered to prevent corrosion in contact with the food. You can think of this as a kind of food safe varnish. Any can with a ring pull will contain a layer of plastic (it is how the ring pull works)

The final exception is that our sweetcorn and tomatoes are plastic lined.

I understand this may be disappointing to you and I apologise for any disappointment this causes.

Thank you for getting in touch.

Kind Regards

Marks & Spencer Customer Services

From:      Waitrose

Subject:   Tinned Foods

To:          Canalily

Thank you for your e-mail regarding the presence of bisphenol A (BPA) in the lining of Waitrose canned foods. BPA is a material that attracts a good deal of controversy and misinformation.

Firstly it is important that there is a protective film inside a can to separate the food from the metal and thereby prevent the can from corroding and migrating into the food. BPA is not itself used to coat the inside of cans but is one of the building blocks used to make resins which are then further reacted to form an inert and resistant protective film. Only minute traces of unreacted BPA are in the finished polymer.

The main issues surrounding BPA (and raised by the EWG) are:-

(1) BPA has been shown to have weak oestrogenic activity in animal studies but this is at dose levels many thousands of times higher than the European Union (EU) statutory limit of 0.6 mg/kg for migration from food packaging materials.

(2) A few researchers have suggested low-dose endocrine effects, however this is a controversial theory that has not been confirmed by a detailed independent study on behalf of the EU.

(3) This EU study also found no evidence of the chromosomal abnormalities reported by Hunt et al at the Case Western Reserve University, Cleveland, USA.

It is a fact that Government ministries worldwide have reviewed and re-reviewed the various pieces of research work associated with BPA and they remain unconvinced that it has any adverse effects whatsoever at the extremely low levels at which it may migrate into foods and beverages.

UK Food Standards Agency

"there is still no conclusive evidence of a link between harmful effects [of BPA] on human reproductive health and exposure to the chemicals"

European Food Safety Authority

"low-dose endocrine effects of bisphenol A in rodents did not demonstrate such activity in ways that were robust or reproducible in humans"

USA Food & Drugs Administration (FDA)

"FDA sees no reason to change its long-held position that current uses [of BPA] with food are safe"

It is with this knowledge from regulatory bodies and the current absence of any viable alternative material that we permit the use of BPA as a raw material for the production of can linings for Waitrose branded products. We do, however, continue to closely monitor this chemical as new evidence comes to light and recognise the concerns of some of our customers as they read the adverse publicity about BPA that emerges in the media from time to time. Please be assured that we regularly get our products tested to ensure that any migration is within the strict EU limit (above) and, to date, have found no problems. We work closely with our suppliers to identify potential alternatives but, as you can appreciate, we need to act in a precautionary fashion to ensure that we do not prejudice the safety of our canned products by changing to a new material until we are completely certain it is an improvement on existing linings.

We trust this answers your enquiry, thank you for bringing your concerns to our attention.

Regards,

Waitrose Customer Sales and Support.

From:      Canalily

Subject:   Tinned Foods

To:          Waitrose

Dear Sir.

Thank you for your prompt reply.

You have, however, missed the point of my enquiry.

I did not write to ask about the safety of BPA. As you say, there is controversy in this area. Some think it safe, others do not.

Having had breast cancer, I prefer to adopt the precautionary approach. It is my intention to buy only those foods that do not contain any BPA whatsoever. Hence my question is: which tinned foods stocked by Waitrose do NOT contain plastic linings that may contain BPA?

With kind regards

Canalily

From:      Waitrose

Subject:   Tinned Foods

To:          Canalily

Thank you for your return email.

I have posed your question to the buyers and unfortunately, there is not a definitive answer :

'In terms of a list of which cans have BPA in the linings, this will include the majority of canned goods. There are some products such as canned citrus fruit and pineapple that contain much less because the can bodies are lined with tin plate rather than lacquer, but even for these products the can ends will be coated with lacquer which contains BPA.

I would like to reiterate that the products are safe to consume but as the customer has particular concerns about any cans containing BPA then the most sensible approach would be to avoid all canned foods.'

I apologise for not being able to fully answer your request.

Regards,

Waitrose Customer Sales and Support.

From:      Coles

Subject:   Tinned Foods

To:          Canalily

Dear Ms Canalily

Thank you for your email and apologies for the delayed response.

Your feedback regarding the BPA was forwarded to our Quality Control department and they have advised that they do not have a list of the products that contain BPA.

They have advised that if you are to provide specific details of the products, then they can advise.

Once again, thank you for taking the time to contact us. Our business is committed to serving our customers and feedback like yours offers us insight into how well we are achieving this. We look forward to being of service to you in the future.

Yours sincerely

CUSTOMER CARE CONTACT CENTRE

So, it seems that all tinned food and drinks are likely to contain Bisphenol-A. The manufacturers protest that the BPA contaminated linings are essential for ‘food safety’ reasons.

A question: Food canning technology has been around for a century or so. I seem to remember eating lots of tinned food when I was growing up and I never once got botulism or died. What did we do before we started lining the tins with resins and plastic?

Another question: Bisphenol-A has been found in mothers’ milk. If we are taking steps to ban BPA contaminating babies’ milk in their bottles, shouldn’t we also be thinking about banning BPA from the food that mothers eat and then pass on to their babies through their breast milk?

All in all I find the replies from the supermarkets rather lame. I award an 'A' for effort to M&S and Waitrose. Tesco and Woolworth’s did not even bother to reply.


More fun stuff about BPA:
What Labels Don't Tell Us - a report about BPA by Breast Cancer Fund

Tips on avoiding BPA, Phthalates and Triclosan  

And a few more...

BPA and male infertility

BPA may damage the immune system

Mouse babies get breast cancer

A sceptical scientist does research

BPA alters genes in live human breast cells

A long article with lots of arguments

Here is a List of American companies that use BPA free tins. If anyone knows of any European or Australian tinned goods that are BPA free, please add a comment below.

A Very Thorough Response

Oh no! My favourite tofu cutlets (by Taifun, available from Portobello Wholefoods) are vacuum packed in soft plastic.

***

mailto:info@taifun-tofu.de

Hello,

I have been trying to eat a diet to help me to defeat cancer. I have been enjoying your tofu cutlets but I now fear that they may be packaged in plastics that can leach Bisphenol A into the food.

Please advise me which of your products are packaged in safe, non-toxic packaging.

With kind regards,

Canna Lily

***

Dear Canna Lily,

Thank you very much for your request and your interest into our products.

All our products are packaged in safe and nontoxic foils or containers. Our plastic foils are made by Polyethylen (PE) and Polyamid (PA) in combination. The PE and PA are used in thin layers to produce the complete plastic foil. The used PE foil is solely in contact with our tofu products. The plastic container consists of PE - HD (HD = high density). Both plastics do not need any softening agent or any other additives. Therefore they do not contain any phthalates that are used as diluent in polyvinylchloride (PVC) and that are classified as harmful to health as well as bisphenole A.

We hope this information will bring back your trust into our products and please do not hesitate contacting us again especially if you have any further questions.

Mit freundlichen Grüßen / Best regards

i. A. Ute Lehmann

Teambereichsleiterin Qualität & Entwicklung

Team Division Leader Quality & Development

***

Dear  Canna Lily,

thanks for your request and your interest in our tofu dishes.

Our packaging films consist of two thin single layers which are polyethylene (PE) and polyamide (PA). Both plastics do not need any softening agent or any other additives. Therefore the films do not contain any phthalates that are used as diluent in polyvinylchloride (PVC) and that are classified as harmful to health as well as bisphenole A. PA is aroma-proof and its abrasion resistance is high. However the permeability of steam increases in the moist state. As a result food might desiccate faster. Consequently this film is combined with PE which has a low permeability of steam and oxygen. By combining the two synthetics our products are optimally protected. Moreover both PA and PE are considered to be non-critical in terms of health aspects.

With an average tare weight of 5 g per 200 g weight of product both the manufacturing and the transport can be classified as ecologically more worthwhile as compared with other packaging materials, for example one-way glasses. With an appropriate disposal plastics combust without any residue and the released energy can be used again. With this film, we decided to apply the most ecologically and most economically option. If someday a more environmentally friendly alternative fulfilling our quality requirements was available we would like to adopt it.

For further questions please do not hesitate to contact us.

Mit freundlichen Grüßen / Best regards

i.A. Evangelia Bolanz

Teammitarbeiterin Auftragsabwicklung


***

So I think the tofu is ok to eat then? Phew.

So Watchya Gonna do About It?

“It’s all very well,” I hear you cry, “giving us all a big lecture about the perils of plastics but what exactly am I meant to do about it? I mean, everything comes wrapped in plastic.”

So true. And as I have discovered, it is impossible to live plastic-free. However, I have come to be of the opinion that many cancers do not have a single cause but rather may be triggered by a coalescence of different genetic, hormonal, dietary and environmental factors. On that basis I just do my best to reduce as many of the risks in my daily life as I can.

Here are a few simple strategies that I have enacted to at least cut down my exposure to nasty chemicals:

• I don’t microwave food in plastic containers or covered with cling film. I believe it is ok to microwave food in a glass or china dish, covered with a plain, unbleached kitchen towel.
• I don’t wrap my food in cling film (but I think it’s ok to stretch it over a bowl, so long as it doesn’t touch the food.) I have acquired a lot of stainless-steel containers with lids and also glass bowls with lids.
• I try not to buy food that is vacuum packed in plastic.
• If I buy fruit and veg that are wrapped in plastic, I take them out of the bags as soon as I get home.
• I try not to drink water from plastic bottles. This is nigh on impossible but I do my best: I order tap water in restaurants. I drink water from a (hard plastic) filter jug at home. I carry stainless steel water bottles for brief periods of time before I lose them. I drink lots of water at home so that I don’t have to top up from those giant-plastic-bottle water coolers when I’m out and about.
• I try even harder not to eat tinned food. The old-fashioned, unlined tins are fine but they’re rare and of course, one can’t tell if the tin is plastic-lined or not until after one has opened it.

Useful things to buy to help deplasticise your life:

• A stainless steel water bottle (not lined with plastic)
• Wooden chopping boards
• Wooden spoons and spatulas for cooking
• A hard anodised non-stick frying pan or a Le Creuset cast iron, enamelled frying pan      (expensive but will last a lifetime)
• Stainless steel and glass storage containers with lids (this second item is often known as a ‘jar’)
• Paper bags for wrapping sandwiches etc
• Fabric shopping bags. If you are feeling particularly militant, you can unwrap all your groceries at the checkout, decant them into your fabric bags and return the packaging to the store.
• A pair of spectacles for reading the tiny recycling numbers hidden on plastic packaging
• A roll of greaseproof paper to take to your local butcher to wrap your meat in – just for fun

And if you’re still wondering whether it is worth all the effort, have a look at this.

Plastic Not Fantastic

You may remember back in January that I wrote about the advice I had been given to try to avoid soft plastics coming into contact with my food and drinks.

It’s a tall order. Just scan the shelves of your local supermarket... I got to wondering what we did before plastic packaging took over the world?

In Sydney, Sam the Butcher’s in Bondi Road willingly agreed to wrap my meat in greaseproof paper, rather than the ubiquitous soft plastic sheets. I was pleasantly surprised by their progressive attitude. I generally view butchers as a Luddite lot. The other day I went into my local butchers (name withheld) on Portobello Road and made the same request. The flesh-hacker on duty practically laughed me out of his shop. “We won’t do that,” he roared, “it’s too expensive. Anyway if we listened to all that rubbish where would we be?” “Healthy and possibly cancer-free?” I muttered. “Oh, I know all about that,” he replied, “my mum died of cancer. My aunty too.” Well that makes sense then.

But trying to avoid all soft plastics in contact with my food is only serving to make me feel fearful and utterly defeated. It’s an unachievable goal. And why do we want to do it anyway? I started reading up a bit more.

Here is what I have learned: There are lots of different types of plastics. Contrary to what I previously believed, if I ever thought about the subject at all, plastics are not necessarily inert. Many plastics leach various chemicals in varying amounts. The chemicals can then be absorbed into our food. Many of these chemicals are toxic and cumulative in the body. Apparently the two main baddies (but not the only ones) are Bisphenol-A (BPA) and Phthalates*. Both act as endocrine disruptors, i.e. they mimic hormones in the body.

The uptake is greater if the food has a high fat content, for example: cheese, meat, bacon, pastry, oily fish and the like. In general, plastic will release far more chemicals when heated. The white lining of tins is made of plastic and known to leach Bisphenol-A. I read that tins are heated to high temperatures when they are sealed. I picture the food inside the tin being bathed in a hot soup of BPA molecules.

Lucky for us, manufacturers are now required to categorise all plastics, for recycling purposes. If you get your magnifying glass out and search you will somewhere find a small triangle made up of three swirling arrows, with a number in the middle. This number indicates what type of plastic it is. I have copied this from the Smart Plastics Guide:

1          POLYETHYLENE TEREPHTHALATE (PET)          No known health issues

2          HIGH DENSITY POLYETHYLENE (HDPE)            No known health issues

3          POLYVINYL CHLORIDE (PVC OR V)                   Many harmful chemicals are produced in the manufacturing, disposal, or destruction of PVC including: • Lead • DEHA (di(2ethylhexyl)adipate) • Dioxins • Ethylene dichloride • Vinyl chloride. Effects of exposure to these chemicals may include: decreased birth weight, learning and behavioral problems in children, suppressed immune function and disruption of hormones in the body, cancer and birth defects, genetic changes.

4          LOW DENSITY POLYETHELENE (LDPE)             No known health issues

5          POLYPROPYLENE (PP)                                      No known health issues

6          POLYSTYRENE (PS)                                           Styrene can leach from polystyrene. Over the long term, this can act as a neurotoxin. Studies on animals report harmful effects of styrene on red-blood cells, the liver, kidney, and stomach organs.

This is where it gets tricky...

7          MIXED (OTHER)                                                  Health effects vary depending on the resin and plasticizers in this plastic that often includes polycarbonates. Polycarbonate plastic leaches bisphenol A (BPA) a known endocrine disruptor. By mimicking the action of the hormone, estrogen, bisphenol A has been found to: effect the development of young animals; play a role in certain types of cancer; create genetic damage and behavioral changes in a variety of species. Bisphenol A is widespread--one study found BPA in 95% of American adults sampled.

So, not all plastics marked number 7 contain BPA, some of them are quite safe. Here is what an organisation called the Institute for Agriculture and Trade Policy has to say on the matter: 

Confused about #7 plastic? You’re not alone. Just a few years ago, most #7 plastic was polycarbonate, a plastic we should avoid. Now many new plastics also fit into the #7 category. If it’s labeled # 7-PC, it’s unsafe polycarbonate. (NOTE: not all polycarbonate plastics have the PC label.) If it’s labeled “PLA” or “compostable,” it’s a safer, bio-based plastic. Otherwise, you will need to call the manufacturer and ask them what type of plastic it is.

There is also a whole new generation of plastic-like packaging materials coming into use, made from things like corn starch. I truly hope that these prove to be safer alternatives.


* Annoyingly, phthalates are also present in a wide range of skin care products and cosmetics.

A Natural Approach

You may have noticed from previous posts that I am somewhat conflicted about taking Tamoxifen. As I have made a decision to hold off for now, mum thinks that I should get some input from somebody she trusts. We drive down the Tasman peninsula to see a naturopath, Ree van Galen.

Ree is a very open and welcoming person who speaks in no-nonsense terms. She does not offer advice on whether of not I should take Tamoxifen. That decision is for me alone. She does, however, give me some very useful information to aid me with my decision.

Here is my somewhat simplistic interpretation of what I learned. This post is a touch on the long side but you may find it helpful if you are in a similar quandary. It will certainly help me to refer back to it in the future.

First she builds up a picture of how my body has produced and handled oestrogen in the past. She asks all about my history. Was I ever on the pill? What were my periods like? Did I ever have PMT? Pregnancies? Based on my answers she ascertains that I have not been over-producing oestrogen.

She explains that there are different types of oestrogens, those that we manufacture in our body and those that we ingest from other sources. Tamoxifen blocks the uptake of all oestrogen. Unfortunately it inhibits uptake throughout the body, not just in the breast tumour. I have never been able to quite get past the idea that the rest of my body must need that oestrogen for some important purpose.

If I am not taking Tamoxifen, Ree explains, then I must do two things: reduce any oestrogen from outside sources and also ensure that my liver converts enough ‘good’ oestrogen to occupy the receptor sites, thereby blocking the uptake of the ‘bad’ oestrogen.

So she asks questions about my liver. Have I had hepatitis? Do I drink alcohol? Take drugs? Were my liver function tests at the hospital ok?

Having established that my liver is up to the job Ree tells me the most common sources of ‘bad’ oestrogens: plastics and pesticides. The substances released by plastics and pesticides are not real oestrogen but the human body does not have receptors for plastics and pesticides, yet, so it treats them as strange oestrogen and sends them to the same places.

“Avoid all soft plastic and non-food grade plastic,” says Ree, “especially if the plastic is heated in any way.” What I understand this to mean is: don’t wrap food in cling-film or plastic bags, don’t drink water out of plastic bottles and never eat food that has been microwaved in plastic. “And don’t eat food out of tins that have that white lining. It is plastic and they heat the tins to seal them. That stuff has already been banned in many European countries.” “Not in the UK,” I tell her. She suggests that I contact the manufacturers of my plastic water filter jug to ask them if the plastic that they use is food grade, which means that it does not leach PVC molecules. I have already replaced my plastic water bottle with a glass lemonade bottle that I refill from the tap. “Tupperware is food grade,” says Ree, “but don’t put it in the microwave.” I visualise the shelves of my local Sainsbury’s. Every single edible item is enveloped in a sheath of soft plastic. Avoiding plastic is going to be difficult.

Next, pesticide. That is more straightforward. Eat organic food wherever possible. I have already done so ever since I was diagnosed. The shame of it is that it has precluded shopping for lovely fresh veggies on Portobello market and forced me into the supermarkets where all the produce is sheathed in plastic. If organic is not available, she advises me to reduce my intake of meat, chicken and dairy. “I have already cut out dairy,” I tell her about Jane Plant’s book. “That sounds good,” says Ree, “but you must get your protein. Eat fish and organic meats along with lots of vegetables and whole grains. The most important vegetables for you are brassicas. Make sure that you eat either cabbage, broccoli, pak choy, brussels sprouts or cauliflower every day of your life.” Apparently brassicas contain a substance that is sold as a very expensive supplement called IC3. It helps one’s to liver convert human and animal oestrogen into a quasi-phyto-oestrogen.

Ree tells me to include some soy products in my diet each week, such as tofu. “But don’t go overboard on the tofu and soy milk.” Also to make a mixture called LSA. This involves milling equal amounts of linseed, raw almonds and sunflower seeds in a coffee grinder and adding a teaspoon each morning to my muesli or porridge. “Make it fresh once a week and keep it in the fridge, otherwise it will turn rancid.” I am also advised to add a teaspoon of lecithin granules daily to my cereal. For B vitamins I should eat oats, brown rice, eggs and nuts.

I have lugged my extensive array of supplements along with me. “Which of these can I live without?” I ask with a pleading eye. I find it tedious to force all those pills down my throat each morning. The supplements that she recommends for me are: selenium (200 ug daily) and omega 3 fish oils. I have been taking an expensive high dose co-enzyme Q10 capsule. “That was important to protect your heart whilst you were having chemo,” she says, “but you could reduce it now. Resveratrol is a powerful anti-oxidant. You should definitely continue that as long as you are smoking.” She gives me an oral test to check my levels of zinc. “Medium to low,” she pronounces. “Keep taking the zinc but do one month on and one month off. Have you had your vitamin D levels measured? You will get plenty of sunshine in Australia but you’ll need to top it up if your levels are low.” I recall that Dr Coulter did request a blood test for vitamin D3 before I left but in amongst all the activity I don’t remember if we ever discussed the results.” I promise to call the hospital and check up on that. “Magnesium is important too,” Ree continues, "but there are two good sources for that: Brazil nuts and a twenty-minute soak in a bath with half a cup of Epsom Salts." How hard can that be?

Finally, Ree wants to inspect the fluid build-up in my back. I take my top off. The way that other medical professionals universally celebrate Mr Hadjiminas’ handiwork is a source of continuing delight to me. “Oh my,” gasps Ree, “that is the most beautiful surgery I have ever seen.” She continues, “it takes time for your lymph vessels to re-establish after surgery. The white pith of citrus fruit helps in the strengthening process.” I am pleased to hear this. I regularly chuck half a lemon, with the skin on, into my juice extractor along with the carrots. She suggests lymphatic drainage massage. “They do it in all the breast clinics,” she remarks. “Not in the UK they don’t,” I reply. “Well in any case, apply some calendula cream but don’t rub hard. Too much pressure disrupts the healing lymph vessels. Just lightly stroke it on in a direction away from the scar.”

On the drive home mum and I stop at several roadside stalls. People in Tasmania just grow everything and then sell it from outside their house or the back of their ute. We buy cherries, sylvan berries, pink-eye potatoes, onions, snow peas and carrots. Every single thing is organic and plastic-bagless.