By Andrew Wilson, Founder of Memios | The Longevity Letter

You have done the things. The checkups. The bloodwork. Maybe a pill or two to keep the numbers in line. And still, somewhere past 50, a quiet worry sets in. Not the fear of dying young. The fear of the slow fade. The knees that ache getting out of the car. The friends who spend their 70s in waiting rooms. You are not scared of the finish line. You are scared of the last long stretch before it, and whether it will be lived or just endured.

Here is the part almost no one says out loud: that fear is rational, and the health system is not built to fix it.

The goal everyone gets wrong

Ask most people what longevity means and they will say “living longer.” More years. A bigger number on the last page.

I think that is the wrong goal, and chasing it is exactly why so many people over 50 end up disappointed.

Longevity is not lifespan, the total number of years you are alive. Longevity, the kind worth wanting, is healthspan: the number of years you live strong, sharp, and independent. Lifespan is how long your heart beats. Healthspan is how long you get to be you.

The two are not the same. And the distance between them is the whole ballgame.

The gap nobody measures

In 2024, life expectancy in the United States hit an all-time high of 79 years. [1] Good news, on the surface.

Now the number that should stop you. Healthy life expectancy in the US, the years a person can expect to live in full health, is only about 64 years. [2] Do the subtraction. The average American spends roughly 15 years alive but not well. [1] [2]

Fifteen years. That is not a rounding error. That is a decade and a half of life lived inside limitations.

And it is getting worse. A 2024 Mayo Clinic study looked at all 183 World Health Organization member states and measured this exact gap between how long people live and how long they live healthy. The United States had the largest gap in the world: 12.4 years, up from 10.9 years at the turn of the century, and 29 percent worse than the global average. [3]

The US has the widest healthspan-lifespan gap on Earth. We are not failing to add years. We are failing to make the years worth living.

Read that twice. We are, by one measure, the best in the world at the wrong thing.

Why this is personal for me

I am 59. I am not training for a marathon. I am training for my 90s. And I did not arrive at that goal from a textbook.

In 2018 I lost my father to cancer. In 2021 my best friend Brad was diagnosed with Stage IV melanoma, and he passed in April 2026. In 2022 the diagnosis came for me. Melanoma, caught early.

When serious illness sits that close, you stop counting years and start counting good days. I watched people I loved get sent home after treatment with no plan to rebuild their strength, as if surviving were the finish line instead of the starting one. I lived that gap. It is the reason I built Memios.

I still have a long list of things I want to do, and every one of them needs a strong body. More travel. More time on the boat. More mornings on the water with a fly rod. I want to be strong in body and mind for as long as I am here.

What I do not want is the slow version. I have watched it up close. People fading in nursing homes. People I love disappearing inside memory units. Friends like Brad, gone too young. Bodies so broken they shrink a whole life down to a single room. That is the future I am training against.

My goal is blunt, and I mean it kindly toward myself: live strong, then go quickly. Compress the hard part. Stretch the good part as far as it will go. That is what healthspan means when it stops being a word and becomes a plan.

So when I tell you healthspan is the number that matters, I am not selling optimism. I am telling you what I decided to organize the rest of my life around.

What actually drives the gap

Here is the hopeful turn, and it is a big one.

The healthspan-lifespan gap is not fate. In the US, the leading contributors to those unhealthy years are not exotic. They are largely chronic, and largely modifiable: cardiometabolic disease, musculoskeletal decline, and mental health. [3] The things that steal your good years are, to a meaningful degree, the things you can push back on.

And the single most powerful lever is the one the fitness industry makes look complicated: movement.

Consider cardiorespiratory fitness, measured as VO2max, how well your body uses oxygen. In a study of more than 122,000 adults, low fitness carried a greater risk of death than coronary artery disease, diabetes, or smoking. [4] The most fit had roughly an 80 percent lower risk of death than the least fit, and the benefit never plateaued. [4] Fitness is trainable at any age. [5] And more than half of the survival benefit shows up just moving from the least-fit group to the next one up. [6]

That last point is the one to hold onto. If you feel like you are starting from zero, you are not behind. You are holding the most valuable ticket in the room, because you have the most to gain from the least work.

The levers of a longer healthspan: body, mind, and spirit

Longevity after 50 is not a single heroic act. It is a handful of ordinary levers, pulled consistently, across body, mind, and spirit. Strong in one is not enough. You want all three.

Body

· Movement. The foundation. Aerobic work for your heart and VO2max, and strength work to protect the muscle that keeps you independent. Movement is the closest thing we have to a longevity drug, and the research behind why movement is medicine is overwhelming. The World Health Organization target is 150 to 300 minutes of moderate activity a week plus strength twice a week, but the biggest gains come from simply moving more than you do now. [7]

· Nutrition. Enough protein to hold muscle, enough fiber and whole food to steady your metabolism and your gut. Food that fuels, not food that merely fills.

· Sleep and recovery. The unglamorous multiplier. Deep sleep is when the brain clears itself and the body repairs.

Mind

· Mental strength. The brain ages like a muscle: use it or lose it. Keep learning, manage stress, and take your mental health as seriously as your blood pressure. Movement is one of the best things you can do for your brain, and mental health conditions are among the largest drivers of America’s unhealthy years. [3] Staying sharp is not luck. It is trained.

Spirit

· Purpose, faith, and connection. A reason to get up in the morning is a health intervention. Loneliness raises your risk of dying early; purpose lowers it. Gratitude, prayer or meditation, and real relationships are not soft extras. After my own diagnosis and everything that came with it, they became the center of how I live, not the decoration.

The safety net

· Prevention. The screenings and numbers that catch trouble while it is still small. My melanoma was Stage 0 because someone looked. That is the whole difference.

None of these require a gym you dread or a diet you cannot live on. They require a direction and a first step.

The system is not coming to save you

I want to be honest about the thing that makes this hard. The evidence for all of this is settled. The delivery is not.

The science that movement extends healthy life has been proven across thousands of studies. Yet most people are never shown how, never referred, never given a plan. The gap between what works and who actually receives it is the reason a country can lead the world in life expectancy and still lead the world in unhealthy years. [3]

That is the gap Memios exists to close, and it is the reason I write this letter. Not to add noise. To hand you the plan the system forgets to.

What it means for you

Stop chasing lifespan. You do not get to pick the last number anyway. What you can influence, starting today, is how many of those years you spend strong.

The shift is simple to say and powerful to live: measure the right thing. Not “how long will I live,” but “how well, and for how long.” Track your fitness. Protect your muscle. Move most days. Sleep. Stay connected. Catch problems early.

You are not too old, and you are not too late. The research could not be clearer that the lowest starting point carries the largest payoff. Your best decade can still be ahead of you.

Related from The Longevity Letter

· Why Movement Is Medicine — the research behind the single biggest lever on your healthspan.

· Strength Training After 50 — how to protect the muscle that keeps you independent.

· Move Your Body — the simplest place to start today.

· Debunking the Top 10 Health Myths People Over 50 Still Believe — why it is never too late to begin.

Your next step

The Longevity Letter is where I share the science, the stories, and one or two things you can do this week to close your own gap. It is free, and it is written by someone living this, not lecturing about it.

Subscribe, and let’s build a long, strong life together. One good day, then another.

Frequently Asked Questions

What is the difference between healthspan and lifespan?

Lifespan is the total number of years you are alive. Healthspan is the number of years you live in good health, strong and independent, before chronic illness or disability sets in. Longevity worth wanting means widening your healthspan, not just your lifespan.

How big is the healthspan-lifespan gap in the US?

About 12.4 years, the largest of any country in the world, according to a 2024 Mayo Clinic analysis of 183 nations. [3] On average, Americans live to about 79 but stay in full health only to about 64. [1] [2]

Can I still improve my healthspan after 50?

Yes, and the data says the lower your starting point, the larger your gain. More than half the survival benefit of fitness comes from moving out of the least-fit group. [6] It is rarely too late to add strong years.

Is this medical advice?

The Longevity Letter shares education, not diagnosis or treatment. Memios goes further than words. Our certified providers in exercise, nutrition, weight loss, and longevity work alongside your existing healthcare team to build holistic wellness plans that grow your healthspan and your lifespan. For diagnosis or treatment, always start with your physician.

References

[1] Centers for Disease Control and Prevention, National Center for Health Statistics. Mortality in the United States, 2024. US life expectancy at birth reached 79.0 years in 2024. https://www.cdc.gov/nchs/products/databriefs/db548.htm

[2] World Health Organization, Global Health Observatory. Healthy life expectancy (HALE) at birth. US HALE is approximately 63.9 years (men 62.8, women 65.1). https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-life-expectancy-and-healthy-life-expectancy

[3] Garmany A, Terzic A. Global Healthspan-Lifespan Gaps Among 183 World Health Organization Member States. JAMA Network Open / Mayo Clinic, 2024. The US had the largest healthspan-lifespan gap at 12.4 years; the global gap grew from 8.5 years (2000) to 9.6 years (2019). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635540/

[4] Mandsager K, Harb S, Cremer P, et al. Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. JAMA Network Open. 2018;1(6):e183605. In 122,007 adults, low fitness carried a mortality risk greater than coronary artery disease, diabetes, and smoking, with no observed plateau. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2707428

[5] Poon ET-C, et al. High-intensity interval training and cardiorespiratory fitness in adults: an umbrella review. Scand J Med Sci Sports. 2024;34(1):e14652. VO2max improves reliably with training across ages. https://onlinelibrary.wiley.com/doi/10.1111/sms.14652

[6] Ross R, Blair SN, Arena R, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign. Circulation. 2016;134(24):e653-e699. More than half the mortality reduction occurs moving from the least-fit group to the next-least-fit group. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000461

[7] Bull FC, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451-1462. 150 to 300 minutes of moderate activity a week plus muscle strengthening on 2 or more days; some activity is better than none. https://bjsm.bmj.com/content/54/24/1451

By Andrew Wilson, Founder of Memios | The Longevity Letter

You do not need more health noise. You need signal you can trust and use.

That is what The Longevity Letter is. Every issue blends three things:

• The science. What the research actually shows, in plain language.

• The stories. Real and human, often my own. I am 59, a melanoma survivor, and I am building my strongest decade.

• The strategies. One or two things you can act on this week.

I started this letter because I went looking for that mix and could not find it. Plenty of studies I had to decode on my own. Plenty of hype with nothing behind it. Not much written for a person over 50 who wants the truth and a clear next step. So I write the letter I wanted to read.

What you will get

Every issue sits in one of our topic pillars, so across the year you cover the whole picture of living strong after 50:

• Movement. Exercise as proven cancer therapy, beating cancer fatigue, and why all-or-nothing thinking wrecks your routine.

• Nutrition and gut. The gut-brain connection, the truth about seed oils, B12 and protein, and foods that earn their place.

• Cancer survivorship. Life after melanoma, newer treatments like TIL therapy, and honest looks at the hard parts.

• Brain health. What actually helps prevent dementia, plus journaling and visualization for a clearer mind.

• Sleep and recovery. Better sleep after 50, and what cold plunging and heat really do.

• Purpose and spirit. Gratitude, prayer, and the meaning that keeps you moving.

• Metabolic health and GLP-1. Evidence-first guidance on doing GLP-1 well, no hype.

• Putting it together. Habits, tracking, and a routine that lasts.

Every issue also brings a personal story, often my own, and one or two steps you can act on this week.

Who you will hear from

This is not one person guessing. You hear from the people who deliver Memios. I share my own path as a melanoma survivor. Wendy Gough, our Vice President of Nutrition and the voice of Reclaim Nutrition, turns nutrition science into food you can live on, with more on TikTok at @wendytalksaboutit. [6] Andrea Leonard, who founded the Cancer Exercise Training Institute and has trained specialists in 60 countries, leads the movement and cancer exercise work. [2]

The science behind it is anchored by Dr. Anna Schwartz, who co-chaired the first national roundtable on exercise for cancer survivors, [3] and Dr. Jay Harness, a surgical oncologist and past president of the American Society of Breast Surgeons. [4] When we turn research into a step you can take, it rests on the same evidence clinicians use. [5]

What makes it different

No hype, no fear, no fine print. When we point to a benefit, we point to the study. When we share a strategy, we have tried it or our experts use it in practice. And when the evidence is thin, we say so plainly. You get the honest version, which is the only version worth your time.

How often

You get the full stream. Two issues a week, a new video, and daily notes on social. [1] Short enough to read, deep enough to use. Unsubscribe anytime.

Where to find us

• Substack, memios.substack.com [1]

• Website, memios.ai

• Facebook, facebook.com/memiosai

• Instagram, @memios_ai

• LinkedIn, Andrew Wilson

Your next step

Subscribe today. Free to join. Cancel anytime.

Frequently asked questions

How much does it cost?

Free. You get every issue in your inbox at no cost.

How often will you email me?

Two issues a week, plus the occasional note. Unsubscribe anytime.

Is this only for cancer survivors?

No. Survivorship is at our core, but the same science serves anyone over 50 who wants to stay strong and independent.

References

[1] The Longevity Letter by Memios. Published on Substack; issues also mirror to the memios.ai blog and social channels.

[2] Andrea Leonard, Founder, Cancer Exercise Training Institute. Has trained cancer exercise specialists in 60 countries. https://nancyslist.org/2025/07/27/andrea-leonard-founder-and-president-of-the-cancer-exercise-training-institute-ceti/

[3] Dr. Anna Schwartz co-chaired the first American College of Sports Medicine roundtable to develop exercise guidelines for cancer survivors. https://news.nau.edu/schwartz-oncology-guidelines/

[4] Jay K. Harness, MD, FACS. Surgical oncologist and past president of the American Society of Breast Surgeons, the American Association of Endocrine Surgeons, and Breast Surgery International. https://mbcglobalalliance.org/team/jay-k-harness-md-facs/

[5] Exercise is Medicine, co-launched in 2007 by the American College of Sports Medicine and the American Medical Association to bring evidence-based physical activity into everyday care. https://www.exerciseismedicine.org/about-eim/

[6] Wendy Gough, Vice President of Nutrition, Memios, and the voice of Reclaim Nutrition. TikTok handle @wendytalksaboutit confirmed by Andrew Wilson (2026-07-30). https://www.tiktok.com/@wendytalksaboutit

By Andrew Wilson, Founder of Memios, with Andrea Leonard, Chief Clinical Education Officer | The Longevity Letter

You have heard that movement is good for you. What you have not heard is how strong the evidence is, or how far it tilts toward the person who is starting from zero.

I am 59, and a melanoma survivor. I am not training for a race. I am training to stay strong and independent for another 30 years. The science says that is a reasonable goal. It also says the path there is simpler than the fitness industry makes it look, and that the people with the most to gain are the ones who feel the furthest behind.

Why movement is medicine is more than a slogan

Movement is medicine did not come from a marketing team. It came from the research.

In 2007 the American College of Sports Medicine and the American Medical Association launched Exercise is Medicine, an initiative that urges doctors to check physical activity at every visit and to prescribe it the way they prescribe drugs. [1]

The reason is simple. Few treatments touch as many systems at once. Regular activity lowers your risk of early death and protects against heart disease, high blood pressure, type 2 diabetes, several cancers, and depression. [2] No pill on the market does all of that in one dose.

What movement does after 50

The World Health Organization recommends 150 to 300 minutes of moderate activity a week, or 75 to 150 minutes of vigorous activity, plus muscle strengthening on two or more days. [2] That is the target. It is not the entry fee.

The most important finding in the research is this one: some movement is far better than none, and the largest gains go to the people who have the most room to improve. [2] [7]

For cancer survivors the effect is striking. People who move after a diagnosis lower their risk of dying from any cause by about 25 percent compared with those who stay still, and the reduction climbs toward 40 percent for the most active. [3] Movement also eases the parts of survivorship that quietly wear people down. It reduces fatigue, anxiety, and depressive symptoms, and it improves physical function and quality of life. [4]

Movement reduces fatigue, anxiety, and depression, and it improves strength and quality of life. Few medicines do all of that at once.

The one number worth knowing

If you track one thing, track VO2max, your cardiorespiratory fitness. It is how well your body takes in and uses oxygen, and it is one of the strongest predictors of how long you will live.

In the largest study of its kind, researchers followed 122,000 adults. Low fitness carried a greater risk of death than coronary artery disease, diabetes, or smoking. The most fit had roughly an 80 percent lower risk of death than the least fit, and the benefit never plateaued. [5]

Here is the hopeful part. VO2max is trainable. [6] And more than half of the survival benefit shows up when you move from the least fit group to the next one up. [7]

Read that again. If you feel like you are starting from zero, you hold the most to gain.

Where the biggest gains are won

Andrea Leonard has spent her career on this. She founded the Cancer Exercise Training Institute and has trained specialists to work with survivors in 60 countries.

The people who gain the most are almost never the athletes. They are the ones who start where they are and keep showing up. That is who this work is built for.
— Andrea Leonard, Chief Clinical Education Officer

The guidelines she helped put into practice were shaped by people like our own Dr. Anna Schwartz, who co-chaired the first national roundtable that set exercise guidance for cancer survivors. This is not folk wisdom. It is a standard of care.

How to start

You do not need a gym or a marathon. You need a first step, and a second one tomorrow.

Start with walking. In a study of nearly 47,000 adults, people over 60 kept lowering their risk of early death up to about 6,000 to 8,000 steps a day, and the most active walkers had about a 53 percent lower risk of death than the least active. [8]

Then add strength twice a week, working the major muscle groups. [2] That is the whole prescription to begin. Walk, lift a little, build slowly.

Here is what a first week can look like:

• A 10 minute walk after lunch, five days. Add two minutes each week.

• Two short strength sessions. Sit-to-stands from a chair, wall push-ups, and a few carries with a grocery bag count.

• One rest day where you just move gently and stretch.

That is it. No membership, no special gear, no before-and-after photo. Just a number that starts moving in the right direction.

Find your starting point. Contact Memios for an initial assessment.

Your next step

The assessment takes a few minutes. It shows you where your fitness sits today and the one change that will move the number most.

One small step today. Then another tomorrow.

Frequently asked questions

How much exercise do I need?

The guideline is about 150 minutes of moderate activity a week plus strength twice a week. [2] Any movement helps, and the largest gains come when you start from a low base. [7]

I have a health condition. Can I still start?

Often yes, with the right plan. Get clearance from your physician first, then start small.

Is this only for cancer survivors?

No. Survivorship is where the evidence is sharpest, but the same science serves anyone over 50 who wants to stay strong and independent.

References

[1] Exercise is Medicine. About EIM. Co-launched in 2007 by the American College of Sports Medicine and the American Medical Association to make physical activity a standard part of clinical care. https://www.exerciseismedicine.org/about-eim/

[2] Bull FC, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451-1462. 150 to 300 minutes of moderate activity a week, or 75 to 150 minutes of vigorous, plus muscle strengthening on 2 or more days; some activity is better than none; activity lowers all-cause mortality, cardiovascular disease, hypertension, type 2 diabetes, cancer, and improves mental health. https://bjsm.bmj.com/content/54/24/1451

[3] Friedenreich CM, et al. Physical Activity and Mortality in Cancer Survivors: A Systematic Review and Meta-Analysis. JNCI Cancer Spectrum. 2020;4(1):pkz080. Post-diagnosis physical activity is associated with roughly a 25 percent or greater lower risk of all-cause mortality, reaching about 37 to 42 percent for the most active in breast and colorectal cancers. https://academic.oup.com/jncics/article/4/1/pkz080/5582677

[4] Campbell KL, Winters-Stone KM, Schmitz KH, et al. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019;51(11):2375-2390. Exercise is safe for survivors and improves anxiety, depressive symptoms, fatigue, physical function, and health-related quality of life. https://pubmed.ncbi.nlm.nih.gov/31626055/

[5] Mandsager K, Harb S, Cremer P, et al. Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. JAMA Network Open. 2018;1(6):e183605. In 122,007 adults, low fitness carried a mortality risk greater than coronary artery disease, diabetes, and smoking, with no observed plateau in benefit (low vs elite adjusted HR 5.04). https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2707428

[6] Poon ET-C, et al. High-intensity interval training and cardiorespiratory fitness in adults: an umbrella review of systematic reviews and meta-analyses. Scand J Med Sci Sports. 2024;34(1):e14652. Structured aerobic and interval training reliably increases VO2max across populations, including older adults. https://onlinelibrary.wiley.com/doi/10.1111/sms.14652

[7] Ross R, Blair SN, Arena R, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign. Circulation. 2016;134(24):e653-e699. More than half the mortality reduction occurs moving from the least-fit group to the next-least-fit group. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000461

[8] Paluch AE, Bajpai S, Bassett DR, et al. Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts. Lancet Public Health. 2022;7(3):e219-e228. In adults over 60, risk of death fell up to about 6,000 to 8,000 steps a day, then plateaued; the most active walkers had about a 53 percent lower mortality risk (adjusted HR 0.47) than the least active. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(21)00302-9/fulltext

You should know who stands behind the advice you act on.

Memios pairs my lived experience as a melanoma survivor with a bench of cancer exercise experts and leaders in longevity and medicine. Not names on a page. People who have spent their careers proving that movement, good nutrition, and good medicine help you live longer and stronger.

Here is who guides the work.

The cancer exercise, nutrition, weightless and longevity experts and leaders guiding Memios

Clinical and science leadership:

• Andrew Wilson, Founder and CEO. A melanoma survivor on a mission to live strong into his 90s, building the company he wished existed the day he got his diagnosis.

• Andrea Leonard, Chief Clinical Education Officer. Founder of the Cancer Exercise Training Institute, the world’s leading organization for certifying cancer exercise professionals. Its credential covers 26 cancer types plus pediatric oncology, and it has trained nearly 20,000 specialists across 60 countries. She is a cancer survivor of more than 40 years, so this work is personal for her too.

• Dr. Anna Schwartz, Chief Longevity Officer. An exercise oncology researcher and nurse practitioner who co-chaired the first national roundtable that set exercise guidelines for cancer survivors. She co-authored the American College of Sports Medicine’s Essentials of Exercise Oncology and helped create its Cancer Exercise Trainer certification.

• Dr. Jay Harness, Chief Medical Officer. A surgical oncologist who built one of the first academic multidisciplinary breast cancer centers in the country, at the University of Michigan in 1985. He has authored more than 100 articles and book chapters and is a past president of the American Society of Breast Surgeons.

• Dr. Jane Yoo, Medical Advisor. A dual board-certified dermatologist and Mohs surgeon at Mount Sinai who treats melanoma and skin cancer, with degrees from MIT and the Harvard Kennedy School.

• Wendy Gough, Vice President of Nutrition. A clinical nutritionist and health coach, the voice of Reclaim Nutrition.

Company leadership:

• Greg Hendrickson, Chief Marketing Officer. More than 35 years in sales and marketing, and a business advisor to cancer exercise specialists at CETI.

• Robert McCauley, Vice President of Business Development. Founder of a healthcare recruiting firm, building our certified provider network.

• Aleksandar Radulovic, Interim CTO. Founder of PurpleOwl.IO, building the Memios platform across web, iOS, and Android.

• Michael Moyer, Corporate Counsel. A partner at BakerHostetler who leads its national emerging companies and venture capital practice.

Advisors and board:

• Adam Zeitsiff, former global CEO of Gold’s Gym, now CEO of Dominique Dawes Gymnastics and Ninja Academy.

• Jim DuBois, former Chief Information Officer of Microsoft and author on modern IT leadership.

• Brad Lovering, former Microsoft Technical Fellow, now building AI systems at Crogl.

• DJ Wilson, founder of the health policy platform State of Reform.

• Shari Hofer, Chief Operations and Marketing Officer at Tovuti, board director at Kaiser Foundation Health Plan of Washington, and former CMO of Wiley.

What it means for you

When Memios makes a claim, it rests on evidence and on people who have spent their careers earning the right to make it. We check what we tell you against the research before it reaches you. That is how we earn your trust, one honest answer at a time.

Your next step

Follow the work and hear from the cancer exercise experts and advisors on our team. Subscribe to The Longevity Letter.

Frequently asked questions

Are these experts really involved?

Yes. They guide the science, the education, and the clinical standards behind Memios.

Will I hear from them directly?

Yes. The Longevity Letter features the cancer exercise experts and advisors on the topics they know best.

Is this medical advice?

The Longevity Letter shares education, not diagnosis or treatment. Memios goes further than words. Our certified providers in exercise, nutrition, weight loss, and longevity work alongside your existing healthcare team to build holistic wellness plans that grow your healthspan and your lifespan. For diagnosis or treatment, always start with your physician.

By Andrew Wilson, Founder of Memios | The Longevity Letter

You are more than a chart

You know the moment. You sit in a paper gown while someone half your age reads your results off a screen, talks about you to the room, and calls you “sweetie” on the way out. Decades of work and judgment, reduced to a chart.

That is where most health care for older adults begins. Memios begins somewhere else.

Dignity is not soft. It is health.

How you are spoken to, and how you see your own aging, shows up in your body.

When staff talks down to older adults, the sing-song, patronizing tone researchers call elderspeak, people push back, withdraw, and cooperate less with their own care. [1] Being demeaned does real harm.

It runs the other way too. People who hold positive beliefs about their own aging live 7.5 years longer than those who absorbed the negative stereotypes, a larger gain than from not smoking. [2] Positive age beliefs are also tied to a lower risk of dementia, even among people who carry the high-risk gene. [3]

Treating you as capable is not a courtesy. It is part of the medicine.

What the promise looks like

• Respect first. We speak to you, not around you.

• Plain honesty. Real evidence, no hype and no fear.

• Privacy protected. We guard your information and never trade on it.

• Patience and empathy. We meet you where you are, especially on hard days.

• Strength over diagnosis. We lead with what your body can still do.

You are not a medical diagnosis to manage. You are a person with decades of judgment, and we speak to that.

If that is the partner you want, subscribe to The Longevity Letter and follow along.

The language we use

We talk about strength, energy, and reclaiming your days. We do not use fear. We do not talk down. We give you the facts and trust you to decide, with your doctor.

Your body is still yours. Your judgment still counts. Your strongest years can be ahead of you.

Your next step

Subscribe to The Longevity Letter, and see what health guidance sounds like when it treats you as a capable adult.

One small step today. Then another tomorrow.

Frequently asked questions

What does dignity mean in practice?

Clear language, real evidence, protected privacy, and a focus on what you can do, not just what you cannot.

How is this different from other health programs?

Many treat you as a problem to fix. We treat you as a capable adult and a partner in your own plan.

Does dignity really affect health?

Yes. Being talked down to makes people resist care, and a positive view of your own aging is linked to a longer life and lower dementia risk. Respect is part of the outcome. [1] [2] [3]

References

[1] Williams KN, Herman R, Gajewski B, Wilson K. Elderspeak communication: impact on dementia care. American Journal of Alzheimer’s Disease and Other Dementias. Patronizing “elderspeak” from care staff increased resistiveness to care in older adults. https://pmc.ncbi.nlm.nih.gov/articles/PMC2836897/

[2] Levy BR, Slade MD, Kunkel SR, Kasl SV. Longevity increased by positive self-perceptions of aging. Journal of Personality and Social Psychology. 2002;83(2):261-270. Older adults with positive age beliefs lived 7.5 years longer than those with negative beliefs. https://www.apa.org/pubs/journals/releases/psp-832261.pdf

[3] Levy BR, Slade MD, Pietrzak RH, Ferrucci L. Positive age beliefs protect against dementia even among elders with high-risk gene. PLOS ONE. 2018;13(2):e0191004. Positive age beliefs were associated with lower dementia risk, including among APOE e4 carriers. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0191004

By Andrew Wilson, Founder of Memios | The Longevity Letter

Proven, but never delivered

The science is settled. People who move after a cancer diagnosis lower their risk of dying from all causes by about 25 percent. [1] [2] There is a name for this field, exercise oncology, and national cancer organizations now recommend exercise during and after treatment. [3]

And yet most survivors are never shown how.

There is no system to deliver it. Oncologists believe in movement, but they believe someone else should provide it. In a survey of the oncology workforce, 84 percent said the work of changing a patient’s activity, diet, or weight should be handled by other trained staff. [4]

So the proof sits in journals. The guidelines sit on a shelf. And the person who just finished treatment goes home with no plan. I watched that happen to people I love.

That gap is our mission.

What we are building

Memios is the bridge between the evidence and the person. We bring movement, nutrition, coaching, and medically guided metabolic care to people where they already are.

• Direct, through Memios coaching and telehealth

• Through certified local partners, the gyms and clinics you already trust

• Through The Longevity Letter, which teaches and earns trust week by week

One model. One plan. Care that reaches you instead of waiting for you to find it.

If that mission speaks to you, subscribe to The Longevity Letter and follow along.

Why now

The need has gone mainstream. About 1 in 8 adults now take a GLP-1 medication for weight loss, diabetes, or another reason. [5] They want to do it well, and to hold on to their strength while they do. The tools to guide them finally exist.

This is not a trend to ride. It is a door that just opened.

Bigger than cancer

We start with cancer survivors because the proof is strongest there, and because it is personal to me. I lost my father to cancer, sat with my best friend through his, and faced my own melanoma. Every one of them ran into the same wall: strong evidence, no one to deliver it.

The same gap runs through the rest of life after 50. Millions of adults are told to move more and handed nothing else. Same evidence. Same silence. Same missing bridge.

Memios is built for all of them. Survivors first, then every adult over 50 who wants to stay strong and independent for decades.

The promise

We measure the mission in what you feel. Less pain. More strength. More energy for the people and the work you love. For survivors, more years. And, we believe, a lighter long-term load on the healthcare system, because strong people need less of it.

Proven therapy, finally delivered. That is the whole mission.

Your next step

Follow the mission. Subscribe to The Longevity Letter and watch us build the bridge in public, one issue at a time.

One small step today. Then another tomorrow.

Frequently asked questions

Is Memios only for cancer patients?

No. We start with survivors because the evidence is strongest and the story is mine, and we serve adults over 50 more broadly.

Does insurance cover this?

Cancer exercise is not widely reimbursed yet, so Memios works on a cash-pay basis now, with coverage as a future layer.

How do I follow the mission?

Subscribe to The Longevity Letter for the science, the stories, and the plan, week by week.

References

[1] Friedenreich CM, et al. Cancer survivors could get survival benefits from postdiagnosis physical activity: a meta-analysis. Post-diagnosis physical activity is associated with roughly a 25 to 40 percent lower risk of all-cause and cancer-specific mortality. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6854247/

[2] Physical activity reduces all-cause mortality in patients with cancer: a systematic review and meta-analysis of randomized controlled trials. Pooled trial evidence shows about a 26 percent reduction in all-cause mortality. https://www.sciencedirect.com/science/article/pii/S0305737226000368

[3] Ligibel JA, et al. Exercise, diet, and weight management during cancer treatment: ASCO guideline. JCO Oncology Practice. 2022. National guidance recommends regular aerobic and resistance exercise during active treatment. https://ascopubs.org/doi/10.1200/OP.22.00277

[4] Ligibel JA, Jones LW, Basen-Engquist K, et al. Oncologists’ attitudes and practice of addressing diet, physical activity, and weight management with patients with cancer: findings of an ASCO survey of the oncology workforce. JCO Oncology Practice. 2019. 84 percent believed these interventions should be delivered by other trained clinical staff. https://ascopubs.org/doi/10.1200/JOP.19.00124

[5] KFF. Poll: 1 in 8 adults say they are currently taking a GLP-1 drug for weight loss, diabetes, or another condition. 2025. https://www.kff.org/public-opinion/poll-1-in-8-adults-say-they-are-currently-taking-a-glp-1-drug-for-weight-loss-diabetes-or-another-condition-even-as-half-say-the-drugs-are-difficult-to-afford/

By Andrew Wilson, Founder of Memios | The Longevity Letter

Most health advice for people over 50 talks down to you. It hands you a fad, a warning label, or a pill, and treats you like a problem to be managed.

Memios does the opposite.

We treat you as a capable adult with strong years still ahead. Memios is a wellness plan for people over 50 who want to stay strong, independent, and active for decades to come.

Here is what that looks like.

Four parts, one plan

Good health after 50 is not one thing. It is a few things that work together. We bring them into one plan so they pull in the same direction.

• Movement and exercise, the foundation

• Nutrition that fuels strength and recovery

• Coaching that builds habits that last

• Medically guided metabolic support when it fits

No app, diet, and coach that never talk to each other. One plan, one direction.

The one number we build around

Most programs track pounds. We track VO2max, your cardiorespiratory fitness. It is how much oxygen your body can use when you push hard, and it is one of the strongest predictors of how long you will live, ahead of blood pressure and blood sugar in large studies. [1]

Two things make it the right number to build around.

It improves with training. [2] And the largest gains go to the people who start at the lowest point. [3]

Read that again. If you feel out of shape, you have the most to gain, and the fastest.

Who Memios is for

• Adults over 50 who want to stay strong and independent

• Cancer survivors rebuilding after treatment

• People managing other health conditions

• People on GLP-1 medication who want to keep their muscle

That last group matters. Between a third and a half of the weight lost on GLP-1 medication is lean mass, not just fat, and muscle is hard to rebuild after 50. [4] Movement and protein protect it. [5] We build that protection into the plan.

What makes Memios different

Weight loss programs sell pounds. Longevity clinics sell expensive tests. We sell strength you can feel, and we measure progress you can use. More energy. Steadier legs on the stairs. More years doing what you love with the people you love.

We treat you as a capable adult, not a patient to be managed. Your body is still yours, and your strongest years can still be ahead of you.

Your next step

Subscribe to The Longevity Letter. Each week we send the science, the stories, and one simple move you can make that week to get stronger.

One small step today. Then another tomorrow.

Frequently asked questions

How do I start with Memios?

Subscribe to The Longevity Letter and follow the weekly plan. Start with movement, then add from there.

Is Memios a gym or an app?

Neither on its own. It is one plan delivered through coaching and simple tools, built on a single model so every part works together.

Do I need to be fit to start?

No. The lower your starting point, the larger your gain in the shortest time. [3] We meet you where you are.

Is Memios only for cancer survivors?

No. Cancer survivorship is close to our heart, but the plan serves anyone over 50 who wants to move more and feel better.

References

[1] Mandsager K, Harb S, Cremer P, et al. Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. JAMA Network Open. 2018;1(6):e183605. In 122,007 adults, the mortality risk of low fitness was comparable to or greater than diabetes, high blood pressure, and smoking. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2707428

[2] The effect of exercise training intensity on VO2max in healthy adults: an overview of systematic reviews and meta-analyses. 2024. VO2max improves reliably with exercise training. https://pmc.ncbi.nlm.nih.gov/articles/PMC11022784/

[3] Ross R, Blair SN, Arena R, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign. A scientific statement from the American Heart Association. Circulation. 2016;134(24):e653-e699. More than half the mortality reduction occurs moving from the least-fit group to the next-least-fit group. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000461

[4] Muscle mass and glucagon-like peptide-1 receptor agonists: adaptive or maladaptive response to weight loss? Circulation. 2024. Lean mass was about 45 percent of total weight lost in the STEP 1 semaglutide trial and about 34 percent in the SURMOUNT-1 tirzepatide trial. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.067676

[5] Resistance training and protein may lower GLP-1 muscle loss. In a 6-month program, participants lost about 13 percent of body weight but only about 3 percent of muscle. https://www.medscape.com/viewarticle/resistance-training-protein-may-lower-glp-1-ra-muscle-loss-2025a10008x6

By Andrew Wilson, Founder of Memios | The Longevity Letter

I am 59 years old, and I am training for my 90s.

Not to run marathons. To stay strong, steady, and independent for another 30 years. I built Memios to help you do the same.

I am not a doctor. I am a person who got hard health news and decided to do something with it.

The three years that changed everything

In 2018, I lost my father to cancer. Multiple Myeloma and Amyloidosis.

In 2021, my best friend Brad was diagnosed with Stage IV Melanoma.

In 2022, the diagnosis came for me. Melanoma.

Brad passed in April 2026.

When you sit with serious illness this closely, you stop taking your health for granted. You also start to see what the system misses. People finish treatment and get sent home with no plan to rebuild their strength.

People finish treatment and get sent home with no plan to rebuild their strength. I lived that gap. So I built the bridge.

What the science says about exercise and longevity after 50

Here is the part that changed how I think about aging.

People who move after a cancer diagnosis lower their risk of dying from all causes by about 25 percent compared with those who stay still. [1] [2] That is not a rounding error. The benefit shows up as longer survival, not just fewer symptoms. [3]

It all points to one number worth knowing. VO2max, your cardiorespiratory fitness, is one of the strongest predictors of how long you will live. [4] Stronger than smoking, diabetes, or heart disease. [4] And it is trainable. [5] The largest gains go to the people who start at the lowest point. [6]

Read that again. If you feel like you are starting from zero, you have the most to gain.

What Memios is

Memios is a holistic wellness platform for people over 50 who want a long, healthy, meaningful life.

We bring four things together:

• Movement and exercise, the foundation

• Nutrition that fuels recovery and strength

• Coaching that builds habits that last

• Medically guided metabolic support when it fits

We organize all of it around that one number, VO2max, because your best years can still be ahead of you.

Our message is simple. Move more, feel better.

If that idea lands with you, subscribe to The Longevity Letter and start here with us.

What we believe

We treat you as a capable adult, never a patient to be managed. Dignity comes first.

• We speak to you, not around you

• We give you real evidence, no hype and no fear

• We meet you where you are, especially on hard days

• We lead with what your body can still do

Your body is still yours. Your strongest years can still be ahead of you.

What you get from The Longevity Letter

The Longevity Letter is where I share what I learn and what I do. Each issue blends three things: the science, the stories, and the strategies you can use this week.

You will hear from me, and from the experts who guide Memios, including leaders in cancer exercise and longevity research.

Your next step

Subscribe to The Longevity Letter and follow along as we build a long, strong life together.

One small step today. Then another tomorrow.

Frequently asked questions

Who is Memios for?

Adults over 50 who want to stay strong and independent, including cancer survivors and people at higher risk due to other health conditions.

Is Memios only for cancer survivors?

No. Cancer survivorship is at our core because of my story and the research, but the same model serves anyone over 50 who wants to move more and feel better.

Do I need to be fit to start?

No. The lower your starting point, the larger your potential gain in the shortest time. We meet you where you are. [6]

Is this medical advice?

No. We share education, not treatment. Always talk with your physician before changing how you exercise, eat, or manage your health.

References

[1] Friedenreich CM, et al. Cancer survivors could get survival benefits from postdiagnosis physical activity: a meta-analysis. Post-diagnosis physical activity is associated with roughly a 25 to 40 percent lower risk of all-cause and cancer-specific mortality. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6854247/

[2] Physical activity reduces all-cause mortality in patients with cancer: a systematic review and meta-analysis of randomized controlled trials. Pooled trial evidence shows about a 26 percent reduction in all-cause mortality. https://www.sciencedirect.com/science/article/pii/S0305737226000368

[3] Association between physical activity and mortality among breast cancer and colorectal cancer survivors: systematic review and meta-analysis. Annals of Oncology, 2019. Higher post-diagnosis activity is tied to markedly better survival, with pooled hazard ratios near 0.69 to 0.71. https://www.annalsofoncology.org/article/S0923-7534(19)36684-0/fulltext

[4] Mandsager K, Harb S, Cremer P, et al. Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. JAMA Network Open. 2018;1(6):e183605. In 122,007 adults, the mortality risk of low fitness was comparable to or greater than coronary artery disease, diabetes, and smoking. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2707428

[5] The effect of exercise training intensity on VO2max in healthy adults: an overview of systematic reviews and meta-analyses. 2024. VO2max improves reliably with exercise training. https://pmc.ncbi.nlm.nih.gov/articles/PMC11022784/

[6] Ross R, Blair SN, Arena R, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign. A scientific statement from the American Heart Association. Circulation. 2016;134(24):e653-e699. More than half the mortality reduction occurs moving from the least-fit group to the next-least-fit group. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000461

My name is Andrew Wilson. I am 59.

I am on a mission to live strong and active into my 90s, and I built Memios to help you do the same.

This is not a story about a doctor telling you what to do. I am not a doctor. I am a person who has lived through hard health news and decided to do something about it.

What changed everything

• In 2018, I lost my father to cancer. Multiple Myeloma and Amyloidosis.

• In 2021, my best friend Brad was diagnosed with Stage IV Melanoma.

• In 2022, I was diagnosed with Melanoma.

• Brad passed in April 2026.

When you see serious illness up close, you stop taking your health for granted. You also see something the system misses. People finish treatment and get sent home with no plan to rebuild their strength.

The science is clear. People who move after a cancer diagnosis lower their risk of dying from all causes by about 25 percent compared with those who do not, and many studies show survival measured in added years.

I lived the gap. So I built the bridge.

What Memios is

Memios is a holistic wellness platform for people over 50 who want a long, healthy, meaningful life. We bring four things together so they work as one.

• Movement and exercise, the foundation

• Nutrition that fuels recovery and strength

• Coaching that builds habits that last

• Medically guided metabolic support when it fits

We organize all of it around one number. VO2max, your cardiorespiratory fitness, is one of the strongest predictors of how long you live. It is also trainable, and the biggest gains come to those who start at the lowest point. Your best years can still be ahead of you. Our message is simple. Move more, feel better.

What we believe

We treat you as a capable adult, never a patient to be managed. Dignity comes first.

• We speak to you, not around you

• We give you real evidence, no hype and no fear

• We meet you where you are, especially on hard days

• We lead with what your body can still do

Your body is still yours. Your strongest years can still be ahead of you.

Your next step

Start here. Subscribe to The Longevity Letter and follow along as we build a long, strong life together. One small step today. Then another tomorrow.

Frequently asked questions

Who is Memios for?

Adults over 50 who want to stay strong and independent, including cancer survivors and people at higher risk due to other health conditions.

Is Memios only for cancer survivors?

No. Cancer survivorship is at our core because of my story and the research, but the same model serves anyone over 50 who wants to move more and feel better.

Do I need to be fit to start?

No. The lower your starting point, the larger your potential gain in the shortest time. We meet you where you are.

Is this medical advice?

No. We share education, not treatment. Always talk with your physician before changing how you exercise, eat, or manage your health.

Disclaimer: Memios shares wellness and longevity content for general education. We are not doctors, healthcare providers, or licensed medical professionals, and we do not provide medical advice, diagnosis, or treatment. We are health conscious individuals documenting what we learn and what we do as we work toward living long, healthy, strong lives into our 90s. Always talk with your physician or qualified healthcare professional before starting, changing, or stopping any exercise, nutrition, supplement, or health program.

by Andrew Wilson • The Longevity Letter • Hospice Cancer Care

Hospice care is one of the most misunderstood parts of serious illness — and one of the most important. If someone you love has been given a terminal diagnosis, or if your doctor has brought up hospice as an option, you probably have a flood of questions running through your mind:

• What does hospice actually mean?

• Does choosing hospice mean giving up?

• What will the final days look like?

• How will you know when the end is near?

• And how are you — the person sitting bedside, holding a hand, trying to stay strong — supposed to get through this?

I’ve walked a version of this road myself. My father battled Multiple Myeloma and Amyloidosis. My best friend is fighting Stage IV Melanoma. I writing this blog post on his boat as he is taking his second nap after taking his pain medication. Every moment, for me, feels monumental. I’m trying to make every moment for him feel like two old buddies “shootin’ the shit”. Inside I’m dying. I’m trying to hold it together, but the waves of grieve keep overwhelming me.

Walking this journey, I know firsthand how hard it is to find clear, honest information during one of the most painful seasons of a person’s life. That’s why I’m writing this. This guide covers everything you need to know about hospice care — including cancer hospice care, why predicting death is so difficult, what the final hours will look like, and how to take care of both your loved one and yourself through every stage of it.

What Hospice Care Actually Is

Hospice care is specialized medical care focused entirely on comfort — not cure.

When a person has a terminal illness and curative treatment is no longer working or is no longer desired, hospice steps in to manage pain, control symptoms, and support both the patient and the family. The goal shifts from fighting the disease to living as fully and comfortably as possible for whatever time remains.

Hospice is not a place — it’s a philosophy of care.

It can happen at home, in a dedicated hospice facility, in a nursing home, or in a hospital. Most people choose home hospice, which allows patients to spend their final weeks or months in familiar surroundings, surrounded by the people they love.

What Hospice Care Includes

A hospice team is a full medical team focused on one goal: your loved one’s comfort and dignity.

The team typically includes:

• A physician who oversees the medical plan

• Registered nurses who make regular visits (and are on call 24/7)

• A social worker who supports the family

• A chaplain or spiritual care counselor

• Home health aides who assist with bathing, dressing, and personal care

• A bereavement coordinator who follows up with the family after death

• Volunteers who can provide companionship and respite

Hospice also covers medications related to the terminal diagnosis, medical equipment like hospital beds and wheelchairs, and supplies like bandages and catheters — all at no cost to Medicare and Medicaid patients.

Palliative Care vs. Hospice Care — What’s the Difference?

People often confuse these two.

Palliative care focuses on comfort and symptom management but can be provided alongside curative treatment at any stage of illness. You can receive palliative care while still pursuing chemotherapy, radiation, or surgery.

Hospice care is a specific type of palliative care that begins when curative treatment has stopped and a doctor has estimated the patient has six months or less to live — if the illness follows its expected course.

Think of palliative care as the broader umbrella. Hospice is a specialized, intensive version of it for people at the end of life.

Cancer Hospice Care: What Makes It Different

Cancer is one of the most common reasons people enter hospice. About 29% of all hospice patients have a cancer diagnosis, according to the National Hospice and Palliative Care Organization.

Cancer brings its own set of challenges at end of life. Pain can be severe. Fatigue can be profound. Symptoms like nausea, loss of appetite, breathlessness, confusion, and anxiety can all occur — sometimes rapidly and all at once.

Cancer hospice care is specifically designed to address these challenges.

Pain Management in Cancer Hospice

Pain control is often the most urgent concern for cancer patients and their families.

Hospice nurses and physicians have access to the full range of pain medications, including opioids like morphine and hydromorphone. These are not given to hasten death — they are given to prevent suffering. Used properly, they make an enormous difference in quality of life.

Many families worry that starting morphine means the end is moments away. This is not always true. Morphine is often started weeks or even months before death to manage chronic cancer pain. It is titrated carefully to keep the patient comfortable without over-sedating them.

Common Symptoms Managed in Cancer Hospice

Beyond pain, the hospice team focuses on:

• Nausea and vomiting — managed with anti-nausea medications

• Breathlessness (dyspnea) — treated with low-dose opioids, positioning, and airflow

• Anxiety and agitation — addressed with medication and calming protocols

• Loss of appetite — managed by shifting focus from nutrition to comfort feeding

• Constipation — a common side effect of opioid pain medications, managed proactively

• Skin breakdown — prevented with repositioning, special mattresses, and skin care

• Confusion (delirium) — treated by identifying reversible causes and calming the environment

The hospice team also supports the family in understanding what each symptom means and how to respond at home.

When to Consider Hospice for a Cancer Patient

This is one of the hardest conversations — and one that often happens too late.

Research consistently shows that patients who enter hospice earlier have better quality of life, experience less aggressive end-of-life care, and often live longer than comparable patients who pursue treatment to the very end. A landmark study published in the New England Journal of Medicine found that lung cancer patients who received early palliative care alongside oncology treatment lived nearly three months longer than those who received standard care alone.

Signs it may be time to discuss hospice:

• Cancer is no longer responding to treatment

• The patient has decided to stop treatment

• Multiple hospitalizations within the past few months

• Significant decline in physical function over weeks or months

• Increasing difficulty eating, drinking, or staying awake

• The patient or family expresses a desire to focus on comfort over cure

If you’re unsure, ask your oncologist directly: “Is hospice something we should be talking about?” A good doctor will be honest with you.

Why Doctors Can’t Always Tell You When Someone Will Die

This question comes up in almost every family meeting. “Doctor — how long does he have?”

The honest answer is: medicine cannot predict death with precision.

And this is not a failure of modern medicine. It is a reflection of how complex the human body is — and how individual each person’s dying process really is.

Why Predicting Death Is So Difficult

Every person’s physiology is different.

Two people with the same cancer, at the same stage, with the same overall health status can have wildly different trajectories. One person may decline rapidly over days. Another may stabilize for months.

The body has an extraordinary capacity to compensate.

Organs can compensate for disease far longer than expected — right up until they can’t. This creates a pattern that doctors call “sudden decline” even when the underlying illness has been progressing for a long time.

There is no reliable biological clock.

Researchers have identified several indicators associated with shorter survival — like reduced functional status, decreased oral intake, changes in breathing, and certain lab values — but none of these are precise. They indicate a trend, not a timeline.

Prognosis is based on population averages, not individual patients.

When a doctor says “six months,” they are estimating based on what happens to people with similar diagnoses and conditions. Half of those people will live longer than six months. Half will not make it that far. Your loved one is not a statistic.

The Six-Month Hospice Rule — What It Actually Means

Medicare and most insurers require a physician certification that the patient is expected to live six months or less — if the illness follows its normal course — in order to qualify for hospice benefits.

This does not mean the doctor is predicting exactly six months.

It means the patient is sick enough that dying within six months would not be surprising. Many hospice patients live longer than six months. When that happens, a physician simply recertifies that the patient is still declining, and hospice continues.

Signs That Death May Be Closer

While no one can predict the exact moment, there are patterns that suggest the final phase is approaching. The hospice team will recognize these and will guide you through them.

Signs that weeks remain:

• Spending most of the day in bed or sleeping

• Eating and drinking very little

• Withdrawing from social interaction

• Increased confusion or disorientation

• Talking about people who have already died

Signs that days remain:

• Inability to swallow food or liquids

• Changes in breathing (Cheyne-Stokes breathing — a pattern of breaths that speeds up and slows down)

• Mottled skin (blotchy, purplish discoloration, especially in the legs and feet)

• Extremities becoming cool to the touch

• Eyes partially open but not focusing

• Decreasing urine output (dark, concentrated, or none at all)

• Jaw relaxation and mouth breathing

Signs that hours remain:

• Breathing becomes very irregular, with long pauses (apnea)

• The “death rattle” — a gurgling sound caused by secretions in the throat that the patient can no longer swallow

• Skin becomes very pale, ashen, or gray

• Extremities become cool and mottled up to the knees or elbows

• No response to voice or touch

The hospice nurse will walk you through each of these signs as they appear. You do not have to figure this out alone.

What the Final Days and Hours Look Like

The dying process is not what most people expect. Television and movies give us dramatic, sudden deaths. Real dying — particularly from cancer or chronic illness — is usually much quieter, much more gradual, and in many ways, more peaceful.

The Days Before Death

As the body begins to shut down, the patient will spend more and more time sleeping. They may become difficult or impossible to wake. This is normal. The brain is protecting itself.

They may stop eating and drinking entirely. This is one of the hardest things for families to watch. Every instinct tells you to encourage eating, to offer food, to do something. But at this stage, the body has made a decision. Forcing food or fluids can actually cause more discomfort — increasing secretions, causing nausea, and adding to the burden on organs that are already shutting down.

The patient may become confused or see people or things that others cannot. They may reach toward the ceiling, call out a name, or have a conversation with someone who died years ago. This is called terminal restlessness or terminal lucidity and is very common. It can be unsettling to witness. But many family members, and many hospice workers, describe these moments as something profound — as if the dying person is experiencing something that the rest of us cannot see.

Your job in these final days is simple: be present.

Hold their hand. Speak gently, even if they seem unconscious. Hearing is believed to be one of the last senses to fade. Tell them what you want them to know. Give them permission to go, if that feels right. Many people seem to hold on until they feel that their loved ones will be okay.

The Hours Before Death

Breathing will change. You will hear long pauses. Then a few breaths. Then another pause. This is the body’s natural rhythm as the brainstem loses its ability to regulate respiration.

The “death rattle” can be alarming if you’ve never heard it before. The hospice nurse will prepare you for it. Positioning the patient on their side can help reduce the sound. Medications can reduce secretions. This sound does not mean the patient is in distress — it means secretions are pooling because the swallowing reflex has stopped.

The hands, feet, and legs become cool and mottled. The face becomes still and quiet.

And then — very often — it is peaceful. A slow, quiet slipping away.

At the Moment of Death

Breath simply stops. Sometimes there is one final exhalation. And then stillness.

If you are in the room, you do not need to do anything immediately. You have time. You can sit with your loved one. You can say a prayer. You can cry. You can simply be there.

Then call the hospice nurse. They will come to the home (or the facility) to pronounce death, contact the appropriate parties, and guide you through the next steps. You do not call 911 for a hospice death — the hospice team handles everything.

Making the Patient More Comfortable

Comfort is everything in hospice care. Here is what you can do.

At Home

Create a calm, familiar environment.

Keep the room at a comfortable temperature. Soft lighting is easier on sensitive eyes. Familiar objects — photos, a favorite blanket, a treasured item — can provide comfort even when the patient seems unresponsive.

Control pain proactively.

Work with the hospice nurse to stay ahead of pain. Do not wait until your loved one is in severe distress to give medication. Scheduled dosing is almost always more effective than as-needed dosing for cancer pain.

Manage the mouth.

When a patient stops drinking, the mouth becomes very dry. Swab the inside of the mouth and lips with a small sponge (mouth swab) or a damp cloth. Apply lip balm. This can provide real comfort even in the final hours.

Reposition regularly.

Turning the patient every two hours prevents pressure sores. The hospice team will teach you how to do this safely. A special air mattress can reduce the risk of skin breakdown.

Manage secretions.

If the “death rattle” is present, position the patient on their side. Ask the nurse about medications to reduce secretions. Remember: this sound usually does not indicate distress.

Use music and touch.

Soft music — whatever your loved one enjoyed in life — can be calming. Gentle touch, like holding a hand or lightly stroking an arm, communicates presence and love even when words are gone.

Keep the room quiet and low-stimulation in the final days.

Loud conversations, bright lights, and constant activity can increase agitation. A calm, peaceful environment helps the patient rest.

Practical Comfort Measures from the Hospice Team

The hospice team can provide or prescribe:

• Liquid morphine for pain and breathlessness

• Lorazepam (Ativan) for anxiety and agitation

• Scopolamine patches or glycopyrrolate to reduce secretions

• Haloperidol for severe agitation or delirium

• Anti-nausea medications for nausea and vomiting

• Comfort care kits — a small supply of the most common end-of-life medications kept at home so that you are never waiting for a pharmacy in an urgent moment

Ask for the comfort care kit early. Having it at home means you can act quickly if symptoms arise, especially on nights and weekends.

Supporting the Caregiver: You Matter Too

If you are the caregiver — the spouse, the adult child, the close friend — you are carrying something enormous.

Caregiver burnout is real, it is common, and it can happen even to the most devoted, loving people. Recognizing it and addressing it is not selfish. It is necessary.

I recommend you read this book (affiliate link) by memios Advisor, Shari Hofer: With Love: A Practical Guide to Caring for Aging Parents Through the End of Life https://amzn.to/4bEnpAQ

Signs of Caregiver Burnout

• Exhaustion that sleep does not fix

• Feeling isolated and cut off from your normal life

• Irritability, resentment, or anger — even toward the person you love

• Neglecting your own health (skipping meals, medications, exercise)

• Feeling hopeless or helpless

• Withdrawing from other relationships

If any of these feel familiar, you are not failing. You are human.

What the Hospice Team Offers Caregivers

Hospice is designed to support the whole family, not just the patient.

Respite care is a Medicare-covered benefit that provides up to five consecutive days of inpatient hospice care — giving the primary caregiver a genuine break. You can use this to sleep, travel, handle personal business, or simply breathe.

Social workers can help with insurance, advance directives, family conflict, and connecting you to local support resources.

Chaplains are available regardless of your religious beliefs. They are trained to sit with people in grief and pain without judgment.

Bereavement support continues for at least 13 months after the death — because grief does not end when the funeral does.

Practical Advice for Caregivers

Accept help when it is offered.

People want to help but often do not know how. Give them a specific task: bring dinner on Tuesday, sit with Mom for two hours on Saturday afternoon so I can sleep.

Stay connected.

Isolation makes everything harder. Even a short walk, a phone call with a friend, or a few minutes outside can reset your nervous system.

Give yourself permission to feel everything.

Grief does not wait until death. Anticipatory grief — grieving a loss before it happens — is real and normal. You may feel grief, relief, guilt, love, anger, and exhaustion all in the same afternoon. All of it is okay.

Sleep whenever you can.

In the final days, you may be tempted to stay awake through every moment. But you cannot be present in any meaningful way if you are completely depleted. Sleep in shifts if possible. Let a family member or volunteer take a watch.

Know that you do not have to be in the room at the moment of death.

Many people feel guilty if they stepped out for a few minutes when their loved one died. The truth is, some people seem to wait for a private moment. It is not a failure. It is just the way it sometimes happens.

Grief After Hospice

The grief after a hospice death can be complicated.

You may feel relief — and then feel guilty about feeling relief. Relief is not the same as not loving someone. After months of watching someone suffer, relief is a natural human response.

You may feel a strange emptiness where the caregiving role used to be. Caregiving becomes your identity when you do it intensively. Losing it — even as you gain back your own life — is its own kind of loss.

You may also feel surprisingly at peace. Hospice deaths, when they go well, can be profoundly meaningful. Families often describe a sense of privilege — of having been present for something sacred. That peace is real, and it is something to hold onto.

How to Have the Hospice Conversation

Bringing up hospice is hard. Here is how to approach it.

Start with questions, not answers.

Instead of saying “I think it’s time for hospice,” try “I’ve been reading about hospice and I want to understand it better. Can we talk about it?”

Talk to the doctor first if you can.

Ask your loved one’s physician directly: “Do you think hospice is something we should consider?” A good physician will be honest.

Frame it around what your loved one values.

“You’ve always said you didn’t want to die in a hospital. Hospice might be a way to make sure that happens.”

Address the fear that hospice means giving up.

Choosing hospice is not giving up. It is choosing quality over quantity. It is choosing comfort over treatment that is no longer helping. For many people, it is the most courageous decision of their life.

Resources and Final Thoughts

Hospice is not the end of care. It is a different kind of care — one focused entirely on the person, not the disease.

If you are walking this road right now, know that you are not alone. Millions of families go through this every year. The hospice team has seen this before. They will be with you through every step.

And if you are reading this before you need it — good. The more you understand hospice care before you are in crisis, the better positioned you will be to make decisions that honor your loved one’s wishes.

One of the greatest gifts you can give someone you love is to know what they want — and to make sure it happens.

Frequently Asked Questions About Hospice Care

1. Does choosing hospice mean we are giving up?

No. Hospice is a choice to focus on comfort, quality of life, and dignity. Many people who choose hospice earlier live longer and feel better than those who continue aggressive treatment. It is not giving up — it is choosing differently.

2. Can a patient leave hospice if they want to resume treatment?

Yes. Hospice is always voluntary. A patient can leave hospice at any time to pursue curative treatment. If they later decide to return to hospice, they can do so.

3. How is hospice paid for?

Medicare Part A covers hospice care for patients who are Medicare-eligible. Medicaid also covers hospice in most states. Many private insurance plans cover hospice as well. The hospice team’s social worker can help you sort out coverage.

4. Can hospice be provided in a nursing home?

Yes. If your loved one lives in a nursing home or assisted living facility, hospice can be brought to them there. The hospice team coordinates with the facility staff.

5. What is “continuous care” in hospice?

If symptoms become severe and difficult to control, hospice can provide continuous nursing care at home — a nurse or aide present for up to 24 hours per day — until the crisis is resolved. This is a Medicare-covered benefit that many families do not know about.

6. What happens if a hospice patient lives longer than six months?

The physician simply recertifies that the patient is still appropriate for hospice care, and it continues. There is no penalty for living longer than expected.

7. How do I know if my loved one is in pain if they are unconscious?

Signs of pain in an unconscious patient include furrowed brow, grimacing, restlessness, and rigid or tense body posture. The hospice nurse will teach you what to look for and how to respond.

8. Can children be present at a hospice death?

Yes — if it is appropriate for the child’s age and temperament and if the parents are comfortable with it. Many hospice professionals and grief counselors believe that including children, when done thoughtfully, can reduce fear and help them process grief more healthfully than exclusion.

9. What is anticipatory grief?

Anticipatory grief is grieving a loss before it happens. It is completely normal to begin grieving while your loved one is still alive. Many hospice social workers and counselors specifically support families through this.

10. How do I talk to my loved one about what they want at end of life?

Start with an advance directive or a living will. Organizations like The Conversation Project (theconversationproject.org) offer free guides to help families have these discussions before a crisis hits.

Additional Information

References and Sources

1. National Hospice and Palliative Care Organization (NHPCO) — Comprehensive statistics, family guides, and hospice finder tools. https://www.nhpco.org

2. Temel JS, et al. (2010). “Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer.” New England Journal of Medicine. 363:733-742. https://www.nejm.org/doi/full/10.1056/NEJMoa1000678

3. Medicare.gov — Official information on Medicare hospice benefits, eligibility, and coverage.https://www.medicare.gov/coverage/hospice-care

4. American Cancer Society — Hospice care guide for cancer patients and families.https://www.cancer.org/treatment/end-of-life-care/hospice-care.html

5. Caregiver Action Network — Resources for family caregivers. https://www.caregiveraction.org

6. The Conversation Project — Free guides to help families talk about end-of-life wishes. https://theconversationproject.org

7. CaringInfo (a program of NHPCO) — Free advance directive forms for all 50 states and patient/family hospice resources. https://www.caringinfo.org

8. National Cancer Institute (NCI) — End-of-life care fact sheets and research. https://www.cancer.gov/about-cancer/advanced-cancer/care-choices/hospice-fact-sheet

9. Palliative Care Fast Facts — EPERC (End of Life/Palliative Education Resource Center)https://www.mypcnow.org/fast-facts/

10. GriefShare — Grief support groups and online resources for bereaved families. https://www.griefshare.org

Disclaimer: memios shares wellness and longevity content for general education. We are not doctors, healthcare providers, or licensed medical professionals, and we do not provide medical advice, diagnosis, or treatment. We are health conscious individuals documenting what we learn and what we do as we work toward living long, healthy, strong lives into our 90s. Always talk with your physician or qualified healthcare professional before starting, changing, or stopping any exercise, nutrition, supplement, or health program.

by Andrew Wilson • The Longevity Letter • Celiac Disease

March 2026

If you have celiac disease — or suspect you might — you already know the frustration. You go gluten-free. You feel better for a while. Then the symptoms creep back. Your gut still feels off. You’re tired. You’re bloated. You’re reading every wellness article you can find, looking for something that will actually move the needle.

That search often leads people to parasite cleanses and fungal detox protocols, including the one I covered in a previous post here on The Longevity Letter. So in this post, I want to do two things: give you a solid, evidence-based foundation on celiac disease itself, and then give you an honest look at whether those protocols are helpful, harmful, or somewhere in between when celiac is part of your picture.

Celiac disease is one of the most common autoimmune conditions in the world, affecting roughly 1% of the global population — yet an estimated 83% of Americans who have it are undiagnosed or misdiagnosed. This is a disease that silently damages your gut for years before most people ever get an answer. Understanding it is one of the most important things you can do for your long-term health.

Let’s get into it.

What Is Celiac Disease?

Celiac disease is an autoimmune condition. When someone with celiac disease eats gluten — the protein found in wheat, barley, and rye — their immune system attacks the lining of the small intestine. The result is damage to the villi, the tiny finger-like projections that line the gut wall and allow your body to absorb nutrients.

Over time, this damage reduces your ability to absorb vitamins, minerals, and other critical nutrients. The downstream effects touch nearly every system in your body.

This is not a food sensitivity or an allergy in the traditional sense. It is an immune-mediated response with measurable, lasting tissue damage. And unlike many conditions, the trigger is known: gluten.

Who Gets It?

Celiac disease affects people across all ages and backgrounds. Research published in Gastroenterology in 2024 puts the global prevalence at up to 1%, with significantly higher rates among certain groups:

• First-degree relatives of people with celiac disease (as high as 1 in 10, and a Mayo Clinic study found 44% of screened first-degree relatives carried the disease)

• People with other autoimmune conditions, including Type 1 diabetes and thyroid disease

• Women more than men — up to twice as many women are affected

Celiac disease has been increasing in incidence for decades. New diagnosis rates have grown roughly 7.5% per year across the industrialized world. Part of this is better awareness and testing. Part of it reflects a genuine rise in the disease itself, likely tied to environmental and microbiome changes.

The most troubling statistic: in the United States, estimates suggest only 17% to 50% of people with celiac disease have an actual diagnosis. Millions are walking around with an active autoimmune attack on their gut and don’t know it.

The Symptoms — And Why They’re So Easy to Miss

This is where celiac disease gets complicated. The classic image of celiac disease — a thin person with severe diarrhea and dramatic weight loss — represents only one type of presentation. Most people with celiac disease don’t look like that.

Classic (Intestinal) Symptoms

• Chronic diarrhea or loose stools

• Bloating and gas

• Abdominal pain and cramping

• Constipation (yes, celiac can cause constipation too)

• Nausea and vomiting

• Fatty, pale, or foul-smelling stools

Non-Classic (Extra-Intestinal) Symptoms

This is where things get interesting — and where misdiagnosis runs rampant. Non-intestinal celiac symptoms include:

• Chronic fatigue and low energy

• Iron-deficiency anemia that doesn’t respond to iron supplements

• Brain fog and difficulty concentrating

• Bone and joint pain

• Headaches and migraines

• Peripheral neuropathy (numbness or tingling in hands and feet)

• Skin rash known as dermatitis herpetiformis (intensely itchy, blistering rash)

• Infertility and repeated miscarriage

• Depression and anxiety

• Osteoporosis

• Elevated liver enzymes (present in about 40% of newly diagnosed patients)

• Mouth sores (aphthous ulcers)

• Hair loss

A landmark study found that 60% of children and 41% of adults diagnosed with celiac disease had no obvious symptoms at all. This means your doctor could be looking right at you, not seeing any red flags, and missing an active autoimmune disease that is damaging your gut every time you eat bread.

The average time from symptom onset to celiac disease diagnosis is 6 to 10 years. That is years of gut damage, nutrient malabsorption, and increasing risk for complications — all while being told it’s probably just IBS, stress, or getting older.

How Celiac Disease Is Diagnosed

If you suspect celiac disease, here is what a proper diagnostic process looks like.

Critical rule: Do not go gluten-free before testing.

This is one of the most common mistakes people make. If you eliminate gluten before your blood tests or biopsy, the tests will often come back negative even if you have celiac disease — because the immune response and the gut damage start to resolve. You will get a false negative and remain undiagnosed.

Step 1: Blood Tests

Your doctor will order serological tests looking for specific antibodies:

• Anti-tissue transglutaminase IgA (tTG-IgA): The most widely used screening test. High sensitivity and specificity.

• Anti-endomysial antibodies (EMA-IgA): Highly specific for celiac disease.

• Total serum IgA: Ordered alongside the above, because IgA deficiency (common in the general population) can cause false negatives.

• Deamidated gliadin peptide (DGP) antibodies: Useful when IgA deficiency is present.

Step 2: Small Intestinal Biopsy

A positive blood test should be followed by a biopsy taken during an upper endoscopy. The gastroenterologist takes multiple small tissue samples from the duodenum. These are examined for villous atrophy — the flattening of those gut villi that characterizes celiac disease.

This is the gold standard for diagnosis. Research confirms that sampling needs to be thorough — damage can be patchy and easily missed if too few samples are taken.

Step 3: Genetic Testing (Optional)

Celiac disease is associated with specific HLA gene variants: HLA-DQ2 and HLA-DQ8. About 95% of people with celiac disease carry HLA-DQ2, and most of the remainder carry HLA-DQ8.

Genetic testing can help rule out celiac disease — if you don’t have these genes, you almost certainly cannot develop celiac disease. But having the genes doesn’t mean you have the disease.

The Gut Microbiome Connection

Here is where the research gets really interesting — and where it ties directly into questions about fungal overgrowth and parasite protocols.

Your gut microbiome is a complex ecosystem of trillions of bacteria, fungi, viruses, and other microorganisms. In healthy people, this ecosystem is diverse and balanced. In celiac disease, that balance is significantly disrupted.

What Dysbiosis Looks Like in Celiac Disease

Research published in the Proceedings of the National Academy of Sciences (2021) and reviewed extensively in a 2023 MDPI Cells paper and a 2024 Frontiers in Medical Technology scoping review consistently shows:

• Reduced beneficial bacteria: Particularly Bifidobacterium and Lactobacillus species, which have anti-inflammatory and immune-regulating properties

• Overgrowth of harmful bacteria: Including Bacteroides, Escherichia coli, and Prevotella, which increase intestinal permeability

• Altered immune signaling: The same receptors that mediate the gut-microbiota relationship also regulate innate immunity. Dysbiosis disrupts this balance, amplifying the inflammatory response to gluten

What is particularly notable: a prospective longitudinal study tracked infants at risk for celiac disease and found that microbiome shifts began appearing up to 18 months before the disease actually developed. The dysbiosis may not just be a consequence of celiac disease — it may play a role in triggering it.

Even more striking: research shows that a gluten-free diet, while it improves symptoms and starts to heal the gut lining, does not fully restore normal microbiome composition. Up to 30-40% of celiac patients on a strict gluten-free diet still experience ongoing symptoms and persistent gut dysbiosis.

This is a critical point. It means there is something beyond gluten elimination that may need to be addressed. And that is exactly why the conversation about probiotics, prebiotics, and gut-targeted therapies is growing rapidly in the celiac research community.

Fungal Dysbiosis in Celiac Disease

Now let’s talk about the fungal side of the gut microbiome — the mycobiome.

Research published in ScienceDirect (Candida albicans in celiac disease) and reviewed in a 2023 PMC pediatric celiac microbiome review found something important:

• Candida albicans was present in 33% of celiac patients versus 0% of healthy controls in one study

• Saccharomyces cerevisiae was found in 33% of celiac patients versus 10% of controls

• C. albicans hyphal wall protein shares structural similarity with gluten-related proteins, and may interact with tissue transglutaminase — the same enzyme central to celiac disease pathology

• Candida overgrowth is more common in celiac disease because intestinal damage reduces immune defense and disrupts enzyme secretion, leaving undigested carbohydrates that feed fungal growth

This tells us that fungal overgrowth is a real and documented feature of celiac disease. It’s not a fringe theory.

Small Intestinal Bacterial and Fungal Overgrowth (SIBO and SIFO)

Beyond general dysbiosis, celiac disease is associated with a higher risk of Small Intestinal Bacterial Overgrowth (SIBO) and Small Intestinal Fungal Overgrowth (SIFO). A 2025 review in Nutrients (MDPI) describes how damage to the small intestinal lining, reduced motility, and impaired immune function all create conditions that allow bacteria and fungi to proliferate in the upper small intestine where they don’t belong.

This matters because SIBO and SIFO produce symptoms nearly identical to celiac disease: bloating, gas, diarrhea, fatigue, abdominal pain. If you have celiac disease and you’re still symptomatic on a gluten-free diet, SIBO or SIFO may be a significant part of why.

The Only Proven Treatment: A Strict Gluten-Free Diet

Let’s be direct. There is one evidence-based treatment for celiac disease: a lifelong, strict gluten-free diet.

When you eliminate all gluten — wheat, barley, rye, and in many cases contaminated oats — the immune attack stops. The gut lining begins to heal. Antibody levels drop. Symptoms improve for most people.

This is not a wellness trend. For someone with celiac disease, eating gluten is not a choice. Every exposure, no matter how small, triggers an immune response and continues the cycle of damage.

What “Strict” Really Means

• A single crouton can trigger a response.

• Cross-contamination matters — a knife that touched bread, a shared toaster, or flour in the air in a bakery can be enough.

• Gluten hides in unexpected places: soy sauce, malt vinegar, modified food starch, some medications, and many processed “gluten-free” products that are made in facilities shared with gluten-containing foods.

• Reading labels is not optional. It’s a daily practice.

Why a Gluten-Free Diet Isn’t Always Enough

Here’s what the research shows that many people don’t hear from their doctors:

• Up to 20-50% of adults with celiac disease still have significant symptoms even on a long-term gluten-free diet

• The gut microbiome does not fully normalize with gluten elimination alone

• Nutrient deficiencies (iron, folate, B12, zinc, vitamin D, magnesium) often persist because of prior malabsorption damage

• SIBO, SIFO, or other overlapping conditions may continue to drive symptoms

This is why researchers are actively investigating additional therapies, and why so many people with celiac disease turn to functional approaches and supplements looking for the missing piece.

What the Research Says About Emerging Treatments

The celiac research pipeline is more active than it has ever been. Here is a summary of where things stand.

Enzyme Therapies (Gluten-Degrading Enzymes)

Latiglutenase is a combination enzyme therapy that degrades gluten peptides in the gut before they can trigger an immune response. Phase 2 clinical trials have shown it can prevent mucosal deterioration and reduce symptoms when patients are exposed to gluten. It is not a cure and not approved yet, but this is one of the more promising near-term approaches.

AN-PEP, an enzyme derived from Aspergillus niger, has shown the ability to degrade gluten in the stomach before it reaches the small intestine. Early studies are encouraging.

Transglutaminase 2 (TG2) Inhibitors

Tissue transglutaminase is the enzyme that modifies gluten peptides, making them more immunogenic. A 2024 study from Tampere University (published in Nature Immunology) analyzed activity across more than 10,000 genes and found that ZED1227 — a TG2 inhibitor — prevented the intestinal damage caused by gluten at a molecular level. This is significant science. A first drug approved specifically for celiac disease may not be far away.

Immune Tolerance Therapies

TAK-101 is a nanoparticle therapy designed to induce immune tolerance to gluten. In Phase 2 trials, it reduced the population of gluten-reactive immune cells by 88% compared to placebo. Vaccines and monoclonal antibody approaches are also in development.

Probiotics and the Microbiome

Research from ASM (American Society for Microbiology, 2024) and multiple other sources confirms that specific probiotic strains — particularly Lactobacillus and Bifidobacterium — can:

• Degrade immunogenic gluten peptides in the gut

• Reduce intestinal inflammation

• Help restore microbiome balance in celiac patients

• Improve the integrity of the gut barrier

Probiotics are not a replacement for a gluten-free diet. But the science supports their use as an adjunct — particularly for celiac patients who remain symptomatic despite strict dietary adherence.

Parasite and Fungal Detox Protocols: An Honest Look for Celiac Patients

In a previous post on The Longevity Letter, I covered natural parasite and fungal detox protocols in detail. I want to revisit that content specifically in the context of celiac disease.

The Fungal Piece: Partially Valid

Here’s what I’ll give credit to: the concern about fungal overgrowth in celiac disease is not unfounded. The research is real. Candida overgrowth is more common in people with celiac disease, and it does contribute to ongoing gut symptoms. Addressing it — through diet, probiotics, and in some cases antifungal treatment — is a legitimate part of the picture.

The problem is how many protocols approach this.

Unregulated “antifungal cleanses” typically involve high-dose herbal compounds (oregano oil, caprylic acid, wormwood, black walnut) taken without testing, without knowing what organism is actually present, and without medical supervision. These compounds can:

• Disrupt the balance of beneficial gut bacteria alongside the fungal overgrowth

• Cause significant gastrointestinal distress — especially in a gut already inflamed from celiac disease

• Interact with medications

• Cause liver strain at high doses over extended periods

If fungal overgrowth is a genuine issue for you, the right approach is:

1. Test — stool analysis or organic acids testing to confirm fungal overgrowth

2. Identify — know what organism you’re dealing with

3. Treat appropriately — under medical supervision, whether natural or pharmaceutical

The Parasite Piece: More Complex

The relationship between parasites and celiac disease is genuinely fascinating from a science standpoint.

Research published in PMC (Rostami et al., 2015) notes that some parasitic infections — particularly helminth infections — actually modulate the immune response in ways that may reduce autoimmune and allergic reactivity. Hookworm (Necator americanus) has been studied specifically in the context of celiac disease, with dermal immunization being explored as a way to reduce gluten sensitivity by shifting the immune response.

This is real science. Some researchers hypothesize that declining rates of parasitic infections in developed countries (the “hygiene hypothesis”) may partly explain rising rates of autoimmune diseases including celiac disease.

However, there is a significant gap between that science and the claim that doing a “parasite cleanse” at home will help your celiac disease.

Here is what the evidence-based medicine community says clearly:

• Parasite cleanses have no documented clinical evidence of eliminating actual parasitic infections

• What has been documented are the risks: diarrhea, dehydration, electrolyte imbalance, disruption of normal gut flora, and in some cases serious complications — particularly dangerous for people with already-compromised gut barriers like celiac disease

• Gastrointestinal symptoms are far more likely to be driven by celiac disease itself, SIBO, fungal overgrowth, or food intolerances than by parasites in someone with no meaningful exposure history

• Antiparasitic herbs at high doses can cause liver toxicity

The other concern: self-treating for parasites can delay proper diagnosis. Many people in celiac communities report that parasite cleanses made them feel temporarily better (often from the dietary changes and reduced sugar intake that accompany them) while the underlying celiac disease, SIBO, or fungal overgrowth remained untreated.

If you genuinely suspect a parasitic infection, particularly after travel or specific exposure, the right step is a proper ova and parasites (O&P) stool test — done at least three times on separate days for accuracy. Then treatment, under medical supervision, with organism-specific medication.

Key Warnings for Celiac Patients Considering Any Detox Protocol

Before you try any cleanse or detox, celiac patients need to understand these specific risks:

1. Many herbal supplements are processed in facilities that also handle gluten-containing ingredients. Cross-contamination is a real risk. Always choose certified gluten-free supplements.

2. Celiac disease causes nutrient depletion. Adding aggressive cleanses, fasting protocols, or high-dose herbal compounds to an already nutrient-depleted system can worsen deficiencies and make you feel significantly worse.

3. A damaged gut barrier means more susceptibility to irritation. Compounds that are tolerable for someone with a healthy gut can cause serious distress in an inflamed celiac gut.

4. Herbal compounds can interfere with absorption of nutrients and medications. If you’re already dealing with malabsorption, adding compounds that further disrupt your gut chemistry is risky.

5. Die-off reactions (Herxheimer reactions) are more intense with a compromised immune system. Celiac disease is an active autoimmune condition. Adding aggressive antimicrobial protocols can trigger immune reactions that are hard to distinguish from a celiac flare.

What Actually Helps Beyond a Gluten-Free Diet

Based on the best available research, here are the approaches that have real evidence behind them for celiac patients who are still struggling:

1. Rule Out SIBO

If you’re bloated, gassy, and uncomfortable despite strict gluten elimination, ask your gastroenterologist about hydrogen-methane breath testing for SIBO. A significant percentage of celiac patients have concurrent SIBO, and treating it (with rifaximin or natural antimicrobials under supervision) can produce dramatic improvement.

2. Add Targeted Probiotics

The evidence supports the use of Lactobacillus and Bifidobacterium strains as adjuncts in celiac management. Look for:

• High-potency, multi-strain products

• Certified gluten-free labeling (critical)

• Strains with research backing: Lactobacillus rhamnosus, Bifidobacterium longum, Lactobacillus plantarum

3. Address Nutrient Deficiencies

Most newly diagnosed — and many long-diagnosed — celiac patients are deficient in one or more of the following:

• Iron

• Vitamin D

• B12 and folate

• Zinc

• Magnesium

• Calcium

Get your levels tested. Supplement under supervision. These deficiencies alone can cause fatigue, brain fog, bone pain, and mood issues that mimic ongoing celiac disease activity.

4. Consider a Low-FODMAP Trial

Some people with celiac disease have concurrent irritable bowel syndrome or food intolerances to fermentable carbohydrates (FODMAPs). A short-term low-FODMAP diet trial under dietitian supervision can help identify whether these are contributing to your symptoms.

5. Support Your Gut Barrier

• L-glutamine: An amino acid that feeds the cells lining the gut wall and supports intestinal barrier integrity. This is one of the more evidence-supported gut-healing supplements.

• Zinc carnosine: Shown to support mucosal healing.

• Collagen peptides: Provide building blocks for gut tissue repair.

6. Eliminate Hidden Gluten Sources

Many celiac patients who think they’re strict have hidden gluten exposures they haven’t identified. A review with a registered dietitian experienced in celiac disease can find cross-contamination sources in your kitchen, supplement routine, or lifestyle that you may have missed.

7. Work With Your Doctor on Follow-Up Testing

Celiac disease is not a diagnose-and-discharge condition. Follow-up antibody testing (tTG-IgA) and in some cases repeat biopsy confirm whether your gut is healing. If antibodies remain elevated despite a gluten-free diet, there is ongoing gluten exposure happening somewhere.

The Bigger Picture: Celiac Disease and Longevity

I think about celiac disease through a longevity lens. Undiagnosed and untreated celiac disease is not a minor inconvenience. Here is what it does to your body over time:

• Malnutrition: Persistent malabsorption leads to deficiencies that affect bone density, immune function, neurological health, and energy production

• Increased cancer risk: Untreated celiac disease is associated with a higher risk of certain lymphomas and gastrointestinal cancers

• Osteoporosis: Years of calcium and vitamin D malabsorption accelerate bone loss

• Neurological complications: Peripheral neuropathy and ataxia (gluten ataxia) can occur even in people with minimal gut symptoms

• Cardiovascular risk: Chronic inflammation drives cardiovascular disease

• Autoimmune cascade: A patient’s risk of developing additional autoimmune conditions increases significantly with age at diagnosis — 34% of people diagnosed after age 20 develop another autoimmune condition

This is exactly the kind of silent, chronic damage that derails a long, healthy, active life. Getting diagnosed matters. Getting properly managed matters even more.

A Note on Non-Celiac Gluten Sensitivity

Not everyone who reacts to gluten has celiac disease. Non-celiac gluten sensitivity (NCGS) is a real condition where people experience symptoms after eating gluten — but without the autoimmune markers and intestinal damage that define celiac disease.

NCGS is diagnosed by ruling out celiac disease and wheat allergy, and then observing symptom improvement on a gluten-free diet.

The management is similar — reduce or eliminate gluten. But the stakes are somewhat different, because the intestinal damage mechanism is different. NCGS does not carry the same long-term complication profile as celiac disease.

That said, NCGS may involve some of the same microbiome dysbiosis, and the same supportive approaches (probiotics, gut barrier support, nutrient optimization) are likely helpful.

Frequently Asked Questions

Q: Can celiac disease develop later in life, even if I’ve eaten gluten my whole life without problems?

Yes. Celiac disease can be triggered or become symptomatic at any age. Many people are diagnosed in their 40s, 50s, and beyond. Triggers can include pregnancy, major infection, surgery, or significant physical stress. Having the genetic predisposition (HLA-DQ2 or DQ8) is the prerequisite, but the disease can remain latent for decades.

Q: How long does it take for the gut to heal after going gluten-free?

This varies significantly by individual. Most people see symptom improvement within weeks. Full mucosal healing can take 1 to 2 years for adults. Some adults never achieve complete histological healing even on a strict gluten-free diet. Regular follow-up with your gastroenterologist is important to monitor healing progress.

Q: Is oat consumption safe for celiac disease?

Oats are a complicated topic in celiac disease. Pure, uncontaminated oats do not contain gluten, and most celiac patients tolerate them. But commercial oats are almost universally cross-contaminated with gluten-containing grains. Even “gluten-free” oats cause reactions in a small subset of celiac patients due to avenin, a protein in oats that can trigger a celiac-like response in sensitive individuals. International research groups, as noted in a 2024 Celiac Canada review, confirm there are no global clinical guidelines on oats for celiac patients. Proceed cautiously and discuss with your doctor.

Q: If I test negative for celiac disease, does that mean gluten isn’t causing my symptoms?

Not necessarily. NCGS is real, and wheat allergy is another distinct condition. Additionally, testing must be done while consuming gluten — false negatives are common when people have already reduced gluten intake. If you suspect gluten is a problem, get properly tested before eliminating it.

Q: Should I do a parasite cleanse or fungal detox if I have celiac disease?

This requires nuance. Fungal overgrowth is documented in celiac disease and may be worth investigating — but through testing and under medical supervision, not through unregulated herbal cleanse protocols. Parasite cleanses lack clinical evidence of effectiveness and carry real risks for people with compromised gut barriers. If you suspect either, talk to your doctor about appropriate testing before taking any supplements.

Q: Are there drugs in development that might replace the gluten-free diet?

Research is advancing rapidly. The ZED1227 TG2 inhibitor (published in Nature Immunology, 2024) has shown strong molecular evidence of preventing gluten-induced intestinal damage. TAK-101 has shown impressive results in immune tolerance trials. These are not approved treatments yet, but the pace of progress suggests we may see the first approved celiac drug within this decade.

Q: Can probiotics help with celiac disease?

Yes, with the caveat that probiotics are an adjunct, not a replacement for a gluten-free diet. Specific strains of Lactobacillus and Bifidobacterium have demonstrated the ability to degrade immunogenic gluten peptides, reduce intestinal inflammation, and support microbiome restoration in celiac patients. Choose certified gluten-free products and discuss with your healthcare provider.

Q: Why do I still feel terrible even though I’m gluten-free?

Several reasons may apply: hidden gluten exposures, persistent microbiome dysbiosis, concurrent SIBO or SIFO, untreated nutrient deficiencies, food intolerances (dairy, FODMAPs), or other overlapping conditions. A thorough functional medicine or gastroenterology workup can help identify which factors are at play.

Q: Can celiac disease affect my brain?

Yes. Brain fog, peripheral neuropathy, anxiety, depression, and even a specific condition called gluten ataxia — where gluten exposure causes cerebellar damage affecting balance and coordination — are all well-documented neurological manifestations of celiac disease. These symptoms can occur even in people with minimal gut symptoms.

Q: What is the most important first step if I suspect I have celiac disease?

Get tested — while still eating gluten. Schedule an appointment with your primary care doctor and ask for a celiac disease antibody panel (tTG-IgA plus total IgA). Do not go gluten-free before testing. A correct diagnosis is the foundation of everything else.

Additional Information

Research References

• Global prevalence of celiac disease: Singh P, et al. Clinical Gastroenterology and Hepatology. 2018. DOI: 10.1016/j.cgh.2017.06.037

• Celiac disease management and long-term surveillance: Kurppa K, et al. Gastroenterology. 2024. DOI: 10.1053/j.gastro.2023.12.026

• ZED1227 transglutaminase 2 inhibitor and molecular evidence: Tampere University / Nature Immunology. 2024. DOI: 10.1038/s41590-024-01867-0

• Gut microbiota and celiac disease — interaction and treatment: MDPI Cells. 2023. https://www.mdpi.com/2073-4409/12/6/823

• Celiac disease gut microbiome scoping review: Luz VCC, Pereira SG. Frontiers in Medical Technology. 2024. https://www.frontiersin.org/journals/medical-technology/articles/10.3389/fmedt.2024.1413637/full

• Microbiome signatures before celiac disease onset (PNAS): Leonard MM, et al. PNAS. 2021. DOI: 10.1073/pnas.2020322118

• Pediatric celiac disease and gut microbiome (PMC narrative review): PMC. 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10255898/

• Candida albicans in celiac disease: Raz-Pasteur A, et al. International Journal of Medical Microbiology. 2020. https://www.sciencedirect.com/science/article/abs/pii/S1568997220301889

• Gut microbiota in action: tackling celiac disease (ASM): American Society for Microbiology. 2024. https://asm.org/articles/2024/july/the-gut-microbiota-in-action-tackling-celiac-disea

• Small intestinal bacterial and fungal overgrowth review: Nutrients (MDPI). 2025. https://www.mdpi.com/2072-6643/17/8/1365

• Parasites and immune-mediated intestinal conditions: Rostami A, et al. PMC. 2015. https://pmc.ncbi.nlm.nih.gov/articles/PMC4403024/

• New developments in celiac disease treatment: PMC. 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC9862998/

• Parasite detox science and risks: Serv-U Pharmacy clinical review. 2026. https://serv-u-pharmacy.com/articles/common-myths-about-parasites-and-detox-treatments/

• Celiac disease epidemiology, presentation, and diagnosis: Gastroenterology. 2020. https://www.gastrojournal.org/article/S0016-5085(20)35165-9/fulltext

• Celiac disease facts and figures: Beyond Celiac. https://www.beyondceliac.org/celiac-disease/facts-and-figures/

Related Resources

• Celiac Disease Foundation: celiac.org — Research updates, advocacy, and patient resources

• Beyond Celiac: beyondceliac.org — Leading patient organization driving research and awareness

• Columbia University Celiac Disease Center: celiacdiseasecenter.columbia.edu — Academic research and clinical resources

• Gluten Intolerance Group: gluten.org — Certification, resources, and community support

• Celiac Canada: celiac.ca — Research and advocacy for the Canadian celiac community

Connect with memios

• Website — https://www.memios.ai

• Newsletter — The Longevity Letter

• Facebook — https://www.facebook.com/memiosai

Disclaimer: memios shares wellness and longevity content for general education. We are not doctors, healthcare providers, or licensed medical professionals, and we do not provide medical advice, diagnosis, or treatment. We are health conscious individuals documenting what we learn and what we do as we work toward living long, healthy, strong lives into our 90s. Always talk with your physician or qualified healthcare professional before starting, changing, or stopping any exercise, nutrition, supplement, or health program.

If you’ve been diagnosed with diverticulitis — or your doctor found diverticula during a colonoscopy — you’re not alone. By age 60, up to half of all American adults have developed these small pouches in their colon wall. And if you’ve experienced a flare-up, you already know the sharp, cramping pain in your lower left abdomen that sends you scrambling for answers.

I want to walk you through what the latest research actually says about diverticulitis diet, how to prevent flare-ups, the real role of your gut microbiome, and whether popular trends like parasite and fungal cleanses have any place in your gut health plan. I’ll also give you a direct answer on that last one — and it may surprise you. This guide is built on peer-reviewed research from sources like the National Institutes of Health, JAMA, Nature Communications, and Gastroenterology. No guesswork. No social media hype. Just the evidence.

What Is Diverticulitis — and Why Does It Matter After 50?

Let’s start with the basics.

Diverticulosis is the condition where small, bulging pouches form in the wall of your large intestine (colon). These pouches are called diverticula. For most people, diverticulosis causes zero symptoms. You may only learn about it when you get a routine colonoscopy.

Diverticulitis is what happens when those pouches get inflamed or infected. That’s when you feel it. Symptoms include:

• Sharp, cramping pain — usually in the lower left abdomen

• Nausea and vomiting

• Fever and chills

• Alternating constipation and diarrhea

• Bloating and gas

• Loss of appetite

The distinction matters because the dietary approach for each is completely different — something we’ll cover in detail below.

How Common Is This?

The numbers are striking. Nearly 3 million Americans carry a diagnosis of diverticular disease, and roughly 200,000 are hospitalized each year. Inpatient healthcare costs exceed $2 billion annually in the United States. Once considered a condition of older Western populations, research now shows diverticulitis is increasing in all age groups worldwide — including people in their 30s and 40s.

That said, if you’re over 50, your risk is higher. The condition becomes more prevalent with age due to natural changes in the colon wall, a lifetime of dietary patterns, and shifts in the gut microbiome.

What Causes Diverticula to Form?

For decades, the prevailing theory was simple: eat too little fiber, get diverticular disease. That thinking came from research in the 1970s comparing Western populations to rural African populations, where diverticulosis was nearly nonexistent.

The full picture is more complex. Current research points to a combination of factors:

• Low dietary fiber intake — Still the most documented risk factor

• High red meat consumption — Consistently linked to higher diverticulitis risk

• Physical inactivity — Sedentary lifestyle increases risk

• Obesity — Especially excess abdominal fat

• Smoking — Linked to increased inflammation

• Gut microbiome disruption — A fast-growing area of research

• Genetics — Emerging evidence of inherited predispositions

• Altered colonic neuromusculature — Changes in how the colon contracts

One large study published in Gastroenterology found that following what researchers called a “low-risk lifestyle” — fewer than four servings of red meat per week, at least 23 grams of fiber daily, two hours of vigorous exercise per week, a healthy BMI, and no smoking — reduced the risk of diverticulitis by nearly 75%.

Let that sink in. Three-quarters of your risk may be addressable through lifestyle choices.

Diverticulosis vs. Diverticulitis: Two Very Different Situations

Before diving into diet, this distinction is critical.

If you have diverticulosis (pouches, no inflammation):

Your goal is prevention. You want to keep those pouches from becoming inflamed. A high-fiber diet is the cornerstone here. Research supports 25–40 grams of fiber daily for most adults over 50. Regular physical activity and staying well hydrated are equally important.

If you are in an acute diverticulitis flare:

Your goal is gut rest. During active inflammation, high-fiber foods can actually make things worse. Your doctor will likely recommend a clear liquid diet first, then a low-fiber diet, before slowly transitioning back to your normal routine.

Here’s the staged approach most clinicians follow:

Stage 1 — Acute flare (first 2–4 days): Clear liquids only. Water, broth, apple juice (no pulp), plain gelatin, popsicles without fruit pieces, plain tea or black coffee.

Stage 2 — Early recovery: Low-fiber foods. Cooked or canned fruit without seeds or skin, well-cooked vegetables without seeds or skin, white rice, eggs, fish, poultry, dairy, white bread.

Stage 3 — Recovery and prevention: Gradually reintroduce fiber over several weeks. Aim to build up to a high-fiber diet of 25–40 grams daily. This is where the research on long-term prevention is strongest.

The Science of Fiber and Diverticulitis

Fiber remains the most-studied dietary intervention for diverticular disease. But the research is more nuanced than most people realize.

High Fiber for Prevention — Yes

Multiple large prospective cohort studies support fiber for primary prevention. Analysis from the Nurses’ Health Study found that the top quintile of dietary fiber intake was associated with a lower incidence of diverticulitis. Whole fruits — particularly apples, pears, and prunes — and cereal fibers showed the strongest protective effect. Interestingly, vegetable fiber alone may not have the same benefit.

Similar findings came from the Health Professionals Follow-Up Study: a “prudent” diet high in fruits, vegetables, whole grains, legumes, poultry, and fish was associated with a significantly lower risk compared to a typical Western diet high in red meat, refined grains, and high-fat dairy.

A systematic review published in the journal Role of Dietary Habits in the Prevention of Diverticular Disease Complications found that high fiber intake was consistently associated with a decreased risk of diverticulitis or hospitalization — with the protective effect most pronounced for fruits and cereal fibers.

Best high-fiber foods to incorporate:

• Whole grains: oats, quinoa, brown rice, bulgur, bran cereal, whole wheat bread

• Legumes: black beans, kidney beans, lentils, chickpeas

• Fruits: raspberries, blackberries, apples and pears with skin, avocado, kiwi

• Vegetables: broccoli, cauliflower, kale, spinach, carrots

• Nuts and seeds (yes, the research has cleared these — more on that shortly)

High Fiber for Preventing Recurrence — Less Clear

Here’s where the science gets complicated. While fiber clearly helps prevent a first episode, the evidence for preventing recurrent diverticulitis after you’ve already had it is less conclusive.

A systematic review found that high-fiber diets were not definitively proven to prevent recurrence. This does not mean fiber isn’t helpful — most clinical guidelines still recommend it. It means that fiber alone may not be enough once the condition has progressed, and additional interventions (covered below) may be needed.

Do You Need to Avoid Nuts, Seeds, and Popcorn?

For years, doctors told patients with diverticulosis to avoid these foods, fearing they would lodge in the pouches and trigger inflammation. The research has overturned this. Multiple studies, including large analyses from the Health Professionals Follow-Up Study, found an inverse association between nut and popcorn consumption and diverticulitis risk. There was no evidence linking these foods to harm.

You can eat them. If specific foods bother you personally, that’s a different matter — but the blanket avoidance advice is outdated.

Red Meat, Western Diet, and Your Colon

The evidence against a Western-style diet is consistent and strong.

Studies following large cohorts for 26+ years found that a Western dietary pattern — high in red and processed meats, refined grains, sweets, french fries, and high-fat dairy — was significantly associated with a higher risk of diverticulitis compared to a more balanced eating pattern.

Red meat specifically increases risk in multiple ways:

• It produces compounds during digestion that damage the colonic lining

• It’s low in fiber, contributing to harder, slower-moving stool

• It is associated with increased gut inflammation

• High-fat, low-fiber diets alter the gut microbiome in ways that favor inflammatory bacteria

The practical recommendation: reduce red meat to fewer than 4 servings per week. Replace some of it with poultry, fish, legumes, and plant proteins.

Your Gut Microbiome: The Hidden Driver of Diverticulitis

This is the area where research has accelerated most rapidly in recent years — and it’s directly relevant to the question of parasite and fungal cleanses.

Your colon is home to trillions of microorganisms. When this microbial community is in balance, your gut wall stays healthy, inflammation stays low, and your immune system works properly. When it falls out of balance — a state called dysbiosis — problems begin.

Research published in Nature Communications in 2024 conducted deep microbiome analysis of women with diverticulitis compared to matched controls. The findings were telling:

• Women with diverticulitis had higher levels of pro-inflammatory bacteria like Ruminococcus gnavus and Bilophila wadsworthia

• They had lower levels of butyrate-producing bacteria (the kind that keep your colon lining healthy)

• Their metabolic profiles showed markers of gut barrier dysfunction and chronic inflammation

Similar findings from a review in Neurogastroenterology & Motility (2023) showed that patients developing diverticulitis had reductions in anti-inflammatory bacterial species including Clostridium cluster IV, Lactobacilli, and Bacteroides. When these protective bacteria decline, inflammation in the colon wall rises — and a vicious cycle begins.

This means diverticulitis is not just a structural problem or a fiber deficiency. It’s also a microbial ecosystem problem.

What Disrupts the Gut Microbiome?

• A diet high in red meat and processed foods

• Low dietary fiber intake (fiber feeds beneficial bacteria)

• Frequent antibiotic use (kills beneficial and harmful bacteria alike)

• Sedentary lifestyle

• Chronic stress

• Obesity

• Smoking

And here is where the lifestyle factors discussed throughout this post come full circle. The same choices that raise your risk of diverticulitis are also the choices that degrade your gut microbiome.

Probiotics: What the Research Shows

If dysbiosis drives inflammation in diverticulitis, the logical question is: can probiotics help restore balance?

A comprehensive meta-analysis published in the Journal of Clinical Medicine (2026), drawing on studies through October 2024, evaluated thirteen trials of probiotic use in diverticular disease. The results were encouraging but not definitive:

• Probiotic therapy was associated with measurable improvement in abdominal pain (a statistically significant finding)

• There was a trend toward improvement in bloating, though this did not reach statistical significance

• The research overall supports probiotics as a complementary therapy — not a replacement for standard care

Key probiotic strains studied for diverticular disease include:

• Lactobacillus acidophilus

• Lactobacillus rhamnosus GG

• Bifidobacterium infantis

• Bifidobacterium lactis

Important caveats: the American Gastroenterological Association does not yet formally recommend probiotics for diverticulitis due to a lack of large-scale, high-quality trials. Probiotics work best as part of a broader gut health strategy that includes diet, hydration, and exercise.

Fermented Foods as Natural Probiotic Sources

You don’t need to rely exclusively on supplements. Fermented foods introduce beneficial live bacteria into your digestive tract. Good options include:

• Plain Greek yogurt (no added sugar)

• Kefir

• Sauerkraut (unpasteurized)

• Kimchi

• Miso

• Tempeh

Start with small amounts and increase gradually, as fermented foods can cause gas and bloating in some people — particularly when you’re first reintroducing them.

Rifaximin: The Antibiotic That Works Differently

One medical treatment worth knowing about — though not commonly used in the U.S. — is rifaximin, a poorly absorbed antibiotic that acts locally in the gut.

A meta-analysis of 1,660 patients found that combining rifaximin with a high-fiber diet was an effective approach to preventing diverticulitis recurrence and keeping patients symptom-free at one year. The drug is more commonly used in Europe. In the U.S., cost and insurance coverage remain barriers.

This is a conversation to have with your gastroenterologist if you’ve had recurrent episodes and dietary changes alone haven’t been enough.

Exercise and Physical Activity

The research here is direct and consistent.

Regular physical activity reduces diverticulitis risk through multiple pathways:

• It speeds transit time through the colon, reducing the time stool sits in pouches

• It reduces chronic inflammation throughout the body

• It supports a healthier gut microbiome

• It helps maintain a healthy body weight

Moderate exercise — including walking, cycling, swimming, water aerobics — has been linked to measurable gut health benefits. You don’t need to run marathons. Consistent, moderate movement is what the research supports.

A large study examining multiple lifestyle factors together found that low-risk lifestyle behavior (including regular vigorous exercise) could theoretically prevent nearly half of all diverticulitis cases.

If you’re managing diverticulitis and wondering where to start with exercise, even 30 minutes of brisk walking most days is a meaningful step.

Parasite and Fungal Cleanses: Should You Try One for Diverticulitis?

This is a direct question, so I’ll give you a direct answer.

I recently covered parasite and fungal detox protocols in depth in a post called Natural Parasite and Fungal Detox: The Protocol That Actually Works (linked below). That post addressed gut-focused detox protocols in the broader context of immune health. Now I want to apply that thinking specifically to diverticulitis.

Here is my honest, research-based assessment.

The Case for Gut Cleansing in General

The gut-health benefits of anti-inflammatory dietary protocols — reducing processed foods, cutting refined sugar, increasing whole plant foods, incorporating antimicrobial herbs — are real. These dietary shifts support a healthier microbiome, reduce inflammation, and can improve digestive symptoms.

If a so-called “parasite detox” gets someone to stop eating processed food, start consuming garlic and turmeric, drink more water, and take a quality probiotic — the dietary changes themselves can genuinely support gut health. That part of the equation is legitimate.

What the Evidence Says About Cleanses Specifically

The evidence for commercial parasite or fungal cleanse products is weak. Major medical centers and the National Center for Complementary and Integrative Health are blunt about this:

• No scientific evidence supports the use of commercial cleanse products for treating or preventing parasitic infections

• Supplements marketed for cleansing are not evaluated or approved by the FDA

• These products can contain ingredients that interact with medications

• Side effects include nausea, diarrhea, and electrolyte imbalances

For people with diverticulitis specifically, aggressive cleansing protocols carry additional concerns.

Why Aggressive Cleanses Are Risky if You Have Diverticulitis

This is where I want to be especially clear.

1. High-dose herbal laxatives can trigger a flare. Some cleanse protocols include senna, castor oil, or other stimulant laxatives. These increase bowel motility forcefully. In a colon with existing diverticula, this can increase intraluminal pressure — the exact mechanism thought to contribute to diverticular inflammation.

2. Aggressive fiber loading can worsen an active flare. Some cleanse diets push very high fiber intake abruptly. During or near an active flare, this is counterproductive and can intensify symptoms.

3. Wormwood, black walnut, and other herbal antiparasitics can irritate the gut lining. The colon wall in people with diverticular disease is already structurally compromised. Harsh herbal compounds that irritate the intestinal lining are the last thing you want near inflamed tissue.

4. Diarrhea is dangerous with diverticulitis. Cleanses commonly cause loose stools or diarrhea. With active diverticulitis, diarrhea can worsen dehydration and electrolyte imbalance, and in severe cases, increased bowel pressure raises the risk of perforation.

5. Self-diagnosis is a real problem. If your bloating, cramping, and digestive symptoms are from diverticulitis — not a parasitic infection — a cleanse won’t address the underlying cause. Worse, it may delay you from getting the right diagnosis and treatment.

My Bottom Line on Cleanses and Diverticulitis

The dietary principles embedded in a quality detox protocol — anti-inflammatory whole foods, reduced sugar, garlic, turmeric, fermented foods, reduced red meat, increased water — are genuinely supportive of colon health and can complement a diverticulitis management plan.

But the aggressive, harsh, supplement-heavy cleanse approach? During an active flare or in a compromised colon, that is a genuine risk.

If you want the gut-health benefits of a detox-style protocol, apply the dietary principles without the aggressive herbal laxatives and extreme fiber loading. And if you have active diverticulitis symptoms — pain, fever, nausea — get proper medical evaluation before experimenting with any protocol.

Vitamin D, Hydration, and Other Supportive Factors

Vitamin D

A 2026 analysis of contributing factors to diverticular disease listed vitamin D deficiency as a recognized risk factor. This tracks with broader research linking low vitamin D to increased gut inflammation. If you’re over 50, getting your vitamin D level checked as part of routine bloodwork is a reasonable step. Many people in northern latitudes — and those who spend limited time outdoors — are chronically low.

Hydration

Fiber only works when it’s paired with adequate water. Fiber absorbs water to create soft, bulky stool that moves through the colon efficiently. Without enough fluid, fiber can actually worsen constipation and increase colon pressure.

A practical guideline: drink roughly half your body weight in ounces of water daily. For a 180-pound person, that’s about 90 ounces — roughly 11 cups. Increase this during exercise and in hot weather.

Alcohol and Caffeine

Current research does not consistently link moderate caffeine or alcohol consumption to diverticulitis risk. Studies have not found them to be significant independent risk factors. That said, excessive alcohol consumption disrupts the gut microbiome and drives systemic inflammation, which are indirect risks.

Foods to Focus On: A Practical Breakdown

When You Are Healthy (No Active Flare)

Fill your plate with:

• Oats, barley, quinoa, brown rice, and other whole grains

• Lentils, black beans, chickpeas, and kidney beans

• Berries, apples, pears, kiwi, and avocado

• Leafy greens, broccoli, cauliflower, and carrots

• Fish, poultry, eggs, and plant-based proteins

• Plain Greek yogurt and kefir (probiotic-rich)

• Olive oil and other anti-inflammatory fats

• Garlic, ginger, and turmeric (anti-inflammatory spices)

• Plenty of water

Reduce:

• Red meat and processed meat (limit to fewer than 4 servings per week)

• Refined grains (white bread, white pasta, sugary cereals)

• Fried foods and high-fat dairy

• Ultra-processed snack foods

• Sugary beverages and excessive alcohol

During a Flare

Follow your doctor’s guidance. In general:

Clear liquids: Water, broth, plain tea, apple juice without pulp, plain gelatin, popsicles without fruit pieces.

Low-fiber transition foods: White rice, cooked eggs, canned or cooked fruit without seeds or skin, well-cooked vegetables without seeds or skin, white toast, plain crackers, yogurt, cheese.

Add fiber back gradually once symptoms resolve — typically 2–4 days after improvement begins.

Stress, Sleep, and Your Gut

The gut-brain axis is real. Chronic stress alters gut motility, weakens the intestinal lining, and shifts the microbiome toward more inflammatory patterns. Poor sleep does the same.

If you’re in a high-stress period and you’re also dealing with digestive issues, the two are likely connected. Gut-supportive habits — regular sleep, stress management practices like walking or meditation, reducing chronic time pressure — are part of the picture.

This is not a soft suggestion. Research on gut microbiome health consistently identifies chronic psychological stress as a factor that drives dysbiosis.

When to See a Doctor: Warning Signs You Cannot Ignore

Diverticulitis can become life-threatening if a pouch ruptures. Seek immediate medical attention if you experience:

• Severe or worsening abdominal pain

• High fever (over 101°F / 38.3°C)

• Persistent nausea and vomiting

• Blood in your stool

• Rigid, board-like abdomen

• Inability to keep liquids down

Complicated diverticulitis — including abscess, perforation, or fistula — requires hospitalization and sometimes surgery. Do not try to manage these symptoms at home.

The Antibiotic Question

For years, antibiotics were the automatic first-line treatment for any case of uncomplicated diverticulitis. That thinking is shifting.

Two large multicenter, randomized trials found that antibiotics did not speed recovery or prevent subsequent complications in patients with uncomplicated diverticulitis. Some European guidelines now allow for expectant management (watchful waiting with diet modification) in mild, uncomplicated cases.

This does not mean antibiotics are never appropriate. Your doctor will assess your specific situation. But it does mean that the reflex to prescribe antibiotics for every episode is changing — and that gut-supportive lifestyle measures carry more weight than ever in prevention and recovery.

Your Long-Term Diverticulitis Prevention Plan

Based on the research reviewed in this post, here is the practical framework I follow — and what I recommend exploring with your doctor:

1. Prioritize fiber from whole food sources. Target 25–40 grams daily from fruits, whole grains, legumes, and vegetables. Build up gradually to avoid gas and bloating. Pair fiber with plenty of water.

2. Reduce red meat significantly. Fewer than 4 servings per week. Replace some red meat with fish, legumes, and poultry.

3. Eat to support your gut microbiome. Fermented foods, prebiotic-rich vegetables (garlic, onion, asparagus, leeks), and a diverse plant-based diet. Consider a quality probiotic supplement, particularly one containing Lactobacillus acidophilus and Bifidobacterium strains.

4. Move your body regularly. Moderate exercise most days of the week. Walking, cycling, swimming — whatever you will actually do consistently.

5. Stay well hydrated. Water is non-negotiable for colon health. Half your body weight in ounces daily is a reasonable starting point.

6. Get your vitamin D checked. If you’re deficient, work with your doctor on supplementation. It appears in the list of diverticulitis risk factors consistently in newer research.

7. Eliminate smoking. Smoking is linked to gut inflammation and increased diverticulitis risk. Full stop.

8. Manage weight. Excess abdominal fat is a recognized independent risk factor.

9. Limit ultra-processed foods. The Western dietary pattern is a consistent predictor of diverticulitis. Reducing processed food consumption shifts your microbiome, reduces inflammation, and moves the needle on most of the other risk factors at once.

10. Know when to see your gastroenterologist. If you’ve had one episode of diverticulitis, a follow-up colonoscopy is typically recommended 4–8 weeks after recovery to rule out other conditions and assess the extent of your diverticular disease.

Frequently Asked Questions

1. What is the difference between diverticulosis and diverticulitis?

Diverticulosis is the presence of small pouches (diverticula) in the colon wall — usually without symptoms. Diverticulitis is when those pouches become inflamed or infected, causing pain, fever, and digestive disruption. Most people with diverticulosis never develop diverticulitis.

2. What foods should I avoid with diverticulitis?

During an active flare, avoid all solid foods initially and follow a clear liquid diet as directed by your doctor. As you recover, avoid high-fiber foods temporarily. Long-term, the research supports reducing red meat, processed foods, refined grains, and fried foods. The old advice to avoid nuts, seeds, and popcorn is no longer supported by the evidence.

3. Is a high-fiber diet enough to prevent diverticulitis?

Fiber is the most well-documented dietary factor for primary prevention. But it works best as part of a broader lifestyle approach that includes regular exercise, healthy body weight, no smoking, and a gut-supportive microbiome. Fiber alone does not reliably prevent recurrence after a first episode.

4. Can probiotics help with diverticulitis?

Emerging research suggests probiotics may reduce abdominal pain and support gut microbiome balance in diverticular disease. A 2026 meta-analysis found statistically significant improvement in abdominal pain with probiotic use. They are considered a complementary therapy, not a replacement for medical treatment. Discuss with your doctor before starting a probiotic regimen.

5. Is diverticulitis the same as irritable bowel syndrome (IBS)?

No. They are different conditions, though they can share overlapping symptoms like cramping and bloating. IBS involves gut motility and sensitivity without structural changes to the colon wall. Diverticulitis involves actual inflammation or infection of structural pouches. Some people have both. A gastroenterologist can help distinguish between them.

6. Should I try a parasite or fungal cleanse for diverticulitis?

The anti-inflammatory dietary principles embedded in these protocols — whole foods, reduced sugar, garlic, turmeric, fermented foods — can genuinely support gut health. But aggressive cleansing products with herbal laxatives, high-dose herbal antiparasitics, and abrupt fiber loading carry real risks for people with diverticular disease: potential flare triggers, gut lining irritation, and dangerous diarrhea. Apply the dietary principles; skip the aggressive supplement protocols unless guided by a physician.

7. How long does a diverticulitis flare typically last?

Mild, uncomplicated flares often improve within 2–4 days of a clear liquid diet and (when prescribed) antibiotics. More severe cases may take longer and may require hospitalization. If your symptoms are not improving within 2–3 days, contact your doctor.

8. Does exercise help prevent diverticulitis?

Yes. Regular moderate physical activity is associated with lower diverticulitis risk. Exercise supports bowel motility, reduces chronic inflammation, supports a healthier gut microbiome, and helps maintain a healthy body weight. All four of these pathways reduce your risk.

9. Can stress trigger a diverticulitis flare?

Chronic psychological stress has been linked to gut microbiome disruption and increased gut inflammation — both factors associated with diverticular disease. While stress may not directly cause a flare, it creates the physiological conditions that make flares more likely. Stress management is part of a comprehensive gut health strategy.

10. Is diverticulitis surgery necessary?

Surgery is reserved for complicated diverticulitis — cases involving perforation, abscess, fistula, or obstruction — or for patients with recurrent severe episodes that fail medical management. The majority of diverticulitis cases are managed without surgery. Newer guidelines have also shifted surgical decision-making, with minimally invasive approaches and more selective criteria for intervention.

Additional Information and References

Research References

• Carlomagno D, et al. Acute diverticulitis in 2024: current evidence to prevent onset and recurrence. Minerva Gastroenterology. 2025;71(4):338-350. PubMed

• Strate LL, Keeley BR, Cao Y, et al. Western dietary pattern increases, and prudent dietary pattern decreases, risk of incident diverticulitis in a prospective cohort study. Gastroenterology. 2017;152(5):1023-1030. Gastroenterology Journal

• Piccioni A, et al. Gut microbiota and acute diverticulitis: Role of probiotics in management of this delicate pathophysiological balance. Journal of Personalized Medicine. 2021;11(4):298. PMC

• Tursi A, et al. Impact of probiotics on clinical outcomes in diverticular disease: A systematic review and meta-analysis. Journal of Clinical Medicine. 2026;15(1):88. PMC

• Liu PH, Cao Y, Keeley BR, et al. Adherence to a healthy lifestyle is associated with a lower risk of diverticulitis among men. American Journal of Gastroenterology. 2017;112(12):1868-1876.

• Marasco G, et al. The role of microbiota and its modulation in colonic diverticular disease.Neurogastroenterology & Motility. 2023. Wiley

• Cao Y, Strate LL, Keeley BR, et al. Gut microbiome composition and metabolic activity in women with diverticulitis. Nature Communications. 2024;15:3612. Nature

• Gaman A, et al. Role of dietary habits in the prevention of diverticular disease complications: A systematic review. Nutrients. 2021;13(4):1288. PMC

• Sacks OA, Hall J. Management of diverticulitis: A review. JAMA. 2024. JAMA PDF

• Floch MH, et al. Emerging evidence and recent controversies in diverticulitis: A 5-year review. Journal of Clinical Gastroenterology. 2020. PMC

• Managing diverticula: Dietary changes for a more comfortable life. European Journal of Clinical Nutrition. 2025. PMC

• Dietary Risk Factors: Fiber and Beyond. Clinics in Colon and Rectal Surgery. 2025. PMC

Related Resources

• NIDDK: Eating, Diet, and Nutrition for Diverticular Disease

• Mayo Clinic: Diverticulitis Diet

• Johns Hopkins Medicine: Foods for Diverticulosis and Diverticulitis

• American Society of Colon and Rectal Surgeons: Diverticular Disease Guidelines

• memios: Natural Parasite and Fungal Detox — The Protocol That Actually Works

Connect with memios

• Website — https://www.memios.ai

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• Facebook — https://www.facebook.com/memiosai

Disclaimer: memios shares wellness and longevity content for general education. We are not doctors, healthcare providers, or licensed medical professionals, and we do not provide medical advice, diagnosis, or treatment. We are health conscious individuals documenting what we learn and what we do as we work toward living long, healthy, strong lives into our 90s. Always talk with your physician or qualified healthcare professional before starting, changing, or stopping any exercise, nutrition, supplement, or health program.: memios shares wellness and longevity content for general education. We are not doctors, healthcare providers, or licensed medical professionals, and we do not provide medical advice, diagnosis, or treatment. We are health conscious individuals documenting what we learn and what we do as we work toward living long, healthy, strong lives into our 90s. Always talk with your physician or qualified healthcare professional before starting, changing, or stopping any exercise, nutrition, supplement, or health program.

by Andrew Wilson • The Longevity Letter • Parasite and Fungal Detox

March 14, 2026

If you are over 50 and dealing with bloating, fatigue, brain fog, skin issues, or digestive problems that never quite resolve — a natural parasite and fungal detox may be one of the most overlooked steps in your health journey. I know because I went through it myself.

This post covers everything you need to know: what a natural parasite and fungal detox actually is, the science behind each ingredient in the protocol I use personally, why couples should do it together, which foods carry the highest parasite and fungal risk, whether your baking soda produce soak is actually working, and what to eat — and avoid — to support the process. I have also included a complete protocol guide, a FAQ section, and links to the research behind everything covered here.

Why Parasites and Fungal Overgrowth Are More Common Than You Think

Most of us picture parasites as something you pick up in a developing country. The reality is different.

Parasitic infections affect at least 12 million people in the United States every year, and over 2 billion people worldwide. Many go undiagnosed for years because the symptoms look like other things — chronic fatigue, bloating, irritable bowel, skin rashes, mood swings, or unexplained weight changes.

Fungal overgrowth — primarily Candida — is even more widespread. The standard American diet is high in sugar and refined carbohydrates, both of which feed yeast. Add antibiotic use, stress, alcohol, and poor sleep, and you have the conditions for fungal overgrowth to take hold quietly over years.

Here is the thing about both: they rarely announce themselves clearly. You can carry them for a long time and just feel “off” — not sick enough to go to the doctor, but not well enough to feel like yourself either.

A natural parasite and fungal detox, done properly and cyclically, addresses both. And for those of us over 50 who are focused on longevity — gut health is foundational. Your immune system, your nutrient absorption, your energy, and even your cognitive function are all tied directly to what is living in your digestive tract.

The Protocol: What I Am Taking and Why

My personal natural parasite and fungal detox stack includes:

• Oil of Oregano — 0.16 mL

• Black Walnut Oil — 1.00 mL

• Wormwood Oil — 1.00 mL

• Black Seed Oil / Nigella sativa — 400 mg

• Thymoquinone (TQ) — 10 mg

• Celery Juice — 16 oz (morning, empty stomach)

• 3 Whole Cloves — taken at night

This is not a random mix. Each ingredient targets a specific stage of the parasite lifecycle or a specific mechanism of fungal overgrowth. Together, they form one of the most complete natural protocols documented in the research literature.

Let me walk you through each one.

Oil of Oregano

Oil of oregano is one of the most well-studied natural antimicrobials available. Its two primary active compounds — carvacrol and thymol — are phenolic monoterpenes that disrupt pathogen cell membranes and interfere with critical metabolic functions.

Studies have demonstrated activity against Giardia, Blastocystis hominis, and various helminth species in laboratory and animal models. For fungal issues, carvacrol and thymol have demonstrated both antifungal and antiparasitic activity, making oregano oil useful when multiple types of microbial imbalance are present at the same time — which is common.

This is one of the reasons oregano oil is frequently included in comprehensive gut reset protocols. It covers multiple targets simultaneously.

One important note: make sure your oil of oregano is food-grade and specifically formulated for internal use. Pure undiluted essential oils are not the same thing. They are highly concentrated and can cause mucous membrane irritation, nausea, and in some cases liver stress if not properly prepared for consumption.

Take with food, once to twice daily.

Affiliate Product Link: Biotics Research A.D.P. Emulsified Oil of Oregano

Typical dosing for a detox protocol: 4–6 tablets 3x daily with meals for the first week, then 3–4 tablets 3x daily for four more weeks. Always follow with probiotics after two weeks of use.

Black Walnut Oil

Black walnut — specifically the green hull of the Juglans nigra tree — contains two key compounds: juglone and tannins.

Juglone is believed to disrupt the energy production of parasites, essentially starving them metabolically. Tannins have astringent properties that may reduce the food source available to parasites and damage their outer layer.

Naturopathic practitioners have used black walnut in combination with wormwood and clove for generations, targeting adult and larval stages of intestinal parasites.

For maximum potency, the green (unripe) hull contains significantly higher concentrations of juglone than the mature brown hull. When purchasing, confirm you are getting a product made from green hull extract.

Take with food, once to twice daily.

Affiliate Product Link: Dr. Clark Store Original Green Black Walnut Hull Tincture (Extra Strength)

A quick note on terminology first: what you want for your protocol is black walnut hull tincture — specifically made from green (unripe) hulls. The green hull contains significantly higher concentrations of juglone, which is the active antiparasitic compound. Products labeled simply “black walnut oil” are often culinary walnut oils pressed from the nut itself and have no antiparasitic value.

Wormwood Oil

Wormwood (Artemisia absinthium) has been used medicinally for over two millennia. It is referenced in ancient Egyptian, Greek, and Biblical texts — all for the same purpose: expelling intestinal invaders.

Its active compounds are sesquiterpene lactones, including artemisinin. These compounds are believed to weaken parasite membranes and interfere with their ability to maintain a grip on the intestinal lining.

Modern research has shown promising results. One animal study found that wormwood reduced dwarf tapeworm levels similarly to praziquantel — a leading pharmaceutical antiparasitic medication. Clinical research has also shown that 500 mg capsules taken three times daily for 15 weeks supported the body’s natural processes in managing Entamoeba histolytica in 70% of patients.

An important safety note: wormwood contains thujone, a compound that can be neurotoxic in high doses or with prolonged use. This is why cycling the protocol (on for 14-18 days, off for 2-4 weeks) is critical. Do not use continuously for months at a time.

Take with food, once to twice daily.

Affiliate Product Link: Naturalma Grand Wormwood (Artemisia Absinthium) Alcohol-Free Tincture

Critical Species Note:

This is the most important thing to get right. There are two different species sold as “wormwood” on Amazon and they are not interchangeable for your protocol:

• Artemisia absinthium — Grand Wormwood / Absinthe — the correct species for antiparasitic protocols. Contains sesquiterpene lactones, artemisinin-related compounds, and the active bitters your protocol requires.

• Artemisia annua — Sweet Wormwood — primarily researched for malaria. Has different active compounds. Not the same herb.

Black Seed Oil (Nigella sativa) + Thymoquinone

Black seed oil may be the most scientifically documented natural antimicrobial in this entire stack.

Nigella sativa has a 3,000-year history of medicinal use. It was found in King Tutankhamun’s tomb. Hippocrates referenced it. Modern science is now catching up to what ancient healers already knew.

The star compound is thymoquinone (TQ) — typically 30 to 48% of the volatile oil fraction. TQ has demonstrated antiparasitic activity in laboratory, animal, and limited human research, with particularly strong results against Schistosoma mansoni (a major parasitic flatworm), Giardia lamblia, and Blastocystis hominis.

For fungal overgrowth, TQ has shown fungicidal activity against multiple Candida species — disrupting cell walls, inhibiting biofilm formation, and causing fungicidal oxidative stress in pathogenic yeast cells. One peer-reviewed study confirmed that TQ induces cell death in Candida glabrata via the generation of oxidative stress.

I take black seed oil at 400 mg alongside a standalone 10 mg dose of thymoquinone. The standalone TQ dose targets the most active compound directly, without relying solely on the variable TQ content of the oil itself. If you are using only the oil, look for a product standardized to 5% thymoquinone or higher.

Take with food, once to twice daily.

​Affiliate Product Link: Amazing Herbs Premium Black Seed Oil Capsules (5X-TQ Formula)

A Critical Point the ConsumerLab Data Reveals

ConsumerLab tested seven black seed oil products in early 2025 and found that two out of seven contained far less thymoquinone than claimed — one product delivered just 41.8% of its stated amount. The cost to obtain 20 mg of thymoquinone from tested products ranged from 18 to 74 cents, but price was not an indicator of quality. ConsumerLab.com

This is why TQ percentage labeling and third-party testing are the most important buying criteria — not price, brand size, or review count.

Celery Juice (16 oz, Morning)

Celery juice is not the flashiest part of this protocol, but it serves an important supporting role.

Taken on an empty stomach first thing in the morning, 16 ounces of fresh celery juice provides natural electrolytes, supports the production of stomach acid (which is itself a first-line defense against ingested pathogens), and helps hydrate and prime the digestive tract for the day.

It also provides a gentle, daily push toward elimination — which matters during a detox. You want the body moving things through, not holding onto them.

Use organic celery when possible, given the high pesticide load on conventionally grown celery.

Drink first thing in the morning, 30 minutes before food.

3 Whole Cloves (Evening)

Three whole cloves taken at night complete what practitioners call the “classic trinity” of natural parasite protocols — and they complete it in the most important way.

Here is the logic: wormwood and black walnut target adult parasites and larvae. Neither is particularly effective against parasite eggs. Cloves are.

Eugenol — the primary active compound in cloves — is one of the few plant compounds with documented ovicidal activity. “Ovicidal” means egg-killing. Eugenol is believed to dissolve the hard casing around parasite eggs, preventing them from hatching and continuing the lifecycle.

This matters enormously. If you kill only the adult parasites, the eggs hatch, mature, and reproduce. You are back where you started. The combination of all three herbs — wormwood, black walnut, and cloves — attacks all three lifecycle stages simultaneously: adults, larvae, and eggs.

Taking them at night is a reasonable choice. Digestion slows overnight, potentially giving the eugenol more contact time in the gut.

Chew the cloves slowly or lightly crush them before swallowing to release the active compounds. Three cloves is a moderate, well-tolerated dose consistent with traditional protocols.

One caution: eugenol in high concentrations can irritate the liver and may interact with blood-thinning medications like warfarin. If you are on any blood thinners, check with your doctor before adding cloves to your protocol.

Take whole, chewed or lightly crushed, at bedtime.

Affiliate Product Link: Simply Organic Whole Cloves

Whole cloves always outperform ground. Once cloves are ground, the volatile oils containing eugenol begin oxidizing immediately. Within days to weeks, a significant portion of the eugenol has dissipated. Whole cloves retain their eugenol in the intact bud structure until the moment you chew or crush them.

When you chew or lightly crush a whole clove before swallowing, you release the eugenol directly and maximally. That is exactly the right approach for your protocol.

Additionally, whole buds that snap crisply when bent are fresh. Buds that bend without snapping have lost moisture and potency. Origin matters too — Sri Lanka (Ceylon) produces the highest-eugenol cloves in the world, followed by Madagascar and Zanzibar.

Your Complete Protocol at a Glance

Oil of Oregano

Primary Target: Adults, protozoa, fungi

Timing: With meals

Black Walnut Oil

Primary Target: Adults, larvae

Timing: With meals

Wormwood Oil

Primary Target: Adults, larvae

Timing: With meals

Black Seed Oil + TQ

Primary Target: Fungi, parasites, immune support

Timing: With meals

Celery Juice (16 oz)

Primary Target: Gut support, hydration, elimination

Timing: Morning, empty stomach

3 Whole Cloves

Primary Target: Parasite eggs

Timing: Evening, before bed

The 3-Phase Protocol Schedule

Phase 1 — Ramp Up (Days 1–4)

Your body needs time to adjust. Start lower and build up.

• Take herbal oils with food, once daily

• Drink celery juice each morning on an empty stomach

• Begin removing refined sugar, alcohol, processed foods, and gluten from your diet

• Increase water to at least 8 to 10 glasses per day

• Begin three cloves nightly

Phase 2 — Full Protocol (Days 5–14)

This is the active clearing phase.

• Take all herbal oils twice daily with meals

• Continue celery juice every morning

• Add a probiotic supplement — take it at a completely separate time from your herbal stack (morning is ideal for probiotics if you take the herbs at lunch and dinner)

• Add anti-parasitic foods: raw garlic, pumpkin seeds, papaya, turmeric, apple cider vinegar

• Continue three cloves nightly

• Stay well-hydrated and prioritize sleep

Phase 3 — Wind Down and Rest (Days 15–18)

• Reduce herbal oil doses gradually

• Continue probiotics and whole foods

• Maintain celery juice if tolerated

• Rest for 2 to 4 weeks before beginning a second cycle

Most practitioners recommend three complete cycles for lasting results. The rest periods are not optional — they protect your liver, allow your gut flora to rebalance, and prevent the body from adapting to the herbs.

What About Die-Off?

You may feel worse before you feel better. This is called a Herxheimer reaction, or “die-off.”

As parasites and fungal organisms die, they release toxins into your system. You may notice:

• Headaches

• Fatigue

• Nausea

• Loose stools or temporary constipation

• Mild flu-like feelings

• Sleep disturbances

These symptoms are typically most intense in the first week. Ease through them by:

• Drinking extra water

• Replenishing electrolytes

• Getting adequate sleep

• Reducing the herbal doses temporarily if symptoms become uncomfortable

• Adding a binder like psyllium husk fiber to help move toxins out of the digestive tract

Not everyone experiences die-off. Some people notice improved digestion, better energy, and clearer thinking within the first week. Results vary.

Should Your Partner Do This With You?

This is one of the most practical questions in the entire protocol — and most guides skip it entirely.

The short answer: yes.

Certain parasites and fungal organisms pass between partners through close physical contact — kissing, shared utensils, shared bedding, and sexual intimacy. Candida in particular cycles between partners in households where only one person addresses it.

If you clear your system while your partner does not, reinfection is a genuine risk. You clean house, then reexposure happens through normal intimacy and daily contact. The cycle continues.

This dynamic is well-established even in conventional medicine. For certain diagnosed parasitic infections, standard medical guidelines specifically recommend treating all household and close contacts simultaneously — not just the index patient.

The case for doing it together is strong:

• You break the reinfection cycle completely

• You both benefit from better gut health, energy, and immune function

• The protocol is food-grade and not harsh when done correctly

• Shared dietary changes are significantly easier when both partners commit

For her, dosing adjustments may be warranted. Women are generally advised to start at lower doses of the herbal oils — particularly oregano and wormwood — and increase gradually. The cloves, black seed oil, and black walnut alone already provide meaningful coverage.

Both partners should add probiotics during and after the protocol to restore beneficial gut bacteria.

The Foods Most Likely to Carry Parasites

Understanding where parasites come from lets you close the front door while the protocol does its work.

Raw or undercooked meat is the highest-risk category. Tapeworms commonly come from undercooked beef, pork, and fish. Pork in particular carries the risk of Taenia solium (the pork tapeworm) and Trichinella. Toxoplasma gondii — one of the most widespread human parasites — can contaminate beef, pork, lamb, and wild game.

Raw and undercooked fish and seafood carry their own risks. Freshwater fish are particularly high-risk for flatworm larvae that can migrate to the bile duct and gallbladder. Long-term infections with these parasites have been associated with liver cancer. Critically, freezing or cooking kills these parasites — but pickling, drying, salting, and smoking do not. If you eat sushi, sashimi, ceviche, smoked salmon, or raw oysters regularly, you are in a higher-risk category.

Raw fruits and vegetables — especially leafy greens — are significant vectors. Lettuce, spinach, kale, and cabbage have rough, uneven surfaces that allow parasite eggs and cysts to cling through washing. Vegetables grown closer to the soil carry higher risk than fruit. Imported produce adds additional risk due to travel time and varying sanitation practices abroad.

Unpasteurized juices and dairy have been cited as sources of Cryptosporidium and other parasite outbreaks.

Pork, lamb, and wild game are the primary sources of Giardia for meat eaters.

The Foods That Feed Fungal Overgrowth

This is the other side of the equation — the foods that do not carry parasites directly, but create the internal environment where fungal overgrowth thrives.

Sugar in all forms is the primary fuel for Candida. Candida needs sugar to grow, to build the protective biofilms that shield it from your immune system, and to switch from its benign form into its more aggressive hyphal form. This includes not just table sugar, but agave, maple syrup, honey, high-fructose corn syrup, and the hidden sugars in packaged sauces, dressings, coffee creamers, and “health” products.

Refined carbohydrates — white bread, white rice, pasta, pastries — convert to sugar rapidly in your gut. Same effect, different packaging.

Alcohol is both a concentrated sugar source and an immune suppressor. It directly disrupts the gut microbiome and lowers your body’s ability to keep Candida in check.

Peanuts, cashews, and pistachios are among the nuts highest in mold contamination. During a fungal detox, these are best avoided or at minimum soaked overnight before consuming.

Cheese and cured or smoked meats — including brie, camembert, prosciutto, smoked salmon, and commercial deli meats — can add to the fungal load in the intestinal tract.

Processed gluten-free foods are a common trap. Gluten-free breads and cereals are often made with refined rice and corn flours, which may be contaminated with mycotoxins and promote inflammatory gut bacteria. Switching from wheat to processed gluten-free products is not a step forward.

Coffee — especially low-grade commercial blends — frequently carries mold mycotoxins. If you cannot eliminate coffee during the protocol, switch to a single-origin, lab-tested brand.

Dried fruits are high in concentrated sugar and often carry surface mold. Both are Candida fuel.

The dietary direction is consistent throughout: whole, unprocessed foods; high fiber; clean proteins; low sugar; plenty of hydration.

Does Your Baking Soda Produce Soak Actually Work?

Many health-conscious people soak their produce in a baking soda and water solution. It is a good instinct — and the science largely backs it up.

Baking soda (sodium bicarbonate) is alkaline. That alkalinity breaks down pesticide molecules on the surface of produce. A widely cited University of Massachusetts study found that soaking produce in a baking soda solution was significantly more effective at removing surface pesticides than either tap water or bleach. It took 12 to 15 minutes to completely remove surface pesticide residues in the study — not the 2-minute quick soak many people do.

On fungal spores, baking soda has demonstrated antifungal activity. It is registered with the EPA as a fungicide. It disrupts the ion balance of fungal cells, creating an inhospitable environment for spore survival. However, research shows that it inhibits spore growth rather than fully killing them — once rinsed off, the pH returns to normal, so effects are temporary.

On parasites, the baking soda soak helps mechanically dislodge parasite eggs and cysts from rough surface textures, and the alkaline environment is unfavorable for many pathogens. But it is not a guaranteed kill — particularly for tough parasite cysts that are specifically designed to survive hostile environments.

The right way to do the soak:

• Mix 1 teaspoon of baking soda per 2 cups of water (or 1 tablespoon per gallon for larger batches)

• Soak for 12 to 15 minutes — not 2 to 3 minutes

• For firm-skinned produce (apples, cucumbers, root vegetables), scrub with a vegetable brush

• Rinse thoroughly under cold running water

• For leafy greens, add a splash of white vinegar to the soak — vinegar reduces surface bacteria that baking soda alone does not address

Where the soak falls short:

Some pesticides are systemic — designed to be absorbed into the fruit flesh itself. No wash removes these. For those, peeling (where practical) is more effective than soaking. And for parasites with highly resistant cysts, cooking remains the most reliable protection.

Bottom line on the soak: It is a genuinely good practice and one of the best things you can do at home. It significantly reduces pesticide load, inhibits fungal spores, and helps physically remove surface contamination including parasite eggs. Pair it with organic choices for high-risk produce, proper scrubbing, and cooking where practical.

What to Eat During Your Detox Protocol

Your herbal stack does the clearing work. Your diet determines whether you reload the system each day or support the clearing process.

Eat more of:

• Non-starchy vegetables: broccoli, kale, spinach, Brussels sprouts, onions, garlic, zucchini, cucumber

• Low-sugar fruits: lemons, limes, green apples, berries (in moderation), avocado

• Clean proteins: wild-caught fish, pasture-raised eggs, grass-fed beef (well-cooked), organic chicken

• Healthy fats: extra virgin olive oil, coconut oil, avocado, flaxseed

• Anti-parasitic foods: raw garlic, pumpkin seeds, papaya, papaya seeds, turmeric

• Fermented foods (after Phase 1): plain yogurt with live cultures, sauerkraut, kimchi, kefir

• Probiotics: taken separately from herbal oils, ideally in the morning

• Fiber: psyllium husk, chia seeds, ground flaxseed — these act as binders that help move toxins out

• Water: a minimum of 8 to 10 glasses per day

Eliminate or minimize:

• Refined sugar and all simple sweeteners

• Alcohol (all forms)

• Refined grain products: white bread, white rice, pasta, pastries

• Processed gluten-free products made from corn or rice flour

• Peanuts, cashews, and pistachios (during active protocol phases)

• Dried fruits

• Cured and smoked meats

• Aged and moldy cheeses

• Commercial coffee (or switch to tested, clean-source coffee)

• Raw or undercooked meat, fish, or shellfish during the protocol

Additional Lifestyle Factors That Matter

The protocol and diet do the heavy lifting. These factors amplify the results.

Sleep. Gut healing happens during deep sleep. Your immune system is most active at night. Prioritize 7 to 9 hours and be aware that die-off reactions can temporarily disrupt sleep.

Stress management. Chronic psychological stress is directly linked to gut dysbiosis and Candida overgrowth. It suppresses the immune response that keeps fungal organisms in check. During a detox protocol, this is not the time to push harder at work or skip your wind-down routine.

Movement. Moderate exercise supports lymphatic drainage, which is part of how the body processes and eliminates waste during detox. Walking, swimming, and light resistance training are all appropriate during the protocol. Intense training may tax your system more than it helps.

Hydration. Water is non-negotiable. It dilutes toxins, supports kidney function, keeps bowel movements regular, and helps the body flush what the protocol is mobilizing. If you are not drinking enough water, the clearing process becomes a traffic jam.

Probiotics. These are essential — not optional. The herbal protocol does not discriminate perfectly between harmful and beneficial organisms. Probiotics help repopulate the beneficial gut bacteria that support immune function, digestion, and a healthy microbiome long-term.

How Long Should You Do This? And Then What?

A single 14 to 18-day cycle is a beginning, not a conclusion.

Most practitioners who use this protocol recommend three complete cycles — each followed by a 2 to 4-week rest — for a thorough and lasting result. This is because parasites have multi-stage lifecycles. A single cycle may clear the adults and some larvae. The rest period allows any remaining eggs to hatch. The next cycle catches the newly hatched organisms before they mature and reproduce.

Maintenance after the three cycles typically looks like one lower-dose cycle per year, along with ongoing dietary practices and produce hygiene habits.

This is not a permanent lifestyle restriction. It is a seasonal investment in gut health that most people over 50 find worthwhile once they experience the difference.

Signs the protocol may be working:

• Improved digestion and reduced bloating

• More consistent energy levels

• Better sleep quality

• Clearer skin

• Improved mental clarity

• More regular bowel movements

Some people notice these changes within days. Others take a full cycle or more. The absence of obvious “die-off” does not mean nothing is happening.

A Note on Testing

If you want to know specifically what you are dealing with before starting a protocol, testing options exist.

Comprehensive stool analysis through a functional medicine lab can identify specific parasites, fungal organisms, bacterial imbalances, and inflammatory markers in the gut. This takes the guesswork out entirely and lets you tailor the protocol to what is actually present.

Ask your doctor about stool testing, or seek out a functional medicine or integrative health practitioner who works with comprehensive lab panels. If your primary care physician does not offer this, independent lab testing services are widely available.

Testing is not required to do the protocol — many people start based on symptoms alone. But it is useful for confirmation, for tracking results after the protocol, and for ruling out serious infections that require prescription treatment.

FAQ

Q: Is this natural parasite and fungal detox safe for people over 50?

A: The ingredients used in this natural parasite and fungal detox — oregano oil, black walnut, wormwood, black seed oil, and cloves — are generally well-tolerated short-term in healthy adults when used at appropriate doses. People over 50 with existing liver, kidney, or cardiovascular conditions, or those on medications (particularly blood thinners, blood pressure medications, or diabetes medications), should consult with their physician before starting. Wormwood in particular should not be used continuously due to thujone content.

Q: How do I know if I have parasites or fungal overgrowth?

A: Common symptoms include chronic bloating, irregular bowel movements, unexplained fatigue, brain fog, skin rashes or itching, sugar cravings, recurring yeast infections, sleep disturbances, and a general feeling of being unwell without a clear diagnosis. These symptoms overlap with many conditions, which is why parasitic and fungal infections are frequently missed. The most reliable way to confirm is through comprehensive stool testing with a functional medicine lab.

Q: Can I do this protocol while taking prescription medications?

A: Certain medications interact with ingredients in this protocol. Oil of oregano and black seed oil may interact with blood thinners. Black seed oil can lower blood pressure and blood sugar. Cloves (eugenol) may interact with warfaryin. Always discuss with your doctor before combining this protocol with prescription medications.

Q: Does the die-off reaction mean the protocol is working?

A: Not necessarily. Some people experience significant die-off symptoms and others experience none, regardless of parasite or fungal burden. Die-off occurs when pathogens die faster than the body can eliminate the toxins they release. If symptoms are severe, reduce doses and increase water intake and fiber. Mild symptoms — brief fatigue, loose stools, mild headache — are common and generally resolve within the first week.

Q: Should my partner do the natural parasite and fungal detox at the same time?

A: Yes, if you are in close physical contact. Certain parasites and Candida pass between partners through kissing, shared items, and sexual intimacy. If one partner clears and the other does not, reinfection through normal daily contact is a real risk. Doing the protocol together, or within close timing, breaks the cycle completely. Her doses may need to be slightly lower, particularly for the herbal oils.

Q: How long does it take to see results?

A: Some people notice improved digestion and energy within the first 7 to 10 days. Others see gradual change over the full 14 to 18-day cycle. Full results often require two to three complete cycles with rest periods in between. The lifecycle of parasites means that a single cycle clears the adults and larvae, the rest period lets eggs hatch, and subsequent cycles address the next generation.

Q: Is the baking soda soak enough to protect against parasites on produce?

A: It significantly reduces risk but does not eliminate it. A 12 to 15-minute soak in baking soda solution is more effective than plain water or bleach at removing surface contaminants, pesticides, and fungal spores. However, parasite cysts are highly resilient, and some can survive standard washing. Cooking vegetables — particularly leafy greens — is the most reliable protection. For raw produce, the baking soda soak combined with a vinegar rinse, and organic choices for high-risk items, gives you the best available reduction.

Q: Can I eat raw fish or sushi during a parasite cleanse?

A: This is not recommended. Raw and undercooked fish is one of the highest-risk foods for parasite exposure, including flatworm larvae that are not killed by pickling, smoking, or drying. During an active protocol, eliminating raw fish removes a major route of reinfection.

Q: What is the best probiotic to take alongside this protocol?

A: Look for a high-quality probiotic with multiple strains including Lactobacillus acidophilus, Lactobacillus rhamnosus, and Bifidobacterium longum. A minimum of 10 to 20 billion CFU per dose is a reasonable starting point. Take it at a completely separate time from your herbal oils — ideally in the morning if you take the herbs at lunch and dinner. Fermented foods like plain full-fat yogurt, kefir, sauerkraut, and kimchi also support probiotic recolonization.

Q: Is the celery juice necessary, or can I skip it?

A: It is not strictly required, but it plays a useful supporting role. Celery juice on an empty stomach supports stomach acid production, provides electrolytes, and helps prime elimination. If you find it difficult to tolerate, you can substitute with warm lemon water or simply prioritize your water intake. The herbal oils are the active clearing agents — the celery juice supports the environment they work in.

Additional Information and References

The information in this post is grounded in published research and traditional herbal medicine practice. Below are key references and related resources for further reading.

Research References

Oil of Oregano — Antiparasitic and Antifungal Activity

​Zuma Nutrition. (2026, March). Oregano oil benefits for gut health: Parasites, Candida and dosage.​https://www.zumanutrition.com/blogs/health/oregano-oil-benefits-gut-health

Black Walnut — Juglone and Antiparasitic Properties

​Portland Clinic of Natural Health. (2023). Parasites and the anti-parasitic properties of black walnut: A naturopathic perspective. https://portlandclinicofnaturalhealth.com/anti-parasititc-properties-black-walnut-naturopathic/

Wormwood — Clinical and Animal Research

​Rupa Health. (2025). Top 5 natural supplements for an effective parasite cleanse. https://www.rupahealth.com/post/natural-supplements-parasite-cleanse

Black Seed Oil and Thymoquinone — Antiparasitic and Antifungal

​Forouzanfar, F., Bazzaz, B.S.F., & Hosseinzadeh, H. (2014). Black cumin (Nigella sativa) and its constituent (thymoquinone): A review on antimicrobial effects. Iranian Journal of Basic Medical Sciences, 17(12), 929–938. https://pmc.ncbi.nlm.nih.gov/articles/PMC4387228/

Zuma Nutrition. (2026, January). Black seed oil for parasites and Candida: Evidence, benefits and safety. https://www.zumanutrition.com/blogs/health/black-seed-oil-for-parasites-candida-evidence-benefits-safety

Thymoquinone — Fungicidal Effect on Candida

​Letscher-Bru, V., et al. (2013). Antifungal activity of sodium bicarbonate against fungal agents causing superficial infections. Mycopathologia. ScienceDirect (2016). Fungicidal effect of thymoquinone involves generation of oxidative stress in Candida glabrata. https://www.sciencedirect.com/science/article/pii/S0944501316304475

Cloves — Eugenol and Ovicidal Activity

​Zuma Nutrition. (2026, March). Health benefits of cloves: Anti-parasitic uses, evidence and safety. https://www.zumanutrition.com/blogs/health/cloves-zuma-nutrition

Dr. Clark Store. Why cloves, wormwood and black walnut hull are the best herbs to kill parasites.​https://drclarkstore.com/blogs/news/why-cloves-wormwood-black-walnut-hull-are-the-best-herbs-to-kill-parasites

Three-Herb Combination Protocol

​Dr. Clark Store. Clove/Wormwood/Black Walnut protocol FAQs.​https://drclarkstore.com/pages/parasite-cleanse-faqs

Vinatura Supplements. (2025). Can you combine clove, black walnut, and wormwood?​https://www.vinatura.store/blogs/articles/can-you-combine-clove-black-walnut-wormwood

Partner Reinfection

​Cleveland Clinic. Trichomoniasis: Causes, symptoms, testing and treatment.​https://my.clevelandclinic.org/health/diseases/4696-trichomoniasis

Foods That Carry Parasites

​Canadian Institute of Food Safety. Common food sources of parasites.​https://blog.foodsafety.ca/common-food-sources-parasites

U.S. Food Safety and Inspection Service. Parasites and foodborne illness. https://www.fsis.usda.gov/food-safety/foodborne-illness-and-disease/illnesses-and-pathogens/parasites-and-foodborne-illness-0

Foods That Feed Fungal Overgrowth

​The Candida Diet. Foods to avoid on the Candida diet. https://www.thecandidadiet.com/foods-to-avoid/

Jawhara, S., et al. (2023). Healthy diet and lifestyle improve the gut microbiota and help combat fungal infection. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC10302699/

Chris Kresser. (2022). Food for mold illness: What to eat and what to avoid. https://chriskresser.com/food-for-mold-illness-what-to-eat-and-what-to-avoid/

Baking Soda Produce Wash

​He, L., et al. (2017). Effectiveness of commercial and homemade washing agents in removing pesticide residues on and in apples. Journal of Agricultural and Food Chemistry, 65(44), 9744–9752. https://pubmed.ncbi.nlm.nih.gov/29067814/

Consumer Reports. Should you wash produce with baking soda?https://www.consumerreports.org/health/food-safety/smarter-should-you-wash-produce-with-baking-soda-a6385579987/

Dr. Clark Store. How to clean produce using natural ingredients: From parasite eggs, bacteria, and mold. https://drclarkstore.com/blogs/news/how-to-clean-produce-using-natural-ingredients-from-parasite-eggs-bacteria-and-mold

Related Resources

Environmental Working Group — Dirty Dozen (Highest Pesticide Produce) https://www.ewg.org/foodnews/dirty-dozen.php

Rupa Health — Comprehensive Parasite Cleanse Protocol https://www.rupahealth.com/post/parasite-cleanse-protocol-comprehensive-lab-testing-therapeutic-diet-and-supplements

Zuma Nutrition — Top 9 Natural Anti-Parasitic Herbs (Evidence-Based) https://www.zumanutrition.com/blogs/health/top-9-natural-anti-parasitic-herbs

Dr. Ruscio — Thymoquinone: 10 Benefits and How to Use https://drruscio.com/thymoquinone/

Medical News Today — What is a Parasite Cleanse and Does It Work?https://www.medicalnewstoday.com/articles/326696

Cleveland Clinic — Parasites: Types, Symptoms, Treatment and Prevention https://my.clevelandclinic.org/health/diseases/24911-parasites

Connect with memios

• Website — https://www.memios.ai

• Newsletter — The Longevity Letter

• Facebook — https://www.facebook.com/memiosai

Disclaimer: memios shares wellness and longevity content for general education. We are not doctors, healthcare providers, or licensed medical professionals, and we do not provide medical advice, diagnosis, or treatment. We are health conscious individuals documenting what we learn and what we do as we work toward living long, healthy, strong lives into our 90s. Always talk with your physician or qualified healthcare professional before starting, changing, or stopping any exercise, nutrition, supplement, or health program.

By Andrew Wilson, Founder of memios | The Longevity Letter

For years, doctors told cancer patients to “stay active if you can.” It was well-meaning advice, but vague. There was no prescription, no structure, no urgency behind it.

That era is over.

Exercise oncology — the science of using structured physical activity as a direct part of cancer treatment and recovery — has just reached a turning point. A wave of landmark clinical trials published in 2025 now confirms what researchers have suspected for years: exercise can extend the lives of cancer patients. Not marginally. Not theoretically. In randomized controlled trials — the gold standard of medical evidence.

This post pulls together six major 2025 publications reviewed and summarized by Dr. Jay Harness, MD, FACS — a breast cancer surgeon and founder of Cancer Fitness. I’ll break down what the science says, what it means for you or someone you love, and how you can apply it right now.

If cancer has touched your life — as a patient, a survivor, or a caregiver — this information belongs in your hands.

What Is Exercise Oncology?

Exercise oncology is the study and practice of using structured physical activity as a therapeutic tool across the entire cancer journey — before surgery (prehabilitation), during treatment, through recovery, and into long-term survivorship.

It is not a replacement for surgery, chemotherapy, or radiation. It works alongside those treatments to help your body fight harder, recover faster, and live longer.

The field has been building for over two decades. What changed in 2025 is that the evidence crossed a threshold. We moved from “exercise seems helpful” to “exercise has been proven in randomized trials to reduce cancer recurrence and mortality.”

That is a profound shift.

The CHALLENGE Trial: The Landmark Study That Changed Everything

The most important development in exercise oncology in recent memory comes from the CHALLENGE trial — a randomized controlled trial published in the New England Journal of Medicine in 2025.

Here is what the study did:

• Enrolled patients with stage II and stage III colon cancer

• After adjuvant chemotherapy, patients were randomly assigned to either a structured exercise program or standard follow-up care

• The exercise program lasted three years and was built around aerobic exercise with ongoing behavioral support to sustain adherence

Here are the results:

• The exercise group experienced reduced cancer recurrence

• They had fewer secondary cancers

• They had lower overall mortality

Let that sink in. A structured exercise program — not a new drug, not an experimental procedure — produced survival benefits comparable in magnitude to many approved cancer therapies.

Dr. Harness summarized it plainly in his report: “The question ‘Does exercise work?’ has been answered with a resounding YES.”

For anyone who has been through cancer treatment, or is supporting someone going through it right now, this is not a small thing. This is a life-extending intervention available to you today.

Why Survival Benefits Matter Beyond Quality of Life

There has long been a misconception about what exercise does for cancer patients. The prevailing view was that it helped people feel better — less fatigued, less anxious, more mobile. All true. But the benefit was framed as comfort, not cure.

The CHALLENGE trial and the body of research surrounding it reframe the conversation entirely.

Exercise is now shown to:

• Reduce cancer recurrence

• Reduce the risk of secondary cancers

• Lower mortality rates in certain cancer types

• Improve disease-free survival

This is the language of cancer therapy, not just wellness support. And that distinction matters — for how doctors approach it, how health systems fund it, and how patients prioritize it.

Think about this: if a pharmaceutical company developed a pill that reduced colon cancer recurrence, cut secondary cancer risk, and lowered mortality — with minimal side effects — it would be front-page news. Oncologists would prescribe it on day one. Insurance would cover it without question.

That pill does not exist. But structured exercise comes remarkably close to what that pill would look like.

The Full Spectrum of Benefits

The survival data from the CHALLENGE trial is the headline. But exercise oncology delivers a much broader range of benefits across the entire cancer journey.

Multiple studies included in Dr. Harness’s review confirm that structured exercise:

Reduces treatment side effects:

• Decreases cancer-related fatigue — one of the most debilitating complaints among patients in active treatment

• Reduces anxiety and depression

• Improves sleep quality and duration

• Reduces musculoskeletal decline from treatment-related inactivity

Improves physical function:

• Maintains and rebuilds strength

• Supports cardiovascular fitness

• Preserves balance and coordination

• Reduces the physical deconditioning that commonly follows surgery and chemotherapy

Supports mental and cognitive health:

• Reduces “chemo brain” — the cognitive fog many patients experience during and after treatment

• Improves mood and emotional resilience

• Restores a sense of control and agency during a time when most patients feel powerless

Enhances treatment tolerance:

• Patients who exercise during treatment tend to complete more of their prescribed chemotherapy doses

• Better cardiovascular fitness reduces surgical risk

• Physical strength improves recovery time after major procedures

Supports return to normal life:

• Patients who maintain structured exercise report faster return to work

• Better participation in family and social roles

• Improved long-term independence

These benefits span the full cancer continuum — from the period before surgery through active treatment, into survivorship, and even into palliative care when appropriate.

Prehabilitation: Starting Before the Fight Begins

One of the most important — and underused — applications of exercise oncology is prehabilitation: structured exercise before cancer surgery or treatment begins.

The logic is straightforward. A stronger, fitter patient tolerates surgery better, recovers faster, and has fewer post-operative complications. Research has confirmed this across multiple cancer types including colorectal, lung, esophageal, and gynecologic cancers.

Prehabilitation programs typically focus on:

• Aerobic conditioning — building cardiovascular fitness before treatment depletes it

• Resistance training — building muscle mass and strength that will be drawn down during surgery and recovery

• Nutritional support — pairing exercise with protein intake to maximize muscle preservation

• Psychological preparation — reducing pre-surgical anxiety through structured activity

Even short prehabilitation windows — as brief as two to four weeks — have been shown to improve outcomes. The F4S-PREHAB trial and PREHEP trial (covered in earlier issues of The Longevity Letter) demonstrated meaningful improvements in fitness, function, and recovery times when patients exercised in the weeks before their procedures.

If you or someone you love is facing cancer surgery, ask your oncology team about prehabilitation. The window before surgery is not dead time. It is an opportunity to arrive at the operating table as fit as possible.

“If Exercise Were a Pill, We Would All Prescribe It”

That line comes directly from a 2025 editorial published in the Journal of Clinical Oncology by researchers Schmitz and Ligibel. It captures the central paradox of exercise oncology today.

The evidence is robust. The benefits are clear. But exercise lacks the infrastructure that medications have.

When a new cancer drug is approved, the system knows exactly what to do with it:

• The dose is specified

• Pharmacies stock it

• Insurance covers it

• Nurses administer it

• Oncologists prescribe it by reflex

Exercise has no such system. There is no standard prescription format. Most oncologists are not trained in exercise dosing. Exercise physiologists are rarely embedded in cancer care teams. Reimbursement is inconsistent. Referral pathways are unclear.

The result is that millions of cancer patients — people for whom structured exercise could meaningfully extend life — are told to “stay active” and left to figure it out on their own.

This is changing. But it is changing slowly.

Several of the 2025 publications reviewed by Dr. Harness directly address this gap. The authors are not just reporting research — they are calling on health systems, policymakers, and insurance companies to embed exercise into standard oncology care, the same way cardiac rehabilitation is embedded into heart disease care.

What a Proper Exercise Oncology Program Looks Like

Here is what the research says an effective exercise oncology program requires — and why telling patients to “just walk more” is not enough.

Appropriate Dosing

Exercise, like medicine, must be dosed correctly. The four variables are:

• Frequency — how often you exercise (typically 3–5 days per week)

• Intensity — how hard you work (moderate to vigorous depending on fitness level and treatment phase)

• Time — duration of each session (usually 30–60 minutes)

• Type — the mode of exercise (aerobic, resistance, or combined)

The CHALLENGE trial used aerobic exercise as its primary modality, targeting 150 minutes of moderate-to-vigorous activity per week — aligned with standard physical activity guidelines but delivered with structure and behavioral support.

Behavioral Support

Exercise adherence is one of the biggest challenges in any population. For cancer patients, it is especially difficult. Fatigue, nausea, pain, and emotional distress all work against consistency.

Effective programs include regular contact with trained professionals, goal setting, progress tracking, and strategies for managing barriers. The CHALLENGE trial built behavioral support directly into its protocol — and it sustained three years of participation at meaningful levels. That is not accidental.

Trained Professionals

Exercise physiologists, physical therapists, and certified cancer exercise specialists bring oncology-specific expertise that general fitness trainers typically do not have. They understand:

• How specific treatments affect exercise capacity

• Which types of exercise are contraindicated during certain therapies

• How to modify programming for lymphedema, neuropathy, bone metastases, or post-surgical restrictions

• How to monitor for adverse events

Triage and Matching

Not every cancer patient needs the same level of supervision. Some patients with manageable health profiles can exercise safely in community settings or at home with remote guidance. Others — particularly those with comorbidities, active treatment toxicities, or recent surgery — require closer clinical supervision.

Effective systems triage patients to the right level of care rather than applying a one-size-fits-all approach.

The Call to Action for Health Systems

The 2025 research reviewed by Dr. Harness is not just making a scientific argument. It is making a policy argument.

Across all six publications, the call to health systems is consistent and urgent:

Embed exercise into standard oncology pathways. Not as an optional referral, not as an afterthought, but as a core component of cancer care — assessed, prescribed, and delivered with the same rigor as any other treatment.

Train and hire exercise professionals. Oncology teams should include qualified exercise physiologists, the same way they include dietitians, social workers, and pharmacists.

Update reimbursement policy. Insurance and government payers must cover structured exercise programs for cancer patients. The evidence now supports it. The continued absence of coverage is, as the authors argue, no longer defensible.

Use community and telehealth models. Not every patient can access a major cancer center with on-site exercise facilities. Telehealth-delivered exercise programs and community partnerships extend reach and reduce equity gaps.

Recognize exercise as a quality standard. The authors draw a direct comparison to nutrition services, which became mandatory within accredited cancer centers. Exercise oncology should hold the same status.

A Global Perspective: Exercise Oncology Belongs to Everyone

One of the most striking themes in Dr. Harness’s review is the emphasis on global equity.

A 2025 paper in the British Journal of Sports Medicine made a call to action specifically for cancer care in Sub-Saharan Africa. The argument: exercise is one of the few cancer interventions that is genuinely scalable at low cost, even in resource-constrained settings.

You do not need a hospital gym or expensive equipment to deliver meaningful exercise benefits. Walking programs, resistance training with bodyweight, and community-based group exercise can deliver substantial benefits with minimal infrastructure.

The authors acknowledge real gaps — limited trained professionals, limited data, limited funding. But they argue that excluding exercise from cancer control strategies in lower-income settings perpetuates inequity. The benefits of exercise oncology should not be limited to patients in high-income countries.

This is a powerful point. And it reinforces something important: the fundamentals of exercise oncology are accessible. You do not need a six-figure clinical trial budget to implement them. You need knowledge, structure, and consistency.

A Cultural Shift in How We Think About Cancer Care

Here is the deepest message in all of this research.

For decades, cancer care has been organized around a central question: how do we attack the tumor? Chemotherapy, radiation, immunotherapy, targeted therapy — these are all weapons aimed at cancer cells.

That framing is incomplete.

Exercise oncology asks a different question: how do we strengthen the patient?

These are not competing approaches. They are complementary. But the emphasis on tumor-targeting treatments has historically crowded out attention to patient-strengthening interventions like exercise.

The cultural shift underway is significant. Oncologists are beginning to see exercise not as a soft wellness recommendation, but as a biologically active therapy. Exercise has measurable effects on immune function, inflammation, hormonal signaling, and tumor microenvironments. It is not magic — it is physiology.

For patients, this shift offers something precious: agency.

Cancer treatment often strips people of control. You are told what drugs you will receive, when you will receive them, and what side effects to expect. Exercise gives back a form of control. It is something you can do — something measurable, something that has real biological effects, something that puts you in the driver’s seat of your own recovery.

For anyone reading this who has been through cancer, or who is in treatment right now, I want that point to land. This is not about being cheerful or pushing through pain. It is about taking an active role in your own biology. The research supports it. The evidence says it works.

What This Means for You: Practical Steps

You do not need to wait for the healthcare system to catch up. Here is what you can do right now.

If you are facing cancer surgery:

• Talk to your oncologist or surgeon about prehabilitation

• Ask for a referral to an exercise physiologist or physical therapist with oncology experience

• Even a few weeks of structured aerobic and resistance exercise before surgery can improve outcomes

• Focus on what you can do — even modest improvements in fitness before a procedure make a difference

If you are in active treatment:

• Ask your care team whether exercise is safe and appropriate during your current treatment phase

• Aim for movement on most days, even if sessions are short

• Fatigue is real — work with it, not against it. A 15-minute walk is better than nothing

• Find an exercise partner or group. Social accountability improves adherence significantly

If you are in survivorship:

• Treat exercise as part of your medical protocol, not an optional lifestyle choice

• Target 150 minutes of moderate aerobic activity per week as a baseline

• Add two resistance training sessions per week to preserve muscle mass

• Work with a certified cancer exercise specialist if possible — their expertise is worth the investment

• Track your activity. Seeing progress matters.

If you are a caregiver:

• Help the person you support understand that exercise is medical, not optional

• Assist with logistics — transportation, scheduling, equipment

• Consider exercising together. Side-by-side activity is often more sustainable than solo exercise

• Advocate with their care team for structured exercise programming

My Personal Connection to This Research

I want to take a moment to speak directly from my own experience.

I was diagnosed with melanoma in 2022. I have watched my father battle multiple myeloma and amyloidosis. I have walked alongside my closest friend through stage IV melanoma.

Cancer is personal to me. Everything I share at memios and in The Longevity Letter comes from that place.

When I read the CHALLENGE trial results — that a structured, three-year aerobic exercise program reduced cancer recurrence, secondary cancers, and mortality in colon cancer patients — I felt something shift.

We have been told for years to stay active. But “stay active” is not a clinical prescription. It does not come with a dose. It does not come with a system. It does not come with the weight of randomized controlled trial evidence behind it.

Now it does.

If you are 50, 60, or 70 years old, and you have had cancer, or you are worried about cancer, or someone you love is fighting it right now — please take this research seriously. Share it with your doctor. Ask what a structured exercise program would look like for your situation.

Exercise will not fix everything. But the evidence now says clearly: it can help you live longer. That is worth acting on.

The Takeaway

Six major 2025 publications, reviewed and compiled by Dr. Jay Harness, MD, FACS, confirm that exercise oncology has reached a positive tipping point.

The key takeaways:

• The CHALLENGE trial proved that structured aerobic exercise reduces cancer recurrence and mortality in stage II–III colon cancer patients

• Exercise benefits span the full cancer continuum — from prehabilitation through survivorship — including reduced fatigue, improved function, better mental health, and improved treatment tolerance

• Structured programs with behavioral support are what deliver results — not vague advice to “be more active”

• Health systems are being called to embed exercise into standard oncology care with the same urgency as any other evidence-based treatment

• The global vision is an exercise oncology framework accessible to all patients, regardless of income or geography

Exercise is no longer merely supportive care. It is evidence-based, life-extending cancer therapy. The science has crossed the threshold. Now the rest of the system needs to follow.

Frequently Asked Questions

1. What is exercise oncology?

Exercise oncology is the clinical field that studies and applies structured physical activity as a therapeutic intervention for cancer patients. It covers every phase of care: before surgery (prehabilitation), during active treatment, through recovery, and into long-term survivorship. It is now backed by high-quality randomized controlled trial evidence.

2. Does exercise actually help cancer patients live longer?

Yes. The CHALLENGE trial, published in the New England Journal of Medicine in 2025, demonstrated that a structured three-year aerobic exercise program significantly reduced cancer recurrence, secondary cancers, and overall mortality in stage II–III colon cancer patients. This is randomized controlled trial evidence — the gold standard in medicine.

3. What type of exercise is recommended for cancer patients?

The research points to aerobic exercise as the primary modality — activities like walking, cycling, or swimming. The CHALLENGE trial targeted 150 minutes per week of moderate-to-vigorous aerobic activity. Resistance training is also important for preserving muscle mass and strength. The specific prescription depends on cancer type, treatment phase, and individual fitness level. Work with a trained exercise professional who has oncology experience.

4. Is it safe to exercise during chemotherapy or radiation?

For most patients, yes — with appropriate guidance and modification. Exercise during treatment has been shown to reduce fatigue, improve mood, and help patients complete more of their prescribed treatment doses. Always consult your oncology team before starting or modifying an exercise program during active treatment. Some conditions and treatments require specific precautions.

5. What is prehabilitation, and who should consider it?

Prehabilitation is structured exercise before cancer surgery or treatment. It builds cardiovascular fitness, muscle strength, and physical resilience so patients arrive at surgery in the best possible condition. Research has shown that even short prehabilitation windows — two to four weeks — can meaningfully improve surgical outcomes and recovery times. Anyone facing major cancer surgery should ask their care team about prehabilitation.

6. Do I need to go to a gym or cancer center to benefit from exercise oncology?

No. Community-based programs, home exercise with remote guidance, and telehealth-delivered exercise prescriptions can all be effective. The key is structure, consistency, and appropriate professional oversight — not location. Walking programs and bodyweight resistance exercises can provide meaningful benefits without specialized facilities.

7. How does exercise affect cancer recurrence?

The mechanisms are still being studied, but research suggests exercise affects multiple biological pathways: it reduces systemic inflammation, modulates insulin and hormonal levels, enhances immune surveillance, and may directly affect tumor microenvironments. The CHALLENGE trial demonstrated real-world recurrence reduction in colon cancer. Research is ongoing across other cancer types.

8. I am in cancer survivorship. Is it too late to start exercising?

It is not too late. Survivorship is actually one of the strongest contexts for exercise oncology. Structured exercise in survivorship has been shown to reduce recurrence risk, improve cardiovascular health, preserve muscle mass, enhance cognitive function, and improve quality of life. Start where you are, work with a professional, and build gradually.

9. My doctor never mentioned exercise as part of my cancer care. What should I do?

Bring it up directly. Ask your oncologist, surgeon, or primary care physician whether a structured exercise program is appropriate for your situation. Ask for a referral to an exercise physiologist or certified cancer exercise specialist. The research is now strong enough that most oncologists will support this conversation. Advocacy for your own care is always appropriate.

10. Where can I find a qualified cancer exercise specialist?

Look for professionals certified through the American College of Sports Medicine (ACSM) — specifically the ACSM Certified Cancer Exercise Trainer credential. Cancer Fitness, founded by Dr. Jay Harness (cancerfitness.org), is also an excellent resource. Many major cancer centers are now beginning to embed exercise physiologists within their care teams.

Additional Information

Referenced Research

The following peer-reviewed publications were cited and reviewed by Dr. Jay Harness, MD, FACS in the report that forms the basis of this article:

1. Structured Exercise after Adjuvant Chemotherapy for Colon Cancer (CHALLENGE Trial) Courneya KS, Vardy JL, O’Callaghan CJ, et al. New England Journal of Medicine 2025;393:13–25 DOI: 10.1056/NEJMoa2502760

2. If Exercise Were a Pill, We’d All Prescribe It to Patients With Cancer. But It’s Not. Schmitz KH, Ligibel JA.Journal of Clinical Oncology 44(1):5–8 DOI: 10.1200/JCO-25-01649

3. Extending Cancer Survival with Exercise — Time for Oncology to Act Irwin ML. New England Journal of Medicine 393;1 NEJM.org, July 3, 2025

4. Time to Fund Exercise Programmes for Cancer Survivors: The Evidence Is Mounting Liu F-F, Khan KM, Yeung RSM. British Journal of Sports Medicine 2025;0:1–2 DOI: 10.1136/bjsports-2025-110638

5. Physical Activity Implementation for Cancer Care and Prevention in Sub-Saharan Africa: A Call to ActionDouryang M, Belinda YNI, Pillay L. British Journal of Sports Medicine 2025;0:1–2 DOI: 10.1136/bjsports-2025-110720

6. Planning for Cancer: Building Accessible and High-Quality Survivorship Care for All Haywood D, Chan A, Lustberg MB, et al. Trends in Cancer, 2025 (In Press) DOI: 10.1016/j.trecan.2025.12.006

Source Attribution

This article was developed from a research report authored by Dr. Jay Harness, MD, FACS, founder of Cancer Fitness. Dr. Harness is a breast cancer surgeon and leading voice in exercise oncology. His report reviewed and synthesized the six publications listed above.

Related Resources

• Cancer Fitness — Dr. Jay Harness

• American College of Sports Medicine: Exercise and Cancer

• American Cancer Society: Physical Activity and the Cancer Patient

• ACSM Certified Cancer Exercise Trainer

• National Cancer Institute: Physical Activity and Cancer

Connect with memios

• Website — https://www.memios.ai

• Newsletter — The Longevity Letter

• Facebook — https://www.facebook.com/memiosai

Disclaimer: memios shares wellness and longevity content for general education. We are not doctors, healthcare providers, or licensed medical professionals, and we do not provide medical advice, diagnosis, or treatment. We are health conscious individuals documenting what we learn and what we do as we work toward living long, healthy, strong lives into our 90s. Always talk with your physician or qualified healthcare professional before starting, changing, or stopping any exercise, nutrition, supplement, or health program.

By Andrew Wilson | The Longevity Letter | memios

The Exercise Question No One Was Asking

If you’ve been through cancer treatment — or you’re supporting someone who has — you’ve probably heard the advice: “Stay active. Exercise helps.”

That’s true. The evidence is overwhelming. Exercise reduces fatigue, improves physical function, lifts mood, and supports recovery across almost every type of cancer.

But here’s the question researchers weren’t asking loudly enough until now:

Does it matter how your exercise program is personalized?

Not just whether you exercise, but whether your program is actually tailored to you — your energy levels today, your treatment side effects this week, your capacity right now — rather than a fixed plan written before you ever started?

A major new systematic review published in Sports Medicine – Open looked at 63 studies involving 4,472 cancer patients and asked exactly that question. The findings are important, practical, and directly relevant to anyone living with or beyond cancer who wants to use exercise as a real tool for managing their health.

As a cancer survivor myself — and someone who spends a lot of time studying what the research says about living long and strong — this paper caught my attention immediately. Personalized exercise for cancer survivors is one of the most underexplored, underutilized strategies in oncology care. And the data shows we’ve been leaving a lot on the table.

Let me walk you through what this research found, what it means for you, and how you can start applying it today.

What the Study Looked At

The review, led by Brent Cunningham at the University of the Sunshine Coast in Australia, analyzed 63 clinical studies that prescribed what researchers called “individualized” exercise to people living with or beyond cancer.

The researchers wanted to understand three things:

• Why was exercise being individualized in these studies? (What was the reason behind the adjustments?)

• When was individualization happening? (Before a session? During? Between sessions over time?)

• How was individualization applied? (What was actually being changed — intensity, volume, type?)

They also conducted a meta-analysis focused specifically on cancer-related fatigue, which is one of the most common and debilitating side effects of cancer and its treatment.

The 63 included studies covered 4,472 participants with a mean age of 58 years. Most had breast cancer, hematological cancers, or mixed cancer populations. Most were receiving or had recently completed chemotherapy, radiotherapy, or surgery.

Here’s what they found.

The Big Problem: Most “Individualized” Programs Weren’t Really Individualized

This is where the research gets interesting — and a little uncomfortable.

The word “individualized” appeared in all 63 studies. Every one of them claimed to be prescribing personalized exercise. But when the researchers dug into the details, only 49% of studies provided enough information to actually replicate what they did.

That’s a significant problem. If researchers can’t describe their individualization approach clearly enough for other scientists to copy it, it raises real questions about how meaningful the individualization actually was.

More importantly, the review found that the way most programs were individualized was not the most effective approach.

Here’s a breakdown of what they found:

Why Exercise Was Individualized

• 41% of studies based individualization on objective data — things like a baseline fitness test, a cardiopulmonary exercise test, or a 1-rep max strength assessment done at the start of the program.

• 30% of studies used subjective factors — the patient’s reported energy, goals, clinical status, treatment side effects, and personal preferences.

• 27% of studies used a combination of both.

The catch? Objective baseline testing is helpful, but it only captures who you are before the program starts. It doesn’t adapt to how you feel on Tuesday after a rough Monday of chemo.

When Exercise Was Individualized

• 25% of studies adjusted the program before each session — checking in on the patient’s current state before starting.

• 25% of studies adjusted the program between sessions — monitoring how the patient responded and then modifying the plan for the next week.

• 10% of studies adjusted the program during a session — making real-time changes based on what was happening in the moment.

• Only 3% of studies used autoregulation — a structured approach where a clinician actively consults with the patient at the start of each session to assess readiness and modify the session accordingly.

How Exercise Was Individualized

Most studies (22%) adjusted the overall prescription — changing intensity, volume, or the type of exercise in loosely defined ways. Very few had a clear, systematic protocol for how adjustments were made.

The takeaway from all of this: most exercise oncology programs set up a plan at the start and then largely stick to it. They adapt minimally as the patient’s condition changes from week to week.

And that’s a problem, because cancer is not a static experience.

Why This Matters: The Fluctuating Reality of Cancer

Anyone who has been through cancer treatment knows that your capacity changes — sometimes dramatically — from day to day and week to week.

Some days you wake up feeling relatively strong. Other days the fatigue is crushing, the nausea is real, and the idea of a workout seems almost insulting. Treatment cycles create waves of energy and depletion. Side effects stack on top of each other. Emotional stress compounds physical exhaustion.

A fixed exercise program — one designed in week one and never meaningfully adjusted — can’t respond to that reality.

The researchers noted this directly: people living with cancer experience “often-fluctuating symptoms and clinical status.” A program based entirely on a baseline fitness test done before treatment began may not meet the patient’s needs by week four, week eight, or week twelve.

This is not just a theoretical concern. The meta-analysis results back it up clearly.

What the Meta-Analysis Found: The Science of Fatigue Reduction

The researchers pulled together data from 12 to 15 randomized controlled trials within the larger review to specifically examine how different individualization approaches affected cancer-related fatigue.

The results were clear and meaningful.

Subjective Adjustment Reduces Fatigue

Studies that used subjective reasoning — that is, tailoring exercise based on patient-reported factors like fatigue levels, goals, and how they were feeling — showed a significant reduction in fatigue severity.

The standardized mean difference was −0.355 (95% CI −0.631 to −0.079; p = 0.0116).

In plain terms: when exercise programs listened to how patients actually felt and adjusted accordingly, fatigue went down significantly.

Purely objective approaches (based on physiological metrics alone) showed a moderate but statistically imprecise effect. The combination of both approaches did not reach statistical significance in this analysis.

Between-Session Adjustment Reduces Fatigue Even More

This is the finding that stood out most clearly.

Studies that adjusted exercise between sessions — checking in with patients after a session, monitoring their recovery and side effects, and then modifying the next session based on that information — showed a moderate and highly significant effect on fatigue.

The standardized mean difference was −0.616 (95% CI −0.962 to −0.271; p = 0.0005).

That is a meaningful reduction in one of the most significant quality-of-life burdens cancer patients face.

Studies that adjusted exercise only before a session or during a session (without between-session monitoring) showed no statistically significant effect on fatigue in this analysis.

The message is clear: the timing of when you adapt your exercise plan matters as much as the plan itself.

What Autoregulation Is — and Why It’s Nearly Absent

The review also looked at a concept called autoregulation, which deserves special attention.

Autoregulation is a specific approach to exercise individualization where, at the start of each session, a qualified professional (like an exercise physiologist) consults with the patient to assess their current readiness and capacity, and then adjusts the session accordingly — scaling it up or down based on real-time information.

If you’ve had a rough few days — poor sleep, nausea, elevated fatigue — the session gets modified. If you’re feeling stronger than expected, it gets appropriately progressed.

Autoregulation has been recommended by exercise physiology governing bodies in Australia and the United States as a best-practice approach for cancer populations. The logic is sound: cancer patients have unpredictable symptom patterns, and their exercise programs should be able to respond to that unpredictability.

Here’s the problem: only 2 out of 63 studies (3%) explicitly reported using autoregulation.

Seven additional studies used methods that functionally met the definition of autoregulation, but none of them labeled it as such or described it clearly enough for replication.

This means that one of the most promising tools in exercise oncology is almost completely absent from the research literature — and almost certainly absent from most clinical practice.

The researchers called for future trials specifically designed to test autoregulated programming in cancer populations. That research doesn’t yet exist at any meaningful scale.

Understanding the “Why, When, How, Who, What” Framework

One of the most practical contributions of this review is a reporting framework the researchers developed for how exercise individualization should be documented and implemented. They call it the Why, When, How, Who, What framework.

This isn’t just for researchers. It’s a useful way to evaluate any exercise program you’re considering or currently following.

Why — What is the reason for adjusting your exercise prescription? Is it based on objective data (a fitness test, a VO2 max result), subjective factors (how you’re feeling, what side effects you’re managing), or both? The best programs use both.

When — At what point is your program being adjusted? Only at the start? Before each session? Between sessions based on how you responded? The research shows that between-session adjustment has the strongest effect on fatigue reduction.

How — What specifically is being changed? Intensity? The number of sets and reps? The type of exercise? Rest days? A well-designed program should have a clear process for these decisions rather than a vague “we’ll adjust as needed.”

Who — Who is making the adjustments? An exercise physiologist? A physical therapist? A personal trainer with oncology training? The qualification and expertise of the person overseeing your program matters.

What happened — What was the actual outcome of the adjustment? Did reducing your intensity in week six allow you to maintain consistency through week ten? Tracking this helps refine your program over time.

If you’re working with a professional on your exercise program — or evaluating a program at a cancer center or rehab facility — these five questions are worth asking directly.

Why This Is Personal for Me

I was 56 when I received my melanoma diagnosis. I was already active, but I wasn’t exercising with any real structure or purpose related to my health outcome.

That changed after the diagnosis. I started reading the research, working with professionals, and understanding that exercise is not just a quality-of-life bonus for cancer survivors — it is a serious medical intervention with measurable effects on survival, fatigue, physical function, and psychological health.

What I learned through that process — and what this research confirms — is that generic exercise advice is not enough. “Stay active” is a starting point, not a strategy. The real question is: what kind of exercise, at what intensity, adjusted in what way, based on what information?

Most people don’t get that level of specificity from their oncology teams. Oncologists are focused on treatment. Exercise prescription often falls through the cracks.

That’s a gap worth closing.

The Problem with One-Size-Fits-All Exercise Programs in Oncology

Let’s be clear about what “generic” exercise looks like in a cancer context.

It might be a brochure from the hospital that says “try to walk 30 minutes most days.” It might be a standard six-week program designed for post-treatment breast cancer patients that doesn’t change regardless of where you are in your recovery. It might be well-intentioned advice from a trainer who doesn’t have oncology-specific training.

None of these are bad. But they miss something critical.

The review found that 35% of studies based their individualization entirely on a baseline assessment — one done before the program even started. They set the program based on your fitness level at the start and then largely didn’t change it.

For a healthy athlete in training, that might be adequate for a few weeks.

For a person managing chemotherapy-related fatigue, treatment cycles, nausea, changing blood counts, and fluctuating energy — it is almost certainly inadequate.

The research on cancer-related fatigue is clear: symptoms change daily and weekly. An exercise program that doesn’t respond to those changes is a program that will either push you too hard on your worst days or fail to challenge you appropriately on your better ones.

Neither outcome serves your health.

What Good Individualization Actually Looks Like

Based on this review and the broader exercise oncology literature, here is what a well-individualized exercise program for a cancer patient or survivor looks like in practice.

It starts with a real assessment. Not just a walk test or a questionnaire, but a genuine evaluation of your current fitness, your treatment status, your symptom burden, your preferences, and your goals. Both objective data (cardiopulmonary fitness, strength testing) and subjective factors (fatigue ratings, quality of life, emotional wellbeing) should inform the starting point.

It adapts before each session. A brief check-in before every workout — even a simple question about your energy and fatigue levels on a 0-to-10 scale — allows your coach or exercise physiologist to make intelligent decisions about that day’s session. On high-fatigue days, you might do a shorter, lighter session. On good days, you progress as planned.

It adjusts between sessions. This is where the strongest fatigue-reduction evidence lies. After each session, your response is evaluated. Did you recover well? Did fatigue spike after Tuesday’s workout and persist through Thursday? That information should shape what happens next week. Weekly or biweekly check-ins with a professional — even by phone or video — serve this function.

It uses autoregulation where possible. Rather than a fixed prescription, an autoregulated program has a structure but built-in flexibility. If your rating of perceived exertion (RPE) is too high, the load drops. If you’re handling the current level easily, it progresses. The protocol responds to you rather than requiring you to conform to it.

It is supervised by someone with oncology training. Exercise physiology in an oncology context is a specialty. Professionals trained specifically in cancer exercise know when to modify, when to stop, how to monitor for adverse events, and how to communicate with your medical team. This matters.

Practical Steps You Can Take Right Now

You don’t need to wait for the perfect clinical trial or the ideal supervised program to start applying these principles. Here are concrete things you can do.

Track your fatigue daily. Use a simple scale — 0 (no fatigue) to 10 (worst fatigue imaginable). Log it each morning. This gives you and any professional you work with real data to guide your program over time.

Plan flexible, not fixed, workouts. Instead of a rigid schedule, think in terms of a “good day” version and a “lower energy” version of each workout. On good days, do the full version. On harder days, do a shorter, lighter version. The goal is consistency over time, not performance in any single session.

Check in with yourself before every session. Before you start, ask: how’s my energy? How’s my fatigue? Rate it on that 0-to-10 scale. If you’re at a 7 or higher, consider scaling back.

Find a professional who understands cancer exercise. Look for certified exercise physiologists with oncology training, or cancer rehabilitation programs at a major medical center. Some cancer centers have accredited exercise programs specifically for patients. These resources exist — they’re just not always visible.

Ask your oncology team. More oncology teams are incorporating exercise recommendations into standard care. Ask your oncologist, your nurse navigator, or your care coordinator whether an exercise referral is available. If they say no, ask why not.

Build a feedback loop. After each week of exercise, ask yourself: How did I feel during? How did I recover? Did fatigue increase or decrease? Use that information to adjust the following week. This is the essence of inter-session individualization, even if you’re doing it yourself.

The Role of Adherence: You Have to Actually Do It

One important note from the research: individualization only works if you’re actually doing the program.

The studies included in this review reported a mean adherence rate of around 60% for session attendance, with some as low as 25%. That’s not unusual in clinical exercise research, and it reflects the real challenges cancer patients face in maintaining any kind of structured program.

A previous meta-analysis cited in this review found that higher adherence produced larger improvements in cancer-related fatigue. In other words, the best-individualized program in the world doesn’t work if you only show up half the time.

This is where the subjective, patient-centered approach to individualization has an advantage beyond its physiological effects: it makes the program more responsive to your actual life. When a program adjusts to your symptoms rather than demanding you conform to a fixed schedule, you’re more likely to stick with it.

Flexible individualization and adherence go hand in hand.

Breast Cancer, Blood Cancers, and Beyond

The studies in this review covered a range of cancer types, with breast cancer (32% of single-cancer studies) and hematological cancers like multiple myeloma and leukemia (14%) being the most common.

Breast cancer patients face a particularly well-documented exercise challenge. Chemotherapy-induced fatigue, hormonal changes from hormone therapy, and the cumulative burden of multi-year treatment regimens make consistency difficult. The research in this area is relatively strong, and several of the studies showing significant fatigue reduction with subjective, inter-session individualization included breast cancer patients.

For blood cancers — multiple myeloma, leukemia, lymphoma — the challenge is often more acute. These patients may have lower baseline fitness, more severe fatigue, and more unpredictable treatment schedules. Autoregulation is especially well-suited to this population, which makes it all the more frustrating that it’s so rarely studied or applied.

Regardless of cancer type, the core message from this research holds: your exercise program needs to respond to where you are right now, not where you were when you started.

What Researchers Recommend Next

The review authors made several specific recommendations for the future of exercise oncology research:

Better reporting standards. Future studies should clearly describe why, when, how, who, and what in terms of their individualization approach — using the framework outlined in the paper. Without this clarity, results are difficult to interpret or apply.

Purpose-built autoregulation trials. No study has yet directly compared autoregulated exercise programming to traditional fixed prescription in a cancer population. That trial needs to happen.

More diverse cancer populations. Most research has focused on breast cancer and a handful of other diagnoses. Larger studies across more cancer types are needed.

Combining individualization timepoints. Future research should test whether combining pre-session, intra-session, and inter-session individualization produces better outcomes than any single approach alone.

Patient-centered outcome measures. Fatigue is important, but so is quality of life, function, mood, sleep, and treatment adherence. Research needs to expand beyond fatigue as the primary outcome.

The Bottom Line for You

Here’s what this research means in plain terms.

Exercise is one of the most powerful tools you have as a cancer patient or survivor. The evidence for that is not in question.

But not all exercise programs are equal. A program that sets a plan in week one and never meaningfully changes it is not serving you as well as it could.

The programs that reduce fatigue most effectively are the ones that:

• Listen to how you actually feel — not just what the baseline tests showed

• Adjust between sessions based on how you’re recovering

• Have a qualified professional overseeing those adjustments

• Give you enough flexibility to show up consistently, even on hard days

You deserve more than a generic routine. Your body’s response to cancer and its treatment is individual. Your exercise program should be too.

FAQ: Personalized Exercise for Cancer Survivors

Q1: Is it safe to exercise during cancer treatment?

Yes, for most people, exercise during cancer treatment is safe and beneficial. It should always be cleared with your oncologist and supervised by a qualified professional when possible. Your program may need to be modified based on your specific treatment, blood counts, and current symptoms. The research consistently shows that exercise — when properly individualized — reduces fatigue, improves physical function, and supports quality of life during and after treatment.

Q2: What does “individualized” exercise actually mean for a cancer patient?

Individualized exercise means your program is tailored to your specific situation — your cancer type, treatment status, current fitness level, energy levels, and treatment side effects — and that it continues to be adjusted as those factors change over time. This is different from a generic program that applies the same routine to everyone. True individualization involves ongoing assessment and modification, not just a custom plan at the start.

Q3: What types of exercise are recommended for cancer patients and survivors?

Most research supports a combination of aerobic exercise (walking, cycling, swimming) and resistance training (weight training, resistance bands). The specific balance depends on your cancer type, treatment status, and individual goals. Most included studies in this review prescribed a combination of both, with sessions averaging about 32 minutes, two days per week. Intensity varied widely but was generally light to moderate.

Q4: How does cancer-related fatigue differ from normal tiredness?

Cancer-related fatigue is not the same as ordinary tiredness. It is a persistent, distressing sense of physical, emotional, and cognitive exhaustion that is not proportional to recent activity and is not fully relieved by sleep or rest. It is one of the most common and debilitating side effects of cancer and cancer treatment. Exercise — especially personalized exercise — is one of the most effective evidence-based interventions for managing it.

Q5: What is autoregulation and how does it apply to cancer exercise?

Autoregulation is an exercise prescription approach where the session is adjusted based on your “readiness to train” on a given day. At the start of each session, a qualified professional assesses your current state — energy, fatigue, any symptoms — and modifies the workout accordingly. If you’re in a rough patch, the session is scaled back. If you’re recovering well, it progresses. This approach is especially well-suited to cancer patients because their symptoms fluctuate significantly. The research reviewed here found it was almost completely absent from current studies — only 2 out of 63 studies explicitly used it.

Q6: Does the timing of exercise adjustments actually matter?

Yes, significantly. This review found that programs making adjustments between sessions — monitoring patient responses and updating the next session’s plan accordingly — produced a statistically significant and moderate reduction in cancer-related fatigue. Programs that only adjusted before or during individual sessions did not show the same effect. The implication is that ongoing monitoring and weekly adaptation may be more important than what happens in any single session.

Q7: How do I find a qualified exercise professional for cancer rehabilitation?

Look for a Certified Exercise Physiologist (CEP) or a physical therapist with oncology experience. Many large cancer centers have accredited cancer rehabilitation programs staffed with exercise professionals who specialize in this population. Ask your oncologist or oncology nurse navigator for a referral. Organizations like the American College of Sports Medicine (ACSM) have certification programs specifically for cancer exercise specialists.

Q8: Can I build my own personalized exercise program without a professional?

You can take meaningful steps on your own — tracking your daily fatigue, using a flexible “good day / lower energy” approach to workouts, and checking in with yourself before each session. That said, working with a qualified professional who understands cancer exercise will produce better, safer results — especially during active treatment. If professional supervision isn’t accessible, there are online cancer exercise programs that incorporate individualization principles.

Q9: What should I ask my cancer care team about exercise?

Good questions include: Is there an exercise referral available as part of my care? Are there any exercise restrictions given my current treatment? What symptoms should cause me to stop or modify exercise? Is there an exercise physiologist or cancer rehabilitation specialist I can work with? The more specific you can be about your current situation, the more useful the guidance will be.

Q10: How quickly can exercise affect cancer-related fatigue?

Results vary by individual and program, but many studies show improvements in fatigue within 8 to 12 weeks of consistent, individualized exercise. The meta-analysis in this review found a small-to-moderate overall effect of exercise on fatigue severity across the included studies, with stronger effects in programs using subjective assessment and between-session adjustment. Consistency matters more than any single session — showing up regularly over time produces the most meaningful results.

Additional Information

About This Research

This blog post is based on the following peer-reviewed systematic review and meta-analysis:

Cunningham B, Chong JE, Fairman CM, Jones MD, Skinner TL, Rose GL. Individualisation of Exercise Prescription in Cancer: A Systematic Review and Meta-Analysis. Sports Medicine – Open. 2026;12:15. DOI: https://doi.org/10.1186/s40798-026-00980-8

This is an open-access article published under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Related Research and Resources

Exercise Guidelines for Cancer Survivors Campbell KL, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51(11):2375–90.

Autoregulation and Exercise Oncology Fairman CM, et al. A scientific rationale to improve resistance training prescription in exercise oncology. Sports Med. 2017;47(8):1457–65.

Periodized Exercise in Cancer Medicine Bettariga F, et al. Periodizing exercise medicine prescription for patients with cancer: a narrative opinion. Sports Med. 2025. DOI: https://doi.org/10.1007/s40279-025-02311-5

Exercise and Cancer-Related Fatigue (Meta-Analysis) Puetz TW, Herring MP. Differential effects of exercise on cancer-related fatigue during and following treatment: a meta-analysis. Am J Prev Med. 2012;43(2):e1–24.

Exercise Across the Cancer Care Continuum Coletta AM, Basen-Engquist KM, Schmitz KH. Exercise across the cancer care continuum: why it matters, how to implement it, and motivating patients to move. Am Soc Clin Oncol Educ Book. 2022;42:932–8.

Australian Exercise and Cancer Position Statement Hayes SC, et al. The exercise and sports science Australia position statement: exercise medicine in cancer management. J Sci Med Sport. 2019;22(11):1175–99.

CERT Reporting Standards for Exercise Slade SC, et al. Consensus on exercise reporting template (CERT): explanation and elaboration statement. Br J Sports Med. 2016;50(23):1428–37.

Chemotherapy-Periodized Exercise Kirkham AA, et al. “Chemotherapy-periodized” exercise to accommodate for cyclical variation in fatigue. Med Sci Sports Exerc. 2020;52(2):278–86.

Find a Cancer Exercise Specialist

• American College of Sports Medicine (ACSM) Cancer Exercise Specialist Certification: https://www.acsm.org

• Cancer Exercise Training Institute: https://www.cancerexercisetraining.com

• Exercise and Sports Science Australia (ESSA): https://www.essa.org.au

• CancerFitness.org (Dr. Jay Harness): https://www.cancerfitness.org

More from The Longevity Letter

• How Exercise After Cancer Surgery Changes Your Odds

• The Science of Prehabilitation Before Cancer Surgery

• Why All-or-Nothing Thinking About Exercise Is Holding You Back

Visit us at memios.ai and subscribe to The Longevity Letter on Substack.

About Cancer Fitness

Dr. Jay Harness is a board-certified cancer surgeon and the founder of Cancer Fitness. His work focuses on one core idea: exercise is medicine for cancer patients and survivors.

Research backs him up. Regular movement reduces recurrence risk, improves treatment outcomes, and rebuilds strength and quality of life.

Visit cancerfitness.org to learn more.

Disclaimer: memios shares wellness and longevity content for general education. We are not doctors, healthcare providers, or licensed medical professionals, and we do not provide medical advice, diagnosis, or treatment. We are health conscious individuals documenting what we learn and what we do as we work toward living long, healthy, strong lives into our 90s. Always talk with your physician or qualified healthcare professional before starting, changing, or stopping any exercise, nutrition, supplement, or health program.

Why This Report Matters

I think about cancer every single day.

After my own melanoma diagnosis in 2022, my father’s battle with multiple myeloma and amyloidosis, and watching my best friend fight Stage IV melanoma, cancer stopped being a headline for me. It became personal.

So when a comprehensive new study — the Global Burden of Disease (GBD) 2023 Cancer Report — was published in The Lancet in September 2025, I read every page. The research team analyzed data from 204 countries and territories, covering 47 types of cancer, spanning 1990 to 2023, with forecasts all the way to 2050.

The findings are sobering. The global cancer burden is large, it is growing, and if current trends hold, it will nearly double within your lifetime.

But there is also real reason for hope — and clear, actionable steps that you can take right now to reduce your personal risk.

Let me walk you through what the data says, and more importantly, what it means for you.

The Numbers: As of 2023

In 2023, there were 18.5 million new cancer cases worldwide (excluding non-melanoma skin cancers). Cancer caused 10.4 million deaths globally. Those deaths add up to 271 million disability-adjusted life years (DALYs) — a measure that captures both years of life lost and years lived in poor health.

Cancer ranked as the second leading cause of death globally, behind cardiovascular disease.

The five cancers with the most new cases in 2023:

• Breast cancer — 2.30 million cases

• Lung cancer (tracheal, bronchus, and lung) — 2.30 million cases

• Colorectal cancer — 2.29 million cases

• Prostate cancer — 1.41 million cases

• Stomach cancer — 1.26 million cases

The five cancers that killed the most people in 2023:

• Lung cancer — 2.04 million deaths

• Colorectal cancer — 1.11 million deaths

• Stomach cancer — 935,000 deaths

• Breast cancer — 778,000 deaths

• Esophageal cancer — 577,000 deaths

If you are 50 or older, these are not abstract numbers. These are the cancers your doctor screens for. These are the ones that affect your neighbors, your friends, your family members. Understanding the landscape of the global cancer burden helps you focus your energy in the right places.

The Forecast: Where We Are Headed by 2050

This is where the data becomes urgent.

By 2050, the study projects:

• 30.5 million new cancer cases per year — a 60.7% increase from 2024

• 18.6 million cancer deaths per year — a 74.5% increase from 2024

• 404 million DALYs — a 46.2% increase from 2024

To put that in plain language: cancer deaths are forecast to nearly double in 25 years.

The most important thing to understand about these projections is why they are happening. The researchers were clear: most of the increase is driven by demographic changes — meaning an aging and growing world population — rather than rising rates of cancer per person.

In fact, age-standardized cancer death rates (which account for population aging) are forecast to change by only about -5.6% between 2024 and 2050. That means the risk of any individual getting cancer at a given age is not exploding — but because there are more older people on the planet, the total number of cases and deaths keeps climbing.

For you, that distinction matters. It means that at the individual level, you have more control than the raw numbers suggest.

The Age Factor: Why Your 50s and 60s Are a Critical Window

The study confirmed what most cancer researchers already know: cancer risk rises sharply with age.

In 2023, adults aged 65 and older accounted for:

• 52.7% of all cancer cases

• 61.7% of all cancer deaths

• 40.9% of all cancer DALYs

Adults aged 40–64 accounted for:

• 38.2% of all cancer cases

• 32.7% of all cancer deaths

This means that if you are between 50 and 75 — the core memios community — you are entering the highest-risk decades of your life for cancer. This is not meant to alarm you. It is meant to motivate you.

The decisions you make in your 50s and 60s about diet, exercise, smoking, alcohol, sleep, stress, and regular screening directly affect your odds of developing cancer in your 70s and 80s. The window to act is open right now.

What Is Driving the Global Cancer Burden?

1. Modifiable Risk Factors Account for Over 40% of Cancer Deaths

This statistic stopped me when I first read it.

The study found that 41.7% of all cancer deaths in 2023 were attributable to modifiable risk factors — meaning factors that can be changed through behavior or prevention programs.

The top risk factors, ranked:

Behavioral risk factors were the biggest category overall. Within that group:

• Tobacco was the single leading cause of risk-attributable cancer deaths, responsible for 21.4% of all cancer deaths. Tobacco contributes to 16 different cancer types.

• High alcohol use was linked to 10 cancer types.

• Dietary risk factors (including low fiber, high processed meat, low fruit and vegetable intake) were linked to 6 cancer types.

• Unsafe sex (linked to HPV-driven cervical cancer) was the leading risk factor for women in low-income countries.

Metabolic risk factors — including high fasting blood glucose and elevated BMI — are growing contributors. By 2023, high fasting plasma glucose had moved into the top three risk factors globally, displacing air pollution from its earlier ranking in 1990.

Environmental and occupational risk factors included asbestos exposure (driving mesothelioma, which had 84.9% of its burden attributable to this single risk) and various workplace carcinogens.

The shift toward metabolic risk factors over three decades is worth paying attention to. Obesity, insulin resistance, and elevated blood sugar are increasingly driving cancers of the colon, liver, pancreas, and uterus. These are conditions that respond to lifestyle changes.

2. Lung Cancer Remains the Deadliest

Despite decades of anti-smoking campaigns, lung cancer remains the leading cause of cancer death globally. By 2050, the number of lung cancer deaths is forecast to increase by 62.5% in absolute terms — even though age-standardized rates will likely keep falling.

That means fewer people are getting lung cancer at any given age, but because the world population is larger and older, total deaths keep rising.

The message for you: if you smoke, stopping remains the single highest-return health action you can take. If you have a significant smoking history, ask your doctor about low-dose CT lung cancer screening.

3. Colorectal Cancer Is Rising Fast

Colorectal cancer deserves more attention than it gets.

New colorectal cancer cases increased by 142.7% between 1990 and 2023 — one of the largest raw increases of any cancer. Deaths from colorectal cancer increased 90.2% in the same period.

By 2050, colorectal cancer deaths are forecast to increase by 93.5% from 2024 levels — the largest projected increase among the three leading cancer killers.

The risk factors for colorectal cancer include dietary patterns (low fiber, high processed meat), physical inactivity, obesity, alcohol, and tobacco. These are all modifiable.

Colonoscopy and stool-based testing (like Cologuard or FIT) catch colorectal cancers early, when they are highly treatable. If you are 45 or older and have not been screened, this is urgent.

4. Breast Cancer: Progress, But Unfinished Work

Breast cancer is the most commonly diagnosed cancer globally in 2023 — 2.30 million new cases. It is also the leading cancer killer of women in 134 countries.

The age-standardized death rate for breast cancer dropped by 7.8% globally between 1990 and 2023, reflecting real progress in early detection and treatment in high-income countries. But forecasts show that lower-income countries will face increasing breast cancer burdens as their populations age and access to screening and treatment remains uneven.

For women in the memios community, the message is straightforward: regular mammography, knowing your personal and family risk, and maintaining a healthy weight and active lifestyle all matter.

5. Prostate Cancer: The Numbers Are Large, Mortality Is Falling

Prostate cancer is now the most commonly diagnosed cancer in males in 112 countries.

The good news: the age-standardized prostate cancer death rate fell by 17.2% between 1990 and 2023. Improved PSA screening and better treatments have made a real difference.

Prostate cancer has minimal attributable risk from the modifiable factors tracked in this study — only 1.6% of prostate cancer DALYs were attributed to modifiable risks. That means genetics and age are the dominant drivers. Regular screening discussions with your doctor starting at age 50 (or 45 if you have a family history or are of African descent) are your best tool.

The Income Gap: Cancer Is Not an Equal-Opportunity Disease

One of the most important findings in this report is how unequally the cancer burden is distributed — and how this inequality is getting worse.

In 2023:

• 57.9% of new cancer cases occurred in low- to upper-middle-income countries

• 65.8% of cancer deaths occurred in the same group

Between 1990 and 2023, age-standardized cancer death rates decreased by 27.3% in high-income countries. They increased by 16.6% in lower-middle-income countries.

By 2050, forecasted increases in cancer deaths are 90.6% in low- and middle-income countries — compared to 42.8% in high-income countries.

This gap reflects stark differences in access to cancer screening, early detection, quality treatment, and survivorship care. It also reflects higher exposure to infection-related cancers (such as cervical cancer from HPV and liver cancer from hepatitis B and C) that disproportionately affect lower-income settings.

If you live in the United States, Canada, the UK, or Australia — where most of the memios community is based — you are in a privileged position with access to screening and treatment. Use it.

The Silver Lining: Age-Standardized Rates Are Improving

Here is the good news buried in the data.

Between 1990 and 2023, the global age-standardized cancer death rate fell by 23.9%. That is a significant improvement over 33 years.

This means that at any given age, your odds of dying from cancer are meaningfully better today than they were in 1990. Better screening, earlier detection, and better treatments — particularly for breast, prostate, colorectal, and hematologic cancers — are making a real difference.

The challenge is keeping up with a growing and aging population. The total numbers keep rising even as individual risk improves.

The forecasts also show that age-standardized cancer death rates are projected to continue falling through 2050, by about 5.6% globally. The progress is real. It just is not fast enough to meet the UN Sustainable Development Goal of reducing premature NCD deaths by one-third between 2015 and 2030.

The probability of dying from cancer between ages 30 and 70 is forecast to fall from 7.0% in 2015 to 6.5% in 2030 — a relative decrease of about 6.5%. Better than nothing — but far short of the 33% reduction target.

What You Can Do Right Now

Here is where I want you to focus your energy. The global cancer burden is rising, but a large share of that burden is preventable at the individual level.

Stop Smoking — or Help Someone Else Stop

Tobacco is responsible for 21.4% of all risk-attributable cancer deaths globally. It contributes to cancers of the lung, larynx, mouth, throat, esophagus, stomach, pancreas, kidney, bladder, and cervix.

If you smoke, stopping is the highest-return health decision you can make. Full stop. Your physician can help with medications, nicotine replacement, and behavioral support.

If you have a history of heavy smoking (30 pack-years or more, currently smoking or quit within the past 15 years, ages 50–80), ask your doctor about annual low-dose CT lung cancer screening. It saves lives.

Reduce Alcohol

Alcohol contributes to 10 different cancer types, including cancers of the mouth, throat, esophagus, liver, colorectal region, and breast.

The research is clear that there is no completely “safe” level of alcohol when it comes to cancer risk. Reducing consumption — or eliminating it — reduces your risk.

Move Your Body

Physical inactivity is linked to colorectal, breast, and uterine cancers. Regular exercise also reduces obesity, insulin resistance, and chronic inflammation — all of which drive cancer risk.

You do not need to run marathons. A brisk 30-minute walk most days of the week makes a measurable difference. Weight training 2–3 times per week has additional benefits for metabolic health.

The research in this area keeps getting stronger. Earlier work published in the British Journal of Sports Medicine has shown that structured exercise after cancer surgery improves survival. Exercise is not just prevention — it is part of treatment and survivorship.

Manage Your Metabolic Health

High fasting blood glucose and elevated BMI are now top-tier cancer risk factors. Metabolic cancer drivers include:

• Liver cancer (linked to non-alcoholic steatohepatitis/NASH)

• Colorectal cancer

• Pancreatic cancer

• Breast cancer (post-menopausal)

• Uterine cancer

• Kidney cancer

Know your blood glucose, HbA1c, BMI, and waist circumference. Ask your doctor to screen you for pre-diabetes if you have not done so recently. Metabolic health is not just about heart disease — it directly affects your cancer risk.

Eat a Cancer-Protective Diet

Dietary risk factors are linked to colorectal, esophageal, and stomach cancers. The research broadly supports:

• High fiber intake (whole grains, legumes, vegetables)

• Low processed and red meat consumption

• Adequate fruit and vegetable intake

• Limited ultra-processed food consumption

No single “superfood” prevents cancer. But overall dietary patterns matter significantly, particularly for colorectal cancer.

Get Screened — and Keep Getting Screened

Regular cancer screening catches cancers at early, treatable stages. The key screenings for adults over 50:

• Colorectal cancer: Colonoscopy every 10 years, or stool testing annually (FIT or Cologuard). Start at 45.

• Breast cancer: Mammogram annually or every 2 years starting at 40–50, depending on your personal risk and your doctor’s guidance.

• Cervical cancer: Pap smear every 3 years, or Pap plus HPV test every 5 years, through age 65.

• Prostate cancer: PSA discussion with your doctor starting at 50 (45 if higher risk).

• Lung cancer: Annual low-dose CT if you meet the high-risk smoking criteria.

• Skin cancer: Annual skin exam, particularly if you have a history of significant sun exposure (this one is personal for me).

Do not skip screening because you feel healthy. Many cancers have no symptoms until they are advanced. Early detection is your most powerful tool.

Protect Yourself from Infection-Driven Cancers

Several cancers are driven by preventable infections:

• Cervical cancer: 100% of cervical cancer DALYs are attributable to unsafe sex (HPV). The HPV vaccine is approved through age 45. Talk to your doctor about whether it applies to you.

• Liver cancer: Hepatitis B and C drive a large share of liver cancers globally. Know your status. Hepatitis C is now curable with antiviral medications.

• Stomach cancer: H. pylori infection is a known cause of stomach cancer. If you have chronic stomach issues, ask about testing.

Talk to Your Doctor About Your Personal Risk

The most important step is also the most obvious: have an honest conversation with your doctor about your cancer risk profile.

Bring this to your next appointment:

• Your family history of cancer (first and second-degree relatives, types, age at diagnosis)

• Your personal history (any previous cancers, polyps, or abnormal screenings)

• Your lifestyle factors (smoking, alcohol, diet, exercise, BMI)

• The screenings you are due for

A 30-minute conversation can shape a prevention plan that is specific to you.

The Bigger Picture: What Needs to Change Globally

Individual action matters. But the study makes clear that individual action is not enough.

The researchers call for comprehensive national and international efforts that address:

• Cancer prevention through policies reducing exposure to tobacco, alcohol, obesity, and air pollution

• Screening and early detection programs, particularly in lower-income settings

• Quality treatment and survivorship care accessible across income levels

• Health system strengthening in low- and middle-income countries where age-standardized death rates are still rising

• Increased funding for cancer control in global health — currently, non-communicable diseases like cancer are dramatically underfunded relative to their disease burden

• Better cancer surveillance data globally, so that estimates can be more accurate and policies better targeted

The UN Sustainable Development Goal of reducing premature NCD deaths by one-third by 2030 will not be met at current trajectories. The study is explicit about this. More investment, more political will, and faster implementation of known strategies are needed.

For those of us in high-income countries, this means supporting policies that fund global cancer control and advocating for universal access to screening and treatment. For those of us on a personal wellness journey, it means doing our part to stay healthy, get screened, and take prevention seriously.

Cancer Specific Takeaways for the Over-50 Community

Because the memios community is focused on living strong and active into your 80s and 90s, here is a direct summary of what this study means for your age group.

You are entering the highest-risk years for cancer. Adults over 65 account for 62% of cancer deaths. Your 50s and 60s are the critical window to build protective habits and stay current on screenings.

Colorectal cancer is the one to watch most closely. It is one of the fastest-growing cancers in absolute terms, it has clear modifiable risk factors, and it is highly detectable through screening. If you have not had a colonoscopy, get one.

Metabolic health is a cancer issue, not just a heart disease issue. Obesity and insulin resistance are now recognized top-tier cancer risk factors. Managing your weight, blood glucose, and inflammation is directly cancer-protective.

Progress is real, but it is not automatic. The fact that age-standardized cancer death rates have fallen 24% since 1990 is genuinely good news. But you have to participate in the system — screening, lifestyle, and working with your physician — to benefit from that progress.

You have more control than the numbers suggest. Over 40% of cancer deaths are attributable to modifiable risk factors. That is not a small number. It means that the choices you make today matter enormously.

FAQ: Cancer Burden, Risk, and Prevention

Q: What does the Global Burden of Disease study tell us about cancer?

The GBD 2023 Cancer Report, published in The Lancet in September 2025, analyzed cancer data from 204 countries from 1990 to 2023 and projected cancer burden to 2050. It found that there were 18.5 million new cancer cases and 10.4 million cancer deaths globally in 2023, and that cases will likely reach 30.5 million per year by 2050.

Q: Why is the global cancer burden increasing so much?

The primary driver is demographic change — the world population is growing and aging. Most of the increase in total cancer deaths is not from rising rates per person, but from more older people being alive. Age-standardized death rates (which remove this demographic effect) are actually falling globally.

Q: What percentage of cancer is preventable?

The study found that 41.7% of cancer deaths in 2023 were attributable to modifiable risk factors including tobacco, alcohol, diet, physical inactivity, obesity, and certain infections. This suggests that a meaningful share of cancers can be reduced through lifestyle and prevention efforts, though not all cancers have known preventable causes.

Q: What is the single biggest cancer risk factor?

Tobacco. It is responsible for 21.4% of all risk-attributable cancer deaths globally and contributes to 16 different cancer types. Quitting smoking is the highest-return single action you can take for cancer prevention.

Q: Which cancers are most common in people over 50?

For men: prostate cancer (most commonly diagnosed in 112 countries), lung cancer, and colorectal cancer. For women: breast cancer (most commonly diagnosed in 164 countries), lung cancer, and colorectal cancer. Both lung cancer and colorectal cancer are among the leading causes of cancer death in adults over 65.

Q: Is cancer risk growing for people my age (50–70)?

Cancer incidence and mortality both rise sharply after age 50. Adults 65 and older account for about 62% of cancer deaths globally. Your risk at any given age is actually better than it was in 1990 — but you still need to take screening and prevention seriously.

Q: How does metabolic health affect cancer risk?

High BMI and elevated blood glucose (insulin resistance, pre-diabetes, and type 2 diabetes) are now top-tier cancer risk factors, particularly for cancers of the colon, liver, pancreas, uterus, breast (post-menopause), and kidney. Managing your weight and blood sugar through diet and exercise directly reduces cancer risk.

Q: What cancer screenings should I prioritize?

For adults over 50, the highest-priority screenings are colorectal cancer (colonoscopy starting at 45), breast cancer (mammogram), cervical cancer (Pap/HPV testing), prostate cancer (PSA discussion with your doctor), and lung cancer screening if you meet the high-risk smoking criteria. Annual skin checks are also important for those with significant sun exposure history.

Q: Will cancer rates keep rising, or is there progress being made?

Both are true. Total cancer cases and deaths will keep rising globally, primarily because of aging and population growth. But at the individual level — controlling for age — cancer death rates have fallen 24% since 1990 and are expected to continue falling. Progress is real, but it requires active participation in screening and prevention.

Q: What can countries do to reduce cancer burden?

The study calls for stronger cancer control policies including tobacco and alcohol taxation, HPV vaccination programs, expansion of cancer screening in lower-income countries, improved treatment access, better cancer surveillance data, and increased global health funding dedicated to non-communicable diseases.

Additional Information

Source Study

This blog post is based on the following peer-reviewed publication:

GBD 2023 Cancer Collaborators. The global, regional, and national burden of cancer, 1990–2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet. Published online September 24, 2025. DOI: https://doi.org/10.1016/S0140-6736(25)01635-6

Related Research and Resources

Global Cancer Statistics (GLOBOCAN 2022): Bray F, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2024; 74: 229–63. https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21834

GBD Results Tool (interactive data visualization): https://vizhub.healthdata.org/gbd-results/

GBD Compare Visualization: https://vizhub.healthdata.org/gbd-compare

GBD 2023 Forecasting Tool: https://vizhub.healthdata.org/gbdforesight/

UN Sustainable Development Goal 3.4 (NCD Mortality Reduction):https://www.who.int/data/gho/data/themes/topics/indicator-groups/indicator-group-details/GHO/sdg-target-3.4-noncommunicable-diseases-and-mental-health

WHO Global Action Plan for the Prevention and Control of NCDs:https://www.who.int/publications/i/item/9789241506236

American Cancer Society — Cancer Screening Guidelines: https://www.cancer.org/cancer/screening.html

National Cancer Institute — Cancer Prevention: https://www.cancer.gov/about-cancer/causes-prevention

HPV Vaccine Information (CDC): https://www.cdc.gov/hpv/parents/vaccine-for-hpv.html

Lung Cancer Screening Guidelines (USPSTF):https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening

Colorectal Cancer Screening Guidelines (ACS): https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html

Global Initiative for Cancer Registry Development (GICR): https://gicr.iarc.fr/about-the-gicr/

Connect with memios

• Website — https://www.memios.ai

• Newsletter — The Longevity Letter

• Facebook — https://www.facebook.com/memiosai

About Cancer Fitness

Dr. Jay Harness is a board-certified cancer surgeon and the founder of Cancer Fitness. His work focuses on one core idea: exercise is medicine for cancer patients and survivors.

Research backs him up. Regular movement reduces recurrence risk, improves treatment outcomes, and rebuilds strength and quality of life.

Visit cancerfitness.org to learn more.

Disclaimer: memios shares wellness and longevity content for general education. We are not doctors, healthcare providers, or licensed medical professionals, and we do not provide medical advice, diagnosis, or treatment. We are health conscious individuals documenting what we learn and what we do as we work toward living long, healthy, strong lives into our 90s. Always talk with your physician or qualified healthcare professional before starting, changing, or stopping any exercise, nutrition, supplement, or health program.

If you survived cancer as a child or teenager, you already know that survivorship does not end when treatment ends.

You carry that history with you. You watch your body. You wonder — sometimes in the quiet of a doctor’s waiting room, sometimes at 3 a.m. — what the decades ahead might bring.

A major new study published in the Journal of Clinical Oncology in August 2025 gives us some of the most detailed answers we have ever had about childhood cancer survivors after 50. Researchers followed 7,490 survivors who made it to age 50, then studied what happened to their health from that point forward — mortality, new cancers, chronic conditions, frailty, and quality of life.

The news is mixed. There are real, persistent risks you need to know about. And there are genuinely encouraging findings, too — particularly if you did not receive radiation as part of your treatment.

This post breaks down what the study found, what it means for you, and what steps you can take right now.

Why This Study Matters

Most research on childhood cancer survivors has focused on people in their 20s, 30s, and 40s. We have had very little data on what happens once those survivors cross into their 50s and beyond — the exact life stage when aging-related health problems accelerate for everyone.

This study, led by Dr. Rusha Bhandari and colleagues from City of Hope, St. Jude Children’s Research Hospital, Fred Hutchinson Cancer Center, and other leading institutions, fills that gap.

The research draws from the Childhood Cancer Survivor Study (CCSS), a large, multi-institutional cohort of 37,577 five-year survivors diagnosed with cancer before age 21, between 1970 and 1999. Of those, 7,490 had survived to at least age 50 by December 31, 2021.

The researchers looked at:

• Overall and cause-specific mortality

• Subsequent malignant neoplasms (new cancers)

• Chronic health conditions (CHCs)

• Frailty

• General health status, physical function, and mental health

They compared survivors to both general U.S. population data and to a sibling control group — people who did not have childhood cancer but grew up in the same families.

The results are detailed, data-rich, and directly relevant to you if you or someone you love is a long-term cancer survivor.

The Mortality Picture: Still Elevated, But Improving

One of the first things the study measured was how likely childhood cancer survivors after 50 are to die compared to the general population.

The overall standardized mortality ratio (SMR) — a measure that compares actual deaths to expected deaths in the general population — was 3.2.

That means survivors over 50 were dying at about three times the rate of their peers in the general population.

That sounds alarming. But here is the critical context: among younger survivors (median 29 years from diagnosis), the mortality risk was nearly six times higher than the general population. So the relative risk drops considerably as survivors age into their 50s and beyond.

Why does the gap narrow? Two reasons:

1. The general population starts accumulating its own age-related health problems in the 50s and 60s, narrowing the relative difference.

2. Survivors who made it to 50 may represent a more resilient group — people whose bodies withstood decades of survivorship.

Mortality by Age Group

Here is how 15-year mortality risk looked after reaching age 50:

• At 5 years (by age 55): 8.6%

• At 10 years (by age 60): 18.4%

• At 15 years (by age 65): 32.7%

These rates are considerably higher than for the general U.S. population at the same ages.

Women Face Higher Relative Risk

One of the more striking findings: female survivors had a higher SMR (4.3) than male survivors (2.6) across all age groups.

The most likely explanation involves cardiovascular disease. Women treated with gonadal-toxic therapies may lose hormonal protection against heart disease. Radiation and alkylating agent chemotherapy can cause primary ovarian insufficiency, which is linked to higher cardiovascular risk later in life.

This is important. If you are a woman who survived childhood cancer, cardiovascular health deserves your serious attention — regardless of whether heart disease feels like a priority right now.

The Leading Cause of Death: New Cancers

The most common cause of death among survivors over 50 was a subsequent malignant neoplasm — meaning a new cancer that developed after the original childhood cancer.

The SMR for death due to new cancers was 4.7 — nearly five times the rate in the general population.

Respiratory cancers accounted for the most cancer-related deaths (6.0% of all deaths in the cohort).

New Cancers After 50: The Radiation Connection

This is where the study delivers one of its most important — and most actionable — findings.

Among the 2,920 survivors evaluated for subsequent malignant neoplasms (SMNs), about 7.6% developed 252 new cancers after age 50.

The overall risk of developing a new cancer was roughly 1.5 to 2 times higher than the general population across all age groups studied.

But here is the critical nuance: that elevated risk was almost entirely driven by prior radiation therapy exposure.

Survivors Who Did Not Receive Radiation

Survivors who never received radiation therapy had new cancer rates comparable to the general population.

Let that sink in. At a median of 44 years after their initial childhood cancer diagnosis, survivors without radiation exposure had essentially normalized their cancer risk.

The study calculated that 40% of all new cancers occurring after age 50 among survivors were directly attributable to prior radiation therapy.

What Types of Cancer Were Most Common?

Survivors had elevated risks for several specific cancer types compared to the general population:

• Bone and soft tissue cancers: more than 13 times higher risk

• Thyroid cancer: 2.6 times higher

• Blood cancers (lymphoma/leukemia): 2.7 times higher

• Breast cancer: 2.1 times higher

• Gastrointestinal cancers: 1.7 times higher

• Lung/pulmonary cancers: 1.6 times higher

Chest radiation was independently associated with the highest new cancer risk in the analysis.

What About Chemotherapy?

The study found no significant association between specific chemotherapy drugs and new cancer risk after age 50.

This is different from earlier-in-survivorship studies that have linked certain chemo agents — platinum, anthracyclines, alkylating agents — to elevated new cancer risk. The researchers suggest that chemotherapy-related new cancer risk is highest in the earlier decades of survivorship, and that risk appears to largely normalize by the time survivors reach their 50s.

This is genuinely encouraging news for survivors whose treatment was primarily chemotherapy-based.

Chronic Health Conditions: A Significant Burden

Beyond new cancers, the study looked closely at chronic health conditions (CHCs) — things like heart disease, lung disease, endocrine disorders, neurological problems, and musculoskeletal conditions.

Conditions were graded from mild (grade 1) to fatal (grade 5). The study focused on grades 3 through 5: severe, life-threatening, or fatal conditions.

The Numbers Are Sobering

Among the 2,723 survivors analyzed for health outcomes:

• At age 50, 60.7% already had at least one grade 3-5 chronic health condition.

• By age 65, that figure rose to 79.2%.

Compare that to their siblings (who did not have childhood cancer):

• At age 50, only 23.0% of siblings had a grade 3-5 CHC.

• By age 65, that rose to 41.7% for siblings.

So survivors enter their 50s with roughly the same chronic disease burden as their 70-year-old siblings without a cancer history.

Let that comparison settle. Childhood cancer survivors after 50 carry the chronic disease burden of someone 20 years older.

Multiple Conditions Are Common

It is not just one health problem. The study found that by age 55, survivors had a 39.5% cumulative incidence of multiple grade 3-5 chronic conditions — which already exceeds the 28.3% rate seen in 70-year-old siblings.

In adjusted models, survivors had:

• 2.6 times the risk of any serious chronic health condition compared to siblings

• 3.3 times the risk of multiple serious chronic health conditions

Again, this elevated risk was primarily found in survivors who received radiation therapy. Survivors treated with surgery or chemotherapy only did not show the same dramatically elevated risk.

Frailty, Physical Function, and Mental Health

The study also examined frailty — a syndrome of physical weakness, exhaustion, and reduced resilience — along with broader measures of health and function.

Frailty

Survivors were 2.3 times more likely to be frail than their siblings.

Even after accounting for the impact of chronic health conditions, survivors remained about 1.6 times more likely to be frail than siblings.

The only treatment factor independently linked to higher frailty was — again — chest radiation.

Physical Function

• Survivors were 2.3 times more likely to report physical limitations than siblings

• Survivors were 2.1 times more likely to report functional impairment

These differences remained meaningful even after accounting for chronic health conditions.

The Mental Health Finding May Surprise You

Here is something the data did not predict: survivors were not more likely to report poor mental health than their siblings.

The researchers note this aligns with previous studies and may reflect genuine psychological resilience — the positive mindset and coping capacity that many long-term cancer survivors develop over decades of navigating a difficult health history.

If you are a long-term survivor reading this, you may recognize this in yourself. The mental and emotional work of survivorship, while hard, can build real strength.

What This Means If You Are a Childhood Cancer Survivor

I want to step out of the research summary for a moment and speak directly to you.

I built memios after my own melanoma diagnosis in 2022. I know what it is like to sit with a cancer history and wonder what it means for the years ahead. I think about it differently now than I did in my 40s — with more intention, more awareness, and honestly, more resolve.

If you survived cancer as a child or teenager, this study is not a reason to panic. It is a reason to pay attention.

Here is what I take from this research:

You Are Not the Same as a Person Who Never Had Cancer

That is not a negative statement. It is just true. Your body carries the effects of treatments that happened decades ago — and for some of you, especially those who received radiation, those effects are still actively shaping your health trajectory.

Knowing that changes what proactive health means for you. The standard “over 50” wellness checklist is a starting point, but it is not enough.

Screening Matters More for You

The study’s authors are direct about this: ongoing surveillance and early intervention for chronic health conditions, plus risk-based screening for new cancers and frailty, are specifically important for survivors in this age range.

That means:

• Regular cardiovascular screening, especially if you are female or received radiation near the chest or heart

• Cancer screening appropriate to your specific radiation exposure history — breast, thyroid, GI, lung, bone/soft tissue depending on what was irradiated

• Frailty assessment — not just asking “do you feel tired?” but structured evaluation of physical capacity and reserve

• Endocrine health monitoring, including thyroid function, bone density, and hormonal status

Talk to a Survivorship Specialist

If you have not already connected with a long-term survivorship clinic, this study is your signal to do that. These clinics specialize in exactly the kinds of late-effect risks this research documents. They look at your original treatment records, your current health, and build a monitoring plan tailored to your specific history.

Many major cancer centers have them. Organizations like the Children’s Oncology Group publish long-term follow-up guidelines that can help you and your doctor understand what surveillance is recommended based on your specific cancer type and treatment.

You Can Still Move the Needle on Lifestyle

The study did not find associations between chemotherapy and late health outcomes after 50. And the chronic disease burden, while real, is not destiny. Lifestyle factors — physical activity, nutrition, not smoking, cardiovascular health — still matter enormously for long-term cancer survivors.

Exercise is one of the most consistent interventions in the survivorship literature for improving physical function, reducing frailty, and supporting cardiovascular health. If you are not already exercising consistently, there is no better time to start than right now.

For Caregivers and Family Members

If you are supporting a parent, spouse, or sibling who survived childhood cancer and is now over 50, this research matters for you too.

The people you love may be carrying health risks they are not fully aware of. They may have lost touch with their original oncology team decades ago. They may not know what “late effects” means or that specific screening is recommended for them.

Sharing this information is an act of care. Helping them connect with a survivorship clinic — or even just asking their primary care doctor about late-effect screening — can make a real difference.

The Encouraging Bottom Line

I want to end the research section on what the study got right — because there is real hope here.

The risks are real. But so are these findings:

• Survivors without radiation therapy had new cancer rates comparable to the general population by their 50s. Decades after treatment, the cancer risk largely normalized for this group. That is remarkable.

• Chemotherapy does not appear to drive new cancer or chronic condition risk after 50 in the same way it does in younger survivors.

• Mental health among survivors was comparable to siblings — suggesting real psychological resilience in this population.

• The mortality risk gap, while still significant, has narrowed considerably compared to earlier decades of survivorship. The relative risk drops from nearly 6-fold in younger survivors to about 3-fold after 50.

• Treatment approaches for childhood cancer have continued to evolve, with efforts to reduce radiation exposure. Future generations of survivors may face a smaller late-effects burden.

Practical Steps You Can Take This Week

This is the part that matters most. Knowledge without action is just anxiety.

1. Pull together your treatment records. If you do not have documentation of exactly what cancer you had, what chemotherapy you received, and whether (and where) you received radiation, get it. Contact the hospital where you were treated. This information is the foundation of any meaningful late-effect risk assessment.

2. Tell your current doctor you are a childhood cancer survivor. Specifically tell them you received radiation, if you did, and where. Many primary care physicians are not trained in survivorship medicine and will not think to ask. You have to be the one who brings this up.

3. Ask about a survivorship care plan. A survivorship care plan documents your cancer history, treatment exposures, and a recommended surveillance schedule going forward. If your oncology team never gave you one, ask for it now.

4. Get your heart checked. Given the elevated cardiovascular risk — especially for women, and especially for anyone who received chest radiation — a cardiovascular workup is worth having. Talk to your doctor about what tests make sense for you.

5. Start tracking your physical function. Frailty does not happen overnight. It develops gradually, often invisibly. Tracking things like grip strength, walking speed, and general energy levels gives you a baseline and an early warning system.

6. Exercise. Consistently. Not perfectly. Not heroically. But consistently. Even moderate physical activity — walking, swimming, resistance training, whatever fits your body and your life — has substantial benefits for cancer survivors. It reduces frailty risk, supports cardiovascular health, and improves quality of life.

7. Do not go through this alone. Survivorship communities exist. Organizations like the Children’s Oncology Group, the National Coalition for Cancer Survivorship, and LiveStrong offer resources. Connecting with people who share your history can reduce isolation and give you access to information and support you may not find elsewhere.

A Word About the Study’s Limitations

Good science is honest about its boundaries. The researchers named these clearly:

• Most survivors in this study were treated between 1970 and 1985. Treatment protocols have changed significantly since then — particularly with efforts to reduce radiation exposure. Survivors treated more recently may have a different late-effects profile.

• The study only captures survivors who made it to age 50 — it does not reflect survivors who died earlier, which means the sample may skew toward more resilient individuals.

• Some cancer types common in young children (like Wilms tumor and early leukemia) are underrepresented because those survivors had not yet reached age 50 when the study data was collected.

• Self-reported health data carries some limitations, including potential under-reporting of new cancers.

These limitations do not undermine the findings — they just mean we should interpret them as a foundation for ongoing learning, not a final word.

FAQ: Childhood Cancer Survivors After 50

1. I survived childhood cancer. Does this study apply to me even if I am now in my 50s or 60s?

Yes. The study specifically analyzed survivors who had already reached age 50. If you are in your 50s, 60s, or beyond and had cancer before age 21, this research directly describes your risk profile — especially related to new cancers, chronic health conditions, and frailty.

2. I only received chemotherapy — no radiation. Should I still be concerned about new cancers?

According to this study, survivors who did not receive radiation therapy had new cancer rates comparable to the general population by their 50s. This is genuinely encouraging. You should still follow standard age-appropriate cancer screening recommendations, but the dramatically elevated cancer risk documented in this study was driven by radiation exposure, not chemotherapy.

3. My radiation was decades ago. Does it still affect my health today?

Yes. The study followed survivors an average of 44 years after their original childhood cancer diagnosis and found that radiation-related health risks persisted into the 50s and 60s. The cells and tissues that were irradiated carry permanent changes, even if the original cancer was cured long ago.

4. What types of cancer should I be screened for if I received chest radiation?

Chest radiation is specifically linked to elevated risks of breast cancer, lung cancer, and cardiovascular disease in this study and in the broader survivorship literature. Talk to your doctor or a survivorship specialist about a personalized screening schedule. The Children’s Oncology Group publishes detailed long-term follow-up guidelines organized by treatment type.

5. What does “frailty” mean in this context, and how do I know if it applies to me?

Frailty in survivorship research is defined using the Fried Frailty criteria — a combination of unintentional weight loss, exhaustion, low physical activity, slow walking speed, and weak grip strength. Having three or more of these criteria classifies someone as frail. It is not just “feeling old” — it is a measurable syndrome with real health consequences. Survivors were more than twice as likely to meet frailty criteria as their siblings without cancer histories.

6. The study says women had higher relative mortality risk than men. Why is that?

The researchers point to cardiovascular disease as a likely driver. Women treated with gonadal-toxic therapies (certain chemotherapy agents and radiation) may experience early loss of estrogen production, which normally offers some protection against heart disease. This means female survivors may be at higher cardiovascular risk than both their female peers and than male survivors. If you are a woman who survived childhood cancer, cardiovascular health monitoring is especially important.

7. Should I be going to a regular oncologist, or is there something more specific I should seek out?

A long-term survivorship clinic or late-effects clinic is the most specialized option. These clinics exist at most major cancer centers and focus specifically on people like you — survivors decades out from treatment who need surveillance tailored to their original cancer and treatment history. A good primary care physician can also provide meaningful care if they are aware of your history and familiar with survivorship guidelines.

8. I feel fine. Do I really need to seek out additional screening?

Many of the conditions this study documents — chronic heart disease, thyroid dysfunction, new cancers in early stages — can develop without obvious symptoms. Feeling well does not mean all is well at a cellular level. Proactive screening is designed to find problems early, when they are most treatable. Waiting until you feel sick means missing that window.

9. What lifestyle changes can make the most difference for a childhood cancer survivor over 50?

The survivorship literature consistently points to regular physical exercise as one of the highest-impact interventions. Beyond exercise: not smoking (smoking plus prior radiation dramatically compounds lung cancer risk), maintaining cardiovascular health through diet and activity, managing stress, getting regular sleep, and staying connected to medical care. No single change is magic — the cumulative effect of consistent healthy habits adds up over years.

10. My children want to know if my childhood cancer history affects their cancer risk.

Some childhood cancers and genetic predispositions can carry hereditary components. If your childhood cancer had a known genetic link (certain types of retinoblastoma, Li-Fraumeni syndrome, hereditary breast/ovarian cancer genes, and others), that is worth discussing with a genetic counselor. For most survivors, the late effects documented in this study are related to treatment exposure, not inherited genetics — meaning your children would not carry the same radiation-related risks. But hereditary cancer risk is a separate question worth asking your doctor.

Additional Information

Primary Source

Bhandari R, Chen Y, Chow EJ, et al. Health Outcomes Beyond Age 50 Years in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study. Journal of Clinical Oncology. Published August 11, 2025. DOI: https://doi.org/10.1200/JCO-25-00385

Related Research Referenced in This Study

• Armstrong GT, et al. Reduction in late mortality among 5-year survivors of childhood cancer. N Engl J Med.2016;374:833-842. https://www.nejm.org/doi/10.1056/NEJMoa1510795

• Turcotte LM, et al. Temporal trends in treatment and subsequent neoplasm risk among 5-year survivors of childhood cancer, 1970-2015. JAMA. 2017;317:814-824. https://jamanetwork.com/journals/jama/fullarticle/2603840

• Oeffinger KC, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med.2006;355:1572-1582. https://www.nejm.org/doi/10.1056/NEJMoa060185

• Dixon SB, et al. Specific causes of excess late mortality and association with modifiable risk factors among survivors of childhood cancer. Lancet. 2023;401:1447-1457. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00108-0/fulltext

• Ness KK, et al. Physiologic frailty as a sign of accelerated aging among adult survivors of childhood cancer. J Clin Oncol. 2013;31:4496-4503. https://ascopubs.org/doi/10.1200/JCO.2013.52.2268

Resources for Childhood Cancer Survivors

• Children’s Oncology Group Long-Term Follow-Up Guidelines — Evidence-based surveillance recommendations organized by cancer type and treatment exposure: https://www.survivorshipguidelines.org

• Childhood Cancer Survivor Study (CCSS) — The ongoing research program that produced this study, with survivor resources: http://ccss.stjude.org

• St. Jude Survivorship Portal — Public data and resources from the CCSS and related research: https://survivorship.stjude.cloud

• National Coalition for Cancer Survivorship — Advocacy, resources, and community for all cancer survivors: https://www.canceradvocacy.org

• LIVESTRONG Foundation — Support services and resources for cancer survivors and families: https://www.livestrong.org

• National Cancer Institute: Office of Cancer Survivorship — Research, resources, and survivorship care planning tools: https://cancercontrol.cancer.gov/ocs

Connect with memios

• Website — https://www.memios.ai

• Newsletter — The Longevity Letter

• Facebook — https://www.facebook.com/memiosai

About Cancer Fitness

Dr. Jay Harness is a board-certified cancer surgeon and the founder of Cancer Fitness. His work focuses on one core idea: exercise is medicine for cancer patients and survivors.

Research backs him up. Regular movement reduces recurrence risk, improves treatment outcomes, and rebuilds strength and quality of life.

Visit cancerfitness.org to learn more.

Disclaimer: memios shares wellness and longevity content for general education. We are not doctors, healthcare providers, or licensed medical professionals, and we do not provide medical advice, diagnosis, or treatment. We are health conscious individuals documenting what we learn and what we do as we work toward living long, healthy, strong lives into our 90s. Always talk with your physician or qualified healthcare professional before starting, changing, or stopping any exercise, nutrition, supplement, or health program.

I need to be honest with you about something personal before we get into the research.

When my father was diagnosed with Multiple Myeloma and Amyloidosis, and then when my best friend was going through Stage IV Melanoma treatment, I watched what happened to their bodies. Treatment is brutal. Energy disappears. Muscle fades. The couch becomes the default. And the medical team — as brilliant and dedicated as they were — almost never brought up exercise.

That silence felt natural at the time. You’re fighting cancer. Rest. Recover. Get through it.

But here’s what I know now, after my own Melanoma diagnosis in 2022 and after deep years of reading the research: that silence was costing people. The evidence has been building for decades that exercise during cancer treatment is not just safe — it is one of the most powerful supportive therapies available.

And yet fewer than half of cancer survivors meet basic physical activity guidelines. A study of over 9,000 cancer survivors found only 30 to 47 percent were regularly active. In the United Kingdom, nearly one in three people living with or beyond cancer were found to be completely sedentary.

This post is for you if you or someone you love is navigating cancer. It is for those of you in your 50s, 60s, and 70s who understand what is at stake when your body is under attack and you are trying to figure out what you can actually do. Let’s walk through what the research says, what a real exercise program looks like, and how to get started safely.

The Evidence Is No Longer Debatable

In 2018, the American College of Sports Medicine (ACSM) convened a major international roundtable on exercise and cancer prevention and control. Seventeen organizations from multiple disciplines reviewed the evidence together. Their conclusion was direct: exercise is associated with a lower risk of developing cancer and with improved survival after a cancer diagnosis.

Specifically, strong evidence links regular physical activity to a lower risk of at least seven types of cancer: colon, breast, endometrial, kidney, bladder, esophageal, and stomach cancer. There is also substantial evidence suggesting that exercise improves cancer-specific survival in patients with breast, colon, and prostate cancer.

This is not a minor finding. This is a global scientific consensus.

The ACSM roundtable also addressed what happens after diagnosis. When they looked at cancer-related health outcomes — the day-to-day experience of living through treatment — the evidence was equally compelling.

Strong evidence showed that specific doses of exercise training improve:

• Anxiety

• Depression

• Fatigue

• Quality of life

• Physical function

The panel also confirmed that resistance training is safe even for patients with or at risk for breast cancer-related lymphedema — a concern that had previously caused many clinicians to advise against strength training.

The bottom line from some of the world’s leading cancer and exercise researchers: avoid inactivity, and follow a structured exercise program tailored to your situation.

Why Most Cancer Patients Are Still Not Moving

If the science is this clear, why are most cancer patients not exercising regularly?

The answer is not laziness or indifference. Most patients want guidance. Multiple studies of breast, colorectal, prostate, and mixed-cancer survivor groups found that more than 80 percent of patients were interested in receiving advice about exercise from their cancer care team.

The problem is on the provider side.

A 2019 survey of 971 oncology clinicians conducted by the American Society of Clinical Oncology found that 78.9 percent agreed oncologists should recommend physical activity to patients. But studies show that only 9 percent of oncology nurses and between 19 and 23 percent of oncology physicians actually refer patients to exercise programs.

The gap between belief and action is enormous.

Researchers have identified the key barriers. Oncology clinicians cite a lack of awareness about the value of exercise for cancer patients, uncertainty about safety, no knowledge of available programs, and a belief that exercise referrals fall outside their scope of practice.

There is also a systemic issue. In most healthcare settings, there is no built-in pathway for exercise referral the way there is for psychosocial distress screening or medication management. Exercise simply does not have a formal place in the standard oncology workflow — yet.

The good news: that is starting to change. In 2022, the American Society of Clinical Oncology issued guidelines formally endorsing exercise as a component of comprehensive cancer care. In 2024, the National Accreditation Program for Breast Centers included exercise recommendations as part of its accreditation standards. The tide is turning.

What “Exercise Is Medicine” Means in Oncology

The phrase “Exercise Is Medicine” is not just a slogan. It is a formal initiative from the ACSM launched in 2007 with the goal of making physical activity assessment, advice, and referral a standard part of patient care for chronic disease prevention and treatment.

The framework is built around three steps: Assess, Advise, and Refer.

Assess: Ask the patient how much aerobic and strength-based physical activity they are currently doing. Physical activity should function as a vital sign — recorded and reviewed at every clinical encounter, just as blood pressure is today. Some US health systems, including Kaiser Permanente and Intermountain Health, have already built this into their electronic health records.

Advise: If the patient is not meeting recommended activity levels, the clinician advises them to increase physical activity. Simply hearing this recommendation from their oncologist significantly increases the likelihood that a patient will actually exercise.

Refer: Direct the patient toward an appropriate exercise program — whether that is a supervised clinical program, a community-based program like LIVESTRONG at the YMCA, or a home-based plan — based on their current fitness level, medical status, and personal preferences.

The key insight from the research is that oncology clinicians do not need to become personal trainers or exercise physiologists. They simply need to assess, advise, and point patients in the right direction. The same way they refer patients to psychological services without being clinical psychologists, they can refer patients to exercise specialists without writing detailed training plans.

The Exercise Prescription That Actually Works

So what does exercise during cancer treatment actually look like?

The ACSM Roundtable generated specific exercise prescriptions based on the available evidence. Here is what the research supports as both safe and effective for most cancer patients:

Aerobic Exercise:

• Three times per week

• Moderate intensity — described as a pace where you can talk but not sing (brisk walking, light biking, water exercise, dancing)

• Building up to 30 minutes per session

• You can break it into shorter segments — 5 or 10 minutes at a time — and still get benefit

• A target of 7,000 to 9,000 steps per day is also supported

Resistance Training:

• Two times per week

• One exercise per major muscle group

• 8 to 15 repetitions per set

• 2 sets per exercise

• Progress with small, gradual increases

• You do not need a gym — resistance bands, bodyweight exercises, light dumbbells, and even heavy household tasks all count

This prescription is described as the minimum safe and effective dose to address anxiety, depression, fatigue, quality of life, and physical function deficits. Your clinician will adjust this based on your specific situation and what your body can tolerate.

One important caveat: supervised exercise consistently produces better outcomes than unsupervised exercise. If you have access to a qualified exercise professional with cancer-specific training, take it.

The Four Phases of Cancer Exercise: A Patient Journey

One of the most useful frameworks to come out of recent exercise oncology research is the idea of phase-based exercise programming — a structured pathway that tracks with where you are in your cancer journey.

Phase 0: Prehabilitation

This is the period between diagnosis and the start of treatment. If you have any time before chemotherapy, radiation, or surgery begins, use it. Baseline fitness measurements are taken. You receive education about what is coming. Exercise programming is initiated if possible. Building your strength and aerobic capacity before treatment begins gives your body more reserves to draw on when the hard days come.

Phase 1: Active Treatment

This is chemotherapy, radiation, or both. The primary goal here is not performance — it is protection. Protecting your immune function. Minimizing treatment-related side effects. Staying as active as your body will allow on any given day. Even gentle movement matters.

Research from randomized controlled trials has shown that exercise during chemotherapy reduces nausea, decreases treatment-related fatigue, and improves overall quality of life. For some cancer types, there is evidence that exercise may actually improve how well the treatment itself works.

Phase 2: Pre-Survivorship

Treatment has ended, but recovery is not. This is the bridge between active cancer treatment and the point where you are exercising independently in the community. Many people in this phase are still managing surgical recovery, lingering fatigue, or early side effects. A supervised exercise program is often most appropriate here, working alongside or following a physical therapy referral.

Phase 3: Survivorship

Cancer-free and in remission. The work is not done — it is actually more important than ever. Research is clear that maintaining an active lifestyle during long-term survivorship reduces the risk of cancer recurrence. This is also when many people transition into community-based fitness programs, ideally with a trainer who holds a cancer-specific certification.

Who Should Be on Your Exercise Oncology Team

Exercise oncology works best as a team effort. Here is who the research identifies as the key players:

Physical Medicine and Rehabilitation Physicians (PM&R) and Oncology-Trained Physical Therapists

These are the specialists at the top of the clinical hierarchy. They conduct comprehensive assessments and design individualized programs for patients who have significant functional limitations — difficulty walking, severe weakness, balance problems, peripheral neuropathy. If you have meaningful physical impairments from your cancer or treatment, start here.

One evidence-based triage tool called EXCEEDS (Exercise in Cancer Evaluation and Decision Support) helps determine which patients need physical therapy, which are ready for supervised exercise programming, and which can safely move into community-based activity. In one real-world program using this tool, approximately 38 percent of referred patients went directly to physical therapy, 14 percent did physical therapy alongside exercise programming, and 48 percent were cleared to continue directly in a supervised exercise program.

Certified Exercise Oncology Instructors

These are exercise professionals with a four-year degree in exercise science or a related field plus oncology-specific certification — such as the ACSM/ACS Cancer Exercise Specialist credential or an equivalent program. They work with patients who are in active treatment without significant functional impairments, designing and supervising individualized exercise programs.

Cancer Survivorship Exercise Trainers

These professionals work at the community level with cancer survivors who have completed active treatment. They provide ongoing exercise programming aimed at maintaining health and preventing recurrence. Certifications include CanRehab, Cancer Fit, and others. They are more accessible and affordable than clinical providers and play a crucial role in long-term survivorship.

The Research on Supervised vs. Home-Based Exercise

One of the consistent findings across the research is that supervised exercise produces better outcomes than unsupervised or home-based exercise. A comprehensive review of 128 randomized controlled trials involving more than 13,000 cancer patients confirmed that supervised programs produced larger effects on physical activity than unsupervised ones.

That said, home-based exercise is still beneficial. Not everyone has access to a supervised program. Distance, cost, transportation, childcare, and eldercare can all create real barriers. The research supports home-based exercise as a viable option — especially when it is structured and supported with some professional guidance.

Telehealth has emerged as a meaningful solution here. One study found that virtual exercise training was safe and feasible for cancer patients, with an 84 percent adherence rate. Nearly 80 percent of participants reported the virtual sessions felt as intense as or more intense than in-person training.

The bottom line: supervised is better, but moving is better than not moving. Work with what you have access to.

The Role of Your Oncologist in All This

Here is something important that the research makes very clear: when your oncologist tells you to exercise, you are significantly more likely to actually do it.

One study found that patients are more likely to exercise if their oncologist specifically tells them to. Another study of patients with advanced lung cancer found that patients assumed their oncologists were aware of their activity levels — and interpreted the absence of any conversation about exercise as implicit permission to stay sedentary.

That silence is doing damage.

A 2023 feasibility study from Sydney, Australia tested what happens when oncologists initiate a brief one-to-two-minute exercise conversation during a regular consultation, then refer patients to an exercise physiologist who follows up by phone. The results were telling.

Patients said the conversation was motivating and gave credibility to the referral process. One patient said hearing exercise advice from their oncologist made them feel more comfortable with it. Another said that without that conversation, she probably never would have followed up with the exercise specialist at all.

The oncologists in the study found it manageable to work into their consultations. The exercise physiologist follow-up call — lasting about 15 to 20 minutes — covered medical and physical activity history, personalized exercise recommendations, identification of local programs, and information about any available funding support.

The key insight: having the exercise professional reach out to the patient (rather than requiring the patient to make the first call) dramatically reduced the barriers to engagement. Patients dealing with cancer treatment already have enough on their plates. Removing even one extra step matters.

This is where patient advocacy comes in. You can ask your oncologist directly:

• “Should I be exercising during my treatment?”

• “What kind of exercise is safe for me?”

• “Can you refer me to an exercise specialist who works with cancer patients?”

You have every right to ask. And based on everything we know, you should.

Community Programs: What Is Available Right Now

You do not have to wait for the healthcare system to catch up. There are community-based programs available today that are specifically designed for people with cancer.

LIVESTRONG at the YMCA

This is one of the largest and most established programs in the United States. It follows ACSM guidelines for cancer survivors and offers two 90-minute sessions per week for up to 12 weeks in small groups of 6 to 16 participants. The program is free for at least the first 12 weeks. YMCA instructors complete specific training before working in the program, including certification and lymphedema training. Multiple independent evaluations have shown the program improves physical activity levels, quality of life, physical function, and cardiorespiratory fitness.

MoveMore (United Kingdom)

Developed by the UK cancer charity Macmillan Cancer Support, MoveMore aims to provide a variety of exercise opportunities in the community tailored to individual preferences and needs. Support is provided for at least one year to promote lasting behavior change. The program includes cancer-specific exercise options in gyms and community facilities, with staff trained through the CanRehab cancer exercise specialist program.

Maple Tree Cancer Alliance

An evidence-based clinical exercise oncology program that has served thousands of cancer survivors monthly across 86 clinical locations in the United States and in 25 countries. They use the EXCEEDS triage tool and a phase-based programming model that takes patients from diagnosis through survivorship.

The ACSM Exercise Program Registry

The ACSM maintains a registry of HCP-supervised and community-based exercise programs for people living with and beyond cancer. You can find it at https://www.exerciseismedicine.org/eim-in-action/moving-through-cancer-2/

At last count, the registry included 150 programs across 25 countries.

What Gets in the Way — and How to Work Around It

Let’s be real about the barriers, because they are real.

Fatigue. Treatment fatigue is one of the most common reasons people do not exercise during cancer care. Here is the paradox: the research consistently shows that exercise reduces cancer-related fatigue. It feels counterintuitive, but moderate activity — even a short walk — often improves energy levels over time. Start small. Five minutes. Ten minutes. Build gradually.

Fear of injury or safety concerns. This is understandable and should be addressed with your medical team. The research across multiple meta-analyses shows that exercise during cancer treatment has very few adverse events. That said, your program should be tailored to your specific medical situation, and your clinician should weigh in on what is appropriate for you.

Lack of access to programs. This is a legitimate structural problem. Many communities, particularly rural areas, have limited access to HCP-supervised exercise programs. Home-based and virtual programs are a real and effective alternative. Telehealth exercise coaching is growing.

Cost. Program costs vary widely. Community-based programs like LIVESTRONG at the YMCA are free for an initial period. Some countries and insurance plans cover rehabilitative exercise programming. In Australia, for example, general practitioners can refer patients with cancer to a care plan that includes subsidized sessions with an exercise physiologist. Policy changes are underway in multiple countries to expand coverage.

Not knowing where to start. This is the most fixable barrier. The EXCEEDS algorithm takes the guesswork out of it. Ask your oncologist or GP for an exercise referral. Use the ACSM registry to find a local program. If you cannot find a supervised program, a structured home-based plan with virtual support is a real option.

What the Research Says About Behavior Change

Exercise only works if you actually do it. The research on what helps people stick with exercise programs during and after cancer treatment is worth knowing.

Factors that predict long-term adherence include:

Goal setting. Setting specific, realistic exercise goals — even simple ones — is one of the most consistently effective behavior change techniques in the research.

Graded exercise tasks. Starting small and increasing gradually. Completing a slightly harder task each week builds confidence and momentum.

Social support. Group exercise programs consistently show higher adherence than solo programs. Whether that is a supervised class at a YMCA, an online group, or a walking buddy, the social element matters.

Action planning. Deciding in advance when, where, and how you will exercise — and writing it down — substantially increases follow-through.

Self-monitoring. Tracking your activity, whether with a wearable device, an app, or a simple notebook, helps maintain awareness and motivation.

Oncologist encouragement. As mentioned, your doctor’s voice carries enormous weight. A single recommendation from your oncologist can shift behavior more than months of general health messaging.

The research also shows that using behavioral theory in exercise interventions produces larger effect sizes than programs that do not. Programs that address not just the physical component but also your confidence, your perceived barriers, and your attitudes toward exercise produce the best long-term results.

What Happens When Exercise Becomes Standard in Oncology

Picture what cancer care could look like when exercise is fully integrated as standard practice.

Your oncologist asks about your physical activity level at every appointment — the same way they ask about your pain level or your appetite. That information is recorded in your electronic health record. If you are not meeting recommended activity levels, your care team connects you with an exercise professional, either on-site or via telehealth. You receive a structured exercise program tailored to your cancer type, treatment status, and fitness level. As you move through treatment and into survivorship, your program evolves with you. Your activity levels are monitored and adjusted. You transition, with a proper handoff, into a community-based program that supports your long-term health.

This is not a fantasy. It is what the leading researchers and clinicians in exercise oncology are working toward. And in some cancer centers — at Kaiser Permanente, at the Maple Tree Cancer Alliance locations, in parts of Canada and the Netherlands — it is already happening.

We are not there yet in most places. But you do not have to wait for the system to catch up.

A Call to Action for Those of Us Over 50

I am 59. I have navigated my own cancer scare. I have watched people I love fight for their lives. And I have spent years reading the research on how to give the body its best chance.

Here is what I know: exercise during cancer treatment is not about athletic performance. It is not about looking a certain way or pushing through pain. It is about giving your body the signal that it is still capable. It is about preserving muscle that treatment will try to take from you. It is about managing the anxiety and depression that come with a cancer diagnosis. It is about reducing fatigue so you can be present for the people you love. It is about improving your odds.

If you or someone you love is dealing with cancer right now, here are the most important steps:

• Ask your oncologist about exercise at your next appointment.

• Request a referral to an exercise physiologist or certified cancer exercise specialist.

• Use the ACSM program registry at https://www.exerciseismedicine.org/eim-in-action/moving-through-cancer-2/ to find a local program.

• If supervised programs are not accessible, explore virtual options.

• Start where you are. Even 10 minutes of walking matters.

• Do not wait until you feel ready. Start moving, and the readiness follows.

The research is clear. The tools exist. The path is open.

Frequently Asked Questions

Is it safe to exercise while going through chemotherapy or radiation?

Yes, for most patients. The research across multiple large meta-analyses shows very few adverse events from exercise during cancer treatment. That said, your specific program should be tailored to your medical situation and cleared with your oncology team. Patients with certain conditions — severe bone metastases, recent major surgery, extreme fatigue, certain cardiovascular issues — may need modification or additional supervision. An exercise physiologist trained in oncology can help you determine what is appropriate.

What type of exercise is best during cancer treatment?

The ACSM recommends a combination of aerobic exercise (brisk walking, cycling, swimming) three times per week for up to 30 minutes, and resistance training (bands, light weights, bodyweight exercises) twice per week. The intensity should be moderate — you should be able to hold a conversation but feel some effort. This combination has the strongest evidence for reducing fatigue, improving quality of life, and supporting physical function.

I am exhausted from treatment. How do I even start?

Start smaller than you think you need to. Seriously. Five minutes of walking is a real start. The research is clear that even small amounts of movement help reduce cancer-related fatigue over time. The goal is to build a habit, not to hit a target. Some days will be better than others. On bad days, gentle movement — stretching, a short walk around the house — is still beneficial.

What is an exercise physiologist, and how is it different from a personal trainer?

An exercise physiologist is a university-trained health professional who specializes in exercise prescription for people with health conditions. In cancer care, they assess your medical history, understand the specific effects of your cancer type and treatment, and build a program that addresses your individual needs. A personal trainer has fitness expertise but typically does not have clinical training in managing cancer-related health complications. For cancer patients, working with someone who has oncology-specific credentials is strongly preferred.

Should I exercise differently depending on what type of cancer I have?

Yes. Different cancer types, stages, and treatments create different physical challenges and different risks. Breast cancer patients may need modifications for lymphedema risk and shoulder range of motion. Colon cancer patients may have specific abdominal considerations. Patients on certain chemotherapy drugs have cardiovascular monitoring needs. This is exactly why working with a cancer-trained exercise professional matters — they tailor the program to your specific situation rather than applying a generic fitness approach.

Can exercise actually improve my chances of surviving cancer?

The evidence is strongest for breast, colon, and prostate cancer. Multiple studies show that regular physical activity both before and after a cancer diagnosis is associated with improved cancer-specific survival. For colon and breast cancer in particular, there is moderate-to-strong evidence linking post-diagnosis physical activity to improved survival outcomes. Exercise is not a cure, and it does not replace your medical treatment. But it is a meaningful part of giving your body the best possible environment to heal and recover.

What if my doctor never brings up exercise?

Bring it up yourself. Ask directly: “Should I be exercising during my treatment? Can you refer me to an exercise specialist?” You are your own best advocate. Research shows that an oncologist’s recommendation is one of the strongest predictors of whether a patient will exercise. If your doctor is not raising it, raise it yourself. If they are unsure, ask for a referral to a physical therapist or certified cancer exercise specialist who can assess you properly.

Are there programs specifically designed for cancer survivors after treatment ends?

Yes. LIVESTRONG at the YMCA is available in hundreds of communities across the US and is free for at least 12 weeks. The ACSM maintains a global registry of supervised and community-based programs at https://www.exerciseismedicine.org/eim-in-action/moving-through-cancer-2/. Many communities also have cancer-specific group fitness classes offered through cancer centers, community gyms, and fitness facilities with certified cancer exercise trainers.

What if I live in a rural area with no nearby programs?

Virtual exercise programming has been shown to be safe, feasible, and effective. One study reported an 84 percent adherence rate with virtual cancer exercise training, with nearly 80 percent of patients rating the virtual sessions as equally or more intense than in-person training. Ask your care team about telehealth exercise options, or search for online cancer exercise coaching from certified professionals.

I have osteoporosis and balance issues. Is exercise still safe for me?

Yes, with appropriate modifications. Exercise — particularly resistance training and balance-focused activities — is actually one of the most effective interventions for bone health and fall prevention. Patients with osteoporosis, balance impairments, or fall risk should be assessed by a physical therapist or physiatrist before starting a program. The EXCEEDS triage tool can help determine the right level of supervision and program type for your situation. Do not use existing health conditions as a reason to avoid exercise — use them as a reason to get properly evaluated and properly supported.

Additional Information

Primary Research Sources

The content of this post is based on peer-reviewed research from the following sources:

Schmitz KH, Campbell AM, Stuiver MM, et al. Exercise is Medicine in Oncology: Engaging Clinicians to Help Patients Move Through Cancer. CA: A Cancer Journal for Clinicians. 2019;69:468–484. DOI: https://doi.org/10.3322/caac.21579

Wonders KY. Clinically-based Exercise Oncology Programs: Development and Implementation. ACSM’s Health & Fitness Journal. July/August 2025;29(4):12–21. Published by the American College of Sports Medicine.

Caperchione CM, English M, Sharp P, et al. Exploring the practicality and acceptability of a brief exercise communication and clinician referral pathway in cancer care: a feasibility study. BMC Health Services Research.2023;23:1023. DOI: https://doi.org/10.1186/s12913-023-10003-x

Key Organizations and Resources

American College of Sports Medicine — Moving Through Cancer Exercise program registry, clinician tools, and the Moving Through Cancer exercise prescription form. https://www.exerciseismedicine.org/movingthroughcancer

LIVESTRONG at the YMCA Free 12-week community exercise program for cancer survivors at YMCA locations across the United States. https://www.livestrong.org/what-we-do/program/livestrong-at-the-ymca

Maple Tree Cancer Alliance Evidence-based clinical exercise oncology programs. EXCEEDS triage algorithm and phase-based programming.

https://www.mapletreecanceralliance.org

ACSM/ACS Cancer Exercise Specialist Certification Professional certification for exercise professionals working with cancer patients.

https://www.acsm.org

CanRehab Cancer Exercise Specialist Courses (UK) Structured training and certification for fitness professionals working with cancer populations.

https://www.canrehab.co.uk

Related Reading

Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Medicine & Science in Sports & Exercise.2019;51(11):2375–2390. DOI: https://doi.org/10.1249/MSS.0000000000002116

Ligibel JA, Bohlke K, May AM, et al. Exercise, Diet, and Weight Management During Cancer Treatment: ASCO Guideline. Journal of Clinical Oncology. 2022;40(22):2491–2507. DOI: https://doi.org/10.1200/JCO.22.00687

Patel AV, Friedenreich CM, Moore SC, et al. American College of Sports Medicine Roundtable Report on Physical Activity, Sedentary Behavior, and Cancer Prevention and Control. Medicine & Science in Sports & Exercise.2019;51(11):2391–2402.

Fong DY, Ho JW, Hui BP, et al. Physical activity for cancer survivors: meta-analysis of randomised controlled trials.BMJ. 2012;344:e70. DOI: https://doi.org/10.1136/bmj.e70

Brown JC, Gilmore LA. Physical activity reduces the risk of recurrence and mortality in cancer patients. Exercise and Sport Sciences Reviews. 2020;48(2):67–73.

memios Resources

• memios — Wellness and Longevity for Life After 50 https://www.memios.ai

• The Longevity Letter on Substack

The Longevity Letter by Memios

Memios empowers individuals to become the best version of themselves through coaching, self-help tools, education, and faith-based learning.

• About Cancer Fitness

  Dr. Jay Harness is a board-certified cancer surgeon and the founder of Cancer Fitness. His work focuses on one core idea: exercise is medicine for cancer patients and survivors.

  Research backs him up. Regular movement reduces recurrence risk, improves treatment outcomes, and rebuilds strength and quality of life.

  Visit cancerfitness.org to learn more.

Disclaimer: memios shares wellness and longevity content for general education. We are not doctors, healthcare providers, or licensed medical professionals, and we do not provide medical advice, diagnosis, or treatment. We are health conscious individuals documenting what we learn and what we do as we work toward living long, healthy, strong lives into our 90s. Always talk with your physician or qualified healthcare professional before starting, changing, or stopping any exercise, nutrition, supplement, or health program.

If you or someone you love has been diagnosed with prostate cancer, this article is one you need to read. A new peer-reviewed study published in the British Journal of Cancer has found that exercise after prostate cancer surgery is directly linked to dramatically better survival outcomes — specifically a 61% reduction in the risk of disease recurrence, progression, or death. But here’s the critical part: that benefit appears only in men who had surgery. Men who received radiation therapy saw no survival benefit from vigorous exercise at all.

That’s not a small distinction. It could reshape how physicians and patients think about exercise as part of cancer treatment — and it matters deeply if you are navigating a prostate cancer diagnosis right now, or supporting a father, husband, brother, or friend who is.

I’m Andrew Wilson. I founded memios after my own melanoma diagnosis in 2022 and after watching my father fight Multiple Myeloma and Amyloidosis while also supporting my best friend through Stage IV Melanoma. Cancer has been a relentless teacher in my life. One of the clearest lessons I’ve learned is that what you do after a diagnosis — how you move, how you fuel your body, how you show up every single day — matters more than most people realize.

This study confirms that in a striking way. Let’s break it down together.

What the Study Actually Looked At

This research was a secondary analysis of the Alberta Prostate Cancer Cohort Study, conducted by researchers from the University of Alberta, Yonsei University in South Korea, and the University of Calgary. The cohort originally included 988 men in Alberta, Canada with newly diagnosed, clinically significant prostate cancer (stage T2 or greater). After the initial case-control phase, 830 men were enrolled in a prospective cohort follow-up study that tracked their physical activity and health outcomes from 2000 through 2014.

That’s a 14-year follow-up. This isn’t a short-term snapshot — this is a long, careful look at what happens to real men over real time.

The researchers wanted to answer a question that most exercise and cancer studies have never directly addressed: Does it matter what cancer treatment you received when it comes to whether exercise improves your survival odds?

Most prior studies have treated cancer treatment as a background variable — something to control for statistically, not something to examine as a potential factor that changes how effective exercise is. This team took a different approach. They used the EXACT Framework (Exercise as Cancer Treatment) and the EPiCC Framework (Exercise Across the Postdiagnosis Cancer Continuum), two newer clinical frameworks designed specifically to study exercise as a legitimate cancer treatment — not just a wellness add-on.

The primary treatments in the study were:

• Surgery (radical prostatectomy) — 245 men

• Radiation therapy — 366 men

• Hormone therapy (androgen deprivation therapy, or ADT) — analyzed as a third treatment modifier

Physical activity was measured at multiple time points using a validated questionnaire called the Lifetime Total Physical Activity Questionnaire (LTPAQ). It captured recreational, occupational, and household activity — including intensity levels. The researchers tracked three levels of activity:

• Recreational PA — leisure-time activity like walking, cycling, and swimming

• Vigorous PA — any activity at 6 METs (metabolic equivalents) or higher, meaning your heart and lungs are working hard

• Total PA — everything combined

They tracked three survival outcomes:

1. Disease-free survival — survival without recurrence, progression, second cancer, or death from any cause

2. Prostate cancer-specific disease-free survival — survival without prostate cancer recurrence, progression, or prostate cancer death

3. Overall survival — survival without death from any cause

The Numbers That Should Stop You in Your Tracks

Let me give you the headline finding first, because it deserves to stand on its own.

Among men who had surgery for prostate cancer, those who engaged in any vigorous physical activity after their diagnosis were:

61% less likely to experience a recurrence, progression, second cancer, or death compared to men who did no vigorous exercise.

The hazard ratio was 0.39 (95% CI = 0.27–0.57). In plain language, that’s a powerful, statistically significant result. It held up even after adjusting for age, cancer stage, Gleason score, PSA levels, smoking history, comorbidities, and other treatments received.

For context, a hazard ratio of 0.39 means that for every disease event that occurred in the no-exercise group, only 0.39 events occurred in the exercise group. That’s not a modest benefit. That’s the kind of number that makes oncologists and researchers take notice.

The Kaplan-Meier survival curves — the visual representation of survival over time — told the same story. Among surgical patients, disease-free survival at the end of the study period was 57.9% in the exercise group versus 32.0% in the no-exercise group. That’s a 25-percentage-point gap in survival outcomes. Real people. Real lives.

Now here’s what makes this study particularly important for decision-making: the radiation therapy group showed no benefit at all.

Among men who received radiation therapy, vigorous exercise after diagnosis had a hazard ratio of 1.14 (95% CI = 0.88–1.47) — meaning essentially no association with improved disease-free survival. The difference in survival curves between exercisers and non-exercisers in the radiation therapy group was statistically flat (p = 0.80).

The interaction between vigorous physical activity and surgery was statistically significant (p < 0.001). The interaction between vigorous PA and radiation therapy was also significant (p = 0.003). These are not random findings.

The Prostate Cancer-Specific Results Are Just as Striking

When the researchers zoomed in on prostate cancer-specific outcomes — cutting out deaths and events unrelated to prostate cancer — the pattern held and actually got stronger.

Among surgical patients:

• Men doing more than 13 MET-hours per week per year of recreational PA after diagnosis were 54% less likely to have a prostate cancer-specific event (HR = 0.46, 95% CI = 0.29–0.73)

• Men doing any vigorous PA after diagnosis were 62% less likely to have a prostate cancer-specific event (HR = 0.38, 95% CI = 0.23–0.61)

The survival curves for prostate cancer-specific outcomes in the surgery group showed a wide and persistent gap between exercisers and non-exercisers: 73.8% vs 57.0% (p = 0.002).

Again, in the radiation therapy group, there was no statistically significant difference based on vigorous exercise.

If you had surgery for prostate cancer and you are not exercising vigorously, these numbers suggest you may be leaving one of the most powerful recovery tools on the table.

Why Does Treatment Type Matter So Much?

This is the part of the study that requires some deeper thinking — and the researchers did a thoughtful job of exploring possible explanations.

Surgery and radiation do fundamentally different things to your body and to any remaining cancer cells.

Radical prostatectomy removes the entire prostate gland, the seminal vesicles, surrounding tissue, and sometimes nearby lymph nodes. It is generally offered to younger, healthier patients with a life expectancy of at least 10 years. In the study cohort, the median age at diagnosis in the surgery group was 64 years.

Radiation therapy focuses external beams of radiation on the prostate — and sometimes the entire pelvic region, including lymph nodes — to destroy cancer cells in place. It tends to be offered to older patients or those with comorbidities that make surgery riskier. In the cohort, the median age in the radiation therapy group was 69 years.

That age difference matters. Older patients typically have more comorbidities and lower physical activity levels. And indeed, the median postdiagnosis vigorous PA in the surgery group was 0.4 hours per week per year, versus 0.0 hours per week per year in the radiation therapy group. The radiation group was simply moving much less overall — which makes it harder to detect an exercise benefit even if one exists.

But age alone doesn’t explain the entire picture. The researchers point to several biological and clinical mechanisms.

The Surgical Stress Response Theory

One compelling explanation comes from preclinical breast cancer research. A recent study in mice found that exercise significantly increased metastasis-free survival — but only in animals treated with surgery. The reason? Surgery creates a physiological stress response. It can inadvertently activate dormant micrometastases or residual cancer cells at the surgical site by disrupting normal immune surveillance and tissue healing.

Exercise, particularly vigorous exercise, may counteract that stress response. It mobilizes natural killer cells, reduces systemic inflammation, lowers insulin and IGF-1 levels, and creates an environment that is hostile to cancer cell survival and spread. After surgical resection, there may be a window of heightened biological vulnerability — and vigorous exercise may be exactly what closes that window.

The Micrometastases Question

After surgery, there is a higher potential for micrometastases — tiny clusters of cancer cells that may have spread to other tissues before the primary tumor was removed. These cells are present but not yet causing detectable disease. Up to 30% of prostate cancer recurrences are pelvic rather than systemic, and the risk of micrometastatic spread after surgical excision may be higher than after radiation treatment that targets the pelvic field.

Exercise may directly reduce the viability and proliferation of these micrometastases. It alters the tumor microenvironment through systemic effects — circulating factors like adrenaline, lactate, and immune cells that flood the body during vigorous activity may actively suppress micrometastatic activity.

The ADT Interaction

There is another important clinical difference between the surgery and radiation groups: their rates of androgen deprivation therapy (ADT).

In the surgery group, only 35.9% of men received hormone therapy. In the radiation therapy group, 75.4% did.

ADT is a powerful systemic treatment. It suppresses testosterone — a key driver of prostate cancer growth. When radiation and ADT are combined, they may deliver a synergistic anti-cancer effect that leaves less biological “space” for exercise to demonstrate additional benefit. The cancer may already be sufficiently suppressed that adding vigorous exercise doesn’t move the needle further.

Conversely, in surgical patients who are not receiving ADT, any remaining micrometastatic disease may be more dependent on the systemic environment — an environment that vigorous exercise can meaningfully shift.

The data offered a suggestive hint here: there were borderline statistically significant interactions (p < 0.10) suggesting that patients not treated with ADT tended to benefit more from vigorous PA than those who received ADT — for both disease-free survival and prostate cancer-specific disease-free survival. This is preliminary, but it points toward a real and clinically meaningful interaction.

What “Vigorous Exercise” Actually Means

Before you start wondering whether a Sunday afternoon walk counts, let’s be precise about what the study classified as vigorous physical activity.

Vigorous PA in this study was defined as any activity with a metabolic equivalent (MET) value of 6 or higher. METs measure how much energy your body is using relative to rest.

Activities at or above 6 METs typically include:

• Jogging or running (even at a moderate pace)

• Cycling at a brisk pace (not a leisurely cruise)

• Swimming laps with real effort

• Aerobics or fitness classes that get your heart rate up

• Singles tennis

• Heavy yard work like digging or hauling

• Vigorous hiking with elevation gain

• Rowing or paddling with effort

• Competitive sports at most levels

The threshold in the study for benefit was simply any vigorous PA versus none. You did not need to be running marathons. The surgery group’s median was only 0.4 hours per week per year — a modest amount. Men who did any vigorous activity above zero had dramatically better outcomes than men who did none at all.

This is encouraging. You do not need to transform yourself into an elite athlete. You need to consistently do things that are genuinely hard — activities that challenge your heart, lungs, and muscles. Thirty minutes of vigorous exercise, several days a week, may be the threshold that matters.

A Broader Pattern in Exercise Oncology

This study fits into a larger and growing body of evidence that exercise is not just a lifestyle recommendation for cancer survivors — it may be a genuine treatment modality in its own right.

The researchers cite a systematic review and meta-analysis by Friedenreich et al. that examined physical activity and cancer outcomes across multiple cancer types. For prostate cancer specifically, the results of four studies showed that higher postdiagnosis PA was associated with a 30% lower risk of prostate cancer-specific mortality (HR = 0.70; 95% CI = 0.55–0.90).

A parallel study in colorectal cancer survivors found that physical activity after surgery — either surgery alone or surgery plus chemotherapy and/or radiotherapy — was associated with reduced mortality risk (HR = 0.75 to 0.84). Notably, the benefit appeared in patients who had surgery. This is a consistent pattern across cancer types: exercise may play its most important role in the postoperative, post-treatment period.

The Alberta cohort itself had previously found that postdiagnosis recreational PA was associated with a significantly lower risk of death from prostate cancer overall (HR: 0.56; 95% CI, 0.35–0.90). The new secondary analysis builds on that finding by showing that the treatment modality shapes whether exercise can exert that benefit.

This is the direction exercise oncology is moving: toward precision. Not just “exercise is good for cancer survivors” but “which exercise, after which treatment, at which time, in which patients?”

What This Means If You’ve Had Prostate Cancer Surgery

If you have undergone a radical prostatectomy, the message from this study is direct and actionable:

Getting up and moving vigorously after surgery is one of the most powerful things you can do for your long-term survival.

This doesn’t mean ignoring your surgeon’s recovery timeline. Immediately after radical prostatectomy, you need time to heal, and there are important restrictions around activity, lifting, and returning to exercise. Most men spend 4–6 weeks in initial recovery before they are cleared for progressively more demanding exercise.

But once you are cleared, and especially beyond the first year after surgery, building a consistent vigorous exercise habit deserves the same priority you give to your PSA monitoring appointments, your dietary choices, and your follow-up care.

Here’s a practical framework to think about:

Phase 1: Early Recovery (Weeks 1–6 post-surgery)

• Follow your surgeon’s specific guidance

• Focus on walking — start with 10–15 minutes and build gradually

• Pelvic floor exercises (Kegels) are often recommended and do not require medical clearance after basic instruction

• Light movement throughout the day to prevent blood clots

Phase 2: Rebuilding (Months 2–6 post-surgery)

• Progressively increase walking duration and pace

• Begin light resistance training if cleared

• Introduce low-impact aerobic activity: cycling, swimming, elliptical

• Target 150 minutes per week of moderate activity minimum

• Start introducing some vigorous intervals if your body is responding well

Phase 3: Active Recovery and Long-Term Maintenance (Month 6 onward)

• Build toward 75–150 minutes of vigorous activity per week

• Strength training 2–3 times per week to combat muscle loss (especially important if you are also on ADT, which accelerates muscle wasting)

• Activities that push your heart rate well above baseline

• Consistency matters more than perfection

Always talk with your physician before starting or changing any exercise program after prostate cancer surgery.Your individual situation — including whether you received additional ADT, your surgical margins, your current PSA trajectory, and any comorbidities — should guide the details of your program.

What This Means If You Received Radiation Therapy

The study found no statistically significant benefit from vigorous exercise in the radiation therapy group. This does not mean exercise is harmful or useless for men who received radiation. It means the study did not detect the same dramatic survival benefit seen in the surgical group.

There are several reasons to continue exercising after radiation:

• Quality of life during and after radiation is improved with regular physical activity

• Fatigue — one of the most common side effects of radiation therapy — is reduced by exercise

• Cardiovascular health — particularly important if you are on ADT, which increases metabolic syndrome risk

• Muscle mass preservation — ADT causes muscle loss and fat gain; strength training directly counteracts this

• Bone density — ADT dramatically accelerates bone loss; weight-bearing and resistance exercise helps maintain bone density

• Mental health — anxiety, depression, and loss of identity are common after prostate cancer treatment; exercise is one of the most evidence-based interventions for all three

The absence of a detected survival benefit in the radiation group does not mean exercise is irrelevant. It means the study’s sample size may not have been large enough to detect a more subtle benefit, and it means the biology of exercise interacting with radiation is more complex — and not yet fully understood.

Future studies with larger samples, more detailed treatment data, and longer follow-up periods will likely refine our understanding of the optimal timing, type, and dose of exercise for radiation therapy patients.

The Deeper Point About Exercise as Medicine

My personal journey has taught me something important: the medical system is designed to treat your cancer. It is rarely designed to help you thrive after treatment.

The oncologist’s job is to get the cancer. Surgeons remove tumors. Radiation destroys cells. Hormone therapy suppresses androgen. These are lifesaving tools. But they leave you with a body that has been through enormous stress — and a future that depends significantly on what you do in the years after treatment.

Studies like this one are the scientific backbone of a broader movement to treat exercise not as a nice-to-have but as a genuine clinical intervention — something that deserves the same attention as chemotherapy dosing, radiation field planning, or surgical technique.

The EXACT Framework and EPiCC Framework — developed by several of the authors of this study — are frameworks designed specifically to bring exercise into the clinical oncology conversation with rigor and precision. They call for studying exercise the way we study drugs: What is the dose? What is the timing? What is the mechanism? What patient population benefits most?

This study is a direct output of that framework. And it is exactly the kind of evidence that will eventually change how oncologists counsel their patients after surgery.

For now, the practical truth is this: if you have had prostate cancer surgery, and you are not already exercising vigorously on a regular basis, you have an opportunity in front of you that the data says is worth taking seriously.

Study Limitations Worth Knowing

This is a well-conducted study. The researchers are transparent about its limitations, and you deserve to know them.

Sample size constraints. The study had 245 men in the surgery group and 366 in the radiation therapy group. This limited the researchers’ ability to analyze treatment combinations rather than individual modalities. A larger sample might have revealed additional nuance.

Postdiagnosis PA is a weighted average. The physical activity data was collected at three follow-up intervals and averaged over time. This means the researchers could not pinpoint the optimal window of exercise — immediately before treatment, during treatment, immediately after treatment, or years later. The study captures “did you exercise after diagnosis” but not “when exactly, and at what dose.”

Cohort era. The men in this study were diagnosed and treated in the late 1990s. Prostate cancer management has evolved significantly since then — particularly in surgical techniques, radiation delivery, and the use of ADT. Today’s patients may have different baseline outcomes and different opportunities for exercise benefit.

No detailed treatment data. The researchers did not have data on whether surgeries included pelvic lymph node dissection, or whether radiation therapy included whole pelvic irradiation. These distinctions could matter biologically.

Observational design. This is not a randomized controlled trial. Men who exercised vigorously after surgery may have been healthier, more health-conscious, or more compliant with their overall medical care — factors that could partially explain their better outcomes. The researchers adjusted for many potential confounders, but residual confounding cannot be ruled out entirely.

These limitations do not undermine the findings. They point to the need for larger, more precisely designed trials — which the authors specifically call for in their conclusion.

Practical Takeaways

Let me summarize the most useful things to carry with you from this study.

If you are a prostate cancer survivor who had surgery:

• Vigorous exercise after your diagnosis was associated with a 61% lower risk of disease recurrence, progression, or death

• Any vigorous activity above zero showed benefit — you don’t need to be an athlete

• Build toward activities at 6+ METs (jogging, cycling, swimming laps, fitness classes)

• Consistency over time matters — this was a weighted average of postdiagnosis activity, not a short-term sprint

• Talk to your physician about an appropriate return-to-exercise plan

If you are a prostate cancer survivor who had radiation therapy:

• The study did not detect a survival benefit from vigorous exercise in your treatment group

• Exercise is still strongly recommended for quality of life, fatigue, cardiovascular health, bone density, and mental well-being

• ADT side effects (muscle loss, bone loss, metabolic changes) are specifically countered by exercise

• Future research may clarify whether and when exercise improves survival in your group

If you are supporting a family member or friend with prostate cancer:

• Ask their oncologist about exercise recommendations during and after treatment

• Help them understand the difference between treatment modality and how it affects exercise benefit

• Vigorous movement — after recovery — may be one of the most important things they can do

If you are not currently facing prostate cancer but are a man over 50:

• This study is another reason to build vigorous physical activity into your life now, before you ever need it for cancer recovery

• Your current habits set the baseline your body will work from if cancer ever enters the picture

• Exercise benefits don’t appear overnight — they are built through years of consistent effort

My Personal Take

When I read studies like this one, I think about my father. He was diagnosed with Multiple Myeloma and Amyloidosis — two diseases at once, each serious on its own. Watching him navigate treatment, I saw how much the non-medical choices mattered. How he moved, how he slept, how he ate, how he stayed connected to purpose and community.

I also think about my best friend, who has lived with Stage IV Melanoma. He has made exercise a cornerstone of his survival strategy — not because any single study told him to, but because it is the one thing in a sea of uncertainty that he can control and take ownership of.

That’s what this research points toward, too. Not a guarantee. Not a cure. But a meaningful, measurable, evidence-based action that may shift the odds in your favor.

For men who’ve had prostate cancer surgery: your recovery doesn’t end when you leave the hospital. In many ways, it begins there. And the evidence increasingly suggests that vigorous physical activity — sustained, consistent, and progressive — may be one of the most powerful tools you have for what comes next.

Move with purpose. Build it back gradually. But build it.

Frequently Asked Questions

1. What type of exercise is most beneficial for prostate cancer survivors who had surgery?

The study focused on vigorous physical activity — defined as exercise at 6 or more metabolic equivalents (METs). This includes activities like jogging, brisk cycling, swimming laps, vigorous hiking, aerobics classes, and similar efforts. Any amount of vigorous activity was associated with better outcomes compared to none at all. Recreational activity (moderate intensity) also showed benefit for prostate cancer-specific survival in surgical patients, though vigorous activity showed the strongest association.

2. How soon after prostate cancer surgery can I start exercising?

This depends on your individual recovery, the type of surgery, and your surgeon’s specific guidance. Most men begin with walking in the first weeks after surgery and gradually increase intensity over several months. Vigorous exercise is typically not appropriate until you are well past initial healing — often 6 weeks minimum, and sometimes longer. Always get specific clearance from your surgical team before returning to vigorous exercise.

3. Why didn’t exercise help prostate cancer patients who had radiation therapy?

The researchers identified several possible explanations. Radiation therapy patients in the study were older (median age 69 vs 64 in the surgery group) and had much lower baseline physical activity levels. Additionally, radiation therapy patients were more likely to receive hormone therapy (ADT) — 75% vs 36% in the surgery group. ADT combined with radiation may provide a synergistic treatment effect that limits the additional benefit exercise can offer. There are also biological differences in how surgery versus radiation affects residual cancer cells and the tumor microenvironment.

4. Does this mean exercise is not beneficial if I had radiation for prostate cancer?

Not at all. Exercise is well-documented to improve quality of life, reduce treatment-related fatigue, preserve muscle mass, protect bone density (critical for men on ADT), and support cardiovascular health for all prostate cancer patients regardless of treatment type. The study simply did not detect the same dramatic survival benefit in the radiation group. Future research may reveal specific exercise benefits in that group as well.

5. What is vigorous physical activity and how do I know if I’m doing it?

Vigorous activity is typically defined as exercise at 6+ METs. A practical guide: if you can speak a few words but cannot hold a full conversation, you are likely in vigorous territory. Your heart rate should be elevated significantly — typically 70–85% of your maximum heart rate. Activities like walking briskly would be moderate, not vigorous. Jogging, cycling uphill, swimming laps, or doing a challenging fitness class would typically qualify as vigorous.

6. How much vigorous exercise is needed to see a benefit?

The study used an “any versus none” comparison for vigorous PA, meaning the benefit was observed in men who did any amount of vigorous activity compared to those who did none. The surgery group’s median postdiagnosis vigorous activity was only 0.4 hours per week per year — a modest amount. Current general health guidelines recommend at least 75 minutes of vigorous activity per week for overall health benefits, and this is a reasonable target for cancer survivors to work toward after recovery.

7. Does this apply to other types of cancer, or just prostate cancer?

This specific study focused on prostate cancer. The broader principle — that exercise effects on cancer survival may depend on what treatments were received — has also been observed in colorectal cancer research. A Korean study of over 43,000 colorectal cancer survivors found that exercise was associated with lower mortality primarily in those who had surgery. Exercise oncology researchers are actively studying this interaction across multiple cancer types.

8. Should exercise be considered a formal part of prostate cancer treatment?

The researchers and the frameworks they cite (EXACT and EPiCC) explicitly propose that exercise should be studied and prescribed with the same rigor as other cancer treatments — including attention to timing, dose, and combination with other therapies. While current clinical practice does not yet formally prescribe exercise as a cancer treatment in most settings, the evidence base is growing. Oncologists and rehabilitation specialists are increasingly incorporating exercise recommendations into survivorship care plans.

9. What about prediagnosis exercise — does it matter?

The study found that prediagnosis physical activity was generally not significantly associated with disease-free or overall survival outcomes in this cohort. The stronger and more consistent associations were seen with postdiagnosis exercise — particularly vigorous exercise after surgery. This doesn’t mean prediagnosis fitness doesn’t matter, but it suggests that what you do after your diagnosis may matter more than what you did before.

10. Where can I find a medically supervised exercise program for prostate cancer survivors?

Ask your oncologist or urologist for a referral to an oncology rehabilitation specialist or a certified exercise physiologist with oncology experience. Many cancer centers now have dedicated cancer exercise programs. The American College of Sports Medicine’s ACSM ProEx certification identifies fitness professionals with cancer exercise training. Some hospitals offer structured programs specifically for prostate cancer survivors, particularly around managing ADT side effects.

Additional Information

Primary Study Reference

An, K.-Y., Jeon, J.Y., Arthuso, F.Z., Wang, Q., Friedenreich, C.M., & Courneya, K.S. (2025). Postdiagnosis physical activity is associated with improved survival in prostate cancer patients treated with surgery but not with radiation therapy. British Journal of Cancer. DOI: https://doi.org/10.1038/s41416-025-03123-0

Related Studies and References

Physical activity and prostate cancer survival — foundational cohort study: Friedenreich, C.M., Wang, Q., Neilson, H.K., Kopciuk, K.A., McGregor, S.E., & Courneya, K.S. (2016). Physical activity and survival after prostate cancer. European Urology, 70, 576–585. https://doi.org/10.1016/j.eururo.2015.12.032

Exercise and cancer mortality — systematic review and meta-analysis: Friedenreich, C.M., Stone, C.R., Cheung, W.Y., & Hayes, S.C. (2020). Physical activity and mortality in cancer survivors: A systematic review and meta-analysis. JNCI Cancer Spectrum, 4, pkz080. https://doi.org/10.1093/jncics/pkz080

Exercise as a cancer treatment — EXACT Framework: Courneya, K.S., & Booth, C.M. (2022). Exercise as a cancer treatment: A clinical oncology framework for exercise oncology research. Frontiers in Oncology, 12, 957135.https://doi.org/10.3389/fonc.2022.957135

EPiCC Framework — exercise across the postdiagnosis cancer continuum: Courneya, K.S., McNeely, M.L., Booth, C.M., & Friedenreich, C.M. (2024). An integrated framework for the study of exercise across the postdiagnosis cancer continuum. Frontiers in Oncology, 14, 1432899. https://doi.org/10.3389/fonc.2024.1432899

Physical activity after diagnosis and prostate cancer progression: Richman, E.L., Kenfield, S.A., Stampfer, M.J., Paciorek, A., Carroll, P.R., & Chan, J.M. (2011). Physical activity after diagnosis and risk of prostate cancer progression. Cancer Research, 71, 3889–3895. https://doi.org/10.1158/0008-5472.CAN-10-3932

Exercise and prostate cancer survival — Health Professionals Follow-up Study: Kenfield, S.A., Stampfer, M.J., Giovannucci, E., & Chan, J.M. (2011). Physical activity and survival after prostate cancer diagnosis. Journal of Clinical Oncology, 29, 726–732. https://doi.org/10.1200/JCO.2010.31.5226

Exercise in colorectal cancer survivors — Korean national cohort: Lee, M., Lee, Y., Jang, D., & Shin, A. (2021). Physical activity after colorectal cancer diagnosis and mortality in a nationwide retrospective cohort study. Cancers, 13, 4804. https://doi.org/10.3390/cancers13194804

Exercise after surgery in breast cancer preclinical model: Stagaard, R., Jensen, A., Schauer, T., Bay, M.L., Tavanez, A.R., Wielsoe, S., et al. (2025). Exercise boost after surgery improves survival in model of metastatic breast cancer. Frontiers in Immunology, 16, 1533798. https://doi.org/10.3389/fimmu.2025.1533798

Aerobic exercise, cancer initiation, progression, and metastasis — preclinical review: Ashcraft, K.A., Peace, R.M., Betof, A.S., Dewhirst, M.W., & Jones, L.W. (2016). Efficacy and mechanisms of aerobic exercise on cancer initiation, progression, and metastasis. Cancer Research, 76, 4032–4050. https://doi.org/10.1158/0008-5472.CAN-15-1427

NCCN Clinical Practice Guidelines — Prostate Cancer: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459

AUA/ASTRO Guideline — Clinically Localized Prostate Cancer: https://www.auanet.org/guidelines-and-quality/guidelines/clinically-localized-prostate-cancer-aua/astro-guideline-2022

Further Reading and Resources

• American Cancer Society — Prostate Cancer: https://www.cancer.org/cancer/types/prostate-cancer.html

• Prostate Cancer Foundation: https://www.pcf.org

• ACSM Guidelines for Exercise and Cancer: https://www.acsm.org/education-resources/trending-topics-resources/physical-activity-guidelines

• Exercise and Cancer — National Cancer Institute: https://www.cancer.gov/about-cancer/treatment/side-effects/fatigue/exercise-pdq

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• About Cancer Fitness

  Dr. Jay Harness is a board-certified cancer surgeon and the founder of Cancer Fitness. His work focuses on one core idea: exercise is medicine for cancer patients and survivors.

  Research backs him up. Regular movement reduces recurrence risk, improves treatment outcomes, and rebuilds strength and quality of life.

  Visit cancerfitness.org to learn more.

Disclaimer: memios shares wellness and longevity content for general education. We are not doctors, healthcare providers, or licensed medical professionals, and we do not provide medical advice, diagnosis, or treatment. We are health conscious individuals documenting what we learn and what we do as we work toward living long, healthy, strong lives into our 90s. Always talk with your physician or qualified healthcare professional before starting, changing, or stopping any exercise, nutrition, supplement, or health program.

If you or someone you love is facing cancer surgery, the weeks before the procedure may matter just as much as the surgery itself. A growing body of research now shows that prehabilitation before cancer surgery — a structured program of exercise and targeted nutrition in the weeks leading up to an operation — can dramatically reduce complications, shorten hospital stays, and speed recovery. Two major clinical trials published in 2025 put hard numbers on this idea, and the results are hard to ignore. One randomized trial found that patients who completed a six-week prehabilitation program cut their 90-day complication rate from 50% down to just 13%. Another study following 140 women with gynecological cancers found meaningful improvements in fitness and nutritional status after just three to four weeks of structured preparation. This post breaks down both studies, explains what prehabilitation actually involves, and walks you through what these findings mean for anyone navigating cancer treatment after 50.

What Is Prehabilitation?

Prehabilitation is exactly what it sounds like: rehabilitation that happens before surgery rather than after.

The traditional model in surgical care has been to operate, then recover. Prehabilitation flips that thinking. Instead of waiting for the body to be cut, stressed, and weakened by surgery — and then trying to rebuild — prehabilitation starts the rebuilding process before the scalpel ever touches you.

A prehabilitation program typically combines:

• Exercise — both aerobic work (walking, cycling, swimming) and resistance training (strength work) tailored to your current fitness level

• Nutrition — targeted protein intake, supplementation, and dietary coaching to address deficiencies and support muscle preservation

• Psychological support — addressing anxiety, stress, and coping strategies around a cancer diagnosis and upcoming surgery

• Lifestyle optimization — smoking cessation, alcohol reduction, and other modifiable risk factors

The length of a prehabilitation program depends on how much time exists between diagnosis and surgery. Most research protocols run between three and six weeks. As you’ll see below, even three weeks can produce real, measurable changes.

Study #1: The PREHEP Trial — Liver Surgery and Sarcopenia

Background and Why This Matters

The first study we’re looking at was published in JAMA Surgery in August 2025. It’s called the PREHEP trial — Prehabilitation With Exercise and Nutrition to Reduce Morbidity of Major Hepatectomy in Sarcopenic Patients.

Major hepatectomy means the surgical removal of a large portion of the liver — three or more contiguous segments. This is one of the higher-risk abdominal surgeries performed today. Complication rates for major liver resection can run between 20% and 70%, depending on the patient’s health status and the complexity of the procedure.

The PREHEP trial specifically targeted patients with sarcopenia — a condition defined as the progressive loss of muscle mass, strength, and function that becomes more common with age and is especially prevalent in cancer patients. Studies show sarcopenia affects between 30% and 74% of people with cancer.

If you’re over 50 and you’ve noticed that your muscle tone isn’t what it used to be, that you tire more easily, or that recovering from physical effort takes longer — sarcopenia may be a factor in your life right now, whether or not you’ve ever heard the word.

Sarcopenia was long considered simply a marker of frailty — something you observed in a patient but couldn’t do much about before surgery. The PREHEP trial was designed to test whether that assumption was wrong.

How the Study Was Designed

This was a randomized clinical trial — the gold standard in medical research. From April 2022 to January 2025, researchers at a tertiary hepatobiliary referral center in Rome enrolled 70 adults with both radiologically confirmed and functionally confirmed sarcopenia who were scheduled for major liver resection.

Patients were randomly assigned to one of two groups:

• Prehabilitation group (30 patients): A structured six-week program before surgery

• Standard care group (30 patients): Proceeded to surgery under normal preoperative protocols

The six-week window existed because these patients were already waiting for a procedure called portal vein embolization — a technique used to grow the remaining liver tissue before removing the diseased portion. Researchers recognized this waiting period as a unique opportunity to intervene.

What the Prehabilitation Program Looked Like

Patients in the intervention group received a specific, structured program for six weeks:

Exercise component:

• 30 minutes of brisk walking daily, or a minimum of 2,000 additional steps per day

• Twice-weekly, 60-minute in-hospital supervised sessions with a trained physiotherapist

• Sessions combined both strength and aerobic exercise

• Each patient received a digital pedometer to track adherence

Nutrition component:

• Branched-chain amino acid (BCAA) supplementation twice daily for the first four weeks, then once daily for the remaining two weeks

• An immune-supportive nutritional formula (Nitronat Plus) was provided

Control patients received no prehabilitation — just standard preoperative care.

The Results Were Striking

Let’s go right to the numbers, because they speak for themselves.

Primary outcome — 90-day postoperative morbidity:

• Prehabilitation group: 13.3% (4 out of 30 patients had complications)

• Standard care group: 50% (15 out of 30 patients had complications)

• Absolute risk reduction: 36.7%

• Number needed to treat: 3 (meaning for every 3 patients who complete prehabilitation, one complication is prevented)

That’s not a small difference. That’s roughly a four-fold reduction in complications.

Major complications (Clavien-Dindo Grade III or higher):

• Prehabilitation group: 0%

• Standard care group: 20% (6 of 30 patients)

• All deaths in the study (one total, from liver failure) occurred in the control group

Muscle mass and strength:

• Skeletal Muscle Index (SMI) improved significantly in the prehabilitation group over six weeks

• Handgrip strength improved significantly in the prehabilitation group

• Neither measure improved in the standard care group

Hospital stay:

• Prehabilitation group: median 7 days

• Standard care group: median 10 days

Readmission within 90 days:

• Prehabilitation group: 6.7%

• Standard care group: 20%

Safety: Not a single adverse event was recorded in relation to the prehabilitation program. 100% of patients in the intervention group completed the full six weeks. Adherence to both exercise and nutrition was complete.

What the Researchers Concluded

The lead researchers — a team from San Camillo Forlanini Hospital in Rome — stated that a six-week structured prehabilitation program was both feasible and safe, and was associated with a 37% reduction in postoperative morbidity compared with standard care.

Critically, they identified sarcopenia not merely as a marker of frailty, but as a modifiable risk factor — something that can be changed through preoperative intervention.

The study’s logistic regression analysis found that prehabilitation was the only variable independently associated with fewer complications. Age, BMI, lab values, surgical approach — none of those factors held up in the model the way prehabilitation did.

A commentary published alongside the trial in JAMA Surgery by surgeons at the University of Virginia called for prehabilitation screening and targeted programs to become part of standard of care for high-risk surgical candidates.

Study #2: The F4S-PREHAB Trial — Gynecological Cancer

Background

The second study was published in Gynecologic Oncology in October 2025. It evaluated a multimodal prehabilitation program for women with gynecological cancers — specifically uterine, ovarian, and vulvar cancers — undergoing surgery at the Radboud University Medical Center in the Netherlands.

This study didn’t measure complication rates as its primary outcome. Instead, it asked a more foundational question: does prehabilitation actually improve a woman’s physical fitness and nutritional status before she goes under the knife?

The answer matters because we assume it should — but clear data in this specific patient population didn’t exist before this study.

Who Was Studied

140 women completed the prehabilitation program between May 2022 and April 2024. Median age was 66 years. Most were overweight or obese (67% had a BMI over 25). Common comorbidities included cardiovascular disease and diabetes mellitus.

Cancer types included:

• Uterine cancer: 43%

• Ovarian cancer: 39%

• Vulvar cancer: 19%

Nearly half of the ovarian cancer patients had received neoadjuvant chemotherapy before surgery — meaning they were already dealing with the physical toll of systemic cancer treatment.

The median time between the start of the prehabilitation program and surgery was just 22 days — less than three and a half weeks. This is an important detail, because the results were meaningful despite a relatively short preparation window.

What the Prehabilitation Program Looked Like

This program was more comprehensive than the PREHEP trial, incorporating four components:

Exercise component:

• Three supervised sessions per week with a physiotherapist in the community

• Sessions included high-intensity interval training on cycling, rowing, or treadmill equipment

• Resistance training: leg press, chest press, abdominal work, lat pulldown, low row, step-up exercises

• Two sets of ten repetitions, starting at 65% of one-rep max, increasing 5% per week to 80% by week four

• Daily low-intensity aerobic activity (walking, cycling, or swimming) for 60 minutes on non-training days

Nutrition component:

• Assessment by a dietitian using the Patient Generated Subjective Global Assessment (PG-SGA)

• Personalized dietary advice targeting 1.5–1.8 grams of protein per kilogram of body weight per day

• Daily protein shakes (30g protein per serving, plus vitamin D)

• Multivitamin supplementation to correct deficiencies

• Three-day food diary and body composition assessment

Psychological component:

• Hospital Anxiety and Depression Scale (HADS) assessment

• Referral to a psychologist for women showing elevated anxiety or depression scores

Lifestyle cessation support:

• Smoking cessation referrals and nicotine replacement therapy

• Alcohol cessation counseling

The Results

Aerobic fitness (VO2peak):

• Average improvement: 8% (statistically significant, p = 0.001)

• At the start: 82% of women had a VO2peak above 15 ml/kg/min (low risk for surgical complications)

• After prehabilitation: 90% of women reached that threshold

• 45% of participants improved their VO2peak by more than 10% — a threshold considered clinically meaningful for reducing pulmonary and cardiovascular complications after surgery

Leg muscle strength (1-RM leg press):

• Average improvement: 20% (from a median of 82 kg to 98 kg, p < 0.001)

• 60% of women increased their leg strength by more than 10% — the threshold considered clinically meaningful for surgical recovery

Functional mobility (Five-times Chair-Stand-Test):

• Improvement of 0.5 seconds (statistically significant, p = 0.001)

Nutritional status (PG-SGA):

• Before the program: 29% of women were at moderate or high risk of malnutrition

• After the program: 19% were at moderate or high risk — a 34% reduction in malnutrition risk

• This result was statistically significant (p = 0.001)

All of these improvements held up after the researchers adjusted for age, comorbidities, ECOG performance score, smoking status, and baseline values.

What didn’t change: body composition (BMI, fat percentage, fat-free mass index) and blood biomarkers (hemoglobin, albumin, CRP, leukocytes). The researchers noted that these measures typically require longer intervention periods to shift — especially albumin, which has a half-life of about 20 days.

What the Researchers Concluded

This study was the first and largest to evaluate the effect of multimodal prehabilitation specifically on physical fitness and nutritional status in women with gynecological cancer.

The researchers concluded that multimodal prehabilitation can meaningfully improve physical fitness and nutritional status before surgery — even in a short window. They called for further studies to define the minimum program duration needed for meaningful results, and to clarify which components of prehabilitation drive the most benefit for postoperative outcomes.

What Both Studies Tell Us Together

Read side by side, these two trials tell a coherent and compelling story.

Prehabilitation works — and it works in people like you.

The patients in both studies were predominantly in their 60s. They had cancer. Many had multiple comorbidities. Many were already carrying extra weight or dealing with reduced muscle mass. These are real-world patients, not elite athletes or otherwise healthy volunteers.

Here are the key takeaways that apply across both studies:

1. Muscle matters more than you think.

Sarcopenia isn’t just about looking lean. Muscle is metabolically active tissue. It supports immune function, hormonal signaling, insulin sensitivity, and physical resilience. When you go into surgery with less muscle — or with muscle that functions poorly — your body has fewer reserves to draw on during recovery.

Both studies show that structured exercise can build meaningful strength in as few as three to six weeks. You don’t need months. You need consistency, supervision, and the right program.

2. Nutrition is not optional.

Both programs included targeted nutritional support — protein supplementation, amino acid support, and dietitian coaching. The F4S-PREHAB trial showed a significant drop in malnutrition risk in less than a month. The PREHEP trial used BCAAs and immune nutrition to specifically target the muscle-building environment before surgery.

If you are preparing for any major surgery, protein intake deserves attention. Most adults over 50 are already under-consuming protein relative to what their muscles need. Surgery increases those demands substantially.

3. Short programs can still produce real results.

The F4S-PREHAB median program was just 22 days. The PREHEP trial was six weeks — but only because that window existed due to the nature of the procedure. If you’re told you have two to four weeks before surgery, that’s still enough time to make a difference.

4. Compliance is achievable.

100% of PREHEP patients completed the full program with zero adverse events. Across the F4S-PREHAB study, 140 women completed the program despite the added burden of a cancer diagnosis, chemotherapy in some cases, and the logistical complexity of a multi-component program.

Fear that a prehabilitation program will be too hard, too time-consuming, or too complicated for patients dealing with serious illness appears to be unfounded in the data.

5. The window before surgery is an opportunity most people are leaving on the table.

Most patients are told to wait, rest, and show up on the surgery date. The research increasingly suggests that waiting passively is a missed opportunity — and potentially a harmful one for those with sarcopenia or reduced fitness.

Why This Is Especially Relevant After 50

If you’re in your 50s, 60s, or 70s and facing any kind of major surgery — cancer or otherwise — these findings are directly relevant to you.

Here’s why the over-50 population is particularly affected by this research:

Muscle loss accelerates with age. After 50, adults lose between 1% and 2% of muscle mass per year without deliberate resistance training. By the time many people reach the age when cancer surgeries are most common, they’ve been losing muscle quietly for years.

Nutritional absorption changes. Older adults often require more dietary protein to stimulate the same muscle-building response as younger people — a phenomenon called anabolic resistance. This means you need to be more deliberate about protein intake, not less.

Recovery takes longer. After major surgery, older adults spend more time in the hospital, experience more complications on average, and take longer to return to baseline function. Anything that reduces the severity of that recovery curve matters.

The cancer-sarcopenia overlap is high. Cancer itself accelerates muscle loss through systemic inflammation, reduced appetite, altered metabolism, and in many cases the side effects of chemotherapy or radiation. By the time surgery happens, many cancer patients — regardless of age — are already carrying a sarcopenia burden.

Prehabilitation gives you agency. One of the most psychologically difficult aspects of a cancer diagnosis is the sense of helplessness — things are happening to you, decisions are being made for you, and your body feels out of your control. A structured prehabilitation program gives you something concrete to do. Something that directly improves your outcome. That sense of agency matters.

A Personal Reflection from Andrew

Reading these studies hit close to home for me.

When my father was going through treatment for Multiple Myeloma and Amyloidosis, and when my best friend was navigating Stage IV Melanoma, I watched firsthand how much the physical condition going into treatment shaped what happened after. My father had been relatively active his whole life, and his resilience through treatment reflected that. My friend’s body was battling the disease and the treatment simultaneously, and the toll was visible. He was a college athlete and triathlete through his 20s. He remained physically active during his entire life. His doctors have said this activity is a major factor in so far surviving seven cancer treatments.

I started memios because of experiences like those — and because of my own Melanoma diagnosis in 2022. At 59, I’m not naive about the fact that surgery may be part of my future, or the future of people I love.

What these studies confirm is something I’ve come to believe deeply through this journey: the time before a health crisis is not a waiting room. It’s an investment opportunity. Every week you spend building muscle, eating well, improving your cardiovascular fitness — those weeks are deposits in a reserve account that your body will draw on when it needs to.

You don’t have to be facing surgery right now for this research to matter. If you’re over 50 and you’re not already doing resistance training and prioritizing protein, this is a reason to start today.

The patients who fared best in these studies weren’t superhuman. They were people who did the work — consistently, for a few weeks, with professional support — and showed up to surgery in better shape than they otherwise would have been.

You can do the same.

What a Prehabilitation Program Might Look Like for You

If you are preparing for surgery — or if you want to be proactive about your surgical fitness in general — here is a framework based on what these studies used.

This is general information, not medical advice. Your specific program should be developed with your surgical team and ideally a physiotherapist or exercise physiologist familiar with your health history.

Exercise (3–6 weeks before surgery):

Aerobic training:

• 3 sessions per week of moderate to high intensity cardio

• Options include cycling, brisk walking, swimming, or rowing

• 20–30 minutes per session, working up to 80–90% of max heart rate

Resistance training:

• 2–3 sessions per week

• Focus on major muscle groups: legs, back, core

• Key exercises: leg press, squats, rows, lat pulldowns

• Start at a weight you can lift for 10–12 reps, increase gradually

Daily activity:

• On non-exercise days, aim for 60 minutes of low-intensity movement

• Walking is enough — just keep moving

Nutrition:

Protein intake:

• Target 1.5–2.0 grams of protein per kilogram of body weight per day

• This is higher than typical dietary recommendations

• Spread protein across 3–4 meals for best muscle uptake

Supplements to discuss with your doctor:

• Branched-chain amino acids (BCAAs) — used in the PREHEP trial

• Protein shakes (used in the F4S-PREHAB trial)

• Vitamin D — commonly deficient in older adults, important for muscle function

Nutritional assessment:

• Ask your surgical team for a referral to a registered dietitian if possible

• A simple tool called the PG-SGA (Patient Generated Subjective Global Assessment) can identify malnutrition risk

Psychological support:

• Consider discussing anxiety or depression with your care team

• Mind-body practices like deep breathing, journaling, or meditation can complement formal support

What to Ask Your Surgeon

Many patients don’t know they can ask about prehabilitation. Here are questions worth raising before your next surgical consult:

• “Is there a prehabilitation program available at this hospital or through a referral?”

• “Do I have enough time before surgery to complete a structured exercise and nutrition program?”

• “Should I be assessed for sarcopenia before my procedure?”

• “Can you refer me to a physiotherapist and/or dietitian before surgery?”

• “Are there specific exercises or nutritional approaches you recommend given my diagnosis?”

Even if your hospital doesn’t have a formal prehabilitation program, your surgeon may be able to point you toward resources or at minimum support you in pursuing one independently.

The Broader Longevity Perspective

At memios, we think about health not just in terms of surviving a diagnosis, but in terms of what kind of life you live for decades afterward.

Prehabilitation fits perfectly within that philosophy.

The habits that make you a better surgical candidate — regular resistance training, adequate protein intake, cardiovascular fitness, active movement, reduced smoking and alcohol — are the same habits that reduce your risk of developing cancer, heart disease, cognitive decline, and metabolic dysfunction in the first place.

These aren’t separate health strategies. They’re the same strategy.

Research on longevity consistently points to muscle mass as one of the strongest predictors of how long and well people live. Dr. Peter Attia and others have called strength and aerobic fitness the two most important measurable indicators of healthspan. The PREHEP and F4S-PREHAB trials add to a large body of evidence showing that muscle matters not just for daily function, but for surviving and recovering from acute medical events.

If you are 50, 55, 60, or 65 today — you have time. Not unlimited time, but meaningful time. Time to build muscle, improve your cardiovascular fitness, get your nutrition dialed in, and enter whatever medical challenges lie ahead from a position of strength rather than depletion.

That’s the memios mission. And these studies give it hard scientific backing.

FAQ

What is prehabilitation before cancer surgery?

Prehabilitation is a structured preparation program completed before surgery. It typically combines supervised exercise, nutritional support, psychological care, and lifestyle modifications. The goal is to improve your physical fitness and nutritional status before an operation so that your body is better equipped to handle the surgical stress and recover faster.

How long does prehabilitation need to be to make a difference?

The research suggests even two to four weeks can produce meaningful improvements in fitness and nutritional status. The PREHEP trial used six weeks and saw dramatic results. The F4S-PREHAB trial averaged just 22 days and still found significant improvements in aerobic capacity, muscle strength, and malnutrition risk.

Is prehabilitation safe for people with cancer?

Both studies reported high safety profiles. The PREHEP trial recorded zero adverse events in the prehabilitation group, with 100% of patients completing the full program. The F4S-PREHAB trial included women who were actively receiving chemotherapy and still found the program feasible and effective.

What exercises are used in prehabilitation?

Programs typically combine aerobic training (brisk walking, cycling, rowing, swimming) with resistance training (leg press, squats, rows, pulldowns). Supervised sessions with a physiotherapist are common. Daily low-intensity walking is usually recommended on non-training days.

What does nutrition in a prehabilitation program involve?

Most programs target higher protein intake — around 1.5 to 1.8 grams of protein per kilogram of body weight per day — along with supplementation (protein shakes, branched-chain amino acids, vitamin D, multivitamins as needed) and personalized dietary guidance from a registered dietitian.

What is sarcopenia and why does it matter for surgery?

Sarcopenia is the progressive loss of muscle mass, strength, and function associated with aging and illness. It affects 30%–74% of cancer patients. Patients with sarcopenia face significantly higher rates of complications after major surgery. The PREHEP trial showed that sarcopenia is a modifiable risk factor — meaning it can be improved through targeted exercise and nutrition in the weeks before surgery.

Can I do prehabilitation on my own without a formal program?

You can make meaningful improvements independently, but supervised programs tend to produce better results. If a formal hospital program isn’t available, ask your surgical team for a referral to a physiotherapist and registered dietitian who can guide you through a personalized plan.

Does prehabilitation reduce complications after surgery?

The PREHEP randomized clinical trial found that prehabilitation reduced overall 90-day complication rates from 50% to 13.3% — an absolute risk reduction of 36.7%. Patients in the standard care group had all major complications; the prehabilitation group had none. The F4S-PREHAB trial found improvements in fitness and nutritional status that are associated with fewer postoperative complications in the broader literature.

Is prehabilitation only for cancer surgery?

No. The principles apply broadly to any major surgery. Prehabilitation research exists across colorectal, liver, pancreatic, cardiac, and gynecological surgical populations. If you are facing any high-risk surgery, asking about prehabilitation is worth your time.

How do I know if I need prehabilitation?

Anyone facing major surgery can potentially benefit. You are especially likely to benefit if you are over 50, have reduced muscle mass or strength, have been less active recently, are carrying excess weight, have concerns about your nutritional intake, or are dealing with cancer-related fatigue or weight loss. Talk with your surgeon and ask for a preoperative fitness and nutritional assessment.

Additional Information

About the Studies Referenced in This Post

PREHEP Trial (Liver Surgery / Sarcopenia) Berardi G, Cucchetti A, Colasanti M, et al. Prehabilitation With Exercise and Nutrition to Reduce Morbidity of Major Hepatectomy in Patients With Sarcopenia: The PREHEP Randomized Clinical Trial. JAMA Surgery. 2025;160(10):1068–1075. DOI: 10.1001/jamasurg.2025.3102ClinicalTrials.gov: NCT05281211

F4S-PREHAB Trial (Gynecological Cancer) Dhanis J, Pijnenborg JMA, van Laarhoven CJHM, et al. The effect of a multimodal prehabilitation programme on preoperative physical fitness and nutritional status of women with gynaecological cancer. Gynecologic Oncology. 2025;203:1–7. DOI: 10.1016/j.ygyno.2025.10.012 Trial Registration: NL8699

Key Supporting Research

PREHAB Colorectal Cancer Trial — The landmark randomized trial showing prehabilitation reduces complications and enhances recovery after colorectal cancer surgery. Molenaar CJL, Minnella EM, et al. Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery: The PREHAB Randomized Clinical Trial. JAMA Surgery. 2023;158(6):572–581. DOI: 10.1001/jamasurg.2023.0198

Sarcopenia and surgical outcomes meta-analysis — Evidence that sarcopenia independently predicts postoperative complications across gastrointestinal cancer surgery. Simonsen C, et al. Sarcopenia and Postoperative Complication Risk in Gastrointestinal Surgical Oncology: A Meta-Analysis. Annals of Surgery. 2018;268(1):58–69. DOI: 10.1097/SLA.0000000000002679

Preoperative exercise and liver surgery — Evidence that prehabilitation improves VO2peak and quality of life in patients preparing for liver resection. Dunne DF, et al. Randomized clinical trial of prehabilitation before planned liver resection. British Journal of Surgery. 2016;103(5):504–512. DOI: 10.1002/bjs.10096

Personalized prehabilitation in major abdominal surgery — Randomized controlled trial showing 51% reduction in postoperative complications with a six-week exercise program. Barberan-Garcia A, et al. Personalised Prehabilitation in High-Risk Patients Undergoing Elective Major Abdominal Surgery. Annals of Surgery. 2018;267(1):50–56. DOI: 10.1097/SLA.0000000000002293

Berardi et al. — Sarcopenia and liver resection outcomes — Prior work from the PREHEP trial team showing sarcopenia predicts complications after liver surgery for malignancies. Berardi G, et al. Association of Sarcopenia and Body Composition With Short-Term Outcomes After Liver Resection for Malignant Tumors. JAMA Surgery. 2020;155(11):e203336. DOI: 10.1001/jamasurg.2020.3336

Preoperative exercise and exercise capacity in cancer patients — Meta-analysis examining the effect of exercise training on peak oxygen consumption across cancer populations. Jones LW, et al. Effect of Exercise Training on Peak Oxygen Consumption in Patients With Cancer: A Meta-Analysis. Oncologist. 2011;16(1):112–120. DOI: 10.1634/theoncologist.2010-0197

Resistance training in cancer survivors — Meta-analysis of the impact of resistance training on muscle mass and function across cancer populations. Strasser B, et al. Impact of Resistance Training in Cancer Survivors: A Meta-Analysis. Medicine & Science in Sports & Exercise. 2013;45(11):2080–2090. DOI: 10.1249/MSS.0b013e31829a3b4e

Related Reading and Resources

• memios: https://www.memios.ai

• The Longevity Letter on Substack:

The Longevity Letter by Memios

Memios empowers individuals to become the best version of themselves through coaching, self-help tools, education, and faith-based learning.

• Prehabilitation overview — ClinicalKey / Elsevier: For clinicians and patients seeking detailed protocols

• American College of Sports Medicine (ACSM): Guidance on exercise for cancer patients — https://www.acsm.org

• Cancer Exercise Training Institute: Resources for finding cancer-certified exercise specialists — https://www.canfitpro.com

• Academy of Nutrition and Dietetics — Oncology Nutrition: Finding a registered dietitian specializing in cancer nutrition — https://www.oncologynutrition.org

• ClinicalTrials.gov: Search for active prehabilitation trials near you - https://clinicaltrials.gov

• About Cancer Fitness

  Dr. Jay Harness is a board-certified cancer surgeon and the founder of Cancer Fitness. His work focuses on one core idea: exercise is medicine for cancer patients and survivors.

  Research backs him up. Regular movement reduces recurrence risk, improves treatment outcomes, and rebuilds strength and quality of life.

  Visit cancerfitness.org to learn more.

Disclaimer: memios shares wellness and longevity content for general education. We are not doctors, healthcare providers, or licensed medical professionals, and we do not provide medical advice, diagnosis, or treatment. We are health conscious individuals documenting what we learn and what we do as we work toward living long, healthy, strong lives into our 90s. Always talk with your physician or qualified healthcare professional before starting, changing, or stopping any exercise, nutrition, supplement, or health program.