Doctor Q&A: Can dandruff increase your risk of cancer? Dr Renee Hoenderkamp answers all your burning questions

Hey doctor Renée, can dandruff really increase your risk of breast cancer? I read a new study on it and panicked a little. I get it quite severely! Regards

I am glad you raised this as I too saw the story in a national newspaper this week and your question highlights how damaging such stories can be.

I have had a deeper dig into the study that the article cited and it looks like nothing to worry about to me.

Firstly, this was an in-laboratory study using mice breast cells, into which they transplanted cancer cells and then injected the fungus in question directly into the tumour and noted that the cancer cells grew faster. Such a study is so far removed from a human with dandruff which might then cross the skin barrier, move into the bloodstream and then find a cancer cell and accelerate its growth that there is no evidence that it can or will actually happen.

Of course, this kind of science is an important stepping stone to understanding processes within the human body but mice studies more often than not do not translate to human results and this one has many more years of study and investigation before we could reach a point where dandruff increases the risk of cancer, so please don’t worry.

If anyone is interested in the actual study, it is here and as you will see, the authors do not know how significant these findings are and if dandruff itself could offer an entry point for the fungus. So please, don’t worry, just try and keep it as controlled as you can!

Dear Dr Renée, sorry to pester you on this but desperate for a solution. Three years ago I had my first spinal operation, keyhole surgery. The following morning I was discharged from the hospital. Two weeks later I was readmitted to hospital to have spinal fluid flushed out due to a spinal infection. I have lost 30 per cent of my strength and mobility ever since. I do regular exercises to stop becoming a "couch potato" but I still ache a lot and it's painful. Do you know if there is a way to make the parts of the body that L4 and L5 discs are situated in less painful? Honestly, your advice would make a huge difference. Thank you

You are not pestering me, this is an important question and one I deferred to a spinal surgeon for advice. You should not have had pain that never resolved and this needs to be fully investigated now before making other recommendations like physical therapy and strengthening exercises.

The spinal surgeon replied to me that you had a decompression surgery and at the time the complication of fluid leaking from your wound after the operation may have been due to a tear of the covering of the nerves (called a dural tear). This means that the nerves may have been physically damaged at the time of surgery and sadly this doesn't always get better. Additionally, you may still have compression of the nerves as the surgery was likely stopped because of the dural tear and again there will be no improvement until this is evaluated and treated.

On top of this, over the last three years, your vertebrae may have moved creating a Spondylolisthesis that again needs evaluating and treating.

The surgery was aimed at getting you back to normal so continued symptoms need re-evaluating with an MRI scan and review by your spine team.

So in summary, it is important to be reassessed first and anything that is persisting since that complication of surgery needs to be rectified. Once that is done then you can undertake some rehab exercises that you can do at home. I always recommend this to my patients and use it myself as my old spine starts to moan! But please don’t use this until you have been reviewed by the spinal team.

I know this is probably not the answer you wanted, but it is important to give you the right advice, even if not ideal!

Hi doctor, are there any herbal supplements on the market I should avoid? I read that some can cause liver toxicity! Thank you

This is such a difficult question to answer as the number of herbal remedies on the market is almost limitless and even within the same type, eg black cohosh, there are hundreds of brands, strengths and mixes. So the only answer I can give is very broad brushstroke.

I think the first thing to say is, that as much as I am a fan of natural remedies, many drugs are formulated from naturally occurring plants and thus natural remedies must always be treated with respect for their power to heal and potentially harm, as with any drug.

Herbal teas and supplements can rarely lead to liver injury and even liver failure and this is called herb-induced liver injury. The liver is such an important organ that injuring it can have lifelong and life-limiting consequences. The liver is responsible for breaking down toxins and producing bile, which carries away waste and is crucial for digestion. Some medications and supplements can form toxic metabolites that damage liver cells. Over time, this can cause scarring, called cirrhosis, which can eventually lead to liver failure. Now, it is important to stress that it is very rare but still important to consider when taking any drug, herb or supplement. So let me give you some rules to apply before diving in:

1. Beware of known liver harmers

Green tea extract, multi-ingredient nutritional supplements, comfrey, skullcap, anabolic steroids, and multi-ingredient nutritional supplements — for example, Herbalife and other weight loss herbal supplements have been associated liver injury in people without the actual ingredient implicated ever being revealed. Certain herbs used in traditional Chinese medicine have also been found to pose some risks and there is a literature review of these here.

2. Always read the label carefully

If its unclear what specific ingredients are in it (watch out for added tea extracts), put it back!

3. Speak to your doctor

When considering adding a herbal supplement speak to your doctor to check for any interactions with your current medications (for example St Johns Wort has many interactions) and for their guidance.

4. Use a liver toxicity database

This database of liver toxic medications/supplements could also be useful https://www.ncbi.nlm.nih.gov/books/NBK547852/

I know this puts the onus back on you to do the background work but hopefully it points you in the right direction.