By Dr Chun Tang — MBChB (Manchester), MRCGP, MBA · Practising NHS & Private GP · Founder, Little Ox & Pall Mall Medical

Why I Ran Through Manchester in a Poo Costume — And What It Taught Me About Preventative Health

Last week I swapped my stethoscope for running trainers and joined a 5K run through Manchester city centre dressed, along with my colleagues and hundreds of others, in poo emoji costumes.

It sounds like a laugh — and it was. But for me, it was also one of the most personal things I've done publicly in my 26 years as a GP.

My father died of bowel cancer. He had bleeding that was diagnosed as haemorrhoids. The cancer was missed. By the time the correct diagnosis was made, it was too late. My brother was later diagnosed with the same condition — but by then, screening had improved. He had regular check-ups, and the cancer was caught early. He made a full recovery.

The difference between those two outcomes was not medical brilliance. It was timing. It was a test, administered early enough to matter. That is the entire argument for preventative health, sitting in my own family history.

The 'Poo Protest' — What We Did and Why

Every April, Bowel Cancer Awareness Month gives those of us who care about this deeply a reason to make some noise. Bowel cancer is the second biggest cancer killer in the UK after lung cancer — and yet it remains the condition people are most reluctant to talk about. Embarrassment costs lives. That is not a figure of speech. It is a clinical reality I have watched unfold in my surgery for decades.

This year, Pall Mall Medical — where I serve as Medical Director — teamed up with Blaze Run Club, Manchester's extraordinary community running group, to take the message to the streets. We put 100 tickets out for a 5K run through the city. They were gone almost instantly. 700 members in a six-month-old running community. That's what happens when a cause resonates.

We ran past King Street waving banners, carrying loo rolls, making noise. People stopped. People filmed. People laughed — and then, hopefully, they Googled the symptoms we were shouting about.

One of the most powerful moments of the day was speaking to Alison Aspinall, 65, from Cheadle. Alison was diagnosed with stage 4 bowel cancer in 2021. She had no obvious stool symptoms — just stomach pain she assumed was IBS. She's had surgery to remove 65% of her liver. Her husband was subsequently diagnosed with stage 4 rectal cancer and died last September.

Alison is still here. Five years on, still turning up to these events, still telling her story, because she knows that one person who hears it and gets checked might avoid the path her husband took. That is what preventative health looks like in practice. Not a laboratory. Not a clinical trial. A 65-year-old woman running through Manchester because she wants someone else's family to stay whole.

The ColoAlert Test — Why We Brought It to the UK

Through Pall Mall, I've helped introduce the ColoAlert test to the UK. This matters in the context of this post, because it illustrates the gap between what the NHS currently offers and what early detection actually requires.

The NHS FIT test checks for blood in the stool. It is a good test. But some polyps — the pre-malignant growths that precede bowel cancer — don't bleed in their early stages. ColoAlert detects KRAS and BRAF mutated genetic markers in pre-malignant polyps, through a simple stool sample. It catches what blood-based testing misses. My father's story might have been different with this test. My brother's was different because screening caught it at all.

The principle is the same whether we're talking about bowel cancer, cardiac risk, diabetes or cellular ageing: the earlier you know, the more options you have. Knowledge is not anxiety — it is agency.

From Bowel Cancer to Cellular Health — The Broader Case for Testing

I want to make a wider argument here, because the principle of preventative testing applies far beyond oncology.

Every day in my surgery I see patients who are fatigued, cognitively foggy, recovering slowly from exercise or illness, and metabolically less resilient than they were in their 30s. They have done blood tests. Everything comes back "normal" — within range, not flagged, nothing to act on. And yet they feel consistently suboptimal.

Part of what is happening in these patients — and I would argue in millions of people across the UK in their 40s and 50s — is cellular metabolism decline driven by NAD⁺ depletion. NAD⁺ levels fall by roughly 1–2% per year from the mid-30s. By 50, most people have half the cellular metabolism substrate they had at 25. This does not show up in a standard blood panel. GP practices are not funded to investigate it. And yet it is measurable, directly actionable, and — crucially — reversible.

This is exactly why I co-founded MeCheck alongside Little Ox. Not to sell tests, but because the measurement is the missing piece.

The Symptoms You Should Never Ignore

Before I finish, I want to do the job I was doing on those streets last week. These are the bowel cancer symptoms that should prompt you to contact your GP — not tomorrow, today:

• Blood in your stool — bright red or darker. Never assume haemorrhoids without being checked.
• A persistent change in bowel habits — going more frequently, looser stools, constipation, or alternating between the two, for more than three weeks.
• Ongoing abdominal pain or cramping — particularly if it is new or has changed.
• A persistent feeling of not fully emptying your bowels.
• Unexplained weight loss.
• Unusual tiredness or fatigue — particularly if accompanied by any of the above, which can indicate anaemia from internal bleeding.

If you are over 60, you should be receiving FIT test kits through the post as part of the NHS bowel cancer screening programme. Use them. Every one. If you're younger and have any of the above symptoms, or a family history of bowel cancer, speak to your GP. The conversation may feel awkward. The alternative is worse.

As Alison told me after the run: "People shouldn't be embarrassed. I can't fault the screening programme. You still have to know your own body as well."

The Bigger Picture — Prevention as a Philosophy

The NHS was founded on the principle that good healthcare should be available to everyone. I was trained in that tradition. But the NHS is — by resource necessity — primarily a treatment service. Preventative medicine, early detection, cellular health optimisation: these happen at the edges, in the gaps, in the conversations GPs manage to have between the urgent and the immediate.

Little Ox exists in that gap. It's not a treatment. It's not a drug. It's the kind of cellular support that I believe the population deserves access to — at a price that makes consistent use possible, backed by science that meets the standard I'd apply as a clinician, and explained honestly by someone whose professional obligations require them to tell you the truth.

Running through Manchester last week in a ridiculous costume was a reminder of why that matters. The goal is not to avoid death — that is unavoidable. The goal is to have the information and the cellular resources to live well for as long as possible. To catch things early. To support the systems that allow recovery and resilience. To not be surprised by your own biology.

That is what preventative health means. And it starts with knowing where you are.

This article reflects Dr Tang's personal views and clinical experience. The NAD Level Test is a laboratory health assessment and is not a medical diagnostic. NMN supplements are food supplements, not medicines. If you have any of the bowel cancer symptoms described, please contact your GP promptly — do not self-manage or delay seeking medical advice. If you are experiencing a medical emergency, call 999.