Should you ask your oncologist about your diet?

Here’s what I notice… across a growing number of clients…

Patients who ask the oncology team if diet can make a difference invariably get the answer no.

Patients who tell the oncology team that they are trying to help themselves with diet often get told to be very careful, or to stop.

Simple logic tells you that the above two assumptions can’t both be correct: either diet makes a difference, or it doesn’t.

It’s astounding that we can turn a blind eye to the ‘normal’, badly imbalanced, Western diet but sound a warning when patients try to improve on that. I’m not sure what’s behind it. For sure, there’s no evidence to show that eating a deep crust pizza vs a poached salmon and asparagus salad would affect chemotherapy outcomes. But, honestly, wouldn’t you expect they’d be more in favour of the latter? Last time I took a friend to the Maidstone oncology centre for radiotherapy the coffee bar was stacked high with junk food and sugary confectionery. The only ‘healthy options’ were a couple of tired-looking pieces of fruit.

I wonder if oncologists realise that their patients hang off every word they say, in the belief that they hold the magic keys to life and death? The responsibility needs to be handled with care.

When we don’t yet have all the answers, people at the sharp end of the treatment need to stay open and alert to any little thing that might help the patient feel better (placebo) or get better (reality). Anything you do or say to stop them looking after themselves takes a little bit of their power away.

We all need to hang on to hope – and I believe that in many oncology departments it’s in short supply. One of my clients was recently offered a place on a chemotherapy trial that was expected to provide benefit for 3% of people; the reported side effects were extremely debilitating. She chose to turn it down.

Inside our hospitals the battle against cancer is being lost. We appear to be getting better at treating cancers diagnosed early but we currently have no cures for cancers that have metastasised – only experiments. That being the case, why aren’t we experimenting with nutrition too? There are several eminent physicians who think we should be.

Scientists have explored in vain many of the genetic theories behind cancer but very little has been done to research metabolic solutions. To my knowledge none of the current chemotherapy or radiotherapy regimes has been tested with different diets to see if they help. No one has tested the effects of surgery and diet vs surgery and chemo. Why not? Because we are stupidly blind to the fact that food acts on your biochemistry just like drugs, and shamefully ignorant of the systemic biochemical shift that can occur when diet is changed.

We have pretty convincing evidence that the right diet can make a vital difference to survival. President of the Memorial Sloan-Kettering Cancer Centre, Craig B. Thompson, presented research to show that the cancer cell’s ability to upregulate the use of carbs is a key feature of the disease, and one we should be targeting. In February 2011, he said

“We now have good evidence… If you overfeed somebody with fat you don’t increase their cancer risk at all. If you overfeed them with carbohydrates then you dramatically increase their cancer risk. And protein is half way in between”

He also showed that restricting the use of glucose in cancer cells resulted in cell death and consequent regression of tumours.

More than 3 years on that message has still not reached the coal face.

Huge and costly research projects are coming up with few answers. In the interests of leaving no stone unturned to prove the genetic origins of the disease, skilled and expensive research teams are currently looking under pieces of gravel. This sort of desperation inevitably breeds a sense of failure. And with that comes fear. Fear that we have no answers, fear that it’s beyond our ken.

If you let someone with that belief take responsibility for your survival you will find the fear is catching. There is a prevailing sense that in cancer we are up against a huge, grisly monster that won’t let go until it has destroyed the human race; that the numbers will inevitably increase generation by generation; that we must continue to try to stop it but in reality we need to prepare to live with it. I know this because I went to a conference at the Royal Medical Society during which an NHS spokesman laid out his vision of cancer: hospitals more like hotels.

He wants to make the cancer experience more comfortable, to ‘take the stigma out of it’. He hadn’t had cancer, or he would know that the prospect of dying in a hotel wouldn’t really feel any more ‘comfortable’ than dying in a hospital. Cancer doesn’t have a stigma, it’s no longer a disgrace, but it is a terrifying ordeal that cannot be alleviated by providing a mini bar.

Of course there are ethical constraints. It’s tricky to offer someone a place on a trial when you don’t expect the outcome to be positive. Food isn’t generally believed to pack the same punch as cisplatin: it doesn’t have the same ability to kill either.

There may also be funding constraints. No one except the human race as a whole would benefit if we discovered that diet was at the root of the cancer epidemic. And we all know that unless there is the potential for corporate profit, nothing can be afforded any more.

As well, there’s the general inability to believe in the power of human beings to change for the better. Even the researchers looking at metabolic solutions say they doubt people would be prepared to change their diet to ward off, or cure cancer.

I don’t believe that for a minute.

I do believe – with all my heart – that we should be giving people an informed choice.

Well designed nutrition has the ability to reduce inflammation levels in the body, to quench free radical activity and, according to the latest research, which every oncologist should be made aware of, to cut off the fuel supply to cancer cells so that they die. This has the ability to be critically important in cancer care and cure. It’s time to invite nutrition into the mainstream.

Why do they refuse to consider it?

The cynical would say it’s about money. I doubt it. All the doctors I’ve met have a passionate and undeniable interest in human wellbeing. I think it’s more about silo mentality. Being a doctor these days is such a pressured profession, because so many people are so badly sick, that staying up to date with all the possible remedies out there is impossible. And with pharma reps knocking on their door every day, it’s no wonder all the focus is on drugs. Our doctors are worryingly overworked and overwhelmed. They don’t have time to study nutrition in any depth. Only a few are able to see the wood for the trees. I pray for your sake that you have one of these on your team.

Outside the mainstream cancer silo a few eminent researchers are also working their socks off. The likes of Thomas Seyfried, Dominic D’Agostino, Jeff Volek and Peter Attia are gaining a share of voice. A few clinical trials have been done in a few patients. The benefits of the ketogenic diet have been gently welcomed, well tolerated, and no ill effects have so far been observed. There are early indications that it may prolong life. It certainly improves it, helping people tolerate cancer treatment. In rat models there is evidence of tumour regression. If you google ‘cancer and ketosis’ you will find there is a lot of noise on this subject. It’s early days (though the roots date back to Otto Warburg in the 1930s) and there is no proof in humans. Yet. But one thing’s for sure: a ketogenic diet won’t kill you.

The fact that the treatment of cancer is managed entirely by doctors might make sense to you but it doesn’t to me. I have yet to meet a patient who has been brave enough to go against the advice of their oncologist. And I have yet to meet an oncologist who thinks he has got cancer on the run. There is a huge and obvious imbalance in that equation that is not acknowledged. Patients are quite literally putting their lives in the hands of people who desperately want to help but who – like all of us – don’t have the right answers. Palliative care is often all they can offer. The worry is that, as a body, these people are also passionately committed to fighting off anyone else who says they can help.

Medically, the only treatment that is so well-refined as to make it an obvious choice in most cases is surgery. Radiotherapy and chemotherapy both have the potential to cause collateral damage and shorten life. Chemotherapy is currently unproven as a cure, particularly for metastatic cancer. (In fact, it has been suggested that many of the benefits attributable to chemotherapy may well be down to the nutritional effect of the calorie deficit caused by loss of appetite and vomiting that typically accompanies the treatment.)

I believe that we have become blinded to the shortcomings of the current regime, seduced into believing that a cure is just round this particular corner if only we subject enough people to enough treatment. It seems that no one is looking objectively at real progress in the last 20 years and asking if we should be diverting some of the funding to other avenues of research.

Given that scenario, given that no one knows how to cure cancer, I can’t understand why we don’t adopt a more multi-disciplinary approach.

I hope there will come a time when the risks and rewards of potential treatments are explained to patients with precision and care, accompanied by references and case studies.

I hope there will come a time when we recognise that giving people a choice is just as important as giving them hope.

I hope there will come a time when nutritional therapy is on the list of choices alongside surgery, and immunotherapy .

I hope there will come a time when radiotherapy and chemotherapy are seen as treatments of last resort.

I hope there will come a time when, if the patient believes in snake oil, the doctor kindly helps him find a reliable supply.

Until that happens, what should you do?

To my mind you have two options:

a) Take a leaf out of the book of one of my very brave clients: look after yourself with a diet that is designed for metabolic cancer support and keep it to yourself.

b) Gather as much information as you can from this blog and other sources and ask your physician to look at it before giving you an opinion.

I wish you the very best of health and encourage you to listen to your feelings and continue to make brave choices on your own behalf. In the view of Bernie Siegel, that’s the one characteristic that links all us survivors: a refusal to take no for an answer.