As I was writing the previous post, I triggered a memory. To be accurate, it was more of a feeling.

I sensed all over again the confusion and frustration I experienced when I was coming to terms with my cancer diagnosis and trying to make decisions about further treatment. It was seventeen years ago, but the feelings are still vivid. And livid.

It’s not until you receive a cancer diagnosis that you realise how much there is to learn, and how fast you have to learn it. I can recall a sense of urgency accompanied by the knowledge that I was so naive that I couldn’t possibly make an informed decision. And it was the most important decision of my life.

At times like that you simply have to cede control to the experts and trust them to make the right decision for you.

I didn’t find that easy, as anyone who knows me will appreciate.

Radio- and chemotherapy were presented to me as no-choice choices.

No other choices were discussed.

I remember being so overwhelmed, so desperate, and so afraid that I would have submitted to anything my oncologist had recommended.

Imagine wielding that sort of power!

The sheer toxicity of the therapies was terrifying. No one in their right mind would choose them without an authoritative recommendation. As my treatment progressed I experienced panic attacks on the day of, and during, the administration of the drugs but I still submitted. I felt it was my only hope, my best chance of being alive to see my daughter go to secondary school. My particular cancer carried a poor prognosis so I was motivated to look at alternative therapies too. Anything to improve my odds. I researched the Bristol Cancer Centre, and became interested in nutrition. But I was alone, uneducated in these matters, with no reliable adviser to turn to. Trying to evaluate all these options for myself was exhausting. I was, to say the least, unqualified. But that was back in the last century.

Almost two decades later, this is still how it works.

We’ve learned a lot since then. Our success rate with blood-borne cancers is cheering, our ability to stop early-detected solid cancers has improved, but our success with metastatic disease is still stumbling along in the dark, relying more on serendipity than strategy. We also know more, perhaps because of improved survival, about the potential for radio- and chemotherapy to sow the seeds for new cancers later in life. These days, patients with metastatic or recurrent disease are offered lots of treatment but precious little hope.

Since 1997, we’ve also learned more about placebo – and nocebo – effect. So we should know that offering ‘not much hope’ is a very dangerous thing to do.

Especially if there’s more you could be considering.

I do understand that we have a duty as a society to protect vulnerable people from exploitation, I believe it too. But if you are going to shield people from charlatans when you have no cure to offer them, then you’d better be sure it’s in their best interests. You’d better have done the research and have first class evidence that talking to me and following my advice would be more harmful than enrolling them on a trial with toxic drugs, life-threatening side effects and a 3% chance of benefit. Let’s face it, you’d have to be a pretty appalling therapist to do worse than that.

In my dream, the NHS loosens its stranglehold on cancer treatment, acknowledges that lives are being lost while not enough progress is made, and opens its mind to other approaches that can be shown to have a bearing on the tolerance of treatment or the outcome, even if it’s ‘just’ placebo. In this scenario, the post-diagnosis ‘What next?’ discussion would not be handled by an oncologist but by a knowledgeable counsellor, well informed about the importance of hope and beliefs, as well as science and medicine, and with an informed view on the crossovers and boundaries between the two ‘sides’ of the debate. The power of choice would be handed firmly back to the patient who would be guided and encouraged to explore for themselves anything and everything that might contribute to their wellbeing, including conventional medical treatment. This would all happen within the NHS and not, as currently happens, outside it so that patients often feel they are somehow playing truant with their ‘alternative’ therapies, and experiencing associated dissonance and fear.

I can hear the ridicule. For many, it’s unthinkable that ‘woo woo’ complementary and alternative therapies could take their place alongside powerful medical treatments. And yet a hundred years ago radiation therapy was alternative, chemotherapy barely thought of. We forget, sometimes, how new this ‘conventional medicine’ lark is, and how many people died along the way – of the treatment, never mind the disease. Many brilliant minds and caring hearts have contributed to our current knowledge of cancer, but we are still unable to cure it. We are going to need a lot more so-called alternative thinking and a lot less conventional thinking if we are going to make more progress.

I can’t understand why nutrition is so unceremoniously dumped in with ‘alternative’ medicine. There’s nothing alternative about eating: we all do it. Neither does it lack power. We have no problem understanding that food can kill; the health agencies have done a good job of educating us to believe that saturated fat clogs your arteries and causes heart attacks, alcohol damages your liver, and red meat can cause cancer in your colon. So forgive me if I ask why it can’t work the other way round? It’s Newtonian: for every action there is an equal and opposite reaction. If you can kill yourself with food,  you can heal yourself with food. A carefully designed diet has the potential to shift biochemical pathways, improve healing response, protect delicate tissues (like DNA) from damage, balance hormonal reactions, normalise digestion, elevate mood, alter blood lipids, change the amount of fat stored and support optimal brain function. How is that ‘alternative’? It’s real, it’s measurable, it works on the same pathways in the body. The only alternative thing about it is that it’s often a more acceptable alternative to drugs.

Still, that doesn’t answer the question of whether nutrition has anything ‘real’ to offer cancer patients. Sadly, I think this is a question that has remained untested and unanswered for far too long.

In the amazing book, The Emperor of All Maladies, A Biography of Cancer, Siddharta Mukherjee tells the story of cancer from its earliest documented occurrences through to the most recent advances. The book takes us through all the schools of thought, the famous surgeons and the mavericks, the false dawns and serendipitous discoveries, the breakthroughs and the broken hearts. It focuses on individuals and organisations and provides a full and fairly frank ‘where are we now?’ analysis of the field of cancer endeavour. In it, we learn that nearly all the eureka moments happened by accident, often by rebellion. Throughout history it’s the people who proposed radical, unthinkable – but often less harmful – solutions who led the way to the breakthroughs.

However, for a book that aims to tell the whole story, there is a surprising omission: there’s no mention of Otto Warburg.

Of course, a five hundred page novel-style account can’t mention every character involved in the history of cancer. But Otto Warburg won a Nobel Prize for his breakthrough in our understanding of cancer. His was an impressive and well-documented achievement in an outstanding career. He moved in elevated circles: he studied under Nobel Prize winning Emile Fischer, who contributed most of what we know about sugars to the field of chemistry; and Hans Adolf Krebs, after whom the Krebs cycle, or citric acid cycle, is named, worked in Warburg’s lab; Albert Einstein was a family friend. Warburg himself became both a Doctor of Chemistry and a Doctor of Medicine. He was nominated 46 times for the Nobel Prize and finally won the Physiology prize in 1931 for his observations on the action of respiratory enzymes in the cell.

His primary work was in the investigation of tumours and the respiration of cancer cells. In a normal cell, glucose is broken in two via glycolysis to make pyruvate which is shunted into the mitochondria to make energy via respiration. Warburg noticed that cancer cells behave differently, the abnormal cells fermented glucose and recycled it to make energy without using the mitochondrial route – a less efficient process that requires much more glucose. He also observed that cancer cells were unable to switch to fats as an alternative energy source in the way that healthy cells will do in the absence of glucose. He concluded that mitochondrial damage made normal respiration impossible and he believed this – and the associated cellular dysregulation – to be the primary cause of cancer. He viewed all the other known characteristics – gene mutation etc – as secondary – and highlighted the metabolic dysfunction as the common link between all cancers. He thus classified cancer as a disease of the mitochondria. His observations were widely accepted, they still are, at least where they are known.

In general, Warburg’s contribution seems to have been completely forgotten. I can’t find an explanation for this except that his conclusions don’t support the prevailing paradigm that cancer is a genetic disease.

We’ve had this knowledge for 83 years and it has never been properly tested in humans. Mitochondrial damage is the common link between all known cancer cells and represents a critical vulnerability. Starve them of glucose and they die. No one seems to disagree with this. Multiple mouse studies suggest that tumour growth can be halted and even reversed with carbohydrate restriction, but no one has launched a full scale trial. Testing it would be demanding, diet wise, requiring significant discipline from the participants, but otherwise non toxic, harmless and easily measurable; it could easily be tested alongside conventional medicine. There’s no reason to believe that as a therapy is would cause cancer cells to become resistant, and neither would it increase the risk of new cancers developing in later life.

Is it me?

Why wouldn’t you test this approach, urgently, with anyone and everyone who was willing?

Designing a healthy nutritional protocol that restricts the supply of glucose to cancer cells is a whole lot easier than trying to design drugs to target individual genes for individual patients, which seems to be the current number one strategy for cancer treatment.

In my dream, it’s option 4 on the menu.

No, scratch that, in my dream, it’s option 2: surgery, nutrition, radiotherapy, chemotherapy. Part of the standard of care for all cancers.

There is already more than enough justification to try a nutritional strategy alongside other therapies. Don’t you agree? The most uncomfortable side effects are likely to be bad breath and constipation. I honestly can’t understand why, with all this knowledge, all this budget, all these brilliant and dedicated people, and all these tragic deaths, it isn’t on the agenda.

That’s my dream.

Is it too much to ask?