The case for complementary care

After studying cancer for over 20 years it’s clear to me that cancer recovery is a multi-factorial process most likely to succeed with early diagnosis, excellent medical care and an informed review of diet and lifestyle – but there are thousands of stories of survivors who didn’t get the first two right and have lived to tell the tale. There’s indisputable evidence that poor nutrition and lifestyle choices cause many cancers and that healthy changes can impact prevention, progression and survival. Many nutrition and lifestyle practices work on the exact same pathways that cancer drugs do with fewer side effects and lower toxicity, Indeed, drugs, diet and lifestyle can work in synergy to potentiate treatment outcomes. For example, the potential for fasting to improve chemotherapy treatment outcomes is well documented.

Probably the most important thing to say is that there is no evidence for any single thing – conventional or complementary – that cures cancer. It’s important that cancer patients are not led up the garden path by false claims of diet ‘cures’ and ‘miracle’ remedies or even the marvels of chemotherapy. There is no cure – but every year, thousands of people go into remission. While medical care is tightly focussed on removing tumours it is increasingly clear that any comprehensive recovery programme needs to widen its focus to eradicate cancer stem cells, correct the ‘tumour microenvironment’ and restore immune function.

Since the 1939 Cancer Act prohibits anyone who is not a doctor from advising patients on cancer treatment, it seems only fair that the handful of people who are trusted to give this life-saving advice are well-informed about anything at all that may improve (or worsen) survival. I would welcome more frankness in this area both about the potential for complementary care and about the limitations of conventional treatment. The recent and worrying trend is that drugs with very small and sometimes insignificant benefits have been allowed onto cancer wards. Taken as a whole, the evidence for surgery, chemo and radiotherapy shows that sometimes people benefit and sometimes people die, and sometimes people die of the treatment. That’s pretty much the same for complementary medicine – except you’re less likely to die from the treatment.

Some of the most exciting papers I’ve read over the past few years have shown unprecedented results when chemo- and radiotherapy have been combined with diet, fasting and hyperbaric oxygen. There are signs that these developments may be integrated into future cancer protocols but the UK seems to be behind the curve, and patients diagnosed today need to take a more proactive approach.

Whoever you choose to work with, it’s important to ask for evidence. But even this comes with a caveat. The system of evidence, which worked so well when we were curing epidemics in the twentieth century is not well-suited to individual care. In fact, evidence-based medicine is widely recognised to have been hijacked by corporate interests, manipulated by drugs companies, skewed to ignore whole categories of health care, and unsuitable for deciding individual patient protocols. Bluntly, as long as you have a big enough budget, you can pay for studies which say exactly what you want – and many of the expert committees are in the pocket of the big food and pharma organisations. (Jerome Burne and Zoe Harcombe are the people to follow if you are interested in how evidence and opinion are being manipulated.) Many experts are calling for another system of validation to tackle the diseases of the 21st century and take us into the next wave of medical progress.

Where does this leave today’s cancer patient?

Right now, our cancer knowledge is streets ahead of our cancer provision. For example, we know that blood sugar, inflammation, oestrogen metabolism, and other genetic factors have a direct effect on the disease, and we know that restricting certain amino acids may help to slow or stop growth and spread. One of the problems is that as soon as these factors are identified the race is on to develop drugs and technologies that can produce the effect rather than turning to diet and lifestyle. When your oncologist tells you “there’s nothing more we can do,” it normally means there is no more medicine available. It is entirely wrong that these words are used before encouraging patients to change their diet, try CBD oil, fasting, hyperbaric oxygen, intravenous Vitamin C or, for that matter, a burning desire to play the clarinet. Hope is, in itself, a powerful immune stimulant.

Be clear in your own mind that recovery is multi-factorial and take advantage of every opportunity to boost your chances of recovery. Not everything you choose needs to be rational or scientific: it’s fine to explore things you are instinctively drawn to, as long as you do some research into the pros and cons. Try not to be taken in by other people on either side of the fence. I’ve met a lot of complementary therapists whose enthusiasm vastly outweighs their knowledge and critical thinking, and I’ve met a few medical professionals whose cancer knowledge is

It’s possible that the thing that will make the most difference is your own determination to stay alive: certainly the celebrated New York oncologist, Bernie Siegel, believed that to be true. Obviously, any treatment which might deplete your health and immune status should be subject to extra scrutiny.

In my opinion, we won’t find the key to cancer until the scientific community is prepared to shift to a higher level of consciousness – in fact, until we acknowledge the role of consciousness on health outcomes – and design a more holistic method of research. Unless we move away from linear research arguments (i.e. does green tea cure cancer) and acknowledge the complex and interdependent effect of thoughts and environment, food and drink, genes and microbes we are unlikely to make the progress we so desperately need. Until clinical trials exist that trace diet and supplements and sleep and purpose and love and microbiome and toxic exposure we will never understand cancer through an evidence-based lens. Until that time the research will always be incomplete, and the medical statistics will keep on getting worse. That means that clinical evidence should not be the be all and end all of your cancer recovery plan.

Reliable stories of people who have survived cancer despite the odds run into thousands. Dr Kelly Turner and Chris Wark are dedicated to sharing survivor stories to inspire others to believe they can change their disease outcomes all by themselves. People attribute remission to a vast array of remedies: diet, supplements, stress management, love, running, gardening. Are they mad? Or are they operating at a higher level than we are prepared to acknowledge?

As I have studied the subject over the last 15 years I have found, time after time, that all the factors your grandmother would have associated with good health – fresh air, exercise, getting to sleep before midnight, regular meals, eating your greens – are supported by the research. Unfortunately, since your grandmother’s day the world has become incalculably more complex, with more chemicals, toxins, technology, stress, fake food, etc than ever before. Uterine exposure to these factors has also created health problems that were unforeseen. Food production on depleted soils and with depleted diets mean that we don’t always get the nutrients we need, and prolonged stress, antibiotics and, of course, cancer treatment cause problems with digestion, absorption and activation of anti-cancer nutrients. And, frankly, some of us were standing in the wrong queue when they were handing out genes.

Over the years, I’ve learned that most of the messages we hear about health are wrong. Sometimes they are wrong on an epic scale, and mostly they are wrong when applied to individuals. Press articles are hastily cobbled together with no real understanding of the research. Public health programmes are designed for 95% of the healthy population and most cancer patients don’t fall into that bracket. Cancer statistics are based on people who don’t make any lifestyle changes. The EatWell plate and the 5-a-day advice are not underpinned by any evidence at all. It’s all a bit bonkers.

It was against this background that I decided to add to my Nutritional Therapy qualifications by completing a postgraduate course in Personalised Medicine (CNELM) in 2016; to immerse myself in the evidence and decide whether or not we can make a sound case for the benefits of diet and lifestyle change following cancer diagnosis. What I found made me more determined than ever to promote the natural health approach. I am pleased to say that my studies made me even more aware of the importance of diet and lifestyle and doubly determined to help women with breast cancer make more powerful and well-informed decisions about their future.

Some key studies are listed below:

A Few Studies

Allen, B.G. et al., 2014. Ketogenic diets as an adjuvant cancer therapy: History and potential mechanism. Redox Biology, 2, pp.963–970.

Ames, B., 2001. DNA damage from micronutrient deficiencies is likely to be a major cause of cancer. Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis, 475(1-2), pp.7-20.

Aragón, F., 2014. Modification in the diet can induce beneficial effects against breast cancer. World Journal of Clinical Oncology, 5(3), p.455. 

Azrad, M., Turgeon, C. & Demark-Wahnefried, W., 2013. Current evidence linking polyunsaturated Fatty acids with cancer risk and progression. Frontiers in Oncology, 3(September), p.224.

Basse, C. and Arock, M., 2015. The increasing roles of epigenetics in breast cancer: Implications for pathogenicity, biomarkers, prevention and treatment. International Journal of Cancer, 137(12), p.2785-2794

Bayet-Robert, M., et al., 2010. Phase 1 dose escalation trial of docetaxel plus curcumin in patients with advanced and metastatic breast cancer. Cancer Biology and Therapy, Jan;9(1):8-14. Pub 2010 Jan 21

Bonucci, M. Pastore, C. Ferrara V. et al (2018) Integrated Cancer Treatment in the Course of Metastatic Pancreatic Cancer – Complete Resolution in 2 cases. Integrative Cancer Therapies, Volume: 17 issue: 3, page(s): 994-999

Boon, H.S., Olatunde, F. & Zick, S.M., 2007. Trends in complementary/alternative medicine use by breast cancer survivors: comparing survey data from 1998 and 2005. BMC women’s health, 7(1), p.4.

Bozzetti, F. & Zupec-Kania, B., 2016. Toward a cancer-specific diet. Clinical Nutrition, 35(5), pp.1188–1195.

Braakhuis, A., Campion, P. and Bishop, K., 2016. Reducing Breast Cancer Recurrence: The Role of Dietary Polyphenolics. Nutrients, 8(9), p.547.

Branca, J. Pacini, S. Ruggiero, M., 2015. Effects of Pre-surgical Vitamin D Supplementation and Ketogenic Diet in a Patient with Recurrent Breast Cancer. Anticancer Research, 35(10), p.5525-5532.

Burne J., 2018. How the UK press published hundreds of fake news stories about cancer drugs. Health Insight UK, http://healthinsightuk.org/2018/09/17/how-the-uk-press-published-hundreds-of-fake-news-stories-about-cancer-drugs/

Bultman, S., 2016. The microbiome and its potential as a cancer preventive intervention. Seminars in Oncology, 43(1), pp.97-106.

Cavuoto P, Fenech MF 2012 “A review of methionine dependency and the role of methionine restriction in cancer growth control and life-span extension”. Cancer Treatment Reviews. 38 (6): 726–36. doi:10.1016/j.ctrv.2012.01.004 

Champ CE, Volek JS, Siglin J, Jin L, Simone NL, 2012. Weight Gain, Metabolic Syndrome, and Breast Cancer Recurrence: Are Dietary Recommendations Supported by the Data? International Journal of Breast Cancer Volume 2012, Article ID 506868

Clayton, P. and Rowbotham, J., 2009. How the Mid-Victorians Worked, Ate and Died. International Journal of Environmental Research and Public Health, 6(3), pp.1235-1253.

Cornelius, C. et al., 2013. Stress responses, vitagenes and hormesis as critical determinants in aging and longevity: Mitochondria as a “ chi.” Immunity and Ageing, 10(1), p.15.

DeBusk, R., et al, 2011. Applying functional nutrition for chronic disease prevention and management: Bridging nutrition and functional medicine in 21st Century healthcare. The Journal of Science and Healing, 7(1)55-57

Dorff, T., Groshen, S., Garcia, A., Shah, M., Tsao-Wei, D., Pham, H., Cheng, C., Brandhorst, S., Cohen, P., Wei, M., Longo, V. and Quinn, D., 2016. Safety and feasibility of fasting in combination with platinum-based chemotherapy. BMC Cancer, 16(1).

Ferguson R.D., Gallagher E.J., Scheinman E.J., Damouni R., LeRoith D. The Epidemiology and Molecular Mechanisms Linking Obesity, Diabetes, and Cancer. Vitam. Horm. 2013;93:51–98.

Godlee, F., 2016. Too Much Chemotherapy. BMJ (Online). 355/i6027

Goodpaster, B.H. & Sparks L.M., 2017. Metabolic Flexibility in health and disease. Cell Metabolism, May 2:25(5) 1027-1036

Greenhalgh, T., Howick, J., Maskrey N., 2014. Evidence Based Medicine: a movement in crisis? BMJ 348(4) g3725-g3725

Grivennikov, S., Greten, F. and Karin, M. (2010). Immunity, Inflammation, and Cancer. Cell, 140(6), pp.883-899.

Gunter, M., Xie, X., Xue, X., Kabat, G., Rohan, T., Wassertheil-Smoller, S., Ho, G., Wylie-Rosett, J., Greco, T., Yu, H., Beasley, J. and Strickler, H. (2015). Breast Cancer Risk in Metabolically Healthy but Overweight Postmenopausal Women. Cancer Research, 75(2), pp.270-274.

Hanahan, D. & Weinberg, R.A., 2011. Hallmarks of cancer: The next generation. Cell, 144(5), pp.646–674.

Hens, J R et al. 2016 “Methionine-restricted diet inhibits growth of MCF10AT1-derived mammary tumors by increasing cell cycle inhibitors in athymic nude mice.” BMC cancer vol. 16 349. 3 Jun. 2016, doi:10.1186/s12885-016-2367-1

Holloway, K., Barbieri, A., Malyarchuk, S., Saxena, M., Nedeljkovic-Kurepa, A., Cameron Mehl, M., Wang, A., Gu, X. and Pruitt, K. (2013). SIRT1 Positively Regulates Breast Cancer Associated Human Aromatase (CYP19A1) Expression. Molecular Endocrinology, 27(3), pp.480-490.

Hyde, P., Lustberg, M., Miller, V., LaFountain, R. and Volek, J. (2017). Pleiotropic effects of nutritional ketosis: Conceptual framework for keto-adaptation as a breast cancer therapy. Cancer Treatment and Research Communications, 12, pp.32-39.

Ionaddis, J.P.A., 2018. The Challenge of Reforming Nutritional Epidemiological Research. JAMA, 969-970.

İyikesici, M.S. et al., 2017. Efficacy of Metabolically Supported Chemotherapy Combined with Ketogenic Diet, Hyperthermia, and Hyperbaric Oxygen Therapy for Stage IV Triple-Negative Breast Cancer. Cureus. 

Jeon H, Kim JH, Lee E, Jang YJ, Son JE, Kwon JY, et al. 2016 Methionine deprivation suppresses triple-negative breast cancer metastasis in vitro and in vivo. Oncotarget. 2016;7(41):67223–67234. doi: 10.18632/oncotarget.11615

Kakarala, M., Brenner, D., Korkaya, H., et al., 2010. Targeting breast stem cells with the cancer preventive compounds curcumin and piperine. Breast Cancer Research and Treatment, 122(3) 777-785

Keklikoglou, I., et al., 2018 Chemotherapy elicits pro-metastatic extracellular vesicles in breast cancer models. Nature Cell Biology, DOI: 10.1038/s41556-018-0256-3

Kotepui, M., 2016. Diet and risk of breast cancer. Współczesna Onkologia, 1, pp.13-19.

Kumar, P., Barua, C., Sulakhiya, K. and Sharma, R. (2017). Curcumin Ameliorates Cisplatin-Induced Nephrotoxicity and Potentiates Its Anticancer Activity in SD Rats: Potential Role of Curcumin in Breast Cancer Chemotherapy. Frontiers in Pharmacology, 8(APR).

Kwa, M. Plottel, CS. Blaser, MJ. Adams, S., 2016. The Intestinal Microbiome and Estrogen Receptor–Positive Female Breast Cancer.  JNCI: Journal of the National Cancer Institute, 108(8), pp.1-10.

Lee, C. & Longo, V.D., 2011. Fasting vs dietary restriction in cellular protection and cancer treatment: from model organisms to patients. Oncogene, 30(30), pp.3305–3316.

Lettieri-Barbato D and Aquilano K (2018) Pushing the Limits of Cancer Therapy: The Nutrient Game. Front. Oncol. 8:148. doi: 10.3389/fonc.2018.00148

Longo, V. and Mattson, M., 2014. Fasting: Molecular Mechanisms and Clinical Applications. Cell Metabolism, 19(2), p.181-192

Miles, A., Loughlin, M., Polychronis, A., 2008 Evidence-based healthcare, clinical knowledge and the rise of personalised medicine. Journal of Evaluation in Clinical Practice, 14(5) 621-649

Miller, RA Buehner G, Chang Y, Harper JM, Sigler R, Smith-Wheelock M 2005 “Methionine-deficient diet extends mouse lifespan, slows immune and lens aging, alters glucose, T4, IGF-I and insulin levels, and increases hepatocyte MIF levels and stress resistance”. Aging Cell. 4 (3): 119–25. doi:10.1111/j.1474-9726.2005.00152. 

Noakes, T.D. & Windt, J., 2017. Evidence that supports the prescription of low-carbohydrate high-fat diets: A narrative review. British Journal of Sports Medicine, 51(2), pp.133–139.

O’Flanagan, C., Smith, L., McDonell, S. and Hursting, S., 2017. When less may be more: calorie restriction and response to cancer therapy. BMC Medicine, 15(1).

Paoli, A. Rubini, A. Volek, JS. Grimaldi, KA 2013. Beyond Weight Loss: a review of the therapeutic uses of very-low-carohydrate (ketogenic) diet. Eur

Schwabe, R.F. & Jobin, C., 2013. The microbiome and cancer. Nature reviews. Cancer, 13(11), pp.800–12. 

Seyfried, T. and Shelton, L., 2010. Cancer as a metabolic disease. Nutrition & Metabolism, 7(1), p.7.

Shay, J. and Wright, W. (2007). Tissue Culture as a Hostile Environment: Identifying Conditions for Breast Cancer Progression Studies. Cancer Cell, 12(2), pp.100-101.

Soldati et al., 2018. The Influence of Diet on Anti-cancer Immune Responsiveness. Journal of Translational Medicine. 20;16(1):75

Teegarden, D., Romieu, I. and Lelièvre, S. (2012). Redefining the impact of nutrition on breast cancer incidence: is epigenetics involved? Nutrition Research Reviews, 25(01), pp.68-95.

Vanden Berghe, W., 2012 Epigenetic impact of dietary polyphenols in cancer chemoprevention: Lifelong remodelling of our epigenomes. Pharmacological Research, 65(6) 565-576

Wang, H., Altemus, J., Niazi, F., Green, H., Calhoun, B., Sturgis, C., Grobmyer, S. and Eng, C., 2017. Breast tissue, oral and urinary microbiomes in breast cancer. Oncotarget, 8(50) pp88122-88138.

Wassertheil-Smoller, S., McGinn, A., Budrys, N., Chlebowski, R., Ho, G., Johnson, K., Lane, D., Li, W., Neuhouser, M., Saquib, J., Shikany, J., Song, Y. and Thomson, C. (2013). Multivitamin and mineral use and breast cancer mortality in older women with invasive breast cancer in the women’s health initiative. Breast Cancer Research and Treatment, 141(3), pp.495-505.

Wang Z Yip L Lee J Wu Z Chew H Chong P Teo C Ang H Peh K Yuan J Ma S Choo L Basri N Jiang X Yu Q Hillmer A Lim W Lim T Takano A Tan E Tan D Ho Y Lim B Tam W 2019 Methionine is a metabolic dependency of tumour-initiating cells. Nature Medicine volume 25, pages 825–837 (2019)

Wise, P. (2016). Cancer drugs, survival, and ethics. BMJ (Online) 355.i5792

Toledo, E. et al., 2015. Mediterranean Diet and Invasive Breast Cancer Risk Among Women at High Cardiovascular Risk in the PREDIMED Trial. JAMA Internal Medicine, 175(11), p.1.

Xia Gao, Sydney M. Sanderson, Ziwei Dai, Michael A. Reid, Daniel E. Cooper, Min Lu Peter G. Mikhael, Samantha J. Mentch, Juan Liu,  Gene Ables, David G. Kirsch, David S. Hsu, Sailendra N. Nichenametla, and Jason W. Locasale. 2019 Dietary methionine restriction targets one carbon metabolism in humans and produces broad therapeutic responses in cancer. Pre-printed article. Not yet peer-reviewed (as at 29.8.19). https://www.biorxiv.org/content/biorxiv/early/2019/05/04/627364.full.pdf