The case for complementary care

At the bottom of the page I have shared a few key papers from among the many studies that underpin my clinical work and postgraduate studies. But first I want to say something about evidence, treatment and cancer because you are making big decisions about your life and I think you need all the information you can get. 

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. Probably the most important thing to say is that there is no evidence anywhere on the planet for anything – 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.

Diagnosis and treatment is the sole responsibility of your medical team and I strongly recommend you keep in touch with your primary care providers at all times.

We know that long term cancer recovery depends on 4 things:

  1. removing the tumour burden,
  2. eliminating cancer stem cells,
  3. repairing the tumour microenvironment,
  4. restoring immune surveillance and response.

There is a fifth area which is overlooked in conventional medicine but which I believe may be more important than all of the above: a strongly felt belief that you can get well and stay well again. When you look at the outliers – the stories of people who have survived against all odds, the common factor is almost always their determination to survive. That isn’t as strange or as random as you might think: quantum physics tells us that the intention of the observer has the ability to alter identical experiments. It’s entirely reasonable to assert that the attitude of the patient has an impact on the outcome of treatment. So I add:

5. the belief that survival is possible

Medical care is tightly focussed on the first goal but a comprehensive recovery programme should include all these goals, and natural medicine is leading the way. There’s indisputable evidence that 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.

In an ideal world there would be large scale clinical trials to support these claims but the money poured into cancer research is almost exclusively focussed on finding patentable drug treatments and improved diagnostic techniques, which means the evidence for natural remedies and preventative measures will never match up. This vicious circle (not enough evidence for natural remedies: no motivation to research natural remedies) is costing lives. To complicate the matter further it is difficult to carry out accurate nutrition research (consider the difficulty of measuring the impact of a ‘dose’ of poached salmon every day vs a dose of tamoxifen) which makes life difficult for those who want to show that food is capable of impacting wellbeing and provides an easy target for those who would dismiss  its importance. To some extent, common sense and ‘beliefs’ are bound to be part of the equation.

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: about the benefits of fasting; the lack of evidence for shark cartilage; the synergy of turmeric; the fact that chemotherapy in breast cancer has been shown, on average to extend life expectancy by 2.5%, or 3 months; and that recent studies have shown some chemotherapy drugs used in breast cancer may reduce tumour burden but increase metastatic spread. Such a discussion should also warn patients that if they only want to try things that are 100% proven to work then there is nothing available.

The intense focus within cancer research means we have lots of evidence for conventional treatment still no sign of a cure. 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 incredible results when chemo- and radiotherapy have been combined with diet, fasting and hyperbaric oxygen. There are signs that these developments may be integrated into cancer protocols in future but patients diagnosed right now 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 to benefit 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. I gave a lecture last year and published an article in IHCAN magazine showing how a patient with Stage 4 disease outperformed her oncologists expectations by working with me to improve these areas. This sort of personalised care is unlikely to be available on the NHS any time soon but many doctors are becoming more open-minded to working alongside complementary health practitioners and I regularly receive referrals from GPs and occasionally from oncologists.

Patients with advanced disease have most to gain from exploring alternative approaches. It is entirely wrong that oncologists are allowed to say the words, “I’m afraid there’s nothing more we can do,” before encouraging patients to try CBD oil, fasting, hyperbaric oxygen, intravenous Vitamin C or, for that matter, a burning desire to play the clarinet. Hope is 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. 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. Until 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… and I see no reason to disbelieve them.

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 causes 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 convinced 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.

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).

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

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.

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. 

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

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).

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.

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.

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.

Next Steps