Thursday, August 1, 2024

Nutrition, supplements and cancer

Nutrition is not the cure for cancer – but ….

Nutrition cannot eliminate your cancer; neither is homeopathy an alternative to proper chemotherapy. The Bristol Cancer Help Centre Scandal in the 1990's made that clear to the whole UK. [1]

BUT if you DO have a cancer diagnosis or as in my case, your spouse has, or a close family relative is affected, then naturally you are asking – "Does anything we do at home make a difference?"


Here are three evidence based options.

First option: Good Nutrition

Nutrition matters:

"there are data correlating poor nutrition in patients with cancer with reduced quality of life, increased toxicities from standard-of-care therapies, and inferior overall survival" [2]

What is Good Nutrition

The 6 aspects of what you eat, that matter, are:

Protein: Have enough protein [1.2g protein/kg body weight for anyone over 60]. This means that even on top of what you might think is a protein rich diet, most older people or cancer sufferers need to take a protein supplement such as whey protein in a dose of 50g/day. This is best taken as single dose to improve utilisation into muscle. Vegans use pea protein. Especially important if your i8llness or your treatment reduces your appetite. Protein supplementation maintains muscle mass and strength; if you lose these, they are the very devil to restore.

Ultraprocessed foods and alcohol – none of these, they wreak havoc with your immunity. Please eat real food.

Sugar intake – Your tumour needs/uses a lot of sugar, don't feed it.

"Cancer cells rewire their metabolism to promote growth, survival, proliferation, and long-term maintenance. The common feature of this altered metabolism is increased glucose uptake in cancer cells, known as the Warburg effect "[3]

Action? Severely reduce your sugar intake: avoid fizzy, sugar-rich sodas or fruit juices [switch for Kombucha or fizzy water with fresh lime juice, or a splash of Angostura bitters]. Give up refined carbohydrates, and shop made desserts.

Polyphenols: take in a lot of polyphenols. These are the anticancer chemicals in fresh vegetables and in whole fruit such as berries. Your target is to have as much vegetable variety as possible [including herbs, nuts, seeds, spices] aiming for at least 30 per week. 

You can help your target by using an 'add-on' such as the Zoe Daily 30 This is a 'sprinkle that you put onto any plate of food. Purchase online from the Zoe website, or instore at Waitrose
https://www.waitrose.com/ecom/shop/browse/groceries/dietary_and_lifestyle/healthy_options/zoe_daily30.

Wheat: best avoid refined wheat products [white flour]. A lot of people are relatively sensitive to refined wheat and it triggers an inflammatory response in the gut and in the body generally that may not show much in the way of symptoms. If you are fighting cancer you don't want to be fighting your own immune system too.

Trace elements: the immune system is dependent on zinc and magnesium and these are deficient in around 35% of diets. Magnesium 500-600 mg every night [it makes you a little sleepy] and it must be an organic salt. I use Mg Taurate which gets into the brain but a citrate or glycinate is fine: not an oxide which is poorly absorbed and avoid chloride and sulphate as they cause diarrhoea. Zinc? Take 30-40 mg daily as a citrate or glycinate or picolinate.

Second Option: Optimise Your Gut Microbiome

You are probably just catching onto the microbiome story. I believe that understanding the importance of the microbiome, foremost in the gut but in other sites too, is the most major health breakthrough since the development of vaccination or the detection of antibiotics in fungi.

What is the big Deal?  Well, most of the impact of your immune system is defined by what the gut microbiome does to modulate the body's own defence systems. Does your microbiome augment or fail to support our own bodily defences? You may not yet get support for this view from your Family Doctor – conventional medicine is slow to spot new trends - but there are nearly 1500 research papers looking at this topic, already.

Here is a summary from a recent article in Trends in Cancer.

"The gastrointestinal tract (GIT) is the largest immune organ and maintains systemic immune homeostasis in the presence of bacterial challenge. Immune elimination and immune escape are hallmarks of cancer, both of which can be partly bacteria dependent: shaping immunity by mediating host immunomodulation". [4]

Essentially, your gut microbiome – the population of bacteria that live there, can be a group of socially-minded, polite and well-behaved bacteria with a strong positive impact, or a bunch of noisy, socially irresponsible troublemakers. The former create a good immune environment, whereas the latter diminish immunity and flare-up inflammation.

How do you optimize the microbiome? Eat at least one, ideally all, of the three K's every day [they are 'live foods' that contain good bacteria]; and give them enough fibre to feed on. 

The 3 K's are

-              Kefir [fermented milk with a better bacterial profile than yoghurt – a cupful], 

-              Kombucha [fermented tea – a cupful] 

-              Kimchi [fermented cabbage or beetroot - 2 tablespoons]. 

Fibre means lots of vegetables but also specifically a tablespoon of milled flaxseed along with a teaspoon of potato flour that can be mixed into the kefir or sprinkled on a meal to provide enough fibre-food.

Your mouth microbiome will influence the rest of the digestive tract so use a probiotic mouthwash such as LuvBiotics

Third Option – Polyphenol Supplements

Plant extracts of polyphenols can have anticancer activity. There is evidence to include quercetin, EGCG (extracted from green tea) curcumin, resveratrol, fisetin and melatonin on the list.

The evidence for usefulness in cancer comes initially from laboratory studies on animals or cell preparations. There have been a wide number of experimental trials on various formulations in several different cancers in humans. However, the evidence is preliminary and incomplete in a clinical sense.

There is evidence for effectiveness in inflammatory conditions for all of thes eand data on which products are actually absorbed into the bloodstream in a therapeutic level.

What should you do?

You can choose to take a punt on taking these or not. It depends on your philosophical stance. The cancer doctor's view would be to go on the evidence or lack of it. 

So your oncologist would not recommend these, as they can say 'they are of no proven benefit in any clinical trial'. 

I take the view that I need to explore all possibilities that may be beneficial. Not all decisions can be taken on the basis of perfect randomized controlled trials. 

Some cancers are very individual and there will never be large scale trials of their treatment.

I know that the reason there are few studies of these plant-based agents is that they are not patentable and therefore there is no profit incentive for Big Pharma to investigate them. As there is good preclinical data to show anti-cancer activity and there are no hazards ,then these may help keep the cancer at bay. Up to you…

For us 'at home' the main problem is that the agents concerned are poorly absorbed in standard form and need to be in an enhanced delivery system to exert a clinical effect. There are good, enhanced formulations of curcumin, quercetin, resveratrol, fisetin and EGCG. All these have shown clinical efficacy in inflammatory medical conditions, so the formulations have been tested. 

Do not just go into a health food store and buy anything off the shelf

Specific recommendations

It is difficult to find good formulations of melatonin that give sustained blood levels. So to help sleep, the Piping Rock product is the one I go for and there are other reputable options. For cancer, although there are research studies special preparations there are none readily available to buy that are affordable or have validated data on blood levels. So I take melatonin off the list for now.

I have chosen for my wife to add in a maximum dose of quercetin, curcumin and EGCG. There is always a challenge in terms of the number of tablets to take and indeed thecost. So you have to choose what is manageable.

What is the very minimum option ie which ONE to choose if that is all that is manageable? Probably curcumin as there is more data on its effectiveness.

In general polyphenols are poorly absorbed and special formulations are required that have enhanced absorption. I have only chosen products for which the product or the delivery system are validated. The most comprehensive data is on the various curcumin products that have been designed for good absorption and in some cases blood brain barrier penetration [the latter important if you have a brain tumour].

Curcumin: as described in an excellent review by Hegde [4] there are 3 levels of development that have occurred and the 3 preparations in the most recent tier of advance have the best profile. So Longvida 500 mg x 3 daily, Lamberts Curcumin Ultra 500 mg x 3 daily [contains the enhanced product curcuwin] and curQfen 500mg  3x daily are my top recommendations. From the middle tier I choose the Meriva phytosome sold by Thorne or the similar product from Intelligent Labs, 500mg x 3 daily.

EGCG: The product by Thorne, sold as 'Green Tea Phytosome' 250mg x 3 daily [the research studies suggest that this the maximum advisable dose].

Fisetin: The phytosomal combination Fisetin 1000mg/ Quercetin 200mg by Cestfilo is an option to consider

Quercetin: The iPerk product 'Liposomal Quercetin has 400mg / capsule. This approximates to the dose most commonly used in human studies as a daily dose.

Resveratrol: this polyphenol seems to enhance the performance of many cytotoxic drugs. Data in human studies in scarce. There are two isomers and only the trans isomer is clinically active.This phytosomal product is probably the best available. https://www.mcsformulas.com/vitamins-supplements/trans-resveratrol-liposomal/. I would take 1 capsule per day. This is currently my least favourite option.

Summary

Here are 3 strategies that are simple to impement and will have general health benefits as well as possible anticancer effect.

Sources

[1] https://www.independent.co.uk/life-style/news-of-death-greatly-exaggerated-the-report-on-the-bristol-cancer-help-centre-was-damning-it-was-also-highly-inaccurate-these-expatients-want-the-world-to-be-told-and-they-are-tired-of-waiting-liz-hunt-reports-1504475.html

[2] Haskins CP, Champ CE, Miller R, Vyfhuis MAL. Nutrition in Cancer: Evidence and Equality. Adv Radiat Oncol. 2020 May 24;5(5):817-823. doi: 10.1016/j.adro.2020.05.008. PMID: 33083643; PMCID: PMC7557144.

[2] Liberti MV, Locasale JW. The Warburg Effect: How Does it Benefit Cancer Cells? Trends Biochem Sci. 2016 Mar;41(3):211-218. doi: 10.1016/j.tibs.2015.12.001. Epub 2016 Jan 5. Erratum in: Trends Biochem Sci. 2016 Mar;41(3):287. Erratum in: Trends Biochem Sci. 2016 Mar;41(3):287. doi: 10.1016/j.tibs.2016.01.004. PMID: 26778478; PMCID: PMC4783224.

[3] Zhou CB, Zhou YL, Fang JY. Gut Microbiota in Cancer Immune Response and Immunotherapy. Trends Cancer. 2021 Jul;7(7):647-660. doi: 10.1016/j.trecan.2021.01.010. Epub 2021 Mar 2. PMID: 33674230.

[4] Curcumin Formulations for Better Bioavailability: What We Learned from Clinical Trials Thus Far? Mangala Hegde ACS Omega 2023 8 (12), 10713-10746  DOI: 10.1021/acsomega.2c07326

 

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