My blog is a little different this month as it’s not my musings on a particular nutrition or health issue. Instead, I thought I’d bring you a review of the this year’s Yes to Life conference on integrative approaches to cancer which took place in London on Saturday 25 November 2017. I know a few people who would have liked to have attended the conference but couldn’t make it. Yes to Life will be releasing a video of the event, but as it was a long day making for a lot of video-watching, this is my shorter summary! There was evidently a lot more discussed than I have room for, but what I have written here are the points and issues that struck me as being most significant from the day. Nevertheless, it’s a much longer post than usual, so feel free to dip in and out. I hope you enjoy it.
The title of the conference was “Starting the Conversation – exploring ways in which integrating conventional cancer care and lifestyle medicine can improve outcomes”. The aim was to discuss how we can bridge the gap between conventional treatment and other approaches so that people with cancer can benefit from the best of both. This involves communication and open dialogue between practitioners from both approaches – hence starting the conversation!
Sophie Sabbage, author of The Cancer Whisperer
That the conference opened with Sophie (not a practitioner but a patient, albeit an inspirational one) reflected how important it is to put the patient at the very centre of the treatment process. In her usual incredibly eloquent way, Sophie described that when she was diagnosed with stage 4 lung cancer, she wanted to do absolutely everything she could to help herself, so she put together a team involving complementary practitioners as well as her conventional medical team. However, she found the scaremongering on both sides very unhelpful; the alternative practitioners warned her of the damage conventional treatments would do to her body whilst the medics were sceptical of the validity of any complementary or lifestyle approaches. There are often elements of arrogance and self-righteousness on both sides, which only serve to promote fear and disempowerment in the patient. In Sophie’s case, the first sign of a bridge between the two approaches came from her TCM practitioner, who likened the cancer in Sophie’s body to terrorists in a house, and described conventional treatments as the SAS taking the terrorists out, with complementary and lifestyle therapies then taking care of the house and the innocent civilians in it.
Sophie referenced Dr Bernie Siegel’s book “Love, Medicine and Miracles”, in which he defines “exceptional patients”. “Exceptional patients refuse to be victims. They educate themselves and become specialists in their own care. They question the doctor because they want to understand their treatment and participate in it. They demand dignity, personhood, and control, no matter what the course of the disease.” This made me cry, because it was one of the first books that I read when I was diagnosed, and made me resolve to be an exceptional patient, something that often kept me going when I felt despair creeping up on me.
She also dealt with one of conventional medicine’s criticism of alternative therapies, that they promote false hope. Sophie said that there is no such thing as false hope, because “Hope does not make promises; it just hopes.” False hopelessness is a more dangerous thing. The final thing that rang true with me was that lifestyle therapies are a wonderful way of claiming some semblance of power in the face of powerlessness. I think that the complete loss of control that results from cancer and its treatment can often be underestimated by those who have not gone through it, and feeling that you are taking steps to help yourself can be incredibly validating and empowering.
If you have/have had cancer and haven’t come across Sophie before, then I urge you to look her up and read her book “The Cancer Whisperer”.
Dr Rupy Aujla of The Doctor’s Kitchen
Dr Rupy is an NHS GP and emergency medicine doctor, who came to a realisation of the benefits of nutrition and lifestyle through his own experience of ill health. Knowing that doctors trained in the UK aren’t educated in nutrition, he is aiming to change this.
He is using and adapting the concept of Culinary Medicine, which has been used in several medical schools in the USA since 2012. Medical students take a series of modules on nutrition in relation to particular health conditions. Each module involves AV presentations, familiarisation with the associated research, and a hands on food preparation session with a chef, a nutritional therapist and a medical doctor based on improving the outcome in a real case. Each module closes with eating the food and a frank discussion amongst the student and professionals of the benefits and controversies of the nutritional approach under consideration.
Dr Rupy has planned a pilot of this at Westminster Kingsway College (which has a fine culinary school). It starts in February 2018 and has been accredited by the Royal College of General Practitioners. The main long-term goals are to change the medical curriculum and to train GPs so that they can have a conversation with their patients about lifestyle – food, sleep, exercise, meditation.
And excitingly, his vision for the future is that every GP surgery in the UK will have a community kitchen associated with it, with a chef and a nutritional therapist. Patients would be referred to it for support in changing their lifestyle – how wonderful would that be?!
Dr Malcolm Kendrick, GP and author of “The Great Cholesterol Con”
Dr Kendrick described himself as “the maverick’s maverick”. Whilst working as a GP, he has managed to challenge some of the accepted ideas of our time, such as the relationship between LDL and cardiovascular disease mortality. His talk was a very entertaining reflection on why change is slow to take place within the medical establishment. The medical establishment is made up not only of doctors, but also of pharmaceutical companies, the media, medical journals and more. As humans we all have strong motivating factors such as a need to conform, fear (of not conforming or of being ridiculed) and peer pressure, and doctors are not immune to that. Beliefs are made in a split second and are then very strongly held by individuals – accepted beliefs tend only to change with a change of generation.
He explained the psychological theory of transactional analysis, which holds that each person can act as either a parent, an adult or a child in a given situation. Often the doctor-patient relationship is stuck in a parent-child model. The doctor may be paternalistic and tell the patient what to do; the patient acts as a child and either meekly does as he/she is told or else is rebellious. This relationship is not helpful! If both parties can act as adults, a conversation can take place in which the patient’s needs are valued and included. Dr Kendrick suggested using phrases such as “I feel you’re not understanding what I’m saying” to maintain the patient’s position as an adult.
Professor Robert Thomas, NHS oncologist and author of “Lifestyle after Cancer”
Professor Thomas is an NHS oncologist who has a special interest in how lifestyle changes impact cancer outcomes. He is the editor of the website www.cancernet.co.uk, which provides evidence based recommendations on lifestyle change for cancer.
He began by discussing how chronic inflammation drives tumours to progress and metastasise. Pro-inflammatory factors include:
- Food intolerances
- Exposure to carcinogens
- A sedentary lifestyle
- Processed sugar and the standard Western diet
whilst anti-inflammatory factors include:
- A diet rich in polyphenols
- Eating nuts
- Being happy
- God gut health
- The Mediterranean and macrobiotic diets are both anti-inflammatory
Conventional cancer treatments put many women into the menopause, with an associated risk of osteoporosis. Dr Thomas said that the evidence is now there to support recommending particular exercise types, such as squatting with weights, to improve established osteoporosis, rather than generic recommendations to exercise.
Dr Thomas’s evidence review of the relationship between sugar and cancer is available here.
Gut health (probiotics were referred to specifically) is now recognised as key for improving immunity, reducing chemotherapy side effects, improving response to cancer vaccine therapies and reducing chronic inflammation. Probiotics and polyphenols have a particularly significant interaction: a higher intake of polyphenols encourage the growth of beneficial gut bacteria, and intake of probiotics results in better absorption of polyphenols in the gut.
Exercise for those who are overweight may not lead to weight loss by itself, but has greater benefits, such as reducing inflammation, improving mood and (if outdoors) improving vitamin D status. For weight loss he recommended a combination of:
- Regular exercise (such as a walk before breakfast)
- 13 hours (minimum) overnight fasting – improves blood sugar control, reduces inflammation and leads to a 30% reduction in recurrence rate for women who have had breast cancer
- Reduce processed sugar
- Eat an anti-inflammatory diet with more polyphenolic compounds (ie lots of brightly coloured vegetables and fruits)
He discussed the clinical trials which he has carried out on the food based supplement Pomi-T and the nail bed balm Polybalm (which protects against nail side effects caused by the chemotherapy drug Taxotere).
Dr Rangan Chatterjee, NHS GP, functional medicine practitioner, BBC1’s Doctor in the House
Sadly, Dr Chatterjee wasn’t at the conference in person, but sent his video contribution of an interview with Robin Daly (Yes to Life chair).
Dr Chatterjee is passionate about lifestyle medicine, but recognises that the under the current NHS model of 10 minute appointments, GPs are not equipped to provide lifestyle advice. However, he has a vision of GPs being able to refer to practitioners who are qualified to support lifestyle change (such as nutritional therapists, exercise therapists etc), just as GPs refer to other specialists within the NHS. The difference is that whilst GPs have an understanding of the work the NHS specialist do, they currently have no training in what lifestyle medicine practitioners can offer. To this end, he has developed a course in Prescribing Lifestyle Medicine. This has been accredited by the Royal College of General Practitioners and will start in January 2018.
Evidence based medicine (EBM) is a philosophy dear to those in conventional medicine. It is often used as a criticism of lifestyle practices when it is deemed that there is not enough evidence to support their use. However, Dr Chatterjee reminded us than when the concept of EBM was first developed, it was said to exist at the intersection of 3 areas:
- Research evidence
- Patient preference
- Clinical expertise
Today, EBM has come to mean research evidence alone. If we ignore patient preference and clinical expertise (ie what a practitioner has experienced working in practice) then we are not interpreting EBM correctly and are not evaluating what is best for the individual patient.
Dr Chatterjee encouraged all practitioners to recognise that thanks to the internet patients are becoming experts in their own condition. Practitioners should not be threatened by this but embrace it and ask patients what they have found out about their condition so that they can learn themselves as well as guiding patients through the information.
Lizzy Davies of CanExercise
Lizzy’s background is as an oncology and palliative care nurse. She moved into work as a cancer exercise therapist after her mother’s cancer diagnosis. Conventional cancer treatment often leads to physical deconditioning, with a loss of muscle mass and an increase in fat to muscle ration. Lizzy advises patients not to wait for that deconditioning to occur but to begin an exercise programme during treatment. Exercise is safe during treatment as long as it is tailored and progressed correctly.
Exercise programmes for people with cancer must be collaborative (also considering eating, sleeping, digestive health and restorative rest) and personalised (considering the type, volume and intensity of exercise that is appropriate and also the stage and type of cancer and the treatment).
Conversations around exercise can be started simply, by suggesting deep breathing, walking or gentle stretching. Ideally, the aim is for 150 minutes per week of aerobic exercise and some resistance work (using weights or body weight) 2-3 times per week. Long-term follow up (after 6-12 months) is useful to maintain motivation.
CanRehab is an organisation which provides training for exercise professionals (for example in gyms or fitness centres) in working with cancer.
The PREPARE programme is now being used in some NHS cancer treatment centres to provide exercise programmes for cancer patients the aim being to reduce functional decline during treatment. The programme is delivered by a dietitian, a nurse specialist and an exercise therapist and is adapted weekly during treatment.
Claudia Manchanda, medical herbalist
Claudi led us on a whistlestop tour of just some of the applications of herbal medicine as part of an integrative cancer approach. She invited us to start a conversation with nature, so that we increase our connectedness to nature. Herbal medicine, like conventional medicine, is founded on the principle “first do no harm” – but this refers to doing no harm to the earth and the sustainability of the plants as well as to the patient! Herbal medicine is an ancient practice which recognises the individuality of each patient, even among those with the same type and stage of cancer. The person’s emotional state is also important in deciding on a treatment. Cancer is often regarded in terms of chronic cell deterioration, deficiency and toxicity. Claudia stressed the importance of using local herbs – everything we need is provided for us within our immediate environment.
A medical herbalist is highly qualified, having a minimum of 500 clinical hours and having a BSc degree or equivalent. They are also CRB checked.
Herbs refer to the medicinal parts of a plant or fungi. The whole is greater than the sum of the parts – isolated chemicals from plants will not have the same effect as the synergy provided by the whole plant.
Particular herbs mentioned included:
Rosa centifolia – a tea of this lifts the spirits. It is used for grief and heartache. The tannins it contains help to seal mucous membranes, for example in the gut
Vitex agnus castus– the effects are dose specific. It is very good in preventing fibrocystic breast disease from progressing to breast cancer. It is progestogenic and lowers prolactin.
Feverfew – inhibits cancer cell division and is generically an anti-inflammatory. Claudia often suggests this instead of turmeric as feverfew is local. The feverfew plant was passed around the room.
Slippery elm – soothing, a demulcent on external and internal (eg from radiotherapy) burns.
Ginger – often used as a carrier to take other herbs to a certain part of the body. It is warming when dried, but not when fresh. Extraction methods for herbs are significant.
Lion’s Mane mushrooms – for burns, chemo brain and cachexia
Mangosteen – prevents chemo resistance
Berberine – helps drugs to cross the blood brain barrier
Beware of drug-herb interactions. Perhaps the most famous is Hypericum perforatum (St John’s Wort) which induces the CYP3A4 liver enzyme and thus increases the clearance of drugs which are metabolised by this pathway. Citrus paradis (grapefruit) and valeriana inhibit the CYP3A4 enzyme and thus the concentration of drugs metabolised by this enzyme can accumulate in the body.
Most mushrooms are aromatase inhibitors. Fomitopsis betulina from Hampstead Heath was passed around the room. This is an immune tonic, anti-inflammatory, anti-tumour, anti-parasitic, a prebiotic, anti-viral, and aromatase inhibitor, antiseptic and anti-angiogenic! Because mushrooms are potentially pathogenic, humans have evolved to have an immune response to them. Beta-glucans in pathogenic and non-pathogenic mushrooms alike bind to macrophage receptors in the small intestine and involve cells from the innate and adaptive immune system. As a food, mushrooms need to be cooked. For use as an immune tonic, it is best to use a decocted tincture using both water and alcoholic extractions to get the full range of activity. We are closely related to fungi and taking anti-fungals can result in kidney damage.
Liz Butler of Body Soul Nutrition
The experience of the nutritional therapists at Body Soul Nutrition is that nobody knows what is needed better than the client themselves – the therapist’s role is to guide clients to learn to listen to their inner wisdom. The two main aims of nutritional therapy for cancer are:
- To move out of the stress response and into the relaxation response.
- To create an environment in the body which is hostile to cancer.
A cancer diagnosis and its treatment often puts people firmly in the stress response! Switching to the relaxation response affects the expression of a number of genes involved in cancer. Creating an environment (and particularly the tumour microenvironment) which is hostile to cancer requires removing anything that is undermining normal function (such as toxins) and restoring anything missing that is required for normal function (eg nutrients).
Nutrition plans are always personalise, but some general principles hold true for most people. The diet would, amongst other things:
- be based on whole foods
- be rich in vegetables and (to a lesser extent) fruit
- be low in carbohydrate
- contain plenty of healthy fats
- contain moderate amounts of quality protein
- contain lots of herbs and spices
- be anti-inflammatory – for most people this means avoiding gluten or even all grains, caffeine, alcohol and possibly dairy
- be pleasurable!
It is Liz’s experience that many people with cancer seem to have experienced what can only be described as a loss of connection – with themselves, with other people and with something greater. Liz and her colleague Sarah Lumley are both HeartMath coaches and offer connection coaching sessions to their clients in order to restore this lost connection.
Dr Robert Verkerk of Alliance for Natural Health International
Dr Verkerk’s talk was on keto-adaptation and dietary diversity.
He discussed the Blue Zones (areas in the world where there are statistically higher numbers of centenarians than elsewhere). In the Blue Zone in Sardinia, the population eats mainly plant protein and mainly animal fats. Meat is only eaten 2-3 times per month. Caloric intake is high (about 2700 cals/day) but exercise is continual. We need to consider not just what we eat but how and when we eat it.
There is currently an interest in low carbohydrate high fat (LCHF) diets, but these were originally investigated for their benefits in tackling obesity in the 19th century. Today we understand that it humans’ normal evolutionary state is to use fat accumulated in the body for energy when food sources are scarce. We are also designed for cycles of feeding and fasting – not continuous eating as we can today. In order to use body fat for fuel we need to have metabolic flexibility – our bodies need to learn and be able to beta-oxidise (break down) fats for use as energy as well as using glucose. In this way, we may not eat a ketogenic diet, but we are keto-adapted; when carbs are scarce in the body we can metabolise fat into ketones which can feed into the Kreb cycle to make energy. He referred to this image from Ditch the Carbs which humourously illustrates the common misconceptions around LCHF diets – they should still be plant-based! There is a fear that following a LCHF or ketogenic diet may result in ketoacidosis, but this is much more common in type 1 diabetes. Dr Verkerk said that for nutritional ketosis, ketone levels should be in the range 0.5-3.0 mmol/litre.
The diversity of the vegetables we eat has reduced markedly in modern times. We can only feed the world’s growing population if we move away from monocultures to a diverse food supply. This does not involve biotech! Organic vegetable box schemes (Riverford Organic was mentioned) which supply heritage varieties of vegetables can help increase our dietary diversity. Dr Verkerk compared the needs of the ecosystem as a whole and the soil in particular with the needs of the human gut microbiome.
Many people are not aware that most salad vegetables sold in supermarkets are hydroponically grown. A mineral feed may be added, but the nutrient density is far inferior to that in vegetables grown in organic soils. Organic food should be regarded as a form of “free from” agriculture, ie it is free from synthetic toxins but organic does not guarantee nutrient density. Know your food source! Wholegrain carbohydrates which are processed (eg bread, noodles) have a similar glycaemic index to white carbohydrates, because they are already broken down by the processing.
Take home points:
- Keto-adaptation (not necessarily ketogenic diet) – <50g carbs/day and intermittent fasting
- Move lots, including while fasting
- Diversify your plant-based diet
- Transform stress
- Find purpose in life.
Meleni Aldridge of Alliance for Natural Health International
Meleni is a Functional Medicine practitioner, with a background in psychoneuroimmunology. She introduced the concepts of Functional Medicine – that it looks at finding and dealing with underlying imbalances rather than only treating symptoms. This is a great strength of FM and means it can easily adapt to incorporate new and emerging science. She often uses a Functional Medicine Timeline with her clients to illustrate how life events have triggered ill health. After seeing her, a client will receive a “prescription” with recommended lifestyle interventions. They need not be complex but are personalised – she quoted one case in which the top recommendation was to sleep more. Other interventions might be to do with light, air, relationships, community and love as well as nutrition, exercise, sleep and relaxation.
The Institute of Functional Medicine was founded in 1991 by Jeffrey and Susan Bland. The Cleveland Clinic in the US is associated with it and has a long waiting list due to its popularity among patients who recognise the value of what it offers.
Nutritional therapists in the UK are trained in functional medicine principles.
Dr Catherine Zollman, GP and medical director of Penny Brohn UK
Penny Brohn UK advocates a whole person approach to cancer. It involves building resilience in multiple areas in life (mind, body, spirit, emotions) so that if one area is under stress there is enough resilience elsewhere to cope.
Penny Brohn UK are working with NHS cancer services in the Bristol area to improve what is offered to patients. They deliver the Recovery Package after cancer treatment at local hospitals, run training courses for oncology teams and have recently been working on a joint statement on nutrition which has the agreement of hospital dietitians, nutritional therapists from PB, oncologists etc. This references the new World Cancer Research Fund booklet “Eat Well During Cancer”.
Susie Budd, chemotherapy nurse in Bristol, spoke about how working with Penny Brohn UK has provided benefits to patients including regaining control, empowerment and avoiding false hopelessness. There are weekly meetings for Bristol NHS cancer patients at Penny Brohn, involving talks, physical activity, guided meditation, treatments such as acupuncture and one-to-one consultations with PB doctors.
Dr Zollman finished by observing that in the current crisis in healthcare there is a great opportunity for integrative care – as there is in our own health crises.
Mark Boscher of Herts MS Therapy Centre
There are 50 Multiple Sclerosis Therapy Centres in the country offering Hyperbaric Oxygen Therapy (HBOT). These centres are all independent and have their own pricing structure and rules. Many offer HBOT to cancer patients as well as to MS patients, although not all have the capacity to. Altogether MS Therapy Centres have provided over 3 million HBOT sessions so very safe procedures have evolved.
HBOT involves breathing pure oxygen in a chamber under a maximum of 1 extra atmosphere of pressure. Pure oxygen at normal atmospheric pressure provides 5 times more oxygen than air and helps load up red blood cells with oxygen. At extra pressure the blood plasma becomes saturated. The MS Therapy Centres’ experience is that HBOT may help two thirds of people. The centres also provide signposting to experts for questions regarding clients’ personal health conditions. Many choose to use HBOT alongside a ketogenic diet when dealing with cancer.
At least 20 HBOT sessions are needed. MS Therapy Centres’ prices vary from £17.50 (in Herts) to £50. Herts offers a free trial. Contact firstname.lastname@example.org for more information.
Dr Damien Downing, President of the British Society for Integrative Oncology
By this stage the event was running late due to the enthusiasm of speakers and audience alike, so Dr Downing was brief, simply urging us to join the BSIO. Lay people are welcome at meetings as well as practitioners so long as it is understood that no personalised advice can be given.
The evening concluded with a brief Q&A (a “conversation”). Topics included radiation from mobile phones and how this can be ameliorated by grounding. The panel were keen to emphasise that it is important to deal with the issues which you can and not get stressed by those which you can’t. Yes to Life were thanked for a superb conference.