The Gut Microbiome, Cancer And Immunotherapy - by Dr Lauren MacDonald

This week we have another insightful piece from Lauren, a 29 year old junior doctor when she was diagnosed with stage IV cancer, who is now celebrating one year NED. Here she discusses her obsession with gut health and why it is so important...

I thought I’d write another post on my favourite subject, “Gut Health”, but this time I’ve gone into the science behind why I’ve been banging on about the importance of looking after your gut microbiome for the past few years. I hope it’s helpful for anyone not yet up-to-speed on this fascinating area of research. 

Over the past few months several human studies have supported the idea that our intestinal bacteria (the gut microbiome) plays a significant role in determining whether cancer patients respond to certain treatments. In the latest research study, Dr. Wargo (a doctor and research scientist in the USA), revealed that the composition of a patient’s gut can significantly influence whether someone responds to the type of cancer immunotherapy I’ve been receiving for the past 22 months (pembrolizumab, an anti-PD1). Interestingly, what seemed to matter most in the studies wasn’t the level of a specific gut microbe, but rather the overall diversity of the gut microbiome. Let’s take a look at the evidence so far…

Where My Obsession With My Gut Health Began

Prior to 2015 I’d never considered the state of my gut microbiome. I hadn’t tried kefir, I didn’t take a regular probiotic and I’d never experienced the joys of eating Jerusalem artichokes (you’ll know what I mean if you’ve tried them!). Then in October 2015 I was diagnosed with stage IV melanoma, a cancer which is notoriously chemotherapy and radiotherapy resistant, and which previously had a 5-year survival rate of around 15%. Fortunately, a new immunotherapy drug was approved by the NHS at the beginning of 2016, just six weeks after I’d received the stage IV diagnosis. Although this was incredible news – and the idea of a “game-changing cancer drug” made for sensational headlines – it transpired that only a small group of patients had responded to the treatment during the clinical trials. The drug I was about to start had a response rate of around 30-40% (meaning patients had their tumours stabilise or shrink) with only 15% having a complete response (achieving no evidence of disease). I was determined to find myself in the latter group so I began researching how I could swing the odds in my favour.

My research began by examining the gut-brain axis, specifically the gut microbiome and its impact on health. I then looked at the way in which stress and anxiety could be impacting on my immune system. This lead me to further explore the growing field of psychoneuroimmunology and the research highlighting the value of mind-body therapies. It soon became apparent that there was a huge area of medicine that had been largely ignored during my medical degree. I felt relatively knowledgeable about “the mind” due to my Psychology degree and “the body” due to my medical degree, but there was a gap in my knowledge at the interface between the body and mind. I became fascinated by the gut-brain axis and, specifically, the impact the gut microbiome has on both mental and physical health.

Prior to becoming a stage IV patient, I’d already had four operations over the past 18 months in an attempt to “cure” me and prevent the cancer from spreading. Along with conventional surgery, I’d also addressed my diet, started juicing, added in supplements and began a regular yoga practice. But nothing seemed to be helping. The cancer kept coming back, again and again. Over Christmas 2015 I could visibly see new tumours growing above my right breast and a scan had already confirmed I had tumours in my lung and adrenal gland. Consequently I started looking for other ways in which I could support my body to either fight cancer cells directly or slow down/prevent angiogenesis (the formation of new blood vessels – which helps “feed” tumours).

The Initial Gut Microbiome And Immunotherapy Research (2015)

Shortly after I started looking at the the gut-brain axis I came across some research which had just been published by the University of Chicago (back in November 2015). They’d found that by introducing a particular strain of bacteria into the gut of mice with melanoma, they were able to boost the ability of the animal’s immune system to attack tumour cells. The combination of oral doses of “good bacteria” and infusions with anti-PD-L1 immunotherapy nearly abolished tumour growth. Around the same time another group of researchers compared the effects of bacterial transfer (via fecal transplant) against immunotherapy (anti-PD-L1). They found that introducing the bacteria was just as effective as treating mice with anti-PD-L1 alone – resulting in significantly slower tumor growth. Furthermore, combining the benefits associated with the “good bacteria” with anti-PD-L1 treatment dramatically improved tumour control.

Turning My Attention To My Gut Health Before Starting Immunotherapy

Given these two fascinating studies I decided to do everything I could to get my gut in the best possible shape before starting immunotherapy. During one of my appointments I mentioned the research to my Oncologist (and explained my intention to diversify my microbiome) but, understandably, he was hesitant to support my plan. The microbiome is, of course, inordinately complex – with trillions of bacteria working in tandem to produce multivariate responses. Although the research in the initial mouse studies had been promising, it might have been the case that altering the gut microbiome in humans would have a different outcome – an idea that has recently been supported by a study which found that certain chemotherapies used to treat colorectal cancer actually become toxic to patients in the presence of certain gut bacteria.

Despite my Oncologist’s reservations, I set about diversifying my gut bacteria in the hope that I might help to push myself into the “complete responder” group. Along with having a diverse microbiome, I knew it was also important to have the right cocktail of bacteria. I didn’t have much to go on – just those two initial mouse studies – so I purchased probiotics which contained the specific bacteria which had helped the mice to survive (Bifidobacterium – although the probiotic I took actually contained several other strains too). I also changed my diet to include as many pre- and probiotics as possible.

Key Diet Changes

I know I’ve shared lots of blog posts about this subject during the past two years, but just to remind you once again…

• The best way to keep your gut microbiome healthy is to make sure you’re getting a healthy mix of probiotics and prebiotics in your diet.
• Although taking a probiotic supplement is also helpful, there are plenty of studies that suggest oral probiotics struggle to make a huge difference to the microbiome (compared to the impact of fecal transplants).
• Simply changing our diets to include plenty of fibre, reducing refined sugars and not eating processed foods, can help improve the balance of bacteria in the gut.
• You can easily load up on probiotics by eating certain foods (e.g. sauerkraut, kefir, miso, apple cider vinegar, sourdough bread).
• Prebiotics are things like garlic, leeks, chicory root, Jerusalem artichokes, asparagus and under-ripe bananas.
• Research also suggests that omega-3 fats (found in oily fish) affect the microbiome in positive ways.
• It’s a great idea to try and fast for at least 12 hours overnight too. There’s lots of evidence to suggest this helps support a healthy gut microbiome.

The Latest Research (2017)

Dr Wargo teamed up with Gopalakrishnan and other researchers to collect faecal samples from more than 100 people with advanced melanoma before they began treatment with anti-PD-1 immunotherapy drugs. The scientists found that those who had the most diverse gut microbes were most likely to respond to the immunotherapy. The type of microbe was also linked to differences in responses to treatment. For example, people whose guts contained a lot of bacteria from a group called Clostridiales were more likely to respond to treatment. A second study showed that people who received antibiotics to treat infections shortly before or after starting immunotherapy did not respond as well to PD-1-blocking therapies. The researchers also found that the presence of the bacterium Akkermansia muciniphila was linked to better responses to immunotherapy. Responders had a far greater density of killer T cells – which are largely responsible for attacking cancer. The researchers found that the presence of the Faecalibacterium and Clostridiales bacteria seemed to account for the difference in T cell density. When these bacteria were given to cancer patients via a fecal matter transplant, they were more likely to respond to treatment and live longer without their tumour recurring or worsening.

The Microbiome: The Future Of Cancer Treatment?

I am under no illusion that the only reason I’m sitting here writing this post is because I’ve been on the receiving end of cutting-edge cancer treatment. I started immunotherapy in January 2016 and by August 2016 my scans revealed “no evidence of disease”. During the previous 10 months I’d become *OBSESSED* with looking after my gut but, of course, I have no way of knowing whether this made any difference to how I responded to immunotherapy. It might have been that I would have responded in exactly the same way, whether or not I’d changed my diet and started taking a daily probiotic supplement. Having said that, the 2015 studies and the new 2017 human studies suggest a big role for gut microbes in determining the cancer-killing potential of immunotherapies. Yet there are still plenty of questions, namely how, exactly, certain bacteria may help the immune system to fight cancer and if there are side-effects or potential dangers of manipulating the microbiomes of cancer patients. It will be fascinating to follow this research in the future. WATCH THIS SPACE!

I hope I’ve inspired you to look after your gut health – whether you are a fellow cancer patient or just someone looking to support their health and wellbeing.

Sending you lots of love and good health.

Lauren x

You can read more inspirational and informative posts on Lauren's blog, www.laurencara.com.

Please make sure you tell your own doctor before you start taking a daily probiotic – especially if you are undergoing cancer treatment. 

Supplements: Gimmick Or Good For You? - by Lauren MacDonald

This week's blog is another from Lauren MacDonald, a 29 year old junior doctor when she was diagnosed with stage IV cancer, who is now celebrating one year NED. Here she discusses her thoughts on supplements...

I was incredibly anxious when I was first diagnosed with cancer and was keen to exert some control back over the crazy world I’d found myself in. One of the first things I did involved going shopping for supplements. I figured that if there was anything I could buy over-the-counter to support my health, it was my duty to buy it. At one point I was taking over 25 different supplements everyday. That may sound excessive, but apparently increasing amounts of us are taking vitamin pills and herbal supplements with the aim of protecting ourselves against all manner of health problems. In the UK the market is currently worth £650m, with approximately 40% of us now popping a pill or two each day. The industry is phenomenally powerful, extremely lucrative and incredibly influential. But should we be taking all these supplements?

Gimmick or Good For You?

The supplement industry is divided into three groups: (1) vitamins; (2) minerals such as zinc, copper, selenium and iron; and (3) dietary supplements such as fish oils, herbs and spices. I went out and invested in various tablets and powders from across these different groups. This was despite my medical knowledge regarding how supplements are likely used by the body. From what I’ve been taught it seems that our bodies are not particularly efficient at digesting, processing, and absorbing supplements in pill form. When you take a pill it first travels to the stomach, where it breaks apart and releases the nutrients it contains. These are then absorbed and processed (usually by the liver), from where only a fraction of the nutrients then go on to enter into the bloodstream. Consequently it’s likely that plenty of supplements actually end up in your urine.

Another issue is that even if your body can absorb some of the nutrients, there is often limited scientific evidence available to support the use of many supplements. Having said that, this is often due to an absence of any proper scientific testing. In this situation all anyone can do is speculate about whether there are any benefits to be gained. Because of this, at the time of my diagnosis I was more than happy to buy my supplements under the caveat that “the scientific proof possibly just hasn’t been confirmed yet”. In my eyes being a guinea pig was far better than sitting back and doing nothing. Plus several friends offered up stories about their distant relatives/friends/neighbours who had cured their cancer by taking a concoction of supplements.

My Experience With Supplements

On reflection I’m sure that as a GP I wouldn’t have been overly enthusiastic about any of my patients taking 25 random pills every day. But back then, my rational “doctor voice” was drowned out by my petrified “patient voice”. I eventually got to a point where I couldn’t walk past a health food shop without diving in to buy the latest “cancer killing” or “immune boosting” supplement. My cupboards were full of spirulina powders to add to my juices, and chaga mushroom granules, dried cleavers, and pau d’arco to make up as teas. The supplements I was taking ranged from standard multivitamins and fish oils, to more unusual supplements like milk thistle, astragalus, and sea kelp. I was probably taking them regularly for about 6 months; right up until until the cancer came back.

Around the time I progressed to having stage 4 cancer (meaning that the cancer had spread to my chest from my leg), some new evidence was published which scared the bejesus out of me. Two studies had found evidence that taking supplements may actually increase the spread and severity of some cancers (specifically melanoma and lung cancer). Overnight my 20 supplements didn’t seem so “life saving”. Obviously this research was only preliminary, but it was enough to make me consider that maybe I shouldn’t be taking quite so many supplements, especially without having mentioned them to my oncologist.

Do You Need Supplements?

If I’m truly honest, I’m really unsure. From the research I’ve read it would seem that the answer is no. The problem is that it’s almost too easy to get your hands on supplements. These days there is a pill available for absolutely anything. Whether you have trouble sleeping, want to lose weight or get more of a certain vitamin into your body, there is a wide range of aids to choose from. Recently several studies have taken place to attempt to justify the use of vitamin and mineral supplements but the majority of them have come to the same conclusion – there is no concrete evidence to suggest that dietary and nutritional supplements have any real positive impact on health. Scientifically speaking there are no miraculous supplements that will help you find solutions to multifaceted health problems – especially not cancer. But it’s easy to fall for marketing promises and personal success stories.

Luckily it’s pretty easy to get everything you need just by eating a balanced, healthy diet and going outside every once in a while. Other than perhaps vitamin D, you don’t actually need to load up on extra amounts of these compounds. And in some cases you can actually overdose. For example, excess vitamin A in the body can cause blurred vision, dizziness and bone softening. However, there are some instances when certain supplements become necessary. For example, very strict vegetarians may need supplementary vitamin B12, and those who are pregnant or breastfeeding should consider vitamin D and folic acid.

My New List:

Two years ago, along with adding in a huge amount of supplements, I also gave my diet an overhaul. Although I have relaxed a little, I still eat a largely plant based diet and it is mainly through food that I now nourish my body – not supplements. My diet now includes more specific food items, such as, nuts and seeds, pomegranates, shiitake mushrooms, fermented foods, fresh turmeric, bee pollen, watercress, parsley, green tea and a whole host of other random bits and bobs which potentially have “immune boosting” or “cancer fighting” properties. Although I haven’t completely stopped all supplements, I am weary of taking too many. I am having regular infusions of Pembrolizumab (immunotherapy) and the last thing I want to do is cause any interactions, or prevent my wonder drug from doing it’s thing.

So…. what made my list?

(1) Vitamin D

Vitamin D helps to control the amount of calcium and phosphate in our bodies. Both are needed for healthy bones, teeth and muscles. Very few foods contain vitamin D (and those that do, such as milk and orange juice, are fortified). We tend to get most of our vitamin D from sun exposure, but in winter this can be problematic.

(2) Omega-3

Omega 3 helps protect against diabetes, heart disease and stroke, as well as providing support for brain health and memory. Found in oily fish such as salmon and tuna, many of us are deficient in omega 3 as we just don’t eat enough in our diet.

(3) Probiotics

I have an entire blog post dedicated to my love of probiotics and gut health in general. I cannot rave about them enough! Take a look at the post here.

(4) B Vitamins

B12 is an essential nutrient needed for nearly every bodily function and energy production. Low levels can cause damage to the nervous system and some of the early signs of deficiency are chronic fatigue, moodiness, and even dementia-like traits. Because the body cannot produce it on its own and it’s also scarce in our food system, it is advised for those with low levels to take a B12 supplement.

And that’s it.

From 25 supplements down to 4. It may seem simple but there it is. If you are taking care of yourself and eating a healthy balanced diet then if you ask me, these are the only supplements you should consider. Having said that, although I’m a qualified doctor, I’ll be the first one to put my hands up and admit we didn’t learn a huge deal about nutrition during our medical degree. To be honest I feel like I’ve taught myself a great deal more about nutrition and supplements since I was diagnosed with cancer. Because of this, I’d just like to highlight that the above information is my opinion only, and does not necessarily represent that of the wider medical community. I’d love to hear from any registered nutritionists or dieticians if you feel that I’m way off the mark with my opinion on supplements. I’m open to learning new things!

Lauren x

Please remember that it’s always advisable to seek professional advice before taking supplements anyway. Speak to your GP before you introduce anything new, especially if you take regular medication.

You can read more inspirational and informative posts on Lauren's blog www.laurencara.com.

Is There A Role For Diet In Cancer Treatment? My Opinion And Personal Experience - by Lauren MacDonald

Following the popularity of her previous blog, we have another post from Lauren MacDonald, a 29 year old junior doctor when she was diagnosed with stage IV cancer who is now celebrating one year NED. Here she discusses the role of diet in cancer treatment from her own personal experience.

Over the past few years I’ve received countless emails from people asking exactly what diet changes I’ve made since I was first diagnosed with cancer (in Feb 2014). Although it’s true that I’ve made certain changes, I’m always a little cautious about sharing them, mainly in case people think that because I’m a doctor that must mean the specific changes I’ve made are based on overwhelming scientific evidence. Although I’ve researched “cancer and nutrition” in detail, trawling through countless medical journals and review papers, I’m still not an expert in this field or a qualified nutritionist. Additionally, from what I’ve come across, there is still very little scientific evidence supporting the use of specific diets in cancer treatment anyway. The changes I’ve made to my diet have largely been in an attempt to nourish my body as much as possible, boost my immune system, and (*potentially*) help my body to fight cancer cells.

The Problem With Extreme “Cancer Diets”

Don’t get me wrong, for a little while right at the beginning, I definitely did get sucked into the idea that certain foods or diets might be able to rid me of cancer. I was guilty of dabbling with a few questionable/ridiculous diets (anyone for ground flaxseeds mixed with cottage cheese??!) but fortunately it wasn’t long before the medic inside of me woke up and put a stop to my nonsense. Yet the fact that I was sucked in at all shows just how easy it is for common sense to go AWOL when faced with cancer. For most cancer patients, changing their diet is as much a mental process as a physical act. It enables you to feel like you’ve got some control over a petrifying situation and I know I also felt comforted by the idea that nature might, just might, “cure all” (rather than toxic chemotherapy or other drugs).

Additionally there’s simply so much information available on the internet about “diet and cancer” that it’s almost impossible to avoid it as a newly diagnosed patient (who can often be found googling “cancer cures” at 2am). Without randomised controlled trials in this area (of which there have been very few – although I’m currently awaiting the results of an interesting one looking at watercress) it is difficult to separate fact from fiction. Ultimately, this can leave us patients, our friends and our families confused and vulnerable to inaccurate (and sometimes downright dangerous) information.

Cancer And Certain Diet Myths

The alkaline diet is one of the most popular “anti-cancer” diets. Fans of this diet believe that an acid diet encourages cancer formation, and that an alkaline diet is therefore the solution. The reason that acidity is seen as an issue is because while healthy cells get the majority of their energy from oxygen respiration, cancerous cells tend to inefficiently use glucose at a higher rate than healthy cells. This consumption of glucose results in acidic waste products, and consequently a higher acidity around cells which use this mechanism. BUT… THE FACT IS THIS: acidity is a consequence of the cancer rather than the cause. Therefore, an alkaline diet CANNOT affect cancerous cells. This is because tissue acidity is tightly regulated by our incredibly clever bodies (because otherwise we would die) and this cannot be altered simply by changing the food you put into your mouth.

Another anti-cancer diet I’ve seen tooted time and time again is the “no sugar diet“. Although there’s an established link between being obese or overweight and developing certain types of cancer, the suggestion that sugar “feeds” cancer is an over-simplification of some complicated biology. Yes it’s true that glucose is a sugar, but it is one required by every cell in the body to function, whether cancerous or not. Ultimately all carbohydrates, whether from vegetables or chocolate, are broken down to glucose for the body to then utilise for energy. The reason that the “no sugar diet” has become so popular is because cancer cells require sugars to grow – and their glucose intake is a lot higher than that of healthy cells (this is known at the Warburg effect). The hyperactive glucose consumption of cancerous cells results in a vicious cycle of continued stimulation of cancer development. However, all the cells in the body require “sugar” to survive so it’s impossible to rid yourself of glucose, no matter what you eat. There’s also no evidence that proves eating a low-sugar diet cures cancer.

The final diet which has limited evidence for curing cancer is the ketogenic diet. The ketogenic diet is a high fat, low carbohydrate, and typically a protein-restricted diet. Normally what we eat is composed of macronutrients: carbohydrates, proteins, and fats. The carbohydrates are things like bread, pasta, cakes and some of the fruits and vegetables that we commonly eat. Protein is found mainly in meat and dairy products. High-fat foods are things like bacon, peanut butter, creams, avocados, coconut milk etc. The average diet is about 50-75% carbohydrates and, thus, this is the energy currency that our bodies use. Contrasting with this, in a ketogenic diet about 90% of what a person eats is fat. There is very little protein and almost no carbohydrates. This simulates a fasting state in the body where instead of carbohydrates being used, the body uses ketones for energy. Some people claim this altered state can starve cancer, yet, there is very little evidence to support this idea (except perhaps for patients with brain tumours but, once again, the evidence is limited). There is some evidence, however, that a ketogenic diet can reduce inflammation in the brain and can help treat strokes and other neurological conditions like epilepsy. Among theories about the mechanism behind the ketogenic diet is that the mix of high-fat, low carbohydrates, and reduced protein intake may reduce firing of excitatory brain cells that can make the brain vulnerable to seizures. Unfortunately implementing this diet is a huge undertaking. It can incredibly challenging (and a little disgusting) to force such high fat foods into your body on a daily basis. I know my brother and his girlfriend tried the ketogenic diet as part of a study during her degree (Nutrition BSc) and they couldn’t maintain it for more than a few weeks.

How I Changed My Diet After My Diagnosis

During the first 12 months after I was diagnosed I went ALL OUT with my diet. I stopped eating anything sweet (chocolate, cakes, ice cream etc), juiced as though my life depended on it (daily – if not twice a day – so at least I got my moneys worth from my ridiculously expensive masticating juicer – it’s an Omega Vert in case you were wondering), added ground flaxseeds to everything, nibbled on raw garlic, made myself eat shiitake mushrooms with nearly every evening meal (despite not liking the texture), and washed all these foods down with gallons of green tea and chaga mushroom coffee. Then the cancer returned, making me a stage IV cancer patient, and I figured my mostly plant-based, highly restrictive diet wasn’t eliminating cancer cells and also wasn’t making my life that much fun. To add insult to injury I was also spending a fortune on my “anti-cancer diet”.

Given that my experiment didn’t “cure” me of cancer, I eventually relaxed my diet and simply integrated a few of my new healthy habits into my daily life. Fortunately, somewhere along the way (about four months after starting immunotherapy), I slowly began to journey from a stage IV cancer patient with aggressive tumours that kept popping up in various parts of my body, to someone with No Evidence of Disease.

What I Eat Now

I’ve pretty much reverted to eating exactly like I did before I got cancer. If I fancy a pizza, I have a pizza; if I fancy a bowl of ice cream, I eat the ice cream; if I fancy wine, I’ll have (red) wine (which apparently has anti-cancer properties anyway). Having said that, I now let myself be guided by what my body wants (I guess thats what people call “intuitive eating“) and my body invariably wants to be fed healthy, nourishing foods. The things I make sure to eat include:

Leafy Greens

Isothiocyanates (ITCs) found in leafy greens have been reported to help the body at a cellular level. The main ones I’ve added in to my diet (pretty much every day in a green juice) are kale, spinach and watercress. In addition to isothiocyanates, cruciferous veggies like broccoli also contain sulforaphanes and indoles – two types of antioxidants that protect the structure of DNA. The evidence is so strong that a pharmaceutical company in the UK, Evgen Pharma, is now designing drugs using sulforaphane. The drugs have been shown to kill cancer cells and improve the prospects of stroke patients.

Berries

Most mornings I have a handful of blueberries, raspberries, strawberries and pomegranate seeds, mixed with a spoonful of greek yogurt, a drizzle of almond butter and some mixed seeds. The ORAC scores of nearly all berries are very high, making them some of the best antioxidant foods.

Orange Foods

I make sure I eat plenty of carrots and sweet potatoes (carrots in my daily juices and sweet potatoes as wedges). This is because there’s some evidence that the beta-carotene found in orange foods is an essential nutrient for immune functioning, and given that I’m on an immune-boosting drug, it seems logical to try and give my immune system a helping hand with these foods.

Mushrooms

Several studies have linked higher mushroom intake to a reduced risk of breast cancer in premenopausal women. It has also been proposed that various mushrooms, such as shiitake, chaga, turkeys take and lion’s mane, may also help fight cancer. However, there is still no conclusive evidence that any type of mushroom can prevent or cure cancer.

Spices

The jury is still out on whether turmeric and ginger are “potent anti-cancer foods” but I still add them to all my juices. Make sure you add some black pepper to help with turmeric absorption.

Fermented Foods

Gut health! My favourite subject 🙂 Most of my blog posts seem to have been dedicated to this subject so I won’t go into too much detail here. The main foods I’ve kept in my diet are sauerkraut, kefir, apple cider vinegar, and cultured yoghurt. I try and have at least two of these foods everyday.

Nuts/Seeds

Have you tasted Pip and Nut’s Almond Butter? Not only is it pretty much the most delicious thing you will ever taste, it’s also a great source of protein, fibre and healthy fats. I also try to make sure I have a few brazil nuts every day as they are a great source of selenium.

Udo’s Choice Oil

I try to add a few tablespoons of this oil into my food at some point during the day (either on my breakfast, drizzled on salads or simply neat if I’ve forgotten to add it to a meal – it doesn’t taste too bad). This oil has the ideal ratio of Omega-3:Omega-6’s. I also try to get plenty of Omega’s by eating oily fish a few times a week. Omega-3 fatty acids exert anti-inflammatory effects and might help the body to fight cancer.

Matcha Green Tea

Matcha contains the highest percetange of polyphenolic compounds (catechin, gallocatechin and EGCG). EGCG has been reported to be linked to the modulation of multiple signaling pathways, finally resulting in the downregulation of expression of proteins involved in the invasiveness of cancer cells. It’s an acquired taste but I’ve grown to love it. Pukka Teas do a mild version that comes in teabags if you can’t handle the intensity of the powdered form.

The Take Home Message

I know this is really boring and not what you want to hear, but there really isn’t any one diet or food that will “cure” cancer. If there is (and I’m yet to come across it in my research) please, please let me know…

Using nutrition to support cancer treatment basically boils down to the age-old adage of eating a well balanced diet, enjoying your food, and not eating too much junk. The reality is that cancer is complex illness, and simple “cures” shared online should be treated with scepticism. Having said that, I truly believe that eating healthily has a role in cancer treatment – I just don’t think it will provide the sole “cure”. Personally I didn’t ever receive any diet advice from my healthcare team during my “cancer journey” and apparently this is not uncommon. This lack of nutritional advice for cancer patients in the UK needs to be addressed. In my opinion, we need a holistic approach to treating cancer and nutrition (along with exercise and stress reduction techniques) should be as much a part of cancer treatment as medicine and surgery.

I hope that this info helps anyone who is currently going through cancer treatment or just wants to live a healthier life. Remember, I’m not an expert in this field – these are just diet changes that felt right for me.

Organisations like Cancer Research UK have patient guides that are worth checking out for reliable information. Unfortunately, they aren’t as sexy as those offered up by online “wellness gurus” – but at least you know they’re based on real facts rather than far-fetched theories.

You can read more inspirational and informative posts on Lauren's blog www.laurencara.com.

Life Beyond Stage IV: Celebrating One Year NED! - by Lauren MacDonald

This week's blog is by Lauren MacDonald who was a 29 year old junior doctor when she was diagnosed with stage IV cancer. She wanted to share her story to inspire our followers to not give up hope, and to keep looking for alternative ways to support their health and wellbeing.

Hello friends!

Sorry I’ve been AWOL for the past few months.

After becoming completely exhausted whilst working full time in the hospital this summer, I decided to give myself another career break for a few months (until I finally finish cancer treatment at the end of 2017). Despite the blood, sweat, tears and shingles, I’m pleased I went back to work when I did as it finally enabled me to complete my F2 training and now puts me in a position to locum as and when I have the energy. In the meantime I’ve been enjoying a mixture of relaxing down-time along with embracing my new ticket to worldwide travel (my yoga teacher qualification) – plus still having treatment at The Royal Marsden every three weeks.

My Recent Adventures

Sri Lanka

Just to get you up to speed on the past few months… For those of you following my Instagram account (dr_laurencara), you’ll have seen I shared my recent stay at Sen Wellness Sanctuary in Sri Lanka. Although the sanctuary is primarily a kundalini yoga and ayurvedic centre, the lovely owner Sam, who has become a dear friend over the past few years, invited me out to experience the retreat but also practice teaching vinyasa/yin styles of yoga. Below are a few photos from my trip – the first one being of my beautiful friend and kundalini teacher, Candace, who I learned so much from during my time at the sanctuary. If anyone is currently stuck in a job that no longer serves them, if you are stressed and exhausted and feeling empty – just take a look at this stock-broker turned kundalini teacher for inspiration!

After a month in this beautiful healing setting I can honestly report I felt healthier and more energised than I have in years. The food was amazing, the people were inspiring and the energy within the sanctuary itself was pretty incredible. I can’t recommend the experience enough.

Portugal

After my trip to Sri Lanka I returned to London for a busy week of CT scans and treatment. Fortunately my scan was once again clear – pushing me beyond the one year NED mark! (yay!). Following this wonderful news I then spent a wholesome week at Vale De Moses, a secluded yoga retreat in the foothills of Portugal. The combination of eating fresh vegetarian food, practicing yoga daily, embracing a slower pace of living, and having limited wifi provided me with another chance to fully rest and recharge in the most beautiful setting.

Cornwall

My final adventure involved joining my friend, Julia, for her first ever yoga retreat down in St Ives. The five day retreat run by Julia and Jo (the team behind By The Sea St Ives) was a combination of vinyasa and yin yoga, nutritious, wholesome food (plus a little bit of wine), surfing, and hiking. I was also invited to speak to the guests about Gut Health which I absolutely loved.

What can I say… the last few months have been pretty epic!

Celebrating One Year Of No Evidence Of Disease

Although I didn’t throw any kind of one year “cancer free” party (or celebrate in any way come to think of it), I think you’ll agree that I’ve been busy living life to the full and celebrating in my own way. I’ve also finally started to make plans for 2018, something I’d have never have done during the first year after my stage IV diagnosis.

Back then the average survival for patients with stage 4 metastatic melanoma was still considered to be less than a year – due to it being a notoriously aggressive and chemo-resistant form of cancer. In fact just a few years ago, maybe just one in 20 patients with stage IV would survive beyond five years. Therefore I found myself living life in three month blocks between my scans. I found it easier to try and live as mindfully as possible, living each day as though it was my last. As soon as I started worrying about the future I’d immediately ruin the present moment.

None Of This Would Have Been Possible Without Immunotherapy!

Despite the abysmal statistics for stage IV melanoma patients during the past few decades, the statistics are finally starting to be re-written and that’s all down to immunotherapy. Pembrolizumab, the drug I’ve been receiving for the past 18 months, is one of the first generation of immunotherapy drugs. It was designed to release the “brakes” that inhibit the immune system from attacking cancers. In the early trials 24% of patients diagnosed stage IV had an overall response to therapy (meaning tumours partially or completely shrank). Fortunately, that’s exactly what happened to me. After my 6th infusion (around 4 months into treatment), several large visible tumours beneath the skin on my chest began to shrink. By my second set of scans – around 6 months into my 2 years of treatment – all the tumours in my body were gone.

Celebrating NED (Rather Than Being “Cured”)

The reality is that while the cancer is no longer detectable, it’s certainly possible that traces of the cancer remain and could potentially return one day in the future. I think I’ll forever be slightly concerned about the fact cancer cells may have crossed into my brain, largely because of a swollen lymph node at the back of my head which appeared just before I started treatment (and then later disappeared). But I guess for now we can say I’ve been in “complete remission” for over a year – which is pretty bloody amazing especially given the situation 18 months ago.

Just to clarrify:

• Cure means that there are no traces of cancer after treatment and the cancer won’t come back.
• Remission means that the signs and symptoms of cancer are reduced. Remission can be partial or complete. In a complete remission, all signs and symptoms of cancer have disappeared.

Obviously the hope with immunotherapy is that when your body has learned to identify your form of cancer, it remains vigilant against it. This seems to be the case for the growing number of patients who have had progression-free survival following immunotherapy. This summer results were published showing 42% of subjects with metastatic melanoma who received pembrolizumab were still alive four years into the study (and the study is ongoing). Some 13% of the subjects who received my drug had a “complete response” (like me).

Remaining Side Effects

I feel like I’ve had a pretty easy ride with my treatment compared to many cancer patients. My only real symptoms have been that I get very tired sometimes and I’ve developed vitiligo on my neck and jaw. And that’s it. However, immunotherapy is far from a guaranteed “get out of side effects free” card. My course of treatment has gone relatively smoothly, but the side effects for some – from fever to colitis to pancreatitis – can be so severe that they’re unable to continue treatment. Additionally not everyone repsonds and in some rare cases people die from the side effects of the immune system being ramped up and going out of control. Just this summer trials were halted in which pembrolizumab was being tested in conjunction with some other immune-boosting drugs to treat multiple myeloma – citing an increased risk of death.

Boosting Immunotherapy

The other side of this coin is that some patients don’t respond to immunotherapy and scientists are now trying to work out what is it about the subsets of patients who respond that makes them different. Obviously it probably depends largely on the extent and spread of disease at the time of starting treatment, but it also appears to involve other factors. One of these factors might be my favourite subject on this blog – gut health.

Gut Health And Immunotherapy

Earlier this year the results of the first study looking at the relationship between the gut microbiome and immunotherapy response in patients was published. Gopalakrishnan et al. found that those who responded to a PD1 checkpoint inhibitor (my drug) had a greater diversity of gut bacteria and larger volumes of a specific type of bacteria than those who did not respond. I know I write about this subject all the time across my blog, but please, please, if you are a newly diagnosed cancer patient take the time to do everything you can to support your gut health (from certain dietary changes to adding in a daily probiotic, or even considering a 12 week programme). You never know – it might make the difference between responding to treatment or not.

The Future Of Cancer Treatment

Recent clinical trials and research continue to show that immunotherapy holds promise for other forms cancer, including breast, lung, ovarian, pancreatic and myeloma. However, not all cancers or patients respond to this treatment. Fortunately another emerging area of research is CAR-T cells. This is when scientists genetically engineer a patients T-cells (the fighters of the immune system) to home in on the patient’s cancer and then grow millions of the modified cells in the lab. When the cells (now called chimeric antigen receptor cells, or CAR-T cells for short) are returned to the patient, they are much better equipped to hunt down and kill the cancer cells. Basically, we are seeing a new generation of cancer treatments that harness the body’s own innate cancer-killing machinery – how cool is that?!

My Future

Right now I have some very loose plans for the latter part of 2017 and 2018 – but nothing is firmly set in stone. I think a huge lesson I’ve taken away from this experience is learning to live each day as it comes and not take anything for granted. I doubt I’ll ever go back to making a “5-year plan”, simply because none of us ever know what is round the next corner.

Wishing you all lots of health, healing and happiness.

Lauren x

You can read more inspirational and informative posts on Lauren's blog www.laurencara.com.

Improving Quality of Life While Living with Cancer

Today’s blog is from Denise from Buckinghamshire, who shares some of the story of her cancer diagnosis and how nutritional advice with support from Yes To Life has helped to improve her quality of life.

My cancer journey began when I started to experience shortness of breath, chest pain and tiredness. The symptoms continued for a few months and then worsened to include difficulties swallowing, reflux and weight loss.   I was eventually admitted to hospital as an emergency case, after being referred by a doctor in a Minor Injuries Unit.  I was immediately diagnosed with oesophageal cancer.  The diagnosis came as a huge shock, as my GP had been treating my symptoms as a chest infection!

The hospital staff were wonderful and very sensitive.   Within eight days I had been diagnosed, had an endoscopy, had a CT scan and had a stent fitted to enable me to swallow.

I was told that chemotherapy was the unfortunately the only option to treat my cancer, as it had already metastasised to my liver and lung, so I gave my consent and started the treatment.  Straight away I reacted quite badly to it - I was very sick during the first chemotherapy cycle and had to have injections to help with the side-effects.  I was supported by Ian Rennie nurses who were and continue to be wonderful.  One good thing was that I didn’t completely lose my hair as a result of the chemotherapy - I wore a cold cap during the treatments, which meant that although cut short, I still retained my hair.

Lamb & vegetable curry with cauliflower rice

Today's post is a recipe from Jenny Philips, who specialises in supporting people with cancer through nutrition. She is running an Outsmart Cancer Cookery Masterclass with us in London on Sunday March 13th, you can book your tickets here. 

For those of you eating meat, this is a very easy to digest and totally delicious recipe. The flavours really come through and it has a mild heat from the chilli, but nothing too overpowering. Pulses such as chick peas can be substituted for a vegetarian option.

Cauliflower is the new star of the low carbohydrate world, and here it makes a great alternative to rice.

Wheatgrass Juice – Nature’s Finest Medicine?

Today’s blog post comes from Dr. Britt Cordi from Live Wheatgrass Limited, talking on Wheatgrass juice and its many, many benefits. 

Wheatgrass juice has become more and more popular over the past years with many juice bars and raw food cafes now serving it in smoothies and various juices.

But what is it that makes wheatgrass juice so popular? And why is it that nutritionists think so highly of it as an immune and energy booster, as a healer of digestive problems and as a blood cleanser?

Raw Beetroot Dip

Today's post is a recipe from Jenny Phillips who specialises in supporting cancer patients with diet & lifestyle interventions. She herself recovered from breast cancer 10 years ago and now helps others to improve their health through nutrition.

‘Keep it simple, and keep it colourful’ is my mantra in the kitchen. This is a typical meal – delicious, nutritious and fast to prepare - chicken with sweet potato & thyme chips, steamed broccoli and a beetroot dip.

Beetroot nourishes the blood, supports the liver and is heart healthy. The phytonutrients which give the characteristic strong red colour have both antioxidant and anti-inflammatory properties. This is very desirable from an anti-cancer point of view, and in-vitro studies have shown a cytotoxic effect when beetroot extract is administered to breast, pancreatic and prostate cell lines.[1]

Beetroot can be juiced, grated raw and added to salads, or baked in the oven with olive oil, apple and garlic. Here it is transformed into a dip that can be spread onto crackers or served on the side.

Satay Noodles

Today's post is a recipe from Jenny Phillips who specialises in supporting cancer patients with diet & lifestyle interventions. She herself recovered from breast cancer 10 years ago. This noodle dish is gluten and dairy free, packed full of nutrition and tastes as good as it looks! 

This is one of the most popular dishes we make at Yes to Life cookery workshops. It ticks all the boxes and is really easy and quick to prepare too. Just one essential gadget you may like to invest in, and that is a spiraliser.

If you haven’t yet met one of these, it’s a really fab gadget which in this recipe makes noodles from raw courgette. It’s also good for carrot, mooli and other hard veg, adding a different texture to raw food and salads.

Our next cookery workshop is being held in London on Saturday 4 July, so make sure you are on the Yes to Life mailing list to receive further information (you can sign up on the right hand side of the homepage)

Inspired Nutrition and Yes to Life take on Brighton

Today’s post is about our recent Cookery Well-being workshop which took place at Brighton Cookery School last Saturday. The morning was hosted by the wonderful Jenny Philips and Jeraldine Curran of Inspired Nutrition who brought a whole load of tasty recipes, years of expertise, a sunny vibe and plenty of jovial flair to the kitchen. If you missed it we are running two more workshops with Jenny and Jeraldine this year, keep up to date with our events calendar for more info.

Think of that person in your life who has cooked for you, gathered fresh ingredients, laboured over chopping boards and stoves with the passion of nurturing you: a mother, grandmother, sibling, friend, partner…then you have some impression of what it felt like to walk into Jenny and Jeraldine’s kitchen. These women are not professional chefs but they are something far more important, cooks who understand the power of food to heal, support and protect.

Although they are both qualified nutritional therapists, it is Jenny and Jeraldine’s personal experiences as much as any qualifications, which make them both such incredible fonts of knowledge.  Jenny recovered from breast cancer ten years ago and Jeraldine has been a close support for family members with cancer so they both understand the topic inside out and were happy to share their stories. The selection of dishes they prepared were designed to support the body through any stage of cancer diagnosis, and it was possible to tailor each to specific requirements…they were also delicious!

Flax Seed Focaccia

Today's post is written by Jenny Phillips who specialises in supporting cancer patients with diet & lifestyle interventions. She herself recovered from breast cancer 10 years ago. 

Jenny is hosting a cookery workshop with Yes to Life in Brighton on Saturday March 7th, if you are interested in coming along please click here for more information.

In this recipe Jenny offers us an alternative to wheat that will have any bread lover fantasising...

Science is consistently showing that the dominance of grains and processed carbohydrates in our modern diet is potentially an issue for health. From a cancer point of view, cutting down or even excluding wheat from your diet is a positive move (read more here) But what to eat instead?

This recipe is really easy to make, and replaces traditional wheat flour with a blend of flax seeds (rich in omega 3) and oats. The addition of eggs too make it a good protein source, and it tastes delicious.

Luxury Chocolate Brownies

Today's post is written by Jenny Phillips who specialises in supporting cancer patients with diet & lifestyle interventions. She herself recovered from breast cancer 10 years ago. 

Jenny has kindly shared a recipe with us which is perfect for the festive season...

Here’s a Christmas treat which is good for you too! This delicious recipe is easy to make, gluten free and packed with protein from ground almonds and eggs. There is natural sweetness from the banana and this is supplemented with xylitol, a sugar alcohol that doesn’t affect blood glucose levels. And because it’s so satisfying you’ll be less likely to over indulge too. A little bit of what you fancy can indeed do you good. Enjoy!

Top 5 Breakfasts to Boost your Immune Health

Today's post is by nutritionist Kyla Williams from Igennus Healthcare Nutrition. Kyla has an educational background in science and a master's degree in Nutritional Medicine. She has a deep understanding of the complexities of nutrition, including diet, lifestyle and supplements. Kyla is Igennus' London-based Nutrition Technical Advisor and also runs her own practice as a clinical nutritionist specialising in skin disorders, digestive issues and weight management.

Whether you are recovering from chemotherapy or trying to fend off the occasional cold, it is always worthwhile to keep your immune system working in tip top condition. Starting the day with a nutritious breakfast is a great way to support your body in fighting off infections, and keeping you feeling well. Here are my ‘top 5 breakfasts’ which are all absolutely delicious and full of healthy nutrition!

1. Raspberry almond pancakes. Pancakes can be very healthy with the right ingredients, and what a great way to start your day! Instead of the usual highly refined wheat-based pancakes, why not opt for something full of omega-3 and omega-6 fatty acids, protein and antioxidants.

Puy Lentil & Feta Roasted Vegetables

Today's post is written by Jenny Phillips who specialises in supporting cancer patients with diet & lifestyle interventions. She herself recovered from breast cancer 10 years ago. 

Jenny has kindly shared a simple summer supper, if only the rain would break for a while!

This recipe combines delicious Mediterranean flavours and is quick and easy to prepare. If you are completely dairy free simply substitute the feta with tofu. I do find that many people tolerate goats and sheep’s cheese very much better than cow’s dairy. They are also less oestrogenic than cow’s milk and may be a better choice for those concerned about hormone levels (1).

We served this dish with a rocket, avocado and sundried tomato salad, and to drink? Fresh lemon, coconut water and ginger topped up with fizzy water. Tres refreshing!

Cashew Nut and Spinach Soup

Today's post is written by Jenny Phillips who specialises in supporting cancer patients with diet & lifestyle interventions. She herself recovered from breast cancer 10 years ago. 

Jenny has kindly shared a recipe with us which contains spinach, a vegetable packed with vitamins and minerals.

Cashew Nut and Spinach Soup

Green leafy vegetables really are a superfood – and spinach is no exception. Optimising cellular health is a key anti-cancer strategy and spinach is a fantastic source of B vitamins, which are essential for cellular energy production. It also contains high quantities of natural folate, one of the vitamins to protect against anaemia. Folate is essential for cell replication and the very important process of methylation which regulates gene expression.

Spinach is also a rich source of minerals including magnesium, an essential nutrient for energy production, the maintenance and repair of healthy cells and bone health, and one of the best plant sources of iron.

This soup is fast to make, particularly if the vegetables are pre-cooked. It’s just simply a case of blending cashews, vegetables, hot water and stock to have a meal on the table in minutes.

The coconut cream can be switched for soft goat’s cheese if you are including goat’s dairy within your eating plan.