Integrating natural lifestyle

strategies into routine oncology

Professor Robert ThomasBedford and Addenbrookes Cambridge University Hospitals

Biological & Exercise Scientist Bedford University

Impact of cancer

£ 2 b - oncology drugs

£ 5 b - general management

£ 8 b - economic and long term disease

Leal et al 2018

- Scientific evidence reviews

- Lifestyle surveys with patients

- Randomised controlled Trials

Primrose Oncology Lifestyle Research Unit

Professionals Communication with public

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- Chronic disease

- Diabetes

- Heart disease

Multiple reviews of cohort studies•2-3 hours a week is linked to a >30% reduction in relapse

Thomas and Stacey BJSM 2018

Thomas & Holmes. BJMP 2014

Davis & Thomas BJC 2011

• Fatigue and tiredness

• Mood, anxiety & depression

• Muscle power and exercise capacity

• Overall Quality of life

Meta analysis of 33 RCT studying

exercise interventions after cancer

Fong J, & Liam Bourke L, Barts BMJ 2012

Biology of exercise

Direct: - Reduce inflammation

- Improves gut health

- Improve immunity

- Anti-oxidant

- Reduce excess insulin

- Epigenetic expression

- Reduce testosterone / oestrogen

Indirect: - Weight control

- Improve mood

- Increase Vitamin D Thomas BJSM 2017

Exercise supervision

NHS:

– Municipal gyms

– Level 4 qualified

Private:

• Genesis care Gym

• Physio

• Motivational interviewing

• Correct exercise for specific goals

• Sensitive to needs and ongoing toxicities

When to start?

Lifestyle & radiotherapy effects

Exercise Smokers Age BMI

Rectal toxicity NS

Incontinence NS NS

Erectile function NS NS NS

Lifestyle & late pelvic effect after pelvic rxt.

Thomas, Jervoise, Maher Clin Onco (2013) 25;4)

440 men with prostate cancer treated over 10 years

PACES Study

• 230 women on chemo

• Supervised high intensity v Home based v Standard

• HI & HB >standard but HI > HB:

• Less decline in cardiorespiratory fitness (P < .001),

• Less nausea and vomiting (P = .029)

• Better muscle strength (P = .002)

• Less fatigue (P < .001)

Van Waart JCO 2015

Weight

control

• 13 hours overnight fasting: Lower levels of glycated Hb

Lowers inflammatory makers

36% lower risk of recurrence

• Take regular exercise – walk before breakfast

• Reduce processed sugar intake

Marinac C, JAMA Oncol. 2016;2(8)

Te Morenga Meta-analyses BMJ 2013;346

Mechanism of obesity• High calories

• Less satiating

• Hunger and fatigue

• Eat more

• Weight gain

Other harm• Insulin resistance

• Diabetes

• Poor gut health

• Chronic inflammation

• Raised IGF

The Primrose sugar avoidance study

44 male and female staff (April to Sept 2019)

Weight

Weight Happiness score

Happiness score Patients opinion4 months

ResultsWeight (n=44)

31 (72%) lost an average of 1.63kg. Chi2 p< 0.01

Happiness score (n=44)

Average increase by 9% (11% those who lost weight) Chi2 p< 0.04

Patient opinion

Would encourage them to change diet:

Definitely yes (94%) versus not sure or no(6%) Chi2 P<0.00001

Swami V. Validation of the Malay Subjective Happiness Scale. Social Indicators Research, 2008;88(2):347

• Feeds Firmicutes

Polyphenol reduces glycaemic index

• Slows glucose transport across gut

• Enhances insulin sensitivity

• Reduce diabetes risk

• Feeds Bacteroidetes

• Improve polyphenol absorption

• Reduce gut and systemic inflammation

• Improve immunity

• Reduce oxidative stress

Bowels issues:

• Inflammatory bowel

• Ulcers

• Bloating

• Constipation

• Indigestion

• Bowel cancer

Systemic:

• Fatigue

• Low mood

• Depression

• More “Colds”

• Cancer

• Cancer growth

• Arthritis

• Osteoporosis

• Diabetes

• Cholesterol

• Heart disease

• Dementia

• Parkinson’s

Monoclonal antibodies

(Ipilimumab, nivolumab)

• Better response rates

– Better gut flora

– Metastatic melanoma

CRUK 2017

Main research funding category

ASCO 2018

Major priority for research

Live yoghurt, kefir,

Natto

Aged cheeses

Miso, kimchi and tempeh.

Sauerkraut pickled veg

Bacteria rich foods

Pre-biotics

Prevent adhesion of firmicutes not Bacteroidetes

Protect good bacteria from enzymes in gut

Natural antibiotics kill firmicutes but not good

Fermentable soluble fibres:

Inulin (leeks, onions, garlic)

Starches oligo and poly saccharides

(chicory, asparagus, pulses, tomatoes

mushroom, veg and grains.

The polyphenols:

Plant lignans nuts, bananas and

cranberries, red wine.

Ellagic acid in tea, pomegranate,

turmeric and chocolate.

Probiotic supplements

• After anti-biotics

• Chemotherapy

• Radiotherapy

• NSAI

• Travelling

• Going into hospital

• Alcoholic binge

Research

• Loosing weight

• Dementia

• Osteoporisis

• Arthritis

Keep-healthy.com

• Reliable company

• Short use by dates:

• > 3 million bacteria

• Oligosaccharides.

Acrylamides

PAH – HCA - Nitroso compounds

Plastics pollution pesticides compounds

• Enhance anti-oxidant enzymes

• Lower oxidative stress

• Lower inflammation

• Lower proliferation

Polyphenols, obesity, exercise

Proliferation, de-differentiation, adhesion, apoptosis,

angiogenesis, invasion, metastasis

Oxidative stress

DNA damage

DNA repair

Epigenetics

Immunity

Polyphenols rich foods

Fruit, tomatoes, rich herbs spices HPFS – Giovannucci et al JN Can Instit, 2002

SoyMeta-analysis - Hwang et al Nutr Cancer 2009

Carotenoid rich foods National Health & Nutrition Exam Survey.

Chaoyang Arch Intern Med 2011

Cruciferous and other vegetables,

Joseph et al Nutr Cancer 2004

TeaSingapore Health Study Sun. Carcinogenesis 2007

Epigallocatechin gallate (EGCG)- Proliferation, apoptosis,

- Differentiation, angiogenesis.

- Phase 2 studies, reduced PSA

Curcumin (Turmeric) - curcuminoids- Growth, invasion, migration, apoptotic

- TK activation of the EGFR.

- Blocked cancer stem cells not normal cells

- Inflammation

Ellagic acid. - Proliferation, adhesion.

- Oxidative stress

- 3 phase II studies reduced PSA

Iothiocyanate (sulforaphane). - Growth and enhance apoptosis.

- Epigenetic effect - gene expression

- Inflammation [

Synergy

Thomas et al The Pomi-T study Prostate cancer & Prostate diseases 2014 (17)

Thomas et al. J Lifestyle Med. 2015 (1) 01

Pomi-T trial

Legal status

• FDA – Not medicinal product

Pomi-T group Placebo group

Joint pains 3.4% 13.4%

Dysuria 12% better 4.6% better

A double blind RCT of a

polyphenol and probiotic supplement to reduce

arthritis and improve exercise performance

Prevention

Is higher intake of broccoli, pomegranate tea

and turmeric linked to lower cancer incidence?

• Prospective cohort analysis of 155, 000 men & women between 1993 - 2001

V

Highest quartile Lowest quartile

Cancer incidence 15 years

Existing treatments Cooling4,5,6

UK nurses:

• Concerns regarding cold damage

• Gloves conceal hand – impairing assessment

• More time consuming

Actions:

• Anti-inflammatory

• Analgesic

• Anti-oxidant

• Anti-microbial

• Moisturising

• DNA repair

T-test p<0.000001

Legal status

• FDA – Not medicinal product

• Polybalm.com

Future trials

Metabolic syndrome

• Two blood pressure medications

• A statin for high cholesterol

• Ranitidine for indigestion

• A laxative

• Oral medication for type II diabetes

• A pain killer for joint discomfort

• A sleeping tablet

• An antidepressant

• Tamsulosin for waterworks

• Ca prostate

• Gleason 3+4

• T2

• No spread

8-5.2 ng/l

• Joined a gym (x3 /week)

• Stopped all sugar & processed meat

• Reduced carcinogens

• Increased polyphenols took Pomi-T

• Stopped all medication

• Savings £6200 /year

More information

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rt@cancernet.co.uk