integrating natural lifestyle strategies into routine oncology · results weight (n=44) 31 (72%)...
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Integrating natural lifestyle
strategies into routine oncology
Professor Robert ThomasBedford and Addenbrookes Cambridge University Hospitals
Biological & Exercise Scientist Bedford University
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Impact of cancer
£ 2 b - oncology drugs
£ 5 b - general management
£ 8 b - economic and long term disease
Leal et al 2018
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- Scientific evidence reviews
- Lifestyle surveys with patients
- Randomised controlled Trials
Primrose Oncology Lifestyle Research Unit
Professionals Communication with public
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Keep-healthy.com
NewsletterBlog
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Keep-healthy.com
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- Chronic disease
- Diabetes
- Heart disease
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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
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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
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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
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When to start?
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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
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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
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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
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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
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The Primrose sugar avoidance study
44 male and female staff (April to Sept 2019)
Weight
Weight Happiness score
Happiness score Patients opinion4 months
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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
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• 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
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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
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Monoclonal antibodies
(Ipilimumab, nivolumab)
• Better response rates
– Better gut flora
– Metastatic melanoma
CRUK 2017
Main research funding category
ASCO 2018
Major priority for research
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Live yoghurt, kefir,
Natto
Aged cheeses
Miso, kimchi and tempeh.
Sauerkraut pickled veg
Bacteria rich foods
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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.
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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.
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Acrylamides
PAH – HCA - Nitroso compounds
Plastics pollution pesticides compounds
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• Enhance anti-oxidant enzymes
• Lower oxidative stress
• Lower inflammation
• Lower proliferation
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Polyphenols, obesity, exercise
Proliferation, de-differentiation, adhesion, apoptosis,
angiogenesis, invasion, metastasis
Oxidative stress
DNA damage
DNA repair
Epigenetics
Immunity
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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
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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
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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
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Legal status
• FDA – Not medicinal product
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Pomi-T group Placebo group
Joint pains 3.4% 13.4%
Dysuria 12% better 4.6% better
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A double blind RCT of a
polyphenol and probiotic supplement to reduce
arthritis and improve exercise performance
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Prevention
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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
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Existing treatments Cooling4,5,6
UK nurses:
• Concerns regarding cold damage
• Gloves conceal hand – impairing assessment
• More time consuming
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Actions:
• Anti-inflammatory
• Analgesic
• Anti-oxidant
• Anti-microbial
• Moisturising
• DNA repair
T-test p<0.000001
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Legal status
• FDA – Not medicinal product
• Polybalm.com
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Future trials
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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
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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