Risks and Benefits for the practitioner

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Joy Murphy
6 years ago
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2 Risks and Benefits for the practitioner An opportunity to make a real difference, at many stages in the cancer journey Intellectually and personally challenging - scientific and personal skills are critical It can be hard to not give false hope, when the end of the road client seeks ones help Cutting-edge NT practice is closer to the latest evidence than mainstream dietetics Oncology teams are hard to win over

3 How NT makes a difference Antecedents, triggers Recognised risk factors for cancer: 75% cancers are avoidable by lifestyle measures smoking, body weight/adiposity, dietary fibre, antioxidants Mediators Inflammation, blood glucose balance, hormones, immune suppression, oxidative damage

4 A holistic approach Diet Lifestyle Supplements Psychosocial aspects Ethical considerations

5 Assessments Vitamin D level should measure level in serum Ideal range nmol/l, but not above 200 nmol/l Gut microbiology and digestive system function HbA 1c - Glycated haemoglobin - This indicates glycaemic health, directly reflects the recent few months blood glucose control - ideally less than 5.5% Hormone panels oestrogen/progesterone, stress GP/oncologist -facilitated tests haemoglobin, FBC, Liver FT, inflammatory markers ESR & CRP.

6 Diet The Evidence cancer risk and recurrence can be reduced by: Low GI/GL endocrine impact, especially in breast, liver, colorectal, prostate, all driven by insulin and Insulin-like growth factor IGF-1 high intake of vegetables and fruit antioxidants, fibre, displacement of less healthy foods Lower intake of mammal produce processed meat in GI cancers, high fat dairy in prostate and breast cancers Lower intake of alcohol liver, breast, pancreatic

7 The big diet-cancer debates Soya - some benefit for women who have lifelong intakes of soya, at least pre-pubescent. Genetic differences exist in ability to benefit from phytoestrogens. In vitro evidence of risk in rats, no evidence in human, in very large trials Dairy high fat dairy associated with increased breast cancer recurrence, prostate Red meat greater risk if cured/processed Fish clear evidence on fish benefits in prostate, some in breast, colorectal Sugar yes it does feed cancer cells like pouring petrol on a fire.

8 Carbs count in Cancer why? Habitually high glycaemic load diet induces high insulin levels High GI diets linked with increased risk of some cancers and cancer recurrence Diabetics more likely to develop certain cancers Breast - Colorectal Pancreatic Liver risk doubled compared with healthy individuals Stomach Uterine

9 Carbs count in Cancer how? Insulin induces IGF-1 production, Insulin suppresses one of the IGF-1 binding protein IGFBP-1 IGF-1 suppresses Sex Hormone Binding Globulin production by liver, liberating oestrogen IGF-1 suppresses p53 protein, which is able to repair DNA or induce apoptosis of aberrant cells IGF-1 directly activates oestrogen receptors Abnormal cells continue to survive

10 Diet Dilemmas or The Curse of the Internet Budwig Diet flaxseed oil and cottage cheese No controlled peer reviewed evidence case reports Apricot kernels laetrile or amygdalin, vitamin B17, allegedly releases cyanide and kills cancer cells surrounded by many claims of conspiracy to prevent this information getting out Gerson therapy raw juices, enemas, liver injections, supplements requires training by Gerson Institute Anti-Candida diet Candida causes cancer no evidence, but immunosuppressed patients may develop Candida bloodstream infections

11 Supplementation Oncology teams almost always ban them and often confiscate them from in-patients because antioxidants protect tumour cells against chemo Recent reviews suggest this is not a universal effect However, many chemotherapy agents do work by oxidative damage Recent evidence on carotenoids suggests they may be damaging, especially in smokers, ex smokers and women with breast cancer

12 Aims of supplementation Support healing at every level: Cellular damage to normal cells Specific tissues e.g. Mucosa, cardiac muscle Support immune system by reducing immune suppressors e.g IGF-1 Enhancing innate immune system Maximise energy Maintain lean body tissue Remember NTs cannot treat cancer, or claim to

13 Supplementation Protocols Each patient is different Detailed information on the chemotherapy regime is vital if supplements are to be used concurrently If in doubt, suspend supplement use during chemotherapy and radiotherapy Emphasize the importance of the diet Flax seeds and oil, hemp protein powder,, spirulina, blueberry juice, other superfoods: use in smoothies, also great when swallowing difficult

14 Specific considerations for Supplements Iron supplements increase the risk of cardiotoxicity with a number of chemo agents, especially anthracyclines Resveratrol may enhance or reduce the effects of some chemo Anything affecting detoxification pathways can affect chemo pharmacodynamics, by increasing excretion (and therefore reducing dose), or by decreasing excretion and enhancing side effects Therefore avoid detoxification during or immediately after chemotherapy. Food is okay e.g beetroot, etc

15 Specific benefits of appropriate Supplements Aloe vera gel on skin after RT Vitamin B6 with Taxol, Paclitaxel, reduces risks of peripheral neuropathy. It may already be prescribed Turmeric the golden treasure of cancer care Enhances chemotherapy and radiotherapy, by increasing the kill rate of cancer cells CRUK sponsoring a trial in bowel cancer in Leicester Ginseng for fatigue, especially in women after treatment for breast cancer survivors Evening primrose oil with Tamoxifen

16 General Supplement plan Typically, a comprehensive MVM without iron; (e.g. Biocare Adult MVM, one/day. As part of a multivitamin, antioxidants can be included, not as single antioxidants, never vitamin A or beta-carotene in smokers, recent ex-smokers or women with breast or ovarian cancer. Increase food antioxidants thyme, rosemary, oregano, berries etc. Essential fatty acids; Immune support Probiotic, but not if the oncology team advises against Vitamin D where indicated by serum level

17 Enhancing the immune system Coriolus (Trametes) versicolor extract used routinely in Japan and China by allopathic oncologists to support the immune system in cancer patients, usually with chemo- or radiotherapy. Acts as a Biological Response Modifier: increases interleukin 2 production by white blood cells, increases LAK cell and T-helper cell production and improved CD4/CD8 ratios. Fermented wheat bran products such as Biobran, AHCC Turmeric multiple actions anti-inflammatory, direct tumoricide, chemosensitisation, radiosensitisation Reduce stress and balance the gut microbes

18 First steps in NT cancer practice Focus on foods, digestion and gut microbes Test vitamin D levels Achieve good blood sugar control by increasing protein and good fats, and moderating carbs Use food based super-nutrients when chemotherapy or radiotherapy is in progress turmeric, superfood powders and hemp or pea protein in smoothies Write to the consultant oncologist (with the client s permission) and explain what you are doing and why, and copy the GP Develop a bank of recipes that are easy for the client

Professional boundaries Etiquette & communication Integrative medicine Cell biology Biochemistry Genetics Physiology Pharmacology Impact of

client with cancer Understand the social and psychological context Provide safe and effective advice on supplements Provide Practical Appropriate

19 Professional boundaries Etiquette & communication Integrative medicine Cell biology Biochemistry Genetics Physiology Pharmacology Impact of Radiotherapy Surgery Chemotherapy Understand orthodox treatment Understand the disease process Function as part of the care team Supporting the client with cancer Understand the social and psychological context Provide safe and effective advice on supplements Provide Practical Appropriate Dietary advice First do no harm Interactions between supplements and drugs/rt Evidence base: Formulation Dosage Empathy & understanding Inspiring and empowering

20 Practitioner development Reflective practice supports practice and the practitioner Clinic journal What? So What? What Next? CPD reading across oncology and CAM fields Professional & Special interest groups Royal Society of Medicine and other medical societies British Society of Integrated Oncology

21 Giving Practitioners a Voice Research to help practitioner support Outcomes may inform training providers, CPD, etc We want to know what practitioners need to help them practice effectively in cancer care Information? Training? Networks? Status? Professional recognition? Links with oncologists? On-line questionnaire for all NT s to tell us how they feel about working (or not working) with cancer clients Focus groups for more in-depth exploration of issues

Dietary advice for people with Inflammatory Bowel Disease

Dietary advice for people with Inflammatory Bowel Disease Crohn s disease and Ulcerative colitis Information for patients Name Your Dietitian Dietitian contact number: 0118 322 7116 What is Inflammatory