Changing concepts in cancer care
Sitting by the bedside of a dwindling relative, she calmly recounted how it had been a terrible year, with her relative becoming completely dependent and her own battle with breast cancer taking its toll, pushing through chemotherapy, keeping up with her children and facing the uncertainty of her future.
From a list of foods asked in passing, she instantly picked out two personal favourites: full fat milk with breakfast every morning, and alcohol every other night at social engagements.
Fighting a hormone-fuelled cancer, this young mother was blocking the hormone receptor with first-line medical treatment and sabotaging that same treatment with second-rate lifestyle choices, feeding daily on (external) estrogen from cow’s milk and speeding up her own (internal) production of estrogen via alcohol consumption every other day.
Breast cancer is the top cancer killer for women, and a large number of cases are estrogen-receptor positive (ER+ve) − the hormone estrogen actively fuels their growth.
And it’s not all a genetic lottery. There are lifestyle decisions we can make and everyday actions we can take to positively influence all this.
Estrogen metabolism can be harmful or protective depending on exposures in our ways of living (lifestyle exposures), including the air we breathe, the food we eat and the mechanical stimuli that our body receives from exercise or lack thereof.
The exposome is a concept that like many other tenets of integrative medicine previously shrugged off to be “pseudoscience”, is now slowly being adapted into mainstream medicine.
Earlier last year, the director for individualised medicine at the Mayo Clinic gave a presentation on ‘Exploring the Exposome’, a subject that would have been unthinkable for mainstream institutions not that long ago.
Genetics are not modifiable. The way we live is.
The patient’s environmental exposure via (air) lungs and (food) gut, along with the combined state of physical-mental strength, are nothing short of critical to the outcome of disease, and this is neither conjecture nor opinion, as some in mainstream medicine still claim, against compelling evidence to the contrary.
Equally against all prudence, some influencers professing to be ‘alternative’ medicine gurus are preaching a dogmatic dismissal of medical interventions in favour of lifestyle solutions for every known disease, and possibly (after listening to one or two rants) a few unknown ones as well.
Integrative or functional medicine complements traditional medicine in providing a more complete evidencebased approach to disease; a levelheaded, patient-centred, strengthoriented, disease-targeting approach.
Alongside follow-up by the relevant specialists in traditional medicine, breast cancer treatment should incorporate integrative care interventions as core treatment modalities.
Improving mental-physical stamina and leveraging the detoxification systems in the body is where the strength and nutritional sciences can excel in breast cancer treatment.
Beyond calorie and step counting, this includes replenishing micronutrients (vitamins, minerals, etc) and specific subtypes of macronutrients, optimising detoxification, maintaining bone and heart health, and preserving muscle mass throughout the course of treatment.
Detoxification amounts to much more than just “drinking more water”. As with other intrinsic hormones and (exposure to) extrinsic hormone-like substances (xenobiotics), when the body goes through the process of eliminating estrogen, it first converts it to “reactive” intermediates, which can cause harm by fuelling cancerous cells and directly damaging DNA, unless converted into “disposable” products easily eliminated through urine and stool.
The body has the infrastructure to provide these ‘disposal services’, and keeping this infrastructure in good form can require nutritional or supplemental interventions to ‘keep cogs turning’ or, where necessary, ‘speed up the turning’ of particular cogs.
These ‘cogs’ are mostly enzymes that ‘facilitate’ bioreactions. Depending on individual susceptibilities and deficiencies, this can involve measures to increase basic elements like sulfur and magnesium or less heard-of plant agents (phytochemicals) like chrysin or luteolin.
Some integrative interventions even complement traditional interventions, adding weight to the integrative philosophy that the best of both medical worlds should come together to improve outcomes for patients.
One such example is the effect of sulforaphane (from cruciferous vegetables) and resveratrol (from grapes, berries) in reducing a harmful “quinone” product of estrogen, similarly reduced by the effects of the cancer drug Tamoxifen, with all three agents (phytochemical and pharmaceutical) speeding up the same ‘cog’ so to speak.
Lifestyle advice is advised in international guidelines as a first-line treatment for many chronic diseases in traditional medicine, yet the actual quantity and quality of this advice is far from what it should be.
Limiting this advice to “eating a balanced diet” in breast cancer is just about as useful as dumbing down exercise advice to “30 minutes of walking daily” in heart disease or diabetes.
A change in our outlook on disease to include more of the natural sciences stands to change outcomes of disease for the better and could save us priceless quality years of life for patients and millions for the health system in medical management.
“Integrative or functional medicine complements traditional medicine in providing a more complete evidencebased approach to disease
Mike Tabone is a physician and writer of several original works and adaptations. He holds qualifications in sports medicine, rheumatology and functional medicine.