However, I have been catching bits and pieces of the rather inspiring BBC Breakfast series this week shining a light on cancer. This has been a truly wonderful set of short films, discussions with experts and interviews with many cancer patients, both current sufferers and those in remission. A particular highlight featured a mother with terminal cancer discussing her fears for her two young sons whom she will be leaving behind on the event of her death – the links are on BBC Breakfast’s Facebook page.
This series also pointed out the issues with male cancers, and the reticence of men to discuss their health for any reason, thereby preventing them from obtaining the early diagnoses which are so often essential to access effective treatment.
But one thing deeply troubled me about several of these interviews that played out on early morning television. And I imagine that the BBC producers were not at all concerned about or paying attention to the one thing that I noticed that really made me angry.
First, a filmed conversation took place between Nick Robinson (The Today Show) and Steve Hewlett (BBC Radio 4’s Media Show) about their respective lung and oesophageal cancer diagnoses and stories. The content of the conversation was inspiring and moving, and it was refreshing to see these two media figures discuss their health so openly in front of the nation.
What wasn’t so inspiring was the fact that they did this in a cafe, and probably for no other reason than ‘scene-setting’ both gentlemen had a mug in hand and a plate containing two french pastries placed in front of each of them.
As I said, I wasn’t going to write this blog… until this morning when the BBC Breakfast team were broadcasting live from Maggie’s in Manchester. Again, the stories were touching and the care being given in this centre seemed impeccable.
That is, except for the seemingly ubiquitous plate of pastries that was placed in the centre of the table in front of the cancer patients and doctors.
Why Do I Have A Problem With Pastries?
So why am I so anti-pastry?
Well, let me start by saying it’s not what you think. Just because I’m a nutritionist doesn’t mean I automatically think gluten is the stuff of the devil.
However, I am well-read enough to recognise that in cancer there are many factors that contribute to its onset.
There are several theories surrounding the development of cancer, with genetics (Theory 1) and lifestyle (Theory 2) being on opposite sides of debate. To debate this and see the two sides of the story, you have to understand the drivers of cancer (and what causes the cancer cells to spread). To understand this, you have to analyse the nature of the cancer cell itself.
The theory of “Cancer as a Metabolic Disease” or “The Metabolic Theory of Cancer” (these are Theory 2) proffers the idea that within cancer cells there is a shift in energy metabolism that takes place due to an alteration in the function and structure of the mitochondria (which are also known as the powerhouse of the cell). This is observable under microscopic examination. We know cancer cells use energy in a different way to healthy cells.
What does this actually mean, though – what are the implications?
Well, if cancer was simply genetic and biological (Theory 1) it would behave according to the laws of Darwin: i.e. survival of the fittest. This would fit with a model where cancer cells are virulent and thriving, strong cells capable of overtaking our biology and essentially hijacking our system. And yet what we see in cancer cells is actually remarkably opposed to that perspective.
Cancer cells actually have rather ‘broken’ mitochondria. This structure and function alteration that we see means that cancer cells have inefficient powerhouses which are structured in such a way that the only way they can use energy is through the use of fermentable metabolites, primarily glucose and glutamine.
It is this need for glucose and glutamine, fermentable metabolites, in order to stay alive, thrive and ultimately grow, that makes me concerned about the pastries.
Carbs and Cancer
Refined carbohydrates get a lot of flack for a lot of things. Unfortunately, given the above, when it comes to the glucose-feeding-cancer theories, they probably deserve it. Providing glucose-filled pain au raisin to a body harbouring tumorous cancer cells is like adding fuel to an already raging fire. Quite apart from the question about the gluten (potential gut issues), the processing of the flour (potential intolerance issues), the inflammatory potential of sugar itself and/or any other concerns about consuming foods like pastries – the pastry is food in the precise form that cancer can use.
For this reason, the pioneering experiments and science regarding cancer revolve around ketogenic diets, i.e. low carbohydrate, metabolism-shifting approaches to dietary intake. Modern science is laying it’s bets on Theory 2.
So Theory 1 or Theory 2: Do Genes or Lifestyle Drive Cancer?
Oh how I wish I could actually answer this question. The truth is that science is still trying to answer this question. I do think that there are conclusions being made in this debate, but in truth there are probably numerous factors which contribute to the potential onset of the disease. It is most likely in my mind that it is a little bit of both. So when that’s the case, we always must look at the pieces of that puzzle that we can influence.
It is proven that lifestyle factors (diet, exercise, sleep, smoking, socialisation) play a role in at least 70-90% of cancers. That means that the genetic lottery approach to cancer only applies in 10% of cases. Why would this be? Whilst genetics display potential and indicate a predisposition, the expression of the genes must be turned on and/or off and the biggest element of this switching on and off process is the diet and lifestyle factors which affect cellular biochemistry.
Chief among these lifestyle factors which turn on potential issues are sugars, smoking/other carcinogens and toxin exposure. And this ties to the idea that cancer is reduced by altering the fuel it is given. So whether it is genetic or metabolic actually doesn’t matter: sugar and simple carbs are still a bad idea.
So What Diet Switches Off Cancer?
You may very well have heard of the ketogenic diet, or a state of nutritional ketosis, being used to alter the symptoms of children with epilepsy or individuals with other neurological conditions. As a health intervention (as opposed to a lifestyle choice or a weight-loss attempt) the process of being in nutritional ketosis is one of starving all of your cells of sugar, glucose and carbohydrates and replacing this drop in food intake with high quality fat. Protein levels remain normal or low (because protein can be converted to be used like glucose) and the availability of only fat as a nutrient forces cells into altering the way they make energy.
Instead of using the fermentable sugars (like the glucose and glutamine mentioned as used by cancer cells above) our livers will produce something called “ketone bodies” when it senses that the supply of carbohydrate and therefore glucose (a primary energy currency of each cell) is low. Though it doesn’t always work as quickly or smoothly as some people might make out, ketosis can essentially tweak your metabolism from burning predominantly glucose to produce energy, to using the ketone bodies produced when the fuel supply is fatty acids from a high fat diet.
Cancer can’t use ketones.
In effect, therefore, the cancer is starved of the one fuel it can use… and so through either direct or assisted means (using hyperbaric oxygen, high dose antioxidants etc.) cancer cells die.
A word of caution: this isn’t a diet for everyone, it is a metabolic alteration. To choose to follow this diet is to choose to switch your primary fuel source into a dense and rich fat substance rather than carbohydrates. Please note also – this isn’t just about cutting out refined carbohydrates, this diet cuts down on ALL forms of carbohydrate… so the healthy sweet potato and brown rice get lumped in with the chocolate cake and sugary pastry. They are all forsaken for butter, coconut oil, avocados and red meat.
Should We All Try Ketosis?
The above might lead you to believe that IF cancer is genetic then the diet doesn’t apply, but IF cancer is metabolic then it does.
But to my mind I don’t actually need to know the origin of the cancer in order to take the decision that a pro-inflammatory substance is certainly not going to help me in fighting it. Whether cancer is metabolic or genetic, it is a disease state in which the presence of inflammation and dysfunction, immune challenge and excess energy demands are all factors. For these reasons, anything that can be done to reduce the likelihood of further compromising my health would be my decision should I discover that I was suffering with any form of cancer. That means that even if genetics drive cancer, I would still choose a low-inflammatory diet (which would equal low-carb, low-sugar, gluten free… so I’d still be saying bye-bye pastries).
But supposing that the new theories about the evolution and metastasis of cancer cells are true, and that the progression of cancer as a migrating disease is aided by and, in fact, fuelled by the consumption of sugar and refined carbohydrates? Well then I would be even more convinced of my choice to avoid inflammatory carbohydrate but I would also be focussed on the, somewhat extreme but functionally beneficial, nutritional ketosis angle – using ketones as a fuel for my body, because I know that the broken mitochondria of the cancer cell cannot benefit from my food.
I don’t actually blame the media for pretty-ing up their sets and their studios with the baked goods that probably weren’t edible and almost certainly weren’t eaten by the guests on these shows and interviews. But it does make me think deeply about the subtle messages our modern media outlets are giving people – much like in my comments about Alzheimer’s earlier in the week. It is not the case that they were promoting pastry eating. But it is the case that through an unthinking move they neglected to realise that everybody whom they were talking to or about would have serious health consequences by basing their diet on the foods that they used to decorate their tables. Regardless of whether Theory 1 or 2 is correct.
One of the biggest things that motivates me in my work is the amount of misinformation and ignorance perpetuated by voices louder than mine and outlets bigger than those that I could ever hope to be part of. The machine of the media is so large that it is unnecessary for them to stay current. Only a few days ago I heard a famous daytime television presenter AND doctor say that the news about intermittent fasting being beneficial for breast cancer was “best taken with a pinch of salt” (news flash – intermittent fasting is a step up from ketosis and works on the same principles outlined above).
I guess my hope would always be that these professionals in one field left the commenting on other fields to those who know better. But my hope is actually more specific than that:
Where healthcare is concerned I would like our messages to be clear, consistent and concise enough to not be confusing.
There is enough controversy when we’re just examining the conflicting and debating science. Additions of misleading messages and half-truths or unconsidered gestures or phrases from leading media outlets makes my job harder, and the health of the nation that much more difficult to safeguard.
So congratulations to the BBC for shining a light on cancer. But next time, can you ensure that the foods that fuel the disease you are discussing DON’T feature so prominently in your footage?