Dr Rupy: We know that obesity is higher after cancer treatment and we know that sugar is one of the strongest reasons why people put on weight. So there's many other reasons. It increases fatigue, which is a big problem after cancer treatment. So if you were doing one thing to help yourself with cancer, reducing sugar is definitely one of them.
Dr Rupy: Welcome to the Doctor's Kitchen podcast. The show about food, lifestyle, medicine and how to improve your health today. I'm Dr Rupy, your host. I'm a medical doctor, I study nutrition and I'm a firm believer in the power of food and lifestyle as medicine. Join me and my expert guests while we discuss the multiple determinants of what allows you to lead your best life.
Dr Rupy: On today's podcast, we are talking about everything to do with cancer with Professor Robert Thomas, who is a consultant oncologist at Bedford and Addenbrooke's Hospitals. He's also a clinical teacher at Cambridge University and visiting professor of sports and nutritional science at the University of Bedfordshire, which we get into a little bit later. Today's pod is everything to do with cancer. It's perhaps one of the most comprehensive and therefore one of the longest podcasts that I've actually recorded ever. For to avoid confusion, we've separated our conversation into three distinct areas. There's what to eat and lifestyle measures in a preventative manner, a peri-treatment and during management, what to eat and lifestyle measures, and then post-cancer, what to eat in terms of reducing the likelihood of recurrence. Now, like I said in my book, Eat to Beat Illness, this topic is perhaps the hardest to talk about, the hardest to write about because it's such a taboo topic. But I think unless we, and when I say we, I mean the conventional medical professionals, entertain conversations and actually look at the evidence base behind them, we will always leave a vacuum that is there to be taken up by people who are not evidence-based and usually promote myths and misinformation that can lead people to harm. This is directed at trying to give people the utensils and the information to better themselves and to give themselves more control and and genuinely improve outcomes as well and reduce risk. So that's why I continue to talk about these subjects because otherwise, it's very unlikely that you're going to get the right information. So right off the bat, if you know somebody or you think that this could be useful for anybody, please do share it and I will continue to try and do more podcasts on this subject if you feel you need that as well. On today's podcast, we literally talk about everything with regard to why professor is involved in the nutrition conversations and lifestyle. We talk about polyphenols, what they are. We talk about the broader sense of what cancer involves. We talk about sugar in particular, which is one of the pet peeves for professor and I can understand why because there is a lot of evidence about processed sugar and why we need to be taking that out quite drastically in our diets. And as somebody who sees patients in and out and the the lack of effort going into messaging to really remind and educate people on the harms of sugar, I think I understand his viewpoint very much so. But it isn't popular with a lot of people and he and I understand that that is a sticking point. We talk about the Warburg effect, exactly what that is. And just to clarify, it's this inappropriate preference of cancer cells for the less efficient respiratory cellular pathways to produce energy, even in the presence of sufficient oxygen. I know that sounds a little bit geeky, but if you look it up before the podcast or even read professor's book, it gives you a much more in-depth picture of what that actually is, as well as some nice pictures too. We talk about the direct and indirect mechanisms of vegetables and polyphenols in particular on on cancer and why that can be extrapolated to have human effects. And we talk about some really interesting ideas around prehab for patients undergoing cancer therapies. And this is looking at vitamin D, improving gut health, yes, changes in diet, and also entertaining perhaps some tailored supplementation. We talk about a lot of things, as you can tell. We even span into some of the work that he's doing with the COVID-19 response and and how nutrition may be uh may be involved in in terms of trying to lessen the impact of the virus. Again, very, very preliminary stuff. We do talk about some ingredients in particular, but as hopefully you'll understand, it is very early days to even be entertaining that kind of subject. And it all comes back to a whole foods, largely plant focused diet with lots of variety and plenty of whole ingredients. So watch this space. To end off with, we talk about the future of oncology, individualized medicine, immuno-oncology, which is the advent of immunotherapy techniques, as well as metabolic oncology and what professor sees as the future of cancer patient journeys. I think this is a wonderful pod if you're starting out on nutrition and just really trying to tackle one of the most the the most difficult subject I think to talk about and the most heart-wrenching condition as well. So with respect, I think it's important to to talk about this subject without adding blame or adding even more conflict to the situation. So in addition, I would encourage you to check out the podcast page because professor is lead of a lifestyle and cancer research unit that conducts designing and conducting government-backed studies that evaluate the impact of exercise, diet and natural therapies. And that's in collaboration with the universities that he works with. And he's published over 100 peer-reviewed scientific papers. Again, some of which we will link to in the show notes on the podcast page. And just as an aside, in 2019, he wrote a book called Keep Healthy After Cancer. And he remains medical advisor for the lifestyle cancer website, cancernet.co.uk. So if you're interested in this or you need more information, I would highly, highly recommend you do check out that website and also the general lifestyle site, keep-healthy.com. Uh additionally, he's got a long CV. For these contributions, he's been awarded the British Oncology Association's oncologist of the year and the Royal College of Radiologist medal as well. Without further rambling, give us a five-star review if you found this helpful. And this is my podcast with Professor Robert Thomas.
Dr Rupy: Robert, I'm really fascinated as to what you're doing now given the current scenario and how your clinical work has has changed given the pandemic.
Professor Robert Thomas: Good morning, Rupy. Yes, well, I'm a mainstream oncologist in two hospitals, one a sort of smaller DGH in Bedford. And we've been dragged into seeing medical patients on the ward to cover our colleagues because there's a lot of people going off sick, and there's a bit more work to do with looking after the ill COVID patients. So a little bit of a challenge because I last did, you know, learned how to treat a heart attack or a chest infection probably 20 years ago. But fortunately, there's lots of guidelines out there and there's the junior doctors these days are, you know, brilliant and the nurses are brilliant. So I feel well supported, but they still need someone to make decisions. So that's why they've dragged consultants out. So different on that point. In the oncology side, a little bit more difficult because the drugs we give can make people immune deficient. So you have to think twice about starting chemotherapy or one of the new immunotherapies which can lower white cell counts. And it is known that if you catch COVID with neutropenia, then your chances of survival is much less. So you have so decisions with patients take longer. If you're only having say a 5% extra benefit from chemotherapy and then you think, well, you know, you could get COVID and be fatal, then the threshold for offering chemotherapy is lower. That said, we're, you know, we're working flat out. We we we're still got the same number of people on chemo. We don't what we don't want is what many people are doing is is not giving a treatment which might offer a significant chance of saving their life, say five to 10 years down the line, because of a say 3% chance of getting an infection now. So you have to think a lot about what you're doing, but interesting times.
Dr Rupy: Yeah, it must be quite daunting going back onto the medical wards after that long out of acute medicine, I suppose, right? But like you said, there's some there's some great algorithms, some great guidance and everyone seems to just be mucking in and helping each other out. I've never seen such a collaborative organization.
Professor Robert Thomas: Yeah, it is it is a bit daunting. As you say, it I was quite impressed the level of staffing from when you know, I was a an SHO or or a registrar where you covered a whole hospital. I mean, most wards have two or three doctors. I thought it was quite luxury, but and as you said, there's good guidelines. I mean, the last time I was on the ward, there were there were two alcoholic patients who were recovering. There there was two heart attacks, there was a stroke, three chest infections. So you're right. I mean, I spend my days, you know, prescribing chemo and radiotherapy and don't think about anything else. So it's but as an oncologist, you one of the attraction for oncology is is you you do have to look at the whole patient. You have to look at the frame of mind, you have to look at the other comorbidities before giving, you know, a very toxic treatment. So I don't feel completely out of my depth. Maybe the first few hours I was a bit nervous, but I sort of found my feet quite quickly, I hope.
Dr Rupy: I'm sure, no, I'm sure. And with that in mind, I'm really, really excited about talking to you. We've met a couple of times. I think we've been on panels together. We've both presented at some some conferences, uh, yeah, I think they're conference, well, not not academic conferences, but um patient facing uh conferences. And you're particularly special in terms of your um your perspective on looking at the patient holistically because you you're a real proponent for nutrition. And oncology and nutrition is something that I think has got a bad reputation, but I think people are coming around to the idea of the importance of diet um uh during treatment, pre-treatment and post-cancer as well. What I thought would be nice to frame this conversation is perhaps describing exactly what we mean by cancer because it's a very, very broad term that's banded around, I think a little bit too liberally and how much we actually know about the causes of cancer at this point in time. I know it's a huge question to to hit you with at the start of this, but um perhaps we can kick off there.
Professor Robert Thomas: Well, as you say, I've been interested in trying to get the evidence for the best advice to give patients because particularly with social media and access to the internet, more and more people are sort of searching what they can do to help themselves. And there's as you know, there's a lot of sort of false news out there for want of a better word. And there's some good research from around the world, but there's lots of gaps in nutritional research and cancer. I mean, it's not the it's getting better, but it's not the the most attractive part of research. I mean, the big drug companies want to develop a brand new drug which has a great chance of response and make them money, etc. Uh but you know, um research on sort of how much exercise to do, what sort of exercise to do does always take second fiddle, but that's what patients can do to help themselves. So they it's important to get the information. So we design trials to find out, you know, what's the optimum nutrition, what's the optimum exercise, where they should be in the sun, where they should be taking vitamin D, things like that. And we've been doing that for now 20 years. So we've had some interesting results. And from that, we can guide patients we see personally in our unit. Uh we can put it out on social media, we can write books and quite importantly, we advise lots of the main charities like Macmillan, Bowel Cancer UK, what should be in their information leaflets because they're keen to get as much evidence as possible as well.
Dr Rupy: And so and so when we when we talk about cancer, why don't we talk why don't we actually describe what we mean by cancer? What is cancer?
Professor Robert Thomas: Um well, cancer is an enormous subject. Many people think we shouldn't call cancer in one name. It should be 50 different names. But you know, there's a whole spectrum from a low-grade prostate cancer which has got a 1% chance of affecting that person's lifespan to a very aggressive say pancreatic cancer where there's a nine-month chance of survival and treatments are very scant. But at the end of the day, a cancer cell, the the genetic damage to cause the cancer is in our cells. We're born with the codes for cancer and they're locked in place by other genes called suppressor genes which stop those those codes of DNA causing a problem. But something happens along the line, it could be by chance, it could be because we've eaten some carcinogenic foods or done something bad. And the genetic material gets rearranged and the codes for that cell become abnormal. So instead of a normal cell growing to a certain size, stopping growing and dying to allow healthy cells to replace it, a cancer cell carries on growing, it creates a mass because it doesn't die, and then it looks for areas to spread. So it will invade other tissues around it and then find ways to spread around the body in order to survive. So it's a bit like an infection really, a sort of slow infection. It's trying to survive and in that process of spreading and invading, it causes a lot of damage to normal tissues and eventually if that damage is strong enough, the organ would fail and the patient would get seriously ill.
Dr Rupy: You mentioned genes there. Um what proportion are we talking about with regards to cancers uh where there's a clear sort of deterministic inherited genetic mutation versus the ones that we acquire throughout our lifespan. So I think people are aware that there are things that we can do to to mitigate against the risk of mutations, whether that be uh limiting excessive exposure to UVB rays, limiting uh food and and we can talk about sugar in specific case. Um but what's really the balance when we when it comes to the genetic risks that we can't really change versus the ones that we can?
Professor Robert Thomas: Well, the WHO and the World Cancer Research Fund have done some quite interesting statistical modeling to say how many cancers are in the world are caused by um caused by um just spontaneous mutations. So you can have the life of an angel and still get them and how many are lifestyle driven. And they've come down to about 50%. That's based on the the large risk factors such as smoking, sedentary behavior, um obesity. I think it's a bit higher to be honest in my personal experience because they haven't taken into account things like gut health, levels of polyphenol in the diet. Um but it comes down to statistical odds. So you can be born with a braca one or a braca two mutation, which increases your risk of breast cancer and ovarian cancer by about 80%. So, you know, you're born with as you can I I've put it to a game of poker. You're born with with bad cards. However, if you lead a very healthy lifestyle, you can, you know, delay when that cancer starts and maybe you can have a less aggressive form of it. But at the end of the day, you've got a high risk whatever you do. But there is a double hit theory. If you have those poor genes, the braca or similar ones and you have a poor lifestyle, you are going to get cancer very quickly and it's going to be very aggressive. On the other hand, you can be like all these annoying people you find, you know, in their late 80s who've smoked all their life and done nothing and laugh at everyone saying, look at me. They've been born with very robust genes. And I think we should find out more about what genes they have to be honest, that's a separate thing. Um but most of us are somewhere in the middle. So we have a strong influence of whether we're going to get cancer or not. So for the middle ground, which is probably 90% of the population, you do have a strong influence of whether you're going to get cancer. And even if you don't stop it, you're going to put it later in life and it's going to be a less aggressive type. We know that from lots of co cohort studies that people who have a poorer lifestyle tend to have more aggressive cancers. So you know, I get this with my patients saying, but doc, I've lived, you know, I'm really healthy and I've still got cancer. I said, yeah, but you're, you know, 84, you've got a grade one prostate cancer. You know, if you weren't healthy, maybe you would have got a high grade cancer in your 50s. So it's all about changing your odds with lifestyle.
Dr Rupy: Yeah. And and on that note, I think um it would be really useful to uh frame our conversation to three distinct areas. So we've got preventative, uh peri-treatment or peri-management, and then post-cancer and the ability of uh of us and our lifestyle uh and nutrition in particular to alter the the outcomes of all those different in those different arenas. So you're particularly interested in um in diet, in polyphenols, you've done tons of work in that respect. What kind of things can we do in terms of our diet and lifestyle to prevent cancers from occurring in the first place? And is that enough, this is a separate question. I know they're they're quite big questions, but is that enough to um substantially mitigate the risk if you do have mutations like braca one, braca two?
Professor Robert Thomas: Um well, that's a long question.
Dr Rupy: I know, sorry.
Professor Robert Thomas: Before we start, we should say, you know, there are medical things you can do before we go on to just as a sort of preamble. It goes without saying, you know, if you're a woman, you get your mammograms to pick up tumors early. If you get your HPV vaccination, uh you you go for bowel cancer screening if you're a man over 60. So all those things which the medical community are doing to pick up tumors earlier or provide vaccines are obviously very important. Um so we're not saying don't do that. In terms of um lifestyle, as I said, fortunately, most of the data for preventative, whether you have cancer to reduce the progression or you've had cancer and you want to stop it coming back, most of the data say the lifestyle factors are pretty similar. So, um there's there's there's not we can sort of put it all in one lifestyle category. Um many people, we'll come on to if you have cancer, many people say, well, there's no point reducing carcinogens if you've already had it, but that's not true either, and we can come on to that. So, breaking it up into different factors. So, you want to avoid bad things. So, bad things are carcinogens. Now, the there's in my book, there's a and I'm sure you have it in your books, there's you know, there's a whole category of carcinogens which you could talk all day. But the common ones would be polycyclic aromatic hydrocarbons, which you get from burnt over overcooked meat, which I'm sure you never do. Um but if you get a sort of a bit of bacon, you put it in your frying pan, you fry it to a crisp, it's covered covered in that black stuff which some people love. Uh that's your polycyclic aromatic hydrocarbons. Now that goes into your stomach and it's converted to aromatic amines and they're highly carcinogenic, especially for stomach, pancreas, bowel cancer. Uh the other thing is smoke, smoke food, smoke can be harmful, um ingested as well as smoked. Um and um then the other category is acrylamides. Acrylamides is is as you know is is uh sugar or carbohydrates heated to high temperatures. So things like uh cereals, I don't want to use a brand name, but uh corn cereals which are heated to a very high temperature have got high levels of uh acrylamides. And there's there's many more. You know, there's then we come on to the pesticides and the herbicides which have estrogenic effects and this is combined with plastic bottles and and car fumes. These are your estrogenic carcinogens and they will increase the risk of breast cancer, ovarian cancer. And at the same time, they will um reduce men's sperm count, reduce men's libido. And you know, if you go to the Amazon and turn a crocodile upside down, apparently they've all got small penises now, but uh I'm sure that's a myth and nobody's actually done it.
Dr Rupy: I haven't heard of that one.
Professor Robert Thomas: Maybe that's your next program. Yeah. Um but what I'm saying what is it's about estrogenizing the the world. Um and um you know, the Woody Allen film, I think it was the sleepers, you know, eventually what will happen is men will, you know, get a low libido, low sperm count, have small penises and you know, obviously we will not have a population. Yeah. Um I think anyway, I'm dramatizing it, but it's heading that way. I mean, the amount of plastic bottles everywhere and there's estrogenic carcinogens everywhere. The only good thing about the COVID is the car pollution is going down. So
Dr Rupy: Yeah, massively, yeah. And I think, you know, not only is the car pollution going down, it's um it's encouraging people to go out and and walk a lot more and actually interact with their neighbor at a safe distance and you know, the number of people I've heard anecdotally that have struck up conversations with people that they had no idea live next to them. Um it's quite amazing. So, you know, and there are some anti-cancer benefits of that, I'm sure as well.
Professor Robert Thomas: Absolutely, Rupy. Um so those are the main things, avoiding carcinogens, but again, we we could go on and on about that. Um and then there's there's sugar, processed sugar, uh which we can expand on in a minute. Uh and then um on the things like sunburning, uh radiation, having too many x-rays, being next to a radiation source, that sort of thing. Uh cosmic radiation, you know, air hostesses, pilots traveling at altitude. So the list goes on and on and on and you know, um there's less and less evidence for the minor things. But then on the on the positive side, of course, things we should do more of and you've just mentioned um social interaction. There's a there's a good there's quite a lot of evidence that people with a better psychological wellbeing have a lower risk of cancer. Um there is evidence that exercise, if you particularly over three or four hours a week, will reduce your risk of cancer, uh keeping your weight down. Um are the are the sort of the main ones. That that was the non-dietary ones. Then going on to diet, then you've got the uh healthy fats, polyphenol rich foods, etc, which I'm sure we'll mention later.
Dr Rupy: Yeah, sure. Well, let's go into polyphenols actually because I think that's something that uh I loved about some of the research work that you've done, the pommy tea trial. It's something I've shouted back quite a bit. In fact, I think I referenced them both in my uh two books as well. Um and uh I think people might not understand exactly what a polyphenol is despite me shouting about them for so long. So so what do we mean by polyphenol?
Professor Robert Thomas: Well, looking at your cookbooks and your blogs, it's basically everything you cook with. So it's um it's within foods, you've got the core components. So you've got the roughage, you've got the vitamins, you've got the carbohydrates, proteins, etc. Um now you've got the vitamins and minerals which are the essential, these are essential chemicals which the body can't make. So they have to be ingested. And if you don't have say a vitamin, if you're a sailor in the turn of the century, you'll get scurvy. If you're eating white rice in the far east, you'll get berry berry, etc. So they're linked to specific syndromes. Now, there's other chemicals within foods called phytochemicals, of which polyphenols are the largest group. And they're the things which give food its color, its taste and its aroma. So if you're a good cook like you, you use a lot of those because it gives it a lovely smell and taste. On top of that fantastic attribute, they're the things which have enormous health benefits. But they're not so obvious as say scurvy or things like that. They're linked to an increased risk of chronic degenerative conditions, which includes cancer. So if you have a diet with poor levels of polyphenols over years, you will have an increased risk of chronic degenerative disease. So that's arthritis, dementia, Alzheimer's, cancer, joint pains, the list goes on. So it's a much more slow process and it's harder to prove a direct link. But we need a lot of them on a daily basis. And many British diets, well, not just Britain, but many Western diets, if you like, are, you know, they they're plain, they they've got white food, um you know, plain white bread, white rice, not so many vegetables, low in fruit. And you know, the people who look at your program think that's not can't be true, but when we audit, when I we every now and again we audit our patient's nutrition, we audit our patient's uh lifestyle. And that's patients who've come through a unit which is pretty active in encouraging healthy living. And we're quite always quite disappointed that the level of uh polyphenols in people's diet on a typical English diet is pretty low. And for that matter, the amount of sugar which is ingested is high and the amount of exercise is low. So there's a lot we can improve on um increasing our polyphenol levels.
Dr Rupy: Just to double click on that for a moment. Uh so I I've been doing some work as part of my uh masters in nutritional medicine uh at the University of Surrey. And one of the um uh topics that I'm going to be be doing my project on is the the consumption of fruit and vegetables as a strategy, as a very simple strategy to improve the health of the population uh across the board. And when you look at uh the five a day campaign that I think everyone is very aware of, despite the popularity and the knowledge base of having five a day, the average consumption is around three portions of fruit and vegetables per day. And that spectrum is from zero to over five. Um and you look across different countries and their respective five a day campaigns, some of it's sometimes it's seven, sometimes it's 10, in the case of Japan, I think it's about 10 or 30 different species uh per week or per day. Uh and and the levels of consumption mirror that. So it it seems as if, and I'm not trying to put words in your mouth here, but one of the reasons why we might be seeing an increase of a whole bunch of different degenerative issues that you've just named there, like arthritis, uh cancer and and diabetes, uh of which cancer is one that we're talking about today, um could be in part related to the lack of consumption in combination with all the other features that we know that are important, sedentary lifestyles, lack of socialization, lack of exposure, uh lack of appropriate exposure, I should say, to UV rays.
Professor Robert Thomas: Yeah, I mean the the five a day was just, you know, we've all sat on these committees and we've had, you know, supposedly clever people coming up with a figure. I mean, that's just an arbitrary number which was was based on, you know, could we initiate change? And there's no point being too ambitious, is it? Because people would just ignore it completely. But there's lots of work. There's a paper called Pierce, which looked at people who had breast cancer and looked at the level of um fruit and veg they had a day. And there was benefits going up to, you know, 10, 15 different portions of vegetables and fruit a day. So five is a bare minimum. We would get much more benefit from more. Um so, yeah, I mean it's it's whatever is achievable, but in Britain we're not even achieving that. And I would totally agree with you. I I you know, if we were to at a very young age, try to persuade our children and and everyone else to to to eat much, probably double or even three times the amount of fruit and veg, more herbs and spices. Fortunately in Britain we had the Indian influx in the 80s, which brought herbs because I don't think I grew up with a herb. I didn't know what a herb was when I grew up in South Wales. As soon as I got to university, you know, it was curries every three times a week and and fortunately those are very high in polyphenols. And and uh so they, you know, it's it's the herb side is is improving, but the levels of vegetables and fruit is still quite low.
Dr Rupy: Yeah, yeah. And with regard to like herbs and spices and different polyphenols. So there are a bunch of different reasons as to why um they might be beneficial uh from a cancer perspective, right? I wonder if we could just talk about the potential mechanisms by which polyphenols exert their anti-cancer effects because I understand that, you know, there are direct and indirect mechanisms for those.
Professor Robert Thomas: Um yeah, so um I mean, again, this is this is a big subject and I've written a paper on it if anyone wants to read it. Um we try to compartmentalize um research foods into different categories, but they they sort of cross over. Um most uh most poly, well we put it in order. So most polyphenols and phytochemicals have a prebiotic property. So um unhealthy bacteria um don't have uh the ability to use this breakdown product of polyphenols called butyrate and they they they eat sugar. So if you have a lot of sugar and low polyphenols, it it gives a a state where the bad bacteria for the sake of argument uh will grow. If you have more polyphenols, they they're broken down in the gut and they form this butyrate which feeds the healthy bacteria. They also feed the uh lining, healthy gut lining cells. So uh so polyphenol rich diet will feed the healthy bacteria which will reduce gut inflammation. They then feed the gut cells themselves which improves gut integrity and reduces permeability. And there's a phrase which some doctors like, some don't called leaky gut syndrome. I think it describes it quite well. I don't know about you.
Dr Rupy: I I quite like the term leaky gut because I think it it it really gives an idea in a patient's mind about what's going on. But I say to them if they want to look it up in the literature, use intestinal uh hyperpermeability because that you'll find more papers on that.
Professor Robert Thomas: Absolutely right. So I I'm all for I'm all for sort of easier names to remember. So so if you if you then so if you don't eat polyphenols, your gut health will get poor, you'll have an overgrowth of unhealthy bacteria, uh your gut will become more permeable. So then when you have toxins, other toxins in food, like the acrylamides or the polycyclic aromatic, they're absorbed quicker. Now, when they're absorbed into your gut, this creates a state of systemic inflammation. And your immunity starts reacting to these toxins, a higher level of toxins. Now, the theory, for example, for type one diabetes, it's not proven, but is, you know, your immunity is fighting these toxins which which are foreign, but they're very similar to maybe normal gut cells. So they start attacking them and as a byproduct of attacking the toxins, it then attacks the joints, the pancreas, causing diabetes, uh the heart, the brain. So this chronic inflammation is is a very serious um you know, over many years is a very serious situation where your own body is is attacking your own cells. Um so uh you really you really have to reduce the the um improve the gut health for that reason. Also, polyphenols have direct anti-inflammatory properties of their own, independent of the gut. Um now, the beauty of um polyphenols is they don't just suppress inflammation, they make the inflammatory system more efficient. So if you stub your toe or you have an operation, it's not going to reduce the inflammatory response, but it makes it it makes it more efficient. So you don't get an inappropriate inflammatory response against something which you shouldn't um react against. Um it also switches off the inflammatory response when it needs to. So that's the other thing. If you take lots of turmeric, for example, people will say, oh, you're I even saw something about COVID saying, don't have turmeric because it will reduce the inflammatory response against the virus, which is the most nonsense thing I've ever seen. It will encourage the inflammatory response, but as soon as that inflammation source is gone, it then encourages the switching off of the inflammatory process. The other pathway is oxidation. Now, we've all most of us have heard of oxidative stress. Now, this is a situation where we have more free radicals in comparison to the antioxidant enzymes. So the balance of free radicals is too high, too many free radicals in in comparison. We need some free radicals, as you know, to uh help with apoptosis and normal fighting against viruses and things, but most of us with a western type of lifestyle have too many free radicals and not enough antioxidant enzymes. So, what uh polyphenols do is again, they upregulate the antioxidant system to so that when you have free radicals, you're able to deal with it. What they also do, there's an enzyme called cap one, they also, again, like inflammation, they switch it off when the oxidative stress goes. So in other words, the time your cell spends in optimal oxidative uh balance is increased. Unlike vitamin A and vitamin E or direct antioxidant supplements. And this is my pet hate when people put polyphenols and antioxidants in the same basket. Um yes, they can encourage improve oxidative um enzymes, but they're not direct antioxidants. Vitamin A and vitamin E are completely different. They are direct antioxidants and taking supplements, for example, of vitamin A and vitamin E, we would very much not recommend. Um and also they have the ability to switch off this cap one pathway. So you you your antioxidant pathway remains too high for longer. So you get a thing called oxidative antioxidant stress. So that's the other pathway. The other thing they have as well is direct anti uh cancer properties. So they can reduce and this is more your cell line and animal data, they can reduce proliferation of cancer cells, they can trigger uh the anti-apoptosis pathway. So in other words, they encourage cells to die when they ought to. There's a thing called angiogenesis. So they um discourage new blood vessels to form into cancer cells. So there's there's some direct uh properties. Going down the indirect, the other indirect properties, for example, they help with the reduced absorption of sugar through your gut and they improve insulin resistance. So uh they they help protecting from diabetes and all sorts of things. And and there's also a thought they reduce the risk of obesity and other things which have cancer links. So it's a bit of a complicated subject, but I hope I got that over okay.
Dr Rupy: Yeah, yeah. I I really I I really appreciate you going through it all systematically because I think people need to understand that uh when you have a food, not a supplement, which is uh you know, a part of a food that's uh built up and and um given in a dose that's unnaturally high. Um and there might be some, you know, utility uses of supplements in in certain cases. But um when it comes to food, you've got a suite of different polyphenols, these plant chemicals that exert multiple different effects, something that we call pleotropic effects on the human cell. And it's quite hard to mimic. And the other thing I think is, and I'm guilty of this as well, we take a very reductionist approach of a binary approach, okay, this is inflammation, I want to try and reduce it, or this is having anti-cancer effect and this is why this is having the desired positive impact. But in reality, it's keeping everything in this dynamic uh balance. Um and if you think about what cancer is at a very basic level, you know, it's a a population of cells that is dividing beyond the confines of what is normal. And a normal cell goes through apoptosis, which is essentially cell cell death or self-death or suicide. Um I think that's where the the term actually comes from uh from Greek or Latin, it evades me now. Um and so having that anti-apoptosis is actually uh something that is is quite useful to understand as well. And I think, you know, when you go into the mechanisms behind polyphenols, um it it just gives you this understanding of like, wow, there's so many different pathways by which these foods can exert positive influences on in a preventative manner.
Professor Robert Thomas: Absolutely right. I mean, the more you look into when we started looking using herceptin and which was a drug which targets over expression of a gene called her2. At the same time, they realized that many of the polyphenols in olive oil actually did the same thing. I'm not suggesting you take olive oil instead of your herceptin, but you could enhance your effect through diet. Um so many things which could have naturally these PD1 inhibitors, which are the latest immunotherapy, there's now strong evidence that polyphenols and and bacterial rich guts will enhance their performance. Um so the whole food has it all built in. And the danger is as you as you just said, to take out a single chemical and think you've got the answer. I don't think nature works like that.
Dr Rupy: Yeah, yeah. And and on that note, I think um it would be really useful to uh frame our conversation to three distinct areas. So we've got preventative, uh peri-treatment or peri-management, and then post-cancer and the ability of uh of us and our lifestyle uh and nutrition in particular to alter the the outcomes of all those different in those different arenas. So you're particularly interested in um in diet, in polyphenols, you've done tons of work in that respect. What kind of things can we do in terms of our diet and lifestyle to prevent cancers from occurring in the first place? And is that enough, this is a separate question. I know they're they're quite big questions, but is that enough to um substantially mitigate the risk if you do have mutations like braca one, braca two?
Professor Robert Thomas: No, I'm a I'm a big campaigner. In fact, you may quite an amusing study we've just submitted for publication was um when you go into a cancer unit, the first thing you see is a bowl of boiled sweets on the on the reception. You go into the chemo suite, you see, I mean, well-wishing patients have donated, well, you know what it's like, chocolates, cakes. I mean, I think junior doctors are the most uh they could they could name every chocolate in a chocolate box. Um and I said, look, come on, it's giving the bad impression. We're telling one we're telling people to stop having sugar and then you see that in the chemo suite. So I we just finished a study where we withdrew all sugar from the public display, so receptionists, and we replaced it with nuts and fruit. So we had a 75% sign up rate from the staff, but the other 25% would were kindly agreed not to eat their sugary items in front of the other staff. And then we measured um weight. There was a there was a 8% reduction in weight in three months, which is which is higher than any exercise intervention. We measured happiness scores through a formal validated question. Happiness scores went up. And then we then we did a survey of patients to say, what did you think of that intervention, you know, where if you a busy nurse might have missed their lunch, instead of reaching out to a bar of chocolate because it's in front of them, they reach out to an apple or some nuts. And 95% of patients said they thought it was a good thing and it encouraged them to change their diet because it gave the right message. So that might we we've just submitted for publication. It was only a small study of 75 staff. But if you think if you expand that across the whole of the NHS, absenteeism for obesity is very high. Um you know, that might be a big cultural change we can work on because it's a very simple maneuver. You just remove the chocolates and add a bowl of fruit, you know.
Dr Rupy: Absolutely. And I think, you know, it's a cultural shift that we have to attain. And like that study eloquently demonstrates, you you have so many different knock-on effects. And you know, it's nice to look at BMI and weight as an endpoint because that's what gets a lot of people excited. But really, it's it's the impression, it's, you know, the messaging like you said. And when you look at the the the mechanistic benefits of reducing that sugar, like you said, the insulinotropic effects, the satiation signals, the impact on insulin growth like factor, etc. You know, you you're doing literally doing amazing things and one of the best things you can do. So I think that's wonderful. I I would be looking out for that and I'll be championing that for sure.
Professor Robert Thomas: Yeah, I mean it it it was in terms of statistics, it probably wasn't the most robust because it's hard to control if you're if you're sneaking under the table and and getting a Mars bar, but uh as you say, it's it's it's creating an impression, it's leading by example. I mean, you have to uh like what you're doing. I mean, you you have to show um the benefits.
Dr Rupy: So if you if you have cancer, uh perhaps you're just about to go into into therapy or perhaps you're still undergoing therapy, what do you say about um the evidence base behind dietary change? Whether this is something that we should be looking into or whether, you know, it marries that of a preventative uh anti-cancer diet.
Professor Robert Thomas: Um yeah, as I said before, most of the advice um cutting out bad fats, carcinogens, um still apply if you've got cancer. For example, if you when you have many cancers, mutate as they go along. Um so unhealthy lifestyle, in my opinion, does um create an environment that more mutations take place. So it's more likely to degenerate into a more aggressive tumor, chemo resistant type of tumor. So it's still good to reduce your carcinogens and and lead a healthy lifestyle. Also, we've we haven't really talked about um coping with cancer treatments, the fatigue, the increased risk of diabetes, uh the weight gain, arthritis, cognitive problems. They are all significantly reduced and those studies have been done if you lead a healthy lifestyle. So there's absolutely a strong encouragement for patients to say, you know, it's not too late, you can still improve your outcomes. Um we there's two things I'd like to talk about. One about the prehabilitation for surgery or chemotherapy. And I don't know if you're going to talk about if you've had your cancer, can you reduce the risk of relapse because they're two subjects. But I'll go on to prehab. The Royal College of Anesthetists have just launched with Macmillan a very big campaign about um prehab. So if you have a you've been diagnosed with cancer, your operation is in three weeks time, what can you do in that three weeks to change your body environment so that when that tumor is being manipulated, it's less likely to spread or your immune system is upregulated to deal with some shredding of cancer cells. And there's there's, you know, there's lots of evidence if you if you go into an exercise program, for example, you um you you're not going to influence your body weight, but you will reduce the risk of of pulmonary embolus and um venous thrombosis, which is actually much higher than you think. A lot of the mortality for cancer is not from the cancer, it's because you've died of a pulmonary embolus. So you can reduce that risk. Um infection, you can pick up a super bug or more recently you can pick up COVID in hospital. And there is reasonable evidence that if you improve your gut health through various measures, you will reduce the risk of getting a super bug. So there's a lot you can do in the acute phase if you're if you're scheduled for an operation to to reduce your odds. Um as I said, I've already we've talked about during chemotherapy, you can enhance um well, you can prevent many of the side effects. And then of course, we're dealing then you once you've had your surgery, the time it takes you to recover can be improved, particularly with exercise, stretching, keeping your body weight down. And in the longer term, if you've gone into remission, what can you do to reduce the chance of that cancer relapsing? And that's pretty much the same as the advice of preventative.
Dr Rupy: And with specific regard to gut health, because I think that's um becoming quite a popular topic. And there's some some information I haven't had a chance to read the papers if I'm honest about um uh patients who have had improved or who have good markers of gut health responding to treatments better than cohorts who who don't. Is there any way in which people beyond the pulses and polyphenols uh to do to actually improve their gut health with the potential of improving outcomes?
Professor Robert Thomas: Uh yeah, I mean, I've not seen too many papers on, you know, whether you can get a better response rate say to chemotherapy. But what tends to happen when you come into hospital and you get given antibiotics or chemotherapy or even radiotherapy is is it damages your gut health. So it's probably it's more that if you have poor gut health, you're not going to do as well rather than can you um can you make your gut better than it already is? Most of the data shows, for example, if you have a good gut, so if you have a healthy diet, you can't actually make it better by taking say probiotic supplements or so forth because it's already good. But that's not the issue. Most of the time people don't have a good gut and you can correct that. Um for example, during capecitabine chemotherapy which causes profuse diarrhea, there is data to show if you take a probiotic supplement between cycles, you're less likely to have diarrhea. But more recently, the exciting um the exciting um new knowledge is that these new immunotherapies for um for many cancers, um the particularly these things called PDL1 inhibitors. Now, these are when a what one thing a cancer does to stop it being killed by the immunity is basically forming a cloak around it which sheds some of the antigens which the body recognizes as foreign. And that's why it can sort of mix around, go in and out of the tissues and cause enormous damage without the immunity attacking it. Now, we have these things called PDL1 inhibitors which stop blocks that ability for the cancer cell to cloak itself. And so therefore it's like a it's like Harry Potter taking off his invisible cloak in in uh in one of his films and and suddenly he gets seen and the immunity attacks it, which is great. This is exactly what you want, your own body to recognize cancers as foreign and kill them. And that's what these PD1 inhibitors do. But um they work very much better if you have a good gut health or a good immunity. In fact, the difference is up to 40%. So it was observed in the MD Anderson in Texas about a year ago that there was a 40% difference in response rates between people who have a good gut health or not. The other thing is is these drugs are quite toxic. They cause quite profuse um um diarrhea and that can be life threatening. And the instance of those very severe toxicity again is significantly reduced if you have good gut health and you have a good lifestyle. So now the the the all of a sudden what you're doing and lifestyle is suddenly being driven to the forefront because they're now seeing if you do a prehab program where you improve gut health, reducing sugar, having some probiotics, lots of polyphenols, exercising, um lots of fiber, you're then going to be in a much stronger position to responding and tolerating these drugs.
Dr Rupy: Absolutely. Yeah, and I think, you know, putting in simplistic terms, what these uh drugs are doing are heightening the uh ability of your own innate immune system to attack cancer cells. So that is predicated on you having a robust immune system. And good gut health is pivotal to having a good immune system. So it makes perfect sense, right? Um and that's really, really encouraging to know.
Professor Robert Thomas: I I think so as well. I mean, for what we can do in the meantime is give general advice of how to improve your gut health. Um in Cambridge and many places, they're trying to go a step further and I think it's very useful research, but uh they're trying to find individual bacteria which might have a an even more enhancing effect, which is great research, but um you know, we'll see what happens, but I think, you know, most of the effect is going to be a general improvement of gut bacteria.
Dr Rupy: Absolutely. Yeah, I totally agree. And then so beyond uh prehab and during cancer therapy, I'm assuming same sort of advice, polyphenol rich diet, uh exercise if you can and also uh perhaps looking after your gut health um with a few uh extra additions to your diet and maybe supplementation.
Professor Robert Thomas: Yeah, um yeah, I mean, we we didn't mention vitamin D. Um very important because there's lots of studies coming out now showing if you're vitamin D deficient, you're more likely to get cancer. Uh there's one in people with um bowel cancer, they responded less well to chemotherapy agents if they had low vitamin D. Um again, don't be don't interpret that data that if you then take massive doses of vitamin D, you're more likely to respond. It's more if you don't have enough, you're less likely to respond. So it's about creating the balance. But for men on active surveillance, I treat prostate cancer as well. I always say, look, try to get as much healthy sun exposure and in the winter take a vitamin D supplement for sure. Um so that that goes without saying. Um fats, we didn't really talk much about fats. I think that uh healthy fats are also important. They I'm not I'm not a believer that omega-6 is harmful. Uh and and people say omega-6 is pro-inflammatory, omega-3 is anti-inflammatory. It's not as simple as that. Omega-6 does does go it does get metabolized into inflammatory um uh prostaglandins and things in the inflammatory pathway. That doesn't mean that they're harmful. In fact, there's it's the balance between omega-3 and omega-6 is good, but it's usually because we don't have enough omega-3. So I wouldn't reduce omega-6 fats, but I would increase omega-3 fats, you know, fish and stuff like that. Um anyway, that that's the other other thing. In terms of supplements, again, um for research, they're vital and it gives us the information. And of course, as a trials unit, we are going to use supplements where we are and we're going to continue to use them to get the information out there. After we've got that information, then it's up to the individual of clearly the number one advice would be to, you know, start the day with lots of fruit, nuts, slow release carbohydrates. You have to go to the free from section of a card or make sure you've got say sugar puffs without sugar in. There's lots of things you can do, but you have to really look for that. Um if you feel you want to, you know, you're not able to get the amount of polyphenols in, then a supplement is if it's well-made, that's the other thing because not all are, it's well-made will give you extra reassurance, but that's not instead of a healthy diet. You know, to be honest, if I could cook, I would follow your book. I can't cook, so it doesn't matter how well you describe it in your pages, it doesn't come out tasting like what you can produce, that's for sure. If I'm traveling or if I've had some busy days, I will take some extra supplements, but I wouldn't rely on them. So it's more it's as well it says, it's to supplement a diet, it's not instead of. But some people like taking them and we know that cancer patients, for example, up to 60, 70% do take them. So the other object uh with research is to say, well, if you're going to take them, maybe the research will tell you which ones to take and which not to take and which to avoid. Particularly, I think I'm getting the message over that people are taking vitamin A and vitamin E supplements, which actually could be doing harm. So stop them taking the ones which are harmful. If you're going to take vitamin D, what dose you should take and it's clear you should take a high dose initially. Um you know, things like uh fish oil supplements, which are very popular, um two trials came out showing that actually they might increase the risk of prostate cancer a bit.
Dr Rupy: Yeah, I heard that.
Professor Robert Thomas: Yeah, and you know, which is odd because, you know, we are tend to be deficient in vitamin in omega-3, so they should in theory help, but the practice was it didn't. And when you look, and I've spoken to the chief investigators of both studies, and I said, well, you know, did you were you did you know that vitamin E is added as an antioxidant to fish oils? So, uh and in the one of the studies, the select study, um vitamin E, it was compared against it was a trial of vitamin E against placebo, and then it sub looked at people who also took fish oil. So he said, well, all you're doing is enhancing the level of vitamin E. And he totally agreed, but that never came out in the literature. So all the press just said, fish oil supplements are bad, but they didn't look into, well, this actually could be because of the antioxidant vitamin E they're adding to it. So a little things like that, you need to know what you're dealing with. So my advice, for example, if someone wants to take an omega-3 oil is to, you know, a, try to get the natural oils. If you can't, make sure you get a supplement without added vitamin E in it. Um so, uh yeah, so there's there's a lot more knowledge we we we need, um and you know, that's what we're trying to achieve with our studies.
Dr Rupy: Yeah, absolutely. I I I'm glad you mentioned that because I think unless if you're just looking at the headlines, then that's what you're going to come away with that, you know, omega-3 equals bad for cancer or in this case specifically prostate cancer. But I think um and to your point earlier throughout this podcast, we've been talking about the impact of high dose supplementation of vitamin A, vitamin E, um and how that can have a negative impact. Can we just talk briefly actually about how that is? Um is it the fact that vitamin E is hijacked by pre-cancerous or cancerous lesions to essentially accelerate their growth?
Professor Robert Thomas: Um well, yeah, I'm I'm I one of my things I get very upset about is when people say the word antioxidants or supplements and thinking it's one thing. Um you know, there are hundreds of thousands of different types of ways you can manipulate food. Um and what they um particularly the term antioxidant. Um there are foods which are direct antioxidants. In other words, they're able to mop up a free radical by providing an electron or removing an electron from a free radical which neutralizes it. Um and these are your uh vitamin A and vitamin E and acetylcysteine and things like that. And the problem with those, if you have a if you you if you take them and you you you're not deficient, it's different if you happen to be deficient in those and, you know, let's not ignore that blindness from vitamin A deficiency is still very common across the world. So if you're in the center of Africa, you do well with a vitamin E supplement, A supplement. Um but for the rest of us with normal levels of these, when you're taking them, you you do a thing called antioxidant stress. You reduce too many free radicals which you need for normal functioning of the cell. Um how that increases the risk of cancer is I'm less certain of, or we know is that studies which have given people vitamin A and vitamin E supplements have resulted in a slightly higher risk of the cancers. So you may know more about that than me, but it isn't a good state to be in to have too much antioxidants. As opposed to whole foods or turmeric, say for example, or broccoli or tea, they work by enhancing the sensitivity of the antioxidant enzymes. So encouraging the antioxidant enzymes to increase when there's oxidative stress. And as I said before, uh when that antioxidant risk goes, or that those free radicals go, you want actually the antioxidant to drop quite rapidly as well. And vitamin A and E block that drop. So so they then deplete the free radicals in the cell which can be harmful. The classic example is during exercise. When you exercise, if you're not accustomed to it, you get a lot of free radicals formed because free radicals are produced naturally in the oxidative phosphorylation process. So they naturally are produced in cells. Over time with training, our antioxidant enzymes go up and it deals with that thing. And that's part of the importance of training, particularly in older people where that adaptive antioxidant enzyme pathway is is reduced. But if you take vitamin E and vitamin A, you block the because because they naturally mop up the free radicals, you you don't get that adaptive increase in antioxidant enzymes. So you're stopping the natural ability of your body to train with exercise. So, um but people put them all in the same pathway. There's doctors in Sweden, I was in Sweden just before the lockdown. There was doctors saying, you know, you shouldn't go into a they were stopping people from going to Pret a Manger getting a ginger shot. He was giving a health warning. I said, come on, you really haven't because he was saying ginger is an antioxidant. So from his study on mice, he was correlating going to Pret a Manger and getting a ginger shot with an increased risk of cancer. I mean, that was a that was a leap of far too far to any common sense. And that's not born out in the data looking at whole foods as well. I mean, that's why a lot of uh Premier League football clubs are suggesting to their um their athletes that they drink beetroot uh juices afterwards. I'm not a big fan of juicing per se, but you know, it does have an impact on vascular endothelial function post um exercise, which can actually be beneficial. But to your point about taking individual um vitamins like vitamin C, yeah, I I I've heard that uh it blunts the adaptive response of skeletal muscle and you don't have that beneficial effect of the stress of exercise. So, you know, again, everything's coming back to balance and and looking towards whole foods rather than individual supplements in high doses.
Professor Robert Thomas: Yeah, I mean, the vitamin C is a tricky one. We always call it an antioxidant. It actually what what vitamin C does is, well, we need, you know, apart from stopping you getting scurvy, um is it it actually um it works with iron to encourage the cellular pathways to recognize genetic breaks. So it actually works on DNA repair. So that's why um there's not really been any studies to show that quite high levels of vitamin C are particularly harmful. Um I wouldn't say that high levels of vitamin C are particularly beneficial, but unlike vitamin A and vitamin E, they've not actually been shown they're particularly harmful. So um that's a different thing. But when you have vitamin C, as you said, when you juice, you actually are changing the the nature of say an orange. You're you're pulling out all the pulp which has got the the citrus bioflavonoids, which are also anti-cancer and antiviral, and just concentrating the juice. And you're changing it into a drink which is then got a high glycemic index. So I I I would agree entirely with that. As they say in California, you juice your vegetables and you eat your fruit.
Dr Rupy: You came on to sports performance. Um yeah, I mean, the nitrates um in um fruit have um have a particularly beneficial effect. I always remember a program, someone from WHO announced that nitrates were really bad for you. Um so we had the press turn up at the Primrose unit where I work, saying, but you know, nitrates are really good for you. And look, did you know that there's nitrates in broccoli? I think that's why they came because I was doing the pommy tea trial at the time. So they were trying to link broccoli with cancer. And I said, yes, but but you you need to sort of I don't want to slag off journalists who are watching. Many are really highly educated, but sometimes they just see the bottom line. As you know, nitrates in food, plant food, uh in the presence of polyphenol and vitamin C are actually metabolized into nitric oxide. Nitric oxide is a vasodilator, increases oxygenation of tissues. As you you know all this, Rupy, but for the general audience. So so when you have nitrate rich foods, you get a vasodilatory effect and um an increased oxygenation effect of the arteries. So in other words, you increase oxygenation of your heart, your brain. So it's supposed to improve cognitive function. You you get better muscle recovery. Uh they've done, I mean, I don't know if you know my other job is actually I'm a professor of sports science now at University of Bedfordshire. So we do, you know, athletes are very keen on this because if you if you increase the amount of oxygen going into tissue, you get less um lactic acid formation, which is formed when there's not enough oxygen around, which can lead to muscle damage. So that's why plants with lots of nitrates in, as you just mentioned, beetroot, pomegranate, um spinach, those sort of things, they improve exercise performance, but also, if even exercise aside, there's lots of diseases which are linked to low nitric oxide such as dementia, heart disease. So that's another way they could be beneficial. On the other hand, in if you have nitrates in meat, which is either naturally occurring in meat or they've been added as a preservative, when you take them, when you when you eat them, if you don't have vitamin C or polyphenols at the same time, so say if you do what many people do in a in a barbecue, they, you know, they stand there with a with a white bread um hot dog which is full of cheap meat, full of nitrates with white bread, they they wash that down with a with a fizzy sugary drink uh and some alcohol maybe. Um those nitrates are converted to nitrosamines, which are direct carcinogens. Um so, you know, it's you can't compare nitrates in meat to nitrates in plants. Saying that, you can mitigate some of the damage from nitrates in meat by marinating it in in um oils, healthy oils, herbs, and there's been data on that. You probably heard me talk about the Maryland study where they marinated meat in in rosemary and you ate it with um salads or fruit. And those nitrates are then converted into nitric oxide as well. So that's why not all meat is harmful. It's how you prepare the meat and what sort of quality of meat you have. So a good quality bit of meat eaten with lots and lots of vegetables and herbs and spices, you will get the benefit then of those nitrates as well as the protein and the vitamin B12 and things. So um yeah, so it's it's an interesting subject nitrates and I'm I'm very keen on it.
Dr Rupy: Yeah, I can tell. Yeah, and I can I can see the future of uh perhaps uh a version of, well, I will name them, Lucozade actually being, you know, something that will enhance sports performance rather than just a sugary drink.
Professor Robert Thomas: I think I think you're exactly right. I think um well, one of because the study is called the Pommy Sport study we're about to start. And I don't particularly like the name sport because we want exercise to be for everyone, even if you you can only walk a few yards, um to someone like yourself, you probably go on park runs and beat 20 minutes every Saturday, I would imagine. Um but but sport is for everyone, you know, it doesn't have to be that you're an elite athlete. Sport can be going for a brisk walk. Um but if you can enhance performance at every level and certainly nitrate rich foods is definitely a a route forward. Um and there is research out there, but we're trying to quantify that a bit, you know, maybe combining celery with beetroot, um you know, adding tea, turmeric, pomegranate with beetroot to see if the interplay between um the the nitrate rich food and the polyphenol rich food will legally improve your ability to exercise and make exercise more comfortable because it will be protecting your joints and improving muscle recovery.
Dr Rupy: Absolutely. And on that subject actually of recovery, um perhaps we should talk about post-cancer and how we can actually uh use lifestyle and nutrition to reduce recurrence and if there's uh good evidence for that too.
Professor Robert Thomas: Yeah, I mean, yeah, there's lots of data um from cohort studies mainly to show that if you, you know, exercise three hours a week, you have a reduced risk of relapse. If you have polyphenol rich foods, there was a study from Shanghai, another one from California, that if you eat even phytoestrogenic foods, you know, foods like soya, chickpeas, um they uh they act a bit like one of the drugs, tamoxifen, they they damp them down your estrogen receptors. They also got lots of other polyphenols. They are linked with a reduced risk of relapse five, six years down the line. Um so, and the same with vitamin D, we know if you're vitamin D deficient, you have an increased risk of cancer relapse. So there's a lot you can do once you've finished all your cancer treatments to improve your outcomes. But again, it's getting the message out there. In breast cancer ladies have been told for years to avoid soya and chickpeas based on no, well, there was evidence, they were just given the wrong advice because uh there is evidence that those foods help you. Where you would be um a little bit concerned if you then got a phytoestrogen rich food such as saw palmetto or soy and put that in a supplement, I would definitely not advise that because then you can override the um the block on the estrogen receptor and it can start stimulating it. But within whole foods, uh they are perfectly safe and very healthy and should be encouraged.
Dr Rupy: Yeah, yeah, I I agree with that. And I think, you know, just the the the word um uh phytoestrogenic, I think is quite scary for a lot of people. And that's why I constantly get messages whenever I use tempeh or, you know, some sort of legume in my food that's known to have isoflavones, etc. Um you know, isn't this bad for you? Isn't this bad for uh cancer, etc. So I'm glad you clarified that because I I get asked about that a lot.
Professor Robert Thomas: No, the the I mean, it's strange because if you look at the cell line data, um there's no it's actually they they have anti-cancer effect. You look at the animal data, they have anti-cancer effect. And in the human data, the two pretty massive studies have all shown a protective effect. Yet people are still being told to avoid these foods. And I think it's because there was a few data where they they did give people high dose supplements and they saw uh a hyper a hyper proliferation effect in some pre-malignant cells and that got all the all the publicity.
Dr Rupy: Yeah, yeah, absolutely. Um Robert, we've we've chatted for so long now and I I'm conscious of your time and also the fact that I've got to go to work in a second, but uh just to summarize everything. So we've talked about, you know, um how to prevent cancer, uh what to do during cancer and and the different sort of nutritional things that we can and and lifestyle uh practices we can do to uh prevent relapse and potentially perhaps at some point in the future that will be born out in some research, improve outcomes and post-cancer as well. Um where do you see the the future of cancer treatment going? There's some really exciting stuff with uh immuno within immuno-oncology. If we could marry that with metabolic oncology and perhaps some other fields that I haven't even thought of with the existing interventions that we have today, what does the ideal sort of uh cancer patient journey look like, do you think?
Professor Robert Thomas: Cancer patients are individual people. That's the issue is we can't dictate to people how they want to choose to live their life and many people don't want to change their lifestyle. But if if it was a utopian society and we could say this is what you want, I you know, I I would want to see nutritionists and exercise professionals being in the clinics next to the oncologists and the chemotherapy suite. So you would come in, you would have a, you know, a series of education um pathways, you know, internet, books, uh uh face-to-face consultations to try and get the message over that there's a lot can be done. So you'd go into a prehab program, you change your diet, and then the the treatments are given side by side with those. And and all the way through the pathway and then coming out the other side, um you know, we we for example refer every patient to the 12-week nutritional exercise program. So we're getting that more involved and using what's out there. So you don't have to own the patient that everything has to be given in the oncology unit because there's enormous sources out there. Um because you could the outcomes would be significantly improved. And this is, you know, we're not going to cure a cancer by having a a good meal or exercising, but the odds of responding, the odds of feeling better and the odds of reducing that relapse are significantly go up. Um that said, you know, we don't want to make people feel guilty if they have relapse and they haven't tried hard enough, but it's all about reducing the odds. And and I don't think we're taking that seriously enough yet. Um there are some countries where I travel around the world, Lithuania of all countries seem to be embracing lifestyle medicine, maybe former Eastern European, they're able to coordinate a bit better, more and they, you know, when you go to the GP with say high blood pressure, um high cholesterol, a bit of arthritis, they will put them into a lifestyle program before giving drugs. Um so and and after cancer, you do have a higher risk of high blood pressure, high cholesterol and things. So, you know, I'd love to be able to sort of say, no, before you get started on a statin or before you have an anti-hypertensive, just try this nutritional and and program first. I think we'd save so much toxicity, we'd save enormous money for the NHS, which we can spend on other things. Um but you know, people are people and they have choices. So it's a case of persuading, not forcing.
Dr Rupy: Yeah, exactly. I totally agree. And I I would love to design some sort of trial or study where, you know, we we could uh give food, not just the raw food, but perhaps cooked food if people prefer that over a time period during their treatment and just measure outcomes and just see if there is an argument for uh not only a qualitative element, so the experience of the patient, but also the outcomes and the cost effectiveness as well, because to your point, if there are simple hacks to improve uh the patient journey and the cost of it, then we can redistribute resources to an already underfunded healthcare service. So I would I would totally welcome that.
Professor Robert Thomas: Yeah, good. Yeah, I would that would be ideal.
Dr Rupy: Well, I'll I'll leave you to that to do that as well as your other your many other hats. Um there there are loads of questions that we had on social media. I don't think we've got time to go through them all because they're so they're random, you know, talking about dairy and alcohol and cancer and hypnotherapy and all this kind of stuff. We might have to do this again. So I might have to drag you away again another time if you're willing uh at some other point. I don't know how I
Professor Robert Thomas: I love integrating with the public because you get, as you say, in my talks, you get asked all sorts of things, cannabis, hypnotism, acupuncture. So even though my main theme is diet and and exercise, you know, you do you do pick up knowledge along the way and it's it's all fascinating stuff.
Dr Rupy: Yeah, great, great. So uh I might I might pepper you with questions uh another time from from uh the the the backlog of questions I'm sure we're going to get after this as well. Um prof, thank you so much.
Professor Robert Thomas: I'd like to come to your kitchen and you can make me some food. I feel like I feel like I've missed out. I've heard you do. Apparently you cook for people, don't you?
Dr Rupy: Yeah, no, I do. I cook so basically I cook for for you uh based on your dietary preferences and dietary requirements if if you have some. And we just have a lovely chat in the studio here, which is uh yeah, which is empty at the moment. So unfortunately, uh it'll have to we'll wait till next time.
Professor Robert Thomas: Yeah, well, I hope so. I hope so.
Dr Rupy: Yeah, definitely. Well, podcast or not, you're welcome here anytime.
Professor Robert Thomas: Thank you so much.
Dr Rupy: If you are still here, thank you so much for reaching the end of the podcast. I know it was a long one, but I hope you have learned a lot more about this complicated topic. Uh you understand a lot more about the impact of polyphenols and sugar in particular, and you are now equipped with a suite of tools by which to spread the message, but also help yourself or loved ones if they do find themselves in this unfortunate position, which a lot of us will will unfortunately experience with the increasing rates of cancer and other degenerative diseases as well. Please do check out the podcast page. There's links to a lot of the uh articles and papers that we talk about are there. And uh do uh sign up for the subscribe, I should say, to the newsletter, the doctorskitchen.com. We give weekly recipes plus lots of healthy tips and lifestyle hacks to help you keep on your healthcare goals. That's me for now. Take care and I'll see you next week.
