Sunday 16 June 2019

Nutritional approach raises more questions re minerals

As mentioned previously I’ve seen a doctor locally who specialises in nutritional and environmental medicine. Vitamins and minerals are crucial to appropriate nutrition and normal body function. As our body doesn’t make most nutrients we need to get them through food. So one of the ways they work is to do a series of tests to monitor my health and diet primary by increasing or decreasing particular foods or using supplements. In this blog I’ve mentioned some of those like the Nagalase test and look at fats.

One of the labs that have looked at my blood is Biolab (i), they write: "A helpful way of approaching the diagnosis and management of clinical problems is to consider any symptom or clinical sign as a manifestation of the individual's failure to adapt adequately to the sum total of their environmental challenges. An important fundamental aspect of this approach is an awareness of the importance of the protective effects of nutrients against toxic substances, and that adequacy of nutrients is absolutely vital for accurate gene expression”.

We are each so different, what works for one may not work for another. This is so clearly true that it seems astonishing that we still see one-size fits all approaches. It was therefore great to see the news this week that research shows that in terms of diet, one size doesn't fit all. This should be no surprise to anyone with a basic understanding of nutrition….


Everyone is different when it comes to diet


The Predict Study was born out of the TwinsUK study and had 1,100 participants; “the verdict: no two people’s responses to individual foods are the same – even between identical twins” (ii). They showed for example, that identical twins often had varying responses to the same foods, and only shared 37% of their gut bacteria. That is only slightly higher than the 35% shared between two unrelated individuals.

The study collected data on a wide range of factors that can impact the way we metabolise nutrients. Not surprising to many of us, it found that our diet, lifestyle and environment are key to our health. Surely this must be the final death knell to any thoughts of links between calories in and out. Jerome Burne at Health Insight UK has written on this, calling the calories in, calories out “the zombie theory that won’t die” (iii). We still see many doctors espousing this theory and the very poor idea that making Weight Watchers available on the NHS is a good way forward. See Dr Zoe Harcombe’s expose of the lack of evidence re the theory held by key health advice organisations in this country here (iv).

Dr Andrew Chan, Professor of Medicine at Harvard Medical School and a gastroenterologist at Massachusetts General Hospital commented on the study: “It is reassuring that our genetic makeup only partially explains how our bodies respond to food. This underscores that our metabolism is not fixed – we have the power to change it. One exciting avenue is to tailor our diets to the bacteria in our gut that helps us metabolise nutrients.”

I like that - 'we have the power to change it’! Some of how I am trying to do that is understanding my body and it’s needs better. In this next bit I want to share a sample of the more interesting points from my recent minerals blood test. For more context and background see also my previous comments on the supplements I am taking here


Recent blood test

Zinc; This is a key to overall health including getting pancreatic enzymes to work - and many consider it important in tackling cancer. In my case it is particularly needed, as it can help get rid of the pesticide on my p53 gene (see previous blog here). Sadly my reading has gone down marginally and is still very much in the low reference area. This is despite taking a high food-state dose plus a zinc citrate in the evening (which is best time for absorption). I have been taking it with food as it can cause problems on an empty stomach. The Mayo Clinic says that zinc supplements work best if they are consumed a minimum of one hour prior to eating or two hours afterward. People who take zinc on an empty stomach may become nauseated or suffer other symptoms of an upset stomach, such as heartburn. However I will try taking a dose an hour before food if I can remember! Some of this supplement taking can get very complicated!

Copper; I don’t take supplements of this - and levels of this mineral were down a little which could be good as a ‘copper complex' was attached to my DNA? Copper has been shown to play a significant role in tumor growth, so low could be good (v)? There is a key relationship between zinc and copper - both minerals help to activate the enzyme copper-zinc superoxide dismutase (CuZnSOD) which serves as an antioxidant that can clear away reactive oxygen species, so that cells can continue to function properly. Zinc and copper basically compete against one another as antagonist in order to regulate the physiological pathways in your body. The proper balance between the two trace minerals is critical to maintaining health. With both copper and zinc low I am probably not achieving a good balance at the moment.

Selenium; this had gone up; it was a wee bit high but has gone higher. This rise maybe good in terms of the fight against cancer (see my previous blog) as there is evidence around selenium's impact on both prostate and colon cancers. However I’m learning that to maximise benefits it is best to to have all three forms of selenium (vi). I have been taking L-selenomethionine which is an organic complex found in most preparations of selenium-enriched yeast. It is also the one that has been used in many clinical trials but I should perhaps consider whether the other seleniums could be useful in the future? There is also some evidence that selenium and zinc impact on each other so that it might be better to take them separately (vii). Could this have been a reason for the lower zinc? However because of the high levels I will stop supplementation at the moment as too high can be toxic and result in selenosis (viii).

Magnesium; as discussed previously this is a crucial mineral - and despite supplementation of a food state magnesium at quite a high dose, the magnesium level has gone down and is at the lower level of the normal reference range.

Calcium; this has gone down a little. I haven’t supplemented with this but I have a diet rich with stuff like broccoli so this decrease is slightly odd. Studies have indicated a possible connection between calcium and prostate cancer risk (ix) but results have been a bit of mixed picture. If as some of the research suggests, men with high-normal levels of calcium in their blood have an increased risk for developing fatal prostate cancer, then being at the lower end of the scale maybe useful? Indeed lower calcium levels could indicate that there is no metastasis? However some of the research was mixed. I suspect one of the challenges of this research is dairy; we know this increases prostate risk so maybe calcium itself is not the problem? Clearly calcium is important; not getting enough can increase the risk of osteoporosis, even among men. Plus of course some treatments can increase the risk of bone loss and fractures. 


So what is going on? 

Well it’s not so clear! I have an excellent plant-based diet plus supplements to support the areas that came out low four months ago. The zinc and magnesium levels are particularly disappointing. My first thoughts are always that getting diet right is key, then with illness it maybe necessary to supplement. However this doesn’t seem to have happened enough.

In my next blog I want to explore this further plus consider my latest ‘Ethythrocyte Essential Fatty Acids’ test results These results are four months on from the last test (see here). I will then consider next steps regarding this approach.



Notes
 

Sunday 9 June 2019

Cause of my cancer?



This was a surprise…more in a moment but I do want to say up front that I see this as only a part of the picture regarding a cause or causes of my cancer….so what was found... 
 
A disinfectant, pesticide, and deodorant on my DNA
 
I mentioned I had previously had a Nagalase test (see blog here), well my independent doctor was intrigued by part of the result that came back from the Nagalase test. One of the levels was low (Dipeptidyl-peptidase 4) so he wanted to investigate further. In particular it looked like heavy metals could be the cause of that low reading, so a test on 19/02/19 was commissioned from Acumen Medical ltd. They looked at my DNA adducts (genomic DNA from leucocytes). They didn’t find heavy metals, but rather found p-dicholorobenzene on my DNA. This is a chemical used for moth-proofing carpets, air-fresheners and toilet bowl blocks (i). Acumen noted that in their report that this is “reasonable anticipated to be a human carcinogen” and that it is “strongly associated” with prostate cancer (ii).

So this is tricky to get my head around - my understanding is that the p53 Gene plays a key role in tackling cancer. Under normal circumstances P53 binds to specific DNA sequences where it controls the expression of a number of genes that regulate growth. It also works with other proteins in response to DNA damage and promotes cell death when the DNA is damaged beyond repair. However without p53 in charge, the cells go out of control, growing rapidly - this is cancer.

A mutation in the p53 gene, like the one found in my blood test, is the most common mutation found in cancer cells and is present in over 50 percent of cancers. See this website explaining further “The p53 Gene and Its Role in Cancer” (iii). In my blood test this chemical was also sitting on another key gene.

Centrifuge for blood test

Role of GST?

A further blood test showed that I have low Glutathione S-transferases (GSTs). This is also not good; GST is over expressed in a wide variety of solid tumors, but prostate cancer is the only example in which the absence or reduced expression of GST is associated with tumor incidence (iv). GST is widely expressed in normal prostate tissue, but its presence is undetectable in malignant cells. It appears that GST is key in detoxification such as getting rid of organic solvents like p-dicholorobenzene. So increasing GST is important but not the glutathione (GSH) as elevated levels are associated with various other tumours and metastatic growth (v). However there are also thoughts that there maybe two types of glutathione.

Chris Woollams from CancerActive writes (vi): “Here’s the rub: There is evidence that cancer cells defend themselves from chemotherapy attack by hiking up their glutathione levels to detoxify it! Cancer cells may be more resistant to death because of high glutathione levels; this being a different type of glutathione and this type may even be controlled by heredity. German and Spanish researchers both noted this phenomenon and a high presence of an enzyme, glutathione-S-transferase in cancer cells.”



Cartoon by Russ for this blog
Diet and supplements

Chris' message is: “just eat lots of fresh fruit and vegetables, especially greens, and take probiotics to help their detoxification action, and release their crucial vitamins and cancer-fighting natural compounds like vitamin K. Also you might look into boosting your ’greens’ with chlorella, wheatgrass and other ’supergreens’ too.”

Diet clearly plays a part and the evidence regarding benefits of compounds like Sulforaphanes in broccoli, broccoli sprouts and cabbage are overwhelming (vii). In addition to the diet it has been suggested that some supplementation may help:


- Amino acid supplement N-Acetyl Cysteine; this contains glutamine (which stimulates the liver to produce glutathione), and L-Cysteine, which is particularly important in DNA repair. N-acetyl cysteine is a free radical scavenger on its own, effective at reducing oxidative stress, particularly due to heavy metal toxicity as it can directly replenish glutathione stores (viii). Update July 2019: Just to add a warning that there is also some research with mice showing that antioxidants can change cells in ways that fuel the spread of some cancers.

Urban Fringe
- Tumeric; I’ve been having turmeric in food but also added turmeric supplements when not in food (see previous blog here). Recently I was able to get a tincture from Urban Fringe in Bristol. I’ve loved their Orange Bitters (a blend of six herbs that tastes great and I use as a warming digestive bitter to improve digestion and absorption) (ix). Anyhow the new tincture included turmeric, black pepper and Saw Palmetto which can be taken twice a day. I like tinctures as they are one of the most effective means of taking herbal medicines; they are easy to store, use and digest - the alcoholic solution of the tincture means herbs are absorbed much more quickly into circulation, and therefore begin to take effect faster than other methods, especially capsules. 

- Other potentially useful supplementation: I've mentioned these previously (see here) - Selenium which binds glutathione so will protect plus Zinc, Magnesium, Milk Thistle and DIM (Indole 3 Carbinol).



Fixing my tincture at Urban Fringe
What else can help detox?

In order to detox I need to make the p-dicholorobenzene water soluble so that it can be excreted but the worry is that it can also be dumped into fat cells. There are numerous protocols for detoxing which I have not got my head fully around - but certainly diet plays a key role. I was also interested in some research comparing intermittent whole-body hyperthermia; detoxification; and cell repair in removing DNA adducts (x). The hyperthermia was best. I have been doing a version of whole body hyperthermia at home but only taking my body up to 39 degrees (again another blog post soon). 


Results?

I’ve not had further tests yet so don’t know how much of what I am doing is helping. I’m told the pesticide can be very persistent so we’ll have to see. One doctor is very much of the view that this is the key if not sole reason for my cancer. Clearly it must play a part, but I am also wondering what conditions it needed to land on my DNA? There seem to be more factors at play. As noted earlier I hope to explore the cause of my cancer in a future blog.


Notes


(ii) The United States Department of Health and Human Services (DHHS) and the International Agency for Research on Cancer (IARC) have determined that p-DCB may reasonably be anticipated to be a carcinogen. See Preamble to the IARC Monographs definition of "Group 2B: Possibly carcinogenic to humans", the International Agency for Research on Cancer classification of this chemical. 
Plus under California's Proposition 65 (Office of Environmental Health Hazard Assessment) p-DCB is listed as "known to the State to cause cancer".

(iii) The p53 Gene and Its Role in Cancer
 https://www.verywellhealth.com/the-p53-gene-its-role-in-cancer-2249349


There is also this interesting discussion about p53:
https://www.sciencemag.org/news/2016/10/protein-mutated-half-all-cancers-new-drugs-aim-fix-it-it-s-too-late?fbclid=IwAR1Ca37cCe13yci6Ki74TMRSVlCgYzWzzG8NY8tGTsMgrw6hfn7wIicXvhM

(iv) https://www.nature.com/articles/1209373

(v) https://www.hindawi.com/journals/omcl/2013/972913/

Saturday 8 June 2019

Transurethral hyperthermia; my experience

Klinik St Georges, Bad Aibling
I’ve been meaning to write this blog for a while as it is 18 months since I had this treatment. I’ve been cautious writing as wanted to see what impact this treatment may have had on my cancer. There are suggestions online about an 85% to 100% cure rate of prostate cancer if the cancer is still in the capsule and you’ve not had a biopsy. There are also suggestions of a 75% cure rate for those having had biopsies - the reason being is that some consider biopsies can spread cancer - see more below and my blog on this issue here. It is worth noting that it is a wee bit difficult to not have a biopsy, as that is what confirms you have cancer. Anyhow in short it is hard to find any hard peer reviewed research around success rates of transuretheral hyperthermia so I suggest treating those figures with caution.

So let me take you back in this blog to September 2017 when I was first diagnosed with T3 prostate cancer. The treatment offered was surgery or radiation with about two years of hormone treatment. At the time I had many discussions with various people including doctors about those options and other treatments that might be available. My blogs on radiotherapy and prostatectomies will give some of the reasons why I was looking for a less invasive treatment. 

Anyhow after much consideration I chose to try and get a place on a High-intensity focused ultrasound (HIFU) trial with Professor Emberton. HIFU is widely used in Europe and other places but only in the UK in specialist centres or a clinical trial. This seemed to me another example of the extreme caution or conservative approach of the NHS. Anyhow it uses high-frequency ultrasound energy to heat and destroy cancer cells in the prostate. The side-effects can be pretty tough but overall it looked better than radiotherapy. You can read more on Prostate Cancer UK’s website here.

To cut a long story short the HIFU trial team took many weeks to come back to me about whether I might be eligible and the financial implications; indeed I only got a letter inviting me to be considered after I came back from the transurethral hyperthermia treatment in Germany. 

Bad Aibling
So how did I choose transurethral hyperthermia?

Well I have long trusted saunas and fevers in terms of their benefits for detoxing and healing. They both have a long history with evidence of their use in Egyptian and Greek times. I had also read about the value of hyperthermia and treating cancer, particularly in conjunction with other treatments like radiotherapy but also as a treatment on its own.


While waiting to hear about HIFU I heard about someone who had transuretheral hyperthermia. This guy's experience was very positive although he only had a Gleason 6 cancer which of course now I know can be treated with Active Surveillance. Chris Woollams from CancerActive also noted it was a possible way forward. I hugely welcomed that the approach had virtually no side-effects and appeared to have such good results. There was also a fair number of clinics, particularly in Germany using this approach - and they have experience of treating many thousands of men. My oncologist in the UK had told me how urgent it was to be treated, so as the weeks passed by, I started to get concerned that HIFU might not be possible. I started to enquire about which clinics might be best; Klinik St Georges was mentioned in several places including the person I spoke to.


Thermae
What next?

The Klinic needed to see my NHS papers and have copies of my MRI. These took a couple of weeks to get and then it took a further week to get agreement that it was ‘likely' they could treat me plus a booking at the Klinik. We also had to arrange payment which in total was close to £6,000 for the five days of treatment. I was then on a plane at the end of November to Munich with my partner and a three hour train journey to Bad Aibling. 

Park, Bad Aibling
Wow what a special town - a spa town....'The Thermae’ which was opened in 2007 was particularly amazing. We managed a half day visit (around £20 each) before the treatment and at the end of the week. There are a collection of thermal spring pools, inside and out (we swam one time in the snow), some with lights and relaxing music, others with water jets and different temperatures. There was also over ten different saunas, some with aromatic smells, some crackling of firewood, one had a thick steam spray fog, while another had a view over the river. Remember the Germans are naked in the saunas and there is a whole etiquette about washing before, sitting on your towel and more. In addition to all that I did also try the traditional peat pulp bath with mineral water; literally covered from head to tow in peat for 15 mins. Anyhow all that and the great little restaurants, Christmas markets, a lovely park to walk in and views of snow-covered mountains made it feel almost like a holiday!

Local hyperthermia treatment rooms
We found an AirB&B before we had arrived and they were fully geared up to folk coming for treatment at the Klinic. We were also able to get organic vegetables in several shops locally including an organic supermarket that owned towards the end of our stay.


How does Transurethral Prostate Hyperthermia work?

Here’s what the Klinik St Georges writes: "Prostate hyperthermia is a very gentle form of local hyperthermia applied under local anesthesia. The machine which directs heat to the prostate works with radiofrequency and is used only for this purpose.

"A heat probe or electrode is placed in a normal bladder catheter and then inserted into the urethra where it is positioned in the center of the prostate. The probe emits radiofrequency waves which are collected either by the hypertrophic tissue of BPH (Benign Prostate Hyperplasia) or the cancerous tissue of a prostate cancer. The heat development inside the prostate is controlled by computer. This elevated temperature causes thermic damage to the malignant tissue, which is destroyed effectively and replaced by healthy tissue. To be precise, with this method we not only destroy the malignant tumor cells in the prostate, but we also trigger an active specific immune response. Due to the temporary hormone therapy, we achieve a hormone growth inhibition of cancer cells outside of the prostate. Patients treated with this method experience a significant improvement in their urination and together with a specific hormone modulation and biological support program can have a very effective treatment with excellent long term results”.

Me having local hyperthermia
Some more background regarding transuretheral hyperthermia including clips of Dr Douwes who runs Klinik St Georges and was very present in the Klinik stopping to talk to many of us:
https://www.youtube.com/watch?v=pfecKEX2iRM

See my video with Prof Alexander who used to work at Klinic St Georges and takes a slightly different approach now:
https://myunexpectedguide.blogspot.com/2018/10/return-to-editingprof-dr-alexander.html

See more generally about hyperthermia here: 

https://www.canceractive.com/article/whole-body-hyperthermia-helps-kill-cancer-cells


Klinik St Georges
What was it like?

Treatment is tailored to your particular prostate cancer. On arrival, which was a short walk from the AirB&B, I was given various medical tests including an ultrasound and blood tests. Staff were friendly and mostly spoke English to a standard well enough to communicate - great as my German is almost non-existent. During the week there was a treatment every day including:

- two sessions of the transurethral hyperthermia which lasted over three hours. Temperatures in the probe reach 48 to 52 degrees centigrade and are controlled by a computer. It was certainly very uncomfortable sitting up and having the probe and catheter inserted for that time; the constant feeling of peeing/burning made it hard to even read a book the first time. However the second time there was less discomfort. 
- five local hyperthermia treatments; these were lying down for about an hour with a hot plate put over the prostate area
- various intravenous infusions; Vitamin C, Selenium and a chelate to help remove heavy metals.

Treatment room for IV
You can read about one guy’s experience on the CancerActive website - not at all dissimilar from my own: 

I was also given six months of three hormones. Time was so short before leaving and communicating with Germany wasn't easy, so I didn't get a chance to find out more about the hormones - I found out later that I could have got these on the NHS on my return. Anyhow I got a prescription from the German doctors and bought them at some considerable expense from the pharmacy opposite the Klinik; Finasterid 5mg, Bicalutamid 50mg and two Trenatone injections that each last three months. 

As noted the doctors considered that the biopsy I had, could have encouraged the cancer to spread so hormones are not always part of the treatment. They write in their information pack: “We combine the, already very effective, transuretheral heat therapy, with a temporary hormone therapy. Why? Because it has been shown that in most patients already had a transrectal multi-biopsy during which, not only, the malignant cells were washed into the system where they lodged in the lymph nodes or bone marrow, but the biopsy insult also induced the local prostate inflammation following a healing process during which many mediators are released such as growth hormones (for example EGF, VEGF, COX2, etc). The biopsy injury to the prostate must heal and for this are inflammatory mediators and growth hormones are needed. But precisely these mediators produce in a less vicious tumour a faster and aggressive growth of the tumor and those feed a general activation."

The reason for this is that they consider the hormone therapy prevents the body’s remaining cancer cells from growing. Hence you see PSA levels drop while taking the hormones and for six months after as the hormones take time to leave the body. The other reason they give for taking hormones, is that there is sufficient time for the hyperthermia induced immunological effects to become active. In short they aim to destroy the malignant tumor cells in the prostate but also trigger an 'active specific immune response’.


Map with pins showing international patients
Side effects? 

Well apart from some minor fatigue due to the concerns/stress and worries about what to expect, I only had a slight burning sensation when passing urine for a couple of days. There were no other side-effects although I understand some people can have some but generally these are very minor compared with other treatments. However the hormones were a different matter - you can read more of my thoughts re hormones and my experience in a previous blog here.


Results

Urination is meant to improve however I didn’t see such changes which have only got slightly poorer over the last two years ie I am still being being woken two times in a night, occasionally three. I use the International Prostate Symptom Score (IPSS) to try and keep track. It has gone from 15 to 18 in two years. See more about IPSS here.

Klinik St Georges
My MRI 18 months on from the first MRI and just over a year on from the treatment, showed “no change”. However as I note in an earlier blog, the MRI could be read as showing a 20% drop in size of the tumor. See previous discussion here.

Now clearly shrinkage is good but also disappointing that results were not more significant. The rise in PSA is also very disappointing. So did the transuretheral hyperthermia only knock the tumor growth back for a while or has it had a more significant impact? 

I have since met a guy in Stroud who has had the same treatment and his PSA is climbing after two years. I understand most people only have one treatment but that a number of people have had two or three treatments to keep their cancer at bay.

I did contact the Klinik again, they give 4 months follow up free but after that the advice is around £80. They recommended a PET scan (more on scans in another blog) and concluded that my "tumor cells are still active. The PSA is a tumor marker and indicates, if there is a problem. This might also be an infection. Therefore, the request for an imaging report. Yes, we assume that another hyperthermia in combination with hormone blockade will have a shrinking effect.” 

It's worth mentioning that while this treatment is widely used in Germany it was seen by my NHS oncologist as being 'alternative'. It is interesting to see the different approaches between countries; Mistletoe is another treatment widely used in Germany but seen as very fringe here by most of the medical profession. I can feel a blog coming up on this issue sometime!

So when I get my PSA result a further hyperthermia might be an option? However at a cost of £6,000 plus possibly a scan this will need serious consideration. Could that huge amount of money be spent better?

Can cycling damage the prostate?

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