Cancer and Nutrition-

Cancer and cancer treatments may affect taste, smell, appetite, and the ability to eat enough food or absorb the nutrients from food. This can cause malnutrition (a condition caused by a lack of key nutrients). Malnutrition can cause the patient to be weak, tired, and unable to fight infections or get through cancer treatment. Malnutrition may be made worse if the cancer grows or spreads. Eating too little protein and calories is a very common problem for cancer patients. Having enough protein and calories is important for healing, fighting infection, and having enough energy (1).

The next factor to explore is the interactions of certain foods and supplements effects on certain anti- cancer therapies. While fruits and vegetables are encouraged, it is important to realize their impacts and adjust intake and or dosages for supplementation to realize the health benefits without jeopardizing the conventional cancer therapies effectiveness.

The next hurdle is whether your foods are actually being absorbed and whether or not there are sensitivities to them which may lead to more inflammation and issues. 

Gut dysbiosis and leaky gut will cause malabsorption and food sensitivities. Understanding these processes is the key to good nutritional gains.

Gut dysbiosis and Leaky gut –

There are 5 major causes of gut dysbiosis:

1.      Putrefaction. Putrefaction dysbiosis results from diets high in fat and animal flesh and low in insoluble fiber.  This type of diet produces an increased concentration of Bacteroides species and a decreased concentration of Bifidobacteria in the stool.  It increases bile flow and induces bacterial urease activity.  The change in composition of the gut flora leads to an increase in bacterial enzymes which, amongst other things, increases cancer causing substances and interferes with the body's hormones.  As there is a decrease in friendly bacteria, the production of short-chain fatty acids and other beneficial nutrients is decreased.  There is also an increase in ammonia which can have negative effects on numerous bodily functions.  Research has implicated this type of dysbiosis in contributing to colon cancer and breast cancer.

 2.      Fermentation / Small Bowel Bacterial Overgrowth (SBBO). This is a condition of carbohydrate intolerance induced by overgrowth of bacteria in the stomach, small intestine and beginning of the large intestine.  Bacterial overgrowth here is promoted by hypochlorhydria, by stasis due to abnormal bowel motility, physical/surgical abnormalities, by immune deficiency or by malnutrition.  Gastric bacterial overgrowth increases the risk of systemic infection and the sufferer develops intolerance to carbohydrate.  Any carbohydrate ingested is fermented by the bacteria and results in production of toxic waste products.

Carbohydrate intolerance may be the only symptom of bacterial overgrowth, making it indistinguishable from intestinal candidiasis; in either case dietary sugars can be fermented to produce endogenous ethanol.  Chronic exposure of the small bowel to ethanol may itself impair intestinal permeability.  British physicians working with the gut-fermentation syndrome have tentatively concluded, based on treatment results, that the majority of cases are due to yeast overgrowth and about 20% are bacterial in origin. The symptoms include abdominal distension, carbohydrate intolerance, fatigue and impaired mental function.

The risk factors for SBBO include those for yeast overgrowth and also: Insufficient stomach acid; abnormal stool motility; Strictures; Surgery; Immune deficiency; Malnutrition.  SBBO has been implicated in gastric cancer and can cause acidosis (where the body becomes too acidic) due to increased production of lactic acid.

3.      Deficiency. Exposure to antibiotics or a diet depleted of soluble fiber may create an absolute deficiency of normal fecal flora, including Bifidobacteria, Lactobacillus and E. Coli. Direct evidence of this condition is seen on stool culture when concentrations of Lactobacillus or E. Coli are reduced. This condition has been described in patients with irritable bowel syndrome and food intolerance.  Deficiency and putrefaction dysbiosis are complementary conditions which often occur at the same time and call for the same treatment regime.

 4.      Sensitization. Aggravation of abnormal immune responses to components of the normal intestinal microflora may contribute to the development of inflammatory bowel disease, spinal arthritis, and other connective tissue disease and skin disorders such as psoriasis oracne.  The responsible bacterial components include toxins which can cross-react with human tissues.

 5.      Chemotherapy induced mucosal barrier dysfunction.  Gut toxicity, or mucositis, is a major dose-limiting side effect of chemotherapy that until recently received very little attention. Despite significant research, the mechanisms that underpin chemotherapy-induced gut toxicity (CIGT) remain unclear. Recently however, there has been renewed interest in the role tight junctions play in the pathogenesis of CIGT and associated diarrhea. Thus, this review will cover the role of tight junctions in maintaining gastrointestinal homeostasis and touch on recently proposed mechanisms of how tight junctions may contribute to the development of chemotherapy-induced diarrhea (2).

The significant clinical and economic impact associated with CIGT and diarrhea has only recently been appreciated. This has prompted significant research efforts in an attempt to reveal the pathophysiology of this debilitating complication. Renewed interest has been shown regarding the role of tight junctions in not only maintaining gastrointestinal health, but also contributing to mucosal barrier injury and diarrhea development. More detailed research into the effect chemotherapy has on the molecular characteristics of tight junctions will lead to a better understanding of the pathophysiology of CIGT and may uncover the therapeutic potential of tight junctions in treating diarrhea (2).

In cases of Putrefaction Dysbiosis, the alterations in bacterial population dynamics which result from this diet are measured by an increase in stool pH (partly caused by elevated ammonia production) and in bile or urobilinogen and possibly by a decrease in short chain fatty acids, especially in butyrate.

 Treatment and Prevention

Putrefaction dysbiosis is usually managed with a diet high in both soluble and insoluble fiber and low in saturated fat and animal protein.  These dietary changes work to lower the concentrations of Bacteroides and increase concentrations of lactic acid-producing bacteria (Bifidobacteria, Lactobacillus and lactic acid streptococci) in the colon.

Supplementing the diet with defined sources of fiber can have variable effects on colonic dysbiosis.  Insoluble fiber decreases bacterial concentration and microbial enzyme activity. Soluble fiber, on the other hand, tends to elevate bacterial concentration and enzyme activity, at the same time raising the levels of beneficial short chain fatty acids.  This disparity may explain the superior effect of insoluble fiber in the prevention of colon cancer. 

Dairy products have a variable effect and fermented dairy foods such as fresh yogurt are occasionally helpful.  Experimentation and careful observation of symptoms may be required to determine whether these foods will help or harm.

Fermentation dysbiosis, conversely, can cause starch and soluble fiber to exacerbate the abnormal gut ecology.  When the upper small bowel is involved, simple sugars are also contraindicated.  A diet free of cereal grains and added sugar is generally the most helpful.  Fruit, fat and starchy vegetables are tolerated to variable degree in different cases.  Oligosaccharides found in some vegetables, carrots in particular, inhibit the binding of enterobacteria to the intestinal mucosa.

Leaky gut – (Increased Intestinal Hyper-Permeability)

Leaky gut – or leaky gut syndrome (LGS) – is a poorly recognized but very common problem, which is rarely tested for.  This condition results from an overly-permeable intestinal lining with spaces between the cells of the gut wall.  These spaces allow "foreign" material (bacteria, toxins and food) to leak into your body where they should not be, placing an additional burden on the immune and detoxification systems.

The junctions between cells not only need to be 'tight' but the surface area of the small intestine must be large for normal nutrient processing to occur.  Continued irritation and inflammation of the gut lining causes an even greater malabsorption by reducing the overall surface area of the lining.  Even when consuming the healthiest of diets, inadequate nutrient absorption may compound the problem of having to deal with all these new foreign invaders.

 Causes

Candida Albicans - is a major cause.  If you have Candida overgrowth in GI tract you also have Leaky Gut Syndrome.  Candida overgrowth causes LGS: when Candida changes from yeast to fungal form it forms rhizoids, a root like structure that breaks the intestinal walls.  Even when you get Candida in balance and heal the gut, your food allergies will remain for a while because you will still have the antibodies to that food.

 Stress. The intestinal lining replaces itself, on the average, every 14 hours.  To replace intestinal walls you need blood and the first organ to lose blood during stressful situations is intestinal tract.  If you experience a lot of stress, your intestinal lining will not regenerate and LGS becomes likely.

Antibiotics and steroids decrease number of friendly bacteria, allowing Candida to proliferate, which causes LGS.

Hormonal imbalance allows Candida to proliferate, a primary cause of LGS.

Alcohol and caffeine decrease number of friendly bacteria, and again allow Candida to proliferate.

Parasites or bacteria such as Giardia or H. Pylori.

Food allergies aggravate LGS.

Enzyme deficiencies e.g.  celiac disease, lactase deficiency causing lactose intolerance.

NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen, aspirin, etc.  interfere with mucus production.

Chemicals in fermented or processed food.

 Treatments include

Zinc - Zinc deficiency is known to result in epithelial barrier leak in the GI tract. Precise effects of zinc on epithelial tight junctions (TJs) are only beginning to be described and understood. Along with nutritional regimens like methionine-restriction and compounds such as berberine, quercetin, indole, glutamine and rapamycin, zinc has the potential to function as a TJ modifier and selective enhancer of epithelial barrier function (5).

Diet Restrictions - eliminating sugars, starches, grains, and any other irritating foods alleviates the inflammation and starves out the yeast overgrowth.  Reducing both of these allows the intestinal tract to slowly return to its normal permeability, stopping the flow of foreign objects into the blood, which will stop food intolerance symptoms and eventually help stop the self-perpetuating cycle. 

Nutritional Supplementation- Supplementing with a good multi-vitamin, large amounts of vitamin D, and Zinc will help the intestinal lining return to normal (assuming the irritants from the diet are removed by following elimination diet).  Essential fish oils have also been shown to really help improve the condition of the intestinal mucosal lining (omega-3’s greatly reduce inflammation among a host of other benefits).

Fiber is crucial as well, without it, probiotics cannot survive.  Start out getting your fiber from steamed vegetables and fruit if your gut is extremely sensitive. If you gut isn’t overly sensitive aim for 30-40 grams of fiber daily. Essentially indigestible fibers (i.e. prebiotics) are the food the helps probiotic bacteria thrive in our gut.  

L-Glutamine, an essential amino acid, the anti-inflammatory L-glutamine contains some significant health benefits including repairing the gut and intestinal lining. Another benefit of taking L-glutamine regularly is that helps thicken your cell walls, which has been shown clinically to resist Staphylococcus aureus bacterial infections (3). 

DGL Licorice Root is an adaptogenic herb; Licorice can also help support the body’s natural processes for maintaining the mucosal lining of the stomach and duodenum. It is especially beneficial if someone’s leaky gut is being caused by emotional stress. It also helps alleviate adrenal fatigue because it aids in the absorption and metabolism of cortisol (79). Licorice contains glycyrrhizin, which has been known to cause edema, and hypertension, so when taking this supplement, it is best to get deglycyrrhizinated licorice, (or DGL) which has had the glycyrrhizin removed. 

N-acetyl glucosamine (NAG), has anti-inflammatory effects, NAG has also been reported to help with osteoarthritis and inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease.

Quecerin, is known to improve gut barrier function because it helps seal the gut lining by creating tight junction proteins, quercetin holds a wide range of health benefits. According to the University of Maryland Medical Center researchers, the key to quercetin’s effectiveness is its ability to keep inflammation at bay. “Quercetin acts like an antihistamine and an anti-inflammatory, and may help protect against heart disease and cancer. Quercetin can also help stabilize the cells that release histamine in the body and thereby have an anti-inflammatory effect.” (3).

HCL with pepsin is a heartburn, and GERD remedy that is also regularly used to treat hypochlorhydria, when the stomach is unable to produce hydrochloric acid. Often bringing the stomach acid up to the correct level will help heal leaky gut and SIBO.

Only take HCL with meals that contain protein.

Anti-fungal agents aprylic acid, cellulose, and oil of oregano can be taking for short term treatment of leaky gut syndrome. One of the main causes of leaky gut syndrome can be imbalance flora the gut including an overgrowth of yeast and candida. These anti-fungals help balance the good and bad bacteria in the gut, which takes the strain off the intestines and helps them heal.

Prebiotics, Probiotics and digestive enzymes - This process aids in re-colonization of the intestinal tract and in the breakdown of the foods we eat to make them assimilate more easily through our digestive tract. When considering probiotics, it is important to use the right strain, genus and species as well as the CFU count which should be a minimum of 15 billion CFU’s. Digestive enzymes include Protease, Amylase, Lipase and Lactase.

Food sensitivities –

 Testing of these sensitivities is accomplished by a lymphocyte response assay (LRA). By discovering these sensitivities and through elimination and a rotation diet, the immune system as well as the gastrointestinal system are able to perform their functions more efficiently. 

Find a good doctor who understands these complex issues and see if you have the signs of these disorders. Tests are available for these conditions and can be performed either in your home or through the local phlebotomy service depending on the tests needed.

References:

1.     www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-pdq#section/-125

2.   Wardill HR, Bowen JM., Chemotherapy-induced mucosal barrier dysfunction: an updated review on the role of intestinal tight junctions., Curr Opin Support Palliat Care. 2013 Jun;7(2):155-61. Doi: 10.1097/SPC.0b013e32835f3e8c.

3.   Contribution of a Thickened Cell Wall and Its Glutamine Nonamidated Component to the Vancomycin Resistance Expressed by Staphylococcus aureus Mu50, Antimicrobial Agents and Chemotherapy. 2000 Sep; 44(9)2276

4.    http://umm.edu/health/medical/altmed/supplement/quercetin

5.  Wang X, Valenzano MC, Mercado JM, Zurbach EP, Mullin JM., Zinc supplementation modifies tight junctions and alters barrier function of CACO-2 human intestinal epithelial layers., Dig Dis Sci. 2013 Jan;58(1):77-87. Doi: 10.1007/s10620-012-2328-8. Epub 2012 Aug 19.