Dr Rupy: Welcome to the Doctor's Kitchen podcast with me, Dr Rupy, where I'll be discussing the most important topics and concepts in the medicinal qualities of food and lifestyle. These are some of the things that I wrote about in my first book, The Doctor's Kitchen, blending together the science with delicious recipes inspired by cuisines from across the world. Now, one of the things I get asked about a lot is the assumption that when I talk about food in medicine, I'm largely referring to obesity or cardiovascular disease, but the aim of this show is to demonstrate the intersection between nutrition and lifestyle across the breadth of medical specialities, which is why we're talking today about diet, lifestyle and cancer. Now, from the get go, this is going to sound like a controversial topic because I think the concept has been hijacked by charlatans looking to financially gain from some of the most vulnerable and desperate patients, and this has been sensationalised in the media quite a bit as well. This is not what the show is about. There is evidence of benefit from lifestyle measures to both prevent and manage cancers of various types. And rather than shying away from the subject for fear of being mislabelled, I think it's really important that people are opened up to the knowledge base so they can make informed decisions about themselves. We need to normalise the conversation around nutrition and health. Today, I have the absolute pleasure of inviting a fellow doctor and good friend, Dr Elsa Lumsden. Elsa, welcome to the show. How are you?
Dr Elsa Lumsden: I'm good, thank you. Thank you for having me.
Dr Rupy: Of course, of course. I'm so glad that you could come and talk about it because this is obviously a subject very close to your heart, I mean it's your profession. But perhaps you want to tell us a little about yourself and and how you actually got into oncology as a subject and and how you started your lifestyle medicine journey.
Dr Elsa Lumsden: Yeah. I've been training in oncology since 2009 now, so a fairly long time. I, as a junior doctor, I got into oncology because I like the fact that you get to build quite a relationship with your patients. You see them sometimes on a weekly or three weekly basis. I'm a bit of a talker and I like, I'm a bit nosy. I like to get involved with people's lives and know what's going on. It's also an incredibly passionate area of medicine. You know, there's no lack of empathy. Everyone's always willing to go the extra mile. I find it's a great area of teamwork to work within the hospital. And so it just kind of fit with all of my character traits and and what I wanted to do.
Dr Rupy: Yeah. And so you had your own personal medical problems, right?
Dr Elsa Lumsden: I was diagnosed when I was a final year medical student with something called achalasia, which is thought to be an autoimmune condition, but basically it's the muscles in my oesophagus don't push the food down, and it can cause narrowing at the top of the stomach. It was pretty bad when I was first diagnosed. I couldn't really swallow any normal food and I would actually regurgitate food. And when I first got diagnosed, initially everyone thought, well, the GPs thought it was a psychological problem because I was doing my finals. And so I went through quite a long time trying to get sorted out. And I actually ended up kind of sorting myself out. I've altered my diet until, you know, having to use lots of soups and things to be able to swallow things, but also aiming to increase nutrition. Finally kind of got established with the diagnosis and I actually went down the treatment of having surgery only two years ago now. The amount of information I learned about my own body and what I could do to help myself alongside the surgeons with their operation they did for me, was amazing. It was and it was mind blowing and it and it really has changed my outlook on how I practice my medicine. I made quite drastic changes to my diet, lowering the amount of sugar, lowering generally lowering the carbohydrates. I I thought I had a balanced diet. I think like most people do. And then when I actually used some of those tools like MyFitnessPal, the app, you know, to actually track my diet, I realised I was eating like 80% beige carbohydrates. You know, toast for breakfast, a sandwich for lunch, spaghetti for dinner, and all of a sudden, you know, that's there's no fruit and veg in there. It's all carbohydrates. And it was very low protein. So by switching, increasing my protein and switching down my carbohydrates and like going for a veggie emphasis, I felt so much better. I had so much more energy. I was also I also became quite keen on the exercise and that paradoxically at a time when I wasn't sleeping because I had a young baby that was breastfeeding through the night, suddenly I had more energy from the from the changes in my diet and my exercise. And I thought, well, if I can do this, anyone can do this. And if I feel this much better despite my sleep deprivation and my chronic health problems, then, you know, my patients would feel better if I pass on this knowledge. And so that opened the door and I ended up attending a conference where I met you.
Dr Rupy: Yeah. I'm not always the biggest fan of these calorie counters, but as you've eloquently demonstrated, a lot of people can actually find benefit because it at least maps out what they're actually eating and it makes you a little bit more conscious about what you're putting into your body as well. And when you can actually see it pictorially or just noted, you can actually find patterns that perhaps are not as healthy as you assume they were. And particularly, you know, being a working doctor, busy mum, you're probably just craving.
Dr Elsa Lumsden: I was just grabbing and I was falling into all the cliche traps. I only tracked for a week and that's all it took was to just be like, oh, right, this is obviously where I'm going wrong.
Dr Rupy: Yeah, yeah, exactly. We're going to be talking about cancer today. Yeah. What would be really useful for listeners is to actually define what we're talking about. What is cancer?
Dr Elsa Lumsden: Yeah.
Dr Rupy: And it sounds like a bit of a simple, silly question, but I think it's important.
Dr Elsa Lumsden: No, I think there's a lot of misconceptions out there. Like cancer really is an umbrella term. As individuals as we are as people, our cancers that we carry are also very, very individual. And that's why there's no one treatment fits all. There is no one diet fits all when you're looking at these treatments. So cancer starts really as, well, we think it starts with a series of mutations. Some of these mutations are inherited, but really only a very small proportion, something like 5 to 10%. The rest are somatic mutations that we acquire through our lives, which is one of the reasons why we see more cancers as you get older. The fact is our bodies are made up of like 100 million million cells. To put that into context, there's more cells in like your little finger than there are people in China. Okay? And these cells have to turn over every day. It's estimated that there's a turnover of about 50 to 70, I think billion cells turning over every day. In order for a cell to turn over, what that means is it has to copy its DNA to make a daughter cell. So if you just think it's kind of mind boggling that your DNA is being copied 50 to 70 billion times a day. Okay? And unfortunately, during that process, unsurprisingly, when given the sheer numbers, some mistakes are made. Now, our cells contain amazing processes to try and find those mistakes. People probably have heard of something called like the BRCA mutation. That's one of the DNA repair mechanisms and that's supposed to go along and repair, find these mistakes and repair them. If you're unfortunately inherit that mutation, that's why you have a difficulty repairing DNA mutations. So to be honest, I find it kind of staggering that there's not more cancer around. And one of the reasons there's not more cancer around is that we have our fabulous immune systems that go around and find these kind of rogue cells that have these mutations and kill them off. So the reality is we have cells mutating probably all the time. It only matters if the mutation happens in a gene that is a cancer promoter or in a gene that's a tumour suppressor that gets turned off. And even then, once a tumour starts, probably our immune system goes around and nips that tumour in the bud. So it's this combination of as we get older, we acquire more and more mutations, plus our immune system tends to dampen as we get older. And that's why you see cancers, you know, cancer is most prevalent in the population over 55 for those reasons.
Dr Rupy: Exactly. Yeah. So we're likely to acquire more breaks, more mutations, and our immune system is less likely to be robust enough to deal with those and kill them essentially and get rid of them. Yeah. There are a number of different things that can impact whether you're in a pro-cancerous and an anti-cancerous state. Is that correct?
Dr Elsa Lumsden: Every day, you know, walking through life, we are exposed to things that can cause cancer. Anyone that reads the Daily Mail knows that pretty much anything in the room can cause cancer.
Dr Rupy: Yeah. This is why I find it quite unlike it's uneducational, right? It's like we know, like we're currently in a room right now where there are pro-cancerous things or we're, you know, we're having, I'm not having a fizzy drink, but if I was having a fizzy drink, there might be some constituents that have been shown in a petri dish to be pro-cancerous. It doesn't really help us because we have these incredible systems that you've just described that protect us so much.
Dr Elsa Lumsden: You know, that's where you can have a protective lifestyle. So that's where things like exercise gets involved. And that's where things like maintaining a normal healthy weight and where a good nutritious diet can become involved because those all of those things support your immune system to keep it healthy, to keep looking for those rogue cells and decreasing the chances of developing a tumour.
Dr Rupy: Absolutely.
Dr Elsa Lumsden: Which is what we're going to hopefully discuss today.
Dr Rupy: So why don't we kick off with exercise actually? Because I think that was one of the things that spurred you on your own lifestyle journey. You're a big BBG fan, is it?
Dr Elsa Lumsden: Yeah, BBG. Kayla Itsines.
Dr Rupy: I still don't know what does that mean? BBG?
Dr Elsa Lumsden: Bikini Body Guide.
Dr Rupy: Oh God. I wish I didn't ask that question now. It's banded around everywhere. You know, I think it's great that so many people are, you know, BBG round 47 or whatever. I don't know what that means. But it's good that it encourages people to.
Dr Elsa Lumsden: It's a workout you can do from home, which when I, I started doing it when my son, my second child was only four months old. And so it just for me, I there was no way I was going to get to a gym. So that's why I I got onto the bandwagon and it and it worked. It got me into exercise. It was a it's a kind of a graduated program. So, you know, you need that when you're unfit because you've just been through pregnancy. But yeah, no, exercise has actually got some of the most robust evidence. You know, there was a huge systematic review in 2010 which looked at a huge number of published and peer reviewed articles and basically found that exercise is safe during cancer treatment and after cancer treatment. So, you know, it's not one to be shied away from. You should always consult your doctor and potentially get specific advice for your particular cancer and what is going on with you because there obviously will be some exercise that will not suit what you're doing. But in general, exercise is certainly not contraindicated and is encouraged and has been shown to improve response rates in things like breast cancer.
Dr Rupy: And as an NHS doctor, you're under the same constraints as most specialities and GPs as well with the amount of time that you're actually able to have, although I appreciate that you probably see them more often. Is this something you actually talk about with with patients? Or you don't have a chance to?
Dr Elsa Lumsden: No, I wish we did. If people ask me, I will talk about it. But for a new patient, we have 20 minutes and we have to we have to prioritise what we can cover in that session. And it has to be the chemotherapy or the radiotherapy, the prognosis, the the big the big hitters. It has to be.
Dr Rupy: And answering their questions as well about that because they're going to have a million and one questions and then.
Dr Elsa Lumsden: The practicalities of where do I go to get this? Where do I go to do, you know, there's I mean, there's thousands of things that, you know, actually apply when you to these consultations. So on a pragmatic basis, no, we don't often get to cover this stuff. It doesn't get discussed and it's a shame. And it's one of my bugbears. I have this dream that one day we'll have this funded service where I can have a clinic where there'll be a physio and a dietitian and myself and the surgeon and a pharmacist who's specialist in oncology because the drugs are getting, you know, huge and people are taking a lot of supplements. So we do need a specialist pharmacist to advise us on interactions and things. So I dream of this kind of poly, like multidisciplinary clinic where where patients can basically see us all and get the right advice.
Dr Rupy: So exercise, as you mentioned, is probably got the most evidence behind it. Is there a plausible biological reason as to why this is so beneficial for cancer sufferers and protective from cancer?
Dr Elsa Lumsden: I think there's been kind of several mechanisms that have been proposed to explain the benefit, the protective benefits. I think a reduction in circulating levels of insulin and hormones and other growth factors, obviously enables you to maintain a normal body weight for your height.
Dr Rupy: Got you.
Dr Elsa Lumsden: And the other interesting thing is that a physical exercise done during certain periods of your life. So if you're particularly physically active as a as a young as a child or an adolescent, seems to confer a protective influence much later on in life.
Dr Rupy: So active kids.
Dr Elsa Lumsden: Active kids, very important. Very in with the current message going on.
Dr Rupy: Exactly. Yeah, yeah. There's a lot of that, I think. And the the benefits are just so far reaching. And I think there's probably lots of other things within exercise that may not have been researched as specifically in in papers, but may have effects on cancer. So the effect on inflammation, for example, or immune system, you know, reducing their circulating of of inflammation, inflammatory cytokines that confers benefits in everything beyond just cancer as well. When reducing your chances of blood sugar dysregulation, cardiovascular disease, etc. So it's good to know that there's some evidence behind that as well, right?
Dr Elsa Lumsden: But just kind of thinking ahead that potentially someone out there is listening and they've got cancer kind of what I do say to patients is that you have to just do what is within your physical capability at that time. You know, I'm not expecting you to go run a marathon. In terms of prevention, yeah, you should follow the guidelines, but, you know, there is some evidence that that more is better, but obviously then you can go too far and over exercising is is also becoming a bit of a problem for some people. But in general, you want to be getting your heart rate up and doing kind of at least 30 minutes, five times a week of kind of moderate brisk exercise. And that can be walking.
Dr Rupy: Yeah.
Dr Elsa Lumsden: You know, walking to the level where you're just struggling to kind of hold a conversation. That that kind of moderate brisk walking.
Dr Rupy: I'm assuming not, but are there any recent studies looking at particular types of exercise and their benefits? I'm thinking specifically of yoga, actually, because I keep on getting loads of people, patients coming to say, you know, I I started doing yoga, it's fantastic. I feel much better on myself. It's improved my circulation, the way I think. And there's probably a lot of intangible benefits of that as well.
Dr Elsa Lumsden: There's a lot of a link between yoga and cancer. And I think it's because it's a a form of exercise that you can do, you know, when you are fatigued and and when life is a little bit harder because you're going through cancer treatment. And obviously it helps with the meditation and the quietening of the mind, the psychological help that yoga brings and obviously the psychological difficulties that you have when you're facing a cancer diagnosis. The other the other exercise type I was going to mention is that I think it's really important to recognise that sarcopenia is a real problem.
Dr Rupy: Okay.
Dr Elsa Lumsden: So sarcopenia is when you get kind of muscle wasting. It's something we see anyway with aging. It's it's very dramatic if if patients are in bed for any length of time. And we do see it during cancer treatment. And so anything you can do to maintain your muscle mass is associated with better outcomes. So maintaining a protein in your diet. I'm not asking you to lift weights, but you need to be able to put resistance on those muscles to help make them stronger. So, you know, it doesn't mean going down to the gym and and doing some deadlifts or something. But it it does mean resistance exercise, not just cardiovascular exercise is is very beneficial in in cancer treatment and afterwards to rebuild some of the muscle that is lost by the sedentary behaviour.
Dr Rupy: Absolutely.
Dr Elsa Lumsden: And that's the other thing to mention is that exercise is not just an event, it needs to be a lifestyle. So the there's other evidence to show that the protective benefits of exercise are not just showing up and doing a 30 minute workout once a day, but it's it's about not being inactive. So if you just do 30 minutes a day and then sit at a desk for the rest of the day, you're not really getting all the benefits. And actually a lot of fit people will say, I'm really fit, you know, but you may be really fit, but you might be quite inactive in your desk job or whatever. And actually it's really important every 90 minutes to walk around for two minutes just to get that circulation flowing. There's good evidence for that too.
Dr Rupy: I think before we go into sort of like the food element and the other lifestyle elements, there is a lot of guilt attached to what people should be eating if they have a cancer diagnosis, for example. And I think that's something that we want to address straight away, right? Because there is a lot of pressure these days, potentially from themselves, but also maybe your family members or friends that they should be eating this or perhaps you should be on this particular diet or I've heard about the alkaline diet and all that kind of stuff. And the link between lifestyle and cancer is not across the board. It was not your fault.
Dr Elsa Lumsden: Absolutely. What I when we were talking about how many cell divisions there are in, you know, in a day, there was a a great paper out, I think it was 2016, where done by some statisticians that looked at the sheer numbers of kind of cell mistakes and cell copying errors in the different cancers. And they estimated how many were due to inherited factors versus lifestyle and what we'd call modifiable factors versus just straight DNA copying errors that have slipped through the net. And for some cancers, the sheer majority are just bad luck. It's DNA copying mistakes and there's not much altering your lifestyle is going to do. For other cancers, most notably like breast and colorectal cancer, there are a bigger percentage of which are modifiable risk factors. So and I guess the most most obvious one would be lung cancer and smoking. Okay, but even then, I think it was I think they estimated that 35% of those mutations were just sheer DNA copying errors. And and I mean, I've certainly treated many people with lung cancer who've never smoked in their life, you know. And we all know someone who's smoked their entire lives and never got lung cancer. None of this is binary. Okay? It's and that's what we have to remember is that, you know, there shouldn't I can't it it breaks my heart. I've had numerous patients come into me, I've been vegan all my life. I've done yoga all my life. Why me? You know, this isn't fair. And it's not fair. Like let's just get this straight. Like it is not fair and it is not your fault. Okay? Even if you smoke, it's still not your fault. 35% of those are DNA copying errors. Okay? That's really important to me that we kind of got that out there and and kind of made that clear.
Dr Rupy: Even across social media and in clinic as well, I get patients probably with the same disposition who are vegetarian their whole life. They've led a very healthy lifestyle. They have a great mindset, they have a great family, great environment, all the rest of it, and they still get cancer. It can just be sure bad luck and in a lot of cases it is.
Dr Elsa Lumsden: Yeah. And I guess the other way I like to see it is that if you are super healthy and you do everything and you eat everything right, you're not immune. So don't think just because you are super, super healthy that you should ignore symptoms. Get checked out. Nobody is immune. Anyone can be affected if we look at it from the flip side.
Dr Rupy: Having said that, we're going to we're going to talk about what we can do.
Dr Elsa Lumsden: Exactly. Yeah.
Dr Rupy: So, something we get asked about a lot is sugar.
Dr Elsa Lumsden: Sugar and cancer. Oh, I it's it just literally sometimes it's it's very difficult because people get very passionate about sugar and cancer. So I I'm going to tread carefully here. I think everybody can benefit by lowering their sugar intake. I'm going to put that out there. I think I felt better by lowering my sugar intake. I'm pretty sure everyone in the current Western average Western diet eats too much sugar.
Dr Rupy: And unfortunately, there are just so many ways in which it's presented to us and we are unmindfully eating.
Dr Elsa Lumsden: Yeah, it's hidden. It's hidden. And that's the complications that come with processed food is that there's often hidden sugar and salt in those foods. I do think sometimes the rhetoric gets too far. I had a family come in where where it was father and son. Father was very, very unwell with advanced pancreatic cancer in a very cachectic state. Cachexia is where like the cancer has increased the metabolism in the body. So you start literally wasting away and it's it's very difficult state. In that position, you really need high protein, high calories, high fat foods to to keep you kind of to keep you going and to try and build some of that muscle mass up. Yet there's a lot of information out there, especially on the internet that talks about how it's really important that you have low or no sugar, the benefits of a ketogenic diet, which is basically, I think less than 50 grams of carbs a day, isn't it? It's very, very low. And even I think one of the one of the one of the big studies is ketogenic with caloric restriction as well. So it's so it's it's very extreme. And for these patients that are very, very unwell, it can be very, very uncomfortable. And you've got to remember he's in the advanced stages. And so this one case I remember was really difficult because you had a son who passionately wanted to save his father, passionately, obviously only wants the best for his dad. But his dad's in his 70s, was feeling ill, was fairly fed up. And it was causing conflict. And at a time where they should be enjoying their time together, arguing over the nuances of his diet was, I felt inappropriate. I got to know the family and I got to see what was going on. And I actually did say something which I actually wouldn't normally do, but I felt like it was so unfair and I needed to I wanted to unburden him of this there's guilt to kind of convince his father that there was another way or something. I'm not sure. So I think that sugar rhetoric has gone too far on the internet sometimes. And I think actually all of these things need to be taken in the context of each person. You know, I'm not a dietitian, I'm not a nutritionist. I'm a I'm a doctor. I haven't had as as you've discussed largely, I've never we haven't had much nutritional training. I only know what I've learned myself through doing my job and through educating myself when I was ill. I would always send someone like that, I would always offer and or recommend that they go and see a trained professional to try and get because I think each patient needs a nuanced dietary advice, not a blanket fits all everyone, everyone with cancer should be on a ketogenic diet or, you know, or at least a low sugar diet. I think you have to just take each case by case discussion. Having said that, there's some very interesting trials being done in gliomas or brain tumours with with ketogenics.
Dr Rupy: With ketogenics. Yeah.
Dr Elsa Lumsden: So it'd be interesting to see how that comes out. And I'm completely open minded to all of these things. I just think I just think we have to wait for a little bit longer and it certainly will not be a one size fits all. There's no one treatment that's going to treat everyone. So why would one diet? And I think sometimes sugar gets hailed as this devil, you know, and it's just actually let's take it down a peg and let's look at the whole fact of food is not just about nutrition, it's about socialising. It's about love, especially at difficult times. Food can be a real expression of love. People want to cook for you. If you're not well, people want to look after you. And if you're sat in a corner eating, I don't know, sardines or something, you know, you know, that you're socially isolating yourself at a time when actually you need to be with other people. So that's my two cents on sugar.
Dr Rupy: On the subject of sugar, there's some interesting stuff looking at metformin, which is.
Dr Elsa Lumsden: There is some really interesting stuff with metformin.
Dr Rupy: It's an anti-diabetic medication that we use quite commonly and it's effect on lowering the rates of cancer, right?
Dr Elsa Lumsden: Yeah, it's being they're rolling out some quite big studies looking at as an adjuvant treatment, which means an additional treatment to what the conventional treatment would be. So using it in as an adjunct to radiotherapy. Anecdotally, I know a few patients that take it off license, so they don't have diabetes, but they take it off license because of the baseline data they've seen. It's not something I could prescribe off license as a as a doctor. There's a theoretical base there to try and reduce the inflammatory, the insulin and the and the IGF-1 and the underlying kind of sugar dysregulation and to try and control all of that and see if it does dampen down that response and so enhance the effect of the of the conventional therapies.
Dr Rupy: Yeah. And there's this concept of the tumour microenvironment and how we can affect that. Glucose being one of the things, but also certain micronutrients and we're talking about anti-angiogenesis as well, right? Which is something that gained a lot of popularity of the back of a TED talk from Dr. Lynn. How that might not be the best way to look at tumours, right?
Dr Elsa Lumsden: Well, I think all that there's all of these things, so the the metformin, the sugar, the anti-angiogenesis thing. They're all looking at.
Dr Rupy: Which I should, sorry, clarify what we mean by that. The microvascular environment of the tumour itself and how.
Dr Elsa Lumsden: Tumours need to they can't depend on like our blood supply. They need their own blood supply because they grow so fast. They secrete growth factors to build their own blood supply. And it's been a theory for a while that if we can block that, the cancer would starve itself of oxygen because there wouldn't be blood to deliver it. And there's and there are drugs that target these pathways that are used in some of the cancers. But they're not these drugs are not universally successful across all the board. It, you know, it certainly hasn't been the heroic saviour or the silver bullet. But it's an interesting other factor. But what I would like to say is that, you know, when you're looking at these, all of these different factors that we're talking about, all of these diets end up advising the same thing. So actually, what we need to do is to not to be rude, but you know, remove some of the BS and actually focus on actually what can you do? Well, you can overcrowd your plate with vegetables. You can eat the rainbow because then you get all the polyphenols. And you can do all the positive things and you'll affect all of these different downstream events. So you'll, you know, you're by by crowding out your plate with vegetables, you'll be lowering your sugar intake because you won't be eating the beige foods that are full of sugar and the ultra high processed foods. And we haven't really talked about genotoxins much, but there are things that sneak into our foods. You're probably all aware that, you know, bacon was demonised and sausages. And it's it's because processed meats often have nitrites or nitrates in them and they and that has been shown to potentially have a genotoxic effect, which means it causes mutations which could cause cancer. So it's been labelled, I think by the by the WHO have labelled it as a a potential carcinogen. So it's not to say that we can't ever eat bacon, but we shouldn't eat it all the time. And actually, if you take a positive approach and the way I like to think about food is not what I can restrict, but what I can put in. So if you fill your plate with all the positive things, the broccolis, the brassicas, the apples, the pomegranate seeds, all of these things, the lycopene from the tomatoes, all of these things that are superfoods, actually, they're all just what we all know, which is a Mediterranean diet has been proven to be beneficial to reduce your risk of cancer versus a typical Western diet.
Dr Rupy: Exactly, which again, what you mentioned, like all foods are really super because they have all these incredible benefits of them. And if they're natural foods away from processed foods.
Dr Rupy: Exactly. So on a spectrum of whole versus processed, we really just want to move our diet towards the more whole food side because that's where we're going to actually reap the benefits of those different plant chemicals that we talk about. And I think like there's lots of different ways in which people like to dissect certain anti-cancerous foods. They might look at the anti-genesis or this is affecting blood supply or this is reducing the glucose. So we're we're reducing the energy source of the tumour. Whereas actually, when we concentrate on the bigger picture, which is getting a variety of these different foods, they're affecting multiple different pathways.
Dr Elsa Lumsden: Yeah. And it's the synergy between the foods.
Dr Rupy: And it's a very reductionist thinking and it's a it's the same way it's trying to make, I don't know, a plant or a chemical, even, you know, a curcumin within tumour. It's trying to pick things out and make them a pill. And that's I think that's an outdated, old fashioned medical model. And I think we need to look more holistically. The way of going forward is not to be so reductionist about the minutiae of what's happening, but look at the bigger picture.
Dr Rupy: Well, this is something I think the pharmaceutical industry could probably learn from, right? Having a more holistic approach because I think like you just talked about, anti-angiogenic medication, the drugs that were formulated were touted as potentially being really, really amazing, like having the silver bullet effect.
Dr Elsa Lumsden: Across all the cancers, yeah.
Dr Rupy: Across all the cancers, exactly. This is the one thing that we need to target. Whereas actually there are so many different processes going on within a cancer, within the human body. You know, it's going to take a multi-targeted approach. And the food that you put in, not to say that food is going to cure cancer, is certainly having those sorts of beneficial effects on multiple different levels rather than isolating. And that's that's what I mean, I have patients that come in with cancer and without cancer as well, that take specific supplements to prevent themselves from cancer or or attacking the cancer. And these are things that they've heard in the papers. Whereas actually, you want to focus on getting these from the whole sources, the grapes, the beets, the the brassica vegetables, all those sorts of things. And that's probably the best way of doing it because there's actually lots of evidence behind the biological mechanisms behind why these certain foods work, right?
Dr Elsa Lumsden: So absolutely. And and there is a lot of theoretical evidence behind why they work. But to try and unpick it and to and to, you know, we're not going to be able to do a randomised control trial of, I don't know, how much broccoli someone eats. So, you know.
Dr Rupy: I find it particularly fascinating, like, and I like to highlight.
Dr Elsa Lumsden: Recording how much broccoli you eat.
Dr Rupy: No, no, no. No, I find it really fascinating how these individual constituents of food can have effect at the cellular level. So sulforaphane, for example, which is a a component in brassica vegetables, you get it in cabbage and cauliflower and broccoli and that kind of stuff. And the mechanism as to why this has an anti-inflammatory effect, stabilising certain cells and and how that crosses the cell wall and all that kind of stuff. Not to say we eat brassica vegetables for this sulforaphane content, we eat it for, you know, the enjoyment of broccoli. And I find broccoli rather enjoyable. But yeah, no, I find it really fascinating that there is a reason as to why these have anti-cancer effects and at least in a preventative role.
Dr Elsa Lumsden: Oh, absolutely. I did my, I did my PhD in molecular biology in prostate cancer and I looked specifically at microRNAs. They were only discovered in 2007 and they kind of they kind of blow my mind a little bit because they are basically fine tuning everything. But one I remember one part I've I've it was just like a line in my PhD, but the breast milk from mothers, there are microRNAs found from the mother's breast milk that survive through the infant's digestive system and so alter the infant's DNA.
Dr Rupy: Wow.
Dr Elsa Lumsden: I know. It's the same with food. It's the same with plants. You know, we're eating, there's a difference between a cellular carbohydrate and an acellular carbohydrate. You know, when we're eating plants, we're eating cells, we're eating DNA, we're eating RNA, we're eating microRNAs. And and we're eating phytochemicals. That's the word I was looking for. And so we're eating all these things. It's so, you know, a piece of broccoli is not a piece of broccoli. It's I don't know, it's amazing. You know, versus a, I don't know, let's take a biscuit, which is just empty calories in many ways. I mean, they're delicious empty calories. Don't get me wrong, I eat biscuits. When you look at them side by side, you know, you just can't compare it. And you start I found as my eyes got open to all these things, it was a bit, you know, I started looking at where can I put vegetables into my meals? So how can I include fruit and vegetables with my breakfast? And I do eat fruit even though it's got sugar in it. Because I because I like fruit.
Dr Rupy: Of course, but it's also got polyphenols. It has fibre. It's going to affect your.
Dr Elsa Lumsden: All the things we said. So again, I'm not an anti, I'm not a big sugar demon. I I still eat sugar. I just don't necessarily have the big box of Maltesers at 3:00 p.m. which I used to do.
Dr Rupy: I think having these like different variety of vegetables also, I mean, people talk about antioxidants and how these scavenge free radicals and all the rest of it. This is just like another dimension as to why food can be so healthy from multiple reasons, not even just cancer, but multiple different conditions, right?
Dr Elsa Lumsden: Yeah, absolutely. Antioxidants are big. I mean, it's difficult. They've done some they've done some actually really big trials and a big systematic review of of vitamin E and and vitamin C and they can't draw evidence. So we can't recommend them. But having said that, the theory is there and perhaps it's because it's in supplement form versus being in real food form.
Dr Rupy: Exactly.
Dr Elsa Lumsden: I mean, I don't know if we need to go over what the Mediterranean diet is, but the Mediterranean diet has been proven to be the most cancer protective diet. And that's a diet that's rich in kind of locally sourced, real foods, mostly plant based, but with some fish and good fats such as avocado oils, olive oils, nuts.
Dr Rupy: It's really interesting looking at vegetables because they have an indirect effect as well on regulating the phase one oxidative and phase two conjugative metabolising enzymes as well, which actually improve our ability to remove things like environmental pollutants and deal with them.
Dr Elsa Lumsden: Absolutely. If our liver's on form, then we should be able to deal with all these pollutants that we're exposed to and detox our body.
Dr Rupy: Exactly. So yet another reason as to why this sort of diet is going to be very protective for us as well.
Dr Elsa Lumsden: Absolutely.
Dr Rupy: I think a colleague of yours, Professor Robert Thomas, he's done a lot of work in this and he's actually got quite a big interest in this, isn't he? And you know, he's a big promoter of.
Dr Elsa Lumsden: I think he's written a couple of books. Yeah, and he's done some studies in in pomegranates.
Dr Rupy: Exactly. Yeah, pomegranates and some extracts that you get from broccoli and stuff like that. And I remember I was at one of his lectures because we were lecturing at the same time. And he looked at the dietary inflammatory index of certain foods and found a vegan macrobiotic diet was the least inflammatory. Whether that's the best for cancer is another question, but it's very interesting to note why inflammation might be one of those things.
Dr Elsa Lumsden: Yeah, we haven't even talked about inflammation yet, have we? Yeah.
Dr Rupy: And again, it's another reason as to why vegetables might might be anti-cancerous. But yeah.
Dr Elsa Lumsden: It's well proven that chronic low level inflammation leads to cancer. And then that links into why they think, one of the reasons they think obesity is linked to an increased rate of cancer. And that is because they believe that there is a low level chronic inflammation when you're in an obesogenic state.
Dr Rupy: Exactly. Because that adiposity leads to inflammation. The cells are quite metabolically active and that leads to that low grade.
Dr Elsa Lumsden: Yeah, I think there's higher levels of insulin, IGF-1. Yes. And chronic inflammation from that point of view, plus the adipose tissue often disrupts your hormonal profiles. You have a lot of aromatase in fat, so you can have higher levels of oestrogen circulating. Chronic inflammation generally isn't good for cancer. They have looked at lower inflammatory diets. I mean, you could go a whole hog and go the kind of paleo, very low inflammatory diet. The vegan diet's very low inflammatory, but I think the problem with the vegan diet is the lack of B12 and iron. But if you address those in other ways, then then you can cover your back there. But again, it comes down to what we've said, which is that if you eat plants, you kind of protect yourself.
Dr Rupy: Yeah, exactly.
Dr Elsa Lumsden: So it kind of all comes back to the same. You know, they've done studies, they haven't found one diet fits all. I'm not sure they ever will because I personally believe each each type of cancer is different and each person is different. So, you know, we've all got genetic mutations within us that make us metabolise food differently, that make us handle food differently. We're all of a different body composition, we're all bigger or smaller or, you know, there's so many variables here that, you know, the idea that we can just work this out, you know, I think is is not true. And so what I tell people and my patients is that to do some self-experimentation. Find what works for you, as long as it does no harm.
Dr Rupy: Exactly. Yeah. And I think do no harm is certainly the the forefront of what we as doctors are all taught to do. But certainly when it comes to diet and lifestyle changes, there's very little harm you can do as long as you're doing it very pragmatically.
Dr Elsa Lumsden: Absolutely.
Dr Rupy: When it comes to vitamins, I'm imagining you check vitamin D levels, right?
Dr Elsa Lumsden: Yeah, we do actually check because as I said, I'm I'm working in breast oncology. So a lot of our patients need bone modifying agents, which are things like bisphosphonates. We do check everybody's vitamin D and what is always strikes me is how low everybody's vitamin D is. I mean, scraping the bottom of the barrel low. You know, it's national guidance now in this country that everyone should be taking a vitamin D supplementation. They should be taking 800 to 1,000 units a day through the winter months because we cannot synthesise enough through our skin between, I think it is October and March because of the angle of the sun, we just do not get enough UV rays. So I think it's really important people realise that. I think vitamin D is very important, not just in its the bone and calcium homeostasis, but also potentially as an immune modulating agent.
Dr Rupy: Yeah, it really does have an effect on so many different processes around the body. And even though it might not have a very well recognised or clinically proven effect on cancer rates.
Dr Elsa Lumsden: That would be very hard to prove, to be fair. And I think I think there's enough background science that makes me convinced that we should all be taking it at the recommended rates. I certainly take it and I I we do check all our patients and the majority of them end up with supplements because very few people have normal levels, as I said.
Dr Rupy: The gut microbiome. We haven't even talked about that. So the population of microbes that live in and around your body, largely concentrated in your gut, and how that is having an impact on cancer. I mean, that's really exciting.
Dr Elsa Lumsden: Really exciting. It's relatively in its infancy, I think, in terms of cancer, but there have been some really exciting kind of preliminary results coming through. There was a an abstract presented at ASCO, which is the big oncology meeting, where somebody had looked in the stool samples, so in the poo of people that had responded to immunotherapy and people that hadn't. Now, immunotherapy is one of our new treatments for cancer, which we're all very excited about, the checkpoint inhibitors. And they found that the people that had not responded versus the people that had responded had very different levels of diversity of their gut bacteria. You know, going as far as saying kind of a dysbiotic gut bacteria in the people that hadn't responded. And the people that had responded had a much healthier gut microbiome with a diverse population of bacteria in there. And I think that's really interesting. The background science is there. It's all been building for a number of years and I think, you know, that's going to be the next step. It's going to be really interesting to see where that goes.
Dr Rupy: Yeah, absolutely. If we could distil our conversation into sort of actionable points for cancer, it's really hard because it's so nuanced and there's so many different things. But just from our brief conversation, loads of vegetables. Yeah. Concentrating on things like greens because of their known anti-cancer properties.
Dr Elsa Lumsden: And if you're talking about microbiota, you're talking about lots of fibre and greens as well, which is good prebiotic for your bacteria to feed on.
Dr Rupy: Exactly. Yeah. So different sorts of prebiotics as well as having a lower inflammatory state. Would you argue that a stress relieving technique could be something that could be beneficial, even if it was just on a personal level?
Dr Elsa Lumsden: I'm not sure you're going to find the evidence for it. But I mean, I think it I think it benefits. Certainly, I recommend it for my patients that are coming through clinic. We talk I spend a lot of my time talking about trying to access some of the charities for psychological counselling and support, as well as there's meditation courses, yoga for meditation, if you need a more active form of meditation, I recommend yoga. I spend a lot of my time talking about that. In many ways, people are more receptive to that than they are to talking about nutrition. And they're least receptive to talking about exercise. I find. Yes, that's kind of the order.
Dr Rupy: Really? That's super interesting.
Dr Elsa Lumsden: Yeah, people kind of recognise that cancer is a psychologically hard thing to go through. Yeah. I think they then kind of think a bit about the food, but I mean, you've got to remember when someone's going through cancer treatment, we're giving them chemotherapy that's disrupting their taste buds. They they lose their appetite or they have high appetites when they're on their steroids. On average, these ladies are putting on a stone in weight when they have their chemotherapy. And it's not just because they're overeating when they have their steroids. Like we're messing with their whole functioning system. So it's interesting. Nutrition is is a very difficult topic to broach when you're in cancer treatment, I think, because it's so multifactorial and because you're dealing with so many different aspects of physically, how do you even get the food in, let alone have the energy to cook the vegetables you need to cook. It's it's really difficult. And that's why I would always, always say, when you're right in the midst of the diagnosis, it's not the time to put the pressure on.
Dr Rupy: Yeah, absolutely.
Dr Elsa Lumsden: Okay, there is time later on. Like, by all means, if you're feeling well and you have lots of energy, follow our advice and try and follow a Mediterranean diet. But if you're lacking in energy, don't heap on the blame if you reach for that cookie to give you that little bit of energy to get you through the day. I think, you know, if you can at any point, that's the that's the point. But it's a balance between how everybody feels and and it's about getting the information out so that everybody can make an informed choice about what they put in their mouth. And I just think there shouldn't be any blame attached or guilt.
Dr Rupy: I think it's important to recognise that a lot of these things that we're talking about today is not well supported within the NHS structure. So I actually rely quite heavily on some charities that I send the patients to see. So I kind of have to give a shout out to Maggie's, who are a fantastic cancer charity. They will often help patients to access nutritional advice from trained professionals. Obviously the Macmillan is very well known. For breast cancer, there's the Haven. And then I also want to kind of give a shout out to some smaller charities like Eat Well, Smart Cancer. They do cookery demonstrations including a lot of information about healthy food and how to incorporate it into your diet whilst in a cancer diagnosis or after the treatment's finished. And that's all run by Jenny Phillips and she also has a very good book called Eat Well, Smart Cancer, which I think has a very pragmatic approach, just like I tried to take, where you take the science with a pinch of salt in places and mingle it with the realism of what it is like to actually be going through cancer treatment. I really want to say that I'm conscious that people that are listening to this may be going through cancer at the moment, may be going through the treatment and the diagnosis. And there should be no pressure to make drastic changes to your lifestyle or to feel a sense of stress or burden about what may have gone on in your life before and what decisions you've made before. I want you to try and use this information as a sense of empowerment where you can regain your health at your own pace and draw on others for support. And remember that food is more than nutrition and it's it's a social necessity. It is an expression of love. There are only benefits to be gained, I think, from treating your body in a way that means it's well nourished and gently exercised and emotionally sound.
Dr Rupy: I think that's a really good way to round up this pod. And thank you so much for coming. Honestly, and sharing your insights. We can find you at.
Dr Elsa Lumsden: I'm at Dr_Elsa, which is A I L S A. Ailsa. Everyone says Elsa. I'm not the Frozen princess.
Dr Rupy: You're not the Frozen princess. I wish.
Dr Elsa Lumsden: I wish.
Dr Rupy: That was a fantastic conversation I had with Dr Elsa, who is an amazing physician. She is super, super passionate about the subject. And I love her perspective, particularly when it comes to making sure we're not burdening patients with the guilt of having to live the most perfect lifestyle as possible to try and improve their condition. I think that's something that's a really, really important take home point. Now, to summarise our conversation, which was very varied, I would suggest a nutrient dense diet. That is getting all the different colours of the rainbow as much as possible because they have things like polyphenols, the different sorts of micronutrients that we all need to improve the functioning of our body. And remember, there are so many intricate mechanisms that our body has to protect us. It's really important to maintain sight of that. Greens are fantastic. Now, we kept on going on about broccoli, but there are loads of different types of greens that you can get into your diet. There's Brussels sprouts, there's rocket, and these are particularly interesting because there is some evidence looking at the constituents, the chemical components of these and why these have anti-cancer effects. They are delicious if cooked in the right way. And one of my recipes that I think conjures up all the different things that we've talked about is the chestnut, broccoli and peas that I actually have for breakfast. And I encourage people to experiment with different greens at breakfast time as well. We talked about low sugar. Now, in a Western diet, we have a lot of refined processed foods that is very high in sugar. Sugar isn't the devil. It is not something that we need to radically remove from our diets, but certainly most people would benefit from reducing the number of added sugars in our foods. Lifestyle is super important. Elsa is a really big fan of exercise in prevention as well as management of cancer, but also things like yoga, stress relieving techniques and even meditation can be beneficial from a psychological point of view as well. Make sure you subscribe to the podcast and you listen out for the next one.
