effects of mind–body interventions, practices such as deep breathing, transcendental meditation or simple walks in nature are a no-brainer for me to advise. I was pleased to read a paper about the positive effect of walking in nature, specifically on cells of the immune system.158 So perhaps the most immune-system-enhancing of activities could be a yoga session in a park followed by deep breathing in natural sunlight. And this brings me nicely onto the subject of vitamin D.
+ Vitamin D More than a vitamin, vitamin D acts as a master hormone that regulates a multitude of genes involved in a huge number of processes. Beyond its well-recognised involvement in bone health and calcium regulation, vitamin D has a very important role in immune health.159, 160 In both the initial ‘innate’ response to infections and the more specific ‘adaptive’ responses, scientists are researching the role of vitamin D and its importance to auto-immune conditions. There are very few sources of vitamin D in the diet and thus medical practitioners in the UK have taken to recommending vitamin D for the whole population during winter months and for those with darker skin colours. The best advice is to get adequate sun exposure outdoors, have regular tests by your GP if you’re at risk and take a supplement during the darker months of September to March in the UK.
+ Sleep deprivation It will come as no surprise to many people that sleep deprivation drastically lowers a person’s immunity. Your immune system is very likely to be regulated by routine and the sleep–wake cycles which influence all other cells in your body operating on a rough 24-hour cycle.161 This is why sleep is integral to a healthy immune system. As a GP, I’ve lost count of the number of people turning up on a Monday suffering acute tonsillitis directly attributable to late nights at the weekend or travel. But this is just the tip of the iceberg. Persistent sleep loss significantly disrupts your immune system, increasing inflammation which drastically raises the risk of chronic illnesses like heart disease, Type 2 diabetes and even cancer. As you can probably appreciate by now, these are all conditions related to an ill-performing immune system. Achieving 7–9 hours of sleep a night could be considered one of the most potent therapies for improving ones’ immune system and it’s definitely on my prescription pad.
To sum up diet and lifestyle strategies to improve immune health we simply need to remember a few facts: gut health is exceptionally important; there are well-recognised detrimental effects of a western diet on immune health162 (high in sugar, refined carbohydrates, low in fibre and lacking in micronutrients); certain micronutrients are critical for the adequate functioning of our immune cells; and the importance of supporting our mitochondria cannot be underestimated. Although this may sound complicated, the reality is that these additions to your diet and routine are accessible and straightforward. I’m confident that it is achievable for you as it is for many of my patients and my recipes will set you on the right path.
This was by far the most difficult chapter to write. Not least because it is a complicated topic to tackle, but also because it is an emotive subject matter and therefore the most controversial. However, I believe it is our responsibility as medical professionals to educate ourselves, appreciate the wealth of literature surrounding this complicated topic and share it responsibly with the public.
Our understanding of cancer biology is continually evolving and the deeper one goes into the literature, the more complex the systems that underpin this life-changing disease appear to be. Cancer can be loosely defined as a series of mutations that have spun out of control, leading to uncontrollable growth of cells. It’s really an umbrella term to describe lots of different types of cancers that can be caused by different things (like bacteria, viruses or UV radiation) and affect different parts of the body. Some cancers are the result of inherited genes, but most of them occur as we age and acquire more mutations. The processes that prevent these mutations from developing into cancer become less reliable with age, which is why we see most cancers in patients over 50.
Apart from the classic ‘eat a balanced diet’ advice, we, the medical profession, have traditionally been reluctant to delve into meaningful discussions about the role of food and lifestyle as chemopreventative. A chemopreventative is a natural or synthetic substance that reduces the risk of cancer (examples included drugs like Tamoxifen to prevent certain types of breast cancer163), but food is generally not accepted as one. The argument against labelling food as potentially cancer protective is that there are simply not enough clinical trials yielding irrefutable, large-scale evidence. But considering how much we already know about the impact of diet and lifestyle, I sincerely hope this will change.
The lack of dialogue has created a vacuum of information that has, on occasion, been willingly filled by unqualified health commentators who have led people astray. It is this taint that continues to mark cancer and nutrition as a taboo subject. But it is time to redress the balance and normalise the conversation around food and cancer. In my opinion, it is simply inexcusable to say ‘nutrition has no role in cancer prevention or management’. This chapter is by no means comprehensive, but it should give you an idea of why I’m so passionate about this subject matter and the need for more robust nutrition and lifestyle advice within the field of oncology.
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