Nutrition can play a fundamental role in an oncological process. Firstly, in preventing the disease, because a diet rich in vegetables and free of highly processed foods and red meat, for example, is healthier and eliminates the specter of cancer risk factors such as obesity or diabetes. But the role of nutrition in patients with an already diagnosed tumor is also becoming increasingly important: adequate nutrition alone does not cure the disease, but can help optimize treatments and avoid toxicities, says Miguel Quintela, director of the cancer program. National Cancer Research Center (CNIO) Clinical Research.
The doctor (A Coruña, 47 years old), who is also an oncologist at the 12 de Octubre Hospital in Madrid and lives between the consultation and the laboratory, defends the potential of proper nutrition as another weapon in the therapeutic arsenal against cancer. In fact, the company has just launched a personalized oncology nutrition spin-off, TNCterapia, to offer diets tailored to the needs of patients: the company has collected all the available scientific knowledge and, using an algorithm that analyzes the patient’s condition individually, Determining their condition, the type of tumor, the stage and treatment they are receiving, and other variables, they create nutritional guidelines that their nutritionists translate into a 15-day, two-course, dessert menu. “We deprive the tumor of vital nutrients, give the tumor toxic nutrients and change the microbiome [el ecosistema de microbios que puebla el organismo] to positively modulate the immune system. “With the therapy, we contribute to the treatment of the tumor: to improve effectiveness and reduce toxicities,” he summarizes.
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The scientific evidence regarding the potential of nutrition to mediate the oncological process is becoming increasingly robust, the scientist emphasizes, although there is still a lot of scope to implement all the findings from scientific studies into clinical practice.
Questions. How does your diet affect an oncological process?
Answer. The Western world’s environment makes us more susceptible to the development of cancer. When it comes to diet, it appears that the incidence of all typical cancers doubles in the cancer-prone environment of developed countries. Partly due to obesity, also because they destroy the microbiome, because they carry a greater hormonal burden, because they are more anti-inflammatory… [El impacto] The treatment is less quantified because the evolution of the tumor and the pharmacological part are so important that the extent will be seen if, instead of randomizing one drug against another, we randomize patients with a free diet or a targeted diet accordingly of this type of factors. What I said. All of this is highly quantified in animal models and it seems that the effectiveness is doubled and in some studies carried out with diets similar to fasting, very high survival rates emerge.
Q What foods are the least harmful for an oncological process?
R. In general, you should try to eat as vegetarian a diet as possible. This does not mean that we suppress protein intake, because there are plant foods that are very rich in protein, such as nuts or legumes. It is also very important to consume fiber and fermented foods. Without animal nutrition, we avoid a number of hormonal disorders and factors disrupting the activity of the immune system, which alter the global response against the tumor, as well as a number of chemical compounds produced during digestion that disorient the immune system. By avoiding processed foods, we avoid administering fructose [un tipo de azúcar], which feeds the tumor, so to speak. And the problem with fiber and fermented foods is that they cause specific changes in the microbiome that have a hugely positive impact on boosting the type of immune response we want.
Q What goal can be achieved by modulating nutrition?
R. It is already clear that the fasting-like diet significantly reduces the toxicity of the treatment and that is crucial and needs to be implemented, but there are other things that can be done. There are fewer published data, but in cases of melanoma with microbiome restoration, a good response has been seen in some patients and time will tell whether they are cured or not. Unlike some new drugs that are already known to be toxic in Phase I trials, here we start with the certainty that we will do no harm. Some aspects have already been quantified, but all together, when, until when and for whom are questions that we want to clarify with concrete clinical studies. Every day we will have more answers.
By avoiding processed foods, we avoid administering fructose [un tipo de azúcar]that feeds the tumor, so to speak.”
Q What is the hypothesis? How far can your potential go?
R. The overall goal is to improve efficacy and reduce toxicity. And when we talk about improving effectiveness, we may mean optimizing and achieving the maximum effectiveness that this therapy can offer, because sometimes we nullify the effectiveness of a treatment. [contra el cáncer] due to a poor diet. Poor nutrition can reduce effectiveness, either due to impairment of the absorption of the drug into its metabolism, due to the administration of toxic nutrients and also because, in the event of severe toxicity, the dose that the patient receives ends up being reduced or interrupted. Therefore, if we optimize the intake of the drug, reducing its toxicity and compromising its action through optimal nutrition, we can achieve the maximum that this therapy can offer.
Q What restrictions are there?
R. There are things that are impossible, things that have been demonstrated in animals that are unheard of, but that would not be possible in patients. For example, there are studies that show that a diet without serine and methionine can do the trick [dos tipos de aminoácidos] It is extremely therapeutic: there is a study where they removed serine and methionine from mice and the tumors disappeared, but the animal died because methionine is an essential amino acid and serine is semi-essential and there is an amount that is below that , which is the case is not compatible with life.
Q But can diet help change the prognosis of the disease?
R. The evidence suggests this, and we want to expand on it. Some maneuvers, either by reducing toxicity or increasing efficacy, appear to improve disease progression.
Miguel Quintela, director of the clinical research program of the Oncology Research Center (CNIO), at the headquarters in Madrid. Samuel Sanchez
Q The strategy, he says, is to deprive the tumor of vital nutrients and supply it with other toxins. How do tumor cells behave?
R. When you introduce fructose into the body, it becomes its most addictive nutrient: the tumor can use it faster and more efficiently than normal cells for which it has no use. Excess serine provides further food for the tumor: serine, which is found in red meat or liver, is extremely useful for the tumor to create other molecular structures.
Q And what is toxic to a tumor cell? What is your poison or weakness?
R. Speaking of sugar, there is a sugar called mannose that is metabolized normally in normal cells, but stops and blocks glycolysis in some tumors with certain mutations. [reacciones químicas que degradan el azúcar para obtener energía]. But here we have to think carefully and see whether the patient is diabetic or not and we can give him a source of mannose or we have to see if he is on immunotherapy because mannose can affect the immune system. That’s why we call it precision therapeutic nutrition. Each patient is a specific case.
Poor nutrition can impair effectiveness, either by interfering with the absorption of the drug into its metabolism or by administering toxic nutrients.”
Q Fasting-like diets are controversial in the scientific community due to the limited evidence available, which is more robust in animal models. What happens at the molecular level when intake is restricted?
R. A normal cell has two states: proliferative, growth; and that of protection and repair. This is influenced by many things, but one of them is the availability of nutrients. When energy-producing nutrients fall below normal, a normal cell enters a state of rest and repair, stops reproducing and growing, and begins a process of autophagy, which, among other things, allows damaged structures to regenerate and repair DNA. What does it do in the tumor cell? It is insensitive to this process and continues to reproduce despite the disappearance of nutrients. And because of this addiction to reproduction, even if there is a lack of nutrients, the tumor cell can die after a certain time. So many of the therapeutics that we use in oncology are directed against the replication process itself, and when you take an agent of this type, it damages your tumor cells and your healthy cells. But because we have induced this state of cellular quiescence through nutrient restrictions, healthy cells are immune to the treatment you administer. This means you have increased effectiveness on the one hand and protected good cells from toxicity on the other.
Q After reading this interview, some patients may think that their cancer process might go better if they cut sugar out of their diet, follow their own diet, or start intermittent fasting. What would I tell them?
R. The recommendation is that no one does anything alone. Likewise, you cannot prescribe cancer treatment yourself.
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