Ian Gawler Blog. Cancer stem cells - what you need to know

Cancer stem cells have been controversial but they may provide an important key in understanding why cancer can recur years after apparently successful initial treatment and point to the need for new treatment approaches.

Obviously this is directly relevant to anyone with cancer, but for those who are well, are lurking cancer stem cells a concern?

So this week, what are cancer stem cells? Where do they come from? What can we do about them? Did you know for instance, that turmeric is one of few things claimed to be able to destroy breast cancer stem cells and as such it make sense for anyone with breast cancer, or concerned about breast cancer, to consume it regularly.

Cancer stem cells are one of the fascinating areas of new research I have been studying, updating and preparing to share with a wider audience during the rapidly approaching speaking tour up the East Coast starting in early July. So more details on that this week too, but first




Thought for the day

If your mind is empty, 
It is always ready for anything; 
It is open to everything. 

In the beginner’s mind there are many possibilities, 
In the expert’s mind there are few.

Suzuki Roshi, Zen master







Given not so many people know about cancer stem cells, this may be a useful blog to share.

There is a mystery in cancer medicine that is not spoken of much, probably because up until recently, no-one really knew the answer. The question is, how is it that cancer can be treated, all sign of it removed, and then years later it recurs? And how can we stop that happening.

To understand we need to consider basic cancer theory. 
As most will know, cancer tends to begin in one location and then, if left unchecked, has a habit of spreading to other places. In the past, the classic way this spread was thought to happen was by cancer cells separating from the initial mass of cancer, and then by them gaining access either to the blood stream or lymphatics and travelling to other parts of the body to re-establish themselves there.

This is why “follow-up” chemotherapy is often recommended after initial surgery – to “mop up” any stray or so-called “rogue cells”. Clearly, however, cancer can lie dormant for years after a first occurrence before appearing again as secondary cancer. How?

What is a stem cell?
Stem cells are precursor or basic cell types. Generally, stem cells are able to develop into many different cell types in the body. When a stem cell multiplies, the resulting cells either continue on as stem cells or, under the right conditions, they can develop into a particular type of cell – muscle, blood, brain, breast etc.

There are two types of stem cells. Embryonic stem cells can make all the different types of cell in the body, while adult stem cells generally can only make the types of cells they directly relate to – so a muscle adult stem cell only leads to muscle cells.

What is a cancer stem cell?

Some cancers are thought to develop from ‘rogue’ faulty stem cells. Cancer stem cells were first
positively identified in 1998. Cancer stem cells share many characteristics with normal stem cells, including self-renewal and differentiation and while hotly debated for years, recent studies have shown that cancer stem cells do have the ability to regenerate new cancers.

For a good general reference paper: Lobo et al. The biology of cancer stem cells.  Annu Rev Dev Biol. 2007;23:675-99. CLICK HERE

Just last month, a team from University of Oxford and the Karolinska Institutet in Sweden, claims to have proven conclusively that cancer stem cells exist.

Why are cancer stem cells important?
If cancer stem cells are as significant as thought, cancer could be eliminated by eliminating cancer stem cells. Targeting cancer stem cells would also mean any cancer cells left over from initial treatments could not sustain themselves.

Dr. Woll, the lead author from the Oxford study says that while the findings are not sufficient to offer patients new treatments today, they do pave the way for developing more effective therapies that target specific stem cells to eliminate cancer.

He also cautions that their study only looked at cancer stem cells in one type of cancer, and that the "identity, number and function of stem cells in other cancers are likely to differ from that."

Reference: Woll P S, et al. Myelodysplastic Syndromes Are Propagated by Rare and Distinct Human Cancer Stem Cells In Vivo. Cancer Cell, DOI: 10.1016/j.ccr.2014.03.036, published online 15 May 2014.

What risks are involved?
Unfortunately, it seems most cancer stem cells are resistant to current cancer treatments. More disturbingly, there is growing evidence that the classic treatments of chemotherapy and radiation actually increase the activity and aggressiveness of breast cancer stem cells – “enrichment” as it is called.

It seems that while chemotherapy may reduce the size and volume of breast cancer, in doing so, it increases the cancer stem cell ratio, making whatever may be left even more malignant.

Reference: Lagadec et al. Radiation-induced reprogramming of breast cancer cells. Stem Cells. 2012 May; 30(5):833-44. doi: 10.1002/stem.1058.

What natural answers are available?
At last some good news! Several herbs and vegetables have been shown in basic research to target breast cancer stem cells specifically.


1. Tumeric and black pepper

Curcumin (in turmeric) and piperine (in black pepper) separately, and in combination, inhibit breast stem cell self-renewal but do not cause toxicity to differentiated cells.

Reference: Kakarala et al. Targeting breast stem cells with the cancer preventive compounds curcumin and piperine. Breast Cancer Res Treat 2010 Aug;122(3):777-85. doi: 10.1007/s10549-009-0612-x. Epub 2009 Nov 7.



2. Cruciferous vegetables (cauli, cabbage broccoli), particularly broccoli sprouts
These vegetables contain high levels of sulforaphane that has been reported to inhibit pancreatic tumour-initiating cells and breast cancer stem cells. The reference here is a particularly good one for those who like the science!

Reference: Li Y et al. Implications of cancer stem cell theory for cancer chemoprevention by natural dietary compounds. J Nutr Biochem. 2011 Sep;22(9):799-806. doi: 10.1016/j.jnutbio.2010.11.001. Epub 2011 Feb 4.

3. Soy – especially the fermented types
Contains genistein which as well as significantly targeting breast cancer cells by promoting apoptosis or cancer cell death, also has been shown to inhibit breast cancer stem cells.

Reference: Fan P et al. Genistein decreases the breast cancer stem-like cell population through Hedgehog pathway. Stem Cell Res Ther. 2013 Dec 11;4(6):146. [Epub ahead of print]

4. Resveratrol

Found in the skin of red grapes, dark chocolate and blueberries, reseveratrol significantly suppresses breast cancer stem cells.

Reference: Pandey PR et al. Resveratrol suppresses growth of cancer stem-like cells by inhibiting fatty acid synthase. Breast Cancer Res Treat. 2011 Nov;130(2):387-98. doi: 10.1007/s10549-010-1300-6. Epub 2010 Dec 29.





For a thorough account of recent theory relating to breast cancer stem cells by Velasco-Velazquez et al, CLICK HERE

Many questions remain to be answered about cancer. 
More studies are needed to determine precisely how different cancers grow and how they resist treatment. Do all tumours contain cancer stem cells? What genes, proteins or other molecules are involved in their development and behaviour? Does a cancer’s immediate surroundings, or ‘microenvironment’; do epigenetics affect how cancer stem cells behave? How can we be free of cancer stem cells? Do natural therapies offer real hope?

The answers to these questions will shape future cancer treatment strategies.

NOTICEBOARD
1. Meditation in the Desert  : August 29 – September 7 
Come, join Ruth and myself along with like-minded people for 7 days of meditation in the extraordinary atmosphere of the Central Australian desert, followed by several days of close contact with senior local indigenous leaders.

Secure your place with a deposit. For details CLICK HERE

2. Cancer and Beyond – Last minute opportunity!

This is the 5 day follow up cancer residential program Ruth and I present at the Gawler Foundation’s Yarra Valley centre in just a couple of weeks. This program was fully booked 2 months ago, but some unfortunate last minute cancellations mean you may be able to attend.

Call the Foundation on +61 3 59671730 or see the details on my website, CLICK HERE.

                             Yoga with Ruth - one of the great opportunities of this program

3. IAN’S EAST COAST TOUR 

 HEALTH, HEALING and the MIND – from JULY onwards



Starting in early July Ruth and I will be travelling right up the East Coast to Cairns, across to Mt Isa and Alice Springs, then down to Adelaide. A road trip with a difference, giving talks along the way.


Hope to see many of you along the way. There will be the chance for a refresher, to help get back on
track if needed; but also exciting new information and the opportunity to meditate together and to deepen the experience of what meditation really is.

A good opportunity to share what we do with family, friends and colleagues.


FULL DETAILS – CLICK HERE  and please do share the link.

                                                             
                                                                With Lionel Fifield at the Brisbane Relaxation Centre last year.

                                                               

Ian Gawler Blog: Eating well, Being well – and the new edition of “You Can Conquer Cancer” is released.

What a delight to speak at the Gawler Foundation’s conference this last weekend, presenting dietary guidelines and some of the exciting research linking nutritional changes with increased survival.

Great chance to catch up with old friends like Petrea King and Dr Craig Hassed and to have the honour of sharing the stage with them. Then there was the opportunity to meet up again with people who came to groups in days gone by. People like the lady who had secondary breast cancer 7 years ago and looks radiantly well. When asked what had helped her most, she thought for a moment, then shared the fact of learning to love herself enough to really care about what she ate, how often she meditated and so on. A real confirmation of Jess' guest blog from last week. Her new husband chimed in with how much he admires her capacity to make those choices and stick by them; how diligent she is.

Lots of new people to meet as well and my new edition of “You Can Conquer Cancer” arrived mid morning on the Saturday, hot of the press as they say! That’s synchronicity for you.

I had the opportunity to speak on the therapeutic potential of food – a vast topic!

A key point. Anyone who might be silly enough these days to say there is no evidence that changing your diet can improve cancer outcomes is just not keeping up with the research.

At the conference I shared 17 recent studies that come from the last few years and typify the exciting times we live in as research is making clear the powerful the between what you eat and cancer recovery. For over 30 years my clinical experience has been that food can be used therapeutically in cancer medicine, now we are getting some good confirmation via the research.

In the new edition of “You Can Conquer Cancer”, there are several fully rewritten chapters on cancer and food and nutrition, providing the detail of how to put all this into action; how to convert the theory into a meal.

The new book is just that, virtually a new book given the rewrite has been so thorough. So for anyone dealing with cancer, for anyone keen on not getting cancer, for anyone interested in a comprehensive, healthy lifestyle, the new book is recommended.

As promised here are the research articles linking cancer and nutrition, reproduced via “Out on a Limb”, and the dietary guidelines in summary. Again, the details are in the new book.

1. NUTRITION & LIFESTYLE prevents 40% of breast cancers by
i) Being lean
ii) Exercising 30 mins/day
iii) One alcoholic drink/day - max
iv) Women breastfeeding exclusively for 6mths
                                     Based on 954 studies: AICR & WCRF 2009

2. FOOD & EXERCISE SAVE LIVES
A major review of breast, colorectal, and prostate cancer concluded:
i) Observational studies suggest a low-fat, high-fibre diet might be protective against cancer recurrence and progression.
ii) There is more support for physical activity, with a dose response for better outcomes.
                                     Davies, N J, Br J Cancer, 2011
      More detail:Blog:  Let food be your medicine – 18 & 25/6/2012

3. LIFESTYLE CHANGES AFFECT BREAST CANCER RECURRENCES
i) Healthy weight decreases secondaries by 40 – 50% c.w. being obese.
ii) Seven or more alcoholic drinks per week almost doubles the risk of cancer in the opposite breast.
iii) Smoking & drinking:  increases the risk of cancer in the opposite breast by 7.2 times.

4. META-INFLAMMATION FEEDS DEGENERATIVE DISEASES
Meta-inflammation is low-level, systemic inflammation:
   - A major factor in most chronic degenerative diseases including cancer
   - Modern nutrition is a significant “inducer”
          Egger,G ACNEM Journal, Mar 2012, Vol 31 No 1 P12-14
 Inflammation potentiates active cancers.
 Improve the diet, reduce inflammation, assist recovery.

5. WESTERN DIET is BAD NEWS
High intake of meat, fat, refined grains & sugary desserts is associated with a
3x increase in colon cancer recurrence and death
                 Meyerhardt, JA et al, JAMA 2007;298:754-764

6. LOW CARBS REDUCE RISK of CANCER DEATH
High carbohydrate intake and high glycaemic load is associated with a
2x increase in colon cancer recurrence and death.
But only in the overweight and obese.
             Meyerhardt JA et al, J Natl Cancer Inst Nov 2012

7. Differential Stress Resistance
FASTING
For normal cells – increases protection
For cancer cells – increases vulnerability
Fasting around chemotherapy leads to:  
i) Better outcomes
ii) Less side-effects
                             Lee C, Volgo et al, Sci Trans Med 2012

8. CUT the CAMOUFLAGE, CURE the CANCER
Cancer’s “camouflage” seems to rely on the protein CD47.
Animal trials show anti-bodies to CD47 remove the camouflage, allowing the body’s immune system to recognise and destroy cancer.
                          Wellingham SB et al, Proc Nat Academy Sci, 2012
                          More detail: Blog - 2 April 2012

9. Multivitamins Reduce the Risk of Developing (or Dying) of Cancer
A very large randomized trial over 11 years concluded multivitamins produced:
1. No effect on prostate cancer
2. 12% risk reduction in total for developing all other cancers
3. Also, a 12% reduction in the risk of dying from cancer (not statistically significant)
                                   Gaziano, MJ et al, JAMA Oct 2012

10. Multi-vitamins & Breast Cancer
Another big study concluded:
1. Multivitamins are not harmful
2. Improved outcomes with radiation, or radiation and chemotherapy
3. Consistent multivitamins use before and after diagnosis, eating more fruits and vegetables, as well as being more physically active is associated with better overall survival.

           Kwan ML et al, Breast Ca Res Treat. 2011 Nov;130(1):195-205

11. SOY is Safe for Breast Cancer
This is the conclusion drawn from this extensive review of the available literature
              Messina MJ and Wood CE; Nutrition Journal 2008

12. MILK increases the risk of Prostate Cancer
Higher levels of cow’s milk consumption in boy’s is strongly associated with an increased risk of prostate cancer in men
                              Torfadottir et al; Am J Epidemiol, 2012

13. TELOMERES are protective, DNA—protein complexes at the end of chromosomes.
Telomere shortness is emerging as a powerful indicator of disease risk, progression, and premature mortality in many illnesses, including cancer.

Telomere shortening is counteracted by the cellular enzyme telomerase.

Increased telomerase activity is associated with
      1. Reduced disease risk generally
      2. Increased cancer survival    
      3. A longer, healthier life

There is a statistically significant inverse relationship between telomere length and both cancer incidence and mortality
                     Willeit P et al, JAMA 2010;304 (1): 69–75

14. WHAT INCREASES TELOMERASE ? 
1.  LIFESTYLE PROGRAMS  - LIKE TGF
          After 3 mths, 10% increase
                            Ornish, D et al, 2008,The Lancet Oncology

 2.  LIFESTYLE FACTORS
            HARMFUL EFFECTS  . Smoking
                                                      . Processed meats
                                                      . High BMI – overweight, obese
            HELPFUL EFFECTS    . Vitamins C,D & E, + Folate
                                                       . Omega 3 Fatty Acids
                            Lin j, Epel E, Blackburn E, 2011, Mutation Research

3.  MEDITATION - The Shamatha Project
       After 3 mth intensive retreat, 30% increase
                                            Jacobs TL, Wallace A, Blackburn E et al,
                                                    2010, Psychoneuroimmunology Jnl

4.  SPECIFIC HERBS   –  Product B – a combination of telomerase activating herbs. For details go to iangawler.isagenix.com

15. TUMERIC & PEPPER target breast cancer stem cells
Turmeric (curcumin) and black pepper (piperine) separately, and in combination, inhibit breast cancer stem cell self-renewal
      Kakarala, M et al, 2010, Br Ca Research & Treatment, Vol 122, No 3, 777-785

16. CURCUMIN (turmeric)
Reduces the side-effects and increases the benefits of radiotherapy
                              Jagetia G C; Adv Exp Med Biol, 2007

17. POMEGRANATE JUICE targets Prostate Cancer
8 ozs each day increases PSA doubling time - by almost 4 times : from 15 – 54 mths
                              Pantuck et al. 2006 Clin Ca Research
                              Pantuck et al. Abstract of follow-up Am Soc Clin Onc 2008

DIETARY GUIDELINES
In broad terms: ADOPT a PLANT-BASED, WHOLEFOOD DIET

1. READ the summary of The Wellness Diet

2. STUDY and APPLY the detail in the new edition of “You Can Conquer Cancer”

3. LISTEN to the 2 food CDs

4. ENJOY the recipes in “Eat Well, Be Well”

5. SEEK personal help if needed

6. DELIGHT in the fact, and the tastes of eating well

RESOURCES

1. DOCTORS & INTEGRATIVE MEDICINE
When you need a doctor trained in nutritional medicine, refer to

i) The Australian College of Nutritional Medicine (ACNEM)
   www.acnem.org

ii) The Australasian Integrative Medical Association (AIMA)
   www.aima.net.au

2. You Can Conquer Cancer – buy the new edition online (or over the phone) via the Foundation’s bookshop and support the Foundation – NOTE: check to make sure you order the new edition, not the old one!

3. CDS 
i) Eating Well, Being Well – Outines the Gawler Wellness Diet – the key to good health for everyone.

ii) Eating for Recovery – Outlines the Gawler Healing Diet specifically developed for people dealing with cancer. Please Note: This CD builds upon the information on "Eating Well, Being Well”. For those dealing with cancer, you need both CDs for completeness.

RELATED BLOGS

DNA and the dangly bits

Food 101 – what fuel goes into your tank?

Eating for recovery