Lifestyle Diet Cancer
Professor Robert Thomas
Bedford and Addenbrookes Cambridge University Hospitals
Biological & Exercise Scientist Bedford University
Head of integrative Oncology UCLH
.
Educational & travel grants: Astra Zeneca, Janssen Cilag, Novaritis, Roche, Pfizer, Ciba Naturemedical, Helsinn.
Paid Journalist role
Previous income from book “How to Live”
No financial connection or travel grants:
- YourPhyto
- YourGut Plus
Disclosures
Inform not blame
But did not consider
Gut health & vitamin D
Islami F et al
46%
Prospective Audit 150 patients
RLHIM Prospective service evaluation
Lifestyle dietary integrative information
No information 65 (43%)
Some information 55 (36%)
Wrong information 30 (20%)
Profile of side effects changing
Adjuvant strategies – prognosis
�- Oestrogen levels �- Insulin sensitivity�- Endorphin serotonin�- Telomere length�- Reduced oxidative stress�- Reduced inflammation
Thomas and Stacey BJSM 2018
�- Weight loss�- Vitamin D
- Circadian�- Gut Health
Prehabilitation
After treatments
Thomas and Stacey BJSM 2018
During treatment
The 8-year overall survival:�� - Exercise group 90.3% � - Information only group 83.2% �� (95% CI, 1.8 to 12.3, p<0.02).
Courneya et al N Engl J Med 2025;393:13-25
Chemotherapy induced PN
Kang et al An RCT of surgical gloves to prevent CIPN (AIUR trial). BMC Cancer 23, (2023).
Brunhilde et al The prospective ELEGANT trial, EJC, 229, 202,
Huang et al Exercise & CIPN: a systematic review of RCT. Front Neurol. 2024
El-Najjar et al B12 Deficiency a Risk Ffor CIPN Asian Pac J Cancer Prev. 2025
Exercise
Vitamin B, D and mineral deficiency
Ideal sleep duration (adults)
National Center for Health Statistics: % of adults who reported <6 hr of sleep MMWR Morb Mortal Wkly Rep. 2005;54(37):933
Benbadis, S. R. 1998). "Daytime sleepiness: when is it normal? Cleveland Clinic Journal of Medicine. 65 (10): 543–9
Cancer outcomes and sleep
Palesh et al (2014) sleep disruption predictors survival among women with ca breast Sleep 37: 837–842.
Trudel-Fitzgerald et al. Sleep and survival among women with Ca B : 30 years of follow-up within the Nurses’ Health Study. Br J Cancer 116, 1239–1246 (2017).
Breast cancer patients (N=3682)
- 49% increased risk of all-cause mortality
Over the counter remedies
Antihistamines
Help sleep letancy
Not overall sleep quality
Dry mouth
Agitation
Adversely affect gut health
Kay et al . Impact of sedating antihistamines on safety and productivity. Allergy Asthma Proc. 2001 22(5):281-3
Maier et al. Extensive impact of non-antibiotic drugs on gut bacteria. Nature. 2018 29;555(7698):623-628.
Melatonin
35 randomized controlled trials (RCTs)
2,356 subjects
Foods which help promote a natural circadian rhythm
Costello et al The effectiveness of melatonin for promoting healthy sleep. Nutr J. 2014 7;13:106.
Abbasi B et al. The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. J Res Med Sci. 2012 Dec;17(12):1161-9.
Covid-19 nutritional intervention study The UK Phyto-V study
placebo
30% improvement in sleep
Thomas et al COVID 2022, 2, 433-449.
Product emerging from study
Apigenin (chamomile)
Resveratrol
Citrus bioflavones
Turmeric
Montmorency cherries
Actions:
Muscle relaxant
Elevating mood
Circadian rhythm
Reduces inflammation
Encourages natural melatonin
Placebo
Placebo
200 Non covid participants
Marinac C, JAMA Oncol. 2016;2(8)
Dysbiosis
Micro nutrient def:
Infection
Toxin ingestion
Immunity
Smaller Peyer's Patches
Impaired gut integrity
Immune dysfunction
Excess tissue damage
Inappropriate excess inflammation
Reduced Immunosurveillance
Overload oxidative pathways
Prebiotics
Probiotics
Prebiotic polyphenols Fermentable soluble fibres
Online resources
40% Better response rates
Gong et al Microbiome and immune checkpoint inhibitors Clin Transl Med 2019;8.9
Better response to Immunotherapies�PDL1 inhibitors
Radiotherapy and probiotics
Xia et al. A Phase II Randomized Clinical Probiotics to Prevent rxt
& chemo Oral Mucositis in Nasopharyngeal Carcinoma. Front Immunol. 2021 24;12.
Doppalapudi et al probiotics and oral Candida in H&N rxt: A randomized clinical trial. J Cancer Res Ther. 2020;16(3):470-477.
Delia P, et al Use of probiotics for prevention of radiation-induced diarrhoea. World J Gastroenterol. 2007 14;13(6):912-5.
Li et al. systemic review of probiotics & chemo. 2024 J of Advanced Research 64, 223-5
Masaaki et al RCT neo-adjuvant chemo oesophageal cancer. Clinical Nutrition, 2017 36, 193-9
Juan et al. Probiotics reduce chemo-related cognitive impairment with breast cancer: a randomised, double-blind, and placebo-controlled trial. Eur J Cancer. 2022 ;161:10-22.
Chemotherapy & lactobacillus
Metastatic renal cell - probiotics plus cabozantinib and nivolumab improved clinical outcomes (Ab543).
Bladder - Lactobacillus were found to correlate with better chemo and biological treatment response (Ab768).
Prostate – Phytochemicals, Lactobacillus slowed progression improved symptoms & inflammation (Ab311).
Gut health - cancer axis
Inflammatory cytokines
Oxidative stress
Lower immune surveillance
Activates phytochemicals
Hormone regulation
Vitamin D absorption
Carcinogen influence
Russo. Microbiome & immunity Therapy Adv Gastrol 9:594, 2016.
Pevsner-Fischer. microbiome & cancers. World J Clin Oncol 7:200 2016,
Keep-healthy.com/gut-health�Shahanavaj: Cancer & microbiome: ExpRev Anticancer Ther 15:317 2015
Polycyclic aromatic hydrocarbons (PAH)
Hetero-cyclic amines (HCA)
Vitamin D absorption is improve by co-administration with Lactobacillus probiotics
Vitamin D acts as a prebiotic helping healthy bacterial growth
Yoon et al (2011). Probiotic regulation of vitamin D receptor. Gastroenterology 140
Jones et al (2013). Lactobacillus & Vit D levels: a RCT. J Clin End Metab, 98, 294
Waterhouse et al. Vitamin D & gut microbiome Eur. J. Nutr. 58, 2895
Synergy
Gut bacteria and Vitamin D
Vitamin D
Post radical cancer
Low 25(OH)D lower overall survival.
Jeffery et al JCO 2008
Metastatic ca bowel
Krishnamurthi et al 2013
�
Ca prostate
Gokhale, S., Provitamin D3 modulation through prebiotics. Sci Rep 9, 19267 (2019).
Jones ML, l Supplementation with probiotic lactobacillus increases mean circulating 25-hydroxyvitamin D: a randomized control trial. J Clin Endocrin Meab. 2013.
How best to increase vitamin D levels
Phytochemicals
Phytochemical rich foods Cancer
Fruit, tomatoes, rich herbs spices
HPFS – Giovannucci et al JN Can Instit, 2002
Soy
Meta-analysis - Hwang et al Nutr Cancer 2009
Carotenoid rich foods
National Health & Nutrition Exam Survey. Chaoyang 2011
Cruciferous and other vegetables,
Joseph et al Nutr Cancer 2004. Thomas et 2020 ASCO
Tea
Singapore Health Study and PLCO Thomas et al 2020 ASCO
Strawberries
Slowed Barrett’s oesophagus, Chen Ohio State 2011
Phytoestrogens after cancer
van Die et al, Phytonutrients & outcomes following breast cancer: a systematic review and meta-analysis of studies, JNCI Cancer Spectrum, 8,1, 2024,
Bresat reduced relapse rate
Soy – 28%
Lignans -31%
Green tea – 44%
Prostate
Non fermented
Tofu, soya milk, edamame
Turmeric Breast cancer
Hussaarts et al Impact of Curcumin (with or without Piperine) on the Pharmacokinetics of Tamoxifen. Cancers 2019 Mar 22;11(3):403
The Tokyo Women’s study�Hot flushes, mood and joint pains
Yanagisawa Y et al (2021). �168. DOI: 10.29011/2577-1450.100068
Prospective intervention
Mood rating scale: �15% improvement (p=0.01)
Hot flushes score:
10% less number and) severity (p=0.015.
Joint pain, stiffness, mobility
13% improvement (p=0.01)
Can an intervention to improve strength and gut health improve Ca P outcomes?�
Chief investigator: Professor Robert Thomas Bedford & Addenbrookes Hospitals
Co-Collaborators: Stacey Kenfield, California, Rob Newton Australia, Anita Mehta UCLH
.
Breaks down phytochemicals to bioactive units
- Helps absorption and bioavailability
- Act as prebiotics enhancing healthy bacterial growth
60% men initially accept AS
> 50% drop out by 5 years
- Patient choice
- PSA progression
- MRI progression
70% take supplements
– most no evidence
1. Kinsella N, et al. Factors influencing men's and adherence to AS. Eur Urol. 2018 ;74(3):261
2. Newcomb et al Long-Term Outcomes for AS, JAMA. 2024 Jun 25;331(24):2084
Dietary intervention studies
- The MEAL RCT 1
- The Canary RCT 2
Capsules:
- Increase selected nutrients
- Measured & standardised
- Spread through the day
Parsons et al. The MEAL randomized clinical trial. JAMA. 2020 14;323(2):140-148.
Schenk et al. The Canary Prostate Active Surveillance. Nutr Cancer. 2023;75(4):618
Why use nutraceuticals
Which probiotic
Dempsey E, Lactobacillus for GI Health:Front Immunol. 2022.
Anti
inflammatory
Pro
inflammatory
Non-dairy non-histamine secreting lactobacillus
Standardised:
Higher potency:
Bio-enhancing ginger:
Cranberry:
4 months pre-trial
Baseline
Post trial4 months
Phytochemicals & placebo
Phytochemicals & probiotic
Change in PSA Velocity
0
20
10
-10
PSA % Change
Diff two randomised groups
PRS+P v PRS v PRS+PB Baseline – 13% v 44%
Diff 31% (p<0.0001 CI 21% to 50%)
Phytochemical + probiotic
Diff 44% t-test (p<0.0001)
Phytochemicals alone
Diff 13% t-test (p<0.006)
Urinary symptoms & erectile function
Longevity end points
Li et al. Inflammation and aging. Sig Transduct Target Ther 8, 239 (2023).
Roberts et al. Grip strength and aging 2011 40(4):423.
Barone et al The Role of Testosterone in the Elderly: Int J Mol Sci. 2022 24;23(7):3535.
11% increase
(ANOVA P<0.001)
6.6% increase
(ANOVA P<0.001)
Improvements in Grip Strength
Baseline
4 Months
40
30
20
Kg
The odds of GS improving 11.8% greater in PRS+PB v PRS+P. (P= 0.002, OR 1.11, 95%CI 1.04–1.20)
Pipeline research trials
Radhi Thomas & de Moor, A Systematic Review of the Biological Effects of Cordyceps Molecules 2021, 26, 5886.
Medicinal mushrooms
Pipeline and ongoing integrative trials
Side effects
Anti-body titres
+/-
+/-
Menopausal symptoms
+/-
Sleep
quality
Time to progresion
+/-
Stephen Paget
“Researchers should look more to the soil which allows disease to grow rather than the seed itself”
The Lancet 1898
Seed and Soil hypothesis
Cure yourself, with the light of the sun and the rays of the moon. �With the sound of the river and the waterfall.�With the swaying of the sea and the fluttering of birds.
Heal yourself, with the mint and mint leaves, with neem and eucalyptus.
Sweeten yourself with lavender, rosemary, and chamomile.
Hug yourself with the cocoa bean and a touch of cinnamon.�Put love in tea instead of sugar and take it looking at the stars.
Heal yourself, with the kisses that the wind gives you and the hugs of the rain.
Get strong with bare feet on the ground and with everything that is born from it.
Get smarter every day by listening to your intuition, looking at the world with the eye of your forehead.
Jump, dance, sing, so that you live happier.
Heal yourself, with beautiful love, and always remember… you are the medicine.
María Sabina Magdalena García
Mazatec spiritual healer
1894 Mexico.
Further information
Newsletter:
Keep-healthy.com
Youtube: @ProfThomasMD
Email: Robert.thomas24@nhs.net