Gut Microbiome Diversity
The Issue
Dysbiosis
Common symptoms of dysbiosis include diarrhea, digestive problems, trouble urinating, acid reflux, vaginal or rectal infections itching, and inflammation.
Genova and Viome offer gut microbiome tests. The Genova test is highly recommended but also more expensive. I used it and received their comprehensive, color-coded, 12-page report. I encourage everyone to get a base line report and get it rechecked as needed—especially if you’ve had disease progression.
It’s important for all cancer patients to understand the health of their microbiome because it can have a big impact on cancer outcomes, AND importantly, you can do something to fix it.
Dysbiosis increases cancer risk, cancer progression, and metastasis. It’s a condition that occurs when the gut bacteria become imbalanced — you may have too many or too few of specific types of microbes. In general, patients with more diverse microbes have stronger immune systems and better prognosis.
Many people, but especially cancer patients, suffer from dysbiosis. Chemotherapy, in particular, can damage healthy cells in the lining of the digestive system, killing off important microbes and causing dysbiosis. Antibiotics can also wreak havoc on the gut microbiome, so it’s not surprising that antibiotics have been linked with poorer overall survival of cancer patients in many research studies.
The Strategy
30 different
fruits & vegetables per week
A super simple step towards avoiding or fixing dysbiosis is to eat 30 different types of fruits and vegetables a week.
I put a whole bunch of different veggies in a smoothie because it’s an easy way to boost my numbers. I also make big salads with a little of everything (pumpkin seeds, bok choy, kohlrabi, kale, etc.). Before cancer, I had never eaten kohlrabi or many other vegetables. This strategy made me more food adventurous. I didn’t like everything I tried, but I do like a lot of new things. Eat raw when possible, except mushrooms which should always be cooked, and buy organic to avoid toxins.
By improving the diversity of our diets, we can improve the the diversity of our gut microbiome.
A diverse gut microbiome promotes gut microbiome health and helps eliminate dysbiosis.
A healthy gut improves cancer outcomes; especially when treated with immunotherapy.
Don’t give up. If your body isn’t used to eating a lot of fruits and veggies, you may feel more gut discomfort before it gets better.
There is early evidence that a healthy gut microbiome can improve cancer outcomes, especially if the patient is utilizing immunotherapy drugs.
MD Anderson research findings reported in 2022 were the first to identify gut microbiome associations with immunotherapy response.
“Immunotherapy has had limited success so far against glioblastoma, the most common and aggressive form of brain cancer. A new study demonstrated that distinct gut microbiome signatures were present in patients with longer versus shorter survival following treatment with immune checkpoint inhibitors.” Link to abstract
Further analysis was done using other clinical trial data and MD Anderson found a link between gut microbiome signatures, immune cells in the tumor microenvironment and immune checkpoint blockade response in melanoma, non-small cell lung cancer (NSCLC) and sarcoma. Specifically, they found that high levels of Ruminococcus were associated with better response to treatment across cancer types. Link to abstract
MITIGATE NEGATIVE ANTIBIOTIC EFFECTS WITH A HEALTHY BIOME
“Strong evidence is emerging to support the effects of the gut microbiome on the development of some malignancies but also on responses to cancer therapies, most notably, immune checkpoint inhibition. Tools for manipulating the gut microbiome including dietary modification, probiotics and faecal microbiota transfer (FMT) are in development.”
Link: “The gut microbiome: what the oncologist ought to know.” British Journal of Cancer, July 2021.
INCREASED RISKS ASSOCIATED WITH ANTIBIOTICS
While the study below focuses on one cancer subtype, there is a substantial amount of data suggesting that antibiotic use creates an increased risk across a wide array of cancer types.
“Women with triple negative breast cancer who received multiple antibiotic prescriptions within three years after their cancer diagnosis were more likely to experience disease recurrence and to die from their cancer than those who took fewer courses of the drugs, according to a study by researchers at Stanford Medicine.”
“Each additional antibiotic increased the risk of death between 5% and 18% relative to patients who weren’t prescribed antibiotics,” said Julia Ransohoff, MD, a fellow in hematology and medical oncology at the Stanford School of Medicine. “
“While other studies have suggested that the gut microbiome is different in cancer patients who do poorly versus those who do well, few have evaluated the upstream choices that patients and doctors can make to affect the microbiome,” (Dr. Ami) Bhatt said. “This study helps connect some of the dots — finding that antibiotic use is linked to lower numbers of a type of circulating immune cell important to fight cancer. We still don’t know if the microbiome is the critical connecting factor between antibiotic use and cancer outcomes, but we suspect that it may be a key player.”
Link to article: Stanford Medicine. (2023, April).
Link to study: Nature Communications. (2023, April).
The Evidence
Research continues to show that there is therapeutic utility in altering the gut microbiome through diet
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The GM has been linked to the development of a number of predominantly gastrointestinal and hepatobiliary malignancies including oesophageal [24], liver [25], pancreatic [26] and, most notably, colorectal cancer (CRC).
Once established, the composition of the gut microbiota is relatively stable throughout the adult life but can be altered as a result of bacterial infections, antibiotic treatment, smoking, disease states, medical and surgical interventions and long-term dietary changes [2].
The normal gut microbiota imparts specific function in host nutrient metabolism, xenobiotic and drug metabolism, maintenance of structural integrity of the gut mucosal barrier, immunomodulation and protection against pathogens.
Strong evidence is emerging to support the effects of the GM on the development of some malignancies but also on responses to cancer therapies, most notably, immune checkpoint inhibition.
Tools for manipulating the GM including dietary modification, probiotics and faecal microbiota transfer (FMT) are in development.
Read more here
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“The microbiota is emerging as a key player in cancer due to its involvement in several host physiological functions, including digestion, development of the immune system, and modulation of endocrine function. Moreover, its participation in the efficacy of anticancer treatments has been well described. For instance, the involvement of the breast microbiota in breast cancer (BC) development and progression has gained ground in the past several years. In this review, we report and discuss new findings on the impact of the gut and breast microbiota on BC, focusing on the HER2+ BC subtype, and the possibility of defining microbial signatures that are associated with disease aggressiveness, treatment response, and therapy toxicity. We also discuss novel insights into the mechanisms through which microorganism-host interactions occur and the possibility of microbiota editing in the prevention and treatment optimization of BC.”
Read more here
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This research confirms the findings from earlier MD Anderson work.
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“Recent studies have suggested that the intestinal microbiome plays an important role in modulating risk of several chronic diseases, including inflammatory bowel disease, obesity, type 2 diabetes, cardiovascular disease, and cancer. At the same time, it is now understood that diet plays a significant role in shaping the microbiome, with experiments showing that dietary alterations can induce large, temporary microbial shifts within 24 h. Given this association, there may be significant therapeutic utility in altering microbial composition through diet. This review systematically evaluates current data regarding the effects of several common dietary components on intestinal microbiota. We show that consumption of particular types of food produces predictable shifts in existing host bacterial genera. Furthermore, the identity of these bacteria affects host immune and metabolic parameters, with broad implications for human health. “
Who might benefit?
Everyone can benefit from this strategy but there is research indicating patients treated with immunotherapies, especially immune checkpoint inhibitors, can have significantly better results for progression free survival and overall survival with a healthier gut microbiome.
Cancers often treated with immunotherapies: Glioblastoma, Melanoma, Non-small cell lung
Breast cancer (all subtypes)
All other cancers
I
I HATE anti-cancer cookbooks.
They overwhelm me. Flipping through endless recipes didn’t help me find health; it only made me stressed. I kept thinking about all the time and money it was going to take to cook a weeks worth of recipes. I get stressed now just thinking about it.
When I found the research indicating the simple strategy of eating 30 different fruits and vegetables a week, it was liberating. I could do that. I could shop and not worry that I would be missing the one ingredient essential for dinner that evening. If I’m pressed for time, I just heap a bunch of the vegetables on my plate and that’s dinner. Over time, I found that I could become more creative by throwing ingredients into Google to get a recipe idea. It’s like a reverse cookbook… plug in what you have to eat and get ideas on how to make those items yummy. That’s WAY more efficient.
Try visiting Cookie and Kate. It has a search bar so you can search for recipes based on your ingredients. Delicious and simple.