November 7, 2024 • 40 mins
Join us for an enlightening conversation with Carla Wrenn as she explores the critical intersection of gut health and oncology care. Drawing from her extensive clinical experience, Carla shares powerful insights into how practitioners can support oncology patients through evidence-based microbiome interventions.
From groundbreaking research on microbiome patterns in cancer screening to practical strategies for managing treatment side effects, this episode offers valuable guidance for healthcare practitioners working with cancer patients. Carla's thoughtful discussion bridges the gap between conventional cancer treatments and integrative support, emphasizing safety, efficacy, and patient well-being.
Key Episode Highlights:
- The emerging role of microbiome patterns in cancer detection and treatment, with specific bacterial signatures potentially serving as future screening tools.
- Critical safety guidelines for probiotic use in cancer care, including essential monitoring protocols for neutropenic patients and those with PICC lines.
- Practical strategies for supporting four distinct patient groups: newly diagnosed, post-treatment, end-stage, and those seeking preventive care.
- Evidence-based interventions for managing treatment side effects, including innovative approaches like glutamine supplementation and coffee/honey rinses for oral complications.
- The surprising connection between oral health and cancer outcomes, particularly in breast cancer, highlighting the importance of dental care during treatment.
- How proper microbiome support may enhance conventional treatment efficacy, with insights into implementing integrative strategies that align with current research.
This episode is essential listening for practitioners seeking to enhance their oncology support protocols through evidence-based integrative approaches.
Shownotes and references are available on the Designs for Health website
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DISCLAIMER: The Information provided in the Wellness by Designs podcast is for educational purposes only; the information presented is not intended to be used as medical advice; please seek the advice of a qualified healthcare professional if what you have heard here today raises questions or concerns relating to your health
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:20):
This is Wellness by Designs, and I'm your host,
andrew Whitfield-Cook, andjoining us today is Carla Wren.
Carla has her own holisticassessment approach, called
Vitae Mosaic, to provide eachperson with an individualised
and integrative treatmentstrategy, and today we're going
to be talking about gut healthin oncology.
Welcome to Wellness by Designs,carla, and thank you so much
(00:42):
for your time.
Speaker 2 (00:44):
Thank you for having me.
Speaker 1 (00:46):
It's my pleasure.
It's been a long time between,do I say drinks.
Anyway, Carla, gut health issuch a huge brushstroke.
Where do we start with thiswhen we're dealing with a
patient who has an oncologydiagnosis?
Speaker 2 (01:06):
Yeah.
So my area of practice has beenaround supporting patients who
have been diagnosed with cancerto help their whole health and
their healing.
Lots of patients come to me andsay what else can I do while
I'm doing the treatment or aftermy treatment has finished?
And so, while I didn'tinitially set out to work in the
gut health space, more and moreresearch is coming out that
(01:28):
really enforces the idea of weneed to look at the microbiome
of patients with a cancerdiagnosis During the diagnosis
stage, when treatment ishappening, perhaps especially
afterwards and maybe evenbeforehand, to reduce the risk
of some diagnosis.
And I've just really beeninspired by the volumes of
researchers available and how wecan start to use them in
(01:50):
practice, because we knowgenerally not in all cases, but
generally a probiotic is areally safe intervention for
people with what looks likereally great outcomes from the
research that's starting to comeout.
Speaker 1 (02:04):
Well, let's talk about that aspect that you
mentioned there straight off theback safety.
So, firstly, we're not talkingabout treating cancer with gut
health things.
We're talking about supportingthe patient who has their own
treatment regimen.
We're just making sure thatthey're healthy so that they're
healthy enough to withstand thattreatment regimen.
(02:24):
That's exactly right.
And the other point I was goingto say is we might as well
bring it up now instead of laterwith red flags, and that is
that you know it's very rare inthe research where you get an
issue with a probiotic.
Can you cover those juststraight off the bat so that
(02:45):
we've got them out of the way?
Speaker 2 (02:47):
Yeah, perfect.
So I guess with the issue withthe probiotic, let's talk about
that first, because often whenpeople hear me talk they get
into a big panic because wedon't always want to use a
probiotic in oncology and thatreally fits around when a
patient is perhaps at risk ofneutropenia.
(03:17):
So if a treatment they're oncertain chemotherapies will
cause the patient to experiencea low white cell count or more
specifically, neutropenia, whichis a low number of neutrophils,
and so if your treatment isgoing to give you neutropenia,
you usually might have seen thatas a kind of side effect of the
treatment.
You usually might have seenthat as a kind of side effect of
the treatment.
But regular bloods are normallydone through this process and
patients when they're told aneutropenic they definitely
don't want to be on probiotics.
It kind of comes back tosomething I always try and say
get professional advice ifyou're on a whole lot of
(03:38):
medications to make sure anysupplements you take it doesn't
have to be a probiotic.
Any supplement is safe.
But people like myself who aretrained to support patients with
complementary medicines knowthe guidelines.
It's loosely around if yourneutrophils are under one or
your white cell count is under2.5, we don't prescribe
probiotics.
Speaker 1 (04:00):
What about things like, for instance it's noted in
the literature Saccharomycesboulardii, where somebody's got
a PICC line or a central lineand the well-meaning nurse doses
them with Saccharomyces?
Continue from there, carla,because I can see you smiling.
Yeah, 100%.
Speaker 2 (04:17):
Yeah, definitely.
No one ever knows thatinformation, so I love that you
know that.
Yes, well, there's been acouple of cases where and
remember, it's just a few cases,but where people have given
themselves sepsis or have beengiven sepsis by Saccharomyces
boulardii is one that I wouldvery infrequently prescribe in
(04:46):
oncology patients.
But just talking about thehygiene of managing the capsules
as well, wash your hands.
If you have a peak line, don'ttouch it when you haven't washed
your hands, whether or notyou've used supplements.
And Saccharomyces boulardii isprobably at the bottom of my
probiotic list in terms of whatI would use to treat patients
during an active treatment phase.
Speaker 1 (05:08):
Okay, cool, so take us through some of the issues
that patients experience then.
Speaker 2 (05:15):
With the probiotics.
Speaker 1 (05:17):
Sorry, forgive me during their oncology journey.
Speaker 2 (05:22):
Yeah, perfect.
So I guess we could take a stepback even before that, and I
think one of the interestingthings to mention, just for
future information that will becoming out, is they're really
starting to see such strongpatterns in the species that
have been discovered in peoplewith particular cancers.
A lot of research is done onthe colorectal cancer space that
patients are even starting tobe able to potentially use
(05:43):
microbiome patterning todetermine what cancers they
might be experiencing, almostlike a screening tool.
So maybe we'll be sitting herein 10 years time or longer
thinking, okay, we're going togo and get our fecal occult
blood test, which is thestandard test to look for maybe
risk of colorectal cancer, and amicrobiome test that says we're
high in a few key species thatare common in colorectal cancer.
(06:06):
So therefore we definitelyshould have further
investigation.
So I love that idea and howthat's starting to develop.
For lots of cancer typesovarian cancer, bladder cancers
they're all starting to seethese microbiome mappings for
risk and maybe screening forthese cancers.
But the next thing I see in mypatients is coming with one of
two things they want to dosomething to improve their
(06:27):
health themselves, they want toknow what they can do.
And then we think about okay,what are these integrative
strategies that we can pull into help support the patient as
they go through their treatment,with their whole health, and
probiotics fit really well there.
And then I also think we see alot of patients coming in with
side effects.
So they'll come in and they'llsay I just can't cope with my
diarrhea or constipation, as anexample.
Fatigue is another reallycommon symptoms that patient
(06:50):
will come in while they'reundergoing treatment and there's
research to suggest that insome of those instances of
course particularly withconstipation and diarrhea, also
with oral mucositis symptoms anda number of other symptoms that
probiotics would be a reallysafe intervention, even after
surgery.
There's some really greatresults that show that if we use
(07:11):
probiotics seeded after surgeryfor colorectal cancer, the
patient has far lesscomplications with surgery and a
greater recovery from thatsurgery.
Speaker 1 (07:22):
Are there any specific species?
Or we could go into strains ifyou want to, because I know that
everybody's thinking about onestrain in particular.
But can we go into certainspecies, strains that you use,
that feel comfortable and that'sevidence-led?
Speaker 2 (07:38):
Yes, look, I think the first step I would say is,
before I even look at speciesand strains, is I'm thinking
about what prebiotic fibers Ican bring in because there is no
risk in that prebiotic fiberspace.
So I think sometimes, ratherthan jumping straight to the
probiotic, I'm trying to changethe environment and feed
(07:58):
whatever's there before I maybedo a more risky is the wrong
word, but a more interventionalstep of introducing a probiotic,
particularly in their earlystage of treatment.
So I always talk to everyoncology patient about trying to
get variety and diversity intheir food, so aiming for 40
plant foods a week and I showthem easy ways to do that and
say how important that is forthe microbiome and that kind of
(08:20):
blows people's minds becauseit's an exciting thing Like
normally we have a reputation asan industry of telling people
what they can't eat.
So it's really exciting to sayto them OK, I want you to go to
the green grocer and buy all theweird fruit or all the
different vegetables and reallytry and eat the rainbow and get
more plants in.
And so I talk to them aboutherbs and spices and legumes and
(08:41):
nuts and seeds and how all ofthese can be really helpful for
their microbiome herbs andspices and legumes and nuts and
seeds and how all these can bereally helpful for their
microbiome.
And then, particularly ifthey're constipated or if
they're having trouble withtheir bowel motions and the
health of them, I try and getsome probiotic fiber in, and so
for some people that's enough ofan intervention.
Certainly from there I would beguided most in most cases by
doing some stool testing.
(09:02):
And I actually have a colleaguein my practice here at Peninsula
Herbal Dispensary, amy Castle,who's a naturopath that has the
certified gut training.
She's done a lot of extra guttraining with people like Jason
Holbrook and also Moira, so shewill see a lot of my patients
when it starts to get a bit morecomplex because, you would know
, the gut is exploding overallin all this amazing information,
(09:25):
and so I will usually then getsome testing done.
But at that point we'll thendecide what kind of strains and
I'm looking at LGG as a numberone one to think about.
But you know, a good low dosebroad spectrum probiotic is also
safe to use if we just followthose rules of watching what the
white cell count is doing,watching what for neutropenia,
(09:47):
and then using those prebioticfibres and the food fibres as a
basis for the intervention.
Speaker 1 (09:56):
When we're talking about gut health.
Obviously you know stool healthcan vacillate between
constipation to diarrhoeadepending on treatment.
Stool health can vacillatebetween constipation to diarrhea
depending on treatment,depending on anxiety, so many
other things, even tumoureffects, direct tumour effects.
So do you ever favour any sortof prebiotics where, in one dose
(10:17):
it can be, it can help withconstipation and in another dose
it can actually help to bulkstool up to stop diarrhea, for
instance?
Speaker 2 (10:29):
Yes, definitely, and I really try and talk to the
patients and educate them a lotabout what to look for in a
stool and all our differentoptions in terms of how we can
change a stool.
And we still, to this day, havepatients that feel embarrassed
talking about their poos.
But we really try and say, okay, you know, these are things
that you can change, because theother option, unfortunately, is
to take laxatives and betweenthe chemotherapeutic agent that
(10:54):
they're on what they might be onis an anti-nausea which causes
often very terrible constipationand then introducing a whole
variety of laxatives.
Sometimes now they can't leavethe bathroom and so trying to
show them how the differentfibres make a difference.
So we talk about chia seeds andpsyllium husks and flax meal.
We have what we call the oldschool fibre recipe here at the
(11:16):
herbal dispensary, which is evenparts of chia, quinoa and
flaxseed and half a part ofpsyllium husk, and you either
use that dry if you've gotdiarrhea, or soak it overnight
and use it like a little puddingif you've got constipation.
And so we try and teach themhow to bring in these.
Maybe add some stewed apple orgrated apple, different foods,
(11:37):
kiwi fruits, prunes, of course.
So really trying to show themhow they can not have another
drug, and not because I'manti-laxatives at all, but
because maybe it's nice to beable to get some control back
and figure out foods and have anenjoyable way of getting on top
of what could be potentiallyquite difficult bowel problems.
Speaker 1 (11:57):
Yeah, I think any good medico would welcome any
avoidance of polypharmacy ifthey could, as long as the
patient was well looked afterand was healthy.
So let's delve into the use ofprobiotics or bacteria foods.
Can we go through the differentum cancers where different
(12:20):
bacteria was associated witheach?
Speaker 2 (12:22):
I was looking at a couple and I'm amazed at the
stuff that you've pulled up yes,look, I I have started to make
a um chart and it's just at thestart point because I was like
we need to collate this research.
Surely it's been done, but Ihaven't seen it yet.
I have seen some really amazingpapers that show, you know,
across gastrointestinal cancersthese are the kind of issues
(12:44):
we're looking for or acrossfemale reproductive cancers,
these are the species that we'relooking for.
But I am in the process ofputting together my chart that
I've called microbiome andcancer to really try and
pinpoint.
Okay, if I see a patient whohas ovarian cancer, what do I
need to look for or get mycolleague to look for in their
stool test?
So, certainly, um, there areconsistencies and we have to
remember those viruses as well,like epsom bar virus and, uh,
(13:08):
the herpes virus, hepatitis is,you know, they're all there in
those characters that could be,you know, increasing the risk of
certain cancer types.
But from a um, you knowmicrobiome more you know
bacterial species.
Definitely we're seeing lots offusobacterium, um, some Ecoli
issues, you know.
You know mycoplasma issues.
(13:28):
It's really dependent on allthe different cancers seem to
have all different researchcoming up.
But I guess what I'm lovingseeing uh, and of course I'm
referencing my chart because Iwant to be as science-based as
possible is that there is goodconsistency across all the
different research and it's notlike one paper is showing this
and one paper is showing thatit's really quite succinct in
(13:49):
what they're seeing at thisstage.
So I definitely think there isplace for looking at microbiome
for each patient, given theirdiagnosis and trying to figure
out is this something that weshould be addressing to try and
rebalance or rectify what couldbe a disrupted microbiome,
especially in places likebladder cancer and esophageal
(14:10):
cancer, where sometimes thetreatment is quite nasty and
can't be sustained for a longperiod of time, and so any
additional support we can offerthose patients, you know, is
really welcome.
Speaker 1 (14:27):
Can I ask Carla, with regards to this goes for all
bacteria, not just commensals orprobiotics.
When we're looking at asnapshot in a patient who has
cancer let's say breast cancer,because it was really
interesting what came up aboutthere when you're looking at a
(14:50):
snapshot, are we seeing cause oreffect?
Are we seeing this cause?
You've obviously asked yourselfthis question question.
So did it cause the problem oris it there because of the
problem, trying to heal theproblem?
What's your answer?
Speaker 2 (15:06):
like you've obviously thought about, I think it's
both I think it's both and Ithink some of the research has
gone as far as kind of pullingthat out, like the bowel cancer.
There's a really great papercalled gut and the microbiome um
, and it was one of the firstones I saw and it definitely
pulls that apart a little bitand goes okay, in the
pre-cancerous stages we'reseeing this kind of shift in the
(15:28):
microbiome and once a tumordevelops we're seeing this kind
of shift in a microenvironmentand I totally I mean I'm a big
advocate for understanding theterrain of tumor growth, like
the tumor microenvironment, andso I think the ultimate answer
is we don't know.
But if we're seeing bacteria orother species, yeast, parasite,
(15:50):
things that shouldn't be there,I think it's worthwhile focusing
on making a change because Ithink overall it has a positive
effect on the tumormicroenvironment and the person
and that even the oralmicrobiome and its connection to
what's happening in breastcancer tumors is just like
mind-blowing.
So I think if we can start tomake those connections, I have
(16:13):
so many people come into myclinic, particularly in the
breast cancer space, and say youknow, I was really looking
after my health and they're likequite devastated that they've
put all this effort in yet theyhave been diagnosed with the
cancer and I think these are thekind of, you know, oral
microbiome, the kind of thingsthese people aren't knowing
about or aren't thinking aboutthat if they've had an issue
(16:35):
with, you know, hygiene,gingivitis, gum disease.
You know, maybe this is alittle piece of the puzzle that
we're uncovering.
Speaker 1 (16:44):
Okay.
So a patient comes to you.
They might have gingivitis longstanding.
You might think, oh, there'ssomething there.
What do you then do about that?
Obviously, it's not to treat ormanage the breast cancer at all
, but what you're doing isbasically dampening another bird
, another driver of inflammationin their body.
So how do you treat that then?
Speaker 2 (17:07):
Yeah, I think there's lots of amazing information
coming out about the oralmicrobiome and I certainly want
to do this more work in thisspace in the coming years myself
.
But I think knowing the rightprobiotics to take and I think
there is enough evidence tosuggest some probiotic species
can really be put into thatdental probiotic range.
But I also think it comes backto hygiene.
(17:29):
You know I often ask myoncology patients have you been
to the dentist?
And you know, I think it's oneof those things that sometimes
get left by the wayside and youjust realise you haven't been
for a while and suddenly it'sbeen five years or, you know,
three years and people areperhaps not looking after their
health as much as they shouldhave from their oral microbiome
perspective and not knowing theycan do something about it.
(17:51):
So there's a good microbiometesting for the mouth now so we
can start to use that.
I haven't used that in mypractice yet, but definitely if
there's a link between a chronicdisease whether it be a patient
with cancer or some otherautoimmune disease or something,
I definitely think it'simportant for practitioners to
ask that question what is youroral health?
Because I just don't think wehave been doing that enough and
(18:14):
it's and it is a burden that wecan definitely see in the
research for breast cancer andsome other cancers is affecting
I'm not going to say the outcomeof the cancer, but it's having
an impact as a driver to disruptthe microbiome.
That then might be having animpact on the tumour
microenvironment.
Speaker 1 (18:32):
Yeah, I also thought that you know, if somebody's got
longstanding gingivitis, it'sworthwhile addressing, if for no
other reason than to preparetheir oral mucosa for a possible
assault due to the medicine, sothat they're a step ahead
rather than catching up behindthe eight ball with regards to
(18:54):
presenting with mucositis or amore severe mucositis than what
somebody ordinarily would have,because once you can't eat, it's
a really hard thing to comeback from, you know.
So I take your point, you know,of how important that is to
really get right.
Yeah, because if you can't eatyou're on a downward sort of
(19:16):
you're pushing a stone uphill.
Speaker 2 (19:20):
And I think in the microbiome research has come out
.
What really kind of shocked mewhen I first became aware of all
this bulk of research was justno one is discussing this in
australia I can't speak forother places but no one's asking
their patients about um, youknow what is happening to their
(19:42):
um, their oral health aroundthat cancer space, or what has
been their experience of other,maybe microbiome-disrupting
conditions.
Because when a patient comeswith cancer, you know there's so
much to do.
You know you're trying to keepthem well during treatment.
You're trying to think abouthow the research might suggest
we can stop progression.
(20:03):
You're trying to think abouttheir emotional health.
There's dietary changes to bemade, and I think the weight of
the research in microbiome andcancer is really making me think
okay, this needs to be one ofthe first conversations we have,
not the last conversation wehave, which it certainly wasn't
a priority for me until Istarted to read all this
research.
Speaker 1 (20:25):
You also made a really good point before about
anxiety and stress and thingslike that, about how that can
have such an acute effect on themicrobiota and therefore again
lead them down a rocky road ifthey don't really watch
themselves.
So it just paints to me howcritical it is to get, as you
said, a rainbow of foods and getthem eating all of the really
(20:46):
weird fruits and stuff like that.
So take us through a patientpicture here.
How do patients present to you?
Do they present late whenthey're already really sick, or
do they present early to say,listen, I've been given this
diagnosis and I want to makesure I'm in tip-top condition
for what's ahead of me.
Speaker 2 (21:05):
Yeah, I get four different types of patients.
The first one is the mostcommon and that's really when
they come in that early stage,you know, they're in that stage
where they're just like theirhead's spinning.
They've just been diagnosed andthey may be questioning whether
or not they align with thesuggested treatment they've been
given, and about 80% of mypatients will follow the
(21:27):
recommended treatment.
10% will have run out ofrecommended treatment or any
treatment, and then about 10%will decline their treatment.
And so in all of thosedifferent types of people
there's a real sense of panic ofwhat can I do?
So I'll get that group in, andreally at that stage it's about
trying to get their ducks in arow and remind them that they've
(21:49):
got a lot of control, thattheir choices are theirs, that
they can, um, you know, beinvolved in their healing and
feel confident in their planthat they've chosen, um.
The next person is the personthat's finished their treatment,
and usually they have a wholelot of side effects, and so, you
know, maybe they've finishedtheir chemotherapy and they're
about to start radiotherapy, orthey've finished chemotherapy
(22:09):
and radiotherapy and they've gotradiation dermatitis and
mucositis and diarrhoea andthey're fatigued and they hate
everyone in their family, butthey're really scared of dying.
You know there's all theemotions.
And then it's really trying toget those side effects under
control first and help them getback to feeling well after their
treatment's finished, becauseoften in that situation there
(22:30):
seems to be just a well done,you've done, you don't need to
come back for treatment, you're,you're on active surveillance
or monitoring, um, and theymight have three months before
they get to be seen again, andthat really can feel quite
disconcerting to someone who'sbeen having regular treatment.
So we try and build somewell-being in for them.
The third person type I see arepeople who are at the end
stages with really not a lot ofhope and are really looking for
(22:54):
anything they can do.
And I really enjoy working withthose patients because it's a
real pleasure and privilege tosupport people in those really
challenging times when sometimesthey might be working with
palliative care teams or lookingat a totally different way of
dealing with their current stateof health, and so that's an
(23:15):
interesting place to work.
And then the other patient thatI see is ones who family
members have had a particulardiagnosis and they're at a high
risk of having that diagnosis.
Speaker 1 (23:25):
And.
Speaker 2 (23:25):
I think microbiome is really interesting to consider
in those people because it givesus, you know, another tool that
we can start to help people,along with a healthy diet and
all the modifiable lifestylefactors like good sleep.
And, you know, microbiome givesus another way we can help
support those patients to maybereduce the risk, as the research
suggests we might, if we avoidparticular microbiome shifts
(23:49):
that might be undesirable in thecancer type they're at risk of.
Speaker 1 (23:54):
This is such an interesting thing.
Can I ask, when you're dealingwith those patients who either
decline therapy or probably moreto do with palliation, do you
have to spend a lot of time withrealistic expectations of
(24:17):
therapy and just say you knowlike, are you expecting to be
cured of cancer, or are wereally on the same page with
what we're trying to achievehere?
Speaker 2 (24:27):
Yes.
So when someone is in theinitial stages and they haven't
had any treatment, I actuallyspend a lot of time debunking
myths about conventional care,because there is this bit of
idea that all chemotherapy isthe same and everyone is going
to be bold and skinny.
And I ask people what do theythink of or who do they think of
(24:50):
when they think of chemotherapy?
And everyone has a story andit's either a loved one where it
was really awful, someoneelse's loved one where they
heard it was really awful, orthings they've seen in the
movies and the media.
And you would know,chemotherapy means a million
different things, and sosometimes it's me trying to help
(25:13):
them understand maybe becausewe have more time that there is
um things that they need to findout before they just throw the
baby out with the bath water.
And if my patient makes adecision that the treatment
they're being offered is notright for them and it's a good,
solid decision I get them to dothings like use some of the
tools that talk about, you know,improve life expectancy with
(25:35):
different treatments, and theydecide not to do that, I'll
still support them, but I'mthinking about their whole
health and I definitely havesome pretty strong conversations
about.
I'm not saying I will save youor do my damned hardest to try,
but I'm not offering analternative to standard
(25:55):
therapeutics.
I'm offering another way tothink about your body and the
terrain of cancer and how, withor without treatment, whatever
their, their choice is, we canaddress some of the
research-based actions thatmight improve their whole health
to be less inhabitable tocancer.
I was going to say thepalliative care side is a whole
(26:19):
other interesting idea where wereally do get to spend time with
people talking about how tomake them live as well as they
can for however long that may be, and that's a really
interesting part of naturopathythat I think hasn't been
explored as much as it should be.
(26:41):
I think there's a lot of scopefor people to work in this area,
but one of the most commonsymptoms that happens when
people start to really declineis that they have a lot of
trouble with digesting theirfood and you know their bowel
function really declines andreflux and heartburn become an
issue and persistent vomiting.
And we have lots of tools thatcan help, whether it be our
(27:02):
knowledge about how to preparethe food to make it more
tolerable or whether it beteaching the loved ones, how to
make nutritional smoothies, orwhether it be talking about
digestive enzymes.
I think there's a lot we canoffer to make people feel well
in a period where they'redefinitely going to decline.
It's just how well can they bewhen they decline?
Speaker 1 (27:24):
Yeah, totally agree.
And you know there's anotherpoint there as well, and that is
we think about the microbiotaand we think about affecting it
like this you know bacteriamicrobiota or food microbiota,
but you know what about sleep?
What about laughter?
What about exercise?
What about loneliness?
You know what about isolation?
You know what about isolation?
(27:49):
So is there something in thispsychosocial sphere, or physical
psychosocial sphere, that wecan do to affect the microbes so
that they, you know, they canthen do their job at least from
a healthier perspective?
Speaker 2 (28:00):
oh for sure I love that, and even the other day
what you said before reminded meabout you.
You know I have a patient whohas quite a devastating
diagnosis as a young person and,despite her ultimate goal being
to live a long and healthy life, her mood is really low and
(28:21):
it's most likely the treatmentshe's on.
She's on a newer immunotherapythat is known to have negative
effects on the mood, but becauseof the complications of the
therapies, I can't use a lot ofthe typical mood herbs and
nutrients we think of.
So I settled on a probiotic.
We know them as psychobioticsbecause it's coming around the
(28:43):
back and having an impact on hermood, but not touching the area
.
That I have to be carefulbecause of the way that the
immunotherapy works, and so Ithink you know it's not even
about the gut.
I mean, it's about the gut, butit's not about the gut.
I'm looking to try and improvesymptoms with the probiotics as
well in some cases.
Speaker 1 (29:03):
There was another interesting concept, if you like
.
I read years ago the paper I'llalways remember the author,
sivan, and it was a mouse study.
But it was a very elegant study, it was beautifully I'm pretty
sure it was Nature Journal, butI can't remember which and what
they did was a crossover, so adouble-blind crossover, with a
(29:26):
washout in mice, uh, and thesemice were given a pd1, pdl1 and
they basically showed thatbifidobacterium breve and longum
helped to reduce the toxicity.
And I think it was that paper.
Forgive me if I'm wrong.
I'm pretty sure it was thatpaper where they said there
appeared to be an improvedefficacy.
(29:49):
That's from a probiotic, youknow these are serious drugs
that really affect your gut,like you wouldn't believe.
Speaker 2 (29:55):
Yeah, and I think we're seeing more and more of
that that if the microbiomeisn't right in inverted commas,
you're not getting the sameresults from treatment, and you
know.
That just blows my mind that,okay, maybe in the future, part
of our role will be in ensuringthat the microbiome is, uh, in
(30:16):
its best form to help thesetreatments work, and it
certainly um puts weight to thefact that, okay, at the start of
everything, we need to thinkabout how we can get this
microbiome to be as healthy aspossible, to get the most
benefit out of treatment aspossible, and there there is
some good studies on that.
Now you know, if you take xdrug with or without probiotics,
you know who gets the bestoutcome.
Um, and it's looking prettypositive for probiotics, yeah
(30:41):
this is really good.
Speaker 1 (30:42):
I look forward to that one.
Can I ask, before we get to theend of the show, can we make
sure that we include those inthe show notes for everyone?
Speaker 2 (30:55):
If you've got them, yes, I'll find them.
You know, just searchingmicrobiome and like paclitaxel
was the drug I'm thinking of.
But there is a few of thosepapers around that are really,
you know, worthwhile looking atwhen you're thinking about your
patients and how we can helpthem with their standard care.
Speaker 1 (31:06):
Well done.
This isn't probiotic driven butthinking about health,
intestinal mucosa, so mucositis.
There's the coffee and honey,swish and spit.
Yes, can I ask you how latealong the road?
(31:27):
How severe a mucositis have youbeen able to rescue with that
therapy, or indeed othertherapies, like you know, oral
glutamine, swishing that aroundthings like that?
What have you used what?
What works for you?
Speaker 2 (31:36):
yeah, I really like oral glutamine.
I find that that works quitewell and I usually get them to
put it in their water bottle andjust keep going all day with it
.
So low dose over the whole dayand I like that hope study, the
coffee and the honey I just sayto people I have handouts for
all the different side effects.
So I say to people look,there's a study on instant
coffee and honey.
I'm not sure where that camefrom, but I'll get them to use
(32:00):
that.
I make oral mouth rinses withthings like chamomile and
calendula and, if it'sappropriate, um, we do manuka
lozenges, um, so lots of options.
I almost find what is?
You get great results.
I'd say any stage you getimprovement.
But what I love most is whenthat extends to the esophagus.
So I think lung cancers andesophageal cancers, and there's
(32:22):
some great papers that suggestif you use liquid, use glutamine
during radiation for lung oresophageal cancer, normally 60
percent of people will end upbeing tube fed.
But when you use glutamine itreally drops it down.
I can't remember the exactnumber so I'm going to be making
it up, but you know, somewherebetween around 10 percent of
(32:42):
people are more likely to or aregoing to need it and the other
50 percent don't.
And so you know.
I think there's a lot to besaid for side effects support
and simple strategies likeadding some glutamine to water,
the coffee and instant coffeeand honey.
Speaker 1 (32:59):
I'm pretty sure it was an Iranian group who were
looking at that.
Okay, makes sense, it's pickedup in my mind, but I thought it
was very interesting that itwasn't an organically grown
gourmet coffee, it was aninstant coffee and it was a
cheap supermarket honey.
Now, I'm all for Manuka orLeptospermum Australian honey, I
(33:20):
don't care, I'm all for it.
Higher the UMF or NGOs aretrying to pull at it, but the
higher the UMF the better.
But this was using justordinary, everyday honey and
ordinary everyday coffee.
Speaker 2 (33:35):
Yeah, and there's another really great study for
side effects from capsidabinewhich is called PPE.
It's a hand and foot condition.
And there's another similarpaper that if you put henna on
your hands and feet, which is asuper messy henna, is that hair
dye.
It must have come from asimilar group because really low
(33:58):
cost, unusual intervention.
It's not my first choice, buthenna was researched and
sometimes it makes you wonderhow did they come up with these
trials and get the funding forit, whatever.
But yeah, um henna was anotherthing that was suggested, and a
funny one at that wow, unreal.
Speaker 1 (34:19):
Um, okay, so what about?
We've covered picking up thepieces.
We've covered longevity.
We've covered picking up thepieces.
We've covered longevity.
We've covered differenttreatment phases.
We've covered a few of the redflags.
Is there any other red flagsthat you see?
We've covered portal of entrywith PICC lines.
(34:40):
Oh, you know where you've got awound, an anastomosis.
Another portal of entry it is.
But you know when they've hadgut surgery and there's an
anastomosis or something likethat.
Speaker 2 (34:55):
I'm saying to be careful with all hygiene too,
because I think you know,especially in radiation
dermatitis, we do a lot oftopical treatment.
One of the things I suggest topractitioners is talk to
patients about the hygiene.
You know, if you have radiationdermatitis and you're putting
anything like, let's just saythey're putting manuka honey on
it, we've got to understand it'dbe like hospital grade, you
(35:18):
know antiseptic uh, or hygienepractices when we're doing
anything in those patients,because they just are so
susceptible to everything.
So, you know, a candida orthrush is another really common
one, and so, you know, justmaking sure that we are really
careful in the way that we'retalking about hygiene and not
getting any wounds infectedwherever they might be, but also
(35:41):
, you know, just watching thespaces that could be at risk of
infection to help our patientspick that up sooner rather than
later where it can be even moreof a problem.
Speaker 1 (35:52):
Can I ask, carla, do you ever combine herbs with
probiotics to get an effect Like, for instance, we know in, say,
urinary tract infections?
Combining pomegranate orcranberry helps the probiotic to
make an anti-infective agent.
Do you ever combine certainfoods?
Speaker 2 (36:09):
Ginger is coming to light with me, but yeah, look, I
would more think about theprebiotics, and probably things
like ginger would feature insome of my prescriptions.
When we've got that probiotic,particularly if we're thinking
about the kind of oralmicrobiome, right through the
gut microbiome, I can't think ofanother place where I would use
(36:30):
it.
But certainly most of myprescriptions would have a
combination of herbs, nutrientsand probiotics in it.
But I'm not necessarilythinking about them in a
synergistic way, except perhapsif I'm using antimicrobials.
Of course I'm going to becareful about when I'm using
probiotics and, yeah, more kindof picking up that prebiotic and
probiotic actions.
Speaker 1 (36:52):
Well, that's actually an interesting aspect about
avoiding certain things whenyou're dosing with probiotics.
So let's say insulin resistance.
I've covered this in anotherpodcast.
How heavy would you go withberberine when you're on a
probiotic?
Speaker 2 (37:07):
Yes, not too heavy.
I try and space them out and ofcourse it can become really
tricky.
I love berberine in oncologybut if you've got a combination
of some active treatment phase,then you're trying to get
berberine in and then you'retrying to get a probiotic.
I try not to make it toocomplicated for my patient.
I feel like quite often the moremedication supplement they have
(37:28):
to have throughout the day, themore they feel like the sick
patient or the sick person, andso I would sometimes pulse it on
different days.
So I might do, you know, everysecond day is berberine and the
alternate day is probiotics.
I've even lately, with a fewpatients started to say have the
weekend off, because I do thinksometimes when we've got all of
(37:48):
these supplements that they'retaking particularly if people
have got lots of side effects toaddress, it can just they get
supplement fatigue, and so I dothink something is better than
nothing.
So when people are feeling likethere's a risk of things not
being great together or they'refeeling overwhelmed, you know,
having a day or two offespecially if it's a scheduled
(38:09):
day or two it's like yourrelaxed day can be really a nice
way for patients to feel morenormal than perhaps taking
something every day or havinglines of pills they've got to
get in between their meals, andyou know whatnot.
Speaker 1 (38:25):
Carla, where can we find out more information?
Obviously, there's a heap ofpapers and we're going to put up
as much as we can on thewebsite for in the, in the show
notes.
But what else are you doingaround this area?
Speaker 2 (38:37):
Yes, I've done a presentation for Designs for
Health, so you can check outthat recording on cancer and the
microbiome.
I've also got lots of trainingsfor practitioners and a podcast
on talking about oncologysupport for patients, and so I
do that under the brand Prosper,so you can check that out on my
website, listen to my podcastand learn more about just how
(39:02):
amazing the amount ofcomplementary medicine research
there is and how we can reallywork to support patients to have
as healthy a life as possiblewhile having a cancer diagnosis.
Speaker 1 (39:16):
So the podcast and the website is Prosper.
Speaker 2 (39:19):
Yes, so you can go to my website CarlaWrencom to find
it there, orProsperCancerCareco to find it
there or prospercancercareco.
Speaker 1 (39:28):
Beautiful Carla Wren.
Thank you so much.
This is only an inkling of whatyou can, obviously, what your
knowledge base is, but thank youso much for taking us through
just a chipping away at theiceberg so that practitioners,
and therefore their patients,can get the best out of their
health and their wellness whilethey're along their cancer
journey.
Thanks so much for joining ustoday on Wellness by Designs.
Speaker 2 (39:50):
Thank you for having me.
Speaker 1 (39:51):
And thank you everyone for joining us.
Remember Carla's webinar isgoing to be up on the
designsforhealthcomau website.
Log in, look at the Educationtab and you can catch up on all
of the other podcasts on theDesigns for Health website.
I'm Andrew Whitfield-Cook.
This is Wellness by Designs.
This is Wellness by Designs, and I'm your host,
andrew Whitfield-Cook, andjoining us today is Carla Wren.
Carla has her own holisticassessment approach, called
Vitae Mosaic, to provide eachperson with an individualised
and integrative treatmentstrategy, and today we're going
to be talking about gut healthin oncology.
Welcome to Wellness by Designs,carla, and thank you so much
(00:42):
for your time.
Speaker 2 (00:44):
Thank you for having me.
Speaker 1 (00:46):
It's my pleasure.
It's been a long time between,do I say drinks.
Anyway, Carla, gut health issuch a huge brushstroke.
Where do we start with thiswhen we're dealing with a
patient who has an oncologydiagnosis?
Speaker 2 (01:06):
Yeah.
So my area of practice has beenaround supporting patients who
have been diagnosed with cancerto help their whole health and
their healing.
Lots of patients come to me andsay what else can I do while
I'm doing the treatment or aftermy treatment has finished?
And so, while I didn'tinitially set out to work in the
gut health space, more and moreresearch is coming out that
(01:28):
really enforces the idea of weneed to look at the microbiome
of patients with a cancerdiagnosis During the diagnosis
stage, when treatment ishappening, perhaps especially
afterwards and maybe evenbeforehand, to reduce the risk
of some diagnosis.
And I've just really beeninspired by the volumes of
researchers available and how wecan start to use them in
(01:50):
practice, because we knowgenerally not in all cases, but
generally a probiotic is areally safe intervention for
people with what looks likereally great outcomes from the
research that's starting to comeout.
Speaker 1 (02:04):
Well, let's talk about that aspect that you
mentioned there straight off theback safety.
So, firstly, we're not talkingabout treating cancer with gut
health things.
We're talking about supportingthe patient who has their own
treatment regimen.
We're just making sure thatthey're healthy so that they're
healthy enough to withstand thattreatment regimen.
(02:24):
That's exactly right.
And the other point I was goingto say is we might as well
bring it up now instead of laterwith red flags, and that is
that you know it's very rare inthe research where you get an
issue with a probiotic.
Can you cover those juststraight off the bat so that
(02:45):
we've got them out of the way?
Speaker 2 (02:47):
Yeah, perfect.
So I guess with the issue withthe probiotic, let's talk about
that first, because often whenpeople hear me talk they get
into a big panic because wedon't always want to use a
probiotic in oncology and thatreally fits around when a
patient is perhaps at risk ofneutropenia.
(03:17):
So if a treatment they're oncertain chemotherapies will
cause the patient to experiencea low white cell count or more
specifically, neutropenia, whichis a low number of neutrophils,
and so if your treatment isgoing to give you neutropenia,
you usually might have seen thatas a kind of side effect of the
treatment.
You usually might have seenthat as a kind of side effect of
the treatment.
But regular bloods are normallydone through this process and
patients when they're told aneutropenic they definitely
don't want to be on probiotics.
It kind of comes back tosomething I always try and say
get professional advice ifyou're on a whole lot of
(03:38):
medications to make sure anysupplements you take it doesn't
have to be a probiotic.
Any supplement is safe.
But people like myself who aretrained to support patients with
complementary medicines knowthe guidelines.
It's loosely around if yourneutrophils are under one or
your white cell count is under2.5, we don't prescribe
probiotics.
Speaker 1 (04:00):
What about things like, for instance it's noted in
the literature Saccharomycesboulardii, where somebody's got
a PICC line or a central lineand the well-meaning nurse doses
them with Saccharomyces?
Continue from there, carla,because I can see you smiling.
Yeah, 100%.
Speaker 2 (04:17):
Yeah, definitely.
No one ever knows thatinformation, so I love that you
know that.
Yes, well, there's been acouple of cases where and
remember, it's just a few cases,but where people have given
themselves sepsis or have beengiven sepsis by Saccharomyces
boulardii is one that I wouldvery infrequently prescribe in
(04:46):
oncology patients.
But just talking about thehygiene of managing the capsules
as well, wash your hands.
If you have a peak line, don'ttouch it when you haven't washed
your hands, whether or notyou've used supplements.
And Saccharomyces boulardii isprobably at the bottom of my
probiotic list in terms of whatI would use to treat patients
during an active treatment phase.
Speaker 1 (05:08):
Okay, cool, so take us through some of the issues
that patients experience then.
Speaker 2 (05:15):
With the probiotics.
Speaker 1 (05:17):
Sorry, forgive me during their oncology journey.
Speaker 2 (05:22):
Yeah, perfect.
So I guess we could take a stepback even before that, and I
think one of the interestingthings to mention, just for
future information that will becoming out, is they're really
starting to see such strongpatterns in the species that
have been discovered in peoplewith particular cancers.
A lot of research is done onthe colorectal cancer space that
patients are even starting tobe able to potentially use
(05:43):
microbiome patterning todetermine what cancers they
might be experiencing, almostlike a screening tool.
So maybe we'll be sitting herein 10 years time or longer
thinking, okay, we're going togo and get our fecal occult
blood test, which is thestandard test to look for maybe
risk of colorectal cancer, and amicrobiome test that says we're
high in a few key species thatare common in colorectal cancer.
(06:06):
So therefore we definitelyshould have further
investigation.
So I love that idea and howthat's starting to develop.
For lots of cancer typesovarian cancer, bladder cancers
they're all starting to seethese microbiome mappings for
risk and maybe screening forthese cancers.
But the next thing I see in mypatients is coming with one of
two things they want to dosomething to improve their
(06:27):
health themselves, they want toknow what they can do.
And then we think about okay,what are these integrative
strategies that we can pull into help support the patient as
they go through their treatment,with their whole health, and
probiotics fit really well there.
And then I also think we see alot of patients coming in with
side effects.
So they'll come in and they'llsay I just can't cope with my
diarrhea or constipation, as anexample.
Fatigue is another reallycommon symptoms that patient
(06:50):
will come in while they'reundergoing treatment and there's
research to suggest that insome of those instances of
course particularly withconstipation and diarrhea, also
with oral mucositis symptoms anda number of other symptoms that
probiotics would be a reallysafe intervention, even after
surgery.
There's some really greatresults that show that if we use
(07:11):
probiotics seeded after surgeryfor colorectal cancer, the
patient has far lesscomplications with surgery and a
greater recovery from thatsurgery.
Speaker 1 (07:22):
Are there any specific species?
Or we could go into strains ifyou want to, because I know that
everybody's thinking about onestrain in particular.
But can we go into certainspecies, strains that you use,
that feel comfortable and that'sevidence-led?
Speaker 2 (07:38):
Yes, look, I think the first step I would say is,
before I even look at speciesand strains, is I'm thinking
about what prebiotic fibers Ican bring in because there is no
risk in that prebiotic fiberspace.
So I think sometimes, ratherthan jumping straight to the
probiotic, I'm trying to changethe environment and feed
(07:58):
whatever's there before I maybedo a more risky is the wrong
word, but a more interventionalstep of introducing a probiotic,
particularly in their earlystage of treatment.
So I always talk to everyoncology patient about trying to
get variety and diversity intheir food, so aiming for 40
plant foods a week and I showthem easy ways to do that and
say how important that is forthe microbiome and that kind of
(08:20):
blows people's minds becauseit's an exciting thing Like
normally we have a reputation asan industry of telling people
what they can't eat.
So it's really exciting to sayto them OK, I want you to go to
the green grocer and buy all theweird fruit or all the
different vegetables and reallytry and eat the rainbow and get
more plants in.
And so I talk to them aboutherbs and spices and legumes and
(08:41):
nuts and seeds and how all ofthese can be really helpful for
their microbiome herbs andspices and legumes and nuts and
seeds and how all these can bereally helpful for their
microbiome.
And then, particularly ifthey're constipated or if
they're having trouble withtheir bowel motions and the
health of them, I try and getsome probiotic fiber in, and so
for some people that's enough ofan intervention.
Certainly from there I would beguided most in most cases by
doing some stool testing.
(09:02):
And I actually have a colleaguein my practice here at Peninsula
Herbal Dispensary, amy Castle,who's a naturopath that has the
certified gut training.
She's done a lot of extra guttraining with people like Jason
Holbrook and also Moira, so shewill see a lot of my patients
when it starts to get a bit morecomplex because, you would know
, the gut is exploding overallin all this amazing information,
(09:25):
and so I will usually then getsome testing done.
But at that point we'll thendecide what kind of strains and
I'm looking at LGG as a numberone one to think about.
But you know, a good low dosebroad spectrum probiotic is also
safe to use if we just followthose rules of watching what the
white cell count is doing,watching what for neutropenia,
(09:47):
and then using those prebioticfibres and the food fibres as a
basis for the intervention.
Speaker 1 (09:56):
When we're talking about gut health.
Obviously you know stool healthcan vacillate between
constipation to diarrhoeadepending on treatment.
Stool health can vacillatebetween constipation to diarrhea
depending on treatment,depending on anxiety, so many
other things, even tumoureffects, direct tumour effects.
So do you ever favour any sortof prebiotics where, in one dose
(10:17):
it can be, it can help withconstipation and in another dose
it can actually help to bulkstool up to stop diarrhea, for
instance?
Speaker 2 (10:29):
Yes, definitely, and I really try and talk to the
patients and educate them a lotabout what to look for in a
stool and all our differentoptions in terms of how we can
change a stool.
And we still, to this day, havepatients that feel embarrassed
talking about their poos.
But we really try and say, okay, you know, these are things
that you can change, because theother option, unfortunately, is
to take laxatives and betweenthe chemotherapeutic agent that
(10:54):
they're on what they might be onis an anti-nausea which causes
often very terrible constipationand then introducing a whole
variety of laxatives.
Sometimes now they can't leavethe bathroom and so trying to
show them how the differentfibres make a difference.
So we talk about chia seeds andpsyllium husks and flax meal.
We have what we call the oldschool fibre recipe here at the
(11:16):
herbal dispensary, which is evenparts of chia, quinoa and
flaxseed and half a part ofpsyllium husk, and you either
use that dry if you've gotdiarrhea, or soak it overnight
and use it like a little puddingif you've got constipation.
And so we try and teach themhow to bring in these.
Maybe add some stewed apple orgrated apple, different foods,
(11:37):
kiwi fruits, prunes, of course.
So really trying to show themhow they can not have another
drug, and not because I'manti-laxatives at all, but
because maybe it's nice to beable to get some control back
and figure out foods and have anenjoyable way of getting on top
of what could be potentiallyquite difficult bowel problems.
Speaker 1 (11:57):
Yeah, I think any good medico would welcome any
avoidance of polypharmacy ifthey could, as long as the
patient was well looked afterand was healthy.
So let's delve into the use ofprobiotics or bacteria foods.
Can we go through the differentum cancers where different
(12:20):
bacteria was associated witheach?
Speaker 2 (12:22):
I was looking at a couple and I'm amazed at the
stuff that you've pulled up yes,look, I I have started to make
a um chart and it's just at thestart point because I was like
we need to collate this research.
Surely it's been done, but Ihaven't seen it yet.
I have seen some really amazingpapers that show, you know,
across gastrointestinal cancersthese are the kind of issues
(12:44):
we're looking for or acrossfemale reproductive cancers,
these are the species that we'relooking for.
But I am in the process ofputting together my chart that
I've called microbiome andcancer to really try and
pinpoint.
Okay, if I see a patient whohas ovarian cancer, what do I
need to look for or get mycolleague to look for in their
stool test?
So, certainly, um, there areconsistencies and we have to
remember those viruses as well,like epsom bar virus and, uh,
(13:08):
the herpes virus, hepatitis is,you know, they're all there in
those characters that could be,you know, increasing the risk of
certain cancer types.
But from a um, you knowmicrobiome more you know
bacterial species.
Definitely we're seeing lots offusobacterium, um, some Ecoli
issues, you know.
You know mycoplasma issues.
(13:28):
It's really dependent on allthe different cancers seem to
have all different researchcoming up.
But I guess what I'm lovingseeing uh, and of course I'm
referencing my chart because Iwant to be as science-based as
possible is that there is goodconsistency across all the
different research and it's notlike one paper is showing this
and one paper is showing thatit's really quite succinct in
(13:49):
what they're seeing at thisstage.
So I definitely think there isplace for looking at microbiome
for each patient, given theirdiagnosis and trying to figure
out is this something that weshould be addressing to try and
rebalance or rectify what couldbe a disrupted microbiome,
especially in places likebladder cancer and esophageal
(14:10):
cancer, where sometimes thetreatment is quite nasty and
can't be sustained for a longperiod of time, and so any
additional support we can offerthose patients, you know, is
really welcome.
Speaker 1 (14:27):
Can I ask Carla, with regards to this goes for all
bacteria, not just commensals orprobiotics.
When we're looking at asnapshot in a patient who has
cancer let's say breast cancer,because it was really
interesting what came up aboutthere when you're looking at a
(14:50):
snapshot, are we seeing cause oreffect?
Are we seeing this cause?
You've obviously asked yourselfthis question question.
So did it cause the problem oris it there because of the
problem, trying to heal theproblem?
What's your answer?
Speaker 2 (15:06):
like you've obviously thought about, I think it's
both I think it's both and Ithink some of the research has
gone as far as kind of pullingthat out, like the bowel cancer.
There's a really great papercalled gut and the microbiome um
, and it was one of the firstones I saw and it definitely
pulls that apart a little bitand goes okay, in the
pre-cancerous stages we'reseeing this kind of shift in the
(15:28):
microbiome and once a tumordevelops we're seeing this kind
of shift in a microenvironmentand I totally I mean I'm a big
advocate for understanding theterrain of tumor growth, like
the tumor microenvironment, andso I think the ultimate answer
is we don't know.
But if we're seeing bacteria orother species, yeast, parasite,
(15:50):
things that shouldn't be there,I think it's worthwhile focusing
on making a change because Ithink overall it has a positive
effect on the tumormicroenvironment and the person
and that even the oralmicrobiome and its connection to
what's happening in breastcancer tumors is just like
mind-blowing.
So I think if we can start tomake those connections, I have
(16:13):
so many people come into myclinic, particularly in the
breast cancer space, and say youknow, I was really looking
after my health and they're likequite devastated that they've
put all this effort in yet theyhave been diagnosed with the
cancer and I think these are thekind of, you know, oral
microbiome, the kind of thingsthese people aren't knowing
about or aren't thinking aboutthat if they've had an issue
(16:35):
with, you know, hygiene,gingivitis, gum disease.
You know, maybe this is alittle piece of the puzzle that
we're uncovering.
Speaker 1 (16:44):
Okay.
So a patient comes to you.
They might have gingivitis longstanding.
You might think, oh, there'ssomething there.
What do you then do about that?
Obviously, it's not to treat ormanage the breast cancer at all
, but what you're doing isbasically dampening another bird
, another driver of inflammationin their body.
So how do you treat that then?
Speaker 2 (17:07):
Yeah, I think there's lots of amazing information
coming out about the oralmicrobiome and I certainly want
to do this more work in thisspace in the coming years myself
.
But I think knowing the rightprobiotics to take and I think
there is enough evidence tosuggest some probiotic species
can really be put into thatdental probiotic range.
But I also think it comes backto hygiene.
(17:29):
You know I often ask myoncology patients have you been
to the dentist?
And you know, I think it's oneof those things that sometimes
get left by the wayside and youjust realise you haven't been
for a while and suddenly it'sbeen five years or, you know,
three years and people areperhaps not looking after their
health as much as they shouldhave from their oral microbiome
perspective and not knowing theycan do something about it.
(17:51):
So there's a good microbiometesting for the mouth now so we
can start to use that.
I haven't used that in mypractice yet, but definitely if
there's a link between a chronicdisease whether it be a patient
with cancer or some otherautoimmune disease or something,
I definitely think it'simportant for practitioners to
ask that question what is youroral health?
Because I just don't think wehave been doing that enough and
(18:14):
it's and it is a burden that wecan definitely see in the
research for breast cancer andsome other cancers is affecting
I'm not going to say the outcomeof the cancer, but it's having
an impact as a driver to disruptthe microbiome.
That then might be having animpact on the tumour
microenvironment.
Speaker 1 (18:32):
Yeah, I also thought that you know, if somebody's got
longstanding gingivitis, it'sworthwhile addressing, if for no
other reason than to preparetheir oral mucosa for a possible
assault due to the medicine, sothat they're a step ahead
rather than catching up behindthe eight ball with regards to
(18:54):
presenting with mucositis or amore severe mucositis than what
somebody ordinarily would have,because once you can't eat, it's
a really hard thing to comeback from, you know.
So I take your point, you know,of how important that is to
really get right.
Yeah, because if you can't eatyou're on a downward sort of
(19:16):
you're pushing a stone uphill.
Speaker 2 (19:20):
And I think in the microbiome research has come out
.
What really kind of shocked mewhen I first became aware of all
this bulk of research was justno one is discussing this in
australia I can't speak forother places but no one's asking
their patients about um, youknow what is happening to their
(19:42):
um, their oral health aroundthat cancer space, or what has
been their experience of other,maybe microbiome-disrupting
conditions.
Because when a patient comeswith cancer, you know there's so
much to do.
You know you're trying to keepthem well during treatment.
You're trying to think abouthow the research might suggest
we can stop progression.
(20:03):
You're trying to think abouttheir emotional health.
There's dietary changes to bemade, and I think the weight of
the research in microbiome andcancer is really making me think
okay, this needs to be one ofthe first conversations we have,
not the last conversation wehave, which it certainly wasn't
a priority for me until Istarted to read all this
research.
Speaker 1 (20:25):
You also made a really good point before about
anxiety and stress and thingslike that, about how that can
have such an acute effect on themicrobiota and therefore again
lead them down a rocky road ifthey don't really watch
themselves.
So it just paints to me howcritical it is to get, as you
said, a rainbow of foods and getthem eating all of the really
(20:46):
weird fruits and stuff like that.
So take us through a patientpicture here.
How do patients present to you?
Do they present late whenthey're already really sick, or
do they present early to say,listen, I've been given this
diagnosis and I want to makesure I'm in tip-top condition
for what's ahead of me.
Speaker 2 (21:05):
Yeah, I get four different types of patients.
The first one is the mostcommon and that's really when
they come in that early stage,you know, they're in that stage
where they're just like theirhead's spinning.
They've just been diagnosed andthey may be questioning whether
or not they align with thesuggested treatment they've been
given, and about 80% of mypatients will follow the
(21:27):
recommended treatment.
10% will have run out ofrecommended treatment or any
treatment, and then about 10%will decline their treatment.
And so in all of thosedifferent types of people
there's a real sense of panic ofwhat can I do?
So I'll get that group in, andreally at that stage it's about
trying to get their ducks in arow and remind them that they've
(21:49):
got a lot of control, thattheir choices are theirs, that
they can, um, you know, beinvolved in their healing and
feel confident in their planthat they've chosen, um.
The next person is the personthat's finished their treatment,
and usually they have a wholelot of side effects, and so, you
know, maybe they've finishedtheir chemotherapy and they're
about to start radiotherapy, orthey've finished chemotherapy
(22:09):
and radiotherapy and they've gotradiation dermatitis and
mucositis and diarrhoea andthey're fatigued and they hate
everyone in their family, butthey're really scared of dying.
You know there's all theemotions.
And then it's really trying toget those side effects under
control first and help them getback to feeling well after their
treatment's finished, becauseoften in that situation there
(22:30):
seems to be just a well done,you've done, you don't need to
come back for treatment, you're,you're on active surveillance
or monitoring, um, and theymight have three months before
they get to be seen again, andthat really can feel quite
disconcerting to someone who'sbeen having regular treatment.
So we try and build somewell-being in for them.
The third person type I see arepeople who are at the end
stages with really not a lot ofhope and are really looking for
(22:54):
anything they can do.
And I really enjoy working withthose patients because it's a
real pleasure and privilege tosupport people in those really
challenging times when sometimesthey might be working with
palliative care teams or lookingat a totally different way of
dealing with their current stateof health, and so that's an
(23:15):
interesting place to work.
And then the other patient thatI see is ones who family
members have had a particulardiagnosis and they're at a high
risk of having that diagnosis.
Speaker 1 (23:25):
And.
Speaker 2 (23:25):
I think microbiome is really interesting to consider
in those people because it givesus, you know, another tool that
we can start to help people,along with a healthy diet and
all the modifiable lifestylefactors like good sleep.
And, you know, microbiome givesus another way we can help
support those patients to maybereduce the risk, as the research
suggests we might, if we avoidparticular microbiome shifts
(23:49):
that might be undesirable in thecancer type they're at risk of.
Speaker 1 (23:54):
This is such an interesting thing.
Can I ask, when you're dealingwith those patients who either
decline therapy or probably moreto do with palliation, do you
have to spend a lot of time withrealistic expectations of
(24:17):
therapy and just say you knowlike, are you expecting to be
cured of cancer, or are wereally on the same page with
what we're trying to achievehere?
Speaker 2 (24:27):
Yes.
So when someone is in theinitial stages and they haven't
had any treatment, I actuallyspend a lot of time debunking
myths about conventional care,because there is this bit of
idea that all chemotherapy isthe same and everyone is going
to be bold and skinny.
And I ask people what do theythink of or who do they think of
(24:50):
when they think of chemotherapy?
And everyone has a story andit's either a loved one where it
was really awful, someoneelse's loved one where they
heard it was really awful, orthings they've seen in the
movies and the media.
And you would know,chemotherapy means a million
different things, and sosometimes it's me trying to help
(25:13):
them understand maybe becausewe have more time that there is
um things that they need to findout before they just throw the
baby out with the bath water.
And if my patient makes adecision that the treatment
they're being offered is notright for them and it's a good,
solid decision I get them to dothings like use some of the
tools that talk about, you know,improve life expectancy with
(25:35):
different treatments, and theydecide not to do that, I'll
still support them, but I'mthinking about their whole
health and I definitely havesome pretty strong conversations
about.
I'm not saying I will save youor do my damned hardest to try,
but I'm not offering analternative to standard
(25:55):
therapeutics.
I'm offering another way tothink about your body and the
terrain of cancer and how, withor without treatment, whatever
their, their choice is, we canaddress some of the
research-based actions thatmight improve their whole health
to be less inhabitable tocancer.
I was going to say thepalliative care side is a whole
(26:19):
other interesting idea where wereally do get to spend time with
people talking about how tomake them live as well as they
can for however long that may be, and that's a really
interesting part of naturopathythat I think hasn't been
explored as much as it should be.
(26:41):
I think there's a lot of scopefor people to work in this area,
but one of the most commonsymptoms that happens when
people start to really declineis that they have a lot of
trouble with digesting theirfood and you know their bowel
function really declines andreflux and heartburn become an
issue and persistent vomiting.
And we have lots of tools thatcan help, whether it be our
(27:02):
knowledge about how to preparethe food to make it more
tolerable or whether it beteaching the loved ones, how to
make nutritional smoothies, orwhether it be talking about
digestive enzymes.
I think there's a lot we canoffer to make people feel well
in a period where they'redefinitely going to decline.
It's just how well can they bewhen they decline?
Speaker 1 (27:24):
Yeah, totally agree.
And you know there's anotherpoint there as well, and that is
we think about the microbiotaand we think about affecting it
like this you know bacteriamicrobiota or food microbiota,
but you know what about sleep?
What about laughter?
What about exercise?
What about loneliness?
You know what about isolation?
You know what about isolation?
(27:49):
So is there something in thispsychosocial sphere, or physical
psychosocial sphere, that wecan do to affect the microbes so
that they, you know, they canthen do their job at least from
a healthier perspective?
Speaker 2 (28:00):
oh for sure I love that, and even the other day
what you said before reminded meabout you.
You know I have a patient whohas quite a devastating
diagnosis as a young person and,despite her ultimate goal being
to live a long and healthy life, her mood is really low and
(28:21):
it's most likely the treatmentshe's on.
She's on a newer immunotherapythat is known to have negative
effects on the mood, but becauseof the complications of the
therapies, I can't use a lot ofthe typical mood herbs and
nutrients we think of.
So I settled on a probiotic.
We know them as psychobioticsbecause it's coming around the
(28:43):
back and having an impact on hermood, but not touching the area
.
That I have to be carefulbecause of the way that the
immunotherapy works, and so Ithink you know it's not even
about the gut.
I mean, it's about the gut, butit's not about the gut.
I'm looking to try and improvesymptoms with the probiotics as
well in some cases.
Speaker 1 (29:03):
There was another interesting concept, if you like
.
I read years ago the paper I'llalways remember the author,
sivan, and it was a mouse study.
But it was a very elegant study, it was beautifully I'm pretty
sure it was Nature Journal, butI can't remember which and what
they did was a crossover, so adouble-blind crossover, with a
(29:26):
washout in mice, uh, and thesemice were given a pd1, pdl1 and
they basically showed thatbifidobacterium breve and longum
helped to reduce the toxicity.
And I think it was that paper.
Forgive me if I'm wrong.
I'm pretty sure it was thatpaper where they said there
appeared to be an improvedefficacy.
(29:49):
That's from a probiotic, youknow these are serious drugs
that really affect your gut,like you wouldn't believe.
Speaker 2 (29:55):
Yeah, and I think we're seeing more and more of
that that if the microbiomeisn't right in inverted commas,
you're not getting the sameresults from treatment, and you
know.
That just blows my mind that,okay, maybe in the future, part
of our role will be in ensuringthat the microbiome is, uh, in
(30:16):
its best form to help thesetreatments work, and it
certainly um puts weight to thefact that, okay, at the start of
everything, we need to thinkabout how we can get this
microbiome to be as healthy aspossible, to get the most
benefit out of treatment aspossible, and there there is
some good studies on that.
Now you know, if you take xdrug with or without probiotics,
you know who gets the bestoutcome.
Um, and it's looking prettypositive for probiotics, yeah
(30:41):
this is really good.
Speaker 1 (30:42):
I look forward to that one.
Can I ask, before we get to theend of the show, can we make
sure that we include those inthe show notes for everyone?
Speaker 2 (30:55):
If you've got them, yes, I'll find them.
You know, just searchingmicrobiome and like paclitaxel
was the drug I'm thinking of.
But there is a few of thosepapers around that are really,
you know, worthwhile looking atwhen you're thinking about your
patients and how we can helpthem with their standard care.
Speaker 1 (31:06):
Well done.
This isn't probiotic driven butthinking about health,
intestinal mucosa, so mucositis.
There's the coffee and honey,swish and spit.
Yes, can I ask you how latealong the road?
(31:27):
How severe a mucositis have youbeen able to rescue with that
therapy, or indeed othertherapies, like you know, oral
glutamine, swishing that aroundthings like that?
What have you used what?
What works for you?
Speaker 2 (31:36):
yeah, I really like oral glutamine.
I find that that works quitewell and I usually get them to
put it in their water bottle andjust keep going all day with it
.
So low dose over the whole dayand I like that hope study, the
coffee and the honey I just sayto people I have handouts for
all the different side effects.
So I say to people look,there's a study on instant
coffee and honey.
I'm not sure where that camefrom, but I'll get them to use
(32:00):
that.
I make oral mouth rinses withthings like chamomile and
calendula and, if it'sappropriate, um, we do manuka
lozenges, um, so lots of options.
I almost find what is?
You get great results.
I'd say any stage you getimprovement.
But what I love most is whenthat extends to the esophagus.
So I think lung cancers andesophageal cancers, and there's
(32:22):
some great papers that suggestif you use liquid, use glutamine
during radiation for lung oresophageal cancer, normally 60
percent of people will end upbeing tube fed.
But when you use glutamine itreally drops it down.
I can't remember the exactnumber so I'm going to be making
it up, but you know, somewherebetween around 10 percent of
(32:42):
people are more likely to or aregoing to need it and the other
50 percent don't.
And so you know.
I think there's a lot to besaid for side effects support
and simple strategies likeadding some glutamine to water,
the coffee and instant coffeeand honey.
Speaker 1 (32:59):
I'm pretty sure it was an Iranian group who were
looking at that.
Okay, makes sense, it's pickedup in my mind, but I thought it
was very interesting that itwasn't an organically grown
gourmet coffee, it was aninstant coffee and it was a
cheap supermarket honey.
Now, I'm all for Manuka orLeptospermum Australian honey, I
(33:20):
don't care, I'm all for it.
Higher the UMF or NGOs aretrying to pull at it, but the
higher the UMF the better.
But this was using justordinary, everyday honey and
ordinary everyday coffee.
Speaker 2 (33:35):
Yeah, and there's another really great study for
side effects from capsidabinewhich is called PPE.
It's a hand and foot condition.
And there's another similarpaper that if you put henna on
your hands and feet, which is asuper messy henna, is that hair
dye.
It must have come from asimilar group because really low
(33:58):
cost, unusual intervention.
It's not my first choice, buthenna was researched and
sometimes it makes you wonderhow did they come up with these
trials and get the funding forit, whatever.
But yeah, um henna was anotherthing that was suggested, and a
funny one at that wow, unreal.
Speaker 1 (34:19):
Um, okay, so what about?
We've covered picking up thepieces.
We've covered longevity.
We've covered picking up thepieces.
We've covered longevity.
We've covered differenttreatment phases.
We've covered a few of the redflags.
Is there any other red flagsthat you see?
We've covered portal of entrywith PICC lines.
(34:40):
Oh, you know where you've got awound, an anastomosis.
Another portal of entry it is.
But you know when they've hadgut surgery and there's an
anastomosis or something likethat.
Speaker 2 (34:55):
I'm saying to be careful with all hygiene too,
because I think you know,especially in radiation
dermatitis, we do a lot oftopical treatment.
One of the things I suggest topractitioners is talk to
patients about the hygiene.
You know, if you have radiationdermatitis and you're putting
anything like, let's just saythey're putting manuka honey on
it, we've got to understand it'dbe like hospital grade, you
(35:18):
know antiseptic uh, or hygienepractices when we're doing
anything in those patients,because they just are so
susceptible to everything.
So, you know, a candida orthrush is another really common
one, and so, you know, justmaking sure that we are really
careful in the way that we'retalking about hygiene and not
getting any wounds infectedwherever they might be, but also
(35:41):
, you know, just watching thespaces that could be at risk of
infection to help our patientspick that up sooner rather than
later where it can be even moreof a problem.
Speaker 1 (35:52):
Can I ask, carla, do you ever combine herbs with
probiotics to get an effect Like, for instance, we know in, say,
urinary tract infections?
Combining pomegranate orcranberry helps the probiotic to
make an anti-infective agent.
Do you ever combine certainfoods?
Speaker 2 (36:09):
Ginger is coming to light with me, but yeah, look, I
would more think about theprebiotics, and probably things
like ginger would feature insome of my prescriptions.
When we've got that probiotic,particularly if we're thinking
about the kind of oralmicrobiome, right through the
gut microbiome, I can't think ofanother place where I would use
(36:30):
it.
But certainly most of myprescriptions would have a
combination of herbs, nutrientsand probiotics in it.
But I'm not necessarilythinking about them in a
synergistic way, except perhapsif I'm using antimicrobials.
Of course I'm going to becareful about when I'm using
probiotics and, yeah, more kindof picking up that prebiotic and
probiotic actions.
Speaker 1 (36:52):
Well, that's actually an interesting aspect about
avoiding certain things whenyou're dosing with probiotics.
So let's say insulin resistance.
I've covered this in anotherpodcast.
How heavy would you go withberberine when you're on a
probiotic?
Speaker 2 (37:07):
Yes, not too heavy.
I try and space them out and ofcourse it can become really
tricky.
I love berberine in oncologybut if you've got a combination
of some active treatment phase,then you're trying to get
berberine in and then you'retrying to get a probiotic.
I try not to make it toocomplicated for my patient.
I feel like quite often the moremedication supplement they have
(37:28):
to have throughout the day, themore they feel like the sick
patient or the sick person, andso I would sometimes pulse it on
different days.
So I might do, you know, everysecond day is berberine and the
alternate day is probiotics.
I've even lately, with a fewpatients started to say have the
weekend off, because I do thinksometimes when we've got all of
(37:48):
these supplements that they'retaking particularly if people
have got lots of side effects toaddress, it can just they get
supplement fatigue, and so I dothink something is better than
nothing.
So when people are feeling likethere's a risk of things not
being great together or they'refeeling overwhelmed, you know,
having a day or two offespecially if it's a scheduled
(38:09):
day or two it's like yourrelaxed day can be really a nice
way for patients to feel morenormal than perhaps taking
something every day or havinglines of pills they've got to
get in between their meals, andyou know whatnot.
Speaker 1 (38:25):
Carla, where can we find out more information?
Obviously, there's a heap ofpapers and we're going to put up
as much as we can on thewebsite for in the, in the show
notes.
But what else are you doingaround this area?
Speaker 2 (38:37):
Yes, I've done a presentation for Designs for
Health, so you can check outthat recording on cancer and the
microbiome.
I've also got lots of trainingsfor practitioners and a podcast
on talking about oncologysupport for patients, and so I
do that under the brand Prosper,so you can check that out on my
website, listen to my podcastand learn more about just how
(39:02):
amazing the amount ofcomplementary medicine research
there is and how we can reallywork to support patients to have
as healthy a life as possiblewhile having a cancer diagnosis.
Speaker 1 (39:16):
So the podcast and the website is Prosper.
Speaker 2 (39:19):
Yes, so you can go to my website CarlaWrencom to find
it there, orProsperCancerCareco to find it
there or prospercancercareco.
Speaker 1 (39:28):
Beautiful Carla Wren.
Thank you so much.
This is only an inkling of whatyou can, obviously, what your
knowledge base is, but thank youso much for taking us through
just a chipping away at theiceberg so that practitioners,
and therefore their patients,can get the best out of their
health and their wellness whilethey're along their cancer
journey.
Thanks so much for joining ustoday on Wellness by Designs.
Speaker 2 (39:50):
Thank you for having me.
Speaker 1 (39:51):
And thank you everyone for joining us.
Remember Carla's webinar isgoing to be up on the
designsforhealthcomau website.
Log in, look at the Educationtab and you can catch up on all
of the other podcasts on theDesigns for Health website.
I'm Andrew Whitfield-Cook.
This is Wellness by Designs.
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