Diet & Disease

"Let Food Be Thy Medicine" ~ Hippocrates

Brain cancer. There are probably few things more terrifying than a brain cancer diagnosis. Each year ~25,000 cases are diagnosed in the United States and only about 1/3 of patients will survive beyond 5 years. There is a critical need for more research in the effective diagnosis and treatment of this disease.

Iskra Miralem Bonanno is 35 years old, a mother of 2 young girls, wife, sister, friend, lawyer, a finalist for Ms. Health & Fitness 2020 and brain cancer thriver. She recently shared her incredible and courageous story with the Olaris team. Upon receiving her diagnosis, rather than despairing, Iskra was determined to fight. Perhaps emboldened by watching her own mother battle and ultimately succumb to the disease, she was resolute to take control of her health. She underwent surgery to remove as much of the tumor as safely as possible but declined chemo or radiation. Instead, while being monitored by doctors through routine scans, Iskra chose to use her diet (a combination of intermittent fasting and ketogenics) as her primary weapon to fight brain cancer. Two years later her tumors have either completely disappeared or are stable. Iskra’s story left me spellbound. Knowing everything I do about cancer, metabolism, and the important role that diet plays in maintaining our health would I have made similar decisions? Moreover, why wait for a disease diagnosis to embrace a healthy diet?

Hippocrates, the ancient Greek physician, whose wise words have become a sacred oath guiding physicians from antiquity to modern-day is also attributed to saying, “let food be thy medicine and medicine be thy food.” Diet is a major determinant of health. This also implies that diet is a major determinant of mortality.

In 2012 half of all cardiovascular deaths in the United States were associated with suboptimal eating habits. In 2017, 11 million deaths were attributed to diet- too much salt, not enough whole grains, and low intake of fruit. Global estimates suggest that 255 million life-years, known as DALYs, or disability life-adjusted years, are lost to not eating the “right” food. In fact, adherence to a diet high in plant-based foods is associated with an 11% reduction in overall mortality.

Diet can also prevent disease. Epidemiological studies suggest that 25% of breast cancer cases could be prevented by the adoption of a more Mediterranean eating pattern, high in vegetables, fruits, whole grains, beans, nuts and seeds, fish, and olive oil over the typical Western diet, often characterized by high intakes of red meat, sugar, fat, refined grains, salt, and more omega-6 than omega-3 fatty acids. Similar studies on the Mediterranean diet have observed benefits for colorectal cancer, breast cancer, pancreatic cancer, prostate cancer, colon cancer, lung cancer, and glioblastomas. It’s been said that “cancer has a sweet tooth”, wherein cancer cells are addicted to glucose. In fact, this is the principle enabling PET scans, wherein we administer a radio-labeled version of glucose and because cancer cells rapidly take it up, we can visualize tumors on a scan. Restricting glucose intake, the premise behind the ketogenic diet therefore should offer a way to starve tumors of their favorite food. Indeed, in both animal and human studies, the ketogenic diet has also shown to have broad anti-tumor activity including in prostate, colon, pancreatic, lung, breast, stomach, liver cancer, and neuroblastoma.

It’s not just cancer that can be thwarted by improved eating patterns. A lower risk of neurodegeneration such as Alzheimer’s Disease is also associated with the Mediterranean diet. Scientists believe foods like olive oil, wine, or pomegranate juice can help reduce oxidative damage and lead to decreased inflammation which has broad health benefits. Diabetes, cardiovascular disease, obesity, infertility, depression, and many other diseases are either directly or indirectly tied to poor eating.

Fructose, like glucose, is a sugar, which is used to provide energy to our body. It is found naturally in fruits and vegetables as a monosaccharide or covalently attached to glucose to form the disaccharide sucrose. It is also the major constituent of the artificial sweetener known as high-fructose corn syrup (HFCS). HFCS is used to sweeten processed foods like breakfast cereals, baked goods, and soft drinks. This is because fructose is quite literally the sweetest sugar- 10X greater than lactose, 2.3X increased over glucose and 1.7X over sucrose. Sweetness is perceived when molecules bind the “sweetness receptor” a G-coupled protein receptor (GCPR) complex involving proteins T1R3 and T1R2. These receptors are mostly found in the taste buds on our tongue but also in the lining of GI tracts, nasal epithelium, pancreatic islet cells, sperm, and testes. When a molecule binds to the sweetness receptor it triggers a release of neurotransmitters in our brains. The rush of neurotransmitters released when HFCS or fructose hits the sweetness receptor affects the brain in much the same way as a narcotic- leading to “food addictions.” While the data is still unfolding, this has led some to believe “fructose is the new tobacco” contributing to the global obesity pandemic and a myriad of other health problems.

What we eat affects our health. Why “we” (myself included) don’t embrace more healthy eating habits is complex – convenience, socialization, marketing, lack of awareness and more, all contribute. Time to effect is also a driver—poor eating habits will result in poor health, but typically over the span of years. Eating a chocolate macaroon will cause an immediate release of dopamine sending off feelings of pleasure. Yet the temporary food euphoria is just that-- temporary. More joy can be found by living. For Iskra, everything from the type of macromolecule, metabolite source, and exact gram is calculated before entering her body. It’s become less of a diet and more of a way of life: as evidenced by her recent triathlon success, she’s “winning”.

My personal belief is that modern medicine and a healthy diet should be implored together. Too often we put off thinking about our eating habits until we get a disease diagnosis. Then we hope and pray to find a drug or treatment that can fix the damage. While the successes of modern medicine are truly awe-inspiring (the recent mRNA vaccines as an example), relying too heavily on pharmaceutical intervention is precarious. Rather if we adopted more healthy eating habits, we may be able to avoid disease in the first place. And for a brain cancer diagnosis, and all disease diagnosis, prevention is the most successful treatment.