How to make your immunotherapy drugs work properly

How to make your immunotherapy drugs work properly

All the research on immunotherapy drugs like Pembrolizumab and Nivolumab points to the need for a healthy microbiome to make them work better - high fibre diets, probiotics, even vitamin D, each and all help make more T-cells, and more active T-cells that these drugs aim to 'unblock' so they can 'see' the cancer.

I recently had an interesting conversation with Professor Robert Thomas before recording my Sunday Show where he was my guest. The subject was immunotherapy drugs.

He was telling me how he'd been conducting research on probiotics and had found that they make virtually any drug work better, especially immunotherapy drugs. This is something I have been daying for nearly a decade.
 
I have a view, that is certainly not meant to be rude, that the majority of oncologists in Britain simply do not understand the microbiome. And they also think that an immunotherapy drug is just another drug.
 
Last year I had a patient who was on Carboplatin and Taxol for about 3 months, then Avastin was added for another three months, and then the lady had Avastin only, plus an immunotherapy drug - Pembrolizumab. She was so pleased that she was having 'immunotherapy'. Unfortunately, it didn't work and a scan about 4 months later showed progression.
 
Used like this, the figures show immunotherapy drugs only work well in perhaps 11% of patients.
 
The reason is simple. It says on the pack that immunotherapy drugs like this one 'UNBLOCK YOUR T-CELLS'.
 
For that to be successful, first you need to have some! And preferably lots. But if you've been on chemo, your gut microbiome will be severely damaged. Research from the USA about 2 years ago showed that 4 rounds of two drugs left patients with just 27% of their full microbiome,12 months after finishing the drugs! In other words, the microbiome was in terrible shape after the drugs and didn't recover as doctors assumed. The research concluded Fecal Microbiome Transplants were necessary. 
 
They are not, if you talk to someone who understands how to rebuild a healthy gut over time. You need to do 4 jobs - heal your gut wall, repair/replace the ravaged gut lining, kill any pathogens, and replenish the microbiome with a diverse selection of lost strains and families.
 
But to go back to the immunotherapy issue, we know categorically that it works better if you have a strong microbiome (1). How could it possibly be expected to work if given simultaneously with a chemo drug, or immediately after? This is a conundrum pointed out by Oncologists at NorthWestern in Chicago and oncologists at MD Anderson.
 
To repeat - chemo flattens your microbiome - but immunotherapy needs a strong microbiome to work properly.
 
We know that immunotherapy unblocks your T-cells so they can attack. It says that on the immunotherapy fact sheet.
 
Clearly then, you need lots of T-cells which is why a strong gut microbiome helps because it increases the numbers of T-cells (and B-cells that make antibodies). And the best way to get a strong microbiome is to eat a high soluble fibre diet and people who do this have the best immune systems and their immunotherapy WORKS BETTER (2)
 
There are about 5 studies that show that taking a probiotic can help immunotherapy drugs work better, and even a study that names the strain that seems to help the most (3).
 
But also T-cells cannot attack unless they are 'armed' by vitamin D (4).  T-cells have receptor sites on them for Vitamin D; it works as a hormone and activates the T-cells. 
 
80% of people diagnosed with cancer have extremely poor vitamin D levels (below 50 nmol/L) with another 10-12% still deficient and below 75 nmol/L.. The T-cells can't be activated unless the levels improve. Not surprisingly, for these deficient people, we know that Vitamin D supplementation increases survival (5).
 
The Endocrine Society, Harvard Medical School, Professor Michael Holick, and yours truly say you MUST be over 75 nmol/L and ideally between 100 and 150nmol/L to be healthy (6). 
 
But vitamin D in the bloodstream is actually in the inactive form as the liver 'processes' it, whether from sunshine or a pill. It was thought that the adrenals re-activated but recently it has been shown that a chemical called butyrate activates it (7). And butyrate is made by about 90 different gut bacteria that could have been wiped out by the chemo drugs taken before the immunotherapy! We give people butyrate after chemotherapy!
 
And this is why we suggest to our patients to take 3 months off after their chemo, to allow us to rebuild the gut and therefore the immune system. It's not just about adding in missing bacteria. Good food choices increase helpful bacteria that avoid illness and reduce inflammation (8), and good foods can restore the volume of good (commensal) bacteria (9).
 
And anyway, the chemo drugs reduced vitamin D levels in the body (10).
 
So, we would give you probiotics and probiotic foods, a high soluble fibre diet, vitamin D3 and butyrate. It's a sensible course to take to improve the success of your (expensive) immunotherapy drugs.
 
 
References
 
  1. Immunotherapy works better in patients with a strong microbiome - https://www.canceractive.com/article/immunotherapy-may%20work%20better%20after%20a%20fecal%20transplant 
  2. Increasing fibre intake improves immunotherapy - https://www.canceractive.com/article/increasing-fibre%20intake%20improves%20immunotherapy%20outcomes 
  3. Successful immunotherapy may be the result of one bacterium - https://www.canceractive.com/article/successful-immunotherapy%20may%20be%20the%20result%20of%20one%20bacterium 
  4. Vitamin D activates your immune T-cells - https://www.canceractive.com/article/vitamin-d%20activates%20tcells 
  5. Vitamin D supplementation increases survival - https://www.canceractive.com/cancer-active-page-link.aspx?n=3896&Title=Vitamin%20D%20supplementation%20increases%20breast%20cancer%20and%20colorectal%20cancer%20survival 
  6. Vitamin D? Shout out loud One-Two-Five - https://www.canceractive.com/article/vitamin-d%20%20say%20out%20loud%20onetwofive 
  7. Butyrate from gut bacteria activates vitamin D - https://www.canceractive.com/article/your-gut%20bacteria%20activate%20your%20vitamin%20d. 
  8. Gut microbiome enhanced by good foods https://the-rainbow-diet.com/the-colourful-mediterranean-diet/study-links-rainbow-diet-foods-to-good-health/ 
  9. Foods that boost good gut bacteria - https://chriswoollamshealthwatch.com/your-illness/gut-health/the-best-foods-for-gut-health/ 
  10. Vitamin D levels lowered by drugs - https://www.canceractive.com/cancer-active-page-link.aspx?n=4100&Title=Chemotherapy%20prevents%20vitamin%20D%20levels%20rising%20in%20the%20body
 
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