Understanding Neutrophil to Lymphocyte Ratio (Part 2): Research Demonstrating its Role as a Valuable Prognostic Marker in Cancer

A large body of research (as well as my clinical observations) point to chronic inflammation as a powerful force in the initiation, growth, and spread of cancer. As a result, an essential component of my protocol for health includes addressing inflammation.

As I discussed in part 1 of this series, there are three points to consider when evaluating the role of inflammation in cancer. First, a chronic inflammatory state can initiate cancer development. Second, it’s important to discover and address the root cause of the inflammation—for example, pathogenic (chronic infection), life-style, stress, and/or poor dietary habits. And third, recognize that the cancer itself creates inflammation—as the cancer energy mutates and gains intelligence, it manipulates the immune system, creating a pro-inflammatory micro-environment favorable to cancer growth.

Research indicates that the systemic manifestations of inflammation can provide a valuable biomarker for prognosis and treatment stratification. In particular, numerous studies indicate that a simple indicator of systemic inflammation—based on neutrophilia and/or lymphocytopenia—can provide prognostic information in a wide range of cancer types. In particular, the value of one index (the dNLR) derived from total white cell and neutrophil counts, is enabling large retrospective studies to be carried out.

Neutrophil to Lymphocyte Ratio May Be a Predictor of Mortality in All Conditions

White blood cell (WBC) count is one of the useful inflammatory biomarkers in clinical practice. For example, even if WBC is within normal range, subtypes of WBC including N/L ratio may predict cardiovascular mortality.

N/L ratio is a readily measurable laboratory marker used to evaluate systemic inflammation. There are many different conditions that can affect N/L ratio, including hypertension, diabetes mellitus, metabolic syndrome (1), left ventricular dysfunction, acute coronary syndromes, valvular heart disease, abnormal thyroid function tests, renal or hepatic dysfunction, known malignancy (2,3,4), local or systemic infection, previous history of infection (<3 months), inflammatory diseases, and any medication related to inflammatory conditions.

Here’s one example of how the N/L ratio can be useful as part of the evaluation of a specific cancer and the treatment protocol: not only N/L ratio but also mean platelet volume, red cell distribution width (5), platelet distribution width, CRP, uric acid and gamma-glutamyl transferase (6) are easy markers to evaluate the prognosis of colon cancer patients (7). However, one should keep in mind that N/L ratio itself alone without other inflammatory markers may not give exact information to clinicians about the prognosis of colon cancer patients. (8,9).


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Inflammation is an essential part of our body’s immune defense. When we encounter pathogens such as bacteria, viruses, or parasites, our body responds with inflammation to fight the invaders and increase immune response. In these instances, inflammation is beneficial. But inflammation has a dark side—left unchecked, it can wreak havoc on cells, tissues, and organs. For example, it’s well established that chronic inflammation is a powerful force in the initiation, growth, and spread of cancer.

There are three essential points to consider: First, a chronic inflammatory state can, over time, initiate cancer development. Second, we still need to find the cause of the chronic state of inflammation—for example, pathogenic (chronic infection), life-style, stress, years of poor eating, or a combination of the above. And third, it is important to keep in mind that the cancer energy, as it gains in intelligence, manipulates our immune system, creating a cancer-favorable, pro-inflammatory micro-environment.

Research indicates that the systemic manifestations of inflammation can provide a valuable biomarker for prognosis and treatment stratification. Numerous studies indicate that a simple indicator of systemic inflammation—based on neutrophilia and/or lymphocytopenia—can provide prognostic information in a wide range of cancer types. In particular, the value of one index (the dNLR) derived from total white cell and neutrophil counts, is enabling large retrospective studies to be carried out.

Although not informative from a biological standpoint in distinguishing cause from effect, the results of these studies are likely to be of significance in how we approach cancer. In my practice, I always consider the role of inflammation in cancer and tailor protocols for patients accordingly. The following markers are among those I consider most important:

  • Tumor-associated neutrophils (TANs)
    Bio-Markers: CD11b+, CD66b+, CD63+

Tumor-associated neutrophils (TAN) play a major role in cancer biology. Neutrophils are the most abundant circulating leukocyte in humans, and are phenotypically plastic. Neutrophils, as a key component in inflammation, often play a crucial role in inflammation driven tumorigenesis. TAN can take an anti-tumorigenic (what we are calling an “N1-phenotype”) versus a pro-tumorigenic (“N2”) phenotype. The anti-tumor activities of N1 TANs include expression of more immuno-activating cytokines and chemokines, lower levels of arginase, and more capability of killing tumor cells. N2 neutrophils are pro-tumorigenic, and secrete T2 cytokines.


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Baking cookies and sharing them with friends is part of our family’s holiday tradition. This year, I created a new recipe that I’d like to share with you. It’s a delicious holiday treat (made with spelt, walnuts, and other healthy ingredients) that I hope you’ll enjoy as much as we do!

Ingredients:

  • 4 oz butter (1 stick butter)
  • 2 oz coconut oil
  • 1 ½ teaspoon vanilla

    Walnut-Coconut Crescent Holiday Cookies

  • ½ cup maple syrup
  • 1/3 cup coconut sugar
  • 1 cup oat flour
  • 1 cup sprouted spelt flour *
  • ½ cup Pamela’s baking mix
  • ½ teaspoon sea salt
  • 1 ½ cups chopped walnuts*
  • 1 cup shredded coconut, toasted on stove for 2 minutes, stirring frequently

Sugar and spice topping:

  • 1 tsp. cinnamon
  • 1/8 tsp. cardamom
  • 2 tsp. maple sugar
  • 1 tsp. coconut milk powder

Instructions:

  1. Soften butter and mix with coconut oil and vanilla. Beat in maple syrup and coconut sugar.
  2. Sift oat flour, spelt flour, baking mix, and sea salt and add to wet ingredients.
  3. Fold in chopped walnuts and coconut.
  4. Shape into crescents and refrigerate for at least 1 hour before baking.
  5. Preheat oven to 350 degrees F convection.
  6. Bake cookies for 20-25 minutes, or until golden brown.
  7. Remove from oven, place on rack to cool, and using a sifter, dust cookies with the sugar and spice mixture.

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Christmas, Hanukkah, and the Winter Solstice are a good time for reflection and renewal as well as celebration. This year, I invite you to take time to consider the way that you view the world, and how you might shift your thinking to become happier, healthier, more compassionate, and more at peace.

In my work, I am acutely aware of the adverse effects of a pessimistic, negative view of life. Depression, anxiety, and loneliness continue to increase in our society. There is no doubt that these are challenging and unsettling times in our world. But the truth is that we have always faced the painful challenges of war, political strife, prejudice, and tragedies on a global and personal level.

I encourage you to not fall into the quagmire of pessimism, discouragement, negativity, or bitterness. I hear many people speak of their distress and their belief that the world is doomed. They see only tragedy, hatred, and destruction, and believe nothing good is happening in the world. Keep an open heart, my brothers and sisters. Take time for stillness, seek the truth, and devote yourself to acts of loving-kindness.

Devote yourself to acts of loving kindness”

Keep Your Focus on Responding, not Reacting

I find it helpful in life to focus on responding, not reacting. This is difficult when we are continually reacting to the barrage of information presented by technology. The more fast-paced and frenzied life becomes, the more we tend to react. Slowing down is a simple way of allowing the opportunity for thoughtful response.

We can begin to slow down by reducing our access to personal smart phones, computers, and electronics in general. Instead, take the time to meet a friend in the park or at a coffee shop. Relax, converse, and enjoy. This may sound radical, but occasionally leave your phone in the car or at home. You may be surprised at how much richer and more meaningful your interactions and life are when not lived through technology. We need to have fellowship, and we need to give love, receive love and feel a sense of belonging. This is spiritual nourishment, and without it we starve.


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I recently read a paper entitled “Integrative Oncology” 1 published in a peer-reviewed medical journal. To say I was shocked at the misrepresentation presented as “fact” is an understatement.

I am strongly compelled to offer a rebuttal to this article. I can only hope that those who most need the perspective of someone who has worked in clinical practice with cancer patients on a daily basis for almost three decades will benefit from my experience.

Personally, I prefer to use the term “Unified Medicine” over “Integrative Oncology” to more appropriately describe the wholistic ETMS (Eclectic Triphasic Medical System) model I developed and practice, known as ‘Mederi Medicine’ or ‘Mederi Care’.

Mederi Medicine is an approach where all aspects of an individual are addressed for optimal health and well being. This includes the fundamental building blocks of nutrition, herbs, lifestyle, and spiritual and emotional health, with the tools of modern conventional medicine employed when necessary. As a musician, I think of Mederi Medicine as similar to the way that the various parts of an orchestra each play an essential role in creating beautiful music. The ETMS is not a fragmented approach, but is synergistic, meaning that the whole is greater than the sum of its parts. This harmonious approach is something that is sorely lacking in modern conventional medicine”.

 

“I think of Mederi Medicine as similar to the way that the various parts of an orchestra each play an essential role in creating beautiful music”

What’s Wrong with the “Integrative Oncology” Paper?

Honestly, when I first saw the title “Integrative Oncology” I felt hopeful. I thought perhaps this paper would offer helpful information to those suffering from cancer, or to those who dedicate their lives to working with people with cancer. Instead, I found bias, misrepresentation, and outright twisting of the facts and outcomes of studies. This paper clearly states that it has been peer-reviewed, but given the many errors, I find that difficult to believe.

I find it strange that the subtext delineates “integrative approaches (e.g., lifestyle, meditation, yoga, acupuncture, massage)” but overlooks botanical and nutritional medicines, which are widely used as adjunct therapies in cancer protocols. I have no idea what the underlying agenda is in this paper. Why would scientifically and clinically proven modalities be dismissed or overlooked when they offer the potential for help without harm?


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Sometimes referred to as the “love hormone,” oxytocin is a powerful natural biochemical with physical and psychological effects. Acting as both a hormone (affecting the endocrine system) and a neurotransmitter (affecting the nervous system), oxytocin is well known for enhancing sexual behavior, reproduction, childbirth, breastfeeding, and maternal bonding. Perhaps less well known is the role that oxytocin plays in generating compassion, empathy, trust, relationship building, and social bonding.

Oxytocin (Oxt; /ˌɒksɪˈtoʊsɪn/) is a peptide hormone and neuropeptide.

The Whole-Body Effects of Oxytocin

Produced by large neuroendocrine cells in the hypothalamus, oxytocin is transported to and secreted by the pituitary gland, where it is released into the bloodstream and carried throughout the body and brain.1 When oxytocin enters the bloodstream, it affects the uterus and lactation, but when it is released into the brain, it affects emotional, cognitive, and social behavior, and enhances relaxation and psychological stability.

By helping the body adapt to highly emotional situations, oxytocin reduces stress and helps us respond appropriately to our social environment. Research shows that oxytocin benefits a variety of conditions, including anxiety, depression, and irritable bowel syndrome.

Oxytocin also regulates nonhomeostatic, reward-related energy intake, hypothalamic-pituitary-adrenal axis activity, and the glucoregulatory response to food intake in humans. For these reasons, oxytocin may be helpful in the treatment of metabolic disorders, as well as helping to manage food cravings and weight.2-5


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