Checked February 2020
Follicular Lymphoma Core Concepts represent the BIG PICTURE.
Follicular lymphoma remains a confusing, controversial disorder. That does not mean, however, that it (and other lymphoma subtypes) cannot be managed effectively leading to long-term, healthy survival far beyond established expectations.
The six Core Concepts below are vital for survivors to be aware of in making wise choices involving lifestyle strategies and arriving at treatment decisions in consultation with their doctors.
Core Concept #1 : The Genetic Fact
The National Cancer Institute (NCI) states that “cancer is a genetic disease”.
Genes, including the proteins and enzymes they produce drive everything that happens in the body 24/7 from birth to death.
All humans have the same genes; over 20,000 of them. Minor, non-harmful mutations (so-called “variants”) in the DNA of these genes make each of us different. Major mutations can be harmful, making certain people more susceptible to developing specific diseases.
The other factor governing variations between people is gene EXPRESSION. Gene expression (believed to occur in most genes) varies up and down every second of every day in response mainly to lifestyle practices, environmental toxicity and chronic infections. (Reference our Follicular Lymphoma Flow Chart page).
It is this EXPRESSION level that is the most potent factor that led to getting follicular lymphoma in the first place. And it is ONLY by this means that follicular lymphoma will ever be resolved.
NO drug, new or old, can correct faulty gene expression. That is why, despite a short period of tumor shrinkage in some cases (known as “progression-free survival” or time to treatment failure), no drug (including maintenance rituximab) has been able to demonstrate an increase in overall survival time with our disorder. This is another reason why follicular lymphoma, like most other cancers remains incurable with standard treatments alone.
Core Concept #2: The Development and Resolution of Follicular Lymphoma
Here are the steps involved in the development and resolution of follicular lymphoma:
* Getting follicular lymphoma in the first place is only partially bad luck.
* All humans have the same genes. So it is not a case of having a gene or not having it.
* Mutations in genes specific to follicular lymphoma (that are now well known) “open the door”, making it possible for the disorder to get started. We are born with some of these mutations. That’s the “bad luck” part. Additional mutations, referred to as somatic, may be acquired later in life. Somatic mutations likely arise from many causes including lifestyle and exposure to environmental toxins.
* Thankfully, a second set of genes that all humans have are (usually) able to hold the mutated genes in check. We refer to these as regulatory genes.
* Regulatory genes are “flexible”. They are able to adjust their expression level 24/7 in response to lifestyle, environmental toxins and infections.
* The rapidly expanding science describing variable gene expression is known as epigenetics. It represents a significant breakthrough in medical science. Epigenetics demands a new and fundamentally different way of analyzing and combating all diseases, especially cancer. Unfortunately, knowledge of the complex processes involved in epigenetics is still lacking in the medical community, which includes many clinician/oncologists not involved in teaching or research.
* Although our immune system is effective in killing cancer cells when they first form, once a colony becomes established, growth and even possible regression of the lymphoma is governed primarily by our regulatory genes, and therefore by lifestyle.
* Of all cancers, follicular lymphoma is one of the most likely to exhibit natural or spontaneous regression. On this site, regression is our GOAL –not just in one or two nodes, but in ALL OF THEM. We now see this as possible. (Detailed guidance is in Articles #3, 10 and 11).
The fact that gene expression is responsive to lifestyle choices represents a HUGE breakthrough for us as proactive survivors. Now we have a chance as never before to personally apply a scientific plan of “gene therapy” leading to the resolution of follicular lymphoma.
Core Concept #3: Our NORMAL Cells Rule
It’s a simple concept. The details are complicated, but it all boils down to the “street-smart” fact that the expression level of our genes, specifically the enzymes and proteins that are produced, determines everything that happens in the human body.
The National Cancer Institute states that cancer is a genetic disease. It is not an infection like the flu or AIDS. Malignant cells can be reduced in number by various treatments, but they cannot be completely eradicated. That’s because no treatment yet is able to correct genetic malfunctions (mutations + faulty epigenetic signaling) driving the cancer to begin with. The net result is that cancer remains incurable over the long term.
Simply put, the expression level of two types of genes drive the malignant process – tumor suppressor genes (the good guys) and oncogenes (the bad guys). A sub-type of tumor suppressor gene called a DNA repair gene can actually correct harmful mutations in our DNA — a remarkable miracle about which most people have no idea. (Refer to the Follicular Lymphoma Flow Chart page).
Tumor suppressor genes slow down the malignant process and can even cause it to reverse (the example in our case being natural regression of follicular lymphoma). On the other hand, oncogenes (a well-known example being Myc) can become overactive, promoting malignant growth, even transformation of follicular lymphoma.
NOW comes the super connection. The expression level of tumor suppressor genes and oncogenes is regulated by what’s going on in our NORMAL cells as stated below:
Definition of a Tumor Suppressor Gene
Any of a class of genes (such as TP53) that act in normal cells to inhibit unrestrained cell division and that when inactivated (as by mutation) place the cell at increased risk for malignant proliferation — (Merriam-Webster Dictionary)
It is well known that good lifestyle practices (quality sleep, stress reduction, physical activity, nutrition and all) positively influence the health of our normal cells. From there, it follows directly that our healthy normal cells create optimal expression of our tumor suppressor genes and down-regulate our oncogenes.
So that’s it – simple and straight forward – now we have the linkage needed to connect lifestyle and environmental hazards to gene expression that can either work to control and possibly even reverse our lymphoma, or on the other hand, cause it to get away on us.
In summary, you might wonder why it has taken so long for the dots to be connected on this vitally important concept in the self-management of follicular lymphoma, with application to other cancers as well.
The diagram below portrays the message graphically.
Keep your NORMAL cells happy, healthy and wise. They are the ones that eventually enable us to overcome follicular lymphoma.
Core Concept # 4 : The Two-Population Fact with Follicular Lymphoma
Follicular lymphoma survivors have two populations of cells in their body:
Χ Malignant Cells
√ Normal Cells
There is only a TINY difference between the biology of our normal cells and the malignant follicular lymphoma cells we have unfortunately acquired. That’s good, because we can often feel well while at the same time harboring a tumor load that would be life threatening with other cancers.
But it’s not good when it comes to treatment. It has not been possible to develop an external “intervention” therapy sufficiently precise that attacks just the malignant population. A treatment strong enough to kill the majority of malignant cells would also cause serious harm to the patient and likely prevent recovery afterwards. That’s one reason why follicular lymphoma remains incurable.
(Note that there is a significant difference between transformed follicular cells and normal ones. That’s what enables certain chemos, when applied correctly, to eradicate the transformed component).
In managing follicular lymphoma for long-term success, we MUST take BOTH populations into account in everything we do. Nothing applies to just one.
The best example is with food and supplements. EVERYTHING we eat, they (the malignant cells) eat too!
Contrary to popular belief, foods or supplements often thought to be the best choices can promote tumor growth. This is what makes dietary plans so difficult to manage effectively.
The following image portrays the message.
The foods and supplements we choose MUST be based on a comparison of benefit to our normal cells against risk of adverse stimulation to our malignant cells.
After several years of research and practical application we have identified these foods as starred items in Article #3.
Keep the friendly dog happy by choosing the right foods and supplements, with an emphasis on “food first”.
In managing follicular lymphoma, whether it is a treatment or a natural strategy, we must take into account the effect it will have on BOTH our malignant cells AND our normal cells. This is especially the case with foods and supplements.
Remember that natural strategies to PREVENT cancer are not necessarily valid AFTER diagnosis. (November 2016 Newsletter).
Note that quality sleep and stress reduction ALWAYS favor normal cells over the malignant ones.
Core Concept #5: The Follicular Lymphoma Treatment Wellness Spectrum
Treatments are helpful. But they can’t on their own make one well.
First we treat, IF and when necessary. Then we adopt a scientifically-based wellness plan. Not both at the same time.
Consistent with the Two Population Fact described in Core Concept #4, we cannot be killing cancer cells in the malignant population using conventional treatments like chemo while at the same time ingesting supplements, special diets and so on to promote wellness.
During conventional treatment, DNA damage will be taking place in both our normal cell population and in our malignant population. Our normal cells, under considerable duress at this point, will not be able to respond to strategies to promote wellness through remediation of their genes.
It is important during conventional treatment to note that basic health must be maintained by ensuring adequate rest, nutrition and physical activity to the degree possible. Sanitation measures need to be emphasized. Vitamin D3 level should be maintained, mainly through supplementation since sunlight may be harmful to the skin during chemo.
So, first we treat (if/when needed), then we try to get well…not both at the same time.
This is portrayed by the scale below.
Treatment -8-7-6-5-4-3-2-1 O+1+2+3+4+5+6+7+8 Wellness
Even if the treatment works perfectly, resulting in a complete response, with “no evidence of disease” the BEST it can do is pull the survivor back out of negative territory back to the zero point. It CANNOT on its own make the person well.
Once the treatment has done its thing, and hopefully delivered the patient back to zero, then it’s up to the survivor to initiate strategies to move into the positive, green, wellness zone leading to extended clinical remission and possible long-term, healthy overall survival.
When in treatment, let the treatment “do its thing” consistent with the way it was designed. Treatments won’t provide a “perfect” result with follicular lymphoma in the sense that ALL malignant cells will be eradicated. But it is often possible to pull the survivor back close to the zero point.
THEN, when blood counts have stabilized, follow up with realistic confidence into the wellness zone by adopting the Four Pillar Epigenetics Program (4PEP) in Articles #3, 10 and 11.
Core Concept # 6 : Momentum Carryover with Follicular Lymphoma
A diagnosis of follicular lymphoma often involves evidence of at least one node that is at least 1 cm. (about ½ inch) in size.
This is not the beginning of follicular lymphoma. In fact, at this point, the disorder is already well advanced, probably having been in development for many years, even decades. A small 1 cm. node contains billions of malignant cells, (even though, as noted above, they are very similar to our normal cells).
In cases with minimal tumor load where the survivor has no B symptoms (Article #2), traditionally it has not been beneficial to over-treat at this point.
(An exception applies to those with stage 1 where localized radiation can lead to clinical remission; however relapses later on are still common).
Faced with a dilemma at this point about what to do when treatment is not justified but where the lymphoma is already well established, proactive survivors…to their credit…are often drawn to “alternative therapies”.
This is noble in principle, but application is hard with good results being rare.
Our Four Pillar Epigenetics Program (4PEP) program in Article #3, developed over many years, is able to zero in on this challenge helping to guide proactive survivors straight away with scientifically-based strategies directed specifically toward gene remediation. Unless the focus is on gene remediation, all natural strategies programs fall short.
BUT, even as potent as the 4PEP program can be, we still cannot overlook the fact that the lymphoma is already well established at the time of diagnosis.
It will usually take an extended period of several months, even with small tumors, before natural regression becomes evident. The lymphoma has taken a long time to show up and it will, like a loaded freight train, take time to first halt and then begin to reverse.
Best in Health,
Robert G. Miller