Cancer diagnosis: A more functional approach to being ‘thrown off the roundabout of life’

When Gina Donnery received a double cancer diagnosis at age 40 and was given a 50 per cent chance of surviving another five years, she felt she had just been “thrown off the roundabout of life”.

In the process of removing endometrial cancer that had grown into the ovaries, doctors realised from scans, she says, that they had cut through a second cancer in the cervix. It wasn’t one linked to HPV but a rare type. “They put me at stage four, basically, right away,” she says. “It’s really then you find out that jobs, material things – nothing matters.”

She and her husband, Robert, were living in Hong Kong at the time, with their two young children. The couple had left Malahide, Co Dublin, nearly 20 years previously, after he landed a pilot’s job with Cathay Pacific and she embarked on a successful real estate career.

The diagnosis came a year after she had lost both her parents back in Malahide in quick succession. Her father to cancer; her mother five weeks later to “a broken heart”.

Donnery recalls sitting in front of doctors who said they would throw everything at her cancer, but they did not know if it would work, nor what harm the treatment might do. While family and friends rallied around saying, “you’ll beat this”, she struggled to understand “the concept of ‘beating’ something that I grew, basically”.

Feeling alone “in a body that was broken”, she applied her logical, business brain to what might have led to this. She did not smoke, drink or take drugs, but was in the habit of joining a gym every year and never going. However, there had been years of stress, juggling a corporate career with motherhood, and then came the double parental bereavement.

“I think it was just the tipping point,” she says 12 years later, sitting in the smart, spacious livingroom of her home in Malahide, where the family returned after Donnery had finished her cancer treatment in Hong Kong. At the time, she was determined to learn all she could about the development of cancer and what she might be able to do to help herself.

She went on a journey of research, avoiding reading “anything where they were trying to sell me something, or [where] a person died at the end”.

A game changer was the book Anticancer: A New Way of Life (2007) by doctor-scientist David Servan-Schreiber, which she read in two hours. Having been diagnosed with brain cancer at age 31 and given six months to live, he threw himself into studying scientific evidence of lifestyle changes combating cancer.

Donnery was upset to learn, only at the close, that the author had since died at age 50, after cancer returned. However, his detailing of what science said about how nutrition, exercise and other lifestyle measures could fight as well as prevent cancer, started to change her mindset.

“I had something to hold on to and I felt as if I had a small bit of control.”

She had no intention of refusing conventional, medical treatment, she stresses; this was about what she could do for herself alongside it. For instance, she would buy lots of fruit and vegetables when she was heading into chemotherapy sessions and exercise the day after. She went to counselling and started to apply psychological and biological lessons to her life. “I changed everything about myself. I tried to find ways to reduce stress. I tried to find a purpose.”

This was helped by the family being able to return to Ireland after her husband transferred to London with Cathay Pacific. Over the next 10 years Donnery studied biomedicine, nutritional therapy, naturopathy and herbal medicine, which led her to functional medicine. “I had this absolute appetite to soak in all the science behind how the body works and how we can change and heal.”

Her new life passion and business background combined when she was approached to take over the Irish Lifestyle and Functional Medicine Conference. It was founded in 2016 by the late Maev Creaven, a nutritional therapist from Galway, to bring research-based resources in an evolving field to healthcare practitioners of various disciplines.

So, how best to explain “functional medicine”, when even the name is derided by some?

I put this question to Dr Joel Evans, a US obstetrician/gynaecologist and director of the Centre for Functional Medicine in Connecticut, who will address the annual conference in Dublin later this month.

“Functional medicine is real medicine that looks at how the body functions, because the body can function in a suboptimal way before you’ve been diagnosed with a disease,” he replies in a video call from Stamford, Connecticut. “A conventional doctor may say that you’re healthy but a functional medicine practitioner, because they’re looking through the lens of how the body’s functioning, says, ‘No, you’re not okay’. We want you to function in an optimal way, as opposed to just making sure you don’t have a diagnosis of a disease.”

He gives the example of a patient with elevated blood pressure but who has not yet crossed the threshold for a diagnosis of hypertension. A conventional doctor may suggest close tracking of their blood pressure, “whereas a functional medicine doctor will come up with a lot of things to do to make sure that you don’t develop high blood pressure. So, it’s an active approach for the prevention of crossing that line of a diagnosis.”

The “sweet spot for functional medicine”, he says, is where people may feel great but want good health, wellness and longevity. Equally, it is “perfect” for people with a diagnosis of something such as diabetes, or pre-diabetes. “We understand the role of lifestyle and how it affects blood sugar.”

The links between stress, sleep, inflammation, nutrition and blood sugar can all be looked at.

What drew Evans to functional medicine was “learning that there were things I didn’t learn in medical school. For example, I had a patient with breast cancer who was told by her oncologist that it didn’t matter what she ate. I did not, in my training, learn about nutrition and cancer but she asked me to look it up, and then I found out about a relationship between sugar and cancer. I was never taught about that, and that got me angry.”

Conventional medicine benefits from people taking a functional approach, he says, and he believes there is a role for people other than doctors, such as nutritionists, in the latter. “Why? Because food is the number one cause of ill health – and the number one solution to getting healthy is eating properly.”

However, as there is no shortage of nutrition misinformation swirling around, Evans says the burden is on the customer to make sure the nutritionist has an appropriate level of certification.

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Indeed, “buyer beware” applies across the board, as anybody could call themselves a functional medicine practitioner. There is no professional association in Ireland and one of Donnery’s ambitions is to set up a registry. In the meantime, there is a list of those who have qualified for International Board of Functional Medicine Certification on ifm.org.

The RCSI’s Centre for Positive Health Sciences (CPHS) in Dublin offers a course in lifestyle medicine, elements of which sound similar to functional medicine. Both fields, along with integrative medicine, are parallel structures that have been emerging since the 1990s, says Dr Pádraic Dunne, an immunologist and lifestyle medicine professional who lectures at the CPHS. All three take a holistic approach in addressing root causes of disease and incorporate the impact of mind and emotions. The big difference, he says, is that lifestyle medicine concentrates on behaviour, while functional medicine focuses on physiological and biological metrics, involving blood tests, for example.

“If anything, functional medicine goes deeper into the physiology, so therefore has more of a backbone than lifestyle medicine,” he says. Both would attract scepticism from people who belief conventional medicine is the one, true way.

“The problem with lifestyle medicine and functional medicine is it’s very hard to do large trials,” says Dunne. “It’s much easier to do a trial if you’re looking at a single medicine.”

Whereas these personalised approaches involve more complexities and, although there are plenty of smaller studies, there are few on the scale that some would consider “proof”.

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Evans, who straddles conventional and functional medicine, knows all about pushback from mainstream colleagues. Critics describe elements as “pseudoscience” and argue it can involve overuse of testing and supplements.

“Those of us that have been lecturing in this field for many years still have PTSD from some of the critiques, so we go overboard with teaching the science that justifies this philosophy. Then there’s also something called scientific plausibility, which means it makes sense.”

For instance, “you don’t need a ton of science” to show losing weight can help with depression, he says. “The mechanism is when you’re overweight, you’re inflamed; fat cells produce inflammatory chemicals.” Through the gut-brain connection, inflammation in the gut leads to inflammation in the brain, which is now linked to depression.

“Research is coming from the conventional medical world that is validating what we’re doing,” Evans adds. “There are departments in major universities studying the gut microbiome – that used to be fringe.”

Donnery wants to change the narrative around functional medicine in Ireland and to promote the idea that practitioners could work alongside GPs, to support people with chronic ill health. Doctors are so pressurised they do not have much time for each patient, she points out. Whereas functional medicine practitioners can give people the time and space to tell their story and take a “deep dive” into what might be the root cause of their illness.

“I don’t diagnose in any shape or form,” she stresses and will refer on for any element that is outside her scope of practice. Her role is to support people to understand themselves better and “with my experience and the science behind it, put a plan in place for them”.

Food and lifestyle are both “medicine”, she says, but in this era of convenient, ultra-processed foods, people lose sight of how real, whole food is a chemical messenger to support healing and regeneration in the body. “I don’t heal anybody. What the body needs is homeostasis and that means all your body systems working together in harmony.”

She is heartened to see an increase in the number of doctors signing up for this year’s two-day Lifestyle and Functional Medicine Conference in Croke Park on November 14th and 15th, which is for healthcare practitioners only and is accredited for CDP (continuing professional development) points. Even if doctors decide it is not something they want to embrace, greater understanding of the concept would, she believes, be beneficial for all.

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One summer’s day, five years after Donnery’s diagnosis, her husband took a call from Hong Kong in the kitchen of their Malahide home.

“It was the doctor that treated me to see if I was still alive, because I was a statistic, right? He didn’t ask what I was doing or how I was, he just wanted to know if I was dead.”

Happily he could be told she had crossed to the positive side of that 50 per cent statistic – and hasn’t looked back since.