Monthly Archives: August 2018

Integrative Cancer Care – Extremely Helpful Tips from Leading Expert Oncologist Dwight McKee

This is one of the more important post I have done. It is long, but full of good advice for anyone with cancer or a loved one/friend with cancer. I have a number of patients who will benefit from this, so read very carefully.

Integrative Cancer Care – Extremely Helpful Tips from Leading Expert Oncologist Dwight McKee

This was a fantastic call with oncologist Dwight McKee who really showcased his mastery of this subject by providing a handful of simple yet profound tips regarding integrative cancer care.

Episode Intro

Dr. Michael Ruscio, DC: Hey, everyone! Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Today I am here with Dr. Dwight McKee. And we are going to be undergoing part 2 of our series on cancer therapy. And we are very excited to have this conversation. Dwight, welcome to the show.

Dr. Dwight McKee: Thanks so much for having me.

[Continue reading below]

Dr. R’s Fast Facts Summary

Reduce anxiety from the cancer diagnosis

  • Consider taking beta-blockers to reduce stress associated with diagnosis
  • Inderal 40mg 2x/day, followed by tapper once less stressed

Checkpoint Inhibitors

  • 10-20% response range
  • Opdivo and Keytruda
  • Can be very expensive –  $400,000 for a yr of treatment
    • Insurance covers if it is considered a first line therapy for your cancer type

Best way to learn about Integrative Cancer Care

  • Avoid the internet – there are over a million articles it can be too overwhelming
  • Speak with an experienced practitioner to start (a practitioner in their mid-40s would likely be more open to integrative therapies)
  • Trust your gut on who you are seeing, confidence in your practitioner is vitally important
    • Get 2nd and 3rd opinions
    • CONFIDENCE CURES CANCER (fear does the opposite)

Immunotherapy or Chemotherapy?

  • If you have a curable cancer – proceed with standard therapies
    • Unless you “categorically refuse chemotherapy” then you may qualify for immunotherapy if it is approved for your type and stage of cancer
  • If you have stage 4 cancer or have relapsed, find out from your oncologist if there is an approved immunotherapy for your type and stage of cancer
  • About 3% of metastatic cancers are curable with chemotherapy
    • About 12% of metastatic cancers are curable with some combination of chemotherapy and radiation
      • Lymphomas, Leukemias, Testicular Cancer

Natural Therapies and Support

  • Curcumin or Turmeric
  • Herbs that help support a healthy inflammatory response
    • Ginger
    • Vitamin C and IV Vitamin C (work for some cancer patients though we do not know which patients)
  • Post chemotherapy, consider mitochondrial support to prevent loss of energy

When treating with curative intent

  • A minimalist approach is favorable
    • Focus on good diet, exercise, stress management, body/mind therapies (acupuncture)
    • Careful with supplements
    • Use mitochondrial therapy post-cancer treatment or between treatments depending on your providers’ recommendations


  • Ketogenic diet can help certain types of cancer, especially early on, recently diagnosed cancer that hasn’t been treated. Then shift out of it. (good for anabolic cancers NOT good for catabolic cancers)
  • If cancer is leading to weight loss and/or edema use a plant based diet (for catabolic cancers)
  • Fasting dramatically reduces toxicity
    • Not recommended for people dramatically underweight who are not able to regain weight by the next cycle
Dr Ruscio Dwight McKee Podcast
In this episode…
Episode Intro … 00:39
Dr. McKee’s Background… 01:00
How to Learn About Immunotherapy … 10:00
Immunotherapy … 16:00
Curable Cancers … 21:00
Natural Therapies … 31:35
Treatment … 34:45
Curative Intent Treatment … 37:51
Diet … 40:00
Beta-blockers … 48:20
Episode Wrap-up … 41:24

Download Episode  (Right click on link and ‘Save As’)

DrMR: Can you tell people a little bit about your background, in case they have never come across your name before?

DrDM: Sure. I have an unusual career path. I started out doing an M.D./Ph.D. program at Case Western Reserve because I had gotten interested in research when I was in college at Williams College in biochemistry. So I thought I wanted to do research. And I did the M.D./Ph.D. in Pharmacology at Case Western Reserve. It was supposed to be a 6-year program, but when I was into it, it was clear that it was really a 9 or 10-year program.

And I grew up in Cleveland. And I think I had seasonal affective disorder as well. So it was kind of closing in on me. And I got very interested in clinical medicine after I was exposed to it. You know, you never know what you will like until you experience it. And so I ended up doing a year of research. And when I had taken all the graduate courses, I just finished my M.D.

I did an internship, and during that time I discovered and got really interested in nutritional medicine and alternative cancer therapies. And I went into practice. I joined Integral Health Services, which had been started by Sam McClanahan. We had two M.D.s, two chiropractors, two massage therapists, two nutritionists, two psycho-therapists, and an acupuncturist. So we were one of the first holistic health centers in the country, certainly among the first on the East coast. This was 1976.

And I started having all kinds of cancer patients coming. Then I started really studying all the extant alternative cancer therapies of the time. I started experimenting with them and using them. These were people who either didn’t want conventional therapy or had been told there was nothing more that could be done. And I was able to help a significant percentage of these people, probably 20%.

And ultimately I got frustrated with what I could accomplish. And I was also frustrated by the attitude of oncologists at the time because I would have stage IV patients who were getting better. They felt better. They were eating, and they were gaining weight. Their pain was decreasing. Functionally, they were improved on every level.

And they would go for their oncology visit and the oncologist would just stick a pin in their balloon. And they would say, well, you know, that’s all fine and good. But you have an incurable disease, and you’re going to be dead in six months. And I saw how devastating that nocebo effect, the opposite of a placebo effect, was. And I decided I needed to be an oncologist.

Dr. McKee’s Background

So at the age of 40, after 12 years in practice, I went back into training. I had to do a second internship because my first one wasn’t in internal medicine. I had to do an internal medicine internship, and then two years of internal medicine residency, and then a three-year hematology/oncology fellowship, which I finished in 1995.

And then I practiced integrative oncology, which didn’t really exist. But I started practicing it in San Diego and then continued in Montana until 2001. And then I moved back to California. And I shifted to doing integrative cancer consultations for other physicians who were by that time doing the non-oncology side of integrative cancer therapy, which had now become a thing.

So I was educating them about how oncology works and what the oncologists are thinking and helped them to communicate with oncologists in a non-threatening way, always thinking of the benefit of their patients. And I emphasized if patients are caught in a cross-fire between their integrative doctor and their oncologist, it’s stressful to the patient and that’s bad for the patient, no matter what the therapy is.

So I spent about 15 years doing that. And I also work as the scientific director of a nutraceutical company that was started by ex-patients and old friends of mine in Arkansas, which ended up becoming quite popular in Europe. So I’m spending a lot of time flying to Europe and back, working with people over there in that project. And I continue to have time to read and stay on the front lines.

When I got into oncology in 1992, what I was really interested in was the sort of high tech immunology, immunotherapy. And I was able to do two years of tumor immunology research at this research institute, which was really interesting. But it was not quite prime time yet. And it is now. And I am so excited to see it.

immune systemAnd I can see how much potential there is to integrate these new immunotherapies with nutrition and exercise and body/mind techniques and many integrative techniques because now we are talking about getting the immune system to work better. That didn’t work. There was a lot of naiveté in the alternative cancer community about, oh, if we stimulate the immune system and we give all these medicinal mushrooms and use this and that, it’s going to work.

But nobody understood until quite recently the ways that tumors vary and sophisticatedly block the immune response. And now we have ways with monoclonal antibodies to dissect this complex interaction in ways that tumors have devised to shut off the immune response, interfere with the tumor’s ability to shut that off, and then allow the immune response to go forward.

These are called check-point inhibitors. And they get responses in the kind of 10-20% range. So it’s not where it needs to be. But the responses are much more durable than those achieved by chemotherapy. And I have a colleague in Vienna who has integrated check-point inhibitors with hyperthermia and fever range interleukin-2 and several other things. And he is getting 60% response rates and 20% complete response rates.

So I know that’s possible. And I think that we are going to get better and better and better at curing cancer, which is a good thing because we are on the threshold of an epidemic of cancer because of what we have done to our food supply and our planet and our lifestyles.

DrMR: There are so many ways that I want to go from there. And there are so many great things that you said. And I just want to commend your staying power to undergo that long rigorous academic road that you went through. And thank you for that.

DrDM: Yea, it was a bit grueling.

DrMR: I’m sure.

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DrMR: So these inhibitors that you are mentioning, are these something that are available in the U. S.?

DrDM: Yea, this is standard therapy. These are drugs like Opdivo and Keytruda. And they are very expensive. A year’s therapy can easily run $200,000 to $300,000 to $400,000.

DrMR: Wow! So insurance coverage, I am assuming, for these is nearly impossible to come by?

DrDM: No, insurance does cover the ones where they are indicated, where there is an FDA indication. And like every couple of months, there is a new FDA indication. I believe Opdivo is now indicated first line in metastatic non-small-cell lung cancer.

How To Learn About Immunotherapy

DrMR: That’s great to hear. So where do you start someone? Let’s say our audience is a mixture of both practitioners and the lay audience. Where would you start someone who says, “Okay, I’ve done some reading and I feel overwhelmed by the topic?”

I don’t even get close to providing people with a list of recommendations for specific cancers, because there are many types of cancers and there are many types of recommendations. But where would you start someone? Is there an association they should go to? Or should they plug in somewhere in particular for the right type of information from an educational standpoint?

DrDM: Well, one thing I would discourage is just random web surfing, because those are dangerous waters. There are over a million websites that are thinly disguised advertising for one product or another. And there are more products that have helped someone with some kind of cancer some time than anybody even with unlimited funds could possibly swallow, ingest, inject. So, I would encourage people to find somebody experienced in the field as a guide.

After Cancer Care Book CoverI wrote a book with an oncologist friend of mine, who is the head of integrative oncology for the New Jersey satellite of M.D. Anderson Cancer Center, and my old friend Gerald Lemole, who was one of the first integrative cardiothoracic surgeons, who happens to be Dr. Oz’s father-in-law. Dr. Oz wrote the foreword to our book. It is called After Cancer Care.

And we wrote it as after cancer care, so as not to have the conflict that arises when people want to take supplements and particularly supplements during treatment. Because there is little data about that, oncologists don’t know about it. And so they are worried about it that it would interfere. When I was treating patients, I would use all sorts of things along with treatment, and I got very good results. But it hasn’t been studied.

DrMR: So is it fair to say that the natural therapies have viability for perhaps mitigating some symptoms, but not treating the cancer during cancer therapy? And then mainly the cancer therapies are more preventing recurrence? Is that where you say they are the strongest?

DrDM: Well, you know, that’s really hard to say. I think there is a role for them both. The majority of patients take supplements during therapy and they just don’t tell their oncologist, which is a suboptimal situation. But the reason they don’t is that they are afraid that if they tell them that they are taking things that they will them to stop.

What I often did was I would put together smoothie recipes for people with various tinctures and herbal concentrates and so forth. And just the concept of them saying I had a smoothie in the morning with a bunch of stuff in it, that doesn’t hit the alarm bells for most oncologists like well I take this supplement of that. I’m taking green tea extract or whatever.

And I think the tides are slowly beginning to shift. And I think there is more openness, especially among younger oncologists. I think the optimal kind of age for people who are interested in integrative cancer therapy for choosing an oncologist is somebody in their mid-40s. They are old enough to be experienced, but young enough not to be a victim of psycho-sclerosis as I call it, which is a hardening of the attitudes.

And I think it is also a very, very personalized journey. And what I encourage patients to do is trust their intuition, because this is way more complex than we have the science to inform. And if people will really trust their instincts, I have seen that work so many times about which doctor to use, about which herbalist to work with, which nutritionist, which psycho-therapist, and even what things to take on what day.

If people tune in to their inner guidance, and obviously some people are better at that than others. People who tend to be very in their heads have a harder time with that than people who have a lot of meditation experience and experience with connecting to their inner self.

And I think it’s a mistake for people to copy what someone else has done that has been successful. I think there are general principles that apply across the board. But the specifics can vary quite a lot.

There are more and more professionals in this space. And I encourage people to get in touch with one that they have confidence in. Get an oncologist that they have confidence in, a surgeon that they have confidence in, because it is confidence that cures cancer.


DrMR: And are there any important…And I guess maybe we can organize these into conventional medicine and then alternative medicine but are there are new and novel breakthroughs of late that are important for people to be aware of? And maybe perhaps there could be even questions one could use as indicators of, okay if this oncologist or herbalist hasn’t heard of X, Y, or Z, then perhaps they are not as up to snuff on the literature as they should be.

DrDM: Well, the first advice that I would give is that if somebody has a cancer that’s highly curable with standard therapy, do that. I have seen too many people who had a curable cancer who went off into some pretty arcane things because they were afraid of having chemotherapy or radiation or both and ended up dying of what was a curable cancer.

DrMR: Right.

DrDM: Find out. If you have an early stage Hodgkin’s disease, by all means, have conventional therapy. If you have early head and neck cancer, by all means, have conventional therapy. If you relapse, then it’s time to go looking. Or if you are diagnosed with a stage IV cancer and there is not a curative therapy, then start looking right away.

But the first question I would ask the oncologist is this. Is there an immunotherapy that is approved for my type and stage of cancer? Immunotherapy tends to be used at the end of the line because that’s the way our clinical trial system works. People go into clinical trials when they have failed all the standard therapies; or better, all the standard therapies have failed them. Then they get into clinical trials.

And immunotherapies are going to work best when the immune system is intact. And all of the conventional therapies, surgery, radiation, chemotherapy, they all take a toll on the immune system. So immunotherapy is going to work best up front. And they are going to work best in a healthy person. It’s possible to have cancer and be healthy.

One of my colleagues who is a brilliant herbalist–I teach seminars with him a couple of times a year–is up in Oregon. This was in the early days when immunotherapy was all still in clinical trials, referred to as the checkpoint inhibitors. They inhibit checkpoints that are built into the immune system to avoid autoimmune disease.

And cancer exploits those checkpoints. So blocking those checkpoints with a specific antibody can allow the immune system to get past that blockade that the cancer has set up. And he had four different clients in four different immunotherapy clinical trials in which his client was the only complete response in the trial with thirty some patients. And the odds of that being a coincidence are astronomical.

DrMR: Sure.

DrDM: And he uses diet and lots of herbs, tinctures, powders smoothies and capsules. And he knows a tremendous amount, and he’s highly intuitive. And he encourages patients to trust their intuition as well. But all four of those were the only complete response.

And a complete response is probably a cure. We don’t have enough time, we don’t have 20 years of experience yet to know that for sure. But they are very, very durable. And when they do relapse, they can be retreated with different immunotherapy and respond again at a very high rate.

So that would be the first question I would ask. If you have a cancer that doesn’t have curative therapy and you haven’t been treated yet, the first question I would ask is, “Is there an immunotherapy that is approved for my type and stage of cancer?”

And if they say, “Yes, but it’s only approved if you’ve failed two lines of systemic therapy,” they can say, “The tide is shifting in this direction.” They can say, “Well, I categorically refuse to have chemotherapy.”

And then they say, “Oh, well, in that case, you’re a candidate for immunotherapy.” But if they didn’t know to say that, they would get two lines of chemotherapy and get the immunotherapy after they had failed two lines.

Curable Cancers

DrMR: And I’m assuming the details here matter in terms of if the chemotherapy was shown to be curable, then you are recommending going forward with the chemotherapy. But if it was not, you would recommend the immunotherapy. Or would you modify that at all?

DrDM: No. I think in broad strokes, yes, that’s true.

DrMR: Okay. And if it’s curable, anyway, I think we need to define that. Is there a certain percentage or range of response that is considered curable and it delineates from non-curable?

DrDM: Well in general terms, about 3% of metastatic cancers are curable with chemotherapy, and about 12% are curable with some combination, either radiation alone or radiation and chemotherapy. So that’s all your lymphomas and leukemias and testicular cancer. Those make up about 3% of cancers. So it’s a small percentage. But I’ve seen people with those cancers avoid treatment and then end up dying needlessly.

DrMR: Gotcha. And when we say something is curable, does that mean we are approaching 100% cure rate?

DrDM: In some cases, like non-Hodgkin’s lymphoma, it depends a lot on the subtype and the stage and the grade and so forth, but in very rough terms, they are about 50% curable. It’s about a 50/50 deal. So do the therapy if you’re in the 50% that’s cured. And I think there are things you can do to improve your odds of being in that 50%, with your lifestyle, with your diet, with stress management, because all those things play into how well your body can maintain.

When other medicines or energies are killing the cancer, the immune system is able to respond to those. Until those cells die, they have a very effective cloaking device. The immune system is blind and can’t see them. When they die, the immune system suddenly sees them.

But if the immune system is suppressed by the radiation or the chemotherapy because the patient is eating an ordinary American diet, and sedentary lifestyle, and high stress, their immune system is not going to be in as good a condition to respond to those dying cancer cells as somebody who is exercising every day, eating a whole food organic diet, managing their stress both with exercise and other things.

One of the studies that I included in After Cancer Care was a very simple and profound one done by Barbara Anderson at Ohio State Cancer Center with women who had been treated for early stage breast cancer, stage II and III, that means node positive and/or locally advanced. They were in remission, but they were at high risk for relapse. And one-half of them did progressive muscle relaxation.

If you’ve ever had a yoga class, often at the end of it they will go through this process of having you tighten one muscle group in your feet and then relax and moving up the body. It takes about 10 minutes. And the women who were compliant with this and did it religiously had a 60%, not reduced risk, but 60% less relapse. And relapse from breast cancer becomes an incurable situation.

DrMR: Sure.

DrDM: So that’s a bigger effect than chemotherapy and hormonal therapy together in breast cancer. So these things really do matter. And there are the things that people can do for themselves. And their oncologists don’t know about them. It’s not part of their training. They won’t tell them not to do it. But they need to know about it, and they need to do it.

DrMR: Now in terms of the conventional therapies and navigating that sea of options, is there anything else that you would add along with that? And I think that immunotherapy tip is very helpful. Is there anything else that is important for people to be aware of or factor into their plan, more so on the conventional side?

DrDM: As I said before, I think the key thing is really not just taking the first oncologist that you are referred to. Get second opinions. Get third opinions. And choose the one that you really feel you connect to, that you really feel confidence in. I think what kills people with cancer more than anything is fear. And confidence is the anecdote to fear.

Cancer is such a boogeyman in our collective social consciousness because we have all seen people suffer and die from it. We all know someone or we all have someone in our family who has died of cancer. And so immediately when you get that diagnosis, your limbic system goes, oh my God, and sends out all these panic messages. And you get into this fight or flight response.

And your immune system is run by the opposite branch. It’s run by the parasympathetic, which you only get when you are relaxed.  So if people are living in fear, they are turning off their immune system. And that’s why I say confidence cures cancer. It doesn’t matter really what the details are. It’s really that people have confidence.

DrMR: I think that is very well said. And that’s one of the reasons why I don’t take a hard line with diets. And I don’t believe that fear is a good tool to motivate patients into dietary changes, for whatever reason.

DrDM: Absolutely not. We should be working with encouraging people what to eat because of its benefit, not what not to eat because of its dangers.

DrMR: Sure.

DrDM: Now, don’t have the, “Don’t eat sugar. Don’t eat white flour.” “Do eat vegetables. Do eat brightly colored fruits and vegetables.”

Another good tip is fasting during chemotherapy. That dramatically reduces toxicity. I have had some patients who nearly died from their first cycle of treatment, but then fasted for 3 days with their second cycle and breezed through it.

DrMR: Boy, you know what’s funny about that is sometimes I’ve heard the recommendation during chemotherapy since it negatively affects your appetite, eat whatever appeals to you, even if it’s ice cream or whatever, to make sure you get in some calories.

DrDM: That’s bad advice. The nausea and all the side effects that chemotherapy causes is telling you, don’t eat. And that’s good advice because what’s been found is that the normal cells when you fast very quickly go into kind of a hibernating state. They really lower their metabolic rate. And cells are sensitive to most chemotherapies based on how fast they are growing and their metabolic rate.

So the normal cells shut down. The cancer cells can’t do that. They don’t know how to do that. They have no mechanisms to do that. So fasting doesn’t slow them down at all. And so they get the full effect of the chemotherapy, and the normal cells are relatively protected.

DrMR: Right.

DrDM: This came from the work of Valter Longo at the University of Southern California. He started out studying yeast and found that when he restricted the calories, the yeast would live a lot longer. And he has founded a company called ProLon, which has developed fasting mimicking diets. And they are developing them for cancer. But what they found out is that they have to have a different set of foods for each cycle of chemotherapy.

The fasting mimicking diet is very low in protein, very low in carbohydrate. It’s a little bit of fat and essential vitamins and minerals. It’s about 200 calories total for the day. And they’ve made these things taste really good. But what they found is that the body associates the food with the toxicity of the chemotherapy. So they can’t use the foods again. So they are developing a whole range of these fasting mimicking diets for cancer patients to choose from.

And I started recommending that people just drink herbal tea and maybe a little coconut water, a lot of water and a lot of herbal tea the day before, the day of, and the day after chemotherapy. And they tolerated it so much better. Their blood counts were not nearly as impacted. Their energy wasn’t as impacted. They don’t get the mouth sores.

And it depends on their chemotherapy type as to what the spectrum of side effects is, but they’re dramatically lower with fasting. And this is fairly new information that the body associates whatever foods or flavors were there when they got the chemotherapy. So they need to choose a different one the next time. But that’s a big one for people going through chemotherapy.

I don’t recommend it for people who are really underweight and really have such a poor appetite that they are not able to regain the weight by their next cycle. If they are able to regain the weight that they lose by their next cycle, then it works great.

DrMR: Gotcha. And we’ve got Valter Longo scheduled to come on a podcast in a few months. So that will be an interesting conversation to have with him.

DrDM: Yea. He’s really done groundbreaking work.

Natural Therapies

DrMR: And that’s a nice transition into some of the natural therapies. And that was my next question. Just like we went through what are some of the important conventional therapies to at least ensure that your oncologist is acknowledging, are there certain natural therapies?

And this may be a little bit more challenging because I am assuming there is a litany of natural therapies. But if someone is trying to figure it out, are there some key indicators, some key questions I can ask my natural provider to kind of assess their competency? Of is there anything like that that could be useful? What would you offer people as we wade into the natural sea of options?

DrDM: You know, as you said, there is a huge number of things. Some of the major players, of course, are curcumin or turmeric. There are scientists at M.D. Anderson who have really pioneered the research in that told me that in vitro in cell cultures, curcumin is 50 minutes as potent as turmeric. But in vivo, like in a mouse model, they are equally potent, because there are so many other things in turmeric. So really either one works well.

And cancer thrives on inflammation. And all of your cancer therapies that we use, including immunotherapy, are inflammatory. So I really emphasize herbs that help support a healthy inflammatory response and help move people out of the chronic inflammatory response.

DrMR: And so would ginger be high on your list there?

GingerDrDM: Well, ginger is very high on the list because it also is a great remedy for nausea and an appetite stimulant. It is a cousin of turmeric. Boswellia is very good, but it’s so threatened in the wild, I hate to recommend a lot of Boswellia until somebody figures out how to grow it sustainably. There are only a few places where that tree grows.

DrMR: Vitamin C, IV vitamin C?

DrDM: Vitamin C and IV vitamin C. IV vitamin C definitely works in some cancer patients. But we haven’t figured out how to predict who they are. So that would be hugely beneficial if we could know. IV high dose vitamin C is actually an oxidative therapy. We think of vitamin C as an antioxidant. But given in high doses intravenously, it’s actually an oxidative therapy.

And the same is true of alpha lipoic acid. This was only recently recognized that IV alpha lipoic acid switches in 600 mg dosage therapy that Burt Berkson does in New Mexico. Alpha lipoic acid is a great antioxidant, but given IV it is actually an oxidative therapy. And cancer cells are more sensitive to oxidation. They have less ability to tolerate oxidative stress than normal cells. So that’s why these kinds of IV therapies can work when they work.

And you know, oncologists are very afraid that if cancer patients take any antioxidants that it will interfere because one of the mechanisms of chemotherapy is to create oxidative stress. So IV vitamin C, IV alpha-lipoic acid is sharing that mechanism with many chemotherapy agents.


And I have heard radiation oncologists tell their patients don’t eat blueberries or kale because they are too strong and interfere. And we do know that the mechanism by which radiation kills cancer cells is by generating oxygen free radicals. But my analogy is that any antioxidants that you can eat or take would have an effect on radiation like throwing a pillow in front of a freight train.

DrMR: Sure. [Laughs] Good analogy.

DrDM: It’s only in children that have been given really large doses, because they are tiny, by their parents, that there has been documentation that antioxidants in large doses orally in small people can interfere with radiation. And they have kind of generalized, so it has just become dogma in radiation oncology training that patients stay away from antioxidants.

I don’t even like the term antioxidant. I prefer to just say redox active because everything is oxidation and reduction. It’s a reaction that goes both ways. I often will supply ubiquinol as the most bioavailable form of CoQ10, which is a fundamental antioxidant in the mitochondria.

Mitochondria are easily damaged. And that’s part of the post-cancer fatigue syndrome because mitochondria don’t have good DNA and repair mechanisms as the nuclear DNA does. So they are quite vulnerable. And protecting mitochondria can be quite helpful in people’s quality of life post-therapy.

DrMR: Two questions for you. If someone is trying to ascertain, and I know it may be hard to give a general answer here, but they are doing chemotherapy or maybe immunotherapy, and they are wondering should they be taking high dose ginger and vitamin C IV or oral, and CoQ10? Do you think it’s a good idea to wait until after that course of conventional therapy, or is it better to do this at the same time, or is not that simple?

DrDM: It’s not that simple. The basic answer is that we don’t know. I combined those therapies with chemotherapy when I was practicing, and as I said, I had good results. But there are things like selection bias and operator attitude and so forth that play into the results that people have. So it’s a very complex question. I would just encourage people to follow their intuition. Try to find an oncologist who is open to them doing whatever.

Curative Intent Treatment

And there’s another issue. And this is one thing I spend a lot of time training doctors and other practitioners who are working with cancer patients on the integrative side. There is an enormous difference between what we can and should do when patients are being treated with curative intent and when they are being treated with palliative intent.

And if they are being treated with curative intent, I really favor a minimalist kind of intervention. It should be really focused on good diet and very focused on good exercise appropriate to their age and condition. It should be really focused on stress management and body-mind therapies, things like acupuncture. I would be very careful with supplements because even in the most curable cancers, it’s not 100%.

So if you have a stage I Hodgkin’s disease and your patient is that 1% who isn’t cured and you gave them a whole lot of supplements, that may or may not have anything to do with them being in that 1% that wasn’t cured. It may have just been the genetics of their cancer or the microenvironment of their body or their genetics. But everybody is going to feel bad about it.

So if people are being treated with curative intent, I tend to recommend against very much supplementation, maybe vitamin D and omega-3 fatty acids. Those are pretty clearly harmless and helpful. But I always stop supplements the day before, day of, and day after chemotherapy of that sort, because we just can’t predict what sorts of interactions there might or might not be.

If they are being treated with palliative intent, like they have a stage IV cancer that it is not a testicular cancer or a lymphoma that is potentially curable, then I think it is absolutely silly to tell them that they shouldn’t take this or take that. They should take anything that they feel drawn to take or do.


Vegiterian DietDrMR: Sure. And regarding diet, there are different camps. There are some who recommend a ketogenic type diet, some who recommend a vegetarian and plant-based diet. It sounds like the fasting mimicking diet is kind of a combination of I guess you could say low carb, low calories.

DrDM: Well, the fasting mimicking diet is not something that you can do for long. It is not sustained. A ketogenic diet I think is quite good for an early just diagnosed cancer that hasn’t been treated, to go along with treatment, especially glioblastomas.

One of my mentors was Emmanuel Revici. I studied with him for six years. And he discovered a dualism within cancer, which is not generally appreciated in mainstream or even the integrative world. And he used the general terms anabolic and catabolic to describe this dualism.

And the cancer always starts off anabolic. And in its late stages of its natural history, it often shifts to catabolic. Or after it’s been radiated, it will always become catabolic. And when it recurs, it is often catabolic. And ketones are catabolic substances. And so they are very good for anabolic cancers. And virtually all of our animal models are anabolic models.

If you have a situation where there is weight loss, edema, these are key signs that this is a catabolic state that the cancer is in. And a ketogenic diet will make that cancer worse. That has been my experience as well. So yes to ketogenic diet in early cancers along with treatment, and then shift out of it, because especially radiotherapy is going to push them catabolic. It is a very catabolic therapy. Most chemotherapy is as well.

And most cancers that relapse…I mean, at least we have ways of measuring it and quantitating it and so forth. But in general terms, they tend to come back with the opposite imbalance that they started out with. So the things that were good for them, in the beginning, become bad for them later on. So I would use the ketogenic diet early and then stop it after treatment.

DrMR: Interesting. Okay, I hadn’t heard that before. That is very helpful. Thank you.

DrMR: Regarding mitochondrial damage, we recently had Dr. Jon Kaiser on the podcast, who has done some interesting research in mitochondrial function. And he has a compound on his K-PAX, which is essentially a multivitamin combined with, I believe, four fairly fundamental mitochondrial supports. I know CoQ10 is in there, alpha-lipoic acid, and I am unclear of the other two off the top of my head. But do you have any familiarity with the K-PAX formula specifically?

DrDM: I don’t know that line. But it sounds reasonable.

DrMR: Okay, good. And so you would be running the mitochondrial therapy post chemo.

DrDM: Yea, maybe even in between cycles, to support the mitochondrial recovery.

DrMR: Gotcha. Okay. That takes us through many of the things I wanted to at least touch on and actually provided many other tips I wasn’t even sure we would be able to pull out of that brain of yours with this wide wealth to pull from. So I’m very appreciative.

Natural Therapies

Is there anything that you would like to offer the audience as we draw to a close? And then after that, would you please tell people if you have a website or any other literature that you would point them to if they wanted to learn more?

DrDM: I don’t have a website. Oh, I should mention that my friend, Nalini Chilkov, who is an acupuncturist and herbalist in Santa Monica, very accomplished in the integrative cancer space, has an online training course, a basic course on integrative cancer therapy. It is a great place for docs, herbalists, anyone who is interested in getting more into the integrative cancer space. Contact her office and find out how to get into that course. That’s a good resource.

I think fundamentally we have made a huge error by approaching cancer with a military and war mentality. I think cancer is trying to send a message to us about what we are doing wrong personally and collectively. And we have learned so much from it. I think we should stop fighting it and really start studying it and listening to it. I should write another book called Listening to Cancer.

The war mentality also brings up the whole sympathetic nervous system. And the healing is in the opposite. It’s in the parasympathetic. It’s in the relaxation. It’s in the love and appreciation. And one of the gifts of cancer is really we’re all going to die, right? None of us gets out of here alive, as somebody said. We get a pretty long heads up.

So when it becomes clear that people are going to die from this process, they have time to spend with friends and family and resolve unresolved things and forgive. I also think that active forgiveness is a huge part of therapy, because resentment is a carcinogenic emotion. I am quite clear about that from forty plus years in the field. So not forgiving somebody only hurts the person holding the grudge. And when your life is on the line, it’s really important to forgive.

But when you drop over from a heart attack or a stroke, you don’t get that. You don’t get a chance to say goodbye. You don’t get a chance to resolve unresolved conflicts or tell people how much you love them. And cancer does allow that. So I think we just really need to shift our perspective collectively, and I think we would do a lot better.


DrMR: I think that’s pretty sage advice. Anything that we can do to take stress off of someone, it certainly only stands to at least be neutral, if not positive, in terms of how it impacts their health and their psyche.

DrDM: Exactly.

DrMR: Well, this has been, like I said a moment ago, a fantastic call. I really think you have provided people with some key navigating stars, if you will, to guide them along this process, which I’m sure is quite stressful. And it is hard to determine what to do and where to go and who to trust.


DrDM: You just reminded me of another pearl. When people are diagnosed with cancer, especially if it’s a significant cancer, that is probably the most stressful event of their life. And we have talked about the effects of stress.

I have found, and it has been noted, that people who are taking non-selective beta-blockers for other conditions like high blood pressure or atrial fibrillation, who have cancer, have way better outcomes. And so I about seven or eight years ago, maybe ten, started recommending that people when they are diagnosed with cancer, get someone to prescribe Inderal, beta block selective, 40 mg twice a day, if they can tolerate it.

You can start with 20 and increase to 40 if they can’t. If they have really low blood pressure, they may not be able to take as much. But pharmacologically blocking the sympathetic nervous system dramatically protects them from that and allows their parasympathetic nervous system to function while they are navigating all the visits to the medical oncologist, radiation oncologist, surgical oncologist, and so forth.

It’s an incredibly stressful time. And nobody can really figure out through their own stress management practices in that period of time how to protect themselves. So I think that is a very valuable medication in protecting them. And then, later on, I encourage them, once they have established a stress management–and I have outlined sort of a menu that people can choose from in After Cancer Care–and then taper off of it. They don’t need it later on if they can develop a good stress management program of their own.

But it hasn’t been done in a clinical trial yet. But looking at it just in population studies, people on non-selective beta blockers have far better outcomes than those who aren’t. And it has been documented also in animal models. So there is good evidence for it. And it’s a very simple thing to do.

DrMR: Great. Well, one more pearl for the list here.

DrDM: Yea. Thank you. Well, you triggered that in your closing comments. So I wanted to throw that in.

Episode Wrap Up

DrMR: Awesome. Well, thank you. Thank you so much for taking the time. Boy, this has been a very enlightening call. And I really appreciate you and the work that you are doing. So thank you again.

DrDM: Great. I really enjoyed it. I don’t have a website. And I retired from integrative cancer consultation. Please don’t try to find me. But there are people out there that I have trained who are very good. And there are more and more people coming into the space all the time. And I think the whole profession is going to move in that direction over the next 20 years. And I hope I am around to see it. I celebrate my 70th birthday in a couple of weeks, and I’m hoping for 20 more. And I think it’s going to be a really exciting time.

DrMR: Awesome. Happy early birthday! And I hope you are right. And I have a good feeling based upon some of what you have said that we are getting closer to a much more leveraged relationship with cancer here. All right, sir. Well thank you again. And have a safe flight.

DrDM: Okay. Thank you.

DrMR: All right. Take care. Bye, bye.

DrDM: Bye, bye.

How to rein in the widening disease definitions that label more healthy people as sick

How to rein in the widening disease definitions that label more healthy people as sick

May 16, 2017 6.10am AEST

The experts arbitrarily and controversially created a new cut-off for diagnosis that classified more than a quarter of all post-menopausal women as having the “disease”. The following year (1995) pharmaceutical company Merck launched Fosamax, a drug for osteoporosis that would soon become a multi-billion-dollar blockbuster.

In 2008 a guideline from the United States National Osteoporosis Foundation further increased the numbers of those diagnosed, with a recommendation that more than 70% of white women over 65 should take osteoporosis drugs. With medication, of course people benefit by avoiding a fracture. But many of those at low risk will suffer more harm than good, unnecessarily taking potentially harmful drugs.

Osteoporosis is just one condition that has had its definitions widen over time and, with that, the pool of people diagnosed as having it. An article published today in the journal JAMA Internal Medicine outlines the first serious attempt to set some global rules for those experts who move diagnostic goalposts that label more people as sick.

Medical panels are constantly changing diagnostic cut-offs and lowering thresholds to classify many conditions and diseases. Those changes determine whether we or our loved ones receive a diagnosis that might help us – by, for example, giving us access to a life-saving treatment – or harm us – by bringing the anxiety, cost and danger of an unneeded medical label.

Osteoporosis has had its definitions widen over time and, with that, the pool of people diagnosed as having it. from

New ‘pre’-diseases

Widening disease definitions have been central to the problem of overdiagnosis, where classifying previously healthy people as sick can lead to more harm than good.

For instance, minor memory or cognitive changes are increasingly being seen as symptoms of a condition called “pre-dementia”. This label can potentially be applied to a third of people over the age of 65. Some of them may never have dementia, yet are faced with the anxiety and stigma of a possible, eventual diagnosis.

Another example is the emergence of “pre-diabetes”, which labels 30% to 50% of all adults, depending on the diagnostic criteria used. “Pre-diabetes” is a controversial term used to describe a blood sugar level above normal, but below that of someone with diabetes.

While some argue the label may bring benefits – for example, by encouraging healthier lifestyles – such a dramatic widening could do much harm. As one article in the BMJ journal states:

A label of pre-diabetes brings problems with self-image, insurance and employment as well as the burdens and costs of health care and drug side effects.

Then there’s gestational diabetes – the type diagnosed in pregnant women. In 2010 a global panel – which influences how the condition is diagnosed in many places, including Australia – recommended changes to the diagnosis that would double or even triple the numbers of pregnant women labelled. The decision was taken on the basis of new evidence suggesting benefits for mother and baby diagnosed at the new lower thresholds.

Yet when an independent group convened at the United States National Institutes of Health in 2013 took a close look at the 2010 decision, they rejected it. The reviewers cited a lack of convincing evidence newly diagnosed women would benefit from treatment. They also raised concerns about additional costs to the health system, and unintended consequences of labelling, such as an increased rate of caesarean births and related patient costs.

Pre-diabetes is used to describe a blood sugar level above normal, but below that of someone with diabetes. from

Reforming new diagnoses

A recent study of changes to the definitions of more than a dozen common conditions, including high blood pressure, depression and asthma, found three things.

First, the expert panels of doctors who made these changes often decided to widen definitions classifying more people as patients. Generally, the motivation was that treating milder problems, or finding diseases earlier, would benefit the newly diagnosed.

Second, these panels did not rigorously investigate the downsides of that expansion; none examined how many people would be overdiagnosed.

And, third, most panel members had financial relationships with drug companies that stood to benefit from panel decisions.

Following that study, a global body that sets guiding rules for these panels – the Guidelines International Network – set up a working group in 2014 to consider the problem of widening disease definitions. It included members with a range of experience, from genetics to guideline development, as well as from the World Health Organisation.

Following a review of the literature and consultation, the group created a short common-sense checklist of questions being published today in JAMA Internal Medicine. These questions are intended for expert panels to think about, before they decide to widen definitions and move the medical goalposts. Some of them include:

  • What are the differences between the old and new disease definition?
  • How will the new definition change the numbers of people diagnosed?
  • What are the potential benefits for those classified under the new definition?
  • What are the potential harms for those diagnosed and society?

This new guidance might seem somewhat abstract. But it directly affects all of us. The next step is to test how the new guidance works in practice, where panels of experts are actually considering a change to a disease definition.

What’s the point of sex? It’s good for your physical, social and mental health


What’s the point of sex? It’s good for your physical, social and mental health

January 17, 2017 6.04am AEDT

Today’s piece describes physical, social and mental health benefits that are a consequence of consenting sexual relationships, or the pursuit of them.

Whether you talk about it in polite society or not, sex is central to who you are as a person. In fact, we are all here as a result of meaningful looks, snatched moments, sweaty palms, clumsy first touches, tangled limbs and orgasms.

Were sex only important for procreation, it would more than do its job from an evolutionary perspective. However, evidence suggests that at a physical and social level, sex is about much more than making babies.

Most nonhuman animals have no interest in sex outside of a reproductive context. But women have sex throughout their menstrual cycle despite being fertile for only a few days each month, and go on having sex long after menopause renders them infertile. And of course, couples who are of the same sex, using contraception or infertile are no less keen for congress than any pregnancy-focused counterparts.

Ultimately, no one knows for sure what the point of all this sex is, but its other biological effects may provide clues.

Sex brings people together

Have you ever met someone who is right for you “on paper”, but when push comes to shove their scent seems wrong, or the spark isn’t there? Our bodies can tell our minds who we don’t want to be with. Similarly, our bodies can give us strong signals about whether we want to stay close to somebody.

When we touch, kiss and have sex, our body responds with a release of hormones linked to bonding. Most important among these appear to be oxytocin and vasopressin.

Such releases are particularly marked during sexual excitement and orgasm. The release of these chemicals is thought to promote love and commitment between couples and increase the chance that they stay together.

Some research supporting this comes from studies of rodents. For example, female voles (sturdy little mouse-type creatures) have been found to bond to male voles when their copulation with them is paired with an infusion of oxytocin.

In humans, those couples who have sex less frequently are at greater risk of relationship dissolution than are friskier couples.

But oxytocin is not just good for pair bonding. It is released from the brain into the blood stream in many social situations, including breastfeeding, singing and most activities that involve being “together” pleasurably. It appears oxytocin plays a role in a lot of group oriented and socially harmonious activities, and is implicated in altruism.

Bonobos resolve conflicts through sexual activities. LaggedOnUser/flickr, CC BY-SA

Bonobos (a species of great ape) appear to take full advantage of the link between harmony and sex, often resolving conflicts or comforting one another by rubbing genitals, copulating, masturbating or performing oral sex on one another. This isn’t something to try during a tense board meeting, but such findings hint at the potential role lovemaking may play in reconciliation between couples.

Sex is a healthy activity

Sex is a form of exercise: a fun online calculator can help you calculate how much energy you burned during your last sex session.

People with poor physical or emotional health are also more likely to have sexual problems. Here causality is hard to establish – healthier people will tend to be “up” for more sex, but it is also likely that the physical workout and bonding benefits conferred by satisfying sex lead to healthier, happier lives.

It’s also possible our long, energetic and physically demanding style of sex evolved to help us appraise the health of potential long-term partners.

Sex can make us creative

Some theorists propose art forms such as literature, music and painting result from our drive to get people in bed with us.

In a society in which there’s at least some choice available in whom we mate with, competition will be fierce. Consequently, we need to display characteristics that will make us attractive to those we are attracted to.

In humans, this is thought to result in competitive and creative displays, as well as displays of humour. We certainly see evidence of the success of this tactic: musicians, for example, are stereotyped as never lacking a potential mate. Picasso’s most productive and creative periods usually coincided with the appearance of a new mistress on the scene.

Science says: go for it

What then does science tell us? Simply put, non-reproductive sex is an activity that can bring biological rewards. It can bring people together, help drive creative endeavours, and contribute to good health.

The bugs we carry and how our immune system fights them

The bugs we carry and how our immune system fights them

The immune system has to establish which cells belong to us and which are foreign, no mean feat.

The bugs we carry and how our immune system fights them

This article is part of a three-part package exploring immunity and infectious diseases around the world.

Human beings are large, complex, multicellular, multi-organ systems. We reproduce slowly and rely on a breadth of mechanisms that allow us to control the myriad of rapidly replicating, simple life forms that have evolved to live in or on us.

The system of defence is referred to collectively as immunity.

The word itself comes from the Latin immunis, describing the status of returned soldiers (Genio immunium) in the Roman state who were, for a time, exempt from paying taxes.

Our immunity protects us from many illnesses, including some forms of cancer. New cancer therapeutics, called immunotherapies, work by boosting our immune cells to fight cancer cells that have found ways to evade them.

The immune system is divided into two interactive spheres, the much older “innate” sphere, and the more recently evolved “adaptive” sphere. A primary challenge for the very specifically targeted cells that form the basis of adaptive immunity is to distinguish “self” (our own body cells and tissues) from “non-self” – the foreign invaders. When that goes wrong, we can develop autoimmune diseases such as multiple sclerosis or rheumatoid arthritis.

Read more: Explainer: what are autoimmune diseases?

The organisms we carry around with us

The human body is host to many organisms over a lifetime. Some are dangerous to health (pathogens), some are benign, and some are necessary for proper functioning.

Most of the genetic material we carry around with us is “non-self”: principally harmless bacteria (called “commensals”) that live in the gastrointestinal tract.

Traditionally, studies focused on the “bad bugs” in our gut that cause diarrhoea and dysentery. But more recently, we’re learning there are also good guys. And there’s a general consensus we need to know more about the “microbiome”, the mass of bacteria in any “clinically normal” gut.

Gut bacteria provide essential vitamin B12 and when they die, release myriad proteins that will be broken down into amino acids, which the body needs. About 30% of our poo is comprised of dead bacteria.

Apart from our microbiome, normal human beings also have a substantial “virome”. Viruses differ from bacteria (which are cells in their own right) in that they are much simpler and can only replicate in living cells.

The greatest number of viruses we carry around are the “bacteriophages”, which infect the commensal bacteria in our gut. Not all “phages” are, however, benign. For example, the toxin that causes human diphtheria is encoded in the genome of a bacteriophage.

There’s also a spectrum of viruses that persistently infect our body tissues. The most familiar are herpes viruses, like those that cause cold sores (H. simplex) and shingles (H. zoster). Both viruses hide out in the nervous system and are normally under immune control. They re-emerge to cause problems as a consequence of tissue stress (such as a sunburnt lip) or as immunity declines with age (shingles). This is why a booster shingles vaccine is recommended for the elderly.

Read more: Essays on health: microbes aren’t the enemy, they’re a big part of who we are

Our innate and adaptive immune systems

The innate system ranges from processes as basic as phagocytosis (ingestion of bacteria), to molecules like the interferons produced by any virus-infected cell that can limit replication. Such innate systems are found right across the evolutionary spectrum and don’t target specific pathogens.

The much younger adaptive immune system is what we stimulate with vaccines. A property of small white blood cells called lymphocytes, it divides broadly into two lineages: the B cells and T cells. These bear the extraordinarily diverse and very specific immunoglobulin (Ig) and T cell receptor (TCR) recognition molecules that detect invading pathogens (bacteria, virus, fungi and so on).

The immunoglobulins bind to “non-self” (foreign) proteins called “antigens”, while the T cell receptors are specifically targeted to “self” transplantation molecules.

The assassins of the immune system are then switched on; the killer T cells that eliminate virus-infected (or cancer) cells. Also activated are the “helper” T cells that secrete various molecules to “help” both the B cells and killer T cells differentiate and do their work.

Read more: Explainer: what is the immune system?

How does our immune system learn and remember?

All lymphocyte responses work by massive cell division in the lymph nodes (the “glands” in our neck that swell when we get a sore throat). This process is started by small numbers of “naive” B and T cells that haven’t encountered the invader before, and only stops when the foreign invader is eliminated.

The B cells differentiate into large protein-secreting cells called plasma cells, which produce the protective antibodies (immunoglobulins) that circulate for years in our blood.

Most of the T cells die off after they’ve done their job, but some survive so they can remember how to target specific invaders. They can be rapidly recalled to their “killer” or “helper” function.

Prior infection or the administration of non-living or “attenuated” (to cause a very mild infection) vaccines sets up the memory so protective antibodies are immediately available to bind (and neutralise) pathogens like the polio or measles virus. While immune T cells are rapidly recalled to “assassin” status and eliminate pathogen-infected cells.

As you may have gathered from this very brief and far too simplified account, the immune system is extraordinarily complex. And it’s also very finely balanced with, for example, cross reactive responses to bacterial proteins sometimes setting us up for autoimmune diseases.

Read more: No, combination vaccines don’t overwhelm kids’ immune systems

Another example of autoimmunity is rheumatoid arthritis, which can be triggered by blood-borne chemicals from tobacco smoke that modify “self” transplantation molecules in the joints.

And when we talk about the possible effects of the microbiome, or the “too clean” hypothesis, we’re discussing how exposure to bacteria and viruses can modify that immune balance in ways that directly affect our wellbeing. This is a very active area of research which, given the underlying complexity, presents scientists with big challenges as we seek to reach verifiable conclusions.

Vaginal dryness.

Efficacy of vaginal therapies alternative to vaginal estrogens on sexual function and orgasm of menopausal women: A systematic review and meta-analysis of randomized controlled trials

European Journal of Obstetrics & Gynecology and Reproductive BiologyPitsouni E, et al. | August 08, 2018

Via a systematic review and meta-analysis of randomized controlled trials, researchers evaluated data on menopausal women with genitourinary syndrome of menopause (GSM) concerning sexual function and use of vaginal therapies, other than vaginal estrogens. Non-hormonal therapies (vaginal laser, lubricants/moisturizers, phytoestrogens and lidocaine) and hormonal therapies (dehyadroapiandrosterone (DHEA), testosterone and oxytocin) constitute the vaginal therapy alternatives to VE. All relevant studies showed improvement in dyspareunia and vaginal dryness. Compared to estrogens, lubricants had lower sexuality scores. DHEA 0.5% showed similar results regarding orgasm domain vs placebo. Same sexual satisfaction and sexuality score were seen when testosterone was compared or added to estrogen therapy. The available data, seems inadequate to provide counseling in menopausal women regarding the effectiveness of vaginal therapies as an alternative to estrogens, on all parameters of sexual function

Laugh a little

Benefits of Progesterone.

I often get women who are told by their gynecologists that they should not be taking progesterone, because they have had a hysterectomy. It does concern me that we have specialists who really don’t understand hormonal treatment. They are confusing the natural progesterone that I use with the synthetic progestogens, which only work on the uterus. So, if no uterus, no need for progestogen. However, the natural progesterone has many important functions in women, especially on the nervous system. This is the reason why nearly all women will benefit from progesterone in the menopause/premenopause.
Climacteric. 2018 Aug;21(4):315-320. doi: 10.1080/13697137.2018.1463982. Epub 2018 May 23.

Non-clinical studies of progesterone.


Progesterone is a steroid hormone that is essential for the regulation of reproductive function. Progesterone has been approved for several indications including the treatment of anovulatory menstrual cycles, assisted reproductive technology, contraception during lactation and, when combined with estrogen, for the prevention of endometrial hyperplasia in postmenopausal hormonal therapy. In addition to its role in reproduction, progesterone regulates a number of biologically distinct processes in other tissues, particularly in the nervous system. This physiological hormone is poorly absorbed when administered in a crystalline form and is not active when given orally, unless in micronized form, or from different non-oral delivery systems that allow a more constant delivery rate. A limited number of preclinical studies have been conducted to document the toxicity, carcinogenicity and overall animal safety of progesterone delivered from different formulations, and these rather old studies showed no safety concern. More recently, it has been shown in animal experiments that progesterone, its metabolite allopregnanolone and structurally related progestins have positive effects on neuroregeneration and repair of brain damage, as well as myelin repair. These recent preclinical findings have the potential to accelerate therapeutic translation for multiple unmet neurological needs.

Progesterone for treatment of symptomatic menopausal women.

Prior JC1,2,3.


This review’s purpose is to highlight evidence that oral micronized progesterone (progesterone) is effective for hot flushes and night sweats (vasomotor symptoms, VMS), improves sleep and is likely safe in menopausal women (who are more than 1 year since last menstruation). Methods include randomized controlled clinical trials (RCT) supplemented with basic science, population and observational data as needed. The barrier to use of progesterone is lack of awareness that safety concerns with estrogen-including ‘menopausal hormone therapy’ (MHT) are not applicable to progesterone. In a single 3-month RCT, progesterone (300 mg at bedtime) was effective treatment of VMS in 133 healthy menopausal women. It caused an overall 55% VMS decrease, no withdrawal-related VMS rebound and a greater VMS decrease in 46 women with ≥50 moderate-intense VMS/week. Progesterone is equally or more effective than estradiol in improving cardiovascular endothelial function and caused no cardiovascular safety concerns in a 3-month RCT. An 8-year prospective cohort study (E3N) in more than 80 000 menopausal women showed progesterone prevented breast cancer in estrogen-treated women. Multiple RCTs confirm that progesterone (300 mg daily at bedtime) does not cause depression and improves deep sleep. In conclusion, progesterone effectively treats VMS, improves sleep and may be the only therapy that symptomatic women, who are menopausal at a normal age and without osteoporosis, need.

DVTs and HRT.

I often get asked about the risk of a blood clot from taking the hormones. any form of treatment as pills increase the risk of blood clots, but not if taken as a troche (Transdermal) There is considerable evidence showing this, and this recent study just confirms this fact.

Risk of venous thromboembolism events in postmenopausal women using oral versus non-oral hormone therapy: A systematic review and meta-analysis


The risk of VTE was increased in users of oral hormone therapy versus non-users.

Non-oral hormone therapy did not affect the risk of venous thromboembolism.

New trials are needed to sort out the impact of different progestins, estrogen doses and administration routes on VTE risk.



Hormone therapy (HT) is an effective treatment for climacteric symptoms. Nevertheless, combined estrogen-progestin therapy and the oral route seem to entail higher risk of venous thromboembolism (VTE) than estrogen-only therapy and transdermal administration. The present study aimed to investigate the risk of thromboembolic events in postmenopausal women using non-oral estrogen compared to women using oral estrogen and control groups (women receiving placebo or non-users of HT), as well as to assess the thrombotic impact of estrogens alone vs. combined estrogen-progestin therapy.

Materials and methods

Systematic review of MEDLINE, Cochrane CENTRAL, EMBASE, and according to PRISMA guidelines.


Twenty-two studies were included in the meta-analyses (9 case-control studies, 9 cohort studies, and 4 randomized controlled trials). As compared to control groups, VTE risk was not increased with non-oral HT, including users of estrogens and estrogens plus progestins (OR 0.97 [0.9–1.06]), non-oral estrogen therapy (ET)-only (OR 0.95 [0.81–1.10]), and non-oral combined estrogen-progestin therapy (OR 0.92 [0.77–1.09]). Conversely, increased risk of VTE was observed as compared with control groups in users of oral HT, including users of estrogens and estrogens plus progestins HT (OR 1.72 [1.47–2.01]), oral ET-only (OR 1.43 [1.34–1.53]), and combined oral estrogen-progestin HT (OR 2.35 [1.9–2.9]). The comparison of non-oral vs. oral HT showed increased VTE risk with oral HT (OR 1.66 [1.39–1.98]).


VTE risk was increased in postmenopausal women with no previous thromboembolic events using oral HT. Non-oral HT did not significantly affect this risk. The quality of the evidence produced in our meta-analyses is low to moderate, and further clinical trials are needed to sort out the impact of different types of progestin and different estrogen doses and administration routes on VTE risk.

HRT and memory loss.

I have published many studies showing that taking hormones in the menopause reduces the risk of memory loss, dementia and alzheiners disease. Here is another very recent study showing the same thing, This alone is a good reason to continue taking hormones long-term.

Menopausal hormone therapy and mild cognitive impairment: a randomized, placebo-controlled trial

Yoon, Byung-Koo, MD1; Chin, Juhee, PhD2; Kim, Jong-Won, MD3; Shin, Myung-Hee, MD4; Ahn, Soohyun, PhD5; Lee, Dong-Yun, MD1; Seo, Sang Won, MD2,6; Na, Duk L., MD2,6


doi: 10.1097/GME.0000000000001140
Original Articles

Objective: The aim of the study was to explore the therapeutic potential of menopausal hormone therapy (MHT) in women with mild cognitive impairment (MCI).

Methods: Thirty-seven postmenopausal women (age range: 57-82 y) with multiple-domain, amnestic subtype MCI were randomly assigned to either placebo (n = 18) or MHT (n = 19) for 24 months (percutaneous estradiol [E2] gel [0.1%, 2 mg/d] and oral micronized progesterone [MP4] [100 mg/d]). All participants received donepezil, and apolipoprotein E genotype was determined. The primary endpoint was general cognitive function: Alzheimer’s disease Assessment Scale, cognitive subscale, the Korean version of Mini-Mental State Examination (K-MMSE), and the Korean version of the Montreal Cognitive Assessment (MoCA_K) were performed in-person every 6 months.

Results: Twenty-one participants (placebo 13, MHT 8) completed the trial (56.8%). Progression rates to dementia were 52.9% (9/17) in the placebo group and 44.4% (8/18) in the MHT group. Within-group analysis showed that all three tests significantly worsened during the trial in the placebo, but not the MHT groups. Analysis adjusted for ε4 allele demonstrated that MHT significantly reduced deterioration of MoCA_K score, a sensitive tool for assessing global cognition in MCI (P = 0.0261). Compared with the control group, both MoCA_K (P = 0.043; mean difference, 3.85; 95% CI, −0.46 to 8.16) and K-MMSE (P = 0.0319; mean difference, 3.26; 95% CI, 0.04-6.48) scores were significantly better at 24 months in the MHT group.

Conclusions: Long-term MHT using percutaneous E2 gel and oral MP4 might attenuate cognitive decline in postmenopausal women with MCI.

We can change our brain and its ability to cope with disease with simple lifestyle choices

We can change our brain and its ability to cope with disease with simple lifestyle choices

This is part of our series on Changing the Brain, about what’s happening in our brain in various mental states and how we can change it for the better and worse.

Our life expectancy has increased dramatically over the past several decades, with advances in medical research, nutrition and health care seeing us live well into our 80s. But this longer life expectancy has also come at a cost, as the longer we live, the more likely we are to develop neurodegenerative diseases such as dementia.

Despite the lack of treatments for these diseases, there’s now a growing body of research to suggest there are a range of lifestyle changes we can adopt to help enhance our brain function. And even prevent brain disease.


The effects of physical activity, particularly aerobic exercise, on brain health have been well studied. There’s now evidence to suggest engaging in physical activity can improve brain health through a phenomenon called neuroplasticity. This is where brain cells can more easily respond to disease or injury.

Read more: Mind-bending drugs and devices: can they make us smarter?

Physical activity can induce a cascade of biological processes that improve function of brain regions responsible for memory, and things such as decision making.

In particular, going for a run or bike ride (as opposed to only strength exercises such as weight training) have been shown to increase levels of “brain-derived neurotrophic factor”, a protein central to the growth and survival of brain cells. Brain imaging studies are also starting to confirm exercise training can result in a bigger hippocampus (the brain region responsible for memory) and improvements in memory.

Just as protein shakes may help muscles grow after exercise, the brain-derived neurotrophic factor may help to strengthen and generate brain cells. This in turn can increase the brain’s ability to cope with injury or disease.

Exercise strengthens our brains as well as our muscles. Kyle Kranz/Unsplash


Over the past decade, there’s been an explosion of interest in meditation and mindfulness as a treatment of mental health disorders, particularly depression and anxiety.

Some studies have suggested long-term engagement in meditation is associated with physiological brain changes (such as larger brain volumes and higher brain activity).

But the extent to which meditation is associated with better memory, or with long-term protection against brain diseases, remains to be determined.


Hypnosis is one of the oldest forms of psychotherapy. It is typically used as an adjunct treatment for pain, and a range of anxiety disorders, including post-traumatic stress. Recent studies show that during hypnosis, changes in brain activity are detected in brain regions that govern attention and emotional control.

One small study (18 patients) suggested hypnosis substantially improved the quality of life of dementia patients after 12 months, with patients experiencing higher levels of concentration and motivation. But this result is very preliminary, and requires independent replication with larger numbers of patients.

It’s likely hypnosis plays an important role in reducing stress and anxiety, which may in turn improve focus, attention and wellbeing in general.

So what works?

The challenge with studying the effects of lifestyle changes on brain health, particularly over a long period of time, is the large degree of overlap across all lifestyle factors. For example, engaging in physical activity will be related to better sleep and less stress – which also improve our memory and thinking function.

Similarly, better sleep is related to improved mood. It may make people feel more motivated to exercise, which may also lead to better memory and thinking function.

The extent to which we can truly determine the contribution of each lifestyle factor (sleep, physical activity, diet, social engagement) to our brain health remains limited.

But a wide range of lifestyle factors that are highly modifiable such as physical inactivity, obesity, chronic stress and high blood pressure can have far-reaching effects on our brain health. After all, it is mid-life high blood pressure, obesity and physical inactivity that can increase our risk of dementia in later life.

Recently, a large study of 21,000 American adults aged over 65 suggested the prevalence of dementia fell significantly from 11.6% to 8.8% (nearly a 25% reduction) over 12 years (from 2000 to 2012). The researchers suggested this decrease in prevalence may be due to increases in education and better control of risk factors for high cholesterol and high blood pressure.

This provides some hope that we can, to a certain extent, take charge of our brain health through engagement in a wide range of beneficial activities that seek to improve mental function, improve heart health, or reduce stress.

It’s never too early to start investing in the health of our brains, particularly when these lifestyle changes are easily implemented, and readily accessible to most of us.