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.
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.
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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
- 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
- About 12% of metastatic cancers are curable with some combination of chemotherapy and radiation
Natural Therapies and Support
- Curcumin or Turmeric
- Herbs that help support a healthy inflammatory response
- 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
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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.
And 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.
I 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.
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.
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.
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.
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.
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.
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.
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?
DrDM: 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.
DrMR: 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.
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.
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.