“Integrative medicine, nutrition, and supplements can be extremely beneficial in our treatment…[but] it gets very complicated, very quickly.” – Robert Ellis
“When all these precision therapies are directed to the tumor burden, and there’s little to no attention given to the host environment–the patient sitting in front of you–well, that’s half of what we need to look at; and it’s often missing. It’s not just what type of unique cancer a person is hosting, but what type of unique person is hosting this particular malignancy.” – Glenn Sabin
Advanced cancer patients must make complex testing and treatment decisions that usually focus on drugs. But drugs are only part of the potential drivers of cancer progression or regression. Core lifestyle factors and complementary treatments, including diet and supplements, can be extremely beneficial.
Robert Ellis, an advanced prostate cancer patient, and Glenn Sabin, an exceptional survivor of chronic lymphocytic leukemia and cancer coach, offered a patient’s perspective on nutrition, supplements, integrative oncology, and complementary therapies.
What is integrative oncology?
Integrative oncology is a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. At its core, integrative oncology addresses lifestyle. It’s important to eat well, sleep well, move your body, reduce stress, hydrate, and be aware of environmental impacts, both in and outside of your home.
What are the benefits of complementary therapies?
Advanced cancer patients should start by looking at the standard of care (NCCN guidelines) for treatment options, and then look at integrative oncology products and practices to see if there are viable complementary treatments. Some integrative oncology practices and natural products can modulate or enhance conventional treatments, help reduce the deleterious side effects of some of the stronger anti-cancer agents, help strengthen your immune function, make you more resilient, and improve quality of life. They can:
- Manage the side effects of treatments. For example, if you’re undergoing chemotherapy, there are natural products and supplements that can help with nausea and perhaps allow for titrating down or off of antiemetics that you are often prescribed. (ASCO just released integrative medicine guidelines for pain management along with the Society for Integrative Oncology.)
- Increase the effectiveness of treatments. For example, there are some supplements that are considered chemo sensitizers that have the potential to improve your response to treatment.
- Add complementary or adjunct treatments. For example, the Care Oncology protocol uses off-label drugs, repurposing drugs that have been used for other diseases to treat cancer.
- Optimize general health. For example, boosting your immune system, energy, and improving quality of life.
What are the challenges of complementary therapies?
Complementary treatments suffer from the same challenges of complexity and personalization that guide conventional treatments. Some things that are good for some cancers may not be good for your cancer. Things that may be helpful to prevent cancer are not helpful once you have been diagnosed with cancer or your cancer progresses. There may be differences in what’s helpful, whether or not you’re hormone sensitive, castrate resistant, metastatic, or non-metastatic. And there are contraindications with several natural products when used with certain anti-cancer and supportive care agents.
What are some tips for complementary therapies?
- Nutrition: Nutrition and diet are core determinants of health. There are other lifestyle factors that are quite powerful as well, but diet is key. Healthy diets include “pescetarian” (vegetarian plus fish) or Mediterranean (based on the traditional foods of countries that border the Mediterranean Sea, including whole grains, vegetables, legumes, fruits, nuts, seeds, herbs and spices, and olive oil as the main source of added fat.) You should eat a rainbow of plants, and well-sourced cold water, omega-rich fish, such as salmon, halibut, cod, sardines, and mackerel. For prostate cancer, you may consider avoiding eggs and dairy products. Broccoli, pomegranate, turmeric, and green tea have been shown to correlate with a positive impact on prostate cancer cells. You should try to fit these things in your diet using a “diet first” approach to get that bioavailability with clean whole foods, and then supplement as necessary, ideally under the guidance of an integrative oncology-trained practitioner.
- Supplements: Your selection and titration of supplements should be informed by blood analysis of nutrient levels and biomarkers, such as oxidative stress/free radicals, inflammation load, circulation, and glucose levels, with retesting every six months or so.
- Beverages: You should consider consuming various organic brewed teas such as green, turmeric (curcumin), and reishi mushroom.
- Fasting: Intermittent fasting and fast-mimicking diets during active treatment helps to keep digestion less busy, and may also increase efficacy of systemically-delivered drugs. This has also been shown to help mitigate the often deleterious side effects of therapy, namely nausea.
- Drug interactions: Resources include drugbank.com and Memorial Sloan Kettering’s About Herbs for herbs, drugs, and interactions.
- Integrative oncology providers: Keith Block, who’s arguably the father of modern integrative oncology, Dawn Lemanne (guidance on off-label anticancer agents), and Will LaValley (guidance on off-label, repurposed, often generic drugs). See the directory of providers in North America on Glenn Sabin’s website for more. For naturopathic physicians, you should look for a FABNO-certified practitioner.
- Book recommendations: “How To Starve Cancer”, “n of 1”
- Reducing stress: Exercise, meditation.
What’s the future of precision integrative cancer care?
In the future you will be treated with personalized conventional therapies (e.g., drugs, radiation, surgery) that attack your tumors, complemented by personalized nutrition and lifestyle treatments. You will be prescribed very specific diets and lifestyle changes that are tailored to your underlying pathology, as well as the agents that you may be getting in your treatment.