Recovery from surgery sometimes involves a very gradual return to normal activities and patients can be frustrated by the amount of time this takes. Ask your doctor if physical therapy is appropriate. Don’t attempt to pick up where you left off with your exercise. Often you will have to start back at square one. At the risk of sounding like a broken record, I will again recommend well-balanced nutrition according to the Mediterranean diet. There are some patients that will have special nutritional needs especially if surgery has involved the GI tract. You may get a lot of benefit from seeing a registered dietician. Some patients try to load up on protein in the healing process but this is not appropriate for everyone and may even be detrimental in some cases. Vitamin C at about 2000 mg per day may help with skin healing but should only be continued for one week or so post op. Remember, vitamin C should not be taken with chemotherapy or radiation since it is an antioxidant. Any intervention that you would like to try should be cleared through your surgeon.

Patients going through any treatment for cancer are stressing their immune systems. In some cases the stress is significant like when a chemotherapy lowers your blood counts. If you are in that situation, your doctor may be using medicines to boost the blood counts to prevent any serious infections. The best ways to protect your immune system during treatment are to eat well (Mediterranean diet), maintain some physical activity, and have a mind-body relaxation practice that you do every day like meditation or guided imagery. We have some clinical trials that have shown increases in blood counts with relaxation, acupuncture, and yoga.

It is tough to know which supplements are good. One sure way is the look for the USP or CL seal on the label. That means they have gone through additional third party testing and passed. The Consumer Labs website lists many brand names of particular supplements and also a lot of information on common uses. There is a fee to join but it’s not much and well worth it. (I have no affiliation with CL or USP.)

It would be wise to avoid supplements that make health claims such as curing cancer or guaranteed weight loss. Same goes for supplement websites.

In general calcium won’t interfere with cancer treatments so I would stick with the general recommendation of 1000 – 1200mg per day. Keep an eye out for more studies on calcium and heart disease, however. I don’t think there is enough information to not recommend calcium (especially to post-menopausal women) but I’m keeping an open mind as new information becomes available.

That depends… Most of the evidence that we have about alcohol and breast cancer indicates that any amount of alcohol increases your risk of breast cancer by “a little bit”. It is difficult to quantify that amount because of differences in the studies that have been done. Now, there are two circumstances that come to mind that may make a reasonable and rational breast cancer survivor still drink an occasional glass of wine. One would be if she felt the benefit of preventing heart disease outweighed the additional risk she may be taking from a breast cancer perspective. The other would be that it would be such a detriment to her quality of life to never drink wine again that she chooses to consume anyway. Either decision I think is justified, and there may be more reasons to consume an occasional glass of wine. Talk with your primary care doctor about it.

In Chinese culture, food is viewed as medicine. Food (like Chinese herbs) has a taste and temperature associated with it that can be used within Chinese Medical theory to help treat illnesses or maintain health. Without any knowledge of Chinese medicine, it might be difficult to prescribe food for yourself. A quick search on Amazon revealed several books on Chinese nutrition if you want more in depth information.

I highly recommend non-pharmaceutical approaches to the treatment of anxiety. First would be to use some mind-body therapies such as meditation, guided imagery, Tai Chi, or breathing exercises just to learn what it feels like to relax. These need to be practiced on a daily basis at least. Exercise is the second therapy I would incorporate. Do whatever gets your heart rate up and something with a meditative component like yoga would be excellent. Eat a healthy diet taking care to avoid processed sugars and caffeine. There are some herbal therapies that may help as well: lemon balm, valerian, passion flower, hops.

Turmeric which contains the chemical curcumin and is found in yellow curry and potentially ginger since it is an anti-inflammatory herb.

Here is a great summary article from the Huffington Post which accurately quotes some of the recent research findings on spices and their impact on health: http://www.huffingtonpost.com/2011/11/10/spices-health_n_1085099.html

Yes, this has been confirmed with volumes of research. Typically when we look at risk factors for certain diseases we do so with observational studies. We try to isolate one trait or lifestyle factor (like obesity) to determine the risks associated with it. Obesity doesn’t usually occur in isolation however. These same patients may have heart disease, high cholesterol, diabetes, poor diets, and sedentary lifestyles. We do our best in the research to “control” for these factors and, yes, it appears that obesity is an independent risk factor for the development of many kinds of cancer.

The jury is still out on how much of a risk reduction aspirin may provide for cancer in general. It probably has some benefit in those at risk for colon cancer. Aspirin has risks associated with it as well so you should talk with your primary care physician to determine whether or not the benefits outweigh the risks for you.

There was an interesting trial done by UCSF that looked at Chinese formulas containing astragalus in patients who were receiving platinum based chemotherapy for non-small cell lung cancer. Those patients receiving the Chinese formulas did have slightly longer progression-free survival. There is also other pre-clinical research on astragalus suggesting that it has some tumor fighting properties. I personally try not to base my recommendations on pre-clinical research but in the case of astragalus we do know it may help in lung cancer or those receiving platinum based chemotherapy as noted above.

Since your question is, “Has any research been done?”, I would have to answer yes. Has any high quality, randomized, placebo controlled research been done---not so much.

Acupuncture and guided imagery both have lots of evidence to support their use in pain management. Other options may depend on the type of pain or the source of the pain. Usually any method of relaxation or anxiety reduction (like meditation or breathing exercises) can help with pain as well.

That depends. It is actually difficult to determine when there are no conventional options left. Obtaining a second opinion or looking for a clinical trial (usually at a university medical center) are certainly reasonable approaches if current therapy is not effective. If indeed there are no more conventional options, then the question becomes more about what a person hopes to gain from “alternative” treatment. If a patient would like to try therapies aimed at decreasing symptoms of either the cancer or the treatment, then the door is wide open as far as what you can try. I would strongly encourage a patient to stick to a therapy that is evidence-based, however keeping in mind that less toxic therapies require less evidence to just “give them a try.” I would encourage patients to not be taken in by therapies that claim to treat the cancer—if those therapies were effective, then they would be in our conventional toolbox and not labeled “alternative”. Be especially mindful of the cost of these therapies as I have seen many patients and their families spend significant amounts without any results to show for it.

Acupuncture can be considered very safe when delivered by a well-trained practitioner. Expected side effects of acupuncture could include discomfort during needle insertion or manipulation, minor bruising, and tiny amounts of blood at the needle insertion site (really tiny). There are some treatments in Chinese Medicine that can cause more bruising (cupping or gua sha) and bleeding (there is a procedure called bleeding for which that is the goal of therapy). The degree of discomfort one might feel during needle insertion and manipulation is dependent on the practitioner and the patient. Acupuncturists feel for a da qi sensation when inserting a needle and some patients may find this uncomfortable. Always inform the acupuncturist if you are experiencing any discomfort.

Acupuncture can help with the side effects of cancer medications. We have good clinical trials to support using it for nausea, fatigue, low blood counts, and peripheral neuropathy to name a few.

Acupuncture is one of the more commonly used forms of complementary therapies. As a consequence, we do have a lot of clinical trial information about the usefulness of acupuncture for a variety of ills. Many of these trials, however have not been conducted well or have limitations. It is difficult to do standardized research studies with acupuncture for several reasons including finding an acceptable placebo (“sham” acupuncture is considered to have some therapeutic effect and is therefore not a placebo), blinding the patient and researcher (not knowing whether they are getting the intervention or the placebo is called “blinding”), and the fact that acupuncture treatments are individualized and vary from one visit to the next. In spite of that, the World Health Organization has published a list of the symptoms and illnesses for which there is enough evidence to recommend the use of acupuncture. Here is a link to some lists: http://www.acucouncil.org/conditions_treated.htm

This is a great question and we have pre-clinical research looking at the cancer killing ability of some of the natural forms of vitamin E (d-alpha tocopherol is found in most supplements and may not have this activity). There have been a couple of disappointing clinical trials in using Vit E for cancer prevention, however. The most highly publicized have been the ATBC Trial and the SELECT Trial looking at the prevention of lung cancer in smokers and prostate cancer in men, respectively. Unfortunately, neither trial showed a benefit to taking vitamin E for cancer prevention. I recommend that you take a multivitamin with just 100% of the US RDA of Vitamin E. You don’t need extra (and it may increase your risk of heart disease at high enough dose). If you can find a multi which lists its vitamin E as mixed tocopherols and tocotrienols that’s a bonus.

You should be able to tell your integrative medicine physician the type of cancer you have, the stage, and the specific treatment you are receiving (names of chemo drugs, whether or not you are getting radiation, etc.). Have the names and doses of your regular medications as well as all the other info you normally give to a doc (surgeries, family history, other illnesses, allergies, etc). Either bring your supplements with you or have the brand name and amount that you are taking. I usually ask for the supplement information ahead of time so that I can research the products for my patients. Most importantly, bring an open mind and a willingness to make some changes in your life.

Each patient is different, obviously, but there are some basics that I include in every consultation. First, I review their diagnosis and treatment plan with them. Usually I ask about their feelings and beliefs around health, illness, and life in general. We spend time discussing the impact that a healthy lifestyle has on survival, emotional well-being, and quality of life. This involves discussing exercise, good nutrition, and a healthy relaxation practice. I usually teach a simple meditation or breathing exercise. We go over some of the anticipated side effects of treatment and the complementary therapies that can help with those. We also discuss which nutritional supplements are healthy and can be used during treatment and which are to be avoided.

Turmeric is a spice commonly used in traditional Indian cooking and medicine. It accounts for the deep yellow color of some curries. Curcumin is a chemical found in turmeric that has some activity against cancer cells in a laboratory. Turmeric is mainly used for its anti-inflammatory properties. A search of the National Cancer Institute database on clinical trials did not reveal any human trials on cancer prevention with turmeric. This is still being investigated in the lab, and if successful there, will move on to human trials.

White flour is highly processed as compared to whole grains. White flour and other processed foods should be avoided as part of a healthy diet. White flour and white sugar have a high glycemic index/load. When you eat them their sugar is immediately absorbed and causes a spike in blood sugar followed by a spike in insulin. This can ultimately lead to insulin resistance and the development of diabetes.

For most patients, it will be safe to take a multivitamin during chemotherapy and radiation that does not contain more than 100% of the US RDA. This is certainly reasonable since it is often difficult to “eat well” during treatment. An exception might be patients who are receiving 5-FU based chemotherapy. There is an interaction between 5-FU and folic acid that can make dosing and managing side effects problematic. Check with your oncologist on that one.

Vitamin D is one hot topic these days, and it’s easy to get carried away with the enthusiasm. What we know about vitamin D and cancer prevention is this: we’re not sure. The studies that have been done looking at an association of vitamin D levels and cancer incidence have been mixed with regard to whether or not vitamin D is associated with a lower risk of cancer. I stress the word “association” here. We really don’t know if there is any causal relationship between vitamin D and cancer incidence. People who have normal vitamin D levels or who are taking vitamin D supplements may have other lifestyle factors that contribute to their overall good health. A randomized controlled clinical trial would be the gold standard to establish a causal relationship and we don’t have one yet. I recommend that you have your vitamin D level checked by your primary care physician and I think it is reasonable for most people to take a vitamin D supplement.

There are some situations in which a cancer patient may want to be sure to drink more water than usual. Some of these situations would include having nausea or diarrhea during treatment (these can lead to dehydration), receiving treatment that makes it difficult to swallow, or getting a chemotherapy that is potentially toxic to the kidneys. The question remains, how much water is enough? That can depend on a lot of factors (physical activity, humidity in the environment, amount of perspiration) and can vary from one individual to another. The Institute of Medicine recommends about 13 cups for men and 9 cups for women as a general guideline. Logic would dictate that you certainly need enough to prevent dehydration. Some of the symptoms of dehydration include fatigue, headache, lightheadedness, dry mouth and skin, decreased urination, constipation, and of course thirst.

Warning signs that you are dealing someone of questionable ethics when it comes to cancer care are:
• They promise you a cure that conventional treatment won’t give you
• They are asking you to spend a significant amount of money on treatment. Most complementary therapies are not covered by insurance, but watch out for those who are asking for a significant amount of money from you for their treatment.
• They recommend that you discontinue treatment with your oncologist. There may come a time when you choose to discontinue treatment with your oncologist but that’s a conversation that you should have with him or her and usually after potentially curative therapies have been exhausted or the side effects of therapy outweigh any potential benefits.
• They have a miracle cure that the FDA won’t approve.
• Ask about whether or not there are published studies on the effectiveness of the treatment they are recommending for you.
• Be careful if they tell you there are no risks or side effects
• Use your common sense…if it sounds too good to be true, it probably is.

Cancer programs may vary depending on the size of your medical center and the services that are available to you. Academic medical centers that are involved in cancer research often have the NCI designation “Comprehensive Cancer Center”. Just because a cancer center calls itself “comprehensive” does not necessarily mean it has this NCI designation. Smaller community cancer programs have often been accredited by the American College of Surgeons and this would be something you should ask about. A radiation oncology program should be accredited by the American College of Radiology.

There are no defined criteria for an “integrative” cancer care program. There are several things you should look for, however. One would be a physician, preferably an oncologist, who has done additional training in integrative medicine. There is an associate fellowship program in integrative medicine at the University of Arizona which was developed by Dr. Andrew Weil and is the one I have completed. A few other universities offer fellowship programs in integrative medicine so you should ask the integrative medicine physician what his or her additional training has been. In two to three years there will hopefully be a national board certification for integrative medicine physicians which will make the task of finding one infinitely easier. An integrative cancer program should emphasize evidence-based therapies that are combined with conventional therapies.

As soon as possible. Check in with an integrative oncologist so that you understand the potential interactions between any of your complementary therapies and conventional treatment. Also you should get some information on things you can be doing to help with side effects and get on to living a healthier life. Why wouldn’t you want to do that as soon as possible?

There were some early reports in the literature that soy foods may reduce the effectiveness of Tamoxifen in animal studies, but at least one study from the Univ of So Cal (wu, JCO, 2007) showed that soy food consumption had no effect on the active metabolites of Tamoxifen in Asian American breast cancer survivors.

As with radiation, anti-oxidants in supplement form can interfere with many chemotherapy treatments but there is no evidence that the anti-oxidants found in whole foods are harmful (againnot dehydrated, concentrated versions of what was once a whole food). If your chemotherapy will decrease your infection fighting cells (as most do) then your doctor or nurse will likely tell you to avoid unpeeled fruits and vegetables and sushi. There are also some foods that should be avoided with specific chemotherapies and your oncologist or chemotherapy nurse can tell you what these are if any.

In general, no. However, there may be reasons to avoid certain foods depending upon where the radiation is being directed. Your radiation oncology physician or nurse would be the best source of information for your particular situation. Although anti-oxidants interfere with radiation, there is no evidence that the anti-oxidants found in whole foods (not dehydrated, concentrated versions of what was once a whole food) are harmful during treatment.

Insomnia is a really common problem for cancer patients. Although there are very effective prescription medications out there, most have some unwanted side effects. Effective nonprescription treatments for insomnia include regular exercise (preferably not just before bedtime), a balanced diet, meditation, acupuncture, and yoga just to name a few. For those of you who are still intent on taking a little something at bedtime to help you sleep, I usually recommend some combination of hops, valerian, lemon balm, and/or passion flower. Chamomile tea is helpful as well.

I love this question because we as oncologists have changed our thinking in the past few years. My former recommendation was that patients with hormone receptor positive breast cancer avoid soy in any form. This was not necessarily based on any hard science, but rather a concern that the phytoestrogens in soy could theoretically promote breast cancer in women with hormone receptor positive tumors. Now we have some pretty convincing epidemiologic evidence that soy food consumption is beneficial in breast cancer survivors (note soy food—not supplements). In a meta-analysis done by Trock, et al.(Journal of the National Cancer Institute, 2006) soy protein intake was associated with a small but statistically significant decrease in the risk of breast cancer. Two other case-control studies (one in a European population and the other in a Japanese population) also showed no increased risk of breast cancer with soy or other phytoestrogen consumption (Am J ClinNutr, 2010, and Iwasaki, et al., JCO, 2008). The Shanghai Women’s Health Study also shed some light on the benefits of soy consumption and breast cancer prevention. In this study the highest consumption of soy was associated with the lowest risk of pre-menopausal breast cancer. In breast cancer survivors, soy intake was associated with a lower mortality and risk of recurrence with a 29% risk reduction for total mortality and 32% risk reduction for breast cancer recurrence (ER pos or neg).

This is really a common side effect with Tamoxifen treatment and all too frequently leads to discontinuation of a really helpful drug. Recommendations that are at the top of the list include regular exercise and a Mediterranean diet. Do those first. Next I would consider acupuncture. There was a study in the Journal of Clinical Oncology a couple of years ago that compared acupuncture to an antidepressant drug commonly used for hot flashes called Effexor. Acupuncture was just as effective in decreasing hot flashes and patients reported increased libido, and improvements in energy, clarity of thought, and sense of well-being with acupuncture. Side effects for the Effexor group included dry mouth, nausea, constipation,and decreased appetite. Black cohosh is another option. I won’t go into all the weaknesses of the big studies that have been done on black cohosh and hot flashes but I’ll summarize by saying the preponderance of the evidence shows that black cohosh is effective in treating hot flashes. It is not a phytoestrogen as some have believed in the past. Many of the common herbal preparations used for hot flashes do contain phytoestrogens so I would avoid those and stick with plain black cohosh.

There are several great ones (unfortunately there are many more to be avoided!)
MSK Cancer Center Integrative Medicine: http://www.mskcc.org/cancer-care/integrative-medicine
MD Anderson Cancer Center (CIMER):http://www.mdanderson.org/education-and-research/resources-for-professionals/clinical-tools-and-resources/cimer/index.html
Pub Med (National Library of Medicine): http://www.ncbi.nlm.nih.gov/pubmed/
National Cancer Institute: http://www.cancer.gov/cancertopics/pdq/cam/cam-cancer-treatment/patient/page2

First some history so we understand how we got to where we are today (I’ll limit it to this last century). Around the turn of the century, Cannon was a Harvard physiologist who paid attention to some connections that he felt other investigators were ignoring at the time. He observed that all vertebrates had a common response to a threat which included increased heart and respiratory rates, tension in large muscle groups, coldness and sweatiness, decrease in intestinal activity, and dilatation of the pupils. All of these were manifestations of activity of the sympathetic nervous system (a part of the autonomic nervous system) which primes an animal (or human) to flee or fight. Common to all animals.

In the 1920-30’s, a physician by the name of Hans Selye made the next major contribution to mind-body medicine. He noticed that patients in a hospital all “looked sick” regardless of their specific illness. He set out to find the anatomic and physiologic commonalities among these sick looking patients. He subjected lab animals to all sorts of noxious stimuli (pain, loud noises, electric shock, heat and cold) and he found some consistent responses in all animals. The adrenal cortex (which secretes stress hormones) was enlarged and components of the immune system (such as the thymus, spleen, and lymph nodes) had shrunk. He defined “stress” as the non-specific response of the body to any demand, and the physiologic changes that he noted, he called the “general adaptation syndrome” or more commonly called the stress response today.

Now fast forward to the early 70’s when researchers were beginning to correlate fight or flight and stress responses with the development of certain diseases. Cardiologists Friedman and Rosenman described the angry, time-obsessed, hypertension and heart attack-prone “type A” executive. The type A person was in a chronic state of anxious readiness which produced physical damage. The connection was being made that if stress contributed to things like heart disease and cancer, maybe by reducing stress one might help prevent these illnesses. This gave tremendous energy to the new field of stress reduction.

George Solomon was a psychiatrist at Stanford who in the 1960s showed that by destroying a rat’s hypothalamus, the animal suffered a marked decline in immune function.

Ten years later, Ader at the University of Rochester, demonstrated that the cells of the immune system (long thought to be under automated control) could be conditioned in the same way that Pavlov’s dogs responded to a bell by salivating. His colleague Felton demonstrated direct connections between the fibers of the sympathetic nervous system and the organs and cells of the immune system. Candace Pert and Soloman Snyder at Hopkins suggested that there were “peptide messengers” between the cells of the brain and those of the immune system. They called this new field of looking at connections between psychological processes and the nervous and immune systems psychoneuroimmunology.

I guess the answer to this question depends on what you mean by the word “prove”. If your question is about whether or not we can prove a connection between stress, depression, or anxiety and the development of cancer, that gets a bit trickier. The progression of research noted above would certainly suggest that this is an area for investigation.

A psychologist by the name of Bahnson reviewed the literature on stress, emotions, and cancer in 1980. At that time he felt that there was evidence to demonstrate an association between what he called a “particular configuration” and the development of cancer. That “configuration” was characterized by denial and depression, absence or loss of affection in early childhood, severe loss later in life, and strong and persistent feelings of hopelessness and helplessness. Bahnson based this conclusion on several studies, one being a prospective study of medical students at Hopkins which revealed a correlation between lack of closeness to parents and later development of cancer. The second was an observation that women with suspicious cervical biopsies who had recently suffered a loss were more likely to develop cervical cancer. The third study found that patients who had cancer were significantly more likely than controls to have suffered loss of an important relationship and to have an inability to express hostile feelings.

In the 28 years since this review, studies on personality and cancer have confirmed some of these findings but not all. A recent meta-analysis from the UK showed that stress-related psychological factors are associated with a higher incidence of cancer. There is some association between personality/stress and the development of cancer, and certainly other factors such as genetics, environment, and diet play a significant role.

What impact does stress have after the diagnosis of cancer? Do our patients’ thoughts, feelings, beliefs, and attitudes affect their outcomes? If so, how can we affect positive change?

One measure of the emotional state of a patient is to assess quality of life. Patti Ganz and Allen Coates showed that patients with lung or breast cancer who are more optimistic, more involved in their usual activities, and more hopeful about the future have an improved survival over those who are less optimistic or engaged. This is a finding that is independent of other prognostic factors. In the same meta-analysis from the UK that I just mentioned, Chida found that a stress-prone personality or unfavorable coping styles and negative emotional responses were related to higher cancer incidence and poorer survival. Another review article from JCO a couple of yearsago, showed there was a correlation between patient reported outcomes (such as quality of life measures) and survival. In her conclusion Dr. Gotay called for “studies that go beyond documenting this phenomenon and test hypotheses about why patient reported outcomes may be linked to survival…” And she goes on to conclude that interventions that improve patient reported outcomes have the potential to increase survival.

The most basic would be a metabolic panel (sometimes called a chem 7 or basic chemistry). It basically is a picture of the electrolyte balance in your body and kidney function. With this test the bicarbonate level will give your doctor an idea of any acid-base problems. The other way to directly measure blood pH is an arterial blood gas. Here blood is taken directly from the artery (usually the radial artery in the wrist) and information about the level of oxygen and carbon dioxide in your blood helps direct your care—usually ventilator settings (yep, this is the “in the intensive care unit” scenario).

No, please save your money. For a more detailed answer please see (http://talkabouthealth.com/how-are-ph-and-the-acid-alkaline-balance-related-to-cancer).

Make sure you understand tests that actually measure acid-base balance. It must be a blood test. Salivary or urinary tests will not completely measure acid-base balance in your blood.

This is one of the more common questions I get since there are folks out there selling alkaline water supposedly to combat acid problems related to cancer. Basically there are many half-truths out there on the internet. The half-truth behind alkaline water is that tumors exist in an acidic environment. The problem is that it is an acidic environment created by the tumor. Acid in the body is largely created by cellular metabolism and tumor cells are metabolizing at an accelerated rate. They produce more acid than the body can clear away and therefore live in an acidic environment. They outgrow their blood supply and hence their oxygen supply which also contributes to the acidity. So acid is not a cause of the tumor, it is a byproduct. Secondly there is no amount of alkaline water that you can drink that will change your body's pH. Your body has thousands of chemical reactions and mechanisms to keep your body's pH at 7.4. If you stray too far from that number then you end up in the Intensive Care Unit. Your kidneys and lungs are well equipped to help your body with acid/base balance. Drinking alkaline water will alkalinize your urine (because it is getting rid of excess base). It will do nothing for your cancer.

There is a lot you can do….and most of it does not require a prescription of any kind. Regular exercise reduces chronic inflammation. Perhaps this is why exercise has been helpful in controlling things like high blood pressure and heart disease and has been associated with better survival in cancer patients. Eating a Mediterranean diet also decreases inflammation (in fact another name for this diet is the anti-inflammatory diet). Omega-3 fatty acids (fish oil) are anti-inflammatory. Getting enough sleep, meditation, fiber, red wine (in moderation), aspirin and other non-steroidal anti-inflammatory drugs, and prescription cholesterol lowering drugs called statins all lower measures of chronic inflammation.

Elevated levels of markers of chronic inflammation are associated with an increased risk of cancer (for more details:http://talkabouthealth.com/what-is-meant-by-the-term-inflammation-in-the-context-of-cancer-and-integrative-medicine). There is a difference between association and causation. While chronic inflammation and many diseases occur together, the exact mechanisms as to how inflammation might cause illness have not yet been worked out—but what an exciting area of research!

Most commonly this is done with a high sensitivity c-reactive protein (hs CRP in medspeak), IL-6 (usually limited to research studies), and serum amyloid A was measured in the study by Pierce, et al. (noted here:http://talkabouthealth.com/what-is-meant-by-the-term-inflammation-in-the-context-of-cancer-and-integrative-medicine) but I’m not as familiar with it. Most likely your insurance won’t cover a hs CRP unless you have heart disease.

Why is there so much excitement these days about inflammation? It’s preventable, treatable (both to a degree), and it has been associated with several chronic health conditions that exert a tremendous cost on our society.

Specifically with regard to cancer, there is mounting evidence that elevated levels of markers of chronic inflammation are associated with a higher incidence of cancer. As an example, there was a really interesting study from Denmark where researchers took blood samples from 10,000 random people beginning in 1976 and then followed these folks for years to assess their health problems. Those who had an elevated c-reactive protein level (a marker of chronic inflammation), had a greater incidence of developing cancer years later, and the higher your CRP level, the worse your survival (Allin, et al. Journal of Clinical Oncology, 2009).

There is also evidence that elevated levels of inflammatory markers are associated with poorer survival in breast cancer (Pierce, et al. Journal of Clinical Oncology, 2009), and pre-treatment levels of c-reactive protein are associated with a worse prognosis in breast cancer (Allin, et al. Breast Cancer Research, 2011).

Integrative medicine comes in to play with lifestyle changes and supplements that can decrease levels of inflammation.

Let me start by saying there are some components of citrus fruits that have anti-tumor activity in pre-clinical studies (those done in test tubes and mice). In particular d-limonene which is a monoterpene found in orange and lemon peels may be active against some tumors and is being investigated in phase I/II trials. Keep in mind this is a concentrated chemical extracted from citrus fruit and given in intravenous form—sound familiar? Yep, this is how chemotherapy got its start. In one trial I read, nausea and vomiting were “dose-limiting toxicities” (one goal of phase I trials is to see how much drug can be tolerated). Side effects like nausea and vomiting occur because of the effect of the drug on normal cells. Now with that said, there is no evidence that lemon juice is effective in the least for treating cancer. As for impact on “normal” cells—have you ever tried drinking much lemon juice? I think you’ll find there is an effect on normal cells.

The standard treatment for lymphedema is lymphatic massage and compression under the guidance of a physical therapist specifically trained in lymphedema management. There is no question that is the most effective treatment. In addition, there is one trial that was conducted in France and published in 1996 which demonstrates some efficacy using an extract of Ruscus (Butcher’s Broom) and Hesperidin Methyl Chalcone ( a citrus flavonoid) called CYCLO 3 FORT. In that trial all 57 patients received manual lymphatic drainage (lymphatic massage) and the patients that received CYCLO 3 FORT had less edema at the end of 3 months. Butcher’s Broom can cause diarrhea.

It's understandable to be confused about sugar and cancer. Often these broad reaching statements like "sugar feeds on cancer" have a kernel of truth to them. Every cell in your body feeds on sugar...including cancer cells. Sugars are usually the first nutrient for your cells but protein and fat can be converted to fuel as well. Some relatively recent research in cancer patients has demonstrated that it's not really the sugar that is important but instead how your body responds to it and the level of insulin required to get sugar into the cells. If the cells of your body have developed some insulin resistance then more insulin is required to get sugar out of the blood and into cells where it can be used for fuel. There is evidence that this contributes to the development of cancer and a person's response to treatment. Spikes of insulin may also be part of the problem. You can improve insulin resistance by losing weight (if needed) and exercise. You can avoid the spikes in blood sugar and subsequent spikes in insulin by paying attention to how the sugar you are consuming is packaged. Processed sugars are immediately available to your body and can lead to that spike in blood sugar. Unprocessed sugars like those found in fruits and whole grains are metabolized more slowly.

The specific dietary recommendations for your brother will depend a lot on the difficulties he is having. If he needs to gain weight then healthy sources of calories will benefit him. The cells that are fighting cancer need fuel, too. Hopefully you are getting your nutrition recommendations from a registered dietician (anyone can call themselves a nutritionist) who has a masters degree in dietary science and has passed a national exam. The bottom line is that processed sugars should be avoided. Natural sugars with their fiber are not a problem. Hope that helps and good luck to your brother. Also the Am Cancer Society has a book called What to Eat During Cancer Treatment that may be helpful to you.

Big problem! Many patients who have been treated for cancer are left with some degree of neuropathy if they received a taxane or other neurotoxic chemo. I have a couple of suggestions. Acupuncture is a good treatment for neuropathy. It has only been looked at in a very small group of cancer patients but it works for other causes of neuropathy. No offense to your acupuncturist intended, but another acupuncturist may approach it slightly differently. So before you give up on that, try another practitioner at least once a week for 10 treatments before you throw in the towel. The other recommendation I have is for alpha lipoic acid 600mg per day. This should not be used while you are still getting chemotherapy or radiation since it is a potent anti-oxidant and will interfere with those therapies. Other suggestions are those therapies that are good for pain in general including guided imagery, massage, and hypnotherapy. Good luck!

My PubMed search on "coffee enema" returned 4 citations. Two were about rectal burns caused by a hot coffee enema and a third was about acute colitis caused by a coffee enema. The fourth was either an editorial or a review but the abstract was not available so I don't know whether or not that paper contained a rational and evidence-based use for coffee enemas or not. Patients often ask me about using coffee enemas for a "detoxification" regimen. I can't find any evidence to support that, it doesn't make sense to my conventionally trained (yet open) mind, and it is potentially dangerous (though I am amazed that anyone actually uses HOT coffee). The danger I would worry about is potential electrolyte imbalances. So no, I don't recommend them.

Tai Chi is sometimes called "moving meditation." It was absolutely one of my favorite things to learn when I studied Chinese medicine but it is something that takes years to master. It is a Qi building exercise that many Chinese participate in on a daily basis. The focus is on slow, intentional movements that based on martial arts moves. The slower the better. There have been a couple of interesting studies involving Tai Chi that come to mind. One looked at improving balance in elderly patients (which it did). A randomized trial reported in the New England Journal of Medicine in 2010 showed that it improved the symptoms of fibromyalgia compared to a control group. A researcher at the Univ of Missouri found in a small trial that it may also improve cognitive function (chemo-brain anyone?) Finally, another study published in Archives of Internal Medicine in 2011 showed that Tai Chi may improve quality of life, mood, and exercise self-efficacy in patients with heart failure.

You're going to hate this answer: It depends! Integrative medicine really has three components: 1)making the patient a partner in the decision-making process 2)considering all aspects of lifestyle in making recommendations and 3) utilizing all evidence-based therapies whether they be complementary or conventional. My treatment recommendations are always individualized. I hope to convey to each patient how important lifestyle changes are (ie, good nutrition, daily exercise, and a daily relaxation practice). Since I see mostly cancer patients I also focus on treating their side effects of therapy. That may be with acupuncture, yoga, nutrtional supplements, etc. Our most popular therapy here is acupuncture which may be reflective of my training in Chinese medicine in addition to the fact that acupuncture is just good for what ails ya!

Traditional oriental medicine refers to the methods and theories used in the practice of medicine in Asian countries that have existed for years (7000ish years). My training included the study of predominantly Chinese medicine including acupuncture, acupressure, Tai Chi, Qi Gong, Chinese nutrition, Tui Na, cupping, moxabustion, and Chinese herbology. Often in the field of integrative medicine or CAM, the word "traditional" refers to the practice of medicine that is particular to that culture and the word "conventional" refers to what we would consider modern western medicine.

Interesting question. Perhaps I should start by clarifying what the FDA (Food and Drug Administration) is responsible for... and that is pretty much just foods and drugs :). However, I also believe that it is responsible to treat nutritional supplements and herbal medicines "like drugs" in that we should consider things like effectiveness, dosing, safety, side effects, and drug interactions when we "prescribe" herbs and nutritional supplements. In 1994, Congress passed the Dietary Supplement Health and Education Act (DSHEA) which has enabled the patients in this country to continue to have access to nutritional supplements and herbal medications of our choosing without a prescription. However, it also gave the FDA a different scope of regulatory oversight than we see with prescription drugs. The FDA is responsible for taking action against any UNSAFE dietary supplement after it reaches the market (which means that supplement manufacturers are responsible for bringing safe products to market). Prescription drugs must be proven to be safe and effective to get FDA approval. Nutritional supplements are not required by anyone to be safe and effective. I could go on at length about how to take supplements safely but that's not what you asked. As far as the way I practice medicine goes, I incorporate recommendations for any evidence-based therapy which is appropriate to my patient's needs whether that be conventional or complementary. Thanks for your question.

Hyperthermia has been used for many years to improve the tumor killing effects of both chemotherapy and radiation. This has been done mostly in experimental settings and it is not a standard part of therapy. It is considered in situations where other treatment options may be limited and is usually given in conjunction with chemotherapy or radiation on a clinical trial. No, we do not offer hyperthermia at my cancer center.

Great question. Most people (physicians and patients alike) would agree that it's probably not a good idea to give hormones to a patient whose breast cancer had hormone receptors on it (ER and/or PR positive). But that's not what you asked. Your question went a little deeper because you asked about "natural" progesterone cream. My interpretation of the word natural here is that the progesterone is likely derived from a plant source which is often wild yam. Wild yam contains a compound called diosgenin which has estrogenic and progestogenic effects in mice. Surprisingly however, humans do not possess the enzyme necessary to convert diosgenin to progesterone. While there are several progesterone or estrogen creams/gels that are FDA approved, I would be cautious about using compounded medications because of concern of purity, dosing consistency, and content. Harvard has some great info about this on this site: http://www.health.harvard.edu/newsweek/What-are-bioidentical-hormones.htm. Let me know if I have not addressed all of your concerns.

You're right about the Black Cohosh. Also exercise and good nutrition play a role in managing the hot flashes, sleeplessness, and mood swings.