Complementary And Alternative Medicine

There are many sources of information about these complementary therapies on the internet, but most are self-serving (the source of the information stands to profit from the alternative therapy). I am convinced that modern cancer therapies can be effective and that they should not be delayed to try complementary therapies. If there are no standard therapies available, complementary therapies are reasonable. This does not mean that a lung cancer patient should not try to eat a healthy diet during therapy, but I recommend that patients do not take megadoses of any natural or alternative supplement.

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.

I require a very complete set of medical records for my new patients. I review these carefully. If I am unfamiliar with any aspect of their cancer or treatment, I research by reading my oncology text books, reading published studies and consulting with my naturopathic and oncologist colleagues. My first visits with new patients are typically 90 minutes so that I can learn as much as I can about each person as an individual (after all they are people with cancer, not just cancer diagnoses). I then several more hours developing my recommendations, which stem from my experience and additional research. I then provide my consultation note and my recommendations to the patient and to their other healthcare providers. I typically follow-up with patients in accordance with their treatment and disease experience on a repeated basis.

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.

EmbodiWorks provides an educational website with integrative cancer care resources about whole person health and healing in five areas–body, mind, spirit, social, and environmental. We also have a Resources section to help cancer patients and caregivers navigate their cancer journey. Our goals are to reduce cancer risk and improve cancer-related survival, quality of life, and whole person health care.

Please visit our site at www.embodiworks.org.

Meditation has been shown to reduce stress, improve mood, and affect immune function, but studies have not yet established whether it prevents cancer recurrence. However, just because a study hasn’t been done yet to prove meditation prevents recurrence, does not mean it won’t be helpful. Stress and depression are often associated with higher morbidity and mortality rates among people with chronic disease in general, so anything you can do to manage your stress will be good for your health. In terms of the type of meditation, I suggest selecting the one you like the best and feels the most right to you. People vary a lot in their response to various forms of meditation and stress reduction. If you are in or around Massachusetts, for classes I highly recommend the UMass Center for Mindfulness http://www.umassmed.edu/Content.aspx?id=41252 originally founded by Jon Kabat-Zinn.

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.

Inflammation is heat or fire in the body. This includes a distinction between acute and chronic inflammation. Think about when you've had a cut or wound. Your skin is red, flamed, and perhaps uncomfortable. That's acute inflammation. But in chronic inflammation, the "flare" does not stop. It continues on and on for months and years where the body acts with immune and other processes to heal a "wound" and yet there isn't one. The chronic inflammation then begins to support health conditions such as cancer.

To reduce inflammation, eat organic vegetables, some fruits, spices such as turmeric, and consider specific supplements. Inflammation levels can also be tested. The most common blood test is called c-reactive protein (CRP) high sensitivity available through mainstream blood laboratories. A healthy level is below 1.0 mg/L.

You can learn more about inflammation and cancer, including a more in depth explanation about inflammation and how to reduce it, in an article on the EmbodiWorks integrative cancer care resources website at http://www.embodiworks.org/cancertreatments/bodymindspirit/inflammation/.

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.

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.

Inflammation is heat or fire in the body. This includes a distinction between acute and chronic inflammation. Think about when you've had a cut or wound. Your skin is red, flamed, and perhaps uncomfortable. That's acute inflammation. But in chronic inflammation, the "flare" does not stop. It continues on and on for months and years where the body acts with immune and other processes to heal a "wound" and yet there isn't one. The chronic inflammation then begins to support health conditions such as cancer.

To reduce inflammation, eat organic vegetables, some fruits, spices such as turmeric, and consider specific supplements. Inflammation levels can also be tested. The most common blood test is called c-reactive protein (CRP) high sensitivity available through mainstream blood laboratories. A healthy level is below 1.0 mg/L.

You can learn more about inflammation and cancer, including a more in depth explanation about inflammation and how to reduce it, in an article on the EmbodiWorks integrative cancer care resources website at http://www.embodiworks.org/cancertreatments/bodymindspirit/inflammation/.

Wishing you optimal health and healing.