EP049: Food and Physiology of Cancer with Dr. Nalini Chilkov

Welcome to the Perfect Practice podcast where we share the most innovative strategies to help you build a successful functional medicine business, attract your ideal patients, serve your community, and get paid what you're worth. Each episode is packed with practical steps that you can take to immediately grow your influence and serve more people. Our mission is to share golden nuggets from successful practitioners, technology experts and innovators from around the world. Your host, Sachin Patel, is a functional medicine and success coach, international speaker and best selling author. He's calling in all his favors to bring this information to you so you can create your perfect practice.

So we're going to be talking today about the food and physiology of cancer and this is really what practitioners and patients need to know about cancer. You know, cancer will likely, if it hasn't already, impact each and every one of us. And we want to arm you with the tools and the resources that you need to stay healthy. But if you ever get caught in that position that you know exactly what to do to get out of that situation and reverse the condition from the inside, that's really where health starts, is on the inside. And food is basically how we interact with Mother Nature. And so it's, you know, sunshine that we eat. And it's important for us to keep that in mind that we're putting in good, healthy nutrition into our body. So today we're going to be speaking with Dr. Nala Lady Chilkoff, who is the leading edge authority and pioneer in the field of integrative cancer care, cancer prevention, and immune enhancement. Of course, cancer is an immune condition, so we need that immune enhancement to take place. And she brings with her more than 30 years of clinical experience, helping thousands and thousands of people personally, but also probably tens, if not hundreds of thousands of people professionally by doing conversations just like this. This is exciting for me and I'm so glad that you're joining us. She's the founder of the American Institute of Integrative Oncology. She's a researcher as well as an educator, and she provides professional and clinical training and mentoring to frontline care providers worldwide. We were just talking before this call started and she was just sharing how much this message has been taking off because people are looking for answers. She's creative integrative canceranswers.com, which is an online resource for patients and families who are affected by cancer, which is really all of us. We all know somebody that can benefit from this. Dr. Chilkoff. She's on a mission, just like we are at Living Proof. She's on a mission to train clinicians worldwide and to meet the rising tide of cancer patients and support families and spouses and loved ones. Sometimes it's our parents, it could be our children. It could be someone that's near and dear to us, like our spouse, that's faced by the cancer equation. So she helps people get healthy and remain healthy so that they can beat whatever they have going on. She's the author of the bestselling book 32 Ways to Outsmart Cancer, how to Create a Body Where Cancer Cannot Thrive and is an international lecturer and frequent speaker resource to the media. Her private practice is located in Santa Monica, California. Nalini, I want to thank you personally because I know there's been times when I've reached out to you just as a friend to get some answers for someone I love and care about. So you're my trusted authority when it comes to anything related with cancer. So thank you so much for taking time out of your busy schedule and sharing this amazing information with us.

Thank you. Sachin. Well, you know, you really hit on something that's really about my why and that is that most clinicians, unless they specialized in oncology, never had much training at all in cancer care and certainly not in promoting the health of this patient population. And so that's why I developed my course so that other practitioners could use my framework and touch many, many more people. So that's my big why. So what I want to do. Oops, sorry. What I want to do is make sure that the listeners have the opportunity to have the slides. If you want to take notes on slides, you can download them at this link and you'll also get a couple of extra bonuses or just sit and listen and you can get the slides later. There's also going to be kind of a summary of all the diets I talk about and a little extra lecture on inflammation and cancer because due to our limited time, I can't cover as much as I'd really like to. And I want you to have that so you understand the impact of managing inflammation on cancer as well. So that's at a I I O R. So you can have the slides to write on if you want to. Also, for those people who are listening who feel the pain of not having this information and training and really don't feel confident enough to step into working with these patients, I want to offer you $1,000 savings off the cost of the tuition of my course because this is just so important to me because Sachin's community is ready with the training that you've given them ready to jump into this as well. I just welcome you. After 35 years in practice and really feeling incompetent myself, I have taken the last 20 years to master this subject. Let's go forward here and see why we're here in the first place. One in two people in the United States and Canada are going to be diagnosed with cancer in their life, and two out of three will survive it. So what does that mean? That means these people are already in your practice. If you have 10 people in your waiting room, five of them maybe already had a cancer diagnosis or someone in their family. And what if they knew you were a resource to them and could ask you for support and help and guidance? But even more important, two out of three people who are diagnosed with cancer are going to be survivors. And you can see here on this slide, by 2024, there would be 19 million cancer survivors in the United States alone. And who is taking care of their health? They should be walking right in the door of our office because we're the ones with the health model and the toolbox. Look at this statistic here. 40% have been alive 10 years or more. And some of those people are still struggling with long term side effects and are frightened of recurrence and would like to know what to do to be healthier and prevent a recurrence. This is a huge need and there are just not very many clinicians who are prepared or feel comfortable and confident answering questions. And so the lecture today is about the question everybody asks, what should I eat? Right. So we're going to take a deep dive into that. But I just want to give you my framework here so that you can listen inside this framework. So the cancer journey and cancer survivorship have phases and the patient's needs are different at each phase. So that's one way to think about it, to know where a person is in their journey when they come in your office. So when they're just diagnosed, they have the most anxiety usually and need some guidance on how to just frame this and be an educated patient and what the changes they can start with. And then when they're in treatment, they're usually wanting to know how to manage side effects, how to keep their weight up, what should they they be eating during treatment and how did they recover afterwards. And hopefully our patients live a life beyond cancer and are quite well, but we can also teach them how to really reduce their rates of recurrence. And there is also a huge group of patients who are living with cancer as a chronic illness. And this is a very underserved population of patients who maybe they're on long term hormone blockade because they have prostate cancer or breast cancer that's hormone driven, and they're dealing with the side effects and the changes in their health that come with that. So this is a patient population that also is not being served by the oncologist, who is not a health specialist. We are the health specialists, and we should be the health experts that really support the patient, give them the outcome they're looking for, because oncologists are fascinated by the disease and they're the disease experts. But what does the patient want? The patient wants the outcome to be health. And that word often doesn't even come up in the oncology office. Part of this framework is to think about what we call the tumor microenvironment or the cancer terrain. And what we mean by that is in the same way that the soil in a garden, if you change that soil, you change the plants that grow there. What we want to do is change this signaling environment so that it is inhospitable to the development and progression of cancer. We also want to change this signaling environment, this terrain, so that it has less growth signals for tumor cell and more stop signals for tumor cells. And because healthy cells and tumor cells are significantly different in many ways, including their metabolism, which we're going to talk about momentarily, then we leverage the fact that the cancer cell and the healthy cell have different metabolic patterns and needs and vulnerabilities to accomplish this goal. And so I expect my patients to be outliers. I. I expect them to have better results than other patients who don't know how to care for their health on this journey. And I also expect them to have less side effects and less toxicity while they're going through treatment. And I expect them to be able to recover. So this is really what's possible, and this is what the patient wants that the oncologist does not address. So I want you to feel at the end of this lecture that you are able to walk into the door of your office with a patient and have something to say to them you feel solid about. When they say, I'm in the middle of cancer treatment, what should I eat? Or I heard I should be a vegan, Or I heard I should eat raw food, or I heard I should be ketogenic, we're going to go through all of that. So my fundamental core question is, what if every cancer patient had a health plan, not just a disease plan. If they have us, they get to have A health plan. If you make relationships with oncologists in your community, I guarantee you you will have a waiting list practice, because not enough people really have expertise in this area. When we think about the cancer terrain, we think about not only the soil garden metaphor, but a wheel with many spokes. And on the spokes of that wheel are the goals and actions and interventions that we need to take in our treatment plan. So we think about things like oxidative stress and cell replication, detoxification capacity, immune capacity, glycemic control, growth factors, etc. And so when I am building a treatment plan, I literally go around this wheel in my mind and make sure I've hit every spoke on that wheel. And because the toolbox we have of botanicals, nutraceuticals, foods, phytochemicals, are multitaskers and bind to many sites and influence many genes, you can accomplish a lot of this with a handful of supplements and herbs and healthy foods. So when we think about diet in good nutrition, in the context of oncology, we want to really have quality of life be part of this, but we also want to really support health while the patient goes through challenging treatments, Reduce their side effects, maybe even enhance the benefits of their treatment, reduce some of the depletions that occur, and really help them enjoy food. Because sometimes their sense of taste changes or they have sores in their mouth. And we can address all of that. That's part of good nutrition, being able to eat and digest your food and maintain your weight and maintain your health. Let's look at the impact of diet on cancer. Now, this is an infographic that is from an article that states that diet impacts 35% of all cancers are impacted by diet. I would venture to say this is probably 99%. And so from where we stand, I think we understand the impact of diet on all functions and tissues and on the psyche and the emotions. And so I want you to just note on this diagram here that there's not one special kind of cancer that is impacted by diet. All types of cancers are impacted by diet. Of course, the cancers of the digestive tract are right in contact with the food that we eat. So you can see colorectal cancer. The statistics are quite high. 70% of all colorectal cancers are related to what we eat, but even the blood cancers as well, and cancers outside the digestive tract are also impacted. Breast cancer, prostate cancer, endometrial cancer, lung cancer, et cetera. Diet touches everything. I think we agree on that in this community. We think of food as information and we think about the epigenetic signaling that is going on. I'm going to show you how specific that can be in the oncology setting. And so for those of you who aren't familiar with the term epigenetics, it means that these are interventions which change gene expression. They don't change the gene, they change whether it's off or on, whether it's expressed or not. So let me give you some concrete examples of some of the phytochemicals in food and how that really happens. Number one, we can hit the off switch. We can inhibit oncogene or tumor gene expression, we can promote turn on tumor suppressor genes, and then we can inhibit the translation of the gene messages into functional proteins. And so at every step of the way, we can see the impact of food. For example, genistein from soy, EGCG from green tea, curcumin from turmeric, all can turn oncogenes off and turn tumor suppressor genes on. I actually tell patients this is why it matters what you eat, because you can turn genes off and on. Here's another example here, where some of the enzymes that impact gene expression are affected by our food and genocide. Again, phytochemical from soy and isoflavin from soy, egcg, a catechin from green tea, sulforaphanes from the cruciferous vegetable family, resveratrol from red and purple grapes, and selenium. One of the highest foods in selenium is Brazil nuts. Mushrooms have a lot of selenium in them as well. This is not complicated. I want you to see that having a diet with lots of plants in it, it is going to give you all these epigenetic signaling molecules that literally change gene expression. So that's one big principle. The other principle that is really newer thinking in cancer is that cancer is a chronic disease and that it's also a metabolic disease, a mitochondrial disease. So let me explain that to you. Thomas Seyfried, who I've quoted here, has wrote some seminal papers and has been a proponent of this newer idea of the cancer as a metabolic disease, and how understanding that can help us really leverage the recommendations we make to our patients. Food comes into this model immediately because tumor cells have a much higher need for glucose. They are glucose dependent. They have more insulin receptor cells, more GLUT4 receptor cells on their surface, and they can therefore take up more sugar more efficiently. And so their mitochondria need lots and lots of glucose. So if we lower blood sugar, serum glucose, if we lower insulin by the way we guide our patients in their diets. We cripple the tumor cells and stress them. But healthy cells can actually use ketone bodies, and that's why the popularity of the ketogenic diet. But I want you to be educated about that. We're going about it in detail. The big principle here is tumor cells have different metabolic needs than healthy cells. Tumor cells are much more reliant on glucose and the presence of insulin to drive the glucose into the cell. If we change that environment and go to low carbohydrate diets where insulin is not triggered, the tumor cell is much more vulnerable to any other therapy. Right now, in many oncology patients centers, patients who are robust enough to fast before they have their chemotherapy, you will get a better response to chemo if your tumor cells are stressed before you have your infusion. That's this principle here that is being leveraged even in conventional oncology. Now you want to think about these macronutrients as well as a few micronutrients. Cancer patients have a higher need for protein at certain stages of their journey. There's kind of a sweet spot with protein. You don't want to give too much protein unless the person is really experiencing sarcopenia, loss of muscle mass. So you want to be a little bit conservative. So paleo diets might be too high in protein. So we want to stay with about 40 to 60 grams of protein for the average patient. Of course, if you have a patient who's a bodybuilder and still works, working out during their treatments, then you have to modify it to the patient. But I just want to make the statement that excess protein can be a pro growth kind of a diet. We also want to make sure that our cancer patients get enough calories. Remember that they may have mouth sores, they may be nauseous, they may be in pain, they may have adhesions in their gut. So we want to really make sure that they get enough to eat. And so there are system strategies for making sure their calorie density is there. Fatty acids are incredibly important. We decrease the carbohydrates and increase the fatty acids in these diets. And so the diet I recommend is kind of somewhere between paleo and keto, and I'm going to show you that. But remember, the mitochondrial nutrients are incredibly important. Important. Cancer patients have a much higher need for zinc and magnesium, the B vitamins, and selenium, because remember, those derive the mitochondrial energy production of ATP. Also, vitamin D is incredibly important for cancer patients. You Want to optimize that to about 75 milliliters per deciliter. And the fluid and electrolyte balance of these patients is crucial, especially chemotherapy patients and especially post surgical patients. Many, many chemotherapy agents deplete magnesium. You want to make sure that you are supplementing magnesium in these patients. Then we mentioned this altered glucose metabolism that is fundamental characteristic of tumor cells. Now, inflammation is also a fact of cancer. And you can see here on this slide that there is a direct correlation between cancer survival and levels of inflammation. So cancer itself is an inflammatory syndrome, but also the presence of inflammation increases cancer risk. So, for example, if someone has chronic esophagitis, they are more prone to develop esophageal and gastric cancer. If they have colitis and inflammatory bowel disease, they're more at risk for colorectal cancer. The presence of inflammation itself is a risk factor. And then the tumor cells themselves produce very high levels of inflammatory cytokines. This is the way that cancer cells start to take control and make their own environment, their own tumor microenvironment. And we have to push back against that and restore an environment which is not such a happy place for the tumor cell, because in this inflammatory environment, cancer cells have better survival. There's more tumor growth, more proliferation, more metastatic spread of cancer, more angiogenesis, which is how cancer cells make their own blood supply and then grow exponentially and enter the circulatory system and travel. There is an immune suppressive environment around tumor cells, and this has to do with some of the inflammatory cytokines secreted by tumor cells. The tumor cells will actually disable the T cells that are coming there to fight the cancer. You can see how smart tumor cells are, and we can change the environment and make them less able to take control of what's happening. Cancer related fatigue is directly correlated with inflammation. Almost every patient who has cancer has cancer, and then there's cancer treatment related fatigue. But the inflammatory environment itself is one of the primary drivers of cancer related fatigue. Of course, when the brain gets inflamed, there's more depression, and when there's more inflammation, there's more pain. So this also speaks to quality of life and peace of mind and emotional resilience. So it's very important to make sure you have a plan for controlling inflammation. It's kind of what I call oncoinflammation. And so I made a little chart here for you. And you can see on the left, some things that are readily available and easy to use. And then on the right I've put the inflammatory cytokines or nuclear factors or prostaglandins there to show you how impactful our medicine is. So green tea catechins, you can see NF Kappa B, TNF Alpha IL1, B Cox 2. Those are very common in the tumor microenvironment everywhere. So green tea is important. One caution with green tea, there's a very small subset of patients who have methylation defects that cause high doses of egcg, the main catechin in green tea, to be liver toxic. So if you're not sure about the patient, then leave out the green tea catechins. A cup of green tea is not going to do that. But if you give high doses of the egcg, you could have a problem with the patient. Curcuma longa, that's where we get curcumin from. And so you can see multiple pathways there. The omega 3 fatty acids I think we're well aware are anti inflammatory, but they also are very important in cell adhesion in the cancer environment. If the cells have good adhesion and if they have healthy cell walls built out of these healthy omega 3 fatty acids, there's less invasion of the tumor into the extracellular space. So there's more functions than just inflammation in many of these. I'm going to talk about probiotics more directly in a moment. If you only remember one Chinese herb from this lecture, learn Scutellaria bicolensis. This is Chinese Huang tin H, U, A N G Q I N. This is a traditional herb that you will find in almost every modern Chinese tumor control formula. But it's super anti inflammatory and it's very rich in berberine. And berberine again is one of our big tools in cancer care. But remember, it also exerts a lot of glycemic control and improves insulin sensitivity. So this is a high risk group for diabetes and hyperglycemia. Ganoderma. This is reishi mushroom. A lot of people don't realize that the medicinal mushrooms are very anti inflammatory. There also impacts glycemic control. And resveratrol not only protects our DNA but it also has anti inflammatory effects. So I give these things about 2 to 4 grams. You have to remember 2 to 4 grams a day. You have to remember there's a difference between a nutritional dose and a therapeutic dose of our toolbox. So it's one thing to dose a healthy patient that wants to maintain health, it's another thing when you have a patient with increased needs because their physiology is dramatically changed by their disease. Process. Now, NF kappa B is a nuclear factor. It's kind of the mother of all cytokines. And so if we exert control way upstream on NF kappa B, we can prevent the downstream production of lots of different kinds of inflammatory molecules. So you'll see on the top here things that are categorized as carcinogens, but they're also pro inflammatory. You can see a number of infectious agents, but you can also see things like heavy metals, alcohol, the presence of obesity, the cancer treatments themselves, chemo drugs, endotoxins, say mycotoxins from mold exposure. So there's a lot of factors that either are within our physiology or in our external environment that can trigger an inflammatory physiology. But then look at the bottom of this. These are molecules from nature, from plants, phytochemicals and some vitamins as well that turn off NF kappa B. So here's another example of altering gene expression and that's why plants are so amazing. You can see here a couple of vitamins, the tocotrienols which are very powerful against cancer. You can see tocopherol there, another molecule in the vitamin E family. You can see ascorbic acid, vitamin C is there. But then look at all the phytochemicals there. Lycopene from tomatoes, epigenin from Parsley and Celery, Indole 3 Carbinol from the Cruciferous vegetables, et cetera, et cetera. You can take a look at this as a list of these are big levers and so it's not hard to eat a wide variety of phytochemicals that alter gene expression. I showed you oncogene expression and tumor suppressor gene expression in a previous slide. Now I'm showing you how you can change the expression of this nucleotide factor kappa B and exert very upstream influence on inflammatory environment in the body. This goes for other syndromes, not just cancer. So you can't give a lecture today without talking about the microbiome. So let's look at it in this setting. Dysbiosis of course is a source of inflammatory cytokines from the gut. But if you have a healthy gut and a healthy microbiome and a healthy ecology, you actually get down regulation of pro inflammatory cytokines. And this is not just the local effect, this is systemic. So the gut again is part of our mechanisms of inflammatory control. Cancer patients quite often have disrupted microbiome. I'll show you all the factors in upcoming slide. But having a healthy microbiome also leads to an upregulation of cytokine IL10, which is anti inflammatory. So it's very important to make sure patients know how to care for the microbiome. And I'm going to show you that in a moment. Because of its impact on the immune system and on inflammation systemically, Here are some of the reasons that the microbiome gets disrupted in the cancer patient. Maybe they've had surgery, maybe they've been given oral antibiotics, oral steroids, oral chemotherapy agents. A lot of chemo gives patients reflux, so they're put on proton pump inhibitors to inhibit their acid. And then of course that messes up their microbiome further. The constipation, slower transit time on opioids for pain. Of course that use is decreasing. But this is a patient population who may reasonably be prescribed opioids. Radiotherapy to the pelvis and the abdomen disrupts the ecology of the gut. And of course some of our patients will contract hospital borne C. Difficile, which is a very treatment resistant microbe that produces debilitating and dangerous diarrhea. Patients can have fluid and electrolyte imbalances quite quickly. And remember, the patient population for cancer patients demographic is older and so more vulnerable, less resilient. And so we need to watch them more closely and keep them safe. So just like any microbiome challenge, we want the patient to be eating soluble fibers, which are the kind of fiber that acts as fuel and substrate for the bacteria in the microbiome that compose the microbiome. And butyrate is an example of a short chain fatty acid that needs to be in high amounts in the gut in order to have a really, really healthy microbiome. So the soluble fibers are in the category of prebiotics. And then we have our probiotics, the ingestion of the healthy bacteria. But if you don't have enough prebiotics, it doesn't matter how many billions of probiotics you take, they will not colonize in your gut. So I think this is very misunderstood. If you're going to restore the gut, you have to have soluble fiber and prebiotics in the plan. Now, fermented foods are in every traditional diet and so we want to make sure the patient understands how to use them as condiments. It doesn't have to be a giant serving. Interestingly enough, fasting will increase short chain fatty acids such as butyrate in the gut and will also increase beneficial microbes. And if we feel a patient has really been disrupted, there are of course stool tests that use DNA probes to look both at the aerobes and the anaerobes and the inflammatory immune condition of the gut, and whether or not you're digesting your food adequately. So here's just some lists for you of traditional fermented foods. Things like sauerkraut and kimchi, even cultured olives and some of the soft cheeses fall into that category. Kombucha falls into that category. Almost every culture has some kind of a pickled vegetable or a fermented food. The vegetables that are the richest in the prebiotic fermentable fibers are the onion, garlic family, the cabbage family. The fiber that's in legumes acts as a substrate. Also artichokes, bananas, asparagus, the chicory family, things like radicchio. These are all the families of foods you want to make sure in a cancer patient they're eating something from the onion, garlic family and the cabbage family every single day. Now, prebiotic functional foods, which you may see in some really super brilliant fiber product form, you want to look for this kind of broad spectrum of different types of fibers. Some patients who are very sensitive to lectins don't do well with a lot of these, but can tolerate acacia gum. So if you have a patient who really has a lot of bowel inflammation and you think they're sensitive to lectins, you can always use acacia gum as a prebiotic. But again, a lot of plant fibers are going to act as substrate. So when you give a fiber powder, you want to have a wide range of fibers. So you're getting prebiotic and probiotic soluble, soluble and insoluble fibers. The insoluble fiber is not fermentable. That's like bran. It's just the cellulose that makes plants stand up. Obesity and glycemic control, of course, are directly related to what people eat. And a lot of people don't realize that both obesity and diabete increase your risk for cancer. About 14% of all cancer deaths in men and 20% in women are directly related to obesity and breast cancer. Your risk of having A recurrence is 40% greater if you're obese. And so when a person has finished going through treatment, that's a teachable moment. And so if they're asking you, what should I eat? Then you put them on a fat burning protocol. Now, here is. We looked at an image like this on the impact of food on cancer, but here's one. The impact of obesity on cancer. And again, I just want to point out, it's a wide range of cancers it's just not one type of cancer. One of the reasons for this is when you have excess fat mass that's a factory for inflammatory cytokines, it's a factory for hormones, and it is also a depot for fat soluble environmental toxins. And so obesity really, really decreases health and well being. And then you have this extra high level of inflammation. People don't feel well, they feel more fatigued when they have a higher fat mass. So here is just a list of the cancers that are impacted that we know are impacted by diabetes, hyperglycemia and hyperinsulinemia. So this is a huge problem in the United States with our obese and sedentary sugar addicted population. We're looking for fasting glucose, somewhere in the 70 to 90 range, a hemoglobin A1C, somewhere between 4.5 and 5.2, and a healthy BMI. So we don't want underweight people, but we want lean muscular patients. So somewhere between like 19 and 23 is a good ballpark for BMI. But remember, cancer patients are really at risk of weight loss and muscle mass loss. So we want to make sure that they don't become underweight. Now, insulin is the growth factor. A lot of people think that sugar is the demon and the culprit, but it's the insulin. So the big principle here is you feed the patient a diet that does not trigger insulin. That is the key. And therefore you're going to eat a low glycemic diet, which will give you blood sugars and insulin levels that are hopefully in the lowest quartile you'll see in diabetics. If you're not used to seeing, diabetics can have fasting blood sugars of 200 and 300. And then in cancer care, the oncologist sometimes gives prednisone oral steroids and then it shoots up. And I often try to negotiate to not have the patient take steroids, which has no impact on the cancer. It just protects a small percentage of patient from inflammatory reactions to some of the chemotherapy agents. But it doesn't have to be in there. My diabetic patients often negotiate with the oncologist and not use steroids, which really increase serum glucose in patients who already can't handle that, in which it will drive more cancer growth. So it won't, it will impair treatment as well. Here's a nice diagram showing the impact of lifestyle, poor diet, being sedentary, on diabetes and cancer. If you are obese and have diabetes, you have an even greater risk. And of course, insulinemia is a fat storage physiology. So we really have to help these patients. So if someone's at undergoing treatment, when they come to you, you take the middle path, do things that the patient can do. They're already overwhelmed, so you can slowly teach them how to eat. Unless they have the personality of I'm all or nothing, tell me what to do, I'll throw out all the food in my kitchen. But that's not most patients. But remember your obese or over fat patients, your insulinemic patients, your patients who've lost insulin sensitivity, they're at risk for cancer and they have a higher rate of mortality as well. They get cancer more often, they get more recurrences and they have higher death rates from cancer. It's really, really important. I've got a lot of references in here for you. In the interest of time, I'll let you go back and look at those yourself. But just to remember that these correlations exist and therefore we should be aware if a patient is in our practice, who, who has prediabetes or diabetes or is obese or is heading that way, that we also need to be mindful that they're at risk for cancer. I think that's not really in the foreground in most primary care frontline practices. Now let's talk about carbohydrate restriction, because this is one of our strategies for lowering plasma insulin levels. And when we do that, we reduce these growth signals so we get lower, less tumor formation, less cancer formation, less growth signals. And then the tumor cells, their metabolism slows down. When you have high insulin levels and you can measure this in your patients, you can do a fasting insulin, you can also do IGF1 insulin like growth factor levels. These are markers, biomarkers in the tumor microenvironment that tell you if you have a very proliferative, tumorigenic, progressive environment. And you can also, if you are advising your patients to be on modified ketogenic diets, then you can also have them check their ketones in their urine. Now let me just say why I said modified ketogenic, because these are fragile patients and we want to make sure we are not pushing them into more physiologic stress. So we'll talk about that. Here's just a nice chart. This was a study of colorectal cancer and hepatoscopic cellular cancer that looked at all the signaling molecules that impact cancer physiology that are present in our obese and diabetic patients. We have insulin resistance, higher insulinemia, we have the activation of several Growth factors in the insulin like growth factor family and the receptors for those factors, we have increased leptin levels, decreased adiponectin levels. That's very common in breast cancer. You can measure those things in the blood. Chronic inflammation is present. You can just measure CRP to be tracking your patient's kind of general inflammation status. But remember, if you have high ferritin or high cereal plasmin, those are also markers of inflammation. So you want to watch all of those things. And of course in the presence of more inflammation and the presence of of diabetes and obesity, we have a lot of oxidative stress. This all produces this tumor microenvironment. That's pro growth. That's the big idea there. This was another study by the same group showing that green tea catechins also had a positive impact on all the factors that we just mentioned, along with a few signaling molecules like beta catenin, which is, is a proliferative cell division type of a molecule. Again, green tea comes into play in many places. It's very antioxidant, it's anti inflammatory, but it also impacts glycemic control and body composition. Now, reishi mushroom, we're going to mention it again. I want you to come away from this lecture with a handful of things you can use. Ganoderma is the Latin for the reishi mushroom. And you can give these two to six grams a day. This is like concentrated food in my mind. The only caution here is because the medicinal mushrooms really are immune stimulating and increase white blood cells. You want to be careful with patients who have leukemia who already have high blood white blood cells. And you want to be careful in patients who have autoimmune disease. Some patients with autoimmune inflammatory syndromes actually get worse when you use these kinds of immune stimulating treatments. So be mindful and individualize your treatment plans. So not only do the medicinal mushrooms and particularly ganodermas well studied, it has a really big impact on glycemic. It helps with a change in body composition. Because of that, it has an impact on the gut bacteria because of the beta glucans and polysaccharides that are in has an impact on the maintenance of intestinal integrity and tight junctions, meaning it's good for leaky gut syndrome. It's also good for leaky blood brain barrier syndrome, which is another epithelial barrier that gets disrupted in the cancer terrain. We also see that it has an impact on delayed gastric empty, meaning that it promotes healthy peristalsis. Because some cancer patients, their food just sits in their stomach and so then they don't want to eat. We have a reduced expression of inflammatory cytokines and improved glucose tolerance and insulin sensitivity. Again, a multitasker. This is the beauty of therapeutic plan and therapeutic phytochemicals.

Can I share something about Reishi?

Absolutely.

So I actually drink a Reishi infused coffee every day. Those of you that follow me know that I share that quite a bit. I'm actually giving a talk all about medicinal mushrooms next week in North Carolina. And so Reishi is the king of mushrooms. It's amazing. They call it the mushroom of longevity. I actually have a client in Brazil, a friend of mine. She's not a client actually, she's a friend, good friend of mine's mother, who has pancreatic cancer. And she was taking four shots of insulin every day. Her blood glucose was in the 200s. This is Canadian numbers, of course, and so it should be less. I'm sorry, this is American numbers. So her blood sugar was in the 220s. In five days of drinking ganoderma infused coffee, her blood sugar went down to 76 and she's on zero. Insulin. Insulin. And her, she's feeling amazing. Even her blood pressure went down. So she's getting off her blood pressure medications and that's in five days. So, you know, amazing things can happen in a short period of time. But this is something most people don't know about. They've never heard of Ganoderma.

Right.

They've heard mushrooms, but they're not using these medicinal mushrooms effectively. So that's. I just wanted to touch on that because there's some amazing results that we're seeing with our patients.

Lots of studies, most of them out of Japan. I just wanted to say also, look, you want to look for the hot water extract products. That's really important in most medicinal mushrooms. It's the fruiting body, not the mycelia that are the most powerful. And a lot of the really cheap mushroom products are just mycelia and a lot of them are just grown on grain. And there's one company that grows their mushrooms on medicinal herbs and gets incorporated into the fruiting body. So it matters the quality and how that.

Absolutely.

Thank you. All right, so if you study mushrooms, you fall in love with mushrooms because they're so mean. All right, so I just have some references here for you that are germane to what we've just spoken about, particularly like this paper, Diabetes and Cancer. Although it was written in 2010, it's just a really good discussion of this physiology that Isn't about date. So if you're interested in this, if you tend to treat a lot of patients with diabetes and prediabetes, then think about these patients at high risk for cancer. All right, let's talk about the diets because there's so much confusion. So I'm just going to go through a bunch of different diets and at the end of this, you will be able to answer patients questions. I just had to put this slide up because it was published by the Journal of the American College of Nutrition, which is a pretty straight conservative organization. But look what they're recommending. They're catching on. They're saying, avoid dairy products if you have prostate cancer. Limit or avoid antibiotics, alcohol, avoid red and processed meat, avoid grilled, fried and broiled meats. Women can consume soy products in adolescents to reduce breast cancer. And in general eat a diet rich in fruits and vegetables. So there's hope that some of these larger nutritional institutions, which don't always update themselves on the newer information, are going to be more in line with the things we say to patients. Now here's a little chart for you and I have a handout with this on it for you just so you can have this to look at. And with a couple of the diets that we are talking about, that's in your bonuses. And the link again is on two different slides in this particular lecture. So a ketogenic diet is mostly fat, some protein and very low carbs. I want you to just take a look at the American Paleo diet because it's actually got a lot of carbs in it. When you compare it it to a low carbohydrate diet, it actually is kind of close to the zone diet. Just a little bit more protein and a little less fat. It's not really the best diet for a cancer patient. Want to go a little lower on carbohydrates? My outsmart cancer diet is mildly ketogenic, very anti inflammatory and very low glycemic. So this is sort of my middle ground here where we're conservative with protein, we're more generous with fat and decreasing the carbohydrates. So I describe the plate to my patient by saying, half your plate is colorful vegetables that grow above the ground. So get rid of the starchy vegetables. A quarter of your plate is healthy, clean protein and then the rest of your plate is healthy fats. And then they don't know what that means. And you have to tell them they need to understand where to get fats in the diet that are Healthy, and I'll show you that in a moment. But this is a healthy diet for a cancer patient. You can't be on a true ketogenic diet all the time. It's not a healthy diet. It's a therapeutic diet. And these are vulnerable patients. I'm more middle path. I will say I'm a more conservative clinician, but my patients are fast. We have to be more careful. I just want to show you the Mediterranean diet. Really pretty high carb. Although it's full of wonderful healthy oils and lots of colorful fruits and vegetables, it actually is rather high carb diet and it can be high in salt. Now bone broth is one of my favorite therapeutic foods. If you look at it, it's got a moderate amount of protein, a decent amount of fat, it's not too high in carbs. So a cancer patient who does not feel like eating can live on a shake and bone broth for a couple of days and get their calorie and nutrient and mineral needs met without any abrasion to their digestive tract. I often have patients actually take bone broth with them to their infusions. Also you can put Chinese herbs. You can could put some of the reishi, mushroom powder or tea into the bone broth and make it really therapeutic. So there's a tradition of that in China. This just to give you kind of the lay of the land, here are my general guidelines for cancer patients. The big ideas of course are organic food, unprocessed whole foods, chemical and hormone free, additive free. We should put non GMO on this list. Also high in fiber, but low in glycemic impact and anti inflammatory. Those are the big ideas. And then we want to limit high iron and high copper foods. And the reason for this is iron and copper are sequestered by tumor cells. Iron is sequestered by tumor cells for its own metabolism. Copper is required in order for angiogenesis to happen. Angiogenesis again is how tumor cells signal a nearby capillary to bud towards it and bring a blood supply. And if you starve cancer patients of copper or keep copper in the lowest quartile of normal in the blood, you can actually put the brakes on cancer progression. There are actually studies on oral copiculation as a way to control disease progression. I limit animal products. I don't ask my patients to be vegetarian or vegan unless they want to. But I do want to limit animal proteins and have them be more plant based overall. And the animal proteins they eat should be really clean proteins. I like to encourage Everyone to have the cruciferous and onion family vegetables, a little fermented food every day. Teach them what, what healthy fats and oils are. Really increase that ratio. So you're getting more Omega 3s than Omega 6s. That's hard on a plant based diet because plants are mostly Omega 6. We can include monounsaturates like avocado and olive oil, a liberal use of herbs and spices because that's a little pharmacy in your kitchen and kind of be in that middle spot with protein with cancer patients, 40 to 60% a day unless it's warranted to give more. And they're both lifestyle reasons as well as pathology reasons to change that. Hydration is incredibly important, both fluid and electrolytes and educate them about what their food triggers are and what their pro inflammatory foods are. Absolutely no artificial sweeteners because that actually signals the brain and it actually makes you store fat. So it doesn't really work work. Plus these are artificial chemicals. I do think stevia is fine. The sugar alcohols are fine. A lot of people don't like the taste of them. And the sugar alcohols also give you a lot of gas because they're fuel for our microbiome and limit alcohol because it is a carcinogen. And I'll talk about that in a moment. But that's kind of the big guidelines. Lots of color, lots of onions and garlic and broccoli and broccoli sprouts, et cetera. It's not a hard diet to eat. It's really good. Now I really like to push that omega 3 ratio up. And if I can get omega 3 to omega 6 to be 1 to 1 or even 3 to 1, that's really fantastic. You get this very, very anti inflammatory cancer controlling environment. But you can only do that with supplements. You can't do that that with food. All right, let's talk about the ketogenic diet. I think it's very, very, very, very misunderstood. And these are two reliable sources if you want to understand this physiology better. There's a seminal paper called Cancer as a Metabolic disease written by Dr. Thomas Seyfid. He's all over the Internet. There's lots of YouTube videos of him giving academic lectures. And Dr. Naysha Winters is kind of one of his proteges and she wrote a book for Pace about the cancer terrain in this context called A Metabolic Approach to Cancer. She's a naturopath and a Chinese medicine doctor who in her 20s was diagnosed with stage three ovarian cancer. Most women die of stage three ovarian cancer and Naysha's, I think close to 50 now, and she's a proponent of this type of metabolic approach. So a ketogenic diet, textbook, classic ketogenic diet alters mitochondrial metabolism. That's how it works. It's about 75% fat, 20% protein, 5% carbohydrates, kind of textbook ketogenic diet. Patients will not stay on a diet like this. It makes you nauseous, it gives you diarrhea, and although it's very satiating and it does tip them into a physiology that controls cancer more. I'm not this strict. I use my outsmart cancer diet and a little loosen up on this. But I will ask patients to do this for 24 to 48 hours before they have a chemotherapy infusion because it will really stress the tumor cells. It actually takes a couple of days to get into ketosis, real ketosis, because you have to use up all your glycogen stores first. But you will drop your insulin and blood sugar just by doing this for a couple of days. And that is stressful to the tumor cells. This is an approach, just an approach. We're going to look at other things. What are ketones? Ketones are another energy substrate that can be used by mitochondria to make ATP. The most energy demanding tissues in the body and organs in the body are like the brain and the cardiac muscle, for example. They can use ketones really efficiently. And this is really an adaption to early humans who didn't have 24, 7 access to food the way that we do. Part of our problem is we don't fast. We eat all the time at all hours of the day, and we're not really designed for that. So all of us who are alive today are adapted to famine, and we're the ones that made it. We're the ones that can make ketones. Other people could not survive long periods without food because they didn't have an adaptive physiology. So we leverage the fact that this is what happens when you drop insulin and glucose. You get ketones instead of glucose to feed your mitochondria to make a ATP. So this is the strategy and this is what we call the Warburg effect that happens in tumor cells, that they have these aberrant kinds of mitochondria that can't do this adaption. They can't use ketones. So if you have more ketones and less glucose, then the tumor cell is quite stressed and its metabolism will slow down. And that's part of a good goal for managing the Tumor microenvironment. Now, the problem with a lot of ketogenic diets is the foods that people choose. And I'm going to show you this chart I found which is going to show you how unhealthy it can be. Remember, these are super low glycemic will drop your insulin, drop your IGF1 insulin like growth factor and improve glycemic control. Those are all good things. Okay? Those are all good things. And then stress the tumor cells. However, depending how you do it, you can end up with elevated LDL cholesterol because you're eating too much saturated fat. It could be pro inflammatory, you could be eating the wrong kinds of fat and also produce more inflammatory prostaglandins. You could increase your cancer risk by having a diet that's too much animal food and you're going to have a paucity of trace minerals and you may even become hypoglycem. Many patients have nausea, diarrhea and fat in the stool. There are patients. A very strict ketogenic diet also changes how your kidneys process minerals. And you can lose your potassium and magnesium and sodium very quickly if you maintain ketosis for a long period of time. And so when you're doing strict ketogenic diets, you must replete minerals. It's very important. That's how people get in the emergency room, by trying to do ketogenic diets when they're not super. So here's a nice example, nice chart that shows you the power of ketogenic diets both on obesity, tumor growth, inflammation and immunity. This is a great paper. So we increase oxidative phosphorylation in the healthy cells and we decrease glycolysis because we're using ketones, not glucose. A tumor cell can't do this. So what happens? We get reduced proliferation of tumor cells, inhibition of tumor growth, inhibition of angiogenesis, less inflammation, and we turn back on apoptosis. A trait of tumor cells is that they don't know when they're supposed to die. They don't recognize that they're aberrant. The apoptotic switch, the cell suicide switch, protects us from having cells that are aberrant and abnormal from continuing to divide. So a smart set says, I might harm the biosystem. I'm going to commit suicide and recycle my goods. But cancer cell says, I'm going to persevere, I'm going to live and I'm not. Even though I'm not a healthy cell, I'm going to keep Sustaining my growth and cell division. All those things are turned down in ketogenic physiology. That's why it has an impact on cancer. So there's a couple of ways to think about accomplishing these goals that are not as extreme as a ketogenic diet. And I also think about cancer is a marathon, it's not a sprint. And we have to give people things they feel like they can do and that they could do for a long time. So I will put them into more strict keto for short periods of time, strategically. Strategically. And then have them do a low glycemic carbohydrate restricted diet for most of the time. And that's what my outsmart cancer diet is. And you can go back to that slide and you'll have a handout on this, because the high fat, low carbohydrate diet does accomplish these metabolic changes, just not as extreme. So when you think about where glucose demand is, the brain is the most glucose demanding organ in the body. So ketogenic diets have the most impact on brain cancers because it so alters the physiology of the most glucose demanding cells. So with those patients, I'm a little bit more strict because, number one, brain cancers are hard to treat. Number two, we can exert some control over the wildfire like progression of these cancers by being more ketogenic. This is just a reiteration of some of these basic principles of what happens when we restrict carbohydrates. When we get this drop in insulin, we also get a drop in lactic acid. Why is that? Because if the tumor cell is primarily using glycolysis, glycolysis, it's producing a lot of lactic acid. I'm going to show you why that makes the tumor environment more acidic momentarily. But that's why people say cancer is acidic. It's because cancer cells are doing more glycolysis and producing the byproduct of glycolysis, which is lactic acid or lactate. I think we've gone over these insulin principles now. This is a study on high protein diets. And I really should have gone back to this paper to tell you what they meant by high protein. But I don't have that information on the tip of my tongue here. There's a number of papers which I've included here that show a low carbohydrate diet can slow tumor growth and prevent cancer initiation without having to be ketogenic. I found this site which shows what you should eat on a ketogenic diet. And if you look at all these foods, it's not really the healthiest. This is what is emphasized on the ketogenic diet. High fat animal proteins. On the other hand, we can guide patients to be using healthy plant based fats for part of this and replacing some of their carbohydrate flours with things like almond flour and coconut flour. You just have to teach people how to do that. So this is a healthier way. This is just a chart that came from this site with also a lot of unhealthy choices. I'm just putting this here to show you how people get lost when they try to do a ketogenic diet on their own. So if you understand the basic principles, you can guide your patient making healthier choices. And basically you want a lot of colorful vegetables, moderate amount of protein and a lot of fat and you'll guide the patient how to do that. Also you can use bone broth and the ketogenic plan and you can also use shakes. And that's often a way to make it easier, easier for the patient. This is a recipe for a ketogenic shake that accomplishes depending how much protein you put in it, It'll either be a 4 to 1 fat to protein or a 3 to 1 fat to protein. But you'll accomplish this shift in metabolism and impact on tumor cells either way. So you decide how much daily protein the patient's going to get when you decide how much is in their shake. So some of my patients for really aren't interested in food. I use a shake as a central part of my treatment plans. You can see there's medium chain triglycerides in here. They turn into ketones right away. Immediate source of energy. There's some flax oil, some omega 3 fatty acids. I like to put some brain nutrients in, so I'll put phosphatidylcholine in. I always put carnitine in my shakes for cancer patients because it's good for the mitochondria. Remember, carnitine is important fatty acid metabolism in the mitochondria and and also preserves muscle mass. Remember that cancer patients are at risk of sarcopenia. I'll put a little CoQ10 in there in service to the mitochondria. And then I'll put some red greens powder because I know my patients aren't going to eat 8 to 12 servings of vegetables every day. They don't feel like eating in the first place. I'll put half an avocado in there. That makes it really creamy. You can put things like pumpkin Seeds, chia seeds. I like to put a little bit of probiotics and some fiber in there. So we're getting prebiotics and probiotics. And then these are such dense shakes that if you take an organic lemon, cut it in half and just throw it in the blender with the seeds, with the peel, it kind of lightens up the taste of it. And with that peel you get all that quercetin and bioflavonoids. So it's a nice thing to do. It makes it a little bit more palatable. And of course I don't have berries in these shakes. People who are not diabetic and have better glycemic control overall, they can put a few berries in there. But I give them recipes where you can flavor it with lots of vanilla and cinnamon or put mint or lots of different ways to flavor it. Then you have to give some pancreatic enzymes and some bile and some lipase when you do a shake like this. Otherwise you'll be really nauseous. And you should encourage people, patients to drink it slowly. And then I'll include an iron free, copper free multivitamin because my patient might be living on a couple of shakes a day for a few days a month. And so I want to make sure that we cover all the bases. I also want to bring attention to this term, the fasting mimicking diet, which has been very popularized of late. And the darling of this research is darling. Dr. Valter Longo happens to be here in Los Angeles at the University of Southern California. He runs the longevity and gerontology labs there, studies aging and longevity. And his research is great. He's a great speaker. He is all over the Internet as well. But he's really studied the impact of fasting and calorie restriction on cancer physiology and also on aging. He published a book in the last year called the Longevity Diet, which is for the general public. He also has a product that puts people through five days of fasting according to his guidelines. I do not recommend it. I absolutely do not recommend it. What we can do for patients is exponentially healthier and accomplish the same thing. This is just another paper on the impact of fasting carbohydrates and nutrient ratios in cancer. And it's fairly recent, 2018, pushing the limits of 20 cancer therapy, the nutrient gains. Excellent paper. Alright, so my moderate modified ketogenic plant based diet. So we kind of call these ketotarian diets, right? So we can still accomplish our goal of creating a hostile environment to cancer cells. It'll Be low carb, high in healthy fats. And in this way we will have the kind of physiology that is exerting control over cancer progression, not feeding it. There's another marker in the microbiome if you are doing stool tests. Ekkermansia is a niche. It's more newly discovered organism that is considered to be the presence of it is considered to be a marker for a more healthy microbiome. I watch that now. This doctor with the soluble fibers will increase your short chain fatty acids and butyrate in the gut. This meets our requirements. This is a paper that's really an excellent paper. And this is a diagram from that paper showing how prolonged fasting and fasting, mimicking diets and ketogenic diets accomplish the goals we want to accomplish in the cancer terrain. For those of you that are more visual, you can look and see how it changes circulation metabolites, how it changes immunology and how it changes the gut. But for those of you who like to read, there is actually another slide in here with all that information typed up for you. But just to emphasize we're just changing glycemic control and signaling molecules, changing the availability of the regulatory tumor cells, T cells rather of the immune system and decreasing inflammatory cytokines and producing a physiology with enough short chain fatty acids for a healthy microbiome. So it's not hard to do.

Can I ask you a question?

Yeah.

What is the rationale behind a low sulfur amino acid diet?

That's a low methionine diet. There's a lot of studies. Not sulfur in particular, but because MSN is actually used in some cancer therapies and naturopathic medicine, which is a high sulfur product. Remember that glutathione is high in sulfur?

Yeah. That's why it's confused.

It's not about sulfur, it's about methionine. One of the reasons that vegetarian diets are less carcinogenic is because they're lower in methionine. Is as unique know a crucial player in many, many biochemical pathways.

Cool. And then the other question I had, if you go back to that previous slide, was about ketones. So do we know the impact of exogenous ketones? Because that seems to be a problem.

Yeah, I'm actually doing a lecture on ketones and ketosis in a couple weeks of of weeks for Designs for Health on the 26th of June. So if anybody wants to participate in that, if you click on the link that's in these slides, we'll have your email address and we'll send you an announcement about that lecture. It's a very deep dive into ketosis and ketones. So when you use exogenous ketones, you are actually not changing your metabolism. Metabolism. And so you're not really impacting the mitochondria in the way that happens when you have a diet that switches a metabolic switch. Right. But the exogenous ketones do act as fuel. Like in a brain cancer patient who might not feel like eating a lot. You want more ketones available to the brain. Think about also like maybe congestive heart failure patients who their heart muscle is failing and that is a muscle that needs more fuel and can use ketones. So I look at it as more therapeutic. It's the lazy man's way to have more ketones in your bloodstream. But it is not, doesn't accomplish all these things.

Got it. I want everyone to hear that. Because some things you can't cheat. Right. You gotta do.

That's right. Our goal here is to change signaling and change a metabolic switch. And it's the adaption to ketones in the loss of glycogen and the environment of glucose that is actually what does that. So it's not the ketones, the ketones. Ketones are a byproduct of a diet like this. Now ketones have some interesting effects, but we do this primarily to give the mitochondria an alternate fuel so that we can stress the tumor cell and still have energy available to healthy cells. That's the basic principle here. There are like long distance athletes have started to use the exogenous ketones. I'm not an expert in that physiology. I'm not sure it's. I'm not sure it's the right thing to do, but I'm not an expert in that. And also, you know, it's just being, it's being used as a trick, but it doesn't accomplish what we want. I'll just leave it there.

Alright.

So I just wanted to bring your attention to the paleo diet, which is not quite right for cancer patients. It is low glycemic, it does decrease insulin and leptin, which is another signaling molecule for oncogenes. It is low in lectins because it's low in grains and legumes. So that's good for some people of those sensitivities. But it can be too high in animal proteins. And if the patient is not eating grass fed animal protein sources, they're going to get a lot of omega 6s and arachidonic acid and it'll end up being really pro inflammatory. Not everybody has access to grass fed animal products because there's no grains in a lot of paleo diets. These patients have higher rates of colorectal cancer, partly because it's too high in animal proteins, but partly because they're not producing enough butyrate in the gut. One of my colleagues, Tina Kazor, is a naturopathic oncologist who specializes in colorectal cancer. And she says that the microbiome of people who've been strict paleo for long periods of time is extremely unhealthy. So there you have it. Wow. Yeah. So we have to modify, right? We have to modify. The paleo diet can be low in B vitamins because it doesn't have a lot of grains in it. So you just have to make sure you are going to supplement patients who are doing diets that are coming kind of extreme. It can be too high in saturated fat. And because of that, those fats carry environmental toxins with them, even if they're organic and even if they're grass fed. So think about what our goals really are in a more fragile patient population. These are very high iron, very high copper diets, they're very high in methionine, they produce increased risk of osteoporosis and as I mentioned, colorectal cancer. This is not the best diet for a cancer patient. We could do a paleoitarian diet and make sure you get enough soluble fiber and then you take away some of the problems of this. As I mentioned, vegetarian diets have the best statistics in terms of cancer risk, cancer recurrence and mortality compared to people who eat meat. Tons and tons and tons of research on that. I have a lot of slides in here with references for you on that. So I say to patients, plant based. Okay, plant based. Some people are already vegetarians or vegans. But then we have to address the problems of those diets because most people do that without guidance. Right? So a vegan diet that's completely plant based can be too high in carbohydrates. Those diets that are completely plant based are typically low in omega 3 fatty acids and B12. So we have to, to monitor these patients and make sure that they are getting all their nutrients that are so crucial. When their physiology is so stressed by cancer and cancer treatments, they have a risk of losing muscle mass. Also more flexitarian diets of all persuasions, people who put eggs in, who put dairy in, who don't eat red meat, but they eat chicken there's all kinds of varieties. But remember that the amount of soluble fiber you get by eating a lot of plants is the gift of a healthy microbiome and a healthy digestive tract and lots and lots of phytonutrients. So that's what plants do for us. The interesting thing also is on the people who eat a lot of fruit, they tend to have more dental care. And sometimes the vegan diets and dairy free diets are really low in calcium and phosphorus as well. So you just have to look when somebody tells you they're vegan or vegetarian, you have to absolutely have them do a food diary and look at reality to help them learn how to make healthy choices.

Basically, it seems like being a vegetarian and supplementing can be a very easy thing. I'm personally vegetarian.

It can, it can. It just really. A vegetarian diet's more work, it takes more thought. You can learn how to stay super healthy on a vegetarian diet. You'll have the lowest risk of cancer in your community compared to people who eat animal products. So it just has some inherent deficiencies you have to be mindful of and it's not hard to address those. It's not hard, hard at all. It's just that so many people put themselves on a diet because they think it's a good idea, but they don't have enough knowledge. And that's why they need us to help them so that they're in the optimum health range, not the marginalized health range. And the other thing about lowering your animal proteins is it lowers IGF1, which is a huge driver of cancer cell proliferation. So if you have a patient that has a high IGF one, just tell them to take the animal proteins out of their diet or to lower the animal proteins and use their muscles more and you'll see that IGF one drop. And now you've taken away a risk factor by diet and lifestyle. All right, dietary fiber, I think we've talked about it a lot, so I'm going to just pass this by. I will say on this slide, the presence of soluble fibers and the amount of secondary bile acids in the gut based on how much fiber you eat and the health of your microbiome does impact estrogen driven cancers. And so that's really, really important. If you have a lot of glucuronic acid in your gut, you deconjugate your estrogens and you get a recirculation of your estrogens and it's a risk factor for estrogen driven cancers. And given the Fact that most women and men have unhealthy guts and our environment is estrogenic. There's multiple factors that drive these estrogen cancers. So your gut is one of them. And so the amount of fiber and healthy fats you eat influences your bile acids and your gut. There's a couple of studies here on plant versus animal fats. Increased risk was not associated when you increase your vegetable fats in your diet. But it does increase cancer risk when you have more animal fat. So remember that unhealthy ketogenic diet I just showed you? It's a pro carcinogenic diet. So you might lose fat on it, but you it's not healthy. So again, I think the key word is how do you make choices in diet that change metabolism, change cancer risk, that are healthy, sustainable. That's a diet you can do for a long time. Here's one on animal fat driving hormone sensitive organs. Here's another one on colorectal cancer risk. Now this is white meat versus red meat. There are studies showing that high iron diets include increase colorectal cancer risk. Remember, iron is a pro oxidant. So it's thought that's part of the picture, that's part of the etiology there. Almost all cancers have higher incidence when you eat more red meat. Basically I just have a lot of slides, but I wanted to emphasize here, that includes the leukemias and the myelomas and lymphomas, not just solid tumors. This is a systemic effect, not just.

Well, a lot of our, A lot of the animals have cancer or have pre cancerous conditions in their body. So how could they produce health in our bodies?

Right, right. That's right. Well, yeah, their fat is full of the environmental toxins. And think of like our dogs and cats, they get so much cancer because they're close to the ground where all the pesticides and herbicides are being sprayed in people's gardens and lawns and all that. So that's one reason that they're getting more. So I just wanted to put a few slides in here about soy because I, I think it's really misunderstood. Soy is not the enemy. Soy is not a drug. Okay? So soy is a food used by an entire continent of people in East Asia. So if you think that soy shouldn't be in the diet, there are reasons to leave soy out of the diet if it's genetically modified, if you can't digest it, or if you're in that small percentage of people where your thyroid is affected by soy. But I honestly, I've been in practice 35 years. I've seen maybe two patients for whom that's true. I think that that is a naturopathic myth that's been perpetuated. So just the problem is in the States here that almost all the soy is gmo. So that's the problem with soy. But I just want to dispel the myth that you can give yourself estrogenic cancers or drive estrogenic cancers by eating soy. That the research has shown that is not true. And I just want to make that point. And the most compelling research is that when young girls, when you eat soy in your diet as a kid and adolescents, you will have less risk of breast cancer as an adult woman. So that's the biggest impact in all the studies. But there are studies of women in the west who have high soy diets, they have low, less risk of breast cancer, and they're just studied lots of studies like that. My colleague Dr. Mary Hardy and Dr. Donald Abrams, two fantastic integrative oncologists, co authored a paper in 2013 looking at all this research and they titled the paper, It's Time for Clinicians to reconsider their prescription against the use of soy foods by breast cancer patients. So read that paper if you want to educate yourself more thoroughly about that. Now, I want to talk about the Gerson diet because patients ask about it a lot, at least in the States, it's a very popular diet. In the 1950s it came about and it's still in place as is. It does not meet any of the requirements for a healthy anti cancer diet that I have described to you. 13 glasses of carrot and apple juice and some greens in it. High glycemic, right? 15 pounds of raw produce every day. That's a lot. Most people can't eat that much, especially they don't feel well. Lots of fruit, more glycemic impact, and the meals are lots of fruit in them with vegetables and whole grains. The detoxification of using coffee enemas, five enemas a day, again, I think that there's a naturopathic myth that's been perpetuated that does not get supported by science. The caffeine that comes through the hepatic portal vein by doing a coffee enema changes blood flow to the liver, but it doesn't change the chemistry of the liver. We know more today. And so also, I don't like the idea of disrupting the microbiome. After all we've learned about the microbiome, why rinse it out every day? It's so hard to reestablish. So I am not a proponent of this at all. I think we have much more skillful ways to impact detoxification pathways that are the challenges we have in our modern life. And we need to be altering the pathways in the liver, not just pushing blood into the liver.

Sounds very uncomfortable.

It isn't their low volume enemas and it just causes a lot of caffeine to end up in the liver. And people feel good for a little while because you get a lot of caffeine. But it's not really the kind of detoxification we need when we have body burden of environmental chemicals doesn't accomplish that. So again, I think we have to be mindful of some older practices and see if what we've learned is still supported by science. Some are like there's some ancient practices. We learn the science and know why worked right. But this isn't one of them. Also, the Gerson diet's really imbalanced. You get a lot of electrolyte imbalances in it and it doesn't have any B12 in it and doesn't have enough. There's a potassium loss because of the. Even though it's a high potassium diet, the kidneys dump potassium and the Luvol solution is an iodine solution. In modern naturopathic and and integrative oncology, we don't like to push on the thyroid. We don't want to ramp up metabolism artificially because you will ramp up the metabolism of tumor cells as well. This is antithetical to what I've taught you today. Now, a lot of patients ask about juicing. And because we're concerned with glycemic control, we need the fiber. We want the fiber. If somebody has a really good blender like a Vitamix and they can pulverize and liquefy a vegetable and make it drinkable, then you still have the fiber in there. Great. But otherwise you're drinking something with too much glycemic impact. Remember, eating high fiber foods slows down the absorption and the glycemic impact of our foods. Of course, a diet that is a juice diet is not going to have fiber in it. Then you won't have the butyrate substrate available in the diet. Not much protein, not many calories. In patients who are at risk for sarcopenia, those people who do a lot of citrus are getting a lot of sugar. But remember, grapefruit accelerates drug metabolism so you can get people in trouble who are on drugs during treatment phase. So I Am not a fan of this. I'm just not a fan of this diet because I'm middle path. And I think this is extreme. I think that patients who've been eating the standard American diet and they go on juices, of course they feel better. They just got rid of all their junk food and got some plant food into them. But it's not a diet you could live on. We know much more healthy ways to accomplish the goals. Now, a lot of people ask about raw foods as well, but let me just say, if a patient wants to do juice and get more density, I'll have them put mostly low glycemic plants into Vitamix, keep the fiber in there, and they put a lemon in there to make it taste better, and a ginger or something like that. And. And you can get a density of nutrients, but you need to mix the juice with your saliva, because when you have food going through your digestive tract faster than it's normal, it doesn't get fully digested. You don't actually get the benefit you think you're getting. So again, we want to educate our patients, if they're really invested in doing something, how to get benefit from it and not throw themselves out of balance. Now, a lot of people want to do raw food diets. It just depends on the patient. Number one, there are some nutrients in food that are only liberated when food is likely cooked. That includes the sulforaphanes and cruciferous vegetables and lycopene and red tomatoes and red peppers and beta carotene and all the yellow and green and red orange vegetables. Some of your vegetables should be lightly steamed or lightly baked or roasted so that you liberate some of these chemicals that our digestive tract cannot. Also, a lot of people who are on raw foods diets are doing a lot of sugar. They're doing a lot of things with honey and agave and maple syrup in them. You want to see what somebody's actually doing. The argument for these diets is there's really high fiber. Then of course, you've still got the enzymes from live food. You've got a lot of phytochemicals, and some of the nutrients are more bioavailable, but some are not as bioavailable as we just mentioned. The problem, the caution, is if you have an immunosuppressed patient, if you have a patient who's neutropenic or leukopenic, you cannot give them food that potentially has bacteria in it. So you have to keep them safe, and so you have to decide, is this safe for the patient who's asking you the question? Again, this slide just increased exposure to pathogens and bacteria, increased exposure to molds and mycotoxins, increased risk of bone loss on these really pure raw food diets that people do for long periods of time. Also, a lot of the chemotherapy drugs and the oral drugs really, really, really compromised digestive capacity. And cooked food's just easier to digest. So again, think bone broth, think blended vegetable soups that you've put some Chinese herbs or reishi mushroom into. And maybe you've cooked down a chicken and blended it. So there's a little protein, if that's what you want. Or you could do mung bean soup. It's really easy to digest. So you have to answer the question for the patient in front of you, because this patient population is going through a lot of challenges and may also have had their system disrupted by the cancer and the treatments or surgeries, etc. Now, I want to speak to this alkaline food, alkaline water issue. Because the PH of the body is very tightly controlled by our physiology. If we are not in a normal PH in our blood, we lose essential functions that support life. So if you go into extreme alkalosis or acidosis, you're in trouble. Physiologically, this is not our goal. Okay? This is not our goal. And even though you think you could drink a bunch of baking soda, your body will put a buffer in there and get you back to a normal ph to save your life. You can go into tachycardia from disrupting your ph and disrupting the signals that take ions across the cell membrane. This, again, is a big myth in naturopathy. Do we want to eat more? Plan? Yes. We want to eat more plants because we will be eating a diet full of phytochemicals and a diet that's full of more fiber. But it's actually the potassium in those plants that is helping to change our ph and the function of our cells. So let me just say this. When you eat a diet high in plants, plants, it's not that it's really alkalinizing. It's that it gives you a lot of potassium and it changes the sodium potassium channels. I mentioned earlier that cancer cells, solid tumors, solid tumors produce lactic acid in the environment around the tumor, not systemically. So the environment around the tumor is more acidic because glycolysis is the main metabolic pathway. So. So anyway, that's the myth. Drinking alkaline water and more alkaline foods is not about changing the PH of the body in a dramatic way. It's about changing the minerals available for normal physiology and giving yourself more phytochemicals. So I think again we have to go back to the science. Okay, so the mature tumor cells are producing lactic acid. Okay, that's what's happening. And they're shifting their metabolism. Metabolism and their waste product is lactic acid. Dr. Neal McKinney is a brilliant, brilliant naturopath up in Victoria in Canada. And this is his statement said more elegantly than I just did. Alkalinity in the blood is resisted by chemical buffers. CO2, which is acidic, is released from hydrocarbonic acid and renal control of bicarbonate. So we have inherent systems for getting us back to the very narrow band of enormous ph where our cells are healthy. Lactic acid both stresses the tumor cells, but it also provides a metabolic advantage to tumor cells for proliferation. Remember, tumor cells have all these strategies for enhancing their survival and proliferation. They have adapted to get benefit also from the lactic acid alkalinizing plant based diet is important in restoring health. Reducing or eliminating salt or sodium, animal proteins and refined sugars, which is what people do when they try to eat a more alkaline diet, take things out that are quote, acidic. However, when you raise the vegetable and fruit intake, the benefits are actually the impact of increasing the potassium to sodium ratio. That's what changes and that's, that's why there's benefit to it. Now. The Hoxi diet, the Hoxi program, which is there's a famous, famous, famous protocol in old time naturopathy. Red clover was one of the main herbs in that in a vegetarian diet. But they both limited salt and increased potassium and even gave supplements of potassium iodide to change the sodium potassium ratio. And that's its beneficial to health. That's not about if you're more alkaline or acidic. So that was a quick discussion of that and we can have a deeper discussion of it with diagrams for people who really want to understand that. I think I've also mentioned the Mediterranean diet already, so I'll go by. I do want to emphasize that alcohol is a human carcinogen and it impacts a lot of different types of cancer. There's a link here to the alcohol and cancer risk fact sheet from the National Cancer Institute if you want more information about it. But when patients ask can I have alcohol? I say alcohol is a carcinogen. I certainly do not want patients with liver cancer or liver metastases drinking alcohol. I do not want patients who are undergoing chemotherapy, which is toxic to the liver. Already drinking alcohol. I don't want brain cancer patients drinking alcohol because it's a neurotoxin. The byproducts are a neurotoxin. So I prefer that my patients don't drink. If my patients want to have a drink, I say have a glass of wine or a little shot of vodka once a week if you must. But I think this is really important to educate the patient. All right, let's go back to the benefits of calorie restriction and intermittent fasting and kind of just go over theirs again. And I promise you that I had that other infographic, and here's another one for people who are more visual and just take a look here, that the normal cells get benefit and the tumor cells get stressed from intermittent fasting. And when we say calorie restriction, we mean the calorie restriction that occurs while you're doing the intermittent fast. And we get benefits of changes in the amount of growth factors and growth signaling, and we get an increase in ketones, et cetera. So we've talked about all these things. Just a visual for you, and you can go back to that slide. And also you can. This is a great paper, and it talks about every single one of these pathways. What? You just don't have time in this lecture to do that. But I want to have you get really clear about the impact of intermittent fasting. The easiest way for people to do intermittent fasting. What do we mean? You take a window of time where you don't have calories. You can do that in a lot of different ways. The easiest way for patients is to just between tonight's dinner and tomorrow's breakfast, have at least 13 hours. That's not hard to do. It could be a lifestyle for their whole life. It benefits diabetics, it benefits cardiovascular patients, it benefits benefits cancer patients. Another style of doing intermittent fasting is to restrict your calories two days a week to only 500 calories a day. That's not a great thing for a cancer patient to do, But a robust young athlete might want to do that. What's interesting is just regular calorie restriction. That is when people go on a diet. A low calorie diet does not have this impact on the immune system and cancer physiology. So that's noteworthy. You actually have to drop your blood sugar and your insulin for a window of time to get this impact. That's the big idea. You see, if you do a minimum of 13 hours, you get a 23% decrease in insulin and a decrease in the IGF1. And this is just removing these huge, huge growth factors. It's a big one lever. It's a really big lever. But here's an amazing study. This is a cohort of over 2,500 patients, none of whom were diabetes patients in early stage breast cancer. And these are patients that would fast for a minimum of 13 hours. So between 13 and 16 is what you want to ask people to do. So a strict person will eat for 8 hours and fast for 16 in every 24 hour cycle. So these patients who fasted for 13 hours or more at night between dinner and Breakfast had a 36% lower risk of having a breast cancer recurrence and a 21% lower risk of dying from breast cancer. That's impressive. I don't know a cancer treatment that does that. All right, now on the other side of it, it's kind of interesting mirror numbers here. The women who didn't fast had a 36% higher risk of a recurrence, a 21% higher risk of death dying, and 22% higher risk of death from any cause. So as a lifestyle, this is a great thing to do. There's lots of papers like this. So what do we mean when we're in that intermittent fasting phase? We mean no calories, no solid food, no beverages like dairy or sugar containing beverages. You can drink tea, but you can't sweep. This will reduce your cancer risk, improve your glycemic control has a very powerful impact on immunity, actually decreases neuropathic pain. And the problem with this is you have to make sure during the feeding hours that the patient's getting adequate nutrition. That's what's really important. And in patients who have liver and pancreatic pathologies, this is not something you want to to do. You wouldn't do this in a person who was severely sarcopenic or cachectic either. So the problem with all these great ideas is there actually are not very many human studies. Most of the studies have been done in yeast and mice. I just showed you human study, but those are few and far between. So we need more information. So again, I'm conservative. I like to err on the side side of safety. If I have a fragile patient, I'm more middle path with them. Now these are the lists I promised you earlier that from those infographics of the impact of calorie restriction on tumor cells. Then this kind of reiterates everything I have talked about in terms of intermittent fasting and glycemic control and low Carbohydrate diets. The only difference when you do ketogenic is you get an increase in ketones. But otherwise you've accomplished about the same things. This is just that slide again with all these text on it. Put on a slide for you. Here are some more references for you. Now, before I end this lecture, I want to just talk about a few things you can do immediately with your patients who might be suffering. As soon as a person has a cancer physiology, they start losing muscle mass. It's microscopic, but it's happening. So you need to be aware of that. Don't wait to see it. But when you see that patient walk in your door who looks like they've been through famine, that's sarcopenia. That's what that looks like. But it's extreme. We want to catch it earlier. We want to catch it much earlier. Stage three and four patients, more advanced cancer patients are four stages of cancer. They have a lot of sarcopenia going on, on whether you can see it or not. These are the patients that need more protein and lots of Carnitine, some CoQ10 that drive the mitochondria and if they can do some kind of weight bearing or resistance exercise because they need to build muscle. I had a patient who is a stage 4 endometrial cancer patient undergoing really aggressive chemotherapy and she had lost a huge amount of muscle mass and was very weak as a result of that. That and didn't think she would be able to finish her chemotherapy in two weeks. I turned it around. She's actually in cachexia. So I'm going to talk about that in a moment. But if you do a shake or two shakes a day that accomplish these nutrients, get about 60 to 80 grams of protein, clean protein. I just do this with a shake for these patients because they're weak and tired. And then you can use carnitine powder or carnitine liquid to get 2 to 4 of carnitine a day in and about 200mg of CoQ10 is enough. Get them to do something like with bands or taking walks or wearing a weight vest and going for a walk, something like that. Just get them to do a little something so you can build that muscle. This particular patient did yoga. So her oncologist was absolutely blown out because she was going down. She was able not only to finish her treatment, she was able to get an immunotherapy drug which completely disappeared all of the tumors in her pelvis and her lungs which were probably going to kill her. So it's important what we do. It's really important. Gives people a chance. All right. Cancer, cachexia, for those of you who are not familiar with this, this is a physiology of end stage disease. And in essence, the body is digesting itself. No matter how many calories you eat, you still lose weight. This is also a state of extreme inflammation. People feel very lousy and very weak when they're in cachexia. And if you don't turn cachexia around, they will head towards death. It increases mortality and it can happen fast. So I just add more omega 3 fatty acids to the shake I just described to you. I will give up to 10 grams of fatty acids a day, the omega 3s. But you could also consider adding something like medium chain triglycerides to a shake like this. And I add some red panax ginseng. We could add Sachin's mushrooms, Reishi mushrooms to it. These patients are in trouble. So I have also turned around early cachexia. But if you can't turn the cantor cachexia around, it is likely the patient will die. Now, most people who don't specialize in cancer might not be seeing these patients. But remember, with the number of cancer patients and cancer survivors in our midst, maybe there's a family member of one of your patients who could use a shake. So you never know when you're going to be able to be a resource to a patient. I've just put the shake recipe here again for you. I also just briefly wanted to talk about mucositis, the inflammation of the mouth, oral cavity and enteritis, the inflammation of the rest of the digestive tract because this prevents patients from being able to eat. And it's very painful. A lot of the drugs which chemotherapy drugs which increase, which are hitting the DNA of fast dividing cells, the healthy fast dividing cells in the body are where you see the side effects. So the lining, that epithelial linings are one of those places. And so the lining of the mouth starts to break down and then people don't want to eat. It can even be painful to drink and you lose that barrier. So there's immune risk there. And so glutamine can be used both as a mouthwash and also as a treatment. The ratio is if you want to use a mouthwash, then you put about a quarter of a teaspoon in about a quarter of a cup of water and have them do a mouth rinse a couple times a day and hold it in their mouth for a while. You can also do that with glutathione. It's a really nice thing to do because part of the problem is high oxidative stress and inflammation. And so you can have them do that. You have to do it every couple of hours. It just works while it's in contact with the tissue, but it is the fuel of those tissues and it helps them repair very quickly. This is even done in hospitals.

You guys have a glutathione or a glutamine lozenge. That would be a good idea.

You know, there are some compounding pharmacists that make some cool things for these patients. I've seen one pharmacist made a gel that adhered to the mucus lining. You know, so you can talk to compounding pharmacists. They can make things like that. They absolutely can. Yeah. So what I want to say also is if the patient has enteritis, like the reason for diarrhea in a lot of patients, or what appears to be GERD gastroesophageal reflux, the patient's sensation of burning, it actually isn't that, it's that they've lost the epithelial lining and it hurts. So a lot of these patients get protein pump inhibitors, which is not what they really need. They just need to repair their lining. So then you need to give 15 to 20 grams of glutamine a day. So a heaping teaspoon is about 7 grams of level teaspoons, about 5. So if they took a heaping teaspoon three times a day, let it rinse around in their mouth and then swallow it, that really rapidly repairs those linings. It makes a huge, huge difference. Huge. So I just want to to summarize here that we really can see how powerful diet is as a lever to influence the tumor microenvironment and tumor cell behavior and survival. That part of the reason for that is that we affect the expression of tumor promoting and tumor suppressing genes. That we can use low carbohydrate and ketogenic diets or modified ketogenic diets to actually influence tumor cell metabolism, put the brakes on tumor growth and proliferation and spread. The most successful diets are plant based and have lots of foods in them which exert inflammation control and glycemic control and promote a healthy microbiome. We can also use intermittent fasting to further create this physiology. Remember that your obese patients and diabetic patients are risk need to address that and that you should discuss alcohol with your patients. So that's kind of my summary there. And then I want to remind you that you can download the slides. You can get this little quick reference guide to the diets and also see another mini lecture on inflammation and cancer by going to the link a I-I o r e.com proof P-R-O-O-F19 19 a and then if you're really really moved and inspired and you want to join our community and take my course and really become super confident and skilled, then I invite you and we will give you $1,000 savings with this code here that's on the slide. Proof 19 and now it's really generous of you.

That's awesome. I did share the links in the chat group, so if you want a direct link to that, you don't type it in. You can just click there and at least get these slides. I've already downloaded them for myself for future reference. Because this is a lot of information that comes distilled from years and years of experience. This is extremely valuable information. Thank you so much for sharing this. I did have a question for you. Maybe you touched on it in different presentations that you do, but what are your thoughts on CBD and or Rick Simpson oil or THC in working with cancer patients? Do you use that at all therapeutically?

So let me answer that in several ways. So cannabinoids have been legal in California for medical prescription for a long time and I have a colleague really near to my office who's an expert in the use of cannabinoids and cancer. So he knows so much more than I do. So I refer my patients to him. But to decide what to do and how to dose and what forms and what terpenes and all of that because that's not my expertise. However, in general CBD is most useful for pain and for nausea. THC is more anti tumor and also improves appetite. Those are the general big ideas. I do not use THC as an anti tumor therapy for one reason only. You're stoned out of your mind at the dose that works and that's just way too disruptive to most people's lives. You can't do a normal day for eight weeks. So it's like chemotherapy. You have to do a high dose for at least eight weeks. So if I've run out of ideas and nothing is working, I will suggest that to the patient. But a lot of patients just don't want to do that because of the alteration of consciousness. With high doses of THC you can do as much CBD as you want. It doesn't have a strong anti tumor activity. It's quite useful in autoimmune disease. Disease. And it also, there's some of the CBDs with a little THC in it are really good for sleep and anxiety for people who are. A lot of cancer patients are struggling with that. Remember, I'm an acupuncturist, so I'll often intervene that way. But the other caution with the cannabinoid products, the cannabis products, is most of them are still grown in greenhouses and. And they're almost all contaminated with mold. And my patient population is really vulnerable. And there is a report of a cancer patient using CBD that got an Aspergillus infection in her lung, which she didn't have the immunity to mount an offense over. So again, one of the reasons I refer to my colleague is because he has in his office the highest quality medical grade products. And so that's what I do locally. But California has been using medical cannabis for a long time. There is also a woman named Constance Finley, and she has a very excellent website. And her product, she's here in California. Her product is used by the nih, the National Institutes for Health, to do research because of the quality of it. And so she's very knowledgeable and she has a very informative website. So that's sort of my general answer to that question. It has value. I'm not an expert.

Awesome. Well, I know we had a few questions that came in and I'd love to hit those and then maybe we can wrap up in the next five minutes or so. How's that sound?

Sounds good.

All right, so let's see here. Michae asks, does stevia count as a restricted sweetener?

Stevia is. Okay. You know, it's such a powerful sweetener, you never get a big dose of it in anything. But a lot of people just do not like the taste of it. And so I actually try to find products that don't have stevia in it because a lot of patients just cannot stand the taste of it. And so you should ask someone if you're prescribing a product that's sweetened with stevia and if there's an alternative, find out for that patient because it lowers compliance if they don't like the taste. But stevia as an at home sweetener, putting a couple drops in things, that's fine.

Okay. And Dina's asking, there's some new evidence that suggests glutamine fever. What are your thoughts on that?

Yes. So this is an area of great confusion. There are a few cancers that are glutamine sensitive and we want to be careful. Like brain cancers can convert to glutaminolysis from glycolysis. This is another adaption, metabolic adaption of the tumor cell mitochondria. It's not in all cancers. Paul and I Anderson, who is a very well respected naturopathic oncologist, wrote an opinion paper on this question. And Donny Yance, who is also well respected in the integrative oncology world, and I also agree with this statement which I will share with you. Glutamine is the most ubiquitous amino acid in our body. If a cancer cell needs to use it, there's a ready source. Our muscles are full of glutamine. So. So if a cancer cell is going to convert to glutaminolysis, a little glutamine to repair your gut isn't going to alter whether it can do that.

Okay. And if anyone's got, if there's one more question, we're happy to take it. You can type it into the Q and A. This was a stunning performance. So thank you so much, Dr. Chilkoff. It's always, always learn something you and just when you think you know a lot, somebody with a tremendous amount of knowledge and experience comes and schools you. So thank you. You actually validated a lot of my current lifestyle choices, so I feel better about that. I'm vegetarian. I intermittent fast. I, you know, make sure I'm keeping track of my carbohydrate intake. You know, as a Indian vegetarian, we've, we've found a great way to make grain food free flatbreads and rotis using cassava flour. We try to eat organic as much as we can. So, you know, I feel much better as a father and a parent and a role model for my clients and patients, knowing that, you know, what I'm doing is supported by the work that you're doing. And it's kind of a tough thing with diet. People get really cultish with their diets. And I don't project my diet onto anyone. You don't even see me really talking about it on Facebook or anything. But, you know, it's like I'm looking at this and I took a screenshot of the summary that you put and I'm looking at the ketogenic diet. And so many people I know are on the ketogenic diet. But how do you bring this to people's awareness, like gently bring it to people's awareness, like people you love and care about without, you know, you know, kind of, you know, shaking them awake?

Here, yeah. What I say, here's what I say. I say a ketogenic diet is a therapeutic diet. It is not a diet. That's a healthy diet. And that's where I start because that's a concept that has to be understood by clinicians as well because there's so many fads. The Paleo diet's not a particularly healthy diet for most people. It's actually kind of a carcinogenic diet. So it's really important to also look at the individual in front of you. Somebody who's a 20 year old, muscular, robust, high altitude climber isn't as fragile as a 75 year old little old lady who's already sarcopenic just because of her age. So it depends. We have different amounts of wiggle room and resilience in our physiology. Joseph Mercola gave a talk on ketogenic diet that was hysterical at a cancer conference conference a couple years ago because he published a book on the ketogenic diet. And he was really into it and he told the story of how sick he felt and how much he was losing his strength and was fatigued all the time and his electrolytes were always off and he realized it was being on a ketogenic diet for so long. A ketogenic diet is a strategy to solve a problem and you can take a couple of days. If you're younger and have plenty of muscle mass, you can, can do more fasting. But when you don't have organ reserve and muscle reserve, you can't do fasting. Walter Longo says if you're over 60, you can't do a five day fast.

I think another challenge for a lot of people and just recognizing this is a lot of animals who are slaughtered are not screened for cancer before they're fed to the population, Right?

Yeah.

And if you're eating animals with cancer, I mean, I look at food as from a spiritual and energetic standpoint and from a fractal standpoint. So whatever disease the animal has, I mean, you've got the same chemistry of that disease being inserted into your body. Right. As you eat this animal. So there's emotion in food and there's, there's obviously also, you know, the hardware that comes with that emotion in that food. So again, I think that, you know, if we are going to eat animals and then there's the dilemma. Right. If you're going to eat animals that are naturally raised and humanely raised, then you know, that's a different story altogether. But most people aren't doing that.

No. And you Know, a lot of people aren't privileged to get to be this picky about their food. So that's why understand as a clinician, understanding the big principles so that even your patients who don't have a lot of money can actually do something huge for themselves. And so my patients, I ask them to make big changes and take a lot of herbs and supplements and I also tell them that when they go to take their handful of supplements and make their big shake, that this is the sacred healing nectar of the gods. This is sacred moment of taking these things as part of, of your healing and to hold it that way.

Amazing. So somebody was asking about, there's a previous question that came up about soy. I think I know the answer, but I'll let you answer it. And the question is, how do you feel about non GMO soy source of phytoestrogen supplements for hormone support in light of soy, in light of the soy conversation.

So, so you there the genistein in soy and there are some other isoflavones in soy do bind to the estrogen receptor alpha and beta and they do exert an effect. Yes, you can use soy therapeutically, but surprisingly you don't have to give very much of it. What's really interesting about soy in terms of being a phytoestrogen nature is so wise, right? So genistein is not only binds to the receptor, the estrogen receptor, but it's also an aromatase inhibitor, which means by inhibiting the aromatase enzyme, this is a treatment in oncology for women with estrogen driven cancers is to block the aromatase enzyme. And guess what, soy does that too. So you're not getting a high level of estrogen conversion in your tissue by eating soy, but you're actually getting health for your bones and your brain. So soy is a pretty smart, the genistein is a pretty smart molecule. And so again, Americans don't eat as much soy as a Chinese person in a village somewhere. That's the stuff of life. So we just don't get that much soy I think to do much damage. It's the deal GMO part of it. But yes, soy can absolutely be used therapeutically as a functional food. Right. And genistein, a phytochemical in soy, can be used as a nutraceutical.

Amazing. Had a question come up about the reishi coffee. So you can go to buyraticoffee.com and the coffee that we were specifically referring to is the king coffee, which is organic coffee which also contains, contains reishi spores, organic Reishi spores. So just something for those of you that are coffee drinkers. This is the coffee that I drink every day. Melanie, I'd love to send you a box so you can try it out. If you're a coffee drinker or a tea drinker, there is tea as well. Red tea, green tea, and then organic coffee. And it combines. It puts reishi into a habit. People have a habit. We put health into the habit. So check that out. And then there's a comment from David here. Maybe we'll close up with this. His comment is that his father is 79 with gastric cancer and when he received seven cycles of chemo every other week, I had him use the Prolon for five days each cycle. He tolerated it well, except for some weight loss. And he actually said if he didn't have that diet, he would have not been able to tolerate eating anything and probably would have been more miserable and experienced even more weight loss due to nausea inside of effects of the chemo. So, David, thanks for sharing that and I hope your father's doing much better now as a result of your love and care for him. And Naledi, I don't know if you have any comments that you wanted to add to that.

Yeah, I mean, that's an example of it working. And not every 79 year old could do it. But the fact that he had your support and was obviously into it made him successful as well. And also, so I just don't like the Prolon kit. That's Valter Longo's product, his retail product. Because I think that we can put together healthier food than is in that kit. But the principle of it is just fine. It's just the food is not very tasty or enjoyable. But if it's an easy way for someone to do it, then I don't disagree with the principle of it.

Okay, amazing. Well, thank you, thank you, thank you so much. For those of you please download the slides, you'll automatically get added to Dr. Chilkoff's mailing list. And I'm sure she's got tons of other valuable information that she can share with you. And her team or herself will be happy to answer any additional questions you have. Dr. Chilkoff, we were supposed to go for an hour and we're at 2 hours and 10 minutes. I want to honor your time. I know that this is something that you're super passionate about and you could talk for literally days about this information. So thank you, thank you, thank you for sharing this with us. The replay will be sent. Please, everyone, when you get the replay, share it with people that you love and care about. And this information is powerful. You never know when you're going to need it. So I would start applying a lot of the principles that you learned today, because you don't want to change your diet after you get cancer. You want to live a life that doesn't create disease instead of one that later prevents disease. So thank you. Thank you, thank you. Good night, everyone, and I love you all, and I wish you amazing, abundant health.

Good night. Thank you.