Five integrative strategies to improve cancer outcomes

By Carolina Brooks, BA, IFMCP

There has been a change in attitude towards integrative cancer therapy over the last few years. I’ve seen several oncologists stop demanding patients cease following dietary advice and taking herbs while receiving chemotherapy, radiation, and other conventional treatments. Many primary care providers have started to work collaboratively with naturopathic doctors, some experts even extolling the virtues of meditation and mindfulness practices, which was inconceivable ten years ago.

In 2018, the International Agency for Research on Cancer estimated 18.1 million new cancer cases worldwide, with lung cancer being the most common, accounting for 11.6 percent of total cases making it the leading cause of cancer mortality. This is followed by breast, prostate, colorectal, stomach, and liver cancers. Socioeconomic and lifestyle factors impact risk levels, according to a University of Glasgow population cohort study.  

Cancer is a multifactorial disease of mitochondrial dysfunction. There is usually no single cause, although there may be a clear trigger. Cancer mediators and triggers include:

• Genes and oncogenes
•  Social toxins such as poor diet, smoking, and alcohol
• The sun and other types of radiation
• Viruses
• Occupational carcinogens such as environmental toxins
• Synthetic hormone therapy and other medical treatments
• Stress and trauma

In my practice, the aims of integrative treatment for cancer patients are to inhibit further tumor growth, mitigate toxicity and nutrient depletion driven by chemotherapy and other treatments, and optimize the terrain to help the body tolerate these therapeutic strategies. I do this primarily with diet, herbal medicine, nutraceuticals, and lifestyle management.

Nutrition

Cancer cells ferment and continue to produce lactic acid even in the presence of oxygen, choosing glycolysis over the more energy-effective oxidative phosphorylation pathway, indicating a shift in mitochondrial function. This is known as the Warburg Effect. Useful supplements to restore mitochondrial function include mixed tocopherols, omega-3 fatty acids, reishi mushroom, ellagic acid found in pomegranates, walnuts, and berries, as well as supplemental quecertin, which is also found in apples, green tea, onions, berries, buckwheat, and broccoli. 

The ketogenic diet is often recommended for certain types of cancer as this lowers blood sugar and starves cancer cells of energy. This approach cuts most carbohydrates and sugars out of the diet. Research has shown benefits for brain tumors, particularly in aggressive glioma, however the ketogenic diet may have other health implications. A recent article in the journal npj Biofilms and Microbiomes indicated the ketogenic diet reduces abundance of beneficial bacterial strains, which could have implications on health. 

In my own clinic, as a baseline protocol, I recommend eliminating all refined carbohydrates, red meat, and increasing phytonutrient abundance to around 50 percent of the diet primarily with fresh, organic non-starchy vegetables, including good amounts of cruciferous vegetables and some colorful fruits, such as berries. The remainder of the diet should be made up of good quality lean proteins such as wild fish, game meats, and organic white meats, minimal wholegrains in unprocessed form, and good quality anti-inflammatory omega-3 fats. I also ask my patients to consider cooking methods and to avoid frying and charring food to reduce the formation of carcinogenic heterocyclic amines.

Patients should also strongly consider eliminating dairy. Dairy raises insulin-like growth factor 1 (IGF-1), which is linked to an increase risk of cancer. IGF-1 inhibitors include green tea, vitamin D3, and lycopene found in red fruits and vegetables.

A 2014 article in Cell Metabolism demonstrated that a lower protein diet reduces growth-hormone dependent creation of IGF-1. In addition, Valter Longo, PhD, professor at the University of Southern California Leonard Davis School of Gerontology, has demonstrated a Fasting Mimicking Diet (FMD) to be as effective as water fasting in reducing, IGF-1, glucose levels, and ketone bodies. FMD also activates stem cells and enhances T-cell mediated cancer cell death. Longo’s research has also showed that it is the combination of chemotherapy and fasting that improves outcome, rather than either strategy on their own. Fasting has been shown to sensitizes cancer cells to chemotherapy due to the increased metabolic rate of cancer cells, and reduces its adverse effects.

Herbs

There are many useful herbs that can be recommended in cancer therapy, and these recommendations need to be personalized to the patient in accordance with the patient’s co-existing health conditions, cancer specifics, presenting symptoms, and potential drug or supplement interactions. 

Patients often call me in a panic because their next chemotherapy cycle has to be delayed due to low white blood cell or platelet count. This is where herbs are absolutely key, as the right combination of immunomodulatory herbs, which support bone marrow activity, can raise levels enough for the next cycle to go ahead with a shorter delay on treatment. Good examples of these herbs include astragalus, turmeric, ashwagandha, Korean ginseng, and Baikal skullcap. We can also use NF-kB inhibitors to reduce and overcome chemotherapy resistance, including ginger, feverfew, myrrh, tulsi, echinacea, and gingko. Turmeric has been demonstrated to inhibit multi-drug resistance of tumors, according to a 2004 study published in the journal BMC Cancer.

Adaptogens are key herbs for restoring vitality and building stress resilience, reducing fatigue, enhancing tissue healing, improving oxygen intake, repairing and protecting against radiation damage and supporting healthy blood sugar regulation. I use numerous formulas both in supplement and powder forms, particularly if a patient has just had surgery or multiple rounds of radiotherapy or diagnostic scans as herbs such as eleuthero, rhodiola, ashwagandha, Korean ginseng, rhaponticum, and schisandra can really speed up the healing process. Licorice is also very useful to raise blood pressure where necessary.

Most chemotherapy drugs are extremely toxic on the liver and kidneys, particularly the platinum drugs. I always ensure patients have detoxification support in place with cholagogue, digestive, carminative, and alterative herbs such as milk thistle, ginger, rosemary, horseradish, artichoke, dandelion, and echinacea. These are all readily available and it requires minimal effort to add these compounds into the diet either in food or as teas.

Many of my patients have had metastatic cancer for several years and have been on numerous drug combinations. Often all avenues have been exhausted and therapies simply aren’t working effectively. By using anti-mutagenic herbs and cytotoxic herbs to induce apoptosis such as ginseng, mistletoe, garlic, ginger, and barberry, we can get a much better outcome. I get my patients to drink citrus peel tea, which is cheap and easy to make at home as it helps to induce cell differentiation. Other herbs which induce differentiation include frankincense, berberine, and burdock. Many of these herbs have multiple overlapping benefits so we can use a smaller number of herbs, with is less daunting for a patient.

We can also test hormones to check how well hormone therapies are working and use herbs to enhance their efficacy. We can reduce the hypercoagulative effects of cancer with herbs that support the cardiovascular system such as Japanese knotweed, garlic, and dong quai. I have patient in her 60s diagnosed with a hormone-responsive breast cancer who refused Tamoxifen post-radiotherapy due to poor tolerance of the drug. She was prediabetic and had extremely high blood lipids. We used a combination of herbs to inhibit hypercoagulation, improve insulin sensitivity, and support healthier hormone balance and metabolism. After six months, her bloods had stabilized. A year later, she remains on various herb formulae and her primary care provider is happy with her progress.

Reducing Toxic Load

Many endocrine-disrupting chemicals (EDCs) have effects at low doses thought to be safe, and the U.S. Environmental Protection Agency’s Endocrine Disruptor Screening Program’s research has evaluated chemicals for potential endocrine-disrupting activity and epigenetic changes mediated by EDCs. 

The recommendations I make around environmental toxins are important for everyone because we are all constantly exposed to EDCs. We are all at risk of experiencing epigenetic changes, but for my cancer patients, reducing exposure to any further factors that may increase tumor activity is crucial as EDCs act like hormones and influence how cancer will develop and progress.

Recommendations I make in my clinic include buying organic to reduce exposure to EDCs in pesticides, along with soaking produce in bicarbonate of soda or citrus essential oil to reduce pesticide residues. The Environmental Working Group (EWG) lists for food, home, and personal care products are extremely valuable in allowing patients to make informed choices. I recommend investing in air and water filters to reduce exposure to EDCs and other toxins in the home, taking off shoes at the door, and allowing new furniture and toys to off-gas before use. I suggest reducing exposure to plastics, especially BPA, avoiding non-stick cooking surfaces, and cooking in glassware or cast iron. I also advise avoiding larger fish such as tuna, swordfish, and marlin due to higher levels of mercury, which is a human carcinogen. Patients with migraines, skin reactivity, and breathing difficulties have all reported huge improvements in symptoms upon implementing these changes. 

Sleep Hygiene & Stress Management

A disruption in melatonin production, circadian rhythm, and nighttime exposure to artificial light increases susceptibility to infection and cancer. Recommendations that I make with patients to reestablish circadian rhythm and improve sleep hygiene include telling them to stop using electronics one or two hours before they go to bed to reduce exposure to blue light, banning electronics from the bedroom, turning off the Wi-Fi at night, magnesium baths before bed, and avoiding exercise or eating too late to avoid sleep disruption. Adequate sleep is crucial for proper immune function, recovery, and repair so aiming for a minimum of 7.5 hours at night.

A number of patients are given Zopiclone to help them sleep, particularly those on hormone therapy or steroids. Melatonin is a useful supplemental alternative for its anti-cancer activity and ability to reestablish circadian rhythm. I also use herbs such as passionflower and California poppy with patients to calm and reduce anxiety and circulating thoughts. From a dietary perspective, berries contain resveratrol, a useful compound for regulating genes involved with circadian rhythm.

Implementing stress management techniques are critical for modulating the physiological stress response which plays a role in cancer pathogenesis and metastasis according to a 2010 article in Future Oncology. Mindfulness-based interventions can reduce stress, depression, anxiety, pain, and improve sleep. Good social support and exercise are helpful to improve outcome. I receive feedback from patients who have experienced remarkable improvements in quality of life when they learned how to meditate, started using Heartmath, talking to their support network, and started spending time outdoors.

There are so many ways to help our patients, and not all of these changes need to be implemented at once. My advice is to start with easy dietary modifications and work on the easy lifestyle factors. The rest can always be implemented gradually. These strategies work. Many patients who originally received a poor prognosis, have, after undertaking these lifestyle changes, are doing better for the change, feel empowered by the choices they have made, and feel positive about the future.

References

Bray F., Ferlay J., Soerjomataram I., Siegel R.L., Torre L.A. & Jemal A. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 26 cancers in 185 countries. CA: A Cancer Journal for Clinicians 2018, 68:394-424. Retrieved from https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21492

Endocrine Disruptor Screening Programme (EDS) Overview (2019). Retrieved from https://www.epa.gov/endocrine-disruption/endocrine-disruptor-screening-program-edsp-overview

EWG’s 2019 Shopper’s Guide to Pesticides in Produce (2019). Retrieved from https://www.ewg.org/foodnews/summary.php

Levine M.E., Suarez J.A., Brandhorst S., Balasubramanian P., Cheng C., Madia F., Fontana L., Mirisola MG., Guevara-Aguirre J., Wan J., Passarino G., Kennedy B.K., Cohen P., Crimmins E.M and Longo VD (2014) Low Protein Intake is Associated with a Major Reduction in IGF-1, Cancer and Overall Mortality in the 65 and Younger but Not Older Population. Cell Metabolism Mar 4; 19(3): 407-417. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3988204/#

Limtrakul P., Anuchapreeda S. and Buddhasukh D. (2004) Modulation of human multidrug-resistance MDR-1 gene by natural curcuminoids. BMC Cancer 2004, 4:13. Retrieved from https://bmccancer.biomedcentral.com/track/pdf/10.1186/1471-2407-4-13

Lindefeldt M., Eng A., Darban H., Bjerkner A., Zetterstrom C.K., Allander T., Anderson B., Borenstein E., Dahlin M. & Prast-Nielsen S. (2019) The ketogenic diet influences taxonomic and functional composition of the gut microbiota in children with severe epilepsy. Npj Biofilms and Microbes 5:5. Retrieved from: https://www.nature.com/articles/s41522-018-0073-2

Moreno-Smith M., Lutgendorf S.K., and Sood A.K. (2010) Impact of Stress on Cancer Metastasis. Future Oncology 2010 December; 6(12): 1863-1881. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037818/pdf/nihms-269073.pdf

Sharpe K.H., McMahon A.D., Raab G.M., Brewster D.H. & Conway D.I. (2014). Association between Socioeconomic Factors and Cancer Risk: A Population Cohort Study in Scotland (1991-2006) . PLoS ONE 9(2) e89513. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3937337/pdf/pone.0089513.pdf