Prevention Practices & Outsmarting Cancer, with Dr. Nalini Chilkov
Everyone’s cancer risk is different based on unique medical histories, genetics, and environmental exposures. But our diet and lifestyle choices are important influences on cancer within our control, which optimize the body’s “terrain” to fight and/or prevent cancer. In this podcast, Dr. Nalini Chilkov shares her recommended cancer-fighting foods and supplements (which may vary depending on your risk factors), as well as lifestyle recommendations like sleep and exercise.
Dr. Michael Ruscio, DC: Hi, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Today, I’m here with Dr. Nalini Chilkov, and we’re going to be talking about cancer, what you can do to prevent cancer, and all things cancer-related. Welcome to the show.
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Dr. R’s Fast Facts Summary
- Ultimate goal is to Create a body where cancer cannot thrive
- It’s important to have a health expert plus disease expert on your wellness team
The outsmart cancer diet
- Basic principles
- Eat a plant based ketogenic diet or a low carb diet
- Studies show low carb can be as effective as keto
- Fasting or ketogenic diets stress cancer cells
- Eat the rainbow – naturally colorful foods are rich in vitamins
- Animal proteins and fats are not encouraged as they can bring higher iron, hormones and environmental toxins
- Study showing Paleo diet decreased colorectal adenomas
Lifestyle tips for reducing cancer risk
- Reduce inflammation
- See targeted supplements below
- Sleep 7-9 hrs per night
- Exercise 30 min per day
Supplements for reducing cancer risk
More targeted supplements
- Curcumin (oil soluble) 2000 – 6000 mg per day – anti inflammatory
- Boswellia – antioxidant
- Reishi mushroom – anti inflammatory
- Green Tea
Where to learn more
Dr. Nalini Chilkov, LAc: Thank you.
DrMR: Can you tell people briefly about your background before we jump in?
DrNC: Absolutely. I’ve been in practice for 35 years. I can’t believe it. I am a Doctor of Oriental Medicine and Acupuncture, and I specialize in Integrative Oncology. And I have built a system called the Outsmart Cancer System, that is really collaborative with all teams of clinicians, so patients get the very best outcomes. I also train clinicians how to use my system, so we have resources for patients and for physicians.
DrMR: Awesome, so are there some fundamental pillars to this system that we can organize, and then jump into an expansion on each?
DrNC: Absolutely. I think what’s really fundamental is to understand that the patient needs both a plan for their health and a plan for their disease. So they usually have their disease expert, but they need us to be their health experts. That’s one piece.
Making Your Body’s Terrain Unfavorable to Cancer
Another piece is that we really take into consideration what we call the cancer terrain and the tumor microenvironment. So all the other things we’ll talk about today will affect the tumor terrain, and affect whether or not we’re sending growth signals or stop signals.
DrMR: Okay, so let’s start there. How do we favorably modulate the terrain to be antitumorigenic?
DrNC: What we really want to do is create a body where cancer cannot thrive. That’s our ultimate goal. We all have different risk factors. We all have different medical histories. We all have different exposures and genetics, so nobody’s identical. But we can all change our diet and our lifestyle and select cancer-fighting foods. We can control our inflammation and our blood sugar.
In the way that you change the soil in a garden—and in that way, change what grows there—you can also change that environment, which will either be permissive and supportive of cancer development, growth and progression, or not. So we can make a lot of choices that influence our cancer risk.
In fact, I really got into this because both of my parents were diagnosed with cancer in their 50s. I got interested because I thought, “Wow, our family has a lot of risk,” because the cancers weren’t genetic cancers. I knew that environment was really the key, both the external environment and our internal environment. That’s what led me on my journey.
DrMR: Now, you mentioned a few environmental pieces, which are inflammation and blood sugar. There seems to be potentially some… I don’t want to say disagreement, but nuanced differences of opinion, in terms of the best way to eat for cancer prevention. Some feel that what I would loosely term a higher carb, fruit, and vegetable-rich diet can be very helpful. There is other research showing that a ketogenic diet could be helpful. Do you draw any distinctions?
We interviewed Dwight McKee, and he felt, depending on the type of cancer and the time of cancer, in terms of the course, that one of these dietary interventions might be better. I believe the way he termed it was, if it was a wasting cancer, that a juicing-type diet would be better. If it was a cancer that was non-wasting, I forget the exact way he termed it, maybe a growth-oriented cancer, that a ketogenic diet would be helpful. That was an interesting partition that he gave for diet. But where do you look at blood sugar and diet as a starting point for patients?
DrNC: First of all, I’ll say Dwight McKee is my mentor, and I respect and adore him. I have an entire two-hour lecture on all the different ideas about cancer and diet.
A Cancer-Fighting Diet
But let me answer this really simply for you. Every patient is unique, so you have to really look at each patient. But there are also some things that are really common to cancer physiology. The first thing to understand is that people will have needs at different stages of their journey, which is what Dr. McKee was talking about. So we have to understand that. We have to understand the aggressiveness of the tumor and what someone really needs, but there are some basic principles that are common to all cancers. We call these the hallmarks of cancer.
One of those is the fact that cancer cells change their energy metabolism. Their mitochondria are different than healthy cells’ mitochondria. And we can leverage that by how we eat, exercise, and sleep. So let’s talk about the low-carb ketogenic diet, and then why we also recommend a plant-based diet. I put the two of those together, and I call that the Outsmart Cancer Diet.
The fundamental energy source for cancer cells is glucose: sugar. And healthy cells can live on ketones. If we put our body into physiologic ketosis by eating super low carb, then the cancer cells are stressed. They cannot divide as quickly and make energy as quickly, so they suffer. It’s really very ideal if you’re going to do something that is cytotoxic to tumor cells, something that would attempt to eradicate tumor cells, whether that would be a chemotherapy agent, a radiation therapy or high-dose IV vitamin C.
Whatever it might be, if the tumor cells are more stressed, then you get a better result of that treatment. More of the cancer cells will die. And so even in modern oncology today, they’re not opposed to the idea of fasting before having your treatment, because it does lead to better outcomes.
Now, a ketogenic diet itself is not a healthy diet. It’s a therapeutic diet. And it really should be done under the supervision of a professional because, remember, cancer patients are fragile to begin with. So we want to make sure we don’t stress their kidneys, their electrolytes stay balanced, and they don’t lose too much muscle mass. We have to modify things.
The other thing is, a really strict ketogenic diet is 75% fat and, usually, the other 25% is a combination of protein and carbohydrate. And the carbohydrates can be as low as two or 3%, but usually, it’s 10%. If we really stress the cancer patient too much, then they will be at a deficit for nutrients they need to thrive. So the goal is health. We have to always remember that. But the ketogenic diet—because it’s so high in fat—makes you nauseated. It gives you diarrhea. It throws your electrolytes off. You could get dehydrated and depleted of potassium and magnesium, which is why you should be supervised if you want to do a strict ketogenic diet.
I use the ketogenic diet as a therapeutic diet, and then have patients lower the amount of fat to be more digestible and they can increase the carbs up to 10 or 20%. That way, you’re able to digest your food, not have diarrhea, and it’s just easier to do, but you still accomplish the goal of stressing the tumor cells. There are studies that show that a low carbohydrate diet can be as effective as a strict ketogenic diet. So you have to look at the patient. The strict ketogenic diet is the most impactful with brain cancer, because it’s such a glucose-demanding organ.
That’s my summary of the reason to think about low carbohydrate and ketogenic diets. It’s to stress tumor cells that cannot thrive in a low-glucose, low-insulin environment.
DrMR: Are you also calling for a plant-based ketogenic diet, or…?
Fight Cancer with Phytochemicals
So we call our plan the Ketotarian plan. Some people will go and eat heavy, heavy red meat and butter, and think that that’s the way to be eating the ketogenic diet. But you’re much better off having plant-based fats and oils, so you’d eat a lot of olive oil, coconut oil, nut butters, and medium-chain triglycerides to up the fat ratio in your diet. We still want it to be a healthy diet. And one of the guidelines in eating—for all of us, but very important to patients with cancer risk—is to eat the rainbow. You want to eat a lot of colorful phytochemicals. So that’s where the “Should I juice? Should I not juice?” or “Should I be vegan?” comes in for two other reasons.
One is, we know that if we eat lots and lots of vegetable fibers, we’ll have a healthier microbiome, because we’re providing that substrate of soluble fiber on which the healthy bacteria can thrive and flourish in our gut. So we need plant fibers. People who do not eat a lot of plant fibers, who are strict keto or strict paleo, tend to have very, very imbalanced and unhealthy microbiomes, so we need those plant fibers. Also, we need all the colors, all the phytochemicals. If we think about some of the most potent cancer-fighting foods, they’re the deepest, most pigmented foods. Like all the berries, kale, broccoli, tomatoes, carrots, things that have deep, deep color. Pomegranates.
These are some of the foods, because those phytochemicals actually enter the nucleus and turn genes on and off. That’s why diet matters. That’s why it matters what we eat. That’s why botanical medicine is important, because there’s this epigenetic effect. There’s this impact of turning tumor-promoting genes off and turning tumor-supporting genes on.
It’s very powerful when you eat a lot of plant pigments. For my patients who don’t think they’re going to eat eight to 12 servings of vegetables and fruits every day, then I’ll use something like a greens powder or reds powder in order to get more of those phytochemicals. That’s part of the rationale for juicing. But I always want my patients to be on a low-glycemic diet. I want to not be triggering insulin. I like, number one, to stick to more vegetable and green juices, and number two, to keep the fiber in it. If you have a good blender like a Vitamix, then you can make a liquid drink out of plants but still have the fiber, which slows down the transit time and lessens that insulin and glucose spike.
DrMR: Hey everyone. I’d like to thank Aerodiagnostics, my favorite SIBO lab, for making this podcast possible.
Again, Aerodiagnostics is the SIBO lab I use in my clinic. They have impeccable organization, customer service, test quality, and support. Regarding support, if you’re not highly proficient in reading SIBO labs, Gary definitely offers the best clinical support I’ve ever come across. He goes over labs in detail and offers insight analysis and really goes above and beyond.
Aerodiagnostics offers cash pay and insurance billing options, and they do a terrific job of keeping costs low and billing easy. They are for accounts for clinicians and direct-to-consumer testing and Aerodiagnostics, again, is my go-to SIBO lab.
If you’re wondering about how hydrogen sulfide ties into traditional testing of hydrogen and methane, please check out our recent podcast with Gary from Aero. Essentially, we’ve developed a simple questionnaire that will allow you to hone in on hydrogen sulfide SIBO, without needing additional testing or cost. Aerodiagnostics, check them out.
DrMR: There seems to be a broad agreement that we have a diet with the highest tolerable intake of fruits and vegetables of a wide variety.
Considerations with Meat and Cancer
The thing that I often wonder is, when it comes to cancer treatments specifically, is the recommendation to avoid animal fats and animal protein… is there evidence? Is there good evidence showing that that, in and of itself, is harmful? Or is it that we really need all the fruits and vegetables, and the animal products don’t really have much of a bearing? Is there any clear data there?
DrNC: Yes, there’s a lot of data. So number one, there’s a lot of data showing that excess iron, i.e. red meat, is definitely a factor in multiple cancers, but particularly the digestive tract cancers. One of the reasons that high iron can be a cancer risk is because it promotes so much oxidative stress.
So we limit iron and we certainly don’t give extra iron in supplements. All our supplements are iron-free for cancer patients unless they’ve suffered blood loss. The anemia that cancer patients have is generally due to bone marrow suppression, not due to iron deficiency, and so we want to be mindful of that. Iron is also sequestered by tumor cells for their own growth, so low-iron diets are better for cancer patients.
If a patient, for example, has had inflammatory bowel disorder or colitis, they are more at risk for colorectal cancer because they’ve had inflammation so much in that tissue. Then, if you throw in something that increases the oxidative stress like a lot of red meat, then that’s a perfect storm for increasing the incidence of colorectal cancer. That’s one reason red meat’s a problem.
The other is that the higher you go up on the food chain, the more environmental toxins, chemicals, and hormones are concentrated in that fat or flesh that you’re eating. That’s the predicament of modern times and the state of the planet. The biggest risk factor for all of us is living in a toxic environment. We want to take control of our exposure to toxins, so by eating more plants and less animal fats and proteins, then we will just have less exposures.
Of course, we’re confused about what food is. A grass-fed animal is making a lot of omega-3s. Whereas a grain-fed animal is making a lot of omega-6, which are pro-inflammatory, while the omega-3s are antiinflammatory. Americans are confused about what real food is. So if you eat grass-fed butter or grass-fed animal products, then you have real food and something more rich in omega-3 and anti-inflammatory, but you still have the problem of hormones. Even if we eat an animal that’s free-range, we eat the female flesh, and that has estrogen in it.
We’re already in an environment of excess estrogen. So if a person has a hormone-driven cancer like an endometrial (that’s uterine cancer) or breast cancer or ovarian cancer or prostate cancer, even some pancreatic, lung, and colorectal cancers can be estrogen-driven. Even some brain cancers can be estrogen-driven. And we’re all exposed to herbicides and pesticides and plastics, which are hormone-like. This is the reason we have so many hormonal cancers. We want to be mindful of how much exposure we’re getting. So if you have a choice, eat less animals and more plants.
This is what the plate looks like that I recommend. Half your plate is colorful vegetables, primarily, because remember, we want a low glycemic diet with few insulin triggers. So lots and lots of color, half your plate and mostly vegetables that grow above the ground to reduce the starchiness, to reduce the carb contribution. Then, you have a lot of fiber and a lot of phytochemicals on that half of the plate. Then, you want to pick some clean protein. I recommend that you don’t have all your protein from animals.
I don’t ask all my patients to be vegan or vegetarian because I want them to eat a diet they enjoy, but to be educated and understand their risks and to make well-informed choices. So, some clean protein. Then, the rest of the plate is healthy fats and oils. So you’re going to eat more olive oil, more avocados, cook with coconut oil and add flax oil to your food. All different ways to put some nuts and seeds on your plate, have more nut butters, all those ways we can increase healthy fats. So I’m not saying eat more grass-fed butter, right, or ice cream. I’m saying, think about the healthy fats. That’s my general guideline.
DrMR: Sure, and I think that’s all good advice, certainly to increase our intake of fruit and vegetables, having a broad variety, aiming for healthy fats. The one point, and I am certainly not a cancer expert, but I do wonder if there has been a little bit of a bias in how we have read literature, that animal protein is somehow causal with cancer.
And certainly, I think it’s very tenable to say much of the literature may suffer from a selection bias where red meat is lumped in along with processed sugar and unhealthy users. There have been a couple of studies that, I think, have done a good job at elucidating this. Because until we have data to answer the question, I would agree that we’d want to steer in whatever direction seems to be the safest, and I think that was definitely more of a plant-based diet, but there are some interesting findings that challenge that.
I just pulled this one up, because I remember reading this a few months ago in the American Journal of Epidemiology 2014: both a paleo diet and a Mediterranean diet were associated with a decreased risk of sporadic colorectal adenomas. Of course, the paleo diet would encompass all of the eat-lots-of-healthy-fruits-and-vegetables, which is great, but it would have some animal protein. I just want to make sure that we’re not–
DrNC: Yes, so you can find literature from all perspectives. So there are a lot of studies that show that diets higher in animal fats and animal proteins increase most cancers. But I think your point is well-taken, because who are the people that are eating heavy meat diets for the most part? And are they also eating a lot of processed food with lots of chemicals in them? Then, are they also eating a lot of sugar? Are they also pre-diabetic? So we don’t do the studies in a very refined way, and we are very, very privileged to be able to pick our diet and our food with so much precision.
DrNC: Most people on the planet don’t have that luxury. So if you’re poor, you’re probably not going to eat grass-fed beef. I would rather give guidelines that steer people in the most healthy direction. Then, those of us who want to eat some rarefied diet because of our ideology, just make sure it’s healthy, you know? Just make sure it’s really a truly healthy diet and that it’s right for you, your constitution, risk factors, and genetics.
DrMR: Perfect. Okay, good. I just wanted to make sure we painted in some of the nuance there.
Tips to Reduce Inflammation
DrMR: Now, you also mentioned inflammation, of course. The diet that you outlined will take a big step forward in reducing inflammation. Are there other antiinflammatory steps you feel are worth mentioning?
DrNC: Well, I think we have to teach our patients how to eat an antiinflammatory diet, which is what we’ve just described. But also, I think it’s very important to really be aggressive with inflammation control. We certainly know that most diseases of aging involve some kind of inflammation. But here’s what’s true about cancer: the cancer terrain is inherently an inflammatory terrain. That is because the presence of exogenous inflammation around the tumor cell in the tumor microenvironment is a setup for the damage to the mitochondria, the damage to the DNA.
These are the two factors that cause cells to become abnormal and aberrant. So the things that reduce oxidative stress and reduce inflammation will reduce cancer risk. We go back to color, right? Eating lots of color.
But then, we can think of some things that are really big levers. We know that turmeric is the source of curcumin. So in my patients, for example, I’ll have them do at least 2,000 milligrams, up to 6,000 milligrams a day, of an oil-soluble curcumin supplement. That’s one way to do it.
Another option is to think about something like Boswellia, which comes from frankincense. This is super antioxidant and antiinflammatory. in botanical medicine, there are some really powerful levers. Also, a lot of people don’t realize that the Chinese medicinal mushrooms are mostly antiinflammatory, and especially reishi mushroom, Ganoderma mushroom is very antiinflammatory. It also has an impact on glycemic control and blood sugar control, as well as being a stimulant to robust immune function. And so those, I think, are really powerful tools.
DrMR: Is there anything else? Obviously, there’s more to this conversation. And probably a lot that we could go into over hours.
Lower Cancer Risk: Lifestyle & Supplements
Are there one or two other things that you feel are really important for people to understand as they’re either trying to prevent cancer in the first place or maybe prevent recurrence, or if they’re currently dealing with cancer? What are some other very important aspects?
DrNC: Well, there’s a couple of things that there are lots of studies on. I’ll mention a few things. One is, sleep has a big impact on immunity and on cancer risk. So seven to nine hours of normal sleep when it’s dark is really important. There are a lot of studies showing that exercise—as little as 30 minutes of moderate exercise a day—profoundly changes outcomes and prognosis, so that’s important. These are things anybody can do. I think about supplementation in two tiers. One is, what are the foundation supplements and the unique needs of this group of patients at risk for, or dealing with, cancer? Then, what are the more targeted things?
We want to have a multivitamin that’s free of copper and free of iron. We mentioned iron, but copper is required for a process we call angiogenesis, which is the capacity of a tumor to make its own blood supply. And so if we keep copper low-normal in the body, then we are not providing one of the sources of cancer spread and metastasis. So a multi that’s free of iron and copper unless the patient is low-iron.
We want to have an adequate, generous dose of omega-3 fatty acids. Not only are they antiinflammatory, but they change signaling. They change cell adhesion or the stickiness of cells. We want to definitely have some kind of probiotic, or encourage people to have fermented food in their diet, because the microbiome regulates so many factors. Immunity, detoxification, hormones, neurotransmitters. Also, the microbiome helps us to utilize plant chemicals in herbal medicines and the phytochemicals in our food. So it’s very, very important.
Then, adequate magnesium. Most of us are magnesium-deficient, but especially cancer patients can be super deficient in magnesium. It’s crucial for mitochondrial function. It also really addresses the chronic fatigue that all cancer patients face and experience because cancer is a disease of mitochondrial metabolism.
Then, vitamin D. So many studies on vitamin D and cancer. The most recent studies show that at the time of diagnosis, if your vitamin D is low, that would be 35 or below, your prognosis is very poor. The optimum blood levels now recommended for cancer patients for vitamin D of 25[OH]D is 75. And so it’s very hard to achieve that without supplementation. The only way to determine what the amount of vitamin D a patient needs is by measuring their blood.
Those are the basics that I put in the foundation. Then, we want to put a few targeted things in there. So curcumin definitely goes in there. Resveratrol is very important. It also enters a number of pathways. Curcumin interacts with over a hundred genes and receptors. Resteratrol, we know, interacts with over 50 genes and receptors. These are signaling molecules that impact lots and lots of pathways. Then, of course, green tea has a big influence on cancer physiology, but it also has an impact on insulin sensitivity as well. So that’s a simple foundation. Nutrients. We described a good diet. And then three targeted supplements, along with the Chinese mushrooms. If you did all of those things, it would dramatically change your cancer terrain.
Balancing Traditional & Integrative Care
DrMR: Do you have advice for people who are grappling with, “I have an oncologist. They are scoffing at anything integrative in nature. And yet, I hear some of these things from the integrative camp that seem pretty alluring. How do I integrate these together?”
DrNC: Number one, on the very first visit, my goal is for patients to feel empowered. Because the oncology environment is disenfranchising and disempowering to the patient. So I think it’s very important for any cancer patient to have a team. They’ll have their oncology team, that are the experts in oncology, if they want it. Or they might have a naturopathic oncologist.
Then, they need a health plan. If you don’t have a plan for your health, you’re not going to get to health as your outcome. So what I say to oncologists and what I encourage patients to say to oncologists is, “Look, you’re my disease expert. I also have a health expert, and that person’s going to help keep me healthy and give me the outcome of health, which is not your primary focus.” That dissipates some of the resistance and helps to build a bridge, because ultimately, the patient is at the head of the team. They get to pick which experts they want to have on their team.
I encourage patients to look for physicians who are collaborative, because everybody wins when the patient’s voice is heard, and their values are respected, and the resources and people with different training come together for the benefit of the patient.
View Dr. Ruscio’s Additional Resources
DrMR: Speaking of resources, I know you do some training for doctors and also some education direct-to-consumer, so can you tell people more about where they can plug in for any of that?
DrNC: Absolutely, so for patients and families whose lives have been touched by cancer, I have a website, integrativecanceranswers.com. And we have a downloadable Outsmart Cancer shopping list, so if you want to have a checklist when you go to the grocery store, you will find that there and also lots of free resources for you.
For the clinicians, I have a gift of a short webinar on inflammation in cancer and the unique pathways that are involved in cancer and inflammation. That can be found at aiiore.com. And for those doctors that are really interested in building their skill and confidence in working with patients who are already in their practice and supporting them through this journey, I have a training course. I’m offering your community a thousand-dollar discount on that. The code for that is “Ruscio” when you check out.
DrMR: Awesome. Well, thank you for everything that you’re doing. I would imagine that the more information someone could have in this situation, the better, and the more information that’s all-encompassing, right?
I would see it being very difficult reading an article here and there on the internet and trying to spackle that all together. Having an all-encompassing resource to help people I’m sure will be welcome news. So thank you for putting all that together. Thank you for taking the time to share that with us today.
DrNC: Thank you. I’m honored to be here.
What do you think? I would like to hear your thoughts or experience with this.
Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.