Integrative Cancer Care with Dr. Paul Anderson

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Integrative Cancer Care with Dr. Paul Anderson

Episode Intro

Dr. Michael Ruscio: Hey everyone! Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Today I have back with me Dr. Paul Anderson. And we’re going to be talking about cancer. So Paul, welcome back.

Dr. Paul Anderson: Hey thank you for having me.

DrMR: Absolutely. And, at the end of our last conversation on biofilms, I somehow had just mentioned that we were thinking about doing a series on cancer and interviewing a few different experts in cancer. I think I was actually asking you if you knew anyone. Because I was struggling to find good names. And unbeknownst to me, you had just finished writing a book on cancer therapy. So, that was kind of a little bit of egg on my face, I guess you could say. But I was very happy to have that. Because that got one name into the queue here.

So, definitely looking forward to talking about the topic more. But tell people a little bit about how you got into it, and what the extent of your involvement with cancer care and/or cancer research has been.

DrPA: Ok, that’s probably a good place to start. I think it was a great serendipity last time. And I think because as of the date of recording, we’re just before the book coming out. So, there had not been a lot of promotion so there’s no reason you would know about it.

But the journey with myself and cancer and integrative oncology is I think the best term for what I do, started over 20 years ago in practice working with people. And I didn’t really set out, in my practice, to specifically work with people who had cancer. But what we just sort of found over time was, at least back, you go two-plus decades ago. There were not a lot of people, number one, who had a lot of information about integrative oncology. And number two, who were really doing anything with it. There were a few people really in North America, and that was it.

So what started to happen was people found out that I was practicing integrative medicine and they started to come in and say, “My child has cancer,” or, “I have cancer,” or some family member. To which I would usually say, “Well, great.” Ok. I had better start learning about this. And we did a lot of supportive care back then.

So if you kind of fast-forward through about, let’s be generous and say 13, 14 years of just private practice oriented, integrative oncology. And then a lot steep learning curve over those years. I was then maybe 13 to 15 years in. I was in a position to be involved in some NIH, National Institute of Health research that was being done here in Seattle between Bastyr University and the Seattle Cancer Care Alliance. So it was true integrative medicine research.

And that research project lasted five years. I was heavily involved with that. And ever since then, we learned a lot there and we discovered actually quite a bit there. And it’s just sort of blown up from there. And that’s what led to the book, really.

Big Picture Thoughts

DrMR: Gotcha. So, of course there’s a lot to this topic. And of course probably more than we can do justice today in a 45-ish minute podcast presentation. But do you have any big picture thoughts as we wade into this conversation?

DrPA: Actually many. But I think that just a couple of things. Because I always assume when we’re doing things to the public that there’s a lot of maybe misinformation. And I know I’ve had conversations with other doctors and patients, etc., about a couple of these things. So I just think these are good framing parts of the conversation.

The first is, at least the way that I approach integrative oncology, and I would say the majority of people do who do it nowadays. It’s not an either-or situation. So it’s not regular oncology is all good or bad and integrative oncology is all good or bad. Our goal, really, is that you can only be good at so many things when you have something as intricate as cancer.

So if I’m really good at chemotherapy or radiation therapy or surgery, or whatever, that’s my world. That’s what I do. And believe me, if you have someone doing that with you, that’s what you want. What they don’t have a lot of bandwidth for. They have the intellectual bandwidth, but they don’t have time bandwidth for, is what do I do either to protect myself from the effects of the therapy. Or what do I do if there isn’t an appropriate therapy for me. Is there something else?

And I really think the majority of the movement in integrative oncology has moved towards it’s not us versus them. It’s what can we all do together. And I think that’s probably the biggest framing comment I’d like to make. Is, there are times when standard therapies are the very best thing. But there’s a lot of things we can do to improve them or maybe decrease the downside, etc.

And then I think the next thing that I would say. And this is kind of at the other end of the spectrum. So I guess we’ll sort of do a deductive and inductive statement at the beginning. After these three decades working in integrative oncology basically, and then after the research and looking at how people do. Because cancer is many, many different processes in different organs and all of that. So cancer is not just one thing. But the one universal thing that I have seen over time that I can really hang my hat on, and I tell patients right up front. Is, if their diet, and lifestyle also, but if their diet is not something that changes. Whatever kind of therapy they’re going to have for their cancer, all the other therapies are not going to work the way they’re supposed to, and they’re not going to work as well as they’re supposed to.

So diet and then lifestyle, we always talk about them as a cornerstone of things. But I can tell you from looking at the numbers and looking at outcomes that the people who refuse to change their diet and a bit of lifestyle stuff, it’s really hard to help long-term. So I guess those are my two framing statements there.

DrMR: Those are great points. I think that’s actually very poignant, because I’m sure that people going onto the internet to research this, like many other things. But I think this is one of the more polarized topics. We’ll find some people who are vehemently opposed to conventional medicine, and will tell you that everything from it’s ineffective, which may be a misrepresentation of the data, I’m assuming. And also that it might be some kind of conspiracy and what have you.

You may get these really dark holes that would make a patient feel like they really had to make a choice of one versus the other. So I think that your remarks are fantastic. And I’m definitely excited to talk more about the diet and lifestyle and how impactful that can be because certainly I think everyone is on the same page, that that’s the foundation of health. And we certainly want to start there.

Types of Cancer That Are More Concerning

One thing I’d like to ask as we move in that direction is are there certain cancer types that are more or less concerning. And I know that’s kind of vague. But are there certain cancer types that you find more or less concerning, and then maybe we can get into some of the reasons why in terms of how treatable they are or what have you. How would you answer that question?

DrPA: Yeah, it’s one of those questions where there could be 200 answers. So I’m going to try and boil it down to a couple of good examples, or I believe good examples. And this is something that I talk with my clinic doctors about, which is, it’s a little bit of the art of medicine mixed with the science and the statistics part. Your approach with a patient who has a cancer that may not have been discovered until it was really aggressive and late stage has to be much more aggressive, because those later stage aggressive cancers, you don’t have a lot of time to mess around with them. For whatever kind of treatment you’re doing.

So some of those that we see, and these are very common ones. People have probably heard these are bad ones. Late stage pancreatic cancer is a good example of that. Late stage ovarian cancer is another good example of that and possibly late stage colon cancer. And one of the reasons that those are sort of the poster children cancers for, “Oh, man I got this and it went so fast,” it’s not so much that in and of themselves they’re a lot different than other cancers. It’s that sometimes they’re very silent, so they’re very advanced by the time anyone gets diagnosed because they don’t leave a lot of clues.

So, they’re concerning in the sense that if you are “suddenly diagnosed” with stage 4 pancreatic or ovarian cancer as examples go, it’s not that that’s terribly different in the management, etc. It’s just that you have a cancer that’s been growing for a while, probably. When things get to stage 3, stage 4, which are the later, more aggressive stages, the cancer cells have learned all sorts of tricks to evade the immune system. So that’s why I say in those cases, we kind of use our integrative oncology in a very aggressive manner with the patient because if you don’t, if you slow pitch those, they’re just going to turn on like a freight train.

On the far other end of the spectrum, and again, I’m just picking common examples. Would be really what we call secondary prevention. Where a patient has a low-grade, low-stage, say breast cancer, prostate cancer. They get some treatment. And the oncologist says, you have no evidence of disease. We don’t use the word cure very often. But they’ll say you’re in remission, or you have no evidence of disease.

And often in those cases, the patient will come to integrative physicians and say, well they said I have no evidence of disease but they said there’s no treatment while you have no evidence of disease. Do you have anything for me? So on that end of the spectrum it’s not that we’re maybe not intense about it, etc. But instead of being treatment oriented, the treatments are focused on prevention. Because that’s the golden time to do prevention, which involves every non-cancer kind of thing you can think of.

So I think they are, of course, all concerning. And people have to take them seriously. But we feel more urgency when somebody has one of these kinds of sneaky cancers that shows up at it’s latest stage very suddenly.

And I suppose the other thing I would say is, the people who have been told they have no evidence of disease. The only problem with that is human nature in my experience. And that is, oh, I don’t have cancer anymore, I don’t need to do anything to keep myself cancer free. And that’s the most dangerous thing a patient can think. So they go off the diet they had. They stop doing everything. And of course, that’s not good. So I think that’s, more context than anything.

Cancer Screening Do’s and Don’ts

DrMR: Ok. That makes complete sense. And you mentioned that, of course, if a cancer eludes detection for a while, and progresses to a stage 3 or 4 that’s a more concerning position to be in. And that begs the question of screening do’s versus screening don’ts. And certainly, this is way outside of my area of specialty. But you hear criticism of some cancer screenings may actually cause more problems.

And actually, this is something that we wrote up in our monthly clinical newsletter regarding thyroid cancer. That the best evidence I’ve been able to find, and the current consensus seems to be that screening for thyroid cancer in non-symptomatic patients may actually elevate one’s risk. So it is recommended against. Now, it’s not the case if someone is symptomatic. It’s different.

So there’s a thinking there that potentially the screenings for thyroid cancer may elevate risk. Mammograms, I know, have been criticized. And I know, again, we could probably do a whole episode just on this. But are there a few important kind of take homes in terms of controversial tests where you would say, do this one, don’t do that one. Or, only do one in this context, what have you.

DrPA: Yeah, I think there are a couple of factors that I think have colluded to a lot of the data that comes out about, and you hear the same thing about prostate cancer screening, etc. What’s the yield of that actual screening that we get. How many false positives versus false negatives do we look at. And then what’s the cost to the person, not just money but also quality of life and treatment and time that they maybe didn’t need.

So I think that is one of those areas where it’s a very delicate balance. In some things like prostate cancer where it has become, at least in the urology world, very clear that they do more watch and wait now than anything. You know, unless they have a very aggressive cancer, obviously, then they’re very involved. But with those marginal ones where it’s, well, you have symptoms but they are here and we’re going to watch and wait. That one seems more cut and dried to me from the oncology world.

The thyroid cancer one is a really good example of context. And it’s fresh on my mind because I just had a conversation with a patient this week that sort of made the case that there’s always exceptions that we need to look for.

So, for the most part, asymptomatic people being screened for thyroid cancer, the thyroid is a very dynamic organ, as you know. It creates cystic things, and it creates all these other things. And what’s interesting with the thyroid is it also has all these cross-hormone receptor actions with non-thyroid hormone. So if people are going through menopause, they’ll get more cystic activity. They’ll get swellings and stuff that may or may not be cancer. So, broadly screening people who have no symptoms and no family history, always put that in, it’s like prostate cancer. It doesn’t yield a lot of good treatment effect.

The counterpoint to that is, if you do have, especially a family history but also symptoms, then it almost goes the complete opposite way, which is, you really need good screening at that point. And now what we can do, is actually, if you have family history or not. There are genomic tests that will say, this is likely to be or turn into this type of thyroid cancer. There’s a whole bunch of types of thyroid cancer. Some are really bad. Some are kind of slow growing.

And this was the case of this person. They had a family history, then they had all of these symptoms where the thyroid was growing and causing compression. And then they had their genomics, and they were getting a fifth opinion from me about their case. And I said, from what I’ve seen with thyroid cancers, you’ve got the watch and wait kind, which is most of them. And then you’ve got the kind that you cannot trust, because they’re so aggressive. That’s the deal there, and that’s what you have. So you’re one out of 500 people.

So this is, I think, where working with whomever you work with for cancer screening, it’s very important if you’re a man and you’re going for prostate cancer screening. You want to have a discussion ahead of time about what’s the rate of false positives. Do I need all this testing? Where are we at? If it’s thyroid or breast or whatever. You just need to have good conversations about it, and then do a little homework on your own.

As you might imagine, medicine is prone to human nature, as well. We had this huge onset of ability to screen between the early 80s and now, and technology. So we just started screening everything and everybody. And now we’re figuring out it’s got to be a little more informed than that. Because we’re treating a lot of people we shouldn’t be treating, probably.

DrMR: Yup. And I think that makes complete sense. And this is where I really think medical science shines. Just going through the data and observing people. For example, that was something that was very interesting to me. To see that the thyroid screening campaigns didn’t actually change the mortality rate from thyroid cancer at all. Meaning that the cancer didn’t lead to any change in outcome. In fact, there may be some evidence that it perhaps worsened outcome. For those who are non-symptomatic. And to your point, where context is very important.

Are there are a few that you would say are more so no brainers. I know there are certain guidelines for routine colonoscopy. I believe it’s once you hit 65, the general recommendation is to have a colonoscopy screening. Mammograms, I know that’s one people are curious about. Are there a couple of others that might be worth giving some of your thoughts on?

DrPA: Yeah, I think that while there are these shining examples of kind of over screening, where we’re getting better. The feedback from the data is informing it. There are some things. Let’s just, for the sake of this answer, we’ll take family history being positive out of it. Because if you have a positive family history for any of the main common cancers, your screening is earlier and it needs to be a little more informed and dialed in.

But let’s say you have no family history. Now still, when it comes to breast cancer, a large number of people have no family history because of many reasons. I think when it comes to colon cancer, the screening tools. And right now, colonoscopy is the gold standard. They’re developing other stuff. But colonoscopy, you can’t get more direct. They can do biopsy, the whole thing. I think in the case of colon cancer, a screening colonoscopy. And they keep changing the age at which that’s appropriate. But the standard screening colonoscopy I think is a really, really good thing.

And part of the reason is, a) it’s not as fraught with false positives as say thyroid screening would be. Or even prostate. So that’s one huge thing. So it’s a better test, so to speak. The other thing is, like every other cancer but colon cancer is just one that I’ve seen this over the years. People who catch it at the pre-cancerous stage or just the early stage where the polyp is getting cancer-like cells. They can have the polyps removed, they get the biopsies done, and then they’re just being monitored after that. So they actually catch it before it goes crazy.

Colon cancer cells have this wide-ranging ability of metabolism. Like most cancer, but colon cancer is very unusual. In that it changes from, for instance with say methylation, which helps with making daughter cells and all that. Methylation is very important to support in the early stages of pre-cancer and the early stages of colon cancer. Once it gets past the middle stages, methylation will actually turn on stuff that you shouldn’t be turning on. So earlier is better in finding that.

So I think that’s a good example of one where the screening tests can actually be curative, number one, but also can really save a lot of trouble. Because it’s a very common cancer. We see people continuously who never had any screening until they started to have symptoms. GI symptoms or bleeding or something like that. And then they got stage 4 colon cancer and they’re having pieces of their colon taken out. It’s a whole lot harder to treat at that point.

And I think when you get to breast cancer, that could actually be a whole show, too. Just screening for breast cancer. Mammograms are what we had, and so they became the state of the art. If it was my wife, or my sister, or somebody and they came to me and they said there’s a lump, there’s this. What would you do? The statistics and the data is so clear that I would do MRI, actually. Breast MRI. It’s like 55% more sensitive, as you might imagine, than mammogram. And there’s no direct radiation. There’s a lot of benefits that way.

Now, insurance isn’t wild about paying for breast MRIs, but that being said, really the tools that are available are much better than the tools that we’re using, generally speaking for many cancers.

DrMR: Gotcha.

DrPA: And that’s about money, you know.

DrMR: Right, which is a factor. We like to think that we have infinite resources, but we really don’t. And sometimes I think it’s easy to suggest someone’s callous when they’re thinking about money. But there’s not infinite resources. So it’s something to calculate into the equation, which is, what is the best screening that we can do for the best cost. Because if the cost is too high not everyone will be able to have it. So it’s a good point you make and I certainly see both sides of the argument. I’m glad that you made that recommendation for mammograms. Because I was going to push you to give some kind of opinion on that one. Because I knew people would have a question on that one.

DrPA: Yeah. And I will say that, it’s one of those things where normally you have to call a physician at the insurance company and say, this is why I want this test. And you need to stack up enough stuff. It’s atypical. They’re younger. They’ve got family history. Whatever it is. And they will approve them. It’s just not the standard right now. It should be, it’s just not.

DrMR: Sure.

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Cancers Best Treated by Conventional Medicine

DrMR: So, let’s transition now into discussing treatment. I look at this and I try to organize this maybe into three categories: One, cancers that may be best treated by conventional means. Other bucket would be those that are best treated by a combination. And I’m assuming that’s going to be the majority. And then another bucket that is cancers best treated solely by natural. And maybe that’s not a good system of organization, but that’s the question I have in my mind going into this. So as we wade into this, would you organize them differently? How would you help the listener or the reader try to organize some of these different cancers by a category of therapy?

DrPA: Yeah. I think that’s a completely appropriate three buckets to put it in. And really that’s the way I have seen integrative oncology evolve as far as thinking goes. I would say with respect to the first and the last one, where is it best treated by standard of care oncology therapy, or is it best treated by all alternative type things. I think in those two cases, there are some situations where thry may be true, just as axiomatic statements.

But in reality, the first one. Even if the best course of treatment, just statistically you’ve got a child with ALL, acute leukemia, non-myelogenous leukemia, where the so-called cure rate is over 90%. There’s other stuff like that. Yes, it’s unpleasant. You’ve got chemo and some other stuff. But the cure rate is so high. You can’t argue with that. There’s certain types of male cancers that are that way. There are certain types of cancers where they are just awesome cure rate.

The caveat we tell people is, yeah, man. Do X, Y, or Z. Whatever this high cure rate thing is. Our job in that situation, in my opinion, is to make sure that their diet, their lifestyle, and probably some supportive supplementation is supporting every possible chance of that treatment working. And what we see is we can get people through those “highly curable” things. And not leave them in a situation where their body is so beat up that maybe a cancer would return later.

So I think in the first case, it’s not more is standard therapy the best treatment. But, if it has real high stats for success, then let’s do that, and let’s do everything we can to support your body during it. The idea of, I’ll get to the middle one, which is the biggest one. But the idea of say alternative integrative treatments only, the place logically and just with practice that I have seen that be the case is people often will be essentially diagnosed either so elderly or so late in their cancer process that there’s really no standard treatment that would be available. It would kill them to do the treatment.

So we often would get referrals, and still do, of people who were told, you’re too old to be treated or your disease is just too far gone, it’s not even worth doing treatment. In those cases, and these are cases over many years, looking at them. In some cases, we can do things that improve their quality of life for whatever time they have left, which is always a goal. In some cases, we’ve actually been able to slow their cancer down so that they essentially live with that cancer more as a chronic illness than a death sentence. And in some cases, people go pretty quick because the oncologist was right, you’re too far gone.

So that’s the time when integrative alternative practices are probably best used alone. Most of the time, we’re usually cycling. So you’re middle bucket of both. Usually we’re cycling between, if we get someone at the beginning of the process, for example. And they say, I’m going to have a surgical biopsy next week. And then if it’s what they think it is, they’re going to start me on three rounds of chemo or radiation or whatever, and that’s going to look like this schedule-wise. And then I’m going to have a break.

What we will do is we will get right on integrative therapies that will support them around their surgical resection, etc. And we’ll set up a schedule that says we’re going to do these things throughout your, let’s say you’re going to have chemo or chemo-radiation. There are many things that we can do to be supportive during that time, and we time it between treatments, etc.

And as I said, diet is, that’s something that we have real hardcore conversations about. Because if you’re not going to feel good during cancer treatment, and when we don’t feel good as humans, we tend to eat not the best. Or horribly, depending on who we are. And so we tell people up front, man, if you haven’t made changes, you’re not going to want to make them as soon as this starts. So let’s work on that now.

So, to me, that’s where integrative oncology shines. It’s sort of a neutral point as to, is the chemo good or bad or the radiation or whatever. If we all believe as a team that this has a high percentage of success to slow the cancer down, or something like that, great. Let’s go for it. But let’s do everything else that I know your oncologist is not informed about and is not going to do to support you so you heal faster. Your cells stay good.

And there’s a thing we write about in the book, which is just, we’ve known about it for a long time. But it’s just come out in the scientific publications the last few years a lot. And that is that your cancer is one problem, but the cancer stem cells are your bigger problem. And they are not killed by normal cancer treatments, they are made stronger.

So I can go and do radiation or chemo on a person and knock out their cancer that we can see, but the stem cells actually then get stronger and just wait to come back as either a stronger version of the old cancer or a new cancer. And that could be months or it could be years, which is hard, because people, what they can’t see can’t hurt them.

It’s only things that are done in the integrative medicine space that are anti-cancer stem cell. Right now, you read every paper about cancer stem cells, they essentially say, they’re here. We don’t want people to not do chemo or radiation even though we may make the stem cell worse. But we don’t know what to do with them. We don’t have drugs for them. And the cancer stem cells, which are my biggest concern with people in keeping the cancer away, that’s one of our huge, huge goals while we’re co-treating.

So, I think of the three buckets, the middle one is the biggest, really. And just two caveats there, going back to the success rate. If somebody comes back and their oncologist has really pitched them hard a chemo regimen or something, and we look and we dig into it. And it’s got a 5 or 10% chance of success, that’s a hard conversation with the patient to say, you are for sure going to get all the side effects. You have a 5 or 10% chance. Do you want to go through it? I’ll support you if you do. And I often tell them, ask the oncologist, “Would you do it?” And most of the times the oncologist will say, “No. It’s not worth the 5% to me.” So that’s one caveat.

So the middle bucket does depend on the success rate of the standard therapy. But the other thing is, it sounds, when I talk about these things or when we wrote about them in the book, like everyone is working together so well and singing from the same song sheet and all that. In reality, the oncology community is very slow to warm up to the idea of integrative oncology. So, I do warn patients, some oncologists are all about it and many are not all about it. So we have to develop relationships, and they need to know they might get caught in the middle. So I do want to put that out there.

Natural Treatment That Aids Conventional Treatment

DrMR: Sure. Well, it’s not surprising. But hopefully the walls will continue to dissolve with time. So, to help give people a little bit better of an understanding with the natural therapies, are these therapies that you would say predominantly…Again, I know there’s probably nuance, but just trying to paint kind of a broad stroke here. Are these therapies that are mostly enhancing what the killing therapy conventionally would be doing? So what the chemo would be doing, what the radiation would be doing? Or are they more so therapies that themselves are killing. Or are they therapies that help to keep people more resilient and prevent their body from breaking down from the negative results from the chemo or from the radiation?

DrPA: That’s kind of the spread. It’s a little of everything. There’s definite timing to natural agents that are what we might call either radiation sensitizer or chemotherapy sensitizer, where they’re actually working together to sensitize the cells for the standard treatment. There are examples of those types of things. There’s times when curcumin works that way. There’s times when vitamin C actually works that way, and other stuff. So there is that. That’s a limited time period usually when they’re doing active treatment.

But what we found that’s so curious and happy circumstance is, those things that tend to make the standard therapy work better are also protective to the normal cells. Most chemo is not protective to the normal cells. It’s damaging to everybody. So the nice thing about some of the natural sensitizing agents is their side job is going to be protecting your normal cells. So that is one thing. And I would say that is probably 20% of what we wind up doing.

There’s also probably 10-20% of natural therapies that are actually direct cancer assaulting, killing, sort of therapies. But the rest of the therapies are aiming at really two, I’m going to really make this broad. But they’re aiming at two grand goals. And most natural therapies are in this area.

One is keeping the normal cells healthy while, and everything you do to keep your normal cells healthy turns out also keeps the cancer stem cells from becoming active. So that’s sort of dual purpose there. And then where the cancer is concerned, instead of directly often being killing to it or assaulting it, what you have is an action that reacquaints the immune system with the cancer. Because cancer has lots of ways to avoid the immune system.

And so if, while you’re protecting the stem cells, keeping them quiet, and the normal cells, you’re also reacquainting your immune system so it can go and directly fight. That’s more of what a lot of the natural things do. But there are some from every category, really. And I would say, one of the things that the last 10 years has really brought us. And it just happened to coincide with the beginning of the NIH research and all that was close to 10 years ago now. But also just the way scientific stuff had gone.

We now have studies, and we know things about a lot of natural agents that we never knew before. And so now there’s ways to look and say, this one is going to be chemo sensitizing. So when you’re getting chemo, we’re going to recommend you do that one. This one is going to help with this immune business and we’re going really focus on that maybe after you’re done with therapy, or if there is no therapy for you.

So it’s now about being a bit more subtle and nuanced in the timing of the therapies. And I promise you 30 years ago we knew like three things about this. The learning curve for everyone has been just huge, especially in the last decade.

DrMR: Great. So you mentioned I guess kind of three categories of natural treatments. Or were discussing and developing those. Those that are anti-cancer, those that enhance conventional therapy, and those that may mitigate negative effects of conventional therapy and/or help to combat the cancer stem cells. Can we go through a couple of examples of what the more popular or more effective treatments in each one of those categories would be?

DrPA: Sure. When you’re working with the ones that are trying to sensitize a chemotherapy or radiation, it’s very specific to the kind of treatment you’re talking about. So, for example, some of the more common, what are some of the older but more commonly used chemotherapies that are directly cell killing, like the platin drugs or the taxanes like Taxol and some of those that people hear about a lot. Those actually have some direct synergy that’s been studied fairly well. As much as anyone would pay to study it. With vitamin C. Vitamin C actually turns out to be synergistic with those chemotherapies, which is the opposite of what all the oncologists always thought.

So that’s an example of a time where we would actually use vitamin C in conjunction with their chemotherapy. And now there’s actually, it’s not very many, because again, funding is always an issue with big studies. Now there are actually studies looking at, if we track 10, 15, 20, 25 patients during their chemo and then match them with people who don’t get vitamin C, do they do better or not? And we’re actually starting to see that in human research.

So, there are times where that’s super specific. There’s another one that’s a little more recent in the publications that was one of those things that on paper looked completely impossible, and that is some of the platinum drugs, which are super common to be used in chemotherapy. Like oxaliplatin.

DrMR: Cisplatin.

DrPA: Anything that ends in -platin, yes. Any -platin thing. They started to come out with research. And I think Stanford did the first one, and then they repeated it somewhere else. And they actually looked, because those drugs have a lot of neurotoxicity. And you’ll go deaf or have other things that you don’t want. So they actually looked and they said, if we give glutathione intravenously before we give the chemo, do people have less neuropathies afterwards? That was the big thing they were looking at. Now, the people who came up with this study had to buck everybody in the world. Because they said, here’s the problem. Platin chemotherapy is directly cytotoxic through an oxidation step. And glutathione is directly antioxidant.

DrMR: Right.

DrPA: So why are we doing this again? And what they found out was, as opposed to on paper where it looked like they would cancel each other out, it actually protected the patients. And there was no decrease in effect from the platin drug at all, which I kind of thought, but I was glad it was proven.

DrMR: And that’s terrific. And it comes back to a concept, which is a great chance for me to kind of reiterate this. Because this is something that I think is an important principle for people, both clinicians and general health enthusiast to be aware of, which is, mechanism is one thing. But it’s important to have an outcome study where we actually test that theory to see if what we thought would happen on paper, as you said, would actually happen or not. So it’s just a great example of that.

DrPA: It has now become the poster child for what we thought was true forever doesn’t workout in humans when you put it in them. So, we’ve actually had, again, I need to say this is not widespread love and affection in the integrative and regular oncology world. But I’ve actually had oncologists call the office and say, I’m going to give platin chemo. I buy this idea of glutathione, and I will order it. We’ll get it for the hospital. I’ll give it to them, just like the study does. But I’ve never given anyone glutathione IV, you’ll have to write the instructions for me. And then I will do it in the hospital. And we’ve had that on more than one occasion now.

And so it’s an area of, that’s how some of these nice crossovers get made. Where everything they believed previously to be true just based on non-outcome studies gets turned on it’s ear. And then they have to look for people who actually know how to use this stuff.

And we had this same thing happen with IV vitamin C, and even oral vitamin C during the original trial.  Because we’re working with the university and all these other big cancer treating places. And they just believed it would just shut off all their chemo. So over a two-year period, I took and collated all of the data that had ever been put together on different chemos and vitamin C. And of 30 pages of data summary, and I put them in little charts so the oncologist could find their drug quickly and say, yes, no. But out of 30 pages, there were only two chemos where there was any real problem. And just by separating the vitamin C and the chemo there was no problem.

And so every other thing was positive. I remember I got an email back from the University of Washington, one of their head oncologists. And I sent it to him before we had published it. And he wrote back, he said, I never knew any data existed about this. He says, I feel a lot more comfortable at least referring people to you now. It looks like you can read science and you’re not crazy.

DrMR: Nice compliment.

DrPA: Yeah. Actually, I thought hell froze over for a minute. But what we found out through that collaboration, though, when we did it in real live humans and not just in studies, it lived up to it’s studies. It was very helpful. So things are changing. They’re not changing super fast. But those are examples of collaborative therapies.

DrMR: Ok. And is this, I’m assuming, you’re using an intravenous vitamin C and/ or glutathione?

DrPA: Yeah. In the cases of platin drugs, it pretty much has to be, well, the way the study was done, it has to be IV and they give it right before they give the chemo. You could probably do the same thing with say a liposomal if you kind of loaded up on it the day before and the day of. So there’s that.

With the vitamin C, vitamin C is a little different than glutathione in that it’s quantity in your blood, or concentration in your blood, makes different effects. But what we found is, let’s say someone can’t get to IV vitamin C, which is what we normally use in between chemo. If they take vitamin C much to the dismay of everyone who thought, before, it didn’t do anything. If they keep their plasma levels at least moderate, which you can do orally, it still has a protective effect on your normal cells, which is still a good benefit. So it’s been a big change. And yes, IV is really important. But we get a lot of people who can’t get to a place to get an IV, and they’ll ask what else they can do. There’s usually work arounds.

DrMR: Gotcha. Ok. What about any treatments that are directly anti-cancer themselves?

DrPA: There’s a few we’ve worked on. So anyone listening who is thinking about, well how do you know the answer to saying it worked or not. Normally what we would do and we started this during this trial because we had some protection through the university’s scientific board that had signed off on doing it.

Normally what you do if you have sort of a novel therapy, or something you want to see if you can regress a cancer. You take people for whom other treatments are inappropriate, or have not worked. They call them salvage cases. Meaning, none of the chemo worked for you. None of the other natural things worked. Your cancer is progressing. Do you want to try something that’s unproven?

So, we did this in a couple of cases. One, which is not really available right now for different reasons, but will be in the future was very high dose intravenous curcumin. And curcumin is taken orally, and you can only get so much absorbed. But very high dose intravenous curcumin, we had a case series of about 15 people where nothing was working. Whether it was their chemo, or natural stuff, or they were just progressing through it. And we had a statistically large enough number of those people either have an arrest of growth of their cancer, or regression of their cancer, to prove the concept that that is something that is directly anti-cancer.

Now, the issues around that are, these were very, very high doses that would be, right now, probably unreachable for cost reason for people. But we proved the concept. Of interest, people should know that there’s a drug company that has a form of curcumin that’s a synthetic curcumin, now in it’s final approval by the FDA as a chemotherapy agent. So, they also are doing it.

So that was one. And then the other was somewhat serendipitous. I’m going to try to really give the cliff notes version of this story, because it’s very long, and it’s wonderful, but it would take us forever. But bottom line is, a collaborative, what I would call metabolic therapy, is another thing that we did with some people who nothing was working on and they were willing to try anything.

So what a collaborative metabolic therapy really evolved to, and what it is, is the diet. And the diet to push you into a metabolic advantage is either a high-raw vegetable, low-carbohydrate diet. So kind of a modification of a Zone diet, where there’s even less carbs but a lot more flavonoids. All the goodies from the vegetables without a lot of sugar. Either that or a ketogenic adaptation diet. So one or the other.

And then we used agents that would go in, because the ketogenesis or even being in the low-carbohydrate environment slows cancer down in one particular way. But there’s a lot of other backdoors out. And what we found was a combo of a couple of things that when we put them together, they shut down some of the back doors out. And we also, in some people, used hyperbaric oxygen, which is another metabolic primer, and a few other things.

So in another group of people where nothing was working, most of them had lymphomas or leukemias. And then there was a small group of people with brain tumors. And they were just progressing through every treatment. We actually had the majority where their cancer either slowed down to a chronic disease basically. Or it actually regressed.

And it was when we did all of that together. And now when I look at the data, we have this wonderful graph that shows the people who didn’t respond. Maybe they felt better but they still died pretty quickly of their cancer. When we look back, the only thing that was in common with that group is they didn’t change their diet at all.

So this sort of goes back to, this is an older version of some of the salvage study. But when we did that, it was like, yes these cool agents that go in and help the metabolism shift away from cancer metabolism are great. But if the diet is not there to back it up, the cancer says, “Well, we’ve still got lots of sugar. We’ll find another way to exist.” So that’s another example where we actually showed an anticancer benefit. And like I said, that’s a long story. You can read the whole story in the book and all that.

But bottom line is that really was a turning point. When I saw that data, and I saw the people who lived and who didn’t live or extended their lives way beyond where anyone had guessed. And the one discriminator of success or failure was their diet, now we start with that. And we say, hey you’re going to have to eat anyway. Let’s change your diet, and then we’ll build everything else around that. And it’s been working.

Dr. Ruscio Resources

DrMR: Hey, everyone. This is Dr. Ruscio. I quickly wanted to fill you in on the three main resources that are available to you in case you need help or would like to learn more. Of course, I see patients both via telemedicine, via Skype, and also at my physical practice in Walnut Creek, CA.

There is, of course, my book Healthy Gut, Healthy You, which gives you what I think is one of the best self-help protocols for optimizing your gut health and, of course, understanding why your gut is so important and so massively impactful on your overall health.

And then, finally, if you’re a clinician trying to learn more about my functional medicine approach, there is the Future of Functional Medicine Review which is a monthly newsletter which is a training tool to help sharpen clinical skills.

All of the information for all three of these is available at the url, DrRuscio.com/resources. And in case you’re on the go, that link is available in the description on all of your podcast players. Ok. Back to the show.

Specific Dietary Treatments

DrMR: And are there specifics with the diet? Meaning, of course I know that the ketogenic diet, for example, I believe with glioblastomas and certain types of brain cancer has shown some promise. But is it specific? Is there specific cancers, specific diets that may have, ok, for this type of cancer you want to do a vegetable juice cleanse type of thing where you’re going to be doing mostly vegetables that are raw, as you said? Or conversely with this type of cancer, a ketogenic diet is best. Or are you having people focus just on natural whole foods? How do you get more granular with the diet?

DrPA: Yeah, and it’s almost going to be the same type of answer as our very first question. But in my mind, it’s situational. So, if you have that person that we talked about in the beginning where we’re talking about, when am I more concerned or less about a cancer. I’m concerned about all of them.

But you get that person, they’ve got a high stage aggressive cancer. We often will, and this is based on experience. We will pull out all the stops in that case. So you’ve got a stage 4, the highest stage available, the most aggressive type of cell. And you’ve got pancreatic cancer, or colon cancer. Something like that. We’re going to probably start with a very specific therapeutic diet. And then if you get better, we’re going to work backwards. Away from it.

So in most aggressive cancers, my experience has shown me that going towards a ketogenic diet. Yes, the GBM, the glioblastomas, the brain tumors, they were sort of the original tumor study. But most cancers respond to it. So with very few exceptions, that’s the direction we go with the aggressive cancers.

We’ve also had people where they just sort of stumbled on it themselves. Because you can read anything online. And they said, well, I’ll try it. And it indeed slowed their cancer down, but they weren’t doing any of the other stuff because they didn’t know about it. So we married them together and kind of got them on that.

Now, what I will say, if you’re doing a therapeutic ketogenic diet, it’s a little different than you would do for maybe athletics or losing weight or something else like that. In cancer, it’s a little more like when you use it for epilepsy. Where the person is going to have a ketone meter. Not just urine strips, a ketone meter. They’re going to really be monitoring their levels of ketosis and all that. Because that actually is the medicinal part, the ketones being high in the blood.

So we tend, in those aggressive cancers, it’s like, we’ll argue about the rest of your diet later. But let’s get you in ketosis, see if we can slow this down. We’ll do some other metabolic therapies, and then we’ll go somewhere else. Now, let’s say we got the other end of the spectrum. You’ve got that person, the classic, no evidence of disease, go live a healthy life, and come back when you get cancer. That’s what they’re told by their oncologist. And they leave, and they say, I have no idea what that means.

In those people, depending on where they’re at. If they’re really into it, and they come in and they want to really kickstart their metabolism and all this stuff. What we may do is a short water fast followed by a whole foods clearing. Whole vegetable, usually raw. Whole juices. In this case, by whole juice I mean like a Vitamix or a Blendtec or something where it’s not filtering out the fiber and all the other goodies. And then we’ll work them into kind of what I described earlier. It’s a lot like a Zone diet, but the carbohydrate is highly weighted towards vegetables with a lot of color. So they’re getting maximum nutrient benefit, and maximum flavonoid benefit, which are big immune helpers.

So for prevention, you’ve got a little more, in my mind, you’ve got a little bit more latitude there. So they may not be in ketosis and all this stuff. But every calorie counts. Every macro nutrient, whether it’s a fat, a protein, or a carbohydrate is the best form they can get. It’s going to be a clean form, as clean as we can have in this world. And normally, that’s what we do with people who are in maintenance. A little bit more, it’s still a healthy diet. It’s still a diet that gives you the most nutrients per calorie. But it’s not as, I guess, therapeutic as the stage 4, we’ve got one chance to slow this down, we’re going to put you into ketosis and keep you there for a while.

So diet recommendations, there are none that you and I would consider bad. There’s no donut diets. There’s no ice cream diets. But the aggressiveness of your cancer is where your latitude really comes from.

And just one other thing I would say, because I see this a lot with people. Because a lot of people read about keto online. You really need to work with somebody. If you have cancer and you’re doing keto, you need to work with somebody who is very good at that and good at helping you make dietary choices that are the healthiest keto you can do. Because you can make any diet bad. Keto you can make really less friendly for humans with a lot of stupid choices. So, just a word to the wise.

Treatment That Prevent Stem Cells

DrMR: That all makes a lot of sense. And coming back to our final bucket there. Treatments that can help to mitigate negative effects and/or combat cancer stem cells. Any ones there that are particularly helpful?

DrPA: There are some that are almost universal, as far as cancer type and conventional treatment type. So these are sort of the hub. And then beyond these, there are many things that are this kind of chemo, this is the best thing for it but maybe it doesn’t work for other types of chemo. So there’s a little specificity.

But the things that so far in the research but also just my clinical experience kind of cross all the lines, and they don’t slow down your standard therapy but they protect the normal cells and keep the cancer stem cells calm. The hub there is curcumin, which, orally is just fine for this particular purpose. Oral vitamin C, regardless of what anyone tells you, it’s fine. You can only absorb so much from taking it orally anyway. It is water soluble and you burn through it really fast when you’re under cancer treatment or surgery, etc. So curcumin, oral vitamin C.

The other one that has almost universal safety profile with patients on chemo, radiation, whatever, is melatonin. And people think of it is as a sleeping help. But it’s really being used at higher than sleeping doses. Your sleeping doses are half to 3 mg or something. In cancer it’s going to be given at 5, 10, 20 mg. So it’s a pretty bit bigger dose. So it’s not about sleep. Melatonin actually has 20 different ways that it calms down the cancer stem cells and keeps the normal cells healthy. And it actually has a little feedback into your immune system. So melatonin is another one.

So all of these are available. Vitamin C, curcumin, melatonin. They’re all kind of available over the counter. There are other things. There’s a prescription called low-dose naltrexone that a lot of us use. You hear about it used a lot in autoimmunity. But it turns out, they’ve started to do studies in cancer because some of us have been using it in cancer and believing we see results and stuff. And the studies that they’re starting to do in cancer actually show that it, at low dose, actually has chemo sensitizing benefits but it also has cell protection. So normal cell protection benefits. So we do use a lot of low-dose naltrexone as a prescription item along with people.

So those are the ones that I normally feel like are universally safe. And they’re not going, if someone is really worked about getting in the way of their chemo or radiation, those are all fine.

The other group, and this is a broad group. It’s a place to look. There’s a lot of medicinal mushroom extracts, and medicinal mushrooms, that are, again, broadly safe with any treatment. But the other thing is, they are actually what you would almost consider cancer preventive. So their goal, one of their big goals, they’re immune stimulating but also they keep your normal cells from being recruited by the cancer stem cells, which is a huge thing. We didn’t even used to know that happened. So that’s why mushrooms have always been a big part of it.

So that’s sort of our core. Everything else that you hear used is probably more specific to a type of cancer, like hormonal cancers versus non. Or certain chemo going on and you would or wouldn’t use the other natural therapies, etc.

DrMR: Gotcha. Ok. Boy, there’s a lot here. I feel like we’re just scratching the surface and we’re already about an hour in. And I guess that’s probably why you wrote a book on this. So I guess tell us a little bit more about the book and the title and where people can pick it up if they’re needing more help in this area.

Episode Wrap-Up

DrPA: My colleague, Mark Stangler, who is also a naturopathic physician, and I started to plan to write this book a couple of years ago. Mark and I were in school together, and we’ve practiced in different parts of the country, and hadn’t seen in each other. It turns out we had the same evolution, where cancer patients kept coming, so we had to learn.

So over time, and one reason we wrote the book together is his area of expertise evolved in a very particular set of cancer therapies or cancer treatments in the integrative space. And mine evolved in kind of the other part of that. So we literally made up an outline for the book. I think it’s got 10 or 11 chapters. And we looked, and we said, alright. You know about these 5 and I know about these 5. We start there, and then we traded and added our little tidbits. So you really get a broad base of experience. And I think that that’s important. Because no one person can know everything. So that’s part of how it came about.

The other thing, though, and it’s sort of a hybrid book, which our publisher is Hay House, which is a big publisher. Deepak and all the people that have big names are published by those guys. They don’t normally do books with a lot of references. So we scared them a little bit with the book.

Our goal with the book was to write it to patients and families of people who have cancer. So it’s not written like a textbook. It’s written like me talking to you as a patient. But we referenced it like a textbook. And the reason that we reference it like a textbook is so that if you go to your doctor, and you say, I’d really like to look into mushrooms, or whatever it is. If they say, I don’t know, is there any research on that, or whatever. They can literally go and look at our citations and see for themselves.

We started with that idea. When we were done, the book has almost 1100 citations, which is a lot for a textbook, let alone a book to the public. You have over 1000 scientific citations. So there’s nothing else really like this that is written to patients, but has the back up so their doctor can look stuff up if they’re curious. And also, just gives the patient a little idea. We didn’t just sit down and make this up. This is why we use these things, and what we’ve seen.

And so we go through things, such as causes of cancer. We go through diet. And while we don’t have any unhealthy diet approaches, we do have a broad sort of mention of different diets. Why maybe a Mediterranean approach is good in this stage of breast cancer, or whatever. But we kind of give a broad approach so that you can see and contrast diet interventions.

The same with supplements, oral supplements. We kind of rate them as, these are the ones we use more with breast cancer versus colon versus whatever. And here’s why. And the other thing we brought into it, which I didn’t mention earlier, but has been hugely, hugely, impactful for our cancer patients, is time restricted eating or intermittent fasting.

Dr. Valter Longo and a lot of other people are actually researching this, and now many places hospitals where you would get chemotherapy, they’re actually implementing some of these strategies where they give you a hand out and they say, studies have shown if you fast part of the day before your chemo, the day of your chemo, just drink a lot of water, and then you eat at a certain number of hours after, you have less side effects and the chemo works well. Blah, blah. Same thing with every other natural therapy. And it doesn’t have to be, it’s not this arduous super-long fasting. It’s just intermittent periods where you don’t eat, but you consume water.

So, we have a lot of information about that. And then there’s a lot of newer things, like the cancer stem cell discussion. And the downer side of it is, chemo and radiation make the cancer stem cells stronger. The upper side is, even though regular oncology isn’t ready for it, all these natural things that we’re recommending you do are the only things we know of that can keep the stem cells quiet. And that’s what you want, is quiet stem cells.

It was a labor of 45 or 50 years of clinical experience, and we did reference it, so anyone’s physician can look this stuff up if they want and we’re happy with it. You can get it on Amazon. You can preorder it, or order it depending on when this show comes out. You want to make sure you have Outside the Box Cancer Therapies, because outside the box is common on other books. It has a square orange on the front if you’re looking. And either Anderson or Stangler, one of us is the author. And you’ll find it on Amazon very quickly.

DrMR: Awesome. Sounds like a great resource. And I can appreciate references, and the time it takes to put them together. My book had just under 1000. And I wanted to provide the evidence for people so that if they needed to have a discussion with their doctor, if their doctor called them on something. Or if they are a doctor, and they’re looking to be comfortable in the therapy that they’re recommending, they can see the scientific leg that we have to stand on there. So I commend you for that. It’s a lot of work. But it gives a piece, that further breath of credibility to have those references there. So good on you for that.

DrPA: Thank you.

DrMR: And thank you for taking the time. This has been a great conversation. I really appreciate the balanced approach. I know people are probably inundated with a little bit left wing crazy stuff on the internet. And it’s nice to kind of have a nice reasonable approach on it. So thank you for that.

DrPA: Yeah, that’s always been my goal. So I’ve achieved it, I guess. Thank you very much.

DrMR: Absolutely. Thank you again for being here sir. We’ll talk to you soon.

DrPA: Thank you very much.

What do you think? I would like to hear your thoughts or experience with this.

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