Strength Training: Improving Quality of Life with Cancer

Strength Training and Cancer Outcomes

How does that transition over into cancer? Like, when did you make a shift?

DrTI:     When I was at Penn State, we were a world leader in publishing research on basically getting stronger. And at some point, the United States Army was faced with a serious dilemma. They have these engineers that calculate one or two people should be able to lift something in a wartime situation. But if you need two, three, or four people to lift that object, you have more people lifting. They should be doing other things, so it’s not a good use of the labor.

They were seeing a consequence if you’re not strong. And their concern was that the women were not as strong as the men. So they basically hired Penn State to study how to take average women and make them stronger than average men.

And this was in the 80s. Back then the challenge was that from a sociocultural climate, it was still an age where women shouldn’t work out, women shouldn’t sweat. There was still this whole taboo like, “If you lift weights, it’s going to turn into fat eventually. So don’t even bother doing it. It’ll make your muscles imbalance.”

So we came out at the time and said, “We’re going to do a strength training study for women.” It was a bit like we were somehow quacks. And we’re just talking about working out, right?” There’s nothing that strange.

DrMR:   Right.

DrTI:     We were quacks because we were doing something that might actually be healthy. Well, six months later, we showed you can take average women and get them stronger than average men. And all of a sudden now, everybody’s like, “You guys are geniuses. How did you know?” It’s like, “We didn’t know the answers. That’s why we’re doing this study. But we weren’t afraid to look into it and study it because it seemed potentially promising.”

From there, it led to us studying the effects of strength training on men and women over the age of 90. This is just lifting weights alone, this is no nutrition or diet, or supplement modifications at all. So, we were still way down on the ladder of the learning curve, if you will.

We found that if we added three pounds of lean body mass to older adults—these are men or women over 90 that were in a wheelchair or had a quad cane, not because they had a spinal cord injury or neurological issue, primarily, they were just frail, they just didn’t have enough muscle to move their body—as we started getting these guys stronger, lo and behold, we had people coming off like 26 medications and not needing any meds at all. And they could now walk outside without a walking device or an assistive device. They’d needed care, nursing assistance, to go to the bathroom.

So it was a similar thing at the beginning of the study, everybody said, “Look, you can’t have old people lift weights, because they’re going to get hurt!” And then were like, “How do you get them stronger if they don’t do anything?” And it wasn’t like we’re taking a guy and throwing a thousand pounds on his back in a weight room. These people are lifting like one to three pounds, because that’s all they could lift at that point. But we got them to 10 and 20 pounds, and that was enough to strengthen their arms and legs so that they could walk better. And the surprise finding was how many meds they didn’t need once they were stronger. That created some controversy, because we’re basically showing, through exercise, you don’t need drugs.

And that wasn’t really the purpose of the study. But imagine if it was your dad and he was on 26 meds, and all of a sudden he’s not on any, you’re going to be telling the world you don’t need drugs, that kind of thing. And then that led to strength training with all kinds of very serious illnesses, including stage four cancers. And the point that was really exciting is we got to see firsthand that there’s a common mistake made in medicine, that when someone is diagnosed with any condition or illness or syndrome, as their health declines, everybody assumes it’s due to the disease, let’s say, or the disease process. But they never take into account that the person’s not moving.

You can take the strongest athlete in the world, and when he gets injured and doesn’t move for a few days, he loses some muscle within three days. It’s substantial. Like, you can see a difference. So if a very fit, strong person can lose fitness, if you will, that quickly, what would happen to someone that’s very frail and diseased, or is dealing with a lot of health issues?

And we started seeing that we could do strength training with pretty much anyone and counter a lot of the loss of function that was basically associated with the disease, but really wasn’t. People just throw everything into one box. And we were saying, “No, there’s other stuff going on besides the disease process.” So we had men and women with stage four cancers out, dancing, food shopping. They could bathe and do the activities of daily living on their own without a care nurse assistant. And if you ask any family member that was involved with the people that were studied, they’d say it dramatically improved quality of life for their loved ones.

But unfortunately, if you look at, let’s say, mortality rates or survival statistics, however you want to phrase it, not everybody lived longer. And so the FDA’s position was that the only outcome measure of concern was, do you live longer? In other words, “Does strength training help these guys live longer?” On average, it did not, at least at that point in time. So what was ignored though was quality of life improvements. Because yes, some guys were alive, let’s say, in other groups. The group that didn’t lift weights were laying in a hospital bed, hooked up to a morphine drip, and they couldn’t recognize their loved ones while they were drooling on themselves. And if you were to interview people and say, “Hey, when you pass on from this life, how do you want to go down?” no one says, “Yeah, I want to drool on myself and I want to look at my wife and not remember her.” No one says that.

So there’s a total loss of connection of how we value life, and how we want to pass on, versus where research statistics say, “Oh, they all live to the same age or they all live to the same point in time.” So that’s how we got into the cancer world if you will. I started seeing all these people that were just, I thought, getting really poor quality care, they were getting drugs and radiation and nothing else. I was like, “Oh my God, there is so much more that can be done.”

So I sort of built the super friends team over here. I got a bunch of guys that are very accomplished in their own right in different areas, and we started talking. I’m like, “Look, man, I think we could do something. I think we could make some serious impact.” And they were like, “We could do it right now. I don’t think we have to wait.” They all agreed and things slowly started forming. Today we’ve got a center in Scottsdale. And every day we’re doing some really cool stuff.

DrMR:   And at the center in Scottsdale, the focus is cancer prevention, cancer treatment, or are you seeing wider breadth of conditions also?

DrTI:     A wider breadth. So in a given day, I could have an Olympian, an NFL guy, a guy with spinal cord injury in a wheelchair, and someone with some very rare type of cancer that can barely stand. And there are principles of fitness and health that are consistent, across, let’s say, the disease or fitness spectrum, which is modified or manipulated based on where someone’s current status is or their starting point is.

It’s so different. If you want to run a marathon, you don’t start at 26 miles. You might work up to that over time. And it’s no different than what we do. We start people at an appropriate level and then we build them up from there.

A Bio-Individual Cancer Approach

DrMR:   And so, tell us more about the bio-individualized approach to cancer that you’re taking.

DrTI:     So let’s say, someone comes in and like, “Hey, I got this cancer and I want to beat it.” Most people make some false assumptions. They assume basic things that they read on the internet and they don’t really have data on their own body. They may have blood work done from other places, but the blood work is telling you, “Hey, you’re alive.” It doesn’t really give you any real details to make a better decision. You already knew you were alive. You don’t need me to tell you that. You don’t need me to tell you things you couldn’t figure out on your own.

So essentially, our algorithm is we look at their nutritional status and if someone has three or more micronutrients at the low end, we might say that fits malnutrition. Then we’d go on a path where we might do an IV, or foods, or supplements or a combination of all three. That builds up the nutritional status so they’re basically not low in those things.

During that time we’re focusing on adding muscle. That can take maybe two weeks to two months, depending on frail they are and how long it takes them to get to a minimal fitness level. Minimal fitness level would be to be able to walk two minutes or further without stopping. It’s not a high bar, for sure, but believe it or not, many people cannot do that.

So, assuming, then, that’s addressed, then we would look at strategies to fight their cancer. If, let’s say, we run some tests and they look really good, there are no issues nutritionally, then we would look at some ways to fight the cancer. And depending on the type of cancer, there may or may not be chemo, or may or may not be radiation. We do not do radiation or full-blown chemo here. But if someone comes in, based on the data for their type of cancer, we might advise them, “Look, there’s actual evidence that chemo may benefit you. And we would suggest doing that. And here’s ways that we can mitigate those side effects.” And then we might have other cases like, “Hey, we’ve treated this quite successfully many times without any chemo radiation.”

Then, we give people the opportunity to make a decision which way they want to go. On our website, there are examples of people that have done no chemo and no radiation, and they got to “no evidence of disease” successfully and continue to remain that way. There are also people that have done full-dose chemo and full-dose radiation, got to “no evidence of disease” and continue to remain that way. The commonality across the different ends of the spectrum is that we’re running tests on these guys to see what’s going on that’s unique about each person, and whatever we find we address.

So they may come here to, let’s say, help beat cancer, or address issues they have orthopedically. Their knee pain is going to be treated, any issues with the brain and body awareness or control is addressed, if they have high blood pressure, heart issues, we address that too. It’s not so much treating cancer specifically as it is really helping this person get healthier than they ever imagined.

And the result is, people tend to want to keep coming back and bringing family members. So we’ve now treated four or five generations of some families. We have just things like a guy comes in and he can’t move, because his knee hurts. Just treating cancer and ignoring the knee pain, essentially, is not a good long-term outcome because he’s not going to be able to move when you’re done. Basically, we’re going to make sure that his knees don’t bother him so he can run or lift weights, whatever he wants to do, and then we’re helping him to embrace a healthy lifestyle that involves movement.

DrMR:   So is it fair to say that the foundation of what you’re doing is this personalized health and wellness plan? And in addition to that, you make some cancer therapy recommendations, but those don’t appear to be the main focus. The main focus seems to be getting the individual healthy as the foundational part. And then in addition, on top of that foundation, is to some extent, our specific cancer therapies? Would that be a kind of correct, loose way of describing this?

DrTI:     Yeah, it would. I’ll give you an example. We test a lot of bacteria or what we call the oral microbiome. And we found all kinds of organisms that people have, that have been connected to different cancers of the mouth or esophagus or the stomach or the large intestine or colon. I can’t say, “Hey, that bacteria caused that cancer,” because I didn’t see it form and happen. All I know is, at this point, this person has this cancer diagnosis and they got all these bad guys in their body. So from a causative relationship, I can’t say one caused the other, but I do know having those bad guys isn’t helping the person in front of me.

So we do strategies, we developed protocols to kill off the bacteria, and then the people respond better to the treatment programs they’re doing for their cancer. So I look at this as a much more complete, integrated approach than anything I’ve seen anywhere else. People that come here typically say, no one’s said this, paid this attention, given this level of detail to their body.

DrMR:   Mm-hmm.

DrTI:     And we try to fix everything we find.

Micronutrient Testing & Analysis

DrMR:   And how are you assessing the nutritional status?

DrTI:     So we run tests using serum markers, leukocytes or white blood cells, red blood cells and lymphocytes, and also whole blood. I think of it as, if we check the air pressure in a tire, you don’t just check one tire and say every other tire in the automobile is fine. You check each individual tire. They’re not all connected, in terms of one pressure doesn’t mean the other pressure is good or bad.

When you look at micronutrient status of people, just because there’s enough in a serum of the plasma, that just means, okay, there was absorption. But it doesn’t tell you utilization. And then just because it’s in a red blood cell, it doesn’t mean it got inside a white blood cell. And then just because your white blood cell on average has adequate status, it doesn’t mean your lymphocyte status is adequate.

In most diseases, the primary cell we’re concerned with is lymphocytes, to either deal with a virus or bacteria or cancer cell. So all these different subcomponents of our body matter. There are groups out of Sweden that have shown that red blood cell status correlates very nicely with the brain, heart, and skeletal muscle. No one’s going to really give up parts of their body, right? So if I could do a blood draw and get some correlation with these other areas in a less invasive way, it’s just a much more reasonable approach.

And a lot of times people say, “Well, how much does this stuff cost? Is it covered by insurance?” Insurance is not designed for optimal biology. Insurance is a better fit when there’s something major. But if you said, “Look, I want to get 10% better,” it’s really not a good fit. If you say, “Look, I’m tired of suffering. I want to find out what’s going on and fix it,” insurance is not a good fit.

So what I’ve done to make things cost-effective is negotiated with these labs to do these giant arrays, meaning we take small amounts of blood from individuals, send it to the lab, and we run every single test they offer. And we get that done at a price point that’s better than anyone else in the world has been able to offer to people. So now we’re saving them thousands and thousands of dollars, and giving them insight they’ve never had on their body before. Now we make it so that it’s sustainable. They may not have to repeat the same testing again. But if they did, they could afford it now. It’s not something that becomes cost-prohibitive to the masses.

DrMR:   Now, is there a certain nutrient as one example, let’s say, arbitrarily, iron? Are you looking at one of these tests to be more representative of iron status? Let’s say, lymphocytic iron. So, you’ve run a whole blood, you’ve run red blood cell, you’ve run white blood cell, and you’ve run lymphocytes. Are you looking for agreement amongst all the measures to give you the best indicator that there’s a certain deficiency in and of itself? Or do you have some data you’re looking to where certain nutrients are best represented by a certain part of the panel that you’re running?

DrTI:     So it’s a very insightful question. Let me answer that two ways. So, if I was looking at, let’s say, the published research, there are fairly clear guidelines that would say, whole blood measurement for a certain marker is better than a serum or plasma measurement. Or maybe a red blood cell test is better than a white blood cell, a leukocyte test. If the goal was just to find the best marker within all these, my vitamins and minerals, that would be one approach. I have a slightly different perspective though. I’m looking to find that every marker shows signs of adequate nutritional status. And the reason is, we know that when there are certain types of inflammation or certain pathways are elevated, there’s some dysfunction of nutrient uptake by different cells.

So an example would be, let’s just say, serum or plasma levels were normal to high, but intracellular levels are low. That means it’s getting into the system. But once it’s in the blood, it’s not getting into the cell. That may indicate that there’s some elevation of cytokines or there’s something else interfering with utilization of the nutrients. And that’s being paired up with, if the guy says, “Man, I’m tired all the time,” and I’m seeing all these nutrient markers involved in making ATP are low, one supports the other. Then we’re trying to figure out, “Well, how are we going to get those nutrients into the cells so they don’t feel tired all the time?”

So I’m looking to get improvements across every measure that we make for a given nutrient. You mentioned iron. If there was some dysfunction with iron metabolism, such that we think there’s an inflammatory event, like an infection, or something the other way like anemia, we have other tests, looking at other markers like ferritin and RBCs and hemoglobin, etc. Then we’ll be able to say, “Hey, there’s something going on here,” and then address it that way.

DrMR:   I see that as being one of the challenges, because cause and effect here can be hard to tease out. In some cases it would seem reasonable to conclude that a low value or even a high value on a certain nutrient mineral, what have you, might be causal of something like fatigue. And then there’s other cases where, let’s say, it’s ferritin in the iron family that could skew high as a result of an infection, and the infection is causing the fatigue, not so much so the high ferritin.

Does this get challenging? I’m assuming there’s quite a bit of context and nuance here in the interpretation and that this gets a little messy. But how are you navigating this without feeling like you’re guessing a lot?

DrTI:     Well, there are a couple of things. One, a mistake a lot of times that’s made is people look at a study, and let’s just say the study shows iron fights anemia. So now they’re looking for this iron. Then some guys may look into methods and the exact form of iron, was it iron bisglycinate or some other form? But then, in reality, people take iron and they don’t feel any different at all. It’s very similar to, let’s say, a car engine needs oil. But at this moment right now, if I said, “Hey everybody, go put oil in your car,” not everybody’s car engine needs oil, right? So we need to have some way of objectively measuring what’s there, then deciding, “I need oil,” or not.

So what I try to focus on is objective measurement. And I can’t tell you causatively that the fact that iron was, say, low or high, is linked to a given symptom that someone is experiencing. But I just notice something wrong, and exactly what’s causing that… When you’re dealing with human life, the focus isn’t to ignore that it’s a human being in front of you and treat them like a research subject or a number. The focus is to really make sure that we get the outcome we want. The outcome is that we want this guy to live. So as we get from, they walk to the door, to the end, where they’re doing better than ever, I can’t say everything perfectly lines up neatly and all that. I think there’s still a lot of art, maybe more art than science sometimes.

I see details, like when people like their physician, they’re more than likely to get better than when they don’t like their physician, independent of the competency of the physician. So we’ve got details like that that we try to make sure of here. People have fun and have a good time, people are laughing and smiling. You don’t see a lot of people crying hardly ever. You don’t see any sorrow, that kind of thing. It’s a much different type of environment. A lot of docs wear white lab coats, as an example. They don’t look like normal people. You wouldn’t even know most of us are doctors. We’re here to help you and be more like your partner in health, not talking down to you.

DrMR:   I agree. The community effect, I think, has been shown to be quite powerful in terms of people’s health recovery.

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Don’t Believe Everything on the Internet

DrTI:     Yeah. I’ll share some insight. If you asked me to look at everything we do, and say what’s the biggest weakness that would make the biggest impact, the biggest thing I see over and over again, is that people read stuff on the internet, and they suffer from a visual bias effect. They think that they’re going to get competent medical advice from the internet and they don’t take into account that the algorithms that determine what shows up in front of them are driven by business models. They’re not driven by optimal biology.

Typically what happens is, someone has some symptoms. They see maybe a family med doc or urologist and they run some tests and now, “Hey, we got prostate cancer.” There’s a little bit of disbelief and a little bit of, “What the heck is going on? I was healthy my whole life, and now all of a sudden…” so they may go on Google or Bing or some other search engine and put in prostate cancer. The next thing is prostate cancer treatment, and they start reading stuff. And now they become convinced that this treatment will help them, and it never occurs to them that they’re a unique human being.

We have really good data now. We use a lab called NA Genomics that does a full exome analysis and we have other labs that do full genome analysis. But what NA Genomics does is they have really bright guys from Harvard, Stanford, MIT, and all these other places where they’re just going crazy over data mining, and they test every single gene in germline genetics.

We can show that every person that we’ve ever tested—we’ve tested over a hundred thousand people, but not every person has done all 22,000 of their germline genetics genes—has genes that are so unique, meaning that mutation has been seen in less than one out of a million people, maybe even less. Now you’ve got a number of combinations of those, less than one out of a million genes.

What that means is that there are no data really on how this human being will respond to something. The mistake people make is that they read something that was done on other people, they see the result, and they’re convinced that that will help them. But it never occurs to them that it may not help them at all, because there may be something very unique, either within their genetics or some other, let’s say, post-genetic issue that makes it so that that treatment will never work.

So the way that people can navigate very dark or murky water, if you will, is you have a competent physician or competent medical care where someone’s going to study your reaction or your response to whatever treatment is being done. So, let’s say, if it was a blood cancer, there are signs the leukemic cells are going down. It’s literally that straight-forward. If it’s a solid tumor, it may take more time, especially if it’s a slower tumor. It may take time to see a change, but you know, PET scans or something along those lines, so that you could see the concerned area changing over time. That’s how you could really create individualized protocol for anyone, even when there is allegedly no cure. Or some other, what I would say, common statement that we don’t know applies to every person.

So we think about their statements about, “Cancer has no cure,” like “a Glioblastoma has no cure.” And lo and behold, we have a bunch of patients who are diagnosed with Glioblastoma and are alive and well today. Could we say we cured them? Well, they’re still alive. They haven’t died yet. So I don’t know, until they get to the end of their life span and see what happens. Just because there’s no cure, doesn’t mean there’s nothing that will work. But then, what works for one individual may not work for another person.