Choosing the best natural therapies to combine safely with conventional treatments can be difficult and is vitally important to get right. Studies estimate that over 80% of people with cancer are using natural and supportive therapies along with their conventional treatments. Integrative oncology allows patients to combine traditional cancer treatments and natural therapies during various stages of treatment. Integrative oncology utilizes lifestyle medicine, evidence based supplements, botanical, and nutritional support to reduce side effects associated with treatment and to optimize response to conventional care. Generally, naturopathic doctors who specialize in integrative oncology believe it’s vital to support the whole person and nourish the whole body while the cancer is being treated or after the cancer has been removed.
Introduction to Integrative Oncology
Natural medicine can support patients in various stages of treatment including before and after surgery, chemotherapy, and radiation. In addition, patients in survivorship following successful cancer treatment can be supported with natural medicine and techniques. Each of these areas requires a specialized approach as the appropriate herb or supplement will vary. Supplements that may not be safe to utilize during chemotherapy may be beneficial once that part of the journey is complete. Ideally, to ensure optimal outcomes, integrative cancer care should be based on evidence and experience. Misleading assertions abound with numerous claims on the internet that a particular substance, diet or approach can cure cancer, and it is essential for patients to discern the healthy, helpful and healing interventions from those that harm.
Surgery: Preparation prior to surgery is essential. Modern protocols, referred to as Enhanced Recovery After Surgery, recognize the importance of proper nutrition, hydration, and activity prior to surgery. Before surgery, it is safest to stop all supplements. After surgery, specific supplements and herbs can help with healing. Zinc and Vitamin C can promote wound healing and are commonly employed.
Chemotherapy: During chemotherapy, some herbs and supplements are safe while others can alter important enzymes in the liver that metabolize chemotherapy and other substances. It is therefore important to avoid treatments that alter this CYP450 system and interfere with chemotherapy. Examples to avoid during chemotherapy include St. John’s Wort, grapefruit, rosemary, alcohol, tobacco and yohimbe. Herbs nonetheless are an essential component of integrative oncology care, and properly selected herbs can be helpful for nausea, fatigue, vomiting, mucositis and peripheral neuropathy.
Survivorship: Naturopathic medicine lends itself very well to survivorship. It is important to remember that once a patient is in remission, the lingering effects of the cancer or therapy should be addressed. Patients often feel depleted and some seek detoxification while others need to focus on balancing hormones especially in the case of hormonal cancers (breast and prostate). Supplements, herbs and homeopathy can help with chronic fatigue, constipation, inflammation, diarrhea, anxiety, and depression.
Naturopathic Medicine Office Visit
An initial visit with a licensed naturopathic physician who specializes in integrative cancer care is typically an hour to an hour and a half. The physician should be a graduate of a 4-year, accredited naturopathic medical school and a licensed provider. During the visit, the patient’s history, including a detailed oncologic and overall health history are discussed. The cancer diagnosis, stage, and treatment plan are reviewed, and importantly, the patient’s health goals are clarified. In addition to assessing the patient’s past medical history, the naturopath and patient will review important determinants of health including sleep, exercise, diet and exposures.
An individualized, holistic plan are developed including nutritional advice as well as recommendations for natural therapies, exercise, herbs and supplements. These plans will change along with the patient’s disease state. As one part of treatment concludes, treatment plans will change accordingly to support and nourish the body during the next stage of treatment. One of the core naturopathic principles is the importance of the doctor’s role as teacher, emphasizing the importance of educating and empowering patients to take control of their health. Counseling and education form a critical part of the visit.
Diets for Cancer Patients
Based on evidence and experience, one of the essential tasks for the integrative oncology provider is to help differentiate fads from helpful advances. This is particularly important in the area of nutrition, where new diets are frequently touted for their possible anti-cancer benefits. Determining the right nutrition plan can be a common challenge.
Recent diets popular with oncology patients include ketogenic, Mediterranean, raw, vegetarian, and alkalinizing. Patients also use fasting and juicing. During cancer therapy, weight loss is common. To combat this, patients may be told to increase calories and de-emphasize the quality of the calories they consume. While cachexia, weakness and weight loss are concerns for some patients, some research suggests that caloric restriction and intermittent fasting can be beneficial. Sorting this out with an experienced provider is essential.
1. Intermittent Fasting: A nutrient rich diet can make a substantial difference in our health especially with regards to cancer. Fresh fruits and vegetables are rich in vitamins, minerals and antioxidants and have cancer protective properties. Some research suggests that intermittent fasting can be beneficial for cancer patients, may prevent or stop the progression of cancer, and improve chemotherapy and radiation outcomes. Fasting is an especially challenging recommendation during chemotherapy, during which patients may be told to consume high calorie meals and snacks. However, research suggests that intermittent fasting may be a better route.
Intermittent fasting lowers insulin-like growth factor 1 (IGF-1) which affects cancer cell proliferation, meaning growth. Healthy cells may thrive from periods of intermittent fasting, but this is not true for cancer cells, which may be left more vulnerable to oncology treatment. When attempting intermittent fasting, research suggests that fasting 13-16 hours between meals has the highest benefit. If one consumes dinner at 7:00 PM, then breakfast and any other food would not be consumed until after 8:00 AM the next morning.
For individuals considering a change in their nutrition and diet regime, the supervision of a qualified professional is advised as caloric restriction and intermittent fasting may not be appropriate for all individuals. Intermittent fasting and caloric restriction would not be recommended for those experiencing cachexia, inability to gain wait, or malnutrition.
2. Ketogenic Diet: The Ketogenic Diet (Keto) originated in the 1920’s as a way to treat epilepsy (seizures) in children. Over the years, it has been proven helpful in weight loss, inflammation, and type 2 diabetes. In the 1950’s, a physician used the Keto Diet for several of his patients with brain cancer with some success. Today, the Keto Diet is being studied for its ability to slow the growth of tumors. The Keto Diet is a high-fat, low protein and low carbohydrate (no sugar) diet. This diet is often confused with the Atkins and Paleo Diet which are both low carbohydrate diets, but they focus more on protein intake whereas the Keto Diet concentrates on high fat. A high fat diet means consuming food like coconut oil, avocado, nuts, and seeds while avoiding sugar, bread, pasta, and rice.
The goal of the Keto Diet is to help the body reach a state of ketosis, meaning the body begins to utilize fat as a source of energy instead of glucose, the sugar that it typically uses. Cells rely on glucose to produce ATP or energy. On a high fat diet, ketones become the source of fuel for healthy cells. It is theorized that cancer cells are not able to efficiently use ketones and may undergo apoptosis (programmed cell death) in the absence of glucose.
Maintaining a state of ketosis can be challenging for some patients as it requires avoiding all carbohydrates and sugar. The Keto Diet has been shown to cause nutritional deficiencies, bone loss, and high cholesterol in some individuals. While the Keto Diet shows great promise, it is not proven to be a cure to cancer by itself and should not be recommended for every patient. As with any major nutrition changes, it is best to see a naturopathic physician or nutritionist.
3. Krill Oil or Fish Oil: Krill Oil is made from krill, small crustaceans, which are a source of food for larger mammals in the ocean. In the last few years, krill oil has been marketed as being superior to fish oil. While both fish oil and krill oil contain EPA and DHA, krill is said to be stronger. Krill oil also contains a natural source of Astaxanthin, a potent antioxidant. Additionally, consumers find that the small capsule of krill oil is easier to swallow.
On the other hand, the scientists are concerned with the over-harvesting of krill and the negative impact on large mammals of the ocean. Also, many feel there is not enough research to support taking krill oil over fish oil. Astaxanthin, the antioxidant krill oil provides, is a supplement that can easily be taken separately if that is of importance.
Opinions abound and the debate over which supplements are strongest, is a common topic that patients ask me about on a regular basis. Typically, the answer to the question of “which supplement is best,” varies depending on the individual, cancer type, treatment protocol, and health goals of the patient.
4. Anti-inflammatory Diets: Inflammation has long been known to play a role in cancer development. In the late 1800’s, a well-known doctor hypothesized that the origin of cancer was at sites of chronic inflammation which he felt enhanced cell proliferation or growth. Today, research has proven that chronic inflammation can damage DNA, produce cytokines that stimulate blood vessels that bring oxygen and nutrients to tumors, and also generate free radicals which further damages DNA. Inflammation can be caused by an infection, such as H. pylori, which is linked to stomach cancer. It can also be caused by chronic inflammatory disease such as pancreatitis or Crohn’s which can lead to pancreatic cancer and colon cancer, respectively. Stress, diet and environmental factors all influence the inflammatory response.
Inflammation can be diminished by exercise, stress reduction and dietary changes. Anti-inflammatory diets, which include antioxidants and supplements like curcumin, CoQ10 and EGCG, decrease inflammatory markers. Avoiding exposures that lead to inflammation, such as xenoestrogen and environmental carcinogens, may lower the risk of developing cancer.
Integrative medicine offers supportive therapies to complement traditional cancer treatment, including surgery, chemotherapy, radiation and survivorship. Nourishing and strengthening the whole body during and after chemotherapy and radiation allows for best possible outcomes. The naturopathic office visit should be a comprehensive and educational visit. It is important to remember that there is rarely a “magic bullet” when it comes to curing cancer, but a comprehensive approach to health, well-being and support are essential to optimizing outcomes and restoring health.
Dr. Jill Kenney is a board certified and licensed Naturopathic Physician at Park Avenue Medical Center and also has a private practice in downtown Fairfield. Dr. Kenney specializes in the integration of naturopathic medicine with oncology care at varying stages of treatment. She works closely with her patients to develop an individualized treatment plan to restore health and vitality. Dr. Kenney can be reached at: 203.418.7657.