Cancer treatment is one of the most heavily researched fields in medicine. Scientists and researchers are constantly seeking better and novel treatments. Daily studies are being published showing new benefits to integrative therapies as well as more effective conventional treatments. At the same time, many diets, supplements and therapies boast unsubstantiated claims. It is a very confusing landscape for patients and their families. As a naturopathic physician, my role in oncology is to help navigate this terrain with patients, helping them find complementary therapies to help their treatment with their oncologist and keep them feeling empowered, in both body and spirit.
Whether it’s the people who have lived their whole life mindful of their heath or people who never really had to consider their body and self-care until a diagnosis, cancer and its treatment can be an overwhelming paradigm shift. For the first time for many people, surgeries and treatments are being done to them, instead of them doing things for themselves. This concept is described as a locus of control, which is the perceived control of one’s life. The driving force in treatment or in a patient’s life often becomes more aggressive treatments; surgery, chemotherapy and radiation. The beauty of involving integrative therapy in cancer care, such as naturopathic medicine, is it continues to help keep the loci of control with the patient. Empowering patients with nutrition, lifestyle, meditation and other nurturing modalities ensures they maintain their power through the process of treating cancer. Why is this important? Having a strong internal locus of control for health has been associated with better outcomes in a myriad of health conditions, including cancer, and also associated with better self-management and quality of life after initial treatment.
Goals of Integrative Treatment
It is important to set expectations of what natural medicine can do for cancer treatment. Often people want to avoid conventional treatment and only do natural treatments. While it’s completely understandable and appealing to only help the body help itself naturally; the benefits and outcomes of conventional treatment need to be appreciated. When cells have gotten to the stage that they are defying the immune system and natural mechanisms of self control are lost, more aggressive treatments can quickly help address these cell changes. That being said, utilizing natural supplements and dietary strategies can dramatically improve outcomes.
Optimize Conventional Treatment and Reduce Side Effects
Surgery, chemotherapy and radiation are the most studied and have the best documented results when it comes to cancer treatment. However, they are not without harsh side effects, long term risks and major concerns for many patients. Naturopathic physicians do not administer these more aggressive treatments, but often advocate for them because of their effectiveness. Using natural supports such as acupuncture, craniosacral therapy, massage, nutrition, vitamins and herbs, the treatments can be more effective at killing cancer cells and with less side effects which often halt treatment. Reducing side effects not only makes treatment more comfortable, but often prevents lasting damage and allows the patient to get on the other side of treatment without delay. Also, cancer cells unfortunately have mechanisms to thwart treatment, but research shows in some cases supplements can downregulate cancer’s defense mechanisms and make the medication more effective. More and more herbal preparations and nutritional supplements are being studied in conjunction with chemotherapy treatments. Offsetting side effects and protecting healthy cells has to be carefully done to not offset the strength and benefit of chemotherapy or radiation. Because there are so many interactions with medications, it is extremely important to discuss all of this with a physician familiar with oncology as well as vitamins and herbs. One study found that up to 75% of people on supplements had interactions with their cancer treatment.
Strengthen The Body: Before, During and After Treatment
One of the best tenants of naturopathic medicine is Vis Medicatrix Naturae or the healing power of nature. The body has the ability to heal itself and be strong. Preparing for surgery can involve reducing inflammation and strengthening tissues and muscles. During treatment, supporting the immune system and the digestive tract can help continue assimilating nutrients and protecting healthy cells. Once in remission, often patients want to detoxify. Detoxification is a process the body does daily, but when looking to “detox” after treatment, it should be about nourishing and nurturing those natural processes in the body. Detox should be about healing the mechanisms of clearing toxins from the body, not purging the body or depriving the body in any way.
Naturopathic and integrative medicine plays an important role in oncology, and it is being recognized more and more by conventional medicine. Because of that, more research and interest in natural supplements and medical diets is evolving. Nutrition and novel applications of nutrients like IV Vitamin C are two treatments on the forefront that we are going to explore.
Updates in Nutrition
Nutrition can be one of the most powerful tools for a patient with cancer. At the same time, nutrition before and after treatment, should be discussed with a physician or nutritionist. Medical diets can vary according to the type of cancer, body composition of the patient and the type of treatment they will be encountering. For example, some cancers are fed by estrogenic foods, and therefore many physicians will have patients avoid things containing soy and plant based estrogens. With other cancers, soy can be very protective!
Cancer cells are highly metabolic and fast growing, and therefore demand a lot of calories. Many people may find they are losing weight easily. Also, some of the medications, including chemotherapy drugs, can affect the GI tract and compromise appetite. Weight loss and weakness also known as cachexia can be a big risk for patients. It can compromise the body’s ability to heal or withstand treatment. Studies have shown that a well-nourished patient has a better treatment response and less side effects from chemotherapy. More than any other dietary plan or objective, nourishing and nurturing the body should be the primary goal. With that consideration in mind, there is a lot of interesting research coming out showing food truly helps the body help itself and enhances treatment.
Two of the most interesting areas of research regarding nutritional approaches to oncology involve cancer cell metabolism and glucose. Sugars and glucose play a key role in cancer cell metabolism because they need so much fuel. Specific medical diets offer insights on how to downregulate cancer by decreasing cancer’s fuel source.
Ketogenic diet
First introduced to popular culture as the “Atkin’s diet”, a ketogenic diet offers many potential health benefits from weight loss to neurological benefits to cancer protection. The diet is essentially high fat, moderate protein and low carbohydrate. By eating this way, the body switches to a different fuel source than glucose, making ketone bodies.
Cancer cells produce energy at a high rate through glycolysis. Molecular models have been found to show that high levels of glucose are associated with cancer growth while depriving cancer cells of glucose leads to apoptosis. Tumor cells lack the metabolic flexibility of healthy cells and are therefore fundamentally dependent on glucose for fuel. The ketogenic diet provides a promising therapeutic avenue to improve outcomes by selectively enhancing healthy cell function and obstructing cancer cell growth. Additional animal studies have shown that ketogenic diets reduce tumor growth and improve survival in malignant glioma, colon cancer, gastric cancer, and prostate cancer.
Although more research is needed regarding the full mechanism by which the ketogenic diet provides anticancer effects, results of studies to date have demonstrated the safety and prospective efficacy of consuming a ketogenic diet in combination with radio-chemo-therapy to improve responses in various cancer models.
Intermittent Fasting
Intermittent fasting is a medical dietary plan that essentially restricts the amount of time between eating. Currently a popular and effective approach to weight loss when combined with calorie restriction, this diet can be used for many other health conditions without risk of losing weight or not having enough calories. Restricting the window in which you eat and allowing the body to have more time without having to put energy toward digestion is one of the main approaches. Essentially the thing everyone was told in nutrition is now the opposite. It may be better to skip breakfast!
For cancer patients, fasting offers an exciting potential. Chronic caloric restriction is challenging to practice for patients with cancer. Intermittent fasting, however, may be more suitable. Intermittent fasting has been shown to enhance treatment with both chemotherapy and radiation therapy. Fasting for periods of time can have a positive effect on our cells. By not eating for a certain interval, healthy cells slow their metabolism and enter a repair and “hibernation” mode until fed again. This decreases the risk of any toxic effects that can come with chemotherapy and radiation therapy. Research has found that starvation-dependent stress by means of a fasting-based intervention is capable of differentially protecting normal versus cancer cells against high-dose chemotherapy in cell culture.
A more recent study found that fasting could slow the growth of tumor cells to improve the effectiveness of chemotherapy. There is even evidence that fasting after chemotherapy can help to reduce the risk of DNA damage from the treatment itself. Therefore, cancer cells might become more sensitive to chemotherapy treatment while engaging in intervals of fasting. In a few small-scale case studies, fasting was well-tolerated and associated with a self-reported reduction in multiple chemotherapy-induced side effects. Due to these findings, researchers have concluded that fasting cycles in combination with chemotherapy could extend the survival of cancer patients by both retarding tumor progression and reducing adverse effects.
Updates in IV Nutrients
Intravenous (IV) Vitamin C (ascorbic acid) has been gaining popularity in the oncology world. Vitamin C for cancer care was first documented by Ewan Cameron and Allan Campbell in the 1970s. Their work got the attention of Nobel Prize- winning Linus Pauling who further expanded the use and popularity of vitamin C in cancer care. Initial studies were on oral doses of vitamin C, however, blood concentrations achieved were less than 300 µM, not enough to be considered a pharmacologic dose. Compared to blood concentrations upwards of 20 mM achieved via IV administration. Additionally, due to bowel tolerance (diarrhea) side effects of oral vitamin C dosing, intravenous vitamin C is a preferred route. Several studies have shown that when plasma concentrations of ascorbic acid are at pharmacological dose (0.1-100 mM) cell division decreases in a variety of cancer cells, specifically, in prostate, pancreatic, liver, colon, certain lung cancers and nervous system cancers.
Studies show combination of Vitamin C with other antioxidants like N-Acetylcysteine, improve the antitumor effect by reducing VEGF, vascular endothelial growth factor, a polypeptide that increases the development of new blood vessels to areas of rapidly dividing cells. A trial evaluating the combination of IV vitamin C and chemotherapy agents carboplatin and paclitaxel included twenty seven women with advanced stage ovarian cancer. (Stage 3 and 4). The patients were randomly divided into two groups, one to receive chemotherapy alone and the other chemotherapy with IV vitamin C. Chemotherapy was given for 6 months at same intervals for both groups. IV vitamin C was given for a total of 12 months. Results revealed a reduction in toxic side effects in the patients who additionally received IV Vitamin C. IV vitamin C was shown to improve quality of life during chemo and or radiation therapy in breast cancer patients. IV vitamin C used as solo therapy in terminal cancer improved quality of life and reduced cancer-related side effects.
IV vitamin C is a very tolerated treatment with limited side effects. Research has shown vitamin C can be safely used in pharmacological doses in individuals with normal kidney function. Those with kidney disease or compromise or who have the inherited disorder known as G6PD deficiency would not be candidates for IV vitamin C therapy due to risk of toxicity. Vitamin C can increase the absorption of iron and would not be recommended for those with iron storage disorders like hemochromatosis. Humans along with guinea pigs and fruit bats are the only primates that do not synthesize their own vitamin C, meaning it must be obtained through the diet or supplement, making it very well tolerated.
It should be noted that not all studies reveal benefit with the use of IV vitamin C and chemotherapy. Research is being done to determine the types of cancers and chemotherapeutic agents that work best with IV vitamin C.
Oral vitamin C dosing can impart health benefits including improved iron absorption and immune support, however, doses achieved orally are only physiological, not pharmaceutical level. The studies referred to above are looking at pharmaceutical dosing of vitamin C only achieved via IV administration. The National Cancer Institute in addition to many other research groups support ongoing trials for integrative and complimentary therapies including IV vitamin C and are enrolling patients on a continual basis. If you would like to read more information you can visit the NCI website for more details.
Finding Empowerment
The terrain can be overwhelming and initially the landscape feels foreign and terrifying, but once someone finds their footing and creates their team, the journey can become empowering, especially with all the tools integrative medicine has to offer. Physicians and researchers are committed to finding novel and more effective ways daily. Every new study offers promise of more treatment options, more cures and more health and balance beyond the battle. Dietary support and new approaches with natural therapies are being better studied as we speak. Setting up for success with cancer treatment means finding a team, finding a plan, supporting the body, mind and spirit through that plan with nutrition, integrative medicine and family support.
Dr. Lauren Young is clinical director and a naturopathic physician at Collaborative Natural Health Partners, an integrative clinic committed to excellence in primary care and naturopathic medicine. Dr. Young has personally worked with hundreds of patients through their cancer treatment and would like to dedicate this article to all those patients who have inspired her to be more empowered and brave. To learn more about Collaborative Natural Health Partners in Manchester, CT please visit: ctnaturalhealth.com or call (860)533-0179.