Cancer Fighting Nutrition

Anti-cancer foods more powerful than previously thought!

Anti-Cancer Plant Based DietWhen it comes to nutrition and cancer there is a lot of information out there, much of which is bogus.  What does science say about the best diets to beat cancer?

The Mediterranean Diet has been the league-leading giant when it comes to published articles supporting health benefits, including reduction in death from all causes. However, this is a broad region of the world and it is hard to pin the benefit on specific foods in the Mediterranean Diet.  Or is it?

A whole food plant-based diet may be the answer in terms of what foods are the most anti-cancer.  There are a lot of similarities with the Mediterranean Diet, minus the animal fat and proteins. One can argue about legumes, lectins and other innuendos in a vegan or vegetarian diet but in the end the benefits of simply thinking “plant-based” handily overwhelm the objections.

Dr. Greger of NutritionFacts.org compiles a lot of information and presents it in a way that is very understandable and impactful.  Enjoy the video below.  Most if not all viewpoints are shared by me, as an integrative oncologist who perhaps digs a little deeper while looking at anti-cancer impact of food vs. the overall health benefits of eating a wholesome diet. There are a lot of great pearls in this video and suggest strongly that eating a plant-based diet strongly supports how not to die from cancer.

If nothing else, this video should have opened your eyes about how much the standard American diet (SAD) is so very bad for you.  Just as it is now becoming accepted that sitting is the new smoking (*hint: strong suggestion that exercise is important too), eating chicken wings and processed foods can be similar to lighting up cigarettes as well.  These are the basics folks.  There is much more to this story and we will continue to cover it.

vitamin d cancerWe have known for quite a while that Vitamin D is a potent pro-hormone in the body, responsible for many beneficial effects. One of these effects is cancer prevention. Furthermore, the developing science is that it can prevent RECURRENCE also! The best plan is to maintain Vitamin D levels before any cancer is evident, but new research shows that higher levels achieved as soon as possible in the disease process can improve prognosis in the fight against cancer.

Here is a backgrounder video which you should pay very careful attention to. It covers soup to nuts about Vitamin D in terms of disease prevention as well as cancer per se. Following this, we will get into the newer research studies which demonstrate that higher Vitamin D in the blood and tissues improve cancer prognosis.

Vitamin D and Cancer-New Information!

Get our free email newsletter at: http://www.ihealthtube.com/content/newsletter Recent studies are showing the benefit of vitamin D levels and a couple of the most common cancers. Learn more about the connection! Also, learn about a food that's been found to dramatically lower blood glucose levels!

 

We now know that the original Institute of Medicine and RDA recommendations of Vitamin D supplementation were kind of low. The concept was that “you can get this from the sun”. The problem is that up to one third of individuals living in the sun belt are still deficient. Why? Well, to some extent the prudent use of sunscreen, to avoid skin cancer and mainly the deadly melanoma, cuts out about 95% of skin production of Vitamin D. Imagine what this is in the “non-sun belt” regions of the world. Supplementation appears critical.

What level is ideal? This is not clear but if one can get to a blood level of 35-40ng/mL (90-100nmol/L) the cancer prevention is about 35%. So, to some extent more is better and some advocate getting to 50ng/mL or more. For the short term, especially when fighting cancer, this may be OK. However, there is also some scientific evidence that very high levels over a prolonged time period can actually CAUSE cancer. So, some caution is warranted.

New research from the Institutes of Natural Sciences at the Shanghai Institutes for Biological Sciences in China showed that every 10 nmol/L increase in blood concentration of Vitamin D were linked to a 4% improvement in cancer survival. In a second study in prostate cancer patients, lower Vitamin D levels at diagnosis were associated with a much more aggressive variant of disease. In fact it is felt that lower Vitamin D in prostate cancer can be a biomarker in that disease. This finding was real was after adjusting the statistics for other risk factors like smoking, family history, diet and calcium intake. In other words, it was a very real association and likely a cause effect mediator in some way. This could be the case for other cancers as well, but not clear yet.

The very best plan is prevention. Second best plan is pump those Vitamin D levels up if you have been diagnosed with cancer. The association with prognosis is not totally clear, but it appears very positive and the risks are very low. The best approach is to get your blood tested for Vitamin D. After that it becomes obvious how much is required to increase your circulating levels of Vitamin D.

Here is a rough estimate of what would be required to raise a level over a few months:
200 IU (5 mcg) per day increases vitamin D blood levels 2 ng/ml (5 nmol/L).
400 IU (10 mcg) per day increases vitamin D blood levels 4 ng/ml (10 nmol/L).
500 IU (12.5 mcg) per day increases vitamin D blood levels 5 ng/ml (12.5 nmol/L).
800 IU (20 mcg) per day increases vitamin D blood levels 8 ng/ml (20 nmol/L).
1000 IU (25 mcg) per day increases vitamin D blood levels 10 ng/ml (25 nmol/L).
2000 IU (50 mcg) per day increases vitamin D blood levels 20 ng/ml (50 nmol/L).

On average I tell patients they should be consuming about 1000-2000IU per day unless they were severely deficient to start.  However, the main point is that the dose should be adjusted based on the lab levels.  Vitamin D can be metabolized differently and consumed variably in any given individual, so it takes careful adjustment rather than randomly adjusting the dose too high or too quickly.

Li M et al Reivew: The impacts of Circulating 25-hydroxyvitmain D levels in cancer patient outcomes: a systematic review and meta-analysis J Clin Endocrinol Metab doi:1012 10/jc.2013-4320
Murphy AB et al Vitamin D deficiency predicts prostate biopsy outcomes Clin Cancer Res. 2104;20(9):2289-2299

Integrative Oncology as a concept which highlights the complementary benefits and divorces the fallacies of “alternative” cancer treatment is getting more exposure and gaining momentum within mainstream oncologic societies. This is critical so that oncologists within mainstream medicine gain appreciation for what can be done to improve cancer patients’ journeys through therapy.

Cancer treatment can often be brutal in terms of side effects and quality of life reduction. We are getting better and moving closer to “kinder gentler” personalized biological therapies, but that day is not here yet. Meanwhile, we can still focus more on the whole patient than is the current practice in most settings. Here is an excerpt from a recent American Society of Clinical Oncology (ASCO) meeting.

I invite you to consider the following and read the source article on the ASCO website. This next quote sums up the huge impact of a system gone astray, partly because patients have had no one to turn to with respect to improving their well being as much as possible during and after cancer treatment:

“So-called alternative therapies are costly and harmful and, most importantly, they do not work and they create problems of their own,” she said. “Quackery, and people who push it, often use the term integrative medicine deliberately to confuse patients, and they do a good job of this because in the United States we spend over $40 billion a year on quack cancer products.”

The point is that the term “alternative” has much more of a connotation of “shady” or “quackery” than adding beneficial aspects to cancer care. There ARE hidden gems of “alternative” treatments which are either undergoing research trials or at least plausible to consider in the absence of clear harm. But unfortunately, the term has been irrevocably poisoned when used indiscriminately.

The following short video is from UCSF Cancer Center about rational, complementary and integrative medicine:

Integrative Gynecologic Oncology is a subset of Integrative Oncology and focuses on the best complementary and natural support for women undergoing mainstream cancer therapy for gynecologic cancers. As such there are some specific modalities, including hormonal issues that are not part of treatment decision-making for all cancer patients. The key point however, is that this is an evolving field which is taking back the full spectrum of care that every cancer patient deserves. Specifically, as the ASCO presentation highlights, the focus is on scientifically proven or plausible modalities and not on what is known as “woo” or “pseudo-science”. This is not, and never should have been, an alternative to optimal integrative oncology care.

When facing a potentially deadly disease like cancer it is perfectly normal to seek out all “alternatives” and options. Ideally, your doctors, which hopefully includes a well trained oncologist, should be able to fill you in on what works and the best possible treatments. But can they or do they keep things from you?

Alternative Cancer Cures?

When you hear the word cancer associated with your name or that of a loved one, the lights go out for a while and an ocean of confusion swirls around your head. Is this it….the end? Is there a cure? What are my chances?

The answers often go in one ear and out the other. In addition the answers are confusing and complicated. The treatments sound rather harsh (i.e. major surgery, radiation, chemotherapy) and the side effects do not seem pleasant, or even acceptable. You get the feeling that your options are actually limited and you are being forced into a corner with uncertain outcomes on the other side. You may agree or reluctantly proceed because you feel that you have no choice. After it’s over, the treatment may in fact have been much easier to tolerate than you imagined or it may have been an unholy terror and massively unpleasant experience. Everyone is quite different, and the truth for most is most commonly in between. Mainstream medicine is moving steadily and quickly towards targeted personalized cancer therapies and advances are accelerating. But what about the here and now while you are being treated? Either at the beginning of treatment or after the initial therapy is over and there is a recurrence, where the whole gut-wrenching scenario starts to play out again, you can’t help but wonder if you were told everything and maybe there was a kinder gentler alternative with better outcomes that was kept from you.  Are there actually alternative cancer cures? You may have seen a book, or received an email or heard from a relative that mainstream medicine and your doctor as just part of the “Cancer Industry” and that there are indeed secret cures that “they” are not telling you about (whoever “they” are). The email you may have received goes so far as to say that these “lies” by your doctors are just so they can keep feeding “Big Pharma”, getting kickbacks and keeping the whole sweet deal rolling to pay for garages full of Ferraris. They claim that there are indeed “alternative” cancer cures that are being held back from you, that you are getting the raw end of the deal and that the “War on Cancer” is a failure and big joke. In the end you will draw your own conclusions no matter what I say here. However, consider this. For the above scenario to be an international reality, literally millions of doctors, scientists, lab assistants, nurses, around the planet would have to be in cahoots. Furthermore, socialist, communist and capitalist countries would all have to collaborate to “keep the cancer cures from you”, not just the FDA. There are of course potential perverse incentives in the profit model that Big Pharma works under, but they can’t keep this conspiracy of this magnitude alive alone. Furthermore, thousands upon thousands of international scientific articles come out every year looking at what works, what does not, what needs to be explored further and what can hurt you. These include mainstream clinical trials as well as tons of basic science studies, many of which look at proposed “alternatives”. Some studies are designed better than others, and are at different levels of “proof”. In other words, some are much stronger that others in stating what would work in humans, especially in many humans rather than isolated “miracles”. It’s impossible to read all of these, but there are many reviews of multiple studies (called meta-analyses) which help one get the big picture. Reviewing as much as you can, through trained eyes or with the assistance of someone who is trained in clinical medicine, some interesting conclusions can be drawn. In the end, if you look at this all objectively, a prudent conclusion might be that if there are true “alternatives” they are either in the pipeline of proposed treatments to study due to scientific plausibility (i.e. there are anti-cancer biochemical/molecular pathways that make sense to explore) or they are already being studied. Based on multiple scientific principles, what appears to be so at first glance, “ain’t necessarily so”. Humanity has proven this a zillion times over. The world is not flat, we CAN fly and we can go to the moon. On the other side of the coin, proposed treatments have bombed out over the millennia. Keep in mind that at one point cigarettes and radioactive substances were used to actually TREAT various mild lung and intestinal conditions. So, “alternative” is a word which speaks volumes and means quite the opposite of what alternative practitioners want you to think. It is not a viable “alternative” as would be defined by Webster’s, but rather an unproven, disproven, and potentially dangerous treatment.

Any Role At All for “Alternative” Unproven Therapies?

Having said all of the above, is there a role for trying “alternative” therapies at any point? My personal opinion is that if there are no reasonable options left in mainstream anti-cancer therapies AND if the proposed “alternative” is not known or suspected to be dangerous, it may be something to try. For example, the “Ketogenic Diet” is currently being studied in various cancers and has some plausibility to it. This diet can produce side effects, but if one were accepting of these, it may be a reasonable “alternative” on an individual basis. In the end, I hope the message that is imparted here is that “alternative” cancer cures are not a pot of gold that has been hidden from you by unscrupulous doctors and “the Cancer Industry”. They are in fact unproven (or currently being studied) and may be dangerous in some cases. In some cases they have been disproven, which should raise the thought that there are individuals on the other side of the fence that are making a ton of money selling bogus therapies. The entire discussion above does not include integrative natural and complementary support for cancer patients. The core of integrative medicine and integrative oncology is inclusion of effective support and anti-cancer therapies that work with mainstream cancer treatments. These approaches may be natural in origin but they are by and large not “alternative”. Mainstream oncologists in various countries are a little different in that they may use unproven therapies more or less readily than others. As noted above, there is a time and place to consider various options on an individual basis. In the United States, mainstream oncologists are generally not trained in integrative approaches, but some partner up with integrative practitioners. Others are not as open to this, partly because they do not understand the intent. So, in some cases mainstream oncologists simply can’t address what is integrative and appropriate vs what is “alternative” and likely not effective. This does not mean they are holding anything back from you along the conspiracy theory line of thought we touched on in this discussion. If this conspiracy were true then many doctors might seemingly face malpractice or even criminal charges. In fact the opposite it true. Some doctors may be overprotective in not knowing about integrative oncology and discouraging, but they still have your best interests at heart in keeping you away from charlatans. If you want more information about what works and what does not in the integrative cancer world, seek out a trained and certified practitioner who can work with your oncologist.

In the area of cancer prevention and nutrition much has been recommended but there are areas that lack optimal scientific data. This makes solid recommendations difficult and we have a lot of wanna-be guru conflicting “guessing” that sounds authoritative. But FIRST we need to apply the “precautionary principle”.

Precautionary Principle Nutrition and Cancer

While we wait for more precise answers from scientific evidence about details, major decisions about personal nutrition and cancer prevention are pressing and carry an urgency. There is something called the precautionary principle, used mostly in environmental health and toxicology, which is not well known or often used or even encouraged in the USA. In contradistinction, the European Union invokes the the precautionary principle “when there are reasonable grounds for concern that potential hazards may affect the environment or human, animal or plant health, and when at the same time the available data preclude a detailed risk evaluation”. This means the best available scientific data, whatever it may be, is looked at carefully and a recommendation is made on that basis. There is still much controversy surrounding many detailed aspects of nutrition in primary cancer prevention as well as prevention of recurrence, or secondary prevention. This is evident when debates occur about whether the “Paleo” diet is better than a plant based whole food diet. But even more important is that at this moment the Standard American Diet (SAD) predominates in this country despite enough evidence to certainly invoke the precautionary principle along numerous topics in nutrition and cancer prevention. The recommendations that follow are exactly that. While we await the answers to deeper questions in nutrition, we should at least climb out of the fast food nutritionally depleted abyss we are in. The problem is that for the general public, which is not aware of the deeper question debates, no one is shouting from the rooftops that the SAD diet may cause them decades of chronic illness and shave years off their life. Our government, although health education programs exist, is not playing enough of a proactive role in warnings about the state of poor nutrition in this country. Before reviewing the recommendations, here is a video which better explains the precautionary principle and why it may apply so well to looking at what you eat in trying to prevent obesity and chronic disease of various types including cancer. We may not have all the answers about Paleo diet vs. plant based and the differences between individuals but we know full well that the SAD diet is at least largely responsible for many of our woes, including cancer.

Researchers Unveil Six Dietary Guidelines for Cancer Prevention

New recommendations published in the May edition of the Journal of the American College of Nutrition (JACN) emphasize a plant-based diet to reduce the risk of several types of cancer. (PRWeb June 10, 2014) Read the abstract and story at Http://www.prweb.com/releases/2014/06/pr… The information boiled down to abstract form is as follows:

Primary Objective: Research has identified certain foods and dietary patterns that are associated with reduced cancer risk and improved survival after cancer diagnosis. This research has formed the basis for dietary guidance issued by cancer organizations. Unfortunately, gaps within nutrition research have made it difficult to make recommendations in some areas. This review specifies suggested dietary guidance in which evidence of a dietary influence on cancer risk is substantial, even if not conclusive. Evidence summaries within the review are based on the 2007 report of the World Cancer Research Fund/American Institute for Cancer Research. This review also describes advantages and disadvantages of following the suggested dietary guidance and includes putative mechanisms involved in cancer progression. Main Outcomes and Results: Suggested dietary guidance where evidence is sufficiently compelling include (1) limiting or avoiding dairy products to reduce the risk of prostate cancer; (2) limiting or avoiding alcohol to reduce the risk of cancers of the mouth, pharynx, larynx, esophagus, colon, rectum, and breast; (3) avoiding red and processed meat to reduce the risk of cancers of the colon and rectum; (4) avoiding grilled, fried, and broiled meats to reduce the risk of cancers of the colon, rectum, breast, prostate, kidney, and pancreas; (5) consumption of soy products during adolescence to reduce the risk of breast cancer in adulthood and to reduce the risk of recurrence and mortality for women previously treated for breast cancer; and (6) emphasizing fruits and vegetables to reduce risk of several common forms of cancer. Conclusion: By adopting the precautionary principle for nutrition research, this review aims to serve as a useful tool for practitioners and patients.

The bottom line is that judicious review of what we eat and the toxins we allow ourselves to be exposed to, in essence an application of the precautionary principle, is something to strongly consider.

Supplements That Cause Cancer

Studies gone bad have alerted us to the fact that some supplements, especially in higher doses, can have no effect or even CAUSE cancer rather than help fight or prevent it.  The thought was simple and noble and is the reason we do clinical research studies rather than rely totally on animal studies or laboratory research in test tubes and Petri dishes.  What SHOULD work well might be disastrous.

Do your own research before choosing supplements

By research I mean look at what was published with a very critical eye. If you don’t know how research is structured, ask for help. Not all research is the same, not all research is done well and some is very early in development. Something that is early in development, like in a lab or animal study, does not prove or disprove much. Similarly epidemiologic studies, although in some ways “better” because they are based on human data, can only show “associations” and not causation. Results from ANY of these can only SUGGEST that it has to be studied in human clinical trials. Why? Because of this very issue with supplements causing cancer. The idea was great and plausible, but fell apart badly when tested in humans.

Anti-oxidants theoretically fight cancer. When consumed in food, in almost all cases this is true and the synergies that are in food between micro-nutrients were put there and refined over eons. However, when you split something out, like a single anti-oxidant, especially synthetic versions, and then use them as a pill supplement the result can be quite different. The following are a few cases in point.

Consistent epidemiologic evidence suggested that high intake of fruit and vegetables are associated with a reduced risk of lung cancer. So, which micro-nutrients are the most likely in this mix? Among many candidates, several top picks surfaced based on biochemistry, lab and animal studies. Retinoids are natural and synthetic derivatives of vitamin A (retinol). Related to these are carotenoids, which are a family of conjugated polyene molecules, found largely in fruit and vegetables. Certain carotenoids are converted to retinol. In addition, there are several variants of Vitamin E or Tocopherol. α-Tocopherol (alpha) is a potent antioxidant, scavenging reactive oxygen species and free radicals, and protecting against oxidative damage. These seemed like top picks and that was exactly what was done. Three phase III studies were completed involving primary cancer prevention: the α-Tocopherol, β-Carotene (ATBC) Study, the β-Carotene and Retinol Efficacy Trial (CARET), and the Physicians Health Study. The data from these studies were VERY disturbing. Smokers(current and ex-smokers analyzed together as a high risk group) who received high-dose β-carotene supplementation had an INCREASED risk for lung cancer. Regarding Vitamin E or α-Tocopherol the only published, controlled randomized trial was the ATBC study which showed no effect on lung cancer incidence. But hold on, the problem with this study was that in food the main Vitamin E is GAMMA Tocopherol, whereas in this study it was ALPHA Tocopherol that was tested. Based on whole food epidemiologic studies where gamma-tocopherol is a major contributor to anti-oxidant potential, the goof may have been in which biochemical variant of Vitamin E was used. The lesson? We tried to outsmart Mother Nature in splitting out what we thought was the best and it failed.

Another famous example is the use of Selenium. Epidemiological studies suggest that Selenium (Se) has anticarcinogenic capacity and plays a role in cellular defense against oxidative stress. When split out from food and tested in the Selenium and Vitamin E Cancer Prevention Trial (SELECT) clinical trial, selenium had no effect on prostate cancer risk, but alpha tocopherol significantly increased prostate cancer risk by 17{e1e3d526fd36fc01ebced66f8743c136750b0fc895f2fe665098c818ee436a7e}. Again, this is not the GAMMA tocopherol that is the predominant form of Vitamin E in whole food. Perhaps the results would have been different but this will always remain the worry. Which forms and doses of micro-nutrients are safe and effective when compared to an anti-oxidant whole food diet which is chock full of beneficial synergies between nutrients?

Whole Food Diet to Prevent Cancer and Heart Disease

There are many other supplements that are highly touted with no data (or poor data) to back that up. We know even less about a multitude of isolated supplements packaged up and marketed as effective and safe. But instead of risking taking a supplement than can be a best draining your pocket book with no beneficial effect or at worst causing your cancer or cancer recurrence, think about what the world’s experts are saying. This video covers the gamut of what you need to know. Please note that I am not a big fan of the few areas of “conspiracy stuff” in this video, but overall it imparts a GREAT message.

Here is the take home message about supplements. Some may help and some may harm you. We do not have all the information required to tell you which is which, especially when you consider taking high doses of anything like that. Here is the good news, especially for couch potatoes with poor dietary habits. In the process of studying prevention of cancer, often unfortunately called “chemo-prevention” even when natural substances are used, we are at least getting to understand the biochemical pathways and the epigenetic effects of all of these substances and nutrients. This opens the door to exciting research in the prevention of cancer but we are still well away from outsmarting whole food approaches WHEN they are applied appropriately. In other words, we may well find “miracle supplement pills” that allow someone to poison themselves daily with fast food, cigarettes, sedentary lifestyle and still reduce their risk of cancer. However, it will be a LONG time before we are able to find something better than an integrative solid whole food and exercise cancer prevention program. So, rather than focusing on seeking the “magic” chemo-prevention agent, synthetic or natural, take a very long hard look at the benefits of whole food disease prevention.

My patients ask me in person and my followers ask on line, what are the very best cancer fighting supplements out there? Which supplements really fight cancer? How much should I take of what? Some even bring a bag full of various mixes of supplements and botanicals for me to review with them, hoping to leave with “THE” answer.

Well, the truth behind the best supplements is very far from visiting the local vitamin shop in most situations. There was a gentleman, an ancient Greek physician who is said to be the father of Western medicine. He lived over 2,000 years ago and, among other things, said “Let food be thy medicine and medicine be thy food”. His name was Hippocrates and the best modern research in the world still rings true to that comment. To this day, even though we can study things to the sub-molecular level, whole food contains wondrous healing synergies that we are only beginning to understand. It is going to be while before we become smarter than Mother Nature by artificially splitting out vitamins and other micro-nutrients and reassembling them with human concoctions.

Unfortunately, the very thing that ails us as a society addicted to pharmacologic prescription pill popping spills over into “natural health”. Only, there is nothing natural about it. You do not have to be a conspiracy theorist to see that Big Pharma is a multi-trillion dollar industry that is focused on the image of wellness through pill popping for everything. Standard mainstream medicine has embraced this way too much. However, it is an integrative medicine truth that in some cases, at least for a while, such medications can be lifesavers. Nevertheless, this is not something you want to depend upon for true health as you will never achieve it that way. So what makes you think that popping fistfuls of various “natural” supplements is any better? The Big Nutra, or supplements biz, is alive and well and is a multi multi billion dollar industry in its own right. The problem is that this industry, in contradistinction to Big Pharma, Big Nutra is hardly regulated at all and marketing glitz VERY often trumps science. Enough said on the “politics” of taking human-made substances, drugs or supplements, but lets move on.

You don’t want to take synthetic drugs when you can avoid them, at least in the long run. By the same token you don’t really want to take synthetic mixes of supplements either. In some cases this pharmaco-nutrient therapy can be very harmful and is grounded in the general belief that more of something is better. We know this not to be the case, with cancer CAUSATION as an extreme example. But what about “natural” supplements? Some manufacturers sell what are coined “whole food vitamins”, which are way more expensive and offer little proof that they are any better. Theoretically they may be better because they are concentrated nutrients from whole foods rather than synthetics. However the process of stripping the nutrients out and concentrating them always uses some proprietary methods which might be heating or enzymes or some other degradation. It is a black box of questions and at the very least separates out micro-nutrients from fiber and may be breaking the synergies required between nutrients to be maximally effective, according to Mother Nature’s plan. We simply do not know and guessing, glitzy marketing and testimonials are just not the answer.

With respect to cancer specifically, all of the best data in the world points to whole foods FIRST as being the answer to this question. If you want to go in-depth, download and read the World Cancer Research Foundation’s report. Rather than trying to outsmart Mother Nature with pseudo-science, rat studies that may not apply to humans, and theoretical benefits, the leading minds around the world agree on this principle. Cancer prevention, both primary and secondary (i.e. prevention of recurrence) is best accomplished through solid dietary management of macro-nutrients (i.e. best mix and sources of carbs, proteins and fats) and micro-nutrients (i.e. supplements, vitamins, minerals and some healing botanicals). Furthermore, there is a whole body of evidence which is related to how food is prepared (i.e. raw vs steamed vs broiled). The bottom line is that creating, honing and optimizing a cancer fighting kitchen is a far better use of time than finding out what stores carry the best vitamin pills. This is a topic for many upcoming reviews and posts.

Here is a great short and to the point video from Dana Farber Cancer Institute regarding “Food First” as an integrative anti-cancer strategy.

Having said all of the above, there may be a few exceptions. First of all, if it is just IMPOSSIBLE for you to follow a solid anti-cancer diet plan, work with a nutritionist of dietitian to ensure you have the basics covered with supplements. This is VERY inferior, but will keep you out of more trouble. Second, there are a few supplements that are notoriously lacking even in a good diet. If you are following a primarily plant based whole food diet, make sure you are getting enough B vitamins. Calcium is also sometimes hard to manage with a combined goal being 1500 to 2000mg per day from diet and supplementary sources. Finally, and most importantly, Vitamin D. This last one is crucial to your anti-cancer battle and is deficient even in sun belt areas. Ask your doctor to measure your blood level and focus on attaining a level above 35-40ng/mL (90-100nmol/L).

All of the above is meant to cover why whole food is a better source of micro-nutrients than concocting supplement packs. However, if you need specific help there is certainly a need for targeted supplementation. For example, rather than taking potentially addicting and side-effect prone prescription sleeping pills, you may benefit from melatonin supplementation. This is highly individualized and is part of a good patient centric integrative oncology program.

Every time I am asked about naturopathic (ND or NMD) doctors and whether my patients should seek one out, I say “it depends”. I have collaborated with naturopaths and like anything else in life, some are better than others and some are better trained than others. So, how is the public supposed to choose?

Is the fact that someone had an N in front of the MD (NMD) mean they are “better” in some way, above and beyond a “regular” or allopathic MD? Is it at all related? Is the training even similar enough to compare the two? What is the real objective story about the role of the ND or NMD naturopath in cancer care? Well, here is my view on this issue, trying to steer clear of the “politics” between naturopathy, especially naturopathic oncology, and the mainstream allopathic perspective. I will also consider MD and DO programs as pretty equivalent.

While Traditional Chinese Medicine, Ayurvedic Medicine, as examples, are ancient, the concept of “Naturopathic Physician” is a relatively modern construct, at least as far as formal training and certification goes. Modern mainstream “Western” medicine is also relatively young as far as training and certification goes, but it is at least a couple of centuries old compared to naturopathy. The concept was originated around 1900, but the real thrust in training and certification in this area really began in the 1970’s. To be fair, naturopathy uses many concepts from Chinese, Ayurvedic and other ancient disciplines. But we are talking about training here and how to determine who is qualified to help you as you try to regain and maintain health.

I won’t repeat or rewrite an already decent historical account of Naturopathy that you can read on Wikipedia. It may not be the most authoritative piece, but it gives you a very good overview. In my view, the problem is that the field is quite diverse in opinion amongst its practitioners. Some are focused on “Alternative Medicine” as a treatment for many conditions, even to the point of vilifying all of allopathic mainstream Western medicine, while others are quite a bit more moderate in opinion and are simply seeking to provide the best vitalism based natural support and preventative care possible. So, here is a good example of “it depends”. In my view, there is good and benefit that can be derived from all types of medical practice. The more you are looking at TREATING life-threatening disease, the more a polarizing and inadequate scientific base for treatment becomes  inappropriate.

Let’s look at the current training. If you go to a website of an accredited and respected school like Bastyr University, you will find a curriculum listing which looks similar to that provided by a traditional Western medical school. In fact the Association of Accredited Naturopathic Medical Colleges (AANMC) offers a comparison year by year between MD and ND programs. The requirements to get in to a naturopathic school are becoming more and more rigorous, so bright minds are entering the field. I have attended chiropractic school in the past, but have not taken classes in a naturopathic school. So, if one assumes that the rigor of the classes is the same, an ND graduate is similar to an MD graduate in terms of basic science training, allowing for the differences in philosophy between the two types of schools. Keep in mind however that graduation from an MD or an ND school with this type of generally comparable curriculum means that you have earned your training wheels. That’s it. You are nowhere near qualified to take care of sick people. You MAY be qualified to help prevent disease, but not treating it. This is especially true of life threatening disease like cancer.

So, what’s next? After an MD program all it takes to be licensed is a year of internship in most states. This is BARELY adequate to prescribe or treat ANYTHING. Most MD and DO graduates go on to take at least a three year residency, and those who go on to practice oncology usually take a three to five year residency, depending upon the ultimate goal of medical or surgical or radiation oncology. Then there is a three to four year fellowship training program, and some go beyond this. So, for bona-fide MD or DO oncologists AFTER four years of medical school we are talking about six to nine years of training which involves taking care of real patients. There are some opportunities for naturopathic school graduates to get an additional one or two years of “residency” at a limited number of institutions. However, you should be seeing quite a difference in the experience achieved by the end of MD vs. ND training. Learning beyond the framework of a residency or fellowship (i.e. self study or 18th century-like apprentice work) is very hard to quantify, with some doctors remaining perennial students of their field and others slacking off to the extent possible in this day of constant re-certification requirements. So, simply adding up the hours devoted to care of patients is woefully inadequate because it is not standardizable and verifiable in many cases. Yet, this approach is used in the board certification process of ND oncologists.

So what is the bottom line? There is no question that MD and DO physicians who choose to pursue oncology as a field are much more robustly trained. This does not mean that ND oncologists have no role. They most certainly do, after verification of their training credentials. If there is a FABNO certification involved, you can be pretty much assured that they are the most highly trained naturopathic oncologists available. Is this enough to manage all of the oncologic needs of a patient? In my opinion, taking into account the differences in total training, the answer is NO. However, as part of a well functioning team, along with a allopathic oncologist, the knowledge base of a certified naturopath in an integrative oncology program can be invaluable. One word of warning though. Not all naturopaths graduate from an accredited or good school and are not eligible for certification.

The following video from the Cancer Treatment Centers of America, presented by a Naturopathic Physician who is FABNO certified gives a good overview of what a team approach to Integrative Oncology might look like.

What about MD and DO doctors? Are they all qualified to be an “Integrative Oncologist” just because they have an MD or DO degree? The answer is a resounding NO. An MD or DO is only qualified to be an Integrative Oncologist if they have completed oncology fellowship training and are board eligible. But this is not enough. They must also have some training and certification in Integrative Medicine. The American Board of Integrative and Holistic Medicine spells out what is required today and into the future.

Let’s cover practitioners of acupuncture and herbalism. So far we have covered programs who graduate doctors that have some similar training, at least a significant part of the way. The EXTENT of training is radically different and that should be clear by now. There are also practitioners who are called “doctor of oriental medicine”, and the degrees granted have varied a lot over the years and differ by state. They also differ by how long ago they were conferred, since regulatory bodies to control what is actually taught in such schools varied, and still varies, tremendously. So, one may see OMD, DOM, L.Ac, DAOM, Dip.Ac, Dip.OM, and so on. As far as acupuncture is concerned, this line of training is probably as in-depth as it gets. As far as covering the totality of ancient Chinese herbal background, although curricula vary by school, this may or may not be the most in-depth training. But the bottom line is, how well trained, beyond acupuncture, are such practitioners in treating or advising cancer patients? Even with a lot of self-study it is unimaginable, based on the described training, that such practitioners could safely treat or advise cancer patients independently. They can certainly become valued members of an oncology team, but to use “doctor” in such cases to imply ability to independently treat or advise patients is, in my opinion, a very dangerous misnomer.

What about other practitioners and doctors like PhD doctors, chiropractors or nutritionists or nurses? Are they qualified to say they are an Integrative Oncologist? The training background here is EXTREMELY variable but suffice it to say that none have the same oncology training background as a board certified or eligible oncologist. The expertise they bring to helping you in beating cancer and optimizing health and quality of life may be VERY valuable, but only if there is an ongoing dialog with an oncologist. This is hard to achieve anywhere other than at centers which have an integrative program, but possible. Just ensure there is two way communication going on before assuming that all of the mainstream and natural support you are receiving is safe, effective and compatible.

One final note. No reasonable well trained science based physician would ever recommend that you ignore standard oncologic medical care in favor of an “alternative” approach. This is especially true at the beginning of care. In the case of recurrence, resistance to therapy and the like, some patients elect to stop standard therapy because it does not appear to be helping them and the treatment side effects are becoming worse than the disease itself. In these situations certainly choices may include whatever it takes to help improve quality of life, and if unproven anti-cancer “alternative” therapy is added it should at least be determined to be safe based on available science. Again, work with an MD/DO oncologist at all times to get input about the plausibility, efficacy and safety of therapies.