Nutrition and Supplements During Cancer: What the Evidence Says

•Manage the side effects of treatments . For example, if you're undergoing chemotherapy, there are natural products and supplements that can help with nausea and perhaps allow for titrating down or off of antiemetics that you are often prescribed. (ASCO just released integrative medicine guidelines for pain management along with the Society for Integrative Oncology.) “A Patient’s View on Nutrition, Supplements, Integrative Oncology, and Complementary Therapies”

•Increase the effectiveness of treatments . For example, there are some supplements that are considered chemo sensitizers that have the potential to improve your response to treatment.

•Add complementary or adjunct treatments . For example, the Care Oncology protocol uses off-label drugs, repurposing drugs that have been used for other diseases to treat cancer.

•Optimize general health . For example, boosting your immune system, energy, and improving quality of life. What are the challenges of complementary therapies? Complementary treatments suffer from the same challenges of complexity and personalization that guide conventional treatments. Some things that are good for some cancers may not be good for your cancer. Things that may be helpful to prevent cancer are not helpful once you have been diagnosed with cancer or your cancer progresses. There may be differences in what's helpful, whether or not you're hormone sensitive, castrate resistant, metastatic, or non- metastatic. And there are contraindications with several natural products when used with certain anti-cancer and supportive care agents. What are some tips for complementary therapies?

•Nutrition: Nutrition and diet are core determinants of health. There are other lifestyle factors that are quite powerful as well, but diet is key. Healthy diets include “pescetarian” (vegetarian plus fish) or Mediterranean (based on the traditional foods of countries that border the Mediterranean Sea, including whole grains, vegetables, legumes, fruits, nuts, seeds, herbs and spices, and olive oil as the main source of added fat.) You should eat a rainbow of plants, and well-sourced cold water, omega-rich fish, such as salmon, halibut, cod, sardines, and mackerel. For prostate cancer, you may consider avoiding eggs and dairy products. Broccoli, pomegranate, turmeric, and green tea have been shown to correlate with a positive impact on prostate cancer cells. You should try to fit these things in your diet using a “diet first” approach to get that bioavailability with clean whole foods, and then supplement as necessary, ideally under the guidance of an integrative oncology-trained practitioner.

•Supplements: Your selection and titration of supplements should be informed by blood analysis of nutrient levels and biomarkers, such as oxidative stress/free radicals, inflammation load, circulation, and glucose levels, with retesting every six months or so.

•Beverages: You should consider consuming various organic brewed teas such as green, turmeric (curcumin), and reishi mushroom.

•Fasting: Intermittent fasting and fast-mimicking diets during active treatment helps to keep digestion less busy, and may also increase efficacy of systemically-delivered drugs. This has also been shown to help mitigate the often deleterious side effects of therapy, namely nausea.

•Drug interactions : Resources include drugbank.com and Memorial Sloan Kettering’s About Herbs for herbs, drugs, and interactions. “A Patient’s View on Nutrition, Supplements, Integrative Oncology, and Complementary Therapies”

•Integrative oncology providers : Keith Block, who's arguably the father of modern integrative oncology, Dawn Lemanne (guidance on off-label anticancer agents), and Will LaValley (guidance on off-label, repurposed, often generic drugs). See the directory of providers in North America on Glenn Sabin’s website for more. For naturopathic physicians, you should look for a FABNO-certified practitioner.

•Book recommendations : “How To Starve Cancer ”, “n of 1”

•Reducing stress: Exercise, meditation. What’s the future of precision integrative cancer care? In the future you will be treated with personalized conventional therapies (e.g., drugs, radiation, surgery) that attack your tumors, complemented by personalized nutrition and lifestyle treatments. You will be prescribed very specific diets and lifestyle changes that are tailored to your underlying pathology, as well as the agents that you may be getting in your treatment. The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab/Prostate Cancer Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action. You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health. “A Patient’s View on Nutrition, Supplements, Integrative Oncology, and Complementary Therapies” Meeting Notes The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab/Prostate Cancer Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action. You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health. SUMMARY KEYWORDS supplements, integrative oncology, oncologist, cancer, agents, diet, patients, disease, drugs, approach, chronic lymphocytic leukemia, prostate cancer, supplementation, oncology, treatment, glenn, eat, glen, turmeric, lifestyle SPEAKERS Glenn Sabin (56%), Robert Ellis (22%), John Powers (9%), Kevin Fordney (5%), Rick Stanton (4%), Eric Hall (2%) Robert Ellis (0:03): Welcome to the Prostate Cancer Lab. We have a very special guest, Glenn Sabin, and this is the first session that we've held where the topic is integrative oncology. We're going to look at some alternative medicine, nutrition, complementary or adjunct kinds of approaches to support prostate cancer treatment. This is a really important topic for us to look at because, first of all, if you've had an experience similar to me when I was first diagnosed, the first doctor I consulted was Dr. Google. Of course, what you discover immediately is that there's so much conflicting evidence or conflicting information available when it comes to integrative oncology, alternative therapies, nutrition, or supplements. We thought that it would be invaluable to hear from people who are actually applying these strategies with patients. We're including integrative oncology in the conversation because we think it's essential to keep it on the same level as everything else. There are some people, including our guest today, who have gotten remarkable results by employing these approaches. We intend for this to be the first in a series of panels and guests to explore this topic. Before I turn it over to Glenn, I just want to talk very briefly about why I think this is so important and what the challenge is for us as patients. First of all, integrative medicine, nutrition, and supplements can be extremely beneficial in our treatment. It is a good way to manage the side effects of some of the other medications or treatments that we're on. For example, if you're doing chemo, there are things that can help, supplements and so forth. They can help with nausea that are a little bit less potent than the medications that we are often prescribed. It can “A Patient’s View on Nutrition, Supplements, Integrative Oncology, and Complementary Therapies” increase the effectiveness of some of our treatments; for example, there are some supplements that are considered chemo sensitizers that have the potential to improve our response to treatment. There are complementary or adjunct treatments like the Care Oncology protocol, which is a protocol using off label drugs. Repurposing drugs that have been used for other diseases to treat cancer had been on that protocol for several years. Also generally optimizing health: boosting our immune system, energy, etc. There's a lot of benefit to exploring this. The problem that we face as patients is that, as we all know, cancer is a highly complex disease. When we look at incorporating some of these options into our personal treatment plans, what you discover is that some things that are good for other cancers may not be good for prostate cancer. Things that may be helpful to prevent prostate cancer are not helpful once you have been diagnosed with cancer or your cancer progresses. There may be differences in what's helpful whether or not you're hormone sensitive or castrate resistant or metastatic or non-metastatic. It gets very complicated very quickly. Most of us do not have access to oncologists who are educated in these alternative approaches or who are supportive of these alternative approaches, who are willing, for example, to prescribe Metformin or some other off label drugs that have been proven to be beneficial for cancer. It's a very intriguing space with lots of potential to be beneficial for us as patients, but it's a very challenging space. I am very excited for today's discussion which will be led by Glenn Sabin. He is a past board member of the Society for Integrative Oncology. He's an author and a speaker. He wrote the book “n of 1”. He's a respected thought leader who works with passion and dedication to advance the field of integrative oncology. He's an adviser to the network of enigmatic exceptional responders, which is a study led by Harvard's Chair of Biomedical Informatics. He's a faculty member at Duke University's Leadership Program in Health and Wellbeing, where he presents a course on health and wellbeing thought leadership. Here's a short video that I'm going to play to introduce Glenn. Here is a transcript of Glenn’s introductory video which Robert played from Glenn’s website, glennsabin.com. The link to the video is here. Glenn Sabin (5:32): I was with my family, my entire nuclear family and Linda. Here I was, you know, 28 years young, when I was diagnosed with chronic lymphocytic leukemia, an incurable cancer and incurable leukemia, Linda Sabin (Glenn’s wife) (5:47) I remember getting a phone call from him, he was crying, which makes me want to cry. And he said, “I'm gonna die.” Glenn Sabin (5:57) “A Patient’s View on Nutrition, Supplements, Integrative Oncology, and Complementary Therapies” My primary care physician contacted my father, who was also his patient and told him, Glenn has chronic lymphocytic leukemia, and I would give him about six months to live. Leo M. Nadler, MD, Dean for Clinical and Translational Research, Harvard Medical School (6:08): Ellis and Glenn Sabin) My primary care physician contacted my father, who was also his patient and told him, Glenn has chronic lymphocytic leukemia, and I would give him about six months to live. Leo M. Nadler, MD, Dean for Clinical and Translational Research, Harvard Medical School (6:08): So Glenn was a young man, and he showed up, and he was absolutely angry. And he didn't want to believe that at his age, this was a death sentence, Glenn Sabin (6:19): I knew that I wasn't going to just watch and wait. And I wanted to be more involved in my own self care. So I went on a journey to learn as much as I could about the things I might incorporate in my lifestyle, to create the overall healthiest person that I could be, who happened to have a diagnosis of chronic lymphocytic leukemia. In the summer of 2003, for the first time, I started to feel the full force and effect of leukemia. Leo Nadler (6:50): His disease had gone wrong. He had been seen at Hopkins, and they told him the same. I said, Glenn, sometimes we have to play medicine. He actually said, “No.” And then he decided that he would come to me not as a treater, but as a credible assessment. Glenn Sabin (7:14): I just had this little experiment going. I was this, you know, N of one. I really wanted to test my body and my mind to see how I could impact where I was at. Leo Nadler (7:29): He's asked me to write things. I said, “No, Glenn, I didn't do any science.” I can attest to one thing: what you say about yourself in the stage of your disease is absolutely correct. The second thing I can attest to is: you did it your way, Glenn Sabin (7:48): I started to see a significant change in my blood chemistry to a point where the blood counts were completely normal. Leo Nadler (7:57): Glenn has the most extreme type of patient who basically decided he's going to engineer his own solution. Can you spontaneously remit to chronic lymphocytic leukemia? The “A Patient’s View on Nutrition, Supplements, Integrative Oncology, and Complementary Therapies” book says, “No.” Magically, his disease disappeared. So every time I've staged his disease, it got better every time, Glenn Sabin (8:19): It’s been seven years since I was able to clear my marrow of leukemic cells, so a complete and durable permission. The idea is to become the most inhospitable host to cancer possible. And you do that by strengthening your immune function. You do that by working on getting into the strongest emotional shape that you can be in and utilizing nutrition and physical activity and clean hydration and restorative deep sleep. Linda Sabin: For me, the lesson that I learned is anything's possible. Glenn Sabin: We don't take anything for granted. We're grateful that we continue living a healthy lifestyle that hopefully, you know, will keep me in a good place for a long time. Glenn Sabin (9:15): I appreciate the opportunity to speak with everybody today. If I was as sick today as I was back in 2003, I would not have refused standard of care because standard of care then was palliative. If I had gone with an experimental bone marrow transplant or even the standard of care with three chemotherapeutic agents, I wouldn't be with you folks today. Today we have wonderful targeted therapies. It's getting to the point where there's a functional cure for chronic lymphocytic leukemia. It's come a long way. All this advancement has been in the last seven to eight years. That's a huge change because I was awfully sick back when I extended my little informal experiment. At its core, integrative oncology focuses on – not unlike functional medicine or lifestyle medicine – lifestyle factors. That's where the literature lives. That's where it's growing fairly rapidly. 30 years ago there was no such thing as integrative oncology, or even integrative medicine. There's been a lot of change over these last few decades, but at its core, what we'll all see if we go to the NCI site, or American Cancer Society site, is related to prevention. It's important to focus on the literature that supports eating well, sleeping well, moving your body, and so forth. Those core fundamental aspects of those lifestyle factors or lifestyle medicine certainly helps to strengthen immune function to make us more resilient. Over the years I talk a lot about the host versus tumor. It should be the host and tumor. When all these therapies are directed to the tumor burden, and there's not enough attention that goes to the host environment, that's half of what we need to look at that's often missing. It's not what type of cancer a person has, but what type of person is it that has this particular malignancy. That's just as critical. An evidence-based “A Patient’s View on Nutrition, Supplements, Integrative Oncology, and Complementary Therapies” or evidence-informed approach to care that focuses on the host environment, the emotional state, and a lot of different factors that support immune function. That's critical in my mind, of course. I could correlate that to these fairly remarkable clinical responses that I've had over time. At the same time, integrative oncology is evidence-informed, if not always evidence-based, and it shouldn't be confused with alternative medicine, alternatives in lieu of standard of care. I'm a walking contradiction, because I refused the standard of care. I earlier expressed why I refused the standard of care. At its best, integrative oncology combines the best of precision medicine or precision oncology