The co-administration of therapeutic supplementation alongside oncological therapies is something that is shrouded in conjecture, and yet, offers so much possibility for patients.
In today's podcast, we welcome back naturopathic oncology expert Dr Lise Alschuler to take us through the evidence-based, safe and measured approaches for supplements when caring for people with cancer.
Covered in this episode:
[00:54] Welcoming back Dr Lise Alschuler
[02:28] What are the dangers with supplements in cancer therapy?
[04:00] Antioxidants - do we need to fear them?
[11:03] The liver P450 enzymes are key
[13:40] Working with drug half-lives
[15:32] Curcumin
[18:34] The therapeutic risks and benefits of foods
[24:28] Glutamine
[28:24] Timing nutrients for optimal outcomes
[32:46] Diindolymenthane (DIM)
[33:55] Melatonin
[36:36] Risks with probiotic therapy in cancer
[40:07] Mood support in cancer therapy
[42:22] Thanks and farewell to Dr Lise Alschuler
Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. Joining me on the line today again, is my dear friend Lise Alschuler.
She's a naturopathic doctor with board certification in Naturopathic Oncology, who's been practicing since 1994. She maintains a Naturopathic Oncology practice out of Naturopathic Specialists, a practice in Scottsdale, Arizona. I should say a beautiful place called Scottsdale, Arizona.
Lise works as an independent consultant in the area of practitioner and consumer health education. She's current president of the Oncology Association of Naturopathic Physicians that's OncANP. She's the executive director of TAP Integrative, a nonprofit educational resource for integrated practitioners, which is brilliant and seminole and unique.
Lise is the co-author along with Karolyn Gazella of The Definitive Guide to Cancer and The Definitive Guide to Thriving After Cancer. Texts which any practitioner should read regarding the evidence and safety of natural medicines in cancer care. Doctor Alschuler co-created ithriveplan.com and co-hosts a radio show Five to Thrive Live on the Cancer Support Network about living more healthfully in the face of cancer.
Welcome back to FX Medicine, Lise, how are you?
Lise: I'm really quite good today actually. And thanks for having me back, always a pleasure.
Andrew: It is always my pleasure, Lise. I'm so happy to speak to you again and can't wait for you to come out to Australia again, later on in this year.
Lise: I know, I'm looking forward to that, a lot.
Andrew: Oh, yeah.
Now we're going to talk about the sort of flip side, if you like today. We're not going to talk about nice positive things. We're going to talk about dangers. Potential dangers. And look at the reality of these dangers and appropriate use. The whole point is for safe use. So we're going to be talking about the dangers of supplementation in cancer.
So, Lise, let's start off, what first are the theoretical fears of oncologists with the use of natural supplements during oncological care? And are these fears real?
Lise: You know, I think that what humans have a tendency to do, a lot of oncologist put supplements, all of them, into one box. And it's this box that's full of stuff they don't know very much about. And they're afraid that the stuff in there is going to interact with their therapies. So I think the fears are really based on could any of those supplements potentially make my therapies less effective? That's really their primary concern.
Sometimes I hear from oncologists that they're also concerned about potential, you know, increase in side effects from their therapies. But mostly, it's really a concern about interfering with their chemotherapy. And certainly radiation oncologists are very concerned about any supplements, almost as if they all are antioxidant, and antioxidants they feel, you know, they interrupt radiation. I think that's really the kind of the main fear now.
Are those fears justified? I think sometimes they are. There are definitely some supplements that are, I would say, either absolutely or relatively contraindicated with certain chemotherapeutics or certain, you know, types of radiation therapy. But of course, that doesn't hold true for all supplements. I think really the answer is in a more sophisticated approach to all of this.
Andrew: Yeah. I remember reading some research by Keith Block, which was basically a review of other research regarding antioxidants during chemotherapy. And it was overwhelmingly positive. Not negative at all.
But I think the interesting thing is why do oncologists feel that a supplement can interfere with radiation? When there is no basis for giving these things after say, a leak from Fukushima or Chernobyl. You know, there is no interference with a bad radiation, let's say, an ionizing radiation.
So how do they think that an antioxidant would protect against this acute dosing? It's really funny, it's really sort of a dichotomy of thought about the action of radiation, ionizing radiation.
Lise: Yeah, you know, well, I think that it really goes to the fact that radiation is clearly a therapy that's based on introducing oxidative stress. And introducing it in a very concentrated way at the tissues. So therefore, just the word “anti-oxidant”, is opposed to the intended action of the radiation. So one would then logically assume that a supplement with antioxidant capabilities or the ability to quench free radicals, which are these you know, charged oxygen particles that radiation is introducing.
So one would, you know, I think logically, say well, then if somebody takes something that's going to quench these oxidants, that's going to interfere with the intended effect, or the cell damage of radiation.
The reality is that, kind of surprisingly actually, that doesn't seem to hold out in clinical trials. There was one big clinical trial that made the rounds in the early 2000's which looked at Vitamin E supplementation during radiation therapy in people with head and neck cancer. And, in fact, the first report that went out showed that when these people were followed for six years out, there was an increased risk of mortality in the people who had supplemented with Vitamin E. Even though during the radiation they had better toleration of the treatment.
So this was seen as big, I mean, it made the circuit like nothing I've ever seen and really fuelled the fire of, "Okay, see, antioxidants are bad during radiation." Now interestingly, in a subsequent follow-up analysis by the same study authors, they actually found that a sub-group within that group of patients namely smokers accounted for 100% of that increased mortality risk. And they went on to say that there was some kind of specific interaction that was happening between the vitamin E, the smoking, and the radiation. And it might have been more of the smoking than the Vitamin E, but nonetheless there was that kind of emerged as the main caution. Of course, that never made the news. And really, that study has been used to kind of fuel this ongoing thought process.
But, you know, so that's an example. I myself, if somebody smokes, do not recommend that they take Vitamin E if they're getting radiation therapy. And in general, I'm just not willing to kind of go to bat for Vitamin E during radiation even in the non-smokers because I don't think it's going to help enough to kind of raise the ire of the radiation oncologists. But other so-called antioxidants, Vitamin C, for example, or CoQ10 even up in doses of just, you know, 300 milligrams have failed to demonstrate any interference effect.
And so we know maybe it's that the radiation is very short-lived, like, it's the way that's it's introduced, most of it gone from the body very quickly, which is why people have to get it every day. And an antioxidant when we take it orally, it's relatively small and not really circulated ultimately throughout the body. And probably not enough in a concentration manner to do much of anything at the site of radiation.
But, you know, I think radiation is an area that I've just found most radiation oncologists are very antioxidant adverse. And I'd rather not triangulate my patients in that, so I just don't really work too hard to give people straight out antioxidants. And get a little sneaky with using botanicals that really do have antioxidant capabilities, but are not considered as such.
Andrew: Shhh, don’t tell them.
So, the conceptual sort of framework that I have an issue with is our term; antioxidants is polar. It only does one thing. Whereas with every antioxidant there is a redoxidant or a redox pair. So, you know, vitamin C, CoQ10, so you've ubiquinone, ubiquinol, in-between you've got semi-quinone. The same goes for lipoic acid, you've got lipoic acid and the more active, if you like, or intracellular part dihydrolipoic acid or dihydrolipoate. That rings true for vitamin E, for vitamin C, for lipoic, for CoQ10, for all of these antioxidants that we term as that.
Are they really an anti-oxidant or are they this redox pair? That we're actually helping to stimulate, or indeed stimulate, as I said, the mitochondrial activity.
Lise: Yup, I think that's exactly it. I agree with that 100%. And then, if we think about it from the perspective of, a lot of, let's say, the botanical so-called antioxidants actually work as oxidants initially. So they introduce or they're met by the cell membrane as an oxidant and they induce then a cellular response that’s, depending on the various state of the cell, is either an NFkB dependent or a NERF2 dependent, and that's going to kind of generate the overall cellular response.
But in reality, that original compound which we called an antioxidant is really working as an oxidant. So I think there's so much more complexity to this from a biochemical perspective that yeah, I agree oversimplifying the issue, I think, is really not helpful.
Andrew: Yeah, of course, the other issue is oral dosing versus intravenous dosing. And we know that vast difference of actions of vitamin C, for instance, given orally versus intravenously. And the doses that you can achieve with such.
From a conceptual point of view, what are the real dangers of supplements during medical oncological therapy?
Lise: You know, I think that there are some things that need to be considered and I certainly evaluate this on an ongoing basis. I think the first thing to consider are cytochrome P450 detoxification enzyme potential interactions.
So, there are many chemotherapeutics that get metabolised by cytochrome 3A, or 2C9, or whatever the case might be. And whether that enzyme is up or down regulated could affect the metabolism of the chemo. Sometimes the chemo is metabolised into inactives, and sometimes it's metabolised into actives. So that's an important piece of information. And so it's important to evaluate for that.
Now we don't really know a lot about the impact of the herbs on those enzymes in the petri dish when we study this. There are invariably a lot of herbs most, maybe even all, herbs affect the cytochrome enzymes. But in most… I would say in 9 times out of 10 when you actually bring that in vitro data into a human pharmacokinetics study, you fail to see a clinically significant effect of those herbs on the enzyme. And that makes sense because herbs particularly, will get broken down by intestinal bacteria and conjugated. So by the time they get to the liver, they're kind of a different molecule.
But that being said, you know, I think there are some examples like Hypericum perforatum or St. John’s Wort is a good example of an herb that does have a really strong affinity for the 3A enzyme, and should not be used with certain chemotherapeutics like Irinotecan. It inhibits the atrophy of Irinotecan. That's been clearly documented in humans.
There are other enzymes like, or other herbs like curcumin from turmeric, which has been shown in vitro to have the ability to inhibit 3A, the 3A4, TC9, and those are drugs which you would think would have impacts on chemotherapeutics and other drugs, but in fact in pharmacokinetic studies with human volunteers just using straight up curcuminoid powder, there's really no inhibition or no clinically significant effect at doses up to 4 grams of curcuminoid. So, I think we have to kind of take all of this with a grain of salt, too. Or at least do our investigation.
And, last thing I'll say about this is, if people are concerned about it nonetheless, I think the thing to do is look up the half-life. The terminal half-life of the chemotherapy and that's readily available online. And let's say we're looking at a taxane, which is about an 11-hour half-life, you multiply that by three, generally. To get kind of a good…by that time most of that taxane is going to have gone through its metabolism. And then just avoid anything that could potentially interfere with it during that period of time, and then you're kind of avoiding potential interaction. So that's kind of a good rule of thumb.
Andrew: Because I don't know as much as you about half-lives. I basically go four half-lives and I go right, err the side of caution. But, as you say, you know, I think every natural health practitioner needs to really study these half-lives and really be aware of them. And that's indeed something that you include in your book.
Lise: And I think, I would characterise that approach as a very safe sort of conservatively solid approach. If there's something that you really want somebody to have within that window of time. Then go and see if there's any human data on potential interactions. And sometimes you'll find data that actually negates the interaction. So then you have more flexibility or freedom to use things.
And that can be important, like with curcumin, since we're talking about that, there is a slew of studies showing that curcumin is a synergist, or it improves the efficacy of things like carboplatin and cisplatin. So you would want to use that, at the same time somebody is getting those drugs. So it's good to know that you're not going to interfere with the chemotherapy, in fact, you’re going to enhance it’s efficacy.
Andrew: Yeah, that's right. Five FU right in colorectal cancer?
Lise: Yup, five FU.
Andrew: I'm so glad you mentioned curcumin. Because I remember looking into curcumin with regards to cyclophosphamide. And there was one study I read where, it was an in vitro study, and it had an issue with cyclophosphamide, with curcumin.
But there was a trial done in dogs, I think, which showed a benefit. So where are we at with cyclophosphamide and curcumin? Do you err on the side of caution to say look, “That's dogs and that's great, but we're human, so at the moment we just don't know?” So are you waiting? How do you navigate that one?
Lise: Yeah, you always bring that one up, you know. Because so far, I'm comfortable with it, with the platins, there's, you know, a rat study but seemed to be…did not affect the dose of Taxol at all. So with taxane chemotherapy.
So, pretty much comfortable with the lot. Cytoxan or cyclophosphamide is one that, the jury's still out on that, I would say. There's, you know, this odd overlap of activity in the cell that because of a pathway called the JNK pathway that curcumin can inhibit, which is normally a good thing. And part of its anti-cancer action. That pathway needs to be intact for cyclophosphamide to work at its best. So, it's possible that there could be, you know, a decrease in efficacy.
So because I'm not sure yet, and the data isn't really out there, that's one you know that maybe I'd be a little bit more cautious with. Now, having said that, in certain people who have a lot of inflammation and their side effect, or the possibility of side effects, from chemo is, you know, inflammatory based side effects is really high, to the point that they're afraid to get chemo, and, or, they might not be able to tolerate the chemo. Then I think we have to do kind of an evaluation of risk versus benefit. And those cases, I generally would tend to consider using curcumin, even with a cyclophosphamide regimen.
Andrew: But do you wait a day or two after the dose of cytoxan?
Lise: Yeah, I think that would be best?
Andrew: Cytoxan's got a quicker half-life, hasn't it?
Lise: Ah, yes, I don't remember what it is off the top of my head. But yeah, it's...
Andrew: Yeah, I thought it was hours, yeah.
In those people where you're cautious about a deleterious interaction with Cytoxan. Would you say, “Look, let's fall back to the secondary state”, which would be food sources? So do you then say, you know, "Do you like curries? Make it with some curcumin." Do you then use that as a sort of possible way of at least getting some curcumin, some dietary sources in?
Lise: I mean, yeah, I suppose that would be one way to address it. I think the other way would be just to avoid the terminal half-life or the half-life times three, time period. And then I'm fine using it because at that point, that Cytoxan has really done its thing for the most part.
Andrew: So talking about foods, are there foods which can be definitely dangerous?
Lise: I mean, I suppose there are some, you know, any food can be a poison in the right dose, right? But you know, so I'm not quite sure how to answer that so broadly. I think I would say that now, unlike some of the radiation oncologists who don't want their patients eating any vegetables because of the antioxidants in the food… I just don't find there to be very many contraindicated foods.
I mean, grapefruit probably is one, that I would have to put in there because that definitely has a very strong impact on cytochrome enzymes. So I think you run the risk of altering the metabolism of chemotherapeutics.
Andrew: The funny thing about grapefruit was that if you get an oncologist that just wants to use their oncological regiment as dictated by the guidelines, then grapefruit juice is out. But I thought it was really interesting that there was some, there were a couple of stories, from a trial, and the trial said, "Well, hang on, if we can actually use grapefruit juice therapeutically and you measure what's happening with the chemotherapy”. So you know, it takes some action on your part. If that's the case, we can actually have a cost saving. And I think it was something like they only had to give a third of sirolimus.
So they can actually have a cost-saving benefit from the healthcare dollar and the patient gets the same action of the chemotherapeutic drug by the grapefruit inhibiting how the drug is metabolised out of the body. And so, therefore, holds on to it in a greater way.
Lise: Yeah, I mean it makes a lot of sense.
Andrew: Yeah, I can't see many oncologists doing it. But where I was basically thinking about the food issues was, I have this recall of a difference in patients benefit from chemotherapy if they'd had a meal versus if they hadn't had a meal while they were receiving a dose of chemo. So how real is this? What happens there? What do you recommend for your patients?
Lise: Yeah, I mean, this is probably, I'm guessing, related to the sort of newer work, which is currently being studied in a number of clinical trials on fasting for a period of usually at least a day before chemotherapy, the day of chemotherapy and then sometimes even for the half to a full day after chemotherapy. And really quite low caloric intake with 600 kilocalories or less, or water fast.
And the idea is that with that fasting period, there's obviously a huge drop in nutrients coming in. So normally, one of the impacts of that on a cellular basis is, cells kind of pause in their cell division, so they stop, you know, doing.. proliferating and stop, kind of, their activity declines. They hunker down because they're waiting for their next influx of nutrients. So that would be healthy cells. Which means those cells are going to take up less of the chemotherapeutic. So it has sort of a protective effect on healthy tissue.
Now, malignant cells, on the other hand, don't have those breaks in place. So they can't hunker down and wait it out, so they keep on dividing so they remain sensitive to the chemo. So it's meant to kind of expose that differential effect to fasting. And Valter Longo has been doing a lot of work around this and has found some other mechanisms related to insulin growth factor 1 and various impacts it has on cellular metabolism.
But from a clinical perspective, you know it is a therapy that I try with some people. Not everybody can tolerate fasting. So constitutionally, I think it's only appropriate for some people. But, for people who can really manage the fasting, it can reduce their adverse toleration, particularly to digestive tract issues. So people who've had a lot of nausea and vomiting and diarrhoea. Sometimes the fasting just for that two and half day period really makes a difference. So yeah, I think in that sense food can be used therapeutically.
Andrew: Yeah, so can I ask about this then… You know how people have their dose of chemo, and while they're sitting there, unless they're not tolerating their chemo very well, and so they're feeling really poisoned and really sick. Most people they sort of have this, you know, half day to a day of grace, and then they feel like rubbish for the rest of the week.
I guess my concern is if somebody is fasting around the dose of chemo, where they could get nutrients, where they are feeling okay. And then afterwards are going to feel rubbish where they're not going to want to eat anyway. You're saying that this work by Walter Longo has actually shown that it benefits them?
Lise: Yeah, so that they don't feel as bad later. You know, they feel generally okay that first day because they're full of steroids. And as those wear off, and usually anti-emetics that have been delivered intravenously, and as those drugs wear off, their side effects start to emerge. But, by managing some of the kind of damage during the infusion, when those drugs wear off there's less symptoms to show up, basically, at that time.
But, you know, of course, I think, you’re kind of is getting to, or hinting at another issue which is important, and that's weight management. For some people, you know, they, with any degree of fasting, will lose weight and at an inappropriate time. So that needs to be monitored. In the studies so far on fasting during chemo weight loss is not really showing up to be an issue for people. They kind of make up the difference calorically between chemotherapy cycles.
Andrew: Right. Now, going on I guess, with regards to a food, or what's in food, and that's glutamine. And it's recently sort of hit the headlines because some researchers have been tricking cancer cells by using glutamine, and that the cancer cells like glutamine. What the message that got out though was don't take glutamine in any way, shape or form, because it's going to feed the cancer cells?
What's the real issue here because I think there's a double thing here?
Lise: Yeah, and so, I mean, this is actually rather complex biochemistry. So glutamine is a preferred fuel by many cells throughout the body, like glucose. And we, as humans beings, make, or are glutamine factories, so we are making a lot of glutamine all the time.
And it's known that malignant cells, some malignant cells, can get to a place where the way they make energy is altered for various reasons, and they don't metabolise glucose very effectively. So they need a lot of it because they're not getting as much energy out of it. And they also start to rely on these secondary fuel sources to a greater degree, including glutamine.
So with that understanding, that's kind of led to this clinical, I would characterize as a clinical jump to say that, "Okay, well, if we deprive the body of glutamine from external sources, then we can sort of starve the cancer cells." The reality is that I question whether that has a lot of clinical practicality.
Number one most glutamine that those cancer cells are using is made within our body. So it doesn't really matter if we're restricting it externally, right, exogenously. Number two, most of the glutamine that we take even in high doses, like, 10-15-gram doses, most of that is going to be taken up by the enterocytes in the intestines and used there. So even then, you're getting very little circulating throughout the body. And I'm just not sure that it really has a big impact on malignant growth over time. Now, having said that, it still makes sense to me, just logically, that you don't want to make it easier for the cancer to get glutamine. So, you know, long-term glutamine supplementation at high doses, ongoingly, in somebody that has active cancer, is probably not really a well-thought out therapy.
But for short term indications, like for example, when people are getting taxane chemotherapy, hypertaxel or docetaxel. You know, there's a couple of clinical studies that very clearly show that high dose 30 grams of glutamine for four days, starting the day of chemotherapy infusion. Will minimise the risk of nerve damage from that taxane significantly. Both the severity and the frequency of that nerve damage. So do I have hesitations about doing that? Absolutely, not. You know I think that even at that dose, I'm not going to fuel that tumour growth really, to any significant level, plus I'm going to mitigate a major toxicity that could have implications for that person long-term. And, you know, I think that's kind of important.
So, and I think there a lot of the new studies that are coming out are really, they're looking at doing a couple of things. Like, there's one I know they're looking at trying to block the pathway of glutamine utilisation with the particular drug. So it doesn't really have anything to do with the sources of glutamine. It has to do with finding a drug that blocks that pathway. That's a really different thing than stopping glutamines. I think this is controversial. And I think it's unfortunately been …the effect of this biochemistry has been overgeneralised, in a clinical context.
Andrew: What about instances where the timing of giving a nutrient can have different effects? For instance, I think there's stuff on carnitine, is that right?
Lise: Yeah, so carnitine is an interesting one actually. There's lots of issues with carnitine.
So, first of all, it really works great for people getting platin chemotherapies. In terms of helping to minimise fatigue. Also for radiation, a really a nice synergist. And there's another chemotherapy that causes nerve damage and fatigue which is taxanes. So there's some thought that carnitine would help reduce nerve damage because that's one of the things it does with the platin chemotherapies.
But, in fact, when this was looked at, actually carnitine makes that neuropathy worse in people receiving the taxane drug. So it's kind of considered a contraindication now for people on taxane chemotherapy. Also, the dose is really important, you know, it seems like there is kind of a minimum of at least two grams, preferably four grams to really see an effect. So I think sometimes, you know, we talk about nutrients as if it doesn't matter what dose, but dose is really important in, you know, in its effect.
Lise: I think what she's referring to is this study of the… acetyl-L-carnitine was actually used in this study, and it was a good study, a double-blind, placebo controlled study. And these were women who were getting taxane chemotherapy. And when they were concurrently getting a acetyl-L-carnitine, they actually had much greater rates of nerve damage. And so I'm not sure about the timing. I mean, generally speaking, it's given concurrently with chemotherapy like with the oxaliplatin or cisplatin or carboplatin. You just sort of take it throughout the whole course of that chemotherapy and there's a reduction in neuropathy.
Andrew: Right. So you wait till after the full cycles of taxanes have been given, and then you would start ALC, ALCAR. Is that right?
Lise: Oh, I see, yes. So maybe that's the timing she was referring to. Yeah, so after…so if you want to try using it to reduce the neuropathy for taxanes, which it may or may not, then you would definitely want to wait until the taxane is out of the system, not coming back in, and then try it.
Andrew: Yeah, I think one of the other things that came out of Janet Schloss' research was, in those ladies on, I think, it was paclitaxel that it may be worthwhile, certainly looking at their history and seeing if they're at risk of B12 deficiency, and potentially, even testing for transcobalamin and B12 levels to make sure that they've got enough. Because they were able to rescue somebody's CIPN, to a certain degree. Which was like, to me it's a groundbreaking thing this. A simple vitamin that can rescue therapy. And therefore, the lady can have the taxane, and therefore the lady can get the benefits of the chemotherapy.
Lise: Right, especially since maybe their other options are more limited.
You know, and another thing to just think about or with carnitine going back to that for a moment, is that, I think, it's important that we don't pigeonhole these nutrients into one effect. You know, one of the reasons why acetyl-L-carnitine, in particular, or carnitine in general, is so much a part of my recommendations is because yes, it helps to prevent neurotoxicity, but it also is very helpful in preventing cardiotoxicity. Specifically, with things like Adriamycin and even, I think aromatase inhibitors and Herceptin. And it is also very good for fatigue. Just general muscle fatigue, so really helpful for radiation. So anytime you have a nutrient that has all those different effects, I think it's something we should really consider.
Andrew: What about neutraceuticals like diindolylmethane? Do you have issues during any chemo with DIM?
Lise: I don't and I'm just hesitating a moment because it's also something I don't go to a lot right up front with chemotherapy. So typically, you know, that's working to modify oestrogen metabolism towards its least carcinogenic metabolites. But it also has been shown to have a very specific immune effect. And it helps to reduce some of the immunosuppression around tumours. And to stimulate tumour lymphocyte infiltration, so it has kind of a specific immune effect as well, and…
Andrew: So would you use it at either side of chemo?
Lise: Yes, and it works on removing fatty liver. So those are all things that kind of are more important long-term, number one, and really after chemo is done. So I tend to kind of put that on board after the course of chemo is complete.
Andrew: Yeah. One thing that's come up with me recently is the use of melatonin. Particularly, in things like glioblastoma multiforme. And particularly in an age group commonly affected by that, and that is kids.
Now, can I ask, how do you use melatonin? And what issues do you find with it? Or what sort of, you know, cautions do you have around its use?
Lise: So, I use melatonin a lot because quite frankly, it's one the best, evidenced based natural therapies in oncology, from the natural perspective. Hundreds of clinical trials and the results are just almost uniformly consistent in terms of reducing the size at profile from chemotherapy and radiation by about 50% typically. And, you know, improving overall survival anywhere from 30% to 50%. So clear benefit.
That being said, there are some times where it doesn't seem to be the right thing for somebody. So there's a certain percentage maybe10% or so, to people who take melatonin that have a paradoxical reaction to it. So, instead of getting sleepy, they get really wired. And you can't really give, you know, you think, "Well, gosh, okay, then take it in the morning." But they'd just get sleepy in the morning. So it just doesn't really seem to work in those people. Sometimes you can kind of work them up to a good dose. But the dose in the clinical literature, for the most part, is 20 milligrams of melatonin. And so you're really looking at almost a pharmacological dose of melatonin. And there's been some really nice articles that differentiate the physiological effects of melatonin. So what happens when we have just our own endogenous levels, versus the pharmacological effects. And they're a bit different, like, for example, just a really quick example is, a physiological level of melatonin really tends to help cells pause in their cycle of division to do some repair. Whereas a pharmacological dose will help to kind of push the cell into apoptosis or suicide. So there's definitely a differential effect with that dose.
So I tend to use it more often than not. With kids, generally speaking, I wouldn't use it as a sleep aid for a child that does not have cancer. Because I think there's lots of other more, you know, safe things to use. Because kids can have, you know, adverse reactions to melatonin. But for a child with a brain tumour, I would definitely use it .Because there's a, you know, reason to think it should be helpful. And there's a lot, you know, they don't have much to lose by trying it basically, so yeah.
Andrew: What about probiotics? Now, there has been some issues with saccharomyces boulardii, haven't there?
Lise: Yeah, so probiotics are interesting too. And of course, there's the issue of normal, healthy, so-called healthy, or commensal bacteria in somebody who has an intact intestinal system. No extraneous devices in their vasculature, there are healthy bacteria, and putting a bunch more in the gut is not going to be an issue.
But, for people who have chemotherapy. One of the almost universal side effects of chemotherapy is to increase hyper-permeability of the gut or cause GI leakiness. And with that leakiness, you're going to get some of these bacterial fragments into the blood. Which even as a commensal bacteria, are going to initiate immune response. Now, this is kind of interesting, because some people think that's actually part of how chemo works. Is that the gut gets leaky, these bacteria come through, they stimulate immunity, and that immunity is then kind of heightened and is able to attack tumour cells more effectively.
And the flip side of that is if somebody's really deficient in their white count. And so their white count is below normal, then there are reported cases of septicemia, even from commensal bacteria. So I sort of use as a general rule of thumb, if somebody's white count is within normal range, then I'm fine using probiotics. But if they're below normal, then I hold it. And I don't think it's, you know, wise.
Andrew: What about the use of probiotics like, for instance, I think, especially saccharomyces boulardii, when people have got a central line?
Lise: Yeah, so I think there's been some reports of some fungicemia from that saccharomyces, in people with ports. I don't really know why that is exactly. Because, you know, where is it coming from? Like, ports kist generally, you have to be so careful with ports, because they can just be these reservoirs of infection and platelets get stuck to them, carry stuff around. They just have to be taken care of so carefully.
Andrew: Yeah, you're right. The reports that I've read were, you know, the well-meaning nurse, was apparently giving the saccharomyces boulardii. Theoretically, got some of the product on her fingertips, then went to clean the central line. And ended up inadvertently causing a portal of entry basically for the organism, and therefore fungemia.
I think the patients that I have read were all rescued with amphotericin, but notwithstanding that's a very serious thing and you should be avoiding it. And you should be absolutely fastidious with central lines. But I think the big thing is, you know, unless you are that, you know, you've got to be really, really careful with SB.
Lise: Yeah, and I think that that point is so important. I've actually had a patient who was getting some intravenous vitamin C therapy during their chemotherapy. And was going to another practitioner to get the IV vitamin C, and the other practitioner was flushing the port, but the hygienics around the office wasn't good enough and she had actually introduced an infection. So it's, I mean, people have to just guard their ports like a rabid dog. Basically, and make sure that it's their… being flushed appropriately, everything's super hygienic. Yeah, really clean.
Andrew: Yep, betadine everything.
Lise, any other sort of general hints and tips? I guess one the closing things for me is, when you're looking at, or when you're avoiding certain supplements because there is a real issue. For instance, like you can't use St. John's-wort because that is a well-known, well-documented issue.
What sort of things can you use if somebody's suffering from anxiety, which of course is a big ongoing issue for people journeying through their cancer? And even thriving afterwards, they have this ongoing, you know, anxiety about what's going to happen now? So where do you sit? What do you tend to use?
Lise: Well, so for example, in that situation, I would think about lavender extract. Which has been shown to not have clinically significant interactions, in human studies, and is a very reliable anxiolytic. You know, for depression, I think going the amino acid route can be quite helpful. So, either assessing for amino acid deficiencies and repleting those. Or looking at simple things like magnesium or B6 deficiency can be very helpful as well.
You know amino acids, they're a little tricky, too. Like, for example, SAMe which we know is a great antidepressant. I mean, really quite miraculous for some people, is also a source of methionine which is an angiogenic factor. And they're even some trials which are looking at can we restrict methionine from the diet and use that as a means to control tumour growth. So that would maybe be something not to use, unfortunately. In somebody that has active tumours, but for somebody who has no evidence of disease, I'm fine with using it.
So I think we just have to be thoughtful and, you know, really think about anything that we're using. Ok, so is there any data on this sort of feeding or spurring cancer growth? Is this data human data? Is it just, you know, cell-based data? Is it theoretical? And then, you know, how long they are going to have somebody on this? Are there any other alternatives? And just kind of really go through almost a mental checklist with every item to try to be as safe as we can.
Andrew: Yeah, and I guess the last point for me to make because there is more and more research coming up about concurrent nutrients with chemo and radiotherapy. I think what we need from you, Lise, is a new version, a new edition of The Definitive Guide to Cancer.
Because I've got to say I've found, particularly, that middle section of the book, I found that so especially useful to just look up as a reference to go, "That's it. That's what I need to do.” Bang.
And thank you for taking us through the real issues of the dangers of supplementation today on FX Medicine.
Lise: Yeah, well, thank you very much. And I'll work on that edition, it's a little overwhelming because there's so many new drugs approved. Like, almost on a daily basis. I don't even know how I would maintain my sanity. If you're willing to have crazy, you know, no longer sane, no longer with us Lise, then maybe I'll do it.
Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.
Additional Resources
| Dr Lise Alschuler |
| Oncology Association of Naturopathic Physicians (OncANP) |
| TAP Integrative |
| Books by Dr Lise Alschuler |
| Book: The Definitive Guide to Thriving After Cancer |
| iThrive Plan for Cancer Survivors |
| Five to Thrive Live |
| Valter Longo - Fasting Research |
Research explored in this podcast
Other Podcasts with Lise
- Targeting Telomeres with Dr Lise Alschuler
- The Truth about Coffee with Dr Lise Alschuler
- Prelude to the Integrative Oncology Seminar with Dr Lise Alschuler
- Insights into Cancer Support
- L-Theanine: A Modern Panacea?
- Ending Anxiety: An Evidence-Based Approach
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