Questions from the Clinic:
Hey Doc, what is the "Special Sauce" to manage cancer?
I get this question asked in various ways many times a week and hundreds of times over this past year. I generally start with a blanket statement about the importance of general fundamentals of health, which incorporate physical topics and the emotional and spiritual equally balanced. Once again, it all goes back to the loving wisdom of a "grandma" in our life. I then acknowledge that knowledge is dynamic and fleeting, and I can only answer this with the statement, "What I know today and hold onto lightly…”.
I start with the encouragement to consider the standard of care guidelines which have survived some rigors and reviews. This generally encompasses some blend of surgical, chemotherapy, radiation, and new targeted therapies and are listed at standard patient-friendly websites such as www.nih.gov and www.nccn.org. Following that statement, I arm them with critical questions to clarify the offering to better understand the potential path and outcome in absolute numbers rather than "relative risk" reduction and other doctors' speak. I remind them that the guidelines are based on high-functioning patients under ideal conditions and inflate the study outcomes. The think tank on each oncology topic may have a few options and alternative treatment paths that get outvoted and then dropped from the final publication. Some analyses report that less than half the patients fit cleanly into a guideline recommendation. Although guidelines and "menu medicine "serve the important purpose of synchronizing standard doses and options, they may also provide a license to quit thinking. This construct fosters the gradual loss of the art of medicine needed to deal with the more common "gray" area decision-making. In the end, you need a cancer doctor with who you can have a heartfelt two-way conversation in the discussion and delivery of the standard of care component.
I mention that there is some unexplained component of why a percentage of people are successful with standard treatments and the inverse ratio are not. While we have some hints at these positive predictors, and fortunately, most of these can be added to a program with minimal downside time and cost. Today, I encourage patients to have a metabolic portion of their treatment, including nutrition and a pharmaceutical component. The nutritional part generally focuses on reduced carbohydrate intake, intermittent fasting if cachexia is not a concern, pre-chemo radiation short fasting, and various activities around specific macronutrient intakes. The pharmaceutical side may incorporate fasting mimetic drugs and repurposed drugs with a safe side effect risk profile and is generally done through the virtual oncology platform www.CareOncology.com. The strategies leverage energy substrate availability that favors normal cells over cancer cells while being mindful of the risk of cachexia (wasting of muscle and immune function) common in cancer patients and possibly responsible for 30 to 40% of their demises.
I speak to the mental and emotional component that has many facets. I encourage patients to fight but like a Zen warrior above the war through parasympathetic nervous system activation generated by nostril breathing strategies. I encourage people to anchor a firm intention by creating an imaging strategy or making a positive mental movie and "marinating" into it until it permeates their psyche. I encourage people to filter out the possible unneeded negativity and stress in their lives to the degree they can to make room for only positive health and life-giving activities.
I encourage patients to tighten down on a disciplined routine of good sleep for body and brain restoration, morning fluid rehydration for detoxification, daily movement, sun exposure, and more when possible. I challenge patients to use this life-changing diagnosis to catalyze an offensive rather than defensive approach on physical activity touching the four principal forms of fitness. I stress categories such as aerobics for cardiopulmonary health, strength per muscle maintenance, balance to prevent falls, and flexibility to maintain posture and structure. I remind them that "body in motion, stays in action "and that a tiny bit frequently performed goes a long way. Everything about exercise fosters anticancer signaling pathways and should be considered a treatment. Remember, muscles are the biggest organ in the body. When active, they compete with nutrient substrates that could otherwise go to cancer cell metabolism without the need for insulin or IGF1. Keep your muscles at the meal table and keep them hungry :-).
A final issue that should never be diminished is the emotional-spiritual component, so frequently left in the toolbox in the discussion of cancer care. In our evolutionary interdependence, I remind people we are "herd" and "tribal" animals. A close friend recently gifted me the book “The Hidden Life of Trees" by Peter Wohlleben, which details the surprising interdependence of trees of different species to support each other above and below the ground to create a natural and healthy ecosystem and ultimate forest. Getting a cancer diagnosis can foster many emotions, and some feel like they're "cut from the herd." We know that social isolation is a predictor for adverse outcomes for many disorders and equilibrates statistically like the finding of smoking three cigarettes packs per day (yes, 60 cigs per day doesn’t leave much time for anything else).
If trees need other trees, I suspect a more advanced neurologic species like humans could benefit from this too. So, in this holiday season blemished by a pandemic, don’t forget the final ingredient to this special sauce, human connection and love. I encourage patients to not be passive in this strategy but to blossom with their families and loved ones, acquaintances, and even strangers at all turns in their routines. Supporting each other positively with a smile or kind word of our mutual challenges and flaws is like a root that brings needed nutrition to a person in the threatened human forest. I challenge and encourage our patients to go out and connect blindly and blissfully and be the giver and thus paradoxically receive so much in return.
Once again, this is what I know today, always looking for more and new ingredients in the "special sauce."
Stay strong, keep smiling and be your own best doctor,
Charles J. Meakin MD, MHA, MS
Disclaimer: This information is not meant as direct medical advice. Readers should always review options with their local medical team. This is the sole opinion of Dr. Meakin based on a literature review at the time of the blog and may change as new evidence evolves.