Although referencing a few research studies, the presentation is designed to emphasize practical/useful information. Promoting wellness – weight management, glucose/insulin balance, decreased inflammation. Treating symptoms
There is the Summary of Treatment info – then the going forward aspect of the plan: e.g. colonoscopy, mammogram, vaccinations, etc. Ongoing medication management; e.g. diabetes, high blood pressure medications, etc. Endorsement for survivorship care plan And re-engaging with the family care physician
The Lifestyle factors – Our primary tools Also, minimizing exposure to risk factors – tobacco, pollution, excess UV, ionizing radiation, solvents, etc.
Nutrition: Energy dense/sugary foods, plant (non-starchy) foods and animal foods Survivors [should] follow the recommendations for cancer prevention!!
I often ask my patients why they are taking a certain supplement and often they state that they don’t know!
Whole foods, primarily plant based diet with a wide variety of food choices and abundant herbs and spices.
Gastrointestinal toxicity Neurological toxicity
Nutrition, sleep, physical activity, etc.
Meat and dairy products, beans, avocado 2 weeks
Beta blocker (atenolol, metoprolol) 2-4 weeks
Lactobacilli (L. casei HA-108; L. paracasei HA-196; L. acidophilus HA-122; L. rhamnosus HA-111; L. rhamnosus HA-114; L. salivarius HA-118)Bifidobacteria (B. breve HA-129; B. bifidum HA-132; B. longum HA-135; B. infantis HA-116) Wheat, corn, barley, peanuts, soybean, egg white, milk
Many of these can be addressed by nutrition and exercise Others need an individualized approach Common supplements with overlapping benefit
Need to expand this; consider multiple slides.
Natural Therapies for Post-Chemo and Radiation Symptoms
Natural Therapies forPost-Treatment Symptoms Chad Aschtgen, NDProvidence Integrative Cancer Care
Presentation ObjectivesUpon completion of this activity, you will be able to: • Describe the role of lifestyle factors and dietary supplements within the context of the comprehensive survivor care plan. • Identify a variety of supplements that may help to mitigate numerous common post-therapy symptoms. • Identify numerous indicators of health that may be evaluated and addressed in an effort to promote wellness and reduce risk of new or recurrent disease. 2
Presentation Outline Survivorship Care Plan – Creating Context Focus on Health – Promoting Wellness Vitamins & Dietary Supplements Symptom Management – Quality of Life EVALUATING AND TREATING THE BIOLOGICAL TERRAIN Risk Reduction – the Role of Supplements Dietary Supplement Considerations 3 Recommended Resources
Survivorship Care Plan – Context Medical Oncology Follow Up Surveillance, evaluation and maintenance care Family/General Physician Care (PCP) Screening for early intervention of other disease Evaluation and treatment of injury and disease HEALTH, WELLNESS & QUALITY OF LIFE FOCUS Promoting health/Preventing injury and disease Addressing pertinent lifestyle factors Dietary supplementation 4
Multivitamins Vs Food – Nutrition 11From Anticancer: A New Way of Life – David Servan-Schreiber, MD
Vitamins & Dietary SupplementsThe research results are conflictingHeadlines are confusing:“Taking Vitamin E Puts Men at Greater Risk for ProstateCancer”“Vitamin D Can Decrease Cancer by Up To 80%”“Vitamin C Kills Cancer Cells”“Vitamin C Supplements May be Harmful” 12
Vitamins & Dietary SupplementsThe research results are conflictingHeadlines are confusing:“Regimens: No Cancer Benefits Seen in Supplements”“Vitamin E Found to Cut Cancer Risk For Prostate”“Vitamin A Found to Inhibit Cancer”“Vitamin D Deficiency Linked to Breast Cancer” 13
Vitamins & Dietary Supplements 14From Anticancer: A New Way of Life – David Servan-Schreiber, MD
Vitamins & Dietary SupplementsUse supplements as you would any medicine– for a targeted, therapeutic effect. 1. Symptom Management 2. Specific Health Promotion/ Risk Reduction Be conscious of the desired effects and potential risks • Is the supplement safe for you? • Is the supplement likely effective? • Understand appropriate prioritization. • Heed general cautions- allergic rxn, drug interactions… 15
Common Post-Treatment SymptomsMany symptoms will resolve on their own… Eventually 17
Common Post-Treatment Symptoms atigue Sleep • 7-8 hrs/n Protein • 25g/ meal Hydration • 64oz/d hey Protein – choose a highly concentrated product; 90% Pure ProteinImage credits – all molecular images from Wikimedia commons @ wikipedia.com 18
Common Post-Treatment Symptoms atigue – What is the cause? oEnzyme Q10 – 100mg twice daily well tolerated; GI upset caution: warfarin, some heart medications 19 shwagandha – 500mg twice dailyPhoto credit – cliff1066 @ flickr.com
Common Post-Treatment Symptoms nsomnia – sleep hygiene elatonin – 1-3mg at bedtime well tolerated; drowsiness, GI upset caution: nifedipine, sedatives, anti-depressants alerian root – 500mg at bedtimePhoto credit – oKikos @ flickr.com 20
Common Post-Treatment Symptoms ental fogginess – ‘Chemo Brain’ See Fatigue and Insomnia cetyl L-Carnitine – 1.5-3g twice daily GI upset, tart flavor (powder) caution: hemodialysis, attention deficit disorder 21Photo credit – Michael Wolf @ wikipedia.com
Common Post-Treatment Symptoms onstipation High fiber foods • 30-40g/d Hydration • 64-96oz/day Physical activity • walking 30-45m/day iber supplement – 5-15g in 8-12oz water at bedtime 22Photo credit – Ahmad Fuad Morad @ flickr.com Pectin, inulin, psyllium, prune or beet powder
Common Post-Treatment Symptomsiarrhearobiotics – one capsule/tablet dailyuse a high-potency productcontaining numerous strains: Lactobacilli & Bifidobacteria 23well tolerated; GI upset
Common Post-Treatment Symptoms ot flashes itamin E – 400IU 2-3x/daily warning: bleeding, GI upset, rash caution: blood thinners esperidin Methyl Chalcone – 500mg 2-3x dailyPhoto credit – Nuts by Adam Wyles @ flickr.com. Citrus by Monica Arellano-Ongpin @ flickr.com 24
Common Post-Treatment Symptomseripheral neuropathylpha-lipoic acid – 600mg 2-3x/dailyvery well tolerated; GI upset, hypoglycemia 25
Common Post-Treatment Symptomsair, Skin and Nail Supportuminous by Vitanica – one capsule twice dailyVitamins C, D and E, Biotin, Calcium, Magnesium,Selenium, Zinc, Silica, Horsetail, Nettlesleaf, Gotu kola herb, Rosemary leaf, andOatstraw. 26ontinue for 3-6 months then consider
Common Post-Treatment Symptomsoint Pain – associated with hormone therapyish Oil – 2g twice daily of a concentrated productwell tolerated; GI upset, revisiting fish tastecaution: blood thinnersitamin D – possibly, but test first!atural anti-inflammatories curcumin, holy basil, boswellia, rosemary, ginger, oregano, etc 27
Factors of Health – Individualized Care Inflammation Oxidative stress Glucose / Insulin balance Nutrient status – deficiency and/or excess Coagulation – components of clotting/ bleeding Hormone balance / Exposure Immune function Optimal/Adequate organ function 28
Targeted Risk Reduction Fish oil – 2-5g daily Green tea – 500mg of EGCG 2-3x/d Curcumin – 3-6g daily; highly absorbable form Vitamin E succinate – 400IU daily Resveratrol – 175-200mg twice daily Vitamin D – 1,000-5,000IU daily as per results Coriolus mushroom – 600mg three times daily 30
Dietary Supplement Considerations Quality & Purity is Important Specific form of nutrients/botanicals matters Vitamin D3 versus D2 Fish oil; cod liver oil vs whole fish vs concentrates Root, leaf, flower Raw material and finished product source matters Purity, potency and microbial contamination Of course “Natural” ≠ Safe Nor necessarily effective Just as Rx ≠ Safe 31
Recommended Resources Five to Thrive: Your Cutting Edge-Cancer Prevention Plan Lise N. Alschuler, ND & Karolyn A. Gazella Anticancer: A New Way of Life David Servan-Schreiber, MD Life Over Cancer: Block Program Integrative Cancer Treatment Keith I. Block, MD The Cancer Fighting Kitchen Rebecca Katz The Journey Through Cancer Jeremy R. Geffen, MD Integrative Medicine: About Herbs, Botanicals & More Memorial Sloan-Kettering Cancer Center website 32 – http://www.mskcc.org/mskcc/html/11570.cfm
Chad D. Aschtgen, ND, FABNOSeattle Integrative Oncology www.seattlend.comInstitute of Complementary Medicine www.icmedicine.comSwedish Medical Center Cherry Hill Campus - Jefferson Tower1600 E. Jefferson St, Ste 603Seattle, WA 98122t: 206.726.0034 | f: 206.726.9434Providence Integrative Cancer Care www.providence.org/swsaat Providence Regional Cancer System4525 Third Ave SE, Ste 200Lacey, WA 98503t: 360.754.3934 ext. 1083 | f: 360.412.8955