This document discusses natural therapies for post-treatment cancer symptoms. It outlines a multi-disciplinary integrative approach and focuses on promoting general health and wellness through nutrition, physical activity, stress management and avoiding toxic exposures. It identifies various vitamins and dietary supplements that may help mitigate common post-treatment symptoms like fatigue, insomnia, mental fogginess, constipation and joint pain. It also discusses evaluating factors of health like inflammation and nutrient status to further reduce cancer risks.

1. Natural Therapies for
Post-Treatment Symptoms
Chad Aschtgen, ND
Providence Integrative Cancer Care

2. Presentation Objectives
Upon 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.
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3. 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
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 Recommended Resources

4. 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

5. Multi-Disciplinary / Integrative Approach
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6. Multi-Disciplinary / Integrative Approach
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7. Multi-Disciplinary / Integrative Approach
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8. General Health & Wellness Promotion
 Nutrition
 Vegetables, Fruits, Whole Grains, Herbs/Spices
 Limiting alcohol consumption
 Physical Activity and Exercise – Intensity
 Sweating & brief muscle soreness
 Healthy Weight Management – BMI < 25
 Sleep Management – 7-8 hours/night
 Stress Management & Psycho/Social Health
 Minimize/Eliminate Toxic Exposures 8

9. Promoting Wellness & Reducing Risk
2007
1. Healthy weight
2. Physical Activity
3.-5. Nutrition x3
6. Alcohol
7. Processed/
preserved foods
8. Dietary
supplements
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10. American Institute for Cancer Research
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11. Multivitamins Vs Food – Nutrition
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From Anticancer: A New Way of Life – David Servan-Schreiber, MD

12. Vitamins & Dietary Supplements
The research results are conflicting
Headlines are confusing:
“Taking Vitamin E Puts Men at Greater Risk for Prostate
Cancer”
“Vitamin D Can Decrease Cancer by Up To 80%”
“Vitamin C Kills Cancer Cells”
“Vitamin C Supplements May be Harmful” 12

13. Vitamins & Dietary Supplements
The research results are conflicting
Headlines 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

14. Vitamins & Dietary Supplements
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From Anticancer: A New Way of Life – David Servan-Schreiber, MD

15. Vitamins & Dietary Supplements
Use 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

16. Common Post-Treatment Symptoms
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17. Common Post-Treatment Symptoms
Many symptoms will resolve on their own… Eventually
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18. 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 Protein
Image credits – all molecular images from Wikimedia commons @ wikipedia.com
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19. Common Post-Treatment Symptoms
atigue – What is the cause?
oEnzyme Q10 – 100mg twice daily
well tolerated; GI upset
caution: warfarin, some heart medications
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shwagandha – 500mg twice daily
Photo credit – cliff1066 @ flickr.com

20. 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 bedtime
Photo credit – oKikos @ flickr.com
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21. 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
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Photo credit – Michael Wolf @ wikipedia.com

22. 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
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Photo credit – Ahmad Fuad Morad @ flickr.com
Pectin, inulin, psyllium, prune or beet powder

23. Common Post-Treatment Symptoms
iarrhea
robiotics – one capsule/tablet daily
use a high-potency product
containing numerous strains:
Lactobacilli & Bifidobacteria
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well tolerated; GI upset

24. 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 daily
Photo credit – Nuts by Adam Wyles @ flickr.com. Citrus by Monica Arellano-Ongpin @ flickr.com
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25. Common Post-Treatment Symptoms
eripheral neuropathy
lpha-lipoic acid – 600mg 2-3x/daily
very well tolerated; GI upset, hypoglycemia
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26. Common Post-Treatment Symptoms
air, Skin and Nail Support
uminous by Vitanica – one capsule twice daily
Vitamins C, D and E, Biotin, Calcium, Magnesium,
Selenium, Zinc, Silica, Horsetail, Nettles
leaf, Gotu kola herb, Rosemary leaf, and
Oatstraw.
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ontinue for 3-6 months then consider

27. Common Post-Treatment Symptoms
oint Pain – associated with hormone therapy
ish Oil – 2g twice daily of a concentrated product
well tolerated; GI upset, revisiting fish taste
caution: blood thinners
itamin D – possibly, but test first!
atural anti-inflammatories
curcumin, holy basil, boswellia, rosemary, ginger, oregano, etc
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28. 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
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29. Evaluating the Biological Terrain
 Inflammation
 Sedimentation Rate
 C-reactive Protein
 Interleukin-6
 Oxidative stress (hepatic)
 Gamma-glutamyl Transferase
 Glucose / Insulin balance
 Hemoglobin A1c/ Glycosylated Hemoglobin
 Nutrient status – deficiency and/or excess
 Vitamin D
 Essential fatty acid profile 29

30. 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
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31. 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
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32. 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
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– http://www.mskcc.org/mskcc/html/11570.cfm

33. Chad D. Aschtgen, ND, FABNO
Seattle Integrative Oncology www.seattlend.com
Institute of Complementary Medicine www.icmedicine.com
Swedish Medical Center Cherry Hill Campus - Jefferson Tower
1600 E. Jefferson St, Ste 603
Seattle, WA 98122
t: 206.726.0034 | f: 206.726.9434
Providence Integrative Cancer Care www.providence.org/swsa
at Providence Regional Cancer System
4525 Third Ave SE, Ste 200
Lacey, WA 98503
t: 360.754.3934 ext. 1083 | f: 360.412.8955