Supplements and Nutrition for Cancer Survivors | June 22, 2021

June 23, 2021

Information

Presentations by Drs. D. Barry Boyd, Gary Soffer, and Annette Hood, PharmD, BCACP

ID6745

To CiteDCA Citation Guide

00:05OK, welcome everybody to our third
00:09smilow shares lecture in our
00:13series of survivorship. Lectures this
00:17are third out of 4th and we are.
00:21Doing this this survivorship series in
00:23honor of National Cancer Survivors Day,
00:25which here at Smilow we decided to
00:27turn into a month long celebration.
00:30Can't believe it's already
00:31the third out of four,
00:33so our third week out of four weeks.
00:36My name is Heather Studwell.
00:37I'm the survivorship coordinator.
00:39At the Smilow Cancer Care
00:42Center at Greenwich Hospital.
00:44Our survivorship is an area that cancer
00:46care that I hold near and dear to my heart.
00:50Having worked as an occupational therapist
00:52at Greenwich Hospital for nearly 20 years,
00:55treating cancer survivors and
00:57those who are surviving cancer.
00:59And it's my pleasure to be facilitating this
01:02panel tonight on supplements and nutrition.
01:05Going to give you a few housekeeping
01:07items as we go along.
01:09There is a Q&A box down at the bottom of
01:11everybody zoom screen so you can use that
01:14to type in your questions throughout.
01:16You don't have to wait till the end,
01:19but we will have all of our presenters
01:21present and then we'll go through the
01:23questions at the end of the lecture,
01:26but also a few questions at the
01:28end of each of the presenters.
01:31Lectures so we have a lot of
01:35people joining us tonight.
01:36Welcome to everybody if you.
01:40Let's see, I just want to
01:42see where we're still good.
01:45OK so our first presenter tonight
01:47is Annette Hood and that is a
01:51clinical pharmacist specializing in
01:53women's oncology including breast,
01:55ovarian, uterine,
01:56and cervical cancers on the main campus.
02:00Of. Smilow Cancer Hospital in New Haven.
02:04She completed her Doctor of
02:06Pharmacy degree from the University
02:08of Connecticut and a residency
02:09at Saint Francis Hospital and
02:11Medical Center in Hartford.
02:13Her main role is to review chemotherapy
02:15orders for all clinic patients,
02:17provide counseling to patients on
02:19chemotherapy and supportive care.
02:20She also works with Doctor Sopher,
02:23an integrative medicine clinic
02:25to review supplements.
02:27So I'm going to have you start off.
02:31Let me share my screen.
02:43Let's see, actually.
02:58Snap the right screen on the 2nd.
03:10Think. Can you see Presenter
03:13view or are you seeing?
03:15The entire slide show view,
03:17but now we're getting your presenter view.
03:19You're just going to centerview, OK, perfect.
03:25OK.
03:27Second, too many screens here.
03:37OK, great. OK,
03:39so thank you for having me today on
03:41this very important talk about dietary
03:43supplements in cancer survivors.
03:45I know that this is a topic that
03:47many of you are very interested in,
03:50so I'm glad that you're here tonight.
03:52Tonight I'm going to talk about
03:54some general information about
03:55supplements and their safety,
03:56and then debunk some myths surrounding
03:59dietary supplements and then later
04:00on Doctor Boyd is going to really
04:02get into more of the specifics.
04:04Next on the safety and effectiveness
04:07of the dietary supplements.
04:18OK. So first let's talk about some background
04:23information on dietary supplements.
04:25So what are they so?
04:26These include our vitamins which could
04:29be multi vitamin products which include
04:31you know several different multi,
04:33several different vitamins and minerals.
04:35Or I could just include single vitamins
04:38such as vitamin A or vitamin D.
04:41It also includes minerals like
04:42calcium and herbs or botanicals.
04:44We can think avec anicia or
04:47valerian root as another example
04:49and it also includes amino acids.
04:52So as the name suggests,
04:54dietary supplements really are
04:55intended to supplement the diet.
04:57They are not intended to diagnose
04:59any illnesses to cure any illnesses,
05:02or to treat or prevent a disease.
05:04An if the label of a certain
05:07product makes these claims,
05:08it's actually in violation of DESHAY,
05:11which is the dietary supplement
05:12health and Education Act of 1994,
05:15which will talk a little bit
05:17more about in the next slide.
05:20So let's get into our first myth.
05:25So myth number one supplements are
05:27regulated by the FDA just like other drugs.
05:33And actually, dietary supplements
05:35are regulated more as foods,
05:37not like the prescription medications
05:39or over the counter medications
05:41that we think about where those
05:43manufacturers actually have to
05:44submit clinical trials proving the
05:46safety and efficacy of their product
05:48before it gets approved by the FDA,
05:51or and then before it comes to market.
05:55So any supplement that was already
05:57on the market prior to DESHAY prior
06:00to 1994 is actually grandfathered
06:01in and therefore does not have to
06:04prove to the FDA any safety or
06:06effectiveness before going to the market.
06:09So only once it's marketed,
06:11then the FDA has to actually prove
06:13that the product is not safe in
06:16order to restrict its use or remove
06:18it from the market.
06:19So what does the FDA actually regulate?
06:22It regulates the label, so,
06:24as I had mentioned earlier,
06:25manufacturers of these supplements cannot
06:27make any claims related to treating
06:29or curing or preventing any illnesses.
06:31And if they do,
06:33then that is in violation of this act
06:36and they could get either fines or have
06:39their product removed from the market.
06:43So because these products are not
06:45really strictly regulated by the FDA,
06:47there are some concerns about supplements,
06:49especially in terms of their quality.
06:53So some supplements may actually contain
06:55contaminants such as lead or arsenic,
06:57or they may have too much or too
06:59little of the ingredient that
07:00it says that is on the label.
07:02And some studies have actually found
07:04that more than 60% of supplements do not
07:06have what the label says that it has.
07:08So for example,
07:09this is a report to the right from
07:11a website called Consumer Lab,
07:13which I'll talk about a little
07:15bit more towards the end,
07:16which looks at products that are
07:18on the market and kind of test
07:20them to see what's in the product.
07:22So they found that there's a
07:23tenfold difference in potency across
07:25different types of Jin sing.
07:26Products.
07:27So because these products aren't regulated,
07:29I will towards the end kind of give you
07:31some tips on what you can do to try to
07:34pick the safest products on the market.
07:38So let's get into myth.
07:40#2 dietary supplements are always safe.
07:43So many patients think that
07:44because something is natural,
07:45or because either because it comes from
07:47a plant or an animal that it is safe.
07:50However, a lot of these supplements
07:52are made into really concentrated
07:53formulations with high amounts
07:54of the specific supplement,
07:56and that will actually make
07:57and make them unsafe.
07:58And this is something that Doctor Boyd
08:01is going to spend a little bit more
08:03time talking about during his slides.
08:06So I wanted to give an example of
08:08something that even though it's natural,
08:11it doesn't mean that it's safe.
08:13So here's an example of apricot kernel,
08:15or also known as apricot seeds.
08:17And it's marketed as vitamin B17.
08:20So as you can see, well,
08:22this is a pit that's found
08:25in the fruit of an Africa.
08:28In the center of the apricot fruit.
08:30Sorry so as you can see in the picture,
08:32it looks like an almond and it even
08:34has the taste of an almond and it's
08:36promoted as an anti cancer agent,
08:38an intern.
08:39It also is promoted to improve
08:40energy levels and well being,
08:42and also as a detox for the body.
08:46So in actuality, there is no evidence
08:49to support that it can treat cancer,
08:51and vitamin B17 is actually
08:53amygdalin in this case,
08:54which is a toxic chemical that in the
08:56body is converted to the poison cyanide.
08:59And if you eat 50 to 60 of these apricot
09:02kernels, it can actually cause death.
09:05And at lower levels,
09:07cyanide poisoning can occur,
09:09so towards the right here is an
09:12article recently from Canada in which
09:14apricot kernels were being recalled
09:17over the risk of cyanide poisoning.
09:20So are the signs of cyanide poisoning
09:22include weakness and confusion,
09:24anxiety, restlessness,
09:24and then in severe cases,
09:26seizures are death,
09:27so you can see on the label.
09:29It does give a warning that
09:31this product tests with apricot
09:32kernels which contain amygdalin,
09:34which can cause symptoms of cyanide
09:36poisoning and to not eat more than 8 seeds.
09:38But you can see that someone who
09:41doesn't really know much about
09:42apricot kernels or who doesn't read
09:44the label may ease just like regular
09:46nuts which could lead to toxicity.
09:48So the main main point about myth
09:51#2 is that just because something
09:53is natural does not necessarily
09:55mean that it's safe,
09:57and this concept can apply to
09:59many other dietary supplements,
10:00depending on the dose.
10:02That is,
10:02you're taking it up.
10:07I did also want to have you take a look
10:09at some labels of different supplements.
10:12These are actually multi vitamins so
10:14on the left here you can see a list of
10:17the multi byte vitamins in this product
10:19and then their percent of daily value.
10:21It's about 100% or less for each of
10:24these vitamins and then the product in
10:26the middle with the yellow you if you
10:29take a look at these supplement facts
10:31you can see that the Feynman in this
10:33product has 8000% of your daily value.
10:36And vitamin B12 has 625% of your daily
10:39value and then all the way to the right
10:42is just a single vitamin D product
10:45with 10,000 international units.
10:48Vitamin D, which has 12150% of
10:50your daily value.
10:51I'm not, I'm just gonna
10:53interrupt you for one second here. It's not
10:56advancing. Oh, I'm sorry.
10:59OK OK perfect.
10:59OK so I'll just briefly
11:01start over really quick.
11:02So to the left here you can see
11:05the product that has the multi
11:07vitamins listed at 100% or less of
11:09your daily value in the middle is a
11:12product that has the higher amounts
11:14with the time and you can see there
11:17at 8000 B 12 at 600 and then to
11:19the right is the vitamin D product
11:21with 12150% of your daily value.
11:23So in general I know a lot of
11:26people probably don't really
11:27look at the supplement facts.
11:29And see what they're actually
11:30purchasing in their in their
11:32supplements that they're buying,
11:33but it's really important to
11:34really take a look and see what's
11:36in there and just the tip is if
11:38you're looking at these products,
11:40really try to stick to something that's
11:42at 100% of your daily value or less.
11:47OK, so Miss #3 supplements do not
11:51interact with cancer treatments.
11:54Let me go back so I know as
11:56cancer survivors do you have many
11:59different types of treatments,
12:01including radiation therapy and surgeries.
12:03Some of you may be on hormone supplements
12:05for hormone stimulating cancers like
12:08breast cancer or uterine cancer,
12:10and there are potential for interactions with
12:13supplements and these treatments as well.
12:15So I wanted to touch on these a little bit.
12:20OK, so first let's talk about
12:22interactions with radiation therapy.
12:24So antioxidants which neutralize
12:25reactive ask oxygen species or the
12:28free radicals that can cause cancer.
12:30Patients use these to protect your normal
12:33tissue from treatment side effects.
12:35However, studies have found that the
12:37antioxidants may actually protect
12:39the cancer cells and interfere
12:41with the radiation treatment,
12:43or they may actually make
12:44the cancer cells grow more,
12:46which is something Doctor
12:48Boyd will touch on in his.
12:51Wise.
12:51So I want to give an example
12:54of vitamin E and radiation.
12:56Initial research has suggested
12:58that Alpha Tocopherol,
12:59which is a vitamin E compound,
13:01might reduce the toxicity from radiation
13:03therapy for head and neck cancers.
13:05But then two randomized control
13:07trials and head and neck cancer
13:09found that patients who were taking
13:11vitamin E at 400 international units
13:13per day they were associated with a
13:16higher risk of tumor relapse and a
13:18decrease in cancer free survival.
13:20So in general, the recommendation.
13:22For patients,
13:23getting radiation therapy is
13:25to avoid antioxidants,
13:26specifically vitamins AC&E.
13:28Other antioxidants include coenzyme Q10,
13:30selenium and christen and then in general,
13:33antioxidants that are found
13:35in food are safe unless you
13:37are using excessive amounts,
13:39which you should be reducing.
13:42Fruits or vegetables and this is
13:44something doctor soccer will go into
13:47more during his nutrition piece.
13:55OK, so there are also potential
13:57interactions with surgery supplements
13:59such as ginkgo biloba, garlic fish oil,
14:02green tea, and vitamin E.
14:04All have an increased risk of bleeding
14:07supplements such as Saint John's Wort,
14:09valerian root, and Kava.
14:11They all may have sedating
14:13or make you sleepy effects,
14:15which can prolong the effects of anesthesia.
14:18Other surgical complications
14:19that may come up.
14:21For example,
14:22Gen Singh may affect your blood sugar
14:24control before and after surgery,
14:25or may decrease the effectiveness
14:27of certain medications,
14:28such as a blood thinner called Warframe.
14:30So it's really important to discuss
14:32with all of your providers if
14:34you're taking any supplements,
14:35and particularly prior to surgery,
14:37your doctor may suggest that you stop
14:39any of these types of supplements
14:41two to three weeks prior to surgery.
14:47Some of you may be taking hormone therapies
14:50for your hormone sensitive conditions.
14:52As we mentioned, breast cancer,
14:54uterine or ovarian cancer,
14:56there are potential side effects.
14:58Potential interactions with
14:59supplements here as well.
15:00For example, Saint Johns Wort really
15:03likes to chew up medications and
15:05get rid of them out of the body
15:08faster and so can interfere with
15:10how tamoxifen works in your body
15:13and makes it work less effective.
15:15Other supplements may make hormone therapy
15:17more toxic or have more side effects.
15:20For example, tamoxifen is associated
15:22in rare cases with fatty liver or
15:25increased risk of liver toxicity,
15:26and if there's a supplement such as cava
15:29which is also associated with liver toxicity,
15:32you may be at increased risk.
15:35Certain supplements such as ginseng,
15:38contain chemicals that we call phytoestrogens
15:41that might act like estrogen and.
15:45Either potentially the growth of
15:47these cancers or just interfere
15:49with the hormone therapy in general.
15:51So other examples that you should
15:53avoid in this case are resveratrol soy
15:56supplements and curcumin or turmeric.
15:59Specifically, the concentrated supplements,
16:01not necessarily the foods.
16:03Finally,
16:03I did want to touch on some interactions
16:06with chemotherapy antioxidants here as well.
16:09There have been data showing that they
16:11can neutralize the reactive oxygen
16:13species that chemotherapy agents
16:15may need to kill the cancer cells.
16:17Other supplements may interfere with
16:19the clearance of the chemotherapy
16:21so they could either make it more
16:23toxic if it's not cleared properly,
16:25or can make it less effective
16:27if it's cleared too quickly.
16:33So finally I just wanted to
16:34get into some resources and
16:36recommendations for you in general.
16:38As I already mentioned.
16:40Please discuss any supplements that
16:41you're taking with all of your providers
16:44throughout your treatment, and in general,
16:46if you're eating a balanced diet,
16:48supplements probably aren't needed.
16:49Some patients may need them if
16:52they have low levels of certain
16:54vitamins or electrolytes,
16:55or maybe not be eating enough so
16:57under the direction of a provider may
17:00be instructed to take supplements.
17:02I've listed here a couple websites
17:04with some helpful information.
17:06The NIH Office of Dietary Supplements,
17:08the National Center for Complementary
17:10and Integrative Health and Consumer Lab,
17:12and I'll go over each of these very briefly.
17:16So this is the website from the
17:18NIH Office of Dietary Supplements.
17:21And you can see they have an
17:24alphabetical list of vitamins and
17:26minerals and also herbal products.
17:28You can click on any product that you
17:31want an read more about uses safety.
17:34Some of these have specific doses listed
17:37interactions and or other side effects.
17:41The National Center for Complementary
17:43and Integrative Health is focused
17:45less on vitamins and minerals
17:46and more on herbal products.
17:48So here's just a snapshot of
17:50some of the herbal products
17:52that they have on their website.
17:55And then finally I wanted to touch
17:57on this website called Consumer Lab.
17:59Unfortunately,
17:59it does require a subscription,
18:01but they do have some
18:02really great information.
18:03So what they do is they actually
18:05go and they take products that
18:07are already on the market and they
18:09analyze them for contaminants.
18:11They analyze them to see if it
18:13actually has what it claims to
18:15have on the label in the amounts
18:17that it says on the label,
18:19and then it provides a report.
18:21So here is just a sample of a
18:23B vitamin supplement report.
18:25That they had looked at.
18:30And so the last thing I want to touch
18:33on is how do you know or how can you
18:36pick the best supplement to ensure
18:38that it is as safe as possible.
18:41So I recommend that you pick
18:43supplements that are certified.
18:44So on the bottom here are different
18:47agencies that certify supplements.
18:48I usually prefer supplements that are
18:50USP certified and on the right you
18:53can see here an example of what it
18:55looks like on this nature made bottle.
18:58So what a certified supplement means?
19:00Is that it has been tested and proven to
19:03contain the ingredients that are listed
19:05on the label in the described amounts.
19:08It does not contain harmful
19:09levels of contaminants,
19:10it the product will breakdown and
19:12release into the body within a
19:14specified amount of time and it has
19:16been made according to the FDA good
19:19manufacturing practices which has safe
19:21and sanitary conditions and that the
19:23supplement will be manufactured with
19:25consistent quality from batch to batch.
19:28So this is just a helpful tip
19:30on what to look for.
19:31If you are going to purchase these products.
19:36That's all I had specifically for you
19:38on general background information an
19:40at this point I'll either take some
19:42questions or will save them to the end.
19:47Yeah we have here I'll
19:49I'll go into one question.
19:52I have a question.
19:53I'm craving oranges since starting chemo.
19:55How much is too much in
19:57terms of dietary vitamin C?
20:01So dietary vitamin C if you're
20:03if you're eating just if
20:04you're not taking a concentrated
20:06supplement of vitamin C,
20:08That's when it really becomes a concern
20:11and you're eating a few oranges
20:14a day that that should be fine.
20:17I would say really it becomes a
20:19concern when you're starting to
20:21just take megadoses of these,
20:22like multiple glasses throughout the day,
20:24every single day.
20:28Alright. That was great.
20:31Thank you so much Annette. So
20:34now we're going to continue on with our.
20:39Supplements and nutrition
20:40lecture with Doctor Barry Boyd.
20:42Doctor Boyden is is an associate
20:44professor who cares for patients at the
20:47Smilow Cancer Care Center in Greenwich.
20:50He received his medical degree from
20:52Cornell University Medical College
20:54and a Masters of Science from Columbia
20:56Institute of Human Nutrition.
20:58He completed his residency and fellowship in
21:00Hematology Oncology at New York Hospital.
21:03Cornell Medical Center.
21:04Dr Boyd is a pioneer in the field
21:07of integrative cancer care.
21:09With a targeted focus on nutritional
21:11support for cancer patients,
21:13incorporating emergent evidence
21:15based medical oncology with cancer
21:17specific nutritional counseling,
21:18he combines comprehensive support
21:20for the healing process.
21:23He authored the missing link,
21:24insulin and cancer,
21:25as well as numerous medical
21:27articles and reviews.
21:28His book The Cancer Recovery Plan,
21:31was the first to address the link
21:33between the little understood
21:35metabolic syndrome and cancer.
21:37Doctor Boyd's research Interests
21:38Center on the interaction of vitamins
21:41and nutrients with chemotherapy,
21:43insulin resistance, and cancer causation,
21:45and progression,
21:46and utility of non conventional
21:48approaches including mind body
21:50techniques in combination with
21:52conventional cancer treatment.
21:54So thank you for joining us Doctor Boyd.
21:57Thank you ever. Do you do use both here
21:59and see my presentation. We had that
22:01you, but you have to share your screen
22:03so we're going to get you started.
22:05And just to let everybody know.
22:08We are recording this so it will
22:10be available afterwards for you
22:12to view again if you need to.
22:13An will put some of the websites and
22:16that if you can put some of those
22:18websites that you had it in the chat.
22:21That would be great.
22:22So everybody can grab those through
22:25the chat as we go as we go on.
22:28We tried to share my screen again. I thought
22:31I had to go. Got it. Not yet. There you go.
22:39Good, let me do this one more time.
22:42You have my screen there, right?
22:44You have your screen, yeah.
22:46Good presentation though.
22:48You don't have my
22:49presentation. We have your blank screen.
22:58Seems like we've been through this road too
23:01many times, every time.
23:05No luck. Low.
23:10Well it says stop share so
23:11that doesn't seem to be the
23:13correct on my other screen.
23:26When you left there.
23:28Not yet. There.
23:54Yeah, go down to the little PowerPoint
23:56button on the bottom of that screen.
24:01And just pop open your.
24:04Your PowerPoint tab at the bottom.
24:07Yeah, I've just been doing that.
24:10Doesn't seem to want to open.
24:12You noted before.
24:25Let me come out and go back in here. It's.
24:37And you look now.
24:41Yep, we can see it.
24:43OK good you can see it finally great.
24:46Alright, they can see it fantastic.
24:51Though it takes 10 or 15 minutes with this,
24:53you know I'm at that age where I wasn't
24:56raised with a computer in my hand.
24:58I'm going to talk to you a little bit
25:00about the evolution of our understanding
25:03about cancer dietary supplements nutrition.
25:05I've been in this work for almost 40 years.
25:09My colleague just retired
25:10and I'm still at it.
25:12'cause I love what I do.
25:14I will mention as an aside that
25:16Annette mentioned amygdalin.
25:18It may be known to you that that's
25:20actually called laetrile.
25:22In the alternative world,
25:23and it was so popular that in 1982
25:26Charlie Mortell from Mayo Clinic.
25:28Had to do a randomized trial to see
25:30if there was any benefit because
25:32we knew was potentially toxic.
25:34It did not help anyone,
25:36but it turned out there is still
25:38alternative physicians and
25:39practitioners who still give laetrile
25:41to cancer patients despite the rest.
25:43So we're living in this world
25:45of false information.
25:46Still,
25:46I want to go back and talk about in the
25:49night how this evolved in the 60s and 70s.
25:52We knew that died was associated with
25:54cancer and cardiovascular disease.
25:56We didn't know how there's a big.
25:58There's a lot of understanding about the
26:01role of dietary fruits and vegetables
26:03that seem to be associated lower risk,
26:05and from this came the antioxidant
26:07hypothesis early on was recognized at
26:09oxidative stress will damage normal cells,
26:12DNA membranes, and maybe causal
26:14not only in heart and cancer,
26:16but in heart disease,
26:17you know,
26:18oxidized LDL and its effect on
26:20UN cholesterol and atheromas,
26:21but this also is the era when we began
26:24to look at the idea of chemoprevention.
26:27The idea of using high dose nutrients.
26:30Based on this hypothesis that we
26:33could actually prevent cancer,
26:34this has been profoundly beneficial
26:36in helping to educate us about
26:38misunderstandings about high
26:40dose supplements.
26:41Unfortunately,
26:41people have never gotten this message.
26:44I am presented discussions about these
26:47trials that I called the landmark
26:50trials that nobody's ever heard of.
26:52Now there is this persistent belief
26:54in the use of high dose supplements,
26:57and again you know we have to remember
27:00that they look nice and multi colored,
27:03but they're not the same thing as
27:06healthy fruits and vegetables.
27:08Back in the early 80s,
27:10two very prominent epidemiologist
27:11from England doll and Peto analyze
27:14the causes of cancer in the US.
27:16They analyze that about 1/3 to 2/3
27:19of all human cancers were caused
27:22by diet and lifestyle.
27:24In a generic sense, OK,
27:25they didn't know what,
27:27but they felt that there was
27:29a clear association.
27:30I will say in 1995 to 19 to
27:3219 to the year 2000,
27:35the the principles and practice of
27:37ONKOLOGIE had lowered that to about 10%.
27:39Of course,
27:40that turns out that that was wrong too,
27:43and still is substantial, but how?
27:46Well,
27:46what we knew was there was
27:48a very interesting
27:49beginning. Looking at a population
27:51in Shannon Lynn, one China,
27:53that had an extremely high incidence
27:55of gastric cancer, surprisingly,
27:57and they thought because it was a
27:59very nutrient deficient population.
28:01There was concern that micronutrient
28:03deficiencies may have played a role,
28:05and so the US and the Academy of
28:08Medicine in Beijing decided to run a
28:10randomized trial of a number of different
28:13nutrients and what they found was again.
28:16Micronutrient deficient 30,000 patients
28:18in rural China now look at the risk 10
28:23times that of other provinces and 100
28:25times the risk of gastric cancer in the US.
28:28Profoundly different population.
28:30AUST and they looked at
28:31four different combinations,
28:33and they found that beta carotene,
28:36vitamin E,
28:36and selenium all in low doses of
28:38essentially replacing the daily
28:40requirement not only lowered
28:42cancer mortality but substantially
28:44lowered gastric cancer mortality.
28:46This persisted.
28:47The duration of The The Study
28:49and then over time the race went
28:52back up to the baseline,
28:53but this became the birth of Chemoprevention.
28:56It became very exciting that you
28:58can use nutrients to prevent cancer
29:00and therefore this was this again
29:02the origin of chemoprevention
29:04came from these early studies.
29:06The other thing was it was recognized
29:09at high dietary vegetables seem to be
29:12associated with lower lung cancer,
29:14is now in smokers high carcinogen exposure,
29:16and therefore maybe the antioxidant
29:18effect of vegetables and fruits
29:20may be potentially reducing risk.
29:22One of the nutrients looked at
29:24was beta carotene and again beta
29:27carotene is a carotenoid.
29:28It's one of 200 carotenoids,
29:30but it's the most common
29:32carotenoid in the you know.
29:34The carrots and the carotenoid
29:36containing vegetables.
29:37And is highly predictive of dietary
29:39intake of those nutrients and
29:41low levels seem to be associated
29:43lower cancer risk in smokers.
29:44Ann is safe and non toxic in high doses
29:47and again is also readily available
29:49so they elected to do a number of
29:52trials to try to use beta carotene
29:55to prevent lung cancer in smokers.
29:57The first one was so called the ATC trailer.
30:00This is doll and Peto again with
30:02Michael Sporn and others who said can
30:05we actually materially reduce human
30:06cancer rates by giving beta carotene?
30:09And this was a very popular hypothesis
30:11even before we knew the results of this,
30:14I had patients taking beta carotene
30:16themselves back in the early 80s.
30:19But what happened was this the ATC
30:21trial that this was in Finland,
30:24male smokers and those who took
30:26beta carotene.
30:26They compared beta carotene,
30:28vitamin E or the combination or
30:30neither and those who took beta
30:32carotene actually had an 18%
30:34higher incidence of lung cancer.
30:35This was kind of a scary result and
30:38at the same time there was a trobbing
30:41done in the US and yell as part of
30:44this called the carrot study was invite.
30:47It was a vitamin A retinal or.
30:49Beta carotene in smokers who
30:51also was exposed to asbestos.
30:53This population in extremely
30:55high risk of lung cancer and
30:57they said can we actually lower the
31:00risk by giving beta carotene and in
31:02the end when this result came out,
31:05the interim analysis of the
31:07study showed low and behold,
31:09beta carotene increased the risk by 28%.
31:12Now, of course, the trouble
31:14was it didn't make any sense.
31:16Nobody understood why this
31:17high dose supplement.
31:19Again, it was in high doses,
31:21and I've calculated it's between
31:2235 and 40 servings of fruits
31:24and vegetables every day.
31:26Far higher than you can get
31:28in the normal diet,
31:30but for whatever reason and I
31:32we now have hypothesis that it
31:34actually enhanced the risk of
31:36developing cancer from this.
31:37However, now look at this cancer treatment.
31:40Centers of America was love this.
31:42They actually next to the cigarettes.
31:44They sell beta carotene in
31:46their their pharmacy,
31:47hard to believe and I actually spoke
31:50there and explain that this is not a safe
31:53supplement to recommend for patients,
31:55but from this they also seem to show
31:57it wasn't what we call a secondary
32:00endpoint and maybe vitamin E might
32:02protect against prostate cancer.
32:04In addition to vitamin E1 of
32:06the other critical nutrients in
32:08antioxidants is silentium and this
32:10is involved as a component of.
32:12Glutathione peroxidase and we know
32:14that selenium seems to be associated
32:17with reduced cancer survival,
32:19cancer cell survival through animal
32:21studies and geographic levels of
32:23selenium appear to correlate with
32:25the dietary intake based on where
32:28your fruits and vegetables are grown.
32:30The highest source of selenium
32:32turns out to be Brazil nuts,
32:35but people using selenium because
32:37of this knowledge and and we knew
32:40also that there was apparent
32:42apparent in low low selenium levels.
32:44A higher risk of cancer.
32:46So when they they then went on to
32:49do a study in in to prevent breast.
32:52I'm sorry, prostate cancer.
32:53Using vitamin A,
32:54selenium both or a placebo and
32:57this was very exciting and much
32:59like the beta carotene studies,
33:01many of the men I knew were
33:03taking vitamin E and selenium.
33:05Assuming the trial would turn out to
33:07be beneficial in lo and behold bang,
33:10it increased prostate cancer is
33:12the vitamin A and the selenium
33:14increased diabetes risk.
33:16Again, totally unexpected,
33:17but lessons for us to try to
33:19retrospectively analyze and use
33:21the next trials to kind of help
33:23us understand this now.
33:25For one, when you look at the ATC trial,
33:28the vitamin E levels correlate
33:30with mortality, low vitamin E,
33:32higher mortality.
33:33But as you get higher there's actually
33:35a higher mortality with increased
33:37levels of vitamin E in the serum.
33:40So there seemed to be what we
33:42would call a U shaped curve.
33:45And then it turned out when they
33:48analyzed many studies of vitamin E
33:50and you see here where that got it.
33:52Red line is.
33:53That's the typical vitamin E capsule,
33:55400 units.
33:56There is a distinct increase in
33:58mortality in all the trials analyzed
34:00people taking vitamin E actually
34:02have a higher chance of dying.
34:04And the cut point for that was 180.
34:07I use 180 units of vitamin D daily,
34:10so there is again below.
34:12That may be a little benefit if you're low,
34:15but if you go up there's an adverse risk.
34:18Again, by the way,
34:20nobody knows about this now again,
34:22the average capsule size today
34:24today at Kirkland's at at Costco.
34:26Or you can go to GNC.
34:28Or you can go to any of the stores.
34:32Anet cells, typically 400 I use, that is.
34:35Already known to be associated
34:37with increased mortality,
34:38and again 13,000 thirteen 100% of your ADR.
34:42So anything we've learned from this?
34:45Well, what about selenium?
34:46Again, if you look at the
34:48levels of Silentium sold there,
34:49is there a significantly above
34:51that of the daily requirement?
34:53Some people may need it if they are
34:55low and they analyzed his skin cancer
34:57study and found that people who took
35:00the selenium in the trial for skin
35:02cancer prevention who were low in
35:04selenium had a decrease in cancer.
35:06But at baseline,
35:07those who had a high level of
35:09selenium had an increase in cancerous.
35:12And the other thing is,
35:13which was designed to prevent
35:15basil cell cancers,
35:16but it actually increased the risk
35:18of squamous cancers of the skin.
35:20So you know,
35:21dose makes the poison or the benefit.
35:24Then again, most people don't know that,
35:27so here's what they typically say.
35:29You know this is this is the sales pitch
35:31potent antioxidant immune supporter.
35:33Selenium has a wide variety of
35:35beneficial impacts on the body.
35:37Most importantly, like the other vitamins,
35:39it helps prevent cell damage
35:41from free radicals.
35:42Big mistake.
35:44Selenium has a U shaped curve for
35:47mortality just like vitamin E.
35:49This is in Haines National Nutrition
35:53study that follows populations of
35:55the US overtime anyone can access
35:58this population to do studies again
36:00a U shaped curve for selenium.
36:03Now here's the problem.
36:05Deficiency as I mentioned there is an
36:08increased risk for multiple diseases.
36:11But on the other hand,
36:13too much selenium is also a problem
36:15and I showed you already that it
36:18increases diabetic risk and may increase
36:20cancer risk when it's excessive in intake.
36:23And so to put together some of the
36:26data on multi vitamins budgell ficken,
36:30others looked at the all the
36:32data on dietary supplements over
36:35to almost 250,000 participants,
36:37the beta carotene etc.
36:39And they found that overall
36:41antioxidants increases mortality.
36:43That's in general,
36:44these are people who don't have
36:46cancer who are taking it to
36:49prevent cancer and heart disease.
36:50And there was actually a higher risk
36:53of dying rather than doing better,
36:55so we must be careful.
36:57Now.
36:57Here's another BB complex buried my
36:59one of my favorite talks because it is
37:02considered by everybody safe at any speed.
37:04Therefore, whatever does it be
37:06complex to take its water soluble,
37:08excrete it,
37:09and therefore it's safe.
37:11Remember,
37:11when you take a nutrient blood
37:13levels of that nutrient at very high
37:16doses remain high until you stop it,
37:18and then you,
37:19as they say,
37:20pee it out so your cells are being
37:22exposed to extremely high levels of these
37:25nutrients until you stop the nutrient.
37:27So it may not be quite what you think it is.
37:31Well, Livestrong recommends B complex helps
37:33your body convert calories into energy.
37:35What could be better,
37:37be 100 contains most at high doses right?
37:39100 milligrams is well above the
37:42average daily requirement for most.
37:44But it's not stored in Tux is,
37:46he's not an issue.
37:47I am getting across the idea.
37:49Toxicity is not the only thing you need to
37:52be concerned about chronically elevated
37:54levels of these nutrients that are not
37:57toxic can have adverse risk and be complex.
37:59As they say, converts food into energy.
38:02By the way, cancer loves energy.
38:05In fact, that's one of the
38:07biggest issues with tumor cells.
38:09It requires energy metabolism
38:11to grow efficiently.
38:13But they showed a very small
38:15study showed an increase in vigor.
38:17Improvements in mood would
38:18be complex by the way,
38:20B vitamins are the greatest placebo
38:23known to man become beat BB 12.
38:25It has profoundly high placebo effect
38:27when people take it, they feel better.
38:31Now these are the levels.
38:33Look at Simon over 6000% B.
38:35Six 5000% B 12 is not that.
38:38I actually believe it or not.
38:40I'll show you some others on that so,
38:43but what's concerning?
38:44#1B1 is critical for enzymes
38:46in tumor metabolism.
38:48Tumors need the need be vitamins as
38:50part of the metabolism of glucose
38:52into what's called 5 prime sugars to
38:54make the precursors for DNA and RNA,
38:57and also some of the NADH.
38:58Some of the precursors for energy metabolism.
39:01And there is a concern that high
39:03levels of B1 may be playing a role in
39:06cancer because it's so widely used.
39:08By the way, nobody knows about these risks.
39:11We don't have enough data,
39:12but I am always concerned about
39:15people using extremely high doses.
39:17Worse than that,
39:18now here is an interesting study
39:20that came out of Norway where
39:22they don't supplement their diet
39:24with their breads and grains,
39:26and they looked at the question what
39:28about using the vitamins folic acid,
39:30B12 and B6 to prevent cancer
39:32and what they found?
39:34Was that the combination of folic acid
39:36and B12 substantially increased lung
39:38cancer risk and lung cancer mortality?
39:40Wow.
39:40However, B6 appeared to be relatively safe.
39:45But it also increased risk in
39:48addition to human logic, cancer.
39:50But it was more so for long.
39:52That's where the greatest risk
39:54was cancer mortality and risk.
39:56Now,
39:57I don't think there are a lot
39:59of people have ever heard about
40:02the norbiton Windows study.
40:04Now to make things much more disturbing,
40:07the largest group of institutions
40:09that follow large cohorts of patients
40:11throughout the US, Europe, and Asia,
40:14including the NIH, the NCI, Harvard.
40:16The Harvard School of Public Health,
40:19UCLA University of Pittsburgh, Oxford.
40:22The European epic.
40:23The European study group all pulled
40:26all of their patients data that
40:28they were following and found
40:31that circulating B12 increasingly increased.
40:34Levels are positively
40:36associated with lung cancer.
40:38Just like that, Rolla just showed you.
40:41More importantly, they did another test.
40:43They looked at the same number
40:46of patients within their cohorts
40:48and analyze them for jeans that
40:50were associated with higher B12 to
40:53try to control is it the dieters?
40:55There's something about B12 itself
40:57that's real and genetically determined.
40:59Variants that are associated with higher
41:02B12 levels were consistently positively
41:04associated with overall lung cancer risk.
41:07And they said, based on the consistency
41:09of these two independent studies,
41:12the studies support the hypothesis that
41:14high B12 increases risk of lung cancer.
41:17Well, now here is a basic supplement
41:20of 5000 micrograms. What's the amount?
41:23It's 200 and 8000% of your daily requirement.
41:26No, it's not twice.
41:28It's not five times its 200 and 8000%.
41:32This is where the supplement industry
41:34has gone with high dose supplements.
41:37Now it's completely out of control.
41:39This is a drug, ladies and gentlemen,
41:41this is not a supplement.
41:43And here are all the wonderful
41:45places you can get 5000 micrograms.
41:48All over multiple supplements so this is
41:50an these again are not regulated by the FDA.
41:53Now let's talk about vitamin D.
41:55This is isobars of UV exposure.
41:57The higher up you go and latitude,
41:59the greater the risk of breast cancer.
42:02You have the same curve for colon cancer.
42:04Unfortunately if you look at the red
42:07the highest areas are also the highest
42:09levels of that are so she canonically
42:11deprived that have higher urban areas
42:13so there may be other korelitz to this,
42:16but you can see it's related to UV light.
42:19And that was sort of the evidence
42:21to support way back that there is a
42:24correlate between vitamin D and mortality.
42:27And So what? And cancer prevention.
42:29And so a number of trials and observation.
42:32ULL studies were done supporting this idea,
42:34but it wasn't really convincing.
42:36But people now believe vitamin
42:38D does prevent cancer.
42:39But is there proof of that?
42:41How strong is that?
42:43Well,
42:43this is early data that levels of vitamin
42:46D seems to be associated with survival
42:48in breast cancer if you're deficient.
42:51You have a higher chance
42:53of potentially dying,
42:54and that's a different question.
42:55Can it change survival?
42:57This is a study looking at very
43:00high dose supplements to prevent
43:02cancer and what they found.
43:05There was absolutely no effect on
43:07high dose B vitamin on vitamin DA.
43:10High dose monthly versus placebo.
43:12It didn't seem overtime to
43:14influence cancer risk.
43:15Then there was a very large vital study.
43:18This was a multicenter study with thousands
43:21of people enrolled in many centers,
43:24giving 1 to 2000.
43:25I use daily of vitamin D.
43:28Or a gram of of omega-3 with a with a
43:31goal of determining whether it could
43:33reduce both cancer and heart disease.
43:36Now in this study,
43:38no effects were shown for either.
43:40Certainly for the omega-3,
43:41there was no effect on either
43:44cancer or heart disease.
43:46And vitamin D did not influence cancer risk.
43:48Now they were at that point in the study,
43:52fairly well nourished with vitamin D.
43:54There was a hint that vitamin D
43:57will improve survival but not risk.
44:00It was saying the same thing and Charlie
44:03Fuchs was with us at Yale and it has
44:05now left and their group at Harvard
44:08showed it in colon cancer patients.
44:10Vitamin D levels do appear to correlate
44:12with improved colon colorectal survival,
44:14so higher levels are beneficial.
44:16We see the same thing again,
44:18but this is a U shaped curve for vitamin
44:21D and survival with breast cancer.
44:23So there may be a point in which
44:26too much is not right.
44:28And again,
44:29very high dose B vitamin D has more
44:32recently in levels that we used
44:33to think were OK been associated
44:36with higher levels of cancer,
44:38particularly GI cancers and
44:39pancreatic cancer.
44:40This is a what's called cooling
44:42cohort of rare cancers,
44:43and they found that high levels of
44:45vitamin D in the range that you
44:48can get easily through supplements
44:50doubled the risk of pancreatic cancer,
44:52and it turns out that there is a U
44:55shaped curve for mortality and cancer.
44:57Too much vitamin D.
44:59Appears to be associate above
45:0045 to 50 nanograms.
45:02This is an ongoing battle because they're
45:04true believers who think you need to be high.
45:07You don't.
45:08The data shows that if you're
45:10between 28 and 45 to 50,
45:12nanograms is the sweet spot for vitamin
45:15D that can be achieved with one with
45:18a thousand 2000 IU's a day of D3,
45:20not a higher dose.
45:22And you should not aim for high doses,
45:25but many people in the alternative and
45:28complementary feel aim for levels of 6200,
45:30which puts you in the upper range of
45:33that U shaped curve toward mortality.
45:36Again,
45:36EU shaped curve for mortality and that
45:38that shows you you get to 60 and higher now.
45:41By the way,
45:42if you spend a lot of time out in
45:44the sun you can't reach that level.
45:47You know you can't reach above
45:4960 if you spend 26 to 30 hours
45:51at a week with sun exposure.
45:53Now what about taking supplements?
45:55If you're a cancer patient,
45:56consume high levels,
45:57most common based on age,
45:59women younger age,
46:00regional differences and also correlate
46:02with higher levels of distress,
46:03and it may improve the ideas
46:05will improve my quality of life,
46:07felt my Wellness and improved survival,
46:09and are the risks and benefits.
46:11Well,
46:11there's a fascinating study that came
46:13out of a SWOG trial for breast cancer.
46:16It's called the Dell.
46:17Kept studying the analyze the
46:19use of dietary supplements in
46:21patients who are getting treated
46:23and they asked what is the effect?
46:25Now I would go to the highlighted
46:27portions in the middle, so we have to.
46:30We can skip for time purposes.
46:32Antioxidants,
46:33increased progression and
46:34mortality by 1.4 times and B12.
46:36We've heard this before actually
46:37enhanced the risk of mortality
46:39and progression.
46:40Taking B12 as a single supplement,
46:42it doubled that risk.
46:43And we know for sure we know irons
46:46bad and that was associated with risk.
46:48But multi vitamins were not.
46:50So now we have more evidence to say.
46:53Maybe you know in the cancer population
46:55we need to be much more cautious.
46:58About this now the problem is the and.
47:01This was in 2013 and the
47:03album Internal Medicine.
47:04It said we should be careful stop
47:06wasting your money on supplements and
47:09they analyzed a number of randomized
47:11trials but they miss something.
47:13There were two trials,
47:14the physicians health study and
47:16soon of Max that in men showed
47:19a decrease in cancer incidence,
47:20but they weren't using high doses,
47:23they were supplementing them with
47:24a simple multi vitamin right?
47:26So what is the answer here?
47:29By the way, and I tell this to my colleagues,
47:33men don't eat their veggies.
47:35Dietary supplements in men who
47:37may not be careful about healthy,
47:39diverse diets and plant based diets
47:41may benefit by a single multinutrient.
47:44This was central and in the
47:46Supermax study was an alternative.
47:48This was not a very high dose,
47:51high potency vitamin.
47:52And here's the supermax data.
47:54I mean the yes,
47:55showing this significant increase
47:57in men but not in women.
47:59Women have better diets.
48:01the US population.
48:03We know many people are actually
48:06micronutrient deficient.
48:07But you don't need high doses of supplements.
48:10That's the key here.
48:12And what about the antioxidants?
48:14Well,
48:15it turns out reactive oxygen species
48:17are critical signaling molecules that
48:20reactivate program cell death in cancer.
48:22And when you turn off that with antioxidants,
48:26tumors love that people will use
48:28things like glutathione infusions.
48:30Big mistake,
48:31because glutathione inhibits the antioxidant.
48:33The oxidative stress that
48:35will kill tumor cells.
48:37They can't because of the rapid
48:40tumor growth cannot handle that.
48:42And yet,
48:43here's the consequense
48:4460% continue supplements.
48:45It's a multi billion dollar industry.
48:46Most people are unaware of this
48:48and they don't even know the dose
48:50of supplements they're taking.
48:51I have talked to patients and they
48:53can't begin to tell me how much is
48:56in the nutrients they're taking.
48:58Ask them to turn it around.
48:59I went into Costco with my wife once
49:01and I asked the person selling Co.
49:04Q10I showed her a bottle of B12 and I
49:07showed her this and she looked at me.
49:09She said what are they doing?
49:11Why did they do that?
49:13I said I don't know you're one
49:16that selling these supplements so
49:18these are the things I've learned.
49:20Respect EU shaped curve toxicity
49:22is predictable an at high risk
49:25in very high doses.
49:26Too much vitamin D can cause kidney stones.
49:30Too much vitamin A can cause
49:32headaches and and what's called
49:34normal pressure hydrocephalus
49:35and birth defects in children.
49:37But it's the adverse risk range.
49:40Beta carotene unexpectedly raises
49:42lung cancer risk in smokers.
49:44Folic acid,
49:45I mean I'm sorry B12 unexpectedly
49:47seems to increase lung cancer risk itself,
49:50low probability, but not zero.
49:52Too much vitamin D.
49:54Twice the risk of pancreatic
49:56cancer and the other issue is the
49:59law of unintended consequences.
50:01It's not predictable until you
50:03do these studies, and then you
50:05retrospectively figure out what is it.
50:07Beta carotene turns on cell cooperation.
50:10It's a gene regulator,
50:12not chest and antioxidant,
50:13and always respect nature.
50:15We are using nutrients at levels
50:17that are incompatible in there
50:19incapable of being reached in nature.
50:22And lastly, the rule.
50:23The economic law patients who take it
50:26donated and people who need it don't take it.
50:29They target people who are well and
50:32healthy with very high dose nutrients.
50:34The higher the better.
50:36And people not aware of that.
50:38So here's the conclusion.
50:40There's no consistent evidence to support
50:42the general use of supplements in
50:44the general population for prevention.
50:46Correcting deficiency may reduce risk,
50:48but high dose nutrient supplements
50:50and healthy non deficient individuals
50:52may actually increase risk.
50:54Remember EU shaped curve?
50:55No, what you are taking.
50:57The majority of the public continue to
51:00consume levels of nutrients and levels
51:02that any are completely unaware of.
51:05This risk.
51:05I gave this talk to a group of
51:08fellows in radiation therapy at Yale,
51:10and none of them have heard of these studies.
51:13Doctors don't know about this,
51:15you know,
51:16because they're not educated in nutrition.
51:18It is very prudent to recommend consumption,
51:21micro nutrient dense foods for
51:22chronic disease prevention.
51:23Maintain healthy weight and
51:25stay physically active.
51:26So again, it's this is common sense.
51:28And I will leave it at that
51:30and open it for questions.
51:35Great thank you Doctor boy.
51:37Just stop your screen share. Sure, going
51:41to just go to two quick questions here.
51:46We have a question about.
51:49Was there a control on their diets
51:52referring to one who said they
51:54could have a huge variation in the
51:57vitamins consumed in their diets?
52:00Oh well, you're talking
52:02about the the DEL CAP study.
52:06I think so. She she wasn't specific, they
52:08they correct for that.
52:09So one of the ways an it's always an
52:12issue and you know I didn't mention.
52:14That in the B12 study to
52:16correct for confounding,
52:17which is what you're talking about.
52:19Something else that may actually explain it.
52:22They use this, we call Edmond
52:24Elion randomization using genetic
52:26markers that are correlated with
52:28higher levels to eliminate the
52:30idea that it was something else.
52:32Is it really related?
52:34Not only was B12 related to lung cancer risk,
52:38it was also a similar rate.
52:40Mendelian randomization study showed
52:42the same thing with colon cancer,
52:44so I think you know, yes,
52:47you could argue maybe with something else,
52:50but taking B12 is at very.
52:52Very very high doses is very easy.
52:55I've had patients who take
52:57upwards of twice that level.
53:00That is they're taking over 400,000%
53:02of their daily requirement and
53:04you won't feel anything until your
53:07cancer progresses and we this is
53:09one of the dilemmas you shouldn't.
53:12You don't need it, that's the point.
53:15You may need more because of
53:17the issues of absorption,
53:19but nobody needs 400,000%
53:20or 200,000% or 100,000%.
53:22It's insanity.
53:23Julie
53:26OK, thank you so much information and
53:29we will get to some of these questions
53:32after we hear from Doctor Gary's offer.
53:36Doctor Gary Software specializes
53:38in pediatric allergy immunology.
53:39An integrative medicine at
53:41Yale School of Medicine,
53:43he completed a degree in human
53:46development at Cornell University
53:48and received his medical degree
53:50at Tel Aviv University in Israel.
53:52He attended the University of
53:55Arizona Andrew Wildcore Center for
53:57Integrative Medicine and receive
53:59certifications in mindfulness meditation.
54:02His interest in food allergies,
54:04mind body medicine, eczema,
54:05asthma and environmental allergies.
54:07He is also the director of the
54:10Smilow Cancer Center Hospital.
54:12Integrative medicine program
54:14so welcome doctor Sopher.
54:19Thank you, let's see if I can
54:22get my share screen right.
54:27Alright, I'm going to warn all of you.
54:298:00 PM is the time that you might
54:32get toddlers bursting into my room,
54:33and I will apologize now if that happens,
54:36but I will pause to give them
54:38a kiss if they do. So let me.
54:43Can you see my slides?
54:45Does that look OK? Great fantastic.
54:48Alright, so survivorship mythbusting
54:50diet nutrition first let me
54:52say what what wonderful talks
54:53just happened right before me.
54:55I just I learned so much from
54:57Doctor Boyden and from Annette and
54:59I hope you guys did too as well.
55:02But we're going to talk about
55:05diet and nutrition.
55:07As a means of obtaining these vitamins,
55:09nutrients that you're looking for.
55:10So let's let's get into it.
55:12So number one myth is this is food.
55:15It might look like food.
55:17It might smell like food.
55:18It might taste like food,
55:20but it's not food.
55:21When we think about survivorship,
55:23when we think about giving our body the
55:25nutrients in the health and sustaining
55:27it and moving it in in the right direction.
55:30So really, think about what you're
55:32eating with processed foods,
55:34and so let's go shoot some basic rules.
55:37That that I think about when
55:39I think about nutrition.
55:40So rule number one.
55:42If your grandmother wouldn't
55:43recognize it as food,
55:45it's probably not food and I had to adjust
55:48this to great grandmother as time goes on,
55:51but.
55:51The simple principle here is if you put a
55:54******* in front of your great grandmother,
55:56she probably stared it for 30 minutes,
55:58having no idea what to do with it.
56:01So think about the food that you're eating.
56:04Rule #2 if you can't
56:07pronounce the ingredients,
56:08it probably isn't food either.
56:12There exceptions,
56:13tomato and tomato and I still
56:15think it's quinoa,
56:17but I'm not entirely sure.
56:22So rule #3. The closer it is to the Earth,
56:25the better it is for you,
56:27and we're going to dive a
56:29little bit into soil later.
56:30That's always a great example of how.
56:33Food can go wrong,
56:34so if you look all the way to the left,
56:37were looking at Adam Mommy,
56:38this is the most natural source of soy,
56:40right straight from the plant.
56:42From the beginning you shift a little bit
56:44to the right and we have tempeh and me,
56:47so slightly processed, but really good
56:48foods because they include fermentation.
56:50They include natural probiotics
56:51and then we move a little to
56:53the right and we have tofu now.
56:55Tofu is good,
56:56but it's not as good as the enemy,
56:58but if we move all the way to the right,
57:01that's where we start getting into trouble.
57:03That's where we have our
57:05highly processed soy foods so.
57:08When you think about what
57:09you're putting into your body,
57:11I want you to consider how close to
57:14the plant the original plant this was.
57:16Because when we look at our tofu dogs
57:19and are tofurky and their soy patties,
57:21those contain so much sodium,
57:23so much additives,
57:24dyes,
57:24and everything else that makes
57:26it moves it away from being
57:28natural and good for you.
57:32So I'm going to steal this quote.
57:34I stole this quote from Michael Pollan.
57:36If you haven't read Michael Pollan's
57:38books on plants and agriculture,
57:40I would really, really recommend it,
57:41but what he says is eat food.
57:44Not too much and mostly plants.
57:48Those are the basic principles,
57:49but let's get back to the myths.
57:53And so. Here's another myth.
57:55This is a superfood and I'm not
57:57picking on bread fruit in particular.
57:59I've never tried breadfruit,
58:01I'm sure it's delicious,
58:02but identifying one single food as
58:04a super food is always a mistake.
58:07So really, what is super food?
58:10Super Food is a nutritious diet.
58:12It's a well balanced and in robust diet.
58:15So to the right when you see is the anti
58:17inflammatory Kermit and it shouldn't
58:19be a surprise that at the bottom of
58:22this pyramid we should be getting
58:24most in your food and most of their
58:26nutrients is fruits and vegetables
58:28and and healthy servings of water.
58:31Moving up thinking about whole grains and
58:33cereal grains and even pasta once in awhile.
58:36Beans are great,
58:37leggings are great and then
58:38we move up to healthy fats.
58:40We're going to talk about that in a second.
58:43Soy foods will talk about soy foods
58:45and then moving up less and less fish.
58:47Fish is great and then T healthy spices.
58:50You know,
58:51this really shouldn't be at the
58:53top because you guys can have as
58:55much healthy spices as you want.
58:57As long as you're adding it to your food.
58:59So load up on the spices.
59:01Choose organic foods when possible
59:03and wash your produce to really
59:05minimize the pesticide exposure.
59:07Increased fiber intake limit red
59:09meat and then try to get fish into
59:12your diet and so let's talk about
59:14fat because there's a claim that
59:16fat is inflammatory can be bad.
59:19We heard about fat free diets and.
59:22We have essential facts that
59:23we need to get in our diet that
59:26we can't make for ourselves.
59:28And we,
59:28the ones that we think of about the most,
59:31or making six,
59:32you know,
59:32make it 3 and it's really about
59:34maintaining a healthy ratio.
59:35So the healthy goal and what's
59:38been shown to decrease cancer risk
59:40is an Omega 6 to omega-3 ratio
59:42about 2:00 to 1:00 or even one.
59:44The Standard American diet,
59:45which we shortened too.
59:47Sad appropriately.
59:48It's about 14 to one,
59:49so we're completely off,
59:51so it's no wonder that we have
59:53increased cancer in our in in,
59:55in, in United States,
59:57and So what I like to see my patients
01:00:00do is eating more omega-3 fats.
01:00:03Things like wild caught fish so
01:00:05sardines or tuna, or herring,
01:00:08and wild caught salmon's or
01:00:10avocados and olives or tree nuts.
01:00:12We love tree nuts.
01:00:14Uh,
01:00:15and then really,
01:00:16you know there's there's a lot
01:00:18of talk about me,
01:00:19but certain grass fed meat actually
01:00:21has higher omega-3 ratio in that
01:00:23supposed to to factory farmed meat,
01:00:25which which has a higher Omega 6 ratio.
01:00:28Other things like fried
01:00:29foods contain Omega sixes,
01:00:30so it's really easy to Omega
01:00:32sixes 'cause you're enjoying them.
01:00:34Those are the foods that you know
01:00:36we're built to love for some reason,
01:00:39but I want to.
01:00:40I want to see my patients shift over
01:00:42to more Omega threes in their diet.
01:00:47So myth is this a myth.
01:00:49I don't know if it's a myth,
01:00:51and I think we're still discovering it and
01:00:54trying to understand it in the science,
01:00:56but the myth is that cancer loves sugar.
01:00:59Again, I don't know if the
01:01:00claim is that cancer consumes
01:01:02sugar quickly to help it grow,
01:01:04and what I really recommend for
01:01:06people is that you consider the type
01:01:08of sugar that you're consuming OK?
01:01:11If this is added sugar.
01:01:12If this is highly refined sugar.
01:01:16Versus sugar that's coming
01:01:17from fruits and vegetables.
01:01:18I say stick to the fruits and vegetables.
01:01:21I just don't want you to be see
01:01:23decieved when you see cane sugar on
01:01:26something that's still an added sugar.
01:01:28That's still refined sugar.
01:01:29Even though it sounds like it's plant based.
01:01:32So keep the fruits and vegetables
01:01:34in your diet.
01:01:35But really try to remove those
01:01:37processed foods with the added sugars.
01:01:39The other thing I want you to always
01:01:42consider is the glycemic index of foods.
01:01:44So certain foods are.
01:01:46Absorbed differently in the body so.
01:01:49White potatoes, for example,
01:01:50have a very high glycemic index.
01:01:52Our body absorbs that sugar very quickly.
01:01:55Sweet potatoes surprisingly
01:01:56actually have a low glycemic index,
01:01:59meaning that the body absorbs it
01:02:01slowly and can handle it differently.
01:02:04I'm not going to dive too deep into it,
01:02:07but it's worth looking into
01:02:08the glycemic index of foods.
01:02:12So the next man.
01:02:13If it says it's healthy and natural,
01:02:16it's good for you, and that's
01:02:17just not necessarily the case.
01:02:19You know Doctor Boyd did such a
01:02:21good job of describing supplements,
01:02:23and how they seem like they're
01:02:25natural and good for you,
01:02:26but how dangerous they can be and the
01:02:28two foods that I always see patients show
01:02:31up with saying they're eating a healthy diet,
01:02:34or granola and oatmeal.
01:02:35And so I just.
01:02:36This is an average granola,
01:02:38nutritional facts,
01:02:38pretty representative of
01:02:39most of what's out there,
01:02:41and if you can see, I know it's small.
01:02:44But this girl has 17 grams of sugar,
01:02:47so in this 2/3 of cup you're eating 1/3 of
01:02:50your recommended sugar intake for the day.
01:02:54Oatmeal flavored oatmeal packets.
01:02:55We think we're eating healthy because
01:02:58it says Apple flavored on it,
01:03:00but really, look at the nutrition facts.
01:03:0213 grams of sugar 200.
01:03:04I can't even see that 260 milligrams of
01:03:07sodium so high in sodium high in sugar.
01:03:10So even though it sounds natural and healthy,
01:03:13you really want to get into the
01:03:16habit of reading ingredients.
01:03:20Myth I need to get my
01:03:22vitamins from my supplements.
01:03:24We just had two speakers do such
01:03:25a wonderful job of describing and
01:03:27explaining why this isn't necessary
01:03:29and that myself and and more Harrigan
01:03:32who's a registered dietitian,
01:03:33wrote an article about the nine most
01:03:36essential vitamins need in your diet
01:03:37and how to get them into your diet,
01:03:40how to find them in your food,
01:03:42and so look up the article
01:03:45and give it a read.
01:03:47But I know we're going to disagree.
01:03:50I know certain patients are going
01:03:52to feel strongly about taking their
01:03:54vitamins and and every patient
01:03:56should have a right to manage
01:03:57their own care with the best of
01:03:59advice that we can give them.
01:04:01And So what in that and I have is
01:04:03we've created a supplements clinic
01:04:04for patients to come in and really ask
01:04:07about the vitamins and the supplements
01:04:09they're taking so we can deep dive.
01:04:11We want to make sure they're safe.
01:04:13We want to make sure they're not
01:04:15interacting with your medications and
01:04:16that you're getting the correct dosing
01:04:18and that you're using a reputable source.
01:04:21And we want you to consider
01:04:23dietary sources for them,
01:04:24because I think we all believe that that's
01:04:27the best way to get your supplements.
01:04:30I'll just add this caveat because most
01:04:32patients who come to see me hear this.
01:04:35Most supplements are derived from diet.
01:04:37At no point in this thousands of
01:04:40years of tradition that made healthy
01:04:42diets was this ever intended to
01:04:45be in a veggie capsule?
01:04:47So I really want you to think about
01:04:50getting these supplements in your food.
01:04:55Here's another myth that might surprise you.
01:04:58Everything needs to be organic.
01:05:00Yes, organics really good for you.
01:05:02And there was a study in France of 70,000
01:05:05people and it seemed that those who are
01:05:08consuming organic food had a much lower risk.
01:05:11Even 25% lower risk of developing cancer.
01:05:14Now that being said, the way
01:05:16marketing is designed in this country,
01:05:18you have to consider what
01:05:20organic really means.
01:05:21And organic doesn't always mean healthy.
01:05:24And I put Kraft macaroni cheese up
01:05:26here because it might be organic,
01:05:28but that's not what I want.
01:05:30You eating in your diet.
01:05:32I'd rather you eat a conventionally
01:05:34grown apple than organic.
01:05:36Kraft macaroni and cheese.
01:05:37But try to buy organic when you can
01:05:40and buy local buy seasonal buy fresh.
01:05:43Keep in mind that getting the
01:05:44organic label is really quite
01:05:46expensive for certain farmers,
01:05:48and they may be practicing organic,
01:05:50but they may not be able to
01:05:53afford the actual label.
01:05:54So talk to your farmers.
01:05:55Go to your farmers markets
01:05:57and interact with them.
01:06:01The next myth is alkaline water or even
01:06:03alkaline food will help prevent cancer,
01:06:06and so the claim is that cancer thrives
01:06:08in more acidic environments and drinking
01:06:10alkaline water or eating alkaline foods.
01:06:13Foods will help prevent that right.
01:06:15Keeping that acid base balance,
01:06:17there's really no evidence to support that.
01:06:19The use of alkaline water foods
01:06:21is going to prevent cancer,
01:06:23and most of the research claims that
01:06:25are quoted really happened in a
01:06:28laboratory setting and not in humans.
01:06:30So in Petri dishes, or.
01:06:32Even maybe in animals, but never in humans.
01:06:34It's never been shown.
01:06:36The fact of the matter is,
01:06:38is that our human Physiology,
01:06:40our liver or kidneys, or lungs,
01:06:42are really good at maintaining
01:06:44an acid base balance,
01:06:45and so by the time you absorb
01:06:47that alkaline water,
01:06:48your body is already readjusted.
01:06:51It's important to also know that excessive
01:06:53intake of it can have some side effects,
01:06:56so alkaline likes to leach calcium
01:06:58and it can do so from the bone
01:07:00and possibly create bone issues.
01:07:05OK, so this is the worst news of all.
01:07:08Is the myth that drinking wine is is good
01:07:11for me and the truth is it's it's really not.
01:07:15The thought is that red wine contains
01:07:17high levels of resveratrol which is
01:07:20good for the body, and that's true
01:07:22with respect to cardiovascular health,
01:07:24but hasn't really been shown
01:07:26for cancer outcomes.
01:07:27In fact, can't alcohol intake may
01:07:29increase your risk for cancer?
01:07:31So if you're interested
01:07:33in getting resveratrol.
01:07:34There's other great sources for
01:07:36grapes in their natural form before
01:07:38they were allowed to ferment.
01:07:40Blueberries,
01:07:40and even Coco now is drinking because
01:07:43it's really tough to completely
01:07:45eliminate drinking from your diet.
01:07:46The recommendations that I would
01:07:48make our thinking about drinking red
01:07:50wine over white wine because red
01:07:52wine does contain more espiritual.
01:07:54Be mindful of of the vineyard
01:07:56that you're buying from,
01:07:58so think about the practices
01:08:00and the location of vineyard.
01:08:03And then really try to limit
01:08:05your intake to about 5 ounces.
01:08:11So another myth is that soy is bad for you.
01:08:16And the theory is,
01:08:17and this is particularly with
01:08:19estrogen sensitive cancers.
01:08:20Is that soy may mimic or block estrogens.
01:08:23But in large population studies where
01:08:25they take large groups of people,
01:08:27they've actually shown no
01:08:29increased risk and potential for.
01:08:32Differential potential for greater survival.
01:08:36It's a great source of fiber.
01:08:38It's a great source of protein,
01:08:40and it's a great source of what we
01:08:43call phyto chemicals or chemicals
01:08:45that come from plants back to
01:08:47the point I was making before.
01:08:49Isoflavones,
01:08:50which are really one of the most
01:08:54wonderful phytochemical and soy
01:08:55contain or have present more in
01:08:57me so than they are in tofu.
01:09:00And so if I didn't give you reassurance,
01:09:02the American Institute of Cancer
01:09:04Research as a whole list of foods
01:09:06that fight cancer and soy is on it.
01:09:08So modern amount of whole soy
01:09:11foods wanted two servings a days is
01:09:13safe and it's likely helpful too.
01:09:15Again,
01:09:16thinking about where you're getting your soy,
01:09:18not soy patties.
01:09:23So there's a thought that
01:09:24raw food might be better,
01:09:25and the claim is that cooking
01:09:27destroys in these vital enzymes.
01:09:29And the truth is, is that some
01:09:31food actually requires cooking?
01:09:33Therese Vital chemicals, so one of the
01:09:35best examples is lycopene in tomatoes.
01:09:37Cooking your tomatoes is going to release
01:09:40lycopene, which has been associated
01:09:42with decreased prostate cancer,
01:09:43carotenoids, and carrots.
01:09:44You need to cook the carrots
01:09:46to get the carotenoids out.
01:09:48Some food also has toxins.
01:09:49If uncooked now,
01:09:51I've never really recommend button
01:09:52mushrooms to my patients because I don't
01:09:55think they have that much benefit.
01:09:57But all mushrooms have
01:09:58carcinogens in them if they are.
01:10:00Uncooked so look out for the mitaki.
01:10:02This should Taki those cooked
01:10:04Asian mushrooms was have a lot
01:10:06of great properties to him,
01:10:07a lot of great benefits to
01:10:09them and and start cooking them
01:10:11in stews and in your diet.
01:10:15The next myth is that you can't cook,
01:10:19and so these are some really
01:10:21nice books that I recommend.
01:10:23The anti inflammatory Family
01:10:24Cookbook is really focused on
01:10:27children and family dyett,
01:10:28the one pot vegetarian. I really like.
01:10:31It's plant based cookbook.
01:10:32It has a lot of very easy basic recipes.
01:10:36Anything by Rebecca Katz over here.
01:10:38She's written a number of really good books
01:10:41and I think the cancer fighting kitchen.
01:10:44This is one of the best ones.
01:10:48And then fast food good food by
01:10:50Andrew Weil who's one of my mentors?
01:10:54Now we're getting to the end
01:10:56and I want you to remember that.
01:10:58Diet isn't everything.
01:10:59OK, there's so much more to your
01:11:02survivorship that you need to consider,
01:11:05and you need to nurture and take care of.
01:11:08You have to think about physical activity,
01:11:11your psychological health,
01:11:12and well being your spiritual health.
01:11:14We don't talk about this enough,
01:11:16and medicine is the need for spiritual
01:11:18fulfillment in the survivorship period.
01:11:20Mind, body activities,
01:11:21and then just remembering things
01:11:24are well beyond our control.
01:11:26And the final myth is that
01:11:28you should go at this alone.
01:11:30We have a number of really good resources
01:11:33through survivorship and through
01:11:34the integrative medicine program,
01:11:36and we're here to support you and help you.
01:11:39An no question is too small and anything
01:11:42that you're curious about deserves.
01:11:44You know,
01:11:44respect and the thoughtfulness to answer it.
01:11:47So thank you so much.
01:11:49It was an honor to get to speak
01:11:52with Doctor Boyden with Annette
01:11:54and I look forward to any.
01:11:57Questions you guys have.
01:12:00Thank you Doctor Software that
01:12:02was wonderful and your your talk
01:12:04actually answered quite a few questions
01:12:07that came up in our chat already,
01:12:09so but I will go through them.
01:12:12We have a few.
01:12:13Thank you everybody for sticking around.
01:12:16I know we're moving along here.
01:12:20So let's start out with.
01:12:23Somebody was wondering about
01:12:25the use of essentialoils for
01:12:27side effects of chemotherapy.
01:12:29Any knowledge on that?
01:12:31Anybody on
01:12:32this panel? There
01:12:34is one. And I think it's a really
01:12:37important example of the law of
01:12:40unintended consequences, and I've
01:12:42talked about other things about this.
01:12:44A group of researchers from the Netherlands.
01:12:48Looked at the use of high
01:12:51levels of omega-3 fatty acids.
01:12:54In the presence of certain chemotherapy,
01:12:56particularly platinum based chemotherapy.
01:12:58Now when you consume omega-3 fats,
01:13:01they get incorporated.
01:13:02These oils get incorporated
01:13:04into basement membranes.
01:13:06And what they found was
01:13:08not only in the tumor,
01:13:09but in the tumor microenvironment
01:13:11cells and what they found
01:13:13was that when you do that,
01:13:15and you treat with platinum
01:13:17based chemotherapy,
01:13:18it cleaves a molecule from the
01:13:19omega-3 in the in themselves in
01:13:21the environment micro environment,
01:13:23and it inhibits chemotherapy.
01:13:25Response is pretty consistent,
01:13:26and then they analyze the levels of omega-3,
01:13:29so they caution this was in JAMA Oncology
01:13:32two years ago and there were several
01:13:35articles that have looked at this.
01:13:37And the argument being,
01:13:38if you're on a platinum based chemotherapy,
01:13:41be careful about high levels
01:13:43of omega-3 around that time.
01:13:45Everybody raises their eyebrows
01:13:46because everybody assumes that
01:13:48will make it for you safe.
01:13:50But this is another example.
01:13:52There's more than we realize in
01:13:54the biology of these nutrients.
01:13:56When you take high levels,
01:13:57you're incorporating those into the
01:14:00cells and remember the vital study
01:14:02showed no benefit for omega-3 and
01:14:04either cancer or heart disease.
01:14:06Right, so this is still a huge assumption.
01:14:09Even survivorship and use of
01:14:11Omega threes to prevent cancer.
01:14:13Weight loss has not been proven
01:14:16to be correct. It is a.
01:14:18It is one of those foods that
01:14:20everybody assumes is really healthy.
01:14:23Sorry I'm looking.
01:14:25Yet we the the evidence.
01:14:26I think you just I tell my patients if
01:14:29they're on a platinum based chemotherapy
01:14:32for around the week that they're on.
01:14:34It don't have high levels of omega-3.
01:14:36I mean 'cause we need to understand.
01:14:39They are very adamant.
01:14:40They recommended in the in the JAMA
01:14:43article to be very careful about
01:14:45taking it because we never recognize
01:14:47this potential adverse effect.
01:14:49Never mind bleeding and the
01:14:51other risks it can happen with
01:14:53high doses of omega-3 fish oil.
01:14:55Any other agents Gary?
01:14:57I don't
01:14:58know if I. I so I wanna just distinguish
01:15:03'cause I'm not sure if the individual
01:15:06is asking about essential fatty acids
01:15:09or essential oils right now, right?
01:15:12And so if we're talking about essential oils,
01:15:15I think essential oils are generally
01:15:19safe if taken as as an inhalation.
01:15:23Certain ones like camp for Eucalyptus,
01:15:25can actually lower seizure thresholds,
01:15:27so I'm I'm pretty careful with any of
01:15:30my patients who have a risk for seizure.
01:15:33And recommending them.
01:15:34But besides that,
01:15:36things like lavender used as an inhalant too,
01:15:39can be quite safe and relaxing.
01:15:43Great thank you. Is magnesium safe?
01:15:53I would say if taken at the recommended
01:15:55daily values as we discussed,
01:15:57some patients may be magnesium deficient,
01:15:59so definitely they should be taking
01:16:01a magnesium supplement as well.
01:16:05About actually induced
01:16:07magnesium loss. And that
01:16:10can lead to issues of vitamin D, efficacy,
01:16:12etc. So you know generally we probably
01:16:14if you look at national got data,
01:16:16magnesium deficiency is far more
01:16:17common than we realize, but you don't
01:16:19want a lot like everything you know.
01:16:21You know if you need it,
01:16:23you should find out where it is to
01:16:25have adequate supplementations.
01:16:26If you need it.
01:16:29So I use. I use some doses of my
01:16:31magnesium to help patients with sleep.
01:16:34I find it helpful in those cases and also
01:16:36use it for for Constipation as well,
01:16:39'cause that can be a side effect.
01:16:41So yes, if taken in the right doses
01:16:44while discussing it with your physician,
01:16:46it can certainly be safe.
01:16:49Right and then also keeping
01:16:51in my magnesium rich foods.
01:16:52OK, so foods like black beans have
01:16:55have lots of magnesium in them,
01:16:57so getting those leggings into your diet
01:16:59and thinking about getting it that way.
01:17:03Good point, we have a
01:17:05couple of questions about.
01:17:07Are there any books about cancer
01:17:09and nutrition which you nicely
01:17:11had a great slide with many
01:17:13of many book options on there.
01:17:15We will also again.
01:17:17You know we have some resources after
01:17:20that will be available to you on our
01:17:25cancercenter.org/survivorship website
01:17:27which will post that at the end too.
01:17:33But see how about we answered
01:17:35a sugar question that was
01:17:36answered in their lecture.
01:17:38What nutrients doctor?
01:17:39Saffer? Yeah, yeah, 'cause
01:17:40I think you know when I
01:17:42gave this talk 2 weeks ago.
01:17:44Yeah, one of the things we're learning,
01:17:46and Walter Willett is described
01:17:48as he called the 4th Paradigm.
01:17:51Vegetables and fruits.
01:17:53Dietary carcinogens.
01:17:55Even dietary vegetables.
01:17:56If you look at across the board.
01:17:58The link with cancer is
01:18:00far less than we realized.
01:18:02Having a healthy plant based
01:18:04diet is clearly the best,
01:18:05but within populations levels
01:18:07of fruits and vegetables the
01:18:09Eskimos had low cancer risk until
01:18:11they moved to a sketch one.
01:18:13But what I was going to get at
01:18:16is metabolism and your metabolic
01:18:17status and weight determine how you
01:18:20handle complex could concentrated
01:18:21carbohydrates and so for some
01:18:24people high levels of sugars and
01:18:26concentrated carbohydrates are really
01:18:28dangerous and Harvard just came out
01:18:30with a fascinating study is not yet.
01:18:32Published where they looked
01:18:34at the use of quote,
01:18:37diabetic type dietze and
01:18:38not not not for diabetes,
01:18:41but people were following diocese.
01:18:43You would use high fruits and
01:18:46vegetables avoiding high concentrated
01:18:47carbohydrates and high levels of
01:18:50of sugar sweetened beverages.
01:18:51Coffee which is beneficial.
01:18:53High levels of nuts and not intake.
01:18:56Reduced levels of saturated fat.
01:19:00And avoiding high glycemic foods,
01:19:02all the things we talked about
01:19:05showed a 25% reduction in cancer
01:19:08progression in women being followed.
01:19:10With with breast cancer,
01:19:12so it seemed to be potentially and again,
01:19:14it's an observation.
01:19:15ULL study,
01:19:16but they were very careful to look at this,
01:19:19and it argues about diets that are
01:19:21designed to lower insulin level,
01:19:23which is my thing.
01:19:24Insulin resistance which
01:19:26activates tumor growth.
01:19:27And it does sort of contain kind
01:19:29of Nuggets of truth about all
01:19:30of these components of diet that
01:19:32may actually benefit long term
01:19:34survival in cancer patients.
01:19:41A minute, what vitamins give you energy?
01:19:46That you can get from.
01:19:49So I love. I love recommending
01:19:51green tea and the reason I
01:19:53love recommending routine and you shouldn't
01:19:55take it in mass quantities but but
01:19:57not only green tea has caffeine in it,
01:20:00but it also has certain phyto chemicals
01:20:02that that ease and calm the nerves as well.
01:20:05So it creates a really nice balance
01:20:07between an energetic boost and not getting
01:20:09the shakes that coffee might give you.
01:20:13About biotin is biotin safe?
01:20:20Believe it or not, in moderate
01:20:22doses it appears to be safe.
01:20:25You know? Unfortunately,
01:20:26it's one of those nutrients that people
01:20:28love to take for their hair and nails,
01:20:31and clearly it does maybe help to
01:20:33some degree, but I think over using
01:20:36it is again a nutrient, but it isn't.
01:20:38It doesn't share the same features of B12,
01:20:41for instance, which is necessary
01:20:43for DNA synthesis and cell growth.
01:20:45You know it doesn't have those same features,
01:20:48but again, don't take too much.
01:20:53And what's an ideal amount of
01:20:56daily protein consumption for men?
01:21:03Depends on your age.
01:21:06You know .8 grams per kilo there.
01:21:09There's some calculations,
01:21:10but if you're over 65,
01:21:11the level of protein intake is needs to be
01:21:14higher to maintain adequate muscle synthesis.
01:21:17They've shown that we become less efficient
01:21:19at muscle protein synthesis as we get older,
01:21:22and so they've been guidelines
01:21:23that say we need to go up.
01:21:26And also if people are chronically ill,
01:21:28we need to maintain adequate levels of
01:21:31protein because one of the worst things that
01:21:33can happen is weight loss and sarcopenia.
01:21:36That is, loss of muscle mass is a major
01:21:39cause of toxicity and impaired survival,
01:21:41and in poor quality of life.
01:21:43So dietary protein is important in those
01:21:45populations in patients who have cancer,
01:21:47but if you're older,
01:21:48you're less deficient,
01:21:49so you may need less.
01:21:51And by the way, we probably get
01:21:53too much protein when we're young.
01:21:56You know we were really enriched in protein,
01:21:58and they've shown that in babies
01:22:00who have twice as much protein in
01:22:03formula as they do in mothers milk,
01:22:05they have a higher incidence of
01:22:07obesity and they actually lower the
01:22:08protein level in the formula and
01:22:10they reduce the obesity in children
01:22:12in multiple centers in Europe.
01:22:14So you know,
01:22:15we load up protein,
01:22:16but you don't need that much.
01:22:20There any thoughts about that?
01:22:24No, I think I think you
01:22:26covered it beautifully,
01:22:27but plant based
01:22:28protein is healthier than
01:22:29animal based protein.
01:22:30A number of studies have shown that.
01:22:32I am a base protein,
01:22:35higher mortality in low carb
01:22:36diets with high protein,
01:22:38higher plant based protein with
01:22:40low carb diets, less mortality,
01:22:42so plant based still is the best within
01:22:45the balance of my macro nutrients.
01:22:48Great. Uhm? We
01:22:52have a question about.
01:22:57Moss said on this scrolling here Doctor
01:23:00Sopher, what nutrients do you find to
01:23:02be the hardest to get from diet alone?
01:23:06I would say vitamin D is
01:23:08probably the toughest to get to
01:23:09get in your diet alone.
01:23:14And are there yeah easy there
01:23:16any good and reliable websites
01:23:18to find out about the benefits and
01:23:20risks of various Chinese medicine's?
01:23:22I lived in China for 20 plus
01:23:24years and my wife is from there.
01:23:27She often encourages me to eat sea
01:23:29cucumbers and Caterpillar fungus which are
01:23:31supposedly good for preventing cancer.
01:23:33But after hearing tonight's presentations,
01:23:35I wonder if there are any true in clinically
01:23:38proven benefits or potential risks in
01:23:40eating these foods in large amounts.
01:23:44So I think what we find with with
01:23:47herbs from China, unfortunately is as
01:23:49poorly regulated supplements are here.
01:23:51They are, they're quite poorly regulated
01:23:54over there time and time again.
01:23:56Studies have shown that they've been
01:23:58adulterated with other products.
01:24:00You know, the most famous and
01:24:03probably the most humorous is is mail.
01:24:06Male Chinese herbs coming over and turning
01:24:09out to be just adulterated with Niagara so.
01:24:13Yeah, I think I think I would
01:24:15use a lot of caution.
01:24:17That being said,
01:24:18there's a lot of promise with Chinese herbs,
01:24:21and there's a lot of research going into it,
01:24:24but I would say the best one is one of
01:24:26my favorite resources that's that's
01:24:28freely available for everybody is.
01:24:30Memorial Sloan Kettering has a website
01:24:33called about herbs that that is a
01:24:35great resource and covers a huge
01:24:37huge amount of herbs and supplements,
01:24:39and discusses their safety and risks.
01:24:42Great.
01:24:45Here's one about the green tea
01:24:46that you mentioned is that amount
01:24:48of caffeine OK on a daily basis?
01:24:50A couple of day I was told
01:24:52no caffeine post surgery,
01:24:53but I missed the green tea.
01:24:56Everybody metabolizes caffeine differently.
01:24:57You know, I. So I think you
01:24:59have to use your own judgment.
01:25:01I wouldn't go past a couple for
01:25:04you during the day, but but it,
01:25:06but it should be generally safe.
01:25:08I would talk to your physician about it,
01:25:10'cause I don't know your individual
01:25:12circumstance and and I would
01:25:13trust your physician and an
01:25:15their recommendations though.
01:25:17Great also wanted to mention there's
01:25:19a lot of green tea supplements
01:25:21out there as well.
01:25:23I would probably try to stick with the
01:25:25green just actually the green tea itself,
01:25:28not a concentrated like green
01:25:29tea supplement or EG CG.
01:25:31Something like that.
01:25:32The green tea itself is
01:25:34in small amounts would be OK.
01:25:36Absolutely those supplements can
01:25:37cause liver damage and we've seen it.
01:25:39It's it's not theoretical,
01:25:41so it's a great point.
01:25:47Heather, you're muted.
01:25:50We have one here about CBD.
01:25:52I have frequent issues with waking in the
01:25:55middle of the night and up for hours.
01:25:57Very tired the next day
01:25:59due to interrupted sleep.
01:26:01Took a trial dose of CBD,
01:26:0330 milligrams, maybe it was too low.
01:26:06Wasn't helpful.
01:26:07Any suggestions regarding the dose
01:26:09or other supplements to help sleep?
01:26:12So my first suggestion here is
01:26:14is always making patients aware
01:26:16that waking up in the middle of
01:26:18the night is completely normal.
01:26:19It happens to everybody and
01:26:21some people don't realize it.
01:26:22But they're waking up with everybody
01:26:24wakes up and I have to tell you
01:26:27from my own personal experience,
01:26:28I was somebody who would wake up
01:26:30in the middle of the night and
01:26:32my mind would just start racing,
01:26:34racing, racing.
01:26:35I'm never going to fall asleep.
01:26:37I'm gonna be tired in the morning.
01:26:39This is gonna ruin my day yadda yadda yadda.
01:26:42Just somebody telling me that fact alone.
01:26:44Allowed me to go to sleep much more easily.
01:26:48Now, if it's still an issue for you
01:26:50after you know that the thing that
01:26:52I've actually found the most useful
01:26:54for patients having difficulty falling
01:26:57asleep is something called sleep stories.
01:26:59It's it's an app,
01:27:00it's on the com app.
01:27:02It's a 7 day free trial,
01:27:04so you can give it a shot.
01:27:07They're really, really boring stories,
01:27:08and I've used it myself and it's
01:27:11really helpful to fall asleep.
01:27:13Give that a shot first before anything else.
01:27:17I love that I'm going to try it
01:27:19myself. Yeah, try it.
01:27:21Can you share your thoughts
01:27:23on the Gerson therapy?
01:27:24Anybody familiar with that?
01:27:30After boy do you
01:27:31want to take this one I? I suspect
01:27:32you've seen this more than I have,
01:27:34but I'm happy to talk about it too. I
01:27:37have a lot of patients who use many
01:27:40of these alternative dietary programs.
01:27:42They are promoted and they're very,
01:27:45very in what they, you know,
01:27:47natural supplements, natural foods,
01:27:48high juices, you know,
01:27:50in the Gerson is of multiple dietary
01:27:53approach and a lot of people follow that,
01:27:56but they they the dilemma
01:27:58with this is number one.
01:28:00People will often use it in
01:28:02lieu of conventional therapy,
01:28:03which is dangerous and #2.
01:28:05There's really no evidence
01:28:07that any of these have.
01:28:09Substantial benefit,
01:28:10I mean we see this all the time.
01:28:12This is a very big dilemma in the world
01:28:15of conventional and alternative therapies.
01:28:17So I mean,
01:28:18that's one of many different diets out there.
01:28:21Gary mentioned the alkaline diet,
01:28:23you know,
01:28:23and that's again very common.
01:28:28I mean, as a as a popular approach
01:28:30that has not been shown to be,
01:28:32you pee out the alkali.
01:28:33That's why it shows up in the urine.
01:28:35That's the body's way of controlling pH.
01:28:39OK. So I will see the American Cancer Society
01:28:43recommends strongly against the Gerson diet.
01:28:45It can cause actual nutritional
01:28:47deficiencies because because of what it is,
01:28:50I don't like juicing because you're taking
01:28:52away so much of the fiber and so much
01:28:55of what makes fruit good for you that
01:28:58you're really missing out on a lot of it.
01:29:01There's also a component in the Gerson diet,
01:29:04which I strongly recommend against,
01:29:06which is coffee enemas.
01:29:07These coffee enemas have
01:29:09really caused a lot of harm,
01:29:11with patients really quite dangerous.
01:29:15Great information, so we're going
01:29:16to go through two more of our
01:29:18questions and then we will answer some
01:29:20of these questions offline after I don't
01:29:22want to take up too much more time here,
01:29:25but we've got a few more left.
01:29:27And then will lagaf and will have to have
01:29:30another Part 2 of this series because
01:29:33the questions and the information just
01:29:35keep coming and it's really wonderful.
01:29:38So would it be beneficial to cancer
01:29:40patients and survivors to have periodic
01:29:42blood work to look at the levels of
01:29:44minerals or vitamins to see if supplements
01:29:47are needed or should be illuminated?
01:29:55So for us as doctors lab tests,
01:29:58it's very important that they are validated
01:30:00and their uses validated and so healthy
01:30:03person should really maintain a good
01:30:05amount of nutrients and nutrient levels.
01:30:07A lot of the labs that get sent by
01:30:09by other practitioners by alternative
01:30:11practitioners are not invalidated studies,
01:30:14meaning that I might go in on Monday
01:30:16at 1:00 PM and my levels might show.
01:30:19One thing I might go in at 3:00 PM.
01:30:23My levels might show another thing I've
01:30:25actually seen that quite a bit with patients,
01:30:27so it's important that you know any
01:30:29labs that are being sent are validated.
01:30:31I think checking vitamin D is can be
01:30:34a really helpful thing to look at,
01:30:36but beyond what your oncologist is
01:30:38sending sending out a standard baseline,
01:30:40I don't think you need much beyond that.
01:30:43Yeah,
01:30:44I would agree.
01:30:45I sometimes in patients using high doses.
01:30:48Will not found this repeatedly.
01:30:50People taking those very high dose B12
01:30:52will have levels that are 1002 thousand UG.
01:30:55You know above what they want
01:30:57and so it shows them that it's
01:30:59too much vitamin D again,
01:31:01but not all the time,
01:31:03and I often will do it seasonally if
01:31:05they're on supplements and most of
01:31:07my patients will take between 1002
01:31:10thousand today because of the data
01:31:12on survival and Gary, I agree 100%.
01:31:14One of the biggest problems is patients
01:31:16go to many many different specialists.
01:31:19In nutrition,
01:31:19who are using non validated tests,
01:31:22often linked to the use of supplements?
01:31:24It's away in the supplements,
01:31:26of course are sold at profit and
01:31:28so it's a way of getting them into
01:31:31a system and the patients feel
01:31:33like they're getting nutrition
01:31:35advice that the doctor,
01:31:37the oncologists are not giving them.
01:31:39And so that's why it's important for all
01:31:42of us to provide that in a reasonable
01:31:44and scientifically based approach,
01:31:46so that they're not going
01:31:47to people who provide these.
01:31:49You know,
01:31:49non valid tests and inappropriate
01:31:51levels of nutrients and nutrition.
01:31:53They often don't even talk about nutrition,
01:31:55they took more about the supplements.
01:31:58Absolutely, and that we
01:32:00have a question for you.
01:32:02Is adrena tone safe? I
01:32:06actually have not heard of adrena tone.
01:32:08If it's type of adrenaline or
01:32:10federa or some type, I'm not sure,
01:32:12but if that is the case then I would
01:32:15probably avoid those types of supplements.
01:32:17There's a lot of cardiac concerns
01:32:19with those types of supplements.
01:32:22OK, the other the
01:32:23other thing I'll add is Anan.
01:32:25There's so many supplements with
01:32:27so many funny names Ann and
01:32:29they're hard to keep track of.
01:32:31Some of the ones with the dreaded
01:32:33nut in it can can actually have
01:32:36steroids in it and cause adrenal
01:32:38suppression so I've seen it clinically.
01:32:40I've seen it in practice so be
01:32:43very very careful with supplements
01:32:45like that. And
01:32:47we have a final final two questions.
01:32:51Any thoughts about low dosing melatonin?
01:32:57So I think melatonin can be helpful
01:32:59for the for certain situations,
01:33:01and I think it's it's probably safe.
01:33:04I think it is safe. I'll say that.
01:33:08The only thing that people make the
01:33:10greatest mistake of is they take
01:33:12melatonin when they can't sleep.
01:33:14You really need to take melatonin
01:33:16a few hours before hand to
01:33:18really get the full effect and to
01:33:20put you in so sleep. That's great advice.
01:33:22How about set your clock
01:33:25when you've traveled?
01:33:26Those who stop working right and interesting.
01:33:29Lee, there's a group in Italy
01:33:31with Sony and others have shown
01:33:33they synergy between melatonin and
01:33:35some oxygen and endocrine therapy,
01:33:37but not in big trials.
01:33:39But it's sort of been intriguing about. And
01:33:44a quick opinion on intermittent
01:33:46fasting during chemo treatments.
01:33:52I can so
01:33:53caution I. I do a
01:33:55lot of this.
01:33:56This is what I deal with every day.
01:33:58People need to be careful.
01:34:00I have patients who want to do this.
01:34:02They don't know that this is Valter Longo
01:34:05and his work at USC who's looked at.
01:34:07You know, it seems to suppress the
01:34:09chemo side effects normal tissues.
01:34:11There has been a concern that it
01:34:13may also suppress the efficacy of
01:34:15chemotherapy in one of his animal models.
01:34:17It showed that the animals
01:34:18that didn't die from chemo,
01:34:20who were on Internet on a low
01:34:22dose fasting before chemo.
01:34:23They actually survived the chemo,
01:34:25but they died faster than the others.
01:34:27That didn't get the fasting.
01:34:28So we have to be careful.
01:34:30It's really and you don't
01:34:31want to lose weight.
01:34:33That's one of the dilemmas with us.
01:34:35And become hypoglycemic,
01:34:36so it's it's a work in progress.
01:34:39I wouldn't recommend it.
01:34:40These are things that need to be studied.
01:34:43Not promoted without good research.
01:34:45If he gets also important
01:34:46to point out that you know
01:34:48we use the term cancer,
01:34:50but every cancer is different and so
01:34:52when we were researching supplements
01:34:54or receive searching certain things,
01:34:56we're looking at specific types of cancers
01:34:59and so you really have to get granular.
01:35:01You have to get nuanced about this
01:35:04and you can't look at it so probably.
01:35:08Yeah, I as an example of that I've
01:35:10been looking at the use of very high
01:35:12dose vitamin C in pancreatic cancer.
01:35:14There are subtypes of
01:35:15pancreatic cancer who can lead.
01:35:17Cornell is shown us that have certain
01:35:19mutations that seemed to have efficacy
01:35:21and he's still interested in this,
01:35:23but many cancers that are slow growing,
01:35:25it has no effect at all.
01:35:30OK, so for our last question,
01:35:32should you take a daily multivitamin?
01:35:34If you're on a plant based diet and
01:35:37currently in good health as a survivor?
01:35:43You know, I would say it's not unsafe
01:35:45to take a daily multivitamin if
01:35:47you are getting an adequate diet.
01:35:50Maybe you don't even need it,
01:35:52but it's not unsafe, so it would be OK to
01:35:55take. Yeah, and I will
01:35:57tell you that all of the studies,
01:35:59including Women's Health initiative
01:36:01in cancer survivors, have shown I
01:36:03mentioned that in the Dell CAP study,
01:36:05but it turns out that in the Women's
01:36:08Health Initiative and Roman ship blasting,
01:36:10all the studies show there seems to
01:36:12be a potential benefit by taking a
01:36:15daily multivitamin. But not a lot.
01:36:17However, you don't want to be taking iron,
01:36:20Big deal, and I will.
01:36:21Woman study was increased mortality
01:36:23in women taking supplemental iron.
01:36:25It's enhanced mortality,
01:36:26and of course they didn't need it,
01:36:28but they were still on it after menopause.
01:36:30So you have to be really careful about
01:36:33what you're taking, but it's healthy.
01:36:35You may not need it, but if you're not sure,
01:36:37it's not probably going to have any risk,
01:36:40but you don't want to have this
01:36:42high potency multivitamin.
01:36:43That's the risk.
01:36:46OK, so I think we're going to wrap it up for
01:36:50this evening we have.
01:36:51I've had so many great great
01:36:53questions and we will respond back
01:36:55to anybody's questions that we
01:36:57hadn't did not get to via email.
01:37:00We also encourage you to email
01:37:02us anymore questions that you
01:37:05have and we will get the right.
01:37:07Person to answer your email
01:37:09so the email address to answer
01:37:12us anymore questions would be
01:37:14cancer answers at yale.edu.
01:37:16So it's cancer answer pleural cancer
01:37:19answers at yale.edu and I just want
01:37:22to thank our presenters tonight
01:37:24for taking the time to be with us
01:37:27and really give all of your expert
01:37:30expert opinions and information
01:37:32expert expertise in this and really
01:37:35just sharing your time with us.
01:37:37Tonight and for everybody who stuck
01:37:39around and stayed with us tonight.
01:37:41It was great.
01:37:42This was such such great information,
01:37:45such a great success.
01:37:46It's so much fun and great to be able
01:37:49to have a part to when we have time.
01:37:52So thank you everyone and
01:37:54stay tuned next week.
01:37:55Same time, same zoo station,
01:37:57zoom at 7:00 o'clock.
01:37:58Next Tuesday we will be talking
01:38:00about holistic coping strategies
01:38:02for our cancer survivor.
01:38:04So I wish you all a good
01:38:06night and thank you again.
01:38:09Thanks for having
01:38:10us. Thank you
01:38:11so much mate everybody.
01:38:15Thanks Emily.