Confronting Cancer as a Chronic Disease: Primary Care Takes a 360-degree View
Conference: IFM's 17th International Symposium
- Date: May 20-23, 2010
- Location: Carlsbad, California
- Presenters: Jeffrey Bland, PhD; Dwight McKee, MD; Mary Hardy, MD; Dean Ornish, MD; Nancy Emenaker, PhD; Gina Solomon, MD; Mary Ellen Chalmers, DMD; Mark Messina, PhD; Jonathan Treasure, AHG; Jed Fahey, MS; Rut DeBusk, PhD; Moshe Frenkel, MD; Lise Alschuler, ND; Tim Birdsall, ND; Care Anne Coscarelli, PhD; Paul Reilly, ND; Anne Coscarelli, PhD; Peter Carroll, MD; Jeanne Drisko, MD; Donald Yance, Jr., MH; Jeanne Wallace, PhD; Mitchell Gaynor, MD; Keith Block, MD; and Dan Rubin, ND.
- Attendee: Joanne Quinn, PhD
This invaluable symposium takes an in-depth look at all aspects of cancer, its treatment and survival. The mechanisms of initiation and development of cancer were discussed including infection, immune dysfunction, inflammation, oxidative stress, impaired detoxification and hormonal imbalances. All of these affect gene expression, cell growth messaging, angiogenesis and apoptosis (death of the cell).
Although there is incomplete evidence according to some, dietary, nutritional, botanical and other lifestyle therapies were explored. The symposium gave clinicians the tools to organize an integrated treatment approach and strategy for the patient to integrate complementary methods in cancer treatment and care.
The symposium focused on the science related to cancer prevention including diet, environmental and other lifestyle factors. The science of dietary and nutritional factors has been shown to be useful in clinical practice. Controversies of soy and isoflavones, issues surrounding glucosinalates and isothiocyanates and various other controversies in cancer treatment and prevention were explored.
Environmental factors that can dramatically increase risk for developing various types of cancers were reviewed. The use of anti-oxidant supplementation and other adjunctive therapies during cancer treatment, incorporating botanical medicine and the importance of psychological and emotional support were covered in detail.
Finally, the symposium focused on the science of secondary prevention and the very real psychological and emotional issues that a cancer survivor faces.
Jeffrey Bland: Looking Anew at Cancer and New Strategies for Underlying Mechanisms of Cancer
Dr. Bland explored the mechanisms underlying primary cancer formation and growth and how those factors are addressed by various cancer prevention strategies and treatments. Specifically he addressed the roles of inflammation, infection, biotransformation, immune dysfunction, redox homeodynamics and hormonal imbalance in cancer initiation and promotion. Dr. Bland evaluated the appropriateness of cancer preventatives and therapeutics based on their ability to address imbalances in these physiological processes involved in cancer. The progression of extant cancer and metastasis was evaluated in the roles of the above mentioned factors. He discussed the unique natural history of each individual neoplasm in appropriate cancer treatment and highlighted areas of synergy between conventional cancer treatment strategies and adjunctive treatments that address underlying physiological imbalances.
McKee: Clinical Conundrums: Dealing with incomplete information in the Assessment, Prevention, and Treatment of Cancer.
Much is known about the biology of cancer, yet there is much that we do not know and must extrapolate from epidemiological data, animal cell models, in vitro studies of tumor cell lines, and other forms of evidence. Dr. McKee evaluated the current level of evidence for cancer treatments and discussed potential sources of uncertainty in existing data sets. He provided a framework and structure for mapping and sorting the body of knowledge available on cancer and helped understand the calculus involved in guiding patients when making decisions that involve risk.
Hardy: The Art and Science of an Integrative approach to Cancer
Dr. Hardy discussed treatment approaches that look at the role of inflammation, infection, biotransformation, immune dysfunction, redox homeodynamics and hormonal imbalances in cancer. She evaluated methods for the design of a therapeutic plan in order to improve patient understanding. The presentation was helpful in organizing an integrated treatment approach and strategy that makes use of the available evidence.
Pearls from Day 1:
- Diet and exercise together maximize success of outcome whether you have surgery, chemo or radiation.
- What is Prevention? How do you know what you didn't get? It is important to live a life style that supports the body and makes the terrain less favorable for cancer and other disease. It is all a choice of what to eat, how to think and whether to exercise.
- We need to move beyond the double blind placebo control trials. There are so many variants in health from one individual to another. We have computer programs that are capable of statistical analysis with multiple variables.
- Probiotics, prebiotics, synbiotics and fiber all facilitate effective immune function. It is a complex ecology in the gut with bacteria and viruses which convert food themselves as well as the elements of intrinsic digestion which doe food conversion. All of these aspects add to the ecology in the gut and this secondary metabolism by healthy gut bacteria is an immune stimulator.
- Phytosterols stimulate the immune system and are considered bio-actives in the body. These have an impact on gene expression.
- Glucosinolates have an impact on the Phase I and II detox processes which take place in the liver. Examples are tomatoes and broccoli for lowering Prostate Specific Antigen (PSA).
- There is a synergy when eating fruits and vegetables is combined with exercise. The impact is great and includes stimulating the mitochondrial activity to alleviate low energy.
- Obesity is a major cause of inflammation which drives the disease process
- In disease we see that there are often times co-morbidities. These illnesses impact each other and all share the same terrain in the individual. Even though our medical system has become so specialized, the entire body must be considered, not just one part.
Ornish: Pliable Phenotypes: Changing the Way we View Cancer
Dr. Ornish discussed his work on lifestyle modification plans and their impact on cancer genetics including the results of his recent controlled trial of prostate cancer patients who benefited from changes in diet and lifestyle. He presented evidence regarding changes in gene expression patterns following various therapeutic interventions and provided techniques for designing lifestyle modification plans that have heath promoting genetic effects for cancer patients and healthy patients alike.
Emenaker: Diet and Nutrition in Cancer Prevention: Separating Fact from Fiction
There are several dietary plans that purport to prevent cancer. Dr. Emenaker evaluated the evidence for specific dietary plans for prevention of different types of cancer, as well as reviewed the overall evidence for a role of the diet in preventing or promoting cancer initiation.
Solomon: The Role of environmental Toxins in Cancer Development
Several environmental toxins have been linked to increased cancer risk, but for many the data is murky at best. Dr. Solomon evaluated the evidence regarding the role of environmental toxins including organic solvents, radiation, heavy metals, mobile phones, power lines, pesticides, and hormone analogues in initiating and promoting cancer growth.
Pearls from Day 2:
- People will always have conversations about other people, things and ideas but it is the idea conversations that stick.
- Appropriate life style interventions are better than polypharmacy in efficacy and safety.
- DIET is a four letter word. It is better to consider it a food plan instead to be done with joy and celebration.
- Awareness is the first step in healing. Be worthy and not a victim
- There is a symbolic and important difference between "I"llness and "We"llness.
- Epidemiology is changing as genotype information improves.
- There is a difference between "public health" and "individual health." Treatment must be individualized.
- Bisphenol A in plastic has shown to be a direct link to Diabetes II.
- There have been pioneers in the field of functional medicine who were ostracized in their time, but redeemed later. Phil Needleman is one such person. His perspective in retrospect was that we are all measured by the outcome of our ideas.
- Vitamin D has a direct impact on genes and it also has two faces. When deficient many genes are affected. When excessive it is an immune system suppressant. It is important to first check 25(OH)D for deficiency but in some cases it is also important to monitor 1.25 dihydroxy and observe the ratio of the two. As an example, if you have an autoimmune disorder you may pull more 25 (OH)D to convert to 1, 25 dihydroxy.
Alschuler: Weighing the Risks and Benefits of Adjunctive Therapies during Chemotherapy and Radiation
Dr. Alschuler evaluated the use of adjunctive therapies to help the health and well being of patients undergoing cancer treatment. She discussed research on several types of adjunctive treatments including diet, nutrients, acupuncture and massage when used along with radiation and chemotherapy. She discussed which cancers have shown to be most effectively handled with an integrative approach and presented ideas on the anticipated future trends in integrative oncology.
Birdsall: The Role of Anti-oxidants and Immunostimulants in Cancer Prevention and Treatment
Dr. Birdsall evaluated the research on anti-oxidants and immunostimulant supplements in cancer prevention and treatment. His talk included discussions about green tea, melatonin, medicinal mushrooms, vitamin C, CoQ10 and selenium. He presented both the risks and potential benefits of their use. His talk explained the details of developing a therapeutic plan that appropriately uses anti-oxidants and immunostimulants in a way that complements other forms of cancer treatment.
Coscarelli: Why Attitudes and Beliefs Matter in Cancer Care
Dr. Coscarelli presented the research on the importance of providing emotional support to cancer outcomes as well as its impact on quality of life during cancer treatment as well as how to develop a plan that appropriately supports the emotional and spiritual health of cancer patients during treatment.
Pearls from Day 3:
- More information regarding Vitamin D was covered. Serum 25 hydroxy is actually a pre-hormone. Once it is converted to 1,25 dihydroxy it is a hormone which is short lived. This number can change rapidly. Elevated 1,25 dihydroxy through a number of channels impacts total serum calcium, possibly causing hypercalcification and can be potentially toxic. Vitamin D receptors affect 50 or more genes. Research is showing that a healthy level of 25 (OH)D to be between 50-80 ng/ml. Since inflammation and autoimmune issues call for a greater conversion of 25 hydroxy to 1,25 dihydroxy it is possible to have normal 25 hydroxy levels yet elevated 1,25 dihydroxy.
- Cancer and cachexia are serious wasting diseases so the patient needs plenty of protein and calories.
- The tumor creates its own microenvironment that is immune suppressing. Tumor debulking helps lower the tumor load and helps the immune system deal well. Obesity causes a major stress on the immune system due to the resulting inflammatory cytokines. If the patient is obese and has a tumor both issues need to be debulked.
- Big Pharma takes a substance and determines the single modulator that works on the issue. Nature however, also modulates through food in a much more moderate potency. The body’s relationship with food creates a symphonic orchestration. Foods can be adaptogenic, sometimes being the agonist and sometimes the antagonist. Rarely do foods hit too strong, but they do moderates function. Sometimes there is a place for "attack" and the use of chemo and sometimes there is a place for "grace" through food.
- The discussion of diet and exercise was consistently covered. The question is what makes the two so synergistic. The bottom line is that cancer is a dysfunction in the mitochondria. If oxygen is not delivered we cannot metabolize or excrete. The KREBS cycle needs oxidative enzymes. Cancer cells survive in low oxygen environments. Exercise stimulates the delivery of oxygen to the cells. In the cancer cell the mitochondria dysfunctions and the respiration of oxygen (in normal cells) is replaced by fermentation of sugar. In any anaerobic activity the driver is glucose. Hypoxia perpetuates the environment of cancer. Antioxidants in fruits and vegetables help modulate pathways that inhibit factors that protect against hypoxia. The strongest plants are those which are stressed and need to work to survive. They produce phytonutrients to protect the plant. Plants which are never stressed produce fewer phytonutrients. Same with the body. A slightly stressed body will rise to the occasion and be stronger.
- It is vital to support cancer patients psychologically and psycho-socially. The term "survivor" should be replaced with "victor/champion."
- We can teach our bodies to orchestrate with grace through food, nutrients, exercise, oxygen, sound, smell and touch to mention a few.
Block: Long-term Biologic Strategies for Secondary Prevention of Cancer
Dr. Block reviewed the literature on emerging and novel biomarkers that may be used as early harbingers of cancer's return to facilitate early detection of secondary neoplasms. He presented evidence about the importance that dietary, lifestyle and nutreceutical therapies play in designing a wellness plan for long term cancer survivors.
Rubin: Looking to the Future in Integrative Cancer Care
Dr. Rubin took an evolutionary view of cancer, presented the theory of cancer as a Darwinian process and discussing how it fit into the key process of adaptation. He described how changing the paradigm from the predominant cytotoxic treatment approach to a more integrative patient-centered approach with improved outcomes. His talk focused on the aspect that cancer is the failure of a wound to heal.
Gaynor: Living Longer and Better: Cancer Survivorship Challenges and Opportunities
Dr Gaynor concluded the conference by discussing the emotional and physical challenges patients face after cancer treatment ends. Mind-body interventions that can help improve the health of the cancer survivors as well as help prevent cancer recurrence was discussed.
Pearls from Day 4:
- There are practices which combine western and eastern medical practices. The research shows that combining these modalities produces a better outcome for the patient.
- It is important for the future of medicine to move into a model of functional medicine where the whole being is considered and not just the parts.
The IFM symposium on cancer treatment and care was an example of an educational process that would benefit all people interested in an integrative approach to cancer prevention and treatment.
To learn more about IFM and their educational opportunities visit the Institute for Functional Medicine web site.
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