Healing and Cancer? - American Brain Tumor Association

Healing and Cancer?
Is there more than
traditional medicine has
to offer?
Rekha Chaudhary, MD
University of Cincinnati Medical Center
UC Brain Tumor Center
2014 Patient and Family Conference
Providing and Pursuing Answers: Advances in Brain Tumor Research, Treatment & Care
www.abta.org
1-800-886-ABTA (2282)
abtacares@abta.org
#ABTA2014
Curing
Healing
External treatment
that removes all
evidence of disease
Internal process that
through which a
person becomes whole
What physicians do
What patients do
Usually on physical
level alone
Physical, emotional, or
spiritual level
Choices in Healing by Michael Lerner
“THAT ONE CAN PARTICIPATE IN
THE FIGHT FOR LIFE WITH
CANCER – BY WORKING TO
ENHANCE YOUR OWN HEALING
IS A PROFOUNDLY IMPORTANT
DISCOVERY FOR MANY PEOPLE”
Choices in Healing by Michael Lerner
Goals and Objectives
• Science behind tumors:
–Counseling
–Exercise
–Diet
• Ketogenic diet
Goals and Objectives
• NOT purely brain tumors
• NOT supplements
• NOT anecdotal evidence
• NOT in lieu of traditional
medicine
Benign Tumors and more uncommon
tumors?
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Meningiomas
Pituitary Adenomas
Acoustic Neuromas
Medulloblastoma
Neuroblastoma
Hemangiopericytomas
Science behind integrative medicine?
Goals and Objectives
• Science behind tumors:
–Counseling
–Exercise
–Diet
• Ketogenic diet
Counseling and Cancer
• 227 patients treated for breast cancer
– ½ patients randomized to psychological
intervention arm
– ½ randomized to regular assessment
• Intervention arm had strategies
– To reduce stress
– Improve mood
– Alter health behaviors
Andersen BL et al.. Psychologic intervention improves survival for breast
cancer patients: a randomized clinical trial. Cancer. 2008 Dec
15;113(12):3450-8.
Counseling and Cancer
Andersen BL et al.. Psychologic intervention improves survival for breast
cancer patients: a randomized clinical trial. Cancer. 2008 Dec
15;113(12):3450-8.
Counseling and Cancer
Andersen BL et al.. Psychologic intervention improves survival for breast
cancer patients: a randomized clinical trial. Cancer. 2008 Dec 15;113(12):3450-8.
Stupp Trial for Temodar Approval
Counseling and Cancer
• Women with metastatic Stage IV breast cancer
randomized to therapy versus no therapy
– Group therapy was 90 minutes weekly led by a
psychiatrist or social worker who themselves had breast
cancer in remission
– Self-hypnosis was taught for pain control and managing
side effects of chemotherapy
• Median Survival
– Intervention group 36.6 months
– Placebo group 18.9 months
• DOUBLE SURVIVAL!
Spiegel Det al. . Effect of psychosocial treatment on survival of patients with
metastatic breast cancer. Lancet. 1989 Oct14;2(8668):888-91.
Goals and Objectives
• Science behind cancer:
–Spiritual/Counseling
–Exercise
–Diet
• ketogenic diet
Exercise and Survival in Recurrent Glioma
Patients
• Prospective trial assessing patients that exercised > 9
metabolic equivalent –h/wk versus < 9 metabolic
equivalent –h/wk
– 9 MET = Brisk walking for 30 minutes on 5 days/week
• Median Survivals
– > 9 MET: 21.84 months
– < 9 MET: 13.03 months (p=.0081)
• Results independent of:
– Performance status
– Age
– Number of prior progressions
Ruden E, et al. Exercise behavior, functional capacity, and survival in adults
with malignant recurrent glioma. J Clin Oncol. 2011 Jul 20;29(21):2918-23.
Impact of Yoga on inflammatory markers
• 200 breast cancer patients assigned to 12 weeks
of hatha yoga 90 minutes twice a week or waitlisted control group
• Decreases in inflammatory markers
– IL-6 (P = .01)
– IL-1β (P = .03)
– No significant change in TNF-α production (P >
.05)
Kiecolt-Glaser JK et al.. Yoga's impact on inflammation, mood, and
fatigue in breast cancer survivors: a randomized controlled trial. J Clin Oncol.
2014 Apr 1;32(10):1040-9
Goals and Objectives
• Science behind cancer:
–Spiritual/Counseling
–Exercise
–Diet
•Ketogenic diet
What my doctor doesn’t know won’t hurt her!
No Grapefruit with Temodar
Ketogenic Diet and Glioma
• Medically regimented high-fat, low
protein/carbohydrate diet (4:1:1)used to treat
refractory pediatric epilepsy
• <600 calories per day
• Increased ketones and decreased glucose in blood
• Unlike normal brain cells, tumor cells cannot use
ketones and rely on glucose
Woolf EC, Scheck AC. The Ketogenic Diet for the Treatment of Malignant
Glioma. J Lipid Res. 2014 Feb 6. [
Ketogenic Diet
Mice were injected with malignant glioma cells and given
ketogenic diet versus standard diet
Abdelwahab MG et al. The ketogenic diet is an effective adjuvant to
radiation therapy for the treatment of malignant glioma. PLoS One. 2012
Ketogenic Diet and Human Studies
• 1 case report of a woman with glioblastoma who
progressed in a short time but did not progress on
ketogenic diet.
• One prospective trial with no clinical activity
demonstrated and 15% of patients could not
maintain diet.
Zuccoli G et al. Metabolic management of glioblastoma multiforme using standard
therapy together with a restricted ketogenic diet: Case Report. Nutr Metab
(Lond). 2010 Apr 22;7:33.
Rieger J et al. ERGO: a pilot study of ketogenic diet in recurrent glioblastoma. Int J
Oncol. 2014 Jun;44(6):1843-52.
Ketogenic Diet
• No real prospective trials in any human brain
tumors
• Unclear of mechanism of diet
– Is it truly ketones or is it glucose reduction
which can be obtained through less restrictive
diets
– Impact on quality of life?
• On going clinical trials currently and will not have
answers for a few years
1. Nebeling LC, Miraldi F, Shurin SB, Lerner E. Effects of a ketogenic diet on tumor metabolism
and nutritional status in pediatric oncology patients: two case reports. J Am Coll Nutr
1995;14:202-8.
2. Zuccoli G, Marcello N, Pisanello A, Servadei F, Vaccaro S, Mukherjee P, et al. Metabolic
management of glioblastoma multiforme using standard therapy together with a restricted
ketogenic diet: Case Report. Nutrition and Metabolism 2010;7:33-53.
3. Schmidt M, Pfetzer N, Schwab M, Strauss I, Kammerer U. Effects of a ketogenic diet on the
quality of life in 16 patients with advanced cancer: A pilot trial. Nutr Metab (Lond) 2011;8:54.
Glucose and Brain Tumors?
• 191 patients with glioblastoma
• Glucose levels were measured in all patients
• Median Survival was
– mean glucose level< 94 :14.5 months
– mean glucose >137: 9.1 months (P=.041)
• These differences were present even when taking
into consideration:
– Daily steroid dose
– Age
– And performance status (how active the patient
can be)
Derr RL et al. Association between hyperglycemia and survival in patients
with newly diagnosed glioblastoma. J Clin Oncol. 2009 Mar 1;27(7):1082-6
Diet and Cancer Remission
“200 patients with
documented spontaneous
cancer remission, 87%
made drastic changes in
diet” (Foster, H.D. Int J Biosoc Res, 10(1): 17-20, 1988.)
Pro-Inflammatory Foods
• Sugar
• Processed white flour
• Meats (especially processed
meats)
• Dairy Products
Risk Factors for Brain Cancer
• 122 incident cases with malignant primary brain
tumors and 122 control cases
• Statistically significant risk factors:
– major life events over the past 5 years before
diagnosis (OR = 1.90, 95% CI 1.13-3.20),
– family histories of cancer (OR = 1.90, 95% CI
1.12-3.22),
– fresh vegetable and fruit intake (OR = 0.29,
95% CI 0.09-0.95),
– skipped meals several times per week
(OR = 0.35, 95% CI 0.16-0.77)
Cabaniols C, et al. Links between private habits, psychological stress and brain
cancer: a case-control pilot study in France. J Neurooncol. 2011
Jun;103(2):307-16.
China Study?
Aflatoxin
20% casein diet
5% casein diet
Colin Campbell. The China Study. 2006 BenBella books
Colin Campbell. The China Study. 2006 BenBella
books
What is the China Study?
• Partnership between Cornell University, Oxford University,
and the Chinese Academy of Preventative Medicine.
• Studies mortality rates from cancer and other chronic
diseases from 1973–75 in 65 counties in China
• Correlated dietary surveys in 1983-1984and blood work
from 100 people in each county to theses mortality rates
• included 367 variables and 6,500 adults
• more than 8,000 statistically significant associations
The China Study
• “Grand prix of all epidemiologic studies” – New York Times
• “ Today AICR (American Institute for Cancer Research) advocates a
predominantly plant-based diet for lower cancer risk because of the
great work Dr. Campbell …began 25 years ago.” – Marilyn Gentry,
president AICR
• “The China Study is a well-documented analysis of the fallacies of the
modern diet. The lessons from China provide compelling rationale for a
plant-based diet to promote health and reduce the risk of diseases of
affluence” – Sushma Palmer, PhD executive director, Food and Nutrition
Board, US National Academy of Sciences
• Former President Bill Clinton is plant-based and lost 24 pounds. He
singles out the China Study and Dr. Campbell as leaders in the
movement.
Conclusions of China Study
• Whole-food plant-based diet is the best diet for
promoting an over-all healthy lifestyle.
– Prevents cancer and turns off tumorgenesis
– Decreases cholesterol and heart disease
– Plants are anti-oxidants that aid in the fight
against cancer
Why are plants so good and animal-based
protein so bad?
• Inflammation?
– 10,525 men and women in the Aerobics Center
Longitudinal Study from 1987 through 2003
– Participants consuming the most proinflammatory diet had a 53 percent higher risk
of mortality during the course of the study.
– Four-fold increase in GI cancers among the
group consuming the most pro-inflammatory
diet compared to the most anti-inflammatory.
– Anti-inflammatory diet is a diet rich in plantbased foods
Steck et al. Data presented in poster form at AICR
meeting. November 7, 101`3
Pro-Inflammatory Foods
• Sugar
• Processed white flour
• Meats (especially processed
meats)
• Dairy Products
Living Luxuriously: The Journey
Practical Tips For a Whole-Food, PlantBased Diet
• Morning: Smoothie
• Lunch: Salad with avocado instead of
cheese
• Snack: Almonds, carrots and hummus
• Dinner: Tomato soup, brown rice,
tofu sushi
Morning Smoothie
Ingredients:
Spinach
Blueberries
Ripe Banana
Ice
Water
Blend in Vitamix
Add chia seeds if desired.
Lunch
• Mason Jar Salad (in this
order)
– Garlic Expressions
Dressing (or dressing of
your choice)
– Olives
– Cherry tomatoes
– Onions
– Avocado
– Lettuce
Snack
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Almonds
Cherry tomatoes with salt
Olives
Carrots with hummus
Snap peas with hummus
Carrots with spicy guacamole
cashews
Chia seed in water
Pumpkin seeds
Sunflower seeds
Spicy Peanuts
Green pepper with garlic dressing
Dinner - I want to go out!
• Chipotle?
– Veggie burrito bowl with
beans, brown rice,
guacamole
• Taco Bell?
– 7 Layer Bean Burrito
(minus cheese, rice and
sour cream)
• Burger King?
– Veggie Burger crumbled
on salad
Prostate Cancer and Diet
• 93 patients with low risk prostate cancer were on a
wait-and-watch treatment
• Patients were randomized to a control arm and a
lifestyle arm
• Experimental arm were asked to adopt a low-fat,
plant-based diet, to exercise and practice stress
management, and to attend group support
sessions.
• At 2 years:
– 27% of the control arm required surgery
– 5 % of the experimental arm required surgery
(P<.05)
Frattaroli J et al., Ornish D. Clinical events in prostate cancer lifestyle trial:
results from two years of follow-up. Urology. 2008 Dec;72(6):1319-23.
“In the midst of winter, I finally learned that there
was in me an invincible summer.” Albert Camus
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THANK YOU
Any Questions?
2014 Patient and Family Conference
Providing and Pursuing Answers: Advances in Brain Tumor Research, Treatment & Care
www.abta.org
1-800-886-ABTA (2282)
abtacares@abta.org
#ABTA2014