Are you aware that the US is not the leader in cancer survival rates?
Are you aware that the Standard of Care for cancer treatment varies from country to country?
In Cancer Self-Defense 101: Quick Tips to Help You Survive, Josh Fulton takes you on a trip around the world to find the evidence-based treatments that work best to inhibit cancer. Supported by over 2,000 scientific references, Cancer Self-Defense 101 is the premiere book on integrative cancer treatment.
Are you aware that the US is not the leader in cancer survival rates?
Are you aware that the Standard of Care for cancer treatment varies from country to country?
In Cancer Self-Defense 101: Quick Tips to Help You Survive, Josh Fulton takes you on a trip around the world to find the evidence-based treatments that work best to inhibit cancer. Supported by over 2,000 scientific references, Cancer Self-Defense 101 is the premiere book on integrative cancer treatment.
[Please note the formatting and images were lost when I copied and pasted]
Nutrition and exercise are normally completely overlooked by traditional oncologists. I have heard many patients say that their oncologist told them eating cake would be fi ne. This is simply counter to science. It is established that diet, exercise, and stress management can have a dramatic eff ect on cancer progression. This has already been demonstrated in a randomized controlled trial with 93 stage I and II prostate cancer patients. The intervention group was restricted to a vegan diet; given a handful of dietary supplements; and instructed to moderately exercise (light walking) 30 minutes a day six days a week, then given instruction on stress management techniques and told to attend a once a week support group meeting to increase adherence to the protocol.1 They received no other treatment. You know, they were told to do all the things that traditional oncologists say don’t work. CANCER SELF-DEFENSE 101 18 The top fi gure shows a decrease in the PSA for the interventional group and an increase in the control (no intervention) group. The bottom fi gure shows the enhanced ability of the blood of the intervention compared to the control group to kill a prostate cancer cell line (70% inhibition, compared to 9%).1 Also, if blood sugar levels play no role in tumor growth, how do we explain this direct correlation of tumor growth with blood sugar level in mice? CANCER SELF-DEFENSE 101 19 Glucose consumption shows a clear correlation with tumor weight in animal and cell line trials.2 As if the above weren’t enough, a CT scan works by using the drug 2DG to mimic glucose along with the radioactive isotope fl uorine-18, because cancer preferentially consumes glucose. So, probably the main imagining test of traditional oncology is based on the fact that cancer preferentially consumes glucose. Yet, so many traditional oncologists neglect to tell people to drastically reduce their sugar intake to fi ght cancer. It is baff ling. So, we know that diet is important, but the question becomes: which diet to follow? What Is the Fuel of Cancer? As we mentioned, the fi rst must-have of any cancer-fi ghting diet is a dramatic reduction in glucose consumption. It has been shown in study aft er study that higher levels of glucose consumption are linked to higher risks of cancer, particularly breast cancer. In one analysis of over 100,000 people, people who were in the top quartile for sugar CANCER SELF-DEFENSE 101 20 consumption had a 51% greater chance of developing breast cancer than those in the lowest.3 Cancer cells have dramatically over-expressed glucose receptors on their surface. These proteins, the receptors, act as magnets preferentially gobbling up the passing by glucose.4 Glucose is also shuttled into the cancer cell by insulin. Cancer cells also have anywhere from a 2 to 20- fold increase in insulin receptor expression compared to normal cells.5 As Nobel Prize Winner Otto Warburg made clear a century ago: glucose is the main fuel of cancer. Glucose is found in far more than just sweets. All carbohydrates are eventually converted into sugars, typically glucose. This is done more quickly in some foods than others. The speed with which the body converts a carbohydrate to glucose is shown in something called the “Glycemic Index’’. Pure glucose has been given the value of 100 on the scale. Foods with a value closer to 100 raise blood glucose levels faster, while foods with foods that have a lower glycemic index raise blood glucose levels more slowly. White foods, such as white rice, white bread, or white potatoes, have higher glycemic indexes than darker foods such as brown rice, rye bread, or sweet potatoes. This is normally because of the increased amount of fi ber in the darker foods. In fact, that is the diff erence between white rice and brown rice: white rice has had its fi brin sheath removed. Processed foods tend to have a higher glycemic index than less processed foods because processed foods have typically had the fi ber removed. For instance, fruit juice has a higher glycemic index than whole fruit.6 It is a good idea to become familiar with where your favorite foods fall on the glycemic index and tailor your diet towards lower glycemic index foods. The glycemic index of nearly all foods is easy to fi nd on the internet. CANCER SELF-DEFENSE 101 21 The second main fuel of cancer is the amino acid glutamine. Glutamine is a non-essential amino acid. It is “non-essential” because the body can synthesize it. We do not need to consume it from the diet (amino acids we need to consume from the diet are called “essential” amino acids). Foods that are very high in protein, such as meat, are also high in glutamine. Cancer cells consume glutamine in inordinate amounts. The HeLa cervical cancer cell line has been found to consume 100 times more glutamine than any other amino acid.7 The nitrogen in glutamine is used by cancer to build nucleic acids, essential for cell reproduction. Glutamine also participates in the uptake of non-essential amino acids from the extracellular environment for use by cancer cells. It is also used by cancer cells in the synthesis of glutathione, cancer’s main defense against the Reactive Oxygen Species that should be killing it. Many cancers show a particular dependence upon glutamine, including advanced cancers and brain cancers. Other cancers that show an extreme dependence upon glutamine are pancreatic cancer; acute myelogenous leukemia;8 small cell lung cancer;9 breast cancer (especially triple negative);10 and melanoma.11 There is no cancer cell line that I’m aware of where glutamine inhibition didn’t at least arrest cancer cell proliferation.12 Mice models of medulloblastoma, a brain cancer, fed a glutamine-restricted diet had about a 50% longer survival time than mice not fed a glutaminerestricted diet.13 Additionally, mice fed the glutamine-restricted diet were found to have lower blood levels of glutamine, despite the fact that mice can synthesize their own glutamine just as humans can. CANCER SELF-DEFENSE 101 22 A glutamine-restricted diet lowers blood glutamine levels.13 Please keep in mind that it is impossible to completely eliminate glucose and glutamine from the human diet or even from the body, as the body can synthesize both glucose and glutamine. The idea is to minimize them. Lastly, cancer cells are dependent on methionine. Remember how we said a glucose mimetic is used in CT scans? Guess what is used in brain PET scans? Methionine, because it is taken up at unusually high rates by cancer cells. Methionine is an essential amino acid, meaning that it must come from food. Methionine is involved in the production of glutathione, the body’s main antioxidant, but also cancer’s main way to keep reactive oxygen species from killing it. Methionine is also involved in methylation, a process crucial to gene expression. The history of methionine depletion in cancer experimentation goes back to 1959, when rats fed a diet lacking in methionine showed a signifi cant reduction in tumor growth.14 A 1974 study showed that healthy cells cultured in a methionine-free medium survived because they were able to synthesize methionine from supplemental homocysteine in the culture, while cancer cells were not and died.15 Healthy tissues have CANCER SELF-DEFENSE 101 23 other ways of synthesizing methionine from various molecules in the body. Cancer does not.16 Therein lies the unique vulnerability of cancer to methionine depletion.17 Just like with glucose and glutamine, intratumoral levels of methionine are strongly correlated with tumor volume.18 One summary found that in 47 diff erent cancer cell lines tested, the absence of methionine killed 30 of them; inhibited 6; and did not kill 11. Methionine restriction also increased the eff icacy of radiation and chemotherapy in animal trials.19 Methionine restriction is also being investigated as a general longevity strategy. In one study, healthy rats fed a diet with 80% less methionine lived 40% longer than rats fed a control diet.20 By now animal studies showing the cancer survival benefi ts of dietary methionine restriction are commonplace.21 There are literally hundreds of them. The human trials on methionine restriction are fewer but are encouraging. A 12-week phase I trial of a methionine-restricted diet in metastatic cancer patients found the diet not only to be safe, but it also exhibited anticancer activity. It lowered the PSA of a metastatic prostate cancer patient by 25%, and contributed to a radiographic response in a previously refractory renal cell cancer patient.22 The phase I trial determined the optimal length of a methioninerestricted diet to be one day, as the majority of methionine blood level decrease was obtained in just a few days. CANCER SELF-DEFENSE 101 24 The largest drop in blood methionine levels occurs with restriction of just a few days. Restricting methionine for an additional week and a half produced a drop of only about 10% more.22 A phase II study paired one day of methionine restriction on the day of chemotherapy for four cycles in 22 advanced refractory cancer patients (20 melanoma, 2 glioma). This limited intervention did not result in any complete or partial responses, but there were two unexpectedly long survivals of over 40 months; they remained alive at the time of publication.23 I cannot help but wonder if a slightly longer restriction of perhaps two or three days would have produced more benefi cial results. A case study found that a three-day methionine-restricted diet improved chemotherapy outcomes in eleven refractory patients with metastatic colorectal cancer. Three patients achieved a partial response, while a fourth achieved stable disease.24 Another human trial examined the eff ect of seven days of a methioninerestricted diet in gastric cancer patients pre-surgery. Methioninerestricted patients showed signifi cantly reduced cancer compared to control group patients.25 CANCER SELF-DEFENSE 101 25 Other human trials have shown that methionine restriction reduced blood insulin26 and glutathione levels,27 both benefi cial in cancer. Importantly, no signifi cant side eff ects have been associated with dietary methionine restriction. A more convenient way to deplete blood methionine levels has been developed: methionase. Initially, it was administered intravenously, but an oral version has been developed. Both intravenous and oral methioninase has been found to deplete blood methionine levels more than a methionine-restricted diet.28 Again, no negative side eff ects have been associated with its administration. Unfortunately, methionase, despite being tested in clinical trials for over two and a half decades, is not close to getting FDA approval. Dietary methionine restriction remains the most accessible way to reduce blood methionine levels. Brendadavisrd.com has a lengthy list of foods and their methionine levels. What Type of Diet is Best? We now know what we should be avoiding most: glucose, glutamine, and methionine. But that still leaves a lot of room for variation in a diet. The two main diets that have shown the most eff icacy against cancer are a vegetarian diet and a high fat, calorie-restricted ketogenic diet. The advantages of a vegetarian diet are: increased polyphenols from vegetables and increased compliance over a high fat ketogenic diet.29 The disadvantage is that a vegetarian diet will be consuming more carbohydrates, which convert to glucose, than the high fat ketogenic diet. Vegetarians have been found to have lower rates of cancer incidence than non-vegetarians. Vegetarians were found to have an 8% lower CANCER SELF-DEFENSE 101 26 incidence of cancer and vegans a 15% lower incidence.30 Other studies on vegetarianism have been even more positive.31 Yet surprisingly, once a vegetarian has been diagnosed with cancer their chances of survival are not signifi cantly better than a non-vegetarian.32 There have been no randomized controlled trials that show an overall survival benefi t from taking a group of non-vegetarian cancer patients and putting them on a vegetarian diet. But the number and size of the existing trials are truly paltry.32 The fi rst study quoted in this chapter showed that a vegetarian diet in conjunction with other interventions did improve cancer prognostics. I personally think that a large rigorous trial that put people onto the vegetarian diet who were not on it before would improve overall survival by at least 11%, the same amount that a vegetarian diet reduces cancer incidence. The high fat, calorie-restricted ketogenic diet is the most promising anti-cancer diet. The normal methods of energy production within the body are oxidative phosphorylation and glycolysis, which use glucose to produce energy. A more eff icient way of producing energy is ketosis: the use of ketones for fuel.184 When the body does not have suff icient levels of carbohydrate, usually about 50 grams a day, it begins manufacturing its own energy source, ketones, in the liver. Ketosis has been used as a treatment for epilepsy in America since 1921.33 Before that, in fact, even in the time of Hippocrates, fasting, which can be a way to induce ketosis, had been used as a treatment for epilepsy, but the epileptic seizures would return once the fast was broken.34 The ketogenic diet actually has a better control rate of epilepsy (over 70%) compared to conventional drugs (65% or less).35 The ketogenic diet has also shown improvements in Alzheimer’s disease; dementia;36 type 2 diabetes; obesity; metabolic syndrome;37 autism;38 migraines;39 and more. CANCER SELF-DEFENSE 101 27 The ketogenic diet seems to be particularly good for the brain. This may be because the brain consumes so much glucose. Despite only accounting for 2% of the body’s weight, the adult brain consumes up to 25% of the body’s glucose.40 Brain tumors have an easy time obtaining glucose while literally in a bath of it. Ketones, which are the fuel source the body produces when in ketosis, cannot be easily used by cancer cells.41 So, the ketogenic diet changes brain tumors from being awash in fuel to grow to being awash in something they cannot use eff iciently. The ketogenic diet shows resounding success in animal models. A recent meta-analysis found that the ketogenic diet resulted in median improvement in overall survival of 21.7% in animals and dramatic decreases in tumor weight and volume.42 The earliest studies examining the eff ect of the ketogenic diet against cancer in humans were in the early 20th century in Germany. In 1927, Fritz Silberstein used a high caloric, very low carbohydrate diet along with insulin injections to lower blood sugar levels in 21 advanced, inoperable cancer patients. Silberstein observed benefi cial eff ects on the patients, and some people responded with a local regression of their tumors.43 The next trial of the ketogenic diet in people with advanced cancer wasn’t until 1942. Wilhelm Brüning administered the ketogenic diet along with insulin injections to 14 people who had no further treatment options available to them and who had tumors that could easily be measured by eye. Of the 14, six (43%) achieved a moderate remission; seven (50%) an extensive remission; and one (7%) a macroscopic complete remission. Brüning then wrote another paper with 30 people where he didn’t have as much success. Even in his fi rst study, the tumors eventually returned. There is a signifi cant possibility that this is because his low carbohydrate diet relied largely on meat and the tumors adapted to utilize glutamine as their primary fuel.44 CANCER SELF-DEFENSE 101 28 Brüning’s study could not be replicated by another set of scientists, and attention shift ed away from the ketogenic diet’s eff ect in cancer treatment. It has been noted that the scientists who attempted to recreate Brüning’s results were less forthcoming about the foods they actually supplied to patients. Additionally, seeing as the follow-up study occurred later in WWII Germany, perhaps they were not able to access the same foods as Brüning.45 The next piece of scientifi c literature on the ketogenic diet’s eff ect on cancer in humans did not occur until 1992 in the form of a case study. A three-year-old girl with a spinal tumor was administered the ketogenic diet. To be more specifi c, she was given an MCT oil-assisted version of the ketogenic diet: 60% of her calories came from MCT oil; 20% came from protein; 10% from carbohydrate; and 10% from fat. She showed a 21% drop in blood glucose and exhibited signifi cant clinical improvements. She continued the ketogenic diet for an additional twelve months, remaining free of disease progression.46 MCT oil is still oft en used as an adjuvant to the ketogenic diet. The next report of the ketogenic diet showing the ability to fi ght cancer was a case report from 2010. A 65-year-old woman with glioblastoma regressed for 8 months while on Standard of Care and a calorierestricted, 4:1 ketogenic diet (4 calories from fat to 1 calorie to carbs and protein). The authors were quite surprised with the success of the woman. Then she broke her diet and progressed.47 In 2012, a study of a calorie-restricted, ketogenic diet in nine people with advanced cancer who had previously demonstrated rapid progression produced either stable disease or partial response in fi ve patients in just 28 days. Ketone levels were three times higher in responders than non-responders, indicating that diet adherence plays a strong role in eff ectiveness of the treatment.48 A 2014 trial of six glioblastoma patients undergoing Standard of Care treatment concurrent with the ketogenic diet resulted in four patients CANCER SELF-DEFENSE 101 29 being alive at a median follow-up point of 14 months. This is far beyond the norm. Additionally, the ketogenic diet patients’ blood sugar averaged 84 mg/dl while the standard diet participants’ blood sugar averaged 122 mg/dl.49 Another 2014 study examined the eff ect of the ketogenic diet in recurrent glioblastoma. Twelve of the participants achieved at least one urine test that showed they had entered ketosis. Six of seven patients treated with avastin, a Standard of Care drug in glioblastoma, achieved an objective response with a median progression free survival (no progress of tumors) of 43% at six months.50 The normal life expectancy in recurrent glioblastoma is only about six months,51 so this group outlived the average. A 2015 study in glioma (brain tumor) patients found that a high fat, ketogenic diet decreased average seizure frequency from 2.14 ± 4.0 seizures per month at the beginning of the dietary intervention to 1.25 ± 3.3 aft er 3 months, then to 0.4 ± 0.2 aft er 6 months. All participants were alive at the end of the 13 month study.52 In 2016, a study from Germany of 78 people with various types of cancer uniformly had better outcomes than people who did not switch to a ketogenic diet. A ketogenic diet is associated with improved cancer outcomes.53 A 2016 case report described a 60-year-old woman who shrunk her stage II myoepithelial carcinoma (a rare aggressive tumor at the roof of the mouth) by 32% with solely the ketogenic diet, no other treatment.54 CANCER SELF-DEFENSE 101 30 A 2019 study of the ketogenic diet and in conjunction with other therapies demonstrated a dramatic benefi t in 25 stage IV pancreatic cancer patients. The benefi t cannot be solely ascribed to the ketogenic diet, but the study is so remarkable, it has to receive special attention. The patients received a combination of chemotherapy, hyperthermia, and hyperbaric oxygen in addition to being instructed to eat according to the ketogenic diet. Before receiving chemotherapy, the patients were instructed to fast for 12 hours. They were then given a shot of insulin (just like with Silberstein and Brüning nearly 100 years earlier). Aft er the chemotherapy (the exact amount of time aft er is not given) patients received localized hyperthermia for 60 minutes, then hyperbaric oxygen therapy for 60 minutes at 1.5 ATM pressure. The average overall survival was 27.4 months. The typical survival is only 3 to 5 months in stage IV pancreatic cancer. Additionally, the fi ve-year-survival rate was about 20%. The typical fi ve-year-survival in pancreatic cancer is approximately 1%. So, this intervention represents a 20 fold increase over the Standard of Care. A chart showing the 5-year survival of the aforementioned patients.55 CANCER SELF-DEFENSE 101 31 In a 2020 randomized controlled clinical trial in 80 women with advanced, metastatic breast cancer, the ketogenic diet in conjunction with chemotherapy decreased tumor size by an average of 27 mm compared to just 6 mm in the chemotherapy alone group.56 Yet another randomized controlled study in women with breast cancer (this time not advanced) showed an overall survival advantage towards the MCT ketogenic diet and Standard of Care group over the standard diet and Standard of Care group. No members of the ketogenic diet group passed away aft er two years, while forty percent of the standard diet group did. A graph showing the survival between the two groups of breast cancer patients.57 Additionally, the ketogenic diet has also been shown to increase the eff ectiveness of radiation and chemotherapy without substantial side eff ects.57, 58 It also improves blood lipid markers, including cholesterol.59 The list could go on and on. It is conclusive: the high fat ketogenic diet has demonstrable benefi t in cancer survival. Outside of the scientifi c literature, there are many anecdotal reports of the life saving power of the ketogenic diet. For instance, the Charlie CANCER SELF-DEFENSE 101 32 Foundation, which has done trailblazing work to gain acceptance of the high fat ketogenic diet for neurological issues, highlighted the story of Adam Sorenson who was diagnosed with glioblastoma one day aft er his 13th birthday. With the help of his parents, Adam adheres to a strict high fat ketogenic diet. He is now an eight-year glioblastoma survivor.60 Adam is not the only one. There are thousands of members of social media groups about ketosis for cancer, sharing their success stories (even if they’re not total remissions) daily. In the ketogenic diet, adherence is critically important. Studies routinely fi nd that greater adherence to the diet is linked to improved results. But the adherence rates of the diet are abysmal, only 12.5 to 82%, depending on how strict the diet is (i.e. is it a 4:1 ratio of fat to carbs, or a 3:1 ratio?).61 In my opinion, if people got recipes like the very appetizing ones they off er on the Charlie Foundation website compliance would be higher than it normally is. There is one line in one trial that has given me pause about the ketogenic diet. There have been no studies, to my knowledge, about rate of progression, etc. of people who go on the ketogenic diet then go off during treatment, but I found this line chilling: “Those patients who had started on a strict ketogenic diet, but then stopped it, experienced initially a remission of the disease or the metastases, which rebounded once they had stopped the diet, frequently with lethal consequences.” 62 Do people who start on the diet then stop have worse consequences than those who never start? Would they have better outcomes if they ate a vegetarian diet low in glutamine and methionine? I don’t know, but I would suggest that if you start the ketogenic diet, you have to be ready to adhere to it, and adhere strictly, for a long time. And if you go off of it, you should go off of it gradually, over the course of weeks. Lastly, please note that a ketogenic diet as I’m describing here is not high in protein (i.e. animal meat), but high in fat. CANCER SELF-DEFENSE 101 33 How to Induce Ketosis The most useful tool in your journey toward ketosis is a ketone meter. There is no other way to reliably check whether you are in ketosis and to what degree than a device that measures your blood. Even if you only eat 50 g of carbs a day for weeks, your blood still needs to be measured. It will also help you see how individual foods aff ect you. Ketone blood meters are available commercially for less than $40. Ideally, your meter should measure blood glucose as well as ketones. 70 mg/dl or a bit less is a good target to shoot for for blood glucose levels. The fastest, most eff ective way to induce ketosis is through a fast. If you are able to exercise during the fast, that is even better. A fast of 72 hours or less should be suff icient to induce ketosis, whereas simply switching your diet to a ketogenic diet could take anywhere from more than 72 hours to multiple weeks.63 If you are having trouble with a total fast, it is acceptable to snack on a few high fat foods, such as coconut, but the more calorie-restricted a diet until ketosis is induced, the better. Oft entimes MCT (medium chain triglycerides) oil, a high-fat oil derived from coconuts, is used as a way to obtain additional calories of fat during a ketogenic diet. MCT oil itself has been found to promote ketosis.64, 65 The most ketogenic type of MCT oil is C8 (caprylic acid),66 which is widely available commercially. MCT oil is typically consumed in the morning before a meal. Due to the possibility of stomach upset, the starting dose is normally 5 g, then as the person gets accustomed to it, the dose is increased to 15 - 20 g.67 Caff eine, which generally speaking has anticancer properties as well, has also been found to increase levels of ketosis by increasing the metabolic rate;68 however, caff eine has also been shown to increase hunger. So, it is a bit of a double-edged sword. CANCER SELF-DEFENSE 101 34 Calorie Restriction and Fasting There are literally hundreds of animal trials showing the benefi cial eff ects of fasting and caloric restriction on cancer outcomes, going all the way back to 1909.69, 70 For instance, studies in both rodents and monkeys have shown that when 30% caloric restriction was started by 12 months of age, spontaneous cancers were reduced by 50%.71 In a mouse experiment examining breast cancer, melanoma and neuroblastoma, two cycles of 48-hour fasting alone were as eff ective as two cycles of chemotherapy at reducing tumor progression.72 Another mouse experiment showed that the combination of fasting with chemotherapy was more eff ective than chemotherapy alone in all cancers studied.72 Fasting and caloric restriction have numerous anticancer mechanisms, including improved immune function;73 increased insulin sensitivity, and decreased blood glucose; growth factor signaling; infl ammation; and angiogenesis.74 Fasting also reduces levels of insulin-like growth factor 1 (IGF-1), which plays a key role in the progression of tumors through the activation of two signaling cascades, Ras/MAPK and PI3K/ AKT. Yet fasting is only able to reduce IGF-1 when a diet has low protein. Even if a diet is low in calories, it can still trigger IGF-1 if it is high in protein.75 A meta-analysis of human trials showed that fasting for 24 hours was as eff ective as a long-term 50% caloric restriction at reducing IGF-1 levels.76 An animal trial showed the majority of IGF-1 reduction caused by fasting comes within the fi rst 48 hours. For instance, aft er 24 hours IGF-1 was reduced by 43%; 48 hours, 76%; then aft er 72 hours, it had only dropped to 82%,77 indicating a 24 - 48 hour fast might be able to provide the majority of benefi ts of a longer fast. Despite the extremely low cost and apparent benefi ts of the intervention, fasting and caloric restriction have been woefully understudied in cancer treatment and prevention in human trials. There are under a dozen CANCER SELF-DEFENSE 101 35 published at the time of this writing. One phase II trial was intended to be phase III, but they could not accrue all of the patients they needed due to an unexpectedly low adherence to the diet, indicating fasting or calorie restriction is not always easy to maintain.78 One human study with 16 participants showed that alternate-day fasting, in which one-day calories stayed at 400 for women and 600 for men, and unrestricted eating on the other day, reduced blood levels of glucose, insulin and IGF-1 with a long-term risk reduction for cancer.79 Alternate day fasting has been shown to be more benefi cial than fasting for multiple days straight.79 Two other studies, one with 19 women at increased risk for breast cancer, and another with 19 newly diagnosed prostate cancer patients found that calorie restriction showed a decrease in blood markers related to cancer progression, including IGF-1.80, 81 Finally, a 2022 trial in 99 cancer patients found that a fi ve-day fast using the “fasting mimicking diet” reduced blood glucose by 18.6%; insulin by 50.7%; and serum IGF-1 by 30.3%. Additionally, immunosuppressive myeloid suppressor cells were reduced, and CD8+ immune cells, the immune cells that actively destroy cancer, were increased. The diet also achieved an impressive 91.8% compliance rate.82 The fasting mimicking diet is a nutritional program containing ingredients at quantities that do not interfere with the fasting response. It generally involves eating only a few hundred (400 - 600 for men; 200 - 400 for women) calories a day, with very little protein, for fi ve or four days. A company called ProLon off ers meal plans to help people implement the diet. ProLon counts Dr. Valter Longo, one of the leaders in fasting research, as one of its fi nancial stakeholders. Fasting for at least 48 hours before chemo has also been found to greatly reduce side eff ects, as has been confi rmed in six human studies.83, 84 CANCER SELF-DEFENSE 101 36 Side eff ects universally go down when chemotherapy is preceded by 48 hours or more of fasting. Ad Lib = no restrictions on eating.84 Another clinical trial with 131 breast cancer patients found that a fasting mimicking diet produced superior responses to chemotherapy than regular diet. Sixty fi ve women were put into the fasting mimicking group; however, only twenty two were completely compliant with the diet, while forty three were compliant for at least 50% of the intended duration. The response rates for the completely compliant group were superior to the partially compliant group, and far superior to the regular diet group.78 CANCER SELF-DEFENSE 101 37 People who were totally compliant to the fasting mimicking diet had a 92% response rate to chemotherapy, whereas only 72% of the regular diet group did. CR/PR = complete response/partial response; SD/PD = stable disease/progressive disease.78 Unfortunately, there is currently not a randomized controlled trial that has measured the eff ect of caloric restriction or fasting on cancer survival outcomes, but all preliminary evidence looks positive. Studies have correlated lower body mass index; weight loss; and bariatric (weight loss) surgery with improved cancer outcomes.69 A retrospective analysis of 2,413 breast cancer survivors found that people fasting for more than 13 hours a day had a 36% lower risk of recurrence than people who did not.85 I believe a 24-hour fast either once or twice a week, with a few days intervening, is good during cancer treatment, especially concurrent with chemotherapy, radiation, or immune checkpoint inhibitors. Complete abstinence from food seems like the easiest way to accomplish this, although the fasting mimicking diet also shows promise. Outside of fasting days, I believe a calorie-restricted ketogenic diet to be the most promising choice. CANCER SELF-DEFENSE 101 38 Foods that Lend Themselves to the Ketogenic Diet When attempting the ketogenic diet, foods with high amounts of fat and low amounts of carbs and/protein are preferred. Some foods like this include: Food (serving size) Fat (g) Carbs (g) Net Carbs Protein Avocado (136 g) 19.9 11.6 2.5 2.7 Green olives (fi ve olives) (17 g) 2.6 .7 .1 .2 Coconut (1 cup shredded) (80 g) 26.8 12.2 5 2.7 Walnuts (.25 cup) (29.25 g) 19.1 4 2 2.5 Coconut Milk (240 ml) 5 1 1 1 Pecans (28 g) 20 4 1.3 2.6 Olive Oil (1 tablespoon) 13.5 0 0 0 Cucumber (104 g) 0.1 3.8 2.5 .7 Kale (sautéed) (2 cups) (42 g) .6 1.9 .1 1.2 Shirataki noodles are also used on the ketogenic diet. A serving of 250 g has no fat, no protein, and 9 g of carbs, with no fi ber. The vegetable that shirataki noodles are made of, konjac glucomannan, has been found to have: anti-diabetic; anti-obesity; laxative; prebiotic; and anti-infl ammatory;86 and anticancer properties.87 Even though it has no fat, it could be a good addition to a ketogenic diet as long as it is compensated for with other high-fat foods. Cucumber also has a lower ratio of fat than carbs and protein; however, it is a fairly low amount of carbs/protein compared to the total serving size. Also, if you are interested in pickles, there are naturally probiotic, fermented ones. They will say “naturally fermented” on the label. Fermented pickles are stored mostly in water. Pickles stored in vinegar will not be probiotic. CANCER SELF-DEFENSE 101 39 When sautéing kale, it is best to devein it. There is much discussion of: should fi ber be included in a calculation for the total amount of carbs, or should the calculation be for the “net” carbs, the total amount of carbs minus the amount of fi ber? Using “net” carbs is most common. However, your ketone meter will be your ultimate guide. If you are not getting strongly enough into ketosis, you will need to cut back on both your carbs and protein, as protein can be converted into carbs by a process called gluconeogenesis in the liver. Many times ketogenic diets with low amounts of fi ber can cause constipation. In situations like these, something like psyllium husk fi ber is added. 50 g of psyllium husk fi ber has only 5.5 g of net carbs. MCT oil is frequently added to meals as a way to increase the total fat intake. It is basically tasteless, and may even bring out the favor of other foods. A full discussion of 4:1 keto recipes is beyond the scope of this book. The Charlie Foundation website and their cookbook are recommended resources. Supplemental Ketones Previously, the primary reason for the anticancer eff ects of the low carb or ketogenic diet was thought to be the decrease in blood glucose that it causes; however, new information has come out indicating that ketones are in and of themselves anticancer. Ketone bodies have been found to inhibit glycolysis, thereby decreasing the main energy production pathway of cancer.88 Ketone bodies are also transported into the cell via the monocarboxylate transporters (MCTs), which transport lactate out of the cell. Cancer produces an abundance of lactate and expelling it is of critical importance to the cancer’s survival.89 By competing for these transporters, ketone bodies CANCER SELF-DEFENSE 101 40 may be inhibiting cancer. Incidentally, metformin also inhibits MCTs.90 In animal models of colorectal cancer, ketone bodies were also found to be a potent growth slowing signal.91 A mouse trial in 1979 actually demonstrated that exogenous ketone supplementation was able to reduce the number of melanoma metastases to the lungs by two thirds. The same trial also demonstrated the eff icacy of supplemental ketones against numerous cancer cell lines, and demonstrated that supplemental ketones were able to reduce lactate levels.92 Incredibly, this important study was almost lost to history, receiving no academic citations in the 1990’s, and only two during the 2000’s. Only now are preclinical trials on exogenous ketones in cancer treatment continuing in seriousness. One mouse study with a highly metastatic cancer cell line found that ketone ester supplementation produced a longer survival than 40% caloric restriction. The control group had a survival of 31.2 days; 40% caloric restriction had a survival of 36.9 days; 1,3-butanediol, a type of exogenous ketone, had a survival of 47 days; and ketone ester supplementation had a survival of 52.8 days. The same study also showed that exogenous ketone supplementation produced a drop in blood glucose levels equivalent to caloric restriction. Another mouse study with the same highly metastatic cell line measured the eff ect of the ketogenic diet with exogenous ketones and hyperbaric oxygen. The control group had a survival of 31.2 days; the ketogenic diet group had a survival of 45.1 days; the ketogenic diet and exogenous ketones combined group had a survival of 51.6 days; and the ketogenic diet, exogenous ketones, and hyperbaric oxygen group had a survival of 63.4 days.93 Supplemental ketones were measured head-to-head against low glucose and hyperbaric oxygen in a cell line portion of the experiment. CANCER SELF-DEFENSE 101 41 βHB, supplemented ketones, reduced cancer cell viability by itself and synergistically with low glucose and hyperbaric oxygen. LG = Low glucose; HBOT = Hyperbaric oxygen therapy.93 Another animal model showed that ketone supplementation sensitized cancer to chemotherapy.94 Cell line experiments have also shown that supplemental ketones have sensitized cancer to radiation.95 Although there are no human trials examining the eff ect of ketone supplementation on cancer survival yet, there are human trials that have shown the safety and eff icacy of exogenous ketones in various ailments. For instance, ketone supplementation has lowered insulin, glucose, and infl ammation levels in humans.96, 97, 98 It has also shown promise in age-related cognitive decline and Alzheimer’s disease.99, 100 Ketone supplementation, although it will temporarily raise blood ketone levels higher than a ketogenic diet, is not in and of itself ketogenic, meaning it does not bring the body any closer to being in ketosis; it does not help the liver produce its own ketones. In fact, supplemental ketones may actually slow down the transition into ketosis,101 although there are, to my knowledge, no human studies examining this. It seems like ketone supplementation may be of best use for people who a.) choose not to attempt to enter ketosis, or b.) who have been in ketosis for a while and do not have diff iculty maintaining it. I would CANCER SELF-DEFENSE 101 42 not supplement with exogenous ketones when attempting to induce ketosis. Also, if I were in ketosis, I would supplement with ketones once, then see if there has been any eff ect on my ketone levels over the next day or two. There should, ideally, be none, as the exogenous ketones will only aff ect blood levels for about four hours. Fortunately, the most eff ective type of exogenous ketone, the ketone ester, is available as a dietary supplement. One company off ering it is KetoneAid. Case Study: Fighting Glioblastoma with the Keto Diet and Modifi ed Standard of Care In February 2016, a 38-year-old man was diagnosed with glioblastoma.102 At the time of his diagnosis, he consumed about 2250 - 2500 calories a day. Soon aft er his diagnosis, along with the help of some doctors who had an interest in the ketogenic diet, he embarked on a high fat, calorierestricted ketogenic diet along with a few supplements and off -label pharmaceuticals. The man underwent a 72-hour water-only fast to induce ketosis. Aft er his fast, he adhered to a high fat (4:1) ketogenic diet for 21 days. He only consumed 900 calories per day during these 21 days. The calories came from 71g of fat (639 calories) as 33% olive/fl axseed oils; 33% MCT oil; and 33% as organic butter. He also consumed 50 g a day (200 calories) as protein (i.e. poultry, fi sh, eggs, with no more than 15% dairy). And 15 g (40 calories) of carbs in a day, mainly from green leafy vegetables. And 20 g (10 calories) of fi ber. The source of this fi ber is not specifi ed, but psyllium husk has a very favorable profi le among fi bers as it contains both soluble and insoluble fi ber. The man also received B-complex vitamins, minerals, calcium, magnesium, and omega-3 fatty acids to maintain nutrient levels. He CANCER SELF-DEFENSE 101 43 had been defi cient in vitamin D3 and supplemented 5,000 IU/day. He had the MTHFR gene mutation which suggested a folate defi ciency and was supplemented with 1,000 mg/day of methyl folate. (About 40% of the American population has this mutation. Generally speaking, methyl folate is a good addition to any keto diet.)103 Lastly, he also received the medications keppra (1,500 mg/day) for preventative seizure control and metformin (1,000 mg/day). Metformin is primarily used for glucose control, but it also has a host of other anti-cancer eff ects (see the Repurposed Drugs chapter). Twenty one days aft er initiation of the ketogenic diet, he underwent a surgical debulking of his tumor. The surgery was “subtotal” meaning it removed between 50 - 90% of the tumor. The vascularity of the tumor had decreased, a positive response to the ketogenic diet. Additionally, no corticosteroids were prescribed to him during the recovery process. In fact, no corticosteroids were prescribed to him at all during his entire 24 month treatment period covered in the study. This is very rare. He was discharged from the hospital two days aft er surgery and exhibited no negative side eff ects. Aft er his surgery, he continued with his same diet, but added a timerestricted component to it. He would fast for 14 hours between his breakfast and dinner, meaning he was only eating within a small window of time. Additionally, he supplemented with EGCG (400 mg/ day), an extract from green tea, which can help prevent cancer from using glutamine, and was prescribed 150 mg/day of chloroquine to inhibit autophagy (autophagy is a very complicated, double-edged sword in cancer treatment; in this case, the fear of the attending physician was that autophagy would recycle cellular proteins and other molecules to help the cancer survive.)104 Two weeks post operation, he began hyperbaric oxygen therapy fi ve times a week, 60 minutes each time at a pressure of 2.5 ATM. He then continued on the same regimen and added Standard of Care treatment: the brain tumor drug temozolomide (75 mg/day) for 42 days CANCER SELF-DEFENSE 101 44 and with 30 rounds of brain radiation. He showed no negative side eff ects from the radiation. He also converted to a higher calorie (1,500/day) high fat, ketogenic diet. Post-surgery his tumor has shown shrinkage of 1.5 cm in each dimension post-operation and low metabolic activity. These MRI scans taken from two diff erent perspectives (the top row is looking down at the brain, while the second row was taken at eye level) show a dramatic shrinkage of the tumor and edema over the course of 20 months. In the top row up to nine months, you can see tremendous midline shift , meaning that the swelling on one side of the brain is literally pushing the other side of the brain into the skull. At fi ft een and twenty months, there is a dramatic decrease in midline shift , with the brain almost normalizing. This man’s case was very rare. Unfortunately, glioblastoma normally unerringly progresses. Not in this case. It has regressed. Again, the combination of simple, nontoxic strategies can have incredible results when combined with the Standard of Care, and even in some instances in the place of Standard of Care. Fish and Other Proteins If someone is pregnant, eating fi sh that is low in mercury is generally very good for the baby, largely because the fi sh supplies omega-3 fatty acids to help the baby’s brain grow. Under normal circumstances, wild CANCER SELF-DEFENSE 101 45 caught fi sh is very healthy. But the information is truly mixed when it comes to fi sh’s impact on cancer incidence and survival. The same goes for many high-protein foods. In one study, fi sh intake was associated with higher rates of breast cancer.105 In a meta-analysis of 232,000 people a modest increase in gastrointestinal cancer was found with regular fi sh consumption, as well as a signifi cant reduction in esophageal, hepatocellular, and colorectal risk.106 The associations are truly all over the place: one is up, one is down. Fish in and of itself does not have a clear correlation with cancer risk upward or downward. The same is true with dairy, eggs, and poultry. In one study they show a decreased risk, another an increased risk (poultry probably has the best profi le of these three). High consumption of red meat, which includes lamb and pork in addition to beef, is consistently associated with an increased risk of many digestive cancers.107 Even though a food may, in and of itself, be neutral with regard to its association with cancer incidence, it may be high in methionine. Therefore, it is not within our guidelines of a low methionine diet. So, if these foods are not ideal due to their methionine content, what is a good source of the modest amount of protein we should consume? Legumes, which includes beans, peas, and lentils, especially legumes that grow in pods like these three. The term for legumes that grow in pods are pulses. The amount of protein in beef is 26 grams every 100 grams. The amount of protein in salmon is 21 grams every 100 grams. The amount of protein in kidney beans is 24 grams every 100 grams. Beans have more protein per hundred grams than salmon and nearly as much as beef. Beans are also very low in methionine. They have only .11 grams of methionine per 100 grams. Eggs have 3.2 grams and chicken and tuna CANCER SELF-DEFENSE 101 46 each have about .8 grams, eight times more than beans. Lentils and peas are even lower in methionine than beans. Beans are not on my list of top three cancer fi ghting foods, ...but they are close. There have been dozens of studies showing the cancerfi ghting ability of beans and other pulses.108 Cancer-Fighting Foods Beyond the general descriptors of “high fat ketogenic diet” or “vegetarian diet”, there are some specifi c foods that stand out for their particularly potent cancer-fi ghting potential. A group of brassica foods. The most notable are members of the brassica family, particularly Brussels sprouts; broccoli; broccoli sprouts; caulifl ower; and cabbage. Reports of the association of brassica consumption with decreased cancer incidence go back over several decades.109 Brassica vegetables have high amounts of indole-3-carbinol (I3C); diindolylmethane (DIM); glucoraphanin; and sulforaphane, all compounds that have been investigated for their powerful anti-cancer CANCER SELF-DEFENSE 101 47 eff ects. Glucoraphanin and Sulforaphane supplementation was found to increase six-month survival in a 40-person human pancreatic cancer study by 41%.110 In a placebo-controlled human trial, I3C supplementation led to a complete regression of precancerous cervical lesions in 8 of 17 women. No woman in the 10-person control group had a complete regression. I3C also helps the liver and has been found to increase the excretion of carcinogens in a human trial.111 (See the Dietary Supplements chapter for more information on these extracts.) Generally speaking, cooking these brassica vegetables (steaming, sauteing, or baking) is preferable to eating them raw, although eating them raw also has its benefi ts.112 Boiling is not recommended.113 At least fi ve servings of brassicas per week are recommended for cancer patients.114 Even the simple white cap mushroom can have medicinal benefi ts. A wide variety of mushrooms have shown anticancer benefi ts. Mushrooms have been used to treat infections for hundreds of years in China.115 They have passed clinical trials and have been part of the Standard of Care in China and Japan for cancer for over 30 years.116 A study of more than 19,500 cancer patients found that the consumption of 18 grams of mushrooms daily was associated with a signifi cantly CANCER SELF-DEFENSE 101 48 lower risk of cancer incidence.117 Mushrooms have a variety of ways they act on the body. Importantly, they upregulate the key immune modulating molecules interferon and interleukin-2. They have also been found to increase t-cell numbers in humans and induce dendritic cell (key immune cells) maturity.118, 119 The mushrooms that are most associated with anticancer eff ects are: • Reishi mushroom • Turkey tail mushroom • Lion’s mane mushroom • Shiitake mushroom • Maitake mushroom It is possible to obtain reishi, shiitake, and maitake mushrooms from many, especially high-end grocery stores. Even regular white button, portabella, crimini mushrooms, and oyster mushrooms have been found to suppress cancer growth in cell lines, with oyster mushrooms being the most potent.120 The most common and aff ordable of all mushrooms, the white button mushroom, was found, in powdered form, to reduce PSA levels in prostate cancer patients.121 It is best if mushrooms are sauteed, grilled or even fermented. Raw mushrooms can be hard to digest and even contain trace amounts of toxins.122 Some mushrooms come in powder form, so they can be easily added to teas or other recipes. CANCER SELF-DEFENSE 101 49 Tea is one of the most ancient beverages in the world. Four types of tea are particularly helpful in the fi ght against cancer: green tea; graviola tea; chaga mushroom tea; and ginger tea. A fi eld of green tea. Green tea is the most popular beverage in China and Japan. Combined these two countries account for nearly two-thirds of the world’s green tea consumption.123 And both China and Japan have been aware of green tea’s medicinal qualities for centuries. One review found green tea consumption demonstrated eff ective prevention or growth inhibition of a wide variety of cancers in 133 out of 147 published studies.124 A sixteen-year-long study tracking 164,000 Chinese men found regular green tea consumption to be linked with a CANCER SELF-DEFENSE 101 50 8 - 21% reduction in the risk of dying from any cancer.125 Another study found green tea consumption to be associated with a 60% decrease in esophageal cancer rates in nonsmokers.126 In a controlled trial, 60 men who had high-grade prostate intraepithelial neoplasia (which has a 30% chance of becoming prostate cancer) were broken into a green tea group and a placebo group. At the end of one year, only one tumor was diagnosed among the 30-person green tea group (a 3% incidence), while nine tumors were diagnosed in the 30-person placebo group (a 30% incidence).127 Green tea has many active compounds in it including epigallocatechin3-gallate (EGCG), epigallocatechin (EGC), caff eine, and theanine. These work synergistically together. It is possible to get green tea in an extract, but extracts typically just have one or maybe two of the compounds. The heat of the tea also increases absorption of the constituent compounds.128 Additionally, there have been more than 30 reports of liver toxicity due to the consumption of green tea extract supplements. There have not been reports of liver toxicity due to consumption of green tea.129 Green tea works against cancer in numerous ways, including priming cancer cells for apoptosis (self-destruction);130 by inhibiting cancer cell adhesion;131 and as an inhibitor of vascular endothelial growth factor (VEGF), a signaling protein that is essential in the creation of blood vessels that feed the tumor.132 According to a study of 120,000 middle-aged Dutch men, the optimum intake of green tea seems to be about 3 cups per day for health.133 Note: Green tea can interact with the multiple myeloma medication Bortezomib and statins. As with anything you will be consuming, it is best to go to drugs.com and check their interactions database. CANCER SELF-DEFENSE 101 51 A graviola fruit. Graviola (aka Soursop and Guanabana) is indigenous to the hottest tropical areas of North and South America. Graviola juice can be found in the majority of Mexican supermarkets and the fruit itself is in a heft y percentage of Mexican supermarkets as well, even though it is virtually unknown in America. The graviola tree has been exported to tropical Africa and India, where the local populations use it medicinally.134 The list of medicinal uses of the tree and its parts is lengthy. In traditional medicine, the fruit is used for treating arthritic pain; malaria; parasites; and to raise breast milk production. The crushed seeds are used against worms and parasites. Even the roots and bark are used for their anti-infl ammatory and hypotensive properties. Of course, the leaves are used against cancer.135 Graviola leaf extract has been found to be eff ective in over 20 lines of human cancer, including multidrug resistant lines.136 In a human, placebo-controlled trial, people who ingested a graviola leaf extract were found to have blood that was more cytotoxic to cancer cells.137 Although the clinical data for graviola is modest, the case reports are encouraging. One woman with metastatic ovarian cancer was having a recurrence and became resistant to her chemotherapy. When she began CANCER SELF-DEFENSE 101 52 taking graviola tablets, her Ca-125 levels, a key biomarker in ovarian cancer, began lowering and she remains in stable disease, with a much lower tumor burden, years aft er initiation.138 Cancer relapses were strongly associated with discontinuation of the patient’s graviola tablets.138 In another case study, a woman with stage IV breast cancer developed metastases to her lung and liver. Between 1998 and 2007, she received, and became refractory to, ten lines of medication. In September of 2007, she added graviola tea into her regimen: 10 - 12 leaves a day, boiled for 5 to 7 minutes in 8 oz of water, daily. At the time of initiation of graviola tea in September 2007, her CEA, an important breast cancer marker, was 12.5 ng/ml. In April 2008, it had lowered to 5.9 ng/ml. In December 2011, she voluntarily discontinued her graviola tea. In March 2012, her CEA was 4.3 ng/ml, and her liver enzymes had risen out of the normal range to AST 75 U/L and ALT 84 U/L. Liver enzymes that high are almost high enough to normally take most people off of their medication. CANCER SELF-DEFENSE 101 53 Aft er receiving her worsening blood tests, the woman reinitiated graviola tea and in November 2012 her CEA was 2.9 ng/ml, her AST was 43 U/L, and her ALT was 50 U/L.139 Graviola juices, leaves, capsules and liquid extract can be found online. The fruit is very rare to fi nd in the United States. The preferred methods of graviola consumption are: making a tea of the leafs; ground leaf powder in capsules; or a graviola liquid extract to be added into teas and/or other drinks. The woman in the case study just cited consumed 8 ounces of tea per day. The leaves should be cut or ripped into small pieces and the stems should be included. Recommendations are to use about fi ft een medium-sized leaves for eight ounces of water. The tea can be preserved for a day, if you’d like to split it into three doses (morning, aft ernoon, and night). The tea can also be sweetened or fl avored with something like lime, but obviously sugar should be avoided. A chaga mushroom outgrowth. Chaga mushroom doesn’t look like a regular mushroom. It is a parasitic fungus that grows on birch trees in cold climates like Siberia, Russia and the northeastern part of North America. It has been cited in Russian medical texts for the treatment of cancer since at least the 16th century.140 Chaga fi rst entered the consciousness of the non-Russian world through the 1968 semi-autobiographical novel The Cancer Ward by Aleksandr CANCER SELF-DEFENSE 101 54 Solzhenitsyn, winner of the Nobel Prize in literature. Aft er the main character, Oleg, develops cancer, he is assigned to a clinic to receive high-dose radiation. He tells his fellow patients that he wishes he could have been given a more simple “peasant’s” cure: “He could not imagine any greater joy than to go away into the woods for months on end, to break off this chaga, crumble it, boil it up on a campfi re, drink it and get well like an animal.” Despite the fact that there are literally hundreds of case reports in Russian literature going back hundreds of years of cancer being successfully treated with chaga tea, and there are experiments showing chaga kills over 20 human cancer cell lines, there are no human studies in Western medical literature, and only a small handful of animal trials.141 One study in mice showed that tumors in mice who consumed a waterbased chaga extract had tumors that were 60% smaller than the control group with 25% fewer metastases.142 Another mouse study found that a water-based extract of chaga mushroom reduced blood markers of pancreatitis by 40%.143 Chaga works on the body in a variety of ways. It is immunomodulatory and anti-infl ammatory.144 It increases the maturation of dendritic cells (cells that activate t-cells).145 It reduces insulin resistance. One mouse study said: “[a water-based chaga extract had] a dose-eff ect relationship within a certain range. 250 mg/kg had an obvious anti-diabetes eff ect, and the eff ect of 500 mg/kg dose was the same as that of metformin.”146 The same study also showed improvements in markers of liver health. Much like with graviola, scientists are still uncovering its mysteries. Although there are no human studies, I feel it is worthwhile to consider adding chaga tea to the diet of the average cancer patient due to its encouraging preclinical studies and long history of use in folk medicine. I fi nd chaga tea better tasting than many teas. The chaga mushroom chunks feel nearly as fi rm as wood. They should be soaked in boiling CANCER SELF-DEFENSE 101 55 water until the tea is cool enough to drink. If fi nances are a concern, the chunks can be reused two or three times. A bag of 30 fresh cut pieces can be ordered online for about $20. Ginger has a medicinal history going back over 5000 years. It originated in China and became one of the fi rst spices to gain worldwide circulation. Many Greeks used to consume ginger aft er a meal to aid digestion.147 Thousands of years later, ginger is still known as a powerful digestive and stomach aid. Ginger tea reduced, to a statistically signifi cant degree, symptoms of vomiting and stomach discomfort in gynecological cancer patients undergoing chemotherapy.148 In a double-blind, placebo-controlled human trial, ground ginger in a capsule also was found to reduce nausea and vomiting in patients receiving chemotherapy.149 This study involved 576 people who were battling a wide variety of cancers. Ginger has also been found to exert anticancer activity in dozens of cell lines.147 In pancreatic cancer mouse model, ginger was found to: suppress cancer cell cycle progression; inhibit mTor; increase reactive oxygen species; and signifi cantly extend survival without serious side eff ects.150 In a randomized controlled trial, ginger extract supplementation decreased proliferation and increased apoptosis in the colon tissue of patients with a high-risk of colorectal cancer. It also increased the expression of the Bax gene, a gene that helps send cancer cells into apoptosis (suicide).151 Ginger is in the same family as turmeric. Their rhizomes (the roots) actually look quite similar and the two foods pair well together. CANCER SELF-DEFENSE 101 56 Ginger and turmeric rhizomes. Ginger tea is simple to make. All you have to do is dice about 30 grams of the root into small cubes, maybe 5 mm long, and let them seep in boiling water until the tea is cool enough to drink. Ginger can be found at many, if not most, grocery stores. Upper row from left to right: cinnamon, star aniseed, ginger, mace; center: fennel seeds, green cardamom; lower row: coriander, aniseed, cloves, allspice, nutmeg. CANCER SELF-DEFENSE 101 57 There are a variety of spices that have been shown to have anticancer properties. Some of the most promising are: turmeric; black pepper; chili pepper; ginger; garlic; saff ron; black cumin;152 cinnamon;153 allspice (which is not a mixture of spices, but a dried, unripe berry);154 oregano;155 parsley;156 corridaner;157 holy basil;158 and more. Although no randomized controlled human trials have examined the eff ect of these spices against cancer, their preclinical data is encouraging. Chili pepper, however, has been associated with increased stomach cancer risk, although not other types of cancer.159 It may, therefore, not be advisable for patients with cancer in the digestive tract. The spice most controversial in regard to its relationship with cancer is salt. Pooled analyses have associated higher salt intake with increased cancer incidence,160 but these analyses have not distinguished between salt intake and type of food being consumed, such as preserved meats. One review described salt as a “double-edged sword” in cancer treatment: it may be associated with worsened prognosis in the early stages of the disease, and improved outcomes in later stages.161 Animal trials have examined the eff ect of salt itself, separate from other foods, on cancer. In advanced cancers in animals, salt is actually associated with improved outcomes.161 As there are no randomized controlled trials examining the eff ects of salt intake on cancer outcomes, I think the existing evidence is at least neutral on its light usage during cancer treatment. Cookware Iron has been linked to cancer progression,162 and cast iron skillets can transfer iron into your food.163 Steel cookware, such as Farberware, should not transfer anything harmful into your food. CANCER SELF-DEFENSE 101 58 What Else Can I Eat? Unfortunately, the overwhelming majority of foods are, at best, dubious during cancer treatment. We are all unwitting conscripts in the war against cancer, and any war demands steadfast self-discipline. Although it is tempting to think we can munch on fruits until cancer goes away, the foundation of any sound anticancer diet are the foods profi led in this chapter, ideally put into the framework of a calorie-restricted 4:1 ketogenic diet. A vegetarian diet relying heavily on the foods profi led in this chapter would be far preferable to the standard western diet, but not to the same extent as a 4:1 keto diet. Exercise Physical exercise helps prevent many types of cancer.164 It also improves quality of life and improves recovery time aft er cancer treatment.165 In an analysis of 61 clinical trials of women with all stages of breast cancer, women who participated in exercise had signifi cantly improved: quality of life; energy; strength; and had less anxiety; depression; and lower body mass index and waist circumference compared to the non-exercise groups. Another analysis of over 1,000 participants with seven diff erent types of advanced cancers found that participation in an exercise program during treatment was associated with signifi cantly improved physical function; energy levels; weight/BMI; sleep quality; and overall quality of life.166 Exercise has also been found to improve recovery from chemotherapy and/or radiation. People who participated in an exercise program posttreatment suff ered from less infl ammation and cognitive fatigue than those who didn’t.167 But can exercise itself kill cancer? The evidence from randomized, controlled human trials does not currently support that. It appears that although exercise helps relieve CANCER SELF-DEFENSE 101 59 symptoms and improve quality of life during and aft er cancer treatment, it has not been found to signifi cantly extend survival. Yet. I believe that properly designed trials examining the eff ect of exercise on overall survival during cancer treatment will show a benefi t to overall survival. In my opinion, the current trials have either used: exercise regimens that were not challenging enough; were implemented for too short an amount of time; or in a population group that was already so advanced the benefi ts of exercise were not enough to signifi cantly extend survival. Let’s take a look at probably the most rigorous randomized controlled trial of exercise and overall survival against cancer: the study supervised people while they were exercising to ensure compliance instead of letting people exercise at home and self-report. The volunteers only exercised for 2 hours a week. Actually, it’s only one hour a week of vigorous exercise if you really break it down. The two hours included 30 minutes devoted to “stretching” and 30 minutes to “winding down”. The study only lasted 8 weeks. So, this is only a grand total of 16 or 8 hours of exercise, depending on which way you slice it, of exercise for the entire duration of the study.168 Are we surprised that we do not get a signifi cant eff ect from this? Human trials out of Germany in the late 1970’s and mid-1980’s conducted by Dr. Manfred von Ardenne did fi nd positive survival outcomes when pairing hyperthermia, hyperglycemia, exercising with concentrated oxygen and chemotherapy.169, 170 One study examined the lungs of mice who were injected with melanoma cells. The mice were broken into two groups: one group could freely run on a spinning wheel while the others could not run at all. The group that could freely run developed about one tenth of the number of lung metastases as the sedentary group.171 The below chart shows the intensity of disease (measured as “photon count”) in mice that were allowed to exercise versus mice that weren’t.172 CANCER SELF-DEFENSE 101 60 Another chart from the same experiment shows the diff erence in caspase 3 positive cells in exercising mice versus sedentary mice (caspase 3 positive cells are better at fi ghting cancer). The mice in the above two charts ran about 800 meters a day, voluntarily. This is the equivalent of about 5.5 miles for a human. Obviously, people should only exercise the amount that they feel comfortable with, but I would expect to see similarly impressive results in humans if humans exercised the same way the mice did. Perhaps even in high-intensity bursts as mice do on the wheel.173 A meta-analysis of 17 trials concluded that exercise in rodents reduces tumor size.174 Other animal studies have shown that exercise can more than double the oxygenation of a tumor,175 which would indicate it could synergize with other anticancer treatments, such as radiation and/or chemotherapy. I know that exercising can be diff icult and that undergoing cancer treatment can decrease exercise capacity,176 but would more rigorous CANCER SELF-DEFENSE 101 61 exercise done for longer periods (or even short bursts) not produce a more pronounced result? Let’s take a look at the physiological eff ects of exercise in humans as they relate to cancer: • Long-term exercise training reduces lactate production.177 The lactate, an acid, surrounding a tumor is one of the key factors that keeps therapeutic agents from destroying cancer.178 • Exercise oxygenates tissues. Tumor hypoxia (lack of oxygen) is one of its key defenses.179 Tumor hypoxia is associated with a worse response to radiation and chemotherapeutic agents. • 45 to 60 minutes of vigorous exercise has been found to increase Natural Killer cell concentrations 10-fold and CD8+ t-cells approximately 2.5-fold.180 • Exercise increases insulin sensitivity, so the body will not produce too much.181 There was a point when it was assumed that the leukopenia, a sudden drop in white blood cell count, following exercise was a sign of immunosuppression. Now, it is understood that what was assumed to be a drop in immune cells in the blood post-exercise is caused by immune cells being transported into the peripheral tissues, including the lungs and lymph nodes, areas that frequently develop metastases. So, the post-exercise period is not a period of immune suppression but actually a period of immune activation.182 With increasingly gentler treatments, such as targeted therapies and immune therapies, patients are able to perform more vigorous activities. Is a more vigorous exercise program not also in store? If there is an ideal time to exercise, it would be either in synergy with other treatments or right aft er a meal. Moderate exercise, even just walking the dog, has been found to reduce blood sugar spikes to 50% of what they otherwise would be.18
As a great believer in integrative medicine and someone who hates the word “cancer” with a vengeance, I was ecstatic to see Cancer Self Defense 101: Quick Tips to Help You Survive on the list of books to be reviewed. Although Josh Fulton is quick to point out that he is not a licensed medical professional, what he has provided in this book is compelling and important.
In Cancer Self Defense 101: Quick Tips to Help You Survive, Josh Fulton is honest, down to earth, and empathizing. Because he is speaking from experience, you will want to listen to what he has to say. Too many people are dying needlessly from this dreaded disease and I give the author a big high-five for this helpful compilation.
I love the entire book, from cover to cover. Without airs and graces, Joh Fulton has delivered a masterpiece on a subject that is so difficult to deal with. This is one book that I will be keeping because of the value it will add to my collection. The book is simple, yet not simplistic. If you can read, you will be able to understand what the author is trying to convey. The message in this book is quite clear and the case studies are a bonus.
Please grab a copy of this book if you know someone who is suffering from cancer; if you think you will know someone who will suffer from cancer; if you have been diagnosed with cancer; or if you are searching for resources and tools to help you or someone survive the dreaded ‘C” word. Cancer Self Defense 101: Quick Tips to Help You Survive is not just another book on cancer, it is the book on how to survive cancer. I have never seen a simpler compilation of sensible tips for self-defense and survival of cancer.