Pallav Mehta, M.D. Assistant Professor of Medicine

Pallav Mehta, M.D.

Assistant Professor of Medicine

Director of Integrative Oncology

MD Anderson Cancer Center @ Cooper

Introduction

Few words inspire more fear than “You have

cancer.”

Introduction

Sometimes, everything is done correctly,

but cancer happens and control is lost

What can patients do to regain control?

Ask questions and become knowledgeable

Seek out support from friends, family,

colleagues, other patients

Understand how, what, when to eat

Calm the mind as much as possible

Stay physically active

What is Integrative Medicine?

Introduction

In 1998, the NIH established the

NCCAM, now known as the NCCIH,

National Center for Complementary and

Integrative Health

“Integrative medicine combines

mainstream medical therapies and

complementary therapies for which

there is some high-quality scientific

evidence of safety and effectiveness.”

Introduction

Yoga

Massage

Reiki

Traditional Chinese

Medicine

Acupuncture

Mindfullness BSR

Ayurvedia

Resistance exercise

Herbs

Meditation

Tai chi

Supplements

Nutrition

Qigong

Guided imagery

Aerobic Exercise

Biofeedback

What Now?

Dr. Mehta : “Congratulations! You finished your treatment!”

Ms. Smith : “Thank you, that’s wonderful…but what do I look for now?”

Dr. Mehta : “Well…if you have any symptoms… or don’t feel right, just call us, otherwise we’ll see you in 3-6 months!”

Ms. Smith : “Is there anything I can do to prevent this from happening again?”

“It’s opener out there, in the wide open air.” – Dr. Seuss

Nutrition Physical Activity Stress

Cancer Nutrition

= 462 calories

Cancer Nutrition Basics - Rules

Breakfast is most important meal of the day!

7-10 g fiber and 10-15g protein

Cancer Nutrition Basics - Rules

Eat something every 3-4 hours

Make a list of healthy snacks

Cancer Nutrition Basics - Rules

Don’t eat too late

Take a hike

Cancer Nutrition Basics – WHY??

Stressed

Bored

Happy

Sad

Tired

Habit

Cancer Nutrition - plants

“Four food groups”

WHOLE

GRAINS

VEGETABLES

NUTS,

SEEDS,

LEGUMES

FRUITS

Cancer Nutrition –Meats

LIMIT

RED MEAT

Beef

Lamb

Pork

Veal

Venison

Goat

AVOID

PROCESSED MEATS (Nitrites and PAH’s)

Smoked, Cured, Salted, added Preservatives

Sausage

Bacon

Ham

Salami

Hot Dogs

Bologna

Cancer Nutrition - Sugar

Myth that “Sugar

Feeds Cancer”

The problem is not

all sugars, it’s the

refined sugars

Opt for natural

sugars like agave,

honey, or molasses

Cancer Nutrition - Sugars

www.GlycemicIndex.com - University of

Sydney

Diets with high GI and GL appear to be

increase risk of breast cancer

recurrence

2. Goodwin, et al JCO, 2001

Cancer Nutrition - Alcohol

The UK Million Women study (actually over 1.2

million women) demonstrated that for every 10 g

increase/d there was a 12% increase risk of breast

cancer3

3. Allen, et al JNCI 2009

10 grams =

Cancer Nutrition – Organic??

Dirty Dozen5 (most pesticides) for 2015:

5. Environmental Working Group

Cancer Nutrition - Takeaways

Eat whole, not processed, foods!

Spice it up!

Stick with it!

Prepare!

Learn how to shop and how to cook!

Eat more often!

Remember you’re setting an example!

Supplements/Botanicals

NCCIH has now established an office for

natural products research

Allows for funding and resources for

many types of natural products

Despite occasional anecdotal evidence,

there is no supplement that will

magically cure cancer

Supplements/Botanicals

Vitamin D – breast, colon, prostate ca Avoid sunburn, not sunshine!

Raising everyone’s level to 40-60 ng/ml would prevent 58,000 cases of breast cancer and 49,000 colon cancers4

Omega-3 Fatty Acids

Curcumin (turmeric)

Quercetin (apples, berries, seeds, nuts)

Isothiocyanate and DIM (cruciferous vegetables)

Green tea – 3 cups/day

4. Garland et al, Ann of Epidemiol, Jul 2009

Physical Activity

A - Z

Alzheimers

Benign Prostatic Hyperplasia

CVA

Diabetes

Epilepsy

Fatigue

Gastritis

Hypertension

Inflammatory Bowel Disease

Juvenile RA

Kidney Stones

Lou Gehrig’s Disease

Migraines

Neurogenic Bladder

Obstructive Sleep Apnea

Pneumoultramicroscopic-silicovolcanoconiosis

Quantal Squander Syndrome

Raynaud’s Dz

Sarcoidosis

Temporal Arteritis

Urinary Tract Infections

Varicose Veins

Wegener’s GM

Xanthoma

Yeast infections

Zollinger-Ellison Sx

Obesity

Rapidly becoming the

greatest risk factor for

death in this country

450,000 deaths from tobacco

400,000 deaths from obesity

What is Obese?

CATEGORY BMI

UNDERWEIGHT 16.5 - 18.4

NORMAL 18.5 - 24.9

OVERWEIGHT 25.0 - 29.9

OBESE (CLASS I) 30.0 - 34.9

OBESE (CLASS II) 35.0 – 39.9

OBESE (CLASS III) >40.0

35% 70%

“ A Disease of Civilization”

As developing nations grow, they’re having

to deal with malnutrition and obesity

Obesity and cancer connection

Bao, et al, BBA – Reviews on Cancer, April 2011

Weight Loss Math

1 pound = 3500 cal, so to lose a lb/wk:

Drop intake by 300 cal/day

Up usage by 200 cal/day (30 min of a brisk

walk)

Myth

Can’t lose more than 10% of body

weight by diet and exercise

Exercise: An activity requiring some degree of

physical effort often carried out to sustain or

improve health

Physical Activity

1996 : the ACS added regular physical

activity to its list of measures in its

cancer prevention guidelines

2001 : AICR then went further and

estimated about 50,000 case of breast

cancer and 43,000 cases of colorectal

cancer were as a result of inactivity and

it’s short and long term consequences

What about it’s role in cancer?

Diminishes obesity Increasing muscle/fat

ratio

Has benefits that extend beyond weight loss

Diminishes stress

Diminishes inflammation

Look and feel more confident

Sitting Disease

Simple tips

Not a program, a change in your life!

Park far away at the mall

Take the stairs,

Walk to furthest bathroom in the office,

Walk when you’re on the phone

Play with your kids more, take walk breaks,

stand at your desk more, etc.

150 min of moderate intensity/wk

Don’t beat yourself up if you can’t do it

Yoga and cancer

Fights fatigue

Encourages deep breathing

Improves sleep

Decrease anxiety and improves sense of well being

Diminishes pain

Improves motion, flexibility, balance and strength in a gentle way

Stress

“ A sad soul can kill you quicker, far quicker, than a

germ.”

- John Steinbeck

Stress

Mice exposed to chronic stress

(confined to small cage for long periods)

had 30 fold higher rate of metastasis of

breast cancer cells than non-stressed

mice.6

6. Sloan et al, Cancer Res, 2010

Stress

Researchers at Ohio State looked at

227 breast cancer survivors

After 11 years of follow up, women in a

stress reduction group had a 45%

reduction in risk of recurrence and 60%

reduction in risk of dying from breast

cancer vs those in the control group

7. Anderson, et al Clin Canc Research June, 2010

Stress – coping strategies

Cancer and its treatment lead to a littany

of physical, emotional, spiritual, stress

And particularly for breast cancer

survivors, hormonal stress

Stress - MBSR

Developed at U. Mass by Dr. Jon Kabat-

Zinn

Brings together mindfulness and yoga

Mindfulness is about paying attention to

present moment both externally and

internally, without judgment

Improve quality of life and mood and

diminish distress in lives of patients with

cancer

Stress – other strategies

Qigong

Combines physical postures, breathing and

mental focus

Stress – other strategies

Reiki

Guided imagery

Progressive Muscle relaxation

Massage

Acupuncture

Biofeedback

HeartMath

Meditation

Neuropathy

Ask your doctor if you should check labs (Hgb A1C, SPEP/IFE, Vitamin B12 levels, etc)

Supplements

Alpha-Lipoic Acid

N-AcetylCysteine (NAC)

Vitamin B6

Omega 3’s

Marijuana

Acupuncture

Biofeedback and Guided Imagery

Cold caps to hands and feet during chemo

Fatigue

Ask your doctor about labs and tests like thyroid problems; deficiencies of iron/B12/folate/Vitamin D; anemia; electrolyte disturbances

Exercise

Acupuncture

Regular meals, steady intake of fiber

Ginseng

L carnitine

Nausea

Ask your doctor whether he/she feels it’s

due to the chemo, a problem with GI

tract, or something brain related

Ginger

Acupuncture – during chemo

Massage

Aromatherapy

Small meals, non high fat