Pallav Mehta, M.D. Assistant Professor of Medicine ...
Transcript of 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