Integrative Medicine: Do Herbs, Diet and Other Approaches Affect Cancer Outcomes?

Surviving cancer is about more than just getting surgery, chemotherapy or other treatments, says one expert. It also includes giving your body the delicate attention to wellness that it needs – like managing stress, seeking social support, maintaining a healthy diet and more.

It’s important for cancer survivors to manage their quality of life, which they can do by utilizing integrative medicine. This knowledge can help them get their body through treatment with less symptoms and stay well enough to help the treatments work efficiently.

“It's the concept of taking best standard of care, and combining it with everything else that's out there, for where there's evidence of safety and effectiveness… But it's a concept that thinks of all of you, not just the part of you that we see when you're in an operating room or in an office or on a chemo unit,” said Dr. Diljeet K. Singh, a gynecologic oncologist with the Mid-Atlantic Permanente Medical Group in Washington, DC, in a presentation at the 12th Annual Joining Forces Against Hereditary Cancer Conference.

The integrative oncology approaches include dietary interventions, medicine that focuses on the mind, body or energy and systems of herbal medicine or other approaches such as acupuncture.

Dietary Approaches to Cancer Wellness

Although trials are still ongoing to assess ketogenic diets, early data has shown there may be some benefit to reducing certain types of tumor growth, Singh said.

The ketogenic diet works by cutting out low-quality carbohydrates and sugar while incorporating more fat and protein in the diet, thus forcing the body to engage in ketosis – or the constant burning of fat.

“As people start thinking about ketogenic diets for the entire time they’re on chemotherapy or even to try to lose weight, long-term cutting out whole subgroups is challenging, in addition to the fact that there are some things on the ketogenic diet that we know increase cancer risk from other diets,” Singh said.

However, she added, there are also elements eliminated by the ketogenic diet that increase cancer risk – so it is still early to know what the real benefit is, unless you have a neural or brain tumor and a health care provider with experience working with ketogenic diets.

Conversely, a method that has had some success worth paying attention to, Singh explained, is fasting.

Fasting can be divided into several categories: water fasting, during which an individual only drinks water or water-based beverages; dry fasting, which means not eating anything; and restrictive fasting, which is when only certain foods are limited.

“The research isn’t where we want it yet, but there is evidence that there are certain foods that physiologically mimic fasting,” Singh said. “And ultimately, I think those may be the most meaningful or beneficial approaches.

The duration of fasting is once again divided into categories: continuous for a defined period (12-24 hours for up to several days); intermittent fasting (eating at certain times during the day); and whole day fasting for one or two days each week.

New data suggests that it may improve cancer outcomes, Singh explained. Animal studies have shown reduced toxicity and increased effectiveness of chemotherapy with fasting. It works by depriving the normal cells of nutrients, which protects them from chemotherapy because they are not doing their regular growth activities, while the cancer cells expend energy and are more susceptible to being attacked.

The in-human studies are still limited and ongoing, though, and it’s important to keep in mind whether the diet is appropriate for certain individuals. This may be patients who have eating disorders, diabetes, low body mass index or have recently lost weight.

“But ultimately, I think still the place where we have the most data is the Mediterranean diet,” Singh emphasized. “And what I consider the one-step advancement for it, the anti-inflammatory diet, which is essentially the Mediterranean diet, adding in some important concepts from traditional Chinese medicine and Ayurvedic medicine.”

This diet is based on fruits and vegetables, whole grains, healthy fats, fish and seafood as protein – but also whole soy, cooked Asian mushrooms, healthy herbs and spices.

“The red wine part is a little bit challenging, because there is evidence that for women to have more than two glasses of red wine a week may increase the risk of breast cancer,” Singh said. “So I would say for women, unfortunately, the better option is to eat grapes, and then things like plain dark chocolate, which has really great antioxidants in it, as well as magnesium and other beneficial components.”

Understanding the Benefits of Herbs and Supplements

Many patients are interested in whether herbs and supplements can provide health benefits that will either prevent or work against cancer. However, the idea that they may be better than a pill given to you by your doctor is not entirely true, said Singh.

“Certainly, herbs and other supplements when we do them in pharmacologic doses, like not an amount that you could eat in a healthy way, they actually can in very many ways act like more traditionally prescribed prescriptions for even over-the-counter drugs,” she said. “But there is a real reason to be fascinated by herbs and supplements, and that's because they have the potential to improve quality of health and improve cancer outcomes.”

Consistent epidemiologic data showed that people who ate more orange and yellow fruits and vegetables had lowered cancer rates. Many wondered whether this could be attributed to beta-carotene. In clinical trials, researchers examined whether smokers who received beta-carotene and retinyl palmitate would have a decreased cancer risk. However, it was found that this increased their risk of lung cancer.

On the other hand, Singh said, they tested to see if vitamins A or E had any effect. It was found that vitamin A also increased cancer risk, while vitamin E had no effect.

“How could taking vitamins increase your cancer risk? … So there might be a whole bunch of reasons. One was that decision was made to use a synthetic form of vitamin A, which is not actually found in fruits and vegetables,” Singh explained. “We know what vitamin A, what (its) job is, is to help one cell differentiate on into another cell – so stem cells kind of becoming an actual skin cell. And so thinking about that, well, maybe if we put in an activated vitamin A, and there's a precancerous cell sitting around, maybe that's going to be more likely with the addition of vitamin A, to go on to become a lung cancer.”

Thus, the study may not have been done in the right population, as smokers already have precancers in place that then were stimulated into becoming cancer when they took vitamin A.

“I call this – and lots of intelligent people call this – the problem of reductionism, right? You can't put a whole apple into a capsule.”

There are benefits to eating whole foods in their original form, Singh urged. For example, drinking orange juice may not help as much as eating an orange, because you’re taking out the fiber, adding sugar and slowing down the body’s absorption. This is why it’s difficult to study dietary effects, because conducting research on integrative approaches means you have to study someone’s entire lifestyle and whole diet.

When thinking about herbs and supplements, Singh explained, the best method is to work with an expert who has an understanding of their effects on the body. It’s difficult, because the Food and Drug Administration (FDA) does not evaluate the safety of herbs, so they’re not as well understood. But your pharmacist and health care provider can help you to understand whether certain herbs and supplements may interact with your cancer treatments. Additionally, reported cases of complications are exceedingly rare.

Acupuncture Is Not a True Alternative

Though acupuncture has been around for centuries, Singh said, it’s not an alternative to cancer treatment. It has been used to treat symptoms like nausea and vomiting, fatigue, pain, hot flashes, peripheral neuropathy and dry mouth of radiation.

However, it’s not a replacement for cancer medication.

A Look into Stress and Cancer

With a great deal of evidence showing stress can both increase the risk of cancer and worsen the impacts of cancer once you have it, Singh emphasized that it is important to work on ways to combat it.

While psychological stressors such as depression, anxiety and isolation can worsen a patient’s condition, some will urge that they feel fine “emotionally.” However, it’s important to also consider the physical stress of multi-tasking, driving and trying to continue everyday life.

“There's all kinds of things that turn on our stressed nervous system, turn on our adrenaline cortisol pathway,” Singh said. “…and unfortunately, that caveman only responds with this adrenaline, cortisol inflammatory pathways. And so turning off that pathway to put our body into a healing state, where inside inflammatory mediators come into play, is important.”

There are many different ways to do this – patients can do breathing exercises, meditate, use creative outlets, etc. “But also, good nutrition, regular physical activity, managing stress – all the variations of it, physical and emotional – social support, getting enough sleep,” Singh concluded.

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