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Integrative Care For Cancer with Dr. Heidi Lucas: Rational Wellness Podcast 261

Dr. Heidi Lucas discusses Integrative Care for Cancer Patients with Dr. Ben Weitz.

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Podcast Highlights

5:05  Dr. Lucas does not feel that there is one cause or theory about how cancer forms in each person, such as the genetic or metabolic theories.  Dr. Lucas does feel that there is a small genetic component but the environmental exposures are probably more significant.  For some patients there is a metabolic component and for others there’s a nutrition component.  “In the case of colon cancer, where it’s one of the only cancers where there’s… I mean, there’s good research on nutrition, but as far as drawing a line from point A to point B with diet, there aren’t a lot of diagnoses that can be that significant as something like barbecued meat, or preserved meats and colon cancer, that kind of thing. So for me, I look at, where has this person lived? What have they been exposed to? Obviously each person has propensities. And so my job is to look at maybe what those propensities are, and then help them to live in this world that we live in, that no matter what we do, we’ve got to drink the water. We have to breathe the air. We don’t live in a bubble, but what choices can we make so that those carcinogens that are in our environment, that we can better deal with them?”

10:57  A Nutritional Moderate.  While some cancer nutrition experts recommend a vegan diet and others recommend a ketogenic diet, Dr. Lucas takes a moderate approach to nutrition and she does not feel that there is one nutritional approach for all cancer patients.  Her approach for most patients could be described as a mostly plant based, low glycemic, anti-inflammatory diet.  She has found that a ketogenic diet has worked best for primary brain cancers and for ovarian cancer.  Dr. Lucas does tend to include yogurt and legumes and whole grains in recommendations for diet for cancer patients, including even wheat and soy, as long as they are organic and patients are not sensitive to them.  She will, however, often will tell patients to avoid egg yolks.

16:31  Dr. Lucas is very big on eating organic, so some organic whole grains and some organic soy are generally o.k. for her when eaten in moderation, as long as there is no sensitivity.  They should not have wheat with every meal like often happens in the standard American diet, but to have some faro with broccoli and a tablespoon of Parmesan cheese is fine, as long as all is organic. 

18:35  Inflammation.  The most important thing to reduce inflammation is to eat more plants. What causes inflammation are refined sugars, refined grains, and meats that are produced more commercially, non-organic commercially raised meats that tend to have more inflammatory components to them.

19:26  The best way to balance our blood sugar is for patients to have some protein, fiber and healthy fats with every meal and snack.

20:56  Some who promote a vegan style of eating for cancer claim that certain amino acids tend to promote cancer, such as methionine or leucine or glutamine promote cancer growth, but Heidi has not found this to be the case.  She has found that as long as you are not eating an excessive amount of animal protein at each sitting and the protein is balanced by lots of veggies and fiber and healthy fats, you will be fine.  She has not found, for example, glutamine to be a problem to consume and patients that have avoided glutamine have not seen any great amount of success with tumors shrinking.  She often uses glutamine supplements to help to heal the gut, since the gut often gets torn up by conventional cancer treatments. 

24:01  Nutrition to support the immune system.  To support the immune system, the first thing you should do is avoid refined sugars, since elevations of sugar are immune suppressive.  Dr. Lucas often recommends teas that support immune function, including rose hip, nettle leaf and burdock root. We should also remove food sensitivities.  Foods that strengthen the immune system include medicinal mushrooms, green tea, rose hips, the fibers in legumes.  Oats and barley naturally have beta-glucans. Cruciferous vegetables are hormone balancing, detoxifying, healthy cell cycle support, and they’re helpful for the immune system.  Ground flax seeds are anti-inflammatory, help to balance hormones, beneficial for the microbiome and for immune health.  28:21  Coffee. A number of studies have shown coffee to be associated with lower cancer risk, largely due to the antioxidants in coffee. It is important to drink organic and Dr. Lucas recommends avoiding milk or cream, since these may contain IGF-1. 

29:54  Antioxidants and cancer.  It is common for oncologists and radiation oncologists to recommend against consuming antioxidants while undergoing chemo or radiation for fear that it would interfere with the treatment effectiveness.  There are a lot of antioxidants in fruits and vegetables, so it makes no sense to tell a patient not to take a vitamin C tablet and not tell them not to eat a red bell pepper, which has more vitamin C in it. Dr. Lucas explained that if there’s a study showing that vitamin E (a popular antioxidant) is synergistic with the chemotherapy, she’ll use it not because it’s an antioxidant, but because it helped with the cell cycle or that it prevented neuropathy.

33:04  Some cancer patients go through wasting and lose too much weight, so Dr. Lucas will use botanicals that support digestion, including ginger, fennel, and herbal bitters.  She also recommends that her cancer patients exercise moderately, which is good for their overall health and will stimulate the appetite.  Her rule of thumb is five days per week for 30-60 minutes, even if it is just doing some stretching.  There are a lot of inflammatory mediators kicked up in the body from cancer, like tumor necrosis factor, so she will recommend fish oil (start with 2000 mg EPA plus DHA) or melatonin (3-10 mg).

38:41  Vitamin D. Dr. Lucas recommends a vitamin D level of 60-80 ng/mL. Also zinc is very important and she will look at both serum zinc and copper, since too much copper can promote angiogenesis. 

39:34  Basic Integrative cancer lab panel:

1. CBC w/ differential

2. Chem screen, including Neutrophil/Lympocyte ratio.  Dr. Lucas has watched this ratio for a while and she is still on the fence about it. It has traditionally been seen if it increases to be a bad prognostic marker for cancer patients.  Neutrophils tend to be higher with acute inflammation and in active disease. Lymphocytes tend to go up more to go after viruses and things like that.  But now we often see neutrophils rise in patients with active COVID infections.  Dr. Lucas will also look at the total protein and albumin to make sure that her patients are absorbing what they’re taking in.  She also looks at LDH as a surrogate tumor marker for cellular turnover, esp. if there is a sudden change in the level. Dr. Lucas also looks at liver enzymes.

3. HsCRP.  She regards below 1 as optimal. This is an inflammation marker.

4. Fibrinogen.

5. Hemoglobin A1C.

6. Fasting glucose.

7. Fasting insulin.

8. Serum zinc.

9. Serum B12.  MMA is a better marker but she is trying to have the medical oncologist order testing so that it is more likely to get covered and they push back on the need for MMA.

10.  Homocysteine.

11. Microbiome testing, esp. if there are a lot of GI symptoms.

12. NutraEval.

13. Galectin-3. She does use a fair amount of PectaSol C, which is form of modified citrus pectin that lowers Galectin-3, esp. when patients are undergoing biopsies and surgery, when there’s more risk of tumor spread.

49:29  Nutritional Supplements with some direct anti-cancer effects that Dr. Lucas will recommend include Modified Citrus Pectin, medicinal mushrooms, and curcumin.  For medicinal mushrooms, Dr. Lucas will rotate them for patients and typically will use one mushroom at a time for several months each. She says that the research shows that the benefits start to decrease after three weeks. She will rotate reishi, turkey tail, cordyceps, agaricus, lion’s mane, etc. but she also takes into account what the diagnosis is and if there is more research on say turkey tail for breast cancer, which has aromatase inhibiting properties, then she may start a breast cancer patient with turkey tail.  Maitake can be helpful for blood sugar issues, while reishi can be good for the heart.  She uses a lot of curcumin and she will also use whole turmeric in cooking and in teas.  For curcumin she will often rotate the specialized forms, including Meriva, BCM 95, and Theracurmin. She has stopped using curcumin supplements with black pepper, since this can be irritating for the gut.

52:54  Fermented wheat germ extract. Green tea extract.  Dr. Lucas used to use Avemar, which is fermented wheat germ extract, though the price was fairly prohibitive for a lot of patients, though she found it to be quite helpful.  Dr. Lucas really likes green tea and decaffeinated green tea supplements that are high in polyphenols.

 

 



Dr. Heidi Lucas is a Naturopathic Physician who specializes in integrative cancer care combining conventional and natural medicine. The treatment modalities she uses include nutrition, botanical medicine, meditation, exercise, and yoga. Heidi is an educator and speaker at the Hearst Cancer Resource Center, Leukemia Lymphoma Society, Oncology Nursing Society, American Cancer Society, Bastyr University, and many hospitals around the country. She was a staff physician at Seattle Cancer Treatment and Wellness center.  Her practice is in Atascadero California and biweekly in Santa Barbara. She also travels yearly to Seattle to see patients. She also sees patients virtually. Her website is DrHeidiLucasND.com.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.



 

Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts, and researchers in the field, to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, DrWeitz.com. Thanks for joining me, and let’s jump into the podcast.

Hello, Rational Wellness Podcasters. Today, I’m excited to be speaking with Dr. Heidi Lucas, and we’ll be talking about an integrative approach to cancer. Dr. Heidi Lucas is a naturopathic physician who specializes in integrative cancer care, combining conventional and natural medicine. The treatment modalities she uses include nutrition, botanical medicine, meditation, exercise, and yoga. Heidi’s an educator and speaker at the Hearst Cancer Resource Center, Leukemia Lymphoma Society, Oncology Nursing Society, American Cancer Society, Bastyr University, and many hospitals around the country. She was a staff physician at Seattle Cancer Treatment and Wellness Center. Her practice is in Atascadero, California, and biweekly in Santa Barbara. She also travels to Seattle yearly to see patients, and she sees patients virtually. Heidi, Dr. Heidi Lucas, thank you so much for joining us.

Dr. Lucas:             Oh, thank you for having me.

Dr. Weitz:            So can you tell us about your personal journey and how you became interested in working with cancer patients?

Dr. Lucas:             Sure, sure. My journey to medicine was a bit circuitous, so I’ll try to give you the high points. So my family are all farmers. And so I really grew up with a very strong connection to where food comes from, and really everyone in my family is a farmer, or a fisherman, for as far back. We’re Croatian immigrants. So I grew up in that way, and then of course I decided to study something totally different, art conservation. So I did that. And then literally I was a doctor for paintings, and I was much more interested in my botanical garden that I had in my home, rather than working on paintings for a time. So I decided to work with a doctor of Oriental medicine in Santa Fe, New Mexico, where I was living. And I managed her herb pharmacy, and so I ordered all of the raw herbs for her teas, and it was an amazing experience.

And I really started to gravitate and resonate with a lot of her cancer patients. I really enjoyed making their teas, I would deliver them to the patients, I would talk to them, and I just really felt like I had a connection. So I saw a picture of the Bastyr herb garden online, and I thought, “Oh, there’s a doctor that you can have a garden and be a doctor.” And so that’s what I… It was very… It was not the most… It was very inspirational, let’s just say, I didn’t exactly know all the details at that time. So the universe brought me to that spot, and so I went to Bastyr University in Seattle. And that affinity, that real drive for oncology patients continued while I was there. All of my preceptorships were in oncology, and I had some really wonderful mentors, Mark Jeaniac and Paul Riley.  And they took me in and they really allowed me as an individual to explore so many aspects of oncology. People always ask me, “Well, what is it about it?” And I often will say, “It turns everybody into a Buddha.” Sometimes for a long time period, and sometimes for a brief period, where we really realize that our lives are precious and we are ephemeral, and that doesn’t necessarily have to be a scary thing if we can talk about it, and really be present with where we are. So I’ve stayed with oncology for almost 20 years, and I get to practice all of the things that I enjoy, because I have a real captive audience as patients. Nothing like a cancer diagnosis to say, “Hey, what can I do in any way possible?” And so I enjoy bringing in all of those modalities.

Dr. Weitz:             So what do you think causes cancer? Is it genetic? Is it metabolic? Is it just toxins?

Dr. Lucas:             Yeah. And so many patients will ask me this as well. And coming from a family of farmers, I really pay attention to the environment that we live in, the soil, the air we breathe, the food we eat. And so it has been shown, yes, there is a small genetic component of… Very, if we’re talking about a very specific genetic anomaly, that that’s actually very much the minority of diagnoses. And then there’s an epigenetic component, okay, what are we doing in our lives? But being a clinician, I have patients who have… I mean, they eat well, they’re yoga teachers, they’re doctors, they’re very conscious about what they eat and what they do, and then that person gets cancer. What do you say to that person? It’s not… So this question of where it comes from, for me, I think the environment that we all live in right now is really pushing our genetics, and even our epigenetic choices that we make in our lifetime.

Dr. Weitz:             Potentially those things cause potentially DNA damage, and that’s one of the factors.

Dr. Lucas:             Yes, yes. And everyone is an individual in terms of what their journey… What choices they’ve made that brought them to this moment. For some people there’s a metabolic component, for others, there is a nutrition component. In the case of colon cancer, where it’s one of the only cancers where there’s… I mean, there’s good research on nutrition, but as far as drawing a line from point A to point B with diet, there aren’t a lot of diagnoses that can be that significant as something like barbecued meat, or preserved meats and colon cancer, that kind of thing. So for me, I look at, where has this person lived? What have they been exposed to? Obviously each person has propensities. And so my job is to look at maybe what those propensities are, and then help them to live in this world that we live in, that no matter what we do, we’ve got to drink the water. We have to breathe the air. We don’t live in a bubble, but what choices can we make so that those carcinogens that are in our environment, that we can better deal with them?

Dr. Weitz:             Okay. Where do you think the conventional cancer care world is right now, especially with respect to metastatic disease?

Dr. Lucas:             Yeah. I mean, I’ve seen it change a lot just in the last 20 years, where somebody gets a more advanced stage diagnosis, stage three or stage four, and there aren’t as many options. It’s not the case now, with the changes in the conventional world of liquid biopsies, with immunotherapy, even just the fact that we’re talking about the immune system. I mean, I remember when I first started and I would talk to the oncologists that we would work with and I’d say, “I really want to work on supporting this person’s immune system.” And they’d be like, “Well, what does the immune system have to do with it?” And now one of the most, I would say prevalent treatment choices, not only for people in active treatment, but in the research, is immunotherapy.  So yeah, I think that my conventional colleagues, there’s been a lot of opening, a lot of progression. I mean, people are willing to test somebody’s vitamin D, so I think that things have evolved. And I think even in that metastatic setting of having that conversation with a patient, and not just being like, okay, this is something that is going to end your life rather quickly. Now it’s like, well, we’ll start you on this. We see how you do, and then maybe you’ll be on this for a year or two, and then maybe we’ll try something else. So it’s a bit more expansive, thankfully. And then as far as my job, or my role in that, just supporting people so that they can stay with good vitality, and thrive long enough for new things to come out as well.

Dr. Weitz:             Right. But in general, it seems to me, from my perspective that most patients with metastatic disease, the prognosis, with a few exceptions, is not that great.

Dr. Lucas:             Yeah. And I think my practice has taught me to deal with people as individuals, because I have a lot of metastatic patients that have done really well for many years.

Dr. Weitz:             Sure, of course. Right.

Dr. Lucas:             So I definitely agree with you that once a cancer learns to move to a different area, we are in a different spot with that. There is a lot more risk there. But on the conventional side of things, I’m not saying that they don’t get a very often dismal conversation with an oncologist. Not always, I have a lot of oncologists I work with that are pretty amazing in that way, and keep it expansive, keep it hopeful, which I think is important.

Dr. Weitz:             So let’s talk about your nutritional approach, and nutrition is like politics these days. There’s these extreme ideological splits. And on the one end, we have the vegan camp, on the other hand, we have the paleo, keto, extreme carnivore. We have doctors who feel that you need to eat extremely low carbs to beat cancer. This morning I interviewed a Gerson doctor who believes in a vegan approach with lots of raw juices. Where are you in terms of your perspective on nutrition for cancer?

Dr. Lucas:             Yeah. So I take the middle way, let’s just say, with this, where I like to find the threads, the golden threads, in between some of the recommendations, because I have not found that there’s a one size fits all. I wish there was. So in general, what I take into consideration is the patient in front of me, okay, what are their, as we were talking about before, what are their propensities? Where do we see these imbalances, and how can we create balance there? So in general, I would say, I favor a mostly plant based… if I was going to call it something… a mostly plant based low glycemic diet, anti-inflammatory diet. What that means for an individual person, we could take that in the case… In my practice, I find the ketogenic diet has worked best for primary brain cancers and ovarian. I find they are the most sensitive to that.

Dr. Weitz:             So certain cancers have certain characteristics that respond better to some things than others.

Dr. Lucas:             Yes, that’s what I’ve found. And as we get more research and more books that come out on different ways of looking at it, what I’ve found-

Dr. Weitz:             No, I’ve looked at some of the data on keto diet, and for sure brain cancer was one that responded much better than others, and especially glioblastoma, as opposed to other forms of brain cancer.

Dr. Lucas:             Yes. Yes. And that’s definitely, I mean, I can for sure say that to a patient, knowing that there’s clinical support for that as well. And then I would also say with ovarian, I’ve seen ovarian very responsive to that. Other, I would say, diagnoses, propensities, colon cancer, switching to a plant based diet. And that makes sense, fiber, fiber is so good for the colon, different types of fiber are changing the microbiome, decreasing inflammation, that’s where the cancer itself is. So to me that makes total sense that nutrition would be even more crucial in terms of the plant based phytonutrients that have anti-cancer properties.

Dr. Weitz:             Right. And then prostate cancer, just to think of one that tends not to respond as well to meat, or a ketogenic diet, and probably does a little better getting most of the meats out of there.

Dr. Lucas:             I would agree with that. I would agree with that. And because there are certain… Even just thinking about cruciferous vegetables, and hormone based or hormone sensitive cancers, any of those plant compounds that can help with hormone balance, hormone metabolism, towards non-growth pathways, we’re going to see a benefit with a more plant based diet. Yes.

Dr. Weitz:             Right. I noticed on your approach, this handout that you give to patients, of course you recommend fruits and vegetables, or vegetables and fruits, but you include some organic free range meats. You do include legumes and whole grains, which some people think are problematic. You include some organic dairy, like yogurt, nuts and seeds. You even recommend for patients who are not sensitive, whole wheat and soy.

Dr. Lucas:             Yeah. I know I’m just a rebel, aren’t I? I mean the reason I-

Dr. Weitz:             But you don’t like egg yokes.

Dr. Lucas:             Yeah, no, I mean, it’s… So again, as we were saying previously, my patients have taught me over the years. So you can read all the books and you can read all of the research, which I try to read as much as I can, but at the end of the day, what I see helpful to the person in front of me is what I’m going to go with. But aside from that, just thinking about that individual again. So I have found some people do very well with fermented dairy. Even just looking at some of the longevity studies, people in the Mediterranean, looking at the Mediterranean diet, there’s not a lot of cream, not a lot of milk. What is there? Fermented cheese, Parmesan, that’s got some good microbial content in it. So for me, and that might be the Croatian in me just wishful thinking, but for me, I find if somebody can tolerate it and it’s not inflammatory, and we’re doing the labs, and they’re doing well, then I see no need to put them on something that’s so rigid, that’s going to create suffering for them.

Dr. Weitz:             Right.

Dr. Lucas:             Suffering is not good for cancer growth, okay? Let’s put it that way.

Dr. Weitz:             They’re suffering enough.

Dr. Lucas:             And if you’re taking in organic whole grains, and for me, the organic is a big piece of this. Something like organic soy versus conventional soy, or organic wheat versus conventional wheat. That is a rant for a different day, perhaps, for us. But I think that they’re very different foods in terms of the way they’re grown, and the nutritional content. So if you look at epidemiological studies, these are people who are eating some of these foods in moderation. Are they eating wheat every day with every meal, like a piece of toast and pasta and a sandwich, like what we do in the standard American diet? No, they might have faro with some broccoli, with a tablespoon of Parmesan. You know, there’s a lot of moderation there in terms of my recommendations. And then-

Dr. Weitz:             I know one of the differences between organic soy and organic wheat and non-organic is that in the United States, almost every instance of non-organic soy and wheat is going to be genetically modified, with Roundup sprayed on it.

Dr. Lucas:             Oh, it’s horrific. It’s very… And I find that the best thing that you can do is to choose foods… And the best thing that you can do for everybody in terms of what causes cancer. There’s so much pesticide/herbicide residue in our environment that just by… And I’ll tell patient families, buy organic foods. Yes, they’re more expensive, but typically people will buy less of them. And we tend to be an overweight community in general. So if we’re eating a little bit less, it’s probably not going to be an issue for us. If things are expensive, it’s because they took time to grow. So anyway, this, you can tell, I can really go off on the farmer’s daughter vibe here, but it is for me the most important thing we can do choice wise.

Dr. Weitz:             So in that handout that you give to patients about your nutrition strategies, you talk about reducing inflammation, balancing blood sugar, and strengthening the immune system. So how do we use nutrition to reduce inflammation?

Dr. Lucas:             So the most important thing is to eat more plants. That’s the take home message for me, because what tends to cause inflammation in our diet is refined sugars, refined grains, and meats that are produced more commercially, non-organic commercially raised meats that tend to have more inflammatory components to them. So for me, it’s really about eating foods that are anti-inflammatory, and limiting the foods that are inflammatory.

Dr. Weitz:             Okay, how best to balance our blood sugar?

Dr. Lucas:             So my mantra for patients is protein, fiber, and healthy fats with every meal and snack. And so if you look down at your plate and okay, where’s my protein, where’s my healthy fat, where’s my fiber? If you have those, and I give a little diagram, half the plate veggies, one third of the plate, complex carbs, one third protein, this half, and then the other third healthy fats, then you’re not going to get those escalations in insulin. And then you’re not going to get the drop, the hypoglycemic drop, from too much insulin that then brings cortisol up.  So for me, if you don’t have that balanced plate, you get two different hits, you get elevations in insulin, and then you get a blood sugar drop, which then brings up cortisol, which is immune suppressive. So by using that mantra, protein, fiber, healthy fats, what those things are… So you’re going to ask what kind of proteins, then I’ll say it depends on the person. So for some people, they do better with some meat in their diet, just vitality wise. If you look at traditional Chinese medicine, there’s a lot to be said for eating some clean animal products in terms of vitality. So some people do much better with that. Others do better with plant based. So I just make that decision based on the person.

Dr. Weitz:             Yeah. There are some proponents of a vegan style of eating for cancer, and they say that we need to reduce certain amino acids, which promote cancer. And they pick one, methionine, or glutamine, or leucine, and therefore a vegan, lower protein diet is better.

Dr. Lucas:             Yeah. And I have seen that in terms of the research. What I find actually is if you look at all the most prevalent anti-cancer diets is they all tend to be lower protein, not low protein total in the day, but lower protein at one sitting. So even if you think about keto, if you think about vegan, if you think about low glycemic or plant based, you’re not going to get into any of these excessive protein amounts at each sitting. So I think if you eat in that way, where you’re not getting an excess of those amino acids, and those are balanced by fiber or healthy fats, all of that, I have not seen it be an issue. There’s a lot that’s been said about glutamine, and it is a, not a hornet’s nest, but it’s definitely an area where you can really get a lot of theories going.

What I have found in my personal practice is, glutamine has not caused an issue. I’ve even given glutamine to patients for healing the gut. Because it’s the most prevalent amino acid, especially patients during treatment and their GI tract gets totally torn up by treatment, it can be a savior for people once they start taking it in. So I think those things are a nice… Blocking certain amino acids is a nice idea, theoretically, but as we know with the complexity of the body, there are a lot of workarounds with those. So when I’ve had patients say, “I’m going to do this. I’m going to take out all things that have L-glutamine in them,” which is practically impossible. I haven’t seen miraculously like, wow, these tumors are just decreasing. I often find they have decreased GI health as a result.

Dr. Weitz:             I have found if you take out all the animal protein, it’s really hard to balance the blood sugar as well.

Dr. Lucas:             Yes, absolutely. For some people, for others, they can do it in a plant based way, but you have to be really mindful about that. If you’re going plant based, or even if you’re going vegetarian, you can’t just only have salads, or you can’t just only eat quesadillas all day, or something like that where you’re not being mindful, which is why I always go back to that. Making sure that people are having good fiber, healthy fats, all that stuff.

Dr. Weitz:             What are the best ways to support our immune system using nutrition?

Dr. Lucas:             Knocking out refined sugars is one of the biggest ones, because I think that elevations and sugar are documented as being immune suppressive. Using actual plant foods that have immune support properties. So for me, in my practice, I use a lot of teas. So I recommend rose hip tea or nettle leaf tea, or some of these things that are medicines, but they’re also foods. Eating burdock root or something like that, adding ground milk thistle to your oatmeal in the morning. So I think also just in terms of the immune system, looking at inflammation becomes a really important piece too, because if there’s increased inflammation, increased neutrophils, if there’s reactivity… One of my mentors used to always say, “If your immune system is busy fighting your lunch, it’s not going to be fighting your cancer.” So making sure that you take out food sensitivities as well.

 



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Dr. Weitz:             Are there particular foods you encourage people to eat to strengthen the immune system?

Dr. Lucas:             Yes.

Dr. Weitz:             I’m thinking about, say, medicinal mushrooms.

Dr. Lucas:             Yes, definitely. Mushrooms. As far as medicine foods, my shortlist, medicinal mushrooms, green tea, rose hips, the fibers that are in legumes if patients tolerate them. A lot of my patients who have more of an autoimmune propensity, we might take out the legumes or the grains if they’re sensitive to that. But if they aren’t, oats and barley, so things that have naturally beta-glucans in them are good for immune health. Let’s see, I’m thinking of my handout I use.

Dr. Weitz:             Cruciferous vegetables.

Dr. Lucas:             Yeah, cruciferous vegetables I typically think of as more hormone balancing, detoxifying, healthy cell cycle support, as opposed to… I mean, yes, I’m sure they’re helpful for the immune system, but they are so… They possess so many potent phytonutrients in them that actually have direct anti-growth properties, rather than getting after the cancer with immune stimulation.

Dr. Weitz:             Ground flax seeds?

Dr. Lucas:             Ground flax seeds, anti-inflammatory of course, both soluble and insoluble fiber, so food for the microbiome, which is good for the immune system. It also binds up in the case of hormone positive breast cancer or prostate cancer, really helpful with balancing the hormones. So binds up excess estrogen in the gut, those kinds of things.

Dr. Weitz:             What about coffee? Is coffee, a good food for cancer?

Dr. Lucas:             Coffee. So having lived in Seattle for many years, so I have my biases.

Dr. Weitz:             The home of Starbucks.

Dr. Lucas:             Yeah, I’m actually not a coffee drinker myself, but I find, and one of the founders of Vesti, Dr. Mitchell, the first thing he used to say was don’t mess with people’s ceremony. So for me, if coffee is good quality for my patients, if it’s organic and it doesn’t cause GI upset, or adrenal or nervous system upset, then I tell them one cup of coffee’s okay. I’m not a big fan of milk or cream in it, just because of insulin-like growth factor and some of the concerns around milk and cancer growth. So I recommend other alternative milks if they want to do that. But one cup a day-

Dr. Weitz:             I mean, there have been a number of studies showing coffee consumption associated with lower risks of particular types of cancer.

Dr. Lucas:             There have been, although in a lot of those studies, when you dig deeper and you look at the actual diet that some of those people were on, coffee was one of the biggest antioxidant foods that was in that population’s diet. So for me, yes, I think there may be a benefit there, but I’m not convinced that we need to all start using it as a medicinal. I think that a small amount is okay.

Dr. Weitz:             Well, what do you think about antioxidants? Antioxidants have been controversial. I’m thinking of that famous rant about antioxidants by Dr. Watson, where he talked about how antioxidants, and I guess now we’re talking especially about supplements, would just totally uncouple any chemo or radiation, and would be really harmful to a cancer patient. And I guess this is especially for patients who are undergoing treatments, conventional treatments, like radiation and chemo.

Dr. Lucas:             Yes. And this is definitely can be a hot topic, but I find that if somebody’s eating a balanced diet, they’re getting plenty of antioxidants from their diet. I don’t supplement. So first of all, the word antioxidants, I have an issue with, because so much of what we eat that’s in the plant world is full of antioxidants.

Dr. Weitz:             Absolutely.

Dr. Lucas:             So if you tell somebody not to take vitamin C, but then you have half of a red bell pepper, but you don’t tell somebody they can’t eat half of the red bell pepper, there’s an issue there for me, in terms of-

Dr. Weitz:             Yeah, or a cup of blueberries, which probably is 20,000 times the amount of antioxidants as this vitamin C tablet.

Dr. Lucas:             Yes. Yes. So even just that idea for me misses the mark. If there’s a study that shows that vitamin E is synergistic with the chemotherapy, I’ll use that vitamin E with that treatment. Not because it’s an antioxidant, because the study showed that it helped with cell cycle, or the study showed that it prevented or helped to decrease neuropathy, and didn’t affect the efficacy of the drug. So I don’t give, in quotation marks, “antioxidants”, because I think they’re cancer fighting. I think if you have a diet that’s high in phytonutrients, you naturally are going to have more antioxidants, but that’s just the tip of the iceberg of the benefits of plants. So I avoid the… A lot of times if I get, for example, a radiation oncologist, they’re the ones who are most sensitive to this.

And granted, their treatment is an oxidative treatment. So theoretically I understand why they would say that, but I don’t give a lot of antioxidants during radiation, not because I couldn’t, but because they aren’t necessarily the things that I find that work the best to support patients. So I don’t consider them as a block. I have run across some interactions with some of my colleagues, and there’s actually been some really nice, I would say, rebuttals to that thought that don’t give antioxidants during treatment, but clinically I have not found it an issue. But I also don’t give them in high dose. Not because I don’t need them, I use plants instead.

Dr. Weitz:            Right. Okay. So one of the issues for cancer patients, especially if undergoing chemo, is they may lose their appetite and stop eating. And we don’t want cancer patients, especially if they’re thinner, to lose too much weight, especially if they’re in that wasting stage. And do you have some tips for helping patients with this?

Dr. Lucas:             Sure, sure. So there’s a few botanicals that I use to help support digestions. So I use ginger, I use fennel, I use a bitters tincture. So these are things I recommend. If patients are open to it, medical cannabis for appetite and things like that. I find if we do a combination of some of the other herbs and low dose cannabis for appetite, that can be really helpful. Some patients do find with just the regular herbs, like some of the carminative herbs and bitters and things. So that’s what I typically will say for appetite.

Also exercise for me is very important, not exercise like, okay, even though you’re exhausted, I want you to go to the gym. I’ll say, “I want you to go for a walk. Even if it’s really slow, I want you to roll your yoga mat on the ground, and just, even if it’s inhale arms up, exhale, arms down,” getting the circulation moving really is supportive for that. And I always tell patients if exercise was a pill, it would be extremely expensive, and everybody would want to take it because it can be so helpful. I can’t underline that enough. So I encourage patients to have activity, and to support their circulatory health. And then as far as nutrition-

Dr. Weitz:            If they have the energy and want to, it’s fine for them to lift weights and go to the gym?

Dr. Lucas:             Yeah. Yeah. As long as it’s… I mean, I don’t, unless I have a patient who was doing that prior to diagnosis and treatment, I won’t advocate that they go out and start that. But for most people, if there was something they were doing before that made them feel good, I’ll always say, okay, start really slow, like 50%, even 25% of what you used to do, and then build on that. Because conventional treatments dramatically affect people’s stamina. So if they go back into the gym thinking they’re just going to go back… And it’s also disheartening, they’ll go back into the gym and be like, “Ugh,” but your body during those treatments is using a lot of its energy for repair. So that’s okay. There’s nothing pathological about that, but they might not have the bandwidth to then go out and do their regular workout.

So my rule of thumb is five days a week, 30 to 60 minutes. That may look like a very slow stretch for 30 minutes, but definitely that consistency makes a big difference. And then nutritionally keeping that balance is important. A lot of times, in the conventional world, people will say, eat whatever you want, lots of carbs, but for me, if you really want to build protein, if you really want to build muscle, if you really want to get your stamina back, you need both that nutritional balance of protein and complex carbs. And then also a lot of the inflammatory mediators that are kicked up in the body from the cancer itself and from the treatment cause weight loss. And so going after that with something like fish oil or melatonin, tumor necrosis factor is a big one for that. So what are the things that we could use supplementally that will actually decrease that cachexia moment for patients? Most patients-

Dr. Weitz:            By the way, most patients, would you mention dosage for fish oil and melatonin?

Dr. Lucas:             Yeah. So 2000 milligrams of EPA plus DHA is typically where I feel is a safe dose to start. If people are on blood thinners and they get easy bruising, or if they’re going into surgery, I’ll have them stop it for a week beforehand. So I’ll make sure that there isn’t any… Some people are quite sensitive to the anti-inflammatory or that decreasing blood viscosity aspect of fish oil. So I’ll watch things closely if I think there’s somebody who might be sensitive to that. But typically 2000 milligrams of the actual EPA and DHA. And I always counsel patients look at the bottle because it will tell you 2000 on the front, and then on the back, you realize there’s only 500 milligrams of the actual EPA and DHA in the capsule. So the details are important on that one.

Dr. Weitz:            And for the melatonin use 20?

Dr. Lucas:             I used to use it as a rule, and then one of the founding researchers gave a talk at one of our naturopathic oncology… Our founding melatonin researchers came and gave a talk at our oncology conference. And she definitely made me reflect about whether I needed to use 20. And that was maybe five years ago. So I use anywhere from three to 20, depending on the patient and depending on their tolerance. Some people don’t tolerate it. So I don’t often give it, as a rule, 20 to everyone.

Dr. Weitz:            What other nutritional supplements should cancer patients be taking?

Dr. Lucas:             So vitamin D of course is my number one in terms of the ease of testing. You get a blood test, you see where your numbers are. My recommendation is to shoot to get between 60 and 80 in the blood test. I also think that zinc can be incredibly important. This goes into some of the blood tests that I use. I do test serum zinc on patients. Most patients I find-

Dr. Weitz:            Do you look at that zinc copper ratio?

Dr. Lucas:             I do sometimes, if I think there’s more of an angiogenic piece, I’ll look at copper. That’s part of my baseline labs that I do for patients, zinc and copper, and try to make sure the copper’s low and the zinc is high.

Dr. Weitz:            Maybe could you go over your basic cancer panel lab test?

Dr. Lucas:             Sure. Yeah. Yeah. So I like a CBC with differential so that I can look at the neutrophil/lymphocyte ratio. I like a chemistry so that we can look at kidney and liver function-

Dr. Weitz:            Maybe you can just talk a minute about the neutrophil/lymphocyte ratio?

Dr. Lucas:             Yeah. And that one’s one that I’ve watched for a long time, and I’m still on the fence about it to be… I find that in some patients, if I see that ratio start to change, I look at the inflammation. I look, is there anything that they’re fighting? In some of my patients who have chronic viral infections, sometimes we’ll see their lymphocytes go up, so that ratio will be off. So there’s a lot in there. Neutrophils, of course, they’re the more acute inflammation. They tend to be higher in active disease, lymphocytes, not as much. They’re more to go after viruses and things like that.

So looking at that, I do find if the neutrophils are starting to go up and it’s not a two to one ratio, and it’s becoming quite skewed, then that gives me an alert that potentially something’s going on. Although lately, and I don’t know if this is a whole nother topic, but I don’t know if it’s COVID related, I’ve really seen lymphocytes go up in a lot of people. So that may be related to that. So I look at that in CBC. Chemistry, I like to look at total protein and albumin just to make sure that people are actually absorbing what they’re taking in, looking at liver enzymes. I also look at LDH, that’s sort of a surrogate tumor marker for cellular turnover.

Dr. Weitz:            Okay. LDH is a tumor marker. So what would be the key level you would be concerned with on LDH?

Dr. Lucas:             For me, it’s more the change.

Dr. Weitz:            Okay.

Dr. Lucas:             Right? So if somebody was at 100 and they were at 100, and then all of a sudden we started seeing it go, oh no, it’s 125, it’s 150. Okay, it’s over 200. For me it’s about that change. If somebody’s been at the same level their whole time, fulminant disease diagnosis, surgery, treatment, and they’re always at the same level. That’s not necessarily a good marker for them, but I like to look at… A lab test is only as good as what I can compare it to with those kinds of tests.

Dr. Weitz:            By the way, have you noticed on liver enzymes that some of the labs have raised their reference ranges?

Dr. Lucas:             I have. I have. I was like, wow, is that really in the low 50s now, I think for one of them?

Dr. Weitz:            UCLA now has 70 and 65 as the reference range for ALT and AST.

Dr. Lucas:             Oh, see, I haven’t seen that only in the 50s for AST or ALT, just the other day.

Dr. Weitz:            Yeah.

Dr. Lucas:             But I like to look at those-

Dr. Weitz:            So my conclusion is after two years of people staying home in the pandemic and drinking more, we now have a higher reference range.

Dr. Lucas:             Irritated livers. Yeah. No kidding. No kidding. So I’m trying to think of what else I do. A high sensitivity CRP, fibrinogen, those look at inflammation for me. Hemoglobin A1C, fasting glucose, fasting insulin.

Dr. Weitz:            So for CRP, what do you consider the key number to look at? Are you concerned if it goes above one? Do you want to see it below 0.5? What…

Dr. Lucas:             I think below one is optimal.

Dr. Weitz:            Okay.

Dr. Lucas:             If somebody is going through treatment and they’re doing a treatment that’s pretty inflammatory, we might see it go outside of that range, but I want it to come back.

Dr. Weitz:            Okay.

Dr. Lucas:             I want it to come back into that below one.

Dr. Weitz:            And what about for fibrinogen?

Dr. Lucas:             Fibrinogen depends on the lab too, because there’s a couple different tests, but that’s for me like LDH. I really like it to be, I think one of the labs I use, I don’t like it to be above 200. Sometimes it can go a little bit higher into maybe 250, something like that. Or if somebody’s, of course, I had someone the other day it was 400. That to us was like, something’s going on here.

Dr. Weitz:            Okay. And then what are the rest of the tests you like?

Dr. Lucas:             So serum zinc we talked about, and I like people to be above 80 if possible. Most people post chemo are low. They’re actually deficient. Because I think you just in terms of cellular repair, especially in the gut, you use a lot. And then B12 I’ll do, and I’ll also do-

Dr. Weitz:            Do you look at MMA?

Dr. Lucas:             I do sometimes. Although, because I have a lot of patients who are working with a medical oncologist, and we’re trying to get some of the tests done that will be covered, sometimes I get a little pushback on that. I find that the B12 is a good indicator for deficiency, because that test is not very… It captures a lot of things other than B12. So if somebody’s serum B12 is low, then we really know they have a deficiency because it’s capturing other things in addition to the B12. But if somebody’s B12 is 1000, I don’t run to the hills and say, “You’re taking too much B12.” So I’ll often use that as a real screen for deficiency.

Dr. Weitz:            Homocysteine?

Dr. Lucas:             Homocysteine I go back and forth on whether I… There have been times where, years ago, I tested it on everyone, and I didn’t really find necessarily a correlation that was helping me clinically, but typically under 10, something like that.

Dr. Weitz:            Okay. Any other tests?

Dr. Lucas:             Let’s see, I do some more extensive testing if it seems indicated for patients. So I’ll do some microbiome testing, if there’s a chronic [inaudible 00:46:11]-

Dr. Weitz:            [inaudible 00:46:11].

Dr. Lucas:             Or I’ll do NutraEval, if I think that a patient just isn’t able to get into the eating rhythm. And so sometimes if we see deficiencies and then it’s there in paper, that tends to be inspiring for people.

Dr. Weitz:            Right, right. Do you look at galectin-3 as an inflammatory marker?

Dr. Lucas:             Sometimes. Sometimes. I use a fair amount of PectaSol because so many of my patients are doing a modified citrus pectin, because so many people are doing biopsies and surgeries, and I’ll often use that around the time when there’s more risk for tumor spread.

Dr. Weitz:            Right.

Dr. Lucas:             So a lot of patients are on it anyway. And so many labs I’ve had difficulty getting it sometimes. So for me, decreasing the stress to the patient around labs, in terms of out of pocket costs. I know in a perfect world, I’d do all kinds of tests, but over the years of working in this integrative model, I try to-

Dr. Weitz:            So on the modified citrus pectin, are you doing 15 to 20 grams a day?

Dr. Lucas:             Yes. When it’s really acutely around a biopsy or a surgery. I have some patients who’ve done very well with maintenance dosing, where they do a teaspoon, which is about 10 grams. Thankfully some of the companies now make them that taste better. So compliance has been a lot better with that. Because I do think that can be quite helpful.

Dr. Weitz:            Yeah. I think the lime is much better.

Dr. Lucas:             I know it’s just… I had some patients who refused. I’m like, “There’s a new flavor. Thank God.”

 



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Dr. Weitz:            You mentioned modified citrus pectin. Are there any other supplements that you think have some particular amount of anti-cancer properties? I’m thinking of curcumin? I don’t know if you’ve worked with fermented wheat germ extract, some of the particular medicinal mushroom supplements, AHCC, or some of the others.

Dr. Lucas:             Yeah. So for medicinal mushrooms, I do a rotation for patients. So I only use one mushroom at a time because some of the research has shown that the benefits start to decrease after about three weeks. They don’t decrease to zero, but they start to wane. So I’ll have somebody on one mushroom for two months, and then we’ll change to a different one. So I do reishi, turkey tail, cordyceps, agaricus, lion’s mane, but I’ll always take into account what the diagnosis is. So if there’s a little more research on turkey tail, is it possible that having aromatase inhibiting properties, I might start a breast cancer patient on that first. And then if they have blood sugar issues, I might say, okay, let’s do maitake next, because each one of the medicinal mushrooms is good for the immune system, but they all have their affinities.

So reishi can be good for the heart… So it’s one of those things where I try to tailor it to the person as well, but I rotate them. And then I do use a lot of curcumin, also whole turmeric root in cooking and in teas. I like the whole plant combined because curcumin is only… Five to 8% of turmeric is curcumin. So if you look at some of the epidemiological studies on people who eat a lot of turmeric, it’s not because they’re taking curcumin supplements all the time. It’s because they’re eating the whole plant. So I encourage people to…

Dr. Weitz:            So there’s all these specialized forms of curcumin. Which one do you prefer?

Dr. Lucas:             So I rotate those as well, because I find if you look at who’s paying for the studies, it’s typically the person who is making that particular compound. So I use Meriva, I use was it BCM 95? I use Theracurmin. So I rotate those as well, but I have found that some of the curcumin supplements that have black pepper in them are irritating to the GI.

Dr. Weitz:            Yes, absolutely. I don’t use those anymore.

Dr. Lucas:             So I stopped doing that, but curcumin is very, and turmeric, is very well absorbed. And there are studies on this as well with fats, with albumen, with soy. So with ginger, with boswellia. So I’ll often give patients a list of, whenever you’re taking your turmeric or your curcumin, make sure that you have it with one of these things that will help with the absorption at the time. So it’s not so much, yes, the supplements can be quite helpful in terms of more absorbable forms. But I think it’s also, what does the patient consume with the supplement as well. Green tea.

Dr. Weitz:            What about the fermented wheat germ extract?

Dr. Lucas:             Yeah, the one that I’ve used the most of is Avemar, and I don’t even know if it’s made anymore. It was prohibitive for a lot of my patients. I found it to be quite helpful.

Dr. Weitz:            But very expensive.

Dr. Lucas:             Yeah.

Dr. Weitz:            I believe it’s made, and I think there’s a one called OncoMAR, which is…

Dr. Lucas:             Yeah, yeah, yeah. So I don’t use that as much. I used to, but I have found just other things that have… If we’re looking for immune support, anti-antigenic, hormone balance, there are other things that are less… And compliance wasn’t as good with that one, either because of the taste. Some other supplements, I keep trying to talk about green tea because it’s one of my favorites.

Dr. Weitz:            Yeah. How many cups of green tea should cancer patients have a day?

Dr. Lucas:             So because of the caffeine content, and there are more polyphenols in the caffeinated tea because some of the polyphenols are lost in the decaffeination process, you can’t push it too far in terms of the cups of tea, without running into the caffeine problem of not being able to sleep or increasing anxiety. Even though green tea has L-theanine in it, which is calming for a lot of people, it’s just not enough. So I’d say one to four cups of green tea as tolerated, organic, if possible. And then I use green tea supplements, a decaffeinated green tea supplement that’s a high polyphenols extract that’s the equivalent of two cups.

Dr. Weitz:            Okay.

Dr. Lucas:             So if I’m trying to get to… It’ll also depend on the diagnosis. So if this person has a diagnosis that’s more sensitive to angiogenesis, I’ll really bump up the green tea, or if they have a chronic leukemia, there’s actually been some studies on green tea polyphenols actually treating chronic leukemias. So I’ll really bump up the dose. And the only way to do that’s with the capsules.

Dr. Weitz:            You put most of your patients with cancer on a multi?

Dr. Lucas:             I don’t. I don’t. I’m not a big fan of multivitamins unless a person has a poor diet and I’m trying to just cover the bases. Because multis, they try to put everything in there. They’ve got oxidants next to antioxidants. They usually try to throw in some enzymes, and for me, it’s a mixed bag. It’s a lot of things at not a very high dose. And so I prefer to say, if you need B6, let’s test it and give you B6. If you need iron, let’s test it and give you iron. Because people can feel pretty poorly with taking those multis. They can make them nauseous, or a lot of them have copper in them. So I tend to focus on capsule real estate. If I could take two or three capsules out and replace it with some herbs, I will.

Dr. Weitz:            Lise Alschuler came out with one that’s specifically designed for cancer patients.

Dr. Lucas:             Yeah. They’re usually without iron and without copper, but I still find if patients are… I find you can only get so much from your foods, and unless somebody’s really depleted, I’d rather track down where their deficiencies are and just treat that, and not try to give them a bunch of things that they may not need.

Dr. Weitz:            What about supplements that can help counter some of the side effects of chemo?

Dr. Lucas:             Yeah. So I’m very active with cardiovascular support with certain chemotherapies that are hard on the heart, anthracyclines and Herceptin, those kinds of things. So I use a lot of CoQ10, Hawthorne extract, those kind of heart supports. L-carnitine sometimes if it’s indicated. Neuropathy is a huge area where that really can be very challenging for patients with taxanes. I’ll use L-glutamine. I’ve been using that for years. And sometimes I get pushback on that, in terms of the L-glutamine piece, are we feeding abnormal cells? And honestly, I find people are so depleted during treatment, and they’re burning through it so quickly. When you give L-glutamine, not in… You can give up to 30 grams per the studies. I never give that much. I start at a teaspoon, and then if we need to give more, we can.

But most patients, especially with the taxanes and something like oxaliplatin, I might start them on a little L-glutamine. And then if we need to add something else I might add alpha lipoic acid. I have some topical treatments that I actually make for patients that are different herbs, like boswellia, St John’s wort, arnica, rose hip seed, those kinds of things that can be really helpful for neuropathies as well. And really GI health. That’s that’s also a really big one that comes up with treatment, that whole constipation/diarrhea spectrum of anti-nausea medications causing pretty severe constipation. So magnesium, I use a lot of magnesium for patients. And that sometimes can be amazing for them because magnesium’s good for pain. It’s helpful if you’re on a platinum medication. And so I try to, if we can choose an intervention that will hit a few targets, rather than say, okay, use a stool softener, let’s actually use something that’s going to give you some benefit.

Dr. Weitz:            So what about fasting for cancer patients? And I know even some of the conventional oncology centers will have patients fast around their chemo infusions, before or during, after…

Dr. Lucas:             Yes, yes. I think it can be very helpful. And I’ve had patients, I advocate that for some patients. Constitutionally, some patients tolerate it better than others. If a person is really having issues with weight loss, and they’re really having some low blood sugar problems, then that would not be my ideal patient to do that with. But I really find if we do, I usually do a vegetable broth fast, and not a water fast. And some of my patients do water fast, but if that’s too much for them, we’ll just switch to vegetable broth. I’ve actually seen somebody on the same chemo with and without the fast have a much better… and this has happened a few times… have a much better response to treatment, and a lot less GI symptoms, a lot less nausea, less diarrhea/constipation, all of that. So I definitely in the right circumstances-

Dr. Weitz:            And so what would you say, fast for two days before chemo and a day after? Or what type of regimen do you like?

Dr. Lucas:             Yeah. If it’s their first treatment, I might, depending on the person, not have them do a long fast, because there’s already so much going on in one’s mind at that time. So I’ll say start at one o’clock the day before treatment, fast from one o’clock that day and the whole day of treatment, and then you can start eating at one o’clock the day after treatment. So it’s about a day, day and a half, and see how that goes. You can definitely, I mean, the research is on longer fasts than that. Depending on the patient that can be quite taxing. So I see how it goes with the short fast, and then we extend there if possible.

Dr. Weitz:            How long will you extend it till?

Dr. Lucas:             Two days before, day of, and day after. So I mean that’s the longest I’ve ever done, and that was in patients… I’m thinking about a few patients who were really committed to it, and they did not have a concern about weight loss, or blood sugar issues, or things like that. I think safer ways… I mean, and in terms of people reacting to fasting around treatment, it can be a little bit… It can be pretty intense. So I prefer, I do an intermittent fast, I’ll have people do a long fast between dinner and breakfast, at least 13 hours. That’s where the literature is. Some of my patients will do a 16 hour fast between dinner and breakfast. I advocate for eating earlier, due to the blood sugar control piece of eating an early dinner, early dinner, early breakfast, so you can get 16 hours that way. Or if patients really want to fast and they can’t tolerate it around treatment, I’ll do a fasting mimicking diet type fast, a la the longevity diet, with Dr. Longo, something like that.

Dr. Weitz:            Right. What about a green smoothie for patients who have trouble eating or having trouble keeping the weight on, as an alternative, for example, to something like Ensure?

Dr. Lucas:             Oh gosh. Yeah. So, I mean, thankfully there’s at least some organic options now. They’re not all that great, but at least they don’t have high fructose scorn syrup in them. So yes, smoothies. Although I like to follow that protein, fiber, healthy fats, because just eating a bunch of greens isn’t going to do much for weight gain.

Dr. Weitz:            Yeah, no, I mean a smoothie as a way to throw in a lot of things, healthy fats, supplements…

Dr. Lucas:             Yes. Although I really advocate for making them small, because when you’re a patient and you are not hungry, and somebody presents you with a large green container, you’re going to have three sips, and it’s too full of too many things. So it’s not going to do anything for you. So I have a whole handout I give patients on a protein shot, or a nutrient dense shot, where I’ll tell people one tablespoon of protein powder, half cup liquid, one tablespoon of blueberries, three leaves of spinach. Just so that it is approachable. And then maybe you can have that a couple times a day. So I could say beware of the large smoothie with patient compliance, it’s disheartening for them.

Dr. Weitz:            Great. I got it. So I think those are the questions that I had prepared. Do you have any other things that you’d like to discuss?

Dr. Lucas:             Yes, I would. I would leave with this. One of the things that I give to every patient, and it’s often something that can be the most important thing for patients, is a breathing practice.

Dr. Weitz:            Okay.

Dr. Lucas:             So every patient I see, I advocate that they do 20 minutes of abdominal breathing. We grow and expand from there as somebody might get that foundation. But everything we’ve talked about today, blood sugar balance, decreasing inflammation, increasing immune function, balancing hormones, helping with sleep, energy, digestion, is supported by that practice. So if there-

Dr. Weitz:            Is there any particular breathing strategy that you like to use?

Dr. Lucas:             Yes. I start very simply for patients, abdominal breathing. So inhale belly out, exhale belly in, and I have patients either sit or lie down feet flat on the floor, elongate the spine, chest and heart center open. So you inhale belly out, exhale belly in, and then inhale belly out, exhale belly in. And then one more time, I have them do it at their own pace. And then I have them relax, just breathe normally. And then maybe a few moments later, again, three of the belly breaths, inhale belly out, exhale belly in. It can be one of the most potent treatments for people on every level. And it just grows with them.

Dr. Weitz:            Do you have them breathe in through the nose and out through the mouth, in through the mouth and out through the nose, or hold their breath?

Dr. Lucas:             In and out through the nose.

Dr. Weitz:            In and out through the nose. Okay.

Dr. Lucas:             And I don’t do breath holding.

Dr. Weitz:            No breath holding.

Dr. Lucas:             Breath holding is a much more advanced yoga practice. And it tends to cause a rise in stress hormone. When you hold your breath, especially if you’re new to it, you’re going to get an increase in stress hormone because you’re holding your breath. So what I like to do is start with this just very simple, abdominal breathing practice, powerful, simple, but powerful. Once people are doing this regularly, then we can expand into breath holding. You can do alternate nostril breathing. You can start to often do a visualization with the breathing practice. So it’s free, it’s always with you, and it’s very powerful. And so that for me is the most important thing.

Dr. Weitz:            You just mentioned stress. I’ve seen some studies correlating flattened cortisol curve with worse prognosis with cancer. Do you do the salivary cortisol testing and take a look at that?

Dr. Lucas:             I do a 24-hour urine. So we actually look at the whole cortisol arc with a urine test, or I’ll do a morning cortisol if we’re doing a blood test. And yes, I do look at those. And it’s interesting because if you really hear the way somebody’s day goes, often those tests are not that surprising, and they can be very validating for people to say, “Wow, this is why I’m tired at 3:00 PM,” or, “Wow. I wake up really tired, but by the time I get going, then I’m fine.” So I do that… That’s actually a test I do very frequently. I use the Dutch test that combines all the hormones and also the full cortisol arc. So, yes.

Dr. Weitz:            Okay, cool. And then use adrenal support?

Dr. Lucas:             Yes. Yes. All of the botanicals. So American ginseng, tulsi, Siberian ginseng, schisandra.

Dr. Weitz:            And of course that helps you with analyzing estrogen metabolism, for working with patients with estrogen related cancers.

Dr. Lucas:             Absolutely. Because estrogen is… It gets a bad rap, but it’s really how do we metabolize it that really creates the problems. So looking at the estrogen metabolism, things like 2:16 ratio, 4:16 ratio, those kind of things.

Dr. Weitz:            Right. Okay, great. So how can viewers and listeners get a hold of you, contact you?

Dr. Lucas:             So I have my website, DrHeidiLucasND.com. And then I also have my Instagram, which is DrPlantsRants. And I try to put videos on there, and work with some of the sustainable agriculture, organic food aspects of some of the choices we’ve talked about today, too.

Dr. Weitz:            Great. Thank you, Heidi.

Dr. Lucas:             Yeah. Thank you for having me.

 


 

Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness Podcast. And if you enjoyed this podcast, please go to Apple Podcasts and give us a five star rating and review. That way, more people will be able to find this Rational Wellness Podcast when they’re searching for health podcasts. And I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition Clinic. So if you’re interested, please call my office, (310) 395-3111, and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you, and see you next week.

 

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