Integrative Approach to Cancer with Dr. Nalini Chilkov: Rational Wellness Podcast 357

Dr. Nalini Chilkov discusses An Integrative Approach to Cancer at the Functional Medicine Discussion Group meeting on March 28, 2024 with moderator Dr. Ben Weitz.  

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Podcast Highlights

4:08  The relationship between cancer and obesity and glycemic control is huge.  Patients who are obese, have hyperglycemia, and hyperinsulinemia have a 40% increased chance of being diagnosed with cancer and have a 40% increased chance of a cancer recurrence.  Both insulin and insulin-like growth factor that are actually proliferative signals.  And tumor cells have more glucose, more insulin-like growth factor receptors, and more insulin receptors than normal cells.

7:34  The United States is a sugar nation and diabetes and obesity continue to rise here.  Obesity accounts for 14% of cancer diagnoses in men and 20% in women, and its higher in women due to the estrogenic effect of fat.  Some cancers are more directly linked with these signally pathways, including GI cancers like colon, gastric, gall bladder, and pancreatic cancer, liver cancer, endocrine cancers, Hodgkin’s Lymphoma, Multiple Myeloma, and renal cancer. There are biomarkers that we can measure to evaluate the cancer terrain in the tumor microenvironment. By identifying these signally patterns, including glycemic control, inflammation, and obesity and making changes to their diet and lifestyle, we can help patients to have better outcomes and have less chance of recurrence. 


Dr. Nalini Chilkov is the founder of the American Institute of Integrative Oncology Research and Education and the creator of the The OutSmart ® Cancer System.  It is her mission to change the face of cancer care so that every patient has a plan for their health and not just a plan for their disease at every phase of the cancer journey. She is committed to training front line clinicians worldwide to become skilled and confident in serving the health needs of patients whose lives have been touched by cancer by utilizing her OutSmart Cancer® System. She is the author of the best seller, 32 Ways to Outsmart Cancer_How to Create A Body Where Cancer Cannot Thrive and is recognized as an authority and pioneer in the fields of Integrative Cancer Care, Cancer Prevention and Immune Enhancement. Dr. Chilkov has lectured worldwide and at the Schools of Medicine at UCLA and UC Irvine and is a frequent expert resource to the media.  Her websites are Nalinichilkov.com and the American Institute of Integrative Oncology.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their 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.

                        I want to introduce our speaker, Dr. Nalini Chilkov. She’s the founder of the American Institute of Integrative Oncology Research and Education, and she’s a creator of the OutSmart Cancer System. It’s her mission to change the phase of cancer care so that every patient has a plan for their health and not just a plan for their disease at every phase of the cancer journey. She’s committed to training frontline clinicians worldwide to be skilled and confident in serving the health needs of patients whose lives have been touched by cancer by utilizing her OutSmart Cancer System. She’s the author of the bestseller, 32 Ways to OutSmart Cancer: How To Create A Body Where Cancer Cannot Thrive. And she’s recognized as an authority and pioneer in the field of integrative cancer care, cancer prevention, and immune enhancement. Dr. Chilkov has lectured worldwide and it’s a frequent expert resource to the media. Thank you, Dr. Chilkov.

Dr. Chilkov:        So, we’re going to be an intimate group, so I’m going to ask you to move to the center. I’m going to ask you to come so I can just look at one place and we can have eye contact and since it is a small group, we can be more interactive. So, while I’m lecturing you have a question, just raise your hand and I’ll be happy to answer it. Otherwise, I’ll also leave time at the end. So, we’re going to talk about cancer, and insulin, and obesity. And I particularly like to give this lecture to primary care clinicians because we have such an epidemic of metabolic syndrome, and obesity, and diabetes in our country. And this really causes a large group of patients to be at high risk. So, we’re going to talk about that and then some of the interventions that I use and some of the assessments that I use. And I think it’s really important in a primary care practice to be aware of this.

                        This is part of a online training that I have for primary care and frontline clinicians. So, if you get really inspired tonight, you can reach out. We’re happy to talk to you about my course. It’s self-paced. And then I also have a mentorship group for those people who want to have you review your cases and help you through them. And it’s a pretty engaged group. It’s a wonderful community that we have once a month online together. And also you can have a big discount by attending this. So, if you’d like that, you can just email us. I’ll give you my email address if you want to get the PDF of this lecture or you want more information about the course with the discount. And also, do you give people a PDF of the lecture?

Dr. Weitz:          What’s that?

Dr. Chilkov:       Do you give them a PDF copy?

Dr. Weitz:          I can.

Dr. Chilkov:       Yeah, so you can have the lecture slides. And I have this little handout that’s really nice to give to patients so that they can understand how to eat if they’re diagnosed with cancer. And so, it’s just like a checklist. It’s a one-page handout. If you’d like to have that for your practice, then you can have that, too.

Dr. Weitz:          All right, yeah, please give me your PDF, I’ll put it in my list.

Dr. Chilkov:       Well, I have one so we can send it to you.

Dr. Weitz:          Okay.

Dr. Chilkov:       We can just send it to you.

Dr. Weitz:          Okay, sounds food.

Dr. Chilkov:        All right. So, if you memorize this slide, you got the lecture. Okay. So, the relationship to cancer, obesity and glycemic control is huge. Patients who are obese, patients who have hyperglycemia and hyperinsulinemia have a 40% increased chance of being diagnosed with cancer and they have a 40% increased chance of having a recurrence. So, it’s a teaching moment for people. And people come into our practices at every stage of their cancer journey. So, wherever they come in, it’s a teaching moment as far as I’m concerned. So, if you look at these relationships, of course lifestyle is a contributor to all of these. But when you have insulin resistance and hyperinsulinemia, you have this driving force that has growth factors. And so, it’s insulin and insulin-like growth factor that are actually proliferative signals. And tumor cells have more glucose, more insulin-like growth factor receptors than an insulin receptors than normal cells. So, that’s why cancer is exquisitely sensitive to changes in blood sugar and insulin.

Dr. Weitz:          There’s one thing missing from the slide. Where’s Ozembic?

Dr. Chilkov:        That’s a whole other discussion, isn’t it? But it is interesting. It is interesting because when people have more normal body composition, less percentage body fat, more glycemic control, more normal insulin, more normal blood sugar, they don’t have the signaling going on. So, that population, that obese and diabetic population, is not only decreasing their risk of cardiovascular disease, which has been in the news, but they are also decreasing their risk of cancer that is driven by these pathways. Not all cancers. And some cancers are more explicitly sensitive to glucose. I have some slides on that for you. But at any rate, so you can measure fasting insulin and insulin-like growth factor one when you do labs on people. And then of course we know that people who are diabetic and obese also have more inflammation. And we also know that there’s a hormonal component, which I’m going to show you that as well.  So, this is essentially what we’re going to talk about. And it’s pretty daunting the amount of people in the world that are impacted by this. And so, that’s why I think it’s really important for primary care and frontline clinicians to be aware of this. And what’s true is that one in two adults with diabetes is diagnosed. So, these people are running around with higher risk, many comorbidities. And so, I think it’s really important for primary care clinicians to be aware of this. And these are just some statistics that are so really depressing. I want to read them to you. But if you look at the darker colors on this, the dark countries, that’s where the highest rates of diabetes are. So, welcome to America. All right.

                        So, this is the curve of the acceleration of diabetes in this country. United States is a sugar nation really. We teach kids to have a sweet tooth, really young. And so, it’s really a problem. So, what we’re going to talk about is first obesity being a major risk for cancer. And of course that goes along with diabetes. But not always. Not always. So, obesity is related to 14% of all cancer diagnoses in women in and… 14% in men and 20% in women. It’s higher in women because of the estrogenic effect of fat. So, that’s pretty daunting. And also, I just want to point out this book. Although it was published a long time ago, I recommend it because it has this really clear explanation of the physiology that we’re talking about. So, if you just want a really good reference to read in more in detail these signaling pathways, it’s just really well-written basically.  And so, if you look at, these are the cancers that are most linked to obesity. But you can see it’s a pretty wide range of cancers. It’s not just one category. So, you’ll see that there are GI cancers there. You’ll see that there are endocrine cancers there, liver cancer, and you can see Hodgkin’s lymphoma and renal cancers. So, it’s a wide range of cancers. So, obesity by virtue of changing the hormonal milieu, changing the inflammatory milieu, this is part of driving cancer. And one of the things we talk about in an integrative approach is oncologists are fascinating by the tumor, but they’re not fascinated by the biosystem that’s hosting cancer. And that’s what we need to be interested in. And so, we want to be interested in what we call the tumor microenvironment or the cancer terrain, which is the signaling environment that will either be proliferative or supportive of carcinogenesis, and proliferation, and progression of metastasis.

                        So, there are biomarkers that we can measure to evaluate that cancer terrain in that tumor microenvironment. And thereby, put a treatment plan together for the health side of the cancer equation. And that’s really what I teach. So, my mission, if you will, is not to train integrative or naturopathic oncologists, but it’s to train people like yourselves, how to monitor patients at every stage of the cancer journey and put together health plans, and identify these signaling patterns in their biosystem so that they also have better outcomes from their treatments, they have less chance of recurrence. And then we can restore their health and give them a biosystem that is not going to be supportive or hospitable to cancer development or recurrence. So, that’s the framework. And so, thinking about glycemic control, and inflammation, and obesity, and body composition is within that framework. Yes.

Speaker 3:         Is there a certain BMI, like is it BMI number 25 that presents this increased risk [inaudible 00:10:56]?

Dr. Chilkov:        So, the question is what about BMI? So, there’s no hard and fast statistics on that. I really think more about body composition. We know BMI is a waffley way too. But you could say 25. You could 25 is where there’s too much body fat. And then you get into because there’s more body fat and less muscle mass, then we get into all kinds of other metabolic issues. And think of the age demographic as well. So, the age demographic for cancer patients historically has been people over 50. Now we’re having an epidemic of younger people under 50 being diagnosed.

                        And in the press right now in the medical community go, “We don’t know why that’s happening.” But that’s a pretty lame comment because of course it’s environment, it’s body composition, it’s the endocrine disruptors in our environment, it’s stress, it’s sleep cycle, it’s all the things we know cause health or the lack thereof, make you vulnerable to multiple types of chronic illnesses. And cancer is a chronic illness. Cancer is not an urgent care. Cancer is not a short-term crisis. It’s a long term metabolic problem. It is a chronic illness and it has to be framed as such.

                        And if you look at it through that lens, you’ll address the whole biosystem and all the signaling, and the way that you are trained to practice already. If you keep looking through that lens, understanding what to pay attention to. So, these are some of the things we want to pay attention to. So, these are the cancers that are most associated with obesity. And so, you can see that they’re also diverse. It’s not kind of one category of cancers. But it is very interesting. Also, I think gastric cancer should really be on this list because gastric cancer is becoming more common, especially in younger people. And it is a cancer where error in fatty acid metabolism is part of what drives the cancer. And so, for example, sometimes we use statins off label for these types of cancers. And so, this in our country where obesity is such a problem is an issue. And should therefore be aware that you might want to be screening people more for cancer if they’re obese or have glycemic control issues.

                        So, I have a lot of slides. This is a longer lecture typically, so I’m not going to read all the slides to you. But if you want to get a copy of them and read the details, I think our time is better spent in dialogue than in me reading slides to you. So, obesity is a risk factor. And there’s other things that go along with that. If you have surgery and you’re obese, you have more complications, you have poor wound healing, et cetera. So, you’re at risk for secondary malignancies when you’re obese. There’s a higher mortality rate in obese patients. So, I want to give you the big concept so you can think it through with your patients.

                        So, here again, we have just what is the physiology that drives this? So, of course we all know that if you’re sedentary, you eat too much, you get obese. But of course we also know that’s not the only reason. It’s not just calories in calories out. So, want to identify metabolic issues in our patients. But if we are able to lower fasting insulin and lower insulin-like growth factor, we do get more control of cancer. And you can do that pharmacologically, but you can do it with lifestyle as well. And so, for example, if you lower your animal protein, you can lower your insulin-like growth factor.

                        So, it’s this tricky thing now since Gabrielle Lyon published her book, if you read her book on muscle medicine, the need to have adequate protein, which as we age to maintain muscle mass and to maintain metabolic health. And also because of the age demographic of cancer patients, we have a population of people who are potentially sarcopenic. And the physiology of cancer itself drives sarcopenia. Sarcopenia, the loss of muscle mass actually starts when you have a solid tumor. And you can’t see it, you can’t measure it, but it’s actually happening. So, it’s very important since obesity and glycemic control are related to muscle health and muscle mass to realize that all cancer patients are at risk for sarcopenia. And that be thinking about that right from the beginning because the oncologist is not. So, we want to be the team members, the collaborative team members that have this health model for the patient.

Dr. Weitz:          But this is a big dilemma. We want to give the patients more protein. It’s a great way to control glycemic balance, insulin.

Dr. Chilkov:        So, the best way is to exercise and increase your muscle mass. And of course you have to have the signal to the muscle, so you have to have enough leucine. So, I find that a lot of my cancer patients are exhausted and overwhelmed typically. And so, they’re not that interested in cooking or eating sometimes, especially if they’re in the middle of treatment. So, I use free-form amino acid powders, particularly branched-chain amino acid powders to give enough leucine to signal the muscle. That’s what I do. And so, you’re able to get adequate amino acids into people who aren’t interested in food or might not want to eat a lot of animal protein.

Dr. Weitz:          I often hear from vegans arguing a particular amino acid is going to increase your cancer risk. And pick different ones, methionine, glutamine, leucine.

Dr. Chilkov:        All right, well, that’s a little bit of a tangent, but I’ll [inaudible 00:17:24]-

Dr. Weitz:          Okay, sorry.

Dr. Chilkov:        … For a minute because we got to get through this lecture. So, cancer cells are smart. They co-opt our normal physiology for their own survival. And so, they do that in a variety of metabolic ways. But not all cancer cells do all these adaptions. So, there is a fear of glutamine in the misinformed community. And glutamine is the most ubiquitous amino acid in the body. It’s stored in the muscle. And if a cancer cell wants glutamine, it doesn’t have to go anywhere to get it. It’s all around. And so, if we want to give glutamine in order to heal someone’s gut because it’s been eroded by chemotherapy, it’s not going to change whether or not the cancer cell has access to glutamine. So, you still have to think of the whole biosystem.

Dr. Weitz:          You have Thomas Seifried recommending glutamine blocking drugs as part of this protocol.

Dr. Chilkov:        So, there are subset of tumor cells that shift into glutaminolysis. But you can’t block glutamine. It’s like junk science. So, that’s my opinion. So, now that’s on tape. So, the other thing is methionine definitely has a role in proliferation. But again, it’s not every cancer, it’s not every tumor cell line. And going on a low-methionine diet is very risky thing to do. And I am not a proponent of it. And for patients who are at the end of the line, they’ve become treatment resistant and they’re desperate to try something. There’s a subset of patients who respond to low-methionine diets, but those patients become extremely sarcopenic. Extremely sarcopenic. And so, we have a colleague who is in LA here who’s a big proponent of low-methionine diets. And I think if a patient wants to try it, they have to cycle on and off of it because otherwise they just become ill. There’s too many things that are methionine dependent, including your mood. So, these patients become extremely depressed and then they can’t be compliant with an already difficult protocol.

Dr. Weitz:          Thank you. One more quick question. Is there lab test-

Dr. Chilkov:        You can’t keep taking off [inaudible 00:19:53], okay?

Dr. Weitz:          Is there a number for IGF-1 labs that you like to see?

Dr. Chilkov:        I like it to be below a 100.

Dr. Weitz:          Below a 100?

Dr. Chilkov:        Yeah. So, that’s hard. So, that’s hard. Nasa Winters, who some of you are interested in cancer may know she’s a colleague of mine. 125 is reasonable. That’s doable. Completely [inaudible 00:20:11].

Dr. Weitz:          Valter Longo says below 175

Dr. Chilkov:        No, no. Valter Longo doesn’t know anything about health. He is a lab rat. He’s a lab rat. He is theoretical. He’s completely theoretical. I was just on a stage with David Sinclair and he’s the same way. If you guys know who David Sinclair is, it’s a longevity. So, he’s a brilliant guy, he’s like reductionist. And so, we have to be whole systems thinkers. That’s what causes [inaudible 00:20:38], is to understand the whole system. So, it’s great to have people that go deep into research. But Valter Longo and David Sinclair don’t know anything about health. Nothing. Nothing. They know about their pathway. I’ve met him, I’ve talked to them. All right, let’s not get lost. I’m barely through my slides.

Dr. Weitz:          Sorry.

Dr. Chilkov:        All right. So, Ben and I have known each other a long time. So, control yourself. So, anyway, these are the things that we can intervene, help people metabolically, put them on anti-inflammatory diets, teach them how to sleep, teach them how to exercise, teach them how to have a good body composition. So, all the things we already do already become more crucial in cancer patients. All right. So, I have tons of references in here for you. So, these things occur together, obesity and cancer. And diabetes and cancer also occur together. So, in bold are the more glucose and insulin sensitive cancers. And so, people always ask me also about a ketogenic diet. And I am not a fan of [inaudible 00:21:57]. There is actually not a lot of research to support ketogenic diets except in brain cancer and pancreatic cancer, which are the more glucose and insulin sensitive cancers. But a ketogenic diet is not a healthy diet. It is a therapeutic diet. And some patients cannot be on if you have a severe osteoporosis, if you have kidney disease, you cannot be on a ketogenic diet. And it’s a hard diet to maintain.

                        And one of the things I’m very sensitive to is that cancer patients don’t have a normal life, they feel socially isolated, and I want them to be able to even their friends and their family. And so, I don’t want them to become more isolated. And so, I only prescribe ketogenic diets in pancreatic and brain cancers. And otherwise where the research is, where the research is solid, and thank you Walter Longo, is in fasting mimicking diets and in intermittent fasting. That’s where the research is solid, really solid.

Dr. Weitz:          What was the first diet you said, the?

Dr. Chilkov:        Ketogenic.

Dr. Weitz:          No.

Dr. Chilkov:        Fasting mimicking diet. That’s lingo that comes out of Walter Longo and his studies. But his fasting mimicking diet is an intermittent fasting diet and a low carb, low glycemic diet. And he’s marketed it and made a product, which I won’t name on tape, but I don’t like it. And because it’s not healthy foods. See these guys that do all this research, they don’t know what healthy food is. And so, you can’t just go on the ride with them. All right. So, glycemic control and body composition change the growth signal for cancer. That’s the big thing. And they change mortality, they change risk recurrence, they change occurrence of cancer. So, getting control of this is hugely, hugely important.

                        So, there’s also so many more. I mentioned so many surgical complications. So, my goal for hemoglobin A1C, which is probably consistent with the [inaudible 00:24:14] is between 4.8 and 5.2. That’s where I want people to be. And it’s totally doable. You just have to teach people how to do it. Realize cancer patients have high cortisol, they’re really stressed. That can push up their blood sugar and impair their glycemic control. So, realize that’s a contributor in this patient population. A lot of cancer patients have disrupted sleep cycles, which will impair their glycemic control. So, you have to do a very thorough analysis of root cause in etiology to make sure that you’re addressing where the impairment is coming from.

                        The other thing that happens to these patients is they become at risk for secondary cancers. Although I don’t see that a lot in my own practice. The research is there. So, here’s the other infographic that helps you see the big picture, the big picture of this physiology that we’re talking about. So, of course we have patients that are more genetically susceptible to developing insulin resistance and for glycemic control. We have patients that are more susceptible both from environmental signaling and genetics also to developing body composition with more fat. All of these patients have more inflammation. You get signaling from adiponectin and also from leptin that changes the signal to the tumor cell and that changes an environment to make it more hospitable to the development of progression of cancer. So, I actually measure adiponectin in leptin in all my patients, and you can do that.

                        And then when you have more inflammation, you get this sort of cytokine environment. The cancer cell itself will secrete inflammatory cytokines. And then the larger biosystem, if it’s more inflammatory, you get inflammatory both from the cell and from the biosystem itself. And so, this is a highly proliferative environment. And so, controlling inflammation, which we know how to do is really important. The oncologist does nothing on this note. And the oncologist is not interested in insulin or glucose either. And in some chemotherapy infusions prednisone is used to inhibit inflammatory reactions to the drugs. Mostly in platinum chemotherapies this is done. So, this impairs the patient’s ability to sleep, number one, but it also shoots their blood sugar up. So, I ask my patients to ask their oncologist to cut that prednisone in half, and I’ve never had anybody object to that. So, one of the things that I feel we should do is be resources to our patients to understand that they can ask for individualized care.

                        And so, if you know a patient already has glycemic issues, you want to remove the prednisone from their IV. And in fact, they also put antihistamines in the IVs. And so, sometimes that’s sufficient. So, if you think prednisone is a really bad idea for your patient, you can have that conversation with the oncologist. So, I think that’s part of our job, is to help the patient be an educated patient. Help them understand how to ask for care that’s more appropriate to them so that they don’t just get cookbook standard of care cocktails. All right. So, the other thing that happens, of course you have a change in liver physiology and gluconeogenesis. But then you also as you know, will have increased risk of fatty liver disease with all of this as well. So, thank you Peter and Tia do all that for us. So, that’s a factor in this patient population, too. So, we have to be mindful of their liver health in the face of metabolic issues.

                        And so, then what happens in addition to that is you have more body fat, you have more estrogen going on, and then you get changes in sex hormone binding globulin due to that. And so, this whole hormonal milieu and this signaling which becomes proliferative. We know that steroid hormones are proliferative hormones. So, we get this whole tipping of the whole metabolic milieu. And this becomes an environment that is able to host cancer development carcinogenesis, but also increases proliferation and metastasis because you get this going on where a vascular endothelial growth factor, VEGF, increases as does plasminogen activator inhibitor. And this increases coagulation. So, the tumor microenvironment is a microenvironment of thrombus risk. It is a microenvironment of hypercoagulation that’s a fact of cancer.

                        So, two things go on as soon as you have a solid tumor. You start to have sarcopenia signaling as a risk and you start to have hypercoagulation as a risk. So, you want to be mindful of that because 40% of all cancer patients have a thrombotic event. They will either have a thrombus or an embolism. And so, there’s no reason for cancer patients to suffer those if we can prevent it. So, I monitor fibrinogen and D-dimer in my patients. And you will see those go up. Those are markers of hypercoagulation in the cancer setting. Those are reliable markers of hypercoagulation. And oncologists are loathe to anti-coagulate their patients because the drugs are so strong. But we can do it with curcumin, and boswellia, and high doses of omega-3 fatty acids. You don’t want to anti-coagulate your patient, but we can inhibit platelet aggregation. It’s a little harder to inhibit fibrin clots. But that’s what cancer patients get.

                        So, if you see that a patient has high fibrinogen and high D-dimer, then you want to give them something like lumbrokinase or natokinase, which are able to act on the fibrin formation. So, the things we think of as anti-coagulants are the typical things are just inhibiting platelet aggregation. But the risk is fibrin clots and cancer patients need to be aware of that. We can so decrease patient’s risk. And if I see a patient with really high risk of thrombus formation. Like I had a patient come into my office and she had a port in her arm for chemo and she had a chain of lip clots below the port. Now I see the patient more often than the oncologist does. I was doing acupuncture weekly.

                        And so, I called the patient on my cell phone in front of the patient in my office while they were on my table and I said, “We need to anti-coagulate this patient. I’m going to send them over as soon as I’m done here.” And I wanted the patient to hear it, hear me say that to the oncologist. And so, we were able to identify that risk. The patient doesn’t know that shouldn’t be happening. And so, we tend to see our patients more often, more personally and observe them better so we can keep them safer. And what else do you tell a patient who’s got a risk of thrombus? You make them make sure they’re not too sedentary. You make sure they’re hydrated. You make sure they’re on an anti-inflammatory diet. And so, we can really keep people much safer. So, the first slide I showed you, the more general slide about obesity and cancer, et cetera. And then this slide, if you want to go back and really wrap your mind around all the factors that are contributing factors, these two slides really have everything that’s important to pay attention to.

                        And so, we know, again, I mentioned that there’s more insulin receptors on tumor cells and that’s why it’s really important to get control of insulin and blood glucose. Okay. So, there are other factors that drive obesity. We know that menopausal women tend to have different relationship to percentage of body fat. So, that’s the patient population that we’re typically working with in this age group. If you have a younger patient, it might actually be someone who had ovarian or endometrial cancer who had a hysterectomy. So, then she becomes in this group as well. As we always do, we always understand the patient’s lifestyle, which the oncologist doesn’t even ask about. And so, you want to be paying attention to that. So, you can see here that as I was talking about this estrogenic effect of obesity and we get changes in sex hormone binding globulin change in the ratio of free and bound hormone.

                        And so, we get changes in signaling and we get increased aromatase. And aromatase is an enzyme in the tissue that converts androgens to estrogens. So, you get more estrogen signaling. Which is why women who have estrogen-driven breast cancers are more at risk if they’re obese or have glycemic issues. It’s a high-risk population. Super high-risk population. A lot of them are in our offices because they want us to help them with their menopause. So, we got their ear. And so, we want to attend to this. And then because lifestyle runs in families, so do all these risk factors, it’s not just genetics. So, we have an opportunity to affect more people in one family if we do our patient teaching in that way.

                        All right. So, I want to hit the highlights so that we can just have a conversation. I think I made this point. But this is really interesting. Oh no, this isn’t the slide I want to talk about. But anyway, you can see that diabetes and glycemic issues are really a driver of breast cancer. But also say estrogen-driven cancers include other cancers. So, lung cancer can have estrogen receptors. Pancreatic cancer can have estrogen receptors. Colorectal cancer, brain cancer, prostate cancer. There’s a lot of cancers we don’t think of as hormonal cancers that have estrogen receptors on them. And so, you can request the pathologist to check.

                        All right. So, here’s what I wanted to talk about was the role of intermittent fasting and carbohydrate restriction. We know that this is a way to get glycemic control. But there’s all these studies on cancer patients and intermittent fasting. And so, I just want to say, there are historically what I call old naturopathic ideas about water fasting in cancer. That’s not what I’m talking about because that is too high risk for sarcopenia in this population. It’s just too high risk. And so, I don’t water fast people over 50 because they need their muscle mass. So, if you have a young patient who’s in good shape, they can tolerate some loss of muscle mass, they’ll get it back. But an older patient’s not going to get it back.

Dr. Weitz:          What about water fasting just before and just after chemo?

Dr. Chilkov:        I don’t want to put my patient at risk for sarcopenia, period. So, the question was what about water fasting before chemotherapy? The better question is what about fasting before chemotherapy? So, we know that there’s good studies that show if you stress tumor cells by making glucose unavailable to them, the cancer cells already stressed when the chemo is administered so you get a higher kill rate. So, it is well documented. However, I’m very careful. So, I look at the patient. If the patient is already underweight and undermuscled, I don’t do that. So, what I have that patient do is maybe drink bone broth or do a protein shake that has no fruit in it at all, and just get or just do branched chain amino acids, something to protect their muscles while we’re stressing the tumor cell does not get this impact. This stress comes from withholding glucose to the tumor cell.

                        So, if you can accomplish that and preserve muscle, that’s your goal. That’s my approach. Okay. That’s my approach. So, if I have a more robust patient, I’ll have them just do protein shakes or bone broth for 48 hours if they’re pretty robust. Some people will do it 24 hours. If somebody can only do it 13 hours, the data shows 13 hours enough to get a switch in the metabolism and have an impact. So, it depends how robust and also how psychologically motivated, and if somebody has experience with fasting and all of that. And they must be well hydrated. When you’re having an infusion of chemotherapy or anything else, you have to be well hydrated. You want to keep diluting what is coming into your system. And so, actually have people drink bone broth during their infusion. So, they’re getting fluids, electrolytes, and some protein. And that keeps them from getting into trouble with their kidneys also. Really, really protects the kidneys and the gut as well. Yes.

Speaker 4:         Do you recommend intermittent fasting for someone’s in remission?

Dr. Chilkov:        Yes. I actually think intermittent fasting as a lifestyle is really great, actually for everyone.

Speaker 4:         But how long?

Dr. Chilkov:        I think I have a study here. Let me see if it’s here. So, here’s the impact of carbohydrate restriction. And I do have sliding here somewhere on the study. So, there’s this balance between enough protein and lowering carbs. And what happens to people is they do need some dietary guidance. I have a nutritionist that works in my practice because when people just take their carbs out, they lose weight. And so, this patient population cannot lose weight. They need to maintain their weight unless they’re over fat, then we want them to lose fat but not muscle. So, if you take the calories out from carbs, you have to replace that with healthy fats with protein so that you maintain your weight. So, there’s some patient teaching that has to go on with that.

                        And I often will put a therapeutic shake into the protocol because again, these patients are not really that interested in food or in cooking for a lot of their treatment cycle. Afterwards, they may be. But during, they’re not, and they really need to be protected. So, they feel well also while they’re going through treatment and that they do well while they’re going through treatment, they have enough nutrients to repair the damage that the chemo causes. So, I do have a study in here, it’s coming up. 13 hours is out of it. 13 hours is out of it. Let me find that slide.

Speaker 4:         Like they do that every day?

Dr. Chilkov:        Yes. It doesn’t take much to fast for 13 hours. You eat breakfast a little later or dinner a little earlier. It’s not hard to do. It’s not to do at all. And if they wanted to have something in that window, they could have branched-chain amino acids during that time. It doesn’t disrupt this physiologic switch we’re trying to accomplish. So, it’s not hard to do. So, I actually recommend it to everyone who has cancer history, cancer risk, or is going through treatment. And then it becomes a lifestyle. So, I’m trying to teach people how to eat for their life, not for their key. And so, I think it’s really important that patients who are going through surgeries really need to keep their protein together and their gut together.

                        Just giving probiotics around any surgery decreases surgical complications in all patients, not just abdominal surgeries. Why? Because of its impact on inflammation and immunity. So, it’s really important and on mood as well, on neurotransmitters. So, at any rate, this is a classic ketogenic diet. And so, I don’t want to spend a lot of time talking about it. If you want to learn about ketogenic diets, I actually gave a really long lecture on one of the supplement companies that I can’t name during the recorded lecture, but I’ll tell you afterwards. There’s a long lecture on this online. Anyway, I don’t recommend it unless pancreatic with brain cancer. Or you could do a ketogenic diet for a couple of days before chemo. But you’re not going to get into full ketosis if you want to do for a couple of days. You only get a therapeutic mileage out of a ketogenic diet if you sustain ketosis.

                        It’s hard to do. You don’t feel well, people get diarrhea. It’s not an easy thing to do when you already don’t feel well. You already don’t feel well. So, I am very, very sensitive to what’s worth doing. What’s worth asking a cancer patient and a family to do cancer doesn’t affect just the patient, it affects their whole family. And so, it has to be sustainable over time. If it’s too hard, it’s not going to work. But anybody can do intermittent fasting and low-carb diet. Anybody can do that, teach them how to do it. It’s not hard to do. So, here is this study. This is a really cool study. It was done with a 13-hour window and it was done with thousands of breast cancer patients. It was a European study. And they found that it changed IGF-1 levels and that it was better than just calorie restriction itself. It was just better to do intermittent fasting.

                        And there’s a lot of different ways to do intermittent fasting. You can do low calories two days a week or like that. But that’s too complicated for people. Which days is it? What are they going to eat? Just fast. Just don’t eat 13 hours of every 24. It’s really easy for people to put that in their lives. So, I have some statistics here, let me find them. So, this was a cohort of 2,400 plus women in early stage breast cancer. And it was a wide age range, which I liked and it was a seven-year follow up. So, I liked this study. 21% lower risk of dying from breast cancer by doing 13 hours of fasting out of every 24. That’s pretty good solid motivation I think to integrate this. And then there were some more statistics, change rates of recurrence changes mortality, as well as recurrence. So, I like that study a lot.

                        So, now let’s just talk about interventions. So, those are the big physiologic functional ideas and we can talk about them more if you want. But let’s look at interventions. So, what time is it? [inaudible 00:44:31]. We’ve got time. Okay, so omega-3 fatty acids are very important in the tumor microenvironment for a variety of reasons. And so, not only for inflammation but also reduces tumor cell adhesion, which is another reason to really optimize omega-3s. I measure them. There’s LabCorp and West has the omega check test, which are sufficient. There’s more sophisticated tests. But those are sufficient to see if the dose of omegas that you’re giving your patient is optimized for them. And so, I tend to dose high on these. I give most of my patients get a minimum of four grams a day of omega-3 fatty acids. If you have a particularly inflamed person or a person with more brain inflammation, I like to use the pro-resolving mediators, the SPMs. Those really are powerful. And especially if someone’s feeling depressed, that also really helps them.

                        Remember that the blood-brain barrier is compromised in all cancer patients due to the high level of matrix metalloproteinases. And so, the SPMs are really great for the brain. Of course the EPA is also. But even better is the phosphatidylcholine-bound omega-3 fatty acids. Those get into the brain preferentially. And so, there’s a couple supplement companies that make phosphatidylcholine-bound, omega-3s. And anybody for example, who has an APOE4 allele, they must have those phosphatidylcholine-bound omega-3s because they have an error in transport of omega-3 fatty acids into the brain, which is why they’re at risk for dementia.

Speaker 5:         What does [inaudible 00:46:26] like for the SPMs? Do you do those in addition?

Dr. Chilkov:        Yeah, I’ll do them concurrently. Yeah, it’s too expensive to do just the SPMs by themselves. So, I’ll give four grams of the EPA, DHA. And then I’ll give two cats twice a day of the SPMs on top of that. And sometimes that’s just phenomenal what that can do for patients. It’s expensive, but it’s therapeutically very powerful. And then as I mentioned, I do a therapeutic shake. So, I wanted to show you what I put in that shake. And one of the things that I like to add, especially if people are having trouble getting enough calories and feel fatigued, you can put medium-shake triglycerides in there. And I really like to put carnitine into either the capsules or powder. A lot of the companies have stopped making powdered carnitine recently. And it makes the shake taste very sulfury. So, people don’t like it. But about two grams of extra L-carnitine, not Acetyl-L-carnitine, L-carnitine for the muscle and the mitochondria.

                        So, when you give that extra carnitine, you address some of the mitochondrial fatigue that cancer patients have, but you also address muscle physiology because you get better energy delivery and fatty acid metabolism in the muscle. And remember that the biokines that are secreted by the muscle also have an impact on immunity. And so, this whole idea of paying more attention to muscle-centric medicine I think is really important. I don’t know, when I went to school nobody ever talked about it. So, I think it’s really important. I think it’s a good contribution.

                        And then you want to make sure people are getting some soluble fiber. Patients think of fiber as insoluble fiber. And so, to teach them where soluble fiber comes from or give them powders to take so that their microbiome has some sustenance. That’s how I put that together. And also you can add more fatty acids to the shake, and add calories and more fatty acids that way. I find these dense shakes, if you put a half of an organic lemon with the rind into the blender, it just brightens up and lightens up the taste of the shake. That was the idea for Mark Kleinman. You can put half an avocado in the shake to give more calories. A lot of these patients are having trouble getting calories, because they don’t have any appetite, or they’re nauseous, or they don’t feel like cooking.

                        So, some people, especially after they have their chemo infusions, a lot of them don’t feel like eating for three to five days. They can live on two or three shakes a day and some branch chain amino acids, and bone broth until they feel like eating. As long as you put some greens powder or some greens into the shake and they’re getting some phytochemicals along with all of this. I also put in some of the Chinese mushrooms into the shakes. The only contraindication to using Chinese mushrooms in these patients is if they’re on PDL-1 and PD-1 blockers, the immunotherapies. Because these are therapies which take the breaks up the immune system. And so, we don’t want to be ramping up their immune system while the drug is doing that. We can cause a forest fire of inflammation where we only want an ember. And so, you want to be careful with Chinese mushrooms, and astragalus, and echinacea, these phytochemicals that push on the immune system. You have to be careful. In the same way, you have to be careful with autoimmune patients in that same way.

                        So, that’s just my shake recipe. Berberine is really great for this patient population because as you all know, berberine is very important. What is that? Oh, somebody opened the door. Okay. So, as you know, berberine is a good agent to use for glycemic control. But look at this slide. Berberine interacts with over 20 different pathways that infect cancer physiology. So, you want to look for multi-taskers. Phytochemicals are phleomorphic. They can bind to multiple receptors and influence multiple pathways. You guys are going to get the slides. So, anyway, berberine is in the news because glycemic control. But I simply want to point out that it’s really powerful in multiple pathways in cancer physiology. It is also like many phytochemicals, very important in changing the microbiome as well and changing how we utilize phytochemicals.

                        So, we’re running out of time. So, let me just go through these. Curcuminoids also have a big impact on glycemic control. They’re not usually thought of in that context. But I want to point out that they do have an impact on glycemic control. This slide also shows you that curcumin also actually affects the pancreatic beta cells. It affects adiponectin, triglycerides, and leptin, and liver fibrosis. So, I think that we tend to get a little siloed in our thinking about some of these phytochemicals. And I have to say, botanical medicine is my first love because of the fabulous multitasking and ability for molecules from nature to bind to multiple receptors and interact with multiple pathways. And so, curcumin is widely used in cancer as you all know. But you can see here there are certain cancers, it’s more powerful. And I use this in almost all of my patients.

                        There’s a subset of patients who get some enteritis from curcumin. So, if you have one of those, use boswellian instead or together. Resveratrol also exerts glycemic control. We don’t think of it that way, but it does. It also has an impact on fatty acids. And resveratrol interacts with multiple pathways that affect tumor cell metabolism. Green tea, you’re all familiar with that in terms of its impact on obesity and body composition. But it also of course has multiple signaling pathways for glycemic control as well. And ganoderma, which is reishi mushroom, also has a big impact on blood sugar. And it’s also one of the only Chinese mushrooms that has a lot of anti-inflammatory effect that you can use it in an autoimmune patient. You don’t have to be so worried about that. So, I really like it because it has this glycemic control, tumor control. Also, it has a big impact on mood. And in the Taoist culture it was used for meditation. And so, that’s why it’s so famous. Affects gastric emptying also.

                        So, let me just summarize because we have 20 minutes. We can have some discussion and you can look back at these slides. So, obesity is linked to cancer and diabetes. Chronic hyperglycemia, hyperinsulinemia and elevations in IDF-I facilitate tumor genesis and worsen outcome. Patients with diabetes really and hyperglycemia hyperinsulinemia need our patient teaching, and need to learn how to get it right. And because there’s this 40% increased risk of occurrence and recurrence in this patient population, there are obese or diabetic or both, the risk is really high and for the complications of traumas formation as well, and complications of surgeries and treatments. And so, we got their attention. We’re the ones that have their attention on this. So, I think it’s really important.

                        So, these are the things that we talked about today that I chose to include as interventions. So, you think about curcumin, resveratrol, green tea, berberine, ganoderma, the omega-3 fatty acids, put the SPM’s in there. And think about carbohydrate restricted diets, low glycemic diets, intermittent fasting and ketogenic diets where appropriate. You can also include the idea of fasting before chemotherapy adjusted to the patient, what’s appropriate for that patient. And that’s how you get a hold of my assistant. And I have a bunch of references in here for you. And then here’s this handout if you want it. And here’s this discount. If you’re interested in my course, if you just want to talk to me about the course, we have a payment plan. And it’s my legacy project is to pass on this out to our cancer system that I created to all of you. Thank you. We can take as many questions as you [inaudible 00:56:05].

Dr. Weitz:          What do you think about apricot seeds that make the blood?

Dr. Chilkov:        So, there’s a lot of cancer therapies that have been done for a long time. And I think what we need to do is be mindful of where the science is. So, there’s a lot of things that have been used in naturopathic oncology that don’t really have good science behind them. I think amygdala does, but it’s so toxic. And I think we have better choices. We understand cancer cell metabolism better. We don’t have to give people cyanide, which is what that is. There’s a better ways to manage cancer.

Speaker 6:         I have few questions.

Dr. Chilkov:        I don’t use it. So, I don’t use it.

Speaker 6:         Do you recommend that these will all be in the form of extra supplementation with supplements? Or can you get this for the diet? I always worry about [inaudible 00:56:50] supplement.

Dr. Chilkov:        So, great question. In order to change signaling in tumor cells, you have to give a pharmacologic dose. You cannot give a nutritional dose. So, you have to think high-dosing. And so, I’ll give two or three grams of berberine a day. I’ll give four to six grams of omega fatty acids a day. I’ll give three to five grams of resveratrol a day. You cannot change a cancer cell’s behavior or change the signaling in the cancer environment with a nutritional dose. Great question. Great question.

Speaker 6:         How do you feel about, I guess the senolytics are there too, but like senolytic or NAD, NR, NMN.

Dr. Chilkov:        So, all those things, yeah, all those things are important. I focused on the things that impact glycemic control. There are certainly multiple things that influence other pathways and cancer cell metabolism. But in that context, you think about mitochondrial function. If you widen your thinking out to mitochondrial function, you start to think about other things like nicotinamide, ribonucleoside, or NNN. Or you start to think about all the B vitamins that drive the cancer. You want to think about optimizing mitochondrial function in these patients, which is where [inaudible 00:58:13] contribution comes in. But he’s too narrow. And [inaudible 00:58:16] ideas have not been really supported by research. So, you have to realize that.

Dr. Weitz:          Now isn’t there a risk of increasing cancer with NR or NNN?

Dr. Chilkov:        So, theoretically there is. So, I’m conservative. I’m a very middle path clinician. Very middle path. So, the things I’ve told you that I give in high doses I think are super safe. But there are things that are questionable. So, I think you can use the senolytics, which curcumin’s in that category, resveratrol’s in that category. Those things are in that. I like Ficetan quite a lot. I think there’s a lot there. I like to stick with things that have human studies over time when we are thinking about cancer patients. As a clinician, I do not experiment on my patients. I’ll experiment on myself, but not on my patients. And so, I think we have to be careful.

                        And baby boomers like me are becoming hysterical about aging. So, I’ll be 71 this year. And so, we have to be careful to not go off the deep end and create Frankenhumans or whatever. We have to be careful because anytime you leverage only one pathway, you’re going to get into trouble. And so, I do think it’s not clear. I think as we age, we need to enhance our NAD pathways. And so, be conservative on that. An aging person needs more efficient mitochondria. But maybe we don’t go into these big therapeutic pharmacologic type doses of these other things I’ve mentioned that I know are safe in those doses. So, I think it’s too new. We don’t know the answer to that.

Speaker 7:         What about IV nutrients? Some practitioners even use IV [inaudible 01:00:19].

Dr. Chilkov:        So, you have to realize I also recommend them, but let’s have context. So, IV therapies are temporary, unlike when we prescribe something more that a patient takes every day. So, the day you get your IV, it has an impact for a few hours and then you pee it all out. So, you have to remember that. So, what are you trying to accomplish when you give an IV? So when you give high dose IV vitamin C, it becomes a pro-oxidant. In low doses it’s an antioxidant. But when you give it in high dose IV 50 to 75 grams per push, then it becomes a pro-oxidant and causes the production of hydrogen peroxide in the blood, which kills cancer cells and spares healthy cells. Not all patients tolerate that. Some people get hyperglycemic when you do that. So, you have to find out.

                        Also, you have to make sure high dose IV vitamin C is safe. You have to measure an enzyme G6 PD to make sure that they will not have red blood cell lysis when you give them high dose IV vitamin C. There are clinicians who are specialized in treating cancer patients with these IV therapies. And there are some good people here in LA and around the country that do that. But just because somebody does IVs in their office doesn’t mean they should be treating cancer patients with IVs.

                        You can give IV resveratrol, IV lipoic acid, IV curcumin. There’s a lot of to IV NAD, there’s IV phosphatidyls pulling. But you need a highly trained person to administer these therapies because… and also I insist that if we’re going to treat cancer patients with these aggressive IV therapies, there better be a nurse in a crash cart in that office. And the team there better be trained to deal with an emergency. And there’s all these clinics where that’s not so, and they’re not safe. And these are vulnerable, fragile patients. These are not healthy patients going for a little upper on their IV. And so, these are fragile, fragile patients and they have to be in a safe medical setting. Yes.

Speaker 8:         Have you heard of C15 or what is it?

Dr. Chilkov:        Those fatty acids? Yeah. I don’t think there’s enough information there to do anything. Yes.

Speaker 9:         Do you have any comments on beta-glucuronidase activity [inaudible 01:02:56]?

Dr. Chilkov:        I didn’t understand you.

Speaker 9:         Do you have any comment on beta-glucuronidase activity, the stool test at risk for the breast cancer?

Dr. Chilkov:        I’m not understanding.

Dr. Weitz:          Oh, some stool test report on beta-glucuronidase.

Dr. Chilkov:        Oh, [inaudible 01:03:11]. Yes. Yes, absolutely. So, if you have an estrogen-driven cancer, I have a whole lecture on the estrovalome, which is the way that the microbiome influences estrogen metabolism. And so, beta-glucuronidase is involved in conjugation and decontagation of estrogens in the gut. And so, if you have high levels of beta-glucuronidase, you have higher levels of decontagation of estrogen. What does that mean? So, estrogen in the bloodstream goes through the liver it gets conjugated, and excreted through the bile into the stool. If there’s too much beta-glucuronidase in the gut, that gets decontagated, which means that estrogen goes back into the general circulation and you get a double whammy hit of your own estrogen. So, patients who have that have a certain type of estrogen dominance essentially. So, you need to fix that. Yeah, you need to fix that. A whole lecture just on that subject.

Speaker 10:       What do you think about melatonin? Some practitioners now are using 200, 300 milligrams a day.

Dr. Chilkov:        So, melatonin can be used to alter tumor cell metabolism at multiple effects. And again, I’m a conservative clinician. So, all the original studies were done by a group in Italy that studied 20 milligrams of melatonin at bedtime as a dose in breast cancer patients. However, we think of melatonin in this very narrow way, but it has a lot of impacts on multiple pathways and metabolic pathways in the cell and in particular has an influence on cancer cells. And there is a rationale to give high doses of melatonin to patients. I’ve never gone myself over 180 milligrams. That’s plenty melatonin, I think.

                        And so, it’s interesting because I think melatonin is misunderstood. Melatonin is not a sedative. Melatonin is a dark signal to the brain. And so, it tells you it’s nighttime. It tells you to get ready for sleep. So, when you get into these pharmacologic doses, it’s not about that. It’s about changing metabolic pathways and cells, and some of which drive proliferation. And it’s pretty safe. I’ve never really seen anybody get into trouble with it. Patients, I think of this placebo effect where they think they’re sleepy because they’re taking melatonin until they explain to them it’s not a sedative. And they can wake up refreshed after they take a high dose of melatonin.

                        But I always start slow. I never go way up there. I’ll start somebody on 20 or 40 milligrams, and then up to 80. And I’ll go upstairs, get people up to see how they do. There are some people who just don’t rate it very well. The primary adverse effect is wild dreams. And so, that’s as bad as it gets. But for some people, that’s not normal. So, you can modulate it down then. But it is quite effective. But I tend not to go straight to those therapies. There are patients who do quite well, do anything extreme. But there are subsets of patients who become treatment resistant in the standard of care oncology setting, in which case we need to really think about what can we do that’s a big lever for them to really change their course of progression.

                        But realize most of the naturopathic therapies don’t kill cancer cells. Most of our therapies are metabolic therapies. You have to really realize that there are times when you need something that’s really toxic, that’s going to kill cancer cells because in some patients, you really need to reduce tumor burden quickly. And there’s nothing in natural medicine that does that. So, that’s why I call my approach integrative because I always ask the question, what’s the right tool for the job? Or what are the right combinations of tools for the job? And some people really, really, really need toxic chemotherapy to reduce their tumor burden for a period of time. And so, the enemy is not chemotherapy. The enemy is cancer. So, you have to have a way of thinking about how you’re going to give this person a good long life and quality of life. And sometimes chemotherapy is part of that solution for a finite period of time. And where people get into trouble is over-treated with chemotherapy. But it has a place.

Speaker 11:       I know you said you don’t experiment on your patients. Do you have any thoughts on peptides minus and alpha that have been showing in research that we do?

Dr. Chilkov:        I think we could say, what about off-label use of drugs? We could say that, too. So, I do think that there are some things that are quite safe to do. And if we’re in the realm of safety, why not? Why not if there’s a good rationale? But I still think you have to look at your patient. What are the metabolic pathways in their tumor cell line? What are their comorbidities? What will they tolerate? What can they afford? So, I look at all of that. I think there’s a lot of things we can do with off-label use of drugs like statins interrupt metabolic pathways significantly in numerous cancers. They’re cheap, they’re safe, and things like that. There’s metformins widely used in the cancer setting. So, I think that that’s a whole other lecture also.

                        But I think if it’s something safe, I think it’s safe to try. Metformin tries statin, try something like a well thought-through peptide. I don’t think there’s any reason not to. Everything I do is individualized. You have to just look at the patient. And I’m very mindful of how much I ask them to do and ask them to spend. And so, if someone really has limited financial resources, then I really want to make sure that what I’m giving them are the big levers that I do know are going to make a difference. It’s quite different when you have a stage four patient that’s become treatment resistant and then you have to think about all other kinds of things.

Speaker 11:       Any thoughts on giving it to younger patients and possibly proliferating cancer?

Dr. Chilkov:        Giving one to [inaudible 01:09:59].

Speaker 11:       Different peptides, because I think there’s a lot of [inaudible 01:10:01].

Dr. Chilkov:        I think we don’t know enough about peptides. I think, look what’s happening with [inaudible 01:10:06]. I mean, it’s the Wild West as far as I’m concerned. It’s dangerous. What we’re doing is dangerous. And so, here we’re in LA welcome to the Hollywood. So, everybody wants to be thin and rich. And so, we always at least be thin. Maybe not rich if you buy your [inaudible 01:10:27]. But I think I am just careful. These are really fragile, vulnerable patients. But it’s tricky because you also have the family to deal with. And so, you might have a patient that wants to engage in the kind of therapies that we include and their family’s freaked out about it or as a willing to spend the money on it.

                        And it’s tricky because I do feel that patients values and wishes for themselves should be respected. And sometimes the family just can’t deal with it. Or the family’s so terrified that the patient’s going to die, that they want to do everything the oncologist says, even though the oncologist stuff isn’t working anymore. It’s complicated. It’s very kind that people have different feelings about death, and mortality, and suffering. And I always say, if you want to work with cancer patients, you have to have a level of complexity. I think it keeps it interesting. Yes.

Speaker 12:       I just want to make sure I didn’t… I know I misheard something earlier about when you were talking about the diet, about the animal protein. You were like some decreased animal protein. But then [inaudible 01:11:38].

Dr. Chilkov:        So, I restrict red meat because there’s a lot of studies showing that red meat is very carcinogenic. And so, I restrict that. And it’s largely because of the iron in red meat. Cancer cells sequester iron and use it for their own metabolism. And so, there’s a whole line of cancer cell physiology, which is involved with ferroptosis and leverages iron as a way to-

Speaker 12:       I heard the protein and then you immediately-

Dr. Chilkov:        Yeah. Yeah. So, cancer patients need protein to maintain muscle mass or restore muscle mass that they’ve lost. So, if they have a high IGF-1, then you have to try and figure out what protein is going to build their muscle and not increase their idea of blood.

Speaker 12:       What was the name of the BCAA powder?

Dr. Chilkov:        There are many companies that make branch chain amino acid powders. Many, many companies. I just pick high quality companies where it doesn’t taste terrible. Basically, I taste everything before… different companies make better tasting things. So, it’s eight o’clock. Are we supposed to stop any-

Dr. Weitz:          Yeah, I guess theoretically [inaudible 01:12:57].

Dr. Chilkov:        Until we get kicked out. Should we get kicked out?

Dr. Weitz:          Thank you everybody.

Dr. Chilkov:        Thank you everyone. Oh, I have something for you. Wait a minute.



Dr. Weitz:          Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. Some of the areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, autoimmune diseases, cardiometabolic conditions, or for an executive health screen. And to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111, and we’ll set you up for a new consultation for functional medicine. And I look forward to speaking to everybody next week.


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