Cancer Prevention with Dr. Nasha Winters: Rational Wellness Podcast 120
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Dr. Nasha Winters discusses Cancer Prevention with Dr. Ben Weitz.
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Podcast Highlights
2:15 Dr. Winters talked about her personal cancer journey that motivated her to pursue her integrative cancer career. When she was a freshman in college she was having debilitating pain and she would even throw up and pass out from the pain in her abdomen and pelvis. She went to the Emergency Room multiple times and she would bet dismissed as having endometriosis or Crohn’s or IBS and they would give her a pharmaceutical and sent out the door. One time she ended up in the ER in tachycardia and labs showed that her organs, her kidneys and liver, were in end-stage shutdown. She had a hugely distended abdomen because she had a grapefruit size lesion on her right ovary, lesions on her liver, and scattered lesions throughout her pelvis. Dr. Winters was in stage 4 ovarian cancer and two oncologists both told her that chemotherapy would kill her and they recommended palliative, hospice care and gave her only three months to live. She had no surgery, no chemo, and no radiation and now it is 28 years later and she is still alive! She said that the two main things that she did that probably helped her body to fight off the cancer were fasting and she also did a family fast. She did not fast on purpose, but was unable to eat because of the fluid in her abdomen. She fasted for between 30 and 60 days on water only. She had a dysfunctional, stressful family life, so she also cut all her ties to her family. She noted that there is an Adverse Childhood Events questionnaire to see if you are growing up in a traumatic environment in your home. If you have 3 out of 10 yeses on the questionnaire, you have a 400% increased likelihood of a chronic illness in adulthood, and Dr. Winters scored a 10 out of 10.
Dr. Winters noted that she also saw an acupuncturist who was also an RN 2-3 times per week, which helped a lot with her pain, stress management, and digestion. She also started working in the supplement section in her local health food store and started taking classes with a local herbalist. Dr. Winters got no traditional care during her cancer journey other than getting imaging, like MRI’s with gadolinium, which caused kidney problems because of the gadolinium toxicity. She actually did not expect to survive at the time.
13:32 The key to Integrative Cancer care is to focus on the cancer terrain. Conventional oncology focuses on the tumor, how to categorize it and name it, figure out which stage it is in, and recommend surgery, chemo, or radiation. Dr. Winters explained that she doesn’t treat cancer or tumors. She treats the terrain that is wrapped around those tumors and tumor cells. Unfortunately, the standard of care oncology is really not making much progress with cancer, since the survival from cancer has barely improved in decades. This is not to say that surgery and chemo and targeted therapies and hormone blockers and radiation are not powerful therapies. Traditional oncology focuses on the cancer type to recommend care, but cancer researcher Mina Bissell has shown that instead of doing one biopsy, if you took the whole tumor out you would find maybe 5-20 different tumor types all in one, which is why a therapy that just targets one tumor type may not work long term. Consider the VEGF pathway and the targeted drug, Avastin, that targets that pathway and lowers VEGF. What often happens is that it often starts to work and then after 3-6 months, you’ll start to see VEGF go up, because the response to that drug leads to the creation of new pathways and new resistance, which is what happens in all of our standard of care practice. They also can make dormant cancer stem cells come alive, mutate further, and become less responsive to any of those standard of care treatments. Standard, modern oncology can seem like a game of wack-a-mole, since you block one pathway or response, and then you’re going to pop up another response. By focusing on the terrain, on the tumor microenvironment, we can help overcome some of that treatment resistance and enhance the standard of care therapies and make the person feel a lot better going through the process.
19:43 While targeted medications can affect a particular molecular pathway or affect one specific gene involved in cancer formation, natural agents like curcumin can affect many pathways and genes, as pointed out by Dr. Nalini Chilkov in a recent appearance at our Functional Medicine Discussion Group meeting in May 2019. See the video here of Dr. Chilkov’s talk: Cancer and Food. Dr. Aggarwal is the famous curcumin researcher who was at M.D. Andersen said that we’re given the opportunity to do chemotherapy three times per day, which is what sits at the end of our fork. The foods you choose can be either pro cancer or anti cancer and they can change the terrain in a way that increases inflammation or increases stress in the body or depletes the immune system or strengthens those patterns. 21:30 Dr. Winters said that some of her key blood tests to monitor the cancer terrain, include a simple CBC, and she will focus on the neutrophil to lympocyte ratio. More than a 2 to 1 ratio of neutrophil to lymphocyte leads to a poor prognosis. She will also get a typical chem panel and she will look at the kidney and liver markers and the alkaline phosphatase levels. An elevated alkaline phosphatase indicates that something is going on with the liver, the kidney, or the bones. Elevated liver enzymes could indicate liver metastasis or liver stress resulting from harsh medications they are taking. A low hematrocrit also indicates a poorer prognosis. Dr. Winters also looks at the sedimentation rate, the ESR, the lactate dehydrogenase, the LDH, and the high sensitivity C Reactive Protein, the HsCRP. HsCRP should be below 1. ESR should be below 10. LDH should be under 175 or 450, depending upon whether it is run by Quest or LabCorp. All of these if elevated are markers for inflammation, chronic illness, and cancer. LDH is an average of 5 different enzymes that can be pointing to lung health, red blood cell health, liver health, kidney health, and even tumor health. LDH may be the best standard cancer marker. For breast cancer Dr. Winters will look at CA 27-29 and CA 15-A as a baseline. Low vitamin D3 is a driver for breast cancer, esp. if it is less than 50. The therapeutic level is 80-100. Insulin should be below 3. Insulin Growth Factor should be below 100. Hemoglobin A1C should be 5 or below. Body fat percentage should be below 25%.
30:14 If you have an elevated IGF-1 the best thing you can do is fast and then make sure that you are getting enough sleep. Even two nights of bad sleep can elevate your IGF-1
31:20 Dr. Winters believes that estrogen is a stimulator of cancer and she is not a big fan of bioidentical hormones and she says that they are neither safer nor more natural. They are synthetic, compounded molecules and they bind more strongly to our receptor sites than our endogenous hormones do. Depending upon someone’s genetics, esp. if they have CYP1B1, CYP2D6, COMT, or ESR2 SNPs, they are more likely to metabolize their estrogen along an unhealthy pathway and you will see an increase in the 4 or the 16 hydroxyestrones, which increases your risk of cancer. She will occasionally recommend a small amount of estriol (such as .5 mg) used intravaginally for a limited period of time to restore their vaginal health. If they also used personal care products that have parabens, if they drink out of plastic water bottles, if they have copper in their pipes, if they are eating pesticide laden food or food with glyphosate, they are more likely to metabolize their estrogen in an unhealthy way.
37:04 Dr. Winters is also not a big fan of women eating soy, even though some argue that soy contains phystoestrogens that is a weak estrogen and by attaching to estrogen receptor sites and blocks stronger estrogens. Dr. Winters argues that there is no clean soy in the US and even organic soy is contaminated with glyphosate. This may be different for women who grow up in China who have a different estrobolome, a different microbiome, and they have a different response to soy than American women do.
40:22 She does think that consuming flax seeds are beneficial, but not flax oil. Dr. Winters says that it’s important to store the flax seeds in refrigerator and to grind them as needed, so they don’t become oxidized. Flax oil becomes oxidized almost immediately once it comes into contact with the air. Also, the lignans in flax seeds are very anti-inflammatory, which are not in the flax oil.
41:30 For men with prostate cancer, Dr. Winters recommends avoiding consuming choline, because this is a good fuel source for prostate cancer cells. The richest sources of choline are egg yolks and chicken skin.
43:33 Other data show that restricting methionine and glutamine may be helpful with cancer. One simple way to reduce the intake of these is to do intermittent fasting. Dr. Winters says that much of what we’re dealing with in integrative oncology is that patients are overfed and undernourished. And we don’t change what we eat based on the seasons. We can end up eating too much of the same foods over and over, like so many Americans now living off of soy burgers (referring to the Impossible burgers), which has never happened before. Based on the need to restrict nutrients like choline, methionine, and glutamine, some practitioners will recommend a vegan diet, but Dr. Winters cautions that such diets tend to be based on a lot of grains. Eating a lot of grains will tend to result in glucose, insulin, Hemoglobin A1C, and insulin growth factor levels all going up. You’ll see elevated LPS and autoimmune conditions flaring and the thyroid whacking out. Dr. Winters pointed out that she spent a month in the Mediterranean and she ate a Mediterranean diet, minus the grains. The real reason the Mediterranean diet appears to be beneficial is that this is a community of Orthodox Christians who spend 200 days of the calendar year in some form of a fast.
48:44 Dr. Winters likes to use a Modified Citrus Pectin nutraceutical with many of her patients, including her patients with prostate cancer. She will measure Galectin-s levels and if they are above 10, then she will definitely recommend a fairly high dosage–15-40 gms per day–until that level comes down and then she will maintain it with 5-10 gms per day. If they have a biopsy or surgery coming up, she will recommend Modified Citrus Pectin and then keep them on it for at least a few months post biopsy or surgery. It’s also a great binder and it pulls out exogenous estrogens and heavy metals, like lead. And it’s a good source of fiber for the microbiome.
50:17 Dr. Nasha likes to use a therapeutic ketogenic diet for patients with brain cancer, which is a super low carb, very high fat, and moderate protein diet. For brain cancer, you would like to keep your blood ketone levels over 3 to maintain the metabolic need of your brain. For other cancer types, you might only need to be in a nutritional ketogenic stage, which is between 0.8 and 3 on your blood ketones. We need to test to make sure we are in ketosis. People often think that they are in ketosis when they are not. You should start out with urine, but once you are keto-adapted after a few days or a few weeks, then you will not be showing ketones in your urine and you need to graduate to blood testing. Dr. Winter recommends the Keto Mojo device, which is reasonably priced and measures both blood ketones and glucose.
58:28 Cachexia is when patients with cancer go into that wasting stage and they lose weight even when they are eating everything. At that stage, the advice that is usually given is to eat whatever you want, including milkshakes with ice cream, or Ensure or Boost. The cancer cells are taking over and starving the muscles of their glucose stores and they utilize it to grow tumors and starve the body. If you look at labs, you will see protein levels below 7, albumin levels below 4, low calcium, and low creatinine levels. 50 to 75% of all cancer patients succumb to cachexia metabolic wasting. But sugar and carbohydrates will feed this process. According to Dr. Winters, the only thing that Ensure and Boost do is to ensure a more untimely death. You can eat 20,000 calories and calories alone will not stave off cachexia. The three things that will accelerate cachexia are 1. Sugar and carbohydrates, 2. Inflammation, and 3. Angiogenesis, which is when the tumor is growing new blood vessels. Ironically, intermittent fasting and a high fat, ketogenic diet, perhaps with some extra protein, (depending upon the patient), will do better to stave off cachexia.
Dr. Nasha Winters is a Naturopathic Doctor and a Fellow of the American Board of Naturopathic Oncology. She is an authority on integrative cancer care and she is currently involved in research using Mistletoe Extract, Hyperthermia, Cannabis, the Ketogenic Diet, and IV Vitamin C to treat cancer. Dr. Winters is a co-author of the best selling book, The Metabolic Approach to Cancer and she is at work on a second book on therapeutic diets for cancer and a third book on Mistletoe therapy. She now consults with clinicians both one on one and through an intensive 4 month mentorship program to learn integrative oncology and her website is Dr.Nasha.com.
Dr. Ben Weitz is available for 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, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com.
Podcast Transcript
Dr. Weitz: This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health. Rational Wellness Podcast. Thank you so much for joining us again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to Apple podcasts and give us a ratings and review. That would be very much appreciated, that way more people can find out about the Rational Wellness Podcast. Also, you can go to YouTube and there’s a video version and if you go to my website, dr weitz.com you can find detailed show notes and a complete transcript.
I’m very excited today that our topic is, we’ll be talking about how to prevent and reverse cancer with Dr. Nasha Winters. Dr. Winters is a licensed naturopathic doctor and a fellow of the American Board of Naturopathic Oncology. She’s also a cancer survivor herself. Dr. Winters is a sought after speaker and an authority on integrative cancer care and she’s currently involved in research on using mistletoe extract, hyperthermia, cannabis, ketogenic diet and IV vitamin C to treat cancer. Dr. Nasha is a coauthor of the bestselling book, The Metabolic Approach to Cancer, which is an amazing book and she’s finishing a second book on therapeutic diets for cancer. Dr. Nasha is on a mission to educate and empower the nearly 50% of the population expected to have cancer in their lifetime. And prevention is the only cure. Dr. Winter, thank you for joining me today.
Dr. Winters: Thank you so much for having me here. It’s a lot of fun already. Before you started recording, we were already in a good space.
Dr. Weitz: Good. Can you start by telling us about your own personal cancer journey?
Dr. Winters: Sure. I think that most of us who come to the field of medicine, especially something more of an integrative or functional medicine sort of like you and I, we didn’t just say, “Hey, I woke up one day and decided this is a career for me.” It’s usually some story of our own personal experience or someone we’re very close to that brings us to this. And I’m no different than that. For me, I just was sort of started off in the world a lot of health care issues, struggled with that all my childhood and into my teenage years. To the point where my symptoms, my digestive symptoms, my hormonal symptoms were, they became just commonplace for me. I didn’t even recognize that I was sick. Right? It was just put on another medication or just ignore it or just cope with it.
By the time I started having some really intense symptoms that I wasn’t, I was someone who had a pretty strong, I still do have a very high pain threshold and avoid medications at all costs and different things. But there was a time in my freshman year in college where I was debilitated with pain that would make… Literally I would pass out. I would throw up from the pain in my abdomen and my pelvis. I would show up in the ER on several occasions over about a nine month period of time. And each time they sort of patted me on the head and said, “You’re histrionic, it’s maybe your endometriosis is still flaring, maybe you’ve got Crohn’s or IBS.” And it just sort of like, “Here’s another pharmaceutical.” And send me out the door. It just happened over and over until finally I landed in the ER with tachycardia. The lab showed my organs, my kidney and liver were in complete end-stage.
Dr. Weitz: Wow.
Dr. Winters: I had a hugely distended abdomen. I know. And that’s when they realized, “Oh God, this woman has liters and liters of fluid built up on her gut in her abdomen.” When you see that sign now as a doctor looking back, that is ominous in all situations. It’s always cancer. I can’t think of a single time when it wouldn’t be. And so that’s when they finally did proper workup and had to give me… delivered the bad news that they’d found a grapefruit size lesion on my right ovary, lesions on my liver, scattered lesions all throughout my pelvis and basically said, you’re in end stage organ failure with further testing of the ascites fluid a biopsy and multiple lab tests and diagnostic imaging came to the conclusion I was in stage 4 ovarian cancer. This is 19 going into my 20th year on this planet. That was the official diagnosis came October 21st, 1991. And we’re coming up on 28 years out from that.
Dr. Weitz: Awesome.
Dr. Winters: Right? I know, whop. And the creepy part is I was so sick, I was so far gone that they said at that point, even a single dose of chemotherapy would kill me. The recommendation was hospice, palliative care. They would give me a second, give me into an oncologist for a second opinion. But they knew that I had three months with no treatments at best and likely at treatment, if I started to try to do chemo, it would probably kill me outright because my organs were shut down. So that made sense and really what they could offer me was palliative support with draining the fluid on my abdomen and basically keeping me comfortable. I think again, in my world, when you’re given no choice many other choices open up. And that sent me on what has become a very long and powerful journey for me, but not only for myself, but also for thousands and thousands of thousands of other patients and colleagues that I’m now working with mentoring and learning from as well. And it’s again, we find our purpose in the most odd ways. Right?
Dr. Weitz: What do you think were the most impactful therapeutics that helped you?
Dr. Winters: Huh. Well, in retrospect now there are two main ones. The first one was I had so much valuable real estate taken up by the fluid in my abdomen that I could not eat. I could not keep anything down. And so there was… I fasted, not on purpose, not by thoughtful desire or devised on medical scientific wisdom. It was out of necessity that I probably fasted it for 30 to 60 days in that first period of time.
Dr. Weitz: Wow.
Dr. Winters: It was weeks. I meant what little bits I could take in were very small amounts and water only. What we now know in retrospect, looking back in fact another study just came out this week of the use of intermittent fasting with cancer treatment and enhancing in all conventional therapies as well as other therapies. That was probably one of the most profound things I could’ve done for myself.
Dr. Weitz: Wow.
Dr. Winters: And it was not thought out, right? That was just, it just happened. Kind of like animals in nature, we observe that kind of do what they need to do to take care of themselves. I was an animal in nature doing that. The second thing, which is often more challenging to discuss is understanding of the psychological reasons for why these things happened. In fact, I was a Biology, Chemistry major, Premed in Medical school and this event woke me up so much that it switched me to a Psychology Biology major and basically a self created major in Psychoneuroimmunology.
This is when the work of Candace Pert. Deepak Chopra’s book is actually one of the first books I ever read in this field. Bruce Lipton, all of these things started to help me understand where I was coming from. And ironically, I worked as a detox counselor at that time, worked in the realm of addictions, was raised in a pretty traumatic environment. If you and your listeners are at all familiar with the adverse childhood events, the ACE questionnaire or the ACE score. Basically the studies or research shows that about 64% of our population has at least one significant adverse childhood event that’s really significant. And that alone can increase their risk of conventional diagnoses of chronic illness in our adulthood. Basically you have three or more yeses to that 10 questionnaire. You have like a 400% likelihood of having a chronic illness in your adulthood. Just to give context, I was a 10 out of 10. So it was no wonder and actually, but of course that I had that diagnosis. I was… Something in me understood that at a very young age when this wasn’t a common discussion out there in the world. One of my other big, what did I do for myself processes was I did a family fast for almost two years. Not only did they have a food fast out of necessity, I also had a family fast. I went into kind of a lock down of deep support for myself because I… A couple of things I knew from the get go is a lot of the people in my circle would have made this much more about them than me and I wasn’t ready to deal with that. I didn’t have the financial support, I was uninsured. I didn’t have any… I was putting myself through college. Well, the first person in my family to go to college. There were so many factors here that I physically moved away from the trauma and the place that created a lot of this for me. I wasn’t going to go back… was not about to go back into that. It just sort of worked out that it was a perfect time for me to sort of cut off all those ties and start my own new tribe of resources and support. So fasting in a variety of ways became very instrumental in my health and wellbeing.
Dr. Weitz: Did you seek integrative care at that time?
Dr. Winters: It’s interesting because when I started learning about it that time was my… The pain was probably my largest physical symptom and the nausea and digestive upset and I found an acupuncturist and she was an RN in our community. She’s since retired, who I was seeing her two to three times a week for acupuncture and she was doing stuff for my digestive tract and for my pain management and then side effects, stress management and other things. And it became a really powerful tool of support for me. And then I started working in a health food store and I worked on the vitamin aisle, the supplement section. I started learning everything I could about herbs and nutrients and supplements and we had a local herbalist in our community. I started taking classes with her, started working with a rolfer. I mean I just started exposing myself to concepts and modalities because I wasn’t given any choices in the Western medical model. So I thought, well want to be-
Dr. Weitz: You got no Western care, no chemo, no radiation-
Dr. Winters: Outside of labs, some imaging, I’m ongoing imaging, which then later, because at that time the imaging we used was in MRIs so I blew out my kidneys. Thanks to that, I still have a lot of kidney issues because of gadolinium poisoning.
Dr. Weitz: Oh.
Dr. Winters: We didn’t know that back then we… That’s a tough one. I’ve been working on trying to get gadolinium out of my system for 28 years and it’s like-
Dr. Weitz: Wow.
Dr. Winters: … holding on for dear life. At least I had my kidneys fortified enough that they are functioning okay. It takes a lot. So those are exactly it. When I actually didn’t expect to survive, number one, let me just be that… I was not on a mission to treat this. I was more on a mission to understand this. That has been what has really informed the way I approach today is I believe that empowerment, knowledge is very good medicine. And so to understand the why I got to where I was, was just as important, if not more important than what I was going to do about it. Today I have a lot of colleagues out there doing great like, “oh, I can do this out of these, I knew this treatment and I spent $70,000 over here in this country doing all these therapies and yet still are sick.” That’s missing one of the critical pieces of this journey is why did you get sick in the first place? What about your construct allowed for this to take root and flourish? What can we do? We can’t heal from the same soil in which we got sick. So what needs to happen now? Understanding where we came from is really powerful to help us understand where we need to go.
Dr. Weitz: Interesting. That’s really fascinating. I just recently interviewed in last week’s podcast was with Dr. Alan Goldhammer and he has a long term fasting program. He puts patients on a water only fast for up to 40 days and he has some documented cancer cases.
Dr. Winters: Yeah. And it’s interesting because I know that he has certain ideologies around the type of foods you should eat when you are eating again-
Dr. Weitz: A little bit different in the type of food…
Dr. Winters: Yeah, I was laughing. I’m like, “Oh good. You have me on right after so we’ll be like the yin and the yang in this.
Dr. Weitz: We went to battle pretty good.
Dr. Winters: Oh, that’s beautiful because what I-
Dr. Weitz: Yeah.
Dr. Winters: … people don’t understand is there are multiple ways to reset your metabolic center system. There are a variety of ways to restore health. There is no one way. And so because I’m such an avid tester, if someone’s like, “Hey, I’m doing vegan raw food, great, well let’s see if that’s working for you. Let’s look at your labs. Let’s look at your genetics. Let’s look at your constitution. Let’s see if that’s working.” Just the same way people are like, “I’m a hardcore carnivore. Okay, well, let’s take a look and see how that’s working for you.” There are so many surprises under the hood. You can’t look at someone and say, “Oh, your going to be great on this.” Right?
Dr. Weitz: Absolutely.
Dr. Winters: That’s what… When people start to get dogmatic and into, frankly, a pissing contest, what’s the best way to go about it? I’m like, “Just show me the data.” I’m trying to-
Dr. Weitz: Absolutely. Let’s test you and let’s see how you doing. How are you Lipids? How are your inflammatory markers?
Dr. Winters: Yeah. Nailed it.
Dr. Weitz: Conventional oncology focuses on figuring out the diagnosis, do you have cancer, what kind, what stage is it in and what the proper treatment, whether it be surgery, chemo, radiation? But you focus on the terrain, the situation in the body in which the cancer is growing. Can you explain why we should focus on the terrain?
Dr. Winters: Sure. You said it, you really introduced the concept well is that Western medicine, standard of care oncology is expert at the tumor and the tumor cell. They are spending billions of dollars every year understanding all of the components of the tumor cell, all the different individual pathways and the different targets on those cells. Yet we’ve barely moved the needle on the dial of really changing survival outcomes and the diagnoses of this to begin with. So just to give an example stats to you listeners, one in two men, one in 2.4 women are expected to have cancer in their lifetime in the United States and World Health Organization’s statistics show that cancer worldwide is expected to double by 2030. That does not show me that we’re making a lot of headway with the way we approach cancer from the get go. All right? Not to say that those therapies aren’t powerful, but they need to be brought into context with the whole organism.
So my expertise, I don’t treat cancer, I don’t treat cancer types, I don’t treat tumors. I treat the terrain wrapped around those tumor and tumor cells. I want to understand the why. It’s interesting because that might sound a little hooey or hokey to a lot of your listeners, but here’s what’s interesting. There was a woman by the name of Mina, M-I-N-A, Bissell, like the vacuum, that has been in oncology research for going 35, 40 years at this point. She is expert in extra cellular matrix tumor micro environments–basically being what soil is that tumor living within. And she has been showing has some beautiful Ted talks and other YouTubes on her understanding as a cancer researcher, to show that we have been putting all of our attention in the wrong place.
What is also very interesting is what we’ve learned in the last 15 years or so is that even an individual tumor has multiple tumor types. It’s this concept of heterogenecity. Basically it means you might get one biopsy that shows this one target and yet, if you kind of took the whole tumor out and you dissected it down to all these little infinite particles, you’d probably find 5 to 20 different tumor types all in one. The concept of how we treat with these targeted therapies or a hormone block, disruptive therapies or chemotherapy or surgery or radiation is number one, it only impacts the target they’re shooting for. And you’re only getting party information, so you might get lucky, right? But 70% of the time, if you have success the first time around, 70% of the time you’re going to have a recurrence and you’re not going to get super lucky because it comes back a bit louder and a little bit more obnoxious and a little bit more resistant. All right. The other thing is that there are multiple patterns and processes happening even within each of those targets. So when we start to play what we call the whack-a-mole game, you push one down, you’re going to pop up another response. A good example is angiogenesis inhibitors like VEGF inhibitors like Avastin. Okay. You will watch in these labs because I watched their labs and I watched their blood biopsies, through companies like Guardant360.
Dr. Weitz: Right.
Dr. Winters: Well look about VEGF and if it’s normal or elevated when they started Avastin. After three to six months, you’ll start to see that, VEGF go up and up even on the drug because that drug is now starting to create new pathways and new resistance. That’s what happens in all of our standard of care. Let them come in and do the targets and do the treatments that are affecting those fast proliferating cells because chemo, radiation, surgery only address fast proliferating cancer cells. They also at the same time make dormant cancer stem cells come alive, mutate further and become less responsive to any of those standard of care treatments. It’s in the extra cellular matrix, I call it the terrain, some people call it the tumor microenvironment. That if we put attention there, we can help overcome some of that treatment resistance. We can actually enhance outcomes of standard of care therapies and we can certainly make the organism feel a hell of a lot better while they’re going through the process. That’s where I put my focus. That’s where my expertise lies.
Dr. Weitz: This is really an excellent discussion, but I’d like to take just a minute to tell you about our sponsor for this episode. For this episode of the Rational Wellness Podcast, we partnered with Headery, a collaborator in university studies on CBD with their own two unique formulas available to the public. Good morning and snooze, designed for around the clock wellness. They featured CBD infused with specific terpene combinations to help you manage negative thoughts and experience clarity throughout the day and night. Visit Headery spelled H-E-A-D-E-R-Y.com and use the coupon rational for 20% off. Now back to our discussion.
Dr. Weitz: I also think it comes to the difference between individual molecular pathway with one drug that hits one pathway versus which Jeffrey Bland has called systems biology.
Dr. Winters: YES.
Dr. Weitz: I was in a seminar that Nalini Chilkov gave a few-
Dr. Winters: Oh.
Dr. Weitz: … weeks ago.
Dr. Winters: Well my girl.
Dr. Weitz: She spoke at our Functional Medicine meeting a couple months ago and she put up this chart, which she got from one of the big pharma companies and it had, they’re working on this pathway and they have this one drug that might hit this pathway. And then they had all these genes and this might hit this gene, this might hit that gene. Then she put up a chart of curcumin and it hits like 40 different pathways. None of them is as strong as these targeted drugs, but the amazing power of diet and lifestyle to affect so many different pathways.
Dr. Winters: Yes. That’s just it is people like Dr. Mina Bissel showing up. But even Dr. Aggarwal, who was at M.D. Anderson for years. He was the famous curcumin researcher, but he also has some pretty great quotes that says, we’re given the opportunity to do chemotherapy three times a day. Which is what sits at the end of our fork. Right? It’s like the foods you choose can either be pro cancer or anti cancer and not like they are cause or effect. It’s not that, but they enhance or change the terrain in a way that increases inflammation or increases stress in the body or depletes the immune system or strengthens those patterns. That’s how we think about things, at the way we can use integrative therapies as ways to enhance the overall system’s response to a standard of care approach.
Dr. Weitz: In your book, you talk about the 10 aspects of the terrain and there’s so much great detail in this book that we could talk about it for hours and I encourage everybody to get this book and read it twice. But maybe we can just touch on, you know, one or two things from each of these chapters.
Dr. Winters: Perfect.
Dr. Weitz: To begin with though, when you assess the terrain, you have a questionnaire in your book, but I wonder is there an ideal cancer biomarkers lab panel?
Dr. Winters: Great question. My patients have coined the term the trifecta and this is a combination of testing I’ve done for over 20 years in myself and in my patient population, that gave me a personal indicator, an indicator light to say cancer’s in the driver’s seat or the train is in the driver’s seat. To give an example it really quickly, I’ve had many patients who’ve gone through standard care treatment who all by all accounts on their tumor markers and their scans are no evidence of disease. Net. Right? And they’re super happy. Then I look under the hood and I’m quivering in my boots. I’ve seen the other be true where I’ve had patients, myself included, who have things on scans and still may have elevated tumor markers, but the terrain looks gorgeous, which basically means that they’re in the driver’s seat and the cancer just is maybe in passenger seat and it’s not causing problems. It’s not growing, it’s not going away, but it’s stable.
The key of us changing the cancer conversation is around stability and maintenance and treating this like a chronic illness like anything else. And great if we accidentally get to a no evidence of disease, that’s a great side effect. That is not the end all goal in a terrain centric approach. That being said, there are what I call my monthly labs. When someone had initially had a consult with me or now I consult with doctors on behalf of their patients to teach them how to do this, I look at five main tests to begin with. Good old, simple CBC. That’s your complete blood count that’s looking at… and I want it with the differential. That’s looking at your white blood cells, your red blood cells, hemoglobin, hematocrit, platelets, your RDW, your percentages of monocytes, eosinophils and basophils and your percentages of neutrophils and lymphocytes. That little out-of-pocket $12 test, then that information can be make or break on somebody’s prognosis just in that one test.
An example is if somebody has what’s called a poor NLR, a poor neutrophil to lymphocyte ratio. You could simply go Google that right now on PubMed and you’ll see hundreds of papers that come up saying that a poor neutrophil to lymphocyte, meaning more than two neutrophils for every one lymphocyte is poor prognosis in all out mortality across the board of all the populations. We should be screening, just taking a look at that in every one of our patients. For instance, if you have say 65 neutrophils and 28 lymphocytes, you’re in trouble whether you have cancer or not. If you have 55 neutrophils and 32 lymphocytes, you’re in a really beautiful zone. All right, so these are simple things we can test on that.
The other thing I look at is a metabolic panel, which is going to have your glucose, it’s going to have your liver enzymes, it’s going to have your electrolytes. Those just show me how in your kidney function, that’s like, how are your organs holding up amongst this battle, right? Not too long ago, if you recall, right? 15, 20 years ago, when we ran a chem panel, it used to be a Chem 20, okay , that used to include things like magnesium, sedimentation rate, lactase dehydrogenase, GGT, which is a particular liver enzyme, way more specific and sensitive than an AST or ALT. Today you only get a Chem 14 at best. We usually have to then add those other two key players is SED rate and the LDH into the mix. But that chem panel can show me a lot of what’s going on mostly metabolically what’s going on. If we start to see elevated Alk-phos, we know there could be things with the liver, the kidney, or the bones.
If we see elevated liver enzymes, that could be things like liver mets, that could be liver just overwhelm of whatever medication it’s on. If we see chronically low white blood cells, that’s usually indicative of chronic heavy metal or chronic infection issues. If we see a low hemoglobin that can give us false readings on our hemoglobin A1c levels so it might look like someone’s doing great metabolically on their blood sugars, but their hemoglobin is so low that it’s giving you an erroneously low level. Or we might see low hematocrit, which is also prognostic. People with low hematocrits also have poor prognosis and mortality rates are higher. These are some simple things. Both these tests together 20, 25 bucks.
The trifecta I alluded to already is the sedimentation rate also known as the ESR or the LDH lactate dehydrogenase, sometimes on your test as the LD. And the third one is the CRP, the C reactive protein. That’s the trifecta. Now again, if you went into PubMed and you looked at any of those individually, like what does an LDH mean? What does an LC… Any of those by themselves are good markers for cancer and chronic inflammatory, chronic illness processes. But if you have all three of those tested regularly, I have my patients retest those labs until their trifecta is perfecta. And by perfect I want to be in my functional optimal ranges. For instance, a C reactive protein, some are high sensitivity, which might have a range of up to 0.3 and some are just regulars, which might have a range of up to three. We ideally want that under 1 or 0.1 at its highest. Anything above that, it’s what you want to get a quantitative because if it just says below three or below 0.3 that means nothing. I need the exact number.
Same thing with the SED rates. SED sates should always be below 10 and lactase dehydrogenase or LDS should be, depending if it’s a Quest or a LabCorp should be under 175 or under 450. One of them goes up to around 600 the other one goes up to 220. You want them well within the limitations. When I’m looking at somebody who’s labs and one of those trifectas are out, that usually points to, hey, I just broke a leg or I just got over an illness or I just had an autoimmune flare. For instance SED rate shows how quickly do blood cells fall out of solution. If it takes a while, if that number is higher because it takes longer for those cells that’s thick sticky blood inflammation, high fibrinogen, and those little scaffoldings that allow cancer cells to move about the building, right? We want that low. We want really nice thin moving blood. If LDH is high, that could be a multitude of things. It’s an average of five different enzymes throughout the body that can be pointing to lung health, red blood cell health, liver health, kidney health, even tumor health, like to what’s going on. My husband who’s a biochemist will say if the LDH is on, basically if it’s elevated then the mitochondria are off. That’s a really good rule of thumb and it’s probably the most profound marker we have for all illnesses, especially in the cancer world. In fact if you have lymphoma or melanoma or multiple myeloma, LDH should be the standard cancer marker that’s being run every month for you. I rarely have ever see that happening in the oncology world, which is just absolutely malpractice in my opinion because it’s a really good way to see if you start to see an LDH go up in your cancer patients, you know cancer’s on the move again and then C reactive protein we already talked about.
Those three along with the CBC and CMP give me a lovely base camp of the terrain for about a hundred bucks and we’ll retest those every month until they stabilize. And that’s a starting point. Now, depending on the person’s history, tumor type age, what types of therapies they are taking, I may very well add in a lot of other tests to this, but like typically let’s use breast cancer as an example. I’ll want the markers. A lot of women don’t even ever get their breast markers done. I want CA 27-29 and CA 15-3 as your baseline. But the three main drivers of most breast cancers is a low vitamin D3 three so anything below 50 is a problem. I want it more at a therapeutic level, at 80 to 100 if they’re dealing with chronic illness, an insulin above three is a problem. An insulin growth factor, well above a hundred is a problem. And a hemoglobin A1C above five is problem pretty much in all cancer types, but for sure in the breast world. Then a body fat index, not a BMI, BMIs are BS. But a body fat index above 25% these are key metabolic drivers of things like breast cancer, a lot of colorectal cancers, pancreatic, brain tumors, et cetera. These are some other parameters that we can really test and assess and address in a profound way to change the terrain, to change the soil so that whatever treatments you’re doing for the tumor has a better chance of taking hold.
Dr. Weitz: Interesting. What do you do if you have an elevated IGF-1?
Dr. Winters: Ah, well one of the best and free things is fasting. Yes. Yup. I love that just when I see those moments happen where it can be something fast, fasting, the high intensity interval training can do the same, proper sleep. Know that two nights of bad sleep can throw your insulin growth factor off the charts. If sleep is an ongoing issue for you, make sure you’re addressing that. Stress will also kick up, so cortisol will kick up insulin growth factor and so will estrogen and androgen dominance. If women or men are taking exogenous hormones, even for optimization, their insulin growth factors are going to be high. That’s not good if you’re dealing with a cancering process. Right? We don’t want things that make things grow, right? These are some really simple things that you can take a look at, but a lot of people are just trying to use diet to lower the insulin growth factor, but there are other things that it will stimulate it as well.
Dr. Weitz: Yeah. I did notice that, I wanted to go step by step but I don’t know if I-
Dr. Winters: I recall all over.
Dr. Weitz: I did notice in your chapter on hormones, you were talking about how estrogen is a stimulator of cancer and you’re not a big believer in bioidentical hormones. I even pulled out a quote from where you said that bioidentical hormones are neither safer, more natural than their synthetic ones, which is in stark contrast to most practitioners in the functional medicine community. Can you explain yourself?
Dr. Winters: I can. Now, believe me, I have a lot of hate mail from colleagues in this arena and I’m here to say, Hey, I’m giving bink. Because here’s the deal, I’m the one who’s cleaning up your cancer patients. They might not be cancer patients as they start with you, but they certainly are after they’ve worked with you. If they’re, if you’ve not looked at their snips, if you’ve not looked under the hood, you’ve not at the way they metabolize or hormones, you are messing with fire. So you bring it like I said, data like people saying it began to fight cancer. Let me see the data. You’re telling me hormones are safe, let me see the data. It’s not okay. I look at a lot of data. Here’s what I mean by this. This is what I’m on my soapbox now then Ben. When people say bioidentical hormones, I’ve been at huge medical conferences where I’ve asked the audience, how many of you think that bioidentical hormones are natural hormones? These are doctors. Almost all of them raised their hand. What gets me is that these are synthetic compounded molecules that are the… Why they’re called bioidentical is they so strongly mimic our own endogenous hormones, that that’s why they’re termed bioidentical. But the caveat is they bind almost irreversibly or at least more rigidly to our receptor sites than our endogenous hormones do. So my coauthor Jess has got some great analogies about, think about the garages. Think about your receptors as a garage when you park an exogenous hormone in there like estriol or estradiol. Okay. And like a bioidentical E1 E3 combination. It’s like putting a giant suburban into a place that there’s not even room to open the doors. We can’t let in more information, other things to help pluck it off there and degrade it and move it through the system.
If somebody has snips like CYP1B1, CYP2D6, COMT snips, ESR2 snips, these mean that folks basically taking hormones in and they keep them parked in the garage irreversibly. That starts to kick up things like more sixteens, hydroxy estrones and more four hydroxy estrones, which are the toxic estrogen quinones. If they have certain things like CYP1B1s, they will also take their progesterones and their testosterones and immediately convert them into estrogens and then park those right inside the suburban as well. That is where until you really know the way your patient metabolizes their hormones and know their snips and know their exposures, like are they lathering their body with parabens every day? Are they drinking out of plastic? Do they have copper in their pipes? Are they eating pesticide laden food? Are they getting glyphosates in all of their diet? They are just adding insult to injury with those exogenous soups they’re taking it. Unless you have the money, if somebody likes Suzanne Somers who can basically test your labs every few months and adjust accordingly, you really shouldn’t be messing with this. And-
Dr. Weitz: So what if you are, what if you’re doing, you’re doing urine testing and you’re measuring your estrogen metabolites and you’re making sure that you’re metabolizing estrogen in the most efficient way mostly along the two pathway.
Dr. Winters: Yeah. If that’s the case and you have good snips around this and someone’s also looking at your fibrinogen. at your thyroid hormone function, your adrenal hormone function, looking at your circadian rhythm patterns, looking at your liver enzymes in particular your GGT, and to look at your trifecta and making sure that all that’s looking good. Then probably you can get away with it. But I’m here to tell you after reviewing hundreds of thousands of labs and tens of thousands of patients, I’ve never seen that be the case. I’ve never in 28 years needed hormones to bring my patients back to balance exogenously.
Dr. Weitz: What about as estriol versus estradiol?
Dr. Winters: Now that is the one caveat is every once in awhile when my patients have not responded to all of my tricks to the trade to bring some good juiciness back to life, so to speak. I might very short term use some estriol topically. Just to give you an example, most people give two milligrams and they just have them do it every day, two milligrams topically. I have those same patients do 0.5 milligrams for two weeks nightly, then twice a week for two months nightly and then once a month for two months beyond that. Guess what? It works every time. So less is more in that category. Though I’m testing those folks, I have had a handful of patients where even estriol kicked up their 16s and their 4-hydroxy estrogens because they had such significant snips in this department. But it was enough where I’ve had women who were like tissue paper taking all like vaginal… That was what it took and we were able to restore their function safely and effectively. And interesting as we’re changing the rest of the terrain around the imbalances, that little bit of estradiol that we brought in for that short term really changed the game and they never had to go back to it because it’s a terrain centric process as well.
Dr. Weitz: Now you’re talking about the fact that the estrogen gloms onto the estrogen receptor sites very strongly.
Dr. Winters: Yeah.
Dr. Weitz: But I noticed in that chapter you’re also not very big on soy and the argument for consuming soy is that it’s a very weak plant estrogen that gloms onto the estrogen receptor sites, thus blocking stronger estrogens. Why isn’t that a good thing?
Dr. Winters: Well, first of all, in the United States, it’s a near impossibility to find clean soy. Organic soy does not mean, I will tell you there has been multiple studies showing that all of our soy, 100% organic or not, is contaminated with glyphosate. Glyphosate does not recognize a fence that says this is organic. It has a two mile spread through the air, a two mile spread through the soil and it’s in all of our water sources. Soy because of that it is the nature of glyphosate, it’s sequesters in soybean crops, all legumes, and all grains. That’s its favorite place to hang out. We’re using these foods in the plant based movement. We’re using these foods to kick up our fight, like “Oh my word. We’re actually just gobbling up things that are turning on those insulin growth factors, those estrogen receptors even more.” You might be getting the benefit of a little bit of supportive at soy. But you’re getting all the things that are frankly making it pee in the wind. So there’s that. Number two, one of things we’ve found, and I have a lot of colleagues out there in integrative oncology who are basically are data driven research readers who say, the studies really show that it may not be harmful because there were many years in the camp of saying soy causes cancer. I don’t believe that. I just believe it’s…
Dr. Weitz: Wasn’t it the largest study ever done with women with a history of breast cancer from China and those women who consumed the most soy had the least risk of recurrence of breast cancer?
Dr. Winters: Exactly and here’s why. They have an estrobolome, a microbiome from a cultural background. I was not… I was raised in Kansas. Yes, I have soybeans growing all around me, but I did not start eating tofu in Wichita, Kansas at three years old. Right? That was not happening. Unless you were raised in an environment that’s culturally the… You were getting through your breast milk, your mother’s tempeh and gorgeous non glyphosated soybean, that’s a whole different ballgame. I had just made the blanketed statement in the United States because of the nature of our farming industry. A lot of these are industry-driven responses that it’s, we have so many things that work better and are far safer and I don’t even want a question because I do test and I do see that soybeans. It’s like if my folks are eating a lot of edamame or a lot of tofu, I see that their IGF1 is high. I see that their estrogens are high. I see their blood sugars are high. I see, I mean I see it, so I’m not making these assertions blindly. I think it’s not necessarily that the soy is the problem, it’s what we’ve done to it and the fact that we’re not literally wired in our own microbiome and estrobolome to deal with it.
Dr. Weitz: Cool. But you do think that flax seeds are beneficial for hormone metabolism.
Dr. Winters: Flax seed, right?
Dr. Weitz: Yes.
Dr. Winters: Not oil.
Dr. Weitz: Yes.
Dr. Winters: Thank you. Mostly because it’s just a good a binder, a good fiber.
Dr. Weitz: Okay.
Dr. Winters: And the lignans are pretty anti-inflammatory. But you again, quality is going to be cure. You want to make sure it’s been vacuum sealed that you keep it in the fridge, that you grind it as needed.
Dr. Weitz: Right.
Dr. Winters: Because it oxidizes very quickly. When it oxidizes that actually kicks up your omega-6s versus what we’re going for. Which is in our world today, we about 1850, our omega-6 to 3 ratio was about 3 to 6 to 1 of omega-6 to 3s. Today it’s about a 30 to 1. That is so much of how we adjust sort of mic monocropped our food sources and put just crappy oil, oxidized oil in everything. That’s also when such an anti flax oil kind of gal because it’s pretty much oxidized that second you open the bottle and it just adds more insult to injury.
Dr. Weitz: Yeah, totally agree. But I think I’ve given it up the idea of hitting everyone of these 10 points. So I’m just going to, I’m just-
Dr. Winters: You want to do nine more of these sessions. I’m sorry.
Dr. Weitz: I’m just going to grab some points out of your book that I thought would be interesting talking topics. In your chapter on genes you happen to mention that the nutrient choline which is a vitamin like essential nutrient. It’s an important methyl donor. It’s really important for liver health. We had a discussion on the podcast about fatty liver and choline is one of the most beneficial things for that. We’ve gone round and round with the TMAO being caused by choline. We’ve had a number of discussions on the podcast about choline, but you talk about the fact that some of the data seems to show that men with prostate cancer, that the choline exacerbates their prostate cancer. Can you talk about that?
Dr. Winters: Sure. This is, I’m really glad you brought this up because this actually feeds into a couple other specific nutrients that the data says, hey, this is probably a good fuel source for cancer cells as well. There is actually a load of literature on choline driving prostate cancer and choline is going to be richest in eggs, poultry skin. Those are kind of the main ones where we want our… Because the data is so strong, I just encourage my men to avoid, with prostate cancer, to avoid those things.
Dr. Weitz: Particularly the egg yolk.
Dr. Winters: Exactly. We can kind of get away with some of the albumen by itself in the egg white. But the egg yolk is definitely the choline rich aspect of it.
Dr. Weitz: Right?
Dr. Winters: I’m not… And again, I explained this to people that for the short term let’s see if it makes a dent. I don’t have enough long term data to show, hey, that’s significantly turn on or off the cancering process, but there is enough data out there to suggest that it’s worthwhile pulling it back. Again, that’s not forever. In my mind it’s something that’s easy. There’s still a lot of other choices and it doesn’t create a lot of stress in the patients. Other things such as glutamine, other things such as methionine. There’s discussions about those being drivers of metastatic processes and of cancer fuel sources as well. What I love about all the data around this is why, again, going back to the freebie, intermittent fasting is going to choline restrict, methionine restrict, glutamine restrict, glutamate restrict. It’s going to pull all those things that we worry about.
Here’s my mindset, there was a time when we all just sort of ate whatever was available whenever it was available seasonally. We were not having access to three to six meals a day every day of the year, whatever we wanted, papya in Colorado in the winter. Those weren’t happening. It was definitely seasonal, local, regional and just what was available. And so we went through many, many moments of fasted states. We never ODed on any one particular nutrient. Right? I think today, so much of what we’re dealing with in the oncology world and the concern is that we’re way overfed and undernourished and we’re overfed in ways that keep our sort of balance, weight tilted. Just like Americans living on soy burgers in the United States. When has that ever happened in our culture? Right?
It’s like just the same in like when have we ever had six meals a day in our history. That’s where even some of my gentlemen are like, “Oh my God, I ate an egg.” And they’re all freaked out about having an egg in their keto pancake or what have you and like, “Well, are you fasting? Are you getting in your 13 hours a day minimum, 16 to 18 hours twice a week, maybe a three day a month water fast, you’re likely fine. What the data has shown me over 28 years is that’s probably the case.
Dr. Weitz: Right, you do realize that there’s a lot of practitioners out there who are saying, “Ah, we have to restrict methionine. We have to restrict choline. That means we need a plant based vegan diet and I know that you’re a big fan of the ketogenetic diet. How do you reconcile those?
Dr. Winters: Yeah, well it’s easy because it’s not… and I’m not really, I got labeled as such as the ketogenic diet, because first of all our publisher wanted us to have that on. It’s in the title. But I mean I’ve been using it what I would call a metabolically flexible diet in myself, in all my patients for all these years. My sister in law is a perfect example. Last night she heard her ketones were off the charts high. This is one that she’s been trying to do a ketogenic diet for the last three years to no avail. She’s a very stubborn metabolic process. When she would fast it would actually make it worse. Her insulin growth factor goes up and her chemistry, when we start looking at her SNPs and other things, we started understanding that she had some very unique attributes. What is funny, what will shake my sister into ketosis is a three day meat diet or 3 day protein diet.
Nothing routine for three days shifts her chemistry in such that she’ll drop physical weight. Her glucose goes way into normal range and her ketones go up. If I did that, I would be the opposite. I’d go into gluconeogenesis, my insulin growth factor goes up, my insulin goes up, my glucose goes up and my ketones go down. This is the place that we all need to titrate to our own metabolic precision individuality process here. When folks start to say, “Oh, we have to restrict this, restrict this, restrict this.? Guess what? If you end up on a fruitarian diet or a high plant based diet with a lot of grains, because plant base in that realm usually needs a lot of grains and legumes as well. You are invariably going to see high insulin. You’re invariably going to see high insulin growth factor, high hemoglobin A1c, high glucose. You’re going to see patterns such as elevated lipopolysaccharides, autoimmune conditions flaring, thyroid whacking out, which is going to change the metabolic burner even more.
Because I’m testing, I can watch. That’s why the pendulum drives me crazy as all these camps in there are fighting with one another. Look at this person’s entire process and see what works best for them and know that it needs to change as they do. Whether it’s the season, whether it’s their condition, whatever. That’s why, again, a process where we have naturally used intermittent fasting since the beginning of time. A lot of people get excited about the Mediterranean diet. Well I just spent a month in the Mediterranean and I ate on the Mediterranean diet, all but the grains. The real issue that they’re finding it may be why the benefit of the Mediterranean diet is this is a community of Orthodox Christians who spent 200 days of their calendar year in some form of a fast. That actually may be more of where their medicine is versus the foods they’re eating or not eating. That’s what I think is really profound and we can go back, I mean in ancient, ancient times, fasting has been a way of life out of just simple necessity. Just like the beginning of our conversation, I couldn’t fit anything in and so I didn’t and it made a huge difference for me. Just like the gentleman at true health or TrueNorth. He has been profound things because sometimes putting in nothing is precisely what the doctor ordered.
Dr. Weitz: Since we’re on the topic of prostate cancer, what do you think about modified citrus pectin for prostate cancer? Since I just put up a podcast interview with Dr. Elias.
Dr. Winters: First of all, right on, I use it very almost all every single patient, but I also test, I get a galectin-3 and if it’s above 10 then we are definitely using modified citrus pectin. If they have a biopsy coming up, if they have a surgery coming up, I will definitely preempt them with that and keep them on it for at least a couple of months post biopsy or surgery. Then our goal is to get the galectin-3 down and we’ll use anywhere from 15 grams to 40 grams a day depending.
Dr. Weitz: Oh, wow, 40 grams a day.
Dr. Winters: I’ve used it in those types of situations where I had extreme metastatic like a galectin-3 of 35. We were able to watch every month as it came down and down. Then we were able to maintain it 5 to 10 grams a day, once we hit the sweet spot. It’s a very profound support. What I think it’s also doing, and maybe Elias talked about this, I don’t know, but is that, it also is a great binder, a great fiber. It’s going to be pulling out a lot of the exogenous estrogens, like the hormones, the heavy metals. It’s going to be resetting the microbiome. We’re getting a lot of pre and probiotics with that pectin as well. There are a lot of sort of uncelebrated side victories of this supplement that I think are very helpful in a lot of cancer types, not just prostate.
Dr. Weitz: Yeah, he definitely talks about that and they have some data showing that it binds with lead and other heavy metals.
Dr. Winters: Yeah. Cool.
Dr. Weitz: Let’s talk about the ketogenic diet a little bit.
Dr. Winters: Yeah.
Dr. Weitz: The ketogenic diet is a super low carb, very high fat, like 75% fat diet. Right?
Dr. Winters: That’s a therapeutic ketogenetic diet because you can get into ketosis in a multitude of ways. But a therapeutic ketogenic diet is somewhere between 5 and 10% carbohydrates and anywhere from 70 to 90% fat. Then sort of the protein makes up for wherever you are in that equation. That is very specific with, as a therapeutic treatment for epilepsy. On what we call kind of like a 4 to 1 ratio of fats to carbohydrates in like the pediatric population. It’s also where important treatment that particular ratio and using a therapeutic ketogenic diet is very critical in my personal experience and opinion and what the literature shows in brain cancer patients. Those are kind of like the places where you’re going to get on a ketogenic diet, a therapeutic ketogenic diet, you’re going to stay there for the rest of your long, long, long life is always what I tell patients.
You might be able to moderate your fat intake a little bit over time, but ultimately you’re going to need to keep your ketones, your blood ketones well over 3 to maintain the metabolic need of your brain at that time. Now for other cancer types, you might need only be in a nutritional ketogenic stage, which is of between 0.8 and 3 on your blood ketones. Hopefully what your listeners are hearing here is the key is if you’re going to implement a ketogenic diet for whatever reason, cancer or longevity or overall health and vitality and fitness, you must test. You are not… Most people think they’re in a ketogenic diet when they come see me, they’re no where close. We’re so ingrained to think that we’re eating low carb. I always tell people that before 1850 we were all low carb naturally,
About 30% of our calories came from starches, carbohydrates, tubers like legumes, honey, that we had to work very hard to get, right? After the industrial food revolution kicked in and we started milling sugar and flour that changed and now we’re all stuck in sugar burning mode and we are not readily moving into fat burning mode. Today our caloric intake, it’s about 70% to 80% of our calories come from carbohydrates, especially if you are lower, if you are vegan or vegetarian, that’s for sure the case. That shift is… That’s a big shift, right? What’s fascinating to me is you can actually create, like I just gave the perfect example of my sister who’s eating meatballs right now for three meals a day and got herself into ketosis where being in true 90% fat intake, ketosis didn’t work. She has several SNPs that prevents her from using fats to utilize and create the beta hydroxybutyrate ketones. For her it was a whole different ball game. We have a lot of patients like that that are out there.
Dr. Weitz: You mentioned blood testing for ketones.
Dr. Winters: Yes.
Dr. Weitz: Can you talk about the difference, because a lot of patients are using these urine tests.
Dr. Winters: Yes. Urine testing is where I start everybody. That’s where your first morning, you’re going to pee on a stick. It’s like a $6 bottle of a urine keto sticks from Amazon and you’re going to use those sticks until you start to see moderate to high ketones on the urine. Once you see that, that’s when you graduate to the blood testing. There’s several devices out there. The cheaper, there’s anywhere from $50 to $120 for a blood monitor and anywhere from 99 cents to $5 for a ketone strip. I always want people to shop around because this isn’t CME. I think I’m okay to, can I say the name of the company I like?
Dr. Weitz: Yeah.
Dr. Winters: I use Keto-mojo because their price point fits. And because they’re also a blood ketone and blood glucose monitor and they’re very well calibrated and very reliable. We can even make them reliable to in office being a straws as well. That’s why I use it. Before that I use precision for years, but the price point was often prohibited for most of my patients. Kudos for the Keto-mojo guys for making it more accessible. But what happens when you start to become efficient as you start to become a fat burner? If you are, because anybody can make, like I said, anybody can make ketones, right? But that doesn’t mean you’re in ketosis. That does not mean that you’re metabolically flexible and it does not mean you’re in a fat adapted state. Once you become fat adapted, you should not be showing ketones in your urine anymore.
Dr. Weitz: Right?
Dr. Winters: This is key. If we are like, “I still show,” everyone thinks they’re in ketosis and we’re like, you know what? I could go out drinking the night before and show high ketones in my urine. That’s what people are doing. They’re out there like, “I’m in ketosis. I pull, I’ve drank three bottles of wine last night and I’m good to go.” I’m like, “No, you’re still showing that you’re actually not in a ketogentic adapted stage, or not metabolically flexible.” That’s where it changes. What you’re seeing in the urine is a acetoacetate. What you’re seeing in the blood is beta hydroxybutyrate and what you’re seeing in breath is acetone. So acetone, even a piece of gum can alterate it in your breath or an alcoholic beverage or just the simple state of not eating for a few hours can kind of blow it up. But it’s not a true marker of your metabolic flexibility. Really the gold standard is and can only be blood, It’s these little guys are little tiny finger prints that really don’t hurt. They’ve got a really good jouster on the keto-mojo.
It’s actually quite painless and it’s just the first one’s the hardest. It’s just that psychological barrier. But once you start to test, you can start to really analyze. One caveat for your listeners, we’re so accustomed to testing our blood sugar first thing in the morning or our ketones on the stick first thing in the morning. Your blood ketones, you want to check your glucose first thing in the morning, but you want to actually wait for three to four hours at the very least to check your blood ketones because we have something called the Dawn effect, which can sometimes make people’s ketones erroneously lower or the testing in the morning. It’s just again, not in everybody that it can happen. Our ketones tend to go up, if we’re metabolically flexible, they tend to go up as the day goes on. I kind of tell people maybe 11 noon, 11 or noon or 3 to 4 in the afternoon is a good time to check your blood ketones.
Dr. Weitz: That’s even if you are having breakfast?
Dr. Winters: Exactly. Exactly.
Dr. Weitz: Okay. And so-
Dr. Winters: Also it’s really great is that if you’re weren’t eating through trying to eat to the… I tell people, don’t eat towards the ketone monitor, eat towards your chemistry and see how the ketone monitor is giving you that feedback. It’s like a biofeedback device, that’s all. Letting you know how far or close you are to metabolic flexibility, which is the fountain of youth.
Dr. Weitz: That’s great. You’ve seen real therapeutic benefit in terms of improving the environment in your body that the terrain in terms of helping the body to fight off cancer with the ketogenic diet.
Dr. Winters: Here’s some really cool data that’s coming out and has been for a while is that being being in a fasted state or having elevated ketones at the time of your radiation or your other therapies will actually enhance outcomes. It’s actually… It’s almost like the Trojan horse that drives the treatment into the cell and sensitizes the cancer cell to those treatments. Whereas I think it’s malpractice that doctors are not checking insulin, hemoglobin A1C and insulin growth factor on all their patients getting ready to go through radiation, because it’s well documented that if you have elevations in those parameters that you are desensitized to the effect of the radiation and you make far more aggressive Stem cells and more aggressive mutated cancer cells that are already in the system. It’s like, how can we not do this? Luckily I keep meeting, almost every cancer conference I go to, I keep meeting more and more radio oncologists that are getting hit to this and employing huge genetic diets in their hospitals around the country to put their patients on at the very least through radiation with a recommendation of staying on it for at least six months after, because radiation is still doing its thing six months to a year after you’re completed.
Dr. Weitz: Wow. It’s great.
Dr. Winters: Right?
Dr. Weitz: Cool. I’d like to ask you one more question and I’m going to have to wrap. Can you explain what cachexia is and why drinking Ensure, and milkshakes with ice cream are not the best answer.
Dr. Winters: Another soapbox, and actually that’s in our next book, we plan having an entire chapter on this. It’s probably the most misunderstood concept in nutrition and metabolic health and cancer care out there. I believe it’s the biggest myth to overcome. The big advice often given to our patients is just eat whatever you want, don’t lose weight.
Dr. Weitz: What is cachexia?
Dr. Winters: Exactly, that’s what I was coming to. What the doctors are worried about is they’re worried about weight loss. But there’s a difference of like, hey, I’m not eating and I’m losing some weight, and there’s cachexia, which is, I’m eating everything and I’m still losing weight. They’re different and that they’re metabolically based. When cancer cells take over, the mitochondria take over the system, they basically changed the fuel sources and they basically start to starve the muscles of all of their glucose stores, and they start to gobble up everything they can of sugar that’s coming into the body, that’s coming out of the muscles that’s hidden in storage, that’s out of the liver, and they start to utilize it to grow tumors and starve the body, that’s its job.
The irony of this is it’s driven by three main mechanisms. More carbohydrates, so sugar definitely feeds this process. Angiogenesis is a particular process of growing new vasculature tumors that also will kick up cachexia and inflammation. If you’re extremely inflamed and you have lots of blood flow coming to your tumors and not to the rest of your body and you’re eating high carbohydrate diet, you are absolutely making this process. Where she can eat 20,000 calories a day and you will not stave this off. Okay. What weight you do gain is going to be the fat and not the good diet. You’re just creating little storage tanks for more cancer cell proliferating stimulators, so that’s a biggie. Things like-
Dr. Weitz: Let me just… But in… For patients who don’t know that cachexia is when you see these cancer patients who lose a lot of weight quick, their face gets really thin and usually that means the end is near.
Dr. Winters: Exactly. In fact, depending on the studies, anywhere from 50 to 75% of all cancer patients succumb to cachexia metabolic wasting. If you’re in the physical fitness world, you might’ve heard this as sarcopenia. But basically we see this for a lot of chronic illnesses such as congestive heart failure, cancer, AIDS, HIV, those are stages where suddenly the metabolic shifts away from nourishing the body to starving the body. That’s a very different process and it’s not responsive to calories in. The only thing that Boost and Ensure do is it they ensure an even more untimely death. That’s the key here is that, ironically, even intermittent fasting will help stop this process. For sure of a high fat diet, so like a therapeutic ketogenic diet will stave this off, and even a little bit higher protein depending on the patient and their needs at the time, especially if they’ve got a lot of liver mets they might actually need a little bit more protein, but that becomes a case by case. But it’s something that’s really misunderstood and is treated, and it’s one of the things that actually your conventional team feels very helpless about. But their way of overcoming, their way of making themselves feel better, it’s, just say eat whatever you want, and that’s not helping anybody, and definitely not help me. I’m always, I think the people who need to be educated in this the most are the loved ones of the patient going through this. Because as you watch your loved ones start to lose weight, people freak out, right?
I tell people skinny is not scary, metabolically sarcopenic and muscle wasting is scary. You can see the difference of that on a laboratory assessment. If protein levels drop below seven on your metabolic panel and if albumin levels drop below four, you know you’re on the edge of cachexia. And then when it’s really bad cachexia: you’ll see very low albumin, very low protein, very low calcium, and very low creatinine. When you see that, you know that the body is already just dissolving it’s muscle mass as quickly as possible. And then it’s even more likely that if you put in a feeding tube or you give them Boost or Ensure that they’re going to die very rapidly.
Dr. Weitz: Awesome. It’s been a great podcast…
Dr. Winters: Awesome topics. Thank you for that. My goodness.
Dr. Weitz: Tons of great information. I have about 30 more questions.
Dr. Winters: Excellent.
Dr. Weitz: For listeners who want to contact you, where would you like to steer them?
Dr. Winters: Sure. So definitely go check out my book, The Metabolic Approach To Cancer that I coauthored with my friend and colleague, ah, there you go, Jess Higgins Kelley. We’ve got two more books coming out in the next year, year and a half in that arena. And then I also have a co collaborative book on mistletoe coming out, which will be a whole another topic. We’ll come back together on that. And then they can also go to Dr Nasha, D-R N-A-S-H-A.com. All my social media handles are in that same realm. That is where I try and keep… There’s a ton of other, like your podcast will be on here and all the other media events as well as events coming up, conferences coming up, it’s also a place where we have a really great newsletter where we’re bringing you up to speed on the latest research in the arena of integrative cancer, metabolic health, mitochondrial function, longevity, intermittent fasting, ketogenetic diet, and a lot of that realm, we just kind of grew that on that. So would look forward to seeing any of your listeners start following me there.
Dr. Weitz: Are you accepting new patients?
Dr. Winters: I’m accepting new doctors to support-
Dr. Weitz: New doctors.
Dr. Winters: … and that’s where I want… Because I was on the one on one forever and I did a lot of retreats, which I’ll… we’ll be starting back up in 2020, so I can see things directly, which I’m excited about. But where I find the bottleneck is our healthcare providers. They need to be trained because the patients are savvy, they’re finding this information, they know what they’re up to, and they’re not finding practitioners who can support them on this journey. So my job is to teach the teacher.
Dr. Weitz: Do you have a particular program or it’s a one on one type of situation?
Dr. Winters: Both. Right now I’m doing some one on ones, but starting in January, I have a four month intensive training for physicians that I’ve worked with. You can only kind of get into the lineup if you have already done some consulting with me so you can see if there’s resonates. Because I’m not for everybody, and that’s okay. I want to be for everybody. I don’t have that energy to be for everybody. If the book resonates with you, if you have patients that are demanding, you consult with me on their behalf and you resonate within an hour conversation we have and you realize this can not just help that person but hundreds if not thousands of patients in your practice, then I’d look forward to doing it. I’m joining you in a deep dive mentoring program that starts in 2020.
Dr. Weitz: Awesome. Thank you Dr Winters.
Dr. Winters: What a great time, and I love your podcast. I was able to geek out on it a little bit before our time today and I’ll be following you for sure.
Dr. Weitz: Great. Thank you. Thank you so much.
