Cancer and the Host – A Functional Medicine Perspective

I recently listened to a fascinating series of podcasts called The Longevity Roadmap offered by Dr. Mark Hyman and his Ultrawellness Center. In one particular episode, Dr. Hyman and other specialists spoke about the specific approach that Functional Medicine (FM) takes on cancer. Here are the highlights:

  • Obesity has overtaken smoking as the number one cause of cancer worldwide and in the US, up to two thirds of adults and one third of children are overweight/obese (BMI over 25) which is contributing to the growth of many cancers. In the younger population, there is an increased rate of colon cancer and it’s now known that obesity and toxins from foods and the environment create inflammation and shift our microbiome which can trigger cancer growth.

  • Sugar is a trigger for inflammation and it not only fuels obesity but puts us at risk for 13 types of cancers. It’s becoming commonly known that the main underlying causes of all age-related disease (including cancer) is insulin resistance – which includes heart disease, dementia (often referred to as type 3 diabetes), diabetes and sarcopenia (muscle loss).

  • Not all pre-cancer cells develop into cancer cells. We are always producing pre-cancerous cells in our body but our lifestyle choices ultimately determine whether these cells become invasive cancer.

  • There are two parts to cancer – the cancer itself and the “host” in which the cancer grows. The host is what you can influence to make your body an inhospitable place for cancer cells.

  • The Functional Medicine (FM) approach to cancer acknowledges that conventional medicine like chemotherapy, radiation and surgery are necessary, but these treatments should be combined with optimizing our biology to boost the immune system and make it unfriendly for cancer growth.

  • FM looks at a systemic approach to find the trigger or cause of cancer. The FM clinician will want to understand the triggers that started the cascade of events leading to cancer formation, so a strong personal history is an essential foundation. This approach looks holistically across seven dimensions: gut and digestive processes, immune processes, energy and mitochondrial function, toxin load, cardiovascular and transport system, hormones and neurotransmitters throughout the body, and structures from mitochondrial membranes to the bones. The symptoms the patient has represents an imbalance in one or more of these systems so it’s important to evaluate all of them to determine the person’s risk of getting cancer. Like the soil that surrounds the plant, the terrain in your body which are all these systems influences how the cancer cells grow and proliferate.

  • Three important tests that FM physicians may order include:

  • A complete nutritional analysis that looks at 125 nutritional markers and biomarkers for metabolic dysregulation, inflammation, oxidation and toxins.
    • A digestive and microbiome analysis looks for markers of inflammation and imbalance of important bacteria, presence of infection and toxins in stool.
    • A DNA analysis looks for variations (called SNPs) in the gene blueprint that will predispose you to physiological abnormalities leading to chronic disease and cancers. Once these SNPs are identified, you can change your lifestyle and nutritional plan with targeted supplements to account for this variation so it doesn’t lead to chronic disease or cancer. These tests look at the pathways like oxidation, inflammation, methylation and detoxification and its variations. For example, if you are like me and have what is called the COMT variation (SNP) leading to estrogen by-products not being metabolized well which can lead to an increased risk for breast cancer, your FM doctor can create a nutrition and supplement plan to manage this so you remain cancer free.

  • Given that up to 30% of cancers are caused by a poor diet, one of the most powerful ways to keep your body’s terrain healthy is through what you put in your mouth. A Mediterranean diet is optimal because of the focus on fish, vegetables, whole grains, nuts, seeds, legumes and olive oil with minimum amount of meat, good dairy and severe limits on sugar and carbs.

  • Risk of cancer is influenced by our genetics and our environment. Our genes are not our death sentence as 90% of cancers being expressed as disease are influenced by our environment. Even with cancer risk genes, we can change how they are expressed. So, it’s important to have a healthy diet, not smoke, keep a healthy weight, promote detoxification and eat whole foods that are nutrient dense.

  • Nutrient enhancements should also be considered to support the body’s terrain. We can influence our epigenetics – the expression of our genes through the foods we choose.

  • Antioxidants – like vitamin C, CoQ10 and Omega 3 fatty acids to fight oxidative stress/damage.
    • Detoxification support – supplements like glutathione, silymarin, N-acetyl cysteine and calcium d-glucarate (for estrogen metabolism).
    • Immune support – mushrooms like turkey tail and minerals like zinc, selenium along with vitamin D.
    • Targeted supplements – wormwood is a compound that can suppress the endothelial growth factor and vascular generation of cancer cells.
    • Berries – Black raspberries make it less likely for pre-cancerous cells to progress into invasive cells.
    • Green tea – contains the active compound EGCG that has anti-angiogenesis properties and prevents growth of blood vessels of cancer cells. Cancer cells need angiogenesis for the blood vessels to grow and feed the cancer cells.
    • Similar to green tea, the key component sulforaphane in cruciferous vegetables can also inhibit tumor production.

  • Fasting is good for cancer: In general, cancer cells are dependent on glucose metabolism –so it feeds on sugar. When you fast and your body goes into ketosis, this starves the cancer cells and shrinks them.

  • Fasting is a good way to support autophagy (cleans out old damaged cells) and we need autophagy to get rid of abnormal cells.
    • Excessive eating triggers inflammation leading to insulin resistance and a higher rate of cancer.
    • Fasting and reducing the amount of food has been shown to improve longevity as it lowers levels of inflammation and oxidative stress in our body.
    • A lot of research has been done on cancer and fasting and even 13 hours of fasting is associated with a decreased risk of cancer. It’s important to give the body the time to rest and let the body heal and work on getting rid of damaged cells.
    • A fasting mimicking diet around cancer treatment has been shown to be effective in the initial results of this ongoing clinical trial. This diet suggests cutting calories for three days before and after treatment so healthy cells can adapt to being in ketosis while cancer cells become vulnerable. It’s important to work with a registered dietician when considering fasting or a fasting mimicking diet as part of the protocol to obtain optimal results.
    • Fasting along with a ketogenic diet has been shown to starve cancers like melanoma and pancreas. When your body is in ketosis, it shuts off cancer cells’ life supply and they cannot grow.

  • Our body has the ability to repair itself but a good diet and protective nutrients (like phytochemicals, vitamins, essential fatty acids and minerals) are important. We need a nutrient dense, plant rich diet with lots of activity, good sleep and stress management to enhance our immune function. Enhancing this with nutrient therapies will facilitate our detoxification systems to promote elimination of carcinogens and other toxins.

  • We also need to get rid of heavy metals, pesticides, phthalates, BPA and other chemicals that erode our health. It’s amazing the amount of toxins we eat – rule of thumb is if you can’t pronounce it, don’t eat it!

  • We need to eat mostly whole foods without labels and drink clean water. Even choosing where we live has an impact as certain regions are known to have higher rates of cancer.  The National Cancer Institute has the stats on cancer for every state.

  • Also be careful what you put on your skin as lotions, soaps and cosmetics can contain parabens, BPA and other compounds that wreak havoc on our health. Read my blog on what to avoid when choosing skincare products.

  • We have the opportunity to reduce the burden of suffering from cancer with proper testing and guided lifestyle choices. Diagnostics like colonoscopy, mammograms, prostate exams are all good but these are geared for early detection and not prevention. We need to focus on the host where cancer grows – that’s what FM does.

  • FM is an emerging science and its systems-based approach is focused on looking for the cause, not just treating the symptoms. Two people with the same cancer could have different reasons for how it developed and two people with different cancers could have the same reasons. So we need an individualized approach to treating cancer.

  • Powerful therapies like immunotherapy can be enhanced through a FM approach. Immunotherapy is designed to activate your own immune system to fight cancer. However, it doesn’t always work because your gut health regulates your immune function. So if you have a poor microbiome and insufficient good bacteria, the immunotherapy won’t be effective. However, if you feed your gut with good bacteria foods that are rich in polyphenols and other bioactive compounds, your gut bacteria will thrive and immunotherapy will be effective. Again, it’s critical to treat the host (the terrain), not just the disease.   

If you would like to learn more about preventing or managing cancer, Dr Hyman’s Longevity Roadmap 8-part Series is offered here.

VR and AR Simulation Medical Training Can Reduce Medical Errors

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Human error is an inevitable event in the practice of any trade, including healthcare and medicine. The errors made in medicine can have many negative effects for patients and healthcare providers. A study out of Johns Hopkins in 2016 found that medical errors accounted for over 250,000 deaths annually in the United States – making it the third leading cause of death in the country (Makary 2016). Research has shown that most medical errors occur during the administration and prescribing stages of healthcare (Durham 2008). Many errors can be reduced in frequency with training, education, and practice. This makes the use of medical simulation-based training a valuable tool.

Perhaps one of the first industries to demonstrate that simulation training can reduce error was the aviation industry. The first aviation simulator was purchased and implemented by the Army in the 1930s following some fatal accidents during training. This revolutionized the training of new pilots in terms of both safety and cost. In the 1960s, The National Aeronautics and Space Administration (NASA) further advanced the use of simulators for flight training, making the first fully digital simulators for the Apollo missions.  While these efforts were costly upfront, they eventually became a cost-effective way to improve the outcomes for safety and training.

The medical industry is another trade that uses simulation training to improve training and safety outcomes. The use of medical simulation has evolved greatly over time. Medical simulation has been practiced for centuries using things like anatomical models built out of clay (Rosen 2008). The first simulation mannequin made its debut in 1911. It was a primitive model, but it paved the way for the invention of computerized models later in the twentieth century. Fast forward to today and healthcare providers are now training with virtual reality (VR) and augmented reality (AR) simulations. The possibilities for the simulations that can be created with VR and AR are endless. Some of the options available for VR and AR simulation medical training include:

  • Rehearsing and practicing surgery
  • Exploring anatomy and studying the human body
  • Practicing patient interactions and exams
  • Rehearsing high-pressure and high-risk situations such as resuscitation
  • Completing training such as advanced life support (ALS) or pediatric advanced life support (PALS)

Studies have also shown that the cost of VR and AR training can be less expensive when compared to mannequin simulation (Haerling 2018). This may partly be due to the fact that VR and AR eliminate the need for faculty and laboratory staff, physical facilities, durable equipment, consumable supplies, and other supplies and personnel to set the scene (Haerling 2018). Therefore, VR and AR simulation may represent a more cost-effective approach toward training healthcare professionals.

Virtual and augmented reality simulations make it possible for healthcare providers to practice rare and dangerous scenarios. These include emergency and critical care situations. This platform also allows healthcare providers to learn from the mistakes that they make without distressing an actual patient. It has been demonstrated that users can learn important skills during simulation, including teamwork, leadership, interpersonal communication, decision-making, prioritizing, and stress management (Flanagan 2004).

But what about the reduction of medical errors with simulation training? A meta-analysis of the relationship between medical error and simulation training has revealed that simulation can reduce medical error and prevent some risks related to medical treatment (Sarfati 2019). It has also been demonstrated that simulation-based learning leads to a reduction in the rate of medication errors by nurses working with critically ill patients (Ford 2010). Other studies have evaluated the impact of medical simulation training and shown that the skillset of the healthcare provider improved, thus reducing the potential for future medical errors. Examples of these findings include:

  • Improvement of physician’s performance with mechanical ventilation and hemodynamic monitoring following simulation training (Havaldar,2020).
  • Improvement of objective skills in practitioners working in emergency situations or surgical intensive care unit (Pascual 2011).
  • Improved preparedness, comfort, and decreased anxiety among multidisciplinary resuscitation teams in the pediatric intensive cardiac unit (Alan, 2010).
  • Safety improvements during labor and delivery following simulation training (Phipps 2012).

These improvements translate to decreased medical error and better outcomes for patients. The use of medical simulation can improve the quality of care delivered by healthcare providers, and virtual and augmented reality medical simulation may represent the future of training in healthcare. It is cost-effective and has great potential for creating a wide variety of training scenarios. One of the major goals of medical simulation training is to reduce the number of medical errors made by healthcare workers, and medical simulation training has a proven record of enhancing patient safety and reducing medical errors.

What is Circadian Rhythm and How Does it Impact Our Health?

I’ve mentioned in several of my blogs about the importance of maintaining a good circadian rhythm for optimal sleep and wakefulness. In this blog, I’ll describe how this master clock in our body influences our daily pattern and its importance in keeping this internal rhythm balanced and healthy.

Your circadian rhythm is your 24-hour cycle that is part of your body’s internal clock that carries out essential functions and processes. It is controlled by your hypothalamus and translates signals from the environment to your body. Your rhythm is influenced by external factors like light and your body can regulate temperature and metabolism to keep you alert or help you fall asleep.

Your sleep-wake cycle is part of your circadian rhythm and during the day, light exposure sends signals to your brain to be awake, alert and active. When your brain detects darkness at night, it stimulates the production of melatonin which is a hormone that promotes deep sleep. And it is this alignment of day-wakefulness and night-sleep that maintains a healthy cycle of your body’s circadian rhythm.

The word “circadian” comes from the Latin phrase “circa diem” which means “around a day” and this rhythm works to ensure that the body’s processes are optimized during the 24-hour cycle. Just as the circadian rhythm of a flower determines when they open up during the day and close at night, the same goes for us humans with our mental and physical systems in sync throughout the body during this cycle. For example, our circadian rhythm tells us when to regulate our digestive system, temperature and hormones to manage our metabolism and energy expenditure. Our circadian rhythms are closely connected to day and night – light is the most powerful influencer on our hypothalamus and impacts how this part of the brain interprets signals to regulate our body’s activities. 

Disruption of the circadian rhythm not only leads to sleep disorders but research is now revealing how it impacts physical and mental health like obesity, diabetes, depression and mood. Studies have shown that circadian rhythm disruption can lead to cognitive impairment and metabolic syndrome as well as psychiatric illness and age-related dementia.

The most common causes of circadian rhythm disruption are due to:

  • Traversing multiple time zones and suffering from jet lag due to not being adjusted to the new day-night cycle of your destination. The easiest way to get acclimated is to try to quickly adapt to the new clock upon reaching your destination.

  • Working the night shift as this will always disrupt circadian rhythm – it will be hard to adjust even if you sleep in complete darkness during the day. My mom worked the night shift for 25 years and I am convinced that her Alzheimer’s was directly impacted by this long-term disruption to her circadian rhythm.

  • Going to bed very early and also waking up early (before sunrise). This is more prevalent in older adults but one percent of the population have this sleep phase disorder. 

  • Night owls who stay up late and then sleep late into the morning. This is more typical of teenagers but this delayed sleep phase disorder also impacts a small percentage of the adult population.

Maintaining a healthy circadian rhythm is critical to getting good sleep at night and functioning at your peak during the day. Here are some good habits to establish:

  • Aim to always sleep in the dark as even the tiniest amount of light can disrupt your circadian rhythm and production of melatonin and serotonin. Use blackout curtains and remove (or put electrical tape over) any remaining light.

  • Keep your room temperature lower than 72 degrees (between 60 and 68 degrees Fahrenheit has been shown to be optimal). When you sleep, your body’s internal temperature drops to its lowest level, generally about four hours after you fall asleep. So it’s no surprise that this cool environment is conducive to sleep as it mimics your body’s sleeping temperature. It helps your body regulate not only melatonin but also cortisol and growth hormone levels.

  • Avoid caffeine after 2pm. It’s been shown that for people that are slow metabolizers of coffee, the caffeine effects last long after the drink. Stick to organic decaf if you need that cup-a-joe. Also, be mindful of products and medications that contain caffeine.

  • Finish eating at least three hours before bedtime – the rise in blood sugar levels after a meal will delay sleep and laying down soon after a meal can increase the risk of acid reflux. Also avoiding foods that you may be sensitive to (like dairy, sugar and certain grains) could help reduce gastrointestinal upset, bloating, gas and the late night trips to the bathroom. If you notice that you have digestive issues, you might explore discussing your nutrition with a registered dietitian as addressing any possible food sensitivities can have a profound effect on digestion and sleep.

  • Make sure to get regular exercise (at least 30 minutes a day) as it can improve your sleep – but get it done at least three hours before bedtime so you don’t get the second wind from the exercise high. This study done by the National Sleep Foundation has shown that those who do moderate to vigorous exercise regularly reported higher quality sleep than non-exercisers.

  • Get sunlight in the morning. It will adjust your circadian rhythm to help you sleep better at night. Try to get at least 30 minutes outside every day – morning is best when the sun is less intense.

  • Stick to a consistent bedtime (even on the weekends) and aim to get to bed early so that your body maintains a good sleep rhythm. Deep sleep happens in the first half of your night so it’s important not to miss this time window which is when your body repairs and recharges.

  • Try to avoid doing work or watching TV in bed. It will be harder for your body to relax when it’s time to sleep – it’s important to keep your work space separate from your sleep space. Avoiding blue light from electronics close to bedtime is important as it’s been shown that blue light can delay sleep, suppress melatonin secretion and impair next-morning alertness. If you must watch that episode to wind down, try blue light blocking glasses and/or a blue light filter for your device. Here are some to try: Blue Light Blocking Glasses

  • If you need an afternoon snooze, make sure to keep naps short (20-30 minutes) and earlier in the afternoon so it doesn’t push back your bedtime and throw off your schedule. 

While establishing good sleep hygiene can help you maintain a good circadian rhythm, there may be other circumstances that can prevent you from getting optimal sleep. If you have persistent sleeping issues and/or daytime drowsiness, speak to your doctor or seek out a sleep specialist to dig deeper into the cause to get to the root of the problem.

Telemedicine in Latin America: educating healthcare personnel

Investment in educational projects is one of the steps that public and private organizations in Latin America must take to boost the benefits of virtual health and telemedicine.

An opinion paper written by Dr. Walter Curioso, from the University of Washington, in the United States, states that e-learning is probably the most viable option for providing fast and efficient knowledge to future healthcare professionals.

Isabel Lobos, executive director of Tula Salud, an NGO that trains doctors and nurses virtually in Guatemala, agrees. For her, virtual programs can have a greater impact than face-to-face education in a country where there are 0.4 healthcare professionals per 1,000 people.

“Educational processes usually reach the same people. We are talking about the institutional heads, the directors, or chiefs, those who are in a middle ground within the staff. Very rarely they can reach the grassroots, those who give care in less favorable conditions, much more solitary. These people should be more or as well trained as those at an urban level”, she says.

Susan Groenwald, former president of Chamberlain University in the United States, also appreciates the potential of digital training. “We could train community workers. They can play critical roles in helping patients and their families with medication instructions or just waiting in their homes”, she considers.

Although it offers opportunities for development, e-learning remains a debt in several regions of Latin America. There are healthcare workers who choose to train in English-speaking schools, which can be difficult as most Latin countries tend to rank low or very low on the English Proficiency Index.

How Hippo can help

The COVID-19 pandemic revealed the need for the world to embrace digital tools in medicine. Hippo Technologies is leading this crusade to improve healthcare services.

One of its latest innovations is a voice-activated, hands-free, and head-worn tablet. Its function is to provide a virtual learning space to keep the next generation of healthcare workers engaged in clinical practice. The company also developed the Virtual Care platform, which combines the advantages of in-person learning with the safety and convenience of remote care.

The future of medicine is here, and Hippo is paving the way for regions like Latin America to keep up.

Telemedicine in Latin America: invest to expand

In certain parts of Latin America, virtual health begins to take steps to meet the challenges and provide digital services to the population. One of the first is to design and execute investment projects in this new industry that gained momentum due to the COVID-19 pandemic.

This is the private (green) and public (blue) expenditure on health in Latin American and Caribbean countries. (Source: WHO, Global Health Expenditure Database, 2016)

According to the Inter-American Development Bank (IDB), resources for telemedicine should be included in plans to improve infrastructure and equipment in healthcare centers. Its experts assure that it is necessary to overcome the inequality gaps that exist in Latin America in the 21st century. These are reflected, for example, in the 2018 Broadband Development Index, which revealed that the region lags the most advanced member countries of the Organization for Economic Cooperation and Development (OECD).

One of the Latin American NGOs developing initiatives to bring telemedicine closer to the people is Tula Salud, which works in rural Guatemala to reduce malnutrition and maternal and infant morbidity and mortality. In 2015, it created the Kawok mobile app to record clinical data and generate medical reports. “Having the support of technology to reach a population that is generally excluded or neglected is an excellent opportunity,” says Isabel Lobos, its executive director.

To identify how prepared the States are to invest efficiently in telemedicine, the Pan American Health Organization (PAHO) prepared a tool that measures the level of maturity of healthcare institutions. According to the guide, there are six variables to be studied: organizational readiness, processes, digital environment, human resources, regulatory aspects, and human resources. Its specialists recommend that the authorities adopt it before executing a plan.

Telemedicine in Latin America: the pending digital divide

Despite the benefits they generate during the COVID-19 pandemic, virtual health and telemedicine need to overcome challenges to grow in Latin America. One of the most prevalent is the digital divide that marginalizes those who live in the lowest socioeconomic strata and lack access to internet services.

In 2017, the International Telecommunication Union (ITU) estimated that there are more than 200 million people of working age who are digitally excluded in the region. A year later, the Inter-American Development Bank (IDB) reported that 56% of people used the internet, but only 45.5% of households had a broadband connection.

These differences in Latin America are of concern to the United Nations Educational, Scientific and Cultural Organization (UNESCO), which states that “digital inclusion is a crucial element […] in the region, where internet services […] are considered essential to ensure the well-being of citizens”.

Entrepreneur Marcel Roehrs witnessed the backlog when he founded Doctor Online, a platform that connects doctors with patients in Guatemala. “During our early days, smartphone penetration was not that great in the country. We realized that there was a lot of need among people who were not being attended to because they were far away and didn’t have money,” he says.

The inhabitants of the most neglected regions are often indigenous people. Historically, they face more obstacles to receiving medical attention in their countries. One of the reasons for this is that public institutions provide care mainly in Spanish. According to the United Nations Children’s Fund (UNICEF), there are 522 native peoples in Latin America, who speak 420 languages and make up around 10% of the population.

The marginalization of indigenous communities occurs in a subcontinent that is highly unequal in other services such as education, employment, among other variables. For example, according to the United Nations (UN), the poorest 20% of the population keeps almost 4% of the total income, while the richest 20% has a little less than half of the total income.

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