An open letter from an oncologist to her patients

March 25, 2022

Dear New Patient,

Cancer sucks.You are probably still in disbelief, tired, terrified, and maybe even angry. Thankfully, by the time most of my patients arrive to see me, they are already weeks out from the first news of their diagnosis. Spared of this unpleasant job, your diagnosis nevertheless catapulted you here to meet me, a total stranger.Within the span of less than an hour you will share with me more details than your best friend might ever know in a lifetime. Your gastrointestinal symptoms, your two hundred paged medical file and the details of your social and personal life. I realize that you have placed your trust in my education and literally your life in my hands. In exchange I promise to offer you the latest, most effective treatments for your cancer.


Knowing this, I have a few secrets to share with you.Some of you are still recovering from a badly executed "delivery of THE diagnosis". I am sorry that it happened that way, and I wished I could have been the one who delivered the news to you. But what is done is done. I can only help by making things smoother and perhaps more hopeful from this day on.

CHEMOTHERAPY: Despite being a Keto Oncologist, I still do believe in chemotherapy.Some patients come to me already skeptical of chemotherapy, because of a relative whom they believed went "downhill" as soon as treatment began. But is it possible that perhaps they went "down hill" not because of the chemotherapy, but rather because the chemo did not work?Chemotherapy can still provide a cure for many cancers, especially the early staged ones and especially in patients who are otherwise in good health. However, the most aggressive treatment may not always be the best for you.If you are too weak or ill, it might be better to start slow and work your way up to more complex regimens . Clinical trials are a way to get to a new treatment before it is FDA approved. FDA stands for the Federal Drug Administration, which approves drugs before they go out to market. 

GOOGLING the RESEARCH : I don't mind if you do some of your own research. In fact it is a sign that you are involved in your care. I'm happy to help you with that too. Googling your research is nice but sometimes is not the best resource since many of the facts could be more than 5 years out of date or worse, flawed. We cancer doctors like to do our research on Pubmed. Sometimes also on Google Scholar. https://en.m.wikipedia.org/wiki/PubMed. If you are searching for a bonafide clinical trial, try www.clinicaltrials.gov  The NIH stands for National Institute of Health. Based in Bethesda, Maryland, this is a federally funded facility where the cutting edge cancer research is being done. You don't have to be a veteran to avail of the free medical services. Civilians are welcome. If you are accepted into one of their trials, they also pay for travel expenses and maybe a tiny bit for housing. We also have this big organization called ASCO, the American Society of Clinical Oncology. Once a year oncologists from all over the world attend an ASCO meeting in Chicago to exchange ideas and our members include expert oncologists from all over the United States and all over the world. Most of the ideas that come out of this yearly meeting will eventually go into clinical practice.

FINDING SUPPORT : If you have a solid organ type of cancer, it is a good idea to find and join an online support group. https://www.cancer.net/coping-with-cancer/finding-support-and-information/support-groupsIf you don't have anyone to talk to , a virtual friend with a similar cancer might actually be an emotional lifesaver.If you have a blood cancer, consider the Leukemia and Lymphoma Society. https://tinyurl.com/y6utvpweIf I sent you to see the Palliative Care doctor, this does NOT mean that I am already giving up on you. Although hospice is one of their services, they have other useful things to offer. Counseling, pain management, spiritual support, referral for home nursing services.I do wish that YOU try be part of our team, because you can make a difference!

WHAT TO EAT , or NOT EAT ...Other little things that you need to know….Cereal and oatmeal are no longer my idea of the best foods for breakfast. Too much carbohydrates which when eaten, turn into sugar/glucose. Same with the whole grain muffins and brown bread. Evidence is emerging that eating grain based diets have links to increased inflammation which in turn can promote cancer. Swap your rice, pasta and potatoes for spinach, broccoli and cauliflower.Juicing sounds like it's healthy, but did you know that a glass of orange juice is full of sugar, and low in fiber? If it was shaken in a blender, chances are, it now has very little vitamin C. If you like fruit, I would prefer that you eat the whole fruit itself.Learn to love cheese, and cook omelets with veggies and mushrooms for breakfast. These are low in carbs but high in protein and nutritional value. Eat more green vegetables.Meat is not always bad if you choose well. https://tinyurl.com/y9xj68sySpice up your food with curry, garlic, butter and salt and learn to love seafood.Dairy has lactose which is a form of carbohydrate.Sugar sounds harmless, but it isn't!

Glucose causing cancer – the inside story



Please get rid of your soda habit. It's not just too much sugar, but has artificial food coloring too. Pass over the candy in the chemotherapy suite. Empty calories indeed! Focus instead on nutrition dense food. When the volunteers bring in the tray of donuts , I hope you'd look the other way. When the nurse offers you ginger ale with your chemo, politely ask for diet soda instead. Better yet, ditch the soda altogether and ask for water instead.  I don't like ingredients that sound like hardware codes. (Red 40, Yellow #6, etc) . Try to eat fresh , unprocessed food....but, if your cancer is already very advanced, I don't think the price of organic food is worth the benefits. GIVE YOUR THROAT A BREAK : Give up smoking. Or at least try... If you have throat or gut cancer, say goodbye to alcoholic drinks. At least for the next 2-3 years... Did you know alcohol also causes cancer? Despite being common knowledge among doctors, it is virtually an unknown fact amongst the laypeople!LOSING WEIGHT: Exercise more . Lose some weight. Check out this link. https://tinyurl.com/yawlusrjContrary to popular belief, when you have cancer, weight loss can actually be better than weight gain.SLEEP AND EXERCISE: Get more quality sleep and turn down the night lights!  https://www.webmd.com/sleep-disorders/news/20170619/is-blue-light-bad-for-your-health   If possible sleep during the dark hours. If you have sleep apnea and own a CPAP (continuous positive pressure ) machine, use it. White noise could help you sleep better, without needing a sleeping pill.Exercise. Even 5 minutes a day is better than nothing. Yoga and relaxation techniques sound harmless and might help reduce your levels of stress hormones.ORGANIZE AND DE-STRESSGet organized. Chemo and radiation schedules can be very confusing. Buy a nice journal and write down every important date and appointment. If you are tech savvy, get a calendar app! Make a living will. If you can, appoint a relative as a POA (power of attorney) in case you later can no longer make your own medical decisions. Reorganize your finances and declutter your possessions. The ultimate goal is to reduce stress. (Again, see above). Listen to some relaxing music. In between chemo sessions, go somewhere far for a mini vacation. If you don't have any friends, make new ones. Try not to burn your bridges.Rekindle old friendships and reconcile with distanced relatives. There is no such thing as a perfect family. Besides, you might need their bone marrow one day.... 😌    https://tinyurl.com/yb6r7oeeMY PROMISE : I am glad that you took the time to read this open letter. I might not always have twenty minutes to sit down with you and chat, in fact it seems that I am always running off to something else. I will try to invest as much quality time with you as I can find, even if it is only 5 -10 minutes. This is my challenge as much as it is yours, your future success as it will be mine. 

Your Oncologist

Exploring the Link Between Cancer and Weight Loss:

March 14, 2024
Breaking Down the Fear  Ketogenic diets often result in weight loss. Cancer patients frequently lose weight. Does this mean that keto diets are harmful to use in cancer patients? Cancer and weight loss are two topics that often come hand in hand, yet the relationship between them can be complex and sometimes frightening. Weight loss, particularly unexplained or rapid, can evoke fear in many individuals, often signaling underlying severe health concerns. However, when it comes to cancer, weight loss can sometimes be one of the earliest signs of the disease. In today's blog, we delve into the connection between cancer and weight loss, unraveling why the latter often instills fear and how understanding this relationship can lead to better health outcomes. Understanding Cancer and Weight Loss: Cancer involves uncontrolled cell growth and abnormal spread of cells throughout the body. These invading cells affect various organs and systems and disrupt their normal function. Weight loss can be very subtle or profound depending on the type of organ invaded. As cancer takes root and establishes itself, it also spews out cytokines (unique inflammatory proteins) that also serve as signal messengers, signaling muscles to lose volume, resulting in a weight loss phenomenon known as cachexia. Cachexia is a complex syndrome. Inflammation is often at the root of this problem, of profound muscle wasting, generalized fatigue, and poor appetite, Why Are We Afraid of Weight Loss? Weight loss, in general, is often perceived negatively in society. There's a prevailing notion that thinness equates to health, beauty, and success, while weight loss may imply illness or a lack of control. However, when weight loss occurs without intentional dieting or exercise, it can be a red flag for underlying health issues, including cancer. In cancer, especially, the presence of weight loss is disturbing because we traditionally associate it with illness. Association with Illness: Unexplained weight loss is commonly associated with illness, particularly severe conditions like cancer. The fear of the unknown and the potential implications of such weight loss can be daunting for individuals. To be of "normal" weight is equated with health. Loss of Control: Weight loss, especially rapid or involuntary, can make individuals feel like they've lost control over their bodies. This loss of power can be unsettling and exacerbate feelings of anxiety or fear. Uncertainty: Weight loss without a clear cause can be perplexing and raise questions about what might happen within the body. The uncertainty surrounding the underlying cause can contribute to fear and anxiety. During chemotherapy, however, weight loss is inevitable because we are in a catabolic state. The active cancer is making us lose weight. The key is to control or snuff out the underlying cancer. Once you weaken the tumor, less cytokine release and less inflammation will follow. As this occurs, the "source" of the cytokine release will die, and weight gain should naturally recover. Therefore, loading up on carbohydrates to make us appear to be of "normal weight" is incorrect. Loading up on sugary treats will only strengthen the cancer and will only be counterproductive! Conclusion: The fear of weight loss, particularly in the context of cancer, is understandable, given the potential implications for health and well-being. However, by understanding the complex relationship between cancer and weight loss and challenging societal stigmas, we can accept some form of healthy weight loss during chemotherapy. We can learn to recognize unhealthy weight loss (loss of muscle mass) and differentiate it from healthy weight loss during a ketogenic diet (most of which is weight loss from fat and excess water). As long as one feels energetic, with normal blood parameters and no indication of significant liver or kidney failure, anemia, or marrow failure, then some healthy weight loss during chemotherapy or implementation of a ketogenic diet CAN be acceptable.

GINGER ALE DURING CHEMOTHERAPY

March 4, 2024
Are you still drinking "ginger ale" during your chemotherapy sessions? You know, those gleaming, chilled cans of sparkly soda that your cheerful chemotherapy nurse hands out along with your anti nausea pills?  The scent and the taste of ginger help nausea stay away. But did you know that your "ginger ale" contains no ginger? Worse, the HFCS high fructose corn syrup, a highly processed sugar, can do you more harm than good. And making your cancer cells really happy. Next time you go for your chemo session, ask for water instead. Or better yet, bring your own ginger-infused drink from home. Here is some background about ginger. For centuries, ginger has been used as a remedy for nausea and digestive issues, and some scientific evidence supports its effectiveness. Here are some examples. Morning Sickness: Pregnant women often experience morning sickness, and ginger has been traditionally used to alleviate these symptoms. Several studies have shown that ginger can reduce nausea and vomiting during pregnancy. For example, a meta-analysis published in the Journal of Obstetrics and Gynaecology Research in 2014 concluded that ginger supplementation significantly reduced the severity of nausea and vomiting in pregnant women without any significant side effects. Motion Sickness: Ginger is effective in reducing motion sickness. A study published in Aviation, Space, and Environmental Medicine 1986 found that ginger was more effective than a placebo in reducing symptoms of motion sickness. Subsequent studies have supported these findings, suggesting ginger can alleviate symptoms like nausea, vomiting, and cold sweating associated with motion sickness. Chemotherapy-Induced Nausea: Cancer patients undergoing chemotherapy experience nausea and vomiting. The Journal of Alternative and Complementary Medicine 2009 published a review that analyzed several randomized controlled trials and found that ginger supplementation could reduce the severity of chemotherapy-induced nausea. Postoperative Nausea: Nausea and vomiting are common after surgery. A meta-analysis published in the journal Integrative Cancer Therapies in 2012 found that ginger effectively reduced postoperative nausea and vomiting compared to a placebo. However, we need more research to fully understand its mechanisms and best dosage. Everyone responds differently, but ginger, in its natural form, is usually safe to take during chemotherapy. Just make sure its the real thing! Photo credit Dan Sorum @ unsplash

Welcome to all our new members

January 30, 2023
Welcome to all our new members

Getting Started On A Keto Diet

May 17, 2022
Getting started on the keto diet usually sounds like someone is trying to lose weight? When you add cancer to that recipe, it becomes a whole new ball game. Do any of these thoughts sound familiar? “ I want to fight my cancer , and I heard that this diet can help me heal “ “ I’m confused because the keto diet will make me lose weight” “I’m afraid to lose more weight.” “I can’t afford to lose weight! “ “When is weight loss just right, and when is it too much? “ Is there real hope for me? Over the past two decades, I’ve seen my share of cancer patients. Yup, the whole package - diagnosis, anxiety, chemo, radiation, hair loss, weight loss, and, failures. But, I also saw many patients who achieve clean CT scans, remission, happy news, hair growth, and of course, the coveted weight gain. I have my own collection of patients with stage four cancers, a few have actually reached their ten to twelve year anniversary with me. Most of them have made it past five years and some are in complete remission. Yes, stage four to stage zero! How did they do it? You may have come to this website, searching for answers. I wish that I could tell you all that I know, in one sentence, but I can’t. It usually takes me several office visits to educate my patients. For now, you can stick around, and try to absorb the knowledge from current posts. Take time to read through my past blogs. Signup for a keto conference. There is one coming up very soon. The MHS 2022 in Santa Barbara California. May 5 to 8. Read books, and more books. You might be surprised. Not all books are the same. Some are full of dense material, while some are mostly fluff. But eventually, you will find the right book for you. Join me in one of my subgroups. But you need to fit the profile and be past the beginners stage when you join. Or you might get bored! I do show up there from time to time, to break the ice. And by the way, when you are stuck and can’t find the answers you are looking for...you need to make your voice heard and post your questions. What if my cancer doctor doesn’t approve? If your cancer doctor doesn’t know much about the keto lifestyle, or about metabolic approaches to cancer, don’t lose hope. Try to educate them, Share your knowledge. Even if they are at first resistant, with time, some will marvel at your progress and will notice that you are doing better than their average patients. Finally... the number one question that shows up on my blog.... What diet is best for me? I’m so CONFUSED! “ Dr. XXX on YouTube said that a keto diet and weight loss is good for cancer, but another doctor YYY said the opposite, that I should eat, healthy carbs, more plants, fruit , avoid fat and protein, try to gain weight. “ Dr. WWW advocates a vegan diet, but Dr ZZZ said do a carnivore diet.... , help!!!! Let me know your thoughts in the comments below!

New drug for relapsed Glioblastoma, a deadly form of brain cancer

March 30, 2022
There is exciting news on the horizon for glioblastoma, which is a deadly form of brain cancer. Have you heard of activated T cell therapy? It is similar to the car-T cell therapies that you often hear about for blood cancers. Well, this form of therapy is now available for patients with brain cancers. The catch is, you must enroll in a clinical trial. It is not yet available to the public. To qualify, one must have glioblastoma, a form of brain cancer , and cancer must have relapsed after the first diagnosis. Patients who are interested are now able to ask for information about enrolment at the Cedars Sinai Medical Centre in Los Angeles. This trial will be classified under a Phase one type of clinical trial. The drug company, Kairos pharma is the sponsor. This exciting new therapy, otherwise known as KROS 201, is a form of activated T cell therapy. The patient’s white blood cells are first harvested. Blood is removed by a simple intravenous blood draw, and then sent off to the lab to be processed in a cell culture. In the lab, the white blood cells are primed by exposing them to small protein substances called cytokines. This process will in turn activate the white blood cells, specifically the killer T cells. Once activated, these cells can now fight cancer by inactivating cancer stem cells. The T cells are returned to the patient’s body by intravenous infusion. The link for enrolment is not yet available but do keep checking on www.clinicaltrials.gov

Mistletoe plus chemotherapy in non small cell lung cancer

March 25, 2022
Iscador, a type of mistletoe preparation was tested by a medical team in Israel alongside conventional chemotherapy in the treatment of patients with advanced non small cell lung cancer. Although no improvement in survival or quality of life was noted,non hematological side effects from the chemotherapy and hospitalizations were less in the group which received the mistle toe preparation. Possible yet unproven mechanisms of action include improvement of immune function via increasing the number of NK natural killer cells as well as improve the function of Tumor Necrosis Factor Alpha. Fever which is also a noted side effect of this preparation has been described prior to spontaneous regression of certain cancers such as melanoma implying a possible role of immunotherapy in the fight against cancer. No randomized trials on cancer patients have yet been published. 

Brain cancer – Challenges with the ketogenic diet

March 25, 2022
We made little progress in the way of survival in the treatment of malignant brain tumors, specifically the deadly glioblastoma multiform. Despite aggressive surgery followed by radiation therapy and precautionary chemotherapy, they relapse early and survival is measured in months. Patients rarely survive beyond a year. Alternative therapies abound with few successes. Some patients attempt to enroll in clinical trials in search of new drugs that might make a difference in their survival.  There is a biologic treatment available. It is the monoclonal antibody called Bevacizumab. It supposedly controls the growth of blood vessels that supply nutrition to the brain tumor. Shrinking the blood supply supposedly starves the tumor. Very exciting, but nonetheless isn't a cure. Long term survivors still remain a rarity. There is mounting interest in metabolic basis of cancer development. In this respect, I do feel that ketogenic diets have potential benefit in brain cancer patients. The role of sugar and carbohydrates in the progression of brain tumors is interesting. Since most patients also are on steroids to improve brain swelling. It is also bad for them because this also increases their blood glucose. I wonder, if we are indeed adding fuel to the fire. A few case reports of brain tumor patients who were offered the ketogenic diet showed that some tumors stopped growing while others improved their survival. Notably, upon discontinuation of the diet, the tumor was noted to again progress, only to regain control upon reinitiation. Currently there are 4 clinical trials ongoing in the United States involving the ketogenic diet in the treatment of various forms of cancer. Another is ongoing in Germany. More clinical trial participation is desperately needed if we are going to move ahead and forge any progress with this deadly cancer. =

Lonsurf, newly approved colon cancer drug

March 25, 2022
Three weeks ago I got word that another new chemotherapy drug has been approved for the treatment of colorectal cancer. Ideal candidates for this drug are patients who failed previous chemotherapy involving one of the following drugs: 5-Fluorouracil, Oxaliplatin, Irinotecan, Cetuximab (also known as Erbitux) and Avastin ( also known as Bevacizumab).This new drug has two active components, trifluridine and tipiracil. Trifluridine is a new nucleoside analog. In other words, a nucleoside is a nitrogen containing biologic compound linked to a sugar, which when phosphorylated, turns into a nucleotide, which is a vital part of the DNA backbone. Trifluridine therefore is a nucleoside analog, meaning it isn't but acts like a nucleoside. It incorporates itself into the DNA structure and interferes with cell growth and proliferation. Tipiracil inhibits the enzyme thymidine phosphorylase, which catalyzes the degradation of Trifluridine, thus allowing it to last longer. Thymidine phosphorylase by itself has pro-angiogenic properties, meaning it promotes blood vessel formation and encourages better blood supply of tumors, so Tipiracil directly stops this advantage. Furthermore, Tipiracil by stopping thymidine phosphorylase, prevents the formation of thymine and 2-deoxy-alpha-D-ribose 1-phosphate. 2DARP is a strong reducing sugar product of thymidine catabolism and causes increased oxidative stress within tumors, promotes release of more tumor blood vessel promoting factors ( angiogenic growth factors) such as interleukin-8, vascular endothelial growth factors VEGF, and matrix metalloproteinase-1 an enzyme which breaks down collagen and extracelular matrix, which is key in promoting tumor metastases. This three mode action of tipiracil ( inhibits thymine production, thymidine phosphorylase VEGF activity, stops ROS and MMP-1 , VEGF and cytokine production)- makes it more attractive since it can potentiate the action of the common colorectal chemotherapy drug 5- fluorouracil whose main action is to inhibit formation of thymine. The RECOURSE trial, a —international, randomized, double-blind, placebo-controlled study conducted in patients with previously treated metastatic colorectal cancer apparently resulted in statistically significant improvement in overall survival and progression free survival . The drug is given orally, twice a day, for two straight weeks, minus weekends, followed by a two week break. Side effects are listed as anemia, neutropenia, asthenia/fatigue, nausea, —thrombocytopenia, decreased appetite, diarrhea,vomiting, abdominal pain,—pyrexia. Since it is barely a month since FDA approval ( Sept. 24, 2015) it still has not hit our pharmacy shelves. I am however eager to try this. Will update you again in a few months. 

Getting into ketosis

March 25, 2022
How long does it take to get into a state of clinical ketosis? By ketosis, I mean the levels of beta-hydroxybutyric acid reaching to above normal levels yet not high enough to bring you into a medical emergency such as ketoacidosis. As little as a day is all it takes. You an achieve this in different ways. The most common and sure fire method is to simply stop eating. If you fast and only limit your intake to water or sugarless herbal , which technically has ZERO calories, you will achieve a state of ketosis in no time. Another way is to try fasting for 15 hours a day, or roughly, just eat one full meal daily. this should bring you into ketosis too, though not all 24 hours are involved. If you try a ketogenic diet, that means, you will be limiting your carbohydrate intake to approximately 20% of your total daily intake, and take the rest in the form of fats ( 70-75%) and proteins (5 to 10%).  Monitoring your progress will be helpful. A simple glucometer will suffice. Individual serum Ketone sticks, readily available from Amazon.com or special order through your pharmacy can be used to check your ketone levels throughout the week.

Update on clinical trials of the ketogenic diet in cancer

March 25, 2022
Several clinical trials are ongoing throughout the United States at the moment.  The University of Iowa Department of Radiation Oncology is running a couple of Phase I trials on the use of the ketogenic diet plus radiation and chemotherapy in head and neck cancers, and they also have another which studies the ketogenic diet plus chemoradiation in non-small cell lung cancers and pancreatic cancer. Michigan State University has one which recruited brain cancers, also known as glioblastomas, a very deadly type of brain cancer. Duke University recently began a randomized trial studying the ketogenic diet plus androgen deprivation therapy in prostate cancer , using the ketogenic diet versus a control standard diet. Unfortunately per recent info posted on the clinicaltrials.gov website, the trial was terminated as of December 2015, due to lack of funding, and due to the principal investigator leaving . Closer to home, the Veterans Affairs Medical Center in Pittsburgh has their own trial which recently concluded in 2015. This trial recruited patients with advanced solid tumors across broad tumor types and patients dieted up to 16 weeks or until tolerated. The results have not yet been publicly released as it is currently under manuscript review.
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