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Weight Loss and Cancer April 28, 2016

Posted by Dreamhealer in Cancer, cancer therapy, Cancer Treatment, Healing, immunity, integrative cancer care, Naturopathic Doctor, Naturopathic Medicine, Naturopathy, nutrition.
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Written By: Dr. Adam McLeod, ND, BSc (Hons)

Everyone has seen a cancer patient who has lost a significant amount of weight as the disease progressed. It is a scary experience to see someone that you love waste away as the cancer deprives their body of the nutrients that they so desperately need. In the chaos of going from one appointment to the next, patients often do not realize how malnourished they have become.

The significant wasting that late stage cancer patients experience is known as cachexia. To understand why this happens it is helpful to look at the molecular pathways relevant to cachexia. The exact mechanism is not well defined but inflammatory cytokines are thought to play a major role. Cancer is a condition that creates significant systemic inflammation and this dramatically increases the concentration of inflammatory cytokines through out the body. The most prominent inflammatory cytokines during cachexia are often TNF-a and IL6 5.

The good news is that there are a number of natural tools which can help to significantly reduce these inflammatory cytokines. Of course there are cases where the disease has progressed to the point where it is not possible to reverse the effects of cachexia. However, in my clinical practice I have seen many patients reverse the effects of cachexia rather quickly when the correct natural supports are used. When we take the time to look at how these natural supports work it is immediately obvious why they can be so effective.

Omega-3’s are potent natural anti-inflammatories and specifically they reduce TNF-a and IL6 levels in the body1,2,3. In order to have the desired therapeutic effect from supplementation with omega-3’s it is critical that the proper dose is used. Many supplements (especially pill forms) containing omega-3’s do not have the appropriate dose of eicosapentaenoic acid(EPA) and this will not have any impact on an extreme case such as cachexia. When the appropriate dosing is used sometimes patients can see significant improvements in cachexia from supplementing with omega-3’s 4.

Cancer loves L-glutamine and it uses it in high amounts to support its metabolic needs. Some patients upon hearing this falsely assume that removing glutamine from the diet would then starve cancer cells. This is the wrong approach to take. Cancer cells will get glutamine whether you have it in your diet or not. If it is not in your diet then the cancer cells will cause the muscles to break down so that the glutamine can be extracted from the muscles. This will rapidly worsen the cachexia. The simplistic view that if cancer uses a substance then it should be avoided is not always correct in these complex clinical cases. When patients are supported with adequate amounts of glutamine this can help to slow down muscle breakdown and give healthy cells the glutamine that they also need to function6. The glutamine is also necessary for your immune system to function properly and this need far outweighs any concerns of “feeding” cancer cells glutamine in cases of cachexia.

In my experience the combination of L-glutamine and omega-3’s can help to heal the gut and this allows cancer patients to absorb nutrients more effectively from their food. A major challenge for advanced cancer patients is that even if they eat enough food, they struggle to adequately absorb nutrients from their food. By supporting gut health with adequate amounts of these simple remedies, this can help to enhance the absorption of nutrients at a time when patients are extremely malnourished.

There are many other natural therapies which can also be applied in cachexia to help improve the patients quality of life. For example, cannabinoids can be used to help stimulate appetite while reducing the sensation of nausea that many of these patients have. In other cases, the use of a Myers IV is indicated to bypass any concerns with absorption and get nutrients directly into the blood. Patients generally feel better when the inflammation is reduced following the application of these various naturopathic supports. It is critical that patients have professional guidance from a qualified naturopathic physician when utilizing these supports. Cachexia is a unique metabolic circumstance that requires the appropriate doses if you expect to see any benefit.

Dr. Adam McLeod is a Naturopathic Doctor (ND), BSc. (Hon) Molecular biology, Motivational Speaker and International Best Selling Author. He currently practices at his clinic in Vancouver, British Columbia where he focuses on integrative cancer care. http://www.yaletownnaturopathic.com

References:

1) Kang, Jing X., and Karsten H. Weylandt. “Modulation of inflammatory cytokines by omega-3 fatty acids.” Lipids in Health and Disease. Springer Netherlands, 2008. 133-143.

2) De Caterina, Raffaele, et al. “The omega-3 fatty acid docosahexaenoate reduces cytokine-induced expression of proatherogenic and proinflammatory proteins in human endothelial cells.” Arteriosclerosis, Thrombosis, and Vascular Biology 14.11 (1994): 1829-1836.

3) Nelson, Tracy L., and Matthew S. Hickey. “Acute changes in dietary omega-3 fatty acid intake lowers soluble interleukin-6 receptor in healthy adult normal weight and overweight males.” Cytokine 26.5 (2004): 195-201.

4) Radbruch, L., F. Elsner, and P. Trottenberg. “Clinical practice guidelines on cancer cachexia in advanced cancer patients. European Palliative Care Research Collaborative.” (2011).

5) Yeh, Shing-Shing, Kimathi Blackwood, and Michael W. Schuster. “The cytokine basis of cachexia and its treatment: are they ready for prime time?.”Journal of the American Medical Directors Association 9.4 (2008): 219-236.

6) May, Patricia Eubanks, et al. “Reversal of cancer-related wasting using oral supplementation with a combination of β-hydroxy-β-methylbutyrate, arginine, and glutamine.” The American journal of surgery 183.4 (2002): 471-479.

How to Protect Your Nerves During Chemotherapy March 10, 2016

Posted by Dreamhealer in best vancouver naturopath, Cancer, Healing.
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By: Dr. Adam McLeod, ND, BSc (Hons)

A common side effect from chemotherapy is peripheral neuropathy which manifests as painful or uncomfortable symptoms in the peripheral nerves. It often manifests as pain, burning, tingling, loss of sensation, balance problems or sensitivity to temperature and touch. The significance of the symptoms varies depending on how badly the nerves were damaged from the drug. Usually the feet and hands are affected first but technically these concerns can manifest anywhere in the body. If left untreated this damage can be permanent.

There are some drugs such as paclitaxel which are well known to cause this uncomfortable side effect. When the oncology team discusses the different side effects of therapy, patients are often left with the impression that peripheral neuropathy is a normal side effect of chemotherapy. As a consequence when it starts happening, patients do not recognize it as a serious concern. What more patients need to be aware of is that if you are experiencing neuropathy then you must inform your oncologist and your oncology nurse so that the dose can be modified accordingly. Do not wait for them to tell you that you have neuropathy, you must take the initiative and inform them as soon as you experience these symptoms.

Many oncologists have this belief that the only way to prevent peripheral neuropathy is to reduce the dose of the drug causing this symptom. Of course modifying the dose is important to prevent damage to the nerves but there are many natural therapies which can help support nerve health as well. What is interesting about these natural supports is that they are well documented to make a substantial difference in some major studies published in the most mainstream oncology scientific journals.

These natural therapies help to support the health of nerves during and after chemotherapy and the sooner that these supports are implemented the better. There are many different nerve supports available but the ones that I will talk about in this article are L-glutamine, B-vitamins and ALA. Another therapy that I will discuss is cryotherapy to the extremities.

L-Glutamine:

Glutamine is an amino acid that can be used to help support the health of nerves during and after chemotherapy1,2,3. In my experience this is particularly helpful with some of the intense chemotherapy regimens given to patients battling colon cancer. I have also found it to be more helpful when it is used to prevent neuropathy rather than waiting until the neuropathy has developed and then deciding to use it.

There is currently a controversy about the use of glutamine in cancer patients. Cancer cells uptake glutamine and it is metabolized by the cancer for a number of different pathways. Some people look at this information and jump to the conclusion that glutamine feeds the cancer. Yes, glutamine does feed cancer but glutamine also feeds every cell in the body. If the cancer does not get glutamine from the blood stream then it will cause muscles to waste away and get the amino acid from those tissues. The cancer will always find a way to get glutamine whether you supplement with it or not. The simplistic point of view that we should avoid everything that has potential to “feed cancer” is seriously flawed because our immune system desperately needs these same molecules as well. When it comes to the use of glutamine during chemotherapy, the benefits certainly outweigh the risks and this is particularly evident when we consider the health of the nerves.

B-Vitamins:

During chemotherapy the body often becomes rapidly depleted in water soluble B-vitamins11. It is critical to make sure that you are adequately supplied with B-Vitamins prior to and during chemotherapy to adequately support the nerves. The vitamins that are most critical to prevent neuropathy are B1 (Benfotiamine) and B12 (Methylcobalamin)4,5. The dosage of these nutrients makes a big difference and many of the low quality brands have completely insufficient doses. I have no idea why many of the popular low quality brands decided to put the same dose of all B-Vitamins (eg. 50mg of each B-Vitamin). Just because they share the letter “B” in their name does not mean that the metabolic requirement for each one is the same. Each B vitamin has a completely different function in the body so clearly some will be needed in greater quantities than others.

In my practice I regularly give B12 injections to patients who are undergoing any taxol chemotherapy. B12 is not an antioxidant and there are no realistic concerns about giving these shots regularly. Often the absorption of B-vitamins are impaired in cancer patients so oral supplementation is insufficient to achieve the desired doses. I have found that when given weekly these shots can dramatically support the health of the nerves. It is important to point out that you do not have to have a blood test which shows low B12 levels to justify the use of B12 injections. Vitamin B12 is a water soluble vitamin so if your levels are high then the excess will just be excreted in your urine. It is not uncommon for me to give these injections to patients who actually have high levels in their blood and their symptoms improve as a result. A test that demonstrates adequate amounts of B12 floating in your blood in no way indicates how effectively your body is actually utilizing the B12. It seems that many people during chemotherapy have a functional deficiency of B12 during chemotherapy, even if the actual concentration in the blood is normal or high.

Alpha Lipoic Acid (ALA):

This natural support has been shown to be a helpful nerve support with certain chemotherapies5. It is critical to recognize that ALA is not safe with all chemotherapies. You must have professional guidance when implementing any of these neurological supports into a cancer treatment plan. ALA helps to prevent neurological damage by supporting the health of the mitochondria. Every cell in the body has mitochondria which are responsible for generating energy and these delicate structures are often damaged by chemotherapy. The ALA helps to directly protect these components within nerve cells which can help to prevent neurological damage.

I have found ALA to be particularly helpful in cases where patients had diabetic neuropathy prior to starting chemotherapy. Clearly in these cases additional supports are needed because the nerves will be inherently vulnerable to any additional stressors. ALA has been extensively studied in the context of diabetic neuropathy and has consistently demonstrated a positive effect  in numerous studies6. This is an example of a natural therapy where the quality of the supplement makes a big difference. It can be administered orally or through an IV. If it is given orally then it must be the pure R form to be effective. If it is a racemic mixture then it will not be effective. When it is administered through an IV it must not be mixed with anything else and the entire line and bag must be completely protected from UV rays. Often the bag and line is wrapped in tin foil to prevent UV degradation of the ALA.

Cryotherapy on hands and feet during chemotherapy:

One of the most basic physiological concepts is how blood flow changes when the body is exposed to extreme temperatures. When our tissues are exposed to cold temperatures the blood vessels in the periphery (arms, hands, legs and feet) constrict dramatically to reduce blood flow to the peripheral regions of the body. The blood is shunted to the internal organs so that your core body temperature is preserved and this allows vital organs to continue to function optimally in cold temperatures. When the body is exposed to very warm temperatures then the opposite happens. The blood vessels in the periphery open up and blood is drawn away from the internal organs to the periphery of the body. This prevents vital organs from overheating and it allows heat to escape on the periphery of the body in the form of sweat.

The concept behind cryotherapy during chemotherapy is that if cold is applied to peripheral tissues then there will be less blood flow to the nerve endings that are vulnerable to the effects of chemotherapy. By this same logic it should also deliver more chemotherapy to the cancer (which is more often located in these internal organs rather than on the hands/toes) by fundamentally changing the flow of blood in the body. This concept makes perfect sense on the physiological level and I would recommend this to anyone who is particularly concerned about neuropathy developing in their hands or feet. There is an abundance of research that supports the use of this therapy on the hands or feet to prevent nail toxicity and peripheral neuropathy7,8,9. In circumstances where patients wish to also preserve taste while reducing the risk of oral mucositis, it can be helpful to chew ice cubes during the infusion10. Of course this should not be done in cases of oral cancers but it is a helpful way to preserve taste by reduce blood flow to the tongue and mouth. This is a simple approach that in my opinion every patient should consider adding to their treatment plan.

Summary:

When used appropriately these neurological supports can be used in a synergistic manner to powerfully support nerve health. The sooner that these supports are used, the better chance of nerve recovery. The therapies that were discussed in detail here are only a fraction of the available therapies. Acupuncture, phosphatidyl-serine, acetyl-L-carnitine and glutathione are also used in specific circumstances to support nerve health. All of these supports must be used properly if you expect to have any positive results. In order to develop an effective nerve support protocol you must have professional guidance from a Naturopathic doctor who has experience supporting patients through chemotherapy.

Dr. Adam McLeod is a Naturopathic Doctor (ND), BSc. (Hon) Molecular biology, Motivational Speaker and International Best Selling Author. He currently practices at his clinic in Vancouver, British Columbia where he focuses on integrative cancer treatments. http://www.yaletownnaturopathic.com

References:

1) Wang, Wei-Shu, et al. “Oral glutamine is effective for preventing oxaliplatin-induced neuropathy in colorectal cancer patients.” The Oncologist 12.3 (2007): 312-319.

2) Savarese, Diane MF, et al. “Prevention of chemotherapy and radiation toxicity with glutamine.” Cancer treatment reviews 29.6 (2003): 501-513.

3) Vahdat, Linda, et al. “Reduction of paclitaxel-induced peripheral neuropathy with glutamine.” Clinical Cancer Research 7.5 (2001): 1192-1197.

4) Dizaye, Kawa F., and Chro Y. Qadir. “Effects of Benfotiamine and Methylcobalamin on Paclitaxel induced Peripheral neuropathy.” Middle East Journal of Internal Medicine 7.1 (2014).

5) Mondal, S., et al. “Comparative study among glutamine, acetyl-L-carnitine, vitamin-E and methylcobalamine for treatment of paclitaxel-induced peripheral neuropathy.” Clinical Cancer Investigation Journal 3.3 (2014): 213.

6) Foster, Tricia Stewart. “Efficacy and safety of α-lipoic acid supplementation in the treatment of symptomatic diabetic neuropathy.” The Diabetes Educator 33.1 (2007): 111-117.

7) Scotté, Florian, et al. “Multicenter study of a frozen glove to prevent docetaxel-induced onycholysis and cutaneous toxicity of the hand.” Journal of clinical oncology 23.19 (2005): 4424-4429.

8) Scotté, Florian, et al. “Matched case‐control phase 2 study to evaluate the use of a frozen sock to prevent docetaxel‐induced onycholysis and cutaneous toxicity of the foot.” Cancer 112.7 (2008): 1625-1631.

9) Eckhoff, L., et al. “Risk of docetaxel-induced peripheral neuropathy among 1,725 Danish patients with early stage breast cancer.” Breast cancer research and treatment 142.1 (2013): 109-118.

10) Karagözoğlu, Şerife, and Mehlika Filiz Ulusoy. “Chemotherapy: the effect of oral cryotherapy on the development of mucositis.” Journal of clinical nursing 14.6 (2005): 754-765.

11) Schloss, Janet M., et al. “Chemotherapy-induced peripheral neuropathy (CIPN) and vitamin B12 deficiency.” Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer 23.7 (2015): 1843.

The Real Truth About Cancer February 22, 2016

Posted by Dreamhealer in best vancouver naturopath, Cancer, cancer therapy, Healing, Naturopathic Doctor, Naturopathic Medicine, oncology.
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Written By: Dr. Adam McLeod, ND, BSc (Hons)

Recently there have been a surge in patients seeking alternative cures for cancer after watching the popular series “The Truth About Cancer”. This series does an excellent job of raising awareness about various natural therapies but it does patients a great disservice by discouraging patients from using conventional therapies. This documentary has given patients a biased view point and as a consequence they feel very polarized in their opinion against conventional care. The problem is that the best treatment plan involves integrating these two worlds together. Both conventional therapies and natural therapies have a lot that they can offer patients but they must be used together in a synergistic way for optimal results.

Patients have the right to choose what ever treatment plan they want. As a Naturopathic physician I have always respected my patients choices, even if I disagree with that choice. It is not my job to force the patient to choose a treatment plan, it is my job to give them the information and then they choose the treatment plan that feels right to them. When developing a treatment plan the key word is “integrative” not “alternative”. This means using natural tools safely and effectively in conjunction with conventional therapies. An integrative approach is what any licensed naturopathic doctor would be recommending and unfortunately this documentary confuses the public by giving them the impression that naturopathic doctors are against conventional cancer treatments. By presenting such a polarized view it often discourages patients from seeking true integrative care that could really benefit them.

Make no mistake about it, I am a big believer in the healing power of nature but this series greatly exaggerates the effectiveness of many natural therapies. Of course there are home runs with simple natural therapies. I have personally witnessed on many occasions where patients have dramatic responses to the simplest natural therapies. Although these responses are amazing and they require further investigation, it does not mean that everyone should abandon all conventional therapies in favour of an alternative approach. What the documentary fails to document is the many people who chose to pursue only alternative therapies and had poor responses. Cancer is unforgiving of delays and poor choices. It is true that chemotherapy, radiation and surgery have side effects but cancer has side effects too.

Many of the natural therapies that this documentary chooses to highlight are not commonly recommended by experts who work in the integrative oncology field. Things like baking soda and apricot seeds are not mainstream natural cancer therapies and have virtually no evidence of being effective. There are countless natural therapies which are more effective than this and which are well supported by scientific evidence. Not all cancers are the same and you must have professional guidance when developing a plan. Many natural therapies are completely contraindicated in certain cancers and just because it is natural does not mean that it is universally safe.

Of course there are times where the use of chemotherapy is questionable. In some circumstances the cancer is unlikely to respond to the drug and intensive therapies are being recommended to only slightly extend life expectancy. In these cases the lowered quality of life must be weighed against the increased life expectancy. There are certainly cases like this where the medical oncologists are only recommending such therapies because there are no other options. It is not unreasonable for patients to resist conventional care in some of these extreme circumstances.

The key thing to recognize is that this does not apply to all cases of cancer. Conventional cancer treatments save lives when used in a timely fashion. The study cited in the series that states the ineffectiveness of chemotherapy is not presenting this information properly. This study is questioning the use of chemotherapy in the context of 5 year survival rate. By the time many of these cancers in the study were diagnosed, the disease had already greatly progressed and it is unlikely that anyone would live for 5 years, regardless of what therapy they choose.

When you take the time to dig deeper into the study it is clear that in many of these cancers the patients are living significantly longer but many of them are not living up to the 5 year mark. In this particular study someone could live for several years with a great quality of life but if they died at 4 years and 11 months then the chemotherapy would be considered ineffective. Obviously if a patient is able to live longer with a good quality of life, this is a success even if they don’t live for 5 years. The public is often left with this false impression that all chemotherapy leaves patients with a crippled quality of life. Certainly some chemotherapies significantly decrease quality of life but not all chemotherapy is the same. Particularly when patients are well supported they have significantly less side effects and can live with a great quality of life. It is not unusual for me to have a patient come to my office who has minimal side effects even when doing an intense round of chemotherapy because they are well supported naturally during this process.

You will never have all studies agree as this is how science works. We cannot base our clinical decisions on one study, we must base it on the totality of the evidence. A quick literature search will find thousands of peer reviewed studies demonstrating the effectiveness of chemotherapy for a wide range of cancers. I have had many patients in the past refuse conventional care against my advice and fly to exotic clinics around the world to receive alternative therapies. During these unnecessary delays the cancer spread to the point that it was no longer curable. In some of these cases I was confident that the patient could have been easily cured had they not hesitated.

Natural therapies can be used to help support patients through conventional treatments. They can help to significantly reduce side effects and support the immune system. When patients have this support not only do they respond better to therapy, they are more likely to embrace both therapies as their answer to this terrible disease. Often those who are the most polarized in their opinions against an integrative approach are people with little to no experience dealing with cancer. These two worlds can coexist and it is a beautiful thing when there is true collaboration.

The bottom line is that a balanced approach is best. The extreme view that no natural therapies work is simply incorrect. Just as the extreme view that only natural therapies should be used is inaccurate. The best treatment plan is an integrative approach which bridges these two worlds. Many patients get scared away from conventional therapies because their oncologist presents the treatments with such a polarized point of view. When you are trained as a hammer, everything looks like a nail. This becomes obvious to many patients after meeting with their oncologist who has a limited set of tools to offer. There are a vast range of natural therapies that can be used to help your body fight cancer but they have to be used in the proper clinical context. A Naturopathic doctor who works with integrative cancer care can help to give you a more balanced view and develop a treatment plan that utilizes the best of both worlds.

Dr. McLeod is currently accepting new patients at Yaletown Naturopathic Clinic, for more information about integrative cancer treatments please email info@yaletownnaturopathic.com. Yaletown Naturopathic is also one of only a few clinics in all of North America who offers Loco Regional Hyperthermia to patients who qualify for this treatment.

Get well. Stay well. 

Detoxification and Cancer February 15, 2016

Posted by Dreamhealer in best vancouver naturopath, Cancer, Healing, integrative cancer care, Naturopathic Doctor, Naturopathic Medicine.
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Written By: Dr. Adam McLeod, ND, BSc (Hons)

On a regular basis I have cancer patients come to my clinic who when diagnosed immediately started a self prescribed detox protocol to rid their body of the toxins from cancer. Intuitively it makes sense to remove toxins from a body fighting cancer. The cancer is very stressful on the body and as a consequence there is cellular debris and toxins that your body must eliminate. There are also many people who believe these toxins are the root cause of the cancer in the first place. Although this make sense on an intuitive level, in the complicated clinical context of cancer this is usually not a good treatment plan to pursue.

Cancer and the conventional therapies used to treat cancer are toxic to the body, but aggressively trying to remove these toxins is not helpful during conventional treatment. One major safety concern that many self prescribed plans neglect to consider is that these detox plans can alter how your body metabolizes the drug. When a dose of chemotherapy is given to a patient, the dose is calculated based on how quickly the body breaks down and eliminates the drug. If your body breaks down the drug faster then it will be eliminated before it has the chance to have its therapeutic effect. Just because a drug is considered “toxic” doesn’t mean that we have to get rid of it as soon as possible. In fact, often we want that drug to remain present for a specific amount of time so that it can have an optimal therapeutic effect.

The whole purpose of any detox plan is to mobilize toxins and eliminate them from the body. This process is inherently stressful on the body and can actually increase inflammation through out the body. This is why patients will often experience joint pain upon initiating a detox protocol. When the body is already in such a stressed and inflamed state from cancer, it is not wise to add any additional stress to the system. After chemotherapy or radiation is complete, then there could be an argument for a detox but even then it must be done at the right time, with the proper guidance.

The challenge when developing an effective integrative cancer treatment plan is that there are so many different therapies that show promise. There is a lot of misinformation on the internet and not all cancers are the same! Just because you read that a therapy was helpful for someone fighting cancer, this does not mean that it would be relevant to a different form of cancer. We have to prioritize the treatment plan and keep it targeted on the common goal of supporting the immune system while controlling inflammation. There are many natural ways to do this but in order for them to be used safely it has to be used in the right clinical context.

The bottom line is that if you are trying to support your body through any cancer therapy, you need professional guidance. Do not develop a plan on your own as not all natural therapies are safe or indicated in specific circumstances. A significant portion of my job as a Naturopathic Physician who focuses on integrative cancer treatments is just making sure patients are not taking supplements that are dangerous. On an almost daily basis I see patients who self prescribed a supplement that is contraindicated or ineffective for their cancer and they never told their oncologist because they were afraid of how they would react. After a Naturopathic Physician develops a safe and effective plan they can then communicate with the oncologist so that everyone is on the same page. This creates a better collaborative healing environment for the patient and allows for the development of a more effective treatment plan.

Dr. Adam McLeod is a Naturopathic Doctor (ND), BSc. (Hon) Molecular biology, Motivational Speaker and International Best Selling Author. He currently practices at his clinic in Vancouver, British Columbia where he focuses on integrative cancer care. http://www.yaletownnaturopathic.com

Cancer: Know Your Enemy August 24, 2015

Posted by Dreamhealer in Cancer, Naturopathic Doctor, Naturopathic Medicine.
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Written by: Dr. Adam McLeod, ND, BSc (Hons)

Chemotherapy is an effective tool at killing cancer cells when it is used appropriately. The biggest challenge is knowing which drug is best suited for an individual’s cancer. Over the years we have learned that certain cancers tend to be more vulnerable to specific chemotherapies. This has resulted in specific protocols being assigned to patients in a “cookie cutter system”. For example, if you have hodgkins lymphoma you are given ABVD1. If you have non-hodgkins lymphoma you are given CHOP2. This model is currently the standard of care with cancer treatment but it is clear that this is not the most effective way to treat cancer.

It is true that certain cancers tend to be susceptible to certain chemotherapies but these generalizations are not universally correct. There is an incredible degree of variation between cancer cells in different people. Genetic variations are significant even between different cells within one tumour in an individual3. In fact, very often there is a protocol different than the standard chemotherapy regimen that would be more effective4. Unless tests are done there is no way of knowing which protocol will be the most effective. It is essential to run these tests first and have a clear rationale for the chemotherapy protocol rather than testing on the patient through trial and error.

There is no question that targeted cancer therapies are the future of oncology. It is very important for patients to realize that we already have the ability to do this. Personalized cancer therapy is available but it is rarely encouraged by oncologists due to the costs. Although these tests are often not covered, they can be done privately for approximately $4000.00.

The older chemotherapy protocols involve using extremely toxic compounds that target any cell which is growing rapidly. In recent years there have been major advances in drugs that target specific pathways in cancer cells5. Before using these targeted drugs effectively it is essential to know which targets the cancer cells are vulnerable to.

When a surgery or biopsy is performed on a cancerous mass it is essential that the sample be sent to a lab that runs these personalized genomic tests. The cancerous cells will be tested against hundreds of different types of chemotherapies and clear evidence will be obtained about which drugs the cancer is actually susceptible to. This vulnerability of the cancer is determined by an actual test on the cells rather than making generalizations based on the type of cancer. As these tests become more affordable it will inevitably become the future standard of care because it is so much more effective than the current standard model.

This is something that patients need to ask for before the surgery. You cannot ask for it to be done afterwards because the cells will not be adequately preserved. This service is rarely offered to patients and few are even aware that this is an option. You need to specifically ask for the cells to be sent to a lab that runs these tests.

Personalized cancer therapy gives patients many additional treatment options. If they do not tolerate the initial chemotherapy regiment well or if the cancer becomes resistant to the first line therapy, then there is a potential “Plan B” that is effective based on molecular evidence. By running this test it will give your oncologist data that justifies the use of a protocol, which may deviate from the current standard of care. The data will give a distinct molecular profile of the cancer that allows a customized treatment plan to be developed for you.

If this customized approach is something you are interested in doing make sure you speak to your oncologist. Any naturopathic doctor who works with cancer on a regular basis will also be familiar with these tests. Contact your local naturopathic doctor to see if this test is right for you.

Dr. Adam McLeod is a Naturopathic Doctor (ND), BSc. (Hon) Molecular biology, First Nations Healer, Motivational Speaker and International Best Selling Author.
He currently practices at his clinic, Yaletown Naturopathic Clinic, in Vancouver, BC where he focuses on integrative cancer treatments.

References:
1) Bonadonna G, Zucali R, Monfardini S, De Lena M, Uslenghi C (1975). “Combination chemotherapy of Hodgkin’s disease with adriamycin, bleomycin, vinblastine, and imidazole carboxamide versus MOPP.”. Cancer 36 (1): 252–9

2) Fisher RI, Gaynor ER, Dahlberg S, Oken MM, Grogan TM, Mize EM, Glick JH, Coltman CA Jr, Miller TP (1993). “Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin’s lymphoma.”. N Engl J Med 328 (14): 1002–6.

3) Ross, Douglas T., et al. “Systematic variation in gene expression patterns in human cancer cell lines.” Nature genetics 24.3 (2000): 227-235.

4) Strickland, Stephen A., et al. “Correlation of the microculture-kinetic drug-induced apoptosis assay with patient outcomes in initial treatment of adult acute myelocytic leukemia.” Leukemia & lymphoma 54.3 (2013): 528-534.

5) McDermott, Ultan, and Jeff Settleman. “Personalized cancer therapy with selective kinase inhibitors: an emerging paradigm in medical oncology.” Journal of Clinical Oncology 27.33 (2009): 5650-5659.

Hyperthermia: An Emerging Adjunctive Cancer Therapy August 11, 2015

Posted by Dreamhealer in Healing.
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Written By: Dr. Adam McLeod, ND, BSc

Hyperthermia is an emerging therapy that has great potential as an adjunctive cancer therapy. In Germany, hyperthermia, also known as “oncothermia” has been used for decades in conjunction with chemotherapy and radiation. These advanced medical devices significantly heat up the tumour and this causes profound metabolic changes within cancer cells that make them more vulnerable to conventional therapies1,2,3.

It is important to point out that hyperthermia is very different from an infrared sauna or the application of a heat pack. A loco-regional hyperthermia device is a state-of-the-art medical device that significantly heats the tissues surrounding a tumour1. You will not heat any tumour effectively without these advanced devices, especially if it is a deeper tumour. Recent research emphasizes the importance of a loco-regional hyperthermia device that possesses at least two active electrodes along with enough power to target deep areas in the body. Currently there are only a few clinics in North America that have these devices.

So how does hyperthermia work? The application of heat will cause major metabolic changes in cancerous cells including protein denaturation and aggregation which triggers cell arrest and inactivation of protein synthesis6. The heat also causes alterations in cellular membrane permeability and results in decreased levels of ATP7,8. The proteins within the nucleus of cancerous cells appear to be particularly vulnerable to the effects of hyperthermia2. In other words, the heat adds substantial stress to the cancerous cells and these metabolic changes that occur make them vulnerable to chemotherapy and radiation3,4,5.

hyperthermia cancer treatment

The goal of any conventional cancer therapy is to damage the abnormal cells as effectively as possible. It is clear that the application of heat adds a substantial amount of stress to these abnormal cells. The combination of the stress from the heat and chemotherapy or radiation is overwhelming for cancer cells. There is a potent synergy with these therapies and hyperthermia should be seriously considered for any patient undergoing chemotherapy or radiation for a solid tumour.

Hyperthermia during Chemotherapy

Chemotherapy is one of the fundamental tools used in a conventional cancer setting. It involves the use of drugs that are often toxic to both cancer cells and healthy cells. The objective when doing chemotherapy is to damage the abnormal cells without causing harm to healthy cells. Cancer cells within a tumour are inherently poor at distributing heat because the cells are so tightly packed together. Normal cells based on their spatial arrangement are more efficient at dispersing heat. Several studies indicate that cancer cells are more susceptible to heat injury than normal cells2,14. Hyperthermia is a adjunctive therapy that can be used to enhance the effectiveness of chemotherapy and the metabolic reasons for this effect are obvious. Hyperthermia is cytotoxic to cancer cells within a tumour and this works synergistically with the cytotoxic properties of chemotherapy. Here are some of the effects that the application of heat has on cancer cells while a patient is doing chemotherapy.

Increased Reactive Oxygen Species (ROS)

Reactive oxygen species are highly reactive molecules which damage DNA and other essential components within cancerous cells. Many chemotherapy drugs work by generating reactive oxygen species which damage these rapidly growing cells. Elevated temperatures increase the rates of biochemical reactions and the net effect is that cell metabolism is increased. This is relevant to patients undergoing chemotherapy because the increased cell metabolism will cause a significant elevation in reactive oxygen species (ROS) and oxidative stress9,10,11. The application of heat causes increased generation of ROS such as hydrogen peroxide and superoxide. Not only does heat increase the generation of ROS, it also makes these molecules more reactive12. The net effect is a significant increase in the formation and activity of ROS within cancerous cells.

Many of the most commonly used chemotherapies operate by generating oxidative stress within cancer cells. This is why patients are told by their oncologists to avoid high doses of antioxidants. If the mechanism of action of a drug is to create oxidative stress then it is logical that you should avoid mega doses of antioxidants which could neutralize this effect. What is so exciting about localized hyperthermia is that it will heat up the tumour and this will only result in increased oxidative stress in the immediate environment of the tumour. When hyperthermia is combined with chemotherapy it generates much more free radicals in the tumour9, thus making the chemotherapy more effective.

Physiological changes with Hyperthermia

One of the biggest challenges with chemotherapy is effectively delivering the drug to the tumour. Tumours have a terrible blood supply because the cells are so densely packed together. Often when chemotherapy is infused into a patient very small amounts of that drug actually get to the tumour13. When any tissue in the human body is heated it results in the dilation of blood vessels. Thus by applying heat to the tumour you are increasing blood flow into that tumour which allows more effective delivery of the drug to the tumour. This is critically important for patients treating solid tumours with chemotherapy. It is essential to actually deliver the drug to the tumour and hyperthermia enhances enhances that delivery.

Chemotherapy often weakens the immune system which is a problem because a functioning immune system is necessary to fight cancer. Chemotherapy or radiation will not be effective if the immune system is not capable of cleaning up the metabolic mess. The application of heat appears to stimulate various elements of the immune system15,16. It is well-documented that the heat will increase the migration of immune cells to the target site and increase the activity of immune cells in the area.

Laboratory and in vivo studies have shown that the combined use of hyperthermia and chemotherapy leads to increased cytotoxic effects of several anti-cancer drugs such as cisplatin, anthracyclines, cyclophosphamide, ifosfamide, nitrosoureas, belomycin, mitomycin and melphalan26,27,28,29,30. For some of these drugs the interactions between heat and drug are extremely synergistic31. These results clearly demonstrate that the effects chemotherapy are enhanced by hyperthermia.

Reversal of chemotherapy resistance

The biggest fear with chemotherapy is that the cancer becomes resistant to the drug. This severely limits the patients options and results in an aggressive, resistant cancer. There is a great deal of genetic diversity within a tumour. As a consequence, with every round of chemotherapy you are killing cells which are sensitive to that drug leaving behind cells that are resistant. As more resistant cells survive eventually the cancer no longer responds to that drug and the therapy must then be changed.

The most exciting effect of hyperthermia in the context of chemotherapy is that it has the ability to reverse resistance to certain chemotherapy drugs17,18,19,20. There are several obvious metabolic reasons why hyperthermia could have this effect on cancer cells. There is evidence to suggest that multi-drug resistant (MDR) cells are particularly vulnerable to the effects of hyperthermia21. This is incredibly important in the fight against cancer because by definition these cells are resistant to chemotherapy. These cells that become resistant to drugs often do not display cross-resistance to heat and as a consequence they are still vulnerable to hyperthermia32.

It is not unusual to have patients stop responding to a drug after several rounds. Only when the chemotherapy is combined with hyperthermia does the cancer start responding again to the same drug. In other words, the application of heat triggered a reversal of chemotherapy resistance and it allowed these patients to continue therapy when there were few options available.

Summary of Hyperthermia and Chemotherapy

In summary the evidence supporting the application of loco-regional hyperthermia as an adjunct to chemotherapy is strong and the reasons are obvious. By heating the tumour it enhances the delivery of the drug to the cancerous cells by increasing blood flow into the tumour. The heat also results in increased immune presence and activity in the vicinity of the tumour. Most importantly, hyperthermia damages the drug resistant cells and in some cases it reverses the chemotherapy resistance so commonly seen after repeated rounds of chemotherapy. In general, the most effective heat-drug sequence is drug treatment immediately before heat delivery. In other words, you should start the hyperthermia as soon as possible after receiving the chemotherapy infusion.

Hyperthermia during Radiation therapy

One of the most promising aspects of hyperthermia in cancer treatment is the ability to eliminate radiation-resistant tumour cells3. Hyperthermia is recognized as one of the most effective radio-sensitizers known. The basis for this effect is that hyperthermia has the ability to kill cells that are under conditions of hypoxia (low oxygen), low pH and that are in the S-phase of cell division. These are all conditions that allow cells to become resistant to radiation. This is why hyperthermia can be effective at increasing the effectiveness of radiation. It has the ability to kill those cells which would otherwise be resistant to the radiation.

It has been suggested that part of the mechanism for this radio-sensitizing effect is that hyperthermia interferes with the repair of radiation-induced DNA damage. Several studies have indeed observed that hyperthermia increased the amount of radiation-induced chromosomal aberrations22,23. A major part of this radio-sensitizing effect appears to be due to the inhibition of base excision repair of DNA damage24,25. The purpose of radiation is to damage the DNA of cancerous cells. The application of heat makes it challenging for these cancer cells to repair from this damage.

At least 19 randomized studies using a combination of hyperthermia with radiotherapy, chemotherapy or both, have shown significant improvements in clinical outcomes of oncology patients, without a significant increase in side effects33. The combination of hyperthermia with radiation resulted in higher complete response rates, accompanied by improved local tumour control rates and better overall survival rates in many Phase II clinical trials34,35,36,37,38,39. These results consistently demonstrate a synergy between hyperthermia and radiation.

Summary of Hyperthermia

When looking at the evidence there is a clear and consistent trend. Localized hyperthermia has significant potential as an adjunctive cancer therapy. The application of heat using these advanced medical devices increases the effectiveness or chemotherapy and radiation. Hyperthermia reduces the risk of the cancer developing resistance to chemotherapy or radiation. At the end of the day the goal is to use every tool at our disposal to increase the effectiveness of conventional therapies and destroy the cancerous cells. Hyperthermia is a potent adjunctive therapy that can help to accomplish that goal.

Medical centres around the world are using this technology to enhance the positive benefits of chemotherapy and radiation. Currently there are only a few clinics in North America that offer hyperthermia as an adjunctive cancer therapy. Yaletown Naturopathic Clinic in Vancouver, BC is one such clinic that offers this service.

References:

1) Noh, Jae Myoung, et al. “In vivo verification of regional hyperthermia in the liver.” Radiation oncology journal 32.4 (2014): 256-261.

2) Sugahara, Tsutomu, et al. “Kadota fund international forum 2004. Application of thermal stress for the improvement of health, 15–18 June 2004, Awaji Yumebutai international conference center, Awaji island, Hyogo, Japan. Final report.”International journal of hyperthermia: the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group 24.2 (2008): 123.

3) Bettaieb, Ahmed, Paulina K. Wrzal, and Diana A. Averill-Bates. “Hyperthermia: Cancer treatment and beyond.” Cancer treatment—conventional and innovative approaches (2013).

4) van der Zee, Jill. “Heating the patient: a promising approach?.” Annals of oncology 13.8 (2002): 1173-1184.

5) Van der Zee, J. “Hyperthermia in addition to radiotherapy.” Clinical Oncology 19.3 (2007): S18.

6) Lepock, James R. “How do cells respond to their thermal environment?.” International journal of hyperthermia 21.8 (2005): 681-687.

7) Richter, Klaus, Martin Haslbeck, and Johannes Buchner. “The heat shock response: life on the verge of death.”Molecular cell 40.2 (2010): 253-266.

8) Sonna, Larry A., et al. “Invited review: effects of heat and cold stress on mammalian gene expression.” Journal of Applied Physiology 92.4 (2002): 1725-1742.

9) Moriyama-Gonda, N., et al. “Heat–Induced Cellular Damage and Tolerance in Combination with Adriamycin for the PC–3 Prostate Cancer Cell Line: Relationships with Cytotoxicity, Reactive Oxygen Species and Heat Shock Protein 70 Expression.” European urology 38.2 (2000): 235-240.

10) Katschinski, Dörthe M., et al. “Role of tumor necrosis factor α in hyperthermia-induced apoptosis of human leukemia cells.” Cancer research 59.14 (1999): 3404-3410.

11) Bettaieb, Ahmed, and Diana A. Averill-Bates. “Thermotolerance induced at a fever temperature of 40 C protects cells against hyperthermia-induced apoptosis mediated by death receptor signalling.” Biochemistry and Cell Biology 86.6 (2008): 521-538.

12) Lord-Fontaine, Stephanie, and Diana A. Averill. “Enhancement of cytotoxicity of hydrogen peroxide by hyperthermia in chinese hamster ovary cells: role of antioxidant defenses.” Archives of biochemistry and biophysics 363.2 (1999): 283-295.

13) Drummond, Daryl C., et al. “Optimizing liposomes for delivery of chemotherapeutic agents to solid tumors.”Pharmacological reviews 51.4 (1999): 691-744.

14) Babbs, C. F., and D. P. DeWitt. “Physical principles of local heat therapy for cancer.” Medical instrumentation 15.6 (1980): 367-373.

15) Bogovič, J., et al. “Posttreatment histology and microcirculation status of osteogenic sarcoma after a neoadjuvant chemo-and radiotherapy in combination with local electromagnetic hyperthermia.” Oncology Research and Treatment 24.1 (2001): 55-58.

16) Calderwood, Stuart K., Salamatu S. Mambula, and PHILLIP J. GRAY. “Extracellular heat shock proteins in cell signaling and immunity.” Annals of the New York Academy of Sciences 1113.1 (2007): 28-39.

17) Towle, L. R. “Hyperthermia and drug resistance.” Hyperthermia and oncology 4 (1994): 91-113.

18) Herman, Terence S., et al. “Reversal of resistance to methotrexate by hyperthermia in Chinese hamster ovary cells.”Cancer research 41.10 (1981): 3840-3843.

19) Raaphorst, G. P., et al. “A comparison of hyperthermia cisplatin sensitization in human ovarian carcinoma and glioma cell lines sensitive and resistant to cisplatin treatment.” Cancer chemotherapy and pharmacology 37.6 (1996): 574-580.

20) Wallner, Kent E., Michael Banda, and Gloria C. Li. “Hyperthermic enhancement of cell killing by mitomycin C in mitomycin C-resistant Chinese hamster ovary cells.” Cancer research 47.5 (1987): 1308-1312.

21) Uckun, Fatih M., et al. “Radiation and heat sensitivity of human T-lineage acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML) clones displaying multiple drug resistance (MDR).” International Journal of Radiation Oncology* Biology* Physics 23.1 (1992): 115-125.

22) Dewey, W. C., and L. E. Hopwood. “„Sapareto, SA, and Gerweck, LE, 1977,” Cellular responses to combinations of hyperthermia and radiation,”.” Radiology 123: 463-474.

23) Dewey, William C., Stephen A. Sapareto, and David A. Betten. “Hyperthermic radiosensitization of synchronous Chinese hamster cells: relationship between lethality and chromosomal aberrations.” Radiation research 76.1 (1978): 48-59.

24) Dikomey, HH Kampinga, E. “Hyperthermic radiosensitization: mode of action and clinical relevance.” International journal of radiation biology 77.4 (2001): 399-408.

25) H. KAMPINGA, AWT KONINGS, AJ EVERS, JF BRUNSTING, N. MISFUD, and RL ANDERSON, H. “Resistance to heat radiosensitization and protein damage in thermotolerant and thermoresistant cells.” International journal of radiation biology 71.3 (1997): 315-326.

26) Hildebrandt, Bert, et al. “The cellular and molecular basis of hyperthermia.” Critical reviews in oncology/hematology43.1 (2002): 33-56.

27) Bates, Diana A., and William J. Mackillop. “Hyperthermia, adriamycin transport, and cytotoxicity in drug-sensitive and-resistant Chinese hamster ovary cells.” Cancer research 46.11 (1986): 5477-5481.

28) Issels, Rolf D. “Hyperthermia adds to chemotherapy.” European Journal of Cancer 44.17 (2008): 2546-2554.

29) Engelhardt, R. “Rationale for clinical application of hyperthermia and drugs.” Strahlentherapie und Onkologie: Organ der Deutschen Röntgengesellschaft…[et al] 163.7 (1987): 428.

30) Dahl, O. “Interaction of hyperthermia and chemotherapy.” Application of Hyperthermia in the Treatment of Cancer. Springer Berlin Heidelberg, 1988. 157-169.

31) Kampinga, Harm H. “Cell biological effects of hyperthermia alone or combined with radiation or drugs: a short introduction to newcomers in the field.” International journal of hyperthermia 22.3 (2006): 191-196.

32) Souslova, Tatiana, and Diana A. Averill-Bates. “Multidrug-resistant hela cells overexpressing MRP1 exhibit sensitivity to cell killing by hyperthermia: interactions with etoposide.” International Journal of Radiation Oncology* Biology* Physics 60.5 (2004): 1538-1551.

33) van der Zee, Jill, et al. “The Kadota Fund International Forum 2004-Clinical group consensus*.” International Journal of Hyperthermia 24.2 (2008): 111-122.

34) Group, International Collaborative Hyperthermia, et al. “Radiotherapy with or without hyperthermia in the treatment of superficial localized breast cancer: Results from five randomized controlled trials.” International Journal of Radiation Oncology* Biology* Physics 35.4 (1996): 731-744.

35) Overgaard, Jens, et al. “Randomised trial of hyperthermia as adjuvant to radiotherapy for recurrent or metastatic malignant melanoma.” The Lancet 345.8949 (1995): 540-543.

36) Valdagni, Riccardo, and Maurizio Amichetti. “Report of long-term follow-up in a randomized trial comparing radiation therapy and radiation therapy plus hyperthermia to metastatic lymphnodes in stage IV head and neck patients.”International Journal of Radiation Oncology* Biology* Physics 28.1 (1994): 163-169.

37) Datta, N. R., et al. “Head and neck cancers: results of thermoradiotherapy versus radiotherapy.” International Journal of Hyperthermia 6.3 (1990): 479-486.

38) Zee, J. Van Der, et al. “POINT-COUNTERPOINT: What is the optimal trial design to test hyperthermia for carcinoma of the cervix? POINT: Addition of hyperthermia or cisplatin to radiotherapy for patients with cervical cancer; two promising combinations–no definite conclusions.” International journal of hyperthermia 18.1 (2002): 19-24.

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Fasting Before Chemotherapy March 30, 2015

Posted by Dreamhealer in Alternative medicine, Cancer, Chemotherapy.
Tags: , , , ,
4 comments

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Written By: Dr. Adam McLeod, ND, BSc

There has been a major movement lately for cancer patients to fast before and after an infusion of chemotherapy. When first hearing this, it sounds dangerous to encourage a patient to fast when their body is already stressed with chemotherapy. Fasting before chemotherapy has been used safely in several clinical trials1,4. It turns out that there is a significant amount of scientific data to support this therapy when the patient is properly supervised. This is a very interesting shift in thinking because the conventional approach in the past has been encouraging patients to get as many nutrients into their body as possible.

There are a number of metabolic reasons why fasting may increase the effectiveness of chemotherapy while reducing the side effects2,3. Fasting triggers normal cells to enter into a protective mode. They rapidly become more efficient and this triggers a reduction in glucose and IGF-1 levels by more than 50%3. This rapid metabolic shift would be very difficult to achieve even with a very potent mixture of drugs. Cancer cells are unable to shift into this protective mode and this makes them more vulnerable to the chemotherapy than normal cells5. This is referred to as differential protection and it has the potential to transform conventional cancer care.

The length of fasting before chemotherapy varies significantly depending on which study that you look at. The most commonly recommended fasting period is 48 hours before chemotherapy and this continues until 24 hours after the chemotherapy infusion. During this fasting period ideally the patient should only have water. It should be as close to complete fasting as possible.

Although it is clearly uncomfortable not eating for a total of 72 hours, the research is indicating that this is a worthwhile sacrifice. The discomfort from hunger will actually decrease the severity of the side effects from the chemotherapy. It is also important to keep in mind that this starvation state is triggering a powerful metabolic shift in your cells that protects your cells while making the cancer cells more vulnerable to the chemotherapy.

As fasting before chemotherapy is further researched it is likely that other mechanisms will be discovered that explain this differential protection. Even without a fully defined biochemical mechanism for this protection, it is clear that fasting does make a substantial difference. Do not implement a fasting protocol before chemotherapy without the supervision of a qualified health professional. It is essential that you are monitored during this process because fasting is not safe for everyone.

If you are currently doing chemotherapy make sure that you contact a Naturopathic Physician who focuses on cancer. There are many different naturopathic therapies which not only increase the effectiveness of the chemotherapy but they can act to reduce side effects from the chemotherapy. These natural approaches are safe to use with chemotherapy when they are used under the supervision of an experienced Naturopathic doctor. A Naturopathic Doctor that works with integrative cancer will take the time to look at your case and help you effectively integrate these approaches into your program.

Dr. Adam McLeod is a Naturopathic Doctor (ND), BSc. (Hon) Molecular biology, First Nations Healer, Motivational Speaker and International Best Selling Author. He currently practices at his clinic in Vancouver, British Columbia where he focuses on integrative cancer treatments. http://www.yaletownnaturopathic.com

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