[MUSIC] Now, it is with great pleasure that I want
to introduce my colleague, mentor, and an
international expert in nutrition and cancer,
Dr. Donald Abrams. He's the immediate past Chief of our Hematology and
Oncology Division at the Zuckerberg San
Francisco General Hospital. He is an integrative
oncologist at the UCSF Osher Center
for Integrative Health, and Professor Emeritus
of Medicine at the University of
California, San Francisco. He co-edited the Oxford
University Press textbook, Integrative Oncology
with Andrew Weil, it's an excellent resource for those who are looking
for something like that, and he served as President of the Society for Integrative
Oncology in 2010. I am really excited for him to share his expertise
with you tonight, so without further
ado, Dr. Abrams. Thank you very much. Could be third, so
pleasure to be here. I do have a weighty topic. I'm going to talk
about nutrition and cancer do's and don'ts. I have a few
disclosures to make. I am a scientific advisor
to a number of concerns. When I started seeing
patients at the Osher Center for Integrative
Oncology in 2005, I would tell patients that
cancer is like a weed, and someone else is taking
care of their weed, and it's my job to work with the garden and
make their soil as inhospitable as possible to growth and spread of the weed. I do that by looking to see how they fertilize their garden, that is, what they eat, and what supplements they take. The importance of what we eat can never be
highlighted too much. This is data from the
so-called burden of diseases from the State of
US Health published in the Journal of the
American Medical Association. There are two charts one is mortality that
you're looking at here, and below it is morbidity. The Number 1 risk factor for
both mortality and morbidity in the United States today
is so-called dietary risks, which surpasses tobacco use, and high systolic
blood pressure, and does not include that
large line Number 4, high body mass index, nor the low physical
activity line further down so if you put those three
together off the chart, lifestyle issues that really are accounting for morbidity
and mortality today. Unfortunately, this
article doesn't tell us what the components
of dietary risks are. For that, you have to go back to a Lancet article published
now 10 years ago. The 14 components of dietary risks are diets that are low in fruits
and vegetables, whole grains, nuts and
seeds, milk, fiber, calcium, seafood, omega-3 fatty acids, and polyunsaturated fatty acids, and diets that are high in
red and processed meats, sugar-sweetened beverages,
trans fatty acids, and sodium. What I use when I
have my conversation with new patients are
the guidelines that are updated continuously
and published about every 10 years as a large volume from the
World Cancer Research Fund, American Institute
for Cancer Research, and they're guidelines for
reducing the risk of cancer, but Number 10 says, after a cancer diagnosis, follow our recommendations
if you can. What I'd like to
do tonight is go through these recommendations, and see what data supports them, and whether or not the
changes that were made in the recommendations
presented in 2007, updated in 2018 are
valid or appropriate. With regards to nutrition
and cancer dos, Number 1, in 2007 was to be as lean as possible
without becoming underweight. I think that might
be a little bit of an incentive for people
to become anorexic. I think the new guideline 2018, be a healthy weight, keep your weight within
the healthy range, and avoid weight gain in adult life is probably
a better guideline. Unfortunately, most Americans
do not meet this guideline. This is a map showing us the prevalence of
obesity in our country. Thirty percent of adults are now obese with the body mass
index of greater than 30, and another 30 percent
or so are overweight with a body mass index
between 25 and 30. Only 1/3 of adults have
normal weight at this time. The CDC estimates that overweight obesity
is now associated with 40 percent of all cancer diagnoses
in the United States, accounting for over 50
percent of all cancer in women and 1/4 of
all cancer in men, and 2/3 of cancers
in senior citizens, so has a very
significant problem. The American Institute for
Cancer Research estimates that obesity-related excesses
of the seven cancers on the left account
for approximately 115,000 preventable deaths a
year in the United States. The largest n there is for breast cancer because so many
women have breast cancer, but only 20 percent
of breast cancer, usually postmenopausal
estrogen receptor-positive is related to obesity. Notice that 50 percent of endometrial cancer is related
to overweight or obesity. The remainder of the overweight obesity-related malignancies are along the
gastrointestinal tract, except interestingly 1/4
of renal cell carcinoma or kidney cancer is also related
to overweight or obesity. Again, in addition
to those listed, this is what the American
Institute for Cancer Research believes are the associations. Note interestingly that
overweight or obesity probably decreases the risk of premenopausal breast cancer. How does overweight or obesity increase
the risk of cancer? Well, certainly for the estrogen
receptor-positive breast and the endometrial cancer, body fat makes estrogen. We think of the
ovaries, the adrenals, but fat also makes estrogen, and body fat secretes cytokines, chemicals that
promote inflammation. An inflamed body is unable to really unleash the immune system to fight in the attack
against cancer. An inflammation
in and of itself, we believe leads to many of the degenerative
diseases of aging, dementia, heart
disease, and cancer. Again, we know from our
current COVID experience, that the obese seem
to be particularly susceptible to death
from COVID and that's likely due to the
impaired immunity. Personally, I think
one of the most important and probably
maybe the most important way that body
fat increases cancer risk, is that too much body fat
triggers insulin resistance. This causes the body to increase the
production of insulin, and insulin-like growth factor, both of which promote
inflammation, and the growth factor is a growth factor for
cancer cells as well. To the point where
we've now looked at blockade of insulin-like
growth factor one receptor as a
treatment for women with estrogen receptor-positive
postmenopausal breast cancer. How do we deal with body weight increasing
physical activity? I just want to
highlight two points, 16 studies of breast
cancer and seven studies of colorectal
cancer survivors, approximately 50,000 people, showed that those who are
most active with breast cancer lower their risk
of death about 30 percent from their breast cancer
and 50 percent overall, similar findings in those with colorectal cancer and survivors
who report an increase in activity after their
diagnosis also lower their risk of death 40 percent more than those who did not. We know from a number of studies
that many patients would love to hear about physical activity from
their oncologist. As an oncologist who did practice conventional
oncology for 38 years, the field of oncology is
so explosive right now. You can't expect your
breast, or prostate, or colon cancer specialist to keep up with
physical activity, or even nutrition, to be honest. Unfortunately, a survey of
Canadian oncologist showed that 2/3 agreed that physical activity was
safe and beneficial, but less than 50 percent
ever recommended it, and only one in four
within the past month. If an oncologist just recommends an increase in
physical activity that results in an increase of 60 minutes of vigorous
walking a week, which definitely contributes to a more positive prognosis. One of the other main do
that's regard to food says, eat a diet rich in whole grains, vegetables, fruits, and beans. This is pretty much the
same as it was in 2007, although whole
grains subsequently became one word instead of two. Unfortunately, we fall very short on
that recommendation. The CDC reports
that few adults eat the recommended number of
servings of fruits and vegetables a day and
that is a low number, in my opinion, 1.5 -2 cups of fruit and 2-3 cup
equivalents of vegetables. Mainly women are best
at doing this and if you look at the younger
generation, 18-30-year-old, very poor consumption of both fruit and
vegetables and that's counting French fries and ketchup as two
different vegetables. We do have a long way to go and I think five
servings is inadequate. I recommended my
patients consume 5-9 servings of fruits
and vegetables each day or 2.5 -3 cups and I'm a
big fan of phytoestrogens. Soy is something that
baffles many people. I think soy is good
for us if it's an organic non-GMO and a whole soy food,
soybean, soy milk, tofu, tempeh, or miso, and not necessarily soy
cheese, soy turkey, or soy hot dogs, those are heavily
processed foods. Cruciferous vegetables, flowers grow in the
shape of a crucifix, have many potent chemicals in them that seem to reduce
the risk of cancer. I believe we can really never eat enough cruciferous
vegetables. Season with ginger, garlic,
onions, and turmeric. My favorite beverage is
green tea second only to cruciferous vegetables
in the potency of its cancer risk-reducing
chemicals. Then nuts, people
are afraid of nuts, they're too much fat but I'm going to show you
that nuts are good. Let me just dwell on soy for a moment because I do
see so many women with breast cancer who are told
to avoid soy because it's a plant estrogen and their
tumor is driven by estrogen. Well, [inaudible], one of my favorite teachers and an incredible plant botanist, medicinal herbal person, said that the most potent
phytoestrogen out there is soy isoflavones and they don't come close to touching
a women's own estrogen. Soy decreases the risk of
both breast cancer and prostate cancer in
Asians living in Asia, eating an Asian diet, which has approximately
one portion of the whole soy food today. There have been a number of clinical trials,
epidemiologic surveys, observational
studies granted not, placebo-controlled
because you can't really randomize one group to tofu and the other
group to placebo tofu. Many people think tofu is
placebo to begin with. But in general, the Kaiser life after
cancer epidemiology study showed that soy intake at levels comparable to those consumed by the Asian population that is, one portion of a
whole soy food today may reduce the risk
of recurrence in women who have been
treated with tamoxifen for their estrogen receptor
positive breast cancer. Similarly in
post-menopausal women, also decreases the risk of
recurrence by 50 percent. This study was confirmed in the Shanghai Breast
Cancer Survival Study and also the women's healthy
eating and lifestyle. All of them confirm the benefits of soy in
women with breast cancer. But I just want to make
a point that it's not one food and that's
why I don't like people taking soy isoflavone or dim supplements because
it's not just one food, it's not just one chemical, it's the whole diet. This was an interesting study I found in China where
they looked at 1,000 women with
confirmed breast cancer and 1,000 age-matched controls. Compared with the women who
didn't eat fresh mushrooms, the women who did
decrease their risk of breast cancer, about 64 percent. If they dried mushrooms it decreased their risk 50 percent. But the important point is that mushrooms in
conjunction with green tea decrease that
risk even further. It's not just one food and it's probably synergy between
different foodstuffs. That was demonstrated
clearly in this study of the Mediterranean diet in
breast cancer patients. This was a study
done in women 60-80 years old at risk for
cardiovascular disease. They were randomized to a Mediterranean
diet supplemented with extra virgin olive oil, Mediterranean diet
supplemented with mix nuts, or controlled diet, and were advised to
decrease their dietary fat. Over the course of time, 35 cases of cancer developed after a median
of almost five years. Again, those patients who had the Mediterranean diet with the extra virgin olive oil
decreased their risk almost 70 percent and those who had the Mediterranean diet
supplemented by nuts also decreased their risk
by about 40 percent. Very recently, just this year, there was another publication
from the Shanghai Study, where women, 3,500 breast
cancer survivors were followed for over
eight years looking for the development of
recurrence or metastasis. They found that 10
years post-diagnosis, those women who consume nuts
had higher overall survival. Doesn't look like
a huge difference but almost four percent, five percent is, and it was
statistically significant, as well as
disease-free survival. This association
was dose-related. The women eating
more nuts did better and the association did
not vary by nut type, I eat tree nuts versus peanuts or the patients
hormonal status. Those are my does and now let's turn to the
don'ts because they are a little bit
more numerous than the does in the American
Institute for Cancer Research, World Cancer Research
Fund guidelines. The guideline number 3 in 2007 said avoid sugary drinks and limit consumption
of energy dense foods, particularly processed
foods high in added sugar, low in fiber, or high in fat. In the most recent update
from four years ago, this guideline was split into
two separate components. Now it says again, limit consumption of fast foods. Shouting out fast foods in particular because we are
a nation quite addicted to fast foods and
other processed foods high in fat,
starches, or sugars. I really like this quote. It say processed foods, high in fat, starches, or sugars embody a cluster of characteristics that encourage
excess energy consumption. For example, by being highly
palatable, high in energy, affordable, easy to access
and convenient to store. As somebody who worked at San Francisco
General for 38 years my organic apple that I eat every day after lunch
costs as much as a double cheeseburger fries and a milkshake and that's
unfortunate in this country that we subsidize
the cheap foods that are not healthy for
patients and not foods that are. Does it really matter
if you eat fast foods? This study was done in Europe. They gave the so-called
new tree score, which is score for
each food calculating using its 100 gram
content in energy, sugar, saturated fats,
sodium, fiber, etc. Higher scores equal lower
quality of the food. They evaluated a half
a million adults in the so-called EPIC study, the European Prospective
Investigation into Cancer and Nutrition. In 10 different European countries patients
have been followed for 15 years and they
developed almost 50,000 incident cases of cancer, mainly breast, prostate,
and colon as we see here. High scores, which remember
mean not a good diet, were seen, surprisingly,
in France, where we consider their diet
to be pretty desirable, Germany, the UK, and Sweden, and the lower scores
associated with healthier eating were found in the
Mediterranean countries, although Norway, surprisingly, also had a low score. What they found was that the higher score was
associated with a higher risk for all cancer and that increased
the risk seven percent. When I see something like that, even though it's
statistically significant, I say, is it
clinically relevant? Chris Pollock, who's an
administrator I work with in my group visits, pointed out to me that G, seven percent of a
million people is a lot of people that you're protecting from getting cancer. That's something to think about and Europe has way more
than a million people. The rates for those countries
or those people who scored high were much higher than
those for low scores. The higher scores, again, more fast food consumption, were associated with higher
risk of colorectal cancer, liver cancer, and
post-menopausal breast cancer in women and lung and a borderline association
with prostate cancer in men. There was also a higher
risk of stomach and other upper aerodigestive
tract cancers noted. The Number 3 guideline in 2007
said avoid sugary drinks. They changed it and
moved it further down the list to limit consumption
of sugar-sweetened drinks. Drink mostly water and
unsweetened drinks. Well, I was at the
meeting in Bethesda in 2007 when they unveiled that guideline,
avoid sugary drinks. I went to the
microphone and I said, there are sugary drinks, and they're sugary drinks. You can drink a cola
beverage, God forbid, or a fruit punch,
which is probably glucose and high
fructose corn syrup. Or you can squeeze three
oranges in the morning. The response I got from the
podium was energetically, they're all the
same. That was it. I didn't really understand
it until I had lunch with Robert Lustig, our
pediatric endocrinologist, who deals with obesity
in children and points out very loudly
the downside of sugar. He told me that if
you eat an orange, the fiber slows down the absorption of sugar
into the bloodstream. But if you squeeze the
sugar away from the fiber, it's like drinking a cola
beverage. Why is that bad? When the body sees that sugar, it responds with insulin and
insulin like growth factor, both of which promotes
inflammation, and the growth factor, as I said, is a growth factor
for cancer cells as well. The average American consumes about £150 of sugar or sugar associated
condiments each year. Now, high-fructose corn
syrup has declined in its appeal since we decided that it was
not healthy at all, but still, the amount of sugar consumed has not really changed. What do we know about sugary
drinks and cancer risk? Again, the French neutral net
salt taste study looked at a 100 thousand
participants and they evaluated consumption
of sugary drinks, including 97 items with a 100 percent fruit
juice included. As well as artificially
sweetened items. In their study, the 100 percent
fruit juices were the most frequently
consumed sugary beverage. What they did was
they found that the mean age in this
cohort was quite young, 42 years, predominantly women. Hence, the high number
of breast cancer cases, but also a significant number of prostate and colorectal cancer. They found a positive
association between sugary drink consumption and
the overall cancer risks. Increased almost 20 percent for each 100 milliliters a day
increase in consumption. That was statistically
significant for breast cancer, both pre and post menopausal. There was in this study, a positive association between 100 percent fruit
juice increasing the overall risk of
cancer at 12 percent. Interestingly, artificially
sweetened beverages showed no increased
risk of cancer. However, I daily
see patients asking me if they should drink this sugary drink to
cure their cancer. These are all exotic fruits
that somebody somewhere put out in social media that they cured their cancer
drinking this or that. I say, no, don't do that. Eat blueberries. In Australia, in fact, they rank food in the supermarket
for the consumer. They recently
dropped orange juice from five-stars to two stars, ranking it below diet cola, which I never would recommend
that anybody drink. Switching to diet soft drinks. Again, the epic study with
a 0.5 million Europeans. Again, predominantly
women age 50, found higher all-cause mortality among participants who consumed two or more glasses
a day of diet soft drinks compared to consumers of less than
one glass a month. That was for the
total soft drinks, sugar-sweetened tend to have deaths from digestive diseases, particularly diabetes
and artificially sweeter drinkers have deaths from circulatory or
cardiovascular disease. But again, going back to the French nutrient that
salt taste study, which was just recently
published this year. They adjusted for multiple
confounding factors comparing non-consumers of
artificial sweeteners to those who did consume them. They found that a
Spartan and ASL sulfate k increased
the risk of cancer. Higher-risk observe again for breast cancer and
obesity-related cancers. Ironically, question with
that, maybe reverse causality. They are obese, so they're
drinking diet soft drinks and the obesity causes the cancer not the
diet soft drink. Interestingly, they
found no association with sucrose noted, but that's because
very few people in their study were
consuming sucrose. The investigators suggest that their findings that
artificial sweeteners and excessive sugar intake may be equally associated
with cancer risks. I tell my patients if they buy something that
comes in a rapper, it's okay to have sugars in
the nutrition facts box. That sugar fuels our brain. Where I don't want to see sugar. The nickname for sugar, however, is in the ingredients list, nor do I want to see such
a long ingredients list. This bar has 13 grams of sugar. However, the first ingredient
is brown rice syrup, which sounds a lot like sugar. Then the ubiquitous
soy protein isolate, followed by evaporated
cane juice crystals, and then crystalline
fructose, sugar, sugar, sugar, and six more
lines of ingredients. On the other hand, we
have another bar which has 15 grams of
sugar, even more. But the ingredients
are cashews and dates. Now they have to tell us how much is added sugar
and when possible, that's best if zero. I tell my patients
don't eat sugar. My oncology colleagues say, Why do you tell all of our patients that
sugar loves cancer? I say, what's a PET scan? We inject people now with
radiolabeled glucose. Where does it go to the cancer? Because cancer loves sugar. It doesn't use
oxygen for energy. Another no was also
changed in 2018. In 2007, the guidelines said limit consumption
of red meats, beef, pork, and lamb, and avoid processed meats. In 2018 they changed it to limit consumption of red
and processed meats. I'll show you why
that's incorrect. This is a linear
relationship between red meat intake and the risk of colorectal
cancer in women. This is an old graph. New Zealand and the
US have been replaced by the Czech Republic and Japan, in the upper right
because we've globalized the Western diet
to the point where everybody is eating the
standard American diet. The reason I don't like limit consumption of
processed meat is that the World Health
Organization considers processed meat a
Class 1 carcinogen. No doubt about it. Making salami, bologna, hotdogs, sausage, anything
you put on a pizza. I actually was on
a call with people from the American Institute
for Cancer Research. I really do appreciate their guidelines and I hand
them out to all my patients. I said, why did you change avoid sugary drinks to avoid
sugar sweetened drinks. Why did you change avoid processed meats
to limit process meats? They told me that
they were trying to meet people halfway, that they didn't want to give
too restrictive guidelines. I'm sorry about that. What is the problem with meat? David Shriver, a dear friend deceased from a brain
tumor and French, so he spelled pork differently, demonstrates the change in our food chain because
of what we feed animals. In the old days, the
ratio of omega six, which promotes inflammation
to Omega-3 fats, which are anti-inflammatory,
was about 2-1 in most of the
foods we consumed. But nowadays as you can see that the food chain
is very different. For example, in eggs, one of the most inflammation
promoting foods out there, the ratio was over 20:1. But in addition to the
Omega-3 fatty acids and Omega-6 fatty acids, which are in meat the
way we raise them today. Meat has iron. Often I see patients with
cancer who were treated with chemotherapy and become
anemic from the chemotherapy. They come in saying, Donald, I'm taking an iron supplement. I say please stop the iron. You're not iron deficient. If you're not iron deficient,
iron feeds cancer. That's one of the
problems with red meat. Processed meats, of course, have nitrates and they
are carcinogenic. We live in a society
that loves to barbecue. When you burn flesh, that creates
heterocyclic amines, which also are carcinogenic. I'll have a half-pound
double-deluxe bacon steer burger, please. You on chemotherapy with that? Funny, but not funny. What about meat trends
in the United States? This is from the NHANES study, Natural Health and Nutrition
Examination Survey. The mean consumption
of processed meat has remained unchanged in
the past 18 years. That's so much luncheon meat, sausage, hotdogs we consume. Mean consumption has declined
for unprocessed red meat, beef, pork, and lamb. Mean consumption has
increased for poultry, but no change at all
for fish or shellfish. I'm a big believer in
deep cold water fish, salmon, black gold, albacore, tuna,
herring, mackerel, and sardines are
the ones richest in the omega-3 fatty acids, which are anti-inflammatory and a little bit anti-depressant. This is from Walter Willett, who's Harvard's best nutrition
investigative scientist, and it's an article
that he wrote on milk in the New England Journal of Medicine two years ago. In the middle of the article, there's this graph of all-cause mortality associated
with protein sources. The dotted line
for zero is dairy, and below dairy is
plants, poultry, and fish, and above
dairy is red meat, eggs, and off the
chart processed meats. The average American
eats 300 eggs a year, one on Passover when we
dip them in salt water. What about dairy? That was the dotted
line for zero. Walter Willett wrote an excellent article in the
New England Journal, dairy does contain some
healthful products. It's our richest
source of calcium, often is fortified
with vitamin D, and has other components
that may be healthy for us. However, there is no other animal that drinks
another species' milk, but no other animal
drives a car, goes to college either, so that's not a
very good argument. But no animal drinks milk
after they've been weaned, and by the age of 3 or 4, we lose the ability to digest the sugars and the
proteins in dairy. We make a big deal
about low fat, no fat, two percent,
it's not the fat. If you want a dairy product, butter is probably best
because it's mainly fat. We talk about lactose
intolerance as if it's a disease or a disorder
when in fact it's the norm, and the ability to
digest lactose is actually a genetic mutation on the second chromosome
found mainly in Scandinavians who need it to digest reindeer milk
in times of freeze. The rest of us are all lactose intolerant and we don't
know until we stop. But there's no mention of dairy in the American Institute
for Cancer Research, World Cancer Research Fund
guidelines. Why is that? I once asked that too because there are a number of
positive associations, prostate cancer, breast cancer, but I guess the evidence has
not been that convincing. Last week, my inbox was flooded with all
sorts of articles, dairy causes cancer, and that's emanating
from this large study, again, done in China. They recruited half
a million adults, five urban and five rural
regions enrolled from 2004-2008 and they filled out food frequency
questionnaires. With a median
follow-up of 11 years, 30,000 cases of
cancer were reported. Dairy consumption has
increased in China, but is still less
than 10 percent of the daily US intake of milk. The cohort, half
a million people, 59 percent were women, most of them were rural, average baseline age was 52. Twenty percent reported
milk at least once a week, and they were defined as regular consumers
compared with those who never or rarely consumed milk who were called
non-consumers. The regular consumers were
more likely to be women, have higher education
and income, and had higher consumption of all major food groups except
preserved vegetables. Dairy consumption was positively associated with a
risk of total cancer, again, a nine percent risk, but statistically significant, liver cancer, female
breast cancer, as well as lymphoma. The associations
were independent of other lifestyle factors
including overweight, obesity, and they were consistent across
all other subgroups. Maybe the American Institute
for Cancer Research might reevaluate if they're going to say anything
about dairy or not. With all this against eggs, against beef, against dairy, should you be a vegan? Well, Seventh Day Adventists are usually some sort
of a vegetarian, and they did a study of 77,0000
Adventists who developed 380 cases of colon and 110 cases of rectal cancer after a follow-up
with seven years. They looked at the
risk of developing these cancers in the vegetarians compared to the non-vegetarians. All colorectal
cancer was decreased 22 percent in the vegetarians. Interestingly, in the vegans, it was only decreased
16 percent. Notice the pesco-vegetarians, those who ate fish in
addition to vegetables, had almost a 40
percent reduction. Again, I don't think vegan
is the optimal diet. This is a graph I put together on comparative macronutrients
of popular cancer diets. The IOM is what the
Institute of Medicine recommends the breakdown
of carbohydrates, fat, and protein should
be in the ideal diet. That is about 60
percent carbohydrates, and when I say carbohydrates, fruits, vegetables,
whole grains, legumes, nuts, these are
carbohydrates, not pasta, bread, white rice, and
cookies and dessert. So 60 percent carbohydrates, 20 percent protein,
20 percent fat. Unfortunately, the
standard American diet is over-emphasizing fat
with decreased intake of protein and fruits and
vegetables as we saw. The vegan diet is a little bit excess in carbohydrates, again, plant-based with perhaps
not enough protein and maybe just a little
bit short on fab. Just want to point
out in the middle there, the ketogenic diet, my least favorite of the popular diets that my cancer patients
like to talk to me about is all fat and a bit of protein and
no carbohydrates, which are really are
healthiest foods. I don't want to bump people out here with this one, but in 2007, the alcohol guidelines said, if consumed at all, limit alcohol to two a day for men and one a day for women. To me, if at all two a day
seem really dichotomous, especially because
I reached an age myself where I just
don't tolerate alcohol, I don't metabolize it, I don't drink it and
we really mainstream alcohol consumption quite
a bit in this country. In 2018, they took a bold step and said
for cancer prevention, it's best not to drink alcohol. We believe that six
percent of all cancer in the United States today is
related to alcohol use, and the leading
cause of death from alcohol in people over the
age of 50 is now cancer. A linear relationship, we wondered for so
long why women in Marin County are more prone
to develop breast cancer. Well, there is a
linear relationship between alcohol consumption and the development of hormone receptor-positive
postmenopausal breast cancer. Another don't in the
American Institutes says don't use supplements
to protect against cancer. That comes from a
lot of data from clinical trials
of Beta-carotene, vitamin E, folic acid that show that using those supplements actually increases
the risk of cancer. I do see a lot of
patients coming to me with a shopping bag full
of supplements saying, can I take this? The real question that
I'm being asked is, is there a potential
interaction between this supplement and any of the cancer treatments
that I'd be taking? That interaction
would come through the cytochrome P450
enzyme system in the liver that breaks
down both supplements, botanicals, as well
as pharmaceuticals. Then the other question is
really radiation therapy creates free radicals of oxygen to knock into the
tumor DNA and kill it, and some of our chemotherapy
does the same thing. If patients are taking
antioxidant supplements, are they going to take
those free radicals out of circulation negating the benefit of the radiation and
the chemotherapy? My general approach is that if our goal is to cure the
patient of their cancer, whether we're giving
chemotherapy in an adjuvant setting
that is after surgery, just to kill any circulating
tumor cells microscopically, then I would air on the
side of caution and delay antioxidant supplements
until the patient is done with their
radiation or chemotherapy. Many of my colleagues at the cancer center tell
their patients to discontinue their
antioxidant supplement the day before, the day of, and the day after
their chemotherapy, but that really doesn't
take into account the half-life of either the
chemo or the antioxidant. I think antioxidant-rich
foods are always okay to eat. I have patients telling me that their radiation oncologist
says don't eat anything but white foods while you're getting radiation devoid
of any nutrients. I think if it comes down to that blueberry and that
beam of radiation, it's clear that radiation wins. If the goal is palliation
and we can't cure the cancer and if the patient feels that they really want
to take an antioxidant, supplement then,
I'm okay with that. The only blood test that I do on patients
coming to see me at the Osher center is usually a
25 hydroxy vitamin D level. Vitamin D deficiency puts patients at greater
risk for cancer, and people with cancer who are vitamin D deficient don't do as well as people who have
a good vitamin D level. That's the only thing I checked and I tried to raise people vitamin D level
into the range of 40-50 nanograms per milliliter. Many people have cancer that might affect their
bones either through metastasis or their
hormonal manipulations are going to make them get
osteopenia or osteoporosis, and since I asked
people to avoid dairy, which is the richest
source of calcium, I do recommend a
calcium supplement. Calcium constipates
magnesium does the opposite. They're both good for bones
and they're both good for protecting
against colon cancer. I say get a
calcium/magnesium supplement and if it comes
with a little zinc, that probably
wouldn't hurt either. I'm a big fan of Omega-3 fatty
acids, as I've mentioned, in those deep cold
water fish but since most people are not going to eat those fish every day, I'm going to recommend
an Omega-3 supplement. I'm a big fan of
medicinal mushrooms. These mushrooms have a Beta-1,3-glucan cell
wall that resembles a bacterial cell wall and when patients take a medicinal
mushroom capsule, their body is tricked into
thinking it's being invaded by a bacteria and amounts to non-specific immune response
to eradicate the bacteria, which we also hope
will eradicate cancer. Mushrooms are widely
used in Asia in conjunction with chemotherapy
and radiation therapy. I'm a big fan of
particularly Turkey tail, tremendous Versicolor as my mainstay
anti-cancer mushroom. The first I heard
about turmeric, the spice that gives most Indian caries its yellow coloration without really
having much flavor. The flavor of a query
comes from the cumin, phenolic, and coriander. Was that our ASCO, American Society of
Clinical Oncology meeting about 20 years ago. Investigators at Ohio State have a mouse model of colon cancer, where the mice are genetically programmed to develop
colon cancer, and if they're fed a
turmeric and rich diet, not only do they not
develop colon cancer, but they survive longer than the control mice because
tumor because of potent anti-inflammatory and it's not well absorbed from the upper
gastrointestinal tract, so it can get all
the way down to the colon to do local
chemoprevention. I tell patients that
chemotherapy is a pretty big antibiotic and the microbiome we know is
important for many things. I tell them if you've had
cytotoxic chemotherapy, it might be a good idea to
take a supplemental probiotic. I like a refrigerated
probiotic that contains lactobacillus and
Bifidobacterium species. Then I'm a big
proponent of cannabis. Cannabis is a centuries
millennium old botanical, it has been widely used as a folk medicine for many years. Only has been demonized
in the United States since 1942 when it
was removed from the US Pharmacopoeia and
it was placed in schedule one by the Controlled
Substances Act in 1970, saying it had no
accepted medical use and a high potential for abuse, both of which in my opinion,
are totally incorrect. When we look at our cancer patients' symptoms, weight loss, cachexia, early satiety,
anorexia, pain, anxiety, depression, nausea, vomiting, there's one
intervention that I can recommend to patients
that being cannabis without writing
prescriptions for five or six different
pharmaceuticals that may all interact with each other or with the cancer treatment that
I'm giving the patient. Recently, there was an article
that looked at 612 women with breast cancer
who responded to a survey about their
use of cannabis before, during, and after
their treatment, 42 percent reported that they use cannabis for
medical purposes. Only 23 percent said it
was strictly medical, meaning that 20 percent were using it also recreationally. Three-quarters reported
that cannabis was extremely very helpful at
relieving symptoms and you can see the
symptoms on the left pain, insomnia, anxiety, stress,
nausea, and vomiting. Seventy-nine percent
use cannabis during their cancer
treatment and again, over 50 percent continued to use it after they
completed therapy. Unfortunately, half of
the participants also said that cannabis was useful in treating
the cancer itself, which is I think a misconception
that we need to address. As I mentioned, cannabis
is a very versatile botanical that's been
around for millennia. When I first started to be interested in studying cannabis, my colleagues in oncology
said, Gee Donald, in these days of nanotechnology
in genomic therapies, why would you be
interested in studying a plant so imprecise, contains so many different
chemicals and they are right. Cannabis contains over
400 different chemicals, including 120 21-carbon
terpene phenolic compounds known as cannabinoids. In addition to the cannabinoids, cannabis also
contains terpenoids which give each strain
its characteristic odor. Limonene, pinene, myrcene,
Beta-caryophyllene. All of these also may have some potential
therapeutic benefit. In addition, like many
other plant materials, cannabis has flavonoids, which also may have
therapeutic benefit. Probably the most well-known of the cannabinoids is Delta-9
tetrahydrocannabinol or THC, which gives the plant
its cycle activity. Jumping into first place in the most favorite
cannabinoid list nowadays is cannabidiol or CBD, which probably is
present in the plant to modulate the activity
of THC, i.e. decreasing its cycle activity, and in my opinion, also decreasing some of its
therapeutic benefit. CBN or cannabinol is a breakdown product
of old Delta-9 THC. If anybody went to
college and had old cannabis lying around
and you smoked it, you said, oh my god, I'm sleepy, that's because CBN seems
to be quite soporific. THCV or
tetrahydrocannabivarin is an interesting cannabinoid
if we're going to study isolated cannabinoids
as opposed to the whole plant because
it decreases appetite, decreases appetite for food, for alcohol, and
also for opiates. We and all animal
species down through sea squirts have two
cannabinoid receptors, so-called Cannabinoid 1, CB1, and CB2. The CB1 receptor is the most densely populated seven transmembrane domain
G-protein-coupled receptor in the human brain. One benefit of doing
Zoom lectures is I've lectured to groups of physician and I've
asked them in a poll, how many of you learned about
this in medical school? The answer is 5-10 percent. That shows you the extent of Reefer Madness that
we don't teach doctors about the most
densely populated receptor in the human brain. Well, why do we and
all animals have these receptors CB1 and CB2, CB2 being present mainly in
cells of the immune system? It's not that sea
squirts, monkeys, and dogs were meant
to smoke cannabis. It's because we make our own
endogenous cannabinoids, endocannabinoids like we make our own endogenous
opiates, the endorphins. It's felt that the whole system of endogenous cannabinoids and cannabinoid receptors
is to help us modulate the experience of pain. I'm often asked by my patients, what should I take and
how should I take it? I often see older women with cancer who go to a dispensary and they think that smoking
is bad and eating is good, so they're told only eat
a quarter of the cookie. They do and nothing happens, so they eat another quarter
and nothing happens, so they eat the whole cookie. Then they have an ego dysphoric
reaction and they call me three days later saying they're never going
to do that again. Well, when you take
Delta-9 THC by mouth, it takes 2.5 hours to reach
a peak concentration. The Delta-9 THC, when
it's taken by mouth, goes through the liver where the cytochrome P450 system metabolizes it into an even more psychoactive
11-hydroxy metabolite. That's why people
get more zonged when they do edibles
than when they inhale. When you inhale cannabis, either smoking a
bong or vaporizer, the peak plasma
concentration of THC is reached in 2.5 minutes
as opposed to 2.5 hours. Because less of it is
going through the liver, you don't make that other
psychoactive metabolite. I tell patients if you want better control over
the onset, the depth, and the duration of the effect, inhalation is probably
better than oral ingestion. When I say vaporizing, I'm not talking
about a vape pen. I am an oncologist, so I am conservative. I know the long-term effects
of inhaling a plant, but I don't know the
long-term effects of inhaling an oil. I think we've demonstrated that it's not probably healthy. Nowadays, most dispensaries
provide tinctures. Tinctures are oils, liquids, when you put
them in your mouth, you immediately absorb some
from under your tongue, which reproduces the
effect of inhalation. Then you swallow the rest, so you reproduce the
effect of oral ingestion. I think the best hybrid kinetics comes from using a
tincture or an oil. People are now using
topical cannabis products. I guess they were bewildered
as to how they do. Many of my patients make their
own suppositories out of coconut oil and they claim that they work
pretty good as well. Where does this notion come from that cannabis is an
anti-cancer agent? Investigators at Virginia
Commonwealth University published in the Journal of the National Cancer Institute in 1975 a report that Delta-9 THC, Delta-8 THC, and
cannabinol all inhibited Lewis lung adenocarcinoma
cell growth in vitro and in mice. Interestingly, CBD did not. It actually increased the
growth of those tumors. Since that time, there's been an increasing body of
preclinical evidence in the test tube and in
animals suggesting that cannabinoids may have some
anti-cancer activity. Cannabis itself is an antioxidant
and anti-inflammatory, two things that I
often look forward to recommend in my cancer patients. Manual Bozeman has
a laboratory in Madrid that studies the effects of cannabinoids on metabolism, and the most metabolic
reactive cells in the body are the brain cells. His lab would add cannabinoids to brain cells in culture, rat brain, and see what happens. They said maybe we can do this faster if we do a brain tumor. They grew up a brain
tumor and they added the cannabinoids and
everything died. They said we must have
done something wrong, so they did it again
and everything died. They said maybe this
is a bad batch of cannabinoids so they went back to the normal brain
and everything lived. What they've determined
since then is that the cannabinoids
complex with the cannabinoid receptor on the tumor and tell the tumor
cell to commit suicide. In addition, they've also
demonstrated that cannabinoids decrease or inhibit vascular
endothelial growth factor, which allows new
blood vessels to form to let a tumor grow bigger. In addition, cannabinoids
block the activity of an enzyme called matrix
metalloproteinases-2, which allows cancer cells to become invasive and metastasize. All of that happens
in the test tube. Now if you take
mice who don't have an immune system and you transplant human
tumors into them, all of those different
tumor types, lung, breast, colorectal, pancreas, skin,
melanoma, lymphoma, thyroid, and brain
tumors can all be inhibited by cannabinoids. The only evidence
that's currently available in the
medical literature that cannabinoids of any sort do anything in any patient
with cancer other than symptom improvement
is a very small study conducted in Europe,
published last year. Nabiximols is a whole plant extract with a one-to-one
ratio of THC to CBD. It's licensed and approved
throughout Europe, Canada, the UK, Australia, and New Zealand for treating spasticity in patients
with multiple sclerosis, not approved in the
US because no study done here has shown any benefit. In this study of patients
with recurrent glioblastoma, the most aggressive brain tumor, nine patients used this under the tongue
spray nabiximols, and nine used placebo in addition to
standard chemotherapy. At six months, 2/3 of both
groups had progressed. However, at one year, 83 percent of the group
using the one-to-one ratio were alive compared to only 44 percent in
the placebo group. The investigators are careful to point out that the
study is not really big enough to make any definitive statement
about survival, but it is an interesting signal and they are doing a
larger follow-on study. Let's go back to the guidelines. Don't use supplements to
protect against cancer. What about following
the guidelines? Do they really
make a difference? Again, the French study
looked at 41,000 people, and they looked at scoring
and if you got one point better on the score that
they gave you for how well you followed the American Institute for Cancer
Research guideline, you had a 12 percent decrease in the risk of overall cancer, 14 percent decrease in
the risk of breast, 12 percent decrease
in prostate cancer. For colorectal cancer, it was close but not
statistically significant. The final guideline
that I wanted to mention is another do. After treatment,
cancer survivors should follow the recommendations
for cancer prevention. Actually let me just
stop for a minute on the word prevention. One of my dear friends
is Robert Bazell who used to be the NBC News
Science Correspondent. Robert told me Donald, if you do anything as an
Integrative Oncologist, can you please get over the concept that cancer
can be prevented. You can reduce the risk of cancer but you can't
necessarily prevent it. I see patients all
the time who say, I did everything I could to prevent my cancer
and I got it anyway. This makes people feel guilty
and they blame themselves. If you have a cancer diagnosis, that's the last thing
you need and I ask, can you just change cancer
prevention to risk reduction? They say, more people understand prevention
than risk reduction. Does it really matter
after a cancer diagnosis? How many patients
come to me and say, I asked my oncologist
what I should eat, and what's the answer? The oncologist always says, eat whatever you want, it doesn't really matter. When we see patients
alive in the old days, we would collect a new
patient intake form and ask them what they ate for breakfast,
lunch, and dinner? You can see this person
who only eats two meals a day and snacks and
occasional ice cream, really has a bit distance to go. Does it really
make a difference? Jeffrey Meyerhardt at Harvard, did a study many years ago of patients with
stage 3 colon cancer. They did a very intensive
food frequency questionnaire. He divided them
into people who ate predominantly Western diet and those who ate a
more prudent diet. This chart shows
you that the people on the left in the
group labeled 1, had the lowest ratio or the
lowest Western diet pattern, whereas the group on the right, labeled 5, had the highest
Western diet pattern. They followed these patients for five years for recurrence
of their cancer and death. You can see that
the group that ate the most Western diet had a threefold increase
in recurrence of their cancer and twice the death of the groups that ate
a less Western diet. Group 5, ate one serving
of red meat a day, five refined grains, and two sugary deserts. Whereas this group ate red
meat a few times a week, two refined grains a day, and sugary deserts
three times a week. A big difference. In fact, this same study was re-evaluated looking
at something called dietary insulin load. Foods with a high
food insulin index evoke a stronger plasma
insulin response. We've already spoken about insulin and insulin-like
growth factor. They calculated the
dietary insulin load from the food frequency questionnaire as well as this
food insulin index. Higher Higher insulin load was associated with worse
disease free survival, recurrence free survival,
and overall survival. The magnitude of the association was highest in the
obese patients. This association
with outcome was independent of the Western versus prudent dietary pattern that I showed in
the previous slide. It is sugar, insulin, insulin resistance,
insulin-like growth factor. What do I think the
ideal diet should be? I think it should be organic. A plant grown outdoors
organically needs to fight to protect itself
from other plants, birds and insects,
and the sunshine. The only way a plant knows
how to protect itself is by making chemicals
called phytoalexins. Those phytoalexins
turn out to be the phytonutrients
that benefit us. In addition, you avoid the
herbicides, pesticides, and fertilizers, which are chemicals that we don't
need in our body. The diet should be plant-based, but I don t think you need to be vegetarian, vegan, or raw. Anti-oxidant rich whole foods. So many patients want juice, fruit, no, even smoothies. I
don't think so. All of these are the
anti-inflammatory diet. I say increase
plant-based foods, particularly heavily
pigmented fruit. The berries are all good. Cruciferous vegetables,
whole grains and nuts, decrease animal
fats, eliminating dairy red and processed
meat and eggs. Poultry should be
organic, and eggs, if you must have them,
should be organic, Omega-3. Increase deep cold water fish, decrease white
sugar, white flour, white rice, brown sugar
too, it's all sugar. Season with ginger, garlic,
onions, and turmeric. If beverages, green tea, and if you'd consume alcohol, red wine would be
the best beverage. Nearly 50 percent of the most common cancers
can be prevented. The doctor of the future
will give no medicine, but will interest his patient in the care of the human body, in diet, and in the cause
and prevention of disease. I don't think we're there yet. Even earlier than that, Hippocrates is the one who said, let your food be your medicine and your medicine be your food. Bon Appetit. Thank you
for your attention. Thank you so much, Dr. Abrams. That was a really
thorough travel through nutrition and
supplements and cannabis. We have lots of questions. I'm going to jump right into it. One clarification
on fiber and sugar. Is eating an orange fiber plus sugar better
than squeezing out the sugar via juicing the
orange in terms of cancer risk? [OVERLAPPING] Again, I say eating the orange is better than
drinking the juice. I think I showed
good evidence that fruit juice is associated with an increased
risk of cancer, although the World
Cancer Research Fund changed it from sugary drinks
to sugar-sweetened drinks. Orange juice, I don t think is a sugar-sweetened drinks,
it's sugary drink. I used to squeeze three
oranges every day, now I do two oranges
once a week. I did it yesterday, I'm
here to talk about it. My guidelines are
guidelines to keep the soil as inhospitable
as possible. I think if you
drink orange juice, you're not going
to fall over dead. Actually, someone later had asked for people
suffering with cancer, let's say they can't actually consume it well,
is juicing okay? Yeah. Again, when
I see a patient, everybody has their own
individual unique issues. Some people cannot
swallow solids, especially patients who are getting radiation therapy have a severe mouth sores and ulcers and they
can't eat solid food. Or people who have a
restriction in their esophagus. We want those people to
be able to eat food. I always say slenderizes a nice soup and eat that as
opposed to a fruit juice. Perfect. Lucy asked, some of my patients here
in San Francisco cannot afford fish or organic
fruits and vegetables. What say you? Yeah, I said it already. I think it's a shame that
our government subsidizes bad food instead of making healthy food
more widely available. This is a question that I was
asked every time I lectured to the third year
medical students at Zuckerberg, San
Francisco General. They said, what about
our patients here because healthy food
unfortunately costs money? I think we're worth it. If we think about
the money we save, if people would eat healthy, instead of not as far
as medical costs, maybe we'd be able
to return some of that to make healthy
food more affordable. I'm not a politician, so I can't answer that one. I think importantly,
there may be resources at cancer
centers including UCSF to help patients
potentially with some of those resources in San
Francisco area and other areas. But I agree it's a real issue. This question from Bobby, we're not going to give
any personal advice but to generalize it. For people with large
advanced inoperable cancers, who have cachexia, should those folks
keep proteins low? If they're losing
muscle and fat, is there anything else
particular to recommend? I'm not a Dietitian. I actually I'm an Oncologist. I don't know the answer to that. I think people that are
trying to build muscle often do like to have
excessive protein. I know that my
patients tell me that the chemotherapy nurse tells them that when they're
getting chemotherapy, they have to have 40 or 60
or 80 grams of protein. I am not a Dietitian, I really I'm an Oncologist. I just masquerade as
a nutrition expert, but I don't know the answer to that
question. I'd have to say. I think importantly for
anything particular, it's always the
best idea to go to your particular oncologist and your nutritionist to get
those answers for you. Someone asked, is
there an amount of soy that is too much? Well, again, the
recommendation is one portion of a
whole soy food a day. Soy beans, soy milk, tofu, tempeh, or miso. I don't have to eat too many, soy three times a day it
would probably be too much. I think in general,
I try to point out that the diet is synergistic. If you eat only the same
thing all the time, that's not really giving
you the benefit of eating a broad spectrum of different foods and
different colors, etc. Thanks Donald. Lindsey gives us a
suggestion which is, don't you think it's an
oversimplification to use the PET scan as a
rationalization for no sugar. Our bodies will continue to make glucose from our
foods to fuel itself, even if no sugar is consumed. I find that patients
almost always want to eat carbs during chemotherapy
because of nausea, the panic about sugar
causes a lot of stress. She's a registered dietitian, and so she says she stresses
high-quality carbs. Everything we eat turns
to sugar, ultimately. It's a question of how
quickly it turns to sugar. I don't know how that's
an oversimplification. You inject people with
radiolabelled sugar, and it goes right to the cancer. It doesn't go particularly to normal tissues because normal tissue uses oxygen for
burning and not sugar. I have worked very
hard with a nurse, may she rest in peace who used to work in the
infusion center to get them to
eliminate sugary foods, as snacks in the
infusion center. When I see patients, they would say that they would
come back to me and say, how could the infusion center
serve us these things? I think they did for a while
try to be more conscious. I don't know what they're
doing now because I'm quite distant from
the infusion center. But again, you're not
going to fall over dead if you eat a piece of candy or take some ice cream
on your birthday. But my advice is for
people how to keep their soil as inhospitable as possible to growth and
spread of the week. Today, I saw a woman
with pancreatic cancer, and she said, I know that nutrition is
not going to cure me. She has metastatic
disease, and she said, I happen to love sugar, and I'm going to eat it because it improves my quality of life. When I see people like that who have an incurable disease, I lost my two best friends
to pancreatic cancer. I'm not going to tell people not to eat foods that they love, or calories that they need. But for other people, where the goal is to try to keep the soil as inhospitable as possible sugar is
the number 1 note. Just look at the guidelines on that handout, how
they're arranged. Number 1, be healthy weight, number 2 exercise, number 3 on the ICR is avoid
sugar-sweetened beverages, which I should think should
be avoid sugary drinks. Thank you, Dr. Abrams. Victoria asks, does it matter what kind of
dairy we consume, for example, cow cheese
versus sheep or goat cheese? No, those are all dairy. They all come from different
animals than your mother. The one guideline
that I didn't mention said breastfeed
and be breastfed. The reason I didn't
mention that is because for most people I see it's a little late to
have that conversation. But we are meant to
drink our mother's milk. By the age of three
or four, as I said, we lose the ability to digest the sugars on the
proteins and dairy. We make a big deal
about fat, low fat, no fat, two percent,
it's not the fat. If you want a dairy product, butter is probably best
because it's mainly fat. Yogurt, the sugars and the proteins have been
altered by the bacteria. If you need a dairy product, I like butter because it's mainly fat or yogurt or Kiefer, as long as they're not
artificially flavored, artificially colored
and with added sugar. Someone asks, could
you please comment on intermittent or
prolonged fasting for a vegetarian, non-keto
cancer patient. Fasting has become very
popular as something that people living with and
beyond cancer want to do. The rationale behind fasting if you're getting chemotherapy, suggests that if you fast, your normal cells are going
to be less likely to take up the toxic chemotherapy and the cancer cells are
going to be more likely. I don't know how
that really works, and I haven't been
impressed that that is really what's happening. I know that there are fasting
mimicking diets that they tried to do where they
send you for five days. First day, you get 800 calories. In the next four days, you get 400 calories in
meals that you're sent. It's supposed to be done
with your cancer treatment. Personally, as an
oncologist for 39 years, I've cured many people of
cancer who didn't fast. I know that I only
fast one day a year. By the time that I'm
going to break my fast, I'm cranky, dizzy, have a
headache, and feel miserable. Why would I want people living with cancer treatment
to go through that? On the other hand, I see
patients who tell me no side effects at all when I fasted before my chemotherapy. I'm just not impressed
that it does anything really of benefit. The only thing in all
animal species that's associated with
prolonged survival is caloric restriction. I think we as a society have difficulty controlling
our portion size. Rather than control the
portion size, we say, I'm going to skip this meal
and not eat breakfast. Personally, I think
breakfast is probably the most important meal of the day because it
provides us with fuel, and it prevents us
from overeating in the middle of the day. I have not embraced, just as I haven't embraced
the ketogenic diet, I am not a big fan of
intermittent fasting. Now, I mentioned obesity
and overweight and I see patients all the time
who were BMIs of 35, 40, and those people do find
it hard to lose weight. In some situations,
fasting may be useful. Even ketogenic diets may
be useful for weight-loss. I'm not completely
closed-minded, it's just not something I
recommend to everybody. Thank you. Marla asks, do you suggest not eating eggs? As a vegetarian,
I thought eating organic eggs were a
good source of protein. I'll just add that many of the studies
that were done were likely not using organic eggs. How do you think about that? I tell patients if
they want to eat eggs, they should be organic omega-3. I think eggs are associated
clearly with prostate cancer. Probably with breast cancer. I think it's the
choline in eggs, which is the bad actor. People ask, is it the egg
yolk or the egg white? I think the egg white
is probably better. But it's still egg, and still, I know some of my dietitian colleagues
don't agree with me, but I'm just reading what
I read in the literature. I think we have a very
strong egg lobby as we have a very strong milk
lobby in this country. Great points and I think one of your points
is really important, which is there will be some
differences of opinion here. It's important for you to take your particular quick
case and questions. You are physicians as well. Great. Astrid asks, what are your thoughts on
vitamin C supplements? Vitamin C, it's an antioxidant. I tell people getting radiation
that they shouldn't take vitamin C. I did a
nutrition research, diet and nutrition practicum at the National
Cancer Institute. I was the only one
who was a physician, and most of them are dietitians. The one thing that I learned
about vitamin C there, was that the maximum amount
of vitamin C that you can absorb from an oral
dose is 240 milligrams. I take vitamin C myself, it's a good stress vitamin. I think it's good for immunity. I don't recommend it for
people getting chemotherapy or radiation that's creating
free radicals of oxygen. But I don't think you
need to overdose and take one or two or three grams because you're peeing
out most of that. I'm not a believer in the
intravenous vitamin C, which many people suggest may have some
anti-cancer activity. I just haven't seen that. The data hasn't supported it. Someone mentions
for clarification, often radiation oncologists
will recommend white foods. For patients who
are experiencing loose stools related to the
radiation side effects, as they often are
better tolerated. I agree. I would not recommend
for antioxidant purposes. Again, I also want in favor of my radiation
oncology colleagues. I'm a big fan of
cruciferous vegetables and that produces
in many people gas. If you're getting radiation
to your rectal cancer, you don't want to have
gas in your colon because it's going to
change the beam, I guess. If the goal is cure, then I think you need to listen to the people that are telling
you what you need to do. The next question
is, in my culture, caviar is viewed as a very healing food and my family is
wanting me to eat this, but let's just ask
it more broadly. Is it okay to eat caviar
during chemotherapy? I guess if you can afford it. I don't see any reason why not? [LAUGHTER] It's not egg. It's not coming
from chickens that are fed food that
makes them make the fat into omega-6 that coming from wild oceans, I guess. I think she was
asking because it's a raw food and so she
said during chemotherapy, should I be eating
any raw foods? I think that's a little
bit of an old lifestyle. Personally, I don't
think you really get infected from sushi. I think that's overstated. Perfect. Thank you.
Jessica Moore asks, "Is coffee on the
do's or don'ts list?" Well, it's not mentioned. [NOISE] Coffee is not mentioned. I say coffee is good for
the brain and the heart, but it doesn't have the anti-cancer activity
of green tea. Tea is the name of the beverage brewed from the tea leaf, the Chinese camellia,
the Camellia sinensis. It's graded on how oxidized the leaf is before the
beverage is brewed. White, Green, oolong,
black and puerh. The only two that have the
cancer fighting chemicals are white and green. I drink four cups
of green tea every morning and the rest of my day, my beverage is sparkling
mineral water. But coffee, in the old days when I was a young oncologist, we thought coffee might
cause pancreatic cancer. Nowadays, we think coffee might decrease the risk
of colon cancer, particularly people that drink more than four cups
of coffee a day. Which I say, well, yeah, your colon would be empty if
you drink that much coffee. But people tend to put two things in coffee
that I'm not in favor of, sugar and dairy. Thank you, Dr. Abrams. Shoddy asks, "With your
list of supplements, vitamin D, Cal-Mag, Omega, mushrooms, turmeric, etc. Is it safe to take
all those during active treatment with
chemotherapy and radiation?" I'll just add that these are
commonly used supplements. But Dr. Abrams, obviously, there's no personal advice that's being given
here. [OVERLAPPING] Again, when I see
people individually, I take into account what
their treatment is and what regimens they're
getting and I modify it. Antioxidants, as I've mentioned, we wouldn't do during
chemo and radiation. Every day I see patients told by their
medical oncologist, their radiation oncologist or
the infusion center nurse, stop all your supplements. I tell them to take them
and they tell them to stop, so it puts the patient in
a little bit of a bind. If I tell a patient
to take something, I think it's okay
for them to take it when they're getting
chemo or radiation. Omegas, as long as
you're not bleeding, Omega-3s might increase
the risk of bleeding if you take over
four grams a day. Vitamin D should
be fine anytime. Calcium. Too much
calcium supplementation can lead to more aggressive
prostate cancer in men. Turmeric. There's a lot of information that
people are saying turmeric interacts with tamoxifen and
all sorts of things. I'm a scientific advisor
to the website, Wellkasa. On Wellkasa, you can
find information about potential interactions between supplements and your
pharmaceuticals. Again, that's
something that may be useful for people and I need
to look at it more myself. Turmeric is a little bit, you need to be
somewhat concerned. Probiotic. I used to tell patients who are
getting immunotherapy, don't take a probiotic. Because there were
studies that suggested that people who have taken probiotics have less of a profound response or beneficial response
to immunotherapy. Now, there's just a review on probiotics and the
microbiome in cancer. They suggest taking
a probiotic may improve the response
to immunotherapy. I actually sent an email to the author and asked
that question. They thanked me for saying that they wrote a
good review but they didn't answer the question because I think there are medical
students or something. But mushrooms stimulate
the immune system. I don't want patients on immunotherapy to take
the medicinal mushrooms. I don't like people with the cancer of the
immune system, ie, product lymphocytic leukemia or lymphoma to take medicinal
mushrooms either. It's just my own feeling, it's not proven in any research. Then there was also an Israeli study suggesting
that people who use cannabis during the
new immunotherapies didn't have as good a response, and actually, died two years quicker than people who didn't use cannabis with
their immunotherapy. I think the flaw in this study, which was not randomized,
placebo-controlled, but a retrospective
observational study was that most of the patients not using cannabis were getting immunotherapy as
a first-line treatment, compared to those
who were using it, who were getting it as
second or third line. I think that's what creates the difference in
response and survival. That's why I see patients
and talk to them about what their
treatment regimen is. For you, I'm going
to recommend this. That's super important details. Thank you for answering that. Danielle says, "You mentioned at one that iron feeds cancer. Would you recommend
that people should not cook in cast iron?" I think that is a
recommendation. Again, I'm not a chef and
I'm not a nutritionist. I don’t know how much iron
you get in cast iron. I'm talking about taking an iron supplement or eating
a nice piece of red meat. I don't know how
much you actually absorb from the cast iron. It's a good question,
I don't either. What about fermented foods,
kimchi, sauerkraut, etc? Do they help with the microbiome
in patients with cancer? Those are prebiotic foods
and they're very good. People that have
GI distress either after their chemo or radiation, I often recommend a probiotic as well as concentrating
on prebiotic foods, sauerkraut, pickles,
kimchi, etc. Then someone just
comments, "I was told to not eat
sushi during chemo. I love it so much, but
I stopped eating it." [OVERLAPPING] I know people are telling
that and they used to say, you shouldn't have
flowers in your room. I think all of that is a
little bit been proven not to be overcautious, I think. Patricia asks, "Is
eating mushrooms as beneficial as taking it as a
supplement?" [OVERLAPPING] Thank you. That's a
really important question because one point that
I didn't get to make, all mushrooms should be cooked. Slicing white button
mushrooms and throwing them in
a salad is a no. White button mushrooms have a cancer-causing
compound in them. All mushrooms must be cooked. Actually, you don't
get the benefits of the nutrients in the mushroom
if you eat them raw, and white buttons have a cancer-causing
compounds in them. The mushrooms that I like for immune enhancement
are not edible. They're shellac and/or fuzzy, and they're not things
that you would eat. You get them in China town and people make them into teas. I don't think that's
quite as concentrated and potent as taking
a mushroom capsule. Excellent question. Edible mushrooms that I
like are shiitake, maitake, and enoki because
they are immune enhancing and perhaps have
some anti-cancer activity. Enoki are the long white filamentous ones
that are in miso soup. This is what led us to find out that mushrooms have some
anti-cancer activity because the farmers in Japan
who worked with enoki mushrooms have lower rates of cancer than their neighbors. That's what led to the
investigation of how these medicinal mushrooms
might work against cancer. All mushrooms must be cooked. Related to that, actually, where do you recommend patients
get medicinal mushrooms? The body doesn't like to see
the same mushroom every day. I tell people who are trying
to do immune enhancement to get turkey tail and take
that for 4-6 weeks, which gives you the
maximum benefit. Then switch to a
seven mushroom blend that he humbly named
after himself, Sam at seven and take that for 4-6 weeks and then go back to the turkey
tail back-and-forth. I have patients who tell me, Gee, everybody in
my house got sick. But I didn't because
I'm taking my mushrooms because they are
immune enhancing. Last question is, what
is an optimal breakfast? I have three breakfast. I ate broccoli, tofu, and rice, number 1. My second one is mochi, which is just pounded brown
rice puff it up in the oven, smear almond butter and put
a sweet potato on top of it, because orange, yellow vegetables
are also good for you. Then when I travel and
I'm not near my stove, I do muesli, which is the only
unsweetened cereal with rice milk or oat milk,
blueberries, and walnuts. Well, that is a perfect close. You have all of Dr. Abrams'
secrets now with you. That was really wonderful. Thank you so much, Dr. Abrams. Super jam packed with information that I think
is practical and helpful. [MUSIC]
