RHR: The Functional Medicine Approach to Cancer, with Lise Alschuler
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RHR: The Functional Medicine Approach to Cancer, with Lise Alschuler

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While the conventional approach to cancer has made some strides, it doesn’t recognize how important diet and lifestyle are for treatment and prevention. In this episode of Revolution Health Radio, I talk with Dr. Lise Alschuler about the Functional Medicine approach to cancer.

Revolution Health Radio podcast, Chris Kresser

In this episode, we discuss:

  • Lise’s background with integrative oncology
  • What conventional medicine gets right (and wrong) about cancer
  • The functional and integrative approach to cancer treatment
  • The most important factors in reducing cancer recurrence risks
  • How to support people through change
  • The importance of diet during cancer treatment
  • Using supplements, fasting, and other methods to prevent cancer

Show notes:

Hey, everybody, it’s Chris Kresser. Welcome to another episode of Revolution Health Radio. This week, I’m really excited to welcome Dr. Lise Alschuler as my guest. Dr. Alschuler is the executive director of TAP Integrative, a nonprofit web-based educational resource for integrative practitioners.

Dr. Alschuler is a professor of clinical medicine at the University of Arizona School of Medicine, where she is on the faculty of the Arizona Center for Integrative Medicine. She practices naturopathic oncology out of Naturopathic Specialists, LLC. Dr. Alschuler cohosts a radio show, Five to Thrive Live, and is cofounder of the iTHRIVE Plan, a lifestyle app for cancer survivors. She is coauthor of The Definitive Guide to Cancer, now in its third edition, and The Definitive Guide to Thriving After Cancer.

I’m really looking forward to speaking with Dr. Alschuler about her integrative and functional approach to the prevention and treatment of cancer. I haven’t had many guests on the show to discuss an integrative approach to cancer, so I hope you really enjoy this one as much as I did. Let’s dive in.

Chris Kresser:  Lise, thank you so much for joining me. I’ve really been looking forward to this.

Lise Alschuler:  Yeah, my pleasure. I have been too.

Lise’s Background with Integrative Oncology

Chris Kresser:  So tell me a little bit about your background and how you got interested in integrative medicine, and particularly integrative oncology.

Lise Alschuler:  Sure. So I was actually headed towards conventional medical school. I had the privilege as an undergrad to be accepted, sort of pre-accepted, to medical schools, called the seven-year med program at the time. I went to Brown University. So part of that experience allowed me to get some really early rotations and observations, exposure.

Chris Kresser:  Right.

Lise Alschuler:  And even though since I was in third grade, I was sure that I wanted to be a doctor, I was a little bit surprised, a lot surprised that the more I saw, the more I realized that really wasn’t the kind of healing that I wanted to practice. There was nothing wrong with it per se, it just didn’t feel right for me.

So I majored in medical anthropology, learned a lot about healing traditions around the world, and just healing, what healing really means to people all over the globe. And it expanded my concept of healing. And so with that, I discovered very fortuitously naturopathic medicine. Read the principles of naturopathic medicine, which include things like find the cause, treat the whole person, doctor as teacher, prevention, all that good stuff. And I realized this was exactly what I wanted to do, and I haven’t looked back since. I absolutely love naturopathic medicine, love being a naturopathic practitioner and did general medicine for about 10 years.

And then had the opportunity to work at a cancer specialty hospital as a naturopathic doctor. And that was tremendous because I was sort of thrown in the deep end of oncology and got to see how conventional oncology is practiced and how natural medicine, in this case naturopathic medicine, can blend with that and really optimize outcomes for people. And really since then, have kept my focus in oncology.

I’ve since left that situation and I have an outpatient based practice now that’s part time. But I work with patients who are, most of whom, I would say, are getting conventional treatment but also want to avail themselves of natural therapies and certainly are interested in reducing risk of recurrences once their therapies are complete and just really love doing this along the way. I also had, I can call it a gift now, although at the time I would say it was more like a cursed blessing—

Chris Kresser:  Right.

Lise Alschuler:  But I was diagnosed with breast cancer and so really got to experience the disease from that perspective. Which, as I said, I’ve learned a lot from it and I am really grateful  to have gone through the experience and come out on the other side of the course. But that’s imbued what I do with a very acute appreciation for the potentially transformative experience that cancer can be for people. And I think that’s one of the reasons why I really enjoy working with people that are diagnosed with cancer. Because it serves for most people as a wake-up call of sorts, allows people to really look at their life in a totally different way and reprioritizing. That’s just a joy to work with.

Chris Kresser:  Yeah, that certainly helps when you can speak from some personal experience in that with your patients, I imagine.

Lise Alschuler:  Yes. And yeah, so that’s been, really, I think, good for me and hopefully good for my patients. My father also. I got to, he was diagnosed with pancreatic cancer, and so both as his daughter, but also in part, as one of his team members of his healing team, got to really watch the power of integrative medicine with him.

And he was a tremendous example in the way he approached his own disease and ultimately his death. But he really gave himself up as an opportunity for all of us to learn about life and living and what it means to go through these changes. And so that’s been very informative for me as well.

Chris Kresser:  It’s always fascinating for me to have these conversations. And my story is somewhat similar to yours. I was pursuing a postbac, pre-med program and then went to interview … I thought it would be a good idea to interview 10 doctors and also shadow them in their practices before I decided to take the very long road through that conventional medical training. And in my case, ended up deciding to study acupuncture and then my own path was inspired by my blessing/curse of chronic illness.

What Conventional Medicine Gets Right (And Wrong) about Cancer

Chris Kresser: So it is, it’s always fascinating for me to talk to other healers on this path. So you mentioned in your practice you’re often working with people who are pursuing conventional therapy and you’ve been exposed to that in your training and your work. So what does conventional medicine do well with cancer treatment or get right about it, and what do you think is lacking, where integrative medicine fills the gap?

Lise Alschuler:  Yeah, I love that question. So first of all, I think that conventional medicine is really phenomenal in terms of the amount of scientific inquiry that’s gone into understanding what cancer is. Our understanding of the genetics of cancer is so different now than it was even 10 years ago, so that there’s just a lot of really smart research that’s going on in the world of oncology. And with that, cancer care from a conventional side is changing.

It’s really shifting a lot into a more personalized approach to cancer using more targeted therapies, more what we call molecular-based therapies, moving away from chemotherapy. I read a really interesting little essay by an oncologist recently who described a situation where he went through his training and he was training to, being trained to use conventional chemotherapeutics. Routinely now there are so many targeted drugs that are often used first, that he had a patient where he had to prescribe chemo and he kind of forgot some of the things that he just did almost automatically previously. So that just really illustrates how much it’s changing.

So I think what it’s doing right is really trying to get more precise and to stay ahead of cancer and tumors, which themselves by their very nature, are evolving at a very rapid rate and are very difficult to kill and control. And so staying ahead of that is challenging, but I think conventional oncology does that well.

I think on another aspect, conventional oncology is an industry and it’s grown a lot, which is good and bad. The good part of that is that there’s a lot of support services available for people diagnosed with this disease within the system that they’re being treated and a lot of community-based organizations. So there’s just a lot of resources available for people now who are diagnosed with cancer, which isn’t true for some other diseases. There’s a lot of public education, so more awareness. People can talk about having a diagnosis much more freely than they used to. So all that’s good.

I think what’s missing from conventional care in a big way is integrative medicine. For me it’s not an either/or, it’s a both/and. I think that it’s a shame, frankly, that every single person who’s diagnosed with this disease isn’t offered, right at the beginning, both natural therapies, lifestyle-based therapies, and conventional treatment with fully informed choice that they can make along the way. But there’s just no doubt in my mind that when people combine lifestyle-based therapies with their conventional treatment they do better, they feel better, their risk for occurrence lowers. It just makes all the sense in the world. It’s so important and the fact that it’s not available to people is really very, a very poor thing in our world.

And it’s almost even worse than that because not only is there an absence of an offering of lifestyle-based therapies, but if you go into a typical chemotherapy infusion center, for example, what you see is sodas and candy and things that are just not, that don’t make sense in terms of people being diagnosed with cancer. So there’s almost like an institutionalized ignorance in many cases for some of these lifestyle-based therapies. So I think that’s kind of the main thing that’s wrong with it. I think there’s lots of other issues that are wrong with it. Our healthcare system today is broken.

Chris Kresser:  Yeah.

Lise Alschuler:  We’re putting all of our money into the end stages of disease, there’s no investment in prevention, there’s mixed-up drug interests and hospital policy interests. I mean, it’s just, it’s a big Goliath, which makes change difficult that matters to the person. Cancer is extremely expensive as a disease. I mean, there’s definitely a lot wrong with it from that perspective, for sure.

Chris Kresser:  Absolutely. Yeah. It’s a systemic problem. Of course, cancer is part of that system, so it’s inevitably affected. I do remember reading that female breast cancer patients are the highest users of complementary and alternative medicine as a subgroup in the population. And I thought that was interesting.

Lise Alschuler:  Yeah, I’ve read similar. I’ve read that actually even if generalizing it beyond breast cancer, but to cancer in general, I think the average population still, it’s about 35 percent of Americans use, for example, if you just look at dietary supplements, use a dietary supplement on a regular basis. But if you take the cancer population, that goes up to over 80 percent. In some surveys over 90 percent, and that’s just dietary supplements. So if you include mind-body medicine

Chris Kresser:  Yoga and all of that.

Lise Alschuler:  So all that, then that numbers almost everybody.

Chris Kresser:  Right.

Lise Alschuler:  So it makes sense, because cancer carries the potential of death with it. So people are extremely motivated to do what they can to get well.

While the conventional approach to cancer focuses on treating the end stage of the disease, the functional approach emphasizes diet and lifestyle-based therapies. Check out this episode of RHR to find out more. #functionalmedicine #chriskresser #unconventionalmedicine

The Functional and Integrative Approach to Cancer Treatment

Chris Kresser:  Yeah, it makes sense. So what is, if you could just kind of, from a 30,000-foot view, if somebody comes to see you. Let’s say they’ve been diagnosed with cancer and they’re pursuing conventional treatment, where do you start? What is your kind of framework for thinking about an integrative or functional approach in the process?

Lise Alschuler:  So from a 30,000-foot view, the first thing I do is familiarize myself with their history. So I really look through their medical records very carefully and understand from the medical standpoint what they’ve been diagnosed with and attributes of their tumor. So I kind of get to know their cancer and some of their treatment history around their cancer. Then I spend a lot of time really getting to know them. In my view, cancer is, if we think about tumorigenesis or cancer formation, cells don’t go bad on their own. Cells are permitted to go bad by the tissue milieu in which they reside.

So there’s some breakdown of normal constraints. Every cell in our body, all they want to do is divide like mad, from the minute they were put into existence until their demise. And the only reason that they all don’t do that is because there are various mechanisms that we’ve evolved to keep cells in place. We have basement membranes that they stick to. We have communication points from one cell to another that keep cells in line. We have cells within what we call our stroma that send chemical messages to the cell saying stay put, stay put, stay put. And so it’s when that kind of gets disrupted in one way that this innate proliferative potential can become unleashed. And so understanding just that unleashed cell and the genomics of that cell isn’t enough. We have to understand what allowed that permissivity in the body.

What situation or risk factors are there for allowing tumors to take hold? And I think that’s where getting to know somebody, getting to know their dietary habits, their stress level, their movement activity levels, what else they have going on in terms of what we call comorbid conditions, all of that is really important. And along with that I do some objective testing, some lab values to help me gain some biomarkers of, for example, chronic inflammation, oxidative stress, glucose metabolism, or insulin resistance, various hormonal issues, and these things too help me to get a better understanding of that tumor microenvironment.

So that’s my kind of thinking as I’m approaching somebody’s … as I’m talking with them and learning about them. And then really try to incorporate that learning and to try to create a body that’s as resilient as possible to the growth of tumors while they’re getting the tumor attacked. And I think both are essential when you’re dealing with an aggressive disease like cancer.

The Most Important Factors in Reducing Cancer Recurrence Risks

Chris Kresser:  Absolutely. It makes a lot of sense. Then when, let’s say the treatment has been successful with the tumor, what are the most important steps you take from there to reduce the risk of recurrence?

Stress Management

Lise Alschuler:  So, of course, this is individualized, but with that being said, to generalize the areas that I have found to be the most impactful in terms of reducing the risk of recurrence and optimizing recovery and optimizing wellness, are … and these are sort of in order, I would say, and my order changes a little bit with the research that comes out. So I think that I would, I would commit at this point to saying that the most important thing is stress management. So stress as a pathophysiological phenomenon unravels health. No doubt about it.

And there’s a myriad of ways that that happens, and it’s a direct path to carcinogenesis or tumor development. And that’s very well documented now. So stress can be considered a cancer causative agent in some regards. So that’s one reason why it’s so important. Another reason is that when people are under a lot of stress or kind of insidious stress and they don’t have good stress management, they can’t do anything else and sustain it for any period of time. So all of the other good things I’m about to mention won’t stick. And so that’s really, to me, the most important thing.

Movement

Next is movement. I’m a strong believer in exercise and really counseling people to determine what their fitness level is to get to the edge of that fitness and keep moving the edge. I know a lot of the research talks about 30 minutes of a brisk walk five days a week. That’s great for people whose fitness puts that level of exercise at their edge, but for people who are more fit, they’ve got to do more. And exercise is in almost all studies so significant in terms of just looking at risk reduction. If you look at breast cancer, colon cancer, it reduces the risk of recurrence by about 50 percent, half.

Chris Kresser:  Wow.

Diet

Lise Alschuler:  That’s as good as any drug out there, and so that’s really important. Then, of course, we need to think about diet. And most people go to diet first, and I think people go to diet first because we eat typically two, three times a day. So we’re doing a lot of eating and we think about what we eat. And obviously, it’s information that’s getting into our body, and the kind of information we give ourselves is going to make a difference.

And it is important, but so far, the data suggests that even the best, apparently best diet seems to have a risk reduction, and this is, of course, a generalization across many cancer types, but reduces risk by about 30 percent. So for sure significant. Absolutely, we need to pay attention to diet, and it’s possible that we haven’t really designed the right studies to gain the full appreciation for the benefit of diet. But I just mentioned that because I don’t want people to think they can just eat their way to health. They have to also exercise and manage stress.

And when you combine all three, that’s where the magic happens. Because then you get a really powerful combination of strategies that optimizes health, that replaces all of that self-control in our body, lowers inflammation, helps us better manage blood sugar. All the things that otherwise, if they’re uncontrolled, can increase the risk for cancer.

Chris Kresser:  Right. Yeah, I have to agree with you on stress, and I would say I treat a lot of patients with autoimmune disease. And I would say it’s very clear to me that stress is the primary factor in many of those cases. And of course the similarity there is the immune system. Psychoneuroimmunology and some of the research in that field over the past few decades has been just so revealing in terms of the multiple and significant impacts that stress has on every aspect of the immune and endocrine systems.

Lise Alschuler:  Yeah.

How to Support People through Change

Chris Kresser:  It’s so, it’s challenging, though. I think it’s one thing to change your diet or even pop a few pills through supplements, but changing your relationship to stress requires a much more, asks a lot more of us. And we have to really examine how we relate to ourselves in our life. And the changes can be much more difficult, I think, for many, but also much more rewarding in terms of the impact that they can have on people’s lives.

So, what has been your experience working with people on the stress management piece with cancer? I wonder because they’ve had cancer, do you find them more amenable to making those kinds of changes?

Lise Alschuler:  Yeah, I would say for sure. And I think there’s been some studies that have shown that it actually doesn’t matter what kind of cancer you’re diagnosed with. That the fear of recurrence is high for everybody who’s been diagnosed with cancer. Which is interesting, and that’s true for people who have been diagnosed with colon cancer as true for skin cancer. I mean it just really, just cancer itself.

So having that fear for people who can, the fear is, the way I talk to my patients about fear is when you’re afraid of dying in this case or fear of having another recurrence, you’re afraid of what? You’re afraid of losing the life that you love. So what is it about life that you love? And it’s really a way to help them see, “Okay, I’m afraid because I love being alive. Because I love my partner. I love my home. I love to get outside in nature.” I mean, whatever it is for somebody. And those can then become kind of the motivation points. I really think that everybody has already, no matter how stressful their life is, they already have in place some things that give them really deep-seated joy and serenity. And so I think it’s first acknowledging and recognizing that, and then doing more of that.

Then it’s about helping people explore other opportunities, which could be anything from helping people develop a mindfulness strategy to helping people develop a breathing pattern that they do periodically to big shifts, like, “Gosh, I’m not in the right relationship,” or, “I’m not in the right job.” And being willing and able to make those changes. And of course, there’s some situations that make this very difficult. What’s in the way for some people? Maybe they’re in a socioeconomic situation where they really don’t have a lot of choice and/or they are caring for an aged parent with dementia and that’s something that they have to do. And so then in those situations, it can be challenging for sure.

I’m sure you’ve experienced this as well. But one of the roles that we as providers can play is to help people strategize and find something that can work for them, even in those situations, to give them just a little bit more peace and comfort in their day, as opposed to stress, and just trying very slowly, taking one baby step at a time, shifting that seesaw so it’s a little bit more balanced. And it takes a while. This is not something that people can turn on and wake up tomorrow and ta-da, they’re stress free.

Chris Kresser:  Absolutely. And often in my experience, people need support. We this last year launched a health coach training because I’ve just become such a believer that that kind of unconditional positive regard and support in helping people to discover their own motivation and strategies for change, which you were just talking about in terms of asking people what they really enjoy from life. What’s meaningful to them? What is worth living for, essentially?

Lise Alschuler:  Yeah.

Chris Kresser:  And that’s a powerful technique. Of course, it comes out of practices like motivational interviewing. But I just … change is hard. I mean, there’s a study, I don’t remember the exact statistics, but it was of people who have already had a cardiovascular event like a heart attack or a stroke. And something like less than one in 10 people go on to make the recommended diet and lifestyle changes, even after that event. So you would think motivation would be very high there, right? It’s not lack of motivation. It’s not even lack of information in those cases. It’s something else that’s standing in the way of change.

Lise Alschuler:  Yeah, I think that’s a really important thing. And I think you hit on the really important obstacle to that change, which is support. So you’re absolutely right. People have to feel supported. They have to have some people around them that are going to support their efforts. And I think too, opportunity.

A lot of people, getting a list of foods to somebody to eat and not eat is really not that helpful if they have no experience with eating differently than they’ve grown up or are accustomed to eating. So I think giving them tools and opportunities to learn and to be educated is also very important. And I mean, I think ultimately too, when people have a big event like that, even though fear might be an initial motivator, it’s not something that sustains change.

Chris Kresser:  No.

Lise Alschuler:  And I think people have to be motivated for different reasons. More for the flipside of fear, like we were just talking about. Wanting to experience more vitality to enjoy the things that they love, for example.

Chris Kresser:  Absolutely. Yeah, it’s so important. And I mean if there is a blessing in a cancer diagnosis and treatment as you suggested earlier, it’s that it can tend to bring those things into focus in a way that perhaps not even a heart attack does. Because the nature … There are different diseases. And I think each condition and even symptom carries a certain kind of energetic pattern with it and has a whole cultural story around it. And it seems like those who are dealing with cancer are perhaps uniquely open to making some of those changes.

Lise Alschuler:  Right, yeah. And I think the treatment also plays into that. The treatment of cancer is almost as feared as the disease itself.

Chris Kresser:  Right. That’s a good point.

Lise Alschuler:  Whereas you have an acute heart attack, you go in and you go under anesthesia, you wake up with a stent, you’re all better.

The Importance of Diet during Cancer Treatment

Chris Kresser:  That’s right. That’s right. Yeah. You’re not dealing with all of the side effects, and maybe some from medication afterwards, but nothing like the cancer treatment. That’s a great point.

So let’s go back to diet. I know you said that in terms of preventing recurrence, diet is less, it’s still substantial, but not quite the same, at least from the data that we have, as exercise. But where do you land in this very controversial murky area of diet and cancer in particular? I mean, it’s murky enough just for general, but what about diet and cancer and cancer prevention? And is there a difference in what you suggest when someone is actively under treatment versus when they are either trying to prevent it in the first place or trying to prevent recurrence? I guess that’s three different categories.

Lise Alschuler:  So yeah. Well, first of all, I’ll say yes. Definitely people who are in active treatment have different dietary considerations, and it depends a lot on the kind of cancer and the kind of treatment that they’re getting, the stage of cancer. So sometimes it’s just for people in treatment, they just need to get enough calories. They’re having trouble eating.

Chris Kresser:  Yeah.

Lise Alschuler:  Other people are looking for ways to optimize, say, the effects of radiation, in which case I would probably recommend the ketogenic approach. So it really varies, and I think it’s hard to generalize about the during-treatment population, except to say that always the first evaluation is, is this person getting enough calories. And for some people, it doesn’t even matter what kind.

Chris Kresser:  Right.

Lise Alschuler:  And then look at the macronutrients. Are they getting enough protein? Carbohydrates? Fat? And then you can kind of nuance down. Now, for somebody who’s interested in using diet as a tool to prevent recurrence or prevent cancer initially, there are a lot of opinions out there. And I think I can cut through the controversy and say that there are some common denominators among all approaches which really are the most evidence-based strategies to lower the risk of cancer, in which many of these dietary patterns share.

And so those are the ones I really advocate for, and what kind of diet pattern that’s sort of dressed in, it doesn’t matter to me so much. So the key principles for me from a diet perspective are, first, is to look at caloric intake. And most cancers now are in some way, the risk of them is influenced by having excess weight. So looking for ways to minimize excess weight and specifically to look at decreasing caloric intake. We all tend to overeat and there’s lots of cultural, societal reasons for that, individual reasons, genetic reasons. But that’s really important. So kind of lowering caloric intake, portion control. That’s one key component.

Another is to increase the consumption of plant-based foods. Vegetables, fruits, whole grains, nuts, seeds, oils from the above. These are all, each and all associated with lower cancer risk. And in every study, if you kind of look at ones that are successful, diets that are successful, what they have in common is basically a plant-based approach. And really if you step back and say, “Well, let me think about Mediterranean Paleo, keto, they’re all plant-based diets.” So that’s very important.

And then the third component is, actually before I get to the third, let me go back for a second and say that one consequence of eating a plant-based diet is that it tends to have a better, it’s better at controlling inflammation. It tends to be an anti-inflammatory diet.

Chris Kresser:  Yeah.

Lise Alschuler:  And it tends to balance blood sugar more effectively, which is really important in terms of cancer control. Which leads me to the third, which is to remove or significantly minimize what are now called ultra-processed foods. So anything that comes in a package, has an ingredient that if it was in your kitchen, you wouldn’t know what to do with it. High-fructose corn syrup, all that stuff is really not good for our bodies. It makes it extremely difficult to lower inflammation, have good blood sugar control, good immune function.

So those would be the three kind of common goals across all diets. And then once we sort of get there, it’s really about what’s the best way to do it. And that’s where individual preference comes in. Now I can work with vegans, I can work with Paleo people, I can work with ketogenic and I can incorporate into all those diets, these core principles.

Chris Kresser:  Right. I really like the way you framed that. It fits very well with my general approach. And there’s some of the misconceptions out there about a ketogenic diet or Paleo diet, and of course there are different ways of doing them. There’s, like, the Atkins version of the ketogenic diet, where you’re probably not eating a lot of plants. But there is a way of doing a ketogenic diet where you’re eating a lot of plants. You’re mostly eating plants and some protein and healthy fats.

And I would say in that situation somebody who’s eating a ketogenic diet could end up eating a lot more plants than someone who’s eating what I would call a junk food vegetarian diet, which is, like, with a lot of bread and processed and refined foods. You could technically be a vegetarian and eating a lot fewer of the anti-inflammatory kind of plants than someone who’s on a Paleo or ketogenic diet. And that gets often lost in this whole polarized debate about diet, unfortunately.

It’s sort of, the way you described it, it’s like these are the principles, and then you want to choose what platform or delivery system that you’re going to use to get these foods into your body based on maybe your body composition. If you’re also overweight and have blood sugar issues, maybe Paleo and ketogenic is more appropriate. If you’re an athlete and you’re burning more calories, maybe eating more starch carbohydrates like sweet potatoes and things like that on a Paleo type of diet is better.

Lise Alschuler:  Yeah. I think there is a lot more flexibility. And I also would say that food is a very important, serves a very important kind of social role in our lives. And I think for, and there’s comfort foods, and that’s a real thing for people. And I think that what I’ve seen is that if people clean up their diet and eat primarily a really healthy diet, they can have excursions and it’s not going to send them off the rails.

Chris Kresser:  That’s right.

Lise Alschuler:  So it’s, I think sometimes people can get so rigid with their diet that eating no longer is fun. It has very significant impacts to their social life. So then we go back to stress. And now diet becomes a source of stress. And so I don’t want that to happen either.

Chris Kresser:  No, I was just going to say in Chinese medicine there’s a saying, “It’s better to eat the wrong food with the right attitude than the right food with the wrong attitude.”

Lise Alschuler:  I like that.

Chris Kresser:  Yeah, and that one of my patients says, he says, “Excursions, when rare and appropriate,” is the phrase that he uses. So if you’re at a wedding, which is probably pretty rare, it’s also appropriate in that situation to celebrate and maybe eat foods that you wouldn’t typically eat. So I’m right with you on that.

What do you think the top considerations are? I imagine they’re similar to preventing recurrence, but I just want to give you a chance to answer this anyways, for someone who wants to prevent cancer initially, from ever developing cancer in the first place.

Using Supplements, Fasting, and Other Methods to Prevent Cancer

Lise Alschuler:  Well my answer is a policy answer and that’s because cancer prevention really needs to start in childhood and particularly in adolescence. When we are going through growth spurts, our cells are at their highest proliferative rate. They’re most susceptible to acquiring mutations and a lot of cancers. By the time they show up, the original cancerous cell has been sitting in there for a couple of decades, or its progeny.

So it’s something that started a while ago, and I think we really need to think much more aggressively about how we can educate our young people to eat well, to exercise, to manage the stress. And so for primary prevention that’s really where it’s that. Having said that, for certain people who, let’s say, are at high risk, let’s take a woman who has the BRCA mutations. So her lifetime risk of developing breast cancer and ovarian cancer is very high.

There have been studies that have shown women with the BRCA mutation who eat a plant-based diet and who get regular exercise, have lower rates of developing breast and ovarian cancer. So even though that’s a high, what we call a highly penetrant mutation, something that has a high risk—

Chris Kresser:  Manifesting disease.

Lise Alschuler:  Manifesting disease, even in that situation, lifestyle can impact that risk. So it’s never too late. It’s kind of the message I’m suggesting. I think that primary prevention is really about the same things: eating well, exercising, managing stress. I do believe in dietary supplements. I recommend supplements to most of my patients and I think there are ways to utilize dietary supplements to fill the niches that it’s harder to get with diet.

So specific to cancer, there’s, for example, there’s a whole group of compounds in plant food called flavonoids. And some of the well-known ones include curcumin and EGCG from green tea. Resveratrol is kind of a flavonoid-type compound. Quercetin. These things have very clear anti-cancer actions, and like diet, they work by being in our system in a consistent manner over time. So it makes sense to me from a primary and secondary or tertiary prevention perspective to think about supplementation with flavonoids, for example. Vitamin D is important. There’s an inverse association between serum vitamin D levels and cancer risk.

There’s definitely some, a role for certain essential fatty acids and reducing cancer risk. There’s certain, I guess you could call them loosely antioxidants, but compounds like alpha-lipoic acid, which have a role in cancer, lowering the risk of cancer. Anything that’s going to help maintain insulin sensitivity potentially has a role. So berberine and things like that. So there’s just lots of dietary supplements that I think could be very important for primary prevention. Somebody’s not going to be taking, like, 20 of them, but a small handful on a daily basis would probably be helpful.

Chris Kresser:  What do you think about the kind of, maybe we could call them next-level interventions like fasting, perhaps. Pulse electromagnetic field therapy, or near infrared. These are obviously not available to a broad population; fasting is. But the others are maybe a little more costly and not always available. But have you looked much into these modalities?

Lise Alschuler:  Yeah, some. So fasting, I mean, as part of my reducing calorie intake strategy, I recommend overnight fasting to everybody for at least 13 hours. In the cancer world, the data indicates that 13 is the magic number where you overnight, even up to, any amount of overnight fasting, allows some degree of cell repair, reestablishing what we call the redox potential in cells or the antioxidant potential in cells. And so that happens.

But when you get to that 12th, most people after 12 hours start to go into mild ketosis. And when that happens, then you start to stimulate autophagy or cell digestion, which is a really important cleanup process in the cancer prevention component. So, and if you can fast longer, that’s great, but it’s not necessary. So I think 13 hours most people can handle. So it’s a good starting point. So yes, I think overnight fasting and then certainly doing like a five/two plan. So you’re reducing your caloric intake very low, like 500, 600 calories a couple days a week. That’s shown to be very helpful. Doing water fasts on occasion. Anything like that, all of that is basically decreasing caloric intake, and in the process of doing that, is stimulating some of these homeostatic mechanisms to restore health.

So I think fasting is definitely important. I think that some of these other therapies like infrared and using magnetic fields and bioelectric fields, all that is something I’m not as familiar with. But I also do not discount it. I’ve had many patients who’ve utilized these therapies and I can say that some patients have for sure experienced symptomatic relief in a lot of ways. I haven’t seen these therapies really change tumors. So I’m open to that possibility. I just haven’t seen it happen.

Chris Kresser:  Yeah.

Lise Alschuler:  But I think in terms of, I mean, we live in an increasingly toxic world. So we have to constantly support detoxification. So even near-infrared to stimulate sweating, which by the way is another benefit of exercise, is really good. I mean, that’s going to be good for us. So I think that there’s relatively low risk of harm with those therapies, potential benefit. Again, though, I would not classify them as anti-tumor therapies—

Chris Kresser:  Yeah.

Lise Alschuler:  At this point, although I see things in the making and in development.

Chris Kresser:  Yes, more research needs to be done, yeah. For sure. And in many cases they have really multiple and general health benefits like mitochondrial, supporting mitochondrial function and stem cell regeneration and things that are probably just a good idea. So if you can,  somebody has access to these kinds of therapies, it to me makes sense to use them. But this takes us also back to the social determinants of health. Your answer to how to prevent cancer is, it’s a policy answer. We’re seeing a growing number of studies of people having higher rates of cancer who were raised in communities that are right next to freeways, probably because of air pollution. So there’s much more to it than just individual choices that we make. There’s more systemic problems that need to be addressed.

Lise Alschuler:  And it’s such an important thing because most of my patients, when they’re diagnosed with cancer, they immediately take on the responsibility themselves. What did I do wrong? And yet, healthy people get cancer.

So it’s not, I mean, certainly what we do contributes to our risk. It either adds risk or it decreases risk. But there’s a certain amount of risk that comes from the genes we come into the world with and a certain amount of risk comes from the environment that we live in.

Chris Kresser:  That’s the modern lifestyle.

Lise Alschuler:  Yeah, and you mentioned, and, I mean, air is now considered a carcinogen.

Chris Kresser:  Yeah, absolutely. Both indoor and outdoor air.

Lise Alschuler:  Yeah, yeah, crazy.

Chris Kresser:  Well, I know we have to wrap up, Lise, but I’ve really enjoyed this. Appreciate this conversation. And where can my listeners learn more about your work?

Lise Alschuler:  Yeah, thank you. It’s been quite enjoyable .And I’ll give you a couple of websites. My own website is DrLise.net. So it’s DrLise.net. And then I have, my coauthor and business partner, Karolyn Gazella, and I have created an online survivorship plan that people can use for free. And they can go to IThrivePlan.com, and it’s an individualized, lifestyle-based tool. So I recommend people check that out. For practitioners, I have a website called TAPIntegrative.org, which is a great resource for all things integrative.

Chris Kresser:  Great. Well, thank you again so much. I know this is, I’ve had a lot of requests for a guest that could speak intelligently about integrative treatment for cancer. And there’s so much, not evidence-based stuff out there.

Lise Alschuler:  Yes, right.

Chris Kresser:  And kind of really polarized views, and that’s just not my perspective. So I’ve been very grateful for your work and grateful that you were willing to come and spend some time with us. So, thank you.

Lise Alschuler:  Yeah, and thank you. And thank you for all that you do, Chris. Appreciate it.

Chris Kresser:  Okay, Lise. All right everybody, thanks for listening. Send your questions in to  ChrisKresser.com/podcastquestion, and we’ll see you next time.

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