Dr. Eric Westman: It is my great pleasure to have Dr. Christy Kesslering with me. Dr. Kesslering is a radiation oncologist who now practices metabolic medicine. It’s interesting that many radiation oncologists turn into metabolic practitioners because they see the changes in their scans. But you’re helping cancer patients and non-cancer patients in the Chicagoland area. Thanks for being with me.
Strategies to fight cancer
Dr. Eric Westman: What are some strategies to fight cancer?
Dr. Christy Kesslering: I don’t actually like to use the word “fight.” I like to use a different analogy with patients. I often will say that cancer is your body’s check engine light going on, saying something is broken here. That is usually right. Being a metabolic health practitioner, I’m saying it’s a metabolism problem. That’s not always the main driver, but it is so prevalent in our cancer world. So many of our cancers are associated with obesity, diet and lifestyle choices. I’m always trying to get a little bit deeper under the hood, and that it’s really not obesity because we have studies that show it’s not about your weight. It’s really about your glucose, insulin, insulin signaling, and insulin resistance. It’s about what is happening under the hood. I like to tell cancer patients, “Let’s just take a step back and look under the hood. Let’s see how you’re processing the diet and lifestyle that you’re leading, and what can we do to optimize your outcomes? What can we do to enhance your cancer therapy?”
There’s now data out there, (albeit not super large,) international trials. These are all still small because diet trials are very difficult to do on a large scale due to money and who’s funding them. But if we use the data that’s available, what we know is that when we optimize metabolism, drive fasting insulin and IGF-1 down, we tend to improve cancer outcomes. When we use fasting around chemotherapies, maybe we use fasting mimicking diets like ketogenic diets. We seem to decrease toxicities associated with treatment, and those are big. Some people are really fearful of getting conventional therapy because of the associated side effects, and what we know, and it’s been shown in various trials, is that we can mitigate or improve chemotherapy toxicities, that we can enhance lean mass or bone density in some patients.
There are so many pieces of our cancer therapies that we can improve. When we look at outcomes, who is more likely to get a recurrence, who is more likely to get a metastasis, who is more likely to succumb to their disease, it’s those who have higher rates of metabolic syndrome, higher levels of fasting insulin and fasting IGF-1. We can use these tools to optimize a patient’s state using the ketogenic diet.
I always recommend ketogenic diets, but not all of my patients will go to that degree. I’m always following numbers. Are you moving those numbers in the right direction? What else do we need to do?
We can use exercise. There is data that certain exercises have more impact on lowering insulin and improving insulin resistance than other forms of exercise. So we might talk about that. I should also mention that body mass, our muscle density, impact cancer outcomes. If we do exercises that actually grow muscle, we can improve cancer outcomes. It’s really interesting science, and I want to help patients become empowered, take action, do the things that will help with how they feel, how they tolerate treatment, how they bounce back from treatments, and ultimately, how well they can do. It’s really exciting to see people not be in this fear mode. I feel like that “fight” word is part of the fear mode.
Knowledge Gap
Dr. Eric Westman: Why wouldn’t a typical cancer specialist bring this up? Is it like the diabetes world we’re living in? where they are trained to give medication or chemo, and they just don’t know about the metabolic effects?
Dr. Christy Kesslering: I think knowledge is a big one. I feel like many cancer therapy practitioners, whether that’s radiation, medical oncology, or surgical oncology, all dietitians, are ignorant of the science. I’m not saying they’re stupid. They’re smart people, and they’re caring people. They want the best for their patients. They just don’t know this science exists. They don’t have time to dig into it and they don’t have the passion to look into it.
If you ask a lot of those providers, they will say, “Oh, this was just bad luck. There was nothing that you did. You didn’t do anything wrong.” I’m not saying that anybody did anything wrong. I think when we’re all ignorant of the metabolic piece and that our current primary care doctors and generalists who are running our annual labs for us, and every year we get that clean bill of health, everything looks great. Okay, good. If it doesn’t, maybe it’s mild. I’ve seen people who have had fasting glucoses over 100 for years, and the primary care doctor just said, “You should probably cut back on sugar intake.” Well, if sugar has been elevated for years, how long has insulin been elevated? Decades. If we would just get back to looking upstream and looking under the hood, we would be able to make informed decisions on our diet and lifestyle, and we just don’t have that.
Dr. Eric Westman: I was involved in a study some years ago where diet reduced weight gain associated with the treatments that were being used. So you might even reduce side effects of weight gain from this down the road. If you’re diagnosed with prostate cancer and you start androgen treatment, being put on Prednisone, you’re probably going to gain weight unless you make some metabolic change.
It’s not only an anti-cancer thinking in my mind, it’s also trying to reduce side effects from the surgery or chemo. Lymphedema from lymph node resection, especially after breast cancer, you want to address the metabolic aspects, and you can actually reduce lymphedema as well. I like the way you’re talking about it, it’s what’s going on inside, is it under the hood, what’s wrong inside? To me, it’s not so important what’s on the plate of what you’re eating or drinking, it’s what effects does it have on you.
Dr. Christy Kesslering: A hundred percent. You did that in a study in the prostate cancer patients on Androgen therapies, we have tons and tons of women for breast cancer on hormonal therapies, and one of the biggest complaints is weight gain. But even if you’re getting chemotherapy as a premenopausal woman, that chemotherapy can often put you into menopause. We know there’s a big shift in metabolism as we go through menopause; so many women put on 10 or 20 pounds even though they don’t feel like they’ve changed a thing in the way that they’re eating or exercising, yet they all of a sudden pack on some extra pounds, and it really comes down to metabolism.
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