Dr. Eric Westman: Hi everyone, it’s my great pleasure to have Dr. Christy Kesslering here again to talk about cancer. Last time, we talked about the link between cancer and metabolic health. Now, we will look at the three biggest mistakes people with cancer make when they get a diagnosis and start thinking about treatments.
What would be the first mistake to make once you get a diagnosis of cancer?
1. It’s not an emergency
Dr. Christy Kesslering: Except in the very rare extreme emergency, most of the time, a cancer diagnosis is not an emergency. I feel like a lot of patients get very scared, and that is a valid emotion, right? We want to just race in and get rid of it and take care of it, which again is a normal response. Sometimes, patients are the opposite. They’re like, “Whoa, I can’t believe I just got this diagnosis,” but yet their provider, their oncologist, or their surgeon is making them feel like it’s an emergency. I just want patients to know that typically cancers have been brewing for many months or even years before they finally are big enough or cause enough symptoms for us to diagnose them.
What we know, if we go back to our metabolism talk, is there is some good evidence showing that if we combine metabolic therapies, diet, and lifestyle we actually can make those therapies work a little better. We might help decrease the side effects associated with treatment. I really feel for the patients who feel like they are pressured into making quick decisions. You hear in the conventional world, oftentimes they’re like, get a second opinion. It’s okay, you can always do that. Our insurances cover second opinions. I would say that the same might go for looking into metabolic therapies or practitioners that can help patients and guide them while they’re going through treatment. So, that’s a big one, and it’s totally understandable because I think when we hear that big “C” word, we all freeze and we’re like, “Oh my gosh, we’ve gotta get moving.”
Dr. Eric Westman: I bet there’s a lot of searching on Google with that diagnosis. Many of my patients come back having done a lot of their own research. I have to say that the internet kind of steers people toward this plant-based thing for cancer. What are your thoughts about that?
2. Following a plant-based diet
Dr. Christy Kesslering: I think, really, that’s the next biggest mistake. There is so much information online. As we have discussed many times in the past, any diet will help start addressing the metabolism issue. We know that when we take out cookies and crackers and donuts and all of those high-carb processed foods, we do start to lower glucose and insulin. It’s that insulin that’s such a big driver in cancers. Unfortunately, there’s so much noise out there when we are really trying to look at interventional studies, not observational studies.
That’s why I’m so adamant about testing and tracking. Even those who find keto and say, “Oh my gosh, I need to follow a ketogenic diet because that’s going to help lower my insulin,” I want to impress upon the patients the need for testing and not guessing.
There are numerous studies that have shown my own clientele that they think they are doing a ketogenic diet, but they might actually just be doing a low-carbohydrate diet. It actually isn’t moving their insulin the way we want them to. So, it really is very patient-dependent. Some people might do a little bit better on one slightly different form of a ketogenic diet than another. Can somebody have a little bit more carbohydrates than somebody else? I’m sure you see that in your own practice. Some people are so carbohydrate intolerant that adding a whole bunch of plants doesn’t really make as much sense. I really think that testing is key, not necessarily just any test. There’s such a broad array of tests that we can do. I really like following people’s glucose, insulin, triglycerides, HDL, really looking at those insulin resistance markers. There are more markers that go along with cancer growth. I don’t really care what diet they want to start with. I do have some patients that feel so compelled to do that, and I say, “Fine, but let’s look at your numbers. Let’s look at them before and after you make changes. Did it do what we wanted it to do? How do you feel? What are other markers doing?” Because maybe again, that’s not exactly the right one for you.
Dr. Eric Westman: I think that’s a great point. The commonality of the diets that people with cancer want to do is the elimination of highly processed sugar and junk food. To me, like you, the end result in the blood is the goal. The tactic of how you do it, whether plant-based or animal-based, is not so important to me. I’m finding that there’s a lot of bias on the internet that my patients are reading. That the only way to do it is with a plant-based approach. Even the autophagy intermittent fasting guru, who sells a fasting-mimicking product, doesn’t understand that it’s not so important to be plant-based. It’s important to get that metabolic change. I’ve met him, and it’s because he grew up in that world of vegetarianism, which is fine but there are other ways to do it.
This leads to the next discussion that you alluded to: “Doesn’t red meat cause cancer?” Patients say, “You’re asking me to do a diet where I can have red meat. Didn’t that cause it in the first place?”
Dr. Christy Kesslering: Yeah, and there are so many different theories. The plant-based or the red meat or the eggs drive IGF-1 or whatever it is, the new headline, the new scare. We really want to learn how to interpret data. That’s asking a lot of the layperson, a non-doctor, a non-scientist, or someone not used to reading and dissecting studies. I always say the first thing we have to look at is the strength of the change. If something is 10 times more likely to do something, well then that is probably real. Anything above two in an increase or 50 percent reduction, those are usually pretty strong. But you have to see consistency, meaning that in an interventional study, does this show the same thing? Is there a dose-response? Ketogenic diets and insulin really do follow all of these rules.
What I often see is, yes, oh, red meat causes cancer, but if you actually go through that data, there’s nothing that supports that theory other than the observational epidemiologic type trials which say, “We’re going to look at all these people and then we’re going to see who is healthy and who isn’t, and then we’re going to look at the differences.” Whenever red meat gets blamed, it is always because of an unhealthy user. Most red meat eaters eat a processed food high sugar, high-carb diet. They’re sedentary, they’re obese, they’re diabetic. It’s not necessarily that red meat caused those problems, but rather those people with the problems tend to eat red meat because we’ve been told red meat is bad. Almost everyone who cared about their health started eating chicken and more fish.
Dr. Eric Westman: That’s important. It’s a barrier. Like you, I reassure my patients that in the context of what they’re going to be eating, now that red meat is not a factor to worry about.
Let’s say someone has a diagnosis, they want to take action, how would you approach your patients?
Dr. Christy Kesslering: I usually perform baseline testing on every patient that comes to see me. Even before I see them, unless they’ve had really good labs, which are often done by some other functional provider or somebody outside of conventional care. A lot of the doctors in conventional medicine, and I know I was in it for a very long period of time, are not checking insulin, they’re not checking insulin-like growth factor one, they’re not checking ferritin and fibrinogen and CRP and LDH, lactate dehydrogenase, and all of these other markers that can give us clues as to what the patient’s current metabolic and inflammatory state is. We can take those tests, and then we can guesstimate, “Hey, wow, there’s a lot of signal going on here. Let’s be really, really strict.” Or, “Wow, even the way that you’re eating, your inflammation markers look great, so maybe we can be a little laxer in you, but let’s keep testing, let’s keep chasing.”
We can get anybody into a ketogenic state if we fast them, but that is not sustainable, right? We hear all the time, “A ketogenic diet, that’s not sustainable.” Well, it is far more sustainable than a plant-based diet because we are bringing in adequate iron and adequate B12. We really are bringing in the nutrients that are needed to run our healthy cells efficiently. When we start to get into these micronutrient deficiencies, which we will do if we restrict meats, in my opinion too long or animal proteins too long, we do then start to get into a more compromised position where maybe our immune system isn’t working optimally. How are we going to fight cancer if our immune system is depressed?
We are really resilient as human beings, right? We can tolerate fasting for a while or calorie restriction for a while or nutrient deficiencies for a while. But at some point, the system will break down if we don’t optimize the entire system. I am always trying to come at it from an “optimize the person” standpoint.
Dr. Eric Westman: There was a big hype a couple of years ago about keto curing cancer, and I’ve always been a little cautious. My advice is to always do this in combination with what a traditional oncologist recommends. What are your thoughts?
Dr. Christy Kesslering: In theory, it might be possible. We don’t have that data in humans very robustly. There are some mouse studies, but it is always in an extremely small portion of the mice. I think it’s just more than that. They’ll say, “Do keto, it starves cancer.” Well, if we don’t eat sugar, our liver will make sugar. We will always have insulin on board because we are maintaining it. Insulin is still shuttling fuel where it needs to go. You know, IGF-1 is still there. It’s keeping our lean mass intact. We’re always repairing muscle and keeping our bones healthy. We’re never going to turn off. I even hear, “Okay, we’ve got to block sugar and block glutamine and block that.” You can’t. Those are all necessary for survival.
I do think a ketogenic diet does take away the excess. Those who do well tend to be in very low optimal states. I also think that it takes away that chronic inflammation. I think it enhances our micronutrients, it enhances our immune system – our immune system is supposed to find damaged cells and get rid of them before they become a cancer. Those of us who might get cancer might have some compromised immune system as well, even though we don’t feel like we’re sick or that our immune surveillance somehow broke down. If we can optimize all of those things with a ketogenic diet, we put ourselves in a much better place. All of the data that is available, well, that I can find, seems to show that a ketogenic diet really does just augment it. It really is like a powerful augmentation of the treatments that you have.
I do think that sometimes these oxidative therapies are what we might need. I’m always working with patients, where they’re from, where they are, what their mindset is, and what can we do to ease their discomfort (their physical or emotional discomfort) as they’re choosing their therapies. I’m always trying, trying to help that patient navigate the waters.
Clinical Trials
Dr. Eric Westman: It seems to me that if you learn an easy, tasty version of a keto diet, what do you have to lose? In my approach, I’ll teach people how to do it, but then I’m cautious about not overselling.
Dr. Christy Kesslering: I definitely think we shouldn’t be overselling and overpromising, but I do think the data is so strong about that metabolism piece. Unfortunately, with almost all of our trials, it’s a drug, it’s an injection, it’s a pill, it’s a radiation treatment. It’s a money maker. I hate to say that, but it is. With a diet, how do you ensure that the patient is following that diet 24/7? We’re starting to put a lot more responsibility on the patient as opposed to “Come into my office and I’ll inject you with this drug”, or “Come into this office and I will radiate you.” I think that there are some nice trials with ketogenic diets where they’re stacked, they’re a nutrition team or dietitian; they’re making the food and giving it to the patients. It’s out there, but diet trials are so expensive because we don’t really have the funding.
Ketone Monitoring
Dr. Eric Westman: Years ago when we were doing our clinical research, I thought this was a great study to do because I could measure ketones to see that someone was actually following the diet. Back then we used urine ketones. Now, you can do blood ketone and breath. Do you incorporate ketone monitoring with your patients?
Dr. Christy Kesslering: I do because I think it gives me valuable information. I think what we don’t know is how high the ketones should be. Do they have to be at a certain level all the time, or is it sometimes okay? I definitely want them to make ketones. If they are making low levels of ketones, that’s when I start to look at diet. Should we be tweaking? Are you actually adding fat? And I will say that that is probably one of the big mistakes that I see in people trying to follow a ketogenic diet, especially for cancer. They’re not checking anything, so they think they’re doing it, and then we realize they’re not making any ketones or they’re making such little ketones. It’s usually because they went low-carb but they did not go high-fat. They’re living in this low-carb, low-fat world, and then they’re starting to feel miserable because they’re not actually producing energy.
I feel like optimizing that, and that is an individual thing. I do start with a cookie-cutter approach, but let patients know that this is just our starting point. Then we’re going to get some information like ketones. I’m going to ask them to track their diet temporarily because it will give me insight into what they’re doing. Are they accidentally incorporating some processed keto foods that we wouldn’t want them to be doing? It’s really about eating real food, and that’s why I get frustrated sometimes in the conventional world. Like, “Oh, don’t do that,” and I’m like, “Whoa, can we look at what they’re eating?” I actually tell patients, “Please tell your providers that you have decided to eat a real, whole-food diet, and you’ve cut out sugars and processed foods, and that’s why you’re losing weight.” It’s okay as long as we’re losing that inflammatory response. We’re okay with you losing weight if you are doing it in the right way.
Picking a Tech
Dr. Eric Westman: Do you ask your patients to measure glucose by using a continuous glucose monitor or anything like that?
Dr. Christy Kesslering: Sometimes we’ll throw a continuous glucose monitor on a patient, especially if they’re struggling. I’ve seen very small amounts of carbohydrates really drive somebody’s glucose up quite a bit. In somebody like that where we’re really struggling, definitely, because I want them to start to learn to eat to their meter. Most of the time, I’m just having them do a finger stick glucose and ketones measurement, just so that I can look at that interaction. Sometimes I’ll say, “Your ketones are great,” and then I realize, ‘Wow, your sugar is still really high. What’s going on?” Now, there’s a mismatch, and then I need to dig a little deeper as to why that is.
Dr. Eric Westman: There are several meters where you can check the glucose and ketones. Do you have a preferred meter that you recommend?
Dr. Christy Kesslering: I think that any of them is okay. I’m usually partial to Keto Mojo, only because they do have a physician panel so I can see patients’ numbers. It’s also free to me, and patients don’t need to do anything other than accept my invitation. I do use that product because I have that interface with the numbers. They are a nice company to work with. They help patients troubleshoot if they are having problems with the technology. I feel like their support staff is really nice to work with.
Dr. Eric Westman: I know they try to keep the cost of the strips down.
Dr. Christy Kesslering: Very low, it’s great.
Artificial Sweeteners
Dr. Eric Westman: People come to me concerned about artificial sweeteners causing heart disease; debunking that consumes half the time I have with people. How do you coach your patients about that?
Dr. Christy Kesslering: I hope they have enough knowledge to realize that a lot of these online articles are just attention grabbers. But I do have to deal with them often. I will always ask first, was it an observational study or was it an interventional study? I try to keep pounding those terms in. Then, we look at the difference. Were the numbers absolute? Was it one percent versus 1.25%? That would be a 25% increase, and really, that’s still one percent or less than one percent absolute. It has to be at least doubling before they even get my attention.
I always go and look at the study if I need to. For instance, when eggs were bad again, what did they count as “eggs”? We think of eggs as scrambled, poached, fried, omelet, or whatever. They think of eggs as any product made with an egg, which is in every single product in your bakery aisle, right? Everything’s made with eggs, every cookie, donut, bread, etc. You have to be a little bit of a savvy consumer and see if you can’t find some additional information. And if not, there are some smart people online that are trying to go through those studies. You could dig into these studies every day, but it’s always back to, is it interventional, is it observational? If it is an interventional, how big was the difference?
Clinical Case
Dr. Eric Westman: Often I find that in my first visit, I can give someone hope; a lot of people come at wits’ end and they’ve just lost all idea that anything’s gonna get better. Can you give us a clinical case of that happening in your practice?
Dr. Christy Kesslering: The two most recent ones that I can think of included an original diagnosis of colon cancer and one with metastatic, locally progressive breast cancer. Both of them found the metabolic health sphere and started their own version of a ketogenic diet. One of them had dramatic drops in tumor markers. One of them had a visible improvement in the skin and the fungating tumor in her breasts before they even started their conventional therapies. They went on to start their conventional therapies, but they were already seeing improvement, and they said, “Oh my gosh, I didn’t understand sugar the same way.” A lot of people have already cut out sugar, especially cancer patients. One of them was a vegetarian doing a lot more of the plant-based style of eating. Once she cut back on that and really optimized that low-carb type diet and added in more animal fats, eggs, fish, some beef and lamb, she saw results. I love the hope that it brings, and I love the hope that patients get excited about how good they feel, and they didn’t realize that they weren’t feeling good.
Fungating
Dr. Eric Westman: The term you used, “fungating”, is a term that we use when you can hardly see it. To have a tumor get smaller like that is not common. That’s rare.
Dr. Christy Kesslering: You definitely would not expect it in the conventional world without giving conventional therapy. They just don’t believe that anything else is going to make a tumor move. It’s impressive what our bodies will help us do if we put them in the right state.
Dr. Eric Westman: The keto diet to me is like an umbrella where we’re teaching people not to eat all of the garbage out there like sugars and ultra-processed foods. And one of the main take-home points, regarding nutrition in general, is that starches get digested to sugars. If you are having really starchy foods, it’s going to be raising the sugar as well. You want to protect yourself from that stuff somehow. We can call it keto, we can call it some other type of diet, but you want to minimize that stuff.
Is there evidence that cleaning up your diet will reduce your chances of cancer? Or conversely, is bad food linked to cancer?
Dr. Christy Kesslering: I will say that when we look at the individual foods, that’s where we get into trouble with all of those observational studies, but there certainly is data on metabolism. It’s still observational, but it’s much stronger when we’re looking at insulin and glucose levels. So, yes, we know diabetics will have higher rates of cancer, we know that.
When we actually dig into that science and look at fasting glucose levels, there’s a little bit of a stronger signal in sugar-sweetened beverages and other things. Blood glucose goes up a little later; insulin starts going up first because more and more insulin is released to keep sugars low. I wish that all of our primary care physicians and pediatricians would be drawing insulin, and we would be basing our recommendations on insulin levels.
3. Starting low-carb too late
Dr. Christy Kesslering: I’m not going to tell someone, “When you’re 40 and you start to put on your belly fat, that’s when you should go low carb.” No, we really should be starting it in childhood because we are seeing so many early cancers, it just gets younger and younger.
Dr. Eric Westman: That reminds me of the two other disease processes – pre-diabetes and diabetes take maybe even a decade to show themselves. With Alzheimer’s, once you have a symptom, that really means you’ve had something going on for 10-15 years. So, take action now.
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