Book Review: Outside The Box Cancer Therapies by Journal of Orthomolecular Medicine

OPEN ACCESS VOLUME 33, NUMBER 3 PUBLISHED: JUNE 2018 REVIEW ARTICLE

Outside The Box Cancer Therapies Alternative Therapies that Treat and Prevent Cancer Dr. Mark Stengler & Dr. Paul Anderson 2018. Hay House, Inc. 358 pages. ISBN 978-1-4019-5458-1 Outside the Box Cancer Therapies is the collaborative work combining the clinical experience and research of two naturopathic doctors, Mark Stengler and Paul Anderson. Stengler is a best-selling author, TV host, and former advisor to the Yale University Complementary Medicine Outcomes Research Project. He is an author and host of Natural Healing with Dr. Stengler, a series of health shows on PBS. He practices at the Stengler Center for Integrative Medicine in Encinitas, California Paul Anderson is Medical Director and Founder of the Anderson Medical Group. His Advanced Medical Therapies facility offering therapies in many modalities which are based on his 20 years of research and patient care. He is also an adjunct professor at Bastyr Integrative Oncology Research Center in Seattle, Washington, and is the primary medical advisor to the Sanoviv hospital in Rosarito, Mexico. Together they have created an excellent resource for practitioners and patients. Introduction Outside the Box begins with some harsh statistical realities: Cancer today is so common it will likely touch every person in some deep way in their lives. Despite its universality, there is a general unfamiliarity by conventional oncologists with the full range of alternative options. With that unfamil-

Book Review iarity comes disinterest, dismissal and more insidiously, condemnation. That’s where Stengler and Anderson’s book comes in, with its distillation of decades of clinical experience. In creating this compendium, they help navigate the vast landscape of holistic cancer treatments that have been developed worldwide. Some of today’s therapies may seem cutting edge, but many have evolved quietly for decades, pushed by small independent groups worldwide. Stengler and Anderson bring the distant, the past and present together into a new “integrative oncology” which uses the best of conventional oncology, but not exclusively: Drugs, radiation and surgery are integrated with the body’s innate powers. What is “the box”? It’s the status quo, the unfortunate by-product of the western scientific method, where the focus is on the disease, not the host. To be sure, a century of surgery, chemotherapy and radiation aimed at the cancer cells themselves has yielded many successes but that’s not harnessing all that is possible. Our immune system, tuned over millions of years is also a powerful, untapped resource. Real Hope with Integrative Oncology In Chapter 1, the authors begin with some inspirational cases from their archives and we are walked through their decision-making process and shown how they handle the successes and setbacks. We see concretely that there really is hope. Some deemed “terminal” see real regressions, a better quality of life and even remissions. Examples are drawn from all ages and include, prostate, leukaemia, esophageal, and abdominal cancers. One comes away with the impression that things have come a long way from Pauling and Hoffer’s Vitamin C regimes of a generation ago, to a real revolution in today’s therapies. The Root Causes of Cancer Chapter 2 is a heavy, technical chapter but one that’s often skimmed over in lay person’s books on cancer. The

Book Review: Outside The Box Cancer Therapies

debate on cancer causation is complex and goes back centuries with no clear consensus. Today’s naturopathic theory on cancer cause and treatment offers the best path forward when conventional treatment fails. Here, Anderson and Stengler introduce readers to the important concept of homeostasis–ability of the body’s physiological and cellular systems to return to its normal healthy state after responding to acute or chronic challenge. Disruption of homeostasis occurs by many routes: the depletion of nutrients by a chronically poor diet, persistent stress, chronic toxin exposure or chronic illness. All these factors may combine with vulnerable genetics to give cancer an edge. A functioning immune system in a homeostatic environment powerfully surveils and stops abnormal cells from replicating (and probably does millions of times over our lives), which is why we do not all develop cancer. But, if that immune process does not complete that initial mission, an abnormal cell may replicate unchecked, gain a foothold and proliferate to form a tumour. Anderson and Stengler list the scientific hallmarks of cancer which include: sustaining proliferative signalling, evading growth suppressors, resisting cell death, enabling replicative immortality, inducing angiogenesis, activating invasion and metastasis, reprogramming energy metabolism, and evading immune destruction. This definition shows how complex cancer is and the holistic approach needed to gain the advantage over cancer. The authors then introduce the main theories of cancer initiation as well as the triggers, the “fuel” and the resistance factors according to the eight hallmarks. They go on to explain the main theories of how cancer initiates using a brief synopses of the genetic theory, the cancer stem cell theory and the metabolic theory. We need multiple ways of examining the existence and persistence of cancer. Contrasting Conventional and Integrative Oncology Chapter 3 outlines the differences between conventional and integrative therapies. Here it’s important to deepen our understanding of basic oncology, a field littered with jargon and euphemisms which make decisions by the patient unnecessarily difficult. Stengler and Anderson explain the differences between response, remission and cure, and explain the concept of a prognosis. Conventional oncology is very much driven by statistics, and it’s critical to understand the survival terms, from cancer specific survival, to relative survival to overall survival to disease-free survival. To appreciate these concepts is the only way to make intelligent therapy choices. A drug having a “90% response rate” on a type of cancer is an almost meaningless statement to a patient whose criteria to live longer and feel better. The authors instead introduce the concept of idea of survivorship, with the quality of life being paramount. Out of the Box brings these vital concepts into the conversation a patient should be having with their doctor.

VOLUME 33.3

Also discussed is how modern oncology diagnoses and monitors cancers using biopsies, x-rays, scopes, lab tests and MRIs. From these traditional tests, the authors then introduce the newer diagnostic techniques which would likely draw a blank with the mainstream doctors. These tests include 80HdG within a cell as a measurement of oxidative stress, disease regression and progression; chemosensitivity tests; circulating tumour cells and circulating tumour DNA tests which measure cancer cells that have shed from a tumour into circulation. Thymidine kinase plays a key role in tissue metabolism in acute or pathological tissue stress states and detecting high levels of TK activity in a tumour frequently predict a rapid disease progression. The authors close the chapter with a treatise on their philosophy of medicine with multiple approaches to the unique issues that come with health and illness. Having a holistic philosophy matters as a physician’s particular view of cancer’s nature and causation obviously informs and influences the way they treat cancer. Conventional oncology has been called reductionist: one looks for the defect causing the disease and prescribes a treatment focused on that. Cancer, in this model, is an abnormal replication of cells, to be cut, burned or poisoned with the goal to destroy it without too badly damaging the host. Stengler and Anderson offer a much broader view: their integrative oncology embraces a whole body approach because even when it is localized, cancer is often a whole-body problem because it arose in a weakened environment where the cellular protections and immune system failed. Conventional and localized treatment may be needed, but the integrative oncologist never forgets to address the mind, body, and spirit of the person as it relates to healthy physiology. In this, they distill integrative medicine philosophy into five points: The healing power of nature; treat the causes, not the symptoms; first do no harm; a doctor must also be a teacher; treat the whole person; and focus first on prevention. This approach gives the body’s native healing powers every advantage to tip the balance in favour of survival. Understanding Conventional Therapies Chapter 4 attempts to bring to the lay-person’s level, the complex mechanics of conventional oncological treatments. It’s a dense chapter but an important one because its essential for the patient to make their decisions with their eyes open and know what’s being offered as a standard treatment. One has to know the cost/benefit for these often very toxic treatments and learn if there are unconventional ways to potentiate their effectiveness and/or mitigate their side effects. In radiation treatment, for example, there is often great damage to normal tissues but this can be mitigated by antioxidants, thus improving the cost/benefit ratio for a patient. The killing power of radiation can also be increased

Book Review: Outside The Box Cancer Therapies

by natural agents that oxygenate the tissues. The section on chemotherapy reviews the history and classes of drugs. Alkylating agents, antimetabolites, antitumour antibiotics, topoisomerase inhibitors, and mitotic inhibitors are explained and the mechanisms of anticancer effects and the common side-effects given. Newer treatments include monoclonal antibodies, lab-produced antibodies used to help the immune system target and destroy cancer; and adoptive cell transfer, which boosts the immune system’s T cells. Cytokine therapy manipulates signalling proteins made by white blood cells; photodynamic therapy uses light activated drugs to target tumours, stem cells and vaccines. Something this chapter underscores is that the effectiveness of new agents over old therapies is often small. Its a fascinating read that is recommended: knowing conventional therapies allows a patient to compare and contrast the standard therapeutic protocols which are often fixed and few. Foods That Prevent and Fight Cancer As integrative oncologists, we can expect Stengler and Anderson to give a comprehensive overview of nutrition’s role is in preventing and fighting cancer and they do this well, navigating between the extremes. Conventional medicine often discounts food’s influence completely and fad-diet advocates often ignore sound medicine and the powers of basic nutritional principles. The authors state that a major concern in cancer is simple malnutrition, a shocking 40% of cancer patients actually die from malnutrition itself. They also explain the emerging evidence of nutrition’s importance in “epigenetics,” where environmental influences such as nutrition can actually affect genetic expression in a positive manner. In this view, the wrong foods may signal cancer initiation, but a properly tuned diet may express the immunological and cellular genes which resist cancer. Foods which increase the risks of cancer include salted foods, alcohol, nitrate preservatives, red meat and high glycemic index foods and fungi-produced aflatoxins from improperly stored foods. On the flip side, foods that decrease cancer are things like cruciferous vegetables, fruits, high fibre and flavonoid rich foods. Dietary sugar is singled out here as this quite toxic substance seems to be roundly ignored by the mainstream medicine. There is a link between insulin resistance (caused by excessive sugar) and a variety of precancerous or cancerous conditions. Various diet outlines are given such as the Mediterranean Diet, the China Study Diet, the Kaufmann Diet and the Ketogenic Diet. The Ketogenic diet, (a carbohydrate free fat-based diet which uses ketones as the primary form of energy) is of particular interest as the medical community has begun to recognize its benefits in seizures, Alzheimers, traumatic brain injury, autism, depression and a host of other conditions. Not surprisingly, the ketogenic diet has anticancer effects: most tumour cells are unable to use ketone bodies for energy production due to changes in their mitochondria structure or function. Ketone bodies are shown

VOLUME 33.3

to have additional anticancer effects by increasing cancer cell oxidative stress as well as being anti-angiogenesis, anti-inflammatory, and proapoptotic. The writers also introduce the idea of the intermittent fast, a counter intuitive approach in patients often subject to malnutrition. Fasting has the ability to decrease certain hormones and other factors that feed tumour formation, including IGF-1, insulin, glucose, IGFBP1 and provides the body with a quick metabolic “reset” which is valuable in prevention of cancers. The authors state that diet and nutrition are the base upon which all other cancer therapies build, a patient’s good response to therapy may evaporate when that base is ignored. Supplements for Treating and Preventing Cancer Integrative oncologist use nutritional supplements to do what drugs can’t: improve a cancer patient’s quality of life. Despite decades of evidence, the reality is that conventional doctors are often oblivious to the efficacy of nutritional supplements in improving quality of life. To dismiss what one doesn’t understand is to givea petient, what Dr. Abram Hoffer once called, “false despair.” The author’s research on nutritional supplements is designed for complementary, not primary therapy. This chapter focuses primarily on oral route nutrients which is followed by a chapter on IV treatments. In both sections we can see the dynamic nature of the field and the many advances made since Pauling and Hoffer first created orthomolecular therapies around a few substances like ascorbate and niacin. The authors helpfully organize each substance down into five bullet points: what it is, how it works, key studies, safety, and dosage. They also introduce many new life-improving supplements such as melatonin, glutamine, proteolytic enzymes and probiotics and the newest anticancer star from Ayurvedic medicine, Curcumin. Newer still are the herbs such as BEC (Solasodine Rhamnosides) for melanomas, Boswellia Serrata, Cannabinoids for pain relief, Resveratrol for prostrate and bowel cancer, Maitake mushroom extract is used as an immune enhancer. This chapter is too exhaustive to review fully, but it’s a valuable excursion of the many novel herbs, vitamins and other nutrients. Following the orally administered nutrients comes an indepth chapter on intravenous nutrients. The IV advantage is that nutrients bypass the digestive system where a great deal of potency can be lost, thus delivering more of an agent to the blood and cells than using an oral route. For example, urinary concentrations from intravenous vitamin C can be 140 times higher than the biggest oral doses tolerated. Often a seriously ill person’s digestive system is so run down that IV administration is the only way to get higher potencies in blood and tissue. We are now in a golden age of experimentation and advances on the IV front. This can be divided into classes: Oxidative therapies that use oxidants to stimulate the body to fight cancer and heal tissue (Vitamin C, Artesunate, Hydrogen Peroxide

Book Review: Outside The Box Cancer Therapies and Ultraviolet Blood Therapy, and IV Biological/Metabolic substances (Glycyrrhizin, Glutathione, Dimethyl Sulfoxide, Silymarin and Curcumin). Curcumin is a very promising agent for IV route, Dr. Anderson states, and references over 40 scientific publications which detail the use of IV curcumin as a potentially groundbreaking therapy. IV Mistletoe also deserves mention as over 2,000 scientific studies on its pharmacology demonstrate an improved quality of life as well as a direct immune stimulation. Mistletoe is a true immunotherapy, having effects on multiple parts of the body’s immune system. It stimulates NK (Natural Killer) cell function that is crucial to tumour cell death. Mistletoe also changes tumour cell biology to weaken the cancer cell. Sometimes true therapeutic synergy lies in the combined use of the above substances. One such pairing in Dr. Anderson’s IV research is the combination of Poly-MVA and DCA for both IV and oral use. Poly-MVA is a lipoic acid-palladium complex that can enter the cell and stimulate mitochondrial energy while at the same time forcing the cancer cell into a metabolism that weakens it. DCA (Dichloroacetate) is a small molecule which, in the past, was used as treatment for the metabolic disorder lactic acidosis. It inhibits lactate formation, and switches cell metabolism away from glycolytic to mitochondrial energy metabolism. This molecule favours energy production favoured by normal cells and not cancer cells. Using these substances together produces a mutual anticancer benefit. Dr Anderson has used this combination successfully and he illustrates this with cases from his original study. The combined use of DCA and Poly-MVA has been one of the truly big advances in integrative cancer therapies in the past 20 years The chapter ends with a section on “Supportive, Healing, and Protective IV Therapies such as low dose vitamin C therapy and the deceptively simple but highly beneficial “specialized hydration with nutritional support.” This therapy is a method that clinically emerged a few years ago to help cancer patients improve their quality of life and decrease side effects. IV hydration is quite simple but highly effective and now, hydrating solutions have broad arrays of vitamins, minerals, and amino acids and the patient receives the benefit of both hydration and nutrient repletion. The authors have seen these formulas rescue people from severe side effects from chemotherapy, improving their mental function, reduce pain, and improve quantity of life at the end of life. In their clinical experience, these specialized hydrating nutrient formulas are a critical part of IV therapy. Protection and Recovery From Surgery, Chemotherapy, and Radiation Chapter 8 deals with the appropriate care before, during, and after standard therapies to protect the healthy cells,

VOLUME 33.3

augment the damage to the cancerous cells; and improve overall quality of life. In surgery, integrative oncology works through the stages of preparation, post op, and recovery when the inflammatory and proliferative stages of surgical wound healing occurs. In the same way, timed intervention for chemotherapy is focused on nutritional support to correct imbalances that may exist prior to starting chemotherapy. Treatment during the recovery phase is aimed at patient-specific side-effects and reducing cancer stem cell / tumour microenvironment activation, which can happen after chemotherapy. In radiation therapy where there is always the potential for skin damage, Integrative methods make use of the botanical medications and even turmeric for an anti-infectious, anti-inflammatory, antiexudative and antioxidant effect. Stengler and Anderson also delve into a subject I’ve never seen in a layperson’s book: that of cancer seeding, the tumour microenvironment and activation of cancer stem cells. This phenomenon is a serious, not often talked about side effect of chemotherapy. Despite chemotherapy effectively killing cancer in the beginning, it actually strengthens a residual cancer cells and makes a relapse far more possible and more aggressive. The strategy here is to prevent cancer seeding, in the tumour microenvironment and to decrease the likelihood of activation which could lead to future cancers. Intermittent use of the ketogenic diet and fasting as well as vitamin C and curcumin maintenance doses is one way this can be addressed. Common Cancers and Integrative Approaches In this chapter, Stengler and Anderson outline the frequency of common cancers, how they differ based on their staging, and the way these clinicians think about treatment protocols based on the cancer type and its progress. They take care to outline the clinician’s thought process in formulating a specific and individualized cancer care plan. The first question is always “What are the chances of survival with standard therapies for this type of cancer?” If there is a very high survival rate, then following the standard protocols while adding a well-rounded integrative support is often the best route. If, on the other hand, the cancer is aggressive and survival chances are low, they often design protocols to reduce side effects and raise the quality of life. Another consideration is the survival potential of the stage of the cancer. Stengler and Anderson posit that since lower stage cancers generally have a much higher survival rate, they will often recommend standard cancer therapies. High-stage cancer, where survival is lower and effects of standard treatment would more likely cause harm than remission, their direction and focus would shift to a more aggressive integrative approach. They close with a review the practicalities of their programs in specific cancers and outline therapies for the most common cancers such as breast, lung, colon, prostrate, pancreatic, ovary and melanomas. Therapies in all instances involve diet, sup-

Book Review: Outside The Box Cancer Therapies

VOLUME 33.3

plements, IV therapies and other supportive measures.

re-establish the body’s natural anti-cancer homeostasis?

Other Alternative Therapies For Cancer

Outside the Box Cancer Therapies is one of the best books on cancer I have read. So often you will see book on cancer from the natural medicine press which offer pleasing theories, great hopes yet few specifics beyond the anecdote. No better is the traditional oncology press which lightly dabbles in nutrition if at all while the valuable scientific principles of therapies are often locked away in textbooks too opaque for the average person. Stengler and Anderson’s book transcends both of these extremes by strongly binding together conventional scientific insights with the integrative cutting edge of what we know today. It gives a solid education on the biology of cancer and hard truths about conventional therapies. As practicing oncologists, these physicians have a full complement of patient histories from every possible circumstance, and they have made a career out of pushing the therapeutic envelope by testing, observing and improving their techniques. This book is highly recommended and great benefit can be had for yourself, a loved one or simply as a powerful reference.

Chapter 10 explores some additional alternative therapies such as detoxification, low frequency electrotherapy, hyperbaric oxygen and hyperthermia therapies, immunotherapy and insulin potentiation therapy and others. Stengler and Anderson state that the primary job of an integrative oncologist is to push the boundaries of current technologies for better outcomes. Patients don’t have the luxury of waiting years for definitive answers. They need an open and dedicated integrative practitioner who will properly weigh safety data, patient responses, and clinical outcomes. to find the right therapy for them. Their approach focuses foremost on the person with cancer because the truth is cancer cells arise from within us and they are inherently similar to the larger host. To become cancerous, normal cells must sustain some initial trauma, then find a way to survive in a body which is compromised in some way. The great question then becomes, what happened in the larger environment that allows the cancer to survive, and what can be done to

–Review by Greg Schilhab