Episode 1: Integrative Oncology and Supporting Optimal Patient Health with Nalini Chilkov

Evelyne Lambrecht: Yes. Thank you so much for being here. We’ve actually known each other for a while. I used to be an intermittent podcaster and had a show called Elevate Your Energy, and I interviewed you back in 2015. So this feels like we’re having a reunion with friends. Thank you for coming.

Nalini Chilkov: Indeed it does.

Evelyne Lambrecht: So Dr. Nalini Chilkov is the founder of the American Institute for Integrative Oncology. And share with us a little bit about your health journey and how you came to specialize in integrative oncology.

Nalini Chilkov: Well, everyone has a personal story usually, and both of my parents were diagnosed with cancer in their fifties, and so that got my attention happily. My mom died at 88, my dad died at 90 both cancer free. But it really got me interested in thinking about our own family’s vulnerabilities and genetics. So then a little bit of knowledge is a dangerous thing. And then I really took a deep dive and really studied oncology and integrative oncology, had wonderful mentors. And then I found so much meaning and fulfillment in really changing the lives of people who have experienced cancer that I just came to specialize in it, and it’s the most rewarding thing I have ever done.

Evelyne Lambrecht: That’s beautiful. And you’ve contributed so much to this field, so thank you. You asked this question at a talk that I thought was so good. What if every cancer patient had a plan for their health and not just a plan for their disease?

Nalini Chilkov: Well, this is my mission. This is my mission because I really feel that when a patient is diagnosed with cancer, they need not only disease experts, but a health expert as well. Because if you are in an oncology setting, the word health isn’t even in the lexicon. It doesn’t even come up in the oncology setting. But what does the patient want? They want to have health. At the end, they want to get their life back, but also they want to remain healthy while they go through difficult treatments and challenges, probably one of the most stressful times in their life.

So we can help patients to support their health, protect their health function, protect their organs, have them get the absolute best outcomes of their treatments, and at the same time then have lower risk to recurrence and maybe no recurrence and really transform their health. And it’s really interesting. Some people say cancer is the best thing that ever happened to me, which is so paradoxical, but people become interested in health who never were interested, and then they say they’re healthier after cancer than they have been in their life. Then I’ve done my job.

Evelyne Lambrecht: Absolutely. Yeah. And you’re passionate about helping practitioners specifically feel confident about supporting those with cancer at every stage of their journey. And I thought this was interesting, one out of every two people will get diagnosed with cancer and two out of three will survive it.

Nalini Chilkov: So that’s the bad news and the good news. So think about it, you’re sitting at a dinner table, half the people at that table either have had cancer or are going to have cancer. That’s daunting. And because diagnosis is earlier these days, and because we have more focused personalized treatments and can support people to get through their treatments, come out the other end doing well, then a lot of people are living quite a long time. Not only surviving, but some people will live with cancer as a chronic illness for a long time as well. So there’s a large population of patients that really need health support. And the reason that the cancer incidence is so high is because of our toxic environment, our unhealthy lifestyle, sedentary lifestyle, and really the levels of stress that people live with as well, disrupted sleep cycles. All these things compromise our immunity.

Evelyne Lambrecht:You created the OutSmart Cancer system. Tell us more about that.

Nalini Chilkov: Over the years, as I began to work with patients whose lives have been touched by cancer, I developed a system in a way of teaching patients how to care for their health, a way of monitoring blood tests and biomarkers. In integrative cancer care. We think about the cancer terrain or the tumor microenvironment. So we want to be able to monitor that and optimize that. And the real goal is to create a biosystem that’s not going to host cancer, that’s not going to be hospitable to the development or proliferation or progression of cancer. So we want to have a way to monitor the patient’s status so that I know that the treatment plan I put together for them is actually meeting those goals. So the care has to be highly individualized. If you have a person who’s a diabetic with cancer versus somebody who has autoimmune disease in cancer or depression and cancer, then we have to really tailor that treatment plan to the patient.

And we do that by talking to them about self-care, about the emotional side of being diagnosed with cancer and the fear that comes with that, the fear of recurrence once you finish treatment. We talk to patients about diet and we have an OutSmart Cancer diet approach that is to transform this biosystem in cancer terrain. And then we have nutraceuticals and botanicals and phytochemicals that go along with that. Sometimes we’ll refer to a physical therapist or an acupuncturist as well. Our job is to educate the patient, make sure they have the right team, including the right oncologist, and make sure that they really have a plan to have a good outcome and a stable future.

Evelyne Lambrecht: And one thing you just mentioned to work with their oncologist or make sure they’re working with the right oncologist, how do you as an integrative practitioner collaborate with an oncologist? Because many oncologists don’t want patients doing anything outside of what they’re doing. How do you work with that?

Nalini Chilkov: It’s an incredibly common question that I get asked. I’m all about relationships, and the first thing that I’ll do is I’ll introduce myself to the oncologist and I’ll say, “You’re the disease expert. I’m the health expert.” And that makes them feel I’m not stepping on their toes. And there’s a lot of confusion. I think an oncologist think that we are claiming that we’re treating cancer, but we’re not what we’re doing. We are preparing the body to have a good robust response to treatment and to stay healthy and resilient and recover.

So once I make that clear to the oncologist, quite often they take an exhale and feel okay about it. Of course, I’ve been in practice 35 years now, so I have relationships with oncologists, and once you’ve shared patients with a physician and they see that those patients do better with this support, then you don’t have to say anything. But it’s important to reassure them. I let them know I am well-versed in drug herb, drug nutrient interactions, and then my intent is to not interfere with their treatment goals, to respect what they’re doing, but to really support the patient. And then it’s win-win. The oncologist, the patient, and our team, everybody wins when the patient does better. So I create these partnerships. And of course some doctors are open and some are not. But that’s been my mission to have a seat at the table, to have our voice, our point of view included.

Evelyne Lambrecht: Yeah. I think that’s beautiful, and I think it’s encouraging to practitioners that we can form this integrative team. So some of the unique needs of these patients. You already mentioned the fear of recurrence and having that mental emotional aspect, restoring normal function, but I know you’ve also talked in lectures about sleep cycle disruption and microbiome restoration. I’d love to talk more about each of those, starting with restoring normal function. What does that look like to you?

Nalini Chilkov: Well, it depends what the patient has been through, but we want the patient to have normal digestion. Quite often the digestive tract in the microbiome have been very disrupted. Some treatments, like a lot of chemo causes the epithelial lining of the GI tract to slough off. And then we want to be able to repair that. Sometimes patients get gastritis and enteritis or mucositis in their mouth and they just have a hard time eating. Or some patients have a lot of scar tissue in their abdomen and have abnormal peristalsis, and everyone who’s ever had chemo has microbiome disruption. So those have to be included. But if you think about it, nutrient status, [inaudible 00:10:45] status, protein status, fatty acids, these are so important to being able to withstand stressful treatments to heal from a surgery.

So we often put together like a therapeutic shake as an insurance policy because a lot of these patients don’t feel like eating. They don’t feel like cooking, eating is uncomfortable for them. So I want them to get those nutrients in calories. So do a super shake and have protein powder and reds powders, greens powders, CT oil, always put carnitine in the shake because loss of muscle mass and sarcopenia is a big risk for all cancer patients. So the carnitine not only supports muscle mass, but mitochondrial function and the fatigue that comes with cancer. So it can be simple to do it, and then the patient has a way, especially on the days they don’t feel like eating at all, maybe take two shakes or three shakes and still get enough calories and nutrients.

Evelyne Lambrecht: Yeah. I was going to ask you about that shake. I know you’re a big fan of that one. And for diet in general, do you have generalized recommendations? But it is still individualized, of course, to depend nutrient status.

Nalini Chilkov: There’s basic principles. So cancer cells have more receptors for insulin, IGF-1 and GLUT4. So cancer cells are exquisitely sensitive to blood sugar and insulin. And insulin is the growth factor. A lot of people say, “Sugar feeds cancer,” but it’s really triggering insulin, which is a growth signal for proliferation for cancer cells. And of course that gets the sugar in the glucose inside the cell. Cancer cells prefer glycolysis to the electron transport chain to make ATP. So one of the biggest levers, one of the most powerful things you can do is do a low carb diet and take away the signal for insulin secretion. And once you do that, essentially, it’s a metabolic approach to cancer. You slow down the metabolism of the tumor cell by withholding its fuel, and the idea of the ketogenic diet is to take away all the glucose and have the body live on ketones instead of glucose.

But the research actually really isn’t there. It’s still somewhat theoretical. So the cancers that are high glucose demanding are pancreatic cancer and brain cancers, gliomas and glioblastomas. Those I will be much more strict. And if the patient can tolerate doing a keto diet, it’s hard to get into ketosis and stay in ketosis. People have diarrhea. You can’t eat with your family, and there’s a lot of things that make it challenging. Some people get disrupted fluid and electrolyte balance. If I have a frail 85 year old patient, I’m not going to do that. If I have a 20 year old athlete, maybe I will. So the research is more strong and solid on low-glycemic diets and intermittent fasting, and again, not extreme. These are vulnerable patients, 13 hour fast, not a 16 or 18 hour fast if we’re talking intermittent fasting.

So I will ask patients to fast for 13 hours, and that’s just between tonight’s dinner and tomorrow’s breakfast. Most people can do that, but it produces a period of low glycemia. Low insulinemia. Very low. So we’re not getting those growth signals. And it also transforms immune response when you do that. And there was a big study that was done in Europe on over 2,400 patients, over seven years, breast cancer patients, and there was a dramatic increase in survival of these patients who just did intermittent fasting, just that. Integrative cancer care can be expensive, but there are these lifestyle things that cost nothing and have a big impact. So you can eat a low glycemic diet, and then you mention sleep.

So we know that having a normal sleep cycle, sleeping when it’s dark and being awake when it’s light and getting enough sleep, seven to nine hours of sleep really transforms immunity. So we need robust immunity during this time. And patients are in pain, they’re anxious, maybe they’ve gone through medical menopause and their sleep’s disrupted from that. So supporting their sleep is crucial to their coping capacity, their resilience, but also their immunity.

Evelyne Lambrecht: Yeah. With sleep, I know it’s a struggle for so many people, cancer or not, what are some of the ways, aside from the sleep hygiene measures that we know about that you like to support with

Nalini Chilkov: Acupuncture. Acupuncture is fabulous, but exercise is a good way to have better sleep. We know that there’s many studies that show that just doing 30 minutes of moderate exercise daily improves recurrence rates, just that. And then if you exercise, you can sleep better. I’m very pragmatic. I like to give people things they can do, but then they can integrate into their lifestyle long-term. Because cancer is a metabolic whole biosystem syndrome. It’s a chronic illness for the most part. So we really want to transform people’s habits and lifestyles long-term, not over when you finish your treatment.

Evelyne Lambrecht: And of course, we’re going to talk about nutraceuticals a bit on the show. What are some of your favorites for supporting sleep, but then also some of the things you mentioned earlier related to the gut?

Nalini Chilkov: Well, I always give cancer patients high doses of melatonin. Now, I don’t give it to them for sleep, but it of course impacts their sleep. A lot of research on melatonin is done at 20 milligrams at bedtime for transforming the cancer terrain, the tumor microenvironment. There’s a lot of signaling that goes on in the immune system with melatonin, but melatonin is not a sedative. It’s a dark signal to the brain and it tells the brain it’s getting dark, it’s get ready for sleep. So you also get that from using melatonin in the cancers terrain setting. So include that.

I just give people magnesium and lavender usually as a start. And quite often that’s enough. If someone also has anxiety as part of it, we might think of using supplements that are anxiety lytic. But I just do simple things because I’ve already asked cancer patients to take a lot of supplements, and so more so I asked them to turn off all their electronics, stop looking at blue light screens, which tell us it’s morning and to start winding down and intending to sleep, preparing their nervous system to tip into the parasympathetic. I’m more interested in training people to re-pattern their stress response. And I’m a big proponent of meditation and teaching people. I think that’s more powerful. I don’t want to give them more and more pills. So I usually just start with melatonin and magnesium, usually magnesium glycinate and some lavender. That’s usually what I give them.

Evelyne Lambrecht: And what about for the gut? You mentioned earlier-

Nalini Chilkov: Well, the gut’s a big project. So you have to think about prebiotics, probiotics, and in cancer patients postbiotics. You need to have a lot of short chain fatty acids and tartaric acid in the gut because that’s what really allows the healthy probiotic bacteria to colonize. And we’ve learned that giving billions and billions of probiotics, most of it passes right through you. So unless you have a lot of short chain fatty acids in there, you’re not going to get colonization of all those healthy bacteria. So I like to use things like the probio phage. I like to use that. That does help us establish that ecosystem in the gut. A lot of cancer patients also have leaky gut because so many of the treatments are pro-inflammatory. So I like to use things like vitamin A that heal the epithelial lining, but also are important in pro differentiation of tumor cells.

The more primitive D, differentiated a tumor cell is, the harder it is to treat. The more differentiated it is, the easier it is to treat because there’s receptors there that you can target. So both vitamin D and vitamin A promote differentiation of cancer cells. A lot of cancers also have viral triggers, and so vitamin A is useful in that setting. We also know that vitamin D, of course, really modulates cancer immunity, also really protects the bone. There are many, many cancers that invade and metastasize to the bone. The more dense the bone is, the harder it is for the cancer to invade. So we want to use a vitamin D with vitamin K in it as well.

So there’s some ADK formulas where you can use everything altogether at once. I actually really like designs for health formulations because they are often higher milligram amounts than other companies, but they’re often these really intelligent combinations, so you don’t have to give 20 bottles of things. So I like the formulations very much. I use inflammatone quite a lot.

Cancer itself is an inflammatory disease, and so if a patient has more baseline inflammation, they’re more vulnerable to certain types of cancers. But at the same time, cancer cells secrete cytokines. So it’s very important to have a plan for inflammation. I usually track CRP, IL-6 in the blood and then also watch the white blood cells. You get a sense of the inflammatory biosystem, but also ferritin and ceruloplasmin go up in cancer. Those are other inflammatory markers in the cancer setting. So you can see what the landscape is.

And then if you take a good history, you’ll know if a patient has a more inflammatory history and they’re more prone to have more inflammation as a cancer patient. And from the treatments or pro-inflammatory, and patients who have certain SNPs, single nucleotide polymorphisms and their genomics in TNF alpha, IL-1 and IL-6 tend to have more cancer related inflammation and more cancer related fatigue. So you can predict the patients that are going to suffer more in that way. And the primary cause of cancer related fatigue is inflammation. After that mitochondriopathy, after bone marrow suppression from their cancer treatments. So those are the types of things you want to pay attention to. And by addressing these, the patient does so much better, that quality of life is better, but their capacity to withstand their treatments and be resilient is better as well.

Evelyne Lambrecht: Yeah. I have a question about glutamine. I know it’s a little bit controversial and in cancer use, however, there are studies showing benefit in cancer patients specifically for healing intestinal permeability. What is the latest research on it?

Nalini Chilkov: It’s a common question, a good question. So this is my thinking and many of my colleagues thinking. So there are cancer cells that instead of using glycolysis to make ATP will use glutaminolysis. So they’ll use glutamine instead of glucose to make energy. We have no way of predicting which cancer cells are going to do that, however. But glutamine is the most ubiquitous amino acid in the body. It’s everywhere, and there’s a lot of it in the muscle, but it’s everywhere. So there is no way to withhold glutamine from a cancer cell. If a cancer cell is going to transform its energy metabolism and use glutamine, it can do it at any moment.

So there’s no impact by withholding glutamine because it’s in the tissue. So we use glutamine for two reasons to manage adverse effects of treatments. We use it to repair the intestinal lining and the oral mucosa, a little mouthwash of glutamine a couple of times a day. It’ll start healing the lining of the mouth that allows somebody to eat normally. So that’s important to their nutritional status and their weight and their caloric intake. Also, a lot of people get really bad enter enteritis. The diarrhea that comes with chemotherapy is really from inflammation in the gut. So the faster we heal that lining, the more able they are to have normal function.

Glutamine is also useful in nerve repair. So neuropathy is common as a side effect in chemotherapy treatments. So we can use glutamine in that setting. It’s used in hospitals all the time for this purpose. It’s not some exotic thing, but this is a question. So to summarize, you’re not going to get any mileage out of restricting glutamine orally because it’s everywhere. So I still use glutamine for the purpose of repairing nerves and repairing the lining of the digestive tract.

Evelyne Lambrecht: Thank you for clearing that up for me. And you mentioned neuropathy, I was going to ask about that next. It’s a common issue, whether it’s in cancer or diabetes. What are some of the most useful treatments that you’ve found for neuropathy?

Nalini Chilkov: Well, think about, we’re in a health model, so think about what causes healthy tissue in nurse. The reason for neuro neuropathy in cancer patients is excess oxidative stress. So that’s how chemo works. It increases oxidative stress, it damages the DNA in the cell and the cell dies. And cancer cells are more vulnerable to that than healthy cells. But any cell that has a fast rate of replication is going to suffer from side effects. So the neurons are fast dividing cells. The gut are fast dividing cells, the bone marrow are fast dividing cells. That’s where you see these side effects. So to restore normal nerve function, so we have to have a healthy myelin sheath, so omega-3 fatty acids, vitamin D, and also we want to repair the nerves. So glutamine and also acetylcarnitine is really good for repairing the nerves.

And what’s happened to these patients is they have incomplete redox cycling. So what happens is they just can’t quench the oxidative stress. And we know certain patients have SNPs where they’re less efficient at that, or just the aggressiveness of the chemo might’ve overwhelmed the redox system. So I also just make sure there’s plenty of antioxidants. Sometimes glutathione can really make a difference. If it’s really bad, you can do IV glutathione, but oral glutathione also, or an acetyl cysteine, which is its precursor. You have to be careful with an acetyl cysteine because it interferes with drug metabolism. So you have to be careful with that.

Acupuncture also is just fantastic. So I have a patient who came to me, maybe six or eight years after successful breast cancer treatment, but her neuropathy persisted, and she was a smoker, so she had even more oxidative stress. It is paradoxal to keep smoking after you’ve had cancer, but there it is, it’s irrational. That’s the human condition. So we put her on this protocol of acupuncture three times a week for eight weeks, omega-3 fatty acids, and I just had her eat the rainbow to get more antioxidants and her neuropathy completely resolved and never came back. So we just had to break that cycle. We had to break that cycle where the oxidative stress wasn’t being quenched.

Evelyne Lambrecht: That’s amazing. I didn’t realize that could resolve after such a long time of having it.

Nalini Chilkov: Yes, it can. I mean, what we know is given the right conditions, the body will repair itself. So we have to have those conditions. So you just have to understand what conditions are needed and provide this.

Evelyne Lambrecht: As you were talking, I was reminded you have an amazing resource on your website. Well, actually, two amazing resources. One is a supplement guide that outlines some potentially useful solutions for side effects of cancer treatment. And then you also have this great, I think you call it the care planner OutSmart-

Nalini Chilkov: Yes.

Evelyne Lambrecht: Can you tell us more?

Nalini Chilkov: Yeah. Many years ago, I did a lecture for Designs for Health on how to manage the side effects of cancer and cancer treatments. And I made a cheat sheet and a handout and a summary of my lecture. So there are some things like glutamine, cryo, carnitine, omega-3, fatty acids, those sorts of things are on there. And then I feel very strongly that primary care and frontline clinicians really need to get comfortable working with cancer patients, but most are super uncomfortable because nobody has any training. If you didn’t specialize in oncology, then you really are at a loss. And especially to understand what the cancer survivor needs, who gets training in that? So that’s part of the training we provide to physicians.

So one of the most important things is as a naturopathic or functional medicine clinician or a nutritionist, somebody comes in your office, they have a cancer treatment history, and you have to think about them differently. You have to take the history differently. So I created this care planner, which walks the clinician through the questions you want to ask the patient and what you want to look for in their medical records, so you understand why they’re coming to you and saying, I’m fatigued. It’s not that they’re hypothyroid, it’s that their bone marrow never recovered from chemo, or the chemo really damaged their mitochondrial function. So you have to think differently about these patients because patients just complain of their subjective symptoms, and we have to be able to figure out what that root cause is. So it’s a skill to take a history of someone with cancer treatment or we have large populations of patients who live with cancer as a chronic illness. So these are patients who have some measure of tumor burden that they’re going to live with as a chronic illness.

But you think of that like diabetes or high blood pressure or high cholesterol. It’s something you monitor and manage, and it’s really a new way to think about long-term cancer survivors. But many of these people are undergoing toxic treatments or hormonal treatments as well. So there are side effects to those treatments. So again, if you’re a clinician and someone comes in and they are a long-term cancer survivor and they’re under treatment, they have unique needs. So it’s important to understand how to take their history and how to understand what their health challenges are as well.

So let’s say someone’s on a estrogen blockade therapy because they had estrogen driven cancer. A lot of those patients have joint pain because there’s estrogen receptors in the connective tissue. So we’ve learned, for example, that high doses of vitamin D and doing more yoga and stretching is sufficient to manage that pain. So the way to understand if a cancer patient is in an optimal range of their serum vitamin D is to measure it because patients utilize vitamin D at different rates. So we monitor our patients about every three to six months with blood tests to make sure we’re optimizing their system.

Evelyne Lambrecht: And that resource is available on your website, which is aiiore.com. Nalini Chilkov: That’s right.

Evelyne Lambrecht: Great. And we’ll share that in the show notes as well. I have one more question for you before we transition to some personal questions that we ask every guest. Let’s talk about cancer and alcohol. Alcohol is a carcinogen. Tell us more about that.

Nalini Chilkov: Well, there’s lots of research showing that alcohol is a carcinogen, and there’s really not very many good reasons to ingest alcohol if you’re into health. So people have to balance their social needs and their lifestyle with their cancer risks. So I ask all of my patients during their treatment to absolutely give up alcohol during that time because I really want patients to be optimized, to have a good outcome from their treatment. Who wants to go through that again? So I feel very strongly about that. And then after people finish their treatment, they have fear of recurrence. So that’s a teaching moment as well to remind them that if they want to take control of their future, they want to take control of the trajectory of their cancer risk. That is an important thing to consider. So you want to have a glass of champagne at New Year’s fine, but don’t have a glass of wine or a cocktail every night. If you have cancer risk, it will increase your risk, guaranteed.

Evelyne Lambrecht: Yeah. I don’t drink anymore, almost three and a half years now. Okay. Some questions that we ask every guest on Conversations for Health. What is your favorite supplements, not for your patients, but your favorites?

Nalini Chilkov: Well, my first love is botanical medicine and also Chinese mushrooms. So I always, always take Chinese mushrooms every single day.

Evelyne Lambrecht: Beautiful. And what are your top health practices for your personal health and wellbeing? Especially because you’re always taking care of other people.

Nalini Chilkov: Yes. Well, when you are in patient care, you have to have good boundaries. That’s a really good self-care habit. But for myself, I’m a lifelong meditator. I’ve been meditating over 50 years, so that’s a piece for me, getting enough sleep. I’m really disciplined about my sleep and exercise and being outside, being in nature. That’s my medicine. I hike almost every day and I’m a gardener. So those are the things that I do to keep myself really robustly healthy.

Evelyne Lambrecht: I love it. That’s beautiful. And what is something that you’ve changed your mind about through all your years of practice?

Nalini Chilkov: Well, recently I changed my mind about how much protein that cancer patients should ingest. The thinking has been that too much protein drives cancer, and that’s actually recently been refuted. And I’m actually happy to know that because cancer patients have a high risk of sarcopenia, loss of muscle mass, and so that’s part of aging physiology as well. So protecting muscle mass is really important. As you age, you actually need more protein, but as you age, you actually have more cancer risks. So I was always conflicted about that, and now I don’t have to be.

Evelyne Lambrecht: I didn’t know. That’s great information though.

Nalini Chilkov: Yeah, I just learned that recently. Yeah.

Evelyne Lambrecht: Thank you for sharing. So thank you so much, Nalini, for joining us today. It’s been a real pleasure interviewing you, and I learned so much, and I just appreciate all the work that you do in this field and have been doing for a long time.

Nalini Chilkov: Thank you so much.

Evelyne Lambrecht: Thank you. Thank you for tuning into Conversations for Health. Check out the show notes for the resources shared on today’s episode. Share this podcast with your colleagues. Follow, rate and leave a review wherever you listen. And thank you for designing a well world with us.

Speaker 1: This is Conversations for Health with Evelyne Lambrecht, dedicated to engaging discussions with industry experts, exploring evidence-based, cutting edge research and practical tips.