LIVE Q&A: Less Discussed Chemo Side Effects and What to Do About Them

Chemo brain, taste changes, sleep & joint pain — what no one tells cancer patients. Q&A inside. #chemotherapy #chemosideeffects #cancerpatient

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Episode Description:

There's a whole category of chemotherapy side effects that almost never come up at an oncology appointment.

Not nausea. Not hair loss or fatigue. The other ones.

 In our latest LIVE, Dr. Chaplin covered what most patients are left to figure out on their own:

• Why taste and smell change — and what actually makes it worse (hint: it's probably in your kitchen)
• The real cause of sleep problems during chemo that most people never think to question
• What works for chemo brain and what doesn't — and why the answer surprises people
• The joint pain that 87% of taxane patients experience and why heat vs. cold matters
• Which supplements actively cancel out your immunotherapy

The replay is up now.

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Inquiries: 

info@elevatingcancertreatment.com

https://elevatingcancertreatment.com

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Disclaimer:
The information provided in this podcast is for educational and informational purposes only, and does not constitute medical advice. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard or read in this podcast or on this channel.
Reliance on any information provided by Dr. Jay Chaplin or Elevating Cancer Treatment is solely at your own risk. Dr. Jay Chaplin is a scientist and drug developer, not a medical doctor providing patient care. The content presented here reflects general scientific understanding and research, and may not be applicable to your individual health circumstances. Individual medical conditions and treatments vary, and no two situations are exactly alike.
Always consult with your personal healthcare provider before making any decisions about your health or treatment plan.

Transcript

SPEAKER_00 0:03

Hello everyone. Jay Chaplin here with elevating cancer treatment. Just a reminder, I am a PhD, not an MD. Everything you're going to hear tonight is medical education, not medical advice. Please, please, please, please, please discuss anything that I say with your oncologist, with your medical team, and get their input. Pauline will be moder moderating. So if there is something that we've done an episode on, she will put a link to that in the comments. She started off with our link to the elevating your cancer treatment. Sorry, elevating your chemotherapy journey information. So please grab that if you haven't before. That's also the way that you sign up for our email updates, that kind of thing to keep you up to date with everything that we're doing here. Um do want to let everyone know again that this is the general information and that I do work with people around their particular chemotherapy regimens. You'll hear a lot of different things tonight about carboplatin, about um oxaliplatin, how those are different from each other, the taxanes, different chemotherapy regimens, and how those impact people. Again, every every every every cancer is a little bit different, and every cancer is a little bit um different in the way that it responds to those treatments. And anything that we say should again be taken as a general comment rather than something specific for you, unless we get into the details. Um, just a reminder next week we're doing the immunotherapy episode that we delayed. So we'll be doing questions and answers around how to optimize your immunotherapy, particularly immune checkpoint inhibitors, but also bi-specific antibodies, engagers, that type of thing. And also following that, August 3rd, we're going to do cancer recurrence and metastasis, how to prevent those, how to set yourself up for success in that regard. So I did want to start off with uh a bit about tonight's topic, which are the less discussed chemotherapy issues, and then I promise I will come back and start addressing the specific questions. I see we already got one about the K2MK4 protocol. All right. So I know that when when the thumbnail went out for tonight, one of the things that was listed was neuropathy. And I actually don't want to talk that much about neuropathy because we did an episode about that. And Pauline, if you can link that in the comments, that would be great. Um we will come back to neuropathy and talk about it a bit, but I wanted to start off because the the topic was the chemotherapy things that people don't talk about, and talk about the most common one that has no specific guidance. NCCN doesn't talk about it, nobody really talks about it, and that's uh dysosmia, and I'm not going to try and pronounce the other one, the changes in smell and taste that come with almost all forms of chemotherapy, but especially with platinum class drugs, somewhat with taxanes, but especially with platinum class drugs, it is almost always happening that people will have changes in smell and taste. And it can make it very hard to eat, it can make it very hard to be inspired by food, it can make it very hard to take in the calories that your body needs in order to maintain itself and have a good response. What do I mean by almost everybody? I mean 93% of people on chemotherapy that includes a platinum class drug have changes to their smell and taste. So what can you do about that? There aren't that many direct interventions the way that people normally think about them. The only things that have seemed to make a significant difference in actually preventing this change of smell and taste are zinc lozenges in your mouth as you're getting the infusions, or ice chips, which basically is an extension of the same kind of icing and compression that you would have for your hands and feet for neuropathy. Now, that being said, there are ways to deal with it more effectively. When you think about taste and smell changes, there are several things. Much of that has to do with metallic taste or bitter taste. And anything that you can do to shift the taste palette away from those flavors is actually really useful. A lot of people try putting more salt on because their sense of taste is deadened, but salt often contains trace minerals, especially, especially if you're using uh a pink salt, a Himalayan salt, mined salt, that kind of thing. Those are pink because of iron and arsenic content. And you can taste that iron and arsenic, and that flavor will be amplified under those situations. So try to not increase the seasoning with salt, but increase the seasoning with acid marinades, whether it's citrus, whether it's vinegar, something like that. The acid marinades actually cut that flavor profile and change it and make the food more appealing in a way that salt won't and actually usually backfires. Similarly, thinking about metallic tastes, and again, I know it's a bit um controversial. Many people don't like to use plastic, but under those circumstances when normal taste sensation, sweet, savory, is deadened, and metallic taste is hyperactivated, again, you want to stay away from metal as much as you can. Use plastic wear rather than metals, metal silverware. Use glass prep bowls or ceramic bowls rather than mixing in a metal bowl. It sounds very silly because it's a trace amount, but you can often taste the difference, and it will make a difference in the way that you eat and your willingness to eat. The other piece about this, and and this goes back decades, is if you are having difficulty eating, if you're having difficulty feeling inspired by food, it is classic, it is normal, it is a very human thing to go to your favorite comfort food. But be thoughtful about that and try and rotate foods, even if it means occasionally having something that you normally wouldn't like that much, because it is a short-term benefit to have something that you automatically think of as good, but it's a long-term detriment because if you keep eating something that you have great experiences with, and then you keep having poor experiences with them, eventually you condition your brain, you condition your body to not like your favorite foods, and then you're in a real situation because then you're always eating things that you don't like very much. You've conditioned your brain to not want the food that you have always enjoyed, it backfires on you really quite quickly. Um, so so there's all of that. I would say that despite the fact that there hasn't been a lot of research, the research that has been done into changes in smell and taste during chemotherapy really mirror the issues with neuropathy. So it looks like most of the same factors are at play. So, similar to treating neuropathy, and here's the tie-in for neuropathy, anything that you can do to prevent is better than what you can do to treat. If you are on a platinum class drug, you can increase magnesium in your diet and reduce calcium near infusions. If you are on platinum, sorry, if you're on taxane-based drugs, you can increase vitamin E up to 300 milligrams per day. And for either one, you can add glutamine. All of those things help with neuropathy. And since neuropathy seems to be the same set of mechanisms as dysosmia, you can preserve your taste and smell by using those same techniques. I'm going to pause here for a moment because I just launched into that. I do have a few more things to cover. I'm curious for those of you who have been in chemotherapy, what tricks have worked for you to make food more appetizing, to preserve a sense of taste and smell? What has been effective for you? Please share that with us in the comments. Share that with the community. And also, if you're willing, I'd I'd be happy to take that and research it further and build episodes in the future based on that. Um, so the next most common thing, well, hopefully you're putting together some of those. Uh, yes, Tanya, zinc lozenges can be used. I wouldn't say necessarily instead of ice chips, they can be used with ice chips. You can alternate back and forth. Zinc does appear to be helpful in the moment, not just as a preventative. Um, the second most common thing that shows up, and this goes back to the first thing that first comment that was put in the chat before we even started, chemo brain. Difficulty with cognitive load. So this is difficulty with finding words, this is difficulty with multitasking, this is difficulty with concentrating. This is incredibly, incredibly common. Again, it happens across your platin class drugs, it happens across the TCAN class. So this is not just full Fox, it's also full Ferinox. It also happens with taxane-based drugs. So essentially any regular chemotherapy, and many of the targeted therapies as well, there is this difficulty in concentrating. So, again, there's electrolyte disturbances. That is a key piece. Again, you want to increase magnesium, increase sodium, increase potassium. While calcium is important, you don't want to have very large amounts because calcium can go either way. Sometimes it can be problematic. You don't want to have none, but you also don't want to have high amounts. The big thing for chemobrain, really, and and I know that people don't like to hear this, the big thing the most associated with help here is exercise. And there are different kinds of exercise. For some things, high intensity exercise matters, for others, it doesn't. So for chemobrain, it's really anything aerobic. It does not have to be intense. This is very different from, say, blood counts. If you want to elevate platelet counts or red cell counts or white cell counts, that's high intensity exercise. We'll come back to that later. For chemobrain, really a gentle walk is the thing. You're looking for gentle aerobic activity. Go for a walk, go outside, take a nap afterwards. Hopefully, you'll feel better when you wake up. That is, again, the best prevention that you can have in terms of chemobrain. The electrolytes help, but not as much. There's also usually a connection to underlying mood and sleep disturbances. Anything you can do to change your stress level, to mitigate your stress level, and anything that you can do to increase your sleep quality, which is the next thing I want to talk about, are really, really good for assisting with chemo brain. There's there's the acute piece that happens because of the drugs, it happens immediately. But getting all of these other pieces in play, getting some exercise in, getting good sleep quality, taking care of stress, keep it from becoming a chronic thing and have it go away much faster. The other piece about this is evening out your blood sugar and evening out your digestive function, because your body is very, very heavily resource strapped during chemotherapy of any kind. There is always damage to your normal healthy cells. Your body is always turning those over, fixing them, replacing them. That is a very, very high load and it has to determine where to put different energy allocations. Does it send it to your brain? Does it send it to regenerating your body? Does it send it to digestion? And so very small meals frequently tend to help quite a lot with chemo brain. And again, please, if you've had success with particular approaches with chemo brain, staving that off or reversing it, please put those in the comments. I do want to talk about sleep quality, chemo joints, which is a real thing. It's not just you're getting old or quit whining. Chemo joints are definitely a thing. And also the platelet crash, I will come back to those, but let me go back and take some of these questions. Um it's a bit off topic, but there is a question about the K2 MK4 protocol, uh, talking about it in more detail. So uh one week on and then the rest of the month off, how often can it be done? That type of thing. So yeah, I do have to say, and I apologize to all of you, the K2 video, which has recently picked up yet again, is one of the few that I kind of kick myself about uh on an ongoing basis, because the the setup that I gave in that episode, it's still true, it's still good, it's still right. It is the minimum, it is the least you can do and have an effective intervention. So for high dose vitamin K, if you're going to use that as a therapeutic, it seems to work on most cancers. The outliers are not on brain cancers, doesn't do anything for glioblastomas, doesn't seem to do anything for gallbladder cancer, calangiocarcinomas, and it seems to require double the dose for breast cancers. That being said, all the rest seem to be responsive, at least at some level. The dose there is over 110 milligrams per day, milligrams, not micrograms. So this is massive, massive dosing, and there's really only one supplement we found that works with that, uh, which is why we recommend that one. It's the only one that doesn't require you to take hundreds of capsules a day. So that's again 110 milligrams a day or more. That works out to three capsules of the life extension mega K. The minimum is three days. Uh, my wife and I, Pauline and I, do three days, three to five days once every couple of months as a prevention, but for treatment, you probably want more. So, again, minimum of 110 milligrams, at least three days. You can go up to 14 before you start running a risk of causing significant mitochondrial damage. So go up to two weeks, up to the 14 days, and then take a 14-day break. That is the opposite end, what I didn't put in the episode. That is the most aggressive version. If you are treating active cancer, you probably want the most aggressive version again, because honestly, at that level, people still don't report any side effects and it's dirt cheap. So maximum 14 days on, 14 days off. You can do that as many times as you want. You can do it on an ongoing basis, but apparently most of the benefit happens in the first three cycles or so. After that, it does make sense to throttle back a bit. And if you want more detail, we can talk about your particular circumstances. Again, that dose has to be doubled from 110 milligrams a day to 240, 250, something like that for breast cancer. Um and Cam's dad had covered some of that. Uh, hit the like button. Thank you. I'm not supposed to mumble. That was mumbling. I apologize. Tanya already covered your question. Please let me know if that wasn't um effective. Andy, yes, magnesium works well. Also, do FMD for three days fasting mimicking diet for three days surrounding chemo. So, so fasting or fasting mimicking diets are great for reducing side effects. The trade-off is that they also slightly slow down tumor growth. And most chemotherapies, not targeted therapies, but most chemotherapies, platinum class drugs, uh, taxanes, things like that, uh, arinate can, 5FU, those things that actually damage the cancer cells, they work during the point where the cells are dividing. And so fasting mimicking diets and fasting do reduce your side effects, but they also slightly reduce the efficacy of the chemotherapy. And so it's a bit of a trade-off. I do want you to think about that. And and that's not necessarily a bad thing. I'm I'm not saying that to get you to stop doing fasting or a fasting mimicking diet, because most people have dose reductions or stop chemotherapy early because of side effects. And so there's there's always a bit of a tight rope to walk there between being as aggressive as you can early on versus managing your side effects as tightly as possible. Because often managing your side effects and continuing all the way through treatment without dose reduction gets you farther than being very aggressive up front and then having to do massive dose reductions or stop halfway through. So it just a matter of knowing where you're at and knowing how severe your side effects are. If you are having a very, very easy time with side effects and chemotherapy treatment, you might not want to be doing a fasting mimicking diet and push more toward the efficacy. But if you're having any difficulty whatsoever with side effects, definitely do the fasting mimicking diet or fasting at the infusion time. Off-cycle the rest of the time, it's definitely good for preventing that growth. Um Misty, this live is being recorded and posted. You can come back to it. You will see anything that you've missed. The only thing is it's a different set of comments. So if you come back to it later, you can't, at least I believe. I haven't been able to comment in this thread, but you can comment in the new one. Umy, how much magnesium should we take? So that depends on a number of things. Um, magnesium is one of those, one of the minerals where the form matters quite a lot. Some minerals do, some minerals don't. Uh, in terms of zinc, you can take the cheapest zinc oxide. It's just as good, it's just as easy for your body to deal with as the most expensive fancy chelates. That is not true of magnesium, they behave differently. If you take large amounts of magnesium oxide or magnesium citrate, you are likely to cause significant diarrhea and GI distress. If you take large amounts of magnesium glycinate or bisglycinate or torate, those tend to get absorbed intact and get into the bloodstream and get across the blood-brain barrier. Those are better for sleep, those are better for internalization, um, different levels. So, in terms of sleep quality, which I will get to later, usually magnesium glycinate is best. And for general absorption, magnesium glycinate is best, somewhere between 200 and 400 milligrams. But again, you have to tighter up and find out where your GI tolerance for that is. But again, magnesium glycinate is one of the better absorbed, it's really good for sleep, and it doesn't tend to cause nearly as much diarrhea as magnesium citrate, excuse me. Um that being said, if you find that after a bout of diarrhea a couple of days later, you're finding yourself significantly constipated, then magnesium citrate peroxide is a great way to go. It's a very gentle laxative, and you get some benefit from whatever magnesium gets absorbed. And yes, Chris, we are recording and we will post. So, the comment about the aspirin study and aspirin not being effective against metastasis, I would take a very careful look at how that differed from all of the other aspirin studies. So, the big thing with aspirin, the the way that aspirin works for reducing metastases and increasing immune function, particularly cytotoxic T cell function, but also natural killer cells against tumor cells, it blocks thromboxane A2 from platelets. And it does that best in folks who are younger, and it does that to most effect in folks who are younger because they have higher killer T cell and natural killer cell counts. It's just a fact of life that as we age past a certain threshold, T cell function begins to decrease. And so anything that you're doing that works on T cells, because they're decreasing, your benefit decreases as well. What you'll find when you look at the aspiry study is it was started later in life than the earlier studies that showed a consistent benefit. So low dose aspirin shows a very consistent benefit against metastases and for immune function against cancer from 30s up through 60s, early 70s. Once you hit about the mid-70s, 73, 75, 78, it begins to taper off very precipitously. And once you're in your 80s, it provides much less benefit, much, much less benefit. So what you'll find is the Asprey study tended to be later in life rather than earlier in life, and that really explains the discrepancy between those two data sets. They are very, very different, and that's the basis for it. I hope that answers your question. Um so we do have a question about the best immunotherapy for PDL1 negative but TMB high breast cancer. That because of some idiosyncrasies with breast cancer is probably something that we should have a chat about. There are a few things that you can use to dramatically increase the efficacy of immunotherapy, and they are especially accessible within most breast cancers. So rather than go into a large complicated web that often doesn't apply, please contact me for a free consult and let's talk about that. There's there's definitely possibilities there. Um your PD1 blockers, not the PDL1 focused antibodies, um, but the PD1 blockers do tend to be more useful in that circumstance, but best when paired with certain other drugs. So let's let's discuss that. Um let me deal with John and Tanya, and then I want to switch back to the topic, the stated topic of this. So, John, when my wife had chemo and her taste changed, and some smells from food would bother her. Firstly, she would eat some foods that she would normally not. Yep. That is very, very wise. I'm glad that she did that. That food rotation really does help. And Tanya asked my oncologist about fasting. She said some of her patients have had worse side effects with fasting during chemo. So it was up to me if I wanted to try it. So it depends it depends a bit, so if you have good bodily stores of many of the amino acids, particularly glutamine, fasting should reduce the side effects. It should significantly reduce the side effects. And again, when we're talking about fasting around chemotherapy infusions, it's really the glucose that we're looking for. You can essentially have a carnivore diet have as much protein and fat as you want. It's it's the glucose that really matters, and having an extremely low blood glucose, that's what helps. If if you are losing weight, if your body is resource strapped, if it's resource deprived, and you fast, then it makes it harder for your body to recover. And it may be easier on the day of, but the days following, you will you will face a higher toll. So for folks like that, if if you have been losing weight through treatment, I would be cautious about truly fasting. This again is uh and sort of similar to the comments that I made earlier about neuropathy and using glutamine. Glutamine can be very, very, very useful for offsetting the side effects of chemotherapy, particularly the platinum class drugs and eriniticin. So if you've been losing weight, if you're resource-strapped in your body, please don't totally fast. Go on a fasting mimicking diet or fast with coffee and glutamine, because that glutamine definitely helps your body repair and replace the cells that have been damaged by the chemotherapy, and it dramatically reduces both the duration of the chemotherapy side effects and the intensity at the same time. It's a really, really good way to go. Sarah, I promise you I will come back to you. Um earlier on when I was talking about chemobrain, I also mentioned sleep quality. And for those of you, those of you who've talked with me uh one-on-one, this will probably be redundant. I apologize. I do want to get the message out there. When people talk about sleep quality, you hear about the same things all the time. Um, light hygiene, don't scroll on your phone and expose yourself to blue light late at night. Uh, try and stick to a regular schedule and take melatonin and magnesium to get to sleep. So all of that is great. All of that's fine. Uh, but it's also incomplete. So melatonin has a very short half-life in the body, very short half-life. And magnesium gets redistributed pretty quickly as well. So taking melatonin and taking magnesium are great for getting to sleep. But what most people don't do is they don't separate the two issues. They can be related, but they are distinct issues. The two issues of getting to sleep versus staying asleep. And melatonin and magnesium are great for getting to sleep, but they don't have the durability to help you stay asleep. So, one thing I do want to let people know about, especially since I talked earlier with chemo brain, about dealing with sleep and maximizing sleep quality. Apigenin, which I already talked about for offsetting platinum class drug issues. Um, apigenin is also really good for helping you stay asleep. 200 milligrams right around bedtime, helps with chemotherapy side effects from platin class drugs, actually makes the platinum class drugs work better. There's a good synergy there, and I don't use that word lightly. And it helps you get to sleep and stay asleep. Similarly, the non-standard amino acid theanine, T-H-E-A-N-I-N-E, theanine, it lasts about four hours. It does not make you go to sleep, it will not make you drowsy. You can take it during the day as an anti-anxiety treatment. Lasts about four hours, 200 milligrams. You can take that, it will help you stay asleep. It quiets a racing brain, it quiets the body's hypersensitivity, it'll help you stay asleep. But again, it only lasts four hours. If you wake up in the middle of the night, you can have it by your bedside, you can take another 200 milligrams, wait 15 minutes for it to kick in and go back to sleep again. Theanine has been a game changer for a lot of people, and it has no drug interactions with any of the chemotherapy agents, any of the pre-meds, any of the follow-ons, which brings me to steroids. Steroids are often the primary cause of sleep disturbance with chemotherapy. A lot of people get steroids in their pre-meds, they get them in their infusions, they get them in pills that they take home, and they don't even really think about it. The timing and the dose of your steroids can completely derail your sleep schedule, can make it very hard to sleep and totally trash your sleep schedule. If you have to take steroids for managing side effects, try and move them earlier. Even if your infusion is later, try and get pre-meds, try and take your steroids as early as possible in the day so that they start wearing down in the evening and they don't keep you awake all night. Or if you can get dose reductions for the steroids, again, many of the other pre-meds, the antiametics, etc., they work for many people well enough. No one wants you to suffer. If you need the steroids for the side effects, please use them. And if you don't need them, reduce them or eliminate them and let the other meds do their work because they don't interfere with sleep or immunity nearly as much as steroids do. Steroids carry a pretty heavy burden. They're it's almost like an addiction scenario. They're very good in the short term and they can be very problematic in the long term. So pick and choose carefully. All right. Um, so with that, come back. And Sarah, I know you said the vitamin K doesn't work for glioblastomas, but what about cancers that have spread elsewhere, like melanoma? So, so yes, Sarah, um, that does seem to be particular to glioblastomas. It's not a matter of vitamin K crossing the blood-brain barrier. Um all the different forms of vitamin K, whether it's MK4, MK7, and I should come back to that because everyone asks about that. Um, those cross the blood-brain barrier. So if there are breast cancer mets to the brain, if there are melanoma mets to the brain, the vitamin K option is still on the table. It's specifically cancers that started in the brain, started from neurons, glioblastomas, pineoblastomas, astrocytomas, that kind of thing. Those are the issue. Um, so everyone asks, yes, MK7, the other form of vitamin K2 will work. You need more proportionally because it's a bigger molecule, and I haven't been able to find a good source of MK7 that's potent enough to not have to take an absolute ton of it, which is why I keep talking about MK4. You can use MK7, I just don't know how to functionally do it. Uh, the other piece that people talk about is safety, and everyone keeps saying, oh, you shouldn't recommend this because it'll cause blood clotting. That is not the way that vitamin K works. Your blood clotting system does not work if you don't have vitamin K. But once you get up to a certain level, it doesn't do anything. Vitamin K does not cause blood clotting. Safety studies have gone up to doses of 380 grams, not micrograms, not milligrams, 380 grams per day for 90 days with no impact on blood clotting, no side effects whatsoever. And the studies actually very clearly said we could not determine a no-adverse effect limit, a uh a level below which there was no side effect because they couldn't find a side effect, they couldn't give a dose high enough to generate a side effect. So vitamin K seems to be one of those very rare things that is actually fairly potent and doesn't cause issues. Um, I hope that answers the question. Um, Michael, hello, I'm stage four colon, colorectal cancer, I assume. Liver enzymes were off the charts. I'm on capesidabines 1650 daily with two infusions per month. Um, you might want to look at time shifting the cape cytobine dose and having more of it in the morning than in the evening. We talked about that um in time shifting medications. Uh, that was a recent episode. Hopefully, Pauline can put that in the comments here. The other thing is, and I know I'm going out a bit on a limb here, definitely track liver enzymes. I'm not saying to ignore them, and also please don't be terribly stressed about liver enzymes. Liver enzymes can go up and down for many different reasons. What I would urge you to take a very close look at is bilirubin. Bilirubin is your overall liver function. The liver enzymes tell you how irritated your liver is. Your liver can be very irritated for a short period of time, recover just fine, and have no problems. But if your bilirubin level goes up, that is a sign that there is a serious problem that has to be addressed now. So they are very different indicators. One of the big things that people take in order to help a stressed liver is milk thistle extract or silomarin. Levels around 500 milligrams a day tend to be useful. Again, many of the things that stress liver, the liver out, can be mitigated by supplementing your diet with glutamine 10 to 30 grams a day. But again, contact us, let's go through the particulars. It may be that there are other things that you can do, and your supplements may be maybe interfering there too. I don't know if you have started anything recently or increased it recently. There is a very small fraction of people, about one out of 400 or so, that when they take high doses of either uh curcumin or resveratrol can trigger a liver autoimmune-like syndrome. Uh, we'll be doing an episode about that in the near future, but please be careful about that. Um, John, adding spices and sauces to meals also helps with taste change. Cook the food with my wife would stay in a different room, then she can. Yep. I again anything you can do to change the flavor profile, intensify the flavor profile, as long as you're avoiding metallic utensils, metallic bowls, and trying to avoid potential metallic tastes with mineral salts. Again, the mineral salts do have a real tendency to backfire pretty spectacularly on people. But that's a great point. Thank you. Um, Misty uh Andy's comment, FMD. I I was assuming the context that I've always seen FMD in this environment is fasting mimicking diet, especially around chemo infusions. That's where it's often used. Um chemo brain definitely exercise. Uh, so this is John uh chemo brain definitely exercise. Also sleeping longer hours, taking adrenal support supplements, um, some games that put the brain to work. So light, fun cognitive load experiments, puzzles, uh, crosswords, that kind of thing, definitely. As long as it's not stressful, you don't want to spike your stress hormones because that will make things worse rather than better. But definitely, and and sleeping longer hours, and it's it's a bit counterintuitive, counterintuitive. It's not just the hours, it's also when the hours occur. Um, believe it or not, you actually do get more value out of sleeping in later rather than going to sleep earlier. If you have if you're going to expand your hours of sleeping, if you're going to add an hour to either end, you will get more value out of sleeping in one hour later than going to bed one hour earlier. Um, it's better to do both, but if you have to choose, sleep in later. It actually has been proven to add more rest. All right. Um fasting, mimicking diet, limiting calories. Yep. Day before and day after, no nausea or GI issues. Um Big Sky. My mom is 50 days in with diagnosis, stage four metastatic pancreatic cancer to the liver, lymph, abdominal wall lesions. Yeah, gastric tube due to blockage, have appointment. All right. I'm looking forward to talking with you. I'm glad that we're talking soon. I know that my calendar is booked way out. Um, pancreatic cancer is definitely something to address quickly. We want to move as fast as possible. Uh, Tanya, thank you. Great fasting explanation. I've not lost anything, gained 20 pounds, but fasting with steroids is impossible. So fasting hasn't been possible. Again, so so let me let me take a step back because I don't want to broadly demonize steroids. There are places where steroids can be very, very useful. Again, if you absolutely have to have them for managing side effects, please use them. The other piece where they are really, really useful is if you're on immunotherapies, particularly immune checkpoint inhibitors, and you start to get immune-related adverse events, that's the standard way to calm everything down. That's a good place for them because they shut down immunity. The other part that goes with that, and it falls into the same bucket, is steroids make great, great sense for leukemias and lymphomas. They work well. But for most tumors, for most solid tumors, the more you can avoid steroids, the better off you will be. Again, I don't want anyone to suffer. I'm not saying don't use them if you need them. However, if you don't need them, they're much more downside than benefit. Please try and minimize that. And again, your oncologist almost never will be willing to just take steroids out. But you can go to them and ask for a dose reduction. Can I take less? I didn't have a bad time this time. Can we reduce my steroids? And they go from 10 milligrams of dexamethasone down to six. And then if you have no bad side effects from that, you come back the next time and they drop it down to four or three. And if you have no issues after that, then they'll take it out. But you have to do it in a stepwise fashion. Just do the dose reductions and see what you actually need and what you don't need. Uh, Sarah, apigenin has definitely helped my sleep. Awesome. Glad to hear that. Apigenin, it's one of the things that I come back to. And you've you've heard it multiple times tonight. It's great for sleep, it's great for uh de stressing, so dealing with the stress hormones. It does reduce cortisol somewhat, not as well as some other things, but something multifunctional like this, where you take it for one thing and you get multiple benefits, it's great. It makes platinum class drugs, aren'titacin and 5FU and capesitabine all work better, you get better efficacy. It reduces the side effects from all of them. It's a winning compound. There are times when you cannot use apigenin. Um, if you are taking heavy duty anti-clotting medication, or if you're about to go into surgery, apigenin may not be right for you. But for most people, under most circumstances, it's nothing but benefit. And it's very cheap, very easy to access. It's a great thing. Um, Misty husband was given is given steroids with treatment. Should we ask doctor to not give them to him at all? I think I just addressed that well enough. If not, please let me know in the comments and and I'm happy to go into it more. But again, in general, I would try and redu dose reductions and reduce the amount of steroids to the lowest level that you can get away with. All right. Um subscriber here from Adelaide, South Australia. I have stage four metastatic breast cancer. We should definitely talk. Um breast cancer is one of those places where the evidence and the drug options have been evolving so much faster than public knowledge or oncologist follow through. We have multiple new drugs. We have a brand new drug that Just came out. We have multiple drugs in the pipeline. We've got great information about dose reductions on many of the drugs that are currently used. Turns out that for several of them, you can be taking one half to one third of the regular dose and have just as much efficacy, but reduce side effects. There's plenty to talk about there. So I hope I hope that we have a call set up soon. So it Melly for real, if if there is still skin surface expression, or if there is any breast cancer that is close enough within a quarter inch of the skin surface, if you haven't seen it yet, uh Pauline, if you could put in a link to the i I was about to say ivermectin. Not ivermectin. Imiquomod, the Aldera cream. There is a cream that is an immune stimulant. Um, it's not a replacement for immune checkpoint inhibitors or anything like that. But if you have skin access, um, or if you have tumor that is less than a quarter inch deep, if you can get Imiquomod cream, IMIQIMOD, IMICOMOD 5%, and place it on that spot, it will convince your immune system that there is a massive viral infection. It will cause inflammation, it will be uncomfortable and itch. But if you can activate an immune response against the tumor through that pathway, you can very often get your immune system to attack other tumors and other locations and bias your treatment, add that to your treatment and bias it toward making immune memory and clearing the cancer from your system. It's a really great way to go. Um, blue angel, husband, stage four prostate cancer in spine, lungs. Um, bone mets are particularly difficult. It's hard to get drugs into bone niches because of reduced circulation and also into the liver because the liver is sort of like a drain. It's hard to get drugs in there because they're always being processed and eliminated. Um, first oncology appointment next week. Doesn't want chemo. Um again, hopefully you're on our schedule. I know it's getting booked out far. We should talk about how prostate cancer is evolving and some of the options there. Um, if you're in the States, I would try and do everything you can to engineer access to Pluvicto. Pluvicto scares a lot of people, but it's actually an incredibly good option and a lot better than androgen deprivation if if we can arrange that. So hopefully you're on the schedule. Um, so next question: any research and or experience with Optune? So the Optune devices, that's an electromagnetic field device, uh, very often used for brain cancers, glioblastomas. You put it on your head, it creates a mild alternating electric field. It is true that it does help somewhat with reducing cancer progression. It is more useful in increasing accessibility both across the blood-brain barrier and into cells of chemotherapy agents. Um, even the ones that are blood-brain barrier penetrant, like T Mazolamide, they cross the blood-brain barrier. The optune device still gets more into the cancerous cells. Um, so optune devices do help. They are definitely a benefit. The benefit is fairly modest. It's not a therapy by itself, it's an add-on that makes your other therapies work better. That's really the best way to think about that. And there's a lot of nuance there. Different types of chemotherapy are impacted by optune devices differently. So, so we should talk about your particular scenario. And again, it depends a bit on where your cancer is. If it is deep buried in the brain stem, that's a very different thing than right underneath the skull. So, so we should talk about the details there. Um which video goes into the into the steroids more? Uh, was it the chemotherapy myths or the first video? Actually, the the one that goes into the steroids the most is the uh general episode on immunotherapy because there's a whole section at the back about steroids. Um treatment for pancreatic cancer before moving to radiation. Um so that that's good. Um I haven't really heard of optum being used for pancreatic almost all of the I'd say over 90% of the circumstances that I've heard of Optum being used for were um brain cancer. So that's good to know about. Um if you're going to be going into radiation, we should talk about Artemisanin, which helps quite a bit, and also with iron loading, which I also discuss in a general format in the Artemisen episode. So, Pauline, if you could put in the Artemisen episode for Wolf 454, that would be really useful. Definitely take a look at those and hopefully we can connect and get you some more details. Uh, real letter 2020, father has stage four mets to right lung, uh, clear cell renal carcinoma, gone through three different treatments, including immunotherapy, grade three pneumonitis, doctors looking okay. Um I'm assuming that the immunotherapy was an immune checkpoint inhibitor and it wasn't interleukin two. If you haven't done interleukin two, it is still a potential there. Um we we should talk. We should talk. Depending on the genetics of his cancer, there are potentially many things that can be done. I am hoping that you have a good genome profile, but um again, we should talk. I I apologize everyone for continually saying we should talk. And frankly, again, all cancers are different. The different therapies that people take bias them down the line, they make them evolve in particular tracks. Every cancer is evolving all the time. There is a lot of nuance here. There are things that I can say generally, but once we start diving into particular specifics, it's we really do need to talk one-to-one and get all the details straight. I don't want to steer anyone in a bad direction. Um yeah, dexamethasone is not great. Umdera cream skin access, direct detour. Um I will ask my husband's oncologist if she can lower dexamethasone when he has full fury. I again, uh Satya, in terms of minimizing side effects, most of the folks that I work with have gotten more relief from side effects with glutamine in general, and also with um I'm having the brain brain freeze with apigenin. Apigenin helps with both arinatic can and the 5FU and Oxaloplatin. So full fox, full fury, apigenin is very much your friend, as is the glutamine. Reducing dexamethasone is probably going to be pretty easy if you add those other things in. Um no longer on an ADC and using taxol. Is apigenin appropriate now? So, Jeff, that is a great question. Um, the apigenin was more useful based on the payload on that antibody drug conjugate that you were using. Now that you're on taxol, I would take the apigenin out. I would focus on high dose vitamin E and glutamine to mitigate the side effects. Uh, apigenin isn't really going to help with that. And um, I hope that we check in soon. I do want to follow up with you. I've been thinking about you a lot. Um, Misty, is there a cancer or cancer treatment that you should not take turmeric with? So um, and after this, I'm going to try and pivot to to the chemo joints real quick because I do want to get into that in the last few minutes. Um, so Misty, it's the cancer treatment primarily. Um turmeric extract or or curcumin is very good at shutting down immune function. It's very good at shutting down inflammation. Those two go hand in hand. Your immune system cannot work without inflammation. So if it is a cancer type that's a leukemia or lymphoma, curcumin turmeric extracts are going to be great. They're also going to be great at slowing tumor growth for many different kinds of cancers, not all of them, but about roughly 50%. The thing that you want to watch out for is because curcumin turmeric extract does shut down inflammation and it shuts down T cell function rather specifically, it will stop your immune system from being able to attack the cancer. If you are on any kind of an immune checkpoint inhibitor, a ketruda, an opdivo, anything like that, and you take curcumin, resveratrol, or black seed oil at the same time, you are suppressing immune function. It they your immune cells just cannot work if you're taking therapeutic doses of curcumin. And it takes a lot of curcumin, but curcumin shuts down the signaling hub that immune cells use to respond. So you cannot get the benefit from an immune checkpoint inhibitor like Cutruda or Opdevo, and the benefit from curcumin at the same time. You've got to pick one or the other. Um, hopefully, I'll have time to get back. I did want to get back to chemo joints. And Jeff, this this goes to you. This is specifically around taxanes. Taxol, paclitaxol, dosa taxol, abraxane, the whole bit. If you're using a taxane-based chemotherapy, it targets the joints. And a lot of oncologists will just write that off to uh being cranky or feeling bad or being old, but it is a real thing. It's got a name. So taxane-associated arthralgia mygia syndrome, TAMS, T-A-M-S, usually kicks in 24 to 48 hours after infusion, not during the infusion. It's not like the platinum class drugs can cause neuropathy right during the infusion. This is a day to two days after infusion. Joints specifically have problems, and it's a little different. So again, often written off as aging or crankiness. This happens to a lot of people on taxanes, about 87% of them. NSAIDs, aspirin, tylenol, that kind of thing, uh, Aleve, Advil, they don't really help that much. If they do, it tends to be very little. Gabapentin actually has good data behind it. It does tend to work on taxane-cause joint pain. The kicker with that is you have to start it before. You have to start the Gabapentin 24 to 48 hours before the infusion and keep it up through the infusion and afterwards. You can't go into it infusion day and then say, oh, I'm gonna take my first dose. You have to have the medication on board at maximum concentration by the time you go in to get the infusion. So that being said, um the the chemo joints issue is worse with co-administration of granulocyte colony stimulating factor, peg philosoph. So if you're going to have those shots to increase your white blood cell count, try to not get them on the same day. If you can split them up, if you can have them the next day, if you can have them before, if you can have them mid-cycle, it's just a shot. It's not an infusion. If you can separate, if you can separate Peg philosoph from taxanes, it reduces your chances of having these joint issues, even though not that much. And the other thing to comment about is that the treatment for the joint pain is different than neuropathy. Taxane-cause neuropathy, tingling in the hands and feet, often responds very well to cold, but the joint issues do not respond well to cold. They become worse with the cold. The joint issues require heat, it's the exact opposite. So, this is one of those details that actually matters. Um, all right, and we've got just a couple of minutes. Um where are we at? Glutamine, how long should one apply aldera? What's a good indicator that treatment can be stopped? Um and sulforophane. So, Chanel, in in terms of aldera, the the big thing about aldera is not how long you continue, but it's how frequently you apply it. And that has to be tightered to your expectations and your tolerance. So, aldera cream can be very, very, very irritating to the skin. It depends quite a bit on your particular immune function, how your body is regulating immune function. If you place aldera cream on your skin, some people have very little reaction. Some people immediately have very intense itching, rashes, uh, maybe even skin erosion, similar to putting on compound W for a wart. It runs a big spectrum. Some people, believe it or not, actually use a Miquimod cream on genital warts and find that tolerable, a bit itchy. Some people will put it on a spot on their back, which is not very intensely innervated, doesn't feel a lot of pain, and they can have uh out of control issues. So again, you have to tighter it to your own expectations. I would start with a very small amount, the size of a dime or smaller, preferably applied with a glove or a Q-tip. Don't get it on your skin, on your hands. Apply that, wait a week, see how it goes, see what your tolerance is. Some people can apply it every day. Some people can only apply it once per week, or else it becomes problematic. Do what works for you. I would continue to use it until either things have obviously progressed. Um, you you do not want, say, melanoma or basal cell to go deep. So if it looks like things are progressing, definitely switch applications, go and get uh surgery or freeze it out, or until everything is resolved. Now, again, if if you have say internal melanoma and you're trying to hit a spot to spark immune reaction and get an abscopal effect where you're stimulating here, but your immune system will attack something somewhere else, then again, keep applying until that spot is gone and then look for other spots, actinic keratosis, basal cell, etc. Um, and we're at eight. Shoot. Um gabapentin doses tend to be pretty high. I will have to get back to you about that. They they go anywhere from half a gram to a gram per day. Um, but let me double check that. In terms of sulforophane, sulforophane is one of those things that works great in cell culture studies and has very, very, very poor bioavailability. Unless it's in a liposomal form or you're injecting it, sulforophane probably isn't doing anything for you. Um, quercetin, similarly terrible bioavailability. It goes in one end, out the other, doesn't do much of anything for you. There are a large number of supplements like that. It's not that they are harmful, it's just that they're wasteful. Um, unless unless you engineer uptake. And there are ways to do that, but again, whether that's really worth the trouble, um, in many cases it's not. Um blue angel, let's talk. It send a quick email and and we'll communicate more that way. Everyone, it's past eight o'clock. I really do want to thank you for coming. I hope that this has been useful. Um, again, next week, immunotherapy, the the delayed episode, and then the week after, August 3rd, cancer recurrence, metastasis, how to prevent that, how to measure it, how to stay on top of it. Um, all right. Thank you everyone. Really enjoy being here. Really appreciate your support and all of your great questions. And again, if you want particular topics, let me know. We're gonna just keep doing this and providing whatever we can. Thank you.