Oncology update: Case studies in alternative

treatments of advanced stage cancersDr. Ralf Kleef, MD

Dr. Virender Sodhi, MD (Ayurved) ND

IntroductionsDr. Ralf Kleef, MD• Board certified in general

medicine, oncology, and naturopathic medicine in 1994

• Post doctoral researcher at Memorial Sloan-Kettering Cancer Center

• Headed commission of experts to fever therapy of cancer at NIH

• Began medical practice and research in Vienne, Austria in 1998

• Serves as a sworn court certified Expert for Hyperthemia and Complementary Medicine in Autstria

Dr. Virender Sodhi, MD (Ayurved) ND• Board certified MD (Ayurved) in

1980• Ayurvedic Medical professor until

1986• Became first Ayurvedic and

Naturopathic physician in the United stated in 1988

• Envisioned and formed AyushHerbs, Inc to bring Ayurvedic medicines to the West in 1989.

• Practicing at Ayurvedic & Naturopathic Medical Clinic in Bellevue, Washington with a focus in Oncology.

Update on Alternative Oncology• In 2020, we are seeing a boom in

research validating often ignored or overlooked techniques for treating late stage cancers.

• In America, much of this research isn’t being widely disseminated or utilized. – The NIH states: “a number of

challenges must be overcome before hyperthermia can be considered a standard treatment for cancer”

• A 2020 study is finding Homeopahy as an Add-On therapy may prolong survival and improve quality of life.

What does Late-Stage management really mean?

• Cure?• Remission?• What is the Quality of Life?• Are the patient’s goals considered?

– “ I want to see my child get married”– “I want to just be able to lie flat on a bed”– “I want to feel ready should something happen”

What are the options?

• When things are not working, or are not optimal: patients and providers have choices: – Wait and see.– Explore new research:

• Hyperthermia• low dose immunotherapy • metronomic chemotherapy

– Switch “medical lenses” • Homeopathy• Traditional Chinese Medicine• Ayurveda

Ayurveda

The Goal of AyurvedaTo treat disease

To maintain optimal physical, mental, emotional and spiritual health.

To fulfill the primary desires of:

(DHARM) - Religious satisfaction

(ARTH) - Financial stability

(KAMA) - Procreative instinct

(MOKSHA) - A balance physical, mental, emotional and spiritual body

A 5,000 year old science of life

Ayu = Life Ved = Science

Ayurvedic Fundamentals

• The Dosha– Ayurveda’s understanding

of phenotype andgenotype

– 3 Primary: Vata, Pitta, Kapha.• Looks at the whole person, and looking for places of

strengths and places of weakness. • Crucial to understanding one’s self, and thus

maximizing quality of life through harmony.

Vata + Pitta Vata + Kapha Kapha + Pitta

Tridoshic/ Vata-Pitta-Kapha

Ayurveda’s Primary Approaches

Nutrition

Lifestyle

Panchakarma

Herbal Therapies

Nutritional Therapy

• Many people eat improper foods for their body– Ayurveda utilizes the

Dosha understanding to make targeted recommendations.

– Help patients eat right for their body.

• Food choices are not the only thing modified

• Food habits are also changed:– When food is eaten– With whom food are eaten– Amount of food in one sitting

Examples of Dietary Therapies

• Generalized (for all Dosha)

– Eat fruits and vegetables that are seasonally available– Create a plant based diet.– Reduce consumption of meat– Eat meals in a scheduled way– Eliminate unnecessary sugars from the diet

• Spices– Spices and flavorings are adjusted for each Dosha type– They are often medicine herbs in their own right. – They help enhance digestion and elimination to

prevent carcinogenesis within the digestive tract and body.

• Examples– Trikatu- a mix of black pepper, long pepper, and ginger

powders, assists in activating epithelial cells in the intestines, assists in breaking down fats

– Cumin-balances pitta in the gut and increases absorption of nutrients

– Honey- scrapes Kapha from the body and modulates allergens

Dosha Specific Recommendations:• Kapha

– Tends towards sluggish digestion, constipation, bowel blockages.

– Need to be warmed up: warm foods, astringent foods are best.

– Avoid sweets, avoid dairy and red meat as these will putrefy in the digestive tract and could lead to carcinogens.

– Vegetables: leafy greens, bitter melon. Also Legumes and tofu for protein.

• Pitta– Tends towards diarrhea, undigested food in stools,

itchy rectum. – Avoid red meat, acidic foods, and hot spices. – Moderate dairy, eat lean proteins and enjoy juicy

fruits.

• Vata– Tends towards a weaker digestion (gas, bloated easily)– Only eat cooked foods to support digestion– Increase dairy such as yogurt– Moist, heavy, and warming foods are best.

Lifestyle

Overview • Daily routine can change the

health of individuals for the better

• Proper waking and sleeping schedules reduce stress and allows the body to heal

• Yoga brings balance to body in using movement

• Breathing exercises not only ease the mind, but detoxify the body using the breath

• Meditations allows the mind to check in with the body

Applications• Yoga

– Research supports yoga reduces Insomnia, pain, fatigue, anxiety, depression and improves quality of life.

• Meditation– Improves immune function,

increases circulating endorphins. – Improves emotional processing of

cancer diagnosis• Breathing Practices

– Increase immune activity – Improves sleep quality– Improves patient’s perception of

quality of life

Danhauer SC, Addington EL, Sohl SJ, Chaoul A, Cohen L. Review of yoga therapy during cancer treatment. Support Care Cancer. 2017;25(4):1357-1372. doi:10.1007/s00520-016-3556-9.Dhruva, A., Miaskowski, C., Abrams, D., Acree, M., Cooper, B., Goodman, S., & Hecht, F. M. (2012). Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: results of a pilot randomized controlled trial. Journal of alternative and complementary medicine (New York, N.Y.), 18(5), 473–479.Hardoerfer, K., & Jentschke, E. (2018). Effect of Yoga Therapy on Symptoms of Anxiety in Cancer Patients. Oncology research and treatment, 41(9), 526–532.Fouladbakhsh JM, Stommel M. Gender, Symptom Experience, and Use of Complementary and Alternative Medicine Practices Among Cancer Survivors in the U.S. Cancer Population. Oncol Nurs Forum. 2010;37(1):E7-E15. doi:10.1188/10.ONF.E7-E15.

Panchakarma(PK)

• A long-term detoxification process utilizing patient specific diet and multiple purging practices.

• Goal: Remove years of toxins that have accumulated in the body.

• Rational: Moves excess doshas and agitates them so that they can be expelled into the digestive system, sweat glands, and urinary system

• After PK treatments, foods are gradually reintroduced, and what remain of doshicimbalances is re-evaluated

PK Methods

• Vamana– Emesis-removes toxins

from the upper gut• Virechina

– Intestinal cleansing-removes toxins from the lower gut

• Nasya– provides herbs through the

nasal passages, reaching the brain directly

• Basti– Enema- removes toxins

from the colon• Rakta mokshina

– Blood donation if needed- removes toxins from the blood

• Detox is accompanied by body treatments:– Massage, shirodhara,

sweat therapy

Herbal Therapies

• Ayurveda in inextricably linked to herbal therapies to treat disease and promote health.

• Science continues to elucidate the mechanisms by which different herbs heal different conditions.

• Ayurvedic practioners incorporate new plants (“Western” herbs) because they are able to learn in the modern era how to apply them using Ayurvedic philosophy as well.

Ashwagandha

• Withania somnifora has been shown to target and eliminate several cancer cell lines in vitro (see figure)4

• Has been shown to reduce colon cancer cell is mouse studies2

• Prostate cancer cells respond quickly to ashwagandha but cancer markers also improve1

Roy R V., Suman S, Das TP, Luevano JE, Damodaran C. Withaferin a, a steroidal lactone from withania somnifera, induces mitotic catastrophe and growth arrest in prostate cancer cells. J Nat Prod. 2013;76(10):1909-1915. doi:10.1021/np400441f.Muralikrishnan G, Dinda AK, Shakeel F. Immunomodulatory effects of Withania somnifera on azoxymethane induced experimental colon cancer in mice. Immunol Invest. 2010;39(7):688-698. doi:10.3109/08820139.2010.487083.Davis L, Kuttan G. Suppressive effect of cyclophosphamide-induced toxicity by Withania somnifera extract in mice. J Ethnopharmacol. 1998;62(3):209-214. doi:10.1016/S0378-8741(98)00039-7.Yadav B, Bajaj A, Saxena M, Saxena AK. In Vitro Anticancer Activity of the Root, Stem and Leaves of Withania Somnifera against Various Human Cancer Cell Lines. Indian J Pharm Sci. 2010;72(5):659-663. doi:10.4103/0250-474X.78543.

Emblica officianalis

• Shown to downregulate pro-oncogene expression in ovarian cancer cells while upregulating inhibitors of oncogene transcription

1. De A, Powers B, De A, et al. Emblica officinalis extract downregulates pro-angiogenic molecules via upregulation of cellular and exosomal miR-375 in human ovarian cancer

Azadirachta indica

• Regulates macrophage inflammatory characteristics in tumor cores

• Regulates the immune system in the cancer microenvironment as well as systemically

1. Goswami KK, Sarkar M, Ghosh S, et al. Neem leaf glycoprotein regulates function of tumor associated M2 macrophages in hypoxic tumor core: Critical role of IL-10/STAT3 signaling. M l I l 2016 80 1 10 d i 10 1016/j li 2016 10 008

Mistletoe

• Clinical trial showed that mistletoe not only improved quality of life, but also reduced inflammation when compared against common chemotherapy.

• Improved survival and case study improvement .

1. Piao BK, Wang YX, Xie GR, et al. Impact of Complementary Mistletoe Extract Treatment on Quality of Life in Breast, Ovarian and Non-small Cell Lung Cancer Patients. A Prospective Randomized Controlled Clinical Trial. Anticancer Res. 2004;24(1):303-309. doi:10.1097/COC.0b013e318172d5de.

Congratulations!

• You are now all certified Ayurvedic practioners

Any questions before we continue?

How does Ayurveda view cancer?• There are several words used to describe cancer in Ayurveda

• Arbuda= large mass

• Granthi= small mass

• Mamsarbuda= melanoma

• Raktarbuda= leukemia

• Etc.

• Cancer is considered a tridoshic imbalance that causes swelling and may travel the tissues (dhatus)

Ayurvedic diagnosis of cancer

• Today, Ayurvedic doctors utilize modern technology for diagnosis

• However, the results are carefully considered with other factors inherent in the individual – Cancer severity and

progression is confirmed by physical examinations on all body tissues

• It is important to note that ancient doctors could identify and treat cancers– Cancer is not a mystery to

Ayurveda– Modern techniques have

helped to identify cancer tissues more easily, improving treatment outcome

If the body can create cancer, it can destroy it too

• All treatments are based on individual needs.

• Conventional treatments are not dismissed, if needed.

• Ayurveda can also support the body during conventional treatment, improving survival, quality of life during treatment and after remission, and also prevent further growth.

Epigenetics• Modifications to our DNA can

improve our health as much as it can destroy it

• Lifestyle and nutrition can alter the way our genome is expressed

• Knowing our ancestral history can help with cancer treatment

• Changes can be made by diet, lifestyle, and herbal therapy

• The Ayurvedic principles play their role in cancer here!

• Methylation on DNA affects gene regulation and can be altered

CASE STUDIES IN AYURVEDIC ONCOLOGY

METASTATIC COLON CANCERRK, 63YO FEMALE

• RK was previously diagnosed with breast cancer in 1998

• Underwent full mastectomy, chemotherapy, and radiation.

• In 2008, RK had a part of her colon removed for T3 N2 colon cancer

• Followed by nine rounds of chemotherapy

• Despite this, she had persistent metastasized colon cancer on her liver

AYURVEDIC INTEGRATION

• Started with Ayurvedic Science in Sept of 2010 for complementary care

• Andrographis, Tinospora, and Aziadica formulation-1 tab TID

• Trifala-1 cap TID

• Urinary herbal formula- 1 cap TID

• Whole Turmeric Powder- ½ tsp BID

• Ashwagandha- 1 cap TID

• Yoga therapy and breathing exercises

• Constitution-based nutritional modifications

NEXT STEPS

• After 1 month of treatment from us, RK underwent a partial hepatectomy

• By February 2011, RK felt well enough to participate in Panchakarma

• After CT, it was discovered that a nodule was growing larger

• Pt received more IV therapy:• Vitamin C and B-complex: March

2010-4/2011 (7 treatments)

• Vitamin C and B complex: June 2011-December 2011 (15 treatments)

• Reported progressive improvement in fatigue, mood, and QOL.

• During IV therapy, RK continued oral supplement protocol

FOLLOW-UP

• April 2012 RK opted to have a wedge resection of the lung tumor and returned to Ayurvedic treatments very shortly after surgery

• She was then placed on Mistletoe IV therapy• After IV treatments, CT scan and CEA levels were

normal and she reported feeling healthy • After a few months of treatment cessation , RK came

back for a second round of PK for 90 days in early 2013• There was a second round of IV mistletoe in March 2013

(8 treatments)• She is still a patient at the clinic and has not had any signs

of cancer since 2013 (7 year remission)

METASTASIZED PROSTATE CANCER

DJ 72 YO MALE

• DJ became a patient after diagnoses and conventional treatment of prostrate cancer:

• Prostatectomy and chemotherapy

• Our initial lab results showed increasing PSA levels despite prostate removal (PSA level of 102 ng/mL)

• Indicating metastatic cancer

• Patient constitution: Pitta Vata

AYURVEDIC TREATMENT

• We provided an intense individualized protocol with counseling starting in January of 2011

• Ashwagandha: 1 cap, 3x/day

• Kidney/prostate support: 2 caps, 3x/day

• Turmeric powder,: ½ tsp, 2x/day

• Boswellia serrata formula: 2 caps, 3x/day

• Neem formula: 1 cap, 3x/day

• Chevanprash: 1 tsp, 3x/day

• He was counseled regarding a comprehensive dietary therapy; as well as, lifestyle modifications like Yoga and breathing exercises.

CONTINUED AYURVEDIC CARE

• In March 2012, PSA levels were 16ng/ml (significantly lower than 1 year ago)

• We then initiated an IV regimen with oral supplement routine form March to April 2012

• 25 g Vitamin C and 5g 20% MgCl in 500ml water then titrated to 50 g Vitamin C .

• Alpha-lipoic acid was added at 250mg per 40ml water, then titrated to 600mg.

CONSEQUENCES OF CEASING TREATMENT

• DJ took a break from all treatments April to August 2012.

• When he returned, PSA had risen from 16g/mL to 26g/mL in 4 months

• We started him on his original supplemental regimen concurrently with an altered IV therapy schedule.

• After 3 months of therapy, DJ had PSA levels were under 1ng/ml.

• He was lost to follow up after 2016

METASTATIC GLIOBLASTOMA MULTIFORME, MD, 54 YEARS

• Dx March 2013

• The patient underwent chemotherapy and radiation while taking Ayurvedic and Naturopathic treatment

• Boswellia serrata- 1 tab TID

• Curcumin- 1 teaspoon BID

• Chevanprash 1 teaspoon TID

• High dose Vitamin C, IV

• Patient reported better energy and returning sense of taste

• Was able to walk his dog again and enjoy meals

MD SURVIVAL

• MD lived 2 years after stage 4 cancer diagnosis

• At the two year mark, his allopathic doctors stressed radiation • He consented and promptly passed one

month after radiation

STAGE 4 MELANOMA76 YEAR OLD MALE

• Diagnosed with 20 known tumors on body. Spine, Neck, and Axilla involvement

• Tumor on right thigh was size of a large orange.

• No Treatment possible per Oncologist.

• Patient’s desire: simply to be able to lie down without pain.

3 WEEKS OF TREATMENT

• PK treatment initiated

• IV Vit C given

• Cold Laser directly into tumor using methyl blue

• Mistletoe Sub Q given

Herbal Medicines

• Cocurmin

• Boswellia

• Turkey Tail

• AmlaPlex

• Probiotics

Results:

• By third day of treatment, patient’s request answered: able to lie on his back.

• By end of 3 weeks: Thigh tumor had shrunk 70% in size.

FOLLOW UP

• 2 months after treatment: Thigh tumor gone, other tumors becoming undetectable.

• He was encouraged to get Keytruda, which he was given after persistent request

• Currently enjoying playing tennis regularly.

• Sleeps well.

• Pandemic has caused him to be unable to continue treatments/follow up.

• He is almost 2 years in remission now

Ayurvedic and Naturopathic Medical Clinic

• Office 425-453-8022• drvsodhi@ayurvedicscience.com