December 14, 2023 • 29 mins
Fatigue is one of the most common side effects of cancer treatment and yet patients with cancer-related fatigue are often left to fend for themselves. On this show, Karolyn talks with naturopathic oncologist Dr. Tina Kaczor about what can be done to address cancer-related fatigue. Dr. Kaczor will provide information about recognizing cancer-related fatigue and practical advice about how to increase energy levels naturally.
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Five To Thrive Live Radio Show is broadcast on W4CS Radio – The Cancer Support Network (www.w4cs.com) part of Talk 4 Radio (www.talk4radio.com) on the Talk 4 Media Network (www.talk4media.com).
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Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Any health related information on the followingshow provides general information only. Content presented
on any show by any host orguest should not be substituted for a doctor's
advice. Always consult your physician beforebeginning any new diet, exercise, or
treatment program. Hello everyone, andwelcome to Five to Thrive Live. I'm
(00:43):
Carolyn Gazella and I co host thisshow with my good friend doctor LESE.
Alschuler. Today we'll be talking aboutcancer related fatigue, which is a huge
issue for so many people diagnosed withcancer. But first I'd like to thank
our sponsors, beginning with nf H, an innovative dietary supplement manufacture that uses
an evidence based approach to creating dietarysupplements for integrative healthcare professionals. If you
(01:07):
want high quality dietary supplements, askyour integrative practitioner about NFH products. You
can also find more information at NFHdot ca. Ammuse is a unique,
patented post biotic that gives your immunesystem a key advantage. Immuse is an
ingredient in many immune supporting dietary supplements. Look for Ammuse on the label or
(01:29):
go to ammusehealth dot com for moreinformation. Also, cognizance citicoline, which
is nature's way of keeping the brain'senergy producing centers firing on all cylinders.
If you're looking for a way toenhance your brain function, including memory,
focus and attention, look for CognizantCognizant on the label or go to Cognizant
dot com for more information. Prothriver'sBrain is a product that contains Cognizant as
(01:52):
well as other brain supporting nutrients andherbs. You can find Prothriver's Brain online
at Pureformulas dot com and Finally dotcom. Oh here is Probiotics. It's
a best selling probiotic for more thanthirty years and it contains twelve probiotic strains
that are shelf stable so no refrigerationis required Because of a unique three year
fermentation process, It's a very effectiveprobiotic. Learn more at doctor Ohira Probiotics
(02:15):
dot com. With me today isone of my go to experts. Doctor
Tina Kayser. Doctor Kayser is anaturopathic oncologist who is also a co host
of the popular podcast called The CancerPod, and she is the founder of
Roundtable CancerCare dot com. Doctor Kayser, thanks for joining me. Thanks for
(02:35):
having me, Carolyn. Okay,let's just dive right in. How common
is cancer related fatigue? Well,the short answer is it's extremely common.
I mean, it depends on whatresource you look at. Some resources say
that it is nearly everyone who goesthrough treatment for cancer, at least during
the treatment period, and then otherresources say it's eighty percent of cancer patients
(02:59):
may experience fatis at some point duringtheir illness or treatment for the disease.
Right, those are yeah, theeighty percent is the one that I had
the top of my mind. Howlong does it typically last? It can
be acute or chronic, So let'sjust talk about that a little bit.
Acute cancer related fatigue refers to atemporary fatigue when you're going through treatment itself.
(03:23):
It could be from the surgery,from chemotherapy, from radiation, immune
therapy, and acute fatigue serves apurpose. So this is where you know
the lingering fatigue and persistent fatigue.Cancer related fatigue is very different. Acute
fatigue serves a purpose. When you'regoing through treatment. Your body is undergoing
intense repair, right, and replacementof damage cells, damage tissue, Your
(03:44):
bone marrow is trying to replenish yourGI. The lining of your GI tract
is trying to repair itself constantly ifyou're under chemotherapy, so that repair requires
a lot of energy expenditure within thecells and within your tissue. Fatigue acutely
is your body's way of getting youto conserve energy outwardly so it can use
(04:05):
it for these internal purposes. SoI tell people that you may not see
it, but your body is verybusy right now. So don't push yourself
right, don't act like you haveall the energy you normally have, because
honestly, you're expending much more energy, at least during the treatment period.
So acute fatigue serves that purpose.Tell It's a way that your body can
(04:26):
tell your brain stop, take arest, let me do what I need
to do inside now. Chronic orpersistent cancer related fatigue, that's different,
and that can be an issue.I mean, if everything goes well over
time, and this is months andsometimes even years, that can go away
over time as you take care ofyourself and you repair your tissues and you
(04:50):
get back to normal. And there'sso many reasons for continued cancer related fatigue
that we can talk about how toaddress that in the long term right,
and such a good point about theacute versus chronic. I had not thought
about that, but it makes alot of sense. It's kind of like
when we sleep at night. Ourbodies are very very active, so that's
(05:10):
why sleep is so important. Soin this case, rust is so important.
And you know, I have totell you, doctor Kazer, this
afternoon, mid afternoon, I gotreally tired. I don't know if I
was anticipating this conversation or what thedeal was, but that type of fatigue,
the type of fatigue that we allget periodically, is really quite different
(05:33):
than cancer related fatigue. Talk alittle bit about that, you know,
I think this is really important.I mean, when is it cancer related
fatigue? When is it somewhat ofa reality? You know, normal fatigue
should happen. Like I said,there's times that your body needs to rest
and you get that signal and youget tired and you should lay down,
(05:54):
or if you're getting a cold ora flu, you're supposed to rest.
Now I'm going to read the definitionof cancer related fatigue because it's very specific.
Cancer related fatigue is a distressing,persistent, subjective sense of physical,
emotional, and or cognitive tiredness orexhaustion related to cancer or cancer treatment that
is not proportional to recent activity andinterferes with usual functioning, and often tacked
(06:19):
onto that definition that's the official definition. They often also tack onto that it
does not get better with proper restand sleep like normal fatigue should. So
it's by definition it is interfering withusual functioning. I think that's a key
takeaway for cancer related fatigue. That'snot general fatigue at all. Yeah,
(06:43):
I would agree. And the factthat it doesn't resolve, you know,
like if I would have taken anap this afternoon, you know, I
probably would have resolved my fatigue.So I think that's a very good definition.
So I know that cancer related fatiguecan negatively impact quality of life,
But are there other concerns? Forexample, does it influence outcomes or recurrence
(07:05):
or just any other cancer related issue? In addition, I mean not that
quality of life isn't a big deal, because it totally is. But in
addition to quality of life, doesit impact other issues? Well, since
it includes the time during treatment,I would say yes. In that treatment
(07:27):
tolerance is something we talk about.So if someone is heavily fatigued and they
can't tolerate their treatment, or theirtreatment needs to be modified in such a
way that it lessens the treatment orreduces the effectiveness rate, you know,
the response rate. Then they mayhave some longer term effects because of the
(07:49):
adjustment. So it fatigues severe andthere's treatment interruptions or dose reductions that may
affect it. But here's the truth. When it comes to longevity, which
is what people like to know,the research is actually mixed. Some research
says that cancer related fatigue is relatedto poorer outcomes as far as longevity goes,
(08:09):
and other studies refute that. SoI think it's still I think it's
probably too general a symptom to realto really have that kind of data on
well. And you know, thereason I wanted to ask that question is
because I was I haven't read anyresearch on this, but I was linking
(08:30):
cancer related fatigue to increase risk ofrecurrence just because of the quality of life
issue. The you know, therecould be mental health issues that come with
the fatigue and all of those thingsstress that may come with the fatigue,
all of those things, you know, could potentially increase risk of recurrence.
(08:52):
But there's no data on that.No, and I'm looking at survival specifically
because you know, cancer related fatiguemay be due to the cancer itself in
addition to the treatments. Right,So if there were higher rates of recurrence
with cancer related fatigue, then youit may be just picking up people who
(09:15):
already have an underlying cancer, Sothat association may not be meaningful in that
if you have metastatic cancer, youmay be more fatigued, so that would
be a natural symptom of your condition. Got it, Okay, So how
does conventional oncology treat this condition?Well, if it's reported and a lot
of people think that it's so normalto be fatigued, they stop bringing it
(09:39):
up because it's hard to bring upthe same symptom at every visit. So
I would encourage anyone listening or anyonewho's you know, helping someone go through
treatment, to really pay attention tothis and kind of go ahead and report
it even if you're not asked,like, here's my level of fatigue.
So that said, conventional oncology willoften look for underlying factors, you know,
the tell you if there's anemia,look at thyroid dysfunction, other medical
(10:03):
conditions, maybe of cardiovascular issues.Especially someone who's had certain chemotherapies that can
be toxic to the heart. Sosometimes the fatigue from that from cardiomyopathy and
cardiovascular damage from chemo shows up seven, ten, fifteen years after chemotherapy.
So everyone should be very mindful ofwhat their treatment risks are in the longer
(10:26):
term, because I think it kindof gets lost in the shuffle, especially
as doctors come and go in ourlives, in our towns and cities.
We don't have the same doc we'retalking to the whole time. Sometimes they'll
treatment adjust like I mentioned, willdose reduced during treatment itself. There are
some pharmacological interventions. I think it'sa last resort to do some of those,
(10:46):
you know, those things that arelike the drugs that give you energy,
lifestyle modifications. They do often referto physical therapy, which is a
good idea for a lot of folksor their dietitians. Diet is really important
in managing fatigue. It has tobe a good nutritious diet, adequate hydration,
(11:09):
enough protein. A lot of times, if this is a post treatment
issue, there's deconditioning, so youlose muscle mass if you're not active and
you're not able to maintain your musclemass during treatment, Maybe you just couldn't
move around as much as you didbefore. Sleep may be disturbed. So
these are all things that can beaddressed right in most conventional doctors, and
(11:33):
I would say primary care physicians areprobably more likely in the long term to
help you through this stuff than you'rea medical oncologists who really, in my
experienced community clinics out there, medicaloncologists are very busy trying to help people
get rid of their cancer. They'reby and large not helping them manage their
quality of life or their longevity.I think that your primary care physician should
be in charge of a lot ofthis and then psychosocial support. Often they'll
(11:56):
refer out for counseling. Yeah,that's a really good point. And also
I just want to mention that integrativenatropathic physicians like yourself work very closely with
oncologists and primary care physicians and arevery well versed in not only side effects
of treatment, but just in managingthis fatigue issue. So and as an
(12:22):
aside, people can go to nA n P O, n C A,
NP DOT O rg UH to locatenaturopathic oncologists to work with. So
let's dig in a little bit moredeeply. You've mentioned some of the things
that you focus on with your patients, but for someone who's been newly diagnosed
with cancer, are there ways tohelp reduce the risk of developing cancer related
(12:46):
fatigue? Can they be proactive ina sense? Yeah, A lot of
it goes back to good old naturopathicfoundational things that you should do, stay
hired, balance your nutrition in thatyou're getting enough plants in your diet,
adequate rest and sleep. I can'temphasize and sleep and rest enough. I
(13:09):
think adequate rest and sleep is somethingthat's sorely lacking in our society and almost
a point of pride that people havethat they can, you know, go
through their days on only four hoursof sleep, and that's not really good
for your body. Managing stress,and of course there's other ways of managing
stress with herbs and things, avoidingtoxins, don't overdo it, and exercise.
(13:35):
I mean I mentioned exercise, yes, but keep moving, keep on
moving. That's probably top of mindfor naturopathic foundational measures is keep moving.
Yeah. And I think you know, with the movement aspect, when somebody
is experiencing cancer, related fatigue,they won't be able to move, They
likely won't be able to move orexercise like they did prior. So even
(14:03):
small movements struggle together are a stepin the right direction, right, absolutely,
absolutely, Yeah, it has todo with consistently not you know,
I think you and I've talked aboutthis before. Sitting is the new smoking,
right, So it's not even abouthaving to you know, you don't
have to take up tennis all ofa sudden. You can just keep moving,
get up walking, make sure you'renot sedentary for long periods of time.
(14:26):
That may have as much benefit asthe diet for example. Actually,
the evidence for exercise is stronger thanevidence for any particular type of nutrition.
Yeah, it's really absolutely critical.So is the advice that you just went
through. Is it about the samefor someone who is presently struggling And we're
going to talk about nutrients and herbsin more detail in a minute, but
(14:48):
just in general, is the advicethe same for someone who is right now
presently struggling with fatigue. Yes,and no, I would say there might
be some modification. So you know, we always say regular exercise. You
know, at least one hundred andtwenty minutes of modern exercise a week more
if you are able. It's justgeneral guidelines. In somebody with cancer related
(15:11):
fatigue we do have, we mayhave to adapt that, right. We
might have to say what went onwith your treatment where you now? Are
you taking a drug that persistently leadsto some kind of damage to your mitochondria
for example. Mitochondria are those whatwe call the powerhouse of the cell,
and so we may have to adaptit according to what's going on with somebody
(15:33):
who has had treatment, has cancer, or is currently on treatment. Same
with nutrition, you might have tobalance it a little bit because there might
be some muscle loss, there mightbe more protein need in somebody who has
muscle loss. There might be absorptionissues. Right, you just went through
treatment, you got chemotherapy. Thatchemo really does do a job on your
ability to absorb nutrients a lot oftimes it really interferes with what we call
(15:56):
our brush border enzymes, which arethe enzymes that are made by your intestinal
cells. Are small intestinal cells getmajor damage from chemotherapeutic agents, often they
stop they stop making these enzymes.So you might not tolerate dairy when you
have tolerated it, your whole lifebefore, so you have to you might
(16:17):
have to do some modifications sleep,same for everybody. And then the only
other is maybe stress management would betweaked to say that there are new stressors
in somebody who has had a diagnosisof cancer and those are cancer related issues,
right m Yeah, yeah, absolutely, So it sounds like it's very
(16:37):
it can be very individualized. Ithink that's the key. I think that's
why studies are difficult. You know, population studies, large studies of large
swaths of people. I think thatthere's a lot going on that's very much
individualized for that person. I mean, is there anemia still lingering? Right?
So did they come back from thatbone marrow assault of their treatment or
(16:57):
did their radiation take down a notch. I've had some people go through radiation
and really have a hard time onthe other side getting back to normal,
and there's a lot of oxidation duringradiation that needs to be overcome eventually.
Yeah, Okay, Now let's diginto nutrients and herbs. So are there
(17:18):
nutrients and or herbs that can helpwith this issue? And if there are,
which ones do you have the mostconfidence in? Well, you know,
you always do the most obvious thingsfirst. You make sure through some
blood work that there are adequate levelsof nutrients involved in energy production or oxygen
(17:38):
dissemination. So making sure there isno anemia, there's no iron deficiency,
there's no low red blood cell count. Making sure there's enough vitamin B twelve
and folate, which are necessary fornormal oxygenation of tissue and normal energy production.
Make sure there's adequate vitamin D Das and dog and vitamin D.
(18:00):
One of the symptoms of a lowvitamin D level is fatigue on exertion.
So you go up a set ofstairs and you're like, oh, that
was harder than I thought. Youknow, so other things that I would
consider. I'll make it three fattyacids and adequate protein, because some people
will go on an extreme diet thinkingthat's a good idea. And so if
someone's on, you know, youcan get enough protein on any diet if
(18:25):
you make a concerted effort. Soeven if you're vegan, just make sure
you're getting adequate protein in that diet. Hydration of course, and then that's
those are the big dogs. Thoseare like the obvious ones that we can
do some labs on, we canreally concentrate on. So those those would
be the big ones. Okay,so I want to dig in even further.
(18:45):
So when it comes to diet,I have read research on intermittent fasting
associated with you know, people gowho are actively going through treatment and then
maybe after what have you read andwhat are your thoughts on intermittent and fasting
as a way not just for energyor to help the patient recover, just
(19:10):
for other, you know, reasonsas well. What's your view on that.
When you say intermittent fasting, areyou talking about the timed eating,
so you're eating for ten hours ortwelve hours a day and then fasting the
rest exactly? Yep, Okay,there are different It's a really good question
back to me, doctor Kaser,because you're right, there's the five two,
there's the you know, other typesof fasting. But that's the one
(19:33):
that I'm talking about, the overnightfast, the intermittent fast overnight. Yeah,
you know, I think that's essentialto foundational health. Now I've really
adopted that as part of you know, another leg of the stool kind of
you need exercise, you need sleep, you need nutrition, and I think
in training your circadian rhythm through theproper ingestion of food and then fasting the
(19:57):
rest of the day essential for yourendocrine system to function normally. So I
put that as just a very foundationalpiece of good living for everyone, and
I do think that it can helpnormalize function of the endocrine systems. And
that means your hypothylamic pituitary adrenal axis, where we derive a lot of our
(20:21):
circadian rhythm kind of ups and downs. Right, You're supposed to sleep well
at night, good hard sleep,deep sleeps, and have energy during the
day. The HPA axis is largelyresponsible for how we feel throughout the day,
and it also entrains other hormonal systems. So even your thyroid is dependent
on this. If you have testosteroneestrogen circulating, then that will vary according
(20:45):
to this twenty four hour circadian rhythm. So in training, your circadian rhythm
is essential. And when I sayin train, it gets programmed by our
feeding fasting cycle as well as ourlight dark cycle, so light in the
day time, pure darkness at night. That also helps entrain all of our
hormonal systems to regulate themselves on atwenty four hour cycle as they should.
(21:07):
Yeah, I noticed that I feelbetter and I've been doing the overnight fasting
for a while now, and Ijust feel better. Okay, let's talk
about other nutrients and herbs that youmentioned correcting anemia. B twelvefol light.
That makes a lot of sense tome. The B vitamins, vitamin D
totally makes sense, Omega three totallymakes sense. What about I don't know
(21:30):
recently, I'm all about magnesium.I take magnesium at night to help me
sleep. I know that magnesium isinvolved in like three hundred different enzyme functions
within the human body. Does magnesiumhave any connection to fatigue? Well,
maybe more indirectly than directly. Magnesiumdeficiency will often lead to poor sleep.
(21:53):
So in some of the simplest studiesout there, they gave magnesium to elderly
folks before bed, and when theygave magnesium, people were able to sleep.
They went to sleep more quickly,and they slept more deeply, and
so they felt more rested. Soin that sense, yeah, I think
it affects sleep. You know allof those enzyme reactions that it functions on
(22:14):
in the body. I would besurprised if it wasn't directly affecting some energy
production as well. But yeah,I think magnesium is such a common deficiency
I don't think that you're wrong intaking it as a supplement because it is
the majority of Americans and the lasttime they did a survey were deficient in
(22:36):
their intake of magnesium when you lookedat their food intake on a questionnaire.
You know, another thing in additionto magnesium that makes me think about is
I do use el carnatine. LCarnatine is an amino acid that plays a
role in energy production, and sothere are studies looking at cancer related fatigue
(22:56):
improving with higher doses of el carnatine. And I say higher doses because there
are studies that showed it didn't work, but those tended to use lesser doses,
so people had to use three fourgrams a day of el carnatine to
see a difference in their energy.Okay, well, I'd like to talk
about gensing. Understand that herbs area little tricky, especially when you're going
(23:22):
through active treatment. But I readand this research was from several years ago,
but I read some studies on andI believe it was American gensing specifically
for cancer related fatigue, and itdid have benefit. What's your thought on
gensing. I'm a big fan ofadaptagens in general, and gensing is a
(23:44):
type of adaptogen, and so inherbal medicine we talk about a class of
plants called adaptogens because they help usadapt to stress and they help that circadian
rhythm normalize, so that circading rhythmis involved with the HPA axis. And
gen sing, whether it's American gensing, which is a very neutral and
(24:06):
very well tolerated type of gen sing, that is probably the most commonly one
used that in my practice because I'mnot following up with people very closely in
that I don't I'm not following themon a week by week basis. I
want them to tolerate it. Panicsgen sing. Korean gen sing is a
little stronger and can be helpful forpeople who are feeling very weak, you
(24:29):
know, they're kind of depleted.It's a little stronger in that sense.
It's just got a different profile.And then there's other adaptogens. There's ashwagandha,
there's cordyceps mushroom, there's licorice root. There's a lot of different adaptogenic
plants. And as an herbalist,what you do as an erbalist is you
look at the plant, you say, okay, it's an adaptogen and it's
also fill in the blank. Whatelse does it do? Is it anti
(24:52):
inflammatory? Does it? Does itaffect your electrolytesse plants are complex? But
to answer your question, I'm ahuge fan of doing an adaptogen of some
kind for everyone. I'm a bigfan of a Luthrococcus Siberian engine sing and
especially just coming out of treatment,because a luthrococcus has been used for anemia,
(25:15):
specifically to help produce red blood cells, and so a luthrococcus is one
of my favorites as people are justemerging from treatment. And you know,
all of these are done in away that you should start small and go
up because I do think that wheneverwe're affecting anything that is in the brain,
we should tie trate upwards in aslower fashion. You don't just take
(25:37):
a large dose of anything when you'redealing with anything that affects hormonal balance and
the pituitary that kind of thing.And are there caveats, I mean,
do you wait for people to bedone with treatment or do you do it
in between treatments or Because I too, am a huge, huge fan of
these adaptogens and their ability to helpheal. The American gensing has pretty much
(26:00):
been cleared to be used during treatment. The study you're referring to us two
grams of Wisconsin gensying. I rememberthat a few years ago. It was
actually presented in the conventional conferences,so most medical oncologists are familiar with it,
and I think that it was perfectlysafe to use during that time.
You know, it doesn't have astrong effect on the liver. It's not
(26:21):
a detoxification plant. It's not goingto affect metabolism of drugs that kind of
thing. That's not how ginsings work. So they're more nourishing to the HPA.
Access is how we think of it. Okay, perfect, well,
good, So this has been veryvery helpful, doctor Kaser. Where can
people find out more about you andyour work? Do you have a couple
of websites that you'd like to share? Maybe your podcast site? Let's start
(26:45):
there, sure, sure, yeah, the Cancer pod. The cancerpod dot
com is the website. And ifyou listen to podcasts already, just punch
that into wherever you're listening already andyou'll see myself, Doctor Leah Sherman.
We have been doing that for acouple of years. We're going to our
third season right now. So actuallywe have an entire episode on cancer related
(27:07):
fatigue. It was episode fourteen.It was Yeah, it was one of
our very first episodes because it's soprevalent, and what we do on the
show is just try to give peopletips and tricks and educate them to understand
symptomology better. So it's about prevention, it's about just survivorship stages, it's
all of it. Anything that canhelp people. And the other place you'll
see stuff, but it will bemore indirect is I am editor in chief
(27:30):
at the Natural Medicine Journal, Sowhat you see at the Natural Medicine Journal
has been curated and probably edited byme, and maybe not one hundred percent
of the content, but large amountof the content. So that's meant to
be useful and either corroborate or challengeparadigms in integrative medicine. Absolutely, that's
great. Well, the cancerpod dotcom I highly highly recommend it. Go
(27:51):
there, sign up and listen NaturalMedicine Journal dot com. And there's also
a Natural Medicine Journal podcast, sothat's good information. And of course WI
there's Cancer Roundtable, I mean roundtableCancerCare dot com as well, Yes,
cancer care Yes, okay, goodwell, thanks again doctor Kaser for this
important conversation. Thank you for havingme. Okay. That wraps up this
(28:15):
episode of five to Thrive Live onceagain. I'd like to thank our sponsors
n f H, the professional supplementline bridging the gap between nutraceuticals and evidence
based medicine, and use post bioticto give your immune system that extra boost.
Cogniti is in sticoling to help enhancememory, focus and attention, and
doctor o'hira's award winning shelf stable probiotic. And you can find past episodes of
(28:40):
this podcast at ithrive plan dot com. Check it out. All right,
may you experience joy, laughter andlove. It's time to thrive. Everyone,
have a good night. Sitting theState, the j and the City
(29:04):
is a striking nin
Any health related information on the followingshow provides general information only. Content presented
on any show by any host orguest should not be substituted for a doctor's
advice. Always consult your physician beforebeginning any new diet, exercise, or
treatment program. Hello everyone, andwelcome to Five to Thrive Live. I'm
(00:43):
Carolyn Gazella and I co host thisshow with my good friend doctor LESE.
Alschuler. Today we'll be talking aboutcancer related fatigue, which is a huge
issue for so many people diagnosed withcancer. But first I'd like to thank
our sponsors, beginning with nf H, an innovative dietary supplement manufacture that uses
an evidence based approach to creating dietarysupplements for integrative healthcare professionals. If you
(01:07):
want high quality dietary supplements, askyour integrative practitioner about NFH products. You
can also find more information at NFHdot ca. Ammuse is a unique,
patented post biotic that gives your immunesystem a key advantage. Immuse is an
ingredient in many immune supporting dietary supplements. Look for Ammuse on the label or
(01:29):
go to ammusehealth dot com for moreinformation. Also, cognizance citicoline, which
is nature's way of keeping the brain'senergy producing centers firing on all cylinders.
If you're looking for a way toenhance your brain function, including memory,
focus and attention, look for CognizantCognizant on the label or go to Cognizant
dot com for more information. Prothriver'sBrain is a product that contains Cognizant as
(01:52):
well as other brain supporting nutrients andherbs. You can find Prothriver's Brain online
at Pureformulas dot com and Finally dotcom. Oh here is Probiotics. It's
a best selling probiotic for more thanthirty years and it contains twelve probiotic strains
that are shelf stable so no refrigerationis required Because of a unique three year
fermentation process, It's a very effectiveprobiotic. Learn more at doctor Ohira Probiotics
(02:15):
dot com. With me today isone of my go to experts. Doctor
Tina Kayser. Doctor Kayser is anaturopathic oncologist who is also a co host
of the popular podcast called The CancerPod, and she is the founder of
Roundtable CancerCare dot com. Doctor Kayser, thanks for joining me. Thanks for
(02:35):
having me, Carolyn. Okay,let's just dive right in. How common
is cancer related fatigue? Well,the short answer is it's extremely common.
I mean, it depends on whatresource you look at. Some resources say
that it is nearly everyone who goesthrough treatment for cancer, at least during
the treatment period, and then otherresources say it's eighty percent of cancer patients
(02:59):
may experience fatis at some point duringtheir illness or treatment for the disease.
Right, those are yeah, theeighty percent is the one that I had
the top of my mind. Howlong does it typically last? It can
be acute or chronic, So let'sjust talk about that a little bit.
Acute cancer related fatigue refers to atemporary fatigue when you're going through treatment itself.
(03:23):
It could be from the surgery,from chemotherapy, from radiation, immune
therapy, and acute fatigue serves apurpose. So this is where you know
the lingering fatigue and persistent fatigue.Cancer related fatigue is very different. Acute
fatigue serves a purpose. When you'regoing through treatment. Your body is undergoing
intense repair, right, and replacementof damage cells, damage tissue, Your
(03:44):
bone marrow is trying to replenish yourGI. The lining of your GI tract
is trying to repair itself constantly ifyou're under chemotherapy, so that repair requires
a lot of energy expenditure within thecells and within your tissue. Fatigue acutely
is your body's way of getting youto conserve energy outwardly so it can use
(04:05):
it for these internal purposes. SoI tell people that you may not see
it, but your body is verybusy right now. So don't push yourself
right, don't act like you haveall the energy you normally have, because
honestly, you're expending much more energy, at least during the treatment period.
So acute fatigue serves that purpose.Tell It's a way that your body can
(04:26):
tell your brain stop, take arest, let me do what I need
to do inside now. Chronic orpersistent cancer related fatigue, that's different,
and that can be an issue.I mean, if everything goes well over
time, and this is months andsometimes even years, that can go away
over time as you take care ofyourself and you repair your tissues and you
(04:50):
get back to normal. And there'sso many reasons for continued cancer related fatigue
that we can talk about how toaddress that in the long term right,
and such a good point about theacute versus chronic. I had not thought
about that, but it makes alot of sense. It's kind of like
when we sleep at night. Ourbodies are very very active, so that's
(05:10):
why sleep is so important. Soin this case, rust is so important.
And you know, I have totell you, doctor Kazer, this
afternoon, mid afternoon, I gotreally tired. I don't know if I
was anticipating this conversation or what thedeal was, but that type of fatigue,
the type of fatigue that we allget periodically, is really quite different
(05:33):
than cancer related fatigue. Talk alittle bit about that, you know,
I think this is really important.I mean, when is it cancer related
fatigue? When is it somewhat ofa reality? You know, normal fatigue
should happen. Like I said,there's times that your body needs to rest
and you get that signal and youget tired and you should lay down,
(05:54):
or if you're getting a cold ora flu, you're supposed to rest.
Now I'm going to read the definitionof cancer related fatigue because it's very specific.
Cancer related fatigue is a distressing,persistent, subjective sense of physical,
emotional, and or cognitive tiredness orexhaustion related to cancer or cancer treatment that
is not proportional to recent activity andinterferes with usual functioning, and often tacked
(06:19):
onto that definition that's the official definition. They often also tack onto that it
does not get better with proper restand sleep like normal fatigue should. So
it's by definition it is interfering withusual functioning. I think that's a key
takeaway for cancer related fatigue. That'snot general fatigue at all. Yeah,
(06:43):
I would agree. And the factthat it doesn't resolve, you know,
like if I would have taken anap this afternoon, you know, I
probably would have resolved my fatigue.So I think that's a very good definition.
So I know that cancer related fatiguecan negatively impact quality of life,
But are there other concerns? Forexample, does it influence outcomes or recurrence
(07:05):
or just any other cancer related issue? In addition, I mean not that
quality of life isn't a big deal, because it totally is. But in
addition to quality of life, doesit impact other issues? Well, since
it includes the time during treatment,I would say yes. In that treatment
(07:27):
tolerance is something we talk about.So if someone is heavily fatigued and they
can't tolerate their treatment, or theirtreatment needs to be modified in such a
way that it lessens the treatment orreduces the effectiveness rate, you know,
the response rate. Then they mayhave some longer term effects because of the
(07:49):
adjustment. So it fatigues severe andthere's treatment interruptions or dose reductions that may
affect it. But here's the truth. When it comes to longevity, which
is what people like to know,the research is actually mixed. Some research
says that cancer related fatigue is relatedto poorer outcomes as far as longevity goes,
(08:09):
and other studies refute that. SoI think it's still I think it's
probably too general a symptom to realto really have that kind of data on
well. And you know, thereason I wanted to ask that question is
because I was I haven't read anyresearch on this, but I was linking
(08:30):
cancer related fatigue to increase risk ofrecurrence just because of the quality of life
issue. The you know, therecould be mental health issues that come with
the fatigue and all of those thingsstress that may come with the fatigue,
all of those things, you know, could potentially increase risk of recurrence.
(08:52):
But there's no data on that.No, and I'm looking at survival specifically
because you know, cancer related fatiguemay be due to the cancer itself in
addition to the treatments. Right,So if there were higher rates of recurrence
with cancer related fatigue, then youit may be just picking up people who
(09:15):
already have an underlying cancer, Sothat association may not be meaningful in that
if you have metastatic cancer, youmay be more fatigued, so that would
be a natural symptom of your condition. Got it, Okay, So how
does conventional oncology treat this condition?Well, if it's reported and a lot
of people think that it's so normalto be fatigued, they stop bringing it
(09:39):
up because it's hard to bring upthe same symptom at every visit. So
I would encourage anyone listening or anyonewho's you know, helping someone go through
treatment, to really pay attention tothis and kind of go ahead and report
it even if you're not asked,like, here's my level of fatigue.
So that said, conventional oncology willoften look for underlying factors, you know,
the tell you if there's anemia,look at thyroid dysfunction, other medical
(10:03):
conditions, maybe of cardiovascular issues.Especially someone who's had certain chemotherapies that can
be toxic to the heart. Sosometimes the fatigue from that from cardiomyopathy and
cardiovascular damage from chemo shows up seven, ten, fifteen years after chemotherapy.
So everyone should be very mindful ofwhat their treatment risks are in the longer
(10:26):
term, because I think it kindof gets lost in the shuffle, especially
as doctors come and go in ourlives, in our towns and cities.
We don't have the same doc we'retalking to the whole time. Sometimes they'll
treatment adjust like I mentioned, willdose reduced during treatment itself. There are
some pharmacological interventions. I think it'sa last resort to do some of those,
(10:46):
you know, those things that arelike the drugs that give you energy,
lifestyle modifications. They do often referto physical therapy, which is a
good idea for a lot of folksor their dietitians. Diet is really important
in managing fatigue. It has tobe a good nutritious diet, adequate hydration,
(11:09):
enough protein. A lot of times, if this is a post treatment
issue, there's deconditioning, so youlose muscle mass if you're not active and
you're not able to maintain your musclemass during treatment, Maybe you just couldn't
move around as much as you didbefore. Sleep may be disturbed. So
these are all things that can beaddressed right in most conventional doctors, and
(11:33):
I would say primary care physicians areprobably more likely in the long term to
help you through this stuff than you'rea medical oncologists who really, in my
experienced community clinics out there, medicaloncologists are very busy trying to help people
get rid of their cancer. They'reby and large not helping them manage their
quality of life or their longevity.I think that your primary care physician should
be in charge of a lot ofthis and then psychosocial support. Often they'll
(11:56):
refer out for counseling. Yeah,that's a really good point. And also
I just want to mention that integrativenatropathic physicians like yourself work very closely with
oncologists and primary care physicians and arevery well versed in not only side effects
of treatment, but just in managingthis fatigue issue. So and as an
(12:22):
aside, people can go to nA n P O, n C A,
NP DOT O rg UH to locatenaturopathic oncologists to work with. So
let's dig in a little bit moredeeply. You've mentioned some of the things
that you focus on with your patients, but for someone who's been newly diagnosed
with cancer, are there ways tohelp reduce the risk of developing cancer related
(12:46):
fatigue? Can they be proactive ina sense? Yeah, A lot of
it goes back to good old naturopathicfoundational things that you should do, stay
hired, balance your nutrition in thatyou're getting enough plants in your diet,
adequate rest and sleep. I can'temphasize and sleep and rest enough. I
(13:09):
think adequate rest and sleep is somethingthat's sorely lacking in our society and almost
a point of pride that people havethat they can, you know, go
through their days on only four hoursof sleep, and that's not really good
for your body. Managing stress,and of course there's other ways of managing
stress with herbs and things, avoidingtoxins, don't overdo it, and exercise.
(13:35):
I mean I mentioned exercise, yes, but keep moving, keep on
moving. That's probably top of mindfor naturopathic foundational measures is keep moving.
Yeah. And I think you know, with the movement aspect, when somebody
is experiencing cancer, related fatigue,they won't be able to move, They
likely won't be able to move orexercise like they did prior. So even
(14:03):
small movements struggle together are a stepin the right direction, right, absolutely,
absolutely, Yeah, it has todo with consistently not you know,
I think you and I've talked aboutthis before. Sitting is the new smoking,
right, So it's not even abouthaving to you know, you don't
have to take up tennis all ofa sudden. You can just keep moving,
get up walking, make sure you'renot sedentary for long periods of time.
(14:26):
That may have as much benefit asthe diet for example. Actually,
the evidence for exercise is stronger thanevidence for any particular type of nutrition.
Yeah, it's really absolutely critical.So is the advice that you just went
through. Is it about the samefor someone who is presently struggling And we're
going to talk about nutrients and herbsin more detail in a minute, but
(14:48):
just in general, is the advicethe same for someone who is right now
presently struggling with fatigue. Yes,and no, I would say there might
be some modification. So you know, we always say regular exercise. You
know, at least one hundred andtwenty minutes of modern exercise a week more
if you are able. It's justgeneral guidelines. In somebody with cancer related
(15:11):
fatigue we do have, we mayhave to adapt that, right. We
might have to say what went onwith your treatment where you now? Are
you taking a drug that persistently leadsto some kind of damage to your mitochondria
for example. Mitochondria are those whatwe call the powerhouse of the cell,
and so we may have to adaptit according to what's going on with somebody
(15:33):
who has had treatment, has cancer, or is currently on treatment. Same
with nutrition, you might have tobalance it a little bit because there might
be some muscle loss, there mightbe more protein need in somebody who has
muscle loss. There might be absorptionissues. Right, you just went through
treatment, you got chemotherapy. Thatchemo really does do a job on your
ability to absorb nutrients a lot oftimes it really interferes with what we call
(15:56):
our brush border enzymes, which arethe enzymes that are made by your intestinal
cells. Are small intestinal cells getmajor damage from chemotherapeutic agents, often they
stop they stop making these enzymes.So you might not tolerate dairy when you
have tolerated it, your whole lifebefore, so you have to you might
(16:17):
have to do some modifications sleep,same for everybody. And then the only
other is maybe stress management would betweaked to say that there are new stressors
in somebody who has had a diagnosisof cancer and those are cancer related issues,
right m Yeah, yeah, absolutely, So it sounds like it's very
(16:37):
it can be very individualized. Ithink that's the key. I think that's
why studies are difficult. You know, population studies, large studies of large
swaths of people. I think thatthere's a lot going on that's very much
individualized for that person. I mean, is there anemia still lingering? Right?
So did they come back from thatbone marrow assault of their treatment or
(16:57):
did their radiation take down a notch. I've had some people go through radiation
and really have a hard time onthe other side getting back to normal,
and there's a lot of oxidation duringradiation that needs to be overcome eventually.
Yeah, Okay, Now let's diginto nutrients and herbs. So are there
(17:18):
nutrients and or herbs that can helpwith this issue? And if there are,
which ones do you have the mostconfidence in? Well, you know,
you always do the most obvious thingsfirst. You make sure through some
blood work that there are adequate levelsof nutrients involved in energy production or oxygen
(17:38):
dissemination. So making sure there isno anemia, there's no iron deficiency,
there's no low red blood cell count. Making sure there's enough vitamin B twelve
and folate, which are necessary fornormal oxygenation of tissue and normal energy production.
Make sure there's adequate vitamin D Das and dog and vitamin D.
(18:00):
One of the symptoms of a lowvitamin D level is fatigue on exertion.
So you go up a set ofstairs and you're like, oh, that
was harder than I thought. Youknow, so other things that I would
consider. I'll make it three fattyacids and adequate protein, because some people
will go on an extreme diet thinkingthat's a good idea. And so if
someone's on, you know, youcan get enough protein on any diet if
(18:25):
you make a concerted effort. Soeven if you're vegan, just make sure
you're getting adequate protein in that diet. Hydration of course, and then that's
those are the big dogs. Thoseare like the obvious ones that we can
do some labs on, we canreally concentrate on. So those those would
be the big ones. Okay,so I want to dig in even further.
(18:45):
So when it comes to diet,I have read research on intermittent fasting
associated with you know, people gowho are actively going through treatment and then
maybe after what have you read andwhat are your thoughts on intermittent and fasting
as a way not just for energyor to help the patient recover, just
(19:10):
for other, you know, reasonsas well. What's your view on that.
When you say intermittent fasting, areyou talking about the timed eating,
so you're eating for ten hours ortwelve hours a day and then fasting the
rest exactly? Yep, Okay,there are different It's a really good question
back to me, doctor Kaser,because you're right, there's the five two,
there's the you know, other typesof fasting. But that's the one
(19:33):
that I'm talking about, the overnightfast, the intermittent fast overnight. Yeah,
you know, I think that's essentialto foundational health. Now I've really
adopted that as part of you know, another leg of the stool kind of
you need exercise, you need sleep, you need nutrition, and I think
in training your circadian rhythm through theproper ingestion of food and then fasting the
(19:57):
rest of the day essential for yourendocrine system to function normally. So I
put that as just a very foundationalpiece of good living for everyone, and
I do think that it can helpnormalize function of the endocrine systems. And
that means your hypothylamic pituitary adrenal axis, where we derive a lot of our
(20:21):
circadian rhythm kind of ups and downs. Right, You're supposed to sleep well
at night, good hard sleep,deep sleeps, and have energy during the
day. The HPA axis is largelyresponsible for how we feel throughout the day,
and it also entrains other hormonal systems. So even your thyroid is dependent
on this. If you have testosteroneestrogen circulating, then that will vary according
(20:45):
to this twenty four hour circadian rhythm. So in training, your circadian rhythm
is essential. And when I sayin train, it gets programmed by our
feeding fasting cycle as well as ourlight dark cycle, so light in the
day time, pure darkness at night. That also helps entrain all of our
hormonal systems to regulate themselves on atwenty four hour cycle as they should.
(21:07):
Yeah, I noticed that I feelbetter and I've been doing the overnight fasting
for a while now, and Ijust feel better. Okay, let's talk
about other nutrients and herbs that youmentioned correcting anemia. B twelvefol light.
That makes a lot of sense tome. The B vitamins, vitamin D
totally makes sense, Omega three totallymakes sense. What about I don't know
(21:30):
recently, I'm all about magnesium.I take magnesium at night to help me
sleep. I know that magnesium isinvolved in like three hundred different enzyme functions
within the human body. Does magnesiumhave any connection to fatigue? Well,
maybe more indirectly than directly. Magnesiumdeficiency will often lead to poor sleep.
(21:53):
So in some of the simplest studiesout there, they gave magnesium to elderly
folks before bed, and when theygave magnesium, people were able to sleep.
They went to sleep more quickly,and they slept more deeply, and
so they felt more rested. Soin that sense, yeah, I think
it affects sleep. You know allof those enzyme reactions that it functions on
(22:14):
in the body. I would besurprised if it wasn't directly affecting some energy
production as well. But yeah,I think magnesium is such a common deficiency
I don't think that you're wrong intaking it as a supplement because it is
the majority of Americans and the lasttime they did a survey were deficient in
(22:36):
their intake of magnesium when you lookedat their food intake on a questionnaire.
You know, another thing in additionto magnesium that makes me think about is
I do use el carnatine. LCarnatine is an amino acid that plays a
role in energy production, and sothere are studies looking at cancer related fatigue
(22:56):
improving with higher doses of el carnatine. And I say higher doses because there
are studies that showed it didn't work, but those tended to use lesser doses,
so people had to use three fourgrams a day of el carnatine to
see a difference in their energy.Okay, well, I'd like to talk
about gensing. Understand that herbs area little tricky, especially when you're going
(23:22):
through active treatment. But I readand this research was from several years ago,
but I read some studies on andI believe it was American gensing specifically
for cancer related fatigue, and itdid have benefit. What's your thought on
gensing. I'm a big fan ofadaptagens in general, and gensing is a
(23:44):
type of adaptogen, and so inherbal medicine we talk about a class of
plants called adaptogens because they help usadapt to stress and they help that circadian
rhythm normalize, so that circading rhythmis involved with the HPA axis. And
gen sing, whether it's American gensing, which is a very neutral and
(24:06):
very well tolerated type of gen sing, that is probably the most commonly one
used that in my practice because I'mnot following up with people very closely in
that I don't I'm not following themon a week by week basis. I
want them to tolerate it. Panicsgen sing. Korean gen sing is a
little stronger and can be helpful forpeople who are feeling very weak, you
(24:29):
know, they're kind of depleted.It's a little stronger in that sense.
It's just got a different profile.And then there's other adaptogens. There's ashwagandha,
there's cordyceps mushroom, there's licorice root. There's a lot of different adaptogenic
plants. And as an herbalist,what you do as an erbalist is you
look at the plant, you say, okay, it's an adaptogen and it's
also fill in the blank. Whatelse does it do? Is it anti
(24:52):
inflammatory? Does it? Does itaffect your electrolytesse plants are complex? But
to answer your question, I'm ahuge fan of doing an adaptogen of some
kind for everyone. I'm a bigfan of a Luthrococcus Siberian engine sing and
especially just coming out of treatment,because a luthrococcus has been used for anemia,
(25:15):
specifically to help produce red blood cells, and so a luthrococcus is one
of my favorites as people are justemerging from treatment. And you know,
all of these are done in away that you should start small and go
up because I do think that wheneverwe're affecting anything that is in the brain,
we should tie trate upwards in aslower fashion. You don't just take
(25:37):
a large dose of anything when you'redealing with anything that affects hormonal balance and
the pituitary that kind of thing.And are there caveats, I mean,
do you wait for people to bedone with treatment or do you do it
in between treatments or Because I too, am a huge, huge fan of
these adaptogens and their ability to helpheal. The American gensing has pretty much
(26:00):
been cleared to be used during treatment. The study you're referring to us two
grams of Wisconsin gensying. I rememberthat a few years ago. It was
actually presented in the conventional conferences,so most medical oncologists are familiar with it,
and I think that it was perfectlysafe to use during that time.
You know, it doesn't have astrong effect on the liver. It's not
(26:21):
a detoxification plant. It's not goingto affect metabolism of drugs that kind of
thing. That's not how ginsings work. So they're more nourishing to the HPA.
Access is how we think of it. Okay, perfect, well,
good, So this has been veryvery helpful, doctor Kaser. Where can
people find out more about you andyour work? Do you have a couple
of websites that you'd like to share? Maybe your podcast site? Let's start
(26:45):
there, sure, sure, yeah, the Cancer pod. The cancerpod dot
com is the website. And ifyou listen to podcasts already, just punch
that into wherever you're listening already andyou'll see myself, Doctor Leah Sherman.
We have been doing that for acouple of years. We're going to our
third season right now. So actuallywe have an entire episode on cancer related
(27:07):
fatigue. It was episode fourteen.It was Yeah, it was one of
our very first episodes because it's soprevalent, and what we do on the
show is just try to give peopletips and tricks and educate them to understand
symptomology better. So it's about prevention, it's about just survivorship stages, it's
all of it. Anything that canhelp people. And the other place you'll
see stuff, but it will bemore indirect is I am editor in chief
(27:30):
at the Natural Medicine Journal, Sowhat you see at the Natural Medicine Journal
has been curated and probably edited byme, and maybe not one hundred percent
of the content, but large amountof the content. So that's meant to
be useful and either corroborate or challengeparadigms in integrative medicine. Absolutely, that's
great. Well, the cancerpod dotcom I highly highly recommend it. Go
(27:51):
there, sign up and listen NaturalMedicine Journal dot com. And there's also
a Natural Medicine Journal podcast, sothat's good information. And of course WI
there's Cancer Roundtable, I mean roundtableCancerCare dot com as well, Yes,
cancer care Yes, okay, goodwell, thanks again doctor Kaser for this
important conversation. Thank you for havingme. Okay. That wraps up this
(28:15):
episode of five to Thrive Live onceagain. I'd like to thank our sponsors
n f H, the professional supplementline bridging the gap between nutraceuticals and evidence
based medicine, and use post bioticto give your immune system that extra boost.
Cogniti is in sticoling to help enhancememory, focus and attention, and
doctor o'hira's award winning shelf stable probiotic. And you can find past episodes of
(28:40):
this podcast at ithrive plan dot com. Check it out. All right,
may you experience joy, laughter andlove. It's time to thrive. Everyone,
have a good night. Sitting theState, the j and the City
(29:04):
is a striking nin
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