May 29, 2024 • 41 mins
Join Dr. Tina Kaczor and Dr. Leah Sherman as they delve into the complexities of heart toxicity in cancer care. This enlightening episode sheds light on the heart’s resilience and the specific challenges posed by cancer treatments known for their toxic effects on the heart muscle. Through engaging dialogue, the hosts explore topics such as risk factors, treatments associated with the highest risk of heart damage, and integrative medicine approaches to prevention and repair.
They share personal experiences, the latest research, and practical tips for patients and healthcare practitioners aiming to mitigate the side effects of cancer treatment on the heart. Whether you’re a patient, a healthcare provider, or someone interested in the intersection of oncology and cardiology, this episode offers valuable insights into keeping the heart healthy before, during, and after cancer treatment.
Leah’s favorite sardine salad recipe (from Martha Stewart!) https://www.marthastewart.com/1050733/lemon-herb-sardine-salad
Prior episodes we mention:
The Movement Mentor: Sarah Court, PT, DPT, e-RYT https://www.thecancerpod.com/the-movement-mentor-sarah-court-pt-dpt-e-ryt/
Magnesium: The Goldilocks Nutrient? https://www.thecancerpod.com/magnesium-the-goldilocks-nutrient/
Omega 3s: Supplements 101 https://www.thecancerpod.com/listen-7/
Heart Sparing Radiotherapy Techniques in Breast Cancer: A Focus on Deep Inspiration Breath Hold https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9309321/
CoQ10 Study on Antioxidant Dietary Supplement Use During Chemotherapy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7062457/
Impact of Hormonal Therapies for Treatment of Hormone-Dependent Cancers (Breast and Prostate) on the Cardiovascular System: Effects and Modifications: A Scientific Statement From the American Heart Association https://www.ahajournals.org/doi/10.1161/HCG.0000000000000082
Adverse Cardiovascular Events Associated With Cyclin‐Dependent Kinase 4/6 Inhibitors in Patients With Metastatic Breast Cancer https://www.ahajournals.org/doi/10.1161/JAHA.123.029361
Cardiotoxicity of Anthracyclines doi: 10.3389/fcvm.2020.00026
Our website: https://www.thecancerpod.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Tina (00:00):
So the heart is a muscle all by itself, pumping 24 hours
a day, seven days a weekthroughout our entire lifespan.
And there are certain treatmentsthat specifically are toxic to
the heart muscle itself.
And Leah, I think you had one ofthem.
Leah (00:16):
Yes.
Tina (00:17):
What did you have?
Leah (00:18):
Well, two of them, right?
At AC.
Tina (00:21):
So, adriamycin and cyclophosphamide.
Leah (00:24):
Mm hmm.
Tina (00:24):
And adriamycin is also known as the red devil.
And so adriamycin causes notjust heart disease, Immediate
effects, when someone's gettingit, delayed effects, and does
that concern you at all?
Leah (00:37):
Oh, absolutely.
Oh, oh my god.
Oh my god.
Absolutely.
All the time, I think about it.
Because I also have a familyhistory of heart disease.
So, you know, cancer treatmentis the gift that keeps on
giving.
You know, it's like for all ofthe good that it does, there's
this kind of like threat
Tina (00:53):
Sequelae.
Leah (00:54):
sequelae, delayed side effects.
Tina (00:56):
We call them sequelae in medicine, but yes, most people
just call it a delayed sideeffect.
And specifically forcardiotoxicity or heart
toxicity, some of these drugsdon't really manifest any
symptoms until seven years, tenyears, down the line, where
people have fatigue.
I mean, that's usually the firstsymptom.
When the heart is not pumpingwell, people are tired.
Leah (01:16):
Yeah.
So I had some weird heartsymptoms that were happening, I
think back in like 2020, 2021.
And I underwent a stress testbecause that was my concern.
Right.
and yeah, they did the stresstest and they're like, you're
great.
Tina (01:28):
Well, that's good.
Leah (01:29):
like, have you ever done a heart stress test?
They're stressful.
Tina (01:33):
By design.
Leah (01:34):
I thought for sure I failed.
I thought for sure I failed.
Cause I was on that treadmilland I was like.
Wheezing practically, andthey're like, Oh, wow, you're
healthy.
I'm like, yes,
Tina (01:43):
All right, well, we will talk about what keeps the heart
healthy and how to make suresome of these side effects that
happen over time don't happen toour listeners.
I'm Dr Tina Kaczor and as Leahlikes to say I'm the science-y
one
Leah (01:55):
and I'm Dr Leah Sherman and on the cancer inside
Tina (01:59):
And we're two naturopathic doctors who practice integrative
cancer care
Leah (02:03):
But we're not your doctors
Tina (02:05):
This is for education entertainment and informational
purposes only
Leah (02:09):
do not apply any of this information without first
speaking to your doctor
Tina (02:14):
The views and opinions expressed on this podcast by the
hosts and their guests aresolely their own
Leah (02:20):
Welcome to the cancer pod
Tina (02:38):
Hi, Leah.
Leah (02:39):
hi, Tina,
Tina (02:39):
So in this episode, we're going to talk about
cardiotoxicity.
Leah (02:43):
heart toxicity.
Tina (02:44):
Specifically, we're going to talk about risk factors, you
know, what makes someone morevulnerable to toxicity of these
treatments.
And What treatments specificallyare associated with the highest
risk of damage to the heartmuscle itself and how to lower
one's risk.
So actively, what can people doin their self care and day to
day integrative medicineapproach?
(03:04):
And we're going to talk aboutsupplements and herbs, things
that we know work.
Leah (03:08):
we're also going to talk about things you can do during
treatment to decrease your risk.
Tina (03:12):
Yes.
Yep.
A little more controversial justbecause some cancer centers
don't allow people to do thingsduring treatment, but there are
some well evidenced approachesduring treatment that actually
lower your risk.
Leah (03:24):
Yeah.
So let's start with, um, some ofthe risk factors and I guess the
biggest risk factor, To somemight kind of be obvious, it's
your risk factor for havingcardiovascular disease in the
first place.
So like a history of smoking,high blood pressure, diabetes,
obesity, or just like I said,like having a history of heart
problems is going to make youmore likely to have heart
(03:44):
problems.
From your treatment.
Um, Age.
So, being over 60, it also canaffect really young children,
And then, being female.
Tina (03:55):
Yes.
Leah (03:56):
of the, one of the joys of being female.
Tina (03:59):
it to the list.
Leah (04:00):
Yeah, yeah, you know, it's a special perk.
and like you mentioned, likethere are certain drugs that
people receive.
So the one that I received, the,Adriamycin or doxorubicin, same
thing, getting high doses ofthat.
And that drug actually has alifetime limit of how much you
can receive because of thepotential for heart issues.
Tina (04:19):
In that class of drugs, anthracycline is dose dependent.
So the more you got fortreatment or the more you're
getting, the higher the risk ofheart toxicity.
Okay.
Leah (04:28):
Right.
And then combining thoseanthracyclines with radiation
therapy further amplifies it.
Tina (04:33):
Yes, and coupling it with another treatment that happens
to have some heart toxicity aswell.
So when you're doubling down,you're getting two agents for
your cancer.
They're anti cancer agents, butthey're also both toxic to the
heart.
And one that stands out in thatarena is Herceptin.
Leah (04:50):
Right.
So if you, which I don't reallythink it happens so much
anymore, but if you getAdriamycin, Red Devil, you get
the Red Devil and then youfollow that up with Herceptin.
Yeah.
But they don't really do that.
Tina (05:02):
No, not so much anymore because of that cardio toxicity,
but there could be listenersthat have gotten that in the
past.
Leah (05:08):
Absolutely.
Yeah.
Yeah.
And as you mentioned, like someof these side effects might not
occur until much later, but someof them happen actually as
people are getting treatments.
And The one that I think of mostoften that, that happens with is
Herceptin.
And part of that is because, Imean, people get Herceptin for
long periods of time.
Tina (05:27):
Mm hmm.
Leah (05:27):
They'll get it over the course of a year, typically with
breast cancer treatment, butsome people are on it for life.
Tina (05:33):
Yeah.
And, um, when we say Herceptin,we're using that drug as a
generic in that class.
So anything that's Herceptinlike, so Progetta is a newer
version of Herceptin.
Leah (05:43):
Yeah.
And you're giving, you're givingthe brand
Tina (05:45):
I am, because that's what people usually know.
I don't want to,
Leah (05:47):
Trastuzumab.
Tina (05:49):
yeah, if we want to say Terastuzumab, we can, but I
think it might be a little bitof a tongue twister.
First of all,
Leah (05:57):
Yeah.
For us.
Tina (05:58):
first of all, this is a podcast, so I don't really want
a tongue twist, but
Leah (06:01):
Yeah.
and the, the, the cardiotoxicityis it's varied.
It's everything from having highblood pressure, which also
happens with Herceptin.
I had to stop myself from sayingTrastuzumab, um, it also happens
with Herceptin and other drugstoo, right?
I mean, drugs that affect yourkidney are going to increase
your blood pressure.
Tina (06:22):
Yeah.
Right.
So when you're talking about theheart muscle, you've got direct
toxicities like theseanthracyclines, but you also
have, it's a system, you know,so anything that raises your
blood pressure puts pressure onthe heart because the reason
that happens is when you havehigh blood pressure with each
pump of the heart, you have topump the blood out against a
(06:42):
larger pressure and that canresult in a cardiomyopathy,
which is just a fancy word forheart damage.
So that can be direct or it canbe indirect through
hypertension.
So it'd be direct literally thatit's toxic to the cells, they
are damaged, and they may or maynot revive from the damage.
So What we're talking abouttoday is, you know, it's a
muscle.
The, the beauty of this is it isa muscle and it has a lot of
(07:05):
healing potential.
I always think of differentorgans in the body as having
different healing potentials.
When you have the heart muscleyou're talking about, it's got a
lot of inherent ability torepair damage.
So as long as you get it earlyenough and it's not completely
dead cells and they havepotential to heal.
Leah (07:23):
So one of the most commonly thought of
chemotherapies that damage thekidneys and can lead to heart
problems is cisplatin And that'scommonly, used in patients who
have lung cancer paired withradiation.
Tina (07:37):
Yeah, yeah, it's also commonly used for ovarian
cancer.
It's a, it's a really commonlyused chemo in general.
I mean, for the last, I don'tknow how many decades.
I mean, cisplatin has beenaround a very long time.
Leah (07:48):
Yeah.
And at the time of thisrecording, um, there is a
shortage of it as well.
Tina (07:53):
Yeah, that's a whole nother, gosh, that'll be an
interesting kind of, I don'twant to call it an expose, but
at least talk to people in theknow, um, when there are drug
shortages, how that is handledbehind the scenes.
Because I think that there's alot of, um, yeah, there's a lot
of unfortunate things thathappen when they have to figure
out who gets it and who doesn'tget the drugs.
Leah (08:12):
Right.
Um, okay.
So moving along the other thingsthat can happen, uh, high
cholesterol.
I'm kind of starting at like thelower end and then we're going
to work our way up.
Okay.
Tina (08:22):
I see.
Yeah.
Leah (08:24):
See, I'm not going to start with like the big, you
know, the big issues.
We're going to say highcholesterol, which is something
also that people don't thinkabout, especially the hormonal
agents, or I should say the antihormonal agents.
Cause once you start messingwith the hormones, you're
messing with the cholesterol andyeah,
Tina (08:39):
True that.
Yes.
Yeah.
Yeah.
Yeah.
So some of the drugs liketamoxifen.
can cause cholesterol to go highand cause triglycerides to
deposit in the liver andactually cause dysfunction of
the liver over time.
So this, these things have to beweighed when people are taking
this drug for five years.
We know that it's, the benefitsoutweigh the risks for most
(09:02):
people, um, but over longerperiods of time, because they're
looking at 10 years and evenlonger now, you have to weigh
the.
risk for each individual forhigh cholesterol, liver
deposition of triglycerides, andblood clots because it does
increase blood clot risk in somepeople.
Leah (09:18):
right.
And cancer treatment itself putsa person at higher risk for
blood clots.
Tina (09:23):
Yeah.
As does the cancerous process.
So cancer, sometimes we know incertain cancers, especially if
it's extensive, if someone hasstage three and certainly stage
four, we have to be on thelookout for high clotting risk.
So people are more likely tohave a blood clot.
form, um, whether, you know, itforms in their lungs or legs or,
um, a stroke even, or a heartattack.
(09:45):
We have to be very mindful thatthat event can occur, not to be
a major downer, but it's justone of those things we need to
know, right?
You need to have it higher onyour list of possibilities.
Leah (09:55):
Arrhythmias or like.
You know, when your heart rhythmisn't what it's supposed to be.
it's when your heart is beatingirregularly.
and that is why with certaintreatments, you're getting EKGs
beforehand, um, echocardiogramsare another way of seeing how
your heart is functioning.
Um, so what I find interestingwith the arrhythmias, there are
(10:17):
medication warnings saying like,this may increase risk of long
QT syndrome.
And you're like, what does thatmean?
And that's seen on an EKG.
Um, so a lot of medications cancause that from medications
you're taking to decrease sideeffects to actual.
Cancer treatments.
And so, and then patients comein taking medications themselves
(10:40):
that may have that as apotential side effect.
And so that's kind of compounds,um, the risk.
Tina (10:46):
Yeah.
And this is something, I knowthat our fellow colleagues know
this very well, but I, just forthe.
People who are not medicallytrained out there, and EKG is
looking at the electricalimpulses through the heart and
can see arrhythmias through theelectrical impulse Now, this is
independent of your entirenervous system.
(11:06):
It is connected, but notdirectly, right?
So we have something calledheart rate variability, but
that's a whole notherconversation.
And when you're getting anechocardiogram, that's actually
looking at the plumbing.
So EKG is the electricianlooking at it, measuring it,
seeing what it looks like withelectrical flow and an echo or
(11:26):
echocardiogram is the plumbing,how much volume of blood is
coming out with each pump.
What does the blood look like asit goes from one part of the
heart to another part of theheart, right?
And so I just like to like provethat to people so that they kind
of understand what they'regetting tested or what it might
be.
The echocardiogram is somethingthat I think people probably
should get just to check ifthey're having any kind of
(11:49):
symptoms, if they're 5 and 10 oreven 15 years out from a drug
that was toxic to their heart.
It's one, it's higher on thelist, like get an
echocardiogram, make sure yourheart is pumping properly and
that the blood flow is reachingyour, your organs and your, your
limbs.
Leah (12:03):
And it, it's cool.
It's, it's an ultrasound of yourheart.
Like it's really kind of a coolthing to, to see.
Tina (12:09):
It's also like a measure of the strength of each pump,
right?
So the ejection fraction.
That's what it's called.
How much blood comes out witheach pump of the left ventricle
of your heart, that ejectionfraction has to be a certain
number, a percentage.
Because it doesn't pumpeverything that's in there, it
doesn't squeeze it completely.
completely clear.
So a healthy ejection fractionis 55%, for example.
(12:33):
And then if you get a treatmentthat's toxic to the heart and
that your 55 becomes 45 or 40 or35, don't despair because it's a
muscle.
You can build it back.
You can do things to improvethat function.
And this is routine for us innaturopathic medicine and other
integrative practitioners outthere.
Building back the heart musclewith proper diet, exercise, and
(12:56):
nutrients and supplements isvery, very doable.
That's why I call it moreresilient than a lot of other
organs.
You can see it measurably getbetter.
Leah (13:04):
And for people who have received Herceptin, that is
something that is checkedregularly.
And so they're familiar withgoing in and getting their
echoes to, to check that out.
So, um, you kind of touched oncardiomyopathy, which is damage
to the actual heart muscle, andthat can lead to congestive
(13:25):
heart failure.
Tina (13:26):
Yeah, there's different types of cardiomyopathy.
I won't go into those kind ofdetails, but the real danger
with cardiomyopathy iscongestive heart failure, which
is When your heart is no longercapable of pumping enough blood
for your function, right?
It's also an enlargement of theheart.
Sometimes this can be picked upon a routine x ray.
(13:47):
You go in because you have acough that won't go away.
You get a chest x ray and theycan see the heart shadow.
It looks a little enlarged andyou go on to get a further
workup from there.
So congestive heart failure issomething that happens usually
in the aging process or when theheart has a hard time pumping
against the wall.
So if someone has blood pressurethat's high and untreated,
(14:10):
eventually you getcardiomyopathy and that
cardiomyopathy can eventuallyevolve into congestive heart
failure.
So this is why you do want totreat a high blood pressure.
You don't want that to be, youknow, too high.
It's too stressful on the heartmuscle.
Leah (14:23):
So two other issues that can come up are myocarditis and
pericarditis.
Itis is never a good thing.
Tina (14:30):
Well, it is true.
Itis means inflamed, right?
It's inflammation.
So myocarditis is inflammationof the actual heart.
Cardiomyocytes, which are thecells that make up the muscle of
the heart, and pericarditis isinflammation of the membrane
that's around the heart.
So there's a nice kind of sackaround the heart and
(14:51):
pericarditis can happen as aside effect of some of these
treatments.
One that I was reminded of, andI had forgotten actually, is
aromatase inhibitors can causepericarditis.
And I have only seen that once,it can't be very common.
But I did see it once and Iremember it being in a woman who
had pretty severe side effectsotherwise from the aromatase
inhibitor.
Like most people would have quitit by then because it was, it
(15:13):
was incapacitating joint painthat she had and she stayed on
it.
And so when she came to see mein that first visit, she already
had really bad joints andpericarditis.
And so she finally had gottenoff the drug and wanted to know
what else she could do becauseshe had to get off the drug.
But only once.
So I, when I came across it inmy reading, I was like, Oh yeah,
that's a.
Rare, but real side effect for afew folks out there.
(15:35):
I call them rare, but realbecause, you know, it doesn't
help someone who's sufferingfrom a rare side effect to hear
that it's rare.
Leah (15:41):
Well, somebody's gotta be that one percent.
I mean, I had so many weirdstuff happen to me during my
treatment, and they're like, oh,this really doesn't happen.
This is really, really rare.
I'm like, what's gotta happen tosomebody?
Somebody's gotta be that onepercent.
Tina (15:52):
Yeah.
And then you, and then you kindof convince yourself that when
you hear rare, it means nothingto you now.
Right?
Leah (15:57):
Oh, absolutely.
Tina (15:58):
Yeah.
Yeah.
Cause that's, that's generallywhat happens.
People are like, I don't careabout the percentages.
So, you know, cause I'm alwaysthat 1%.
Leah (16:04):
Yeah, but if you have, like, hundreds of thousands of
people, it's And so I mean, 1percent is kind of a big number.
So anywho, um, there were somedrugs that we did not mention
that also can affect heartfunction.
So the tyrosine kinaseinhibitors.
So those are like the ones thatend with I.
B.
and I.
B.
the nibs tie curb is like.
(16:25):
One of the ones that is used inbreast cancer.
Um, and then you have the othertargeted therapies as well.
so some of these newer drugs aregreat, have fewer side effects
for some people, but then theycan also have, cardiovascular
side effects.
Tina (16:40):
Yeah.
That whole, especially in thetyrosine kinase inhibitors,
there's a class of them thatRight.
Act on VEGF, the vascularendothelial growth factors,
inhibitors.
Um, that class in particular islikely to have hypertension and
other cardiovascular riskfactors.
So, the big one we saw in clinicwas Avastin or Bevacizumab is
(17:05):
its generic
Leah (17:06):
Right,
Tina (17:07):
Since you want me to say generics, I'll say them.
So, I, I,
Leah (17:17):
I was trained to say generics and I'm making this
funny voice because Tina was oneof the people who trained me.
Tina (17:26):
I doubt I was a stickler for that though.
Leah (17:28):
Yeah.
You brought you, that wasn'tyour thing.
I just think it's funny that
Tina (17:32):
Um, and then the other class of drugs, I think, I don't
know if you mentioned this or,and I just wasn't paying
attention to you, which is
Leah (17:38):
you're listening to
Tina (17:40):
it's possible.
I was very busy for that 30seconds.
Um, the checkpoint inhibitordrugs.
Leah (17:50):
Oh no, I did not say that.
I was actually looking that upto see like, wait a minute.
I thought there was somethingelse.
That caused it.
And that's exactly what it was.
So
Tina (17:59):
So this is the PD 4 inhibitors, the whole checkpoint
inhibitor class.
They're all immune agents thatare being used to great success
in, depending on the cancer, 20to 40 percent of the people
getting it.
I shouldn't call it drugs.
They're really antibodies.
Leah (18:17):
yeah, I just kind of call everything drugs.
It's getting too complicated.
Um, and so I guess, I don'tthink we mentioned, do we, we've
talked briefly saying the wordradiation, but radiation is
another cause and it's radiationto the chest, to any, Where
close to the heart, um, so thereis a technique I know for
(18:37):
patients who are gettingradiation for breast cancer If
the radiation is going to gonear the heart, there are breath
holding techniques that kind ofdisplaces the heart Move it
aside to reduce that injury.
So, you know, if you have likeleft sided breast cancer and
getting radiation there areoften techniques used to of
reduce that risk.
Tina (18:57):
Yeah.
And I'm sure they're noteverywhere yet, but there are
fancier radiation machines thatfollow the breath so that
there's less toxicity to the, tothe heart,
Leah (19:07):
Okay, so let's take a break.
And when we come back, we'regoing to talk about supportive
treatments, both while gettingtreatment as well as afterwards.
And we'll mention a few cautionsand see where it goes.
Tina (19:19):
all right, let's do it.
All right, so we mentioned thatsome of the risk reduction
happens during treatment.
We mentioned some of it can bedone after treatment for repair
of any damage to the heart.
Should we just talk about it allin one fell swoop?
Leah (19:39):
Yeah, we'll kind of say like if something is used during
and or after.
Um, yeah.
So what are things that you haveused with, with your patients?
Tina (19:48):
So movement is good because it's a muscle, right?
So not using it means that it'snot going to get challenged and
you're not going to get repair.
Okay.
Leah (19:55):
So you're talking exercise.
Tina (19:56):
exercise.
Well, sometimes people don'tlike to hear the word exercise.
I'm fine with people just keep,just keep swimming, you know,
just keep swimming, just keep,just keep walking, just keep
moving.
Leah (20:06):
Walking, right?
And that helps with reducingyour risk of blood clots too,
because being sedentaryincreases your risk of blood
clots as, you know, not beinghydrated.
So make sure you're hydrating,especially if you're moving and
exercising.
Tina (20:20):
And at this point, look to see if the center you're at has
an actual exercise duringtreatment program.
A lot of them do now, especiallythe larger centers, but kind of,
I'm surprised some of thesmaller centers are getting this
in their departments too.
They're kind of like, there'scardiac, you know, the cardiac
department has their ownexercise.
exercise team.
A lot of the oncology centersare now getting an exercise team
(20:41):
together.
So there's that.
Put that in place.
Leah (20:44):
and I, I am making these funny faces at you, um, because,
um.
That is something that I helpedset up at the Cancer Center in
Northern Indiana.
Along with cardiopulmonary, weset that up for patients to be
referred to exercise programs totarget fatigue or whatever it
was, and that's really, reallyimportant.
Just don't go to like your localgym and talk to a trainer and
(21:06):
tell them what, because they'reThey don't know specific needs
of cancer patients.
Um, maybe they are a cancersurvivor.
They still don't know unlessthey've had specific training.
And so there are physicaltherapists, cardiopulmonary
therapists who have receivedtraining on the specific needs
of cancer patients.
And yeah, so where I wasworking.
(21:27):
Before I came back to Oregon wasa small cancer center.
It was not that big and they hadthe program.
So definitely check.
And if they don't have theprogram, talk about it a lot
until they start one.
Tina (21:38):
Exactly.
Yes.
A little grassroots movement.
And you and I talked to SarahCourt, the physical therapist
who has her own exercise duringtreatment program that's free
online and people can go backand we'll link to that episode
so people can find thatdiscussion if they're interested
in exercise specifics.
And then diet.
I mean, the base is always a lotof plants in the diet.
(21:59):
I would specifically say oliveoil for this reason, the heart
muscle.
is unique in that it uses,preferentially uses, fatty acids
for its fuel source.
So, unlike so many cells in yourbody, it's not really using
glucose preferentially, it'susing a lot of fatty acids.
(22:19):
And the fatty acid, one of themthat it prefers is the oleic
acid from olive oil.
So all these Mediterranean dietsthat are linked with lower
cardiovascular disease risk, itmay be as simple as you're
feeding the heart a preferredfuel.
every day of your life if youeat a Mediterranean diet because
it's so high in olive oil.
So I would put olive oil high onthe list no matter what
(22:41):
someone's background is or theirancestry is or what, you know,
their ancestors ate as far asfats.
Usually I use that as a guidefor fats and intake.
Um, in this case, when we'retalking about heart muscle, I
think the heart really wants totake in the fatty acids.
Leah (22:56):
So just a kind of a little tip, which I learned from a chef
about olive oil, because youdon't really want to heat olive
oil too high.
if you cook something with ahigher temperature oil, um, you
can go back and drizzle theolive oil on top of it.
And so you're getting the flavorof the olive oil and you're not
destroying all the, all of thebeneficial bits of it.
So that's just a little hot tip.
Tina (23:17):
Yeah, that's a, that's a good point just to get the other
nutrients that are in there.
Leah (23:21):
Speaking of nutrients, other nutrients that help to
support your heart that you canget through food, not
necessarily through supplements,but you can also get through
supplements.
Tina (23:29):
Um, The amino acid L carnitine is a complement to the
fatty acids that the heart uses.
So the carnitine is what thefats used to bring that fatty
acid into the mitochondria.
It needs that amino acidcarnitine.
It's also an amino acid you andI have talked about when it
comes to fatigue.
Fatigue during treatment and Lcarnitine is, is in foods, yes,
(23:52):
but you can also take it as asupplement, um, in a pretty good
dose.
Whenever I dose amino acids,whether it's carnitine or
another one, and I want, uh, toaffect someone's physiology, the
lowest dose I use is like 1.
5 grams, but I, and I go up tothree grams per day.
Actually in carnitine, I go upto four grams because there were
studies on four grams, butgenerally speaking,
Leah (24:14):
So yeah, what I was thinking for in terms of
nutrition that you would try toincrease more of the foods is
magnesium.
Tina (24:20):
Mm hmm.
Leah (24:21):
So magnesium is great.
Sometimes it's supplementingwith magnesium during treatment
can be a little precariousbecause people might have looser
stools, diarrhea, and magnesiumisn't.
So great for that because itwill just exacerbate it.
But, um, eating magnesium richfoods, nuts, seeds, dark leafy
greens, blending them if youdon't like them, throwing in
(24:43):
some blueberries, you know, tokind of mask the flavor.
But eating those magnesium richfoods is another good way of
supplementing your, your hearthealthy diet.
Tina (24:54):
Yeah, I totally agree.
Yeah, magnesium is, is really,it's one of those that's
commonly deficient too.
And so, the heart uses a lot ofcalcium and magnesium, and of
the two, magnesium is morelikely to be deficient.
Mostly because we have a giantcalcium storage.
And we have a skeleton, if wereally need it, we'll just pull
it out of, pull it out of ourbone.
Leah (25:14):
And, and we tend to eat calcium rich foods.
Tina (25:17):
after that, I use a lot of taurine.
Yeah.
taurine is another amino acid.
It's not an essential aminoacid.
Um, but it is consideredconditionally essential by some
people.
And taurine is, is, it's a multipurpose amino acid.
It does so many things.
It's calming to the brain.
It's good for the heart.
It's good for your gallbladderand your, um, digestive
(25:40):
processes and your bileproduction.
Um, it also, when it syncs upwith magnesium in your system,
it helps create the properamount of osmotic pressure in
your bloodstream.
So that's a nice thing to have,especially if you're low
protein.
What else does it do, Leah?
Leah (25:56):
It's anti inflammatory.
People might have heard oftaurine.
This is so random, um, becausedogs that are on, um, like the
no grain diets.
tend to get a lot of foods thathave legumes.
And so for some reason thatseems to displace the protein
that's in the meat of these,like, no grain diets.
That's what's one of the thingsthat they think is happening
with dogs.
(26:16):
Um, and so, yeah, it's affectingthe taurine.
So if you have dogs and they'refed, grain free diets, your vet
may have talked to you about therisks of your pet not getting
enough taurine.
But that's a complete aside andwe don't treat animals.
Um.
Tina (26:34):
Well, only our own.
Leah (26:36):
Only our own.
Yes.
but yeah, so another nutrientthat I like give patients
because it is something that'sfrequently used in the chronic
fatigue world is D ribose.
Tina (26:49):
Um, I've never gotten into D ribose.
Isn't that a funny thing?
I've never really used much ofit.
Leah (26:55):
That is funny, Tina.
Tina (26:57):
it's, been around a long
Leah (26:59):
if I had patients that were receiving Avastin.
They were fatigued becauseyou're on that for a long time.
It can cause fatigue and thenyou're just trying to protect
the heart in general.
I, that's when I would recommendit.
So it wasn't really necessarilyto address a cardiac issue after
it happened.
Tina (27:16):
Okay.
Leah (27:16):
It was more just like, you're really tired, you're
receiving a cardiotoxic drug.
Let's try some D ribose
Tina (27:22):
Yeah.
And after, after, well, there'sprobably a couple other
nutrients I might think about,you know, obviously, and I
haven't said it yet, so maybeit's not obvious, but, Um, omega
3 fatty acids.
So we have to make sure thatthere's some, there's adequate.
I wouldn't give it in largeamounts.
I think that, you know, adequateamounts, make sure people aren't
deficient.
(27:43):
I'm not a mega doser of theseomega 3 fatty acids or fish
oils.
Leah (27:47):
Eat your, eat your fatty fish if you like sardines.
Eat your sardines if you cantolerate them during treatment.
I loved my sardine salad duringtreatment Um, yeah, so any sort
of like, fatty cold water fish,right?
We've talked about this before,we have our whole omega three
episode, but yeah, any coldwater fish for those fisher
people out there, you know, haveit once a week if you can
(28:08):
tolerate it.
Tina (28:09):
Yeah.
And if you take a supplement,you don't have to take a mega
dose.
Um, you know, 500 milligrams.
You know, is, is it will keepyou from being deficient.
Leah (28:17):
there are a few more that we were going to mention.
Um, one is coenzyme Q10, which Ithink a lot of people think of
for the heart in general.
Um, it is kind of a more popularone.
I've had patients coming in,taking it.
Because maybe their doctor said,Oh, you're taking a statin.
You could take the coenzyme Q10along with it.
so yeah, CoQ10, coenzyme Q10,that is what powers the
(28:41):
mitochondria in your cells.
So it's kind of fueling thepowerhouse of your cells.
And like Tina mentioned, yourheart is a muscle.
There's a lot of mitochondria inmuscle and there's a ton in
heart muscle.
Tina (28:56):
Yeah.
You know, because 24 hours aday, seven days a week,
contract, relax, contract,
Leah (29:00):
It never takes a break.
It does not.
No.
Tina (29:04):
right?
It never takes a break.
It needs a lot of energy.
Leah (29:08):
there are some potential cautions with using CoQ10.
there's some question as towhether or not it can interact
with blood thinners.
Um, if someone is taking amedication for asthma,
Theophylline, which is not usedso much anymore, but there are
probably people out there whomay still be taking it.
that is anothercontraindication.
There was a study that came outin 2020 saying that the use of
(29:32):
CoQ10 and other antioxidantsalong, oh no, it was the use
before and during treatment forbreast cancer may have adverse
outcomes.
But for patients that weretaking antioxidants and CoQ10
during treatment without havingtaken it before, there were no
adverse outcomes.
So I don't know about thisstudy.
Tina (29:54):
That was, that's the one you mentioned to me before we
hit the record button and Ilooked at it and, uh, yeah, it's
an observational study with alot of problems.
Leah (30:03):
Not that many people were looked at and my favorite part
was reading the affiliations ofall of the people who
participated in the study.
So, anyways, we'll put a link tothat.
Y'all can look at it
Tina (30:14):
No, and you know, when people are getting treatment,
you stick to a few things thatyou know are going to be safe.
If there's even speculationabout something being harmful,
we just avoid it.
And again, the heart being asresilient as it is after
treatment is over, then we cando things like CoQ10.
Leah (30:30):
but there are alternatives to CoQ10 if you are told you
cannot take it.
Um, and that we have used withour patients.
And I would also say super highdoses aren't necessarily Good
for any of these supplements,except, well, you're saying with
the L carnitine, you use higherdoses, but that's what's what
was used in the study.
(30:50):
But, I mean, I've had patientstaking it very high doses of
CoQ10, and it's not necessary.
They don't have congestive heartfailure.
They're trying to use it toprevent something.
I don't know.
I think just caution with, withdosing is also, indicated.
Tina (31:04):
Yeah.
Yeah.
And we didn't even talk aboutthe complexities of cancer cell
metabolism.
And so that goes into mythinking when I'm seeing a
patient is what kind of cancerdo they have?
Are we concerned at all thatthat cancer also uses a pathway
that maybe we don't want to give600 milligrams of CoQ10 to that
particular patient because wedon't want the path of
(31:25):
respiration to be jacked up andsupported.
So there's, there's otherconsiderations that you'd have
to be seeing a practitioner whoknows metabolism really well to
know whether that's, you know,contraindicative in that level.
Leah (31:36):
something else that I used with patients more during my
residency than when I was at,Cancer treatment centers.
It's Hawthorne.
Hoth Your face just lit up! Butyeah, we would use the Hawthorne
extract that like, was it WiseWoman?
Tina (31:49):
Yes, wise woman had a solid extract.
Leah (31:51):
Yeah, and it tastes a little bit like prune paste.
Tina (31:55):
It's delicious! Don't
Leah (31:57):
bad, it's not bad.
Um, because it's
Tina (32:00):
it sound bad, it's delicious!
Leah (32:04):
because I'm just trying to remember we have some in the
fridge, I'm sure.
but yes.
Hawthorne extract.
And I know, yeah, I don't knowif this is the last thing we're
going to talk about, but I knowthis is Tina's favorite thing to
talk about.
Tina (32:15):
Well, cause I, I love tonic.
You know, these plants that areliterally tonifying an organ or
system is like the mostbeautiful thing in plant
medicine.
Hawthorne berries and Hawthorneleaves literally strengthen the
muscle of the heart.
So to the point where you cansee studies where people can
(32:35):
have improvements on theircardiovascular output.
So it's always in my mix.
I would say Hawthorne is alwaysin my mix, and taurine is always
in my mix when people havecardiomyopathy.
Magnesium is always in the mix.
There's certain ones that I'mjust like, those are definitely
going, you know, going to be onthe plan here because it's just
supporting the muscle of theheart in total.
Leah (32:56):
So there are contraindications to Hawthorne,
so talk with your pharmacist andsee if there's a medication
you're taking that, if you areconsidering taking Hawthorne,
because we're not recommendingit for you, but um, the one that
I remember learning that was thebiggest contraindication is if
somebody is taking digoxin.
So it can increase the effectsof the digoxin.
Tina (33:17):
Yes.
What's interesting is it'sreally not a drug interaction,
it's strengthening the heart soyou need less right?
So,
Leah (33:25):
but that's what a lot of these, these interactions, if
you look them up, it says itincreases the effect of the,
whatever drug it is.
So, but it is a, it is aninteraction according to your
doctor.
So,
Tina (33:37):
So in an ideal world, you get to take less of the, if
you're working with your doctorand you're watching your
medication, you can lower themedication because the actual
system is stronger andhealthier.
Leah (33:49):
but don't do it on your own and don't tell anyone we
told you to do it because wedidn't.
Tina (33:54):
I didn't tell you to do anything.
Leah (33:56):
No, and we're not making recommendations for you.
We're talking about what we dowith our patients.
Okay.
Tina (34:00):
and this was true of people on, um, high blood
pressure drugs too.
I really was very diligent abouthaving people take their blood
pressure at home and having itchecked in my office.
And there were times where we'dlowered their blood pressure
medication over time becausetheir system got better and
better.
They might've gotten more inshape and maybe they lost
weight, all sorts of reasonsyour blood pressure can go down
when you're healthier andhealthier.
(34:21):
So, um, it's important torealize that when you're on
medications and you're Thosemedications need to be checked
because if you are gettinghealthier, if you're eating
better and now you're exercisingand you're taking things that
improve systems that were not asefficient before, you may have
to adjust your medicationsaccordingly.
So you do need to work withsomeone or the prescribing
(34:41):
doctor, um, go back to thatperson and say, you know, do we
need to make any adjustments?
They'd be happy if you, if youimprove your blood pressure by
yourself and they could loweryour medication.
They will be amazed because itdoesn't happen very often.
Right?
Amaze your doctor.
Leah (34:57):
Anything else you wanted to add in?
Tina (34:59):
Um, just, I always talk about colors in general.
Anthocyanins, anthocyanidins.
So tomatoes, berries, anythingthat's very colorful is good.
And there's a few plants likehibiscus that are particularly
good for the heart.
Leah (35:13):
yeah, hibiscus is really nice and it also has a diuretic
Tina (35:16):
Mm hmm.
Right.
So if someone It needs adiuretic effect, then that's
there.
And the other very colorful,plant food is beets.
Beets improve circulation.
They, they cause the bloodvessels to relax a little bit,
and you get better perfusion oftissues, including the heart
muscle.
And beets are supportive for theliver as well.
So if you like beets, um, Ithink adding them to the diet is
(35:39):
a good idea too.
I think the only thing we didn'tmention that it can be done in
the diet is garlic.
Leah (35:44):
Hmm.
Tina (35:45):
Garlic is very good for your whole cardiovascular system
and it's, has an, an effect thatprevents clots from happening.
So it's, uh, if your fibrinogen,fibrinogen can be measured in
your, in your labs.
If that's high, then garlic ismore likely to be something
that's useful for that person.
Leah (36:03):
Yeah.
So again, if somebody is intreatment, just, you know, if
you can tolerate it, you know,Add it to sauces, you know,
different foods and then out oftreatment.
If you like garlic, then go forit.
Tina (36:16):
Yeah.
I think we touched on prettymuch everything.
I mean, I'm always.
I mean, you can name everynutrient and say, Oh, that's
involved in that's about likeassuming that someone doesn't
have any nutrient deficiency.
So they've got enough of the Bvitamins and vitamin D, et
cetera.
So I think I,
Leah (36:29):
Oh yeah, vitamin D is, you know, always important.
And, um, uh, another kind ofherbal food is, you know, green
tea.
Very supportive to the hearthealth.
Tina (36:41):
yeah,
Leah (36:41):
We could go on forever.
Tina (36:43):
was going to say, there's so many weights because it is a
muscle and we're, we're, we'resupporting it's, it's physiology
and it's, it's strength and itwith each pump of the heart.
I don't know if people realizethis.
I know every doctor does andevery nurse does, but you know.
Talking to non medical folks, Iwould say one of the cool things
is when you hear a heartbeat andyou hear the lub dub, lub dub,
lub dub, assuming it's normal,what you're hearing is the, the
(37:06):
closing of the valves.
They're snapping closed.
Lub dub, lub dub.
So it's, it's kind of a neatthought that what you're hearing
is the little valves closing upeach time.
Leah (37:16):
I find that sound to be so soothing.
Like I probably need one ofthose little baby things.
like sound monitor type thingsthat play the human heart.
I, I could listen to a heartforever.
I just, it's to me one of themost soothing sounds, listening
to that, that regular heartbeat.
Tina (37:33):
So we went through risk factors for heart toxicity.
And then we covered the types ofheart toxicity, so things like
arrhythmia, congestive heartfailure, and the treatments that
can cause it.
And then we went through somesupportive therapies, pretty
briefly, and maybe notexhaustively, but we covered the
high points.
Leah (37:53):
I think so.
Tina (37:54):
And I think the last thing, if people are listening
this long, thank you forsticking with us.
Ha ha
Leah (38:01):
Here's the true one and only thing that's going to work.
Tina (38:06):
No, what I want to remind people of is if you have had a
treatment that you know, and youcan look it up always, is, was
toxic to your heart, even if itwas 10 years ago or longer and
you have symptoms that could berelated, like fatigue.
exercise intolerance where the,like, you can't exercise as well
(38:26):
as you used to be able to, thatkind of thing.
You know, tell your primary carephysician, inform them, because
your health care practitionermay not have it top of mind.
They don't know exactly what yougot 10 years ago, always.
And so I just want to say thatfor self advocacy, you know, you
may have to be the oneremembering what happened to you
a decade ago or longer.
Leah (38:45):
Yeah.
If you're having really oddswelling in your lower, you
know, in your feet and yourankles, I mean, that's another
sign.
So yeah, definitely advocate foryourself.
I think that's one of the mainthings that we like to tell our
patients, as always, you want tofollow us on social media, where
the cancer pod on most socialmedia platforms, Wherever you
(39:09):
are listening to us, leave us arating, leave us a review.
Let us know what you liked aboutthis episode.
Let us know what you didn'tlike.
But be kind, please.
Tina (39:20):
Yeah, and Spotify lets us do little polls.
So if you see a poll on there,go ahead, vote.
We're, we're checking it out,you know, and it's fairly new to
the whole Spotify system, butthere'll always be a little
question on there.
Sometimes we make it up.
Sometimes Spotify does.
Leah (39:36):
And another way to support the podcast is we have a Buy Me
a Coffee.
It helps us to keep thiswonderful, podcast going, um,
and it helps us to pay ourbills, not our electric bill at
home, but more just the thingsthat we need to keep cranking
these out.
Tina (39:55):
Yep.
This fancy ring light that makesme look 20 years younger.
Leah (40:01):
Paid top dollar for that.
Tina (40:03):
That's right.
Leah (40:06):
On that note, I'm Dr.
Leah Sherman,
Tina (40:09):
And I'm Dr.
Tina Kazer.
Leah (40:11):
and this is the Cancer Pod.
Tina (40:12):
Until next time.
Thanks for listening to thecancer pod.
Remember to subscribe, reviewand rate us wherever you get
your podcasts.
Follow us on social media forupdates, and as always, this is
not medical advice.
These are our opinions.
Talk to your doctor beforechanging anything related to
your treatment plan.
The cancer pod is hosted by me,Dr.
(40:32):
Lea Sherman.
And by Dr.
Tina Caer music is by KevinMcLeod.
See you next time.
So the heart is a muscle all by itself, pumping 24 hours
a day, seven days a weekthroughout our entire lifespan.
And there are certain treatmentsthat specifically are toxic to
the heart muscle itself.
And Leah, I think you had one ofthem.
Leah (00:16):
Yes.
Tina (00:17):
What did you have?
Leah (00:18):
Well, two of them, right?
At AC.
Tina (00:21):
So, adriamycin and cyclophosphamide.
Leah (00:24):
Mm hmm.
Tina (00:24):
And adriamycin is also known as the red devil.
And so adriamycin causes notjust heart disease, Immediate
effects, when someone's gettingit, delayed effects, and does
that concern you at all?
Leah (00:37):
Oh, absolutely.
Oh, oh my god.
Oh my god.
Absolutely.
All the time, I think about it.
Because I also have a familyhistory of heart disease.
So, you know, cancer treatmentis the gift that keeps on
giving.
You know, it's like for all ofthe good that it does, there's
this kind of like threat
Tina (00:53):
Sequelae.
Leah (00:54):
sequelae, delayed side effects.
Tina (00:56):
We call them sequelae in medicine, but yes, most people
just call it a delayed sideeffect.
And specifically forcardiotoxicity or heart
toxicity, some of these drugsdon't really manifest any
symptoms until seven years, tenyears, down the line, where
people have fatigue.
I mean, that's usually the firstsymptom.
When the heart is not pumpingwell, people are tired.
Leah (01:16):
Yeah.
So I had some weird heartsymptoms that were happening, I
think back in like 2020, 2021.
And I underwent a stress testbecause that was my concern.
Right.
and yeah, they did the stresstest and they're like, you're
great.
Tina (01:28):
Well, that's good.
Leah (01:29):
like, have you ever done a heart stress test?
They're stressful.
Tina (01:33):
By design.
Leah (01:34):
I thought for sure I failed.
I thought for sure I failed.
Cause I was on that treadmilland I was like.
Wheezing practically, andthey're like, Oh, wow, you're
healthy.
I'm like, yes,
Tina (01:43):
All right, well, we will talk about what keeps the heart
healthy and how to make suresome of these side effects that
happen over time don't happen toour listeners.
I'm Dr Tina Kaczor and as Leahlikes to say I'm the science-y
one
Leah (01:55):
and I'm Dr Leah Sherman and on the cancer inside
Tina (01:59):
And we're two naturopathic doctors who practice integrative
cancer care
Leah (02:03):
But we're not your doctors
Tina (02:05):
This is for education entertainment and informational
purposes only
Leah (02:09):
do not apply any of this information without first
speaking to your doctor
Tina (02:14):
The views and opinions expressed on this podcast by the
hosts and their guests aresolely their own
Leah (02:20):
Welcome to the cancer pod
Tina (02:38):
Hi, Leah.
Leah (02:39):
hi, Tina,
Tina (02:39):
So in this episode, we're going to talk about
cardiotoxicity.
Leah (02:43):
heart toxicity.
Tina (02:44):
Specifically, we're going to talk about risk factors, you
know, what makes someone morevulnerable to toxicity of these
treatments.
And What treatments specificallyare associated with the highest
risk of damage to the heartmuscle itself and how to lower
one's risk.
So actively, what can people doin their self care and day to
day integrative medicineapproach?
(03:04):
And we're going to talk aboutsupplements and herbs, things
that we know work.
Leah (03:08):
we're also going to talk about things you can do during
treatment to decrease your risk.
Tina (03:12):
Yes.
Yep.
A little more controversial justbecause some cancer centers
don't allow people to do thingsduring treatment, but there are
some well evidenced approachesduring treatment that actually
lower your risk.
Leah (03:24):
Yeah.
So let's start with, um, some ofthe risk factors and I guess the
biggest risk factor, To somemight kind of be obvious, it's
your risk factor for havingcardiovascular disease in the
first place.
So like a history of smoking,high blood pressure, diabetes,
obesity, or just like I said,like having a history of heart
problems is going to make youmore likely to have heart
(03:44):
problems.
From your treatment.
Um, Age.
So, being over 60, it also canaffect really young children,
And then, being female.
Tina (03:55):
Yes.
Leah (03:56):
of the, one of the joys of being female.
Tina (03:59):
it to the list.
Leah (04:00):
Yeah, yeah, you know, it's a special perk.
and like you mentioned, likethere are certain drugs that
people receive.
So the one that I received, the,Adriamycin or doxorubicin, same
thing, getting high doses ofthat.
And that drug actually has alifetime limit of how much you
can receive because of thepotential for heart issues.
Tina (04:19):
In that class of drugs, anthracycline is dose dependent.
So the more you got fortreatment or the more you're
getting, the higher the risk ofheart toxicity.
Okay.
Leah (04:28):
Right.
And then combining thoseanthracyclines with radiation
therapy further amplifies it.
Tina (04:33):
Yes, and coupling it with another treatment that happens
to have some heart toxicity aswell.
So when you're doubling down,you're getting two agents for
your cancer.
They're anti cancer agents, butthey're also both toxic to the
heart.
And one that stands out in thatarena is Herceptin.
Leah (04:50):
Right.
So if you, which I don't reallythink it happens so much
anymore, but if you getAdriamycin, Red Devil, you get
the Red Devil and then youfollow that up with Herceptin.
Yeah.
But they don't really do that.
Tina (05:02):
No, not so much anymore because of that cardio toxicity,
but there could be listenersthat have gotten that in the
past.
Leah (05:08):
Absolutely.
Yeah.
Yeah.
And as you mentioned, like someof these side effects might not
occur until much later, but someof them happen actually as
people are getting treatments.
And The one that I think of mostoften that, that happens with is
Herceptin.
And part of that is because, Imean, people get Herceptin for
long periods of time.
Tina (05:27):
Mm hmm.
Leah (05:27):
They'll get it over the course of a year, typically with
breast cancer treatment, butsome people are on it for life.
Tina (05:33):
Yeah.
And, um, when we say Herceptin,we're using that drug as a
generic in that class.
So anything that's Herceptinlike, so Progetta is a newer
version of Herceptin.
Leah (05:43):
Yeah.
And you're giving, you're givingthe brand
Tina (05:45):
I am, because that's what people usually know.
I don't want to,
Leah (05:47):
Trastuzumab.
Tina (05:49):
yeah, if we want to say Terastuzumab, we can, but I
think it might be a little bitof a tongue twister.
First of all,
Leah (05:57):
Yeah.
For us.
Tina (05:58):
first of all, this is a podcast, so I don't really want
a tongue twist, but
Leah (06:01):
Yeah.
and the, the, the cardiotoxicityis it's varied.
It's everything from having highblood pressure, which also
happens with Herceptin.
I had to stop myself from sayingTrastuzumab, um, it also happens
with Herceptin and other drugstoo, right?
I mean, drugs that affect yourkidney are going to increase
your blood pressure.
Tina (06:22):
Yeah.
Right.
So when you're talking about theheart muscle, you've got direct
toxicities like theseanthracyclines, but you also
have, it's a system, you know,so anything that raises your
blood pressure puts pressure onthe heart because the reason
that happens is when you havehigh blood pressure with each
pump of the heart, you have topump the blood out against a
(06:42):
larger pressure and that canresult in a cardiomyopathy,
which is just a fancy word forheart damage.
So that can be direct or it canbe indirect through
hypertension.
So it'd be direct literally thatit's toxic to the cells, they
are damaged, and they may or maynot revive from the damage.
So What we're talking abouttoday is, you know, it's a
muscle.
The, the beauty of this is it isa muscle and it has a lot of
(07:05):
healing potential.
I always think of differentorgans in the body as having
different healing potentials.
When you have the heart muscleyou're talking about, it's got a
lot of inherent ability torepair damage.
So as long as you get it earlyenough and it's not completely
dead cells and they havepotential to heal.
Leah (07:23):
So one of the most commonly thought of
chemotherapies that damage thekidneys and can lead to heart
problems is cisplatin And that'scommonly, used in patients who
have lung cancer paired withradiation.
Tina (07:37):
Yeah, yeah, it's also commonly used for ovarian
cancer.
It's a, it's a really commonlyused chemo in general.
I mean, for the last, I don'tknow how many decades.
I mean, cisplatin has beenaround a very long time.
Leah (07:48):
Yeah.
And at the time of thisrecording, um, there is a
shortage of it as well.
Tina (07:53):
Yeah, that's a whole nother, gosh, that'll be an
interesting kind of, I don'twant to call it an expose, but
at least talk to people in theknow, um, when there are drug
shortages, how that is handledbehind the scenes.
Because I think that there's alot of, um, yeah, there's a lot
of unfortunate things thathappen when they have to figure
out who gets it and who doesn'tget the drugs.
Leah (08:12):
Right.
Um, okay.
So moving along the other thingsthat can happen, uh, high
cholesterol.
I'm kind of starting at like thelower end and then we're going
to work our way up.
Okay.
Tina (08:22):
I see.
Yeah.
Leah (08:24):
See, I'm not going to start with like the big, you
know, the big issues.
We're going to say highcholesterol, which is something
also that people don't thinkabout, especially the hormonal
agents, or I should say the antihormonal agents.
Cause once you start messingwith the hormones, you're
messing with the cholesterol andyeah,
Tina (08:39):
True that.
Yes.
Yeah.
Yeah.
Yeah.
So some of the drugs liketamoxifen.
can cause cholesterol to go highand cause triglycerides to
deposit in the liver andactually cause dysfunction of
the liver over time.
So this, these things have to beweighed when people are taking
this drug for five years.
We know that it's, the benefitsoutweigh the risks for most
(09:02):
people, um, but over longerperiods of time, because they're
looking at 10 years and evenlonger now, you have to weigh
the.
risk for each individual forhigh cholesterol, liver
deposition of triglycerides, andblood clots because it does
increase blood clot risk in somepeople.
Leah (09:18):
right.
And cancer treatment itself putsa person at higher risk for
blood clots.
Tina (09:23):
Yeah.
As does the cancerous process.
So cancer, sometimes we know incertain cancers, especially if
it's extensive, if someone hasstage three and certainly stage
four, we have to be on thelookout for high clotting risk.
So people are more likely tohave a blood clot.
form, um, whether, you know, itforms in their lungs or legs or,
um, a stroke even, or a heartattack.
(09:45):
We have to be very mindful thatthat event can occur, not to be
a major downer, but it's justone of those things we need to
know, right?
You need to have it higher onyour list of possibilities.
Leah (09:55):
Arrhythmias or like.
You know, when your heart rhythmisn't what it's supposed to be.
it's when your heart is beatingirregularly.
and that is why with certaintreatments, you're getting EKGs
beforehand, um, echocardiogramsare another way of seeing how
your heart is functioning.
Um, so what I find interestingwith the arrhythmias, there are
(10:17):
medication warnings saying like,this may increase risk of long
QT syndrome.
And you're like, what does thatmean?
And that's seen on an EKG.
Um, so a lot of medications cancause that from medications
you're taking to decrease sideeffects to actual.
Cancer treatments.
And so, and then patients comein taking medications themselves
(10:40):
that may have that as apotential side effect.
And so that's kind of compounds,um, the risk.
Tina (10:46):
Yeah.
And this is something, I knowthat our fellow colleagues know
this very well, but I, just forthe.
People who are not medicallytrained out there, and EKG is
looking at the electricalimpulses through the heart and
can see arrhythmias through theelectrical impulse Now, this is
independent of your entirenervous system.
(11:06):
It is connected, but notdirectly, right?
So we have something calledheart rate variability, but
that's a whole notherconversation.
And when you're getting anechocardiogram, that's actually
looking at the plumbing.
So EKG is the electricianlooking at it, measuring it,
seeing what it looks like withelectrical flow and an echo or
(11:26):
echocardiogram is the plumbing,how much volume of blood is
coming out with each pump.
What does the blood look like asit goes from one part of the
heart to another part of theheart, right?
And so I just like to like provethat to people so that they kind
of understand what they'regetting tested or what it might
be.
The echocardiogram is somethingthat I think people probably
should get just to check ifthey're having any kind of
(11:49):
symptoms, if they're 5 and 10 oreven 15 years out from a drug
that was toxic to their heart.
It's one, it's higher on thelist, like get an
echocardiogram, make sure yourheart is pumping properly and
that the blood flow is reachingyour, your organs and your, your
limbs.
Leah (12:03):
And it, it's cool.
It's, it's an ultrasound of yourheart.
Like it's really kind of a coolthing to, to see.
Tina (12:09):
It's also like a measure of the strength of each pump,
right?
So the ejection fraction.
That's what it's called.
How much blood comes out witheach pump of the left ventricle
of your heart, that ejectionfraction has to be a certain
number, a percentage.
Because it doesn't pumpeverything that's in there, it
doesn't squeeze it completely.
completely clear.
So a healthy ejection fractionis 55%, for example.
(12:33):
And then if you get a treatmentthat's toxic to the heart and
that your 55 becomes 45 or 40 or35, don't despair because it's a
muscle.
You can build it back.
You can do things to improvethat function.
And this is routine for us innaturopathic medicine and other
integrative practitioners outthere.
Building back the heart musclewith proper diet, exercise, and
(12:56):
nutrients and supplements isvery, very doable.
That's why I call it moreresilient than a lot of other
organs.
You can see it measurably getbetter.
Leah (13:04):
And for people who have received Herceptin, that is
something that is checkedregularly.
And so they're familiar withgoing in and getting their
echoes to, to check that out.
So, um, you kind of touched oncardiomyopathy, which is damage
to the actual heart muscle, andthat can lead to congestive
(13:25):
heart failure.
Tina (13:26):
Yeah, there's different types of cardiomyopathy.
I won't go into those kind ofdetails, but the real danger
with cardiomyopathy iscongestive heart failure, which
is When your heart is no longercapable of pumping enough blood
for your function, right?
It's also an enlargement of theheart.
Sometimes this can be picked upon a routine x ray.
(13:47):
You go in because you have acough that won't go away.
You get a chest x ray and theycan see the heart shadow.
It looks a little enlarged andyou go on to get a further
workup from there.
So congestive heart failure issomething that happens usually
in the aging process or when theheart has a hard time pumping
against the wall.
So if someone has blood pressurethat's high and untreated,
(14:10):
eventually you getcardiomyopathy and that
cardiomyopathy can eventuallyevolve into congestive heart
failure.
So this is why you do want totreat a high blood pressure.
You don't want that to be, youknow, too high.
It's too stressful on the heartmuscle.
Leah (14:23):
So two other issues that can come up are myocarditis and
pericarditis.
Itis is never a good thing.
Tina (14:30):
Well, it is true.
Itis means inflamed, right?
It's inflammation.
So myocarditis is inflammationof the actual heart.
Cardiomyocytes, which are thecells that make up the muscle of
the heart, and pericarditis isinflammation of the membrane
that's around the heart.
So there's a nice kind of sackaround the heart and
(14:51):
pericarditis can happen as aside effect of some of these
treatments.
One that I was reminded of, andI had forgotten actually, is
aromatase inhibitors can causepericarditis.
And I have only seen that once,it can't be very common.
But I did see it once and Iremember it being in a woman who
had pretty severe side effectsotherwise from the aromatase
inhibitor.
Like most people would have quitit by then because it was, it
(15:13):
was incapacitating joint painthat she had and she stayed on
it.
And so when she came to see mein that first visit, she already
had really bad joints andpericarditis.
And so she finally had gottenoff the drug and wanted to know
what else she could do becauseshe had to get off the drug.
But only once.
So I, when I came across it inmy reading, I was like, Oh yeah,
that's a.
Rare, but real side effect for afew folks out there.
(15:35):
I call them rare, but realbecause, you know, it doesn't
help someone who's sufferingfrom a rare side effect to hear
that it's rare.
Leah (15:41):
Well, somebody's gotta be that one percent.
I mean, I had so many weirdstuff happen to me during my
treatment, and they're like, oh,this really doesn't happen.
This is really, really rare.
I'm like, what's gotta happen tosomebody?
Somebody's gotta be that onepercent.
Tina (15:52):
Yeah.
And then you, and then you kindof convince yourself that when
you hear rare, it means nothingto you now.
Right?
Leah (15:57):
Oh, absolutely.
Tina (15:58):
Yeah.
Yeah.
Cause that's, that's generallywhat happens.
People are like, I don't careabout the percentages.
So, you know, cause I'm alwaysthat 1%.
Leah (16:04):
Yeah, but if you have, like, hundreds of thousands of
people, it's And so I mean, 1percent is kind of a big number.
So anywho, um, there were somedrugs that we did not mention
that also can affect heartfunction.
So the tyrosine kinaseinhibitors.
So those are like the ones thatend with I.
B.
and I.
B.
the nibs tie curb is like.
(16:25):
One of the ones that is used inbreast cancer.
Um, and then you have the othertargeted therapies as well.
so some of these newer drugs aregreat, have fewer side effects
for some people, but then theycan also have, cardiovascular
side effects.
Tina (16:40):
Yeah.
That whole, especially in thetyrosine kinase inhibitors,
there's a class of them thatRight.
Act on VEGF, the vascularendothelial growth factors,
inhibitors.
Um, that class in particular islikely to have hypertension and
other cardiovascular riskfactors.
So, the big one we saw in clinicwas Avastin or Bevacizumab is
(17:05):
its generic
Leah (17:06):
Right,
Tina (17:07):
Since you want me to say generics, I'll say them.
So, I, I,
Leah (17:17):
I was trained to say generics and I'm making this
funny voice because Tina was oneof the people who trained me.
Tina (17:26):
I doubt I was a stickler for that though.
Leah (17:28):
Yeah.
You brought you, that wasn'tyour thing.
I just think it's funny that
Tina (17:32):
Um, and then the other class of drugs, I think, I don't
know if you mentioned this or,and I just wasn't paying
attention to you, which is
Leah (17:38):
you're listening to
Tina (17:40):
it's possible.
I was very busy for that 30seconds.
Um, the checkpoint inhibitordrugs.
Leah (17:50):
Oh no, I did not say that.
I was actually looking that upto see like, wait a minute.
I thought there was somethingelse.
That caused it.
And that's exactly what it was.
So
Tina (17:59):
So this is the PD 4 inhibitors, the whole checkpoint
inhibitor class.
They're all immune agents thatare being used to great success
in, depending on the cancer, 20to 40 percent of the people
getting it.
I shouldn't call it drugs.
They're really antibodies.
Leah (18:17):
yeah, I just kind of call everything drugs.
It's getting too complicated.
Um, and so I guess, I don'tthink we mentioned, do we, we've
talked briefly saying the wordradiation, but radiation is
another cause and it's radiationto the chest, to any, Where
close to the heart, um, so thereis a technique I know for
(18:37):
patients who are gettingradiation for breast cancer If
the radiation is going to gonear the heart, there are breath
holding techniques that kind ofdisplaces the heart Move it
aside to reduce that injury.
So, you know, if you have likeleft sided breast cancer and
getting radiation there areoften techniques used to of
reduce that risk.
Tina (18:57):
Yeah.
And I'm sure they're noteverywhere yet, but there are
fancier radiation machines thatfollow the breath so that
there's less toxicity to the, tothe heart,
Leah (19:07):
Okay, so let's take a break.
And when we come back, we'regoing to talk about supportive
treatments, both while gettingtreatment as well as afterwards.
And we'll mention a few cautionsand see where it goes.
Tina (19:19):
all right, let's do it.
All right, so we mentioned thatsome of the risk reduction
happens during treatment.
We mentioned some of it can bedone after treatment for repair
of any damage to the heart.
Should we just talk about it allin one fell swoop?
Leah (19:39):
Yeah, we'll kind of say like if something is used during
and or after.
Um, yeah.
So what are things that you haveused with, with your patients?
Tina (19:48):
So movement is good because it's a muscle, right?
So not using it means that it'snot going to get challenged and
you're not going to get repair.
Okay.
Leah (19:55):
So you're talking exercise.
Tina (19:56):
exercise.
Well, sometimes people don'tlike to hear the word exercise.
I'm fine with people just keep,just keep swimming, you know,
just keep swimming, just keep,just keep walking, just keep
moving.
Leah (20:06):
Walking, right?
And that helps with reducingyour risk of blood clots too,
because being sedentaryincreases your risk of blood
clots as, you know, not beinghydrated.
So make sure you're hydrating,especially if you're moving and
exercising.
Tina (20:20):
And at this point, look to see if the center you're at has
an actual exercise duringtreatment program.
A lot of them do now, especiallythe larger centers, but kind of,
I'm surprised some of thesmaller centers are getting this
in their departments too.
They're kind of like, there'scardiac, you know, the cardiac
department has their ownexercise.
exercise team.
A lot of the oncology centersare now getting an exercise team
(20:41):
together.
So there's that.
Put that in place.
Leah (20:44):
and I, I am making these funny faces at you, um, because,
um.
That is something that I helpedset up at the Cancer Center in
Northern Indiana.
Along with cardiopulmonary, weset that up for patients to be
referred to exercise programs totarget fatigue or whatever it
was, and that's really, reallyimportant.
Just don't go to like your localgym and talk to a trainer and
(21:06):
tell them what, because they'reThey don't know specific needs
of cancer patients.
Um, maybe they are a cancersurvivor.
They still don't know unlessthey've had specific training.
And so there are physicaltherapists, cardiopulmonary
therapists who have receivedtraining on the specific needs
of cancer patients.
And yeah, so where I wasworking.
(21:27):
Before I came back to Oregon wasa small cancer center.
It was not that big and they hadthe program.
So definitely check.
And if they don't have theprogram, talk about it a lot
until they start one.
Tina (21:38):
Exactly.
Yes.
A little grassroots movement.
And you and I talked to SarahCourt, the physical therapist
who has her own exercise duringtreatment program that's free
online and people can go backand we'll link to that episode
so people can find thatdiscussion if they're interested
in exercise specifics.
And then diet.
I mean, the base is always a lotof plants in the diet.
(21:59):
I would specifically say oliveoil for this reason, the heart
muscle.
is unique in that it uses,preferentially uses, fatty acids
for its fuel source.
So, unlike so many cells in yourbody, it's not really using
glucose preferentially, it'susing a lot of fatty acids.
(22:19):
And the fatty acid, one of themthat it prefers is the oleic
acid from olive oil.
So all these Mediterranean dietsthat are linked with lower
cardiovascular disease risk, itmay be as simple as you're
feeding the heart a preferredfuel.
every day of your life if youeat a Mediterranean diet because
it's so high in olive oil.
So I would put olive oil high onthe list no matter what
(22:41):
someone's background is or theirancestry is or what, you know,
their ancestors ate as far asfats.
Usually I use that as a guidefor fats and intake.
Um, in this case, when we'retalking about heart muscle, I
think the heart really wants totake in the fatty acids.
Leah (22:56):
So just a kind of a little tip, which I learned from a chef
about olive oil, because youdon't really want to heat olive
oil too high.
if you cook something with ahigher temperature oil, um, you
can go back and drizzle theolive oil on top of it.
And so you're getting the flavorof the olive oil and you're not
destroying all the, all of thebeneficial bits of it.
So that's just a little hot tip.
Tina (23:17):
Yeah, that's a, that's a good point just to get the other
nutrients that are in there.
Leah (23:21):
Speaking of nutrients, other nutrients that help to
support your heart that you canget through food, not
necessarily through supplements,but you can also get through
supplements.
Tina (23:29):
Um, The amino acid L carnitine is a complement to the
fatty acids that the heart uses.
So the carnitine is what thefats used to bring that fatty
acid into the mitochondria.
It needs that amino acidcarnitine.
It's also an amino acid you andI have talked about when it
comes to fatigue.
Fatigue during treatment and Lcarnitine is, is in foods, yes,
(23:52):
but you can also take it as asupplement, um, in a pretty good
dose.
Whenever I dose amino acids,whether it's carnitine or
another one, and I want, uh, toaffect someone's physiology, the
lowest dose I use is like 1.
5 grams, but I, and I go up tothree grams per day.
Actually in carnitine, I go upto four grams because there were
studies on four grams, butgenerally speaking,
Leah (24:14):
So yeah, what I was thinking for in terms of
nutrition that you would try toincrease more of the foods is
magnesium.
Tina (24:20):
Mm hmm.
Leah (24:21):
So magnesium is great.
Sometimes it's supplementingwith magnesium during treatment
can be a little precariousbecause people might have looser
stools, diarrhea, and magnesiumisn't.
So great for that because itwill just exacerbate it.
But, um, eating magnesium richfoods, nuts, seeds, dark leafy
greens, blending them if youdon't like them, throwing in
(24:43):
some blueberries, you know, tokind of mask the flavor.
But eating those magnesium richfoods is another good way of
supplementing your, your hearthealthy diet.
Tina (24:54):
Yeah, I totally agree.
Yeah, magnesium is, is really,it's one of those that's
commonly deficient too.
And so, the heart uses a lot ofcalcium and magnesium, and of
the two, magnesium is morelikely to be deficient.
Mostly because we have a giantcalcium storage.
And we have a skeleton, if wereally need it, we'll just pull
it out of, pull it out of ourbone.
Leah (25:14):
And, and we tend to eat calcium rich foods.
Tina (25:17):
after that, I use a lot of taurine.
Yeah.
taurine is another amino acid.
It's not an essential aminoacid.
Um, but it is consideredconditionally essential by some
people.
And taurine is, is, it's a multipurpose amino acid.
It does so many things.
It's calming to the brain.
It's good for the heart.
It's good for your gallbladderand your, um, digestive
(25:40):
processes and your bileproduction.
Um, it also, when it syncs upwith magnesium in your system,
it helps create the properamount of osmotic pressure in
your bloodstream.
So that's a nice thing to have,especially if you're low
protein.
What else does it do, Leah?
Leah (25:56):
It's anti inflammatory.
People might have heard oftaurine.
This is so random, um, becausedogs that are on, um, like the
no grain diets.
tend to get a lot of foods thathave legumes.
And so for some reason thatseems to displace the protein
that's in the meat of these,like, no grain diets.
That's what's one of the thingsthat they think is happening
with dogs.
(26:16):
Um, and so, yeah, it's affectingthe taurine.
So if you have dogs and they'refed, grain free diets, your vet
may have talked to you about therisks of your pet not getting
enough taurine.
But that's a complete aside andwe don't treat animals.
Um.
Tina (26:34):
Well, only our own.
Leah (26:36):
Only our own.
Yes.
but yeah, so another nutrientthat I like give patients
because it is something that'sfrequently used in the chronic
fatigue world is D ribose.
Tina (26:49):
Um, I've never gotten into D ribose.
Isn't that a funny thing?
I've never really used much ofit.
Leah (26:55):
That is funny, Tina.
Tina (26:57):
it's, been around a long
Leah (26:59):
if I had patients that were receiving Avastin.
They were fatigued becauseyou're on that for a long time.
It can cause fatigue and thenyou're just trying to protect
the heart in general.
I, that's when I would recommendit.
So it wasn't really necessarilyto address a cardiac issue after
it happened.
Tina (27:16):
Okay.
Leah (27:16):
It was more just like, you're really tired, you're
receiving a cardiotoxic drug.
Let's try some D ribose
Tina (27:22):
Yeah.
And after, after, well, there'sprobably a couple other
nutrients I might think about,you know, obviously, and I
haven't said it yet, so maybeit's not obvious, but, Um, omega
3 fatty acids.
So we have to make sure thatthere's some, there's adequate.
I wouldn't give it in largeamounts.
I think that, you know, adequateamounts, make sure people aren't
deficient.
(27:43):
I'm not a mega doser of theseomega 3 fatty acids or fish
oils.
Leah (27:47):
Eat your, eat your fatty fish if you like sardines.
Eat your sardines if you cantolerate them during treatment.
I loved my sardine salad duringtreatment Um, yeah, so any sort
of like, fatty cold water fish,right?
We've talked about this before,we have our whole omega three
episode, but yeah, any coldwater fish for those fisher
people out there, you know, haveit once a week if you can
(28:08):
tolerate it.
Tina (28:09):
Yeah.
And if you take a supplement,you don't have to take a mega
dose.
Um, you know, 500 milligrams.
You know, is, is it will keepyou from being deficient.
Leah (28:17):
there are a few more that we were going to mention.
Um, one is coenzyme Q10, which Ithink a lot of people think of
for the heart in general.
Um, it is kind of a more popularone.
I've had patients coming in,taking it.
Because maybe their doctor said,Oh, you're taking a statin.
You could take the coenzyme Q10along with it.
so yeah, CoQ10, coenzyme Q10,that is what powers the
(28:41):
mitochondria in your cells.
So it's kind of fueling thepowerhouse of your cells.
And like Tina mentioned, yourheart is a muscle.
There's a lot of mitochondria inmuscle and there's a ton in
heart muscle.
Tina (28:56):
Yeah.
You know, because 24 hours aday, seven days a week,
contract, relax, contract,
Leah (29:00):
It never takes a break.
It does not.
No.
Tina (29:04):
right?
It never takes a break.
It needs a lot of energy.
Leah (29:08):
there are some potential cautions with using CoQ10.
there's some question as towhether or not it can interact
with blood thinners.
Um, if someone is taking amedication for asthma,
Theophylline, which is not usedso much anymore, but there are
probably people out there whomay still be taking it.
that is anothercontraindication.
There was a study that came outin 2020 saying that the use of
(29:32):
CoQ10 and other antioxidantsalong, oh no, it was the use
before and during treatment forbreast cancer may have adverse
outcomes.
But for patients that weretaking antioxidants and CoQ10
during treatment without havingtaken it before, there were no
adverse outcomes.
So I don't know about thisstudy.
Tina (29:54):
That was, that's the one you mentioned to me before we
hit the record button and Ilooked at it and, uh, yeah, it's
an observational study with alot of problems.
Leah (30:03):
Not that many people were looked at and my favorite part
was reading the affiliations ofall of the people who
participated in the study.
So, anyways, we'll put a link tothat.
Y'all can look at it
Tina (30:14):
No, and you know, when people are getting treatment,
you stick to a few things thatyou know are going to be safe.
If there's even speculationabout something being harmful,
we just avoid it.
And again, the heart being asresilient as it is after
treatment is over, then we cando things like CoQ10.
Leah (30:30):
but there are alternatives to CoQ10 if you are told you
cannot take it.
Um, and that we have used withour patients.
And I would also say super highdoses aren't necessarily Good
for any of these supplements,except, well, you're saying with
the L carnitine, you use higherdoses, but that's what's what
was used in the study.
(30:50):
But, I mean, I've had patientstaking it very high doses of
CoQ10, and it's not necessary.
They don't have congestive heartfailure.
They're trying to use it toprevent something.
I don't know.
I think just caution with, withdosing is also, indicated.
Tina (31:04):
Yeah.
Yeah.
And we didn't even talk aboutthe complexities of cancer cell
metabolism.
And so that goes into mythinking when I'm seeing a
patient is what kind of cancerdo they have?
Are we concerned at all thatthat cancer also uses a pathway
that maybe we don't want to give600 milligrams of CoQ10 to that
particular patient because wedon't want the path of
(31:25):
respiration to be jacked up andsupported.
So there's, there's otherconsiderations that you'd have
to be seeing a practitioner whoknows metabolism really well to
know whether that's, you know,contraindicative in that level.
Leah (31:36):
something else that I used with patients more during my
residency than when I was at,Cancer treatment centers.
It's Hawthorne.
Hoth Your face just lit up! Butyeah, we would use the Hawthorne
extract that like, was it WiseWoman?
Tina (31:49):
Yes, wise woman had a solid extract.
Leah (31:51):
Yeah, and it tastes a little bit like prune paste.
Tina (31:55):
It's delicious! Don't
Leah (31:57):
bad, it's not bad.
Um, because it's
Tina (32:00):
it sound bad, it's delicious!
Leah (32:04):
because I'm just trying to remember we have some in the
fridge, I'm sure.
but yes.
Hawthorne extract.
And I know, yeah, I don't knowif this is the last thing we're
going to talk about, but I knowthis is Tina's favorite thing to
talk about.
Tina (32:15):
Well, cause I, I love tonic.
You know, these plants that areliterally tonifying an organ or
system is like the mostbeautiful thing in plant
medicine.
Hawthorne berries and Hawthorneleaves literally strengthen the
muscle of the heart.
So to the point where you cansee studies where people can
(32:35):
have improvements on theircardiovascular output.
So it's always in my mix.
I would say Hawthorne is alwaysin my mix, and taurine is always
in my mix when people havecardiomyopathy.
Magnesium is always in the mix.
There's certain ones that I'mjust like, those are definitely
going, you know, going to be onthe plan here because it's just
supporting the muscle of theheart in total.
Leah (32:56):
So there are contraindications to Hawthorne,
so talk with your pharmacist andsee if there's a medication
you're taking that, if you areconsidering taking Hawthorne,
because we're not recommendingit for you, but um, the one that
I remember learning that was thebiggest contraindication is if
somebody is taking digoxin.
So it can increase the effectsof the digoxin.
Tina (33:17):
Yes.
What's interesting is it'sreally not a drug interaction,
it's strengthening the heart soyou need less right?
So,
Leah (33:25):
but that's what a lot of these, these interactions, if
you look them up, it says itincreases the effect of the,
whatever drug it is.
So, but it is a, it is aninteraction according to your
doctor.
So,
Tina (33:37):
So in an ideal world, you get to take less of the, if
you're working with your doctorand you're watching your
medication, you can lower themedication because the actual
system is stronger andhealthier.
Leah (33:49):
but don't do it on your own and don't tell anyone we
told you to do it because wedidn't.
Tina (33:54):
I didn't tell you to do anything.
Leah (33:56):
No, and we're not making recommendations for you.
We're talking about what we dowith our patients.
Okay.
Tina (34:00):
and this was true of people on, um, high blood
pressure drugs too.
I really was very diligent abouthaving people take their blood
pressure at home and having itchecked in my office.
And there were times where we'dlowered their blood pressure
medication over time becausetheir system got better and
better.
They might've gotten more inshape and maybe they lost
weight, all sorts of reasonsyour blood pressure can go down
when you're healthier andhealthier.
(34:21):
So, um, it's important torealize that when you're on
medications and you're Thosemedications need to be checked
because if you are gettinghealthier, if you're eating
better and now you're exercisingand you're taking things that
improve systems that were not asefficient before, you may have
to adjust your medicationsaccordingly.
So you do need to work withsomeone or the prescribing
(34:41):
doctor, um, go back to thatperson and say, you know, do we
need to make any adjustments?
They'd be happy if you, if youimprove your blood pressure by
yourself and they could loweryour medication.
They will be amazed because itdoesn't happen very often.
Right?
Amaze your doctor.
Leah (34:57):
Anything else you wanted to add in?
Tina (34:59):
Um, just, I always talk about colors in general.
Anthocyanins, anthocyanidins.
So tomatoes, berries, anythingthat's very colorful is good.
And there's a few plants likehibiscus that are particularly
good for the heart.
Leah (35:13):
yeah, hibiscus is really nice and it also has a diuretic
Tina (35:16):
Mm hmm.
Right.
So if someone It needs adiuretic effect, then that's
there.
And the other very colorful,plant food is beets.
Beets improve circulation.
They, they cause the bloodvessels to relax a little bit,
and you get better perfusion oftissues, including the heart
muscle.
And beets are supportive for theliver as well.
So if you like beets, um, Ithink adding them to the diet is
(35:39):
a good idea too.
I think the only thing we didn'tmention that it can be done in
the diet is garlic.
Leah (35:44):
Hmm.
Tina (35:45):
Garlic is very good for your whole cardiovascular system
and it's, has an, an effect thatprevents clots from happening.
So it's, uh, if your fibrinogen,fibrinogen can be measured in
your, in your labs.
If that's high, then garlic ismore likely to be something
that's useful for that person.
Leah (36:03):
Yeah.
So again, if somebody is intreatment, just, you know, if
you can tolerate it, you know,Add it to sauces, you know,
different foods and then out oftreatment.
If you like garlic, then go forit.
Tina (36:16):
Yeah.
I think we touched on prettymuch everything.
I mean, I'm always.
I mean, you can name everynutrient and say, Oh, that's
involved in that's about likeassuming that someone doesn't
have any nutrient deficiency.
So they've got enough of the Bvitamins and vitamin D, et
cetera.
So I think I,
Leah (36:29):
Oh yeah, vitamin D is, you know, always important.
And, um, uh, another kind ofherbal food is, you know, green
tea.
Very supportive to the hearthealth.
Tina (36:41):
yeah,
Leah (36:41):
We could go on forever.
Tina (36:43):
was going to say, there's so many weights because it is a
muscle and we're, we're, we'resupporting it's, it's physiology
and it's, it's strength and itwith each pump of the heart.
I don't know if people realizethis.
I know every doctor does andevery nurse does, but you know.
Talking to non medical folks, Iwould say one of the cool things
is when you hear a heartbeat andyou hear the lub dub, lub dub,
lub dub, assuming it's normal,what you're hearing is the, the
(37:06):
closing of the valves.
They're snapping closed.
Lub dub, lub dub.
So it's, it's kind of a neatthought that what you're hearing
is the little valves closing upeach time.
Leah (37:16):
I find that sound to be so soothing.
Like I probably need one ofthose little baby things.
like sound monitor type thingsthat play the human heart.
I, I could listen to a heartforever.
I just, it's to me one of themost soothing sounds, listening
to that, that regular heartbeat.
Tina (37:33):
So we went through risk factors for heart toxicity.
And then we covered the types ofheart toxicity, so things like
arrhythmia, congestive heartfailure, and the treatments that
can cause it.
And then we went through somesupportive therapies, pretty
briefly, and maybe notexhaustively, but we covered the
high points.
Leah (37:53):
I think so.
Tina (37:54):
And I think the last thing, if people are listening
this long, thank you forsticking with us.
Ha ha
Leah (38:01):
Here's the true one and only thing that's going to work.
Tina (38:06):
No, what I want to remind people of is if you have had a
treatment that you know, and youcan look it up always, is, was
toxic to your heart, even if itwas 10 years ago or longer and
you have symptoms that could berelated, like fatigue.
exercise intolerance where the,like, you can't exercise as well
(38:26):
as you used to be able to, thatkind of thing.
You know, tell your primary carephysician, inform them, because
your health care practitionermay not have it top of mind.
They don't know exactly what yougot 10 years ago, always.
And so I just want to say thatfor self advocacy, you know, you
may have to be the oneremembering what happened to you
a decade ago or longer.
Leah (38:45):
Yeah.
If you're having really oddswelling in your lower, you
know, in your feet and yourankles, I mean, that's another
sign.
So yeah, definitely advocate foryourself.
I think that's one of the mainthings that we like to tell our
patients, as always, you want tofollow us on social media, where
the cancer pod on most socialmedia platforms, Wherever you
(39:09):
are listening to us, leave us arating, leave us a review.
Let us know what you liked aboutthis episode.
Let us know what you didn'tlike.
But be kind, please.
Tina (39:20):
Yeah, and Spotify lets us do little polls.
So if you see a poll on there,go ahead, vote.
We're, we're checking it out,you know, and it's fairly new to
the whole Spotify system, butthere'll always be a little
question on there.
Sometimes we make it up.
Sometimes Spotify does.
Leah (39:36):
And another way to support the podcast is we have a Buy Me
a Coffee.
It helps us to keep thiswonderful, podcast going, um,
and it helps us to pay ourbills, not our electric bill at
home, but more just the thingsthat we need to keep cranking
these out.
Tina (39:55):
Yep.
This fancy ring light that makesme look 20 years younger.
Leah (40:01):
Paid top dollar for that.
Tina (40:03):
That's right.
Leah (40:06):
On that note, I'm Dr.
Leah Sherman,
Tina (40:09):
And I'm Dr.
Tina Kazer.
Leah (40:11):
and this is the Cancer Pod.
Tina (40:12):
Until next time.
Thanks for listening to thecancer pod.
Remember to subscribe, reviewand rate us wherever you get
your podcasts.
Follow us on social media forupdates, and as always, this is
not medical advice.
These are our opinions.
Talk to your doctor beforechanging anything related to
your treatment plan.
The cancer pod is hosted by me,Dr.
(40:32):
Lea Sherman.
And by Dr.
Tina Caer music is by KevinMcLeod.
See you next time.
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