Diarrhea: The Return of Side Eff@¢ks!

Tina 0:00

welcome to episode 25 of the cancer pod. In this episode, we're talking about diarrhea, loose stools, and ways to address them. I'm Dr. Tina Kaczor And as Leah likes to say, I'm the science-y one

Leah 0:13

And I'm Dr. Lee Sherman and I'm the cancer insider,

Tina 0:17

and we're to naturopathic doctors who practice integrative cancer care.

Leah 0:21

But we're not your doctors

Tina 0:23

This is for education, entertainment, and informational purposes only.

Leah 0:28

do not apply any of this information without first speaking to your. doctor

Tina 0:32

The views and opinions expressed on this podcast by the hosts and their guests are solely their own.

Leah 0:39

Welcome to the cancer pod. Hey, Tina. Hi, Leah. So I'm wondering if we should do like a content warning for this episode. I don't know if people would be kind of sensitive about talking about diarrhea

Tina 1:08

Yeah. I think we're desensitized as naturopaths.

Leah 1:12

Yeah. Cause we talk about poop all the time and we didn't do a content warning for constipation, but yeah, if you're like, Grossed out from talking about bodily functions. This might be an episode that you skip

Tina 1:24

or we'll just, we will be gentle. We're not gonna be graphic.

Leah 1:27

No, but we're just talking about, it's like, like with the vomiting episode, just by saying the word sometimes

Trigger Warning- Diarrhea is discussed throughout this episode

Leah 1:32

that triggers people. So this is your trigger warning. All right. That's it. So this is the third episode in our side-effects pod. And. Uh, first one, we covered kind of the basics on why bowel changes happen. And then our second one was about constipation. And now we're talking about diarrhea, the flip side, the flip side. Yeah. So what is. What do you do about it? Integratively? What do you do about it? You know, from the pharmaceutical or over the counter standpoint. And then we end this episode with not only our song, but our moment of

Tina 2:09

whoa. Great. Yeah. And we'll go, we'll go through diarrhea and loose stool. We should just say loose stool. Cause it really. That's when you start to treat it, don't you think? I mean, you don't wait for overt diarrhea if you can help it,

Leah 2:21

but people define it differently. So diarrhea is defined as being loose or watery stools three or more times

Diarrhea- Defined

Leah 2:29

a day. So back in the first episode, when you talk about kind of that milkshake, consistency that happens as the stool moves into the large intestine, basically. Water isn't being absorbed out of that and it continues to pass. Then there you go. That's your diarrhea. So yeah. Looser, watery, stools, yes. With frequency.

Tina 2:54

Yes. So that is the definition of diarrhea

Leah 2:56

that opposite. See, I just, I just fit that in,

Tina 3:00

slipped it in there. Well, and I want to just say acute diarrhea is considered. Less than two weeks of diarrhea and chronic diarrhea is two weeks or more if it's lasting longer than

Leah 3:11

two weeks. Right. And you know, there are patients who will enter treatment with this being a chronic condition, you know, like. It's just something that they've managed and lived with. It's the same with constipation. Like you, that's kind of your baseline. And so that's really, when, we want to be really proactive because the treatments aren't going to, I mean, sometimes they'll shift you to the other way, but you know, you

Diarrhea- Consequences of not controlling it

Leah 3:34

just want it. You want to stay on top of it because again, diarrhea is one of those side effects that treat. Can be held doses can be reduced because of the consequences of the symptom.

Tina 3:47

One of the largest consequences besides actual pain identification, which can happen with diarrhea is the electrolyte issue, right? Like losing your electrolytes more quickly than you're replacing them would be the big, one of the big consequences which can lead to spasms and weakness. Low sodium can present as weak legs. For example.

Leah 4:07

Yeah, so people become dehydrated because that all that fluid is just coming out. And so staying on top of hydration, not only, you know, with water, but we'll go into more, um, of other ways of replenishing what gets lost.

Tina 4:21

Let's take a break and come back with some details on what people can do about it.

Leah 4:25

Perfect.

Tina 4:28

Did you know that your stool is mostly composed of water? After that most of the solid part of your stool is actually bacteria. What you often hear referred to as the microbiota of your gut.

Leah 4:45

So in our first episode, we kind of touched on why. Bell change has happened. And we, it was just kind of a general overview, but I guess we can quickly

Diarrhea- Causes

Leah 4:53

review some causes of diarrhea during treatment.

Tina 4:57

Yeah. Yeah. The most obvious causes the treatment itself

Leah 5:01

rapidly dividing cells,

Tina 5:03

right? Some treatments will list diarrhea as a side effect of that treatment. And some of them are chemotherapies. If you're getting any radiation to the. In particular, um, that can cause diarrhea.

Leah 5:16

Oh, if you get radiation to your spine in a location that is on the other side of your gut, I think that's something also people don't really expect or if for prostate cancer patients, the GYN cancers to cervical cancer, that's a big side effect.

Tina 5:33

Yeah. So if there's radiation hitting anywhere along the GI tract, whether intentionally or due to the radiation field, including the GI tract, whether it's the pelvis or the abdomen, And then surgery, short bowel syndrome could be an issue or just a portion of the GI tract has been removed due to the cancer, right?

Leah 5:54

Like just even for people who have had gallbladder surgery or anything that would affect the pancreas where you would not have enzymes that help to process your food. And then the targeted therapies was a big one, as well as the colitis that could happen with immunotherapy. Right. And

Tina 6:10

then lastly is some cancers they're not common, but there are some cancers that present with

Leah 6:16

right. The carcinoid. Yeah. Yeah. And then I guess ultimately, you know, the changes to the microbiome, right?

Tina 6:22

Yeah. It's always going to be a consequence. The microbiome will change during

Leah 6:25

treatment. Right. and that would also be like infection. So something like C diff you know, Present in a lot of people. And then with treatment, it gets out of balance and then it becomes really, you know, difficult to treat an important to treat issue. So,

Tina 6:43

yes. So first off, try to pursue the cause of the diarrhea so that you can treat the cause if that is possible or at least know how to manage it with keeping the cause in mind. And then afterwards there can be. Abnormalities and your endocrine function, their auto-immune reactions that have been triggered.

Leah 7:00

There's all sorts of reasons. So when you're saying endocrine, you're talking about like thyroid issues. Yeah. Yeah. So the point is back down to the people talk.

Tina 7:10

Yes. So follow up with primary care physician, it's important to keep a primary care physician as part of your care team, so that when treatment is over, if you have lingering symptoms, that's the most appropriate person to address lingering symptoms after. Whether it's diarrhea or anything else, right? Not

Leah 7:27

your oncologist, even though we all do go back to our oncologist and talk to them about those things. Cause we probably see them more often than we do our primary care. This is

Tina 7:36

true. This is true. But studies suggest. Bringing in and keeping a primary care physician, you get better

Leah 7:43

outcomes. I'm just thinking like you see your oncologist like every three months or so. And then, you know, like, right. It's a lot of doctors. I know. I'm just, I'm just saying I'm just, I'm just here to keep it real.

Diarrhea- Integrative medicine treatments

Leah 7:55

Okay. So, um, what to do integratively, what are the things that we think of with, with the patient who has diarrhea? So we've ruled out infection. 'cause that would be like C-Diff. And then for that they're getting antibiotics.

Tina 8:11

Um, so yeah, after managing the hydration aspect and making sure that lots of fluids are going in and sometimes intravenous fluids are required, the diarrhea is severe avoiding anything that's going to trigger. It is probably the most obvious thing to do first. So lay low on dried fruits, fruits, and general fruit juices. Caffeine things that are stimulating to the bowels, dairy, dairy, even if you tolerated it before treatment. So sometimes people during treatment can have that damage to the upper GI

Leah 8:40

area

Tina 8:40

that normally helps you break down lactose in the dairy. If you don't break that lactose down with your lactase enzymes, then that will lead to loose stools. And that can be transient. It will heal eventually,

Leah 8:53

but dairy is a big trigger because of that damage. Yeah. Yeah. The brat diet is a really popular thing that people will hear have probably heard of it even before going through treatment. But that's bananas white rice. Applesauce and toast like burnt toast, kind of really toasty toast. And, um, that is kind of like the staple, the Bret diet don't use brown rice that has too much fiber. You got to use the white rice and that can help to slow down the bells as well. And you touched on the hydration.

Dehydration- Rehydration options

Leah 9:28

Um, I commonly recommend cause everyone kind of reaches for Gatorade and I don't know really if Gatorade has the right balance of electrolytes, but it's popular and it's out there. I tend to steer patients towards. Pedialyte, I prefer them to do the flavor lists, but if, if they want the flavored, if that's what they tolerate better, that's fine. Um, I also really like the fact that Pedialyte has the Pedialyte pops, which are like in these little plastic sleeves, they look like those Otter pops that you used to get when you're a kid and they're brightly. And sometimes that's just easier to tolerate because of the, you know, it does have strong artificial flavor, but it's frozen and it's just, it's a little comforting. It's easier on patients.

Tina 10:12

Yeah. That's a good point. And then the, I often steer people towards the oral rehydration salts as well, which is the official kind of world health organization packet formula that has. A significant amount of sodium potassium. And it does have glucose because it's important. It's not just important. It's essential to have some glucose alongside the sodium, because the way we have. Sodium in our small intestine is that it's transported into the cells and into our system, right. Alongside glucose. So that's called a sodium glucose co-transporter and without the glucose, this is why you can't drink sea water. Sea water would give you diarrhea because that sodium will come out the other end because there's no glucose alongside it. Not to mention that's a huge dose of sodium, but in any case you need the glucose. And I say that because I feel like there's a lot of in the natural foods. Electrolyte formulas that do not put glucose in because they don't want sugar on their label. And if they don't put that in, then the sodium's not going to get absorbed. So it's not going to be as valuable. Pedialyte for example.

Leah 11:21

Right. And you'll see, it'll say dextrose, on the Pedialyte label, I believe, but, yeah, and that always made me wonder about those kind of electrolyte drinks, the ones that don't have sugar at all, they have like artificial sugars in them for people who have, issues with their blood sugar. I'm just wondering How those work, I mean, are they working entirely? So it's just something to think about. No, they don't. Well, there you go. They don't work. Okay. No, they don't work. You're just drinking gross salty blue drink. Yeah. So, so yeah, so, so do be mindful, especially if you do have blood sugar issues that you will need some glucose to really process that. I mean, you can still replenish with the other electrolytes, but it just might not be as effective.

Tina 12:05

Yeah. And you can always remember to salt your foods and either use no salt, which is a potassium. No salt is potassium instead of sodium. It's the stuff that they sell in the store is a grocery store is when people don't want to be doing a lot of sodium in their diet. Um, that's a possibility. And then there's foods that are high in potassium. Like avocados are a classic

Leah 12:26

example, white potatoes. I know people always think about bananas, but white potatoes, avocados, most lagoon. I don't know if you really want to eat legumes, though, if you're having diarrhea, just cause of all that fiber

Fiber- Is soluble or insoluble better?

Leah 12:38

that's true, which brings us to fiber. we talked about fiber in the first episode, you want to look at soluble fibers because that kind of slows things down, soluble slows. And so oats, I think of oatmeal as like. Uh, good soluble

Tina 12:55

fiber. Yeah. And this goes back to knowing why you have loose stools or diarrhea, because if it is due to irritation of your colon, if there is a level of colitis or even if there has been a removal of part of the colon, either way, the insoluble fibers are not going to be well tolerated. So Metamucil, psyllium, and just inside will fibers from foods. So the peels of things. Part that's not soluble. The fibers sources that are irritating to the lining will definitely be contra-indicated in anyone with any kind of irritation of their GI tract and particular the colon if they have diarrhea.

Leah 13:33

So yeah, so the inside of the apple, so the apple sauce without the skins, like if you have a friend who brings you over homemade applesauce with skins, that would not be helpful. Um, probiotics are the big thing that people think of and, you know, it's, I think that. Our good brands of probiotics. It's just so hard to say, like which ones specifically, because of the different strains and Saccharomyces boulardii is a really popular one that I've seen used for antibiotic induced diarrhea. And it can be really helpful, but if you're going through active treatment, I do caution. patients, because there are risks with it. Patients who are older, if they are receiving enteral nutrition, if they are immunosuppressed, you know, they have neutropenia, or if there's any sort of inflammation of the GI tract, like whether it's from surgery or from the cancer. there have been cases of people who have

Probiotics- Benefits & Risks

Leah 14:30

sepsis after taking Saccharomyces boulardii. So it's just a caution.

Tina 14:36

I'm sorry. I just want to clarify, when you say sepsis, you mean the sacrifice he's boulardii makes it into their bloods. Yeah, what's

Leah 14:42

it? Um, it's fungemia I think it's called because

Tina 14:45

Saccharomyces boulardii is a fungus technically. Yeah, it's a

Leah 14:49

yeast. Yeah. It's related to sacrifices survey CA which makes beer ferments. So, yeah, so it can leak into the bloodstream and it can cause people to be really sick. We had a hospitalist, um, where I worked lasted. He had seen several cases of that. So, yeah, it's just something to keep in mind.

Tina 15:11

Yeah. And that's interesting because that translocation of any organism, whether it's lactobacilli, Saccharomyces any organism, other types of yeasts that can translocate in that means it goes from either the mouth of the GI tract somewhere where it's contained in the. Into the bloodstream, which causes a sepsis. Sepsis is basically infection your blood. That is usually due to a combination of. Immune suppression and the ability to translocate, meaning there's some kind of neither mucositis stomatitis like you said,

Leah 15:42

irritation or right. Inflammation of the GI track. Yeah. It just, there's a little passageways. And so again, that's why if a patient is taking probiotics, with their therapy, They are told that they are neutropenic. They need to stop, you know, if they start to feel feverish and they start to feel the symptoms of having low white blood cells, um, which would be fever and you know, all of that. So, so they would stop taking the probiotics as well.

Tina 16:07

Right. So just so it's clear, these are rare

Leah 16:10

events. But it's just, it's something, I mean, neutropenia is not necessarily,

Tina 16:15

why don't you manage a peanut? The sepsis is a rare

Leah 16:18

event. Oh yeah, yeah, yeah. No, these infections are not common, but they have happened. And so it's just better to be cautious. Yeah. So stopping medications, speaking of stopping

Medications/Supplements- that may worsen diarrhea

Leah 16:29

supplements, you know, there are certain medications that people take day to day, they came and taken their MiraLax and they suddenly have diarrhea from treatment. And they don't think about their. The thing that they take all the time to manage their bowels, you know, stopping certain medications, stopping supplements, like magnesium, vitamin C, anything that has that affect the bowel effect. Oh, that reminds me of a story. Okay. Tell a story, Tina,

Tina 16:55

it was during my residency and I was reviewing supplements with a patient who had unrelenting diarrhea. It was bad. She had seen GI specialists. She was sent to me to help out with it. And I looked through her records and all I did was take her supplement history and she was taking a huge amount of magnesium. And my point was she had like seen other people who just didn't do a thorough enough intake and looked at every item that she was putting in her mouth closely. Noticed it, anyone would have noticed it, any nurse or doctor pharmacists would have noticed it. If they had taken a thorough history and seeing how much she was taking, but everyone just kind of wrote off, she's taking a magnesium supplement. They didn't see that she was taking an immense amount of it.

Leah 17:36

So why was she taking a huge amount? I don't remember. Oh yeah. I mean, I would see magnesium and I would just like, be like it. Okay. Yeah, because that is something that you commonly see, someone's taking magnesium for some other issue. They don't think of it with their bowels. It never affected their bowels before the treatment changes and all of a sudden, the dam breaks, so right. Yeah. Immediately stop any of those things. Anything else that we, we think about, um, to be mentioned slippery on, I think we mentioned it in a previous episode, slippery Elm is one of those, herbs that can. Help with either diarrhea or constipation just depends on how much you take

Tina 18:18

Yeah. So slippery Elm, sometimes prebiotics can be helpful again, depending what the cause is of the diarrhea. So if it is because of the microbiome shifting and just. You know, reasons, not no actual physical issue, like colitis or surgical consequence, then something as simple as prebiotics, like large, a rabbinical lacked hands, which are a prebiotic that you can get

Leah 18:44

in a powder. Yeah. And you know that for some reason, I just thought of sometimes if there's an obstruction, People experienced diarrhea. So because it's just that small little passageway, if there's a partial obstruction in their bowels. And so the only thing that gets through is the liquid. So whether the obstruction is from impaction of stool or if it's a tumor that actually can present itself as, as diarrhea. So for somebody who's like, oh, I'm so constipated, you know, and now I have diarrhea that that could be why. So I think that's another kind of consideration. To keep in the back of your mind. There's also, um, charcoal that was looked at for one specific chemotherapy for, with and that's a whole protocol. That was something that we would use for patients.

Tina 19:35

And the T can is also called CPT 11. So just for the listeners out of.

Leah 19:42

So let's see, I think that's, that's probably. It's probably it, you mentioned the foods to avoid the fatty foods, spicy foods, anything that would trigger it, taking antibiotics, you know, if somebody takes antibiotics for any sort of infection, it could trigger, um, as well.

Adsorbants- How they help & some cautionary notes

Tina 20:00

Yeah. And I want to say when there is almost like an acidity. When it's exiting, someone can feel some acidic aspect. Sometimes that can be because the food is going through so quickly. Your beer bile acids are fairly acidic. So stool, a normal pH of stool is around six give or take. And if it goes through and it comes out and more acidic, you're going to notice. At the exit and that

Leah 20:24

will be irritating. So if you, if you have burning poop, if you have burning diarrhea,

Tina 20:29

I'm trying not to gross people out

Leah 20:30

if your poop stings, when it comes out. Yeah. Think that maybe you're having rapid

Tina 20:34

transit. Yes. And the one thing that can prevent that as petroleum at the time. To protect the tissue until you figure out how to get it, you know, improve the, the absorption. And that's where the charcoals come in handy in these adsorbents, whether it's whatever the source is that you're going to adsorb with those soluble fibers

Leah 20:54

and the, you know, there is caution with. And, you know, we'll talk about more of the, over the counter stuff next, but there's caution with those things like charcoal and, um, and different fibers, in terms of interfering with the absorption of oral medications. And so being careful not to take them, alongside and then also, um, yeah, charcoal, I wouldn't recommend. Charcoals use to like absorb poisons. And so it's not something that I would recommend for just regular diarrhea, because I don't know. I just feel like it there's always potential for it to interfere with something.

Tina 21:32

Oh, as far as oral agents

Leah 21:33

or other drugs. Like if you, if you're getting diarrhea from taking an oral agent, that's I wouldn't look at those adsorbents. Does that bring us to our next segment? That the that's the lead in for the next segment? We're going to talk about. Pharmaceuticals and over the counter stuff. Right. So

Tina 21:50

yes, the other side.

Leah 21:52

Fiber rich foods have some combination of both soluble and insoluble fibers. If you're trying to slow down your. try oatmeal, barley and bananas, soluble fiber foods also are supportive for heart health and help regulate blood sugar.

Tina 22:09

All right. So of course there's plenty of medications that are used for diarrhea as well, both over the counter, as well as

Leah 22:16

prescriptive. Yeah. So these are the things, cause you're always mentioning about like commercials for pharmaceutical stuff and I don't ever see those commercials, but these are commercials from like my childhood that I remember. Right. So, let's start with like the antisecretory. Medications. And so those are like bismuth, which is Pepto-Bismol the classic. And yeah, my caution with Pepto-Bismol is it can turn your stool black and it can also have turned her tongue black. Right. It's good to remember, which could be freaky.

Medications- Over The Counter (OTC)

Leah 22:52

Yeah. Yeah. So, so that's, that's a little heads up about that. we also have already kind of touched on the ad absorbents, which is the activated charcoal, but there's also Kaopectate, So that's another one that kind of just kinda like stuck. Whatever's going on in the gut. And then, um, the antimotility agents would be like Loperimide, which is Imodium, which is another common one that patients will take. And then just, yeah,

Tina 23:20

I was just gonna say, I think that's the most common one that I've seen prescribed here.

Leah 23:25

Yeah. And the caution with Imodium is it can send you in the other direction, depending on how you take it. So taking it as prescribed by either, you know, your doctor or the nurse who recommends it, you know, there is a certain way of taking it, a protocol. So making sure that you, you know, you follow that so that you're not sending yourself into constipation. And then yeah, there are the prescriptions I think of like Lomotil, which is it's has atrazine in it. And so that's, that is another medication. Um, and I may have mentioned this already. I can't remember. I know I wanted to mention this, but like my, my bit of advice is going into treatment to have. Imodium on hand and having, you know, a couple of different kinds of laxatives on hand, because you don't know which way it's going to go. And then once it happens, especially with the diarrhea part, like you want to make sure that you don't have to get out and go to the drug store. You already have it as part of your, your kit, your chemo kit.

Tina 24:25

Right.

Diarrhea stories- Lactose, Carcinoid & Fruit

Tina 24:26

So I know I keep coming back to figuring out the source of the diarrhea or loose stool, but it's probably because of my experience with so many people and assuming it was one thing, and it turns out to be another, I had a patient many moons ago who had unrelenting diarrhea, but she also had a cancer that caused diarrhea.

audioTinaKaczor63615270325 24:46

it was a carcinoid tumor This can cause. The excretion of a lot of bile acid it was fairly well managed, but not well managed enough to have a normal life. She still had to stay home every morning until 11 or 12 before she could really start her day. So it was, it was pretty consequential. in any case we managed as best we could. We managed the GI doctor We did everything possible. We removed dairy one day unbenounced to me this entire time, she was an avid consumer of dairy products. And I said, well, take out the dairy and see what happens. And don't, you know? she was actually lactose intolerant the entire time. And this was about three years of lactose intolerance. That was undiagnosed. And unfortunately I too didn't repeat. I didn't go back and ask and probe more because I also assumed it was a consequence of her cancer, like everyone else. And so it took us longer than, than it should have to figure it out.

audioTheCancerPod53615270325 25:44

And there are certain foods when someone has a carcinoid tumor that needs to be avoided. But I don't know if dairy is one of them.

audioTinaKaczor63615270325 25:51

No, It's not.

audioTheCancerPod53615270325 25:52

It's not. Yeah. oh, you know, and then that also lends itself to that has its own. treatment. Octreotide is used for patients with carcinoid, but yeah, carcinoid could be really, tricky because It's a symptom of the cancer and it can be hard to manage, but then, you know, people are more than just cancer, right. They're complex. And so they've got other things going on as well. Yeah. That's, that's a tough one. that was a good catch.

audioTinaKaczor63615270325 26:16

Well, this is why I probably am someone who rounds back and says, look at the cause. And even when you think, you know the cause if what you're doing, isn't working, given that causation, you know, I kind of have this thing in my, my head. It's a little Diddy that goes reassess, reassess, put your ego to the test.

audioTheCancerPod53615270325 26:33

Yeah. I find that. Yeah, the first place I'll go. If it's, some sort of mysterious onset of. diarrhea. I immediately go to, what are they taking? That they start something new, even like a change in the diet. You know, you get somebody who suddenly starts like doing green juices with all the fiber in there. And that can, that can definitely move your bowels. And so just really, you know, playing detective, being an investigator and it might not be the treatment. It could be a number of other things.

audioTinaKaczor63615270325 27:03

Yeah. Don't give up, if you're doing something that should work and it doesn't work, you have to round back and say, what else could it possibly be? And just be a little bit dogging and unrelenting, and that can be helpful. And there are times that, there is nothing but management, you know, and I think of the. Post resection, you know, when a good part of the colon is removed, it's very difficult to control loose stools because there's not enough. there's just not enough time for the body to, or length of colon to re absorb the water. that's in the stool. So that, that becomes more of a management issue. A lot of the time.

audioTheCancerPod53615270325 27:36

So your story reminds me of a patient that had a mysterious onset of diarrhea. And after going through her medications and her supplements and, checking for any change in diet, she was like, you know what, I've been eating a lot more fruit and she ate like a bag of cherries and that's what CA that's what did it. And so,

audioTinaKaczor63615270325 27:58

Yeah.

audioTheCancerPod53615270325 27:58

Sometimes it's something where it's like, yeah, I changed my diet. I'm like eating all these fiber filled foods that can send you so caution about those cherries.

audioTinaKaczor63615270325 28:07

All right. So

Moment of Woo- Castor oil packs

audioTinaKaczor63615270325 28:08

does this bring us to our moment of woo.

audioTheCancerPod53615270325 28:11

Yeah. We have a song and we have a moment of womb. So let's start with a moment of whoop, which we haven't done it a lot. So I feel like I'm a little out of practice, but, okay. So for those who are just joining us moment of Wu is something that more like folklore or traditional medicine. I try to find some sort of science to back it up. So today's moment of woo is castor oil pack. Castor oil packs are, something that we learn how to do in naturopathic school. And you take like a cotton or linen or towel. And you saturate that with castor oil, which you could find in the drug store. They're applied to the abdomen. you can apply it kind of like over the rib cage, like kind of on the right side where the liver is, and then you can apply it over the actual, lower abdomen, if there's constipation and then some sort of heat sources put on top, whether it's a low level heating pad or a hot water bottle, and you just kind of sit back and you relax for a short period of time and it's supposed to help with constipation. you can also rub castor oil on your belly and then get into a hot tub. And it's supposed to have the same effect, heat isn't apparently needed for it to be effective, but people often like that feeling, I don't necessarily have patients apply it over any area where there's a malignancy. and that's just, I think that's just something I learned in school. And so I just run with it. But, Castro oil itself is derived from a plant from the castor bean. And it's something that is found in cosmetics. Like, you'll see it on the ingredient list and lipstick. And then it's also used internally as a laxative. So if you're taking castor oil and you have a sudden onset of diarrhea, Stop that, and it's also used to stimulate labor. midwives have used that kind of a fun fact is it's used in paclitaxel, which is a chemotherapy used for ovarian cancer, as well as breast cancer. And it's known as crema for crema for, I'm not sure how to pronounce it, but it's the delivery system for the drug. And so. A lot of drugs are commonly bound to something to carry it to where it needs to be. And in paclitaxel, that is what it's bound to. And that's what causes the allergic reaction that people can have when, when getting the drug.

audioTinaKaczor63615270325 30:35

Yes.

audioTheCancerPod53615270325 30:35

And in terms of studies, I couldn't find an actual study. I found the abstract on looking at the effect of castor oil packs in an elderly population at these restrooms in Turkey. And they monitored the patients for seven days prior to doing the castor oil pack three days during and four days after. And.

Leah 31:00

About 80% of the study participants had reported constipation for 10 years or longer. And applying castor oil packs didn't have any effect on how many bowel movements or how much they were passing through, but it decreased what was known as the feces consistency score. And so it lessens straining as they were passing their bowel movements. And it also helped with. Feeling of incomplete evacuation.

audioTinaKaczor63615270325 31:26

Okay.

audioTheCancerPod53615270325 31:26

So, yeah, I don't have access to any of the methods or anything, but, um, that was the only study. Well, there was another study that I found, which was, I think, through the Edgar Casey Institute. I can't remember what it's called now, but Edgar Casey is, he was a faith healer in psychic, in the 1920s and he really popularized the use of castor oil packs. And so. They had looked to see if there was any sort of way that the castor oil was actually being absorbed. And that was the kind of mechanism of action for it helping. And when applied externally castor oil, didn't, have the same. By-product that is excluded when taken internally. So through your urine, if you take castor oil internally, there is this a poxy di carboxylic acid that's excreted. And that was not found when it was done. Topically. Okay. Thought was well, maybe because transdermal drugs don't go through first-pass liver metabolism as they do when they're orally taken. And so maybe that's why it wasn't excreted in the urine, but they were just trying to figure out is this being absorbed?

audioTinaKaczor63615270325 32:38

Which is funny because Edgar Casey was a faith healer, so they shouldn't have to try to prove it. if they was his people doing it, it's kind of funny that they were looking for evidence when all he needed was faith.

audioTheCancerPod53615270325 32:48

Yeah. And you know, it was like I said, I mean, they only had three volunteers who are familiar with using castor oil packs. And so it was, I wouldn't even, I, would put study in quotes.

audioTinaKaczor63615270325 32:58

yeah, I was just going to say that deserve some air quotes. study.

audioTheCancerPod53615270325 33:02

Yeah. And so, you know, a caution with castor oil packs, other than, you know, my caution with using the heat over malignancy would be, it can be irritating to the skin.

audioTinaKaczor63615270325 33:12

the Edgar Casey brand of castor oil is that heritage that has that.

audioTheCancerPod53615270325 33:17

Oh, that's what the Institute is. The heritage Institute. That's who did the study?

audioTinaKaczor63615270325 33:20

They still sell that brand of castor oil.

audioTheCancerPod53615270325 33:23

Yeah, I know that. Yeah. So Edgar Casey also had a thing, apparently like when I was little, I think my sister read a book about him and he would sleep with his ear on his elbow. Like his elbow bent in his ear, on his elbow to like, kind of get information through osmosis. He'd have like a book underneath his pillow. I think that was at Casey. Anyways. We don't have to include the story, but it doesn't work. I just want to tell you it doesn't work. I tried it. and just a little aside just for working with any oils, because castor oil is so thick. it's really hard to clean out a fabric. When we learned about it in school, we would advise people to kind of wrap saran wrap around the pack, you know, to try to keep it from getting on clothing or sheets and put an old t-shirt. They don't care about over the pack. Um, you can use baking soda To take out the oil, you know, just apply that immediately to whatever gets all oil. These are my Martha Stewart tips.

audioTinaKaczor63615270325 34:18

I'm laughing because I'm not sure we convinced anyone to actually do the pack.

audioTheCancerPod53615270325 34:21

I'm just saying no, I'm just saying it's, it's a good thing. I'm sure that I'm sure that, you know, Gwyneth Paltrow's talked about it and people are doing it. Who knows, or maybe she hasn't done it yet and she's going to listen to us and she's going to be like, I'm going to talk about this. People use it because they, they use it for detoxification and.

Leah 34:39

That's not what we're doing here. We're trying to, we're trying to detoxify by having people poop.

audioTinaKaczor63615270325 34:45

Right,

audioTheCancerPod53615270325 34:46

So don't use this. If you have diarrhea, this is for constipation.

The unofficial theme song is announced

audioTinaKaczor63615270325 34:50

right.

audioTheCancerPod53615270325 34:50

Are you ready for the song?

audioTinaKaczor63615270325 34:52

so ready for the song?

audioTheCancerPod53615270325 34:54

Okay. You got to get the, you got to get the duck ready because I can't say the name of it without getting.

audioTinaKaczor63615270325 34:59

yes. So to avoid the explicit rating for the podcasts, we don't allow any

audioTheCancerPod53615270325 35:05

No bad words.

audioTinaKaczor63615270325 35:06

profanities. Yes.

audioTheCancerPod53615270325 35:07

Yeah. So the unofficial theme song for this episode is by L seven. from the 1992. Bricks are heavy and the song is sht list.

audioTinaKaczor63615270325 35:20

All right.

audioTheCancerPod53615270325 35:21

So it doesn't really have to do with poop. Other than you got to list, you're going to be put on it.

audioTinaKaczor63615270325 35:25

Okay. So it's not about diarrhea, but it is about a shit list.

audioTheCancerPod53615270325 35:29

Yeah. I mean, when I get mad and I get pissed, I grabbed my. And I write out a list and you know who it was on that list, diarrhea. I just changed the lyrics.

audioTinaKaczor63615270325 35:41

Okay. Got it.

audioTheCancerPod53615270325 35:42

So, yeah. So that's, that's, that's the song. It's an awesome song. They were a great band. So that's our song. we've pretty much come to the end of our pod are side effects, pod, our side effects, pod, for, you know, for the family crowd. remember to. Subscribe, wherever you listen to podcasts, subscribe to our podcast and leave a review. We are getting these awesome comments on Instagram and leave it where you, where you listen

audioTinaKaczor63615270325 36:12

Yes,

audioTheCancerPod53615270325 36:14

so that other people can read it. And then they want to listen to.

audioTinaKaczor63615270325 36:17

That's right. Telephone.

audioTheCancerPod53615270325 36:19

Share it on social media and we are on social media. We're on Facebook, Twitter. And like I mentioned, we're on the Instagram, so, and on Tik TOK, but I never do anything on Tik TOK.

audioTinaKaczor63615270325 36:29

I'm not on most of them.

audioTheCancerPod53615270325 36:30

I know. Well, well I'm, I am as the CA we are Tina. We are, as the cancer pod, we are on. on the talk on the ticket talk.

audioTinaKaczor63615270325 36:40

We're on the tick-tock. Huh? So all these crazy things. I think in my head, I could put a video too and go viral.

audioTheCancerPod53615270325 36:47

Yeah, I think we're going to have to start putting the corgi and videos because that's the only way we're going to go viral.

audioTinaKaczor63615270325 36:52

I think the viral. videos have to do with the core. You're getting along with something it's not supposed to get along with like a hamster.

audioTheCancerPod53615270325 36:57

and you know, if you like what you hear, you can also buy as a cough. So the link should be in our show notes as usual. And it's basically a way to support the podcast if you like us. And it will help us hopefully be able to hire an editor and a producer, maybe someone to run the social media and just let us focus more on.

audioTinaKaczor63615270325 37:21

That's right. Want to reach a lot of people? That's the goal.

audioTheCancerPod53615270325 37:24

So, yeah, you can buy us a coffee. I like Americano decaf please.

audioTinaKaczor63615270325 37:30

I'm an Americano fan myself.

audioTheCancerPod53615270325 37:32

Oh, twinsies two Americanos please. 16 ounce.

audioTinaKaczor63615270325 37:36

Oh no. 12 ounce. extra room. Sorry.

audioTheCancerPod53615270325 37:38

Oh man. 16 ounce, no room. Boom. Okay, there you go. That's our order. And on that note, Um, Dr. Leah Sherman,

audioTinaKaczor63615270325 37:48

And I'm Dr. Tina Kaeser

audioTheCancerPod53615270325 37:50

and this is the cancer pod.

audioTinaKaczor63615270325 37:52

until next time.

audioTheCancerPod53615270325 38:38

We don't have to include the story