Who's In Your Pod? Chanchal Cabrera, The Medical Herbalist

Tina: 0:00

I know that you and I have this in common we both were inspired to pursue naturopathic medicine because of plant medicine, because of herbalism.

Leah: 0:08

Oh, absolutely, absolutely. There is that herb shop in the East Village that used to be there back in the 80s, and I would just go in and try to learn about it as much as I could. And yeah, that's completely what brought me to naturopathic medicine.

Tina: 0:21

Yeah, For me it was a small book by Michael Tierra called The Way of Herbs. I have that book. I still have it.

Leah: 0:28

You still have it. I think so. I think that's the one. Yeah, no, I saved all of those old herb books that I had before I even started naturopathic school.

Tina: 0:37

Yep, I read The Way of Herbs, cover to cover probably, and started putting together things. I was in college, undergraduate and a little kitchen chemistry going on, which I really enjoy anyways, to this day. But we have a great guest today on our program, Chanchal Cabrera, who is a renowned master herbalist and specializes in cancer care.

Leah: 0:58

Yeah, this was a really good talk. This was they all are really good talks, but I downloaded the book on Audible so I could listen to it quickly before we talked to her and, yeah, it was just so inspiring. It really reminded me of what brought me to naturopathic medicine.

Tina: 1:19

Exactly, exactly, because we get kind of bogged down in straddling between conventional and natural all the time and of course you know keeping all of that in our heads as integrative practitioners, it feels a little bit bogged down with the conventional side because of course there's more modern day evidence for that and for supplements for that matter, and there's less strong evidence for whole plant medicine than there is for the supplements or for drugs is certainly so yeah, it was nice to get back to our roots.

Leah: 1:51

It's speaking of roots. She does mention this is a weird segue speaking of roots, she mentions a couple of herbalists who, if you're not familiar with the herbal world, people might not know who these people are. So one of them is Dr Eric Yarnel, who is a naturopathic doctor. He's up in Seattle area, right, and he teaches at conferences.

Tina: 2:18

He teaches at the naturopathic schools, and he also owns an herbal company. Oh, he does, yeah, which one. He owns a company that sells herbs, Heron.

Leah: 2:29

Oh yeah, I know I have one of his books on men's health or urology that's what it is.

Tina: 2:35

He teaches urology. Yes, that's right. That's right, yeah. And the other name she mentioned that would be well-known in the herbalist community but probably not well-known in general, is Donnie Yance, who is an herbalist down in Southern Oregon and also specializes in oncology, and so she did some of her earliest training there, and so she mentioned that in the episode. So those are the two names that probably need a little context like this. Other than that, we just have an inspiring conversation about plant medicine and how that can be useful during and after treatment for cancer.

Leah: 3:11

Yeah, and it's a little different than how I practice, because I have been sort of led away from herbal medicine and so it was just kind of nice to have this conversation and get her perspective on things. So with that, here's our conversation. Hi Tina, , we have a guest today. Yes, a very special guest.

Tina: 4:21

Do you want to tell us about her? Yeah, so today we are talking with renowned herbalist Chanchal Cabrera. For some background, chanchal is a medical herbalist and has been in clinical practice for 35 years, with a specialty in holistic oncology. She's the author of Fibromyalgia A Journey Towards Healing, and her latest book is called Holistic Cancer Care and Herbal Approach to Reventing Cancer Helping Patients Thrive During Treatment and Minimizing the Risk of Recurrence. That was published just earlier this year in 2023, so it's very much updated. She held the faculty chair in botanical medicine at the Boucher Institute of Naturopathic Medicine in New Westminster from 2004 to 2016. And she publishes widely in professional journals and lectures internationally on medical herbalism, nutrition and health. She's also certified in forest bathing, certified master gardener, certified horticultural therapist. She lives on Vancouver Island in BC where she and her husband manage Innisfree Farm and Botanical Garden, a seven-acre internationally-registered botanical garden specializing in food and medicinal plants, and where they host apprentice ships in sustainable food production and herbal medicine. The farm also hosts gardens without borders, a federally-registered not-for-profit society established to run the botanic garden and provide horticulture therapy. Wow, that's a life dedicated to plants if I've ever seen one. Thank you so much, t'chang-shall, for joining us. I'm really excited to talk about plants and you know, from the novice to the expert, I feel like you have something for everybody and I so appreciate you taking the time to talk to us today.

Chanchal: 5:59

Thank you so much for that introduction, Tina, and thank you for the opportunity to come on to your show. You know, I truly believe that herbal medicine is the most democratic medicine available. It is of the people, for the people, by the people. Everybody does herbal medicine. If you made a cup of coffee this morning, you have already done some herbal medicine, because it has all those bitters, it has all those antioxidants. If you put black pepper on your dinner, you're taking herbal medicine. People are doing it without even realizing what they're doing. Just, you know, as you know, there is no separation between food and medicine. That is a spurious division that really doesn't hold up in any kind of clinical practice. We use many foods as medicines. Even in the clinic we'll use extracts of rosemary or celery or sage, which could just as well come from the kitchen, but we use the minimal clinical context. So yeah, I think herbal medicine is something that everybody can do and should do, and indeed actually does already.

Tina: 7:05

Yeah, so many herbs in the kitchen.

Leah: 7:06

What I really like about your book is that when you talk about plants, it's not only as food and herbal medicine, but also being in plants and being in nature. So I just I love how it's so immersive. You know just every part of the plant. I love that.

Chanchal: 7:24

Yeah, I think it's really important that we bring the beauty and the magic back into medicine. It doesn't have to be this scary thing that we only do when times are tough, like there's actually healing from just going for a walk in the woods, there's healing from having flowers in your home and you know, as a horticulture therapist, that's part of the work that I do is to actually get people, I guess, like in touch with nature as an entity, not just needing medicine but healing on a much deeper I mean maybe I could even say on a soul level, connecting people back to plants, connecting people to nature. Really, for me is the work and the clinical aspect actually comes after that. So I'll often take my patients even my cancer patients, if they're in the person, will go and walk in the medicine gardens and I'll introduce them to some of the plants that are going to be in their formulas. They're not going to grow those themselves, they're not going to make that medicine, but at least they have a sense that it isn't just a horrible tasting potion in a bottle or a capsule. That's sort of abstract and anonymous. It's actually plants doing the work. And my not so very hidden agenda is actually, as a fairly active environmentalist. I'm very involved with environmental groups here in my community, sitting on boards and so on, and so I really believe if people don't notice nature, then they won't care to protect it either. So part of my work as a herbalist is to help people notice nature so that they care to do something about it.

Tina: 9:02

Well, I think, in the tone of your book, because it is your tone and your belief, it is interwoven nicely. I'll admit it's very long it's 450 pages of actual content for the lay public and then a second section for practitioners, which I really appreciate it, of course. But I found myself thinking about even the land that I'm sitting on now. I'm in high desert. There's not a ton of plants, our soil has zero nitrogen, naturally. But even then there's an alder tree and I'm reading in one section I skim, and it says alder bark and I'm like huh, I never even think of that alder tree as medicine, to be perfectly honest, because I've never, even as a naturopath and part-time herbalist, I don't think of using the alder tree. And so it had me thinking I need to do a little stock assessment of what I'm walking on to my own property and just walk around and look at the smallest flowers to the biggest trees and look them up and see what we have. So it was really nice. I felt inspired.

Chanchal: 10:02

Yeah, I think there's almost. Every plant has some medicinal constituents, whether they're readily accessible and easy to use or not. But again, that alder tree is giving you shade and it's actually releasing those leaves in the fall and that's the opportunity to use those to build some soil with. But alder is a tree that grows where there is very little nitrogen because it has the bacteria on its roots, like a pea plant that puts nitrogen in the soil. So where that alder is growing, you're actually building better, healthier soil. And alder is short-lived, so when it falls, when it dies and you cut it, you're going to have enriched soil below. So there is a purpose to every plant.

Tina: 10:49

Yeah, and that's the part that's inspirational, correct me if I'm wrong, but thinking of plants as an extension of ourselves, and not just medicine but wellness.

Chanchal: 11:00

So, even if you're not ill looking at herbal medicine as optimal medicine, yeah, I think that's really important because we sadly, in our modern culture, we don't have health care. We have sickness care. We have this wonderful thing in cancer practice called watchful waiting. It's like you're not sick enough yet to do anything drastic, so just hang around a bit, you'll get sicker and then we'll do something. I find this absolutely unconscionable. It's like what is wrong with us that we can't practice proactive, preventative wellness care and therefore not need as much sickness care. And you know, in Canada we do have socialized health care, everybody gets health care, but very few people get great care because it's spread so thin and there isn't enough to go around. So, again, waiting until disaster strikes. We spend less than 1% of our health care budget on prevention in this country. And yeah, you know the National Cancer Institute very mainstream, very conservative. They say that 65% of all cancers are preventable through diet and lifestyle. So why do we only spend 1% of our health care budget on prevention? Well, you know we could go down a few rabbit holes about, about, you know, the vested interests in keeping us sick and selling us drugs. But I prefer not to have that sort of negative approach to it. I prefer to come back around and say that's a great opportunity for us as health care providers and wellness counselors and a great opportunity for the patients, the individuals, to actually do something about that, to get involved and take some level of responsibility for their own well-being. So I'm sure you're aware the root of the word doctor is the same root as the word teacher, so a doctor is a teacher Traditionally. Originally you would talk how to help be healthier, how to live a healthier life, and really that's where it is most effective. And in my book I definitely emphasised this thing that I find so difficult when people talk about alternative medicine, as if we have to choose between, you know, taking herbs or other naturopathic practices versus mainstream conventional interventionist medicine, and I find that very unfortunate for the patient because it puts them in an untenable position of making choices that they shouldn't have to make. So I call my work collaborative medicine, because that's really the attitude I bring to it. I want whatever it is that makes you feel better, that's a good thing. Well, maybe not anything, but you know, within reason, you know, if drinking a bottle of whiskey a day makes you feel better, it's probably not going to get my vote of approval. But I also feel like. If having a glass of red wine on a weekend is part of your unwinding and de-stressing, it's probably not the worst thing that you're going to do to yourself. So it's all about context, it's all about moderation, I suppose, and in my book. You know, I was contracted to write a book for the general public and I looked around at what other books were available in that arena, and there's some excellent books available for the general public on how to navigate cancer and how to manage some of the side effects, how to get through it and how to prevent it. There's some very, very good books written by some of our colleagues, in fact. But what I found was missing was the books for the practitioners, and there are a handful, your own included, but I felt like there wasn't really anything that focused specifically on the plant medicine. So there's some good resources for practitioners, but not a lot that was grounded in the earth, and so that's where I decided to go with mine. So my publisher blessed them. They were very gracious about it because I told them I couldn't really write the book they wanted. It wasn't, I guess, challenging enough for me because I knew there were some other good materials available. I wanted to go to the next level and they agreed that we could do a kind of two-part book. We even looked at doing two books at one point but decided to hold it all in the one book. So it is designed for the sort of patient and family and care support team at the beginning of the book and more of the clinician or prescribing practitioners towards the end. But I have to say that a lot of my patients are reading it all the way through and coming back to me and saying now I understand why you're giving me these big, complicated protocols with all these different moving parts and asking me to do a poultice and a tincture and a tea and go for a walk in the woods. And I'm like, yep, there is actually science behind every one of those decisions. It's not a random grab bag of let's try this and let's try that. There's real science behind it. And I'm sure you're familiar with the delicate darts of trying to take analytical isolated constituent research and translate that into whole herb or holistic medicine. And it's very tricky darts because the research is compelling about isolated constituents, animal models and test tubes, torturing rats. And we do this research on animals because they're somehow different enough from us that we can sort of morally justify it. I'm struggling to say that, but that's what the science suggests that they're different enough that they don't have the same level of consciousness that we can do that research on them. And yet we're then expected to extrapolate that to humans as if it's similar enough that we can apply it to the human body, and this is a big disconnect. So what I did with that was I looked at all the analytical research, of which there is reams and reams about berberine and curcumin and thymoquine and all the isolates, and then I went back into traditional herbal medicine literature and looked for whether those plants have application and if I could find a connection between the isolated research and whole herb medicine from history, then I could feel that there was a holistic strategy that I could really put into the book and put into my clinical practice. So I do use a few isolates in clinic for various reasons, like, for example, green tea. I do use the EGCG because the research is really good and it's really hard to get that much of that one constituent by drinking cups of green tea float away. But I will also give people green tea to drink, and particularly matcha, because you can get a lot of green tea that way, alongside of their isolates. So I'm still trying to do holistic approach, even when I'm using that isolated research and isolated constituent. Sometimes it's a delicate dance.

Leah: 18:30

I appreciate when you say in your book about using a whole herb may be safer than actually using the extracts. And I've heard that from attending lectures from other herbalists and I don't know how much you know about what I do. I work in integrative cancer centers and so I'm surrounded by oncologists and other providers so I'm a little bit more cautious in my prescribing. I came to naturopathic medicine because of my love of herbs and I rarely use them because of where I am, and so it's just. It's just. Your book was very, like Tina said, it's very inspirational. It kind of brought me back to where I started and because the whole herb is more food, like you know, and just knowing that with all of those constituents there would be less of a risk of interaction, because that is such a huge concern when you're in a cancer center setting.

Chanchal: 19:33

Yeah, I think there's a few things in there to unpack there. Those are great points. You know, generally speaking whole herb would tend to be safer because you tend to get a bit less of any one thing, but they're also often much more effective. So a really good example of that is with Artemisia annua, the Chinese wormwood or sweet Annie, which has become very, very successful and popular as an anti cancer herb, specifically the Artemis cennin, which is one isolated constituent. It's a sesquiterpine lactone from the essential oil and it's incredibly effective as a cytotoxic agent. Maybe we could even call it herbal chemotherapy because of the nature of what it does in the cells. But and it's being used extensively now as an isolate, it's even being used in injectable forms and the research is very compelling that it is more bio available when it's given in conjunction with the naturally occurring flavonoids that are also in that plant, which of course, the water soluble sesquiterpine lactone is not so water soluble. So where I come, there is I would use Artemis cennin in specified amounts because the research is really exciting and really compelling. But I will also give whole herb Artemisia annua in a low alcohol tincture. It's not pleasant to drink it as a tea. It's quite bitter. People will, but I have to encourage them. But the tincture at 25% alcohol will get the flavonoids, won't get much of the sesquiterpines, but I give that in conjunction with the Artemis cennin so that they have something akin to a whole herb extract going in alongside of the purified isolate and you can often therefore use less of the purified isolate because it's more bio available. That brings in the safety again. But the other thing I want to say and no disrespect to anybody here but let's be honest there's very little you could do with herbal medicine that's going to do more harm than what most of the drugs are doing, and I hold that as a truth because it stops me from being too afraid to do my work, because if I really went down the research danger and risk I would not be able to do anything. And so what I look at is least harm. Is the idea right? That's what we're taught in medicine is always to do least harm. And least harm in many cases means helping the patient tolerate their chemotherapies better, helping them actually physically sustain the treatments that they're receiving and not have to drop out of chemotherapy because it's so toxic to their kidneys or their liver If we can do herbs that help them manage their other treatments better, then I feel that's a really, really often they're positive interactions, they're beneficial interactions, and I'll just segue for a second and tell you about a case that I've been working on at the moment as a really good example of this. I have a patient who developed profound anxiety around COVID and she ended up on some very, very basic effects or very, very basic anti-anxiety medications and she had a catastrophic reaction. She basically, for lack of you know layman's term, she lost her mind. She ended up um section, she ended up institutionalized, and every time they would layer in a new anti-anxiety or antidepressant drug, she got worse and worse and worse. She finally went to a this was quite extraordinary a forensic psychiatrist who works in mostly the prison system, helping to work out why people on certain anti-anxiety or anti-depression medications have mental breakdowns and causing them to be violent and psychopathic and homicidal. So this forensic psychiatrist works with dangerous prisoners who are on medications that are causing some of these mental aberrations. And so my patient ended up there and she got genetic screening and discovered a whole series of cytochrome enzymes in her liver were not working properly, either overactive or underactive, and they were all the ones that her drugs her um, psychiatric drugs were going through. So until somebody stopped and looked at how she individually metabolized her drugs, she was literally institutionalized from drug effects. She started with bad anxiety. She ended up with a catastrophic diagnosis and completely dysfunctional, lost her job, can't leave her home. So I sat down and I worked out a protocol I thought would help her with herbal medicine. And then I cross-referenced every herb against those enzymes to see which herbs would induce or inhibit which enzymes and the enzymes that were inhibited by her genetic profiling. We used herbs that would induce them, the enzymes that were induced by her particular cytochrome genetic makeup. I used herbs that would inhibit. So I'm literally trying to rebalance her liver enzymes by using herbs that are specifically induced or specifically inhibit. That obviously takes a great deal of time. I can't always find all the literature and research I want, but talking about safety with herbs, I think that it's critically important that we pay attention to this. But the truth is that many, many, many people are taking drugs. It's really not working for them. So where is the safety testing there? Why is not every patient who's being put on those kinds of anti-anxiety drugs getting a genetic screen to know if it's going to work or not. So I try and put it in context. What's going to do least harm is always my bottom line and most of the time the herbs will do least harm. And if I can find research to back that up and validate that and cross-reference that with the drugs I do, it's not always available or possible and then I go in really slowly with the herbs. I start at one quarter dose of what I think they might need and after we've established that as a safe level, then we go to half dose and we look at monitoring plans. How do you know if it's working for you or going to cause a problem? What can you measure? Is there something that you could do predictive measuring with? So my work is incredibly intricate. I spend hours with a case. I do a 90-minute interview, but I'm spending sometimes two or three hours working up the file afterwards because I take it very, very seriously. I believe herbs are medicine and we should give them that level of respect and not just throw them out casually at people. Oh, it's just a plight and if it doesn't help it won't do any harm. Well, that's not true. But as I dug into that book, the more I dug into it, the more I found a lack of good research about the danger of the herbs with the drugs. Of course, each and every herb could have a risk profile based on its constituents, but in context of clinical practice with drugs in the mix, there's a great deal of supposition, a great deal of isolated extrapolation and a great deal of fear mongering and very little hard evidence. And my expert reader was the inimitable Dr Eric Yarnel. And boy oh boy was Eric useful to me. There was one momentous day when he wrote to me. I hope I'm OK to say this. He wrote to me this is crap, capital letters crap. You don't know what you're talking about. I'm like thank you, eric. That's why I asked him to be my expert reader, because not only is he brilliant an expert, but he's also relentless in his feedback. He not just edited for me, he line edited, he went through every reference and checked. He followed up every reference I have in that book. And when I was writing the section on herb drug interactions and safety, I was being very cautious. I was really trying to downplay the herbs in there and really trying to make it ultra safe for everybody. Eric wrote back and said why are you being so mealy-mouthed about this? Why are you holding back on how brilliant the herbs are? The herb drug interactions are often very beneficial. Why don't you reframe it as a positive thing? How can you use those interactions to enable the patient to have less drugs and better outcomes? And he really helped me reframe it away from the fear factor of what the herbs do in the context of drugs and, really looking at that again, it's saying how amazing that these herbs do similar things to the drugs and augment the drugs and therefore you might need less of those drugs with all their attendant side effects. There's very few side effects for most herbs. The risk is always about is it going to induce or inhibit the drug? Is it going to increase clearance or delay clearance? And that's actually something that we can often measure and can actually work with instead of having it be a barrier. So Eric was incredibly helpful in showing me how to reframe that as a positive thing, not a place to get stuck on.

Leah: 29:25

But I think that reinforces that if somebody wants to pursue herbal medicine while undergoing conventional treatment, they need an expert. I just saw a patient recently who saw a traditional provider in the area prior to coming to the Cancer Center and they were given these formulas, which I went through, and they were given licorice when the medication that the person was going to be taking caused hypertension as the main side effect. And so there are a lot of nuances. Like you're saying, there's a lot more in-depth knowledge that goes behind it. You got to know a lot more.

Chanchal: 30:06

Yeah, I think you're absolutely right. There is a continuum here, from the home health care, eating a good diet, taking some chamomile for sleeping, some basic things that everybody could do and using what we might call the baby safe herbs, all the way through to active herbal cytotoxics. And that is a continuum. And again, in my book I try to kind of navigate people through that process whereby what can you do? Well, you can start with your own kitchen and your own home, cleaning out toxins, cleaning up your diet. That everybody can do without risk. Not everybody has access to all of that, but at least it's risk-free. Nobody is going to get sicker by eating more vegetables and avoiding sugar. Those are things that everybody can access for themselves without needing expert intervention. But if you're actually going to use herbs that change the physiology, then yes, of course I would recommend a consultation with a professional, whether it's a herbalist, a natural path, somebody who is qualified. And I would go further and say not just any herbalist or any naturopath actually, but someone who has chosen to specialize in this area. Just like if you were looking for pregnancy care, you wouldn't just go to any herbalist, you would go to someone who works in that arena with some special knowledge, because there's too many variables. So I think that's a very good role for a naturopath or a herbalist. And you both are working extensively in the cancer field and so you probably have already realized that as a practitioner you can't be all things to all people, and being a general practitioner is great, but you need to know when to refer on. So I was a general practitioner for 15 years. I had a very, very busy herbal medicine practice, seeing all sorts of conditions you know, from menopause to eczema, to asthma, to arthritis, and of course herbal medicine had a great deal to offer. But at a certain point I realized I was saying no to cancer patients because I didn't feel I had anything to offer. I thought herbal medicine wasn't big enough for this condition because it's so big and the drugs are so big. And then I went back to graduate school. After 15 years of clinical practice I went back to get my master of science in herbal medicine and I ended up apprenticing myself to a herbal master, to Donnie Yance, who, by the way, has only a grade 12 education in terms of formal schooling. He never went to college, but he is very, very brilliant and so I found a teacher that I had a great deal of respect for after 15 years of being a teacher myself and a clinician and running a college. Then I went back to start all over and started really digging into the oncology and did my master's research in oncology breastcap sort of herbal medicine actually and found how much there is that we can do. But it has become a specialty and I think that's really what we need to be fostering, and I know the naturopathic profession certainly is fostering that that there is a division of naturopathic specialization around cancer care and those are the naturopaths I refer my patients to because they have that level of the most current knowledge, the most deep knowledge about this very huge topic of cancer care that is really too big for the general practitioner to have a great skill set in. They can certainly help around the edges and obviously there's lots of things that are very simple. You know polter-sing and you know there's lots of non-threatening, non-risky things that any good practitioner could get involved with. But if you're actively working with a cancer patient who's currently in treatment you know taking chemo, taking radiation then you definitely need some specialization and sometimes you've got to hold the patients back and you know I'm dealing with someone right now who elected to do a whole lot of self-care with a sort of black salve polter-sing on a brass can. So that's created a really awful ulcerated mess now and, quite you know, I would have to say, probably set herself back quite a ways because she didn't seek expert care.

Tina: 34:48

There's a few lines that stuck out when I went through the book and I will admit I didn't read it line for line. Like I said, it was 450 pages, but I did skim a good part of it. One and this is a quote from the book the key word here is effective, and you put effective in italics. A treatment plan should be crafted based on which strategies will be most effective for a particular patient, and I think that's what you're saying. I mean, when someone comes to me and I had that happen as well where someone used a black salve for some time and created basically a massive open wound and surgery, especially early stage breast cancer surgery, was a viable solution to a small lump in the breast and chances were good for a good outcome. So effective should be top of mind. I think that was a really. When I read that I thought that's exactly it. It's like least risk, most effective and throw all philosophies aside. Really. I mean, in the grand scheme of the continuum from totally conventional to totally alternative, I don't think either extreme serves the person. I think it's always a combination, somewhere in the middle of integrating.

Chanchal: 35:59

Absolutely. Yeah, I couldn't agree more and this is why I'm so big on this term collaborative medicine, because that really puts the patient in the center of the story and bringing in all the different disciplines. It might be prayer, it might be chemotherapy, you know, it might be herbs, it might be homeopathy, what it doesn't really matter to me what the toolkit is, as long as it's working. And that is really the interesting job, isn't it is to find the right tools for this particular person at this time, because that also changes. So they might need a certain type of intervention during their chemo, for example, to help manage their neuropathy, keep their kidneys working, and then six months or a year later we're into a different process and the protocols need to be kind of living, the protocols that change and adapt as the person's circumstances change. So I do a lot of checking in with patients, I do a lot of monitoring plans. I help them build out a request for their blood work and their scans of how much and how often, and we're always looking for least intervention. And you get away without that CAT scan by doing something else. You know, right now we're really looking a lot at the urine testing for bladder cancer because the scopes that are being done every two or three months are extremely invasive and causing scar tissue and trauma, and so if there's a simple urine test, that's surely going to be better. So I work a lot with trying to find least harm, most efficacy.

Tina: 37:41

Yeah, I have one lingering question in my mind about what we talked at length about complementing isolates, whether it's artemisinin, and then giving some wormwood alongside it. This begs the question how about isolates that are then used as chemotherapy so the taxane drugs like taxol and taxiteer come to mind? Do you give the plant they originate from, which is the utri or uBARC? Is that something that you do, because I know that there is a contingent of naturopaths. How do this out there?

Chanchal: 38:12

I absolutely do. Yes, so the taxol and the derivatives of that, obviously very, very successful chemotherapy drugs but relatively short window of efficacy because people build resistance very quickly. So taxol is one of 26 or 27 different dieterpenes in the bark of the Pacific U and of course now it's a semi-synthetic drug. They start with a little bit of uBARC and turn it into a drug in the lab when it starts as a dytopene in the plant and the body quickly develops resistance because that particular dytopene up regulates the multidrug resistance pumping, the mechanism that the cells have to get rid of toxins. All cells have that. Cancer cells really do it very well. I don't like this drug out. You go and it pumps it out, but there are other dytopenes in that bark that inhibit multidrug resistance pumping. So when I have a patient on taxol I absolutely give them you bark extract and very careful dosing to enable the chemotherapy drug to stay in the target tissue longer, to be more efficacious in the target cells but also less collateral damage because it's not getting kicked out into the surrounding tissues. So yes, absolutely, that's what I'm doing. I'm actively choosing a plant that mirrors the drug in order to get better outcomes from the drug. I will also say that my monograph in the book on you was one of the hardest to write because everybody's so afraid of you that I couldn't really find any good literature on the dosing of you bark. I ended up in a commercial site of one company that sells it and I've tried to calculate dosing from there but there was a lot of discrepancies in their literature and altogether that section of the book, the chapter on the cytotoxic herbs, was challenging to write because they're poisonous herbs. There was plenty of literature about isolates but very, very little contemporary literature on whole herb safe dosing strategies. I ended up back at the eclectics a lot going back to the 1800s because they used some of those herbs internally, like Mayapple and poke root and so on, but I found many, many discrepancies in the literature. There's a section in the poke root about should it be fresh, should it be dried, because the eclectics always said it should be fresh, but Kerry Bone, who's a contemporary herbalist that I have great respect for, one of my teachers, he says it should be dried and so I'm trying to kind of wiggle my way through all of that and give dosing ranges that are realistic to be effective but still also keeping people safe, and that was a very difficult chapter to write because of the really lack of contemporary research, because so many of us are afraid of those herbs because they're strong and because they're cytotoxic, and because they're often being used alongside of chemo. And how do you measure what's doing what? And so, yes, the answer is I will often use a herbal extract that mirrors or matches what the drugs are doing to push that along further or to keep the drug where it should be and stop it causing other damage in the body.

Leah: 42:02

And your book is full of such actionable information. I downloaded the audio version and it came with a PDF of recipes and other references that patients, survivors, you know, physicians, they can use these. You talk about fasting, so it's not just herbs. You talk about supporting the microbiome with weeding, seeding and feeding.

Chanchal: 42:33

Yeah, credit to Kerry Bowen for that. That's one of his buzzwords weeding, seeding and feeding the biome.

Leah: 42:40

And in relation to some of the newer treatments that are out there, like immunotherapy, I mean that's key.

Chanchal: 42:48

So exciting. Oh my gosh, working in the cancer field right now has like a whole curtain lifted in the last 10 years. The immunotherapies are absolutely game-changing. I mean not without their own risks, of course they're difficult drugs to be on, but I mean I have. It's been over 20 years I've been working in the cancer field and I have copies of Time magazine from 20 years ago with a front cover article about targeted cancer therapies the way of the future, and they were talking there about testing. And we started with very several things like Herceptin, which has been out for 20 some years now. Herceptin is wonderful drug If you have that particular receptor site that it targets and of course green tea is a great synergist with Herceptin and makes it more effective. But actually a whole lot of different cancers overexpressed that same receptor site, gastric cancer, for example. Probably Herceptin's going to get approved for gastric cancer soon enough because it is showing promise. But yeah, the immunotherapies are game-changers for cancer patients and so now our task is to. You know, what's happening in Canada is that there's so many new drugs coming out in the marketplace and they are regrettably being a little bit thrown at a patient to see what sticks Rather than what they're intended, which is you test the heck out of the tissue to know exactly what drugs might work and that's the drug they get. But unfortunately here there's a little bit of. Let's just try this immunotherapy and see what happens. In fact, the clinical trial that was running in Vancouver for a number of years. They were recruiting patients and giving them a selection of 12 different immunotherapy drugs on offer, without any genetic screening at all to know what was going to work. Needless to say, the outcomes were quite dodgy. So you know it's early days. I think there's a lot of refinement to be done on how the drug is chosen for the patient.

Tina: 45:03

I wonder if that differs here in the United States, because I think that there is a lot of molecular profiling done. I mean it's standard of care for certain cancers like lung and melanomas and various and they're looking specifically for micro satellite and stability or high mutational tumor burden. So it's interesting, cause I wonder if we test more in the general sense, cause I feel like nearly all of my patients get in molecular profile.

Chanchal: 45:29

I think you do test more, and this is one of the downsides of our healthcare system in Canada or I mean, there's good and bad in all of it, isn't there? In the US, healthcare is driven by insurance and insurance doesn't want to pay to drugs that don't work because of the cost. And now the patient is even sicker and needs more healthcare, and so there's a very big push in America to test everybody for everything and it gets a lot of it's covered on insurance because it saves insurance companies money. We don't have that here. We have a different approach to medicine. It's a bit more one size fits all up here and in the bigger hospitals in the bigger cities. Yes, tumor mutational burden and micro satellite and stability and all of those things are being tested, but not, I would say, teamly. But I have a lot of patients who are in very rural communities. With telemedicine today, we're not tied to our own township, so I have patients up North, I have patients in areas where the medical care is very limited and I even still get breast cancer patients who did not get her two new testing done. Wow, I know, I know. Wow. So I'm often the one saying this hasn't been done, this hasn't been done, this hasn't been done and I can give you some care right now, but you need to get more information. So I'm very often the one writing up letters to the oncology department saying, please, can we get this information? Of course, that tissue is still available for that kind of testing. It's held for some time, so it really is hospital access driven, I think, and up here we are routinely 10 to 15, even 20 years behind what I see in the US. I still work with patients out of Donnie Yance's Clinic in Oregon because I lived there when I was doing my grad school and I've maintained a relationship with that clinic and I have a number of US based patients and what they bring to me is vastly more detailed than what most of my. Canadian patients are accessing, at least at the front end of their story. We work to get more information for them, but it's not always available and a lot of that is just budget. The hospitals just don't have the money. Yeah. And it takes longer for it to filter down into mainstream clinical practice.

Tina: 48:07

Yeah, I think even here there's a vast difference regionally between what's done in the Northwest and what's done in the Southeast or the Northeast or whatever. So there is a city, rural differential, but there's also just regional differences, because I've done remote consultations with people across the United States and I can see a very different level of care and even style of care. I mean, it's very much a mutual decision making here where I am in Oregon and in the Northwest in particular. But I would say there are parts of America where it's more kind of old school. You just the patient just does what they're told and goes home and doesn't question, doesn't inquire, doesn't understand or they're not expected to understand, so they don't know what they don't know. So I think the mutual decision making can go too far sometimes, because my patients sometimes are like well, somebody just please tell me what's best. How am I going to know which chemo or which treatment? This is that's why the oncologist exists to make these decisions. So it can go too far.

Chanchal: 49:09

but yeah, it really is a continuum that each individual person is navigating and so much of the outcome depends on who that they, who they have in their support team. So if they have a top-down oncologist who's all about Tumor-centered care, not patient-centered care, then they go on to get some kind of mainstream Standard that's not customized and they're not going to be encouraged to take Responsibility and get involved on their own all the way through to the patient who never sees on colleges because they just think that they're Devil incarnate and they're not going to. And then I actually have also turned away patients who refuse to engage in the medical system Because I am not licensed for primary care. So I am not willing to be the only one on the team they have in my practice. They have to have an oncologist on board so that I have a backup system, so that I can get the testing I need for them. That I can, you know, keep them on track. I mean I can't order the CAT scans, for example, that they need. So I'm pretty clear about the collaborative aspect and yeah it does vary. The response I get from the medical system does vary, of course, as well, but more and more the doctors are realizing that patients need to be involved in the process and have a right to be involved, and so I definitely have seen Improvement in the communication over the last number of years.

Tina: 50:41

Oh, definitely definitely more open minds.

Chanchal: 50:43

You know, if the doctors start challenging me, I just tell them to read your book. When I went to after write my book, it was a great COVID project, I have to say. I got the contract at the beginning of COVID and I told them I wouldn't be able to start writing until the fall of 2020, because I run a farm and you know it was a farming season and what have you. But. But once I sat down to write, I actually left home. It was quite odd. We were all in lockdown, it was all. Everybody was isolated, I, just me and my husband on the farm. But even with that, I didn't feel quite able to get my focus properly. So I rented a house 20 minutes away for three months. I went away and I saw my husband on the Sunday morning. He bring me groceries, have breakfast and leave. And for three months I stayed alone to write and I didn't take any of my reference books because I didn't want to Be influenced or be. You know, I didn't want to start Taking from everybody else. I wanted to have my own words on the page. But when I came back to my office here, I quickly went through every reference book I had, notably, you know the big one from you and just to check back back what I had done. But but you know, that textbook is incredibly useful because it's written in such a medical way that I can tell oncologists you're challenging me or questioning what I'm saying and doing. Here's where you can go to get some reassurance that I'm not just some flaky hippie herbalist in the back woods. Yeah, I'm not only.

Tina: 52:23

I see the same, just not. Not only that, you're more than that. Yeah, well, I gotta say okay. So there were times when I read the book and as I was going through I was like gosh, some of these things might strike integrative practitioners even who are maybe conventionally professionals, like an MD or pharmacist, or even naturopaths who have strayed away from good old fingers in the dirt. You know, herbalist, naturopathic medicine. And there was a paragraph that I'm going to read because I was like that's so radical and right on and it encompasses how we think very eloquently. I will say so here's. Here's the excerpt Holistic medicine reports that if one can strengthen and rebalance the body, mind, spirit network, if we can become quote unquote whole again, then normal patterns will be restored and the body may be able to resolve the cancer. It is worth pointing out here that it does not require eradicating every single cancer cell for cancer to be resolved. People can survive and even thrive with cancer, and herbs may contribute to that. Healing is not the same as curing. That's it, yeah, that's what we're trying to bring to people, and this is really an important, essential message for anyone with a later stage cancer. However, we frame this to help someone understand that it's something we're striving for is wellness and health in any context, and so it might mean creating a dormancy of an existing cancer If it's not growing and it's not giving symptoms, that success. So I really appreciate that. I mean, I really stood out and I was just like that's a really nice paragraph.

Chanchal: 54:09

Yeah, thank you for picking that one up. It is an important point. I mean, we all make cancer cells every day, we know that we all have cancer in that sense, but does it bring us down, does it stop us in our tracks or not? And my master's research I was working in Donnie Yance's clinic and he's specializing cancer for many years and he hired me to do research which I could then use for grad school which is very convenient, I must say. But I ended up writing a dissertation. I did research on long-term survivors of breast cancer in his practice and I was doing quality of life reviews with them and they were all 10 years or more with breast cancer and my dissertation was called living with breast cancer because all of those women had still cancer after 10 years or more, but they were thriving, they were living their full life Although they still ostensibly had cancer. And that was such a big wake up to me that you can actually have a dormant cancer, you can actually see it on a scan but it's not doing anything and you can actually get through that and go on from there. It was a big wake up for me all those years ago in grad school and I often remind myself that my job is not to cure anything. I'm a conduit for the herbs to do their work. But cure is not something I talk about. I talk about living well, living your best life. And if tomorrow is the end, well, let's have a good end. Let's get you there as well as you can. And I actually have learned over the years that in clinical practice, having a patient pass away is not a failure. It's not a failure as a practitioner. It's not a failure of the medicine. Sometimes you've helped them to die better than they would have otherwise, in a better way, and that was a really big lesson for me as a practitioner, as a young practitioner thinking it was my job to save the world. It took a lot of work to get past that savior complex and into just like let's just live our best lives as long as we can and when it's done. That's what's going.

Leah: 56:35

So with that, we're kind of coming towards the end. Is there anything that you want to add? Is there anything that you know? Actually, I do have one more. I have one quick question, and this will be brief. If there was one thing from your book that somebody would take away from it let's say, like a desert island thing You're on a desert island, you can only take one thing from your book what would that be?

Chanchal: 57:03

Well, I would have said walking in nature, but if it's a desert island that might not work, okay maybe it's just an island no desert. And the absolutely number one thing, in my opinion, is to avoid sugar. You know, it's not just about cancer, it's about every aspect of our well-being. We were not designed to eat the 152 pounds of refined sugar per person, but yeah, the average American eats. It's not good. So avoiding sugar is like to me, the baseline. It doesn't mean you can't have birthday cake once you know now and again as a treat, but in a daily diet, no refined sugars, everything will be better and you do talk about using sugar.

Leah: 57:53

I'm not going to reveal everything, but you do use sugar. And then there is that research behind carb loading around surgery not necessarily refined sugar, but yeah, of course I mean.

Chanchal: 58:03

I'm talking about avoid all refined sugars. White flour, white sugar, a little bit of honey, a little bit of maple syrup. Fruit, natural sweeteners that's a different story. Not agave syrup, that's nothing natural about that. But maple syrup and honey is what I tell people if they really want to add a sweetener and fruit and cultivating a different palate that doesn't crave that intense sweet that we've been adulterated or corrupted into craving as a people now. Yeah, so number one thing that's the only real ground rule in my practice is get away from refined sugar. Everything else is negotiable.

Tina: 58:46

That makes sense. It's interesting because if people give up refined sugar, other things taste sweeter anyways, so it gets easier usually.

Chanchal: 58:54

Yeah, we corrupt our taste buds with refined sugar. Yeah.

Leah: 58:59

We've definitely talked about that. The podcast and the book are great companions because there is something that we have covered in almost every chapter. But again, I'm really pushing for people to go out. We'll have a link for people to buy the book. It really is inspirational.

Chanchal: 59:19

Yeah, thank you. I'm tickled that you got the audio, because it's hard for me to imagine anybody listening to it. It's quite dense. I also had the rather interesting job of listening to different readers to pick the person who was going to make the audiobook, which was quite interesting. And, if I could be so bold, I am going to be doing an education series in the fall on a website called Botanic Wise which is run by Charis Lindroth. There was a choral practice actually Botanic Wise and she's just set me up to start teaching a series of classes in November and December for the, I would say, committed patient or the practitioner. So I have a series out on the shift network right now, which is more entry level following the beginning of the book, setting people up to start thinking about health care for themselves with cancer. But I'm going to do a more advanced level programs late in the fall with Botanic Wise and so some of your audience might be interested in that.

Tina: 1:00:27

Well, we can link to everything you just mentioned so that people can find you online teaching classes, whether it's beginner or practitioners, and we'll just put those two links into our episode notes. So again, chinchal, I can't thank you enough for joining us today and having this discussion. It's a little off the cuff, which is unusual for us, where at least you know we at least give you a heads up or we're going to talk about beforehand, but this was free form and I thoroughly enjoyed it. So thank you so much for showing up and putting up and for taking the time to write that book. I mean, I can hear your voice in it. So I think the isolation and just totally immersion into the writing process probably served you so well, because you are there, you're in the book and it's empathetic, it's actionable, it's useful and it's very thorough, which I really appreciate. Everything from you know what to do to why to do it. So I just love it. I can't say enough about it.

Chanchal: 1:01:31

Yeah, thank you so much, both of you, for the opportunity to speak here With that book. I will say that, aside from a couple of the very, very cutting edge mechanisms of delivering chemo, every single thing in that book I've actually done in my clinic and I think that's really important to say, because it isn't just a book of theory, of reading other people's work and distilling it down. It's actually based in my clinical practice. That is real stuff. Every recipe in there is recipes I have worked out in my clinic with patients, so it's really grounded in reality and I hope that makes it very accessible to people and practical for people and, as you say, actionable. That was my intention. I wanted people to feel empowered by it at whatever level they are in their cancer journey, from a patient with a new diagnosis right through to an experienced practitioner. I wanted there to be something for everybody in there. So I appreciate your comments. Thank you so much, and I appreciate the chance to come and have a chat with you today.

Leah: 1:02:36

So everybody needs to go buy this book, absolutely. Such a great book, whether you are a cancer patient, survivor provider. So much in there.

Tina: 1:02:48

Yeah, like she said she made it for the lay public and for her fellow professionals. So there really is something in there for everybody.

Leah: 1:02:55

Yeah, and we'll have a link on how you can get it. That will be in the show notes. Yeah, what a delightful conversation and I really wish that she read the audio book herself. She's got such a nice voice, such a nice voice and, yeah, I think, because she's got so much invested in it, like it just would have been a really nice touch to have her reading her own book. But, yeah, that aside, if there is anyone that y'all want us to talk to, if you know of someone who's written a book, or you've heard about someone you want us to reach out to them, let us know.

Tina: 1:03:34

Yeah, yeah. Anyone who has naturopathic or integrative medicine information that is useful to our audience, we are open to talking to and bringing that perspective to our listeners. So yeah, if you have a rock star or a practitioner you want us to talk to, please let us know.

Leah: 1:03:50

Or if you have a rock star you want us to talk to, we're open for that too.

Tina: 1:03:53

That would bump our ratings.

Leah: 1:03:54

Woo. And speaking of ratings, leave us a rating. That's right. Leave us a comment, say hi, drop us an email, share this episode and sharing is really easy.

Tina: 1:04:06

You just hit the three little dots on the page somewhere on Spotify or Apple and just send it off. You can message it, you can email it to your contact, and it's simple. And you can buy us a coffee. And you can buy us a coffee, of course, and thank you to Amy and Paul who just bought us 20 cups of coffee.

Leah: 1:04:22

Yes, that's going to keep us warm through this cold winter season. Yeah, thank you. Thank you to Amy and to Paul. That was really generous. All the money that comes in goes back into the podcast and it helps us keep bringing you this high-end content that we do. That's right. So, thank you. And, on that note, I'm Dr Leah Sherman and I'm Dr Tina Kaser, and this is the Cancer Pod Until next time. Thanks for listening to the Cancer Pod. Remember to subscribe, review and rate us wherever you get your podcasts. Follow us on social media for updates and, as always, this is not medical advice. These are our opinions. Talk to your doctor before changing anything related to your treatment plan. The Cancer Pod is hosted by me, dr Leah Sherman, and by Dr Tina Kaser. Music is by Kevin MacLeod. See you next time.