The guiding principle at Amitabha clinic is a holistic and integrative view that is multifaceted and patient driven. Each individual arrives at his cancer diagnosis with a unique "ecology." Unraveling, clarifying, and rebalancing this ecology is crucial to effective intervention and long-term recovery. This ecology is all-encompassing in the sense that it is derived from the entire history of that person – his genetic makeup and family history, childhood environment and experiences, illnesses, traumas, toxic exposures, dental health, diet, work situations, lifestyle, relationships, spiritual path, and the emotional and physical patterns, habits, and strategies by which he lives.
We honor the uniqueness of the individual by partnering with him in his care. Rather than dictating a proscribed protocol, we focus our interventions on his health status, the aggressiveness of his cancer, and underlying functional issues, but also his own health goals and lifestyle demands. Two men, both diagnosed with prostate cancer and with the same Gleason Score, might actually have very different conditions, and we would develop two very different programs to meet those needs.
While committed to science-based therapies, we recognize that there is a rhythm and an intuitive, artful process in treatment that guides the choices, timing, and sequencing of therapies suited to each patient. This style of practice is based on the work of Dr. Isaac Eliaz, MD, MS, LAc, reflected in protocols that he has developed over 20 years of clinical experience in working with cancer patients. Dr. Eliaz is the founder of the Amitabha Medical Clinic.
Establishing a Baseline
Correct assessment is the first and most crucial step in the evaluation of any patient with prostate cancer. We work collaboratively on staging, often seeking a second opinion on the Gleason score from an expert pathologist. This initial assessment includes thorough history, and physical examination using various medical systems, laboratory testing, and imaging. The evaluation may also include imaging such as color Doppler ultrasound, bone scans, an endorectal MRI, and/or a ProstaScint/CT. A thorough and accurate baseline forms the basis of treatment decisions, whether that decision involves an "active noninvasive" approach (i.e., watchful waiting/active surveillance), complementary therapies, or an integrative protocol that includes conventional treatment.
Extensive lab work is also a foundational aspect of the initial workup. An example of a typical lab order for prostate cancer evaluation includes a CBC, comprehensive metabolic panel, cardiovascular panel including Lp(a), PSA (total/free), PAP, fibrinogen, testosterone (total/free), total estrogens, estradiol, estrone sulfate, DHEA-S, SHBG, progesterone, prolactin, LH, FSH, DHT, HgA1-C, fasting insulin, IGF-1, serum copper, ceruloplasmin, zinc, selenium, B12, and 25(OH) vitamin D.
A thorough diet and lifestyle evaluation provides the basis for developing these key aspects of individualized treatment. An assessment using Traditional Chinese Medicine (TCM) offers insight on constitutional factors and energetic balance. Depending on the patient's history and symptoms, additional evaluations may also include salivary diurnal cortisol, 24-hour urine hormones and metabolites, a DMPS challenge, a GI health panel with salivary food allergy evaluations, HLA-dq testing, or genomic testing.
Individualizing the Protocol
We begin treatment with cornerstone supplements that include Prostacaid (a multinutrient formula) and Pectasol modified citrus pectin, both by Econugenics Inc., as well as vitamin D3. This initial protocol is simple for the patient to use and powerfully affects many of the functional areas that need to be addressed in prostate cases. As we continue to evaluate the patient's particular issues, we begin phasing in other targeted interventions. Approaching an individualized protocol in stages allows us to assess tolerability, reduces overwhelm, and ultimately leads to better compliance.
Major therapies used in the clinic include detoxification, infusion therapy, acupuncture, TCM, vaccines such as the BCG vaccine (Bacillus calmette-querin), and other immune-enhancing therapies. A great deal of our work focuses on evaluating and then improving the body's detoxification capacity using specific botanicals, nutrients, chelating agents, and intravenous therapies. In choosing a targeted protocol, we formulate the intervention with a range of functional goals in mind.
• promoting apoptosis
• lowering viscosity
• anti-inflammatory therapies
• modifying genetic signaling
• modifying insulin signaling
• nutrient sufficiency
• anabolic rebuilding and repair
• immune modulation and enhancement
• hormone modulation and detoxification
• methylation support
• constitutional balancing
© 2010 Amitabha Medical Clinic, Sebastapol, California.
We use supplements that benefit the patient through a number of different physiological mechanisms. For example, Prostacaid combines medicinal mushrooms, Chinese and Western herbs, and nutrients vital in prostate therapy. This formulation has a beneficial impact on multiple aspects of functionality in one supplement, enabling us to simplify the patient's regimen (another approach that promotes better compliance). The formula was developed by Dr. Eliaz, based on decades of experience in working with prostate cancer patients. A recent paper on Prostacaid published by Columbia University demonstrated its efficacy in all prostate cancer cell lines using only very small concentrations. We also extensively use formulations developed by Donald Yance, a clinical herbalist and founder of Natura, which produces supplements that combine multifunctional botanicals with nutrients.
Nutrients, mushrooms, and botanicals that are incorporated into our protocols include ALA (alpha-lipoic acid), artemisinin, boswelia, bromelain, concentrated proanthocyanidins, curcumin, DIM (diindolylmethane), EGCG (epigallocatechin gallate), L-glutamine, grape seed extract, herbally enhanced mushrooms, honokiol, liposomal glutathione, lycopene, methylation support with activated B vitamins, NAC (N-acetylecysteine), nattokinase and lumbrokinase, nigella seed oil, omega-3 oils, pancreatic enzymes, quercetin, resveratrol, selenium, sprouted cruciferous extracts, TMG (trimethylglycine), vitamins A, C, and E succinate, whey, and zinc, as well as Chinese herbs. We use innovative delivery systems such as rectal suppositories for botanical formulations, which effectively target and optimize absorption in this highly vascular area of the body.
We also use pharmaceutical agents with known anticancer activity, including COX-2 inhibitors such as Celebrex, Metformin, Noscapine, Disulfram, LDN (low-dose naltrexone), sodium phenylbutyrate, tetrathiomolybdate, and rapamycin, as well as Lupron, Casodex, Avodart, and Proscar.
Sequencing of therapies is an artful process. Each person is closely supervised and monitored on an ongoing basis, with modification in his protocol as required.
We find that IV infusions provide a number of important benefits. Both IV vitamin C and IV C in combination with K3 are oxidative therapies that we use in tandem with other treatment modalities. Recent research at the University of Kansas is once again validating the use of high-dose intravenous vitamin C as a valuable treatment modality for cancer patients.
One of the most common causes of serious illness and death in cancer patients is thrombosis, either peripheral or pulmonary emboli, because of the increased immune activity, inflammation, and upregulation of clotting factors in cancer. As a preventative measure, we check for fibrinogen, D-dimer, and Lp(a) as part of the initial evaluation with ongoing monitoring. Therapeutically, we use nattokinase, lumbrokinase, bromelain, proteolytic enzymes, and botanicals to prevent blood clots.
There are three issues that we address in relation to detoxification.
- The first is the fact that most people have toxicity in some form, due to either heavy-metal or pesticide burden, or as a byproduct of dysbiosis.
- The second issue is detoxification "competence." Every prostate cancer patient whom we have tested has defects in his ability to methylate estrogens, which can result in toxic forms of estrogen associated with a higher risk of developing cancer.
- In addition, we need to support the body's ability to excrete the byproducts of tumor cell death, an added burden to an already overburdened detoxification system.
Nearly 100% of our prostate cancer patients have a history of significant toxic exposure, and many test positive for toxins. Pectasol-C (modified citrus pectin, or MCP) is an ideal compound to use to counter these effects, because of its multifunctionality. In published studies, this oral plant-based chelator has been shown to remove lead and mercury safely. In addition, MCP has been found to inhibit angiogenesis, and to interfere with cell adhesion and metastasis by binding to galectin molecules on the surface of cancer cells. Galectins are involved in cell signaling and adhesion, and are associated with the tendency to metastasis.
Modified citrus pectin removes heavy metals by binding and then eliminating them through the gut. We always use MCP in conjunction with any other chelating agents, as we think that it adds an element of safety to our detoxification programs. MCP is extremely gentle; patients rarely experience side effects, and when they do, the effects are usually mild GI disturbances. A recent publication demonstrated the synergistic effects of both modified citrus pectin and Prostacaid in PC-3 cell lines.
A good example of the influence of heavy-metal toxicity on cancer progression is the case of a prostate cancer patient who came to us with a PSA of 102 and metastasis to the pelvis. A key point in his history was his army career as a helicopter mechanic and pilot. He had shrapnel exposure as well as ongoing exposure to gasoline and other chemicals. His lead levels were very high. An otherwise healthy man, his prostate cancer was unusually aggressive. Reducing his lead burden with Pectasol Chelation Complex (a formula combining MCP and alginates) and other oral and intravenous treatments resulted in an improved response to our treatment protocol with the resolution of his bone metastasis and stabilization of the prostate cancer (Eliaz et al. 2007).
Intestinal health is another area that we think is central to cancer treatment. Dysbiosis can take the form of an overgrowth of pathogenic bacteria or fungus, parasitic disease, food sensitivity, low secretory IgA, pancreatic enzyme deficiency, or chronic inflammation in the colon or small intestine. We typically see one of these issues with most of our patients who have chronic illness. Unresolved GI health issues can result in immune dysfunction, poor digestion, poor nutrient absorption, chronic infection, toxicity from pathogenic byproducts, or chronic inflammation.
This is an area that we think is very important for cancer patients as a potential source of chronic inflammation and infection, which can affect the entire body and dysregulate the immune system. From the perspective of TCM, each tooth has an associated meridian and an affected organ system. We have seen numerous correlations between the cancer site and problems with the associated tooth or meridian. Root canals, old amalgams, and periodontal disease are all significant issues that we encourage the patient to address.
As a form of therapy, acupuncture can have a deep impact on constitutional aspects of the patient. As a diagnostic tool, acupuncture can help us see where his energy is blocked, to restore good energy flow. Typically with prostate cancer, people tend to be locked in the pelvic region, so acupuncture can be helpful in restoring energetic balance. As an ongoing treatment, acupuncture integrates well with our other treatment modalities.
Thirty years ago we asked people what their family history was, and you could see clusters of susceptibilities. Today we can actually identify some of the genes that are involved. There are several options in terms of genetic testing, including:
- HLA DQ testing available from Lab Corp provides a quick snapshot of patient vulnerability due to poor detoxification of metals, chemicals, or endotoxins from infection.
- Genetic testing from specialty labs such as Genova evaluates detoxification pathways by testing for genetic defects or SNPs, which can help us determine whether the patient has significant detoxification deficits.
The old notion that our genetic makeup is set in stone is no longer the working model. Genetic signaling is a malleable process. We can modify signaling and thus phenotypic expression. Research has shown that plants contain information which can communicate with and modulate human genetics. Using genetic testing as a guide to individual predispositions, we can target botanicals to normalize, block, or upregulate specific genes.
In addition, we can use genetic profile testing to track the upregulation or downregulation of specific genes that control cancer growth and proliferation, inflammation, and angiogenesis – and the status of genetic repair mechanisms.
Abnormalities in insulin sensitivity and glucose metabolism can drive inflammation, elevated blood sugar, immune compromise, reduced tissue oxygenation, hormone imbalance, and increased viscosity.
Diet and exercise are important areas to assess and improve for normalization of weight and insulin sensitivity. Targeted multinutrient botanical formulas can also improve insulin sensitivity, promote lean muscle development, reduce abdominal fat, and reduce inflammation, thus taking the fuel from the flame. New research is showing that Metformin has anticancer activity in addition to its insulin-sensitizing effects.
We work closely with the patient in defining his goals, what he's going to do, and what he's trying to avoid. We build protocol around the patient's needs and wants, bringing a broad range of tools and resources to the issue, working closely with him at every stage of the decision-making process.
For those who choose to incorporate more conventional treatment options, our work has a crucial place in terms of preparation, side-effect reduction, and long term well-being. For example, combining our protocol with intermittent androgen deprivation therapy increases the effectiveness of treatment because we are working on the problem from many angles. We are often able to successfully delay the development of androgen-independent disease, adding years of quality life for more advanced prostate cancer patients. This integrative approach also addresses the deleterious short- and long-term side effects of androgen deprivation therapy, supporting cardiovascular and skeletal health, reducing hot flashes, fatigue, and depression with carefully crafted protocols.
We often see patients who have failed conventional treatment, who come to us with very limited options. Integrative treatment protocols have been very effective for this population. We have found that the use of sophisticated nontoxic, noninvasive therapies promotes improved outcomes in the majority of the patients whom we see, effectively modifying their disease process, supporting their response to treatment, and slowing PSA velocity, while enhancing overall well-being.
Another population appropriate for integrative treatment is found among the growing number of low-grade prostate cancer patients, who have historically been overtreated. This has resulted in the promotion of "watchful waiting" for larger numbers of prostate cancer patients. Integrative practitioners have the ideal skill set to offer highly personalized care to this population, drawing on clinical experience in providing nontoxic treatment protocols and prescribing lifestyle therapies. This presents a unique opportunity for information exchange and bridge-building to the benefit of patients and providers alike.
Elaine Weil, NP, NC
Cheri Quincy, DO
An integrative medical and healing center for people with cancer and chronic illness
7064 Corline Court, Suite A
Sebastopol, California 95472
Nancy Faass, MSW, MPH
The Writers' Group, San Francisco
Elaine Weil, NP, NC, received her bachelor’s degree in human biology from Stanford University and then earned certification as a nurse practitioner with a specialty in women’s health. She received her clinical nutritional training at Bauman College. A lifelong student, she brings to her practice the perspective of her ongoing studies in integrative medicine, herbology, clinical nutrition, and integrative care for patients with cancer. She mentored intensively with Dr. Isaac Eliaz in his approach to cancer treatment by implementing, researching, and developing new protocols for cancer patients at Amitabha. Elaine has authored continuing education courses for nurses and NPs in women’s health and has published articles in peer-reviewed journals on bioidentical hormone therapy as well as integrative approaches to cancer treatment.
Dr. Cheri Quincy completed a residency in internal medicine in 1980 and a fellowship in geriatrics in 1982, and was an assistant professor of medicine from 1982 to 1986. She was a founder of one of the first preventive health curricula for medical students in 1982, produced a conference on Death & Dying, and has been invited to lecture on life transitions by such groups as the International Conference on Shamanism and the American Osteopathic Association. Dr. Quincy has been interviewed on New Dimensions radio, WBAI Radio (The Positive Mind) in New York City and KQED in San Francisco. She also has special interests in aging and life transitions, and has written papers on the physiology of the death event, apoptosis, and other integrative topics
Nancy Faass, MSW, MPH, is founder and director of www.ProWritersGroup.com, a coop that offers writing and project development for authors. She has worked as a freelance writer full time for more than 15 years, provided writing support on more than 40 books, and worked with hundreds of authors.
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