Victoria Maizes MD (00:02.178)
Dr. Dawn Lamon is a board-certified medical oncologist and a widely recognized authority on integrative oncology. She's the founder as of 2014 of Oregon Integrative Oncology. Dawn is a graduate of our fellowship program and now serves on our fellowship faculty as well as serving as assistant clinical professor of medicine at the University of Arizona. Welcome, Dawn.

Dawn Lemanne, MD, MPH (00:30.965)
Great to be here. Thank you for having me.

Victoria Maizes MD (00:33.432)
Dawn, you have been so innovative in your integrative oncology practice, and you really take pride in approaching every patient as an N of one. What does that actually look like in practice?

Dawn Lemanne, MD, MPH (00:49.867)
Sure. So that is something that I I really am very, very interested in and learned a lot about in the Integrative Medicine Fellowship. That was one of the reasons th that I went to the fellowship. I was not happy with a

Protocol list and something that you did this for every single patient based on a diagnosis that was written down because the diagnosis seemed a little fuzzy to me. And as I went through my career, I I found out that you know everything in medicine is a little bit fuzzy, and so why not try to focus in on the person who's exactly in front of you? And so

One of the things that we do in in integrative oncology very, very well, I think, is listen to the patients and hear where they're different from the patient that was in the room a few minutes before, with ostensibly the same diagnosis on paper. And I think in oncology we have been forced to do that because

When we follow the protocols exactly for each patient with the same written diagnosis, we get wildly different results constantly. And so I think every oncologist comes to the point where they understand that there's more to this business than finding the diagnosis and then matching the treatment to it. And what this requires on the ground is changing treatment a lot.

and changing it constantly and changing it in different ways for different patients.

Andrew Weil (02:39.14)
Dawn, where where is the field of integrative oncology now? You know, my impression over the years is that the demand for this has been great, but the supply of practitioners trained to practice it is not that great.

Dawn Lemanne, MD, MPH (02:52.791)
So, you know, there are a lot of f people from the fellowship who are treating cancer patients with integrative methods. I think there are fewer

Medical oncologists and and and radiation oncologists, people who are trained also in oncology itself, who are are doing that. But the number is increasing. And this certainly patient interest is driving this dramatically. So you can't find now a large academic

cancer center that doesn't have somewhere at least one room that has integrative medicine or integrative oncology over the door. So yes, pati and and the the focus of those are sometimes, you know, in various degrees limited or expansive depending on who's there and what their interests are. But yes, it's being driven by patients and it will only grow. And I think, you know,

Andy, one of the things that you taught me and you continue to say is that integrative medicine is going to just become medicine and integrative oncology is just going to become oncology. And that's very much patient-driven in a in a good way. And we oncologists are scrambling to keep up and but that's that's a positive development, yes. and you're right, there are not integrative oncologists are are few.

Andrew Weil (04:05.264)
Mm-hmm.

Victoria Maizes MD (04:18.306)
Dawn, one of the concepts that I've learned from you has to do with adjusting a patient's treatment protocol in real time based on the evolution of their tumor or their cancer. Sometimes it's called adaptive therapy.

This is, I think, a real challenge to the conventional approach. So I would really love to hear you talk a little bit about this. And my understanding is one of the exciting potentials is that it can reduce the risk of treatment resistance.

Dawn Lemanne, MD, MPH (04:57.037)
so you know, one of there are many epitomies, but one of the epitomes of integrative approaches is to think of cancer in a particular patient as an interloper in an ecosystem, with the patient being the ecosystem.

Victoria Maizes MD (05:01.388)
Ha ha.

Dawn Lemanne, MD, MPH (05:13.557)
And the cancer being the interloper. You can think of it as an invasive species, something like that. And that's a you know a vague metaphor. We have to use metaphors to think about this being human. But oncologists, including me, have started talking to ecologists. And I mean literal ecologists, people who study ecosystems and look at the population dynamics within very, very complex systems. And we've taken some instructions.

Victoria Maizes MD (05:30.984)
Ha ha ha.

Dawn Lemanne, MD, MPH (05:43.434)
From that. And a good example, I think, that everybody will relate to is gardening and putting a particular pesticide on your garden. So in the 1950s, DDT was invented, I believe. And from 1950 to 1956 or so, cotton farmers in the South, the American South, where cotton is the major, to this day, major crop.

had a problem with a parasite or some sort of entity called a bowl, cotton bowl weevil, meaning a bowl of cotton, a B O L L. And D D killed them. First year

They applied this stuff like water to the fields. All of the bull weevils were gone. The farmers would walk through the fields and there's none. That's great. Well, the next year the bull weevils are back. Put some more on. Okay? This went on till 1956 when they put on as much DDT as they could get their hands on, and the bull weevils just thrived. So what happened? What happened was all of the bull weevils that were sensitive to DDT, who were poisoned by it.

Died off in the first round, and it was most of them. But there was a small percentage of the whole bole population that was inherently insensitive or resistant to this chemical, DDT. And so those survived and reproduced, and each year you got more and more of them, and fewer of the sensitive ones.

We've heard about that with with antibiotics and I don't want to get too much into antibiotics because we've used the metaphor of antibiotic therapy in cancer to our detriment for many decades. We can talk about that later. But we've heard about the development of resistance in germs that we treat with antibiotics and and how that's been a problem because of overuse. It's the same issue in cancer within one patient. If you give a drug

Dawn Lemanne, MD, MPH (07:45.352)
over and over and over again, at first, at first the drug is going to look like it's working beautifully. And I'm talking about let me back up one minute here and say that what I'm discussing right now has specifically to do with diseases in the oncology field that are considered incurable today with standard therapy. And these are things like metastatic breast cancer, metastatic prostate cancer, metastatic colon cancer, metastatic lung cancer.

Metastatic pancreatic cancer, and there are there are quite a few more. I didn't list all of them by any means, but I'm talking about diseases that are considered incurable. I'm not talking about early stage breast cancer or early stage colon cancer, early stage prostate cancer. I'm not talking about those. Those need to be treated with we do have curative treatments for those, so those should be treated in that sense with standard therapy for cure. But if you have a disease that's not curable, let's take metastatic prostate cancer. Not curable.

with current standard therapy. And what happens is is that at the beginning, the gentleman will come in with, you know, perhaps widely metastatic prostate cancer involving the bones. Specifically, that's where prostate cancer likes to spread first in most cases. And we can see that on a bone scan. We give them the standard treatment, which is called androgen deprivation therapy. It's a testosterone system blocker. And the bone scans get better.

Over the next three, six months, the bone scans completely clear up. The PSA, which is high, goes down, sometimes becoming almost undetectable, and everybody's really happy. But within another six months or so, on average, the disease comes back. We say it comes back. What we really mean, what we should say, is that it never really went away. And the reason is it's the same story as with the cotton bowl weevils and the DDT. We kept applying the same remedy. We destroyed the

Treatment sensitive tumor cell population. And the tumor cells that were left were the ones that were resistant to our treatment, and they've been repopulating the tumor all over the patient's body. So that's a really common scenario. We see that over and over again. And one of the things that this really, this really, I think this kind of lit a fire under me. When I was in training, one of the things that we would tell patients.

Dawn Lemanne, MD, MPH (10:10.963)
over and over again, and we said this with a straight face, is we're gonna treat you, and this cancer is not curable, but it's treatable, and we're gonna treat you. And then we'd say, and when the treatment stops working, we're gonna go on to another you know. So th the problem with that story is is that number one, we oncologists just accepted that. We didn't question it and say, well can we do can we do better than this? Why why are we accepting that

you know, the treatment's gonna stop working. And and the the second thing that I didn't go too much into there is that the second rounds of treatments don't work as well. And the third rounds work less well than that. And pretty soon you start having more side effects than benefit and the story doesn't end well. So those are some of the things that that really got me going in this and what this looks like on the ground in terms of trying to do something different is

Pausing treatment before we wipe out all of the sensitive cells.

Why would we want to do that? Why would we not want to destroy all of the cancer cells, as many as we could, even if they're the sensitive ones? I mean, just destroy the destroy as many as you could. Well, it turns out that the sensitive cancer cells actually are doing my job. They're helping to control the resistant cells, which are more dangerous because we can't treat them. So if the resistant cells have a lot of competition for nutrients, waste removal, oxygen.

Victoria Maizes MD (11:34.442)
Uh-huh.

Dawn Lemanne, MD, MPH (11:46.268)
space, everything that they want in that ecosystem, if they have a lot of competition from the treatment sensitive cells, their population is kept suppressed. In other words, we keep them in a low number. So that's how, and how we do that is we pulse the treatment. And we do that not just, you know, well let's give you one week on and one week off. We actually look at the tumor growth dynamics. And what does that mean?

Alright, well prostate cancer was one of the first tumors that this was done in, and ver for a very specific reason. Most patients with prostate cancer have a beautiful tumor marker called the PSA. And every man over 50 is going to know what the PSA is. Prostate-specific antigen. When you go in for your annual checkup, your doctor will you know will ask you if you want to have that checked, and if you do, that you know, here are the numbers that you want to watch for, etc. So the prostate specific antigen is made by prostate cells, normal or malignant.

And if you have a lot of prostate cells in your body, you're going to have a high number of high level of PSA that we can measure in your blood. If you have a high level of PSA in your blood, it's likely not coming from benign normal prostate cells. You likely have a lot of extra prostate cells, and they are cancerous and trying to spread to other parts of your body. So that's what the PSA is. We can measure the PSA dynamics. So when we do adaptive therapy, we measure the PSA as often as once a week.

So if if you have prostate cancer, you know, your your doctor may measure your PSA every three months, you know. A lot well, by then a lot of things have happened. So we measure the PSA and we try to keep the PSA instead of suppressing it as and making it go as low as possible, we try to put the PSA down and I'm these numbers are just to make the math easy right now.

Victoria Maizes MD (13:14.776)
Wow.

Victoria Maizes MD (13:20.941)
Uh-huh.

Dawn Lemanne, MD, MPH (13:44.108)
These are not the real numbers. Okay, so do not do this at home. But if a gentleman comes in with a PSA of let's say 100, we'll try to get it down to 50 and then let it go up to 75, maybe back to 100, and kind of cycle it in between there. And we do that by by timing the treatment. And one of the things that's made this possible and much more easy is that now there are oral androgen deprivation.

Victoria Maizes MD (13:47.298)
Ha ha ha.

Victoria Maizes MD (13:58.067)
huh.

Dawn Lemanne, MD, MPH (14:11.379)
therapy drugs like Orgovix, Relugalix that are pills. You can just take a pill. The usual treatment has been a shot that turns off testosterone production for months. Three months, you know, y I I actually measure the testosterone level. A lot of gentlemen do not recover their testosterone after one three month lupron shot until month five or even six. So they're really not, you know, three month shots for a lot of

Victoria Maizes MD (14:39.811)
Right.

Dawn Lemanne, MD, MPH (14:41.035)
But if you give them a pill every day that does the same thing, lowers the the whole body testosterone system function, you can stop that at any moment. They you know, okay, Mr. So and so, your PSA has gone from a hundred to fifty, we don't want it to go any lower, let's have you stop your your pills and let's let it go up. So

Victoria Maizes MD (15:04.749)
So let me pause you for a second, because in so many ways this is so counterintuitive. And Andy, I'm gonna pick on you for a second as my resident ecologist. Can you think of a place that we're doing this in the plant world so that we have a a healthier ecosystem? Because you gave such a beautiful analogy, Dawn.

Andrew Weil (15:12.495)
Yeah.

Dawn Lemanne, MD, MPH (15:15.126)
Yeah.

Andrew Weil (15:22.127)
Yeah, I think yeah, I think there are forms of of natural agriculture, regenerative agriculture, where you don't wipe out all the weeds or all the things that you consider noxious. You know, you let some of them grow and you wind up having a healthier ecosystem than when you do a monoculture.

Victoria Maizes MD (15:29.846)
Mm-hmm.

Victoria Maizes MD (15:43.148)
Yeah, we have been having a conversation with one of your neighbors actually, Wendy Johnson, who wrote a book called Kinship Medicine, and she talks about

Making an effort to live in harmony, not just with the plant world, but also with the animals, including the animals who may be nibbling on your garden. And I think that's an indigenous practice as well, that you don't necessarily rid everything, because there's benefits actually to this diversity of plants and animals.

Andrew Weil (16:15.365)
Well, I think the lesson from using pesticides on against insects is very dramatic. You know, that we have made insect predation on plants much worse by our use of of insecticides. No question about that. We've bred insects that are stronger, tougher, you know, more damaging than were there to begin with. Yeah.

Victoria Maizes MD (16:21.303)
Mm-hmm.

Victoria Maizes MD (16:36.984)
Yeah. So the equivalent of those resistant tumor cells. So, Dawn, when people hear these three terrifying words, you have cancer, what they're often hoping for next is, and we have a cure. How do people react when you tell them we don't actually have a cure? And our goal is not to, you know, get you to what looks like a remission, right? Briefly at least.

Dawn Lemanne, MD, MPH (16:54.271)
Okay.

Andrew Weil (17:00.101)
Well.

Victoria Maizes MD (17:06.722)
But rather to just suppress to a certain point turn this into a chronic manageable disease. I think people are so frightened. do people go for this?

Dawn Lemanne, MD, MPH (17:18.641)
Yes. So our first patients, we started this I work with s some so there's such a thing, an entity called a mathematical oncologist. And I I work with them and we started doing this clinically in about twenty se 17, 2018, I think, something like that. And our first patients were physicians, all of them. And they came in and they said already, you know, we get it.

Victoria Maizes MD (17:42.668)
Yeah. Huh.

Dawn Lemanne, MD, MPH (17:48.13)
We're gonna just wait for resistance and then go on to the next thing. We don't want that. And there were some, you know, very early trials, clinical trials progressing at Moffat Cancer Center and a couple of other places that looked promising. And so those were the the first patients. Now that knowledge has trickled down to to people who are not physicians and they've heard of it. We have we have a very public patient who's a professor of genetics at

The University of Utah and he and his oncologist are very public about this. that they're using our techniques and advancing them themselves as well for this particular gentleman who has an advanced form of male breast cancer. And he's been doing well for many, many years, presented de novo with metastatic breast cancer and has been

I think he just got back from a trip to Africa, he's completely active, doing whatever he wants, doing his research, his genetics work, and AI work in genetics, using an adaptive approach that's constantly changing. So we will treat him with tamoxifen for a while, and then we'll stop, and then we'll treat him with some chemotherapy drugs. And not just guessing, but trying to to fit the various mechanisms together so that when we treat him with one

particular entity, the way that the tumor evolves resistance to that entity then makes it susceptible to the next thing that we're going to to apply. So yes, patients do accept this. The thing that's hardest for patients to come to grips with and understand at the beginning is watching the tumor marker go up on purpose when the treatment is paused.

Victoria Maizes MD (19:42.36)
Mm-hmm.

Dawn Lemanne, MD, MPH (19:46.7)
That's difficult psychologically. And that's because we're, you know, we don't want to see our our quote unquote enemy, if you're thinking about it that way, getting stronger. But you know, the that one of the the leaders in this field, Dr. Robert Gatenby, whom I think you know, Victoria, Yes. Yes. okay. Okay. Well he was at the University of Arizona.

Victoria Maizes MD (20:04.898)
He was a speaker at our conference a few years back. You introduced us to him.

Dawn Lemanne, MD, MPH (20:12.747)
for part of his career. So but one of the things that he says is that, you know, we don't want to play whack-a-mole with cancer anymore, which is what we're doing with our current standard treatments. We want to play chess. We want to be a few moves ahead of it, and we want to drive it into the direction we want it to go.

Victoria Maizes MD (20:28.142)
Uh-huh.

Dawn Lemanne, MD, MPH (20:28.821)
so that we can continue to control it. And so that's the the idea, and that's you know, and that's completely from the field of ecology formally. So there there's an ecologist at the who who's at the Department of Mathematical Oncology, integrated mathematical oncology, that's what they've called called it, which I think is great. named Joel Brown, who spent has spent his career studying

Ecology and mathematical ecology. And so they develop you know the the protocols for each patient, how how how far up to let the the tumor marker go, how far down to suppress it before we you know remove treatment again, those kinds of things. So it's very dynamic. the more the closely that we can measure the tumor dynamics with a blood test, the better. If you try to do it with imaging, because imaging is you know several months behind blood.

You're way behind. You know, you're the the even if with whack-a-mole your the mole has gone back underground by the time you get your your racket out. So with the new blood tests that we have, like circulating tumor DNA, those have been a real game changer and oral medications that we can give to really control the dosing and the dosing intervals, that's been really important.

Victoria Maizes MD (21:31.448)
Yeah.

Andrew Weil (21:48.666)
When I look back and

Through my career in medicine on how we've managed breast cancer, there's a very dramatic progression of turning this into a chronic disease for many people. You know, when I was in medical school, first you took the tumor out, then you took the breast out off, then you took the ovaries out, then you took the adrenals out, and the patient died. you know, and now for many women this has become a manageable chronic disease. That's real progress.

Dawn Lemanne, MD, MPH (22:18.741)
Yeah, absolutely. And you know, I I I think you've had Volter Longo on. And one of the things that he's shown is that you can reverse you can reverse treatment resistance using

Victoria Maizes MD (22:24.386)
Yes.

Dawn Lemanne, MD, MPH (22:34.731)
Fasting. His fasting mimicking diet is what he he uses to do that in his trials. And you know, that's another way that we can integrate you know, lifestyle into cancer management. And yes, breast cancer in many of its forms has become much more manageable. but we are using adaptive treatment in in breast advanced metastatic breast cancer if we can find a good tumor marker and we're actually alternating

Andrew Weil (22:58.895)
Mm-hmm.

Dawn Lemanne, MD, MPH (23:03.505)
anti-hormone therapy with hormone replacement therapy to maintain bone health, cognitive health, those kinds of things in in very carefully selected patients.

Victoria Maizes MD (23:08.406)
Interesting. Yeah.

Victoria Maizes MD (23:14.434)
Dawn, I'd love for you to talk a little bit more about fasting. I think it will be surprising to many listeners that the evidence for the value of fasting, especially before and after chemotherapy, has grown dramatically. Can you

Andrew Weil (23:14.935)
And twelve, yeah.

Victoria Maizes MD (23:33.774)
present that and also how do you talk to your patients about fasting? Because again, there's a little bit of counterintuitive, you know, I think a lot of us have this idea of when you go through chemo, you lose your appetite, you lose weight, you don't feel well, and now we're gonna ask you to fast on top of that.

Dawn Lemanne, MD, MPH (23:54.22)
Sure, sure. So so yes, fasting is is counterintuitive when when you know, when you're a child and you're ill, your mother, you know, brings you food. that's that's the the the thing that you do when somebody's sick. You bring them food. Well cancer, certain cancers, and again

Victoria Maizes MD (24:03.738)
Yeah.

Dawn Lemanne, MD, MPH (24:11.947)
We have to be really careful who we use these approaches with. It's not appropriate for everyone. It's not. So don't do this at home. But with your practitioners and doctors, you can explore this and you can explore it safely. fasting works in cancer by protecting, it's the holy grail, it protects normal cells from damage from chemotherapy and radiation.

Victoria Maizes MD (24:15.276)
Mm-hmm.

Dawn Lemanne, MD, MPH (24:41.881)
And it enhances the susceptibility of cancer cells to those two things. So if you're going to have chotherapy or radiation,

You want to make sure that you've weakened the cancer cells by fasting. And the the in my opinion, and I I I I I think this will be proved, but I could be wrong. In my opinion, the secret sauce is lowering the blood glucose. So it doesn't matter if you get there by fasting, by partial fasting, by you know, taking a GLP1 receptor anti agonist, you know, any way you can get that blood sugar down below 90 during your your treatment, and lower is better, 70 is easy.

Even better, the more damage you're going to do to those cancer cells, and the more you're going to protect the normal cells. So normal cells are protected from damage during these treatments because they go into a dormant state. A cell in a dormant state is not dividing. Dividing and division that particular state.

opens up all of the DNA in the cell, it literally unravels and fills the cell and makes a great big target for the chemotherapy and the radiation to to get at and to to to to damage. So when your DNA is unraveled,

And you're ready to divide. You're very, very sensitive to these drugs if you're a cell. Well, a normal cell, when the blood sugar goes down, says, this is a bad time to divide. Let's roll everything up tight, let's throw all the old furniture in the fi fire to keep us warm, and let's just wait till this famine passes. All right. And then, you know, every cell is one or two cells from a blood vessel, so when the chemotherapy comes through in the in the blood vessel, they're they're battened down and they are not susceptible. And so they're safe.

Dawn Lemanne, MD, MPH (26:30.849)
with radiation the DNA is again wrapped up very, very tiny. It's not spread out in the cell, so when the radiation comes through, it's like cannonballs. it's much less likely to get hit. It can, but it's not. It's not it's not gonna be as much damage as if you were had the DNA all spread out. Cancer cells can't go into that dormant state. Their DNA is spread out as much as they can. Their instructions in their and this is a metaphor, of course, their mind, is we have to grow. We're gonna grow.

Victoria Maizes MD (26:57.974)
Yeah.

Dawn Lemanne, MD, MPH (27:00.905)
at all costs. Whatever we need to do, we're gonna grow. So every minute that you can, expand that DNA, get the division apparatus set up and let's go, go, go. Well, when the blood sugar goes down, they still do that, but they get a little nervous and you know, so so they they will continue to try to divide

But then the chemotherapy comes by and they're like, there's no food around, maybe we should take that in and see if we can get some energy out of it. So they'll take the chemotherapy in and kaboom, kablooey. So that's good. and also if they take the chemotherapy in and they're and kablooe doesn't completely kill that particular cell, if there's no repair material around.

lots of food, proteins, fats, vitamins, you know, B twelve, they love that, B twelve. you know, if there's none of that around, they will just eventually peter out and die. Okay, but if you put in food after your chemotherapy or during your chemotherapy infusion, what do the cells do? The cancer cells, they use it to repair the damage. So that's all work done by Volter Longo, who who

has you know laid out how how this this works. And patients will accept fasting when you tell them that story.

A lot of patients have fasted. you know, cancer patients are no longer very naive. They're pretty savvy. They before they get to me, they've done a lot of reading, they've listened to your podcast, they've heard Walter Longo, you know, they're they know you know that I'm gonna tell them that maybe we oughta think about fasting. A lot of them have tried fasting themselves. And so it's you know, one of the things that I I tell

Victoria Maizes MD (28:45.41)
Mm-hmm.

Dawn Lemanne, MD, MPH (28:58.761)
you know, student doctors if if you know, if they're thinking about using these things with their patients, is try it yourself.

So I will, you know, I've done a week-long water fast. It was hard the first few days, and then it became very easy, surprisingly. I followed my blood tests and watched the uric acid go up as it was supposed to and all of that. And you know, so I understand from the inside what it feels like to conduct a very long fast. And so I suggest to physicians who want to explore that and are thinking about exploring with their patients, explore.

On yourself first, if if you're able to, if you have you know health that allows that. Don't do it if you're not healthy and can't do it for some reason like that. But I think that if the physician is confident in what happens when you fast, what the first few days are like, what the last few days are like, most of the fasts around chemotherapy are 48 hours. That seems to be the sweet spot. Longer isn't as good, and shorter doesn't do anything. So 24-hour fast does not get the cells into the state that we just talked about.

Victoria Maizes MD (29:52.343)
Mm-hmm.

Victoria Maizes MD (29:58.904)
Mm-hmm.

Dawn Lemanne, MD, MPH (30:06.457)
Forty-eight hours fast, this is work done at University of Southern California, I believe, maybe City of Hope, in the late 20 teens, found that in human patients on the most common types of chemotherapy, forty-eight hours was the best time to prevent damage to the immune system. They looked at something called the comet assay, which looks at DNA damage in white blood cells. And also subjectively, of course this is fuzzy, but patients felt better

at that particular amount of time with fasting. So

Andrew Weil (30:39.343)
Dawn, I have a practical question on another subject.

I have a long-standing interest in Chinese herbs that are used in cancer treatment. If if I tell a patient, if I recommend to a patient a using a particular herb, say a stragalus, for example, I often tell them probably best not to mention this to your oncologist, because more likely than not they will be told not to take anything during their conventional treatment, including all supplements. how do you

Dawn Lemanne, MD, MPH (30:49.003)
Yes.

Dawn Lemanne, MD, MPH (31:02.838)
Right.

Andrew Weil (31:12.923)
feel about that? Is that changing?

Dawn Lemanne, MD, MPH (31:15.721)
you know, I i I get this all the time and patients will say, I don't want to tell my unc you know my treatment team that I'm doing this or that. Usually I'm on the treatment team so that's not you know an issue for me but I it's it's difficult. I tell patients that I think honesty is the best policy and one of the reasons is that it gets you know standard oncologists used to the idea hey your patients are doing this. If you don't want to know about it

That's to your detriment and to your patient's detriment. You need to have a patient-facing persona that accepts whatever the patient tells you and and deals with it. It's not about you, it's about them and this is what, you know, and you can tell them I don't know very much about it, which I think is becoming the more honest answer. Not that there's no data. It's that, well, I haven't read that data, I'm too busy with my standard stuff and you know.

Andrew Weil (31:48.538)
Mm-hmm.

Dawn Lemanne, MD, MPH (32:09.931)
So I tell patients, you know, if they have a Chinese medicine practitioner, which I think is is grand, they want to talk to me. That practitioner can talk to me. One of the things that I do, I really do want to know is what's in that. You know, and if the patient brings in a bottle and it's in Chinese since I don't read it, that's not gonna be very helpful for me or the patient. So, you know, I want something that's translated and I want to work

Andrew Weil (32:27.663)
Mm-hmm.

Dawn Lemanne, MD, MPH (32:38.143)
together and closely and and and and see what we can figure out with this patient. And we do this all the time with other specialties, so why not with Chinese medicine? you know, I'll call up ENT and say, what should I do with this patient's ear you know, so what should I do with this patient's Chinese herbs? You know, tell me tell me what it is and wh why you're doing it and and all of that. So I think that open dialogue, and I know this is idealistic, but I think open dialogue is what I want to push toward. And patients you know

Andrew Weil (32:46.819)
Isn't it?

Dawn Lemanne, MD, MPH (33:08.343)
This is this is gonna be a little edgy, but if you feel if you're a patient and you feel that you can't be honest with your oncologist, is that the oncologist you want? You know, really? would you wanna rethink that maybe? And I know that it's not that easy to change you know, I I get it, but I want to at least get that question out in the open. And yeah.

Victoria Maizes MD (33:10.946)
Mm.

Andrew Weil (33:18.222)
Right. Yeah.

Victoria Maizes MD (33:18.702)
Yeah.

Victoria Maizes MD (33:32.216)
Dawn, you spoken a bit about short-term fasting, about this adaptive treatment plan. You also offer some less conventional treatments like hyperbaric oxygen and temperature manipulation. Can you talk about those and how do you decide when to put those into practice?

Dawn Lemanne, MD, MPH (33:55.682)
Sure. So so let's start with hyperbaric oxygen therapy.

And hyperbaric oxygen therapy has increasing evidence, although it's not perfect in terms of the evidence base. But there seems to be some evidence for certain patients with triple negative breast cancer, especially if they're on a drug called Trodelvi, because there's a nice interaction there. there may be some benefit in patients who are fasting and have a

KRAS mutated GI tumor, adding hyperbaric and also high dose vitamin C in those situations might be useful. And this is from this is

This is not strong evidence, and I don't want people to feel like, if I can't do hyperbaric oxygen therapy, I'm missing my chance. No. But if you can and you want to and it's safe for you, it's something you might explore. And some other things, sauna bathing is something. I I don't use I think you were maybe talking about hyperthermia where you aim microwaves at the tumor or something like that. I don't do that. I just don't have that equipment, that's a big deal. there's a there's a center.

UCSF off and on offers hyperthermia in their radiation oncology department, and then there's a place in British Columbia. Those are the places I know of on the West Coast that do that. But there's whole body hyperthermia where you're kind of sedated and you're put into an oven, basically, and your body temperature is brought to 105 degrees, central your core body temperature. That's really a you know, a real serious endeavor and procedure needs to be done by a physician who's very, very capable in that. I don't do that.

Dawn Lemanne, MD, MPH (35:44.006)
But I do recommend for a lot of patients sauna bathing, and I I recommend that they get their core temperatures measured under their tongue up to 101 to 102. And that takes a finished sauna, typically not an infrared just because they're not hot enough. Takes a sauna that's at least 170 degrees Fahrenheit to get you there.

within a a short period of time. and you want to measure, do not take a thermometer in the sauna with you. It'll just go straight up to 180. But leave it outside. When you think you're hot enough, get out, take your temperature under your tongue, and when you've hit 101 to 102, you're there, you're done. You can get out if you want, you can stay in if you want, but that's the goal. You want to get there. And the the thinking behind that, and this again is not proved science, but there's enough there's enough hints in my

Victoria Maizes MD (36:11.222)
Yeah.

Dawn Lemanne, MD, MPH (36:32.385)
to my mind to say, well, it's certainly not harmful for most people and it might be helpful. so so that's something that I I like to recommend.

I the sauna bathing has to be done quickly. The heat has to rise quickly because this cancer cells can't make the proteins that protect them from heat damage very quickly because they're so busy they have to turn off all the you know the the the busy division part of things and go make some heat shock proteins and things like that. Takes them about 30 minutes, all right, literally, okay, that at least in the in the test tube. So if you get

Get your body temperature up in five to ten minutes, you're going to trigger the death of some of these cancer cells.

Normal cells, because they're not all busy with all of those other things, can trigger the production of shock proteins pretty quickly in five to ten minutes or so. So they protect themselves. And also in normal cells, you can condition that response so they get better at it. And so that's why an infrared sauna, as beautiful as they are, cannot do what a finish or traditional rock, hot rock sauna can do, which is get you hot very, very quickly.

and then cold therapy, contrast therapy it's sometimes called. It doesn't have to be fancy, just in my backyard I have a a little sauna and I have a

Dawn Lemanne, MD, MPH (37:59.512)
stock tank it's a hundred gallons I think something like that. It's just a basically a big rubber-made bucket. And fill it with my hook garden hose. I do use a RV drinking water level hose so I'm not getting a lot of plastics and things like that. But I don't think that's a huge deal. I just was able to do that so I did. But jumping in the cold plunge or taking a cold shower immediately afterwards is a really good idea. You don't have to get an ice

Victoria Maizes MD (38:05.933)
Yeah.

Dawn Lemanne, MD, MPH (38:27.733)
bucket and you don't have to get one of these ten thousand dollar repurposed meat freezers that you see people buying please don't do that. My my Rubbermade giant dishwashing bucket costs something like fifty bucks at the local Grange hardware. So so I do recommend that and three times a week is where you start seeing benefits statistically. Up to seven times a week the benefits keep increasing. So so I do recommend those.

Victoria Maizes MD (38:34.08)
Yeah.

Dawn Lemanne, MD, MPH (38:57.911)
So did I get ki I think H bot sauna and I put in vitamin C, I think high dose IV vitamin C

Victoria Maizes MD (39:03.288)
Yes. Well

I mean, it is always interesting to talk with you and to learn about the way in which you're tracking these innovations that could be really important if you have a difficult to treat cancer. You mentioned that if you have a highly curable cancer, going the conventional route might be just fine. but when you have one that's metastatic, that is not currently able to.

Be cured, these other therapies that are coming onto line could make a tremendous difference in your lifespan.

Dawn Lemanne, MD, MPH (39:43.372)
Yeah, and th that's exactly right. And I wanna make a really clear distinction here. If you have a curable cancer and you use an adaptive approach, you're making your situation worse. So these are not things that you would transfer from the metastatic scenario to the curable scenario at all. And so anyone who has a curable cancer, if your doctor says we can cure this, cure.

Andrew Weil (39:57.594)
Yeah.

Dawn Lemanne, MD, MPH (40:13.227)
Go with it. That's what you need to do. If your doctor says, well, this is treatable but not curable ding, you can think and explore the idea of adaptive therapy. It may or may not be right for you, but that would be the first clue that it would possibly be an option for you.

Victoria Maizes MD (40:33.366)
It is wonderful to talk with you. I also want our listeners to know that our center has developed a free resource for people who are newly diagnosed with cancer. It's on our website, it's under the Health Hub tab, and you can scroll down to find the Can Heal Toolkit. So that can be one other resource that people can find and make use of. Don, it's just been wonderful to have you as a guest on Body of Wonder. Thank you.

Dawn Lemanne, MD, MPH (41:02.172)
it's my pleasure. Thank you for having me.

Andrew Weil (41:02.202)
Thank you.