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Natural Medicine Journal Podcast

Natural Medicine Journal's interviews with thought-leaders in the field of natural and integrative medicine dig deep into the most important topics in the field. Whether it's a one-on-one with top researchers in integrative medicine or a conversation with a practitioner about treating hard-to-tackle conditions, each episode promises to provide trusted, cutting-edge, evidence-based knowledge about natural medicine that you won't find anywhere else.
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Now displaying: October, 2019
Oct 21, 2019

In this interview, leading botanical researcher Ajay Goel, PhD, AGAF, describes 3 herbs that he has studied which show great promise in cancer care: curcumin, boswellia, and French grape seed extract. Goel discusses the research associated with these botanicals, as well as any contraindications or safety issues.

 

About the Expert

Ajay Goel, PhD, AGAF, is a professor and chair of the Department of Translational Genomics and Oncology at the Beckman Research Institute City of Hope Comprehensive Cancer Center in Duarte, CA, as well as director of biotech innovations at the City of Hope Medical Center. He has been recognized as an American Gastrointestinal Association Fellow (AGAF) for his research on colorectal cancer. Goel has spent more than 20 years researching cancer. He has been the lead author or contributor to more than 300 scientific articles published in peer-reviewed international journals and has also authored several book chapters. Goel is currently researching the prevention of gastrointestinal cancers using integrative and alternative approaches, including botanical products. Three of the primary botanicals he is investigating are curcumin (from turmeric), boswellia, and French grape seed. 

About the Sponsor

EuroMedica® specializes in bringing proven natural medicines to the United States and in developing unique formulas containing clinically tested, safe, and effective ingredients. EuroMedica’s founder and president, Terry Lemerond, has more than 45 years' experience in the nutritional supplement industry, beginning with the founding of his first companies, Enzymatic Therapy and PhytoPharmica, and culminating in his current company, EuroMedica.

Terry Lemerond is credited as the first to introduce standardized ginkgo, glucosamine sulfate, and IP-6 to the United States. Several of EuroMedica’s products have been featured in published scientific papers. New clinical trials, some including the well known BCM-95®/Curcugreen™ Curcumin, are now underway at prestigious research centers. EuroMedica is perhaps best known for Curaphen® Professional Pain Formula and CuraPro® products, both containing BCM-95®/Curcugreen™ Curcumin. Additonally, EuroMedica provides unique and proprietary products including EurOmega-3®, Traumaplant® Comfrey Cream from Germany, Bladder Manager® featuring the clinically studied SagaPro®, ProHydra-7™ with SB-150™ Seabuckthorn Oil, and Clinical Glutathione™ with Sublinthion®.

Transcript

Karolyn Gazella: Hello. I'm Karolyn Gazella, the publisher of the Natural Medicine Journal. Today we'll be talking about three key botanicals for cancer care, but first I'd like to thank the sponsor of this topic who is EuroMedica. My guest today is Dr Ajay Goel, who is a professor and chair of the molecular diagnostic department with the Beckman Research Institute at the City of Hope Comprehensive Cancer Center. Dr Goel, thank you so much for joining me.

Dr Ajay Goel: Good morning. Thanks for having me on the show. It's a pleasure.

Gazella: So before we dig into our topic, I'm always curious as to what motivates researchers. And in your case, why were you drawn to the study of botanicals?

Goel: Thanks for asking this very relevant question. So I think my answer would be twofold. One, I've always been a firm believer, and there's a lot of data gathered over the last decades or even centuries, that natural medicines are a lot more potent, lot more valuable, a lot more effective then we have given them credit for. If you look at some of the oldest systems of medicines like Chinese traditional system medicine or Indian system of Ayurvedic medicine, they've been there for centuries. They've been there for a long time and we knew that some of the botanicals which were used in these traditional medicinal approaches, they work beautifully. What we didn't have was, we didn't have all the science behind it, but we can negate the fact that these botanicals did not work. So that's one.

Second, I work in oncology and I work very closely with my oncology colleagues and what bothered me all this time is that first, we don't have good modern drugs for treating patients with cancer. So that's one, but whatever drugs we have, the problem is they don't work on most patients. But even in the patients, very small number of patients where they work, they have huge toxicity profile. They have adverse effects associated with them, which makes them almost, I've seen patients who would say that I would rather give up my care rather than accepting any of these modern drugs. So I think that's a twofold answer. One, the natural medicines are lot more powerful. And second, they don't have all the baggage, they don't have all the side effects and toxicity, which most of the modern drugs give us. So I think those were the two motivational reasons for me to continue to research the field of botanical medicine.

Gazella: Yeah, that makes a lot of sense to me. Now today we're going to be focusing on three botanicals in particular. I'd like to start with curcumin, and I have to say, we here at the Natural Medicine Journal really enjoy talking about curcumin because the science is so fascinating and interesting. And there's just a lot of it frankly. So specific to cancer, what are the key mechanisms of action when it comes to curcumin?

Goel: So again, very wonderful question, and just like you said, curcumin is probably, and I check this on a daily basis or a weekly basis, the body of scientific evidence behind curcumin and especially in the context of cancer grows on a daily basis. You know? So to the best of my knowledge, this is the only botanical for which we have the most amount of scientific evidence. And by that I mean, scientifically peer reviewed publications showing the efficacy of curcumin in virtually every kind of cancer, and all kinds of other diseases as well. Now, what is the mechanism of action? How does it work in patients who have cancer? Actually, we can talk about it all day long because there's not one singular mechanism which stands out. But if have to pick one or two, I think it boils down to curcumin's ability to fight inflammation.

So I think it's probably one of the most potent anti-inflammatory agent. And as we recognize all the molecular underpinnings are the basis of most disease, including cancer. We recognize that although once a patient has cancer, we know that many of the genes are not behaving the way they're supposed to. But what is the process which starts this misbehavior of genes? It's always inflammation.

And when we talk about inflammation, we're not talking about acute inflammation, something which we all can easily recognize if you fall or get hurt, we have a bruise or a localized pain somewhere. Now what we're talking about is chronic inflammation, which is completely asymptomatic, there are no symptoms for that. But that is very intimately linked with our foods and diets and lifestyles, and as you would know our lifestyles have changed a lot in the last few years and few couple of decades. And that is the reason why we have such a huge epidemic of cancer because chronic inflammation stays there, and if it continues to persist, it leads to many diseases including cancer. And so if I have to pick one mechanism, it'll be anti-inflammatory activities of curcumin.

Gazella: And you said that there might be another second mechanism that you're drawn to as well.

Goel: Yeah, so the second mechanism would be it's antioxidant potential. What that essentially means is, its ability to capture and get rid of all the free articles floating around in ourselves. Because if we let these free radicals, which are very reactive, hang around in the cells, they begin to oxidize lipids and fats and proteins, basically rupturing all the cells. So if you can capture and scavenge, or just absorb all of these free radicals, get rid of this and increase this amount of antioxidative stress that is the second properties. It's a very, very potent antioxidant along with its anti-inflammatory potential.

Gazella: Great. Now I know that you have done some work with curcumin and cancer. Can you describe some of your research? I realized that there's a lot of research in this area, so maybe choose some of the more recent published trials on curcumin.

Goel: Yes, absolutely. So curcumin is one of my most favorite botanicals. As you can tell I've worked on it for a long time, and we have published quite a bit on curcumin. So if I have to highlight some of the trials which we are very proud of would be fairly simple in a way. So one of the things we recognize, how do cancer cells grow? So cancer cells love to grow because that's in their benefit, that's to their advantage. And one of the ways cancer cells continue to grow without dying is they basically shuttle away all the nutrition from the surrounding healthy cells around them. So they are very slick. They are clever. So for their own survival they need nutrition. And the way they get this nutrition is by fooling the healthy cells around them by telling them this is to their advantage. Please allow me to continue to derive all the nutrition from you, away from you.

And what we showed in one of the beautiful studies, which has been cited a lot, is that cancers don't grow in a silo, they grow in communication. We call it tumor microenvironment, which basically means tumor cells are growing, your healthy cells are growing, your stromal cells are growing. And if some strategies, some drug, some botanical, can basically block that sense of communication between cancer cells and healthy cells, what would happen? Healthy cells would not give the nutrition to the cancer cells. And when that happens, the cancer cells will die. And that's exactly what we showed in a very elegant study a few years back. There had been cancer cells are treated with curcumin, within a matter of hours or days, these cells begin to wither away. And what we showed was this is exactly curcumin does.

It basically stops a communication of cancer cells with the healthy cells. And once that happens and the healthy cells stop giving the nutrition to the cancer cells and eventually the cancer cells die away. So that's one mechanism which is very, very important. Second, which is very relevant to a lot of the patients who get cancer actually, they typically would meet their physician saying, I already have a cancer and you're prescribing me the chemotherapy or radiation therapy. Can I take curcumin along with, maybe it'll enhance the benefits of my treatment? And most of the times if the physicians are not aware of the beneficial effects of curcumin, they will tend to suggest, no, please don't interfere with my care and don't take anything, any supplement, especially along with my care.

And that is not true because we showed, and there are many other studies done on this aspect too where we very clearly showed that patients who have, especially colon cancer or even pancreatic cancer, because those are the areas of my research, that in these cells, in these patients, if these patients are given curcumin along with their standard of care chemotherapy, actually the efficacy of the chemotherapy multiplies many, many fold. And the quality of life of these patients while they're already on chemotherapy when they take curcumin along with improves significantly. Which is a good thing because now the patient don't have to experience all the toxicity from the chemotherapy, but continue to improve the quality of life.

On the same lines, we published another study where we showed actually the combination of chemotherapy along with curcumin, actually, if you use it, you can reduce the dose of chemotherapy by tenfold, or 10 times, and still have the same level of benefit which you would have with chemotherapy alone. So this is amazing because what that means is you could reduce not only the dose of the chemotherapy by 10 times, you're reducing that expense by 10 times. And you also, more importantly, reducing the toxicity by tenfold, but still having the same level of benefit. So these are some of those studies which are very, very important. And more recently, which we'll probably cover in the conversation later, we have begun to see that when we combine curcumin with other drugs or other botanicals there's a lot of synergy between these. Which is, again, something which we are very excited about.

Gazella: Yeah, I mean this is some amazing research, and we could probably talk about curcumin all day long, just focusing on the research. But I would like to talk about the form of curcumin, because there is a lot of debate, some controversy surrounding the form of curcumin that can be used or should be used for efficacy. Now this is due in part because of absorption issues. I'm curious as to what form you prefer to use in your research, and why do you prefer that form over the several other forms of curcumin that are presently on the market?

Goel: Thank you for asking this question, I think this is very, very relevant to anybody who would consider taking curcumin because the form of curcumin I've used in my research for the last 10 plus years is called BCM 95 curcumin. And the reason I chose this curcumin for all my research for over the years is simply threefold. One, this is a high absorption curcumin. So what that means is, curcumin by itself, if you take a generic curcumin, one of the challenges or limitations of curcumin is that it is poorly absorbed by our human bodies. If you take some amount of it, most of it will come out of your body within a matter of hours. So if that's the case, your body is not going to be healed. Your body is not going to derive all the benefits of curcumin if much of it comes out so fast. So it is very, very important that anybody considering taking curcumin, they should take a curcumin which is high absorption curcumin.

So that is the reason I use BCM 95 curcumin because there's been studies done that it is somewhere between 10 to 12 times better absorbed compared to generic acumen. That's one. Second, not only is it absorbed in the body 10 to 12 fold better, but it stays in the body longer too, which is almost a no brainer that if you are taking something for therapeutic purposes you would want that thing to stay in the body longer, because longer it stays there it'll continue to fight inflammation like we talked. It'll continue to fight oxidative stress. So the second thing is it stays in the body longer. Third, which is equally important is that this is, I call it a clean curcumin, because it's all natural. So one of the limitations of many forms of curcumin is that people, many of the manufacturers or vendors will try to increase their yield of curcumin from turmeric.

And in the process they will use strong synthetic chemicals to get as much curcumin they can get out of turmeric. And in the process what happens is you have curcumin, but as a consumer, as a patient, or as a physician when you're giving this curcumin to your patients, you're basically ingesting small amounts of chemicals which are not good for your body. So that's the third reason I used BCM 95 because it does not use any strong chemicals. It is all natural and one of the mechanisms, the way it is better absorbed in the bodies is that the curcumin is actually mixed together with the natural essential oils which are present in the root of turmeric, and that is a way to enhance its absorption. So it's all natural, better absorbed, stays in the body longer.

Gazella: That makes a lot of sense. Now are there any contra indications or safety issues with curcumin specific to oncology?

Goel: To the best of my knowledge, no. There have been studies done, we call these dose escalation studies where people will take highest possible dose of curcumin until they see some toxicity. And these studies have been done in human trials and people have used up to 12 grams of curcumin a day for, I think, I believe it was six months, and virtually no toxicity or adverse effects at all. Some people do sometimes feel for a very short term, some sort of upset stomach, but that only lasts for a day or two. But typically in terms of toxicity or serious adverse effects or any concerns, absolutely zero.

Gazella: Okay, good. Now before we move on to our next botanical, what is the therapeutic dosage that you recommend of the BCM 95 in oncology? I imagine it varies based on the individual and their circumstances, but is there a general dosage range?

Goel: Absolutely. So again, we can't, because curcumin and other botanicals they're not drugs, so there's a fair degree of range of forgiveness if you take a little bit more, or a little bit less, because they are very safe. So we don't have to worry that much. So based on my experience, especially if you're working with a high quality curcumin extract such as BCM 95 I think for the oncology patient a general range should is somewhere around two grams to three grams a day. Which should be split equally in three or four doses over their entire days. You don't want to take your all two or three grams in one dose. So it should be split in, you know, morning, afternoon, evening, or maybe four doses if somebody can manage. So somewhere in the range of two to three grams a day. And then depending upon their disease severity stage of the cancer and so forth I've seen patients even using up to five grams, but I think that would be extreme situation. But about three grams I would say is the average dose over entire day.

Gazella: Okay, perfect. So let's talk about boswellia. Now when we think of boswellia, I personally think about joint pain and osteoarthritis. How does boswellia work when it comes to cancer care? And just describe for us the oncology mechanisms of the actions for this particular botanical.

Goel: Absolutely. Again, so boswellia, just like you said, most people when they think about boswellia they think about joint pains and osteoarthritis and so forth because that's where it's been used for longest times. And one of the traditional uses for boswellia has been in arthritis, and even in patients who have actually another condition would be asthma. People have used boswellia quite a bit there. But in terms of cancer, I mean evidence is not there that much, but we have done quite a bit of studies. And I would say in the last three to five years there's a lot more studies around cancer. And one of the ways it helps in patients who have cancer is, again, it's ability to fight inflammation. So when we talk about inflammation, we just covered earlier we were talking about again, chronic inflammation. And when we talk about chronic inflammation, inflammation in our body is not controlled by one pathway.

There are multiple pathways of controlling inflammation. We just talked about curcumin. And one of the preferred ways curcumin functions there is by inhibiting an enzyme called cyclooxygenase two or COX-2. So that's a very, very key pathway which basically triggers inflammation, and curcumin works beautifully there. But there's another pathway which is equally important when it comes to inflammation we call it five lipoxygenase pathway, or 5-LOX pathway, and if that pathway is active, that will mean there'll be increased inflammation in our body which we don't want. And what we have shown is that in cancer patients, if they take boswellia, what happens is this 5-LOX activity goes down. And when that goes down there is a reduced inflammation and these patients tend to do so much better in terms of the response to cancer. So I think one of the preferred mechanism for boswellia, especially in the context of cancer, will be anti-inflammatory activity, and that activity mediated through 5-LOX pathway.

Gazella: And now you mentioned that these are human clinical trials involving boswellia and oncology, is that the case?

Goel: Not really. Some of these things are preclinical studies, but my understanding is there a couple of trials currently being planned. But for curcumin there are many human trials. And of course [crosstalk 00:18:40]. But for boswellia, most of the evidence so far has been preclinical evidence, which means before human trials.

Gazella: Got it. Okay. So now I understand when it comes to boswellia that boswellic acids are important. So what should practitioners look for when deciding on which a boswellia product to use, or what form of this botanical would be the most effective?

Goel: Again, thanks for asking such an important question. So just like we covered curcumin, and again, I think that's a normal notion that when we take any botanicals we have to be sure that we're taking the best product out there for which we have the best science. So when it comes to boswellia, I think one must consider taking... So when we look at boswellic acids, which are extracted from boswellia serrata tree, it's actually a combination of multiple boswellic acids present in there. And some of them are actually anti-inflammatory, while other actually ingredients or the actives in total boswellic extract could be pro-inflammatory, which is something you don't want. So if you have something pro-inflammatory is going to increase more inflammation, which is not desired. So one of the most important active anti-inflammatory boswellic acid is called AKBA, or one keto alpha boswellic acid.

So as a consumer who is desiring to take boswellic acid for cancer or for other indications to fight inflammation, you have to look for a boswellia extract which is highly enriched for AKBA. So you need to look for a product which is pure and has highest amount of AKBA content, because that is the one which has most anti-inflammatory activities. If you take a total extract with other boswellic acid in there, there may be some component of pro-inflammatory boswellic acid. So one has to pay attention to the extract which is rich and AKBA.

Gazella: Can you spell that for me Dr Goel?

Goel: Yes. So the acronym is A-K-B-A. So it stands for one alpha keto boswellic acid.

Gazella: Perfect. Yeah. A lot of our healthcare professionals who are listening will want to know that, so thank you for that. Now are there any safety concerns with boswellia?

Goel: Again, to the best of my knowledge, no. But again, compared to curcumin, we don't have too many safety studies. But based on my experience, based on our studies we have done, I think one of the things when we talk about safety we have to keep in mind the amount of, or the dose of, any product we are using, whether it's curcumin or boswellia or anything else for that matter, anything in life. So I think if you're going to cover this, so boswellia, again, in the context of cancer patients, I think those are for about two to three gram also has shown a lot of anti-inflammatory and anti-cancer activity. So I think to the best of my knowledge, if somebody is using these range or even twice as much, I don't think there's any concern for toxicity of any sort.

Gazella: Okay, that's good to know. So now I want to talk about the third and final botanical, which is French grape seed extract. And again, we don't often think about cancer when it comes to this particular botanical. So how does the preliminary research show us that French grape seed extract works when it comes to oncology?

Goel: Yeah, so I'm very excited, and when we begin to work quite a bit on a French grape seed extract, just like you said, when people think about grape seed extract, or grapes in general, I think most people think about resveratrol and so forth. Which is used in many different contexts and especially anti-aging products and so forth. But if you know, resveratrol typically comes from the skin of grapes and from the flesh of the grapes. But grape seed extract, just like the name says, comes from the seeds of the grapes. And it's unfortunate that being in US, we tend to go to stores and many times we ended up finding grapes which are very proudly sold as seedless grapes. So I think it's not necessarily a good thing. But when we look at grapes with seeds, they have these very, very active molecules.

We call them OPCs, oligomeric polys anthocyanidins. So OPCs, and they are present in grape seed extract, which are again very, very important anti-inflammatories, antioxidants. And we are particularly excited about this particular VX1 French grape seed extract, because if you take a genetic grape seed extract, it'll have lot of tannins and a very small amount of OPCs. So if you ground up all the grape seed extract it'll have probably majority of it will be large molecular weight tannins. So as a consumer, if you take the generic grape seed extract, what happens is you're thinking you're taking 300 or 500 milligram of grape seed extract. But most of it, more than 90% of it will never enter our cells.

That's what we want because if it goes into the cells it produces anti-inflammatory or antioxidant activity. But most of the generic grape seed extracts are so enriched in high molecular tannins, which are unable to enter our cells. But this particular grape seed extract, French grape seed extract is unique because it gets rid of all these large molecular tannins, and it is enriched for these very, very small OPCs which can easily enter the cells, cause this anti-inflammatory activity, antioxidant activity, and give health to patients who have cancer. So we have done several studies in the last two, three years, and we are seeing phenomenal results as an anti-cancer agent.

Gazella: Well that's great. And here again, we have another example where the form is important. And it's my understanding that with this particular extract you should look for it to be standardized to contain that appropriate concentration of polyphenols. So to get the most therapeutic effect, what specific form of this extract do you recommend? What should practitioners look for on the label?

Goel: So I think what they should be looking for a grape seed extract which is highly enriched or standardize for highest amount of OPCs, which is again oligomeric proanthocyanidins. So you have to look for a extract which is enriched for these because these are the small polyphenols which can enter our cells and show the activity what we're looking for. Because if you're just using a generic extract, which is not standardized for OPCs, you will not get the benefits what you seek.

Gazella: Right, exactly. And it won't match what's happening in the research literature.

Goel: Absolutely.

Gazella: Again, any safety issues with this one?

Goel: Nope, not at all. But these are very, very safe compounds for the most part. And we have done quite a few studies where we use very large doses of these compounds and we have not seen any sort of adverse effect or toxicities.

Gazella: Okay, perfect. Now in the beginning of our interview you mentioned the synergies, specifically with curcumin, that when you combine curcumin with other botanicals. So regarding these three herbs that we just discussed, do you see any synergy between the three? Would there be any advantages to using these three in particular together?

Goel: Absolutely. Although we have not done studies on all three together, but we have done studies where we've combined curcumin with boswellia. Again, the curcumin extract being BCM 95 curcumin, and boswellia being extract which is named as BosPure, which is highly enriched for AKBA. So we have done studies where we have combined curcumin and boswellia together and we have seen amazing synergistic activity. And the reason I say it is amazing is because we have compared the efficacy of this combination of curcumin with boswellia, and we have compared it to the efficacy to standard of care chemotherapies. And it was amazing to see that just the combination of these two compounds was much more potent than chemotherapy alone. That's beautiful because now you don't need to worry about taking a chemotherapy because if you can take these two natural, safe, inexpensive compounds and have the same level of benefit for chemotherapy or even better, then this is a win/win.

More recently we have done a study where we have combined curcumin with this French grape seed extract, same kind of activity. That the combination was so potent, a lot more efficacious compared to standard of chemotherapy. And another thing in this particular study we noticed where we combine curcumin with French grape seed extract, that this combination was very, very important in killing cancer stem cells. Which is very important because patients who have cancer, we can get rid of the cancer cells, but most times we leave behind something we know, cancer stem cells, which are basically super powered version of the cancer cells, which those who don't respond to any kind of treatment.

And if you leave them behind, these patients will experience, you know, cancer coming back in six months or one year because these cells are left behind. But what in this study where we have used combination of curcumin and French grape seed extract we have shown actually this combination is not only very, very promising in killing cancer cells, but it gets sort of most of the cancer stem cells, which is wonderful news for the cancer patients. What that means is if they use this combination, there's a very less or likelihood that their cancer will ever come back. So we are very excited. We are planning on studies, we will try to combine all three compounds together. But so far we have looked at individual combination of these two.

Gazella: Yeah, that is exciting, especially about the stem cell. Now I'm assuming that so far these have been all in vitro studies.

Goel: Actually no. So this reasons study that we did, we call it a ex vivo study, which what that means is we actually using human cancer sample from a patient itself. So in this combination study, we actually took the colon cancer tissue from the patient who had colon cancer, and we have developed a unique way to grow this tumor outside of the human body. But the good news is we are looking at actual cancer sample from an actual patient who have colon cancer. So these are not real human trials, but they are not neither in vitro studies. So we call them ex vivo studies where we can continue to see the effect of these compounds, these botanicals and drugs, on the actual human tumor.

Gazella: That's great. Yeah. And you know, it makes sense, and the curcumin and boswellia in particular makes sense because you were talking about the two different inflammatory pathways that they impact. One, you know COX-2, and then the one is the 5-LOX pathway. So that would make sense that combining the two you're going to have even a heightened anti-inflammatory effect.

Goel: Absolutely. And similarly when we combine curcumin with this French grape seed extract, because this French grape seed extract works on absolutely very different anti-inflammatory pathways too. And I think although we are still working on the mechanistic aspects of this, but what we are seeing is that when you combine curcumin with this French grape seed extract, I think in a matter of few days we can see the effect, which is very, very, very pronounced and very important in killing cancer cells.

Gazella: Well that's great. Well, you know Dr Goel, you have been a true leader when it comes to researching botanicals in oncology care. So I'm curious about, you know, what your thoughts are on what the future holds when it comes to the utilization of botanicals and cancer care? What can we expect to see in this area of integrative oncology?

Goel: I think that's a very important question. And I think, I've been working in those fields for 20 plus years, and I can already tell you I've seen a change already. And I think we will continue to see this change. And by change I mean as that patients have become a lot more smarter because they have access to all the scientific studies and literature, which is online and so forth. So they become more curious. They ask the right questions, they desire to use some of these integrative approaches in their cancer care and so forth. And I can tell you that every single day, you know, I hear from a lot more patients who are beginning to adopt some of these integrative approaches on their own, sometimes with the consent of their physician, sometimes on their own. But since you asked me what are the future, I think the future is that we are going to see continued awareness and continued educational effort of recognizing the benefits.

And at the same time, that's where we started, the benefits of these botanicals as well as the safety of these compounds in helping patients who have cancer and other diseases. And I have no doubt about it, we are already seeing a huge growth and awareness about the potential of these natural medicines. And I can only imagine that it'll continue to grow. And I think at some point the mainstream modern medicine will begin to use these things. Maybe not stand alone, but possibly as adjunct or in combination with the standard modern drugs they're using. So the future is bright.

Gazella: I would agree, and I hope that certainly does happen. It's exciting to watch, honestly. Well, this has been very informational. Once again, I would like to thank our sponsor who is EuroMedica. And Dr Goel, I'd like to thank you for joining me today. Let's stay connected so we can stay on top of the research, the exciting research that you're doing.

Goel: Absolutely. Thank you so much for having me on the show, and I really enjoyed it.

Gazella: Great. Have a great day.

Goel: You too. Bye-bye.

Oct 21, 2019

This article is part of the 2019 Oncology Special Issue of Natural Medicine Journal. Read the full issue here

 

Tina Kaczor, ND, FABNO, interviews Shauna Birdsall, ND, FABNO, on what clinicians need to know about skin cancers. From preventing squamous cell carcinomas to recognizing melanoma, Birdsall details the essentials of cancer-related dermatology.

This interview includes a broad review of what you can do to help patients prevent skin cancer. Do you remember the ABCDE’s of recognizing melanoma? Where do squamous and basal cell carcinomas usually occur? What is the ideal range for serum vitamin D? What other supplements have evidence for reducing the risk of squamous cell cancers? We cover all this and more in this in-depth discussion between integrative oncology experts.

About the Expert

Shauna M. Birdsall, ND, FABNO, is a naturopathic physician and fellow of the American Board of Naturopathic Oncology. Birdsall graduated from National University of Natural Medicine in 2000. After completing a residency at Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center in 2002, she provided patient care and supervised naturopathic medical students there until 2008. She took on a leadership role at Western Regional Medical Center at CTCA in Goodyear, AZ, in 2008 and was later elected vice chief of the medical staff there. She also chaired the Medical Executive Committee, Credentials Committee, Peer Review Committee, and served as the Medical Director of Integrative Oncology until 2018. Birdsall recently joined Avante Medical Center in Anchorage, AK. One of Phoenix Magazine’s Top Doctors 2014-2018, Birdsall is strongly committed to providing individualized, compassionate, evidence-based care to empower and provide hope to cancer patients.

Transcript

Tina Kaczor, ND, FABNO: Hello. I'm Tina Kaczor, editor-in-chief here at the Natural Medicine Journal. I'm talking today with Dr. Shauna Birdsall about skin cancers, and Dr. Shauna Birdsall has graduated from the National College of Natural Medicine in the year 2000. After that, she went to Cancer Treatment Centers of America, and she has been a specialist in integrative oncology since graduation. She's most recently taken a position at Avante Medical Center in Anchorage, Alaska, where she'll be providing patient care in a hospital-based setting. Shauna, thanks so much for joining me.

Shauna Birdsall, ND, FABNO: Oh, thank you for having me.

Kaczor: Dr. Birdsall, you've recently worked closely with a lot of dermatologists in a dermatologist setting, and you and I got talking about that. I was intrigued by a lot of the things that you learned, and I would like you to elaborate a little bit on how working closely alongside these dermatologists maybe changed your perspective of oncology and skin cancer specifically.

Birdsall: I have to say I was blown away, and this is a bit embarrassing. Working with patients undergoing chemotherapy and radiation for cancers like breast cancer and pancreatic cancer, I had always seen dermatology as more on the periphery. Working with dermatologists showed me how often dermatologists are diagnosing things like melanoma and really saving people's lives. It completely changed my perception around the integral nature of the specialty.

Kaczor: Yeah. I think that's what struck me, because you and I have parallel universes in the idea of our professions. We both graduated in the same year, and we've both been doing integrative oncology. I have to say I haven't worked closely with dermatologists. I share your inclination to say, "Ah, yeah, skin, we can catch that. No problem. We always catch skin cancer," and, I mean, that's despite the fact that of course we've both worked with people with metastatic melanoma.

We'll get to that and the importance of prevention, especially to prevent such tragedies as metastatic disease. I'd like you to give us a primer, and just give us a really basic overview for the clinicians out there on the types of skin cancers that there are, and who they most likely effect as well.

Birdsall: Sure. First of all, skin cancer is the most common type of cancer, and in the United States this year, more than 5 million people will be diagnosed with skin cancers. First and foremost, we like to talk about actinic keratoses. These are also known as AKs, and they are really precancerous lesions. You'll hear, the resounding themes of those that have sun exposure as being at risk for these cancers as I go on, but essentially actinic keratoses are often flaky or scaly patches of skin, and it's important that those are identified and treated, as sometimes they can lead to squamous cell carcinoma.

The most common type of skin cancer is basal cell carcinoma or BCC. This accounts for about 80% of skin cancers, and BCCs usually look like a flesh-colored pearl or bump, or a pinkish patch of skin. All of these skin cancers are going to be more prevalent in patients with fair skin, although patients with skin of all colors can develop these skin cancers.

Then, as I mentioned we're going to repeatedly talk about risk with sun exposure, and that means that the areas of the body that are most frequently exposed to sun such as the face, head, chest, arms and legs are going to be the most prevalent areas that you can see these cancers.

Squamous cell carcinoma is the most second type of skin cancer, and you're going to also see squamous cell cancers on areas like the rim of the ear. You really need to be able to make sure that those are identified, as those cancers can spread more deeply into tissues and cause additional damage, as well as metastasize elsewhere.

Melanoma, as we talked about earlier, is the deadliest form of skin cancer. It's actually been on the rise for the last 50 years. Melanoma in situ annual incidents in the United States is 9.5%, and in the United States melanoma has become the fifth-most common cancer in men and women. Melanoma increases with age, and you do see again the sun exposure and fair skin as common risk factors. I think later on, we'll talk about more risk factors for melanoma.

Kaczor: Yeah. That's an incredible statistic. Nearly 10% incidence for in situ melanoma. Wow.

Birdsall: Yes. Which is why I really started waking up to the issues with skin cancer detection and prevention, working with dermatologists, because I just was blown away, as I mentioned, with how often they were diagnosing either melanoma in situ or melanomas.

Kaczor: That's just checking. I mean, that's just skin checks, not coming in with that complaint.

Birdsall: Yes.

Kaczor: Most of our listeners are practitioners that are primary practitioners. Very few are going to be specialists in skincare, of course. I'd like us to maybe, if you could, go through how to recognize melanoma, and maybe making sure that when we are seeing our patients ... and this could be in a specific skin exam, or it could also just be an incidental finding on their arm or their face or whatever. What are we looking for with melanoma?

Birdsall: Melanomas frequently develop in a mole or suddenly appears as a new dark spot on the skin. If you'll recall, we have the ABCDE warning signs, and I'm just going to go through those just for all of our review. A stands for asymmetry. B stands for border, either irregular, scalloped or poorly defined. C stands for color, varied really from one area to another in the same mole, and you can see shades of tan and brown, black, white, pink, red or blue. I think one of the most shocking melanomas that I saw was a melanoma inside the web of the toes in a patient that just looked like a little pink spot.

D stands for diameter. While melanomas are usually greater than 6 millimeters in size, which is the size of a pencil eraser, when initially diagnosed they can be smaller. E stands for evolving, a mole or a skin lesion that looks different from the rest or is changing in size, shape or color.

What is important to know as well is that melanomas don't necessarily read the textbooks. As I mentioned, they can look like something that, for those of us who are not dermatologists, may not look like something of concern, which is why I became aware of the need for annual skin exams.

Kaczor: Yeah. Yeah. It is remarkable that some of them don't look like much, and I think that erring on the side of caution, especially as our patients get older and older, because aging is a risk factor for all cancers, and I'm assuming skin cancer is included in there. Okay. Is there anything else? Last notes besides ABCD and E, and anything else that people should be looking for clinically before we close that discussion?

Birdsall: An area that's itching, bleeding. An area that opens up and appears to heal over, and then opens up again. Anything like that also needs to be evaluated.

Kaczor: Okay. Yeah. Referral to a dermatologist is simple enough that I think it's ... again, erring on the side of caution seems like a smart thing to do. We talked about melanoma, and experience shows us that of course it's the most likely to go somewhere. It's most likely to spread and become fatal for some patients, but I'm curious. Basal cell and squamous cell carcinoma, what is the risk of any local or metastatic disease with those?

Birdsall: In the majority of patients with cutaneous squamous cell carcinoma or basal cell carcinoma, the disease remains limited to the skin and with appropriate treatment is considered, "cured," which you and I both know we don't get to use that word very often in oncology. It's exciting that something can be cured with appropriate treatment. However, in 3 to 7% of patients with cutaneous squamous cell carcinoma, and rarely in individuals with basal cell carcinoma, local, regional or distant metastases can occur, which increases the risk for mortality or death.

Kaczor: Do you happen to know, is this analogous to melanoma in that the depth of the lesion has anything to do with it? Do you know?

Birdsall: Yes. For both basal cell and squamous cell carcinomas, both the depth and the size can contribute to risk, which is why even though a patient might only have a small spot, why it's important that it be caught early and treated, because left to its own devices, the larger it gets, the more at risk a patient is.

Kaczor: Okay. Well, that makes logical sense. As far as melanomas go, you mentioned in situ is nearly 10%. Are most of them still caught in the early stages, before they go anywhere?

Birdsall: Yes. Yeah. About 85% of melanomas are caught when there's only localized disease, so Stage I or Stage II at presentation, which as you and I both know, that's when you see the best survival rates. At diagnosis, about 15% have regional nodal disease, and only about 2% have distant metastases at the time of diagnosis. We're getting better at diagnosing skin cancers and melanoma, and it's theorized that dermatologists are more likely to biopsy these days because of seeing a higher prevalence.

Kaczor: I see. Okay. Can I ask one question? That is, in some states, including where I am in Oregon, naturopathic physicians can do minor surgery. The question I have ... I know my opinion on this, but I want to hear your opinion on this. It's not uncommon for shave biopsies to happen in-office. This is true of primary care physicians across the board, not just naturopaths. If someone suspects a melanoma, yea or nay on something like a biopsy of that, whether it's a punch biopsy or a shave biopsy?

Birdsall: Nay, and the reason is that there is research that the sooner after initial diagnosis ... so the sooner after initial biopsy ... that patient is able to get definitive treatment for their melanoma, the better. One of the risks, if someone other than a dermatologist or another health professional biopsies melanoma, is that there's then a delay potentially in getting the patient in to the provider that's going to be able to provide definitive treatment for that melanoma. That's one of the risks. Really, you want to see the highest level of specialty if you suspect a melanoma.

Kaczor: Okay. I think that needs to be reiterated time and again, because every once in a while you come across those patients, and your hair stands up when they tell you what first happened to their lesion, and you just hope that it didn't go anywhere. Okay. Let's talk about, again, we're talking to our audience is generally practitioners that are frontline folks, and which patient populations, which types of people, should there be particular vigilance for skin cancers, like higher levels of suspicion, and who exactly?

Birdsall: Okay. I warned you that we'd keep going back to a couple of things. Fair-skinned individuals, particularly those with blonde hair, red hair, lighter-colored eyes, blue eyes, although again, the warning that skin cancers can occur in patients of any skin color, and then that hallmark UV, exposure to UV radiation. More sun exposure, more risk. Also, however, living in sunny climates or higher altitudes, again because you're getting more direct exposure to UV radiation, as well as lower latitudes. Moles, patients that have more than 50 moles are at higher risk, and patients that have had a history of dysplastic nevi nearby or abnormal moles.

Patients with actinic keratoses are at higher risk. Patients with either a family history of skin cancer or a personal history of skin cancer, and immune suppression. I want to just take a moment to talk about immune suppression, because that can include a variety of different patient populations. That can include patients living with HIV or AIDS, or oncology patients that maybe are receiving chemotherapy or maybe their immune system hasn't recovered from prior chemotherapy, and it does include patients on immunosuppressive drugs such as for organ transplants. Patients who've had an organ transplant are at high risk for skin cancers because they're likely to have a lifetime of immune suppression because of those immunosuppressive drugs.

Lastly, exposure to radiation. You and I think of patients that have been exposed to radiation like breast cancer patients, lung cancer patients, et cetera. However, sometimes patients are exposed to radiation for skin conditions like basal cell carcinoma or eczema or acne, just different types of radiation. Then, exposure to chemical substances like arsenic can also increase risk, and then age increases risk. We're just at higher risk, the longer that we're living a lifetime out, being exposed to the sun.

Kaczor: Is it true that childhood exposures can have an effect decades later? Like someone who grew up down in San Diego, for example, but they live in Minnesota?

Birdsall: Yes, especially to melanoma. I am a-fair skinned person and I had an unfortunate history of a couple of different blistering sunburns, and that history of childhood sunburns and history of blistering sunburns can increase risk, especially for melanoma.

Kaczor: Okay. Yeah. That's good to have validated, because I've always heard that. Maybe in our patient intakes, it's something we should put on our intake forms. Not only where did you grow up, but did you get burned, sunburned?

Birdsall: Yes.

Kaczor: Back in the day, of course, there was a time when people intentionally went out there and called a burn halfway to a tan.

Birdsall: That actually reminds me. I don't think of indoor tanning frequently these days, but exposure to indoor tanning and tanning beds. Maybe your patient is very responsible now as an adult, but maybe in their teenage years had a long history of exposure to tanning beds.

Kaczor: Yeah, yeah. It's something that's easily overlooked in an intake. Maybe we should make sure that that's top of mind. Let's talk a little bit about screening and prevention, and how can we make sure that we do catch things early, especially melanoma. What are the current recommendations, even, for skin cancer prevention?

Birdsall: It's interesting. As far as screening, it remains somewhat of a controversy, which surprised me. US Preventive Task Force is considered one of the authorities on screenings, and to date, the US Preventive Task Force hasn't found sufficient evidence either for or against skin screenings. What's interesting is there is a lot of debate amongst other experts in the field. The American Cancer Society actually recommends a cancer-related checkup every three years for patients between age 28 to 40, and then also encompassed in that cancer-related checkup is other kinds of screenings in addition to skin cancer screenings, and then every year for anyone over 40. Interestingly, the American Medical Association really sees it as individualized, and recommends that a patient should talk to their physician about frequency for skin cancer screenings, and those at moderate risk even should see their PCP or dermatologist annually.

The American Academy of Dermatology issued a statement regarding their disappointment over the recommendation by the US Preventive Task Force, and felt that the public should know that that recommendation that was neither for nor against annual skin cancer screening did not apply to individuals with suspicious skin lesions or those with increased skin cancer risk, and does not apply to the practice of skin self-exams. The American Academy of Dermatology recommends that patients really function as their own health advocate by regularly conducting skin self-exams and that if the patients see anything unusual, that they should see a dermatologist. Unfortunately, we all know that there's not always consistency with patients regarding advising for self-exam, and a patient can't necessarily see the back of their neck or their back, that may have had a lot of sun exposure. A number of dermatology providers still recommend annual skin exams, which after working with dermatologists, I'm definitely an advocate for as well.

Kaczor: Yeah. Yeah, that makes sense. All it takes is a few cases. We're all a product of our experience, right? You see a few cases where it could have been prevented, and it seems and it is tragic. What can we do? I guess once we identify patients who are at higher risk, due to either childhood or exposure or fair skin or immune suppression, like what can we do to prevent skin cancers?

Birdsall: Again, not to sound like a broken record, but decreasing sun exposure is the first thing. Interestingly enough, while I was just reviewing the research when I was preparing for our interview, I was looking at the Environmental Working Group and sunscreens, because there are definitely sunscreen ingredients these days that people have concerns about. For a patient that might be more holistically inclined, they might feel somewhat reluctant to put some of the ingredients that are in sunscreens on their skin, and so there's still a number of things that we can recommend. One is the physical sunscreens that are more of a barrier, and zinc oxide and titanium dioxide were considered generally safe and effective by the Environmental Working Group, and those are sunscreens with definitely friendlier ingredients that people may feel a lot more comfortable using and recommending. Secondly, wearing clothing shields our skin from sun exposure. There's some really interesting sun-protective clothing that is coming out as well if people are in the sun more frequently. Just trying to stay out of the sun during the peak periods or during high heat indexes is also something that patients can do as well. Then, doing annual skin exams. Because as you and I talked about, we may not feel concerned about a lesion that a dermatologist may instantly pick up on as something that may need to be further evaluated.

Kaczor: Yeah. On that note, I don't remember when I read this, but years ago I remember reading they did surveys of lesions, and they had primary care physicians and dermatologists assess them and see who was most accurate. Nobody bats a thousand, but it was remarkable how much better the dermatologists were at visually assessing lesions correctly.

Birdsall: Well, what was interesting working with dermatologists is I'd ask them why they were attracted to their field, why they went into dermatology, and they said because it's actually a field of medicine that you visually diagnose. You can visually see what's going on. Internal medicine, you might look at the results of a patient's lab work or a chest X-ray, but dermatology, you can actually see pathology and treat it.

Kaczor: Yeah. How interesting. Yeah, so I guess you're good at that. Some people are better than others, I think. We are naturopaths, and so let's talk a little bit about diet and supplements and other things that we can do. What can we do from a supplement standpoint? Is there anything we can add or anything we should avoid, for that matter, that could lower the risk of developing cancer, skin cancer specifically?

Birdsall: There was a really interesting Phase 3 randomized trial of nicotinamide for skin cancer prevention published in the New England Journal of Medicine in October of 2015, and in the study, 386 participants who had a history of at least 2 non-melanoma skin cancers ... again, that's basal cell carcinoma or squamous cell carcinoma ... in the past 5 years were randomized to receive 500 milligrams of nicotinamide twice daily or placebo for 12 months. They were seen by dermatologists every 3 months.

At the end of the study, the rate of new non-melanoma skin cancers was lowered by 23% in the nicotinamide group, and noteworthy was the fact that there was no benefit after the nicotinamide was discontinued. I would say about 70% of the dermatologists that I was working with recommended nicotinamide to their patients. That's actually compelling data from my perspective in regards to a supplement.

There's another supplement that has less research but is something interesting to watch called polypodium leucotomos, which is a fern from Central and South America. It was actually shown in studies to prevent both UVA- and UVB-induced toxicity and DNA damage. There was a study showing that 240 milligrams of a supplement containing that ingredient twice daily suppressed sunburn, and was found to extend the time outdoors before skin started to tan, so that's another possibility. I think we know as naturopathic doctors that vitamin C, E, zinc, beta carotene, omega-3 fatty acids, lycopene and polyphenols, especially in things like green tea, do also help to prevent free radical damage, which is what the exposure to UV radiation causes as well.

Kaczor: Okay. Yeah. Is there a specific role ... I don't I honestly don't remember where I have this idea from, so you can validate or invalidate my presumption ... about using vitamin A specifically for actinic keratosis?

Birdsall: Sure. There was a study on high-dose vitamin A reducing the incidence of actinic keratosis converting to squamous cell carcinoma, and the study looked at doses ranging from 25,000 IU a day, 50,000 IU a day and 75,000 IU a day. They did indeed find that that did prevent those AKs from turning into SCCs pretty significantly. However, from my perspective, there'd need to be a risk/benefit weighing of that for any particular patient.

Kaczor: Yeah. Because 25,000 to 75,000 IU daily for an extended period is ...

Birdsall: Correct. I had some concern after looking at that.

Kaczor: Yeah. Yeah. Recently, I mean, I generally wasn't too concerned with vitamin A levels as we gave them until ... because we would often use this dose for antiviral effects. Recently I came across a study that did suggest that high doses for prolonged periods actually can lead to or at least are correlated with fatty liver. I was a little surprised by that. I came upon it, of course, by way of patient care and doing a little due diligence. Anyways, that's just a little caveat

Birdsall: Right. I just am looking at that study and thinking about the fact that you would need to be on that long-term. I just had some concerns about using that particular amount of time.

Kaczor: Yeah, yeah. Not just the known, but the unknowns. Okay. Let's turn to vitamin D, because that whole "Do I'd get enough sun for vitamin D, am I getting so much sun that I'm increasing my risk of skin cancer," it seems to be a bit of a conundrum. On the same note and maybe in the context of this, is there a difference between sunburns and suntans and their link to skin cancer?

Birdsall: Okay. I think that there's definitely good evidence to suggest that vitamin D production from sun exposure poses too much of a risk for skin cancer. That's probably not the way that we want to be getting enough vitamin D, and there is more risk with a sunburn. However, suntans, our concept of tanning as being something that adds to our attractiveness, which I think in this day and age has faded with all the concern and the risk. Tanning does pose a risk too. That is still damage to your skin. Actually, as I was reviewing the research and thinking about this interview ... I'm just going to throw this in now, even though it's a little tangential and random ... if you have patients that are worried about the anti-aging, about the appearance of their skin, really the very best thing that they could do is to avoid sun exposure, to apply sunscreen, et cetera, because even that tanning still actually represents damage.

Kaczor: Okay. The vitamin D, what I hear you saying is it's best taken supplementally.

Birdsall: Yes.

Kaczor: Because we have access of doing labs for our patients and such, is there an ideal dose to give, or do we base it on laboratory values? What is your opinion on that?

Birdsall: My opinion is that we need to base it on laboratory values, because there's so much individual variation on intake of vitamin D and the impact of that intake. One patient may consume a lot of dietary sources of vitamin D and actually be at perhaps not an optimal, optimal level, but not be deficient in vitamin D. Another patient may take some vitamin D supplements and actually get to pretty high levels of vitamin D pretty quickly. I think the only thing that we can do for our patients right now is to do lab testing.

Having said that, there is a lot of controversy over what the right values are, what the right range is. Again, when I was doing research just to make sure that I was totally up to date before we talked, it looks like people are in agreement over the fact that a 25-hydroxy vitamin D level below 20 nanograms per milliliter is considered deficient and does need repletion. We have more concurrence over that value.

What's still controversial is what is that optimal range? Is it between 30 and 40? Is it 50? What we do know is that vitamin D can reach toxic levels, and that that's not good either, and that there is more and more data on too high of a level of vitamin D posing risk. I think that that again argues for making sure that we're adequately testing our patients, because say they're deficient, we decide that they need repletion. It's still hard to monitor, without doing that testing, where they're at from a vitamin D level as you're doing repletion.

Kaczor: Sure. Sure. Yeah, I totally agree. I think that laboratory values should be just part of a routine lab for most people, given the many ways that vitamin D adequacy protects us from so many diseases.

My last question is having to do with those who know they have a family history of skin cancers, maybe even particularly melanoma, but skin cancers in general. Is it appropriate, I suppose, for certain patients with a strong family history to look at genetic predispositions and hereditary syndromes that include skin cancer?

Birdsall: That's interesting, again still a little bit of a controversy. We can test for a couple of genetic mutations related to melanoma. People who have a mutation on a gene known as CDKN2A have a higher risk of developing melanoma, pancreatic cancer, or a tumor of the central nervous system. A mutation on the gene called BAP1 means a higher risk of getting melanoma, melanoma of the eye or mesothelioma, and kidney cancer. However, the challenge is that if a patient carries a mutation on one of those genes, their lifetime risk of getting melanoma ranges from 60% to 90%. However, only about 10% of the people who develop melanoma have one of these genes.

What we do know is that we're still evolving our scientific knowledge of genetic mutations, and it's highly likely that there are additional genetic mutations that we just haven't found yet for melanoma. This is a really important conversation for a patient to have with their healthcare provider, or even ideally with a genetic counselor, who can counsel them on the risks and benefits of genetic testing overall.

Kaczor: Yeah. Yeah. Genetic counselors are a great referral for us to have, because we don't need to figure everything out and they have it all either at their fingertips or in their minds, so they're they're great professionals to ally with. All right. Well, I think that that's a really good survey and a nice review of reminders of things we may know, and maybe some things that are definitely new to our listeners. I can't thank you enough for taking some time and sharing your expertise with us today. Thanks, Shauna.

Birdsall: Thanks. Thanks for having me.

Kaczor: Take care.

Oct 16, 2019

The mission of the Climate Collaborative is to leverage the power of the natural product industry to positively impact climate change. Their goal is to bring the industry together in an effort to reverse climate change. In this interview, the organization's director, Erin Callahan, describes how they intend to achieve this lofty goal.

Here's more NMJ coverage on how climate change will impact our food supply:

About the Expert

Erin Callahan, director of the Climate Collaborative

Erin Callahan is the director of the Climate Collaborative, responsible for management and execution of the Collaborative’s work, including all programming, communications, and outreach. Erin has a range of corporate campaigning and sustainability experience. She previously worked for CDP, managing corporate engagement for the We Mean Business coalition’s commitments campaign. In that role, Erin worked with hundreds of the world’s largest companies, industry groups, and investors, supporting them in making leadership commitments on climate change. She has also worked in public relations and international development and earned a master’s degree in international relations and economics from Johns Hopkins University School of Advanced International Studies. She is based in Oakland, CA.

Transcript

Karolyn Gazella: Hello. I'm Karolyn Gazella, the publisher of the Natural Medicine Journal. Today we are tackling the big topic of reversing climate change. My guest is Erin Callahan, who is the director of Climate Collaborative. Erin, thanks so much for joining me.

Erin Callahan: Thanks for having me.

Gazella: Well, first let's have you tell us a little bit about the history of the Climate Collaborative.

Callahan: Yeah. I'd love to. Well, thank you again for having me, I'm really excited to talk about some of our work. So the first thing to note is that we're a relatively new organization. We launched about 2 and a half years ago, just over that, at Natural Products Expo West, which is the largest food show in the US.

And we launched because it did become really clear that within the natural product space, which is the fastest growing part of the food and ag sector and full of innovative companies, who are really helping define their mission and work via social impact and issues related to it, there wasn't yet a convening space for companies to come together on climate change. And we in fact did this study that showed that around 97% of the companies we surveyed really understood the urgency to be doing something on climate change, but almost 80% of them didn't know how to translate that understanding into action. There was a big gap between knowing that they wanted to do something and having the capacity to tackle it within their businesses.

And so we launched to kind of address that gap. We really wanted to create a community of companies within the industry who could learn from each other, move forward together and get the rest of the industry really excited about climate change. And so that's what we've been trying to do for the past 2 and a half years. And I can certainly talk about the ways in which we do that, if that would be useful.

Gazella: Yeah. Let's start with what you've been focusing on since 2017 when you started. So what's been the focus over the last couple of years?

Callahan: Yeah. Well, you know, when Jessica Roth, the founder of Happy Family Organics the baby food company, and Lara Dickinson, the founder of OSC2, they were the cofounders of the Climate Collaborative and they really wanted to launch it as an industry collaboration.

So we're a project of 2 organizations, SFTA and OSC2, and have collaboration deeply built into our model. And so over the past year we've really been working to try and extend that, kind of, baseline of collaboration and understanding that to tackle a problem as big as climate change, we can't act alone. No one in the industry can think that they're going to solve it on their own in a silo, so we've really been trying to build robust industry collaboration.

And we've done that by creating this roadmap of nine commitment areas that represent the key emissions drivers for most companies in the sector. So it's packaging, food waste, agricultural practices, transportation, policy engagement, and we ask companies to make commitments, public commitments, in one or all of those areas. And that sends a message out to the industry that, "Hey. We are taking this seriously, we're setting public goals, and we are working as part of a bigger movement within the industry to do this."

And so we asked companies to make commitments and then we help them on the implementation side. So we host webinars, we connect companies to partners and solutions providers, we try to connect companies to case studies and representations of what best practice looks like within the industry and work really closely with a really wide range of partners. And, crucially, we do this all for free.

We're a nonprofit, so it's really important to us to not have cost, or any other issue, be a barrier to entry for companies. We work mostly with small and medium-sized companies who otherwise might not have the resources to start tackling this stuff. And so we really want to enable companies, regardless of where they're getting started, to be able to get on a pathway to action. And to do so as part of a really whole of industry movement.

So we have everything from farmers and producers, to distributors and food retailers and brands, all working together collectively across the supply chain. Recognizing you need every link to really make change. And so that's been the baseline for the past 2 and a half years has really been building a strong base of companies who are committed to action. Kind of building this movement within the industry, and then starting to go down the road of providing really robust programming that can help them on the implementation side.

You know, our theory of change is commit, act, impact, and we're kind of trying, you know, over the course of years of being around, to move companies from making these public commitments toward acting on them and then ultimately seeing real impact in the industry. And that's been the journey so far.

Gazella: Yeah. I think it's brilliant. I mean, that's really why I was drawn to your organization, because you have this holistic collaborative from start to finish and you're getting commitments from organizations. So how many organizations have made this commitment that you're talking about? You know, you have 9 commitment areas, and they need to commit to 1 or all, how many organizations have done so?

Callahan: Yeah. It's really incredible. We've got over 400. We've got nearly 450 companies signed up. We're at about 440 companies who've made over 1,600 commitments.

And that's, I think, over 2 a day. I did the math recently, since we launched, commitments coming in. And, in fact, our busiest single month ever was this past August 2 and a half years in. And so I think what that shows is that the energy and momentum and sense of importance and value of what we're doing is only picking up as companies see climate change impacting their supply chains more and more and hear their customers talking about it and inherit it becoming a policy issue ahead of the 2020 elections. It's only becoming more important and central to what companies are doing, and that is incredibly heartening to see. We are so happy to see that progress.

And so, yeah, we've got about 440 companies committed. They've made... You know, those represent General Mills and Dannon, really large food companies that everyone here has heard of and probably have their products in the pantry, but also really small startups and everything in between. So we're really happy to work with kind of a really wide range of companies who are at every stage of the sustainability journey and kind of going really deeply on things. Like packaging, in some cases, and, in some cases, trying to tackle everything. And, you know, so we really do have the full spread represented.

Gazella: That's great. Well, congratulations on that progress so far. Now, obviously, your organization feels climate change is a big problem and we here at The Natural Medicine Journal are trying to cover this as well, so how concerned should we be about climate change? You know, what damage can and will occur with climate change if we don't act together, as you're talking about?

Callahan: Yeah. Well, a lot is the short answer. And I think... I feel like everyone, this year especially, something's changed and we're all kind of scared of looking around and seeing... You know, this August, for example, all of us were watching sort of helplessly as the Amazon burned, and Hurricane Dorian just hovered as this slow-moving, giant storm over The Bahamas, and just these great tragedies affecting millions of lives and livelihoods and communities and just not being able to do anything. And, you know, that's a trend that's only worsening.

I'm from the Mississippi/Gulf Coast and grew up watching hurricanes get worse throughout my childhood. And Katrina destroyed my hometown. And so these are very visceral things that I think we're starting to see and not be able to not connect... We can no longer avoid connecting it to climate change, and so I think everyone's sort of feeling it very viscerally.

And then, you know, on the data side, we've got a huge amount of evidence to back up the fact that climate change is happening. It's getting worse. We're already seeing the impacts, and if we don't act quickly and at scale, the problems are going to be tremendous. You know, when we look at UNFCCC Reports, and even an EPA report that came out in November 2018, that showed that absent action, this could slash 1/10 of the US economy by 2100. You know, the UN has showed us that we have about 10 years to act to avoid catastrophic damage. We're on a road to exceed 1.5 degree increase in global temperatures, and we have to stop that. We have to take action to reverse it.

And, you know, I moved to California year ago and within a couple of months was wearing a mask to avoid the smoke and fires, and saw my friends have to pull their kids out of school, and so I... It's a very emotional thing and it's a very practical thing that we have a lot of evidence backing up the risk of inaction. And getting into the health a little bit, it's very clear that climate change is absolutely a public health issue, in addition to an environmental issue and so many other types of issues. And so I think part of the conversation is how do we break this scary complex issue out of a silo of just being isolated to kind of environmentalism? And really focus on how is this having an impact on generations? How is it impacting the lives and livelihoods of the poorest people who are the most vulnerable to climate impacts? The youngest people who are going to bear the brunt of the problems that we see now?

So, you know, I think that that's all becoming increasingly clear and hard to ignore, which is, you know, both heartening and terrifying. It's been really great to see the type of action that happened last week at the climate strikes in New York, right? I think they had to shut down Battery Park because there were so many people gathered. And this is all because of 16-year-old climate activists, Greta Thundberg, who, I think, is just been one person who has created this giant, global movement that gives me real hope. But it also just shows the energy and strength behind how many young people are recognizing the threat to their future that they see.

Gazella: Yeah. I would agree. Well said. And before we get into the practical information, you know in the description of this an interview, I called your goal to reverse climate change lofty. I was actually surprised when I read on your website that the goal was to reverse climate change. What do you think? Is this a pretty lofty goal? And, even more important, is that a realistic goal?

Callahan: Well, yes, it is a very lofty goal. And I think we absolutely can't do it single-handedly, so I don't have any illusions. As much as it would be wonderful if I could work with these 450 companies to single-handedly reverse climate change, I don't think that's possible.

I think what we're trying to do at the Climate Collaborative is highly ambitious, and, essentially, what we're trying to do is create a new model of doing business within the natural product space that is replicable and scalable. And that shows that there is a way that companies can take advantage of the tremendous opportunity that responding to climate change represents. Be first movers on creating new systems and ways of doing business that are an inevitability, I really believe. In terms of new ways of doing agriculture that helps restore carbon in the soil, new types of packaging, reductions in food waste. The shift toward these types of practices is inevitable, and why not have this innovative industry be at the helm of creating those shifts?

And so, you know, that is really... We want to create a model that then cascades across the food sector. And I think... So when you ask, are we looking to really reverse climate change? I think that when you look at the fact that the food and agricultural system accounts for about 23% of global emissions, it's going to be absolutely key to solving climate change and have this huge kind of double-edged sword of being a huge potential opportunity as a solution, through carbon soil sequestration and other mechanisms, but also is a tremendous risk factor if we don't take action. And so I really look towards the types and group of companies that we work with as leaders in creating those new systems.

And so maybe not reversing all of the climate change, but maybe reversing how the food sector responds to climate change. And any company with an agricultural supply chain, how they can shift their practices to really create a new model for the food system. And so I hope we can do at least that much. I still believe that is an incredibly lofty goal, in that there are a lot of structural barriers to getting there. When you look at certain policies that disincentivize the types of practices that our companies are looking to start making or already making, and then the absence of things like a price on carbon and absence of policy and incentives rather than disincentives for farmers to be changing their practices to help restore carbon in the soil and all of that.

So that's why policy is such a crucial piece of what we do as one of our 9 commitment areas. And it's potentially the most important, because every company in our network could get to net zero emissions and it would be the drop in the bucket, when you look at global emissions. So policy has to go alongside whatever action that companies take, and my hope is you can then create a virtuous circle where you have companies acting and proving policy mechanisms can support these actions at scale, and then wider set of businesses taking up these policies and then you kind of create that virtuous circle.

So, that's my hope. But I completely agree, it is still really lofty. But I think we don't have really any other choice but to be ambitious and lofty in our goal setting these days. So, I am hopeful.

Gazella: Well, I agree. And I was going to ask you, "Why the natural health industry?" But you bring up such a good point, if you can create this new model that can then be replicated, you could have that ripple effect and have that, as you mentioned, cascade into the food sector. So to me that makes sense, so now I'm feeling better about my term lofty. Because I think-

Callahan: Oh. Good.

Gazella: Yeah. That makes total sense to me now. So let's get to the heart of the matter. So exactly how is your organization going to reverse climate change? Or, you know, if we put this into more digestible pieces, how is your organization going to create this new model of doing business that can then be replicated?

Callahan: Yeah. Well, the first thing is getting companies to make public events. And I think that... You know, I mentioned before, and kind of getting to your point around why the natural health and products industry, and I think that is because it's almost a quarter of global emissions when you look at the food and land system. There was just a Land Use Report that the Intergovernmental Panel on Climate Change put out that just showed how critical the sector is in responding to climate change, and that kind of double-edged sword of it being a solution and a problem.

So that's why these companies. And, you know, I think that within the food sector, our companies already have a status of first movers. When you look at issues like organic and non-GMO, fair trade, the natural products space, they've been first movers on those. And then have then become standards that we all know, we all shop and look for those labels, and we're all kind of very aware and it's cascaded across the food sectors. So we have model of what it could be and how that scale could work and look, and now we need to make climate that issue.

And that's part of the type of model we've tried to adopt here at the Climate Collaborative. In terms of how we do that on climate, it is predominantly through our commitment areas. So we have these 9 commitment areas. They're focused around carbon farming and regenerative agricultural practices. So it's changing on-farm practices so that you're pulling carbon into the soil and keeping it there, and that things like compost applications and cover crops. Intensive rotational grazing, when you're looking at pastures with animals. So changing your on-farm practices to really help draw down carbon, and that's a huge opportunity.

If, you know, you're familiar with Paul Hawken's Project Drawdown, which is this giant list of climate solutions, that's number 11 on the list. Another one that we work on, number 3 of his solutions, is food waste. And that is, you know, about a third of food is wasted and so we're trying to help at least the corporate part of that, so companies and their supply chains, to reduce food waste. And at source. So not just looking at waste diversion and donations, but really looking at how can we reduce the waste that's produced in the first place and make a more efficient supply chain from producers to grocers selling it to consumers? So we had a big project this year where we did intensive consultations with retailers in the US on reducing their food waste in store.

Packaging is another really big issue that we look at. It's the single biggest challenge for companies, you know? Everyone, I think, has paid attention to the plastic straw bans, and plastic in the oceans, and been very aware... It's a very visceral thing because you hold it in your hands and you see it, and then you throw it in the trash or the recycling and... It was just a very visceral way to be aware of your footprint, I think. And so that has been the single biggest issue and challenge area for the companies we work with and we do a lot to try and help them reduce their packaging impact. And, you know, there's policy, energy efficiency, switching to renewable energy, so we're looking at very concrete practical solutions that are very action-focused.

You know, I would say that for companies it's also really important to take a look at your footprint and say, you know, "Where are my emissions concentrated?" Start measuring and setting goals, and so we do encourage that. And, above all, we want companies to just say, "Okay. Let's start taking action. Let's start doing something and be part of, kind of, a larger community of companies within the industry doing that." So we do that through working groups. We have one on regenerative ag, we have on consumer engagement, one just for retailers and we really try to just kind of get companies able to talk to each other a little bit more about their efforts.

So that's a little bit. I'm happy to go into more detail, but those are a few of our projects.

Gazella: No. I think that's great because what we're going to do is we're going to put a link to the Climate Collaborative website, and I know that you list these 9 commitments. And you have a ton of information on your website, videos and such, so I highly recommend that any manufacturers who are listening, you know, or anybody really, click over to the Climate Collaborative to learn more.

Now, technically our journal is a part of the integrative health community and not necessarily the natural health community, per se, with a lot of retailers and manufacturers and such, but I'm wondering how our readers, are individual doctors, can help with this effort. So what advice do you have for the individual? And, in particular, I mean, our doctors are seeing patients and they're influential, you know? So what advice do you have for them to make an impact in this area of climate change?

Callahan: Yeah. Well, a couple of things come to mind there.

Firstly, we host one day of the year called Climate Day, which is my favorite day of the year. It's where we bring the whole industry together and get a set of thought leadership speakers, and everyone in the room just talking about the biggest issues that we need to tackle on climate change over the next year. And last year one of our keynotes with Yvon Chouinard, the founder of Patagonia, which, I think, if there's a company who's doing just fantastic work on climate change and making their whole mission focused around reversing, it's Patagonia. They've just been real leaders. And he was interviewed by Dr. Zach Bush who some of your listeners might be familiar with. I actually wasn't too familiar with him, but it might be an interesting conversation to reference in this because his whole talk was really around the relationship between the microbiome in all of us and climate, our biome. And what are those connecting, and how does one impact the other, and how does how we manage the climate then filter down to the nutrition and the food that we eat? And, overall, the microbiome and health of our bodies?

And so I just want to reference that, because I think that there's a lot of interesting stuff happening. A lot of interesting research happening there right now that I'm fascinated by and there's a lot to mine there. So, that is one thing. The other thing is, I think when it comes to doctors, or really anyone as an educated, active citizen, 1) voting and advocacy matters. And then, 2) being a really conscious consumer. And asking the businesses that you're purchasing from and working with what their practices are, and asking them questions about their packaging, asking them questions about their footprint. And business is new because of stakeholder action and requests and consumers are such a crucial stakeholder. It's why we're launching this consumer aspect of the product this year.

But I think creating an aware base of people who are talking to these companies, and working with them, in some cases, and shopping for... You know, with their products. Make smart choices but with your dollars. We have a group of fantastic companies that are really piloting new work and it's really important that we acknowledge that through engagement with those companies, through dialoguing. By pushing them farther and getting engaged in their mission, but also just generally when shopping by making really informed choices about the company that you're looking at.

And that's a very hard thing to do. I mean, I'm a consumer and it's really hard to hold the fact that I need something in a certain price point, I need it to be really good, I need it to be exactly for what I'm doing, I need to get it pretty conveniently. And then also, on top of that, I need to care about what's its footprint? Where did they source the ingredients? You know? And then also is it fair trade? Is it... You know, are they using renewable energy? What's the packaging? It's a lot to hold, but I think the more you can be okay and accept that complexity and really try to make informed purchasing decisions, the farther where we're going to go.

And, luckily, we're already seeing real movement. You know, I think 70% of Americans are looking to see more from the companies they're doing from a study that came out last year. I mean, you look at the younger demographics, those numbers get even higher and they really are making their purchasing decisions based on the footprint and choices of the companies they purchase from. So I think the more we can all lean into that, the better.

Gazella: Yeah. I would agree. And I think that's great advice. So, in closing, why don't you go ahead and describe some of your short-term goals moving forward. Say, within the next year or 2, what is your organization want to accomplish in the near term?

Callahan: Yeah. Well, firstly, on the outreach side, we've got an incredible base of companies committed. We're at about 440, like I mentioned, I want us to get to 500 by March of 2020. That is my goal.

It really matters to keep that energy and momentum up, and so I'm looking to bring on new companies. We're really looking to actually move in to a lot of health and nutrition companies and we're going to be at a conference in a couple of weeks talking to them. And, you know, that's kind of a subsector of the industry that we really want more actively engaged, so that's the one thing. And then on the programming side and the work of it side, we're just over a year away from the 2020 elections. Giving our companies pathways toward active engagement on policy issues ahead of that election and getting them informed on what they can be seeking out on and supporting, is a real, real priority of mine. We're working with a great set of policy partners on that front to do that and that's something that we're going to really try to be doing a lot of over the next year.

Outside of that, I mentioned consumer engagement. We are launching a consumer engagement part of the project over the next year, where we're trying to actually create a common set of messages that companies are using to engage in dialogues with consumers. And also to raise awareness on specific issues. Like soil health, like food waste, packaging, and really try to create dynamic, fun, engaging conversations with consumers that are action-focused as well. So we're hoping to really get that off the ground in the next year as well.

And then our rooted community, the regenerative agriculture community that we have, we meet 4 to 6 times a year right now and going to be doing our first on-farm site visit over the next year as well. And I really hope we can be doing more of that, and constantly just trying to roadmap the business case for action. I think a lot of companies understand the altruistic and moral reasons to act, but when you back that up with saying that there are real business cases to be doing certain things like this, especially when you're working upstream in your supply chain with farmers who have very small margins and also really know... They know how best to manage their farms, and so when you have these conversations, what are the incentives we can provide and what data do we have to back that up?

So we're constantly looking to increase the amount of data that we have on that and to connect your companies to it to really help promote these practices within the industry. So, those are a few key priorities. I think, overall, we're also just trying to keep the energy and momentum up in the industry. Climate is a really complex issue with a lot of nuances and not a lot of clear black and white solutions that we can just easily adopt, and so the more we can get companies excited and motivated and willing to work together, which I think they increasingly are, the more opportunity we have to really see transformative change in how the industry at scale is really attacking some of these issues.

So that's my biggest hope. Is that we just keep the energy up, from as wide a group of stakeholders as possible, around focusing on climate and moving forward with real action.

Gazella: Well, those sound like some great goals and it sounds like you're going to be very busy in the coming couple of years.

Callahan: I think so. Yeah.

Gazella: Yeah. Well, I just want to congratulate you on creating the... Well, your founders creating he Climate Collaborative and your work as the director. I really applaud you. I think it's great work. It is lofty and it's huge, but it's so important.

So thank you so much for joining me today and telling us about your work. And I encourage our listeners to go and check out the Climate Collaborative, and thank you, Erin, for joining me today.

Callahan: Thank you so much.

Gazella: Have a great day.

Callahan: You too.

Oct 2, 2019

In this interview, Benton Bramwell, ND, discusses the unique Mediterranean herb Arum palaestinum. Listeners will learn about the traditional use of this herb, as well as current research that helps illuminate its modern-day clinical applications including oncology specifically. Synergy, safety, and dosage will also be discussed.

About the Expert

Benton Bramwell, ND, graduated from the National University of Naturopathic Medicine in 2002. He manages a private practice and also provides consulting services to food and dietary supplement industries in matters of scientific and regulatory affairs. He enjoys the wonderful outdoors, especially working the vegetable gardens with his family and going on bicycle rides that allow him to think and exercise at the same time.

About the Sponsor

Hyatt Life Sciences

Hyatt Life Sciences is Putting Science Behind the Tradition™
Headquartered in America’s heartland, Sterling, Kansas, Hyatt Life Sciences continually searches for unique botanical entities and combinations that have been used traditionally in their countries of origin for hundreds of years. Rather than depending only on tradition and legend as many nutraceutical companies do, scientists at Hyatt Life Sciences research, test, and evaluate each herb, root, and component to discover the scientific reason for the ingredient’s benefit. We offer products only after each ingredient has been thoroughly researched for benefit, safety, and purity. At Hyatt, we are committed to Putting Science Behind the Tradition™. Read more.

Transcript

Karolyn Gazella: Hello. I'm Karolyn Gazella, the publisher of the Natural Medicine Journal. Today, we're going to have an interesting discussion about the Mediterranean herb Arum palaestinum. My expert guest is Dr. Benton Bramwell. Before we begin, I'd like to thank the sponsor of this topic, Hyatt Life Sciences. Dr Bramwell, thank you for joining me.

Benton Bramwell, ND: Pleasure to be here, Karolyn.

Gazella: Well, let's start with the basics. Where does Arum palaestinum grow?

Bramwell: Great question. Arum palaestinum grows in the Mediterranean region and is particularly known and used in the Middle Eastern portion of the Mediterranean.

Gazella: Okay. Perfect.

Bramwell: Quite a history to it actually, Karolyn. It's been known in the region for actually, literally, thousands of years. In fact, it shows up on some drawings in ancient Egyptian temples. We believe it was probably brought to Egypt from Canaan in about 1440 BC. It's been there for a while.

Gazella: Yes. Yes. Also from a historical perspective, what conditions was it used traditionally for?

Bramwell: It appears from the historical literature that it's been used for many different kinds of conditions. Primarily for a treatment for cancer, historically, but also as a treatment for infections and open wounds, as a treatment for kidney stones, and even for a worm treatment in animals and humans. Also, it's a way to strengthen bones. This is one herb that has been used in a very diverse applications, perhaps not the least of which because it happens to also be a wonderful food. It made its way from food into medicine. Really that distinction as, of course, you know in a lot of places in the world, there really is no distinction, right? A lot of times the best medicines come from our feed. This is certainly a prime example of that.

Gazella: Yes, exactly. Let's fast forward to today. What are the main clinical applications of this botanical today?

Bramwell: Yes, we're still learning about that in terms of modern application, where it's going to be the best fit. We certainly continue to see it used clinically in the ways that has been used traditionally previously. That's in the Middle East. It's still used as a complimentary supportive adjunctive support for patients with cancer. It's also finding its way into skincare, and I think we're catching up, frankly, in the modern scientific age as to where it should be best used. I think we still have a lot to learn there, but we're learning as we go.

Gazella: That's a pretty diverse list of conditions that this herb can help with, which is kind of common with some botanicals. I'm assuming that's because there's a variety of mechanisms of action. Is that a correct assumption? Can you tell us exactly how this botanical works in the body?

Bramwell: Right. I can tell you what we're starting to see there and understand. There are a variety of mechanisms. Just for a minute, let's focus on where it might fit in terms of something that makes supportive sense for the patient with cancer. What we're seeing is that it may very well, at least in the in vitro models that we're seeing, it may very well help with the cellular process of apoptosis. That's the process by which a cell decides that it's time to basically do itself in. It's programmed cell death, right? There are some interesting mechanisms through proteins that are caspases. I think that we're going to continue to see the literature develop there quite a bit, but I think that's one important mechanism.

It's also important in terms of cell signaling by means of phosphorylation. There are many pathways in the cell which run off messenger systems based on phosphorylation. It seems that Arum palaestinum probably inhibits some of those pathways as well, or at least the compounds from. Those are several of the mechanisms that we see in play.

Gazella: Okay, good. I understand that there's a topical application of this plant. Can you tell us a little bit about the topical application and what that formulation actually looks like?

Bramwell: Yes, I can tell you a little bit about that. I'm glad to see that one coming forward. It's certainly in line with the traditional use. That product, Arumacil, it contains the Arum palaestinum extract, as well as dimethicone and petrolatum. The object there is to help protect the skin, give it a chance to heal, basically. I wouldn't be surprised, and I don't think the literature has necessarily caught up to us here, but one of the main categories of plant chemicals that we're talking about here are flavonoids. Flavonoids are known in the literature to have antiviral effects. Again, a little bit more to learn there, but I wouldn't be surprised at all to find this topical application of good use, clinically for people with cold sores and other minor skin irritations, frankly.

You're going to get a lot of antioxidant action from these compounds, as well as potentially some antiviral, although I think we need to learn more about them.

Gazella: Okay. That makes a lot of sense. From what I've read, this is a pretty complex botanical. It has a lot of different constituents. From the therapeutic perspective, what are some of the key active compounds in the plant?

Bramwell: Well, there are many actually. In the literature where I've spent some time, and from what we can find, there's about 180 phytochemicals that we can at least tentatively be identified at this point in time. Most of those, as I mentioned, are flavonoids of one kind or another. As I look at the list of what's been identified, some of those I would pull out would luteolin, which I think is going to prove to be very important from an anti-inflammatory point of view. That's certainly an active bioflavonoid, in particular, a class of flavonoids called flat bones. I think that's going to, doing the [inaudible 00:07:52] one of the important ones. But there are others as well. There are derivatives of rutin in there, and epicatechin. So I think those are all going to be important.

In addition to the flavonoids, there are also phenolic acids and derivatives of phenolic acids in here as well. Rosmarinic acid is one that pops out, and these are all compounds that I mentioning that when you look at the individual ingredient, it doesn't take you long to find in the literature that these individual ingredients, upwards of between 20 or 30 of them, have a little body of literature of their own, as to their anticarcinogenic potential.

And so, I think what we've got here among the flavonoids, the phenolic acids, and I should mention also some terpenoid derivatives, of course solic acids in there as well as some iridoid derivatives. When you put all those together, and each of them have an anticarcinogenic potential, the complexion of the botanical is one that seems well suited for its historical use.

Gazella: Yes. Especially when you consider a condition like cancer, which in and of itself is so complex. I'm fascinated by the fact that there are all these little compounds, and as you've mentioned, you could probably take one compound, do a scientific literature search and find data to support that one compound, but here we're talking about multiple compounds all within the same plant.

Bramwell: Well, that's exactly right. And actually some of the interesting work that's been done, one of the interesting approaches here is to take some of the compounds that occur in the plant naturally and make a fortified extract, if you will. So, that work's been done in vitro and in vivo and in several different places. They've taken out, for example, linolenic acid, beta sitosterol and isovanillin.

Those are items, constituents that you can get in a water extract of the plant and then made a fortified product from that... material. And when that material has been tested in the in vitro and animal models, it seems to perform superiorly to the raw extract, and I find that very interesting. It seems that Genzada Pharmaceuticals, Hyatt Life Sciences have done a very good job in the work that's been ongoing here showing an increased potential of this fortified extract approach.

Gazella: Yes, that sounds like some pretty cool science. I want to focus, in particular, on a 2018 study that was published in scientific reports. Now in that study, it compared to three different formulations and all of the formulations included Arum palaestinum. What were the results of that study? Tell us a little bit about that particular study and what the objective was and what the results were.

Bramwell: Right. So, this is an approach, again, where a fortified... a number of things were tested. One of the things that they tested was combination of the three plant extracts, Arum palaestinumcurcumin longa, which most people are familiar with turmeric, as well as another from the Middle East peganum harmala, sometimes known as Syrian rue.

So, those 3 botanicals were studied together and then various combinations of a fortified extract, or in one case, a chemical constituent from each of those was mixed together, and that actually looked the most potent as far as it's anticarcinogenic potential. And in that case, isovanillin, which you would find in the Arum palaestinum, was mixed with harmine, which you would find from the Syrian rue and also curcumin from the turmeric and all three of those plant chemicals were used together. And that actually seemed to have a very potent anticarcinogenic effect in the in vitro and in the animal models that we're studying here, in terms of looking at the invasive potential and proliferation, of the cancer cellulars models that we used.

And in this case, the researchers were looking at the head and neck squamous cell carcinoma, which is a very fast growing, aggressive kind of cancer. And, it does appear that the cells that were used here were very sensitive in these models, to that combination.

Gazella: So remind us, which combination then performed the best in this particular study?

Bramwell: Right. In this particular study, the combination of the three phytochemicals, so isovanillin, Arum palaestinum, and harming from the Syrian rue and curcumin from turmeric is what performed the best.

Gazella: Got it.

Bramwell: And again, they were able to show the effect on the molecular signaling cascades within the cell. So, there's some definite believable mechanisms of action here as to why the compounds would have the effect that they do. I think we're going to see a lot more about this one in the future as it becomes translated to human clinical studies.

Gazella: Right. Yes. Based on that study and other research, it sure seems like Arum palaestinum is best used in combination, potentially with other botanicals versus as a single botanical. Is that true? And if it is true, why is that?

Bramwell: That's an excellent question. I think that probably is the case, that either combination of the Arum palaestinium with other botanicals or even compounds, key compounds, from each of several important medicinal herbs. The question is why do we see this additive or even synergistic effect with these compounds or with the botanical blends that seems to manifest in the literature? I don't know all the reasons for that, but I rather think, given as complex as cancer is, being able to affect multiple pathways is probably the breadth of the attack against cancer cells, is probably why we're seeing that synergistic kind of benefit.

One way to attack something is with a very narrow focused approach. A deep attack. Another way is with a multitude of effects together. A nice, you know, cover all the bases. And I think that's potentially what we're seeing as this literature sort of declares itself here.

Gazella: And now what combination or what product, what Arum palaestinum product do you use in your clinical practice?

Bramwell: So right now what I'm using is the Afaya Plus and you can learn about that, consumers, patients, physicians can learn about that at the Hyatt Life Sciences website. But I think that that's the best product certainly than I've seen on the market at this point in time.

Gazella: Mm-hmm (affirmative) great. We'll also provide a link to the website too, so listeners can click right over. So, so far, there's been some compelling in vitro and in vivo and we all know that that's kind of the progression of research as we study these botanicals. What about human clinical trials?

Bramwell: That's the next step really, Karolyn, and I don't know when those are going to be published or what stage we're at, but we're definitely ripe for what would be called phase one and phase two clinical trials here. From what I can see in the literature.

Gazella: Are they underway? Phase one, is this phase one underway or is that still, are we still waiting for them?

Bramwell: I think we're still waiting for that, at this point in time. I hope to hear more about that in the near future. But at this point, following the literature and everything we see we like.

Gazella: Right.

Bramwell: And can't wait for the next human work to actually be published.

Gazella: Yes, I mean, the traditional use combined with the preliminary research sure does seem to be compelling. I'd like to talk a little bit about how it's used in oncology in particular. Do you look at this botanical as an adjuvant to be used with treatment or maybe after treatment? What's the clinical application when it comes to oncology?

Bramwell: Right. Well that's a very good question and because of where we are in the scientific process here, we're still early on. Although I think Hyatt Life Sciences, to be fair, has done much more work than many dietary supplement companies ever do. But we're not there yet in terms of knowing all we want to know. So at this point in time, I don't think anyone would responsibly say that this is a treatment for cancer. What we would say is, traditionally the syrup has been used by patients who have cancer. It's part of our herbal armamentarium historically, and it seems to make supportive sense.

And so, this would be something I would recommend while the patient is going through treatment. Although I tend to leave a space of time between conventional care and herbal therapies, just to make sure that the chemotherapy has time to do its work. So I would tend to leave three or four days, or at least one or two before and after a chemotherapy treatment. I think, from what I see in the literature, at least from the the Middle Eastern region where this is used quite heavily, when oncologists in that area are surveyed, they're not reporting anything really of concern as far as interactions go. But I would still leave a couple of days on either side of treatment, make sure the chemo gets in and does its job.

Gazella: Yes, that, Oh, go ahead.

Bramwell: No, you're fine.

Gazella: Well, I think that that's a good, prudent recommendation and I think that oncologists would agree with that. Now beyond oncology, is the herb safe? You talked about no interactions with chemotherapy that we know of, but are there any other interactions or contraindications that we should know about?

Bramwell: You know, not that we can see at this point in time. The only thing I would point out and highlight there, Karolyn, is that even in traditional use, where this has been used as a food, what's been known for a long time is that it's boiled. It's boiled several times in water and that water is decanted several times, taken off, in the preparation of the herb as a food. Or in this case, before it's a supplement. Don't know all the reasons for that, but part of the thinking has been there that there's a high amount of oxalates in the plant and in order to prevent toxicity, that's an important part of the plants preparation as a food/medicine. So, I would highlight that for you.

Gazella: Yes, that's interesting. Is there any kind of standardization with this botanical?

Bramwell: Yes, it could be standardized. But since we're in the process of learning all that's important about it, I think the closest thing to standardization is the work that was done several years ago with the fortified extract of isovanillin, linolenic acid and beta sitosterol . That complex looked quite promising. And if you wanted to standardize to something, that would be one way to do it, but I'm not aware of a totally standardized extract at this point without fortification, if that makes sense.

Gazella: Okay. Yes. Let's talk a little bit about dosage. So what dosage do you recommend and does that dosage change based on the clinical application or if it's for prevention versus treatment?

Bramwell: I would tend to be more aggressive with a patient who's using this as a supportive. Make it a supportive care during cancer. And the Afaya Plus, two capsules [inaudible 00:23:07] of that is going to give about 900 milligrams, of a combination of vanillin powder, tumeric powder, harmala powder, the Syrian rue and Arum palaestinum. I would tend to go at least two capsules, twice a day on that.

But again, when you're working with a patient with cancer, you're going to have to titrate the need, titrate the dosage that they can take. Some patients going through treatment have a difficult time getting food in. And one thing we always have to remember with a patient with cancer is that we want to feed them first. And we don't want capsules to take the place of food, and so it's going to depend on what the patient can tolerate. But I would start off with a two capsule b.i.d. kind of an approach. And if they can tolerate that well, even up to two capsules t.i.d. As a maintenance kind of thing, for general health, I could see taking a single or two capsules a day, single serving.

Gazella: Do you feel like it has a good application? Like for example, somebody, a patient who may be at high risk of developing a type of cancer. So as a way to kind of help reduce risk, do you feel like there's an application for that?

Bramwell: We don't really know at this point, but I would suspect so. There again, I'm not one to, I don't necessarily subscribe to the philosophy of more is always better. But I think it's something that I would carry in my mind. You know, if dad and grandfather both had prostate cancer and I want to take something and it's kind of a daily maintenance to keep as healthy as I can, to maintain that prostate tissue in a good state, I would think of serving of this a day would make a lot of sense.

Gazella: Okay, great. Now, we talked a lot about oncology, but we also mentioned skincare, infections, kidneys, bones, when you're looking at the clinical potential of this botanical and the clinical application of this botanical, does oncology bubble to the top over everything else?

Bramwell: I think it definitely does. In fact, there are many other applications that we've mentioned here. And we're going to learn more about those over time. I think this is something that naturopathic physicians and other integrated healthcare practitioners are going to learn about as they go. And that's okay, really. We're using something that's been in traditional use for a very long time. But it would be something that for other conditions like skincare, I would just try it clinically and see what we see with it. But I think the biggest, biggest application, Karolyn, is going to be oncology.

Gazella: Yes, I would agree based on what we've discussed today. For sure. Now, Bramwell, I'd like you to pull out your crystal ball and kind of look into the future as a clinician, what would you like to see happen with this botanical as it relates to oncology specifically?

Bramwell: Couple of things and I think already some progress has been made in terms of what formulations are the most effective, but I'd like to see a little bit more work in that regard, with various combinations. I think that we will see, in the next few years, based on what's already been done, phase one and phase two clinical trials. And I hope, based on what's done that that includes work in both patients with prostate cancer, as well as patients with head and neck squamous cell carcinoma and some of the other lines that have shown promise. I mean, there's been some work that's a promising in glioblastoma cell lines as well as lung cancer. So we'll see where it goes in humans first, I hope with patients with prostate cancer and patients with the head neck cancer especially. I also am intrigued, in that 2018 paper that you referenced, there was some work indicating that it may go very well in combination with Cisplatin.

Bramwell: Platinum chemotherapy is very commonly used in colon cancer treatment, as well as other cancers. And boy, if there would be something that would help the platinum chemotherapy be even more effective than it is, I think that would be a wonderful combination and as I kind of look to the future, that one comes to the front of my mind, Karolyn is, is this an adjunctive therapy that could actually make the conventional therapy a little more effective? And I would really hope that the future upcoming human work will really hone in on that and help to answer that question.

Gazella: Yes, and it would also be kind of interesting to see if this botanical could help reduce some of the side effects that come with conventional chemotherapy. I think that would be kind of an interesting... I'm curious as to why prostate and head and neck. I mean, head and neck, that's a tough one and I would love to see it be effective, but why are those two ones kind of standing out in your mind as to where this botanical may help?

Bramwell: Right. Well that's based on the work that's been done so far. So yes, there's going to be a great, great question. The 2018 work was primarily done in head and neck squamous cell carcinoma, and the work before that, in 2015 that was published, was quite focused on prostate cancer cells. So, it makes sense to build on what you have there.

But, you know what? Here's the great thing about Arum palaestinum, from everything I'm reading, it looks like the mechanisms of action, and there are multiple of them, could be applicable across many kinds of solid tumors. So this would be the kind of thing where you can build on your in vitro and animal work and human studies, but you might quickly branch out and other areas of exploration as well. It could be something that could be beneficial to many patients. We don't know yet, I don't think. But, when I read this literature, the question I asked myself is, could this be the next [00:30:30] ? Could Arum palaestinum be that botanical source for a cocktail of phytochemicals that really finds broader use and helps many patients live longer and much better lives. I hope so. Time will tell. Human data will certainly inform things from here, but what we see so far is it's highly encouraging and kudos to the Hyatt Life Sciences for getting this out there.

Gazella: Yes, I hope so as well. It sure sounds like there's a lot of potential here and we're going to definitely, The Natural Medicine Journal, will definitely be following this research on this interesting botanical, Arum palaestinum. Well, once again, thank you Bramwell, for joining me today and I'd also like to thank the sponsor of this topic, Hyatt Life Sciences. So, thank you for the interesting information, Bramwell, and I hope you have a great day.

Bramwell: Well, thank you, Karolyn. Pleasure to be with you.

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