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cancer support

Joining us today is Sarah Franklin, a  naturopath and registered nurse specialising in Oncology. Today we are discussing safe and simple cancer support.

In today’s episode, we discuss:

  • The variables of cancer therapies
  • Common side effects of chemotherapy and radiotherapy
  • Diet and lifestyle support
  • How to support a patient through chemo or radiotherapy
  • Gut health and chemotherapy
  • The glutamine conundrum
  • Post chemo support

About Sarah
Sarah Franklin is a highly qualified practitioner with over 25yrs experience in healthcare.

Sarah started out her health career as a paramedic in the Australian Army while studying for her nursing degree at Griffith University. Once she became a qualified nurse, she went on to specialise in Oncology and Emergency.

With cytotoxic qualifications from the Australia College of Nursing,  she then went on to work in oncology and palliative care. With an inquisitive mind and a passion for understanding pharmacology,  she then went on to study Naturopathy, Nutrition, Western Herbal medicine, and Acupuncture. Sarah now runs her own clinic combining the best of both worlds.

Sarah still works as a registered nurse in a variety of settings and presents at a range of integrative settings, including local hospitals, support groups and via podcasts for different organizations.

Sarah has been recognised for her work across our industry, and received many awards for her dedication.

  • Winner of the 2015 Bioceuticals Integrative Medicine Awards
  • Judge for Bioceuticals Integrative Medicine Awards 2018 & 2019 Medicine Awards 2018 & 2019
  • Medi-Herb Master Herbalist 2014 to 2021
  • 2005 Clinical Nutrition Award for Nutrition Care Australia
  • Presenter for QLD and NSW cancer council and local cancer support groups
  • Contributor for Gold Coast Bulletin, Multi-Sport and Triathlon Magazine and other publications
  • Podcast Interviews for FX Medicine

Connect with Sarah
Website: 
www.balancehealth.com.au
Facebook: @balancedhealthsarahfranklin
Instagram: @balanced_health_naturopathy

 

Transcript

Introduction

Andrew: This is “Wellness by Designs,” and I’m your host, Andrew Whitfield-Cook. Joining us today is Sarah Franklin, and today we’ll be discussing cancer care, simple, safe, naturopathic care. Welcome to “Wellness by Designs.” How are you, Sarah?

Sarah: Goodness. Thanks for having me, Andrew. Thanks for having me on board to chat about a topic that I’m very passionate about.

Andrew: And you’ve dedicated your career to, which is great to see. So, Sarah, for our audience, can you take us through your career and your credentials for a moment, please.

Sarah: Yep. So, I started off as a registered nurse, so I went to…did a bachelor in nursing at Griffith Uni, and I worked in a range of areas, but then I ended up specializing in oncology. So, worked in the day units giving chemotherapy. And then after a period of time when I was looking at having kids, I had to move from oncology, giving the chemo, and I went into more palliative care where I didn’t have as much cytotoxic drug exposure as a nurse because there are risk for nurses that work in that industry with fetal abnormality. So, I moved out. And it was through that process of I loved to learn and I love enjoying and I love pharmacology.

So, oncology nursing is very pharmacology based. It’s very pharmacology-based type of nursing where there’s a lot of drugs and the way that they all work is they’re all very different. And so, in palliative care, I liked plants and I liked trees. So, I thought, “Oh, I might go study about, you know, do some botany.” And then it was through studying about botany that I went, “Oh.” You know, I knew nothing about naturopaths, I didn’t know what herbal medicine was, I wouldn’t have known what a supplement was. I was that nasty nurse that told patients to stop everything.

And it’s through that process that I realized that a lot of the drugs that we used and even some of the chemotherapies that we use come from plants that are found in nature. So, it started to open pandora’s box of, “Well, why can’t we use herbs or vitamins or minerals to get a similar effect without the level of toxicity?” So, then that sort of led me down the track of studying naturopathy and herbal medicine. And now, you know, I’ve been in the industry over 20 years now, so about 23, 24 years. And now I’ve learned how to meld the two together. So, there’s a place for both, but I guess I walk that middle line where, how can I support those cancer patients?

I’ve been there on the front line, I’ve given them chemo, I’ve seen firsthand what the side effects are for those patients going through treatment and then what the results are for their treatment. So, that’s where natural medicine or complementary medicine, that whole debate of complementary or integrative medicine comes into a play where you can really, I’ve seen it time and time again, the difference between how well my patients tolerate their treatment when they’re supported with nutrition or diet or lifestyle or supplements, whatever it may be, that their outcome is greater, their survival rates are greater, their quality of life is better, which is what’s really important for me.

Andrew: Yeah. Yeah. I note with a little bit of chagrin, the research that came out, it’ll be about five years ago now. So, probably late 2000s. What did they call it? The noughties, late noughties. And it was talking about those people that did orthodox cancer care versus those people who refused orthodox cancer care. And I thought, where’s the middle ground here? Where’s the people that want to be responsible by saying, “I’d like that life-saving, but potentially toxic medicine?” But I’d also like to make sure that I’m well during that treatment phase because there’s some side effects that can be quite deleterious indeed, they can stop me having that toxic life-saving treatment. So, I was perplexed by why they did not look at that middle ground, those people that had used both. Have you ever read any research looking at this?

Sarah: Well, when I started off as a naturopath, which was in the early 2000s, I would’ve said it was very much that there were two camps. There was the complementary therapy camps and then there was the very hard line medical camps. So, I think there was a lot of… I think with technology, like when doing my nursing degree, I remember going under the hospital. This might make me feel like I’m very old, but I’d go under the hospital, I’d actually have to physically get the textbooks to get the journal articles, to photocopy, to do my assessments. So, I think technology has brought us a long way where I think it was very hard to get access to information to support either side of the argument.

So, nobody wants to have chemotherapy, so nobody is gonna line up for that if they don’t have to. But definitely when I started out, the medical was, “You take anything natural, we’re not gonna treat you.” So, I saw that time and time again from an oncology point of view. But then I know that there are some cancers that it’s not worth. You don’t wanna put all your eggs in one basket because it just doesn’t…You know, you’re much better if you can sort of blend the two. So, I think in the last decade with technology, you know, with more, I think there’s definitely a lot more evidence and there’s a lot more research now to support natural therapies, which there wasn’t 20 years ago. It was all more anecdotal and we think this works, but we don’t know why. There’s been a lot of misconceptions around antioxidants and all sorts of things that I won’t even go into. That’s a different podcast when it comes to oncology.

So, there’s been a lot of mistruths along the way, which is hard because we’re still trying to fight some of those mistruths for some of these things are safe to use with integrative cancer care. But I think technology, I think as a society, we are becoming a lot more open-minded. By having resources, it’s easy to chat to other practitioners around the world. But I know when I became a naturopath, I didn’t like calling myself on because I was so indocturated in that medical model that I felt like I had to be one or the other. I couldn’t be both. So, it’s taken me a long time to be comfortable in going, “I’m a naturopath and I’m a registered nurse” where when I do my nursing shifts, I wouldn’t tell anyone I’m a naturopath because I didn’t wanna get judgment from my medical peers. But then I didn’t wanna tell other naturopaths I was a registered nurse because I didn’t wanna criticism for having my medical views. So, it’s taken me a long time to be confident enough in my…who I am and who I am as a practitioner really, which has taken time to go, “I am both and that’s okay.” And I’m proud to be both. I don’t have to wear one badge and represent one team.

Andrew: You know, you remind me of Dr. Kevin Tracy. Sadly, he’s passed away now, but he was a great integrative doctor who did medicine and naturopathy. Studied them both at the same time. I mean, there’s a mind that just wants punishment, but anyway. While he was studying both at the same time, he would tell neither camp that he was studying the other, because like you, he felt judged. So, I’m glad that this is moving forward. Let’s get back to the topic though. With regards to the scope of this topic, safe simple cancer support. What can we do here? How big is this topic?

Sarah: Well, it’s massive because there’s no one cancer. So, even in my 20 years of doing this, I haven’t seen anyone really present to me in the same way. And that goes for a lot of diseases that’s just not cancer. So, it’s such a individual…it’s like a fingerprint. So when, you know, A, there’s thousands and thousands of types of cancer, but then you’ve got different types of cancers. People getting diagnosed at different stages, which changes the ball game depending on the services that are available in your area. So, whether you’ve got a patient in a rural area, they’re treated very differently to patients that are treated in metros because they can’t be traveling back and forth for treatment. So, there’s a lot of variables when it comes to cancer therapy.  So, I think when I go to approach a cancer patient, it’s really…before I get too much into what I’m going to provide as far as supplements for all things go, it’s very important as a practitioner that you know what drugs are gonna be used and what the protocol is. So, some chemotherapy is given weekly, some are given three weekly. You know, the process is different. Some of the drugs have different excretion times. So, some of them are out of the body within 24 hours, some of them are out of the body within 72 hours, some of them are in the body for seven days.

So, what’s really important is that you know what your chemotherapy drugs are. You do your research and find out what the excretion time is because you don’t wanna do anything that’s going to affect it while it’s in the body. But by knowing that, like, if I’ve got a patient that’s on a three-week cycle but they’ve got a seven-day excretion time, ,that gives me two-week window where I’ve got a bit more movement. So, I’ve got a bit more movement to get in there, treat what I wanna treat, and then get back out. So, it’s like, you know, you’re able to get in, get out and then you can sort of do that on and off their cycle to try to get them through the treatment better. Sometimes if they’re having a treatment weekly, it makes it harder because some of the drugs, you just don’t have enough time to get in and get out. So, you’ve just got to support them through the process. So, before I provide any supplements, I definitely wanna know what they’re having, what’s the excretion time, and what are the side effects. So, I’ve actually got a little chart that I use myself. So, I’ve got all my drugs, what are the side effects? What are the excretion rates so that when someone says I’m having whatever, paclitaxel, then I know, “Okay. It’s a taxol, it’s gonna be neurotoxic.” We’re looking at neuropathy, potential neuropathy, potential hearing, potential, like, you know, it affects the nerves everywhere. Everyone thinks hands and feet, but it can affect hearing and sight as well. So, then I know what side effects I’m looking for.

So, then I’m also conscious that when I’m seeing my patients and when I’m having follow-ups with them, I’m particularly asking questions around the side effects that I know are relevant for that particular chemotherapy they’re having. So, some of the chemotherapies patients have a neurotoxic, so they’re already toxic to the nerves and they call it numbness. Some cause nausea, some cause diarrhea, some cause bone marrow suppression. So, the immune system is a lot more paramount. And suppressing the immune system isn’t something that generally chemotherapy were after, it’s just a side effect of the bone marrow not recovering fast enough for treatment. So, there’s lots of the hair loss. There’s different options there for women with hair loss to try and help with that hair loss whether you’re using cold caps or different things that are now being used.

So, I think what’s really important when you’re treating cancer patients is you’ve really gotta understand what the drugs are and how they work and what the patient is gonna be dealing with because you can’t expect the oncologist to understand how your stuff is gonna interact with them. So, I’ve probably got three categories of oncologists that I deal with in my area. I’ve got some that are really supportive and I’ve actually got some oncologists that will refer patients to me. If they say, “Oh, I’m thinking of seeing a naturopath.” They’ll say, “Yep. Go see Sarah.” They know that I’m gonna cross my Ts and dark my eyes and I’m gonna play by the rules because we’re trying to work together with the patient. I’ve got some oncologists that their quote is, “I don’t think it will help, but I think it will harm.” So, again, we try to do our best in that. But some oncologists adamantly say if they’re gonna take supplements and things that they’re not gonna treat them. And that’s okay too. So, what I don’t wanna do as an integrative naturopath is then come in and bug the oncologist because you’ve got this person in the middle that you’re then gonna create a lot of self-doubt and confusion in a time when they’re already really confused.

So, unless that patient is wanting you to really use complementary therapy and they’re open to having a second opinion with a doctor that’s more open to it, you’ve gotta sort of walk that line with them and go, “Okay. What are you comfortable with doing?”If you don’t wanna take any supplements, but you really… They’ve got a lot of faith in this particular oncologist, which is very anti-integrative. Then with those patients, I still work with them, but I just use lifestyle and I use dietary things until we get to a point where we can use other things. So, it’s putting the patient first, not your ego first. And you’ve really gotta assess their mental status as far as you want them to have confidence in their medical team. So, unfortunately, as a profession, I’ve come from nursing, so there’s a nursing saying call that, “We eat our own young,” which is very true. So, nurses are pretty harsh to each other in their young years. But it’s the same thing. I think we do it as well with naturopathy and I see it within our industry too where we’re very quick to criticize other practitioners, and we’re very quick to say, “Well, that’s not what I think.” And it’s like, “That’s okay if you don’t agree.” But at the end of the day, if you contra… You know, if you question everything that the patient is being told to do by its other practitioners, all you’re doing is adding a lot of doubt in a time when they really need some confidence about what’s happening with them.

So, sometimes you might have a doubt about something that’s going on, but unless it’s a high-risk incident, just don’t comment on it and go, “That’s okay. Well, how about we do this?” Because we’re trying to work together. We wanna be part of the solution for this patient. We don’t wanna be part of the problem where they then walk out and go, “Oh, well, I don’t know what to do. My oncologist said this, my GP says that, my naturopath says this, my osteopath says that.” It’s like we’re all working together and we need to listen to each other and respect that.

Andrew: Yeah. okay. So, let’s start off with that third type of oncologist, the one that just will not take any notion and it does not have any acceptance of natural medicine. How do you then support them? Certainly, things like lifestyle, like exercise is great research…

Sarah: Yeah. Like lifestyle, so.…

Andrew: Yeah.

Sarah: Yeah. Sorry, Andrew. So, yeah. Great research. So, we know exercise. There was a trial years ago with very similar results to herceptin back in the breast cancer trials. So, we know that exercise definitely is great for cancer patients. So, trying to get your patient to exercise throughout chemotherapy, we know that they get much better results. But again, you’ve got to look at your patient’s fitness and bits and pieces, and don’t get too overzealous if they haven’t done fitness training before. But definitely, with your HIIT training, any type of exercise, it’s gonna be good for their mental health. And we definitely know that it helps with how they tolerate chemotherapy. With the diet, I think there’s lots of ways that you can go with the diet with these guys too. So, I’d be thinking lifestyle. So, exercise whether you engage them with an exercise physiologist or a PT group. With their diet, I think when you look at all the research, you know, you’ve got so many different types of diets. You’ve got keto diets, you got…there are so many, you know, whether you go keto vegan, keto protein, fasting, all of this sort of stuff. And there’s still a lot of data coming out about fasting. So, there’s a lot of research to show patients that fast on the day of chemotherapy have less side effects with some of the trials that are coming out of Europe.

So, those sort of things are things that you could look at. If you do your Googling, you’ll find a lot of research to support fasting around the day of chemotherapy that they get less nausea and less issues with treatment. I think when they’ve got so much going on with chemotherapy, I don’t hammer them with their diet, although they’re highly motivated because they’re scared. You’ve got to remember that when you’re having chemotherapy, your coralic load is higher. So, the body needs more energy to get through treatment because you’re causing so much damage to the body that it actually requires a bit more energy than usual to repair cells and to replenish. So, for me, I try to focus on just a really clean diet. So, your proteins. I get my patients to avoid sugar, you know, processed sugary foods, I get my patients to avoid processed foods. So, your hams, salamis, bacon, all those sort of things. Making sure if they’re having protein that is hormone-free. You know, that has less chemical as possible. I probably limit the red meat to a couple of times a week just because there seems to be a fairly strong correlation with high red meat diets in cancer. So, I don’t eliminate it out of the diet, but I’m conscious of reducing it in the diet. Mediterranean diets are great as well for cancer. So, that’s more pescatarian, you know, your fruit, your vegetables, bits and pieces, and your whole grain. So, trying to reduce the processed grains in the diet and trying to stick towards some more whole grains in the diet.

Andrew: And so with regards to…there’s no point talking about the middle ground because they have no comment really. But for those oncologists that are willing to work with you, what things can you do to support the patient through the onslaught of chemo or radiotherapy that are safe, that are quite innocuous? What sort of things do you advocate for, you know, many patients, particularly if they’re quite toxic?

Sarah: Yep. So, for me, looking at their mineral vitamin B status. So, there are some Bs that are really good peripheral neuropathy, there are some that you shouldn’t be using peripheral neuropathy. So, some of your Bs are great as long as you are not using chemotherapy drugs that can become an issue in. I find with most of the chemotherapy, the mushrooms are pretty safe, any of them. So, any of the shiitake, maitake, reishi. Most of them are pretty safe during chemotherapy. Again, you have to check. So, some chemotherapies, again, that mushrooms can be an issue, but for a lot, mushrooms I find are a safer immune support rather than some of the other stuff. So, I tend to use the mushroom. It’s easy on the gut compared to some herbs like…I do find liquid herbs can be a bit of a struggle with patients, so I do use liquid herbs, but they can be a bit of a battle for patients that have got a bit of a sensitive stomach and that their taste or smell might be a little bit different. So, mushrooms for the immune system. If I can, I use a bit of glutamine in my treatment. So, I find glutamine good. I know that there’s a big debate out there about glutamine you shouldn’t be having with cancer patients, but the mechanism doesn’t work that way. You could probably explain that better than me, Andrew.

Andrew: No. It doesn’t ring true, does it? Yeah. It doesn’t. Well, it doesn’t ring true because if we are talking about glutamine, which is ubiquitous in our diet from meats and things like that, tell me if this research is going to be, say, “Don’t eat any of these high glutamine sources of food because they’re going to feed cancer.” It’s not so. The gut uses an inordinate amount of glutamine just to keep itself well. So, particularly, if they’re under stress, you know, like mucositis and things like that, their requirements go up massively because it’s a conditionally essential amino acid. You can’t make it. Sorry. Yeah. You can’t make it by your…Let’s reword that. Your body can’t make all of its requirements when it’s under excessive stress.

Sarah: Yeah. Correct. And so, I find glutamine good for leaky gut. So, I use it for leaky gut anyway, with our cancer patients. So, I love glutamine. And your chemotherapy patients will end up with, you know, whether you wanna call it leaky gut or not, they will end up with gut inflammation and damage from the chemotherapy. So, I find I really like glutamine. There are some products out there that I like that have got glutamine. It’s got quercetin in it, which there’s a lot of research around quercetin for cancer anyway, but quercetin also can help make cancer cells more sensitive to chemotherapy. So, they often have been using quercetin in patients where they can tend to become intolerant to certain forms of chemotherapy. And it’s got the pectin in it, which is great. And there’s a lot of research around the pectin. So, there’s a product that I use that’s got those in it which I find really beneficial. It’s really soothing, helps with the reflux, really helps with the bow, to calm the bow down, and it helps with mucositis. So, you can guggle the powder that I use. You can use glutamine for when they’ve got the mouth ulcers and bits and pieces. You can use glutamine as a mouthwash, like as a guggle. For mouth ulcers, I tend to use…well, you can use honey and coffee. So, there’s a lot of research around that one. So, just a little bit of coffee and honey as a mouthwash, as a guggle. Obviously, the hospitals use, you know, bi-carb soda or the baking soda or whatever just to try…you’re just trying to help soothe the mouth because mouth ulcer is a very painful when patients have that.

But what you gotta remember is if your patient is having mouth ulcers that that lining in the mouth is the same all the way through to the rectum, the same type of tissue. So, if they’ve got ulcers in their mouth, they’ve probably got similar damage down the track. It’s just that the nerve innovation is different in the gut than it is in the mouth. So, you would expect that there’s gonna be similar damage elsewhere. So, you really wanna focus on healing that, but the only benefit of the gut lining is it repairs so quickly. So, fortunately, it’s a part of the body that can replenish and heal. So, yeah. I like those products. Again, depending on the…

Andrew: The problem I found with the… Oh, sorry. The problem I found with the coffee and honey swish and spit was that because it tasted so nice. It was swish and swallow. And the danger that you have is when you’re having the equivalent of 20 cups of coffee per day and being like Dave Grohl from Foo Fighters. That’s why he’s such a fast drummer. Yeah. But it was quite a pleasant therapy for many people as long as they drink coffee.

Sarah: Yeah. Yeah. And it’s an acquired taste, so not everyone likes the taste of the coffee. And yes, we don’t want them swallowing all the coffee. But it does work really well. When they’ve done the clinical trials with it, it works really well. So, there’s a lot…You know, we are seeing more products on the market that are helping with the mouth ulcers. But I find that’s good. I tend to use saccharomyces boulardii. I like that as a probiotic during chemotherapy. Just works a bit differently. And I find if, particularly, if they’re getting the diarrhea and things from treatment, that helps a bit more in that department. What you’ll find is with your patients, they’ll either get diarrhea because the gut is so inflamed. So, you’re trying to manage that because obviously, they’re not absorbing anything while the bowels are so loose and they drop a lot of weight. And then you’ve got the other patients that will get constipation after treatment. So then with those patients, it’s like you’ve got to be more proactive and time it to keep on top of the bowels because the body is trying to get rid of those things out of the gut. So, we’re trying to help the body detox and get that stuff out naturally through your digestive tract as well.

So, what I tend to do is get my patients to do a diary, and then I’ll get them to do a diary for me after the treatment. You know, did they have diarrhea? Did they have nausea? Did they have constipation, mouth ulcers, headaches? Was there anything unusual? And then I get them to diarize it because usually, you’ll find they’ll get the same symptoms every round. It doesn’t change a lot. So, if they get constipation on day two, they’ll probably get constipation on day two every round because of the way the medications work. So, then I’m more proactive about, “Okay. So, on day one, I want you to take this so that we’re ahead of constipation on day two.” So, you can sort of gauge it. And half of this stuff that we’re doing is control for the patient. So, you’d be amazing how empowering it is for a patient to do a diary of their symptoms because they’re in a situation where everything is out of control. They’re being told what they have to do, they’re doing a treatment they don’t wanna do. So, that’s why I find exercise is great, that’s why I find dietary changes are good, and that’s why I find diarizing and managing their stuff all really important because it gives them some sense of control over a situation that’s out of control. And it keeps them involved in the process. They’re not walking into my room going, “Okay. What do you want me to do?” They’re coming in and they’re like, “Okay. This is what’s going on. How can I manage this?” Or they become a bit more involved in the process rather than coming in here and just saying, “Okay. What am I doing now?” You want them to be part of the process, part of the solution, what’s gonna work for them. So, a lot of it is that emotional and mental stuff too, just supporting them through how they’re adjusting to that.

Andrew: Yeah. Okay. So, there’s a good point that you make about the mental, and emotional state and linking that to journaling. Many people don’t sort of treat this as an active therapy, they put it as a, you know, it’s a psychosocial thing, but I’m thinking about as an active treatment of journaling your feelings during your cancer treatment for the purposes of hopefully, reducing adrenaline or epinephrine and no epinephrine or no adrenaline, the response which has been shown to activate how certain cancer cells metastasize. So, we can sort of think about on an emotional level saying reducing stress is good for your body. Now we’re talking actually the biochemistry, the pathophysiology of cancer cells and how they metastasize to different parts of the body, and how we can just by a very simple and safe intervention, hopefully, use that as part of the puzzle to reduce their overall stress and therefore, give them a better outcome.

Sarah: Yeah. Absolutely. When you talk about that journaling, it’s a bit like when they’re journaling their symptoms if they know that day three is a write-off and they’ve got the steroids and that’s a day that I’m really tired. That patient then knows not to go out for lunch that day, don’t organize any bookings because that day is here, lay at home and it’s your Netflix day. But the same thing with your journaling, the good thing with journaling is that you will see the ebbs and flow and emotion as they come up for a test. You know, like I see with my patients, it’s almost like, I hate to use the word, but it’s almost like a post-traumatic stress when they come up to having, you know, patients that have finished treatment when they’re coming up to scanning their level of anxiety while they’re waiting for results to come back to their doctor. But journaling with those ebbs and flows about, oh, you know, the anxiety coming into treatment and then journaling how you felt after treatment, then that would also help them to understand this is all transient, it’s all flow. I know that you’re a bit anxious about having your treatment, but after a couple of days after treatment, you’re okay again. And they could sort of reflect back on that journal and also just see the journey. A lot of people that get diagnosed with cancer have not had a serious health condition before, so they’ve never had to deal with their own immortality unless you’ve been unwell or unless you work in an industry where you genuinely deal with immortality as a part of your occupation. A lot of people don’t think about their own demise until something…until a serious event happens. And that’s a lot for somebody to process to get there. Then you know, that’s again, a different podcast, but you’ve really got to support them through that process and through that fear and that they need to come to the other end of that and be okay with where they’re at and okay with what’s happened to them.

Andrew: Yeah. Just the last couple of questions. And the first one going on with that topic of stress, with that hyper-vigilance. How do you help patients safely during that period of hyper vigilance, whether it be during their treatment or after treatment with regards to, you know, supplements that you can use? Like for instance, you know, there’s a real big concern about using things like St John’s wort, for instance. But there seem to be safer options, like for instance, chamomile. And maybe in the way that you use it, not as a herbal medicine, as you spoke about the conundrums you have there, but maybe as a tea. Do you find that there’s any effective options there that people can use?

Sarah: Definitely. So, yeah. Some of your big guns like your St John’s wort, your carbo, some of those big guns you have to watch. They work great, but you have to watch with interactions. Ziziphus, I probably put middle of the road. It works well with most people, but again, it’s a stronger nervous system herb, but yeah. Chamomile is great. Chamomile tea is good. I find oak seeds are really gentle herbal. If you’re a liquid herbalist, oak seed is a really nice gentle herb. Passionflower is a really nice gentle herb as a herbal liquid. Skullcap is another one. So, there are some other guys in the herbal realm out there that are softer, but yeah, your chamomile’s great. Again, that comes into your exercise. There are some psychologists out there too that specializes in grief. So, not all psychologists are good with grief. So, finding a psychologist that can help them with that grieving process and communication to just to settle that fear down when it comes up is really important. And then, you know, there are a lot of good books. As a practitioner, you can read out there on grief. I think grief is something that as a practitioner, if you’re working in…if you wanna work with a lot of cancer patients, you really need to understand the grieving process and the psychology around what they go through so they can go, “Oh, okay. We’re up to this part. So, how can we help them through this part?” But it’s also recognizing that grief it’s like a wave that comes and goes, it’s good days, bad days, good mornings, bad mornings, and there’s no timeline as to how long this is gonna go for.

So, it’s your understanding that process so that you can help them understand the process. And having an understanding, it’s like anxiety for patients that have anxiety. If they understand anxiety and they understand why it comes up or what their trigger was, or how do they manage it even without medication or supplements, their anxiety is better because they know what it is, they understand it, and they know what to do in that situation to help relieve it. And grief is the same thing when it comes up, and they’re feeling scared and whatever, it’s the same thing. It’s okay when it comes up. How can we rationalize that to your brain of what’s happening and what’s our process for talking you down or… But yeah. But chamomile’s great. I find peppermint tea is great doing… I think all your teas are safe with chemotherapy. You can’t go wrong with your teas, are all such low doses. But I find licorice is great for the gut. It can help soothe. Marshmallow tea is good. Chamomile is good for your nervous system, peppermint is another really good one for nausea.

Andrew: And mucositis as well.

Sarah: Yeah. Yep, yep. Yeah. Your marshmallow. Yeah. And licorice. And peppermint’s really good for nausea. So, your peppermint teas, your ginger teas, ginger, ginger, ginger for nausea. Your ginger teas are great as well. So, there’s a lot of things that you can do that aren’t big, heavy hitters that you can still, you know…and there are the things that you would use with those oncologists that don’t wanna play ball with you at all. Then there are sort of things that you can use to, you know if you… Like, I love mushrooms. If I had an oncologist, it was like, “No, I don’t want you to take supplements.” Use mushrooms in your diet. You know, mushroom sauce, mushroom soups, mushroom, mushroom, mushroom, garlic, ginger, you know.

Andrew: There’s some beautiful…and if you use them in the correct way, they can be extremely powerful foods that we have now we have access in our diet, like for instance, enoki mushrooms, reishi mushrooms. You know, you can see these in your supermarket, and even the common butter mushroom. You and I have spoken about this. It’s not without merit. These polysaccharides are ubiquitous throughout the sort of food world, but the mushrooms have this particular sort of action on priming or helping our immune system. Just one last sort of question. And I guess it relates to that stress topic back into picking up the pieces when the rounds of chemotherapy have finished, when the drugs have largely gone from the body, they’ve done their job, but you might have a patient that’s left in a poor state. How heroic do you go with regards to picking up the pieces? And is that when you use things like the stress herbs like ashwagandha and the adaptogens to help build them up again?

Sarah: Yeah. So, once they’re finished treatment, then that’s when I really like to get in there. So, my two big focuses or three big focuses post-chemotherapy is trying to detox. So, that would be coming in there. I actually don’t mind using low-dose silymarin. Again, you gotta check with your different chemotherapies, but there is a gain and some merit to using low-dose silymarin as long as you’re not using big doses in patients having better outcomes with a little bit of liver support during treatment. But again, you gotta check which chemotherapy agents you’re using. So, when they’ve finished treatment, for me, it’s really restoring their nutrition. So, getting their nutritional levels up. So, that might be with your Bs and your magnesium, your calciums, and all your bits and pieces. And don’t forget your little micro guys like your seleniums, iodines, those little guys too that are really important for wellbeing that gets forgotten about. So, for me, it’s trying to restore their nutritional value because their body’s just been through months of damage and their absorption. It’s been realistic that their absorption for nutrition would have been quite poor during treatment.

So, for me, it’s working on getting nutritional levels up. So, your iron, your Bs, your minerals, your bits and pieces. Detoxification. So, and don’t forget the kidneys. So, we all focus on the liver but really focus on the kidneys as well because they do a pretty big job, particularly since some of the chemotherapies are, you know, toxic to the kidneys. So, really focusing on detoxing. Yeah. So, really detoxing on the liver, the kidneys, the lymph, getting it all detoxing nicely, and quite four things. Immune system. So, getting the immune system big up and running, we wanna get those natural killer cells going. We want to really make that immune system nice and robust because it’s been hammered. It’s like whac-a-mole, so it’s just been through whac-a-mole for six months. So, you wanna try and really get that immune system nice and strong to prevent recurrence of disease because that immune system is vital at filtering and monitoring the body to prevent a recurrence. And the other thing for me, again, going back to my…that product that I like that’s got the pescatarian and pectin and glutamine in it is really restoring gut health. So, if you don’t restore gut health, you’ve got no hope. So, for me, I like to use that type of glutamine product. It helps pull the leaky gut, it helps to repair it, it helps to soothe it, it gets to heal it, it makes their bloating better, it makes them more comfortable in the gut, which means that the food that they can tolerate is better.

There’s another product I like that’s got berberine and wormwood in it. So, again, you’re probably thinking that’s parasite herb; what is she talking about? But again, if you look at berberine is amazing for cancer, and there’s a lot of research around wormwood as well, but again, great for leaky gut, and great for repairing the gut. So, I use that as like a little bit of cancer support while I’m healing the gut while they’re not having any treatment that I’ve got like this…I guess I look at it as a bit of a…the berberine product as a bit of a security blanket, I guess, while we’re not having any treatment and we’re just seeing how the chemotherapy went. And then I’d be looking at probiotics. So, again, I like the saccharomyces boulardii when we are going through treatment. And then after treatment, when we’re repairing that gut lining, then I’d be looking at like a bit of a more multi-strain type probiotic to sort of get the gut building back up. So, for me, it would be…

Andrew: Yeah, good.

Sarah: …repair the gut, boost your immune system, restore your nutrition, and get those probiotics and bits and pieces going. And, you know, you can talk about detox. Definitely, dietary detox if they’re up for it. I tend to do a detox with my patients, cancer patients every few months. Like I’d rather do a week or two every few months than do some big six-week challenge at the end of their chemotherapy. So, I think you’ve gotta think long term that these guys are gonna be having CT scans, they’re gonna be having diet put in, they’re gonna be having ongoing…And some of these drugs that they’re using stay in the system for long periods of time. So, it’s like doing a slow chip away rather than trying to get rid of it all in two weeks.

Andrew: Yeah.

Sarah: And the other thing with these patients is just, yeah, so you’re focusing on getting all that stuff out of the system because it’s not really till we get those follow-up scans in three or, I guess, up to that 12-month mark that we really know whether the treatment was successful or not. So, generally, if we don’t get any recurrence in 12 months, everyone’s oncologists are generally quite happy that it’s all tracking in the right direction. But I think definitely trying to get the person going as good as you can, but you’ve also gotta listen again, listen to the patient. What I’ve learned from experience is sometimes my patients get to the end of the treatment and they don’t wanna take anything. We have like this Mexican standoff where they just say to me, “I just don’t wanna take anything. I’m over this. I’ve been bullied around I’ve realized I…”

Andrew: Supplement fatigue.

Sarah: Yeah. Absolutely supplement fatigue. So, if your patient’s got supplement fatigue, that’s when you’ve got to look again, look at their… I tend to get copies of their blood from a lot of my patients. If they’ve got supplement fatigue, then I can go, “Okay. What’s important to me?” So, if I’m looking at their blood tests and their liver function’s very okay and their immune system’s okay, then I’ll go, “Well, can we just work on your gut? Can we just do this?” If the guts…if they’re not complaining of any digestive issues, but their immune system’s low, then I’ll go, “Well, can we just work on that?” So, I guess it’s gonna be different for every patient. But at that point, if they do have supplement fatigue, it’s breaking it down, and you’ve gotta prioritize what do you think the patient needs right now? Even though in my head, I’d be like, “Oh, well, I wanna detox first because we’ve gotta get this rubbish out of the system, and we’ve got to fix the gut.” Otherwise, what’s the point of doing anything else. They might not be ready for that. So, then it’s like, well, we need to work on something else until they…

Andrew: Work on the simple things first. Yeah.

Sarah: Yeah. Definitely.

Andrew: Yeah. This is obviously a massive topic. And you know, as I’ve learned from yourself, I’ve learned from Janet Schloss, I’ve learned from Liz Arshler, and Tanya Wells. All of you are dear to my heart. You know, they’re not just hints and tips, but it’s the ethics and the care that I’ve learned from all of you guys. You’ve really changed how I look at cancer care. And this is such a big topic, but thank you so much for sharing just that little bit of the opening into the sort of, I wanna call it pandora’s box into the treasure room of what we have available as simple and safe cancer support for our patients. Thanks so much for joining us today on “Wellness by Designs,” Sarah Franklin.

Sarah: Thanks, Andrew.

Andrew: And we will put a whole host of support material up on the Designs For Health website for you. Remember, you can catch up on all the other podcasts and indeed, the show notes for this one on the Designs For Health website. This is “Wellness by Designs,” and I’m Andrew Whitfield-Cook.