Maintaining a Healthy Immune System Through Cancer Treatment and Beyond
About the Lecture
Maintaining a healthy immune system through the continuum of cancer treatment and afterwards is one of the topics of great interest to patients diagnosed with cancer as they seek to find ways to participate in optimizing their own health. Supporting the immune system is one of the most common reasons patients take dietary supplements with or without a cancer diagnosis. In this lecture the latest research on the effects of immune nutrition and supplements for immune health are discussed as well as how to review and interpret labels of dietary supplements.
Carolyn F. Katzin, MS, CNS, MNT has 25 years of experience working in the field of oncology and nutrition. She received a Master of Science in Public Health in Nutritional Science from UCLA. She has extensive knowledge and experience counseling patients around wellness, nutrition, and physical activity as well as a wonderful understanding of the complex needs of patients with cancer. She has a long history of providing consultative educational sessions with patients on nutrition, supplements and how to improve one’s wellness while getting cancer treatment and beyond. She has also worked with individuals in developing healthy diet and lifestyle for cancer prevention. She is caring and compassionate in her care of patients and their families.
Carolyn Katzin has written two books, The Cancer Nutrition Handbook and The Everything Cancer-Fighting Cookbook. She has been a member of the American Cancer Society National Nutrition, Physical Activity and Cancer Control Committee and co-Chair of the California Division Board of Directors Nominating and Development Committee.
This is a summary of a lecture presented on August 13, 2013.
When diagnosed with cancer, many individuals want to participate in their own wellness and, as a result, would like to optimize their immune functioning. While, on the surface, this seems like a straightforward endeavor, it is very complicated. Immune health in the context of a diagnosis of cancer and beyond is a complicated and vast topic. Given the exciting pace of research in this field today, it is also one of relevance to all of us.
Overview of Immunity and Immune System
What does immunity mean? Immunity is a term that describes the interface between ourselves (or “Self”) and our environment (or “Not-Self”). It includes the estimated 21,000 foreign chemicals in our food, what we drink and what we breathe on a daily basis. In addition, we have recently become aware of the importance of the microbiome – those microbial entities whether they are bacteria, viruses, yeasts or other microbes that live synergistically in and on us. The microbiome forms a huge interface between Self and Not-Self. The Self and Not-Self communication system provides both innate and acquired responses. Our immune system is a highly intricate and delicately regulated network of cells operating 24-7 throughout our lives. There is no “downtime” in the network of communication that occurs throughout the body. The term immunity comes from the Latin immunis or “exemption.”
Immunity may also be described further in several ways. Innate immunity is how the body rapidly clears away foreign or infectious agents, for example, with complement or killer T cells. We have innate immunity at birth. Adaptive or acquired immunity develops over a longer period of time and involves B and T cells and their ability to remember how to fight off disease or infection. Another classification is “passive” or “active” depending upon how a response is derived. If the body produces antibodies in response to infection then it is called active immunity; if antibodies are transferred to our body, in the form of immunizations, for example, then it is called passive immunity.
The immune system is a network of cells generated in the bone marrow and specific organs including the thymus, spleen, lymph nodes and lymphatic tissue and vessels. At least 75% of all immune cells are found lining the digestive tract, which makes sense as our digestive tract, and the microbes that reside there, is a key interface with our food. New understanding of the role of these microbes in recognizing and providing nutrients is shining a light on why certain foods are particularly helpful for optimizing health.
Most of us are not aware of the complexities and nomenclature of the immune system. What we may see are blood test results that identify the total white cell count and further subdivide that information into how these cells stain under the microscope and inferring from that what they do in the body. For example, we may learn that a high white count is associated with infection or that a high percentage of eosinophils may be the result of allergies. If your white cell count drops, you may not be able to continue your cancer treatment until the count is brought up, usually by taking a white cell stimulant such as Neupogen or Neulasta.
Nutrients and the Immune System
Since the early 1970’s, we have known which nutrients are important in the formation of white blood cells and in maintaining a healthy immune system. Protein, Zinc, and vitamin A were first recognized as crucial to effective immunity. More recently, a recognition that omega-3 fatty acids, conjugated linoleic acid (CLA), other essential fatty acids, B vitamins especially riboflavin (vitamin B2) and folate, minerals magnesium, boron and selenium are all required as well. Carbohydrates in the form of polysaccharides (from poly for many and saccharides for sugars) are also essential to healthy immune functioning. These are not the same as simple sugars (like table sugar or sucrose); however, complex carbohydrates may be broken down into simple sugars by microbes. Dietary fibers are a form of complex carbohydrate or polysaccharide. We need sufficient dietary fiber for healthy immune functioning in the gastrointestinal tract. Dietary fiber rich foods are those from plants such as beans or legumes, vegetables, and fruits.
In 2008, the National Institutes of Health (NIH) launched the Human Microbiome Project. Since then we have learned new and fascinating facts about the vast array and variety of the microbes that make up 10 times as many cells as our own cells and 100 times as many genes as our own. With new RNA detection tools, we have opened up a whole new world of investigation that is called “symbiotology,” a study of how these tiny life forms live synergistically with us. If this ecosystem is out of balance, either because we do not eat the right food (dietary fiber rich) or because of damage to the cells that may occur as a result of cancer treatment or broad-spectrum antibiotic use, our immune system and its functioning can be impaired. Resetting this system involves addressing the imbalances by diet modification.
Zinc and Iron
Zinc and iron are especially important mineral nutrients. We need both of these trace elements or minerals in small quantities, and they form regions of genetic coding such as zinc fingers. These regulate how DNA is copied rather like punctuation in the writing of codes for how proteins are made and shaped. Zinc is also a cofactor in the repair enzymes that make sure DNA and RNA are accurately transcribed. In addition, zinc regulates cytokine gene expression selectively in macrophages (white cells that encompass and destroy foreign substances). Zinc also increases the expression of macrophage colony-stimulating factor (the target of Neupogen) and decreases expression of TNF-alpha, IL1 beta, and IL8 genes, thus playing a direct role in modifying the immune response. Zinc also plays a key role in apoptosis (programmed cell death). Bioavailable Zinc in a chelated form allows zinc to enter and quickly leave reactions. Vegetarians and vegans and those who drink alcohol on a regular basis need more zinc than those who consume a broader diet or who do not drink. The RDA for zinc for men is 11 mg, for women it is 8mg with a tolerable upper limit (UL) of 40 mg. A typical multivitamin usually contains 15 mg.
Food sources of zinc include liver (organic is best), lean red meat, shellfish, fortified cereals and breads, seeds such as sunflower and pumpkin, yogurt and some tree nuts, e.g., walnuts and pecans. Oysters are an especially rich source of zinc and provide up to 20 times the RDA per 100 gram or 3 ½ ounce serving.
Iron is another essential nutrient for healthy immunity. The reason pus or mucus secretions change color from a green to yellowish color is because iron changes its oxidation status in its active fight against bacterial infections. Many bacteria use iron, so it is important to have just the right amount in our diet. Some doctors may monitor storage iron as ferritin to ensure you have sufficient iron without overload. The RDA for iron is 8mg, and the tolerable upper limit (UL) is 45 mg.
Food sources of iron are similar to zinc and include liver, lean meat, eggs, beans, dried fruit, and spinach. Many culinary herbs and spices are also good sources including rosemary, paprika, and thyme.
Vitamin C (ascorbic acid) is another important nutrient for healthy immune functioning. Vitamin C is found throughout nature, and most animals can synthesize their own. Humans are one of the few species that need to eat it on a regular basis. A lack of Vitamin C can lead to scurvy, a potentially fatal condition. Scurvy was at one time common among sailors, pirates and soldiers who were unable to get fresh produce as a result of long voyages or battles. Today we understand that vitamin C is an important nutrient that we need to consume regularly. It is, however, easily destroyed by heat. The RDA for men for vitamin C is 90 mg, for women is 75 mg, and the tolerable upper limit is 2,000 mg, indicating this is a very safe nutrient. Foods rich in Vitamin C include citrus fruit, bell peppers, kiwis, berries, and broccoli.
Vitamin A is also crucial for immune health. Vitamin A and other fat-soluble vitamins D, E and K, are all very important for health; they are stored for long term use in the liver. Because of this, however, it is possible to have too much Vitamin A. Vitamin A may be formed in the body from dietary carotenoids or provitamin A. Carotenoids include beta-carotene, alpha-carotene and beta-cryptoxanthin. The RDA for Vitamin A is 900 mcg RAE (3,000 IU) for men; 700 mcg RAE (2,100 IU) for women and the Tolerable Upper Limit (UL) is 3,000 mcg RAE (10,000 IU). IU conversion depends on the source (retinol>carotenes or beta-cryptoxanthin). Food sources of Vitamin A include sweet potatoes, liver, carrots, kale, and spinach.
Vitamin D is both a nutrient and a hormone. It has recently been found to play an important regulatory role in immunity. Like Vitamin A, it is a steroid shaped chemical that binds along with zinc and a steroid response element (SRE) to cell surface receptors. This then triggers a response involving cytokines or intracellular messengers and enzymes called kinases, which activate or phosphorylate proteins. Although routine testing for Vitamin D is not yet a standard of care for everyone, it is valuable to learn what your serum level is before supplementing with mega (levels greater than twice RDA) amounts. The RDA for Vitamin D was recently raised to 600 IU, and the tolerable upper limit is 4,000 IU.
Food sources of Vitamin D include oily fish— such as herrings, salmon and sardines—and fortified dairy products and milk made from soy or almond. Vitamin D is best absorbed with oils and fats so having a salad dressed with Extra Virgin Olive Oil is a good idea if you have sardines or salmon as a source of protein and vitamin D.
Another fat-soluble vitamin important in immune functioning is Vitamin E. This vitamin works in concert with its water soluble partner, Vitamin C. Food sources of vitamin E include nuts and seeds where it acts to inhibit oxidation or rancidity. For patients undergoing treatment who have delicate digestive systems, we recommend nut butters or nut milks rather than whole nuts as a source of vitamin E because they are more easily digestible. Supplements of Vitamin E should always include the full spectrum of tocopherols (chemical term for Vitamin E) with gamma as well as alpha tocopherols. Several studies using vitamin E in its alpha tocopherols-only form were stopped early as the participants had poorer outcomes than the controls. The RDA for Vitamin E is 15 mg (22.4 IU), and the Tolerable Upper Limit (UL) is 1,000 mg (1,500 IU).
Selenium is another trace element that has an important role in immunity; however, selenium has a narrow range of safety so supplements with selenium should only be taken under the care of a health care provider. Symptoms of selenium toxicity may be subtle, such as fatigue or headache. How much selenium is in our food depends on the soil levels in which they food was grown, and these levels vary around the world. Recent studies evaluating the benefit of selenium and Vitamin E together for cancer prevention have not shown any benefit for either nutrient. The RDA for selenium is 55 mcg, and the tolerable upper limit (UL) is 400 mcg. Typical multivitamin and mineral supplements contain 200 mcg, so if you are taking a once-a-day multi-vitamin you are getting sufficient selenium without needing additional supplementation.
Inoculation, Immunization, Vaccination
Inoculation, immunization, and vaccination are all slightly different forms of generating an immune response in an intentional manner. Smallpox (from the Latin word variola or “stain or mark on the skin”) is an immunization success story; eradicating smallpox through vaccination opened a new era of intentional directing of our own defense system. Today, vaccinations against a wide number of diseases have resulted in many more infants and children surviving into adulthood. Eighty-three percent of infants are now vaccinated against Diphtheria, tetanus and pertussis (whooping cough), and several new vaccines are becoming more widely used. Polio is an example of a disease that has been eliminated from most developed countries although visitors from other countries may still bring it into the country. When sufficient people are immunized a larger group is protected – this is called herd immunity. Scientists discovered that immunizing 5-10% of a herd of cattle against brucellosis protected the entire herd. Although only a few cattle need to be immunized against brucellosis, at least 45% of children need to be immunized against childhood diseases for a community or school to be protected from that disease, e.g. measles or whooping cough.
What happens when a healthy immune system malfunctions?
When a healthy immune system malfunctions, there can be consequences. One type of malfunction is when either the wrong type or wrong number of cells form. An example of this is leukemia: white cells or their precursors overproduce, which reduces the number of well-formed, fully mature cells. As a result, the white blood cells do not behave as they should. There are many types of leukemia depending on where it occurs, and how chronic or acute is the condition; the consequences vary by type. Childhood leukemia was the first cancer to be successfully cured thanks to the relative simplicity of mutated cells that cause the disruption in white cells. Until the early 1970’s childhood leukemia used to be a certain death sentence, but after harnessing the immune system to address this disease more than 94% of children who receive treatment survive into adulthood.
Another type of malfunctioning of immunity is when the body turns upon itself and perceives its own cells as foreign, called autoimmunity. An example of an autoimmune disease is lupus. When the immune system behaves in an aberrant manner, it may result in the overproduction of “messengers” associated with inflammation. Examples include IL2 or IL10 and C-reactive protein. Over time, individuals who have chronic inflammation are more likely to develop cancer in the affected regions. For example, someone who has had hepatitis since birth is more likely to develop liver cancer after about 30 years. Mutated genes are, by definition, how cancer arises, and cells that divide faster than usual due to inflammatory triggers may make more mistakes which, if in key regions of the genome, may result in precancerous processes or dysplasia. How is it that immune cells fail to recognize such changes? How do they get past the screening mechanisms? We still do not fully understand this aspect of immunity in both prevention from and in the treatment of cancer, although there is a growing body of literature.
PROBIOTICS AND FERMENTATION
As mentioned earlier, microbes form an essential interface between the digestive tract and internal fluids. Probiotics are microbes that are supportive for our health. Examples of foods rich in probiotics include fermented foods like yogurt, sauerkraut, vinegar, kimchee, tofu, and tempeh. Foods that support healthy immunity by supporting microbes in our digestive tract include fermented foods and also what are called prebiotics. These are fiber-rich complex carbohydrates, also called poly (from many) saccharides (sugars). Unlike simple table sugar (which is rapidly digested into two sugar molecules, fructose and glucose), complex carbohydrates are slowly broken down into their component sugars. Many of these component sugars are not enzymatically digested, but instead provide nutrients for microbes and generate gasses in the process–one reason some of these foods create gas. If we eat more complex carbohydrates, over time our internal ecology shifts and we can digest more fibrous foods and produce less gas.
Fermentation is a traditional way of preserving food. Fermented papaya extract, as well as fermented wheat germ, may be beneficial in supporting the immune health and ease side effects of many chemotherapy treatments (formulations are currently available in the Reflections Boutique at UCLA). Fermented products provide nutrients that support healthy redox (reduction and oxidation) which is at the heart of immunity.
Other foods that support immune health are mushrooms. These fungi occur in both vegetative and fruiting body states. Vegetative mushrooms are rich in alpha glucans, and when fruiting or in typical mushroom formation beta glucans predominate. Both alpha and beta glucans stimulate natural killer T cell numbers and activity. Ganoderma lucida (Red Reishii or ling zhi) is a rich source of biologically active triterpenoids and Coriolus versicolor also called turkey tail is particularly rich in PSP or polysaccharide peptide.
Sea vegetables and kelp are also rich in complex carbohydrates and can improve our intestinal flora number and activity or optimal microbial ecology. An example is Fucus vesiculosus, also called bladder wrack or black tany. Sea vegetables make delicious snack foods or may be steamed and served as an accompaniment to fish dishes.
Immune responses depend upon healthy microbiota (microbes in the digestive tract) and also the nutrients needed not only for the formation of the cells involved, but also in surrounding activities. Nutrients essential for T cell regulation include omega-3 fatty acids and CLA (conjugated linoleic acid) from culinary herbs like rosemary, oregano, and thyme. Also required is Vitamin A (or its precursors). Arugula is a dark green salad vegetable rich in provitamin A and also ALA (alpha-linoleic acid), an omega-3 fatty acid that is at the foundation of a typical Mediterranean Diet. Today, most people have diets high in Omega-6 fatty acids because, instead of allowing cattle to graze on grasses, we feed them a diet of corn that is high in omega-6. As a result, meat and dairy products (milk, yogurt, and cheese) are high in omega-6. Omega-3 (and other odd-numbered fatty acids such as omega-9 – the main fatty acid in olives and olive oil) are precursors to more anti-inflammatory cytokines or cellular messengers and act to balance out the more pro-inflammatory AA (Arachidonic Acid) or omega-6 fatty acid. (See chart).(?)
T cell activation and functioning (a vital component of the immune system) also depends upon the essential amino acid arginine. Sunflower seeds contain a natural arginase inhibitor; thus, allowing more arginine to be available to our T cells. Tahini made from ground sunflower seeds makes a great dip and may be a useful food to eat in supporting the immune system.
If we assume the immune system is fully active and healthy, we can assist the body’s natural process to detoxify or essentially “cleanup.” The nutrients that are important in helping the body reduce toxins are focused on the liver and kidney. These two organs benefit from vegetables from two main groups; the allium or garlic family and the cruciferous or cabbage family. Allium vegetables include onions, shallots, chives, scallions and garlic. The cabbage family includes arugula, bok choy, broccoli, Brussels sprouts, cauliflower, collard greens, horseradish, kale, radishes, rutabaga, turnips, watercress, and wasabi. When chewed the cruciferous vegetables, release glucosinolates or sulfurous molecules that have detoxification and anticarcinogenic activity. Supplements that provide these include sulfurophane glucosinolate or DIM (diindolylmethane). Sulfur in the form of glutathione is a core ingredient of the key liver and kidney detoxification enzymes. Whey and avocado provide sulfur in an important peptide form.
Curcumin is an anti-inflammatory and anticarcinogenic nutrient found in the culinary spice turmeric; it is used as an ingredient in foods such as curry. Curcumin is a spice from the ginger family and is widely used in tropical countries for its flavor and also because it prevents food spoilage.
How do these nutrients affect immunity in the field of oncology?
New directions for cancer therapies are harnessing our growing understanding of immune responses and aim to balance key pathways involved in recognizing and screening cells that are not behaving in a normal and healthy manner. Examples include interferon alpha for CML, Interleukin IL-2 for metastatic kidney cancer, colony stimulating factors to improve white cell counts, monoclonal antibodies like Rituxan and Herceptin, vaccines, gene therapy and nonspecific immunomodulating agents such as BCG for bladder cancer. I like to use the analogy that this can be thought of as adding better screening equipment and more screeners at airports. General terms used for these new therapeutic agents include biologic response modifiers or BRM. Lectins are a BRM; they occur in a variety of foods including wheat germ, legumes (especially soy, peanuts, red kidney beans and lentils), tomatoes and other members of the tomato family like eggplant and pepper, dairy products containing whey, mushrooms and members of the allium or garlic family. These foods would be expected to act as stimulants via the innate immune pathway called complement. Foods low in lectins are likely to be less stimulating to the immune system and might be suitable for those undergoing radiation to the gastrointestinal tract. These foods include fish, leafy vegetables, olives and calves’ liver.
The nomenclature that describes immune therapies is descriptive of the targets. For example, Rituxan locates a specific protein CD (cluster of differentiation) 20 and makes it more visible to the immune system. There are 139 that have been identified as human leukocyte antigens or HLA. Growth signals may be blocked in another manner by interfering with an epidermal growth-factor receptor-like Herceptin or Erbitux. If an immune modulating modifying drug ends in –mab then it is a monoclonal antibody or if it ends in –ib it means it is a small molecule. The prefix of such a generic drug has no specific meaning.
In order to personalize this new knowledge, it is valuable to ask a few questions. What do you know about your family medical history? What is your body composition? Do you have a waist size that is more than half your height? If so, then you may be at a higher risk of generating inflammatory cytokines. My Family Health History is a useful online tool available at https://familyhistory.hhs.gov/, and you can print out the results and take them with you when you next visit your primary care physician.
Dietary supplements and their safety is an important topic; we estimate that as many as 65% of all cancer patients take some form of supplement, and many of these patients do not share this information with their health care team. Some nutrients may reduce the effectiveness of chemotherapy agents by competing for the same liver enzymes. An example is the grapefruit, which contains naringin, naringenin and bergapten—flavonoids that interact with the liver enzyme cytochrome P450 3A4. This enzyme is responsible for up to 70% of intestinal and 30% of liver detoxification activity. Supplements or juices with grapefruit or bitter orange affect this liver enzyme in an irreversible manner that lasts up to 72 hours, or until the body synthesizes new drug-metabolizing enzymes. Statins like Lipitor are examples of medications that are affected by grapefruit, grapefruit juice or bitter orange (also known as Seville). Other citrus fruit do not contain these bioactive principals, so you do not have to avoid them. Check with your pharmacist to be sure that you are aware of any potential drug-nutrient interactions that may reduce or potentiate active ingredients and result in untoward outcomes.
Many bioactives affect blood clotting or platelet activity; this may be life threatening if platelet counts are low as a result of chemotherapy. Examples of supplements with blood thinning actions include St John’s wort, Dong Quai, and Curcumin. CoenzymeQ10 may interact with the blood-thinner Coumadin and make it less effective. Estrogen blockers such as tamoxifen may also be affected by supplements containing phyto (or plant) estrogens including soy, Dong Quai, wild yam, kudzu, cinnamon, and flaxseed. Other botanical supplements may stimulate immune activity, such as Astragalus, Echinacea, and Golden Seal; these should be avoided if you are on immunosuppressants.
Some specific diet suggestions for different chemotherapies are available in the Cancer Nutrition Center Handbook which is provided at no cost as part of the integrative oncology counseling session. Examples include having small, frequent meals for those on Avastin; having a diet that is bland (not spicy), with foods rich in soluble fiber such as applesauce and oatmeal if on Etoposide, or avoiding fish oil supplements when on platinum-based chemotherapies such as Carboplatin.
So what should we eat when undergoing treatment for cancer? It is important to remember that we eat for pleasure as well as for nourishment. Food serves to connect us with loved ones and symbolizes loving nurturance. Food provides us with nutrients, but it also indirectly supports the microbial environment inside as discussed earlier. Sometimes a patient just needs to get the calories and nutrients of a particular protein into their body. It may be helpful to think of eating “medicinal food,” meaning having spaced out feedings of high nutrient and protein rich smoothies in the way that medicines are taken at different intervals throughout the day.
Another aspect of eating well for healthy immunity is to avoid adding toxins such as pesticides. The Environmental Working Group, a not-for-profit group, has a regularly updated shopping list of the top 12 foods worth buying organic that they call the “dirty dozen. “
Dietary supplements may potentially be a source of toxins if adulterated. Supplement safety is an important aspect of nutritional health and a topic of interest as the FDA finalizes rules. In 1994 DHSEA (usually called Dayshay) passed into law and expanded the number of items defined as dietary supplements from 4,000 to 55,000. Many of these new ingredients were never seen before in this context such as theanine. The definition of supplements is… “intended to supplement the diet, containing one or more dietary ingredients (including vitamins, minerals, herbs or other botanicals, amino acids and other substances) or their ingredients, intended to be taken by mouth as a pill, capsules, tablet or liquid and labeled on the front panel as being a dietary supplement.” Current Good Manufacturing Practices or cGMP have been compulsory since 2010. Examples of organizations that verify cGMP include NSF and Natural Products Association. USP is an internationally recognized supplement verification program used in over 140 countries. Supplements should be appropriately and truthfully labeled. A supplement may contain a cautionary statement such as “not suitable during pregnancy.” Not having a cautionary statement does not mean that there are no adverse effects. Contrast this with lengthy, data-driven pharmaceutical disclosures. (?)
A healthy diet to support immune function would look like this. We would start the day with whole grains and some organic berries, maybe a different piece of fruit as a mid-morning snack and then a broad selection of salad vegetables with avocado at lunch to accompany some lean protein. In the afternoon, have a snack of a handful of walnuts or almonds (or as nut butters if your digestive system is sensitive) or a small square of organic dark chocolate. Dinner might be some fish, lean meat or vegetarian protein with some grains and at least 2 different vegetables. Berries would be a great choice for your desert. You may choose another snack at bedtime if you find it challenging to maintain muscle mass such as during chemotherapy or radiation treatment. Drink plenty of water as your meal beverage, with perhaps some low acid coffee such as Costa Rican or some green or white tea for hot beverages in the morning. We recommend no caffeine after 3 PM so as not to disturb your sleep pattern.
UCLA Jonsson Comprehensive Cancer Center http://www.cancer.ucla.edu/
Simms/Mann – UCLA Center for Integrative Oncology https://www.simmsmanncenter.ucla.edu/
NIH Human Microbiome Project http://www.hmpdacc.org/
Resources for learning more about dietary supplements include:
FDA (http://www.fda.gov/ or Tweet @US_FDA);
NIH Office of Dietary supplements (http://www.nds.nih.gov/ or Tweet @NIH_ODS);
National Cancer Institute http://www.nci.gov/ or Tweet @theNCI)
Consumer Lab is an independent lab testing dietary supplements http://www.consumerlab.com/
[Editor’s Note: Carolyn Katzin, MS, serves as the Integrative Oncology Specialist at the Simms/Mann UCLA Center for Integrative Oncology and offers a fee for service for individuals to develop a more personalized approach to nutrition, complementary care and supplementation because of the complexity of this field. The goal is to educate patients to be informed consumers and to consider the individual characteristics – nutrition, cancer, treatment, other illness, and goals of care. Information is communicated back to oncologists as it is our belief that cancer care should be an integrative process and that all health care providers should be included as part of your overall team. We need to discuss openly Western medicine and complementary care.
Reflections Boutique is a reliable resource for finding high-quality supplements, 200 UCLA Medical Plaza, Ste. 163. Products have been selected from companies with excellent reputations for high standards of manufacture and ingredient selection. All proceeds from sales at Reflections support the operations of Reflections and the free services provided at Simms/Mann–UCLA center.]