Reset your brain and body for a pain-free life.

Joe Tatta, PT, DPT


Cancer Related Fatigue: The Most Common and Persistent Complaint of Long Term Cancer Survivors with Dr. Nalini Chilkov

Welcome back to the Healing Pain Podcast with Dr. Nalini Chilkov

The overall state of cancer care has improved over the past two decades through the widespread use of traditional therapies such as surgery, medications, and chemotherapy. Improved cancer therapy has led to an increased life expectancy and cure rates. The good news is that in most types of cancers, the survival rate has increased dramatically. The not so good news for the more than 10 million survivors of cancer in the United States of America is that when most returned to a normal life, 20% will have functional limitations up to five years later, and some of that may persist indefinitely without proper treatment. One of the greatest challenges presented to this growing patient population of survivors is that of cancer-related fatigue and pain. Dr. Nalini Chilkov speaks about creating a body where cancer cannot thrive as well as how to heal from cancer-related fatigue and pain.

In this episode, we’re talking about the ever-growing problem of cancer-related pain and fatigue. The overall state of cancer care has improved over the past two decades through the widespread use of traditional therapies such as surgery, medications, and chemotherapy. Improved cancer therapy has led to an increased life expectancy and cure rates. The good news is that in most types of cancers, the survival rate has increased dramatically. The not so good news for the more than 10 million survivors of cancer in the United States of America is that when most returned to a normal life, 20% will have functional limitations up to five years later, and some of that may persist indefinitely without proper treatment. One of the greatest challenges presented to this growing patient population of survivors is that of chronic pain and chronic fatigue.

The optimal treatment of the cancer survivor must include treatment of cancer-related pain and fatigue. For some, cancer can evolve into a chronic illness with unpleasant side effects due to the treatment toxicity from repeated therapies such as chemotherapy, and this causes the pain management challenges to continue to increase in complexity. Here to speak with us about creating a body where cancer cannot thrive as well as how to heal from cancer-related pain is Dr. Nalini Chilkov. Dr. Chilkov primarily serves patients with cancer, and is a respected expert in the collaborative integrative cancer care movement. She is a seasoned clinician, educator, and innovator, building bridges between modern and traditional healing paradigms and partnering with physicians to provide the best outcomes for cancer patients. She has been a lecturer at the School of Medicine at UCLA as well as UC Irvine in California, as well as many schools of traditional oriental medicine, naturopathic medicine, as well as functional medicine over her long and distinct career.

Dr. Chilkov is a regular contributor to the Healthy Living section of the Huffington Post. She also provides training for practitioners through the American Institute of Integrative Oncology. On the podcast, Dr. Chilkov and I will be talking a significant amount about the damaging effects of chemotherapy on our cell’s mitochondria, and how it contributes to pain as well as fatigue in those with cancer. Mitochondria are found in each of our cells, especially our nerve and muscle cells, and they are known as the powerhouse of the cell or the power plants of the cell. If you think about a power plant, the sole purpose of a power plant is to generate energy, and if you’re not generating energy efficiently in your body or your body cells, fatigue and pain may develop. The mitochondria actually require many nutrients that play an indispensable role in its ability to produce energy, as well as to provide antioxidant protection from free radicals, and it’s these free radicals that can make pain, fatigue, and inflammation persists in your body.

The good news is that through functional medicine and through functional nutrition, a growing body of evidence has supported and upheld the belief that certain nutrients help alleviate many of the symptoms associated with mitochondrial damage from cancer. When you nourish your body and your cells with these nutrients on a daily basis, it can help alleviate or prevent the mitochondrial-induced diseases that include things like Parkinson’s disease, diabetes, as well as pain and fatigue. For a full list of these specific nutrients, I’ve created a handy dandy cheat sheet to accompany you on this podcast. Listed out for you in this cheat sheet are specific vitamins, minerals, nutrients and botanicals that will support your mitochondrial health. All you have to do to receive it in your email inbox is to open up your computer and type in the URL, If you’re listening to this podcast on your smartphone, simply text the word 85Download to the number 44222.

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Cancer Related Fatigue: The Most Common and Persistent Complaint of Long Term Cancer Survivors

Dr. Nalini, welcome to the Healing Pain Podcast. It’s great to have you here.

I’m so happy to be here, Joe.

You’re such a good friend of mine and I know so much about you, but I want to start off by you telling us your story of how you got involved in cancer care with patients, because it’s such a wonderful, brilliant, and beautiful story, and I want everyone to know and love you as much as I do.

I got interested in cancer because both of my parents were diagnosed with several different types of cancer during their 50’s. My mom died at 88, my dad died at 90, and neither of them died of cancer. I got interested from the point of view that there was some genetic susceptibility. Maybe there was some environmental contribution, they both got cancer around the same time in their lives. From that, I began to be interested in how I could help my patients who had family histories like that prevent cancer. Then how to optimize the outcomes and results of patients who are going through treatment and protect them during treatment. Then have them be the exceptional patient that didn’t go under the bell curve of statistics, but defied the odds. I’ve been doing that for over 30 years and that’s my mission and my passion, to empower patients and families and clinicians to put a health plan into a cancer patient’s journey, not the disease plan.

Obviously with integrated and functional medicine, something that the concept of treating cancer naturally, either while someone has cancer or hosts cancer, is not new. Take me back 30 years ago and tell me what the environment was like when you decided to dip your toe in the water of working with cancer patients naturally.

First of all, we have to be clear that a health model doesn’t mean throwing out regular oncology, because there isn’t always equivalence in natural medicine to what’s in conventional oncology. I wrote integrative meaning just that, which is to take the best of both worlds, and to say, “How do we get to the outcome we want, which is we don’t have a cancer conversation again?” We want to resolve the cancer and live long and live well and recover from the short term and term side effects of treatment. 30 years ago when I started this, it was a more polarized environment, where that word integrative wasn’t in the conversation. It was either or, you’re going to do natural treatment or you are going to do conventional treatment.

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The patients who have best outcomes do take the best of both worlds.

What we’ve learned is that the patients who have best outcomes do take the best of both worlds. We’ve learned that over time is that if you just do conventional treatment, you don’t protect your healthy organs and healthy functioning. You have more side effects. Sometimes you end up with more treatment resistance and a greater risk of recurrence, or if you try to do all natural, you might have less of a good eradication of all the tumor cells and then be at risk for recurrence because of that. What we’ve learned is that if we combine those models and that a patient has a disease expert who’s their oncology team and then a health expert to support their health and do the things that the oncologist isn’t doing, that’s how you get the best outcome.

At this point, you are seeing patients throughout their life cycle from their diagnosis all the way through to the resolution of their disease.

Yeah, or somebody who has a family history where say all the women in your family get breast cancer and you don’t want to be one of those women. What do you do about that? It can be that preventive model, it could be prevention of a recurrence, it could be how to do better while you’re going through treatment, how to learn, how to get individualized care while you’re going through treatment, and what’s really the right care for you, and then how to recover or restore your healthy function and live well beyond cancer. There’s also a group of people who are living with cancer as a chronic illness who can live quite a long time. You didn’t eradicate all their cancer, but they’re not going to die of it either. That’s a lot of people now as well.

Pain is very common in those with acute cancer as well as after cancer, but so is fatigue. Fatigue is one of the things that does not get as much attention as it deserves. Can you tell us what you see as far as fatigue in your patients? Is there a certain type of cancer or a certain chemotherapy or radiation? Give us a little bit of the umbrella of it first.

First of all, cancer physiology itself has the contributing factors to exacerbate and contribute to fatigue. What does that mean? That means that cancer is number one, a very inflammatory syndrome, and inflammation is the primary cause of fatigue and ongoing fatigue and cancer patients. The other characteristic of cancer is that it’s a disease of the mitochondria. It is a metabolic disease of the little energy factory inside yourself. If that is disrupted and abnormal, you don’t make as much cellular energy, and so that contributes to fatigue, just the cancer, and then the treatments themselves exacerbate both of those things. They ramp up your inflammation and they’ve further damage your mitochondria. Those are the big players that contribute to fatigue. That’s true whether you have cancer or not, and true to fatigue in general.

Close to 100% of cancer patients complain of fatigue, either it’s a symptom of cancer. It can happen before diagnosis and then it’s certainly a side effect of treatments of cancer. Then you have other contributors like your cell counts are low because your bone marrow has been affected by chemotherapy, then you become anemic. You could have gone through very stressful treatments like surgery or radiation. You can be not sleeping because you’re anxious or have pain. After you go through treatment, there’s more contributors, so almost 100% of all cancer patients complain of fatigue.

I think if as clinicians, we asked everybody, everyone would say yes. Some people just don’t complain, I think what’s important is once somebody is finished with their treatment, then nobody’s asking them. If you have a patient in your practice or you are a patient and you’re under the care of a clinician, you want to report to that clinician that you have cancer-related fatigue that’s never resolved even though ten years ago you had successful treatment of your breast cancer or your prostate cancer, but you’ve never felt the same since. I think this is why we should be having this conversation, because ten to twenty years later, patients who are cancer survivors are still complaining. This is a long-term side effect, not just when you have cancer and when you’re undergoing treatment. That’s why this is an important conversation.

So much of what you said is so true, everything from the practitioners learning how to start to look at this from the patients realizing, “Maybe I don’t have to live with this pain or live with his fatigue on an ongoing basis.” You mentioned inflammation and you mentioned mitochondria and mitochondrial dysfunction. Which do you look at first, or are you looking at the same time? Because there can be a lot going on for someone who has active cancer?

I think we have to put inflammation first because it is number one the biggest factor that takes away a sense of well-being. It’s a common denominator, and it’s also something we can have a big impact on. The inflammation that is associated with cancer itself actually damages the blood-brain barrier and then a lot of inflammatory molecules called inflammatory cytokines flooded the brain and this is one of the reasons you lose your sense of well-being and feel so fatigued. Think about if you have a viral infection like the flu and how tired you get. It’s a similar flood of inflammation that in a way is nature’s wisdom to make you rest. You feel tired, but the reason is this flooding of inflammation not only into the body but into the brain. We want to also make that blood-brain barrier less porous and less permeable as a way also of protecting the brain from the spread of cancer to the brain. This inflammatory process should be addressed right away.

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You feel tired and the reason is this flooding of inflammation not only into the body but into the brain.

So often people think of the barrier they’re looking at is the barrier in the guts, and they don’t really think so much about the brain. With fatigue, so much of it is related to your nervous system. Often we think of fatigue goes, “I can’t get going in the morning, I need coffee, it has to do with my body,” which of course you know because it is your body, but talking about the central nervous system is super important and we’re talking about pain. Great and important topics. Let’s talk first about your most common dietary guidelines you’d give someone around inflammation, then let’s talk about some supplements and other herbal strategies that are unique to some of the things you do.

There’s always diet, lifestyle, and then what supplements we can give. Basically an anti-inflammatory diet is a more plant-based diet, number one. That also is going to give you more antioxidants. All the colors in fruits and vegetables are plant chemicals that actually enter the nucleus of your cell and turn genes on and off, including some of the genes related to inflammation and oxidative stress. There’s a factor in your nucleus called NRF2, and that is a trigger for your body to try and start solving problems related to inflammation and oxidative stress. You just eat the rainbow and you eat a lot of colors, you’re going to get a lot of those factors that turn that on, so eating a lot of color and a lot of plant food, number one.

Number two, having lots of healthy fats and oils in your diet makes your diet very anti-inflammatory. That’s like olive oil, flax oil, avocados, hummus, things like that. Almonds, almond butter, walnuts, the healthy fats and oils, and then eating less carbohydrates, meaning, less grains and starches, and also being mindful of the things that are triggers of inflammation for you. You want to make sure you take out things. Maybe you have a gluten sensitivity, maybe you have a dairy sensitivity. Maybe it’s eggs and you want to also not eat refined sugars and flours. If you eat a whole-foods diet that’s fresh, healthy food, not processed, organic, hormone-free, that’s the way to tip yourself away from inflammation. It’s also those healthy oils and fats that really dial down inflammation, so that’s important.

In terms of supplements, we like to add omega-3s because it’s hard to eat enough of those in the modern diet, and so I’ll put that in. Your kitchen is like a pharmacy, so if you add things like ginger and turmeric, those are rich in anti-inflammatory plant chemicals as well. It’s not very hard to eat an anti-inflammatory diet. If you eat the standard American diet on the other hand, you’re eating a pro-inflammatory diet. It’s not too hard to do that. Then you want to take some big levers in terms of supplements, what has the biggest impact and what can we get good quality supplements. I mentioned omega threes, at least 2000 milligrams a day. If you’re under the supervision of a professional, you can go up. A lot of my patients take 4000, 6000, but you want to do that under the care of a professional. Also high quality curcumin; look for something that has an emulsified oil-based capsule because that helps you utilize the curcumin and again, you want to do at least 2000 milligrams a day on your own.

If you’re under the care of a professional, you can go up to 4,000 or 6,000 milligrams of curcumin as well. Then probiotics, if you have fermented food in your diet and you’re taking a good quality probiotic, that’s a big key to managing inflammation. Those are important things. There are actually two supplements that help repair the blood-brain barrier which we just talked about. One is astragalus, which is an herb from Chinese medicine, which is also an amazing immune tonic. You can drink that as a tea, take it as a capsule about a 2,000 or 2,000 milligrams a day. Also melatonin repairs the blood-brain barrier. A therapeutic dose of melatonin starts around ten milligrams. Most of the research has been done at twenty milligrams at bedtime, so there’s a lot that you can do.

The part with melatonin is really interesting. I’ve read a little bit about that as far as it being a strong antioxidant. People don’t look at it as that, which is important. In you talking about diet, you didn’t mention protein. I’ll let you talk about it because there is some data around protein in the diet as far as cancer goes.

It’s controversial. First of all, I set a plant based diet. I include plant-based proteins in that statement, so let’s clarify that. Most of the research shows that a more plant-based diet, getting some of your protein from plants, not just animals, getting some of your fats and oils from vegetarian sources as we mentioned. You need 60 grams of protein a day minimum if you’re a cancer patient, because the cancer physiology is a high-energy demanding physiology. Also a lot of the treatments like surgery and radiotherapy and chemotherapy are damaging tissue. You need that protein to repair and help with detoxification of that energy for your body to detox. You want that to be clean protein. The cleanest proteins are organic vegetarian sources, but if you’re going to eat some animal protein, which you can, then you want that to be organic, hormone free, wild caught, grass-fed for the most part. If you don’t think you’re going to eat enough protein in your day because you’re nauseous, you’re not interested in food or cooking because you’re under treatment or you’re tired, you’re suffering from fatigue, you’re not interested in cooking, then a shake is an insurance policy.

Is there anyone who you do not recommend a plant-based protein for who has cancer?

I’m a middle path pragmatic clinician. I always prescribe what somebody will do, first of all. I ask them what they’re willing to do. Definitely, we want to limit red meat because the high iron in red meat produces more oxidative stress. Iron is a very high pro-oxidant mineral and it’s definitely linked, for example, to colorectal cancer, colon cancer. Tumor cells will sequester iron, and so if the iron levels in the blood are low-normal, that’s healthier for a cancer patient or person with a cancer history. I don’t like people to have a high iron diet. We were strict to red meat. I reckon you can have at least one serving of vegetarian protein a day, switch out animals serving for a vegetarian so it’s healthier.

As we talk about diet, I think this is the year of the ketogenic diet, which is funny because it’s in my book as it relates to pain, and there is some research around ketosis and the ketogenic diet for cancer. If someone is interested in pursuing that type of diet, do you support them and recommend that? Can you talk about that a little bit?

There is a lot of confusion, and then the word ketogenic is starting to be used in very imprecise ways, and so let’s get clear on what we mean by that. A true ketogenic diet is a ratio of four parts of fat in your calories to one-part protein plus carbohydrates combined. Nobody can live on a diet like that. That’s a therapeutic diet. Number one, it has so much fat in it that it makes you nauseous and gives you diarrhea. A true ketogenic diet is a therapeutic diet. It’s not a healthy diet. It’s a strategy to switch your metabolism and stress tumor cells. Nobody should live their daily life on that kind of diet. There’s what I call a modified ketogenic diet, and that’s something sustainable where you are eating more protein. You’re putting protein back in.

For cancer patients, a low carbohydrate diet is the key.

The studies show that for cancer patients, a low carbohydrate diet is the key. You don’t have to highly restrict protein, which I don’t like to do in cancer patients who are at risk for losing muscle mass. The physiology of cancer itself causes what we call sarcopenia, the loss of muscle mass, and the only way to protect your muscles is to eat sufficient protein every day. The ketogenic diet starts to cause loss of muscle mass, which makes you very weak also. I prescribe what I call a modified ketogenic diet, which is closer to what Paleo diets look like, where you have higher fat, higher protein on your plate, and take the carbs out. Half the plate is plants, a quarter of the plate is a healthy protein serving, eight of the plane is healthy fats and oils in terms of where calories come from. There’s no grain on that plate, there’s no fruit on that plate.

That is a diet you can live on, but if you put a person into real ketosis who has cancer, then it stresses the tumor cells. Tumor cells need insulin and glucose to thrive and replicate and grow into big tumors and to travel and metastasize. If you starve tumor cells and insulin and glucose by taking the carbs out, then you’re in a physiology that doesn’t support a proliferative active cancer. That’s a viable thing to do, but let’s say you’re having chemo tomorrow. If you do a pure ketogenic diet for 24 hours, and if you’re young and robust, you can do it for 48, then the tumor cells are so stressed that when you have your chemo, you get a better response to the treatment. More cells die, because then healthy normal cells can live on ketones, but tumor cells cannot.

Think about early humans. We had long periods of time where we didn’t have calories or food, so our physiology is actually adapted to fasting. We are adapted to be able to live on ketones when we don’t have blood sugar and insulin, so we can do it, but again, you don’t want to lose your muscle mass. If you’re an 80-year old frail cancer patient, you don’t do that. You consult someone who is a naturopath or a nutritionist or integrative cancer practitioner how to do that safely. You’d think about how do we distress cancer cells and promote healthy cells. A modified ketogenic diet is a viable way to do that long term.

You said it brilliantly. When you look at a ketogenic diet, it’s a high fat content, but it’s also a low carbohydrate content.

There have been studies on that, but the other piece that can put you into mild ketosis is what’s called intermittent fasting. Studies show that if you have no calories for thirteen hours or more between tonight’s dinner and tomorrow’s breakfast, that puts you into mild ketosis, but it also turns on your immunity, and it also turns down the risk of diabetes, high blood sugar, high insulin, which drives cancer. Most people can do that. Most people can eat dinner and then drink tea and fluids in the evening and then have breakfast thirteen hours later. That’s a viable lifestyle.

Let’s shift gears from diet and inflammation and let’s go into mitochondria function.

Ketogenic diets are actually mitochondrial diets, because the mitochondria in tumor cells are not normal. What happens is that the little energy factory in a cancer cell is not functioning very well, making energy, making ATP, and so it switches over to using more glucose than some healthy mitochondria. When you go on a low carbohydrate diet, then you stress the mitochondria in the tumor cells and the normal cells can use all the ketones, but the cancer cells cannot. By using a ketogenic or a low carbohydrate diet, you are then stressing the mitochondria in those cancer cells also. Then the mitochondria also are very sensitive to oxidative stress, and that means free radicals, and remember inflammation promotes more oxidative stress and they go together.

That inner membrane of the mitochondria is inherently an area where there’s a lot of oxidative stress to begin with, because that’s where the electron transfers are going on. We want to protect that inner membrane and the healthy cells so you can do that with things like CoQ10 and lipoic acid, 100 milligrams two or three times a day of each of those, but remember the rainbow diet, remember all those pigments from plants, those also help to protect the mitochondria in the cell from all that oxidative stress. You’d go back to eating pigments like the ellagic acid that’s in pomegranates and berries. The EGCG that’s in green tea, this silymarin and that’s in milk thistle, things like that are important in mitochondrial protection.

As you’re evaluating and working with the patient, what kind of clinical tests do you run to assess mitochondrial function or dysfunction?

You don’t have to test patients. You can assume that oxidative stress and inflammation are going on, but you want to look at the highly sensitive CRP, definitely that’s a good mirror of inflammation. You want to also look at white blood cell levels. If they’re high, then you can surmise that either you have an infection or inflammation going on. Those tests are common tests you might see on anyone. You have to do exotic testing, but measure carnitine also to assess if the mitochondria has all of the basic nutrients that it needs because carnitine is very important to fatty acid oxidation and the production of energy in the mitochondria. If we’re telling patients to eat less animal protein, they’re not actually eating very much carnitine and although our body can make carnitine, we want to optimize this for the patient, so I always give carnitine in about one to two grams a day, 1,000 to 2000 milligrams a day and I’ll put that as a powder into a shake. If the patient also has neurological symptoms that acetyl L-carnitine is more fat soluble and it will penetrate the nerves, it will penetrate the mitochondrial membrane, and it’ll penetrate the brain more than the L-carnitine. That we also use in about the same dose, one or two or even up to three grams a day for somebody who has a lot of neurological symptoms and needs repair.

Are the neurological symptoms something you commonly see with your patients who have cancer?

There are more vulnerable patients. There are patients who have genes that caused them to make more inflammation and resolve it less efficiently and to be less efficient at cleansing that oxidative stress. In the case of patients who have more neurological symptoms, which could be cognitive symptoms like memory loss, confusion, concentration issues, chemo brain, or peripheral neuropathy, numbness or pain in your hands and feet or even your tongue sometimes, those patients need more omega-3 fatty acids. They need more antioxidants, they need more color, so I often use a concentrated powder like greens powder or reds powder if I don’t think someone’s going to eat enough plants in their diet, put that in a shake for example or just in water. Those are the main things. Glutamine also is very restorative to the nerves. That can also help repair the blood-brain barrier and heal the lining of the gut, but also repairs the nerves that have been damaged by the high oxidative stress of the inflammation of cancer, the ramped up inflammation from chemotherapy or radiotherapy.

Obviously chemotherapy is important because it kills the cancer cells, but it’s also extremely toxic for the body. When a patient is like, “I need to detoxify myself.” What types of supplements are going to help them detoxify?

Let’s be careful. Number one, cancer patients are pretty depleted, so I never do a big detox on them. I do gentle mild detox by giving supplements on a daily basis that sweep out the toxins and we never give detox agents concurrently with the chemo because we don’t want to have drug interactions. We want to let the chemo do its work, not detox the drug too fast. Most chemo is active for about four days, so if you can day one is the day you get your infusion, by day five, you can start doing things like milk thistle and N-acetyl cysteine. Those are powerful in terms of detoxifying the liver and the kidneys and also increasing glutathione in your cells, which is the natural antioxidant that your cells make. The N-acetyl cysteine is the precursor of 800 to 1000 milligrams three times a day of N-acetyl cysteine and maybe 3,00 to 6,000 milligrams a day of milk thistle during that window of time.

We have to be well nourished. We have to manage inflammation. We have to protect our gut.

Let’s say you’re a cancer patient who’s getting chemotherapy every three weeks. Day one is a day of your infusion. On day five, you can start taking inositol cysteine and milk thistle and you can go all the way to day 21 and then stop and then get your infusion on your next day one. If you had a two-week schedule, you’d start on day five and stop on day fourteen. That also makes oncologists comfortable because they realize that we’re not going to interfere with them.

Talking about making oncologists uncomfortable, you are an integrated practitioner and you work compassionately in caring with your patients, but I’m sure every once in a while you run into a physician who is unaware of nutrition or diet or supplements. In my experience, when physicians are not comfortable, they say just don’t do anything until you’re done. That’s not always the way to approach it. How do you talk to a fellow practitioner, from one licensed healthcare practitioner to the next to try bridge that gap and make people understand that we’re on the same team?

First of all, it behooves us to pick up the phone and call the person’s oncologist and make a relationship because that’s better for the patient that their care providers are talking to each other. Sometimes it’s that they’re not aware of the information, but sometimes it’s character logic. They’re just a closed person or they are not interested or they don’t play well with others. I’m trying to swim upstream too much, but I will at least say, “I understand you are the disease expert. You are the oncologist. Your mastery is understanding cancer and treating cancer, but I am the health expert and I’m taking responsibility for the health of this patient. I want them to be well nourished and I have expertise in drug-nutrient, drug-herb interactions. I’m going to make sure this patient does not take anything that will interfere with your treatment.” That is like acknowledging their expertise, saying “I’m not here to treat the cancer. You’re treating the cancer, and I’m supporting the health of the patient.”

That’s palatable to a lot of oncologists who maybe don’t know me. I practiced for over 30 years in the Los Angeles area. A lot of the oncologists have shared patients with me and seeing how they do. Once an oncologist sees that I don’t a mess up their treatment and that those patients do better, we have to be well nourished. We have to manage inflammation. We have to protect our gut. We have a lot of things we have to deal with the stress that the patient is going through. We want to address the fatigue, because then the patient can complete their treatment. If they are too weak or have too many side effects that they can’t complete their treatment, then that’s a problem for the oncologist also. If we want to see that at the table, we have to make those relationships and we have to start by saying, “I’m not going to step on your toes. I respect what you’re doing. I’m not anti-oncology.”

On this podcast, we talk a lot about opioids. It’s interesting because the one place where everyone agrees opioids have a place is when someone has active cancer, but it can be challenging if someone’s prescribed opioids for the active cancer they continue to take them and then they can’t get off them. You see that in your practice. As the cancer is getting better, then we should say, “Let’s start to move away from all the medicines.”

I’ll give you another example, which is patients who have colorectal cancer who have surgery on their lower intestine or their rectum where there are a lot of nerve endings, they have a lot of pain, and they are most frequently prescribed opioids because it’s the only thing that touches their pain. Then they can’t get off them because the oncologist doesn’t think about the fact that they’re habituating. It is a very effective pain management for the patient but then they need a plan to get off of them. I have patients who have never taken drugs in their life and they don’t realize that they we’re taking an addictive drug either. They weren’t told that and they struggle to get off the pain medications and go through terrible withdrawal. As the healthcare provider, we need to educate the patient that now that your tumor mass isn’t pressing on a nerve anymore or now that your surgical incisions have healed, now we can have a plan to get you off that medication.

I use acupuncture. I use anti-inflammatories. There are some good herbs that are helpful for pain management. Corydalis is an herb that’s great for bad pain. A lot of post-surgical pain and cancer related pain is inflammatory. It’s not actually neurologic. Certainly an incision that cuts through nerves is neurologic, but once that heals, you should be able to move away from those pain meds. We always make sure we’re managing inflammation well because sometimes that takes away a huge amount of the pain and also just giving the patient a sense of control as you well know as a pain expert that that psychological component or saying, “We have a plan. I’m going to walk you through this and we’re going to get there.”

For doing this over 30 years, what has this work really meant for your life?

I would say this is the most meaningful thing I have ever done in my life because every day I make a difference, even if it’s a small difference; if I reduce someone’s anxiety by saying, “Don’t worry, we’re going to heal your neuropathy.” I got an email from a patient who’s had a very inflammatory reaction to an immunotherapy and she got colitis as a side effect of the immunotherapy drugs which shrank her tumors. She’s got this side effect and she’s had watery diarrhea, painful diarrhea, and fatigue from losing their fluid and electrolytes and not being able to eat normally and ramped up inflammation. She feels lousy and so she’s scared because she lost six pounds. I sent her an email and I said, “You’ll gain the weight back.” If all I did was reduce her anxiety, then that’s meaningful but if in fact I allowed her to not have a recurrence or if she gets a recurrence twenty years from now instead of two years from now, that’s meaningful to me. Even if a patient die, some people have advanced cancer when they come to me, but if they had a sense of peace and good quality of life during that time, that’s a win also.

You have a great practice in LA, but you’ve gone on now to train practitioners.

My mission is to touch more people. I want to have more impact. I’ve created a system called Out Smart Cancer. I have a professional training that I launched and it’s called Foundations of Integrative Oncology and it’s all online. We have a lot of medical doctors in the program and we have a lot of naturopathic and integrative clinicians in the program. It’s interesting. It’s a lot of seasoned clinicians who’ve been in practice fifteen or twenty years, most people in the program because of the pain of not having this training, not knowing what to do with these patients. I want to pass on my system.

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We want to address the fatigue because then the patient can complete their treatment.

Even a lot of nurses take the program also because oftentimes the nurses are the one who may be assisting the oncology physician.

The nurse often knows what’s going on at the patient more than the doctors sometimes. They’re the hands on or they’re the person that’s available to ask the question too.

One of the most brilliant things I’ve ever heard anyone say is Nalini quite often says, “I’m mission-driven.” Nalini says this over and over again. Conferences, amongst friends, “I’m very mission-driven,” and that’s one of the reasons why I want to have Nalini on the podcast. As this podcast grows and we’re entering towards Episode 100, which is a big milestone, it’s one of my passions that I bring people on that are intelligent, that are heart-centered, that are compassionate, and someone who’s mission-driven is the type of practitioner you want in your life, whether it’s cancer or chronic pain or back pain or migraine. I’ve been obviously talking to Dr. Nalini Chilkov. If you’re a patient or a caregiver, you can find out more information about her by going to If you are a health professional practitioner and you want to learn from Nalini, you can go to The AIIORE stands for?

It stands for the American Institute of Integrative Oncology Research and Education. If you go there, you can also see a handful of videos of me lecturing to clinicians. We also have a bonus for everyone who listened to this, which is at That is if you’re a patient or family member, it summarizes some of the things we do for inflammation, which resolves fatigue. If you’re a clinician, that’s a great handout for your patients.

I want to thank Nalini for being on the podcast and to the link to that special bonus. As with every podcast, especially this one, it’s super important, make sure to hop onto your favorite social media, hit the like or love button, share it out with your friends and family on Facebook, LinkedIn, Twitter, wherever you share your favorite social media posts. I want to thank all of you for being here with me this episode. I want to thank Nalini. I wish you all a peaceful day.



About Dr. Nalini Chilkov

HPP 085 | Cancer Related FatigueDr. Nalini Chilkov, L.Ac., O.M.D. is a leading edge authority and pioneer in the field of Integrative Cancer Care, Cancer Prevention and Immune Enhancement.. She is the Founder of the American Institute of Integrative Oncology, where she teaches Integrative Cancer Care to clinicians online and worldwide. She also founded, providing resources for patients and families whose lives have been touched by cancer. She is the author of the number one best selling book “32 Ways to Out Smart Cancer: How to Create A Body Where Cancer Cannot Thrive.” Dr. Chilkov brings over 30 years of clinical experience, combining the best of Functional Medicine and Oriental Medicine. She has lectured at the School of Medicine at UCLA and UC Irvine in California and the Medical Academy in London, UK. She is featured as a cancer expert on NBCTV and and has been recognized as one of the top 10 Online Influencers for Breast Cancer by Dr. Mehmet Oz and WebMD. She serves on the Advisory Board for the Mederi Foundation and Fran Drescher’s Cancer Schmancer Foundation. She has a private practice in Santa Monica, California.


The Healing Pain Podcast features expert interviews and serves as:

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A catalyst to broaden the conversation around pain emphasizing biopsychosocial treatments.
A platform to discuss pain treatment, research and advocacy.

If you would like to appear in an episode of The Healing Pain Podcast or know someone with an incredible story of overcoming pain contact Dr. Joe Tatta at Experts from the fields of medicine, physical therapy, chiropractic, nutrition, psychology, spirituality, personal development and more are welcome.

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Dr. Joe TattaCancer Related Fatigue: The Most Common and Persistent Complaint of Long Term Cancer Survivors with Dr. Nalini Chilkov
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  • June - May 11, 2018 reply

    Thank you Dr Joe, integrated Oncology is an area I am very interested in pursuing. Dr Nalini is awesome in what she has created. I looked at her professional course and I am considering it. However it’s a big financial commitment. Also not sure how it will be received in Canada? I try to be a health advocate for my oncology patients. It doesn’t get better than that. Thank god my health is better and being a chronic pain patient I have gained so much.

    Dr. Joe Tatta - May 16, 2018 reply

    Thanks for your kind words June! 🙂
    I know you know how important this is.
    If you are interested in learning more about Dr. Nalini’s program please let me know.
    It’s top notch!
    Dr. Joe!

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