Transcript
WEBVTT
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I know that you and I have this in common we both were inspired to pursue naturopathic medicine because of plant medicine, because of herbalism.
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Oh, absolutely, absolutely.
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There is that herb shop in the East Village that used to be there back in the 80s, and I would just go in and try to learn about it as much as I could.
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And yeah, that's completely what brought me to naturopathic medicine.
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Yeah, For me it was a small book by Michael Tierra called The Way of Herbs.
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I have that book.
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I still have it.
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You still have it.
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I think so.
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I think that's the one.
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Yeah, no, I saved all of those old herb books that I had before I even started naturopathic school.
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Yep, I read The Way of Herbs, cover to cover probably, and started putting together things.
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I was in college, undergraduate and a little kitchen chemistry going on, which I really enjoy anyways, to this day.
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But we have a great guest today on our program, Chanchal Cabrera, who is a renowned master herbalist and specializes in cancer care.
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Yeah, this was a really good talk.
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This was they all are really good talks, but I downloaded the book on Audible so I could listen to it quickly before we talked to her and, yeah, it was just so inspiring.
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It really reminded me of what brought me to naturopathic medicine.
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Exactly, exactly, because we get kind of bogged down in straddling between conventional and natural all the time and of course you know keeping all of that in our heads as integrative practitioners, it feels a little bit bogged down with the conventional side because of course there's more modern day evidence for that and for supplements for that matter, and there's less strong evidence for whole plant medicine than there is for the supplements or for drugs is certainly so yeah, it was nice to get back to our roots.
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It's speaking of roots.
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She does mention this is a weird segue speaking of roots, she mentions a couple of herbalists who, if you're not familiar with the herbal world, people might not know who these people are.
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So one of them is Dr Eric Yarnel, who is a naturopathic doctor.
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He's up in Seattle area, right, and he teaches at conferences.
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He teaches at the naturopathic schools, and he also owns an herbal company.
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Oh, he does, yeah, which one.
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He owns a company that sells herbs, Heron.
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Oh yeah, I know I have one of his books on men's health or urology that's what it is.
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He teaches urology.
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Yes, that's right.
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That's right, yeah.
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And the other name she mentioned that would be well-known in the herbalist community but probably not well-known in general, is Donnie Yance, who is an herbalist down in Southern Oregon and also specializes in oncology, and so she did some of her earliest training there, and so she mentioned that in the episode.
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So those are the two names that probably need a little context like this.
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Other than that, we just have an inspiring conversation about plant medicine and how that can be useful during and after treatment for cancer.
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Yeah, and it's a little different than how I practice, because I have been sort of led away from herbal medicine and so it was just kind of nice to have this conversation and get her perspective on things.
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So with that, here's our conversation.
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Hi Tina, , we have a guest today.
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Yes, a very special guest.
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Do you want to tell us about her?
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Yeah, so today we are talking with renowned herbalist Chanchal Cabrera.
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For some background, chanchal is a medical herbalist and has been in clinical practice for 35 years, with a specialty in holistic oncology.
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She's the author of Fibromyalgia A Journey Towards Healing, and her latest book is called Holistic Cancer Care and Herbal Approach to Reventing Cancer Helping Patients Thrive During Treatment and Minimizing the Risk of Recurrence.
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That was published just earlier this year in 2023, so it's very much updated.
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She held the faculty chair in botanical medicine at the Boucher Institute of Naturopathic Medicine in New Westminster from 2004 to 2016.
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And she publishes widely in professional journals and lectures internationally on medical herbalism, nutrition and health.
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She's also certified in forest bathing, certified master gardener, certified horticultural therapist.
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She lives on Vancouver Island in BC where she and her husband manage Innisfree Farm and Botanical Garden, a seven-acre internationally-registered botanical garden specializing in food and medicinal plants, and where they host apprentice ships in sustainable food production and herbal medicine.
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The farm also hosts gardens without borders, a federally-registered not-for-profit society established to run the botanic garden and provide horticulture therapy.
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Wow, that's a life dedicated to plants if I've ever seen one.
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Thank you so much, t'chang-shall, for joining us.
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I'm really excited to talk about plants and you know, from the novice to the expert, I feel like you have something for everybody and I so appreciate you taking the time to talk to us today.
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Thank you so much for that introduction, Tina, and thank you for the opportunity to come on to your show.
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You know, I truly believe that herbal medicine is the most democratic medicine available.
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It is of the people, for the people, by the people.
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Everybody does herbal medicine.
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If you made a cup of coffee this morning, you have already done some herbal medicine, because it has all those bitters, it has all those antioxidants.
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If you put black pepper on your dinner, you're taking herbal medicine.
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People are doing it without even realizing what they're doing.
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Just, you know, as you know, there is no separation between food and medicine.
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That is a spurious division that really doesn't hold up in any kind of clinical practice.
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We use many foods as medicines.
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Even in the clinic we'll use extracts of rosemary or celery or sage, which could just as well come from the kitchen, but we use the minimal clinical context.
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So yeah, I think herbal medicine is something that everybody can do and should do, and indeed actually does already.
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Yeah, so many herbs in the kitchen.
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What I really like about your book is that when you talk about plants, it's not only as food and herbal medicine, but also being in plants and being in nature.
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So I just I love how it's so immersive.
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You know just every part of the plant.
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I love that.
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Yeah, I think it's really important that we bring the beauty and the magic back into medicine.
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It doesn't have to be this scary thing that we only do when times are tough, like there's actually healing from just going for a walk in the woods, there's healing from having flowers in your home and you know, as a horticulture therapist, that's part of the work that I do is to actually get people, I guess, like in touch with nature as an entity, not just needing medicine but healing on a much deeper I mean maybe I could even say on a soul level, connecting people back to plants, connecting people to nature.
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Really, for me is the work and the clinical aspect actually comes after that.
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So I'll often take my patients even my cancer patients, if they're in the person, will go and walk in the medicine gardens and I'll introduce them to some of the plants that are going to be in their formulas.
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They're not going to grow those themselves, they're not going to make that medicine, but at least they have a sense that it isn't just a horrible tasting potion in a bottle or a capsule.
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That's sort of abstract and anonymous.
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It's actually plants doing the work.
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And my not so very hidden agenda is actually, as a fairly active environmentalist.
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I'm very involved with environmental groups here in my community, sitting on boards and so on, and so I really believe if people don't notice nature, then they won't care to protect it either.
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So part of my work as a herbalist is to help people notice nature so that they care to do something about it.
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Well, I think, in the tone of your book, because it is your tone and your belief, it is interwoven nicely.
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I'll admit it's very long it's 450 pages of actual content for the lay public and then a second section for practitioners, which I really appreciate it, of course.
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But I found myself thinking about even the land that I'm sitting on now.
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I'm in high desert.
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There's not a ton of plants, our soil has zero nitrogen, naturally.
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But even then there's an alder tree and I'm reading in one section I skim, and it says alder bark and I'm like huh, I never even think of that alder tree as medicine, to be perfectly honest, because I've never, even as a naturopath and part-time herbalist, I don't think of using the alder tree.
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And so it had me thinking I need to do a little stock assessment of what I'm walking on to my own property and just walk around and look at the smallest flowers to the biggest trees and look them up and see what we have.
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So it was really nice.
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I felt inspired.
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Yeah, I think there's almost.
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Every plant has some medicinal constituents, whether they're readily accessible and easy to use or not.
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But again, that alder tree is giving you shade and it's actually releasing those leaves in the fall and that's the opportunity to use those to build some soil with.
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But alder is a tree that grows where there is very little nitrogen because it has the bacteria on its roots, like a pea plant that puts nitrogen in the soil.
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So where that alder is growing, you're actually building better, healthier soil.
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And alder is short-lived, so when it falls, when it dies and you cut it, you're going to have enriched soil below.
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So there is a purpose to every plant.
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Yeah, and that's the part that's inspirational, correct me if I'm wrong, but thinking of plants as an extension of ourselves, and not just medicine but wellness.
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So, even if you're not ill looking at herbal medicine as optimal medicine, yeah, I think that's really important because we sadly, in our modern culture, we don't have health care.
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We have sickness care.
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We have this wonderful thing in cancer practice called watchful waiting.
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It's like you're not sick enough yet to do anything drastic, so just hang around a bit, you'll get sicker and then we'll do something.
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I find this absolutely unconscionable.
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It's like what is wrong with us that we can't practice proactive, preventative wellness care and therefore not need as much sickness care.
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And you know, in Canada we do have socialized health care, everybody gets health care, but very few people get great care because it's spread so thin and there isn't enough to go around.
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So, again, waiting until disaster strikes.
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We spend less than 1% of our health care budget on prevention in this country.
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And yeah, you know the National Cancer Institute very mainstream, very conservative.
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They say that 65% of all cancers are preventable through diet and lifestyle.
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So why do we only spend 1% of our health care budget on prevention?
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Well, you know we could go down a few rabbit holes about, about, you know, the vested interests in keeping us sick and selling us drugs.
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But I prefer not to have that sort of negative approach to it.
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I prefer to come back around and say that's a great opportunity for us as health care providers and wellness counselors and a great opportunity for the patients, the individuals, to actually do something about that, to get involved and take some level of responsibility for their own well-being.
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So I'm sure you're aware the root of the word doctor is the same root as the word teacher, so a doctor is a teacher Traditionally.
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Originally you would talk how to help be healthier, how to live a healthier life, and really that's where it is most effective.
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And in my book I definitely emphasised this thing that I find so difficult when people talk about alternative medicine, as if we have to choose between, you know, taking herbs or other naturopathic practices versus mainstream conventional interventionist medicine, and I find that very unfortunate for the patient because it puts them in an untenable position of making choices that they shouldn't have to make.
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So I call my work collaborative medicine, because that's really the attitude I bring to it.
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I want whatever it is that makes you feel better, that's a good thing.
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Well, maybe not anything, but you know, within reason, you know, if drinking a bottle of whiskey a day makes you feel better, it's probably not going to get my vote of approval.
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But I also feel like.
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If having a glass of red wine on a weekend is part of your unwinding and de-stressing, it's probably not the worst thing that you're going to do to yourself.
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So it's all about context, it's all about moderation, I suppose, and in my book.
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You know, I was contracted to write a book for the general public and I looked around at what other books were available in that arena, and there's some excellent books available for the general public on how to navigate cancer and how to manage some of the side effects, how to get through it and how to prevent it.
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There's some very, very good books written by some of our colleagues, in fact.
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But what I found was missing was the books for the practitioners, and there are a handful, your own included, but I felt like there wasn't really anything that focused specifically on the plant medicine.
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So there's some good resources for practitioners, but not a lot that was grounded in the earth, and so that's where I decided to go with mine.
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So my publisher blessed them.
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They were very gracious about it because I told them I couldn't really write the book they wanted.
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It wasn't, I guess, challenging enough for me because I knew there were some other good materials available.
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I wanted to go to the next level and they agreed that we could do a kind of two-part book.
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We even looked at doing two books at one point but decided to hold it all in the one book.
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So it is designed for the sort of patient and family and care support team at the beginning of the book and more of the clinician or prescribing practitioners towards the end.
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But I have to say that a lot of my patients are reading it all the way through and coming back to me and saying now I understand why you're giving me these big, complicated protocols with all these different moving parts and asking me to do a poultice and a tincture and a tea and go for a walk in the woods.
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And I'm like, yep, there is actually science behind every one of those decisions.
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It's not a random grab bag of let's try this and let's try that.
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There's real science behind it.
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And I'm sure you're familiar with the delicate darts of trying to take analytical isolated constituent research and translate that into whole herb or holistic medicine.
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And it's very tricky darts because the research is compelling about isolated constituents, animal models and test tubes, torturing rats.
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And we do this research on animals because they're somehow different enough from us that we can sort of morally justify it.
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I'm struggling to say that, but that's what the science suggests that they're different enough that they don't have the same level of consciousness that we can do that research on them.
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And yet we're then expected to extrapolate that to humans as if it's similar enough that we can apply it to the human body, and this is a big disconnect.
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So what I did with that was I looked at all the analytical research, of which there is reams and reams about berberine and curcumin and thymoquine and all the isolates, and then I went back into traditional herbal medicine literature and looked for whether those plants have application and if I could find a connection between the isolated research and whole herb medicine from history, then I could feel that there was a holistic strategy that I could really put into the book and put into my clinical practice.
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So I do use a few isolates in clinic for various reasons, like, for example, green tea.
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I do use the EGCG because the research is really good and it's really hard to get that much of that one constituent by drinking cups of green tea float away.
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But I will also give people green tea to drink, and particularly matcha, because you can get a lot of green tea that way, alongside of their isolates.
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So I'm still trying to do holistic approach, even when I'm using that isolated research and isolated constituent.
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Sometimes it's a delicate dance.
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I appreciate when you say in your book about using a whole herb may be safer than actually using the extracts.
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And I've heard that from attending lectures from other herbalists and I don't know how much you know about what I do.
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I work in integrative cancer centers and so I'm surrounded by oncologists and other providers so I'm a little bit more cautious in my prescribing.
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I came to naturopathic medicine because of my love of herbs and I rarely use them because of where I am, and so it's just.
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It's just.
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Your book was very, like Tina said, it's very inspirational.
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It kind of brought me back to where I started and because the whole herb is more food, like you know, and just knowing that with all of those constituents there would be less of a risk of interaction, because that is such a huge concern when you're in a cancer center setting.
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Yeah, I think there's a few things in there to unpack there.
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Those are great points.
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You know, generally speaking whole herb would tend to be safer because you tend to get a bit less of any one thing, but they're also often much more effective.
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So a really good example of that is with Artemisia annua, the Chinese wormwood or sweet Annie, which has become very, very successful and popular as an anti cancer herb, specifically the Artemis cennin, which is one isolated constituent.
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It's a sesquiterpine lactone from the essential oil and it's incredibly effective as a cytotoxic agent.
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Maybe we could even call it herbal chemotherapy because of the nature of what it does in the cells.
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But and it's being used extensively now as an isolate, it's even being used in injectable forms and the research is very compelling that it is more bio available when it's given in conjunction with the naturally occurring flavonoids that are also in that plant, which of course, the water soluble sesquiterpine lactone is not so water soluble.
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So where I come, there is I would use Artemis cennin in specified amounts because the research is really exciting and really compelling.
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But I will also give whole herb Artemisia annua in a low alcohol tincture.
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It's not pleasant to drink it as a tea.
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It's quite bitter.
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People will, but I have to encourage them.
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But the tincture at 25% alcohol will get the flavonoids, won't get much of the sesquiterpines, but I give that in conjunction with the Artemis cennin so that they have something akin to a whole herb extract going in alongside of the purified isolate and you can often therefore use less of the purified isolate because it's more bio available.
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That brings in the safety again.
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But the other thing I want to say and no disrespect to anybody here but let's be honest there's very little you could do with herbal medicine that's going to do more harm than what most of the drugs are doing, and I hold that as a truth because it stops me from being too afraid to do my work, because if I really went down the research danger and risk I would not be able to do anything.
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And so what I look at is least harm.
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Is the idea right?
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That's what we're taught in medicine is always to do least harm.
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And least harm in many cases means helping the patient tolerate their chemotherapies better, helping them actually physically sustain the treatments that they're receiving and not have to drop out of chemotherapy because it's so toxic to their kidneys or their liver If we can do herbs that help them manage their other treatments better, then I feel that's a really, really often they're positive interactions, they're beneficial interactions, and I'll just segue for a second and tell you about a case that I've been working on at the moment as a really good example of this.
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I have a patient who developed profound anxiety around COVID and she ended up on some very, very basic effects or very, very basic anti-anxiety medications and she had a catastrophic reaction.
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She basically, for lack of you know layman's term, she lost her mind.
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She ended up um section, she ended up institutionalized, and every time they would layer in a new anti-anxiety or antidepressant drug, she got worse and worse and worse.
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She finally went to a this was quite extraordinary a forensic psychiatrist who works in mostly the prison system, helping to work out why people on certain anti-anxiety or anti-depression medications have mental breakdowns and causing them to be violent and psychopathic and homicidal.
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So this forensic psychiatrist works with dangerous prisoners who are on medications that are causing some of these mental aberrations.
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And so my patient ended up there and she got genetic screening and discovered a whole series of cytochrome enzymes in her liver were not working properly, either overactive or underactive, and they were all the ones that her drugs her um, psychiatric drugs were going through.
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So until somebody stopped and looked at how she individually metabolized her drugs, she was literally institutionalized from drug effects.
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She started with bad anxiety.
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She ended up with a catastrophic diagnosis and completely dysfunctional, lost her job, can't leave her home.
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So I sat down and I worked out a protocol I thought would help her with herbal medicine.
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And then I cross-referenced every herb against those enzymes to see which herbs would induce or inhibit which enzymes and the enzymes that were inhibited by her genetic profiling.
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We used herbs that would induce them, the enzymes that were induced by her particular cytochrome genetic makeup.
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I used herbs that would inhibit.
00:24:56.778 --> 00:25:06.142
So I'm literally trying to rebalance her liver enzymes by using herbs that are specifically induced or specifically inhibit.
00:25:06.142 --> 00:25:09.923
That obviously takes a great deal of time.
00:25:10.035 --> 00:25:21.739
I can't always find all the literature and research I want, but talking about safety with herbs, I think that it's critically important that we pay attention to this.
00:25:21.739 --> 00:25:26.515
But the truth is that many, many, many people are taking drugs.
00:25:26.515 --> 00:25:28.101
It's really not working for them.
00:25:28.101 --> 00:25:31.483
So where is the safety testing there?
00:25:31.483 --> 00:25:38.142
Why is not every patient who's being put on those kinds of anti-anxiety drugs getting a genetic screen to know if it's going to work or not.
00:25:38.142 --> 00:25:41.122
So I try and put it in context.
00:25:41.434 --> 00:25:47.943
What's going to do least harm is always my bottom line and most of the time the herbs will do least harm.
00:25:47.943 --> 00:25:59.644
And if I can find research to back that up and validate that and cross-reference that with the drugs I do, it's not always available or possible and then I go in really slowly with the herbs.
00:25:59.644 --> 00:26:08.681
I start at one quarter dose of what I think they might need and after we've established that as a safe level, then we go to half dose and we look at monitoring plans.
00:26:08.681 --> 00:26:12.681
How do you know if it's working for you or going to cause a problem?
00:26:12.681 --> 00:26:13.759
What can you measure?
00:26:13.759 --> 00:26:17.664
Is there something that you could do predictive measuring with?
00:26:17.664 --> 00:26:21.065
So my work is incredibly intricate.
00:26:21.065 --> 00:26:23.643
I spend hours with a case.
00:26:23.643 --> 00:26:32.846
I do a 90-minute interview, but I'm spending sometimes two or three hours working up the file afterwards because I take it very, very seriously.
00:26:32.934 --> 00:26:39.484
I believe herbs are medicine and we should give them that level of respect and not just throw them out casually at people.
00:26:39.484 --> 00:26:42.261
Oh, it's just a plight and if it doesn't help it won't do any harm.
00:26:42.261 --> 00:26:43.578
Well, that's not true.
00:26:43.578 --> 00:26:57.243
But as I dug into that book, the more I dug into it, the more I found a lack of good research about the danger of the herbs with the drugs.
00:26:57.243 --> 00:27:18.201
Of course, each and every herb could have a risk profile based on its constituents, but in context of clinical practice with drugs in the mix, there's a great deal of supposition, a great deal of isolated extrapolation and a great deal of fear mongering and very little hard evidence.
00:27:18.515 --> 00:27:22.724
And my expert reader was the inimitable Dr Eric Yarnel.
00:27:22.724 --> 00:27:26.241
And boy oh boy was Eric useful to me.
00:27:26.241 --> 00:27:31.045
There was one momentous day when he wrote to me.
00:27:31.045 --> 00:27:32.701
I hope I'm OK to say this.
00:27:32.701 --> 00:27:36.221
He wrote to me this is crap, capital letters crap.
00:27:36.221 --> 00:27:37.882
You don't know what you're talking about.
00:27:37.882 --> 00:27:39.279
I'm like thank you, eric.
00:27:39.279 --> 00:27:48.684
That's why I asked him to be my expert reader, because not only is he brilliant an expert, but he's also relentless in his feedback.
00:27:48.684 --> 00:27:55.002
He not just edited for me, he line edited, he went through every reference and checked.
00:27:55.002 --> 00:27:57.602
He followed up every reference I have in that book.
00:27:59.717 --> 00:28:05.559
And when I was writing the section on herb drug interactions and safety, I was being very cautious.
00:28:05.559 --> 00:28:13.509
I was really trying to downplay the herbs in there and really trying to make it ultra safe for everybody.
00:28:13.509 --> 00:28:17.766
Eric wrote back and said why are you being so mealy-mouthed about this?
00:28:17.766 --> 00:28:21.905
Why are you holding back on how brilliant the herbs are?
00:28:21.994 --> 00:28:25.644
The herb drug interactions are often very beneficial.
00:28:25.644 --> 00:28:28.864
Why don't you reframe it as a positive thing?
00:28:28.864 --> 00:28:35.728
How can you use those interactions to enable the patient to have less drugs and better outcomes?
00:28:35.728 --> 00:28:57.601
And he really helped me reframe it away from the fear factor of what the herbs do in the context of drugs and, really looking at that again, it's saying how amazing that these herbs do similar things to the drugs and augment the drugs and therefore you might need less of those drugs with all their attendant side effects.
00:28:57.601 --> 00:29:01.025
There's very few side effects for most herbs.
00:29:01.025 --> 00:29:05.266
The risk is always about is it going to induce or inhibit the drug?
00:29:05.266 --> 00:29:08.923
Is it going to increase clearance or delay clearance?
00:29:08.923 --> 00:29:16.220
And that's actually something that we can often measure and can actually work with instead of having it be a barrier.
00:29:16.220 --> 00:29:24.780
So Eric was incredibly helpful in showing me how to reframe that as a positive thing, not a place to get stuck on.
00:29:25.615 --> 00:29:35.624
But I think that reinforces that if somebody wants to pursue herbal medicine while undergoing conventional treatment, they need an expert.
00:29:35.624 --> 00:29:55.723
I just saw a patient recently who saw a traditional provider in the area prior to coming to the Cancer Center and they were given these formulas, which I went through, and they were given licorice when the medication that the person was going to be taking caused hypertension as the main side effect.
00:29:55.723 --> 00:29:58.222
And so there are a lot of nuances.
00:29:58.222 --> 00:30:04.267
Like you're saying, there's a lot more in-depth knowledge that goes behind it.
00:30:04.267 --> 00:30:06.019
You got to know a lot more.
00:30:06.978 --> 00:30:08.282
Yeah, I think you're absolutely right.
00:30:08.282 --> 00:30:28.367
There is a continuum here, from the home health care, eating a good diet, taking some chamomile for sleeping, some basic things that everybody could do and using what we might call the baby safe herbs, all the way through to active herbal cytotoxics.
00:30:28.367 --> 00:30:30.181
And that is a continuum.
00:30:30.181 --> 00:30:36.768
And again, in my book I try to kind of navigate people through that process whereby what can you do?
00:30:36.768 --> 00:30:45.257
Well, you can start with your own kitchen and your own home, cleaning out toxins, cleaning up your diet.
00:30:45.257 --> 00:30:49.007
That everybody can do without risk.
00:30:49.007 --> 00:30:53.105
Not everybody has access to all of that, but at least it's risk-free.
