[00:00:00.000] - Dr. Lemanne

If you have cancer and you're on insulin and you're diabetic, we should really try to get you off the insulin and manage your diabetes, not your a1c. We don't want to make you look better on paper. We want to make you really better. So that's one of the places where relying on a test or a biomarker is a mistake. Fixing a biomarker is not the same as fixing a problem. You have found your way to the Lemanne Gordon podcast where Docs Talk Shop. Happy eavesdropping. 

I'm Dr. Dawn Lemanne. I treat cancer patients.

[00:00:39.120] - Dr. Gordon

I'm Dr. Deborah Gordon. I work with aging patients.

[00:00:42.920] - Dr. Lemanne

We've been in practice a long time.

[00:00:45.310] - Dr. Gordon

A very long time.

[00:00:46.910] - Dr. Lemanne

We learn so much talking to each other.

[00:00:49.140] - Dr. Gordon

We do. What if we let people listen in?

[00:00:57.170] - Dr. Lemanne

In this episode, Dr. Gordon and I discuss a few of our favorite and unusual medical tests, including how to predict longevity from a measure of grip strength and a special test of living blood cells that shows how well a patient can resist cancer growth. Medical testing is not a field, exactly, but it certainly is part of every doctor's practice. And I think it's an interesting exercise to look at what tests particular doctors do, which ones they like, which ones maybe are underutilized or maybe over utilized. Talk about that. I think that's an important topic.

[00:01:40.120] - Dr. Gordon

When you brought it up the other day, I thought, oh, my gosh, this is huge, realizing that in my own mind, I'm having this conversation with myself kind of every day when I say to my patient, okay, here's this long list of tests I'm going to do. And they all say, my regular doctor never tests these things, and I have a real reason why I'm testing each one of them, and that's a little different for everybody. But it is fascinating to think about why you choose tests, what it means that you test things that maybe other doctors don't. And I'm sure other doctors test things I don't test, too.

[00:02:15.960] - Dr. Lemanne

I think this is really interesting and important topic, and I think that it's one that patients really want to know about. Those are the tools that we use to investigate what's going on with the patient and what might be a better path for them, either medically or in terms of their personal health habits like exercise and diet. I'm really excited to talk to you about this, and I know you do some really interesting tests. And one of the things that has always fascinated me is in your research and experience with dementia reversal, there are a lot of tests that can be done, and I know that you find the testing both a blessing and a bit onerous at times. Can you talk a little bit about how you approach medical testing for patients who might have a cognitive issue that you want to try to address or reverse?

[00:03:03.470] - Dr. Gordon

I'll start by pointing out that there's a plethora of tests we could do for the brain, because the brain is affected in so many different ways. But what's most interesting to me is thinking about the intersection between the tests I do for the brain that happen to be the same tests that I do for cardiovascular health and the same tests that I do for renovascular health or renal health.

[00:03:27.700] - Dr. Lemanne

So renovascular health, you mean the health of the kidneys?

[00:03:29.980] - Dr. Gordon

The health of the kidneys, right.

[00:03:31.780] - Dr. Lemanne

So brain, heart and kidneys.

[00:03:33.850] - Dr. Gordon

That's where the blood vessels get small and the rubber meets the road, so to speak. If you have some slight narrowing of your artery to your foot, well, eventually you're going to get a little discolored circulation effect on your toe or coldness of your feet or something like a.

[00:03:52.910] - Dr. Lemanne

Diabetic foot ulcer, lots of stuff.

[00:03:56.280] - Dr. Gordon

But if you have obstruction in any way or ill health in the tiniest blood vessels in your body, there's no room for error. That's when you start losing the cells that those blood vessels feed.

[00:04:09.250] - Dr. Lemanne

What you're really testing then is the health of the tiniest blood vessels.

[00:04:12.900] - Dr. Gordon

The health of the tiniest blood vessels overlaps for all of those.

[00:04:16.760] - Dr. Lemanne

So all the organs need their tiny blood vessels. And you like to do tests to see how the tiny blood vessels are doing.

[00:04:22.690] - Dr. Gordon

That's right So that's sort of my little bee that's been in my bonnet this week because of some testing I've done, some conversation I've had with an expert of small blood vessels to the heart who just said, why do you do all those tests? We don't do those tests because there's nothing you can do about it.

[00:04:40.940] - Dr. Lemanne

Was this person referencing, there's nothing you can do about it in terms of the heart, or?

[00:04:45.600] - Dr. Gordon

Yes, because he said, you just put them on a statin. I'm thinking he has better behave patients than I do. I said, yes, well, this patient.

[00:04:53.500] - Dr. Lemanne

You don’t like statins very much. Is that fair to say?

[00:04:55.920] - Dr. Gordon

You want to hear a great statin story this week? So I have a patient who has dementia and he's been really conscientious about doing this comprehensive reversal program that I've seen have good success with a lot of patients.

[00:05:11.720] - Dr. Lemanne

So he's on a program to reverse dementia.

[00:05:13.530] - Dr. Gordon

And if we put him in a study, and here we are a year out working with him and his dementia is no worse, a study would consider that a success. His family and I don't consider it a success. Why hasn't he gotten better? Why hasn't he recovered some of his lost cognitive function three months ago, at the behest of his family, because of his very high lipid numbers, we decided we would put him on what we consider a brain friendly statin.

[00:05:45.990] - Dr. Lemanne

What's that?

[00:05:47.200] - Dr. Gordon

Typically, the brain is very well protected from random elements in the body by the blood brain barrier, and it's including most statins. Most statins will cross the blood brain barrier. Blood brain barrier is lipid. And most statins are lipophilic, meaning they will access cell membranes and cross the blood brain barrier. And there's a subcategory of statins that is hydrophilic and is less likely to cross the blood brain barrier. So we gave him a very low dose of Pravastatin, and it's been two or three months, and that's a hydrophilic status, so it shouldn't go into his brain. Over the last few weeks, he's developed some emotional behavioral issues. He's become kind of a pain in the whatever to his family. And I thought sometimes you get personality changes with statins.

[00:06:42.460] - Dr. Lemanne

Is that because the cholesterol goes down?

[00:06:44.440] - Dr. Gordon

The brain loves cholesterol, so could that be happening? It was all theoretical, and I said, Listen, anytime you start something new, it's worth repeating his lipid panel, which did look a little bit better. Another test I like to do for a medication that can have personality effects is to stop it and start it again.

[00:07:04.520] - Dr. Lemanne

Oh, okay.

[00:07:05.480] - Dr. Gordon

And with statins, that's a really good idea, because it's side effects, which are cognitive impairment. Cognitive emotional changes and musculoskeletal problems can come on suddenly, and people cannot notice them. They also can be irreversible, but sometimes they're reversible. But I stopped his statin, really, because he'd become kind of a creep, and he's a really nice, respectful, calm, sweet, delicious thanks me very much for my care, and I'm thinking, I haven't made you any better yet. So we stopped his statin to see if his Crabbiness with his family would go away. And his wife writes me, and she goes, his brain is halfway back. His brain had always been functioning. Let's say his cognitive score was 20 out of 30.

[00:07:51.430] - Dr. Lemanne

So when you stop the statin, his brain came back.

[00:07:54.010] - Dr. Gordon

And so I think everything we've done was making his brain better. But in the meantime, we'd put him on this statin. We weren't seeing any improvement in his brain, but as soon as we took away the statin, he began speaking up in public, asking for the menu, knowing how to order things, remembering items of conversation. This is all in a week of stopping a statin that he's only been on for three months.

[00:08:19.170] - Dr. Lemanne

So all of the work that you did over the previous year, you think was helping, but the improvement was masked by this last three months of statin use.

[00:08:27.910] - Dr. Gordon

Exactly.

[00:08:28.660] - Dr. Lemanne

And so then when the statin was withdrawn, the cognitive improvement couldn't shine through.

[00:08:34.240] - Dr. Gordon

Exactly.

[00:08:34.790] - Dr. Lemanne

Interesting. So how did you test for this? You saw that his total cholesterol went down. What else happened when you tested this patient on statin? How did the statin change? Nothing.

[00:08:44.980] - Dr. Gordon

Very impressive. You know, what you would expect, which is where my level of interest has been this week. So because I have patients who won't go on statins if I have things I've seen in either cardiac imaging or my rather extensive cardiovascular testing, I'm looking for solutions other than statins to mitigate their problems. In that pursuit. I was talking to the cardiologist locally, asking for an expansion of my ability to order certain imaging tests. There's three I'd like to order. I can only order two.

[00:09:19.960] - Dr. Lemanne

What are the three tests you would like to have?

[00:09:22.370] - Dr. Gordon

Coronary artery calcium test, Cat scan, low amount of radiation testing, old events that your body has put a Band-Aid over. Oh, I mean, a calcium plaque.

[00:09:35.190] - Dr. Lemanne

Okay.

[00:09:35.910] - Dr. Gordon

A carotid intimal medial thickening. And that's an ultrasound of the neck. Not the one that's in the drive around van that looks at the flow in the blood vessels, but one that looks at the thickness of the thickness.

[00:09:48.980] - Dr. Lemanne

Of the vessel wall.

[00:09:50.120] - Dr. Gordon

All right. I mentioned that to the cardiologist in my case for wanting to do the third test, a much trickier test where you have to set up an IV, use contrast material and look at actually, the blood vessel of the heart with the heart in motion to see where there's soft plaque, which is the cardiovascular injury that results eventually in calcium, but is prelude to it.

[00:10:16.770] - Dr. Lemanne

Do you remember what that test is called?

[00:10:18.700] - Dr. Gordon

A CT angiogram.

[00:10:20.560] - Dr. Lemanne

So those are the three tests that you would like to have. The first one was the coronary artery calcium score, which is a low dose CT scan. The second one was the carotid artery intimal media thickness. Intimal media thickness. Did I say that correctly? Okay. And the third one is a CT angiogram.

[00:10:38.560] - Dr. Gordon

Yes. Of the coronary arteries.

[00:10:40.230] - Dr. Lemanne

Exactly. We used to have that in the Rogue Valley. I was one of the experiments when they were first setting it up, oh, maybe 14 years ago. So it's no longer being used?

[00:10:49.600] - Dr. Gordon

Oh, it is, but I can't order one because why? Because I would have to refer them to the cardiologist. He said, I have confidence. Yes, you could order one, but if we start doing them for you and he named off two or three other doctors, they'll start wanting them too. And this is pertinent to a socioeconomic problem we're all having right now. We don't have the capacity in the valley to expand the number of those that we do to any significant degree. So I can't open the barn door for fear all the horses will come in and want to be in the barn. So they do it.

[00:11:21.770] - Dr. Lemanne

They're funneled through the cardiologist at the moment. Okay.

[00:11:24.320] - Dr. Gordon

And he says, and we wouldn't do it for the guy you're telling me about, because we would just tell him he needs a statin. He has vascular disease. We know that. What's the problem? So maybe I need the name of your cardiologist with whom you're such good friends.

[00:11:35.900] - Dr. Lemanne

He's retired. So these are imaging tests that you use to look at the blood vessels and the heart specifically. How about blood tests for cardiovascular disease? Or, as you're pointing out, for any vascular disease anywhere in the body?

[00:11:52.080] - Dr. Gordon

There's a very common test that's commonly done a lot of doctors order it, which is the highly sensitive C-reactive protein?

[00:12:00.350] - Dr. Lemanne

Yes. hsCRP.

[00:12:03.430] - Dr. Gordon

Would you think most doctors order that?

[00:12:05.960] - Dr. Lemanne

I don't know if most do, but I certainly in oncology it's an important marker in cancer of a certain type of inflammation that's relevant in cancer. I know it's relevant in heart disease, which is not something I treat, but in cancer, an elevated hsCRP is of significance, and I pay attention to that, and I do order that on most of my patients, and we try to optimize that.

[00:12:26.240] - Dr. Gordon

Are there specific cancers that it's important.

[00:12:28.770] - Dr. Lemanne

In or I don't think we know the answer to that. It's a marker of a certain type of generalized inflammation that I'm not an expert in, but there are certain things that will improve this or make it worse, and we kind of aim for that. So I will see this elevated in patients who especially have advanced cancer, and I've seen it in the hundreds, hsCRP in the hundreds. Now, we want it really low. We want it one or less. Some hospitals think that women and men should have a different normal range, with some hospitals saying that the range should be 1.5 for women or less and 1.0 or less for males. So that's something to keep in mind. Are women allowed, or do women need more of this certain type of inflammation than men do? That's a big question that we have, but I like to see it less than one in every one. So in a patient with advanced cancer, I will often see it up in the double digits, 1012 15. And like I said, sometimes it can go up into the hundreds. I've seen that in patients who are also on cancer immunotherapy, certain types of off the shelf immunotherapies in patients who aren't on those particular drugs.

[00:13:32.200] - Dr. Lemanne

We try to decrease the inflammation by treating the cancer, number one. And if you can get the tumor burden down, that helps lower the hsCRP and diet. A lot of times people will do better in terms of hsCRP if they're on a less inflammatory diet, which usually means for most patients, a lower carbohydrate diet, not necessarily a full keto, but lower carbohydrate diets may be beneficial for some patients and improve their lipid profile and also their hsCRP. So there's some ways that we we address that.

[00:14:04.190] - Dr. Gordon

One time I went in and my annual labs, my hsCRP, which is usually less than 0.5, which is my goal.

[00:14:11.830] - Dr. Lemanne

Actually, with my patient good goal.

[00:14:14.150] - Dr. Gordon

I came back with an hsCRP of 45 one time, and of course, I decided I had ovarian cancer.

[00:14:20.350] - Dr. Lemanne

But all I think so many doctors are hypochondriacs. I think that's why we go into this field. I think that I've had many colleagues, especially in oncology, who will say, I have a headache. I must have a brain tumor. And the nurse will roll their eyes and say, get Dr. So and so a cup of coffee. Coffee deficiency, headache is everything.

[00:14:42.900] - Dr. Gordon

Well, the first thing I did, I repeated the test, like, in a week or two, and it was down. And this hsCRP is highly sensitive, but it's not really as specific as we'd like it. So your patient could have torqued their back or cut their kids flu, and it could be briefly up.

[00:15:02.780] - Dr. Lemanne

You're correct. And I recently had a patient who does have a history of cancer but seems to be doing fine. All the scans and blood work are extraordinarily normal. But she came in with CRP. It was in the couple of dozens. I think it was about 24 or 36, something like that. She did say to me, well, right when I had that test done, I had this horrible cold and et cetera, et cetera. So we repeated it and it was absolutely normal. It was less than one just a few weeks later. So, yes, you're right. It's dynamic. It responds to episodes of inflammation that.

[00:15:31.870] - Dr. Gordon

Can be transient and can be good for you.

[00:15:34.320] - Dr. Lemanne

And everything the body does is in the service of your health. Basically. It's trying to get you back to homeostasis, whatever it's doing. So that's another point. When we talk about blood tests, one thing that kind of irks me is that I want to hear your take on this because I'll bet you have a different take on this. And that's when we do things like certain vitamin levels, and patients will bring in a big panel of vitamin level tests and minerals, and they might be a little bit high in one and low in another compared to this general population or at least the standardization of those tests. And they tell me, well, we should fix this. And I say, well, just a minute. Maybe your body is doing something smart. Maybe you need more of this particular vitamin than most people do, and your body is saying, we're going to keep that level high in your circulation, or maybe you need less. And so we look at the whole picture. And just because something is out of range doesn't always mean that there's an illness or a problem to be fixed. There's a wisdom of the body.

[00:16:34.100] - Dr. Lemanne

And just like the hsCRP, if the hsCRP is high when you have a cold or the flu, that's a good thing. Your body is responding normally. Do we want to fix that? Not really. We want to watch it and make sure that everything ends up fixing itself. But we wouldn't give you steroids or something like that to bring that number down.

[00:16:49.480] - Dr. Gordon

So there's two inflammatory settings where conventional medicine would advise you to take an over the counter anti inflammatory. You've got a fever. Take some ibuprofen, bring it down. You sprained your ankle, take some ibuprofen, help the swelling go down. There are now studies in both regards showing, no, that fever is good for you. That swelling and redness stimulated by a so called bad fatty acid or academic acid, which we get from eating meat. That swelling that happens in your ankle is your body's first step to saying, let's clean this house and put it back together as healthy as it was when it first injured itself, rather than just aborting the process right. Then by taking an anti inflammatory.

[00:17:37.960] - Dr. Lemanne

What you're saying is we don't want to interfere with the body's normal processes, which at times involve going into an unusual state. I'm not going to call it abnormal. It's not abnormal to have a fever if you have an infection. It's not abnormal to have swelling if you sprained your ankle. Fixing those things may be to your detriment.

[00:17:56.110] - Dr. Gordon

Yeah. Another question is, can you fix them or mitigate the suffering without interfering with your body's wise process?

[00:18:04.600] - Dr. Lemanne

One of the tests that irks me in that regard is the A one C in type two diabetics. And a lot of studies have looked at whether a particular drug or insulin therapy will improve the A one C. So, for instance, insulin therapy in a type two diabetic. Now remember, a type two diabetic is impervious to insulin. They make too much of it. The body says, We've had too much of this. And each cell plugs their ears to the insulin's message and says, Just go away. We don't want you any more of this. We're overfed. Leave us alone. Don't try to put any more glucose into us, Mr Insulin. So insulin therapy in type two diabetics will improve the A one C. It improves it, it can even get it to near normal, which is a tough thing to do for many type two diabetics, but it doesn't add 1 second onto their lifespan.

[00:18:55.200] - Dr. Gordon

I thought it actually shortened it.

[00:18:57.260] - Dr. Lemanne

That's controversial. But there are studies suggesting that some studies have found that it may shorten life. If you have cancer and you're on insulin and you're diabetic, we should really try to get you off the insulin and manage your diabetes. Not your A one C, your actual diabetes. We don't want to make you look better on paper. We want to make you really live longer and be healthier. So that's one of the places where relying on a test or a biomarker can be a mistake. Fixing a biomarker is not the same as fixing a problem.

[00:19:27.030] - Dr. Gordon

And it points out an area, too, where there is a test that should be done every time a fasting sugar and an A one C is done and it's rarely done, which is a fasting insulin level.

[00:19:39.610] - Dr. Lemanne

Yes, very true. And you want to see where the insulin is. You want to see how much insulin it takes to get that glucose in the right place for that patient. I'm so glad you brought that up. If patients understood this, I think they would be really empowered. Having a low glucose is good. Having a low glucose and a low insulin is much, much better. You might be on the road to diabetes and have a normal glucose. And the way you know that is you look at your fasting insulin. If your body requires a lot of insulin and your pancreas has to pump out a lot of insulin to keep your blood glucose in the normal range you're prediabetic. If you stay on that route will become a full blown diabetic at some point. And you very much can reverse that by changing your lifestyle and diet and exercise habits sleep whatever it is off to make sure that your body is sensitive to insulin can respond to very tiny amounts of insulin and respond briskly. That's a state of health, not a normal glucose with a high insulin level.

[00:20:46.190] - Dr. Gordon

So there's some finesse in all that. I had a patient who had an okay blood glucose fasting, around 100, something like that. She had a high A, one C. That always made us unhappy and nervous of 5.8 or 5.9. So that's in the realm of pre diabetes, which most doctors, frankly, will just look right past. But anyway, her fasting insulin was so low, it was one and I said, I think your pancreas is kind of napping on the job. So rather than restrict her already low carbohydrates, I told her what do you think I told her?

[00:21:22.160] - Dr. Lemanne

I have no idea. I'm guessing in the context, you told her to increase her carbs.

[00:21:25.520] - Dr. Gordon

I told her one night a week to take her pancreas out for a hefty bit of exercise and to have a high carb dinner once a week. Interesting, because what happened and I said dinner particularly because that's when your pancreas is likely to be the most sluggish. So she would eat this high carbohydrate diet and spike her blood sugar and have it persist for the longest period high carbohydrate dinner. Exactly right. High carbohydrate menu for that dinner.

[00:21:51.950] - Dr. Lemanne

One meal in the evening, without getting.

[00:21:53.650] - Dr. Gordon

Too inflammatory, it would persist a little bit longer and really kind of, you know, slap the cheeks of her pancreas and wake it up. Her A one C went down three points.

[00:22:05.030] - Dr. Lemanne

Interesting. So she was perhaps overdoing the low carb part for her body, for her.

[00:22:10.650] - Dr. Gordon

Body, for her age. You don't want your pancreas lulled into complacency.

[00:22:15.110] - Dr. Lemanne

See, that's brilliant. So you were able to help this patient, and you were able to broaden the perspective, your perspective and the patient's perspective about the benefits or the personalization of the diet. So some people need a low carb diet. Some people need a low carb diet punctuated with a high carb meal here and there.

[00:22:32.370] - Dr. Gordon

It sounds like she went through it like a trooper. She said, I was so good. I had French bread. I had ice cream for dessert. I had an extra baked potato. But I did it for you, Doctor.

[00:22:45.170] - Dr. Lemanne

I imagine she might have enjoyed it.

[00:22:46.800] - Dr. Gordon

She did enjoy it. I think her husband particularly enjoyed it too.

[00:22:50.870] - Dr. Lemanne

There's a test that I want to talk about, if you're willing. And that's called the natural killer cell activity or functional assay. Natural killer cells are part of the immune system that's tasked with destroying cells that have damaged DNA. And the most common causes of DNA damage in a cell's nucleus are viral infection or cancer. So natural killer cells are really important in oncology. We want them active and vigorous. And there is a test that will look at the activity level of your natural killer cells, not just the quantitative cells. It's pretty easy to do a quantitative test, meaning counting up the number of natural killer cells per particular unit of blood. Often doctors will order those and labs will do them because they're easy. Actually, measuring the activity of natural killer cells is a specialty and it's hard to get these tests done correctly. They have to be drawn in the morning. The live blood tube has to be not cooled or heated up, just has to be at room temperature. And it has to be sent overnight so that it arrives in the testing laboratory within 22 hours or so so that it can be set up at the testing laboratory and that cells can be sought out and tested for their activity within 24 hours of being drawn.

[00:24:08.760] - Dr. Gordon

Must be tricky for you to order it and know. Excuse me, I don't want to question you about how well you do your job, but can you tell me how you handle this specimen?

[00:24:17.610] - Dr. Lemanne

The first few times I will order it from a particular laboratory, usually it will flop the drawing station. We will not manage to draw the test in the morning, making sure it's Monday through Thursday. If you draw it on Friday, it's going to arrive on Saturday when the testing lab is closed. And the first one or two times any particular lab tech does this test, usually something goes wrong and you can.

[00:24:37.910] - Dr. Gordon

Tell that by the result.

[00:24:39.150] - Dr. Lemanne

The result will actually say, test not run, arrive too late, or something like that. And that's frustrating. But if we can get a good natural killer cell activity test, that's very important to know. And a lot of my cancer patients have very poor natural killer cell activity. It's very few, I would say only maybe one in ten who actually have a normal natural killer cell activity level. But that's a good number to know because we can do something about it. So Life Extension is a supplement company that I really like that makes something called Natural Killer Cell activator. And I've had patients take that and watch their natural killer cell levels go straight up. Also, certain mushrooms may help. I like reishi, and a good reishi extract will often increase a patient's natural killer cells functional assay number. And we can just look at that. It's not a guess. People say, Well, I'm going to take some medicinal mushrooms. Well, how do you know you're on the right one? Or that it's working. Well, the natural killer cell activity test will tell you or may tell you if you're making some headway there.

[00:25:37.520] - Dr. Gordon

This comes to mind because I had a patient recently who came up with a chronically activated cytomegalovirus titer. And when you look up what to do about chronic cytomegalovirus CMV, the most efficient thing is if you can boost natural killer cell activity. Sure. And I thought, well, what am I going to do about that? Now, I know that I can suggest she go to her Quest lab and get that actually tested, but what are the ingredients in the life extension?

[00:26:05.470] - Dr. Lemanne

I think it says something like proprietary ingredients. And it looks like it's something that has to do with some kind of fungal or mushroom, maybe they're like the.

[00:26:13.460] - Dr. Gordon

Humic acid, fulvic acid that's in a lot of immune boosting.

[00:26:17.020] - Dr. Lemanne

So fungi are interesting. You know, they're in a kingdom of their own. They're not plants and they're not animals. But we share 50% of our genes with fungi. The proteins and things in fungi are a little bit foreign to our bodies, but similar enough to just set off our immune system. So when we put some fungus in our diet, our immune system says, this is almost human, almost animal wipe. Let's ramp up and get rid of this. We're not sure we really like it, but it doesn't ramp up too much. It's kind of a toner. It makes the immune system wake up and do some intelligent testing of its own and become a little more active.

[00:26:50.620] - Dr. Gordon

So it's what we'd call a hormetic stressor. It noses you out of your comfort zone and you wake up and get yourself a little healthier.

[00:26:58.590] - Dr. Lemanne

Exactly. So, yes, taking a little bit of fungus extract or toxin here and there will set your immune system on alert in a good way and boost your Natural killer cell activity..

[00:27:08.410] - Dr. Gordon

And are there specific cancers that this is most pertinent to or it's not?

[00:27:14.670] - Dr. Lemanne

Related to a specific cancer. It's more about the patient and how they're responding to whatever cancer or if they have cytomegalovirus, which is also, of course, in a family of viruses very closely related to many, many cancers. They damage your DNA just to get themselves reproduced. Now, that's not necessarily carcinogenic in itself, but every now and then they'll insert their DNA next to a growth section of DNA. And then when the virus is transcribed, the growth signal for that cell is also transcribed. We think that's how some of these things work. Or they'll insert themselves in the middle of a breaking a stop signal in your DNA so that that cell no longer can respond to stop growth signals. The DNA viruses, Epstein Barr viruses, a DNA virus, the chickenpox virus, varicella, and of course, the herpes simplexes one and two. I think there's a herpes simplex six and a herpes simplex eight. And those are often associated with malignancies Epstein Barr virus. Is associated with nasal pharyngeal cancers in Asia, it's associated with Burket lymphoma. In African children who are coinfected with malaria, you have to have both infections. Cytomegalovirus and EBV have been associated with various lymphomas and other cancers in our populations here in the United States.

[00:28:27.170] - Dr. Lemanne

So it's really interesting.

[00:28:28.480] - Dr. Gordon

How commonly is the NK killer cell activity measured by oncologists?

[00:28:34.430] - Dr. Lemanne

It's not part of the usual oncology panel. The usual oncology panel is usually a complete blood count with differential. So we can see the types of white blood cells in the total blood count, and then a chemistry panel, which is usually about 36 or so various tests testing the electrolytes, the calcium, liver function, kidney function, and some subsets of those. Those are what cancer patients typically get, and then also a tumor marker if that's pertinent to their particular tumor. So, for instance, a prostate cancer patient might have a prostate specific antigen test, PSA, done regularly to see whether the PSA is going up. That suggests the tumor burden is going up. If it's going down, it suggests that the treatment is being effective. So those are the tests that cancer patients get CBC, chemistry panel, and a tumor marker.

[00:29:22.030] - Dr. Gordon

So it would be a little bit overstep, but if I have a patient who's being treated or followed by somebody other than yourself for their cancer, I could, in their annual labs, order this without it interfering in any way with their conventional cancer treatment. And maybe it shouldn't.

[00:29:40.660] - Dr. Lemanne

Mushrooms are interesting. They're culinary. We just eat them. And oncologists won't tell their patients, oh, you shouldn't need mushrooms. Taking a mushroom preparation is probably not going to interfere with anyone's cancer treatment. Although one would certainly want to be honest and upfront with their treating oncologist and discuss anything that they might be taking with that treating oncologist and not use this as advice. But in my opinion, mushrooms are pretty benign in terms of their effects and their interference. I have a colleague who will not give mushrooms to cancer patients who are on immunotherapy, worrying that that might overstimulate the immune system and cause some problems with adverse effects from the treatment. I don't think that's ever been studied, but, you know, that's a legitimate worry. I haven't seen that. That's one opinion. So you definitely want to be upfront with your treating oncologist and get their opinion about that.

[00:30:31.710] - Dr. Gordon

It's not stepping on anybody's toes to really suggest that patients in general might be interested in knowing this value for themselves.

[00:30:38.220] - Dr. Lemanne

I think the natural killer cell activity test is an important test for anyone who wants to know whether their immune system is able to fight and destroy cells in their body that have damaged DNA. That's important.

[00:30:50.430] - Dr. Gordon

That is. Can it be too high?

[00:30:52.900] - Dr. Lemanne

Yes. So autoimmune conditions will cause a high seven to I think it's 128, something like that. I'd have to look to be absolutely sure. But if something like that is considered normal, in the Quest version, which is the one I usually get, and then over 128 or so is considered possibly a sign of autoimmune issues. Less than seven is abnormally low. I have a lot of patients who are three, four, six.

[00:31:13.590] - Dr. Gordon

It could be high in an autoimmune patient, and I've never thought this. I treat autoimmune disease with diet and lifestyle. It's great if I can go by their symptoms. Oh, my rheumatoid arthritis pain seems to have completely gone away. I'll sort of consider that a win without caring. But for somebody who has IGA nephropathy, a kidney autoimmune disease, she has no way of knowing whether going off certain foods is improving her autoimmune status. She doesn't want to go off the foods I'm telling her she should go off of. If she saw that number normalize, that might okay, thank you. That's practically helpful.

[00:31:46.790] - Dr. Lemanne

Yeah.

[00:31:48.450] - Dr. Gordon

I just want to talk about one more test I like to do.

[00:31:50.690] - Dr. Lemanne

Sure.

[00:31:51.320] - Dr. Gordon

Which is the grip strength. The better your grip strength, the better your brain is likely to survive, and the better you are likely to survive. And it can be tested at a moment, but it does take a little bit of a cheerleader. So I have a dynamometer in my office.

[00:32:09.390] - Dr. Lemanne

So you have a special gadget that lets you determine the strength of someone's grip, huh?

[00:32:14.800] - Dr. Gordon

Yeah, it's handy. It's the size of a large sandwich with a handle on it. I have them stand up and squeeze on the handle. That calibrates how forcefully they squeeze. The stronger they squeeze, the stronger their brain and the longer they live.

[00:32:30.960] - Dr. Lemanne

Wow, that's fascinating. And it's such a simple test. There are other tests of physical fitness. There's cardio respiratory fitness, the Vo two max. That's a great test.

[00:32:41.280] - Dr. Gordon

I'd love to learn more about that because it seems so complicated to do.

[00:32:44.710] - Dr. Lemanne

It formally, but there are ways to do it really simply. You can do it yourself. You can kind of cheat and get a really good estimate of your cardio respiratory fitness, and it correlates with longevity.

[00:32:55.750] - Dr. Gordon

Great. I want you to tell me more about that.

[00:32:58.380] - Dr. Lemanne

How about in a future episode?

[00:33:00.150] - Dr. Gordon

That'd be good. And while we've been talking, I've only thought about a couple more dozen tests I'd like to talk about.

[00:33:05.720] - Dr. Lemanne

Oh, there are so many. Well, this has been great. Thank you.

[00:33:09.200] - Dr. Gordon

Dr deborah Gordon and Dr. Don Lemon. You have been listening to the Leman Gordon Podcast, where docs talk shop.

[00:33:20.180] - Dr. Lemanne

For podcast, transcripts, episode notes and links, and more, please visit the podcast website@dockstockshop.com. Happy Eavesdropping. Everything presented in this podcast is for educational and informational purposes only and should not be construed as medical advice. No doctor patient relationship is established or implied. If you have a health or a medical concern, see a qualified professional promptly.

[00:33:56.480] - Dr. Gordon

We make no warranty as to the accuracy, adequacy, validity, reliability, or completeness of the information presented in this podcast or found on the podcast website.

[00:34:08.510] - Dr. Lemanne

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[00:34:23.070] - Dr. Gordon

Again, if you have any medical concerns, see your own provider or another qualified health professional promptly.

[00:34:29.880] - Dr. Lemanne

You must not take any action based on information in this Podcast without first consulting your own qualified medical professional.