Hey, hello, everyone. This podcast is being brought to you today from the Center for Advanced
Medicine just outside of Atlanta, Georgia. Please visit them at TCFAM.com. That's TCFAM.com.
Dr. Stegall, thank you for being here in the studio with us today. I have been looking forward to this
opportunity like you cannot believe. Me too, Robert. Thank you for having me.
Dr. Stegall, for those that don't know who you are, please describe your background.
From the very beginning, how you ended up getting into medicine, how you became an
integrative oncologist, who were your mentors, who did you look up to? So many times
a patient sees a doctor and they detach them from being a real human being.
I think it's really important for people to understand who Dr. Stegall is.
Sure. My story really starts when I was born. I was born almost three months prematurely.
I obviously don't remember that, but I was always told as I grew up that I was a preemie.
At that time, I weighed one pound and 14 ounces. At that time, it was about a 50-50 chance of
survival. I was always told as I grew up that I was meant for something big and something special.
I didn't know what I wanted to do when I was a kid. Obviously, with my life, I wasn't one of those
kids that grew up and said, I want to be a doctor, I want to be a police officer. I didn't know,
but I always remembered it was something important. Then when I was five years old,
my grandmother was diagnosed with stage four stomach cancer. She was really the first
relative I remember who had any sort of health issue, certainly cancer. I remember
when she was diagnosed, my mom telling me that she had a tumor, which is like a growth,
and that she would be having to undergo some pretty nasty treatments, some chemotherapy,
radiation, things like that. That was going to affect the way grandma felt and the way she
looked. She prepared me that grandma was going to lose some weight, lose her hair,
probably not be herself. That was true. I remember, I always like to tell this story,
but I remember when my mom took my grandma to buy a wig. She came home and had a wig for me too,
and it was a clown wig. I still have that clown wig actually. I actually pulled it out the other
day to look at it. I've saved it all these years, but I thought that was just kind of a sweet thing
just to let me get a wig just like grandma got. But of course, as grandma went through treatments,
she just declined. She lost a lot of weight, lost her hair, didn't feel good, nauseated,
that kind of thing. She ultimately passed away. I just vividly remember how that took what was
otherwise a really happy, healthy, seemingly healthy woman. He was very positive and upbeat.
It wrecked her body, but it also just crushed her spirit. I remember being keenly aware of that,
even at five years old, that grandma's different. That really made an impression on me. Then of
course, growing up, I didn't really think much more about it. But then I really felt called
toward medicine when I was in college. So I, again, wasn't exactly sure where life was going
to take me. I was actually about to graduate with a business degree. I was just sort of praying about
next steps. I thought business would be a good major, just whatever I did in life. God just put
on my heart to be a doctor. That was not something I had really planned on. My mom was a doctor.
She was an integrative family doctor. I was obviously exposed to that in a positive way,
but going to medicine myself was just not something I had thought about. I just really felt
called to that and kept praying about that. I just felt that was the right thing to do.
So obviously I had to go back and take a whole bunch of classes I didn't get. A lot of science
courses, organic chemistry, and biology, and physics, and all those things. But I did that
and really just proceeded down the path of becoming a doctor. For those who are listening
there's a lot of steps. There's courses. There's the MCAT test, which is a big test you have to
take to get into medical school. I actually decided to do a master's degree in physiology.
I thought it was going to be important for me just not having a science background as much to do that.
My program was at Georgetown University. It was unique because they had a grant from the NIH to
study alternative medicine. That was right up my alley because I knew when to go to medicine. I also
had this appreciation for various alternative therapies. The program was very science-based
in that we talked about physiology, and biochemistry, and all those things. But we also
had courses in various alternative therapies, herbs, supplements, mindfulness, all kinds of
different therapies. We were trained to examine those from a scientific perspective. We were
trained specifically on how to evaluate the literature. As I went into medical school and
my further training, I realized how important that is. You have to be able to look at a study
and see is it a good study, who funded this study, was it a good population of patients,
was it even done on people, or was it done on animals, was it done in the lab. There's a lot
of things to have to think about in terms of research. I really got a great foundation in how
do we evaluate research and decide if we think this is going to be good or not. Little did I know
how important that would be for me in integrative oncology because as I go through my training to
medical school, residency fellowship, again, I knew I wanted to incorporate integrative,
but there's not a blueprint for that. There's not a standardized curriculum for integrative
oncology. I had to create it as I went. To be able to look at the science for various things and
decide whether they're worthy or not has been a really great skill to have.
It's fantastic. What is your grandmother's name?
Her name was Addie Lee. She's from here in the South. Addie Lee was her name.
And your mother's name?
My mom is Susan Stegall.
I just want to honor them because they've had such an influence in your life in those early years.
My mom, of course, she passed away a few years ago, but she was just an incredible influence on my
life. That's fantastic to hear. Well, I'm certain that they are proud of you.
Thank you. I hope so.
For sure. You mentioned that it was Georgetown you were at, correct?
For graduate school.
That there was a grant, I think, some money for integrative
complementary medicine.
It was. They sponsored this graduate program specifically in physiology to study certain
complementary alternative medicine therapies.
And you said you had that that grabbed your interest. It sounded like you already had an
interest. Where did that come from? Where did at that age? I mean, I'm just thinking most young
people are not thinking that way, right? Of course, you're in medical school, but where did
that come from?
All right. That was my mom's influence. I grew up with integrative medicine in my house. So
my mom had me taking supplements way before they were popular. My friends always thought it was so
weird. Like, why are you taking pills and stuff? But I knew about that. I knew about supplementation,
good nutrition. I was a health nut in terms of nutrition way before. Again, most people were
talking about it. Just the importance of basic lifestyle things, exercise, hydration, sleep.
I really grew up with all that. And then I saw my mom just have such success with patients with
various health issues. And of course, she treated birth to death a whole lifespan. So she had
little babies and toddlers. She had teenagers, adults, elderly. She really saw the whole spectrum
of ages. And just hearing about her successes with patients using various integrative therapies was
just a huge influence. And I thought, I have to incorporate this. I mean, I want to, I have to.
To really help people.
And she was a medical doctor also. You know, normally when we hear a medical doctor, we just
think medicines. But here you are, you're growing up in a household where your mother, who's a medical
doctor, is actually using supplementation. She's giving it to you. She's saying, hey,
Jonathan, here's what you need to take this for.
Right. Absolutely. Yeah.
Okay.
Yeah. And actually reaching for those things before she would reach for a medication. So I
actually had that approach as well of, you know, maybe there are some natural things you can try
for a certain ailment. And then if that doesn't work, we could always try a medication later.
So it was, it obviously depended on the condition. But it wasn't reached for the
pharmaceutical. And if that doesn't work, try something more natural. It was let's try something
natural. If you think it's going to work well, then we'll go to something pharmaceutical if it doesn't.
So that was always sort of my thought process.
Wow. Now for those watching this right now are listening to it.
Why doesn't that happen on a regular basis when I go to a doctor appointment?
Conventional medical doctor. I think it's training. I think, you know, as I went through medical school,
my mom hit on it one time. She said, you're having to flip your brain in a way as to learn everything
you need to for medical school, because it's not the same way of thinking. It's very, you know,
disease driven, symptom driven. It's not as much about how that disease is affecting that patient.
And I think there's a subtle, there's a subtle difference, but it's a big difference. If we think
about are we treating a disease or are we treating a patient who has a disease?
And so when we look at it from a patient centric approach like that, I think it totally changes
our paradigm. And so, you know, in medical training was outstanding. I mean, I think it's,
I have a huge appreciation for Western medicine. I use it every day, but it leaves out a lot.
And I think when we talk about what we're trained in, we're just trained in basically what the
conventional medical model uses and what insurance approves. And so I think that really
limits the toolbox when we're talking about a spectrum of therapies to choose from for patients,
because it leaves out a whole lot of stuff that does have some good science behind it.
It's just not part of that standard of care. And so doctors aren't taught about it.
And then you to not get too much off on a tangent, but the other problem is doctors just don't have
as much time as they would like with patients in general under that normal conventional medical
model. And so not only do they not have the training in a lot of these other therapies,
but they also don't have the time or interest to really go learn more about them either and
to incorporate them. So it's a multifactorial problem, but it's out there. And I think unless
you have a doctor who's willing to learn some of these things on his or her own and really step
outside the box, it's just not, they're not going to know anything about it.
Would it be fair to say that when a young doctor is coming out of medical school,
and he's conventional doctor, taking medical insurance for payments, etc., versus like
yourself, because you have a private practice, you don't take medical insurance.
So is it fair to say that the doctor like yourself that's not taking medical insurance versus the one
in a conventional practice that is that that contributes to having less time to continue to
do further research? Absolutely. Absolutely. I mean, even for oncology, the average visit
length is about 17 minutes. Now, can you imagine you're going in and maybe the visit is a little
bit longer when you're seeing that doctor for the first time, maybe it's a little bit longer to talk
about your diagnosis and treatments. But even imagine going through treatment, that's a pretty
fast visit, 17 minutes, you're barely able to say hello and how you're feeling that day and
answer a few questions and that 17 minutes is going to be up, especially if they're reviewing
any sort of test results or anything like that. So I think that's a problem because
doctors just aren't able to get the information that they need. I mean, one of the things I learned
early on in medical school was if you talk to the patient, they'll tell you, they'll tell you their
problem. They'll tell you they want to tell you. And we're trained to listen, we're trained to
ask questions and then be quiet and listen. But then if you look at the research, doctors
usually cut patients off after about eight seconds. So they asked you a question and then let the
patient talk and then they interrupt them. And that's just not effective health care, as you know.
And is that just happening because I got to get to the next patient?
I think that's a lot of it. Okay. There's a lot of it. And I think there's also an arrogance to,
I know what the problem is. I don't need to hear anymore. I mean, I think it's both, but I think
it's largely just because doctors know they're seeing 30, 40, 60 patients that day and they need
to eat on to the next one. When you consult with a patient doctor, on average, how long is that
consultation? Our first consultation is usually at least an hour, hour and a half, sometimes even two
hours. We spend a lot of time. And then, you know, even for follow-up visits, it's at least 30
minutes, usually 30 to 45. That's fantastic. Yeah, especially when you have a health crisis
that's what I would expect. I'd want to sit with my doctor for an hour. I'm in a health crisis.
I got a cancer diagnosis here, right? Absolutely. That's fantastic to hear. So,
I'm glad that we're bringing this up because every viewer listening to this needs to know that
someone like a Dr. Stigalo as a private practice is not taking medical insurance for payments,
has really the advantage to continue to do research, spend more time with the patient,
which ultimately translates into a better quality of care for the patient.
Absolutely. And I'm glad you brought that up because I think a lot of patients here
that were not contracted with insurance and they say, oh, well, you know, why not? That's not very
nice of you. Why wouldn't you take insurance? And it's not because we don't want to. It's,
number one, because insurance doesn't cover a lot of these integrative therapies. And then, number
two, like you said, we do want to spend more time with our patients. We don't want to be told by
the insurance company, you can only bill for 10 minutes with this patient, 15 minutes. And that's
how insurance companies do it. They say we bill for X, Y, and Z. And if you do that and the insurance
covers that, that's great. But if you do anything outside of that, then you don't get paid. So,
it's a really broken system because it's not about the patient. It's really not. It's about
what insurance companies want to pay for. Yeah. I'm not going to put words in your mouth, but
as far as I'm concerned, that's an immoral system. I mean, health is sacred. So, and the patient-doctor
relationship is sacred as far as I'm concerned, but you cannot develop a level of intimacy with
your doctor in eight minutes, not over health crisis. When you were in medical school, what
was your biggest aha moment during medical school during that time? Well, during that time, I was
again, sort of figuring out what specialty, what area, because you don't have to choose that up
front. You choose that about the time you're graduating, you kind of choose, okay, here's
a specialty I want to do. And I was just really drawn to cancer patients. So, I would go back
after my work was done and I would just go visit with them. And it was really powerful the day I
realized that I wasn't really able to help them much from a medical perspective. I mean, I had
enough knowledge to know how to do the basics, but I knew for most of those patients, I was not going
to get rid of their cancer. But I was able to at least be there for them just as someone who cared,
someone who would listen, someone in a white coat, even though it was a short medical student,
white coat, not a long attending physician, white coat, still just someone on the medical team who
could listen to them, would care for them, would get on the glass of water, or whatever they needed.
And so that was really my big aha moment. And as I went through more training and obviously became
a physician and started managing patients myself, I still felt the same way. In medical school,
I thought it was because I wasn't a doctor yet and because I was still learning. And once I had
learned what they wanted me to learn, I still felt like I couldn't really help them. And that was one
of my, okay, integrative oncology is where the answer has to be. How much of that was your
grandmother? Probably a lot more than I've thought about. Probably. Yeah. More than I've realized.
Yeah, absolutely. Wow. Okay. So when you finish medical school, you've made up your mind, you're
going to be an integrative oncologist from the very beginning? Is that how you started from get-go?
I was drawn to cancer. I didn't really know if I wanted to do that for sure yet. I initially just
chose internal medicine because that's sort of a good base. You can stay in primary care
or that's also the required step if you want to subspecialize. So if you want to do oncology,
cardiology, critical care, whatever sort of specialty, you do internal medicine first. So
I started with internal medicine residency and then while I was in internal medicine residency,
I realized that I really felt called toward cancer specifically. Got it. Okay. Now,
one of the things that has always struck me about Dr. Stegall is that I find you to be a researcher.
You always seem to be dedicating time to looking at what is up and coming
in the cancer field. What do I need to evaluate? Is there something up and coming that people
should know or is there something that's intriguing you right now where you think there may be some
significant hope here with this modality? Is there anything like that on the horizon?
Well, there's a lot of stuff. I don't know how long you want me to talk on this, but
to take a step back for a second, we always talk about the cure for cancer. We've been looking for
it for decades. Going back to President Nixon declared war on cancer and we're going to develop
all this research to cancer. We spent billions of dollars and we haven't found a cure. I think the
reason for that is not because we're looking in the wrong place, but because it's not going to be
one thing. There is not probably going to be one medicine we give to cure cancer. It's probably
going to be a cocktail of things. It's going to be a combination. So in thinking of it like that,
I think there are some things I'm excited about. We'll talk about chemotherapy later, I believe,
but I'm still excited about chemotherapy. It does a lot. It's a powerful tool. But aside from that,
I think immunotherapy is a really exciting field. We're learning about how to better harness the
immune system so that it sees cancer better and fights it better. There's a lot of research with
that. I think we're going to see a lot more good things coming from all the genetic research that's
been going on lately too. We mapped the human genome a couple of decades ago, but we don't know
what a lot of those mutations mean. But what we're finding is that we may be able to soon go in and
target some of those mutations and repair them. And that's not going to mean anything we hear
about the next year or two, but soon in terms of in the next 10, 20 years, we may be able to do that.
And so I think that has obviously some potential pros and cons associated with it. But
to be able to truly affect cancer on a genetic level is something that excites a lot of
mainline cancer researchers. In terms of more supportive therapies, there continues to be more
and more good data on nutrition, how important that is. We find most of the research leading
us toward a more plant-based diet, obviously a concentration of fruits, vegetables, beans, grains.
And then of course, you can debate over how much animal protein to add in there or things like that.
But if plants are sort of the foundation, the bulk, if not all of the diet, then I think that's
really going to be strongly anti-cancer. And then there's even some good data on the importance of
when we eat. So it's not just what we eat, but when we eat. And so we're talking about things
like fasting. There's a lot of good research coming out now on intentionally not eating for
a certain period of time, whether that's part of a day or even several days straight. And all the
good effects that that provides in the body. So I'm excited about a lot of it. It really depends
on which area we're talking about. And all these things that you just mentioned, are they things
that you're currently integrating with your patients right now at the Center for Advanced Medicine?
Yes, other than obviously the genetic alterations. That's way down the road. But yes, I mean,
I believe in a truly integrative approach where we're really taking the best of modern medicine,
chemotherapy, immunotherapy, surgery, but integrating that with a lot of good natural
alternative therapies as well. That's really to me where the magic happens. Because we have a
bigger toolbox that way. We're not limiting ourselves like a conventional oncologist or
even someone who's strictly alternative in their approach. They're missing a lot of other tools
they could be using. Okay, got it. Now, I know you're an author, you have a book called Cancer
Secrets. And you also have your own podcast. You have your own website dedicated to this,
which is fantastic. It answers so many frequently asked questions for patients. So thank you for
investing the time. I really appreciate that. Let's talk about chemotherapy because when
patients hear you have cancer, you got cancer, immediately treatments kicks into their mind.
And that's going to be chemo or radiation, maybe a surgery. You mentioned the story about your
grandmother and how your own mother prepared you for the physical changes that were going to take
place. And they did take place. And this is the image that we all have in our minds about
chemotherapy. It's like, I think for most of us, we think this is a bomb that's going to get dropped
on me. Please explain to our viewers why we don't need to be afraid of it in that kind of way. Give
us a history of chemotherapy. Explain to us how you leverage this tool because I think you mentioned
in your book, hey, we got a toolbox here. And this is a major tool that shouldn't necessarily
be abandoned but used differently. Right. Right. So the history of chemotherapy is
you know, decades old. I mean, it goes back to the 1950s. When chemo was first used, there was a
certain type of pediatric cancer, I believe it was a lymphoma that they found actually responded
well to a derivative of mustard gas. And so the joke is that chemotherapy is mustard gas. But
obviously it's evolved a lot since then. But they obviously had to play with the dosing and the
frequency and everything with that regimen. But the approach at that time was these are kids who
have a horrible diagnosis. Let's give them as much of this drug as they can stand because we want to
make sure we get rid of it. And so the whole concept of what's called maximum tolerated dose
chemotherapy, we sometimes abbreviate that MTD for maximum tolerated dose. That's what came about.
And interestingly, as more and more chemo drugs were developed, the whole concept of MTD chemotherapy
remained. And so that's what you see today. If you go into any conventional oncology office,
they're going to dose the patient using a maximum tolerated dose approach. And that's basically
taking the patient's height, the patient's weight, and then establish dosing guidelines for that
particular chemo agent. And that's what the patient gets. And they know they can only give it once every
two or three weeks, typically, sometimes some can be given once a week. But typically there's a two
or three week break from one dose to the next because the patient couldn't safely tolerate more
than that. And now when we talk about maximum tolerated dose, we're not just saying the patient
will have side effects. Obviously they will. It's more like how much can we give the patient not to
put them in the hospital with some degree of certainty. So we know that we're still probably
going to wipe out their immune system. We're going to probably cause some anemia, maybe
affect their kidneys or their liver. Obviously that can cause a lot of side effects, whether it's
nausea, vomiting, diarrhea, rashes, whatever it may be. So that is what we associate with chemotherapy,
especially if we've had a relative maybe go through that or maybe some of our listeners are
going through that themselves. And that makes me sad because to me, chemotherapy is just a tool.
And I would argue that we've been using it the wrong way all these years. If you think about
maximum tolerated dose, I would rather think about it in terms of minimum effective dose. So what's
the least we can use to still get the effect we want? And chemo is just like any other tool,
Robert. Is it being used in the right hands by the right person? And is it being used
responsibly? It's like a car. You can get behind the wheel of a car. You can go 200 miles an hour
and you can cause a fatality. And if everyone did that, we would probably say that cars are dangerous.
But because we know how to use cars and how to drive them safely, they still get us where we need
to go. But they're generally recognized as safe. We can use a lot of examples to illustrate that.
But I think chemo is just so effective. I know it is. We just need to use it better.
And so what I really found to work in my practice is called fractionated metronomic chemotherapy.
And that's basically a long way of saying that we're using lower doses of chemo and we're giving
it more often. And there's good research to support this. There's research showing that these lower
doses given more often work really well because it actually keeps a nice steady level of chemotherapy
in the body all the time. And that may sound scary to some people, but from a cancer treatment
perspective, that's a good thing because the problem we run into with these big doses that
are given with a big gap in therapy is there's a long period of time where that chemotherapy is not
in the blood at all. And that gives the cancer cells that are still there a wonderful opportunity
to mutate so that treatment doesn't affect them later. And so we have this concept of resistance
that we talk about a lot, cancer cell resistance. And that really breeds resistance when we're
given that big dose of chemo and then we have to wait all that time to give another dose. So with
the lower dosing more often, so instead of giving one dose every two or three weeks, we're giving
these small doses three times a week, for example, it keeps a nice steady level so that cancer
doesn't have a chance to adapt. So we should get more longevity out of that treatment.
But with the lower dosing, we're avoiding a lot of those side effects that patients associate
with chemo. So it's not to say you can't have any side effects because everybody's different,
but the risk of the hair loss, nausea, vomiting, fatigue, all those horrible chemo symptoms,
the risk of that is just so much lower. So I found it to work really well. And that's why I view
chemotherapy as a really powerful tool to the point that if someone's recommended to have
chemotherapy and they don't do it, they're really missing a huge opportunity to treat their cancer
better. So I want everyone to know that, that if you're supposed to have chemo and you're choosing
not to, that you're making it a lot harder on yourself if you don't do it.
Okay. When you talk about these fractionated doses that are lower, earlier you mentioned the
maximum tolerated dose based on height, weight. So is a fractionated dose also based upon height
and weight in a percentage or what does that look like?
It is. Great question. So we still take that maximum tolerated dose calculation,
but then we take a percentage of that. So if we call the maximum tolerated dose 100%,
then we usually give about 10 to 15% of that, sometimes 20%. So we're a much lower dose than
the normal. But the way that's metabolized by the body, I think it worked really well.
And so they're getting that two to three times a week.
We typically do three. Yeah.
Okay. For how many weeks?
We typically do it in a four week block. So over that four weeks, they're going to get,
you know, about 12 treatments. And then we found that it's important to take a break at that point.
We've played with various lengths of treatment. We've tried six weeks, we've tried three weeks,
and we found that the four week amount of time is really a good amount of time. If you go beyond
that, you can start to see it wear on the patient a little bit more. So we take a break and we
typically put the patient on some kind of oral chemotherapy, usually a low dose, for about a
four week period. And then we'll come back and do more, another four weeks of the IV chemotherapy.
So in the context of my office, we do a 12 week treatment program, four weeks in the office with
IV chemo, four weeks at home with an oral chemo, and then four weeks back in the office with an
IV chemo again, along with a lot of other therapies, obviously. Sure. So about a three
month commitment on the part of the cancer patient themselves. But really a small commitment of time
when you think about the health crisis, right? Right. The picture that we're in here. As far as
those fractionated doses over a period of four weeks, and the accumulation, the fact that it's
staying in the body, is this accumulating to what full dosages would look like over a period of time?
Or is it just, I know nothing about biology the way you do. So what is happening in the human body
during this time? Yeah, that's a great question. So a lot of patients do like to say, okay, well,
how many of these small doses will equal a full dose? That's an understandable question. But really,
the way these drugs are metabolized and broken down in the body, it's not exactly the same because
we also have metabolites of these drugs that are doing some work for us as well. So if you look at
the what's called a half life of a lot of these medications, many of them are hours or a day or
so, a day or two. So a lot of that drug is actually going to be metabolized out even a couple days
later for most of these chemo agents. So that's why we feel like it's safe to go ahead and give
another dose again. So it's a little bit different because the body is metabolizing that and there's
a lower level and then we hit it again. So it's not exactly the same as saying, you know, 10 doses
at 10% of the full dose is the same as one full dose. It's not, I think about it differently than
that. Okay, you just mentioned a word half life for those that have never heard that explain it
to us. So half life is the amount of time it takes for half of an active component of a medication
to be broken down in the body. So the, we primarily think of the liver doing that. The kidneys are
involved in the metabolism of some drugs as well. But basically, if you start with 100 milligrams,
if the half life is four hours, then after four hours, you'd have 50 milligrams left.
And then, you know, of course, that same period of time half life, you'd have it again. So it's
different for different medications. And the nice thing about these drugs, they've all been studied
in detail to know exactly how they're going to work in the body. We know what to expect in terms
of not only how they work, but how long they work. When patients hear chemotherapy, some, not all,
but some think to themselves, it's all the same. But how many actual chemotherapy agents exist in
the world today? I mean, is there is there over 100 of these things that exist? Yeah, there are a
lot. I mean, there's there's certainly dozens. There probably are over 100 total. There are a
lot. So they all work a little bit differently. So that's the other thing you people need to realize
is, you know, chemotherapy typically works on the nucleus of a cancer, that's where the DNA and the
RNA, all those important genetic components are. So chemo works on those. But there's different
areas of that DNA or RNA that are being targeted by the chemo. And so that's why we usually like to
use two or three different chemo agents at the same time to attack that cancer cell differently.
So they all work a little bit differently. And some chemos are even derived from plants. I like
to tell patients that they think all chemo is just made in some lab by some evil drug company. Well,
a lot of them did are derived from plant active ingredients are obviously purified
in concentrated in the lab, but they are kind of plant based in a way.
Okay, got it. So when you do these fractionated doses, you're using two to three chemos within
the same infusion? Okay, same treatment time. And these three combined are equating to the 10 to 15
of the full dose. So they're each 10 to 15% of a full dose for that agent. So chemo A 10 to 15%
of the full dose for that chemo B 10 to 15% chemo C 10 to 15%. So they're all 10 to 15% of the full
dose given one after the other at the same treatment session. Okay, so they're not all in
the same bag. They're no they're pushed separately. Okay, depending on the chemo, sometimes they can
be given through an IV, you know, push and then other times they have to be dripped in. But they're
given sequentially. Okay, that's good to know. Now, with all these chemotherapy agents that exist,
in conventional oncology, are there like go to chemotherapies for certain cancers? In other words,
if you have breast, this is the go to chemotherapy we want. If you have pancreatic cancer, this is
the go to. Does that exist like that? It does. And we rely heavily on that because the the research,
we let the research guide us if we have three or four chemos that we know are sort of the first
line. Most the most studies seem to be the best effective for a certain cancer, then that's
typically what we start with. And we found that to work well, very well with our methods as well.
So we do rely on the research in that way. There are some some various tests that can be done to
maybe help clarify that. But we found those are usually aren't needed. Usually we can go with what
the research shows. Okay, great. Now, I know with these chemotherapy agents, there's material safety
data sheets for these, right? That tells you about their side effects, etc. But those would be based
upon full dosage, correct? Correct. Correct. So that's assuming a full dose. So a lot of times
when I talk to patients about my chemotherapy recommendation, they go online and they start
reading about it. And they say, Dr. Stegall, there's 50 side effects I could be getting from this. I'm
not sure I want to do this. And I tell them that, you know, there's certainly they're there for a
reason. But typically, that's associated with a full dose and doesn't necessarily apply with a
lower dose. Right. And obviously, there are paid studies to demonstrate what a low dose side effect
is. Okay. Okay, got it. Now, talk to us a little bit about how you deliver this fractionated
dose because that's different. You know, we just discussed lower dosages. But how is it getting
delivered at Center for Advanced Medicine? Right. Good question. So one of the issues with
chemotherapy is that it only targets what we call actively dividing cancer cells. So if you can
imagine within a tumor, it's pretty chaotic. All the various cancers, let's say there's a million
cancer cells in that tumor, which sounds like a lot, but it's actually not. I mean, there can be
many millions of cancer cells within a tumor. Some are going to be growing and dividing, which is
what cancer likes to do. It likes to grow and divide so that it can continue to spread. But some
of those cells are going to be dormant. They're not going to be growing or dividing. They're going to
be basically asleep. And these cells can go in and out of growth and division and dormancy
all day. I mean, it just depends on when you give that chemo, you're going to target the ones that
are growing and dividing. But if they're not dividing, then you're not going to hurt them.
And that's one of the real problems with conventional cancer treatment is, you know,
let's say you're giving that big full dose once every two weeks. Well, you're probably going to
kill the cells that are dividing, but what about the ones that weren't? And then you know, you're
going to have to wait two more weeks before we can try again and just hope that some of those
other cells are vulnerable. So one of the things that we do is really try to have as many actively
dividing and therefore vulnerable cancer cells at that time of chemotherapy. So it's under our
control, our supervision, but we want that because that's going to make our dose go farther if we can
have more vulnerable cancer cells at the time. So the first thing we actually do is we have patients
fast before chemotherapy. That's really important. So studies have shown that a fast leading up to
chemotherapy helps it work better. It also reduces side effects. And so that was shown in
conventional literature and conventional oncology. So we apply that to our method as well. We usually
have patients stop eating eight or nine o'clock the night before treatment. So they come in in
the morning, they've been fasting for about 12 hours usually, give or take. That's going to help
prime the environment. And if you think about it, you know, cancer is so energy driven. It has
a significant increase in the glucose or sugar receptors on its surface. They have a lot more of
a need for insulin because they're so active. They're growing so much faster than a normal
healthy cell would. And so we take advantage of that. And so we use something called insulin
potentiation therapies, sometimes abbreviated IPT. And what that entails is we actually give insulin,
and I'm sure everyone knows that insulin is a diabetes drug. It is designed to lower blood
sugar. But we actually give insulin to activate as many of those dormant cancer cells at the time
of treatment as possible. So we have a much greater population of vulnerable cancer cells.
And so what that looks like is we actually have a patient come in fasting, we give them
IV dextrose, IV sugar, we raise their blood sugar, and we then give insulin to lower that blood sugar
back toward normal. And we found that that works really well. We used to actually do it the opposite.
We used to lower the blood sugar first, lower them down below normal, which which wasn't very
comfortable for some patients. And then we give some sugar to raise it back to normal. But we found
that if we raise the blood sugar first, we can actually give more insulin because insulin is the
driver of this whole thing. The sugar helps sort of buffer the insulin to make sure the blood sugar is
behaving like we want it to. But the insulin is really what we feel is driving this process to
sort of activate those cancers over the time of treatment. So we do that. And really the patient
doesn't really feel anything. I mean, there's not going to be lightheadedness or chills or any of
that like you'd see with low blood sugar. When a patient has a high blood sugar, it's like you just
had a nice big meal, right? You're not going to feel badly. And so we found it to be very safe.
We're checking blood sugar regularly. So even though we're manipulating the blood sugar a little
bit, we're very careful to make sure that it's falling within the parameters that we are looking
for. And that's it. And the chemo's go in during that time while we're delivering the insulin and
the dextrose once they've taken effect. And so it's a really easy well-tolerated procedure.
That's how we give chemo. And we do that every time we give chemo. So Monday, Wednesday, Friday,
in my practice, that's how we do it. IPT with chemo. Perfect. Perfect. Thank you for that
explanation. So Dr. Stegall, when it comes to giving the patient insulin, I want to make sure
I heard this correctly. One of the key purposes is that there's dormant cancer cells that are not
dividing. Right. All right. So you give the insulin to make these dormant cells
wake up as it were. Are they dividing at this time? Is that the theory? Yes. That they're
growing in preparation or actively dividing when we give chemo. That makes them vulnerable.
Okay. So then when you deliver the glucose, which follows next, which they're hungry for,
exactly. Right. It's kind of like Pac-Man. Right. They're coming to consume it. Then you follow it
up with the fractionated chemotherapy. So they're consuming that. The idea is in theory that those
fast dividing cells are all, there's more of them now because they were dormant and they're
consuming that chemotherapy and you're killing cancer cells at that point. Bingo. Okay. And
minimizing the side effects at the same time. Right. All right. It's fantastic. It's good news.
What are you integrating with IPT to make it work better? Because obviously there's other things
that you're doing. You mentioned it earlier. You're an integrative oncologist. Right. What have you
found to be very successful? We found that hyperthermia, which is heat, applied to a specific
area. So we call that local hyperthermia versus a global hyperthermia would be basically heating
the patient, giving them a fever. We don't want to do that. But local hyperthermia, we're able to
place a pad, especially designed hyperthermia pad over a certain area is important because that is
going to do a few things. Number one, it's heat kills cancer. So cancer doesn't withstand heat as
well as a normal healthy cell would. And so we know that there's going to be a cancer cell killing
effect from the heat. It's going to recruit some immune cells to the area being heated, but probably
most importantly, heat is going to bring a little bit extra blood flow to an area. So if you can
imagine the timing we're giving chemotherapy, there's blood in the chemotherapy. It's going to
circulate around. Let's divert a little bit of that blood to the area of greatest concern for the
patient. If they have a breast mass, we'll put the hyperthermia device over their breast and bring a
little bit more chemotherapy-rich blood to that area. Or if it's over the liver, we're going to
put some heat over that area. And we found that to work well because obviously the chemo is still
going to be systemic and we want it to be, right? Because who knows where cancer cells might be,
but we know if there's a certain area to prioritize that the hyperthermia is going to help us do that.
And the nice thing about this device is it's not going to burn the skin. A lot of the older
hyperthermia devices would actually burn the skin because most of the heat is there versus this
actually causes the heat to collect under the skin to a certain extent. So we're able to heat an area
below the surface and really spare the skin from the burns. So we found that to work really well
to integrate with chemo and IPT. And the local hyperthermia is being done prior to the fractionated
chemotherapy through IPT. Yes, we apply the heat, let that get to a certain temperature,
and then that's when we start our chemo, when we know that there's already the heat in that area.
Got it. So as I'm putting this together and correct me if I'm wrong, when I think about the IPT and
you give insulin to the patient to wake up those dormant cells, as it were, you're really creating
like a magnet in the body to receive the chemo. But by applying the local hyperthermia beforehand,
now you're making it a super magnet where the tumor is.
Right. Exactly. If it's more concentrated to a tumor, as well as more likely to be taken up by
cancer cells, that's going to be less chemo that can go to places we don't want it to go. So we
think about collateral damage and only are we addressing that with a lower dose. But if we're
targeting the chemo better, the chances of a lot of these other untoward side effects is going to
be a lot lower. I'm sure there was a time where you were not using local hyperthermia in the practice,
but you were using IPT, fractionated doses. So from the time that you weren't doing this to
the time that you are now, you're actually doing, what was the difference that you noticed with the
patients? I definitely noticed an improvement in the reduction of tumors. I mean, I certainly
got good results before, but I do feel like it's increased the results. Especially,
the really neat thing is seeing patients that have tumors that are visible. So some patients will
come to us, they'll have a breast mass that's come through the skin that's exposed or something like
that. And you really can literally watch those get smaller over the course of weeks of treatment.
And so it's pretty cool to see. And obviously we monitor labs and imaging as well. So if it's an
internal tumor, we still are going to see that too. But it's neat to see that as we go along,
to actually see the effect of the treatment. And I have seen an increase in those benefits
just since we included the hyperthermia. Fantastic. With the insulin, and I know I'm
going back here just for a minute, but it just dawned on me. Is there any risk of insulin causing
the cancer to spread because those dormant cells are not coming to life? In other words,
is it possible through the insulin that over a period of maybe four weeks or eight weeks later,
that there could be more cancer cells that are dividing and spreading? Is there a risk of that
at all? That's a great question. So we don't have any research showing that that accelerates the
growth of and spread of cancer. Now, I view it more as, if you have cancer, anytime you eat,
potentially you're going to fuel cancer, right? That's just the reality of it because cancer is
relying on those same nutrients and other things that normal healthy cells are. So we know that
anytime we give any sort of fuel, it could cause cancer to grow. But because we're doing it under
our supervision at the time of treatment, I don't have any concerns about that. Now, we do know from
the research that the diabetics get more cancer and they have worse outcomes from cancer than
people who don't have diabetes. So part of that is because they don't have as good a blood sugar
control and part of that is quite possibly because of insulin. But because we're doing it in a
controlled setting, limited times, and we're talking about giving, of course, of a three-month
treatment program, it's 23 chemotherapies that we give, IV chemo. And so it's 23 times you're
getting insulin. That's not significant at all. Whereas if we were obviously giving it every day
for 10 years, maybe that could cause some issues. But because it's under our control at the time of
treatment, we know we're giving chemotherapy. I have no concerns about that. Okay. And there's a
really targeted approach that you're describing. Absolutely. Okay. One of the things that
you mentioned earlier in conventional medicine was that there are dormant, these dormant cells,
these dormant cancer cells, and the chemotherapy will develop a resistance. And so I'm thinking
of myself, I think we've all met a cancer patient that had conventional chemotherapy,
and maybe even integrative. I don't know, but it has come out and said, I'm cancer-free.
Only to have the cancer reappear in three months or six months or 12 months, they obviously,
it's great to hear those words, you're cancer-free. However, that was determined. But
if there's dormant cells, I mean, should we be telling patients this? I mean,
or when should we tell patients they're cancer-free? What's your opinion on this?
Yeah, I agree. We throw around cancer-free cure. We throw on those words a lot. I actually don't
use them in my practice. I will say that there is no evidence of disease, no evidence of cancer,
but I can't guarantee that there's not a cancer cell in there somewhere. Even with the advanced
testing that we incorporate, it's great when that test doesn't show any evidence of cancer,
but that doesn't mean there couldn't be something there that could pop up later.
That's why the monitoring is so important. How often should people monitor themselves
and monitor themselves with what test? So patients who have cancer, I'm really big on
getting your information. I always say, if we don't know our enemy, we can't fight it well.
Cancer is a formidable adversary, right? I mean, we know it can take over the body if we let it.
On a very basic level, this may be common sense to our listeners, but get a biopsy. If you think
you might have cancer, get the biopsy. There's all kinds of stuff on the internet about biopsies
spread cancer, and they're dangerous, and they don't. So get your biopsy. You need to know,
first of all, whether it's cancer or not, but then also that's going to give us some extra
information on that tumor. If it is cancer, let's say it's breast cancer, well, is estrogen driving
that cancer or not? Is progesterone driving that cancer? We can do all kinds of studies now on that
tumor tissue to actually see how it's behaving and whether that gives us different treatment options.
But then beyond that, I do use the conventional tumor markers, things like the CA125 or CA153
or PSA, things like that. I think they're important to monitor as you go through cancer,
just to see how those respond. I don't think they're perfect. Those are just proteins that
we measure, and they can be elevated for other reasons as well. So I do think imaging plays an
important role. No one wants to be exposed to radiation, but a PET CT scan is kind of the gold
standard. So I do think that's important to get a PET scan or even just a CT or MRI. Just depending
on the cancer type, we decide what's appropriate. But a picture is worth a thousand words, and
a lab test won't necessarily show you everything you need to know. So I think imaging at regular
intervals is important. Then I'm also using a test right now called Signatera that I really like a
lot. It actually takes a sample of the patient's tumor tissue, and that can be previously obtained
from biopsy or surgery. The pathologist at Signatera will come up with what they call a
genetic signature, and it's unique to that patient and their cancer. It's about 16 unique, what they
call molecular identifiers that they found are not only unique to that patient, but they don't
change over time. They don't change as a result of treatment. So that's sort of their genetic
signature forever for that cancer. And they can get a blood sample from the patient and actually
look for that pattern and measure what's known as circulating tumor DNA. And you may see that
abbreviated CT DNA, but you can think of that as basically fragments of cancer DNA. So we're able
to actually take a blood sample, look not just for cancer cells, but little pieces of cancer DNA
from inside cells. And I found that to be really helpful in addition to the other testing we talked
about, because if you're negative on Signatera, 0.00, no evidence of cancer, and you show over time
that you remain at 0.00, your chance of recurrence is extremely low. So that gives our patients a
lot of confidence in only the treatments working and that they're maintaining that no evidence of
disease status, but that once they reach a certain point that their chance of that cancer coming
back is very low. Signatera was the name of it. And I want to make, because this was so valuable,
what you just mentioned, they're looking at the tissue biopsy in the lab. Are they seeing this
tissue within 12 hours, 24 hours that it's been taken out? How soon is this? It can be years old.
It can be three, four, five years old tissue that's been preserved, because a pathology lab is
required to preserve tissue for up to 10 years. So the pathology lab will have it. The pathology
lab has it. And so it's just a matter of getting that sent to Signatera. They're in California. So
most US-based hospitals can send it, no problem. And then they spend about three weeks or so
working on that pattern. And then the blood testing part takes about a week. So the nice thing is,
even though that first result takes about a month to come back, subsequent testing only requires a
blood sample, and it takes about a week to come back. So it's a really nice way. We use that to
monitor our treatments as we go, but then also after treatment to make sure the patient keeps
doing well. And you mentioned the zero, zero, zeroes, right, for no evidence of disease.
For the period of time that you've been working with this lab, do you feel a level of greater
confidence with those results versus an image? Or would you recommend both? I recommend both,
but I have found that we can usually extend, for some patients at least, extend the amount of time
between scans if Signatera remains good. Because the key thing is, on an image, something needs to
be about one millimeters or larger to show up. And a one millimeter lesion is about a million cells.
So if you can imagine, that's a lot of cells in order to be detectable on a PET scan or a CT.
With Signatera measuring just fragments of cancer cell DNA, it's a much, much smaller entity. So
I'm very careful to say we don't need to exclusively rely on Signatera. It's not designed
to be a standalone, but to supplement imaging, I think it's a really good strategy. Because we're
going to capture a lot if we combine Signatera with imaging with regular lab testing as well.
So if you're doing the Signatera, a patient that's already gone through the Center for Advanced
Medicine, get a Signatera test every six months, every three months? Good question. So we get a
test at baseline, and then we actually will test again after about a month of treatment. So in the
context of our 12-week treatment program, about week six when they're home, for those that break
in the middle, we'll do another Signatera. And the nice thing is we'll have both the baseline and
that roughly six-week Signatera back before they come back for their last four weeks of treatment.
So if we need to tweak anything, we can. I mean, we typically see that number come down,
meaning the cancer load is less. But if we need to tweak something, we can. And then we'll actually
check another one about two weeks after they finish the 12 weeks of treatment. And then beyond that,
it really depends on what we see. If the Signatera is positive, meaning it's showing some cancer
activity there, then we typically will do it monthly. And if it's negative, meaning 0.00 in
abundance of cancer, then we do it every three months. Okay. And then as far as the imaging,
let's say a PET CT once every six months, once a year? Yeah, it depends on the patient.
Typically we'll get an imaging before we start treatment and then again, about two weeks after
we finish. So that'll be a three months in between those because that's measuring treatment. After
that, no more often than every three months, but most often I'll wait six months for a lot of
patients moving forward. Do the image. Okay. And sometimes a year, it just depends on the patient.
And I know this is such an important topic for patients because they're like, they want to make
sure that, well, there's no evidence of disease, right? I'm not going to use Orcure or you're
cancer-free. However, if the patient wants to do the Signatera test more frequently, because they
just want to, they're willing to pay for it. Are you willing to support them? Sure. Okay.
Absolutely. And so for how long, maybe we have to go out years. I don't know if this is two years,
five years. For how long of a period of a time do they need to see those negative 0.00 to really
be in that spot where you think as a professional, as an integrative oncologist, where you're like,
you're okay. Yeah. Signatars research has really put a lot of weight on that two-year mark. So two
years of consistently negative Signatars results. So 0.00 every three months up to that two-year
mark, the risk of recurrence is extremely low in their research. So it's not to say we don't need
to still monitor it after that because we do, but I would say we would do it less frequently,
maybe go to every six months at that point or every, or just know that even if we are sticking
with three months, that the chances of recurrence are low. What I'm hearing you say is you have a
very systematic approach when it comes to measuring the response when the patients come to you. This
is so important. What about the whole idea that somebody's cancer can be completely resolved in a
period of two or four weeks going to some integrative or alternative? I mean, what are the chances? I
mean, outside of a true miracle, right? But I'm not talking about a true miracle from God. I'm
talking about medicine. I mean, what are the chances of this even happening?
Right. Thank you for asking that. Cancer by all estimations takes a long time to develop. I mean,
just because someone has identified a tumor, it didn't just pop up right then. It took years
to develop. And so the notion that you can get rid of it in just a few weeks is ludicrous. So
that's exactly why we have a 12-week program. And it's not a guarantee that your cancer will
be gone in 12 weeks. We have had patients that had that even stage four, but I'm not going to
promise that people. I mean, you have to just understand that that's a starting point and you
may need more treatment than that. And we know that because we monitor patients really closely.
And so everyone's different. I haven't treated you. So you may need more than that, but I'm
confident you don't need less than that. There's just no way if you've never treated your cancer
with any legitimate treatments that you can just get rid of it in three or four weeks. There's no
way. This is a long distance marathon for the patient. It is. It is. Because if a patient's
coming to us with a tumor, we have a lot of work to do, whether it's a stage one or a stage four.
There's a lot going on to get to that point that we need to address. Okay. Fantastic. It's good to
know. Very valuable insights that you're giving us here, Dr. Stegall. In your book, Cancer Secrets,
there was something I read. You talk about the grim reality when it comes to conventional
chemotherapy, that there's no studies being done on fractionated chemo. And let's face it, if there
were, and it was found to be more advantageous to do fractionated doses of chemotherapy,
the pharmaceutical companies would end up losing a great deal of money in that process. Is that
correct? It is. There's really no incentive to pay for those studies, especially since most of
these chemo drugs are off patent. A lot of them are, so they're generic on some level. And so
the money's going into new drugs. They can be patented. They can be, they can cost a whole
bunch of money that someone has to pay for, typically insurance companies. So yeah, there's
really no financial incentive to do research on lower doses of chemo. However, since I wrote my
book, and actually I want to mention the second edition of Cancer Secrets is coming out here in
the next couple of weeks. But one of the things I updated in there is some new research on
low dose chemotherapy versus full dose. And it's really fascinating, a group, again, it wasn't a
drug company that did this study. It was just a group of just cancer doctors that decided we
wanted to study lower doses of chemo. So they looked at advanced cancers, or they looked at
stage four lung cancer, stage four colon cancer, stage four ovarian cancer, and any stage pancreatic
cancer. So these are all advanced aggressive cancers, right? They took, they put these patients
into two pretty much identical groups and made sure that the patients were very similar in terms
of their average age, gender, extent of cancer, all that. So they gave one group full dose chemo.
They gave another group low dose chemo, which they defined as 50% or less of the full dose.
And they not only followed these patients for a few weeks or a few months, they followed them for
10 years. And what they found is, first of all, no one in the full dose chemo group lived 10 years.
And only one person in the full dose chemo group lived five years, but they had multiple people in
the low dose chemo group that lived 10 years. And so they found that the average survival was higher
for all cancer types with full dose, I mean with low dose chemo compared to full dose. So the low
dose chemo patients live longer than the full dose did, significantly so with some of the cancer
types they looked at. And as you would expect, the side effects risk was lower as well,
the side effects. So they live longer and they had fewer side effects. That sounds like a great deal,
doesn't it? Yes, absolutely. So my hope is that with this research, which has not been published,
but it has been released. So I don't know if it's been published as of now, it had not been a couple
weeks ago. But it's legitimate research, it's out there. And I'm excited about it because this
hopefully will encourage others to do similar research, right? We need this. Absolutely. And
I'm excited because I see this in my practice all the time. I mean, I see it all the time.
But everyone says, well, where's the data? Where's the data? Well, here's some data. So it's very
exciting and it reinforces everything I believe to be true. This is very interesting because
obviously the pharmaceutical companies are not going to fund these studies, but this was a group
of doctors that did this on their own. And this is really what it appears it's going to take in the
future. Doctors like yourself, they're really willing to put their money where their mouth is,
where they will make the financial investment to find out, hey, is this integrative stuff working?
Is this different way? This other way of doing this, will it work? So this is exciting. And
you're talking about this in your next book that's coming out. Yes. The second edition of Cancer
Secrets, which will be out in the next few weeks, that's in there as well. What's the title of the
next book? Cancer Secrets, second edition. Okay. So it's the same title everyone is familiar with.
And just to remind everyone, that was with low dose chemo. That didn't even include IPT. That
didn't include fasting. That didn't include getting your diet right. It didn't include taking
the right supplements. It didn't include all these other things that I think are also very
relevant. That was simply looking at chemo full dose versus a lower dose. Wow. So yeah.
That's super encouraging because we know that all these other tools that you're going to use
are going to help the patient. That is fantastic. Now, give us the name of your website where people
can go to your podcast and get all kinds of frequently asked questions answered. Sure. So
the best place to go is cancersecrets.com. You can find information about my podcast. You can listen
to all the previous episodes on there as information about my book. And then also I recently released a
cancer course, an online course that they can find out about on that site as well. It's called Cancer
Secrets University, but it's basically a lot of video modules of me teaching on various topics.
What is cancer? How do you get cancer? Going through all the different therapies, conventional
and natural therapies. What the research is on these. What I recommend to my patients in my
practice. So I think that's something people will really benefit from. That's fantastic. That is
absolutely fantastic. So exciting, Dr. Stegall. Well, listen, everyone, I hope you notice that
Dr. Jonathan Stegall is one of the leading up and coming integrative oncologists in the United States.
He's not afraid to tackle a subject. He's not afraid to answer the difficult questions.
And I could spend another three hours with him in this room, but unfortunately, Dr. Stegall has
patients that he's committed to. But I highly recommend that you go to his website, tcfam.com.
Once again, that's the letter T-C-F-A-M.com and find out about getting a consultation with
Dr. Stegall. It's not going to be an eight minute consultation. It's going to be an hour or 90
minutes or who knows how long it's going to be, but you're going to receive the personal touch
that you deserve when it comes to a cancer diagnosis. Dr. Stegall, I want to thank you
for coming in here today. Thank you. I really appreciate it. I appreciate it.
All right. I'll do this again soon. Yes. Keep up the good work. All right. Thank you.
All right. God bless you. God bless you.