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Welcome to The Dr. Kumar Discovery, a health and wellness podcast hosted by Dr. Ravi Kumar, a board-certified neurosurgeon. This is the medical podcast for anyone who wants honest, evidence-based answers to the health questions that matter most. No corporate influence. Just a physician who reads the research, questions the dogma, and breaks it down in plain language so you can make better decisions about your own health.
Dr. Kumar is a practicing neurosurgeon who brings a surgeon's precision to topics most doctor podcasts only scratch the surface of. Each episode dives deep into the science behind metabolic health, cardiovascular disease, heart disease, hormones, nutrition, brain health, mental health, pain, inflammation, weight loss, aging, blood pressure, sleep, and longevity. Whether it's the truth about seed oils, the real data on GLP-1 drugs and weight loss, the science of cold water therapy, how light can heal the body, or why your testosterone is declining, Dr. Kumar goes straight to the peer-reviewed literature and tells you what the evidence actually shows, not what the headlines say. This is evidence-based medicine in plain English.
The show features three formats. Solo deep dives explore a single health topic from the ground up, covering everything from the biology to the practical takeaways you can use today. Expert interviews bring on leading researchers, clinicians, and forward-thinking voices in health and medicine for in-depth conversations you won't hear anywhere else. The Tribulations series tells the true stories behind medicine's greatest breakthroughs, from the discovery of penicillin to the invention of vaccines to a father's fight to save his son's life. These are the stories of the doctors, scientists, and patients who changed the course of medicine.
Topics covered on the show include testosterone and hormone optimization, sleep science, photobiomodulation and red light therapy, exercise with oxygen therapy, creatine, uric acid and gout prevention, gut health and probiotics, cardiovascular risk and Lp(a), cholesterol, PANDAS in children, PTSD and trauma, acetaminophen safety, glyphosate, foot health, and much more.
If you're tired of generic health advice and want to hear from a neurosurgeon who actually reads the studies, The Dr. Kumar Discovery is your podcast. New episodes drop regularly. Subscribe and join the discovery.
For show notes, references, and more, visit drkumardiscovery.com/podcast
Welcome back to the Dr Kumar Discovery. I'm Doctor. Ravi Kumar. Most of us, myself included, have thought of cancer as just bad luck, something that just happens to you. And once it does, all you can do is fight it with everything that conventional medicine has.
Ravi Kumar MD:Doctor Peavler, who I'm interviewing today, is a hospitalist who has spent years digging into the metabolic and mitochondrial science of cancer. He sees things a little differently. He's not saying skip chemo or ignore your oncologist. He's saying that there's a whole another layer of biology, energy metabolism, oxidative stress, cellular fuel that most cancer patients have never heard about and could change the trajectory of their disease if they consider it in their therapy. So by the end of this episode, you'll understand why some researchers think mitochondrial dysfunction comes before the genetic mutations that we've all blamed cancer for.
Ravi Kumar MD:You'll understand what the PRES Pulse framework is, something that I'm hearing about for the first time, and how this framework starves cancer cells of the fuel that they depend on to grow. You'll also understand why something as simple as high dose vitamin C has shown real results in big clinical trials. Now, I've been trying for a long time to get someone to come on this show and talk about cancer, and honestly, it's been very difficult. Most people don't wanna talk about cancer because it's a very difficult topic with very serious implications for people's health. It's also a complex and hard topic to understand.
Ravi Kumar MD:But Doctor. Peavler is fantastically curious, open minded, and unafraid to delve into topics like this, and I'm very appreciative of it. So that being said, it has to be very clear here that none of what we talk about today is advice. It's not medical advice. It's meant to empower you with information so you can work with your oncologist or your doctor to make better decisions about your own health.
Ravi Kumar MD:In no way is Doctor. Peavler or I suggesting that you go off your chemotherapy or standard cancer treatment. Everything we talk about here today is a potential add on if you work with a qualified health professional. So take this as education, as a way to open your mind to new possibilities and potential ways to get through the crucible of cancer. So that's my disclaimer.
Ravi Kumar MD:And again, take this show as education, not as medical advice. And just to be clear, this show is separate from my role as assistant professor at UNC. Now, one more thing. About 100,000 people tune into the Doctor. Kumar Discovery every month, but only a fraction of you are subscribed.
Ravi Kumar MD:If you're finding value in these conversations, hitting subscribe on YouTube or following on Apple Podcasts or Spotify takes about three seconds, and it's the single biggest thing that helps this show grow and reach more people. Also, a review on Apple Podcasts is like a great gift. So if you have access to Apple Podcasts and you're feeling generous, please leave a review. Alright. Let's get into it.
Ravi Kumar MD:My name is doctor Ravi Kumar. I'm a neurosurgeon in search of the causes of human illness and the solutions that help us heal and thrive. I want you to join me on a journey of discovery as I turn over every stone in search of the roots of disease and the mysteries of our resilience. The human body is a mysterious and miraculous machine with an amazing ability to self heal. Let us question everything and discover our true potentials.
Ravi Kumar MD:Welcome to the Dr Kumar Discovery. Doctor. Peavler, thanks so much for coming on the show. I want to ask you one question to start this off. Is cancer a metabolic disease?
Ravi Kumar MD:Wow, that's a way
Casey Peavler MD:to start off the podcast, That's a paradigm shifting question. And what I will tell you is that I do believe that cancer is different than what we were taught in medical school and undergrad. And I do think that it's much more a metabolic disease than it is a genetic disease. It's just that I'm not saying genes aren't involved. It's just that I think that the metabolism of the of the organism through the mitochondrial, you know, function or dysfunction likely is the precursor to that, you know, those genetic abnormalities that we see in cancer.
Casey Peavler MD:Yes.
Ravi Kumar MD:Okay. So if you do think it's a a metabolic disease, which I also agree with you on that, how should we be thinking about cancer as far as preventing and treating it? I mean, what's different in the way we should be thinking about it versus what we're actually doing with it in modern medicine?
Casey Peavler MD:Yeah, that's a great question. Well, first of all, in conventional medicine, we kind of believe that we don't have a lot of power over whether we get cancer, and if we have cancer, there's nothing we can really do about it. So I think first things first, is we have to teach the truth about how our lifestyle and environment contributes to whether we get a disease like cancer, or if we do well or not well with a disease like cancer. So, you know, what I'll say is that I think it used to be, you know, the doctor would say, Hey, you have this. Go do this.
Casey Peavler MD:You know? And the the patient, if they were a good patient, they would go do it. And I think that that's gonna that that should change a lot. That should be a team a collaboration between the doc and the patient, and the patient has to take a lot more responsibility over their health. And I think that has led to where we're at right now.
Casey Peavler MD:So in terms of just the overarching theme is that you have some onus of what happens to you in terms of the disease, which changes the way we look at prevention. And we also have onus over, if you have a disease, what can you be doing in your role to change the trajectory of the prognosis of that disease? I think that's a very high level way of looking at it. I think that when it comes to straight prevention and straight treatment of diseases, I think that that is where it gets very nuanced. And I think that some of the things that we believe are really good for us may not be.
Casey Peavler MD:And I'll give you probably the most clear cut example of this. So, it's likely that taking certain antioxidants, or having antioxidant rich diet, would likely help prevent cancer. Because the lowering of oxidative stress and inflammation is likely what leads to mitochondrial dysfunction to some degree. And so you probably would have chance at lowering your risk. I think there's a lot of data to support that.
Casey Peavler MD:Whether it be dietary or even some supplemental support that certain either nutraceuticals or dietary strategies that are anti inflammatory or antioxidant type rich diets can help prevent the disease. And there's kind of an imaginary gray line here. Because once you have cancer, the data is also pretty clear that if you're taking antioxidants, it actually worsens prognosis and worsens disease control and mortality. So that's kind of scary. You know?
Casey Peavler MD:Because if it's something like I've been on I mean, an example that I heard on one of your podcasts recently talking about the glycocalyx was NAC or lipoic acid. NAC in studies have actually shown to worsen prognosis and improve or worsen death, right, outcomes of I think the imaginary gray line that's scary is that we've all heard this cliche that, Oh, we all have cancer cells in our body, you know, all the time, and our immune system's taking care of it. And then you don't have a tumor. Right? And when do you know to stop those things?
Casey Peavler MD:Because now all of a sudden you're in this other side of having a cancer. Right? And that's like these nuance y questions that is very difficult to tackle. And we were kinda talking about behind the show, you know, before the show started about how how there's kind of these camps, and these kind of near, like, religious, like, groups. And, as soon as you start to say that NAC, or CoQ10, or astaxanthin, or whatever the thing is that you're kind of offending, saying it could not be a magic bullet that is good for everything, then that's when, you know, people start getting angry.
Casey Peavler MD:You know? So it makes it very difficult sometimes to talk about these but talk about these things.
Ravi Kumar MD:Yeah. I mean, dogma in medicine, like many things, is very strong. And swimming against the current can, even when it's based on the evidence, can make people angry and can even jeopardize your career. And you and I both know that sometimes if you say something that's against the medical dogmatic consensus, people wanna torture you. They wanna burn you for that.
Ravi Kumar MD:Even even though the evidence is right there, like big clinical trials will will support it, but it's not what they think. And that and that is something that it's part of human behavior. You know? You see it in religion and politics too. But, yeah, I I hear you there.
Ravi Kumar MD:So, okay, let's let's go back to this whole thing with the oxidant versus antioxidant. Sure. This will we'll understand this more as we get through the episode and talk more about cancer biology. But when you are if you wanna prevent cancer, antioxidants are beneficial because they prevent that oxidative damage that may lead to cancer tumorigenesis and biology. But when you do have cancer, you actually part of the way you look at cancer is you need to be pro oxidative at certain points to induce cancer stress and and tumor death.
Ravi Kumar MD:So we'll we'll talk more about that in a little bit, which I think is a very important concept. Sure. But people, you know, generally, I mean, even I've thought this for a long time, is that, you know, cancer just happens. It's like bad luck. You get cancer, and you're helpless.
Ravi Kumar MD:There's nothing you can do about it except take drugs and do therapies that try to kill cancer by basically poisoning the body. Correct. And I'm and I'm not I'm not saying that we shouldn't be doing that. That's not what I'm saying. But that is the general way that we treat cancer is by therapies that kill or poison the tumors and poison the rest of our body less.
Ravi Kumar MD:Right? Hopefully. Hopefully. Hopefully. Yeah.
Ravi Kumar MD:Exactly. So but I think that people have to, like, basically change the the paradigm in their brain when they're thinking about cancer in that listen. These traditional therapies, they are effective, and we got a lot of clinical trials that show that they do work. But there's a whole lot more out there as far as prevention and treatment that are not in the mainstream but are strongly evidence supported by the evidence, either empirically or with hard clinical data. And when you get cancer, you should actually be very open minded.
Ravi Kumar MD:I mean, I would be personally. Because why? When when so much is on the line, why not look at low risk possible high reward therapies to add on to our traditional our traditional treatments to try to get through this? Because Right. In the end, I mean, there are a lot of situations where or a lot of cancers that are curable, and there are a lot of case studies and examples of people with uncurable cancers.
Ravi Kumar MD:I'm making air quotes if you're not watching this. No.
Casey Peavler MD:I see it. Oh, I see. Yeah.
Ravi Kumar MD:For the audience, you know? Correct. Uncurable cancers that are cured. I mean, even things like glioblastoma, I've seen it. So, okay, so let's talk about patients who do have cancer.
Ravi Kumar MD:They come to you, they want to know, hey, what can I do outside of my normal traditional therapies? And there's something that you have been working with called PRESPULSE. We talked about it, before the show. Can you explain what that is? Because I think it's a very important concept that people will never hear from their oncologists, but it fits pretty well with cancer biology and may be very effective at improving outcomes in conjunction with normal therapies.
Ravi Kumar MD:So can you tell us what is PRES and what is
Casey Peavler MD:PULSE? Sure. So it basically is interventions that you do all the time, and there are interventions that you do some of the time, things that So are it's like two different levels of interventions. Some of them are chronically done, and some of them are intermittently done.
Ravi Kumar MD:Right, okay. So tell me, what is the press, and what is the pulse?
Casey Peavler MD:Right. So traditionally, the presses are diet and stress reduction techniques. The diet specifically a therapeutic ketogenic diet with specific targets, and the stress reduction would be pretty much any kind of mind body practice that would help lower glucocorticoids and catecholamines to help reduce glucose and insulin so that it doesn't derail your ketogenic diet.
Ravi Kumar MD:Okay. So you're generally pressing, basically pushing glucose down. Tell us why that matters in cancer biology. Like why does having lower glucose levels affect cancer?
Casey Peavler MD:What we know is that cancer cells, from a metabolic perspective, behave different than a normal cell. A normal cell that has functioning mitochondria and plenty of oxygen can be metabolically flexible. And cancer cells, which have damaged dysfunctional mitochondria and are hypoxic or have low oxygen levels, cannot be metabolically flexible because they don't have oxphos on their side. So we're trying to leverage that from a dietary perspective.
Ravi Kumar MD:Okay. So basically, you're saying that cancer cells are highly dependent on metabolizing glucose for energy.
Casey Peavler MD:And the and the amino acid glutamine. Correct. Yeah.
Ravi Kumar MD:Okay. And but the rest of our cells are non cancer cells. They're more flexible. They can metabolize other things like ketones and fats to create energy. Correct?
Ravi Kumar MD:The cancer cell is can't do that?
Casey Peavler MD:Correct. And and other amino acids. Right? Other amino acids can break down to either glucogenic amino acids or ketogenic amino acids through the various pathways, but they still require an intact electron transport chain, and they require also oxygen there. If you don't have that, it is you cannot be flexible like that.
Casey Peavler MD:Yeah.
Ravi Kumar MD:So why does cancer lose this ability to stay metabolically flexible like the rest of our cells?
Casey Peavler MD:Yeah. So I think that, from what I understand, is that there is a gradual loss of mitochondrial function in that colony of cells that develops a malignancy. Okay. And it's kind of debatable, like the actual mechanism. I tend to favor, like, a Doug Wallace type view of it, where you're looking at what they call mitochondrial heteroplasmy, which is the percent of good or healthy wild type mitochondrial DNA to diseased DNA, and that changes the bioenergetics of the mitochondria because those proteins on the mitochondrial DNA encode for oxphos proteins.
Casey Peavler MD:So if you have damaged DNA, they can't encode for the same quality of proteins, and you get a bioenergetic decline when you hit
Ravi Kumar MD:a threshold, that is what leads to a disease. Okay. So so glycolysis, which is churning glucose into pyruvate into to net ATP, very inefficient, and it leads to lactic acid production. That's generally intact in cancer cells. But that further progression to oxidative phosphorylation, which is the electron transport chain, that is that is all gunked up from mitochondrial gene mutations.
Ravi Kumar MD:Is that what you're saying?
Casey Peavler MD:What yeah. It's a combination of things. Basically, pyruvate cannot effectively get into the mitochondria through basically, there's an there's an enzyme that blocks pyruvate dehydrogenase called PDK, pyruvate dehydrogenase kinase, that's set up by the metabolic reprogramming, MYC and HIF. These are these are basically factors that lead to metabolic reprogramming. So it's it's a combination of mitochondrial dysfunction, like the electron transport chain proteins are broken, hypoxia, low oxygen, which sets up in tumors, and other kind of like metabolic messengers that actually kind of divert flux away from mitochondria.
Casey Peavler MD:Probably as a protective mechanism, to be honest with you. Okay. To lower ROS, to make sure there's not an intrinsic apoptotic event. And then what you're left with is a, like you said, a very inefficient process that doesn't require intact mitochondria and doesn't require oxygen.
Ravi Kumar MD:Okay. So this kind of goes back to where you said earlier that many cancer patients have mitochondrial problems. They're not efficiently metabolizing energy. And it sounds like it leads to this cascade of cancer, honestly, because that sounds like in the progression of, you know, energy metabolism. Okay.
Ravi Kumar MD:So you're pushing down, you're pressing down glucose, and you're doing that through diet. Is that correct?
Casey Peavler MD:I would say everything that I have my at my disposal. I use diet. I use nutraceuticals. I use pharmaceuticals. I use light.
Casey Peavler MD:I use exercise. I use anything possible. I've looked at K. Anything we can do because it's not easy for a lot of people to get their glucose down. It's not easy.
Ravi Kumar MD:It's not. Okay. So what kind of nutraceuticals and pharmaceuticals will lead to low glucose levels?
Casey Peavler MD:Sure. So I guess we'll start with pharmaceuticals. I I I like to use metformin. There's actually data to support metformin actually from a mortality perspective. So I I like it because it got some mortality benefits.
Casey Peavler MD:It's got a lot of metabolic benefits that are outside of its traditional use as a anti hyperglycemic, used for diabetics or pre diabetics. So I like metformin.
Ravi Kumar MD:Okay.
Casey Peavler MD:And then I use nutraceuticals that have data behind them. Things like berberine, things like milk thistle, things like fibers, all have A1C data, fasting insulin data, glucose data. And there's a bunch of other ones that have weaker data. Even, you know, berberine, which is kind of like the most famous of the natural ones, is actually not as good as milk thistle, not as good as garlic, you know, when it's getting it. Know?
Casey Peavler MD:So Okay. It's kind of interesting. But, yeah, there's a lot of things that you you can do, you know, to help your blood glucose. There's no question.
Ravi Kumar MD:Okay. So you're doing pharmaceuticals, nutraceuticals, and then, of course, diet. To push glucose down, do you put patients on zero carb diets, or can they have some amount of carbohydrates in their diet?
Casey Peavler MD:Yeah. That's a great question. So I think zero would be difficult or impossible, but, you know, definitely low. You know, I kinda like just go from a general structure perspective. Like, A ketogenic diet is generally a low carbohydrate diet.
Casey Peavler MD:It's a high fat diet. And the protein is really the macronutrient that I'm kind of like playing with a little bit. I want it to be as high as I can get, but what really is gonna determine whether or not what their macros truly look like will be their glucose ketone index.
Ravi Kumar MD:And that is the comparison of blood glucose to ketones in the blood.
Casey Peavler MD:Correct. It's a tool that C Fried again, et al, had created to figure out, are you in ketosis at all? Right. And what degree of ketosis are you actually in? So it's basically just glucose over ketones equation.
Casey Peavler MD:It's just that you have to do a unit conversion here in The States because we use milligrams per deciliter. You have to basically divide it by 18 to get the millimoles. But there are calculators, you know, online. You just plug in your glucose, you know, milligram per deciliter, ketones, millimoles, and then it just does the calculation for you.
Ravi Kumar MD:Okay. So say someone is goes on a low, you know, carb diet, high fat, and they're doing the nutraceuticals and pharmaceuticals. Is there some is there some difference between different people you see that, hey, this person's gonna go into ketosis really well, and this person's just it's gonna be hard even with all these things that you're doing?
Casey Peavler MD:I mean, think there's always the kind of the obvious ones. Like if you have a BMI above thirty, if you have known either prediabetes or diabetes, it's gonna be a longer journey for you. And that's kind of the n equals one to this. Some people, they may be ready to start, you know, pulsing, like, within a week, you know, because they've got their glucose down and their ketones are, like, perfect within a couple of days. And some people, it may take months, you know, before it gets there, you know?
Casey Peavler MD:And I think it's this is a this is a really easy area to be very dogmatic and, you know, perfectionist as well. It's like, oh my god. If my GKI is not one, I'm like, you know, hurting myself. I mean, like, let's keep it in context. Like, most people who have cancer, they are not even thinking about their glucose levels.
Casey Peavler MD:You know? They're not thinking about their fasting insulin levels. They're not thinking about the A1C. Right? That's just not on their radar.
Casey Peavler MD:So the fact that you're even thinking about it means you're probably like better than 99% of people in your position. Right? So I try to like, I try to think of it as a continuum. You know?
Ravi Kumar MD:Yeah.
Casey Peavler MD:You know, if your glucose is two fifty, you're doing probably pretty poorly. If it's 180, you're doing better. If it's 100, you're doing better. You know? But the goal, just to put it out there, is to keep it as low as you can.
Casey Peavler MD:You know? If you can hit one, that's kind of the goal, the hard goal. But the softer goal is less than two continuously. And even that's difficult. That can be very difficult.
Ravi Kumar MD:Hey, guys. If you're enjoying this podcast or it's helping you, please help me get it out to the rest of the world. All you need to do is rate and review it on Apple Podcasts. Share it with a friend, post it on Facebook, and that's basically it. The algorithm rewards engagement.
Ravi Kumar MD:Every review, every mention puts this show in front of someone who's looking for clear, no nonsense health information, the type of information that I'm putting in these podcasts. So thanks so much, and let's get back to it. So you're pushing glucose down as much as you can. You also talked about glutamate, which is another source that cancer can create energy from. So what are you doing with glutamate?
Ravi Kumar MD:Because we make glutamate in our body, right? Correct. Yes.
Casey Peavler MD:It's the most abundant amino acid in the bloodstream. It could be 10x higher than some other amino acids. And so there's not a lot you can do from well, from a dietary perspective, short of not pounding glutamine powders, you know, and maybe like some protein drinks that have a lot of glutamine, like whey has quite a bit of glutamine in it per serving, you know, there's not a whole lot you can do from a dietary perspective. Now, will say that acute genic diet, one of the things people are kind of misunderstanding is it's also not like a high protein diet either. Right?
Casey Peavler MD:So it is kind of a moderate to low, depending on your situation. So you're not gonna be bringing in a lot, but you cannot control the bloodstream amount of glutamine. Know? Yeah. To be fair, I'll back up a little bit.
Casey Peavler MD:There is some studies that show that if you exercise, it will lower blood glutamine levels for about two hours after an exercise bout, but it's transient. It's not really making a meaningful difference. The goal for that is not necessarily to lower dietary glutamine or lower blood glutamine levels. That's difficult, or impossible maybe.
Ravi Kumar MD:Okay. Are you doing anything there, or are you letting it ride?
Casey Peavler MD:Everything I possibly can. Okay. So what I'll tell you is that traditionally, if you look at how it's being handled from a metabolic perspective, A, as in Sieffried's group et al, are looking at effectively one enzyme within a system of enzymes. And that system is called glutaminolysis. Instead of glycolysis, now we're moving over the glutamine glutaminolysis.
Casey Peavler MD:And that system is just like glycolysis. There's an uptake channel, and there's enzymes that break down different levels, and it enters into the TCA cycle, or it does other things. So there are several targets in that system. And the way I think about it is kind of like how we go after HIV or tuberculosis. We use three or four different drugs at Instead a of using just one hammer, why not kinda shut down the entire system or mildly hit every system?
Casey Peavler MD:And then maybe if you're gonna hit it, maybe do that in a pulse fashion because there is maybe harm. That's kind of why the glutamine side of it is pulsed. That's still kind of to be determined about exactly how to best do that. We don't have as many therapeutic tools there. I mean, some of them are being developed, but, yeah, that's that's the way I look at it, I guess, to be concise, is that I look at it as a system, and I try to affect as many nodes in that system as I possibly can.
Ravi Kumar MD:Okay. So is blocking glutaminolysis in the pulse side or the press side of this strategy?
Casey Peavler MD:Yeah. So traditionally, it is a pulse. I will tell you is that there's literature suggests that pressing it may be better, and it may be safe. Know? Okay.
Casey Peavler MD:A couple examples. There are papers that are looking at Dawn, which is the classic glutaminalysis blocking drug, at lower doses daily. Seems to be better tolerated and fairly safe without a lot of side effects, and also maybe efficacious. And then if you look at there's a there's a there's a paper in in your wheelhouse at GBM where they added to I think it was surgery radiotherapy and temozolomide. They added mebenazole.
Casey Peavler MD:Mebenazole down regulates the expression of a glutamine enzyme called glutaminase, and that improved outcomes in that small phase one clinical trial. Right? Yeah. And they were given massive doses of of meibenazole daily. Right?
Casey Peavler MD:So as a in a kind of a pressed fashion. Right? So I think it's arguable what needs to be pressed, what needs to be pulsed, and I think we have a lot to learn still. Okay.
Ravi Kumar MD:Okay. So but conceptually, pressing, again, just for the audience, is this initial step in cancer biology or your diet and lifestyle and drug therapy for cancer, where you are trying to push the energy inputs for cancer down through de stressing less glucose energy metabolism and possibly less glutamine for energy metabolism for the cancer. So you are basically putting this cancer under stress because it doesn't And have then a stress system is much more vulnerable to pulses of it sounds like pro oxidant therapy that you're I think you're gonna tell us. So tell us what the pulse is. What what are you doing now that you've got this tumor chronically stressed?
Ravi Kumar MD:What are you doing in on the pulse side?
Casey Peavler MD:Before I get there, can can I can I thicken the plot a little bit? Yes, please. So when I also first got into this, I was only thinking about this from an ATP perspective, an energy perspective. And I'm not saying that's not important. I'm not trying to minimize it.
Casey Peavler MD:But I do think that another thing that I learned in all this journey is that if you actually look at where the antioxidant systems of our body rely on this chemical called NADPH, probably 80% of it comes from glucose and glutamine metabolism. Right? So what I'm trying to get at is that the redox balancing systems in our body rely on glucose and glutamine also. Right? So if you shut down glucose metabolism and glutamine metabolism, you're also shutting down redox homeostasis balancing systems.
Casey Peavler MD:Glutathione, thioridoxin, all of them require NADPH. So my point is, is that you're you're maiming it bioenergetically. You're maiming you're maiming it from a biosynthetic perspective too, because glucose turns into glycine and other, you know, biomolecules to the PPP, and glutamine turns into other amino acids and helps with DNA and RNA synthesis and fatty acid synthesis, you name it. So biomass also is diminished because it's a raw material as well. But the redox homeostasis thing is really interesting because not only are you lowering energy, but you're lowering the ability for that cell to protect itself from oxidative stress.
Casey Peavler MD:And that seems to be, I think as important, or maybe in the long run more important than even the energy side of things. Because if the cell can't protect itself against oxidative stress, it'll either collapse under its own ROS, RNS, or if you add exogenous stress to the system, whether it be conventionally through some certain chemotherapies or radiotherapy, it's gonna have a different biology fundamentally and ability to protect itself against those therapies than it would otherwise.
Ravi Kumar MD:So you're blocking basically the biosynthetic inputs for these antioxidant systems that protect the cancer cells from ROS, which is reactive oxygen species, which are like firecrackers inside the
Casey Peavler MD:cell. Mhmm.
Ravi Kumar MD:And that's not happening in normal cells?
Casey Peavler MD:Well, what they what's believed is that cancer cells are riding on this redox edge. Make a lot of ROS more than a normal cell. They rely more heavily at the edge of their antioxidant systems. So they're primed to be over the edge, just at baseline. Whereas the normal cells, they're much lower amounts.
Casey Peavler MD:Right? Okay. And because they're more metabolically flexible, they can also kind of like deal with oxidative stress better in pulses than the cancer cells can. Right? So you're kind of leveraging that.
Ravi Kumar MD:Okay. Okay. So the fact that you've pushed down glucose and glutamine metabolism, you're already handicapping the antioxidant ability of these cancer cells. And now you're coming in with pulses, and what are you doing there? You're introducing pro oxidants.
Ravi Kumar MD:Correct?
Casey Peavler MD:Yeah. I mean, think everybody's an A equals one. But the the two kind of nontraditional ways of delivering oxidative stress are either intravenous high dose vitamin C or hyperbaric oxygen therapy, and those could easily be stacked and combined.
Ravi Kumar MD:Okay. Okay. Let's talk about IV high dose IV vitamin C because I've seen this actually perform like like a medical miracle. I'm not joking. I actually did a whole podcast on vitamin c, and there was this boy who came in with basically leptomeningeal spread of cancer from his brain all the way down his spine.
Ravi Kumar MD:Every surface of his central nervous system was covered in cancer.
Casey Peavler MD:Oh my god, man.
Ravi Kumar MD:And he went through radiation and started chemotherapy, and finally, the the pediatric onc guys were like, he needs to go on palliative care.
Casey Peavler MD:Sure.
Ravi Kumar MD:Well, the mom I had shunt done a VP shunt on him, so the mom came to me and is like, hey. I want you to help me convince the oncologist to let me use his port to put IV vitamin c in because they had told her no. And so I went and had discussion with the pediatric surgeon and oncologist. I was like, come on. Just what do we have to lose here?
Ravi Kumar MD:And they said
Casey Peavler MD:they said,
Ravi Kumar MD:well, it could get infected. I said, yeah. And, I mean, versus death, let her try this. This is a source of hope for them. So they said yes.
Ravi Kumar MD:She went and started doing IV vitamin c on that little boy. This was six years ago. He's still alive today and completely almost completely normal. Wow. I'm talking every single peel surface of his brain and spinal cord covered in cancer.
Ravi Kumar MD:Every single surface. Unbelievable. And leptomeningeal disease of the central nervous system is a death sentence within I
Casey Peavler MD:believe it.
Ravi Kumar MD:Week within weeks. Yeah. And this boy is thriving six years later. Was completely amazing. From IV vitamin c, he was not doing anything else.
Casey Peavler MD:Nothing else. Yeah. That that's the that's the fascinating thing, Robbie, is that actually when you look at the publications of intravenous vitamin c, it's basically intravenous vitamin c plus standard of care. It's not like IVC plus chemo or keto plus nebenazole plus something else crazy. It's just vitamin C.
Casey Peavler MD:And it actually does improve outcomes. So the problem that actually the port would have been the best place to inject it, because it can be fairly If you do it chronically, I mean a lot of the people that I It seems like it's mostly women, but if they do it fairly regularly, it does seem to cause a little bit of phlebitis, or just they can't find a vein as easily. I don't know if it's a sclerosis of that vein that they use all the time or something like that, because I think it's probably got a little bit of maybe a little caustic or something like that. But in general, it's very well tolerated. It's also expensive.
Casey Peavler MD:I hate that about it. It But is an amazing intervention.
Ravi Kumar MD:Yeah. I mean, because the clinical trials are pretty significantly impressive. I mean, they're very impressive. Like, pancreatic cancer adding Doubling survival? Yeah.
Ravi Kumar MD:Doubling survival in pancreatic cancer is, like, from eight months of survival to sixteen months just by adding IV vitamin C to the therapy. And the IV vitamin C is completely tolerable. So Yeah. And they've shown something similar in GBM. Mean, they've done it in breast cancer.
Ravi Kumar MD:The only trial I've seen that there wasn't some significant benefit was prostate cancer, and they they surmised that it was because a catalase was blocking the hydrogen peroxide, or catalyzing the hydrogen peroxide. But I mean, what do you think is happening here with IV vitamin C that's creating such benefit for cancer?
Casey Peavler MD:Yeah. That's a really great question. So I like mechanism. You know, I like to understand why something works. I think most of us go to medical school, we wanna know why.
Casey Peavler MD:Right?
Ravi Kumar MD:Right.
Casey Peavler MD:And I think we kinda I don't know if you agree with this, but I think we kinda lose that, like after the preclinical years. You know? After like second year of medical school, you pass your boards, and like, you just kinda forget about biochemistry for the rest of your life. And I think that's really too bad. But anyway, so, yeah, I think what I've been really focusing in on recently is something called ferroptosis.
Casey Peavler MD:And it relates to vitamin C because the vitamin C, what it does is it reacts with extracellular iron. And there's this I'm not a chemist, but it's called the fentanyl reaction. And the fentanyl reaction leads to more unstable radicals, like the hydroxyl radical or other radicals. And that damages lipids on the extracellular part of the cell. But what's fascinating is, is that once the ascorbate, the ascorbic acid, the vitamin C, you know, interacts with iron, it then transforms into dihydroascorbate or DHA.
Casey Peavler MD:There's three DHAs in medicine, which is confusing. Yeah, right. And DHA is almost structurally identical to glucose. So it actually goes into a GLUT1 transporter, reacts with antioxidant systems inside the cell, re goes into ascorbic acid, and starts doing damage inside the cell through hydrogen peroxide signaling through that way to the fentanyl reaction. Yeah.
Casey Peavler MD:So it's oxidative stressor, but it has to be at a certain dose, and kind of like timing too. It probably would matter, like if you do, let's say, generally the dose from these experts is like zero point five to one point five grams per kilogram, like two to three grams per week. That's kind of like the general expert opinion. And most of the clinical trials use seventy five or eighty five grams, you know, three grams per week. That's kind of the clinical trials, the way they do it.
Casey Peavler MD:And so my point is, is that if you gave the right dose and even the right schedule, but you infused it over like twenty four hours, it probably wouldn't have the same effect as if you did it in an, I'm not saying you slam it in, but you do it over like an hour and a half or something like that. So it probably, the concentration really matters. And the kind of concentrations you need with vitamin C to get that effect that you're looking for is not at all achievable any other way. Even low dose intravenous would not be achievable. And this is where it gets very nuanced because the same chemical can be given orally or liposomally or other ways.
Casey Peavler MD:And people think, well, I can't I'm not saying that you should feel bad about this, because I think if I was in that shoes, it would be hard for me to afford it. But my point is if you can't afford the vitamin C IV, then you're like, well, me take this liposomal because this doctor said that it's as good as vitamin C IV, and it's not. And then you're looking at the papers that show a mortality detriment. Right? So it's very nuanced.
Casey Peavler MD:Very nuanced.
Ravi Kumar MD:Yeah. Okay. So that's very interesting because most people think of vitamin C as an antioxidant. Correct. Which it is.
Ravi Kumar MD:It is. But here, it's actually reducing iron, which then basically reacts with oxygen, creating hydrogen peroxide in this hydroxyl radical, which most people haven't heard of a hydroxyl radical. There it is the most damaging compound in human biology. There's no enzyme that can basically neutralize it. And that is specifically happening in cancer cells because cancer cells have more iron in them.
Ravi Kumar MD:Is that correct?
Casey Peavler MD:Well, what I will say, because the initial reaction happens in the TME, the tumor microenvironment, is what it seems to be on the extracellular side of things. And I don't know the exact levels, and I've tried to actually figure this out. But there is clearly differences. Just like cancer cells can't use ketones or fat effectively, they also import iron at a much greater rate than a normal cell in amount, and they don't export it as much. Right?
Casey Peavler MD:So they they need it for replication, for cytochrome creations, or whatever they gotta do with those things. But like, it also makes them exquisitely vulnerable to ferroptosis compared to a normal cell that doesn't have not have the same iron storage kind of like differences.
Ravi Kumar MD:Okay. Okay. So that makes cancer specifically susceptible to high dose IV vitamin C that normal cells don't have susceptibility to.
Casey Peavler MD:Right.
Ravi Kumar MD:So it's
Casey Peavler MD:gonna be much less damaging.
Ravi Kumar MD:Yeah. And I and the studies have shown that high dose IV vitamin C is very safe, unless you have like g six p d s negative Which
Casey Peavler MD:is rare, but it does happen.
Ravi Kumar MD:Yeah. And and then and you know if you do because it's a genetic trait that that that your doctors likely warned you of. But okay. So high dose IV vitamin C, you're you're suggesting this on the pulse side to induce oxidative injury to an already stressed system because you've pushed down its energy its fuel for energy production.
Casey Peavler MD:Correct.
Ravi Kumar MD:And then you mentioned hyperbaric oxygen therapy. Tell me about that.
Casey Peavler MD:Yeah. So, you know, before I got into this, I had like very little experience with hyperbaric oxygen. I had a little bit, because I was a flight surgeon in the air force, and we had to do like hyperbaric medicine courses. But like in general, I had little understanding of of of what we were actually doing. So what I'll say is that there's there's probably multiple mechanisms of how, you know, hyperbaric oxygen functionally works.
Casey Peavler MD:But what I will say is that and this is hard to grasp. But the cancer, the more hypoxic or low oxygen it is, the more it thrives. Because it doesn't require oxygen for energy. Right? Because it's using those fermentation pathways, it can be just pretty much just fine in even near anoxic regions.
Casey Peavler MD:And that limits therapy from working well. So one thing that hyperbaric oxygen can do is it can deliver oxygen to tissues in ways that mean you breathing 21% cannot. Right? Because, you know, if I was to check your pulse ox or you check my pulse ox, like we're like at 97%, 98%. Maybe if I take a big deep breath in, maybe it goes to a 100, maybe.
Casey Peavler MD:Right? So my point is, is that we've already saturated hemoglobin maximally. And you have a very small amount of oxygen dissolved in plasma. And that is the oxygen that we're really trying to affect. We're not trying to push hemoglobin from 98 to a 100.
Casey Peavler MD:That's basically useless. What we're trying to do is we're trying to dissolve plasma oxygen. And there is a cutoff of what you can do depending on the fractional excretion or inspirational oxygen. Right? So if I turn your nasal candle up to six, right, you're gonna get about 45% oxygen.
Casey Peavler MD:Right? If I put a mask on you, you'll get maybe closer to eighty, ninety percent. Right? If I put you on a BiPAP or intubate you, you're gonna have higher percents. Right?
Casey Peavler MD:But you're still limited by the amount of pressure at that. Right? So what we're doing is we're adding percent oxygen to depending on the chamber you're in, because some of them it's kind of a little bit fishy. Some of them will just use kind of like 45% oxygen. Some of have a mask, so you're breathing like a 100% oxygen.
Casey Peavler MD:You kind of have to know. But then you're adding You're not only adding percent oxygen, but you're also adding pressure. And I'm not a physicist, but that basically, you know, through gas laws, makes it so you can dissolve more, oxygen or gas into plasma, right? Into plasma. And so you're able to dissolve many folds.
Casey Peavler MD:I don't exactly know what it is, because there's various publications that say different things. But it could be somewhere between 10, as much as more than 100 fold oxygen in your bloodstream. And that is important because the oxygen in the dissolved plasma is much more able to get in nooks and crannies in places where normal hemoglobin can't. And if you look at the tumor itself, the tumor biology and the blood vessels that are created in a disease environment like that, they are very leaky. They're very weak.
Casey Peavler MD:They're very disformed. So hemoglobin already has a hard time getting there. So the dissolved plasma is really good. So hyperbaric oxygen is a way to deliver oxygen maximally to that tumor. Now that can help reverse some of the metabolic reprogramming seen for, you know, HIFs and stuff like that.
Casey Peavler MD:And I think that's probably a piece of the mechanism. But the other mechanism is reactive oxygen species. And reactive oxygen species, as you would imagine, the limiting factor for reactive oxygen species creation is oxygen. And these cancers are generally pretty hypoxic, which kinda protects them from oxidative stress. So we're adding what's missing, and that is leading to hopefully radical creation and oxidative stress for the cancer.
Ravi Kumar MD:Okay. So it's similar to IV vitamin C in that you are creating oxidative stress. Correct. By delivering oxygen to a tissue that's generally anoxic and surviving on glycolysis now, and it doesn't have the antioxidant systems that deal with all this oxygen, you're flooding it in there and creating oxidative damage. Whereas the remainder of your cells, all your healthy cells, they still have functioning mitochondria and electron transport chains.
Ravi Kumar MD:They can they can use that oxygen to make energy and and and basically neutralize any free radicals that come from that. So, like, flooding your body with oxygen for short periods of time is not damaging. Long periods of time, it can cause oxygen, toxicity, but that takes a long time. Yeah. Cancer, in short order, is essentially poisoned by oxygen, is that right?
Casey Peavler MD:Correct. Yeah. I think it's fair to say it's basically poisoned by oxygen. I mean, I think it could be taken from a non nuanced perspective as a little bit simplistic, but yeah, basically it is. Okay.
Ravi Kumar MD:Okay, so that's our Is that your press and your pulse? I mean, did we go over the full gamut of tools you have, or are there more things you can do?
Casey Peavler MD:Yeah. Yeah, that's funny you say that like that, because, yeah, I would say that's like the traditional press pulse.
Ravi Kumar MD:Okay.
Casey Peavler MD:I think there's a hell of a lot more you can do.
Ravi Kumar MD:There is.
Casey Peavler MD:Okay. Yeah. I think there's a lot more you can do. And I think it has to do with, again, thinking about this as a system. Right?
Casey Peavler MD:And it's gonna take a team effort, there's no question. That's why I read so many papers from experts, biochemists or cell pathways. And I've really tried to study what makes conventional medicine, and even maybe metabolic medicine, fail. And so, yeah, I think there's other antioxidant systems that could be targeted. I think that there are other targets outside of glucose and glutamine directly that could be beneficial targets.
Casey Peavler MD:There's a lot of meat on this bone.
Ravi Kumar MD:There is, okay. So that's definitely something that if you're gonna work with someone who's doing cancer energetics or mitochondrial energetics, you can explore. But there is this framework for stressing and then basically putting cancer in a stress state and then giving it a pulse of oxidative therapy that can be effective. You know, this kind of reminds me, and I I think I read this somewhere, that this was modeled after ecology. Because if you look at ecological environments, when an environment is stressed, let's say there's like drought, and so the environment's stressed, the plants don't have enough water, the animals don't have enough food, and then you get a viral pathogen or something comes through, the whole ecosystem collapses.
Ravi Kumar MD:Whereas if the ecosystem wasn't stressed in the first place, it wasn't pressed, that virus would have been dealt with, have there been resilience in all this, and it would have survived, but here, because of your you have a chronic stress, and then you induce an acute stress on top of it, the whole thing collapses from an ecosystem wise. And that sounds kind of like what's happening with cancer.
Casey Peavler MD:Yeah. I think it's how I think it's where where doctor Sieffried actually got it from. It was basically something like that.
Ravi Kumar MD:Yeah. Okay. So I must have read it in one of his Okay. So that's really cool. There's a couple drugs I wanted to just briefly go over.
Ravi Kumar MD:And Sure. The the reason I wanna talk about these is the two drugs are mebendazole and ivermectin. These drugs have been completely, especially ivermectin, have come been completely politicized to the point where we stop asking the basic question, well, do they work or don't they work? Are they harmful or are they not harmful? And instead, we start asking, well, do Democrats think they work or do Republicans think they work?
Ravi Kumar MD:You know?
Casey Peavler MD:I mean, and it it totally Or or independent li libertarians. What do they think they work?
Ravi Kumar MD:Yeah. Right. I mean and and we and and now you hear the word ivermectin and you think conspiracy theorists where it turns out ivermectin studied at, you know, Harvard and Johns Hopkins, there's been large clinical trials done on it. And they have shown real clinical data to affect cancer biology in beneficial ways. But we've we've gotten so dogmatic about just their names that we don't even wanna ask the question, do they work?
Ravi Kumar MD:So can we talk a little bit about that? I know it's a Yeah. A lightning rod. But I'm happy
Casey Peavler MD:to talk about it. I'm actually Okay. I do videos on these things, so that's fine with me. What I will tell you is that despite being smeared by, you know, media, they are FDA approved medications.
Ravi Kumar MD:Yeah. Right.
Casey Peavler MD:And they have been for a long time. And most of us I mean, I don't know about you, but I had zero experience with these medications at all. Because let's be honest, I don't treat parasitic infections. I don't treat, you know, worm infections. I don't I don't I don't I don't have any of that that I'm aware of in terms of, you know, at the hospital or something like that, where I'm not using it.
Casey Peavler MD:Don't know to dose it. You know? Like so, yeah. I guess in some ways it's foreign to me because that's for countries over there. Right?
Casey Peavler MD:Like, not here. Right. But it is FDA approved. You know? It is on formulary.
Casey Peavler MD:You know? And
Ravi Kumar MD:And they're both anti Correct? They're both anti parasitics.
Casey Peavler MD:Yeah.
Ravi Kumar MD:Okay. But they they have biological effects that are being explored in cancer and antiviral viral effects. Yeah. Okay. Okay.
Ravi Kumar MD:So just that that I just wanna make sure the audience understood what you're talking about third world countries because, yeah, they're very safe and effective anti helminthics, which is an antiparasitic drug. So okay. Tell us what what the science tells us about what these do to cancer biology.
Casey Peavler MD:Yeah. So what I'll say is is that the reason why they're approved is for on target, clear biologic mechanism effects. But just like any drug like Benadryl or any other drug, they can be dirty. Right? They can have off target effects that are not expected.
Casey Peavler MD:So some of the mechanisms are truly on target, like for example, mebenazole and being a microtubule inhibitor or whatnot, that's important for cell division. And it still kind of looks at cancer from genetic disease. Replicating, always dividing. So it needs to be, of course, these needs the microtubules. But, you know, that may not be the only reason that it works.
Casey Peavler MD:There's a bunch of other mechanisms that happen to to be and I and I always try to look at something holistically, I guess, of all the things that it can do. But I have to be honest, I'm also fairly biased. I wanna know, does it affect glucose, does it affect glutamine pathways? And both do. You know?
Casey Peavler MD:Okay. What we know about, what believe about mebendazole and its cousin, Fenbendazole, or Albendazole, or Flubendazole, they're all the same family, right? They likely I don't wanna say block, but likely block or inhibit or down regulate GLUT transporters on the cell surface. So less glucose getting into the cell. There may be off target effects at the level of glycolysis as well, maybe hexokinase two, maybe some other glycolytic enzymes.
Casey Peavler MD:And what I think the main reason for using it potentially in cancer is the fact that it down regulates to a high degree the glutaminase enzyme. The glutaminase enzyme is, I would argue, it probably is the most important of all the enzymes in the system. Because once glutamine is converted into glutamate by that enzyme, glutamate is then used in multiple ways inside the cell, whether it be fatty acid, whether it be nucleotides, whether it be other amino acids, whether it be energy production, whether it be glutathione production. So I would say I would you could probably make the argument that that is the probably most important node. And at fairly, I believe, and time will tell, achievable concentrations, if dosing used in human studies, you are likely decreasing the expression of that enzyme by 50 to 60%, you know, which could be meaningful.
Ravi Kumar MD:Yeah. Yeah. So that that's really interesting. And and the interesting thing about membendazole is it it crosses the blood brain barrier. Does.
Ravi Kumar MD:Does. Which it it's hard to get anything into the brain. Most of our drugs don't cross. And, there was one study I saw where they I think they combined mebendazole with a statin, doxycycline, and maybe metformin. I can't remember.
Ravi Kumar MD:There was, like, four drug cocktail. And it was like a almost a doubling of survival in glioblastoma. Mean, it was it was ridiculous. You know? I mean, if we had a a chemotherapy came out that did that, they it'd be, you know, it'd be a billion dollar drug.
Ravi Kumar MD:But here we have, you know, these repurposed generic medications doing something, and then it just goes silent. No one hears about it. So okay. So mebendazole is interesting. It it it sounds like it's a it's got a a multifactorial or more multi target effect on cancer.
Ravi Kumar MD:Can people who are taking normal their normal standard chemotherapy and radiation treatments take mebendazole?
Casey Peavler MD:Obviously, it's gonna be a discussion between your doctor, but I would say that it makes a lot of sense to do it because of you know, again, bioenergetically speaking, you're lowering glucose availability to the cell. You're lowering glutamines availability to the cell. Yeah. And you are effectively maiming antioxidant systems before hitting it with radiation or certain chemos, which have pro oxidant effects. Yeah.
Casey Peavler MD:So it would make sense to me. And a lot of times it's pretty cool because Ravi, when they study these when they say these compounds, you know, whether it be some nutraceutical or whether it be Ambenazole, a lot of times they're looking at it and they're saying it enhances gemcitabine chemotherapy or cisplatin chemotherapy or whatever, or radiation They're therapy, looking at it from a synergistic perspective. So not only mechanistically does it make sense that it would, but at least in preclinical models, a lot of times, most of the time, it does seem to have synergistic effects with the standard of care as well.
Ravi Kumar MD:And how tolerable is it? Mean, there side effects with mebenzol, the big ones?
Casey Peavler MD:Yeah. I mean, the most I would say the most I don't wanna say feared, but the most common would be, you know, elevations in transaminases, the AST, ALT elevations. It's not common. I would say, you know, even at, like, good doses, you know, I would say it's, maybe less than five percent of people have even a mild bump in their transaminases. Most people don't have any at all.
Casey Peavler MD:I've only seen a couple people who have kind of like hyper responded, I guess you'd call it, in a negative way with either Memben or Phenben, where they will bump their transaminases even at fairly, what I would consider subtherapeutic doses. And as soon as you back off, no matter what the camp they're in, they will generally normalize within a week. So it's something that's not that big of an issue for Okay.
Ravi Kumar MD:Imidazole. And those transaminases, those are the liver enzymes.
Casey Peavler MD:Yes.
Ravi Kumar MD:Yes. So okay. So yeah. And again, folks, you know, everything we're talking about here is for education, and you can work with your doctor or find a doctor who's able to guide you through this. But you do have to have a doctor guiding this.
Ravi Kumar MD:Don't go down the Tractor Supply store and buy it does have to be pharmaceutical grade medications. Your whole clinical picture has to be examined. You gotta follow lab tests. But why we're tea why we're talking about this is because we want people to know that there are other things that may be fairly safe, very low risk and high reward that can lead to better outcomes. And the the more you know about that, the larger your chance of having a good outcome is gonna be.
Ravi Kumar MD:So okay. Let's let's talk about ivermectin. This is the real the real redheaded stepchild. Yeah, man.
Casey Peavler MD:So ivermectin, again, had no clinical experience with it as a as a doctor until I started getting into the research. And, you know, I started my channel looking at compounds that were I'm I'm I'm I tend to focus on natural things. I've never been a big, like, big like, pushing pharmaceuticals. So I kinda like stayed away from looking at that, but I got so many comments about it. Look into this.
Casey Peavler MD:Please look into this. Yeah. And I'm like, okay. I gotta do a deep dive, or at least a couple deep dives. And there is substantial amounts of literature.
Casey Peavler MD:Substantial?
Ravi Kumar MD:Yeah.
Casey Peavler MD:Yeah. Oh, yeah. Substantial amounts of literature and like multiple mechanisms. And, you know, especially mechanisms that I like, bioenergetics. As a matter of fact, it's like, I did a video recently on a on a paper.
Casey Peavler MD:Think I it was published in like 2223. And it basically was looking at the protein expression levels of key bioenergetic enzymes in the systems, either exposed to ivermectin or not. And it was down regulating key parts of glutamine and glucose metabolism by upwards of 70%. Now it was a preclinical model. It was an ovarian cancer model.
Casey Peavler MD:And it was very fascinating. And there's a lot of other publications that kind of show that it can down regulate a lot of glycolysis and maybe TCA function as well. So I think that there's a lot of promise from a metabolic perspective. What I will tell you is that, I guess this probably goes without maybe not without saying. I don't personally believe in one magic bullet.
Casey Peavler MD:I don't think methylene I don't think ivermectin or mementosol or whatever the chemical of the day is. I don't believe there's a magic bullet, but I do believe that there probably will be some kind of a I don't wanna say magic, but very solid scientific kind of like systematic framework that could be assembled. And I do think that ivermectin could fit into that framework. It should be relatively cheap. It should be easy to find.
Casey Peavler MD:But there are more side effects with ivermectin. There's no question. I mean, if you get into a decent dose of ivermectin, I would say upwards of thirty to fifty percent of people have some kind of a side effect from ivermectin. Generally, it's fairly benign, kind of like these eye floaters or little stars I see transiently. If you hold it for a couple days or if you back off the dose, it generally goes away.
Casey Peavler MD:But there is more side effects that are noticeable on ivermectin than there is on nebenasol for sure. Okay.
Ravi Kumar MD:Okay. So let's let's talk about what you do because you're you're obviously a hospitalist in your day job, but you actually see patients who are suffering with cancer who are staying on their traditional therapies, but they're asking you to help them with adjunctive stuff. What kind of results have you seen with doing this PRES Pulse and adding these adjunctive medications on? Are you seeing people have their tumors recede or shrink?
Casey Peavler MD:Yeah. I'm gonna be I'm gonna try to be, like, very accurate and careful with what I wanna say here. Because what I will tell you is I believe in press pulse ketogenic metabolic therapy with everything that I am. I'm all in on this. But at the same time, are clear limitations to what I'm able to see.
Casey Peavler MD:Number one, I would say that I just started of doing integrative kind of consults for this particular patient population. Maybe a little bit less than two years ago. That's one limitation. Number two, I'll say that the way that my consulting practice is, is that a lot of people will consult me for education about a certain protocol or medication or whatnot. And kinda I'll give my opinion about, okay, this is like what C.
Casey Peavler MD:Free is saying. This is what a ketogenic diet is. This is what the macros look like. This is what the drug has been studied to do. And so that time that I spend with those people, I try to give them as much as I possibly can.
Casey Peavler MD:Besides the limitation of just being fairly new to this, this is an emerging science, and I don't think I think if anybody says they have all the answers and know exactly what to do, I think that that would be, for me, at least a yellow flag, if not a red flag. Because this is too new to have twenty years of expertise in this. But that being said, the other limitation that I have is people will come to me and consult. I'll explain to them how to set up a ketogenic diet, what a ketogenic diet looks like, what the literature says about a certain drug or nutraceutical. And I may never see them again.
Casey Peavler MD:I get people from all over the world, literally, who consult me. And it could be a financial thing. It could be I don't know. Sometimes I never see them again. I lose a lot of people to follow-up.
Casey Peavler MD:And that could just be poor business practices on my part. But my point is that I lose a lot of people to follow-up, so I don't see a lot of times these longitudinal outcomes. Some of the people that I have had a chance, have been lucky enough to actually follow for a significant period of time, I have seen some pretty spectacular results in some cases. And I have seen cases where I would have expected for spectacular results, and they don't happen. Not necessarily that they're having progressive disease or but generally, like, maybe they would be stable where I would thought, man, I thought they were gonna have regression, you know?
Casey Peavler MD:Yeah. And some I I think that's that's the next frontier for me personally, and and I think the field in general, is to know like what's working and what doesn't. And, yeah, that that that would that's what I would say as being, like, intellectually honest about kind of where I'm at in my journey.
Ravi Kumar MD:Yeah. And that's good. I I I appreciate you being candid about that. You obviously believe in it, and you're helping patients in their cancer journeys with this adjunctive style of medicine, which I think is if I had cancer, I wouldn't just be taking the chemotherapy and radiation. I'd be looking at all avenues because I'd wanna live.
Ravi Kumar MD:You know? I'd wanna survive. And so and that's why I always tell my audience, my patients, go for the lowest risk, highest reward things, and if you find those things, why not? I mean, there there there's, like, zero reason not to do that, especially when you're talking when your life is on the line, which it is with cancer. So okay.
Ravi Kumar MD:Well, very cool. So how can patients get ahold of you or people get ahold of you? If they wanna talk to you more, they wanna learn from you, maybe they wanna get a consult from you, how do they get Sure. Ahold of
Casey Peavler MD:I think probably the easiest kind of front door is just my YouTube channel because I have like, you know, 200 plus long form videos. And, know, it's very science heavy, and I make it like that because first of all, I'm interested in that. And also, think in this particular realm of medicine, specifically cancer oncology, it's not something you want like, know, Doctor. Peavler, so and so on the internet said, you know, you should do this. Like, I like to stick close to the literature.
Casey Peavler MD:You know, I'm learning how to read it better every day, and learning new things every day. And I try to share those kind of discoveries on the channel. And so that's probably the easiest way. Then in every video that I've ever put out, I mean, maybe there's a couple that I forgot, but every video that I put out, basically, it has my email there. It has my website.
Casey Peavler MD:That's a way you can interact more with me. Either email me, or you can book a consult through that system. And then my latest creation is I created a school community. And this is fairly new for me, because I've pretty much intentionally avoided social media for the last, like, multiple years, other than YouTube. And so it's kinda like, you know, you have like a little wall, you know, where people can like comment, and like, you know, post things.
Casey Peavler MD:And, there's like a little classroom tab. And so I have built out, I've really poured myself into this thing. And think it'll get better over time. But basically, in that school community, I have like a roadmap of like, okay, start here, first seven days, first month, second month, third month, when to move on, when not to move on. You know, it's as guided as it can be without It's not an equals one because everybody's different, and everybody's gonna have a different journey.
Casey Peavler MD:So I really like that. And what I really love about it is that I have people in the group. I do have one oncologist, believe it or not. But most people are either family members of people who have cancer, or they have cancer themselves, and they are doing some version of what PRES Pulse is on their own, or with help from their own local doctor. And then we're discussing what is believed to be the best practices.
Casey Peavler MD:And we go over cases on Q and As. I started out when I didn't have many members, doing twice a month. And now I'm doing weekly. And it becomes pretty lively, for as much as cancer can be, discussion about these kind of very nuanced things. And it really helps motivate me getting feedback.
Casey Peavler MD:And it helps motivate other people, I think, in the group to see someone over here in Australia or Canada or United States has what I'm going through, they're doing this, and they're getting these results. I think this is it's a pretty cool thing that I'm doing there.
Ravi Kumar MD:Yeah, that sounds like a fantastic idea, getting people together, teaching the concepts of cancer biology and, you know, energetic medicine. I think that sounds fantastic. Okay. So I'll put your the links to your YouTube channel, which is awesome. Your YouTube channel is great, and I highly recommend it.
Ravi Kumar MD:It's tons of just free, in-depth, good information. I'll put a link to your YouTube channel, your website, and then your I'll I'll put your email in there if I can if you send it to me. Actually, I have it, so I'll send I'll put that in there. And then, hopefully, if anyone's listening to this who has cancer, who has a family member who has cancer, wants a different way of looking at it in addition to their standard therapies, I mean, Doctor. Peavler is the way to go, honestly.
Ravi Kumar MD:That's who I'd be calling. So that this was great. Thank you so much for coming on and teaching us
Casey Peavler MD:about welcome. It means a lot to me you say that. You know? What I'll tell you is that it's nice to talk to another physician about this. You know?
Casey Peavler MD:Because just like we were talking about with ivermectin, just the entire the entire field just feels like taboo. You know? And it's hard to talk to other colleagues about this. So I
Ravi Kumar MD:It's appreciate you unfortunate. Catching me I don't know why we do that. Why we we instead of looking to evidence, we look to dogmatic belief in in something. Ask question no. Question everything.
Ravi Kumar MD:Right? I mean, here's I love that.
Casey Peavler MD:Question everything. I love that.
Ravi Kumar MD:Everything. Question it all. You know? I mean, question the left, question the right, question the middle. Just you know, if someone says, hey, I think this, don't say, no, that can't be.
Ravi Kumar MD:That that will never be. No. Well, why don't you look into it? Because that's how discoveries are made. You know?
Ravi Kumar MD:Someone makes an observation, as wild as it might be. And that turns out to be a Nobel winning discovery that saves millions of lives. That's how they've all So, come yeah, question everything and don't don't just believe something because someone tells you that's what it is. You have to look into it for yourself. So and you're someone doing that, so I really appreciate it.
Ravi Kumar MD:Cheers, and thanks so much for coming on.
Casey Peavler MD:Alright. God bless. Talk to later.
Ravi Kumar MD:Okay. That was a heavy one, and I know we covered a lot of ground. Here's what I want you to walk away with. Cancer might have far more to do with how your cells make and use energy than we were ever taught about in medical school. And there's real work you can do around that concept.
Ravi Kumar MD:The good news is for most of us, it's completely free stuff. Getting real sunlight, protecting your sleep and circadian rhythm, lowering chronic stress, and dialing back the ultra processed food and sugar in your diet that target the exact metabolic pathways that doctor Peavler talked about today. Now for anything further along the spectrum, like a diagnosis of cancer, high dose IV vitamin C, hyperbaric oxygen, or repurposed drugs like metformin or mebendazole, may be something you want to talk to your doctor about, especially a doctor who understands this framework. And it's definitely not something you want to try on your own. And if you just want to learn more, Doctor.
Ravi Kumar MD:Peavler has put out over 200 videos breaking this science down for free on his YouTube channel. And he also runs a community for people navigating a cancer diagnosis in themselves or someone they love. I'll put those links in the show notes. So if you know someone who's staring down a cancer diagnosis right now, feeling like their only option is to sit and wait for the treatment to work, send them this episode. It might give them one more thing, one more piece of information that they can bring to their doctor.
Ravi Kumar MD:And until next time, stay curious, stay skeptical, and stay healthy. Cheers.