Dr. Lise Alschuler is a Professor of Clinical Medicine at the University of Arizona, where she is the Associate Director of the Fellowship in Integrative Medicine at the Andrew Weil Center for Integrative Medicine. A graduate of Brown University, she completed her naturopathic medical training and her residency in general naturopathic medicine at Bastyr University. Board certified in naturopathic oncology, she maintains a clinical practice, co-hosts a podcast, Five to Thrive Live! and is co-author of Definitive Guide to Cancer and Definitive Guide to Thriving After Cancer.
I had the pleasure of interviewing Dr. Alschuler just before the holidays. We spoke about her work, how cancer changed her life, the balance of traditional and alternative medicine, and how naturopathic medicine addresses the “being” side of human beings. Our conversation has been edited for length and clarity.
Anne Fulenwider I’d love to start with your background. Were you always interested in this or what was your path here?
Lise Alschuler In third grade, I remember telling my father I wanted to be a nurse when I grew up. And he said, “Nursing is a great career; have you thought about being a doctor?” And I said, no, but okay, I’ll be a doctor! And from that time on, it was my mission in life. I read every book I could, fiction/non-fiction, to learn more about medicine. I remained passionate about this and when I went to Brown University for my undergraduate degree, I was also fortunate to be accepted into their seven-year med program. This program allowed me to have early hospital rotations and gave me direct observational experiences with medicine.
At that time, I also took a college class where people who had been diagnosed with cancer came and described their experiences. I was blown away with these individuals. They were a tremendous testament to the courage that human beings can evidence when having to deal with such a significant illness. This confirmed my desire to someday work with people like that as a physician — and then, literally on the threshold of medical school, I pulled out.
Lise I realized that the kind of medicine that I was learning about was not what I wanted to practice.
Anne That must have been a really tough moment for you.
Lise It was very disheartening since I’d wanted to be a doctor for so long. Instead of medical school, I went to the Peace Corps and did rural health for a while. Then I returned and became an EMT. I was floundering when, on the same day, two individuals gave me catalogues for the John Bastyr College of Naturopathic Medicine (now called Bastyr University). I read the principles and immediately knew that’s what I wanted to do. I called right away, got an interview, and went that fall. And boy, I have never looked back. I’m so, so happy that I found naturopathic medicine. It tied together my interest in the science of medicine and health, with the respect and fascination of the being part of human beings. I love the way naturopathic medicine brings these forward in clinical practice — and I’m delighted to have chosen this career.
Anne That’s fascinating — and I’d love to delve a little deeper. Can you talk a little bit more about the idea of naturopathic medicine addressing the being side of human beings? How does it do that?
Lise One of the principles of naturopathic medicine is that we encourage the innate healing process within each person. We understand that each of us possesses an inherent ability to bring ourselves to health or to strive towards health. In order to embrace that principle fully, we have to embrace the whole person in front of us because that healing force is comprised not just of biology, but of spirituality, of emotionality, of our societal context. It brings all of that together into what we often refer to as our vital force.
We can’t treat disease as if it were this isolated thing happening in a person. We have to recognize that disease is within the very complex and beautiful vital essence of the being in front of us — and that for that the innate healing process to awaken and to continue, we need to bring all of that together in order to fully address disease. In some cases, that means recommending chemotherapy to kill a tumor or using surgery to remove diseased tissue. We do have to do that, certainly, but at the same time, that’s not enough because that’s only removing an impediment to health and neglects stimulating full healing.
Anne How much of that vital healing force within us do you think we’re conscious of on a daily basis if we’re not in the field?
Lise That’s a good question. I think there are parts of our vitality that we’re very conscious of, expressed as our energy for the day, how passionate we feel about who we are and what we’re doing in life. And then I think there’s another part of our life force that we’re not fully conscious of but is constantly at work. The human body is amazing in what it does for us at all times just to survive in this world. The adjustments we’re constantly making to remain in a sort of homeostatic vital equilibrium in the face of all the stresses that we have is quite extraordinary. I don’t think we’re really fully aware of that on a day-to-day or moment-to-moment basis.
Anne How does naturopathic medicine engage with the biological workings of the body that we’re not thinking of?
Lise We do it in several ways. One way naturopathic doctors support this process is by helping people to align their mind, body and spirit. When there’s disharmony or incoherence in those areas, it makes vital expression difficult. Naturopathic doctors work with patients on all those levels. For instance, I can give an herb to help a patient have less pain — and also ask them to spend some time being mindful, take a moment to be present, and to ask themselves, ‘What is this experience of pain creating an opportunity for me to reexamine?’
Additionally, when I recommend an herb, I’m not necessarily just saying, Okay, this person has these symptoms, I want the symptoms to go away, so I’m going use this herb. I’m more thinking about, ‘Why are these symptoms present? What’s going on at a deeper spiritual level, on a cellular level, on a molecular level?’ And, based on this inquiry, I think about what can I do from multiple perspectives — plant medicine or whatever it is that I’m using — to address things at a very deep kind of root cause level. This is a way that naturopathic doctors focus on the inner vitality that people have.
Anne There’s a recent study about the placebo effect and its impact on the body’s own healing properties. What do you think about such results?
Lise There’s a lot of research on the placebo effect. There are even studies in which researchers tell patients they’re getting a placebo, that there’s no actual medicine in prescription, and people still get better. That really speaks to the power of mind, body, spirit — the will to move into greater health. Not to say that we can always heal from every disease; obviously, there are things that are very difficult to overcome. But I think that that placebo effect is a great illustration of the incredible power of the mind.
Anne Can we turn now to your own personal health journey and how that’s informed your work?
Lise Sure. Overall, I’ve been blessed with really good health throughout my life. However, I did have breast cancer diagnosed in my early 40s. It was kind of shocking for me because I was in good health. I felt like a healthy person with breast cancer. While my cancer was caught at an early stage, it had characteristics that made it aggressive in nature. So, I underwent surgery, chemotherapy, radiation. I took five years of endocrine therapy. I went through the whole thing but at all of those points I combined natural integrative strategies. Even though I had symptoms, I recovered from them and always felt like I had a really strong core of health throughout that process, even though at times I was suffering.
Lise Fortunately, at this point, as far as I know, I’m cancer free and continue to feel like a healthy person. That experience definitely changed me in lots of ways. Anybody diagnosed with cancer immediately gets this amazing kind of clarifying mirror thrust right in front of their face — and looking back at them is their own mortality in an acute way. I think it causes people to do a deep reckoning of what their life is, what is important about life and what deserves greater appreciation and attention. I think that I continue to live my life with those values still very much intact and that’s obviously influenced all the activities that I do, the way I interact with people, and the way I interact with patients.
I think patients sometimes find me because they know I’ve been through cancer. My practice focuses primarily on people diagnosed with cancer and they see a kindred spirit in me because I can recognize and empathize deeply with their experience.
Anne Were you seeing many patients diagnosed with cancer before you had breast cancer?
Lise I had done general naturopathic medicine for about 10 years prior before specializing in cancer care. I had the opportunity to work at a cancer specialty hospital as a naturopathic doctor. And now for 20 years I’ve been focusing on what we call naturopathic oncology.
Prior to my diagnosis, my father was diagnosed with pancreatic cancer and given a very poor prognosis of 3 months. However, over the next 17 months, he engaged in a variety of conventional treatments along with naturopathic care and he lived quite healthfully for the majority of that time. That was a profound experience for me and really validated the power of what I call integrative cancer care, integrative medicine.
Anne What does your professional life look like these days?
Lise Today I see patients one day a week and work at the Andrew Weil Center for Integrative Medicine at the University of Arizona. In 1994, Andrew Weil founded a fellowship program in integrative medicine to train primarily physicians — now healthcare providers of all types – from all over the world. His idea, of course, is to transform healthcare. I am the associate director for that fellowship program, and we train more than 150 physicians each year, from all specialties. These are physicians seeking to learn more about integrative natural therapies and to incorporate that into their conventional practices. I also continue to do a clinical practice, however, because I really enjoy seeing the transformation that people make in their lives and being a part of that transformation. It’s a nice way to enrich myself and continue to offer my services to the world.
Anne When you say that naturopathic medicine has a lot to offer cancer patients, what do you mean?
Lise I think one of the fundamental premises of naturopathic oncology is that it’s a both/and approach, not either/or. Unfortunately, many people with cancer feel like they have to make a choice. Our world is so dichotomized now, which is really unfortunate, and this is another area in which that occurs — people feel like they have to choose either conventional therapy or alternative therapy. In my view, neither of these is the best route. The best route pulls the best of both together, and that’s really what naturopathic oncology is. We recognize the importance and validity of conventional treatments, but also understand that they can be quite difficult for people. They can create a lot of toxicities and we have naturopathic tools to address some of those issues and to support the body.
The tools of conventional oncology are really good at killing tumor cells, but the tumor lives in a person and the health of that person needs to be addressed. That’s where the naturopathic side excels, specifically by trying to create a body that’s less hospitable to cancer. In that way, it synergizes with the conventional treatments in a more complete anti-cancer strategy. Meanwhile, we’re also helping to improve quality of life. Our tools are fantastic for optimizing survivorship and helping to reduce risk of recurrence as well.
Anne We recently did a story at Sage by Gaia about Chaga and its immense powers. Are there certain ingredients or elements that are particularly prominent in your own practice?
Lise One size does not fit all and one of the important contributions of naturopathic oncology is that we personalize our care so that two patients with the same diagnosis, let’s even say the same age, same gender, same race could walk away with different treatment plans because there’s uniqueness to their life experience and their symptomology. Having said that, there are some common friends that we utilize quite a bit in our recommendations. For example, turmeric is an herb that interestingly does not have as many clinical studies supporting its efficacy in the world of cancer but is well-known for downregulating a lot of inflammatory pathways in the body. Inflammation is a very important thing to address in people who have cancer because it predisposes people to worse symptoms with their disease and increased risk of recurrence. So, we really work on inflammation in people.
As for chaga, I would say in general, medicinal mushrooms are very commonly recommended for a variety of cancers because they’ve been shown in conjunction with conventional treatment to improve what we call disease-free survival as well as overall survival. Different mushrooms are used for different conditions. We might use reishi mushroom for somebody with colorectal cancer as opposed to turkey tail mushroom for somebody with breast cancer, and may get maybe chaga for somebody with bladder cancer or melanoma.
Anne Fascinating. You mentioned the dichotomized world we live in. As a person out here trying to be healthy I feel that there’s this sense that I can’t admit to my conventional doctor that there are supplements I take or things that I’m trying. And I feel like I’m not alone in feeling uncomfortable when talking to my conventional doctor about such things. Is that changing?
Lise I think healthcare is far from ideal right now. In fact, I think it is imploding. The experience most people have when they enter the healthcare system is bad. It’s hard to see doctors; people with conditions that need to be addressed now are waiting six months, eight months, a year to get in. Meanwhile, doctors are busy; they’re under huge pressures of time and production. They’re getting burned out. And then, healthcare is expensive. It’s really not sustainable.
What if it was integrated? So that when a patient goes in with a condition and they’re seeing an acupuncturist and a naturopathic doctor and perhaps they have a massage therapist, their conventional doctor embraces it and accounts for these approaches in their own recommendations. That would be a great experience. Of course, it would help if that conventional provider had some training in integrative therapies as well. I think that is happening more often than it used to but it’s happening amidst a collapsing system. However, I think, in fact, that integration is one of the solutions. I think we’re at the beginning of is seeing the healthcare system being rebuilt, in part by incorporating integrative approaches with conventional care. And, while this rebuilding is happening as the healthcare system is collapsing, this process of change is slow. I’m not sure how much of this is we’re going to see in our lifetimes.
Hopefully, it’ll start to accelerate as more and more providers and patients start to demand this kind of quality of care. Imagine if we addressed, say, lifestyle causes of disease, from an early age. Young people would be counseled about diet, about activity, about sleep, about stress management. With that, we can start to change the trajectory of disease and illness as we get older. And, if we continue to incorporate those principles, even when we’re diagnosed with disease, then we can lessen the impact of the disease, both on the individual and the system. And, of course, we continue to have these amazing tools of conventional medicine available when needed.
Anne Where is the motivation for changing the healthcare system coming from right now?
Lise I think there are several players. There are some conventional doctors that, for example, come in through our fellowship program. These are amazing individuals. These are doctors who have been listening to their patients say, “Hey doc, what about this supplement?” Or “What should I eat?” They don’t have the answers but are willing to go through a two-year training program to get the answers. These are doctors who are exhausted and burned out in their practice, and the reason they went into medicine, to help people, now feels like the last thing on their list. These physicians have taken it upon themselves to change the way they practice as a doctor.
Then there are the integrative healthcare providers — not alternative providers per se, but integrative, meaning people who practice various forms of natural medicine with the understanding that what they’re doing is not in opposition to conventional medicine but what they do integrates with conventional practice for the good of the patient. I think these people are looking to be change agents from the outside and are part of this rebuilding by providing their services, by making overtures to the conventional providers, and by trying to understand more about the science of health and disease. These are also change agents.
And then I think there are patients who are changing healthcare. Look how much medicine has changed because patients said, “I want to be more informed.” Patients started using the internet to figure out what’s going on with them and now come in with a list of very informed questions for their doctors. Patients have created a demand for integration that will change the way healthcare’s practiced.
Anne What do you think of the role that Dr. Google plays?
Lise It’s a mixed bag for sure. Unfortunately, now there’s a lot of hucksters on Dr. Google and it’s very hard when people are in a vulnerable state. They read everything they can and this can become information overload. Without medical training it can be hard to filter through that information or know whether there is science to back it up. It can be very difficult if people are using Dr. Google on their own and don’t have a trustworthy healthcare provider to help them interpret and prioritize what they’re reading. The flip side is that it’s creating this informed person, somebody who is armed with information so that they can take on a more proactive role in their own health and healing.
Anne As we wrap up, I’d love to just hear your own health habits. What are the basics of your own routine?
Lise I start my morning with exercise, that’s really important to me. My exercise, which is quite vigorous, is a cornerstone of my health. Then, my spouse and I spend a beautiful hour outside with our dogs on a walk. That’s another cornerstone of my health: being out in nature and continuing to engage in movement. Then I have a little quiet time. I have a little ritual that I do usually with a cup of coffee. I’ll do some word games and practice some Spanish or just be very quiet and relaxed. Then I get into my work day. I protect my morning routine with vengeance. I feel that starting my day in that very ritualized way really helps me.
When I was diagnosed with cancer, as much as I loved what I was doing at the time, I realized it was not really feeding my soul in a way that I needed it to be fed. And so, since then I’ve made various career changes and feel like I’m in a really good place right now. I’m very passionate about my work and enjoy it — and it’s a good thing because I spend a lot of time working!
My diet is not perfect, but I do eat an unprocessed whole foods diet with lots of colors of food on my plate every day. I take time to really appreciate my food, so I’m not just like shoveling it down as I go. Then I’ll have another walk with my dogs, and usually my partner joins me on these walks as well so we get some time together. And as I’ve gotten older, I’ve stopped working as much. I set my limits and try to spend the evenings socializing, relaxing and not working into the wee hours of the morning as I did when I was younger.
I should also say that I walk my talk in terms of herbs and supplements. Throughout my day I do have quite an extensive supplement and herbal regimen, which I’ve taken on a regular basis.
Anne Can you give us some details on that?
Lise I take supplements that are ostensibly to help reduce my risk of cancer recurrence by reducing inflammation, oxidation and preserving detoxification. For example, I take adaptogens every day, which are herbs to help manage the stress response and keep a healthy circadian rhythm. I take medicinal mushrooms every day and there are anti-inflammatory herbs and supplements, which I take on a regular basis, and things to help my brain sharp.
Anne How did fighting cancer change how you worked — as in to make it more satisfying or fulfilling to you?
Lise I was working at a cancer specialty hospital at the time. It had been a wonderful experience in most ways, giving me a deep dive into the world of cancer care. I was working right alongside with conventional oncologists, providing naturopathic care. I was also learning a lot about hospital administration and medicine. But I just didn’t have the opportunity to interact with patients in the way that I wanted to. And, intellectually, there were ways I wanted engage in my craft differently. Over time, it was no longer the best fit for me.
I also realized I love the desert. So, my partner and I moved down to Arizona and I felt much happier. It took me a little while to resurrect my career — and I went on a circuitous route doing different things along the way — but each phase fed me in different ways. I knew I hadn’t found my end game, so to speak, but I felt clear that I was on a very good career path — that whatever I was doing, I was fully engaged and really enjoying it. I kept gathering these jewels and moving forward. You know, I suppose life can change again, but I do feel like what I’m doing now is really fulfilling to me and exactly where I should be. And I enjoy it quite a bit.