I am Massimo Bonucci. I am a doctor, I'm a medical doctor. My degree in surgical pathologists, and the second one is oncologists too. I work as a director of the surgical pathology department in Rome, in San Feliciano Hospital in Rome. Inside the San Feliciano Hospital, there are also the department of outpatient integrative oncology, and I work as integrative oncology too. I am also president of the- the name is Artoi in Italy in Association Research Therapy Oncology Department. Artoi is born in 2010 and now is the blow-up because Artoi has made many, many doctors, and the 30 percent of the medics are oncologists. Oncologists work as private, but many in public health. Artoi for me is a one of the Italy, the one association for developer integrative oncology. So, how many people, how many doctors and healthcare practitioners are included in Artoi, I understand that it's a national Italian group in integrative oncology. Yes. The number now is about 95 doctors, and the 95, about 30, 35 doctors are oncologist. We are national because we have doctor from many many Italian region. There are two region that we haven't in Sardinia and in Calabria but in the other in Italia region, we have the doctor. We are the center of Artoi. In research center, we have the same philosophy because we develop the integrative- they think about integrative oncology. You have previously told me that you're also directing a second degree program about integrative oncology in the University of Rome. Yeah. Probably the first in Italy and in Europe. We reorganized the Master degree in integrative oncology, postdoctoral after the doctor, the medical doctor or biologists or the pharmacist, and we organized, the first edition is finished, the second as in the end and now we prepare the third edition. Such edition is two years long. We have man hours of lesson, because we think is necessary to form the people, the doctor to speak about the oncologists, because I am oncologist but before we teach doctors that is possible to speak about the oncology. To know about the integrit oncology too. For my impression, I mean as Artoi is Italian National Group in integrative oncology, I understand that you are involved both in clinical practice, in medical education, in research, and a lot of work you do within the politics as well. I know that in one of the conferences, it was inside the Italian Parliament and in collaboration with regional governments like in Tuscany, so, what's your vision for integrative oncology in Italy. The Artoi, when it was born, our hope were the best treatment for our patient, and we are the clinician, we are clinical trials. Also, we have medics, we have research, and then we take research with the University of Ancona, University of Rome it was held in Rome. Because, we are the necessary to have the the basis of research to develop the use of herbal medicine and other. Also, we need to increase the knowledge about the integrative oncology too, and then we speak about the institution with the Minister Of The Health, the region of Tuscany and also Emilia-Romagna in Piemonte because in this region and also Lombardia, the parliamental region is more open about the parliament of national parliament. But we increase not very fastly, but with the waiting, we expect the moment to speak about because in Italy now in such moment is not so easy to speak about integrative oncology. I wanted to ask you about one of the unique aspects that you have developed over the years, and that's the relationship between herbal medicine and the cuisine or the food that people eat. Including working, design a special cuisine works up and recipe book, can you tell us how you developed it and what's the your null in such a manner. Yeah, I think the best treatment for our patient is chemotherapy, radiotherapy, biological, you'll use it, immunotherapy, is necessary to use herbal medicine or occupation but the basis is nutrition, because everyday we eat, and we need to have the good food. Because, when you take a patient milk, an example. The milk is very very very good for the burt, because when a baby is very little, to take milk, it grow up in amounts. But if you have the patient with cancer, this cell very very fast to grow and if you don't take substance that you grow up very fast. Then you need to avoid the milk or the other type of a protein to grow very fast. But is possible to change the type of the protein. Vegetable, the vegetable is very good. The fish is very good, and then inside the dish is put the best treatment for the patient, and the food, it become a medicine for the people. So, actually what you do is trying to develop a concept while the food that we eat, is more like a medicine? Yes. So, how do you do that? Which products you put, which herbal remedies do you recommend to incorporate into the daily food in patients that are undergoing chemotherapy? We were toking about-. Yes, of course. Because I use herbal medicine with chemotherapy. I think we have no more medics that in combination but is necessary to know very well our work, the medicament, our work the herbal medicine. For example, the pepper, the black pepper is good for it, but it's not good for our liver because the pepper is metabolized inside the liver and has become an answer of the CYP, but the medicament of the chemotherapy, they give in, in the same local. It go away very fast in our body then, when you take a chemotherapy, doesn't use pepper. It's very complicated but it's very easy to know our work the herbs. You mean black pepper? Black pepper one. As the Ginkgo biloba two and also Akinesia, because work in the same element of the liver. So, you don't recommend these products? I don't recommend. As part of chemotherapy, nutrition? Yes. During chemotherapy herb is not recommended that you use. Because it's possible to interfere with chemotherapy, is it Gingko biloba, the Epericum, in the Sun Georgia, also the ikinetia, also the soy. Because, the soy is a very good product for protein, but it's a very impressive work as a fighter estrogenic stimulation. If you use a tamoxifen for breast cancer, that is block the receptor, estrogen receptor. You can use soy because, the tamoxifen doesn't work and then is necessary to recommend, not recommend the soy when you take chemotherapy for breast cancer. So, which herbs you do recommend during chemotherapy or before chemotherapy? We use herbs. Not all together but herb about type of the cancer but about type of the chemotherapy. So, you modify the herbs according to the chemotherapy, according to cancer. Yes, of course. Because example, when the people to take a chemotherapy with platin, cisplatin, carboplatin, oxaliplatin. I, use aloevera, because the aloevera is demonstrated over study that announce the work of platin in the cancer cells and I use. But if you don't use platin, I don't use aloevera. I use astragalus for lung cancer,. For lung cancer? For lung cancer. Because the astragalus announce the work of platin in lung cancer and then I use astragalus to enhance the results. I use also astragalus for fatigue and then I use it in independent of the type of a chemotherapy. Is very complicated but when you know very well the type of the herbs, the type of the chemotherapy, for us is quite simple to know how herb use in such type the cancer, as such type of a chemotherapy or radiotherapy too. So, actually, if I understand correctly, you tailor the herbal treatment? Yeah. Sometimes according to the cancer cells type? Yes. Sometimes in regard to symptoms? Yes. Sometimes in regard to the chemotherapy. So, you can decide, for example, using astragalus to use it for fatigue as a symptom related indication, you can decide to use it for lung cancer. Yes. When I use the platin. When you use platinum. Yes, this is very complicated but is it, for us is-. Scientific based, I would say. Scientific basis. Because there are very many study that in astragalus would go very well in lung cancer, non-small cancer cells and those small-cancer type. That for us is positive to use, because it does interfere and is not related with the CYP, A4 is inside the liver. Because is the problem. Can I ask you, back to the idea, I mean, the amazing idea of writing a recipe cookbook for patients during chemotherapy, I know that you had a tremendous work with chefs and cuisine experts and your experts from our toy. Can you talk a little bit about the connection between the two worlds, on the one hand the scientist and the physician and on the other hand the chef? We have a school, a school of choosing in body, that use our knowledge, to put our knowledge inside a dish and then they use a vegetable for the recipe uses some type of the fish, because the big fish is not good for the problem of metal problem. They cooking very slowly because the high temperature is not good for the protein and use many, many herbs like cumin, like a coriander, like other type of this spice for the dish. Because, this dish is my medicine all day and such type, such time or every 10 days or 15 day, you can use also the meat. But when you use the meat, I say, you must know the grandfather of the beef or the chicken, because this is necessary to know which type of the meat I eat, because they eat the meat is now all toxic. Some time is good for the dish with about a little bit meat, it's good. It's not only, only toxic, but sometimes. So, how did you develop the collaboration between physicians and people that cook in the cuisine? Did you have any recommendations like guideline that you have developed and implemented it within this school of cooking? How did you do that? Yes. Our congress were shopper, their cuisine they selected, you know very well. Now, we're writing a book in Cucina, Mediterranea Integrata, and Therapia Integrata. Integrative Mediterranean? Integrative, cuisine Mediterranea, cuisine integrative, and integrative therapy together. We have the recommendation, we had the guideline, our tall guideline because as I saw that it is necessary to know very well how eat every day. Our recommendation is don't eat meat every day, don't eat big fish, don't eat a milk, don't eat pasta and bread with the grain raffinit, don't eat sugar, don't eat fruit during chemotherapy because the fluid in the sugar, and then we don't eat. If you want to eat fruit, you can eat the mitilo, cranberry, strawberry, and fruity bosco, in Italy is fruit TD Bosco. Don't eat soya because, I am surgical pathology too and every type of cancer had receptor of estrogen. Don't use soy in any type of cancer. Massimo, I wanted to ask you from your own experience as an integrative oncologist and your really one of the few oncologists who are marry integrative physicians who are not oncologist by profession and you are. I wanted to ask you, what is the most important phase for consultation in integrative oncology? Is it before the first chemotherapy? Is it during the chemotherapy? Is it when the chemotherapy is concluded? When is the most important time to meet the patient if, for example, a government will finance only one consultation? Where is the most important timing to provide the concentration before the chemotherapy or after? When I know that I have a cancer because this is the start of treatment, natural treatment. Then, you use our treatment with chemotherapy, with the radiation therapy. But, when I know that people have cancer, we use our other natural treatment to announce the results. That would you do to reduce the side effects and then after, we have the prevention. I wanted to ask you, during this fragile time and considerably show time from the moment of diagnosis what we call breaking bad news. Yeah. You have cancer until the first chemotherapy cycles sometimes it's only few weeks. So, you say it's one of the most important timing to provide consultation about herbs? I think it's not only herbs, but psychological integration. So it's herbs, psychological. And nutrition. And nutrition. Psychological, herbs, and nutrition. I think is the first very important model to aid the patient. So, why is it so important to have this consultation right after the diagnosis and before the chemotherapy? Why is it so? I think it's one doctor that is integrative doctor had many, many possibility to hate, one week, two weeks before the chemotherapy because it will enhance the work. It would help patients to feel better if they have the consultation prior to chemotherapy? Yes, prior to chemotherapy. In what sense? Less anxiety? Yes, to enhance about the knowledge, about the time of the [inaudible] very slowly in Italy. Then, many patient need time to speak about, and then integrative medics is a good because there is no problem. Then, the second time is after chemotherapy because we must know which type of chemotherapy because could change the type of the herbs, but the first time before chemotherapy is the best. So, it would help patients to feel better psychologically and physically? Yes, and physically and when the patient say, "I have a cancer. I'll eat now." They don't know, but they ask the medics, "How are my nutrition?" Many doctors say, "All, all you want." Also, when you take chemotherapy, you must to eat more. No, is not good, and then, it's necessary to have something, the people, the doctors, or other type of the integrative people that know what is the best treatment of the cancer.
