Transcripted by AI
Ronit: Hi, I’m here today with Dr. Michael Herling. I’ll let you introduce yourself.
Dr. Herling: Hello. My name is widely known as Miki, and I’m a family doctor by day, and at night I’m a husband and father to 4 children. I’ve been a family medicine specialist for over twenty years now. I also have various other roles, some standard and some more unusual. I’m a skater, I ride a skateboard a lot and surf, and I teach breathing, martial arts, and Qigong. I also have a nice website where I publish various articles.
Ronit: I’m sorry for interrupting, but you also studied Chinese medicine, right?
Dr. Herling: Yes, look, I’m already 57, so I’ve done so many things that I don’t remember some of them. I’ve already forgotten what I haven’t learned yet.
Ronit: I mean you have a very broad background and your approach seems to be holistic, not standard.
Dr. Herling: Yes, let me double-click on that word “holistic” for a moment. Just today, a patient came to me saying “I came to you as a holistic doctor.” So I asked him, “Wait, wait, wait, let’s stop” because I really like to philosophize. I said to him, “What do you mean when you say holistic? Do you mean that I’m better than another doctor you’ve been to? Do you mean that I see the patient in a broad perspective? What do you mean?”
He stammered because he didn’t know what he meant. I explained to him that today the word “holistic” actually means nothing. It’s like a blank canvas that you can paint whatever you want on it, and if you have nothing to paint, then it has no meaning. People say “holistic” but don’t really mean anything, and this word has become a marketing word that also has value in medicine.
Among other things, it doesn’t say much about whether I see the patient in a broader way, asking more questions about the family, lifestyle, doing more tests, referring to more dimensions than another doctor. Am I holistic? Not at all, because holistic is everything.
I might be a little more sophisticated in my approach, but I certainly don’t see everything. It’s like comparing the first amateur telescope to the Hubble telescope today. No matter how much I see about the patient, I still only understand a very small part of their life and being.
But this approach of trying to capture as many dimensions of the patient as possible, and trying to get to know them as well as possible, has several advantages in my eyes. It helps create what psychologists call “rapport” – a really good connection with the patient.
In family medicine, this human space and connection is very important, in order to create a good relationship for many years. It also helps with the patient’s adherence to my recommendations, because they feel that comfortable connection.
Ronit: Wait, this connection, one of the things you strongly encourage, if not preach, is the topic of preventive medicine, through exercise, through food, and so on. You deal a lot with physical activity. I wondered, in the context of when someone gets cancer, is the physical activity you recommend suitable even for people with serious cancer?
Dr. Herling: Excellent question. So first of all, in the meeting, because it’s a holistic meeting, I can understand the context and the person’s situation. And then my answers are of course person-dependent, they’re not generic.
A generic answer, like “do physical activity,” is what many doctors say to patients without much behind it. If we want to discover what medical science has to say about physical activity, the World Health Organization’s recommendations are 150 minutes a week of light to moderate intensity walking, for example. But that’s still a generic answer.
I need to first understand the context of the individual patient, and from that context I start to derive my recommendations. This is something that’s also unique to a family doctor. For a cancer patient, for example, the recommendations for physical activity would be very different than for a healthy person. I need to take into account the stage of the disease, the treatments they’re undergoing, and their overall condition.
Some cancer patients may benefit greatly from gentle, low-impact exercise to maintain strength and mobility. Others may be too weak or ill for anything beyond light walking. It really depends on the individual case. The key is to tailor the recommendations to the patient’s specific needs and capabilities at that point in time. A one-size-fits-all approach doesn’t work when it comes to physical activity for cancer patients.
Ronit: That makes a lot of sense. Can you give me a bit more detail on how you would approach physical activity recommendations for a cancer patient?
Dr. Herling: Absolutely. The first thing I would do is have an open and honest discussion with the patient about their current state of health, the progression of their cancer, and any treatments they are undergoing. This helps me understand their baseline physical capacity and limitations.
From there, I would work collaboratively with the patient to set realistic goals. For some, it may be as simple as aiming for 10-15 minutes of light walking per day, while others may be able to handle slightly more intense exercise like gentle yoga or Tai Chi. The key is to start very slowly and incrementally increase as tolerated.
I also place a heavy emphasis on activities that promote relaxation and stress relief, like breathing exercises, meditation, or even just time in nature. The psychological and emotional benefits of these practices can be just as important as the physical ones for someone going through cancer treatment.
Importantly, I stay in very close communication with the patient’s oncology team. I want to ensure my recommendations complement their medical treatment plan and don’t interfere with recovery. It’s a collaborative effort to optimize the patient’s overall wellbeing.
The most important thing is to remain flexible and adjust the plan as needed. Cancer is an unpredictable disease, so physical activity recommendations may need to change over time. But keeping the patient engaged, motivated, and feeling empowered is crucial throughout their journey.
Ronit: That’s really insightful. It sounds like a very thoughtful, personalized approach. Do you find that cancer patients are receptive to these types of holistic recommendations from you?
Dr. Herling: You know, it’s really mixed. Some patients are very open to exploring complementary approaches like exercise, nutrition, and mind-body practices. They see it as a way to take an active role in their care and maintain a sense of control.
However, others are quite skeptical, especially if they’ve had negative experiences with alternative therapies in the past. They just want to focus solely on the medical treatment plan outlined by their oncologist.
I try not to be pushy. Instead, I gently introduce the ideas and explain the potential benefits based on the latest research. I make it clear that these recommendations are meant to support, not replace, their standard cancer treatment. It’s all about finding the right balance for each individual.
Over time, as the patient sees positive impacts on their energy, mood, or symptom management, they often become more receptive. Building that strong rapport and trust is key. They know I have their best interests at heart and am simply trying to help them through this incredibly difficult experience in the most holistic way possible.
Ronit: You mentioned that family doctors typically don’t prioritize physical activity. Can you elaborate on that?
Dr. Herling: You’re right, many family doctors don’t make physical activity a central focus. They may not have the time, interest or opportunity to really dive into it. They may believe in its importance or they may not.
But the moment I make it a priority, I can draw on the deep well of knowledge I’ve accumulated over 50 years of intensive study and experience in this field. From that extensive background, I can provide my patients with very tailored, personalized “nuggets” of information – practical tips and recommendations customized to their individual health needs and conditions.
This level of personalization comes from the scientific research field, which tends to be drug-focused and based on large-scale studies. But I’m able to apply that knowledge in a more individualized, less strictly medical way.
Ronit: So how does your approach differ from a traditional doctor’s?
Dr. Herling: Well, as an amateur scientist, I go beyond the standard doctor’s algorithm of taking a history, examining the patient, ordering tests, and prescribing treatment. I put on my “hat of an amateur scientist” to explore questions that existing science hasn’t answered.
I conduct my own research, gather information, and experiment with my patients. Then I can reach conclusions and immediately provide recommendations – with the crucial caveat that they must be safe, effective, and have a high predictive ability. This is in contrast to classical medicine, where my ability to accurately predict individual treatment outcomes is quite limited.
As an amateur scientist, I can often achieve faster results with fewer risks. My recommendations focus on what I call “low-hanging fruit” – simple, easy, available and inexpensive interventions that I’ve found to be surprisingly impactful.
Ronit: So what motivates patients to seek out an amateur scientist like yourself?
Dr. Herling: Traditional medicine sometimes falls short in answering the specific questions my patients have. As an amateur scientist, I can dive deeper into these uncharted areas, conducting my own research and experiments to find solutions.
My recommendations may not be “game changers” like the cutting-edge treatments provided by elite specialist teams in the hospital. But they can make a meaningful difference, even if the changes are relatively modest. You could think of me more as the unsung hero in the army’s logistics corps – providing the essential support that enables the elite units to do their best work.
My strategies may be small in scale, but they can have a cumulative, positive impact on my patients’ lives. And that’s what really drives me as an amateur scientist – finding effective, low-risk solutions that can truly help people, even if they’re not dramatic “home runs.”
Ronit: So your recommendations to patients seem more like a broader “small steps strategy” rather than a single “game-changing” intervention, is that right?
Dr. Herling: Exactly. My approach is to provide a collection of low-hanging fruit recommendations, rather than a single dramatic treatment. These are small, easy, and inexpensive changes that patients can start implementing right away.
For example, one recommendation I’ve developed is a simple stretching exercise using a bar or branch – what I call a “dead hang.” It only takes 10-30 seconds per session, but done consistently, it can have surprisingly beneficial effects.
Ronit: Can you explain how something like that dead hang exercise could be helpful for cancer patients?
Dr. Herling: Well, the dead hang exercise meets all my key criteria – it’s easy, simple, available, cheap, and effective. Physically, it can help improve posture and body composition by subtly elongating the spine and narrowing the waist.
But more importantly, I’ve read research by Dr. Helene Langevin at Harvard that suggests stretching the body’s connective tissue may have anti-inflammatory benefits. In her experiments on mice, daily stretching was shown to help shrink implanted tumors, even without any other treatment.
Now, I know we can’t directly extrapolate mouse studies to humans. But intuitively, it seems plausible that gently stretching the body daily could have downstream health benefits, including for cancer patients. And since it’s such a low-risk, low-effort intervention, I feel comfortable recommending it, even without full clinical trials to back it up.
Ronit: Aren’t you concerned that recommending unproven treatments could be irresponsible as a doctor?
Dr. Herling: You make a fair point. As an amateur scientist, I don’t have the same rigorous standards as a formal medical researcher. But I also believe that much of what we do in daily life hasn’t been validated by clinical studies.
When I recommend something to a patient, I make sure it has no known side effects and is generally beneficial. Then I focus on building the habit and reinforcing it over time. The key is that I have a strong relationship with the patient and their trust in me. They’re open to trying my suggestions, even if they’re not scientifically bulletproof.
My recommendations may not be “game changers,” but I believe the cumulative effect of making small, sustainable changes can meaningfully improve people’s health and quality of life. It’s an infantry strategy rather than an elite commando raid. And for some patients, especially those facing serious conditions like cancer, even modest interventions could make a real difference.
Ronit: You’ve talked about your approach being more of an “infantry strategy” with many small, cumulative recommendations rather than a single “game-changing” intervention. But how does that apply to cancer patients who are in a very weakened state?
Dr. Herling: You’re absolutely right, that’s a critical consideration. For cancer patients who are facing intensive treatments like chemotherapy, and may be in a very depleted physical and mental state, my usual recommendations just won’t be enough.
With these patients, the relationship-building process is probably 99% of the work. The actual recommendations I make are almost secondary. If I simply tell a patient, “You need to do physical activity,” it’s an empty statement – they likely don’t have the energy or willpower to act on it.
Instead, I need to take a much more personalized, hands-on approach. I might refer them to a specialized physiotherapist or physical activity consultant who can create a tailored program and work closely with the patient. Having that dedicated support and accountability is often essential.
Ronit: But doesn’t that limit your ability to scale this approach beyond your individual patients?
Dr. Herling: You raise a fair point. As an amateur scientist, I’m naturally limited in the number of patients I can work with directly. Scaling this approach is certainly a challenge.
I’m not the type to aim for grand “moonshot” solutions. My focus is on making small, incremental improvements – a “blip” in the ocean, as I sometimes say. Those who happen to be in my sphere can benefit, but I can’t reach everyone.
To scale this, I’d need to become much more well-known, speak on more platforms, write more. But that goes against my natural inclination towards modesty. I’m the son of a very humble man, and that modesty is deeply ingrained in me.
Ronit: Okay, so for patients who can’t access you directly, how can they benefit from your approach and recommendations?
Dr. Herling: Well, the good news is that many of the physical exercises and lifestyle changes I recommend are quite universal. They have zero side effects and can be beneficial for almost anyone, regardless of their health condition.
So even if someone doesn’t have the opportunity to work with me one-on-one, they can still try out the “low-hanging fruit” activities I suggest, like the dead hang stretching exercise. It’s a matter of trial and error to find what works best for their individual needs and capabilities.
For cancer patients who are quite debilitated, I’d encourage them to seek out specialized support, whether that’s a physiotherapist, activity coach, or even just enlisting family members to help facilitate gentle movements and routines. The key is starting small and building up gradually.
My role then becomes more about providing guidance and encouragement remotely – perhaps through a book, blog, or other accessible resources. But the personalized relationship-building is something that’s harder to replicate at scale. It’s a limitation I acknowledge, but I hope the cumulative impact of my recommendations can still make a meaningful difference for those who can access them.
Ronit: You’ve mentioned teaching breathing exercises, even during the current war situation. I can personally attest that these have been very helpful, even in a traumatic context. But wouldn’t some of these more intensive breathing exercises be risky for cancer patients?
Dr. Herling: You make an excellent point. For cancer patients, I absolutely do not recommend any kind of intensive breathing exercises that put the body under stress. Even for generally healthy people, those types of challenging breath holds and respiratory workouts can be beneficial. But for someone who is already dealing with the immense stress of illness and treatment, the last thing they need is additional physical strain.
Instead, with cancer patients, I focus entirely on calming, restorative breathing techniques. It’s as simple as just slowing down the breathing rate – for example, aiming for 6-10 breaths per minute rather than the typical 15-20. This triggers the parasympathetic nervous system, which promotes a state of rest and relaxation.
The beauty of this approach is that it’s 100% predictable. When someone consciously slows their breathing, their nervous system will calm down, without fail. It’s not a “game-changing” intervention, but the consistency of the results is remarkable.
I might have a patient track their breathing rate, and then guide them through breathing exercises using online videos or apps that provide pacing cues. The key is making it incredibly easy and accessible, with no added burden on the patient.
Ronit: That reminds me of the research Professor Shamgar Ben-Eliyahu did on using certain drugs to induce an anti-inflammatory, calming state in cancer patients before surgery. Is there a connection there?
Dr. Herling: Ah yes, that’s a great observation. There does seem to be a clear link between this kind of relaxation response and positive outcomes for cancer patients.
Professor Ben-Eliyahu’s work, while still preliminary, suggests that creating a more anti-inflammatory, parasympathetic-dominant state can actually help prevent the spread of tumors, even in advanced cases. The challenge, of course, is translating that into a reliable, scalable medical intervention.
That’s one of the immense frustrations I have as an amateur scientist – the barriers to getting new treatments approved and into widespread use. The process is arduous, expensive, and filled with obstacles, both in terms of recruiting patients and getting buy-in from the medical establishment.
My simple breathing recommendations may not be “game changers,” but they can at least provide an accessible, low-risk way for patients to access some of those same physiological benefits. And that’s really what drives me – finding ways to empower people, even in small ways, without the huge institutional barriers that formal medical research faces.
Ronit: It’s an interesting and admirable approach. But for patients who can’t work with you directly, how can they access and benefit from your recommendations?
Dr. Herling: That’s a great question, and an important limitation of my work. As an individual practitioner, I’m inherently constrained in the number of patients I can work with closely.
My hope is that through books, blogs, videos and other accessible resources, I can share my recommendations and approach more broadly. The core principles – simple, low-risk interventions that can have a cumulative positive impact – are widely applicable.
But you’re right that the personalized relationship-building aspect is much harder to replicate at scale. That’s where I encourage patients to seek out specialized support, whether it’s working with a physiotherapist, activity coach, or even just enlisting family members to help facilitate gentle routines.
My role then becomes more about providing that initial guidance and inspiration. I may not be able to work directly with everyone, but I’m hopeful that the cumulative impact of my recommendations can still make a meaningful difference for those who are able to access them.
Ronit: So, what can you tell me about the role of supplements, like vitamins and herbs, for cancer patients? And how might someone go about researching these types of alternative treatments?
Dr. Herling: That’s a great question. When it comes to supplements for cancer patients, it’s a tricky area. On one hand, there’s a lot of anecdotal evidence and personal beliefs around the benefits of things like vitamin mixes and herbal remedies. But from a medical research perspective, we really need rigorous, double-blind studies to conclusively prove the efficacy of these treatments.
The challenge is that these types of studies are extremely difficult and expensive to conduct, especially for something like a supplement or herbal remedy that can’t be patented. Pharmaceutical companies have no financial incentive to invest in that kind of research. And even with government funding, the chances of getting a large, high-impact study published are quite low.
This creates a real catch-22. Doctors are understandably hesitant to recommend treatments without solid scientific evidence, but that evidence is incredibly hard to come by in this realm. It’s a frustrating situation, because I know there are many promising leads and ideas that simply don’t get properly investigated.
Ronit: Ah I see. That makes a lot of sense. So in the meantime, what do you suggest for cancer patients who are interested in exploring supplements or alternative therapies?
Dr. Herling: Well, I think the key is to maintain a balanced perspective. As a patient, I believe it’s reasonable to try supplements or other complementary therapies, as long as you do so with the understanding that the benefits are unproven. The placebo effect can be powerful, and even if a treatment doesn’t cure the cancer, it may provide some psychological or emotional benefits.
But I would caution against relying on these alternative approaches as a replacement for conventional medical treatments that have been rigorously tested. Cancer is a deadly disease, and patients need to be very careful about making decisions that could jeopardize their chances with proven therapies.
Perhaps the best approach is to be open-minded, but also pragmatic. Try some supplements if you feel it could help, but don’t abandon your doctor’s recommendations. And if you do notice any positive effects, consider participating in a small study, even if it’s not going to make it into a high-profile journal. Every bit of data helps expand our understanding.
Ronit: That makes a lot of sense. You know, this reminds me of an interesting story I heard about the history of breast cancer treatment. Do you happen to be familiar with that?
Dr. Herling: Ah yes, the story of the radical mastectomy is a fascinating one. It really highlights how difficult it can be to challenge entrenched medical dogma, even in the face of emerging evidence.
Back in the late 19th century, there were two prominent surgeons who hypothesized that breast cancer spreads in a circular pattern. Based on this theory, they developed the radical mastectomy – an extremely aggressive surgery where they would remove the entire breast, underlying muscle, and all the lymph nodes in the armpit.
This became the standard of care for decades, even though the patients were suffering terribly and dying left and right. It wasn’t until the 1970s that research finally showed that less invasive lumpectomy procedures could be just as effective, without all the devastating collateral damage.
But for the longest time, the top surgeons who had built their reputations on the radical mastectomy refused to accept this new evidence. It was only when patients themselves started pushing back and advocating for the less invasive approach that the medical establishment was finally forced to change.
Ronit: Wow, that’s an incredible story. It really shows how difficult it can be to challenge established practices, even when there’s a better alternative. And you’re right, the role of patient advocacy was crucial in driving that change.
Dr. Herling: Absolutely. The history of medicine is full of examples like that, where new ideas and treatments face tremendous resistance, even when the evidence is compelling. It’s a powerful reminder of how important it is to remain open-minded, to carefully weigh the evidence, and to be willing to challenge the status quo when necessary.
And you’re right, the patients themselves can play a vital role in driving that change. When they advocate for their own wellbeing and refuse to accept suboptimal treatment, it can be a real catalyst for progress. It’s a lesson I try to carry with me in my own work – to always keep an open mind, to value patient perspectives, and to pursue better solutions, even in the face of entrenched resistance.
Ronit: That’s such an important point. It really highlights the need for a collaborative, patient-centered approach in medicine. And I think the story of Lourdes that you mentioned earlier also speaks to the power of faith and belief in the healing process.
Dr. Herling: Absolutely. The story of Lourdes is a fascinating example of the profound impact that faith and belief can have, even in the face of seemingly intractable medical conditions. The fact that this small town became a pilgrimage site, attracting millions of sick people seeking miraculous cures, and that a rigorous medical clinic was established to carefully document and validate these apparent ‘healings’ – it’s just a powerful testament to the transformative potential of the human mind and spirit.
Now, I’m certainly not one to dismiss the scientific method or to suggest that faith alone can replace proven medical treatments. But I do believe that when used in conjunction with conventional therapies, the power of belief and positive mindset can be a tremendously valuable asset, especially for people facing serious illnesses.
As you noted, it’s about finding that right balance – maintaining a grounding in evidence-based medicine, while also being open to complementary approaches that can harness the body’s own innate healing mechanisms. It’s a nuanced and complex challenge, but one that I believe is crucial for improving patient outcomes and overall wellbeing.
Ronit: I have a question about sun exposure for cancer patients. I’ve heard that during chemotherapy, patients are often told to avoid the sun. Why is that?
Dr. Herling: That’s a great question. The reason has to do with something called photosensitivity. When cancer patients undergo chemotherapy, certain chemicals from the treatment can make their skin more sensitive to the sun’s rays. This can lead to severe rashes, burns, and other skin reactions when exposed to sunlight.
It’s not just chemotherapy either – this can happen with some antibiotics and even certain cosmetic products that contain ingredients like retinol. The skin becomes more vulnerable to sun damage, so doctors recommend limiting exposure to prevent those nasty side effects.
Ronit: Ah I see, that makes a lot of sense. But what about the role of the sun and vitamin D for cancer patients more broadly? Is the sun friend or enemy when it comes to cancer?
Dr. Herling: That’s a really complex issue, to be honest. On one hand, we know that excessive, long-term sun exposure can increase the risk of certain skin cancers, like melanoma. The UV radiation can damage skin cells and contribute to tumor growth.
But on the other hand, the sun is also our primary natural source of vitamin D, which has been shown to have protective effects against many types of cancer. Vitamin D deficiency has been linked to higher cancer rates, so getting adequate sun exposure (or supplementing) is important.
The challenge is finding that right balance. It’s not as simple as saying the sun is good or bad for cancer patients. We have to look at the big picture. Yes, too much sun can be harmful, but moderate exposure may actually provide significant benefits in terms of vitamin D production and other mechanisms we’re still learning about.
Ronit: Fascinating. You mentioned some of the complex interplay between sun exposure, vitamin D, and cancer risk. Can you elaborate on that a bit more?
Dr. Herling: Absolutely. The relationship between the sun, vitamin D, and cancer is really quite fascinating, and it illustrates the importance of looking at the big picture rather than focusing on isolated factors.
You see, it’s not as straightforward as “more sun exposure = more vitamin D = lower cancer risk.” The reality is much more nuanced. For example, studies have shown that people who work primarily indoors actually have higher rates of certain cancers, like melanoma, compared to those who get regular sun exposure.
This suggests that there are other mechanisms at play beyond just vitamin D production. Things like the sun’s effects on electrical and electromagnetic properties, as well as its impact on circadian rhythms and hormonal pathways, may play a significant role.
Additionally, the type and duration of sun exposure seem to matter. Acute, intense sun exposure may have different effects than moderate, regular exposure over time. And the timing – whether it’s during childhood, adolescence, or adulthood – can also influence the cancer risk.
So in the end, it’s not as simple as just taking a vitamin D supplement. The sun’s relationship with our biology is complex and multifaceted. We’re still unraveling all the nuances, but it’s clear that a balanced, thoughtful approach is needed when it comes to sun exposure, especially for those dealing with cancer.
Ronit: Wow, that’s really fascinating. It’s amazing how much we still have to learn about these interconnected biological systems. And you mentioned the potential for future technologies to help detect and treat cancer using more targeted frequencies and approaches. That’s an incredibly exciting prospect.
Dr. Herling: Absolutely. I think the future of cancer treatment and prevention is going to involve a much deeper understanding of the body’s electromagnetic and vibrational properties. We’re just scratching the surface of what’s possible when we start looking at cancer through the lens of frequencies, light, and electrical signaling, rather than just focusing on the chemical and material aspects.
Technologies like liquid biopsies and frequency-based therapies hold tremendous promise. But as with any new medical frontier, it’s going to take time, research, and a willingness to challenge established paradigms. We’ll need to be open-minded, patient, and persistent in our pursuit of these breakthroughs.
And in the meantime, there are still so many simple, low-cost interventions – like optimizing vitamin D levels – that can have a real impact on cancer risk and outcomes. It’s all about taking a holistic, balanced approach, and never losing sight of the complexity and interconnectedness of the human body and its relationship with the natural world.
Ronit: Well, thank you so much for this insightful and thought-provoking conversation, Dr. Herling. I appreciate you taking the time to share your knowledge and perspectives with me.
Dr. Herling: Thank you for your time. Thank you also for hosting me on your excellent podcast. And let’s wish good health to everyone. Amen. We’ll end in silence.