PODCAST- Dr. Sunil Aggarwal: Advancing Integrative Medical Care

About Our Guest- Dr. Sunil Aggarwal

Sunil Aggarwal, MD, PhD, FAAPMR is a Board-Certified Physician in Hospice and Palliative Medicine and Physical Medicine and Rehabilitation and Medical Geographer and serves as the Past Chair of the American Academy of Hospice and Palliative Medicine (AAHPM) Integrative Medicine Special Interest Group and an inaugural member of the Safe Use in Psychedelic-Assisted Therapies Forum. 

He was recently named as a Top 20 Emerging Leader by the AAHPM. He is an Affiliate Assistant Clinical Professor in Rehabilitation Medicine at the University of Washington School of Medicine, an Affiliate Assistant Professor in the Department of Geography, and an Affiliate Clinical Faculty with Bastyr University. He completed his MD and PhD degrees at the University of Washington and Residency and Fellowship at Virginia Mason Medical Center, NYU Langone Health, and the NIH Clinical Center. He is a Co-founder, Co-director and practitioner at the Advanced Integrative Medical Science (AIMS) Institute in Seattle, a multispecialty teaching clinic and research institute offering cutting edge care in oncology, psychiatry, neurology, rehabilitation, pain, and palliative care. He also serves as an Associate Hospice Medicine Director and On-Call Palliative Physician for MultiCare Health System. He has published over three dozen peer-reviewed article and book chapters that have been cited over 800 times per Google Scholar.

Full Podcast Transcription

Dr. Sunil Aggarwal 00:25
A lot of these patients I know are ones that get stigmatized by the medical system
because they have invisible diagnoses you can\’t sort of see right away but there\’s
something below the surface. We treat those patients – we we try to work on a you know,
holistic approach. We try to help with the different foundations of health – we try to
integrate cannabinoid medicine like I was talking about before, and other types of
naturopathic care.

Diva Nagula 02:01
Hello, this is Dr. Diva Nagula. Welcome to From Doctor To Patient, where our goal is to
bring you topics of discussion that will educate you on the various healing modalities to
help balance the mind, body and spirit. Hello everyone and welcome to a another episode
of From Doctor to Patient. Today I am joined by Sunil Agarwal. He is a Board Certified
physician in hospice and palliative medicine and physical medicine and rehabilitation and
medical geographer and serves as a past chair of the American Academy of Hospice and
Palliative Medicine, Integrative Medicine Special Interest Group and an inaugural member
of The Safe Use in Psychedelic Assisted Therapies Forum. He was recently named as Top
20 Emerging Leader by the AA HPM. He\’s an affiliate assistant clinical professor in
rehabilitation medicine at the University of Washington School of Medicine, and affiliate assistant professor in the Department of Geography, and an affiliate clinical faculty with
Baster University. He completed his MD and PhD degrees at the University of Washington
in Residency and Fellowship at Virginia Mason Medical Center at NYU Langone Health
and the NIH Clinical Center. He\’s co-founder and co-director and practitioner at the
Advanced Integrative Medical Science Institute in Seattle, a multi-specialty teaching clinic
and research Institute offering cutting edge care in oncology, psychiatry, neurology,
rehabilitation, pain and palliative care. He also serves as an associate hospice medicine
director and an on-call palliative physician for a multi-care health system. He\’s published
over three dozen peer-reviewed articles and book chapters that have been cited over 800
times per Google Scholar. Dr. Agarwal, how are you today? Thank you for joining me.

Dr. Sunil Aggarwal 03:52
I\’m doing very well. It\’s such a pleasure to be here with you Diva.

Diva Nagula 03:57
Thanks for coming on board and I\’m as I\’m sitting here, reciting your your bio, I\’m just like,
wow, I\’m like I\’m in the presence of a great scholar here. So this is fantastic. I\’m so happy
to have you on here. And with all the expertise – and we\’re actually, it\’s interesting, we\’re
actually fellow physical medicine and rehabilitation specialists. And that\’s been our
foundation and and we\’ve done so many different things beyond physiatry and it\’s, it\’s
interesting where it\’s taken you and it\’s interesting where it\’s taken me. Absolutely,
absolutely. I\’m so happy to meet a fellow physiatrist, certified physiatrist, who went
through residency and learned the basics of function and rested quality of life and
restoration and how that involves, like, not just the physical but the psychological and the
social and the community and it involves advocacy and it involves understanding of
anatomy and physiology – like it\’s very integrative field, you know, which it does allow
itself to sort of allow you to kind of go in different directions because that\’s such a such a
broad area. It\’s a different approach to medicine that served me well. Yeah, it\’s
interesting. I am actually an osteopathic physician trained. And so I was at the very
beginning, always using my hands and looking at things from a very holistic integrative
approach. So me going into rehab was kind of a natural progression for me and then
getting into pain, and then getting into what I\’m doing now with integrative medicine,
holistic care and really look at how to heal somebody from different facets of philosophy
using Eastern medicine, Western medicine, and mystical medicine, if you want to call it
that.

Dr. Sunil Aggarwal 05:43
Yeah, absolutely. That\’s so good. I think my sister is an osteopathic physician – she\’s four
years younger than me. So she came in after me and I was just so happy to see, you know,
to learn as she learned in her training and she married an osteopath. I\’m a big fan of
Osteopathic Medicine and definitely, there\’s some amazing podiatrists that were in my
residency class that were osteopath, almost half of the class was and I think it\’s really
wonderful to see how osteopathy has integrated in with like, allopathic – it didn\’t used to
be that way. You know, it was its own. It was a whole process, as you know about how it
took time to even get, you know, AMA in the old days of trying to suppress it and people
you know, there was all this like turf war stuff and it was nice to see – you know, it\’s a story
actually, a positive story. As long as people still remember and don\’t end up you know, it\’s
all the same or you know, like, they lose their unique osteopathic angle, which should not
be lost because it is, as you said, very holistic. I think we\’ll dive into this stuff later as we
go. But there was an osteopath named John McPartland. He\’s a researcher in Virginia and
he wrote this paper in the Journal of the American Osteopathic Association called the the
endocannabinoid system and osteopathic perspective. I just wanted to recommend it for
you. It\’s open access, and it\’s kind of distills the endocannabinoid system, which is
something I learned a lot about, that we weren\’t taught in formal medical school, maybe
bits and pieces here and there, even though it was really being understood for the last 30
years, really, in the late 80s, early 90s, we started discovering this massive signalling
system that regulates mood, appetite, memory, inflammation, pain, perception, bone
growth – it\’s very, it\’s very dynamic. And it also explains how cannabis works in the body,
and many other things too, like Tylenol. Nobody knew how acetaminophen worked in the
body for a longest time. And so it\’s s pretty important system, but I think the reason why it
was so suppressed is because it had that \”cannaba\” word in it. And that the idea that
cannabis can have anything medicinal to it was a politically unpopular position, you
know, because the government had already decided that it was not useful and was set up
a lot of bureaucracy to make sure it wasn\’t going anywhere. And here, you\’re getting this
information that completely contradicts that notion. So that\’s part of the reason why a lot
of doctors don\’t know about it. So in his paper, he was trying to teach osteopaths about it
and saying this actually really tracks well with the principles that you learn in osteopathic
medicine, which I thought it was really cool to see.

Diva Nagula 08:29
Yeah, I\’ll check out this paper. Thanks for sharing that with me. Let\’s get into some
conversation here. So I kind of want to understand and have our listeners understand
exactly – with all of what you do at, you know, Advanced Integrative Medical Sciences
Institute in Seattle and how you\’re able to help so many people.

Dr. Sunil Aggarwal 08:48
Yeah, well, that\’s a big question. We call it AIMS for short- AIMS Institute – we really try
and cover a spectrum because we have a lot of different practitioners that have
certifications or experience in the areas of oncology, psychiatry, neurology, rehabilitation,
pain, and palliative care. And we take an approach that is truly integrated. That means
that we have MDs, we don\’t have any DOs maybe one day, we have nurse practitioners,
ARMPs, and some of them are psychiatry, highly trained, some of them general. And then
we have naturopathic physicians. And my co-founder was a professor, or still is a
professor at the Bastyr University, which is one of the largest and oldest naturopathic
medical schools in the US and they train many high caliber doctors, but there\’s so few
opportunities for those doctors when they graduate to do residencies and to expand
further because, just like osteopathy, if they\’re still trying to gain traction, like osteopathy –
many years ago, we were talking they\’re still trying to gain traction get licenses in
different states, but in Washington, they are licensed and they can get actually insurance,
their insurance credentialing and everything as well. So it\’s, it\’s a really, they\’re well ahead.
And so we have built the clinic around a chance to also train and bring in naturopathic
physicians who are skilled, and they are skilled in many different areas, including _
medicine. First of all, the training is essentially the integrative guidebook, so everything –
herbal medicine, mind, body, spirit, diet, nutrition exercise, biochemical basis of illness and
well-being – I mean, it really is a nice comprehensive curriculum. I got exposed to it myself,
when I was a medical student at University of Washington, we did an exchange, where I
got to spend a few days over at Bastyr and then some of the Bastyr students came to our
medical school and there was, it was a wonderful thing to see how they, for example, in
the first year medical school, we learn anatomy and living anatomy, so we check out okay,
where is your cycling process? Where do your ribs start, you know, they were doing those
same kind of things. But they would also add in like, we\’re gonna use a teach you how to
use a flashlight to visualize the sinuses. You know, we didn\’t, I didn\’t learn that – I didn\’t
learn visualization of the sinuses with light, but you can do something like that. So it was
interesting to see how they followed many of the similar topics. But the one thing that
they don\’t do as much that we doctors do, which is going into hospitals, hospital-based
care, acute care, and that\’s really, I think it\’s a process that I hope to, you know, we hope
to provide opportunities in the future. But in any way, your listeners should know that we
bring these kind of doctors in who are skilled, and they they\’re paired or work in
conjunction with these other types of medical providers I was mentioning, and that allows
us to really expand the scope and ability to treat patients with chronic and serious
illnesses. And that\’s really our focus at the AIMS clinic is patients who have conditions
treated by these oncology, for example, that really is the one of the signature areas that I
think Dr. Standage, my partner – she\’s a board certified naturopathic oncologist. So
there\’s actually – that\’s one field you can actually get certification in now, because there\’s
so many people that are fed up and want more options in oncology care, and there\’s so much out there that isn\’t as mainstream, whether it\’s high dose vitamin C, or it\’s a
metabolic approach, or it\’s, you know, there\’s so many different approaches that are out
there that I think, you know, people seek that out actually is interesting at the NIH where I
spent a year you mentioned, the National Cancer Institute, which is the largest cancer
research institute in the world. They were one of the first people that I think started an
alternative medicine office, you know, it was that area, it was in cancer care, that really, I
think, we call it non-conventional medicine, but really, it\’s more like integrative medicine.
So that\’s where that was sort of established. And so that\’s been going on for a long time in
cancer care due to demand of patients. And so Dr. Standage and her team of
naturopathic oncologists and residents, they can bring in some of this latest information
understanding about genetic tests and targeted care and using botanical targeted care.
And, like the metabolic approach that I was mentioning, sometimes intermittent fasting
before chemotherapy and how that can, like – there\’s so many things I\’ve learned. Tthat\’s
sort of what where we can work alongside with a patient\’s oncology team, primary
oncology team, share notes. And Dr. Standage\’s group makes sure to give references. So
those doctors are educated as well, you know, we just, we think they should take this
mushroom. But why? Is there any science to that? And it turns out there is. So anyway,
that\’s the kind of thing that\’s happening with cancer care.

Diva Nagula 13:52
Taht\’s really interesting, because this is probably a facility that\’s unique in its own merit in
what it is able to deliver to patients, right? There\’s nothing else that\’s out there, you know,
you\’re talking about a hybrid of delivering care that\’s integrative based, and not only
integrative based, you\’re having the best of both worlds, you\’re having the naturopaths
coming in, they\’re able to provide their expertise from the naturopathic setting. And you
have various specialists in the western medicine field, you know, oncology, psychiatry,
rehab pain, and palliative. And it\’s all geared for patient\’s well being who are suffering
from some cancer. So, this is like, this is how it should be done. And, you know, for myself,
my own purpose, you know, I wish this was around. How long has it been around, by the
way?

Dr. Sunil Aggarwal 14:43
We\’re coming into our third year.

Diva Nagula 14:45
So I wish it was around six years ago when I was diagnosed with cancer because I didn\’t know about this. I didn\’t know anything about what about alternative medicine, no
common alternative alternative and complementary medicine, naturopathic. I had to
learn about it the hard way and do my own research when I was diagnosed with Stage
Four Non -Hodgkins Lymphoma. And it\’s it\’s interesting, it\’s like now that this exists. I
mean, it is a haven for people who are diagnosed with cancer and because there\’s the
first thing that is thrown at them is, you know, chemo, and immunotherapy. And it doesn\’t
matter what the diagnosis is or how far along the cancer is. I mean, that\’s just what\’s
thrown at them. That\’s the actual standard of care, right? But you\’re talking about all
these other alternatives that exist, I mean, gosh, high dose vitamin C, that\’s unbelievable
that you guys are offering that. I had a client that came to me who has had nine different
cancers. It was all the same primary, it was all appendiceal, that was recurrent for the last
15 years. I knew some people – a naturopath that offers high dose vitamin C, and I sent
him over there, he hasn\’t had the appointment yet, because this is a couple weeks ago,
and I saw him. And that\’s the first thing that I wanted him to do. And then I also have a
referral – I sent him over to the integrative medicine at George Washington University.
We\’re doing some great things – it\’s a university setting, right. It\’s great that they have the
integrative medicine program, and they have the tools to do some of these new
therapies. It\’s great that this is what is offered now. And I know it\’s not mainstream yet.
But I think you guys are on the forefront of something great here.

Dr. Sunil Aggarwal 17:28
Thank you so much Diva, from it really means a lot hearing it from you as a doctor and a
patient who, the survivor of a very challenging to say the least diagnosis. Blood cancer is
no joke, I\’m sure fatigue was off the charts. And you know, it\’s obviously staging, it\’s must
have been, and that\’s the other that\’s the psychological, emotional, psycho spiritual….

Diva Nagula 18:01
Which never was addressed for me. And that\’s the thing. When I wrote in my book, I was
so focused on the physical portion of the pain. I didn\’t address the mental I didn\’t address
the psychological. I mean, I ended up having a divorce as a result of this -during this
treatment process. I got separated with my ex-wife when I was going through chemo, and
the divorce happened subsequently after I went into remission. But I really think all of that
could have been mitigated or prevented if I had the right counseling at the time of
diagnosis. And my oncologist didn\’t offer that for me. And I was at Mayo Clinic. So…it\’s a
travesty, and more and more people are getting diagnosed with not only cancer, but
chronic conditions. So the type of things that you\’re doing there – it should be a template
that can be used for treating chronic conditions -not only just cancer. And I\’m sure that\’s
what you\’re seeing. I mean, do you have those types of patients?

Dr. Sunil Aggarwal 19:02
Yes. It\’s such a special area and important area and I think Dr. Standage\’s work already…in
this year, she\’s like 70 years old, she\’s a senior doctor and has been working on this for a
while. I had worked in cancer settings as a palliative doctor, outpatient standard care, but
it\’s a whole other world to really see the role of integrative medicine as a restoration of
hope, less side effects sometimes, safety, and you know, integrating it in with with
standard care. I\’m not saying either or – it\’s got to be a way to find this happy medium.
And anyway, so cancer, through that window – I\’ve learned a lot, how to work with
naturopathic doctors and what they\’re capable of. And then, over time, I\’ve started to see
also rheumatological disorder patients like psoriatic arthritis. I\’ve got patients with the
usual array that you get in rehab medicine, outpatient practice. So failed back surgery
syndrome, chronic Lyme disease, Fibromyalgia, something called Ehlers Danlos Syndrome

• EDS, which maybe listeners might have heard or not heard. It\’s a hypermobility disorder,
  which can affect all kinds of tissues, like hyper flexible joints, but also flexible interstitial
  tissue, which can impact your esophagus and cause hernias or even even your aorta, in
  some cases, in severe cases. So it\’s a difficult condition. And there\’s a lot of pain. And
  patients don\’t always react the same way to standard medicines. A lot of these patients
  notice are ones that get stigmatized by the medical system, because they have invisible
  diagnoses, you can\’t sort of see right away, but there\’s, there\’s something below the
  surface, so we we treat those patients, we try to work on holistic approach – we try to help
  with the different foundations of health, we try to integrate cannabinoid medicine like I
  was talking about before, and other types of naturopathic care. Cannabinoid medicine,
  cannabis medicine is a form of natural medicine. I mean, it\’s it\’s just a, you know,
  subdivision. We pull it out because of histories of XYZ but in traditional medicine systems,
  like from India, or China, or the places that it was an important herb, but in the family of
  herbs, so it shouldn\’t really be treated so separately – we kind of made that up, but it
  should be part of the plant medicine community. So we do that. And then this whole idea
  of psychospiritual healing.

Diva Nagula 21:28
Yes, talk more about that, like what kinds of things are you focused on? When you are
using this modality for clients?

Dr. Sunil Aggarwal 21:38
First of all, it\’s, it starts with an assessment to really ask the question, and I think, in medicine, in the standard conventional approach, you train, and you don\’t, because of
limitations of time, or maybe limitations of technique or method, you know, you don\’t
even ask about the different realms of suffering, of distress, of well being too, that you
may not know what to do with, but sometimes it\’s the most profound – and that has to do
with the spiritual realm. And so that means, what is somebody\’s sense of meaning, their
sense of purpose? What is it that gives them value, or gives them hope? Do they feel
connected? Do they feel a sense of belonging? Or do they feel disassociated, do they feel
hopeless, meaningless, lack of purpose, lack of value, a sense of deep anger or
resentment? So you might think, okay, these, that\’s just mental health, no, it\’s more. It\’s sort
of like – the WHO has done a good job defining health – it\’s not just the absence of
disease, but it\’s a state of complete, well-being in the areas of mental, physical, social and
spiritual well-being. Something like that. You typically think about cognition, mood, you
know, sleep, you know, that kind of thing. But the spiritual is another spectrum, that\’s, that
could encompass the body too, it\’s really important that you sometimes in order to take
care of your body, well, you need to have a sense of like, I connected with this body, the
body has some value to me – the body, I feel integrated. Or in some, when you heal the
physical body, your sense of spiritual well-being increases – you know, mental can as well.
The mind-body disconnection is a whole made up thing as well, that the whole all of
medicine after Descartes, you know, we kind of thought that was the thing, but it\’s not.
Spiritual is another way to approach the system. And it\’s not talked about and it should
be in medicine, because of the taboos. And because of religious trauma, people think that
this has to do with like, a Catholic church or some temple or mosque, it has nothing to do
with any institution – spiritual health and well-being it\’s just an emergent property of a
being human. And so I think that\’s the assessment always starts with, hey, do you do you
feel at peace? Do you feel connected? What is actually a really nice survey instrument I\’ve
been trying to use, it\’s only available for research settings now. So people who can get into
a IRB approved outcome study, we have one going or a couple going. But for those
patients, Ican ask them this thing called NIH heals, healing experiences from all life
stressors. It\’s 35 items they try to make it even shorter now, and they really tried to kind of
touch all some of these other areas about connection, belonging, sense of higher purpose,
and there\’s a few there\’s a few domains and it\’s been validated. I actually participated in
its validation when I was a fellow and I just wanted to say, that\’s all you have to start with.
If you just have time to ask those kind of questions and create space for it, sometimes
you\’ll find out that they\’re fine. And you know, I\’m really solid there, I really, I feel
connected. I really know what I need and want and you know, thank you, that was just an
acknowledgement of being there. Oftentimes, especially the kind of patients that we treat
because of the traumas they\’ve been through medical trauma or serious illness threats – it
sounds like what might have happened in your case, there\’s a huge gap there, they don\’t
know how to put it into words, but it\’s like a sense of crisis, a sense of just
meaninglessness, disconnection. Yeah, part of that can be depressed mood, as we say, but this is a little bit more subtle than that. And let me say a little bit more about it. So what
do you do then? Because I think part of the reason we\’ve actually had to get better about
this, and really start to probe into that, is because of the modality of psychedelics and
entheogens. It\’s another another term I like to use. Because we\’re offering that, at least
the way that we can right now with ketamine-assisted-psychotherapy, ketamine-assisted
integrative therapies – that forces you to really have a deeper understanding of spiritual
health. Because these medicines, by their nature, trigger the change in the in the standard,
what we call the default mode network, the way you\’re normally operating your normal
awareness of self and other, it dissolves for a little while. And that can be a very powerful,
like frightening, but also extremely therapeutic, if it\’s properly prepared for. And I think,
the only way to really understand how that what those are doing to people is to really
understand to get a sense of their spiritual well-being, meaning and purpose and
connections. And so we now when we ask about that, and we offer this therapy, which is
an excellent modality – I want to share more about it, if there\’s time, but I think these kinds
of therapies could actually end up doing a lot of things on multiple levels – the physical
body, the mental body, and certainly the spiritual health.

Diva Nagula 27:07
I\’d like to know more about that, in terms of the different medicines you are using to help
someone to explore spirituality or heal through spirituality. Ketamine is something that
you are probably using as well as cannabis. What roles do they have in in treating your
patients? And if there\’s other things like psilocybin, I don\’t know if that\’s anything that you
guys can use at a hospital setting at this point, unless it\’s under a research label?

Dr. Sunil Aggarwal 27:30
Right. Yeah, that\’s the thing, you know, we\’re trying to…. the laws, the restrictions and
regulations really have made it challenging. This whole class of medicines has been kind
of under official lockdown for, you know, 40 years or 50 years, actually, if you go back to 1970. So actually we\’re in the 50th year – just last year was the 50th year of lockdown,
formal lockdown. I mean, it\’s really, it\’s an unfortunate thing. But at the same time, this
society and culture wasn\’t ready for this level of work. And there was a worry that these
medicines were getting out of hand and, you know, not controlled. And I think, you know, I
think that was overblown, because these type of medicines and modalities, it\’s not like
humanity just discovered these 50 years ago, they\’re actually more like 50,000 years old.
And they go back to really their earliest forms of healing, that many hunter-gatherer
societies, something called shamanism, you know, they\’re very much employed and
shamanistic medicine practices that are still active today. And in many traditional
societies that have maintained traditions and COVID go far back. And so really, what we lost was the ability to really properly honor these medicines and hold them properly. You know, that means preparation, adequate screening, preparation, support during, and support after. And if you do that, and it\’s true with any strong medical intervention – there\’s many things in medicine that we do that really need a good preparation, different surgical procedures come to mind or electrical procedures that we do to people\’s hearts or things like that. They\’re pretty intense, and you need a good preparation and aftercare for it to really be safe and effective. And the same thing is true with this medicine. So anyway, we, I think what we have been left with is ketamine because it was never banned. And it was only made in the 60s or late 50s, early 60s by Parke Davis. But it turns out that we kind of fell into a created in the lab, a class of medicine that really does tap into that default mode network and sort of disrupt it for a little while if you have the right dose. It\’s also used as an anesthetic. It\’s the most commonly used anesthetic in humans in the world. So it\’s widely used in the future because it\’s very safe. And you don\’t have to put anybody on a breathing machine, you know, ventilator when they\’re under the highest dose of it because it doesn\’t suppress the respiratory drive. So that\’s very, very helpful. Anyway, so it\’s very safe. It\’s on the WHO list of essential medicines. It\’s used in children and in animals. But at low doses, below the anesthetic dose, you can kind of get into some of these areas where you\’re awake, but you\’re in a different state of consciousness or awareness. And that\’s sort of the side of ketamine that\’s newer in medicine, I would say I think it actually was pioneered in the 70s by a doctor, a Mexican doctor named Salvador Roquette, whose name should isn\’t spoken as much about but it really was the first doctor that I know of, and he went to the only national psychedelic research – can you believe the United States had a federally funded psychedelic research institute into the mid-70s, in Maryland at the Spring Grove Institute?

Diva Nagula 30:47
Not too far from where I live.

Dr. Sunil Aggarwal 30:48
Okay. So yeah, there were pioneers there. And, and so this, Dr. Roquette, came there and
showed them. I know doctors who were there at the time, and they\’ve told me these
stories, and there\’s a lot of histories about this. They were also working with LSD there and
psilocybin and other psychedelics. But he was able to show how ketamine can be well
integrated into that as a sort of a secondary medicine or preoperative medicine and, and
the other medicines that are now coming back, you know, right now psilocybin is still
Schedule I only through research can you get it, but with an attorney, I have started an
effort to petition the government for compassionate access called right-to-try. There\’s a right-to-try law that we have in the country, which was passed in 2017, 2018. I think almost
every state in the United States also has a right-to-try law. And they were mostly passed
unanimously by the houses of the states – that\’s a very well supported law, which says, if
you have serious illness, terminal illness, advanced illness, you and your doctor thinks that
a medicine could help you, that has already done a phase one clinical trialn- so it\’s been
proven to be safe, we\’re showing safety data. It\’s still in development. So it\’s still a ways off
until you can get it through FDA channels. Because your time is limited, you have the right
to try that medicine now. That\’s a federal law and a state law, like I said, and DEA said, oh
sorry, psilocybin doesn\’t apply because we got this other 1950-year-old law, which is the
way we treat it. And we think that\’s not right. So, we are petitioning the court of the Ninth
Circuit, the Federal Ninth Circuit Court to review that, and we\’re doing our arguments this
month, actually, the briefs are being submitted this month. So if that goes through, then I
will be able to get psilocybin in for two of my patients that I petitioned for that have
different forms of cancer. But ketamine, I treated them with ketamine, and that did help
them. Every medicine – there\’s different strengths and capacities.

Diva Nagula 32:58
When you say you\’re helping them, I mean, what way is the ketamine helping these
patients who are here who were at, if not an end-stage cancer, but they\’re certainly in
some stage of cancer when they\’re in that hospital setting with you?

Dr. Sunil Aggarwal 33:12
I should mention – we\’re in an outpatient setting, would it be nice to have a hospital
setting one day. We\’ll get more into in-patient settings where patients really need this, and
nursing homes and palliative care units and hospice units – I\’d love to see that. But in our
clinic, we create a space where they have these treatments, which are well decked out,
you know – art and comfortable, and we play really good quality music that\’s nonverbal,
and allows a lot of music therapy, and I mentioned all the preparation pieces. So what we
were trying to achieve for these patients is a sense of okay, you\’re dealing with a stress of
illness, you might be dealing with spiritual distress, mental distress, depressed mood –
these things impact your ability of your body to fight cancer, and to be well. And it
impacts your ability to tolerate further treatments. And of course, your ability to further
function in your life. And all these things we know affect your immune system – it\’s
something called psychoneuroimmunology. And all of that can impact how your body
handles this foreign excessive tissue growth. So our idea is, well, let\’s just try to work on
healing. You want to have a timeout from ordinary reality – what would be your intention,
if you wanted to go back and rewire yourself, what would you want to wire in? So there\’s
an aspect here where the patient is invited to state what their goal is, what their wish is, what their intention is. I think there\’s sort of a, that\’s sort of the you know, they say attitude
makes a difference, and when when you want to run a marathon….if you go in saying, I
don\’t know if I can do this, I\’m not good enough, versus like I really can do this, your body
will…..it literally makes a huge difference in terms of your whole physiology. So that\’s what
we\’re really trying to bring out, elicit that. And then when people have the experience, you
know, making sure they\’re safe and comfortable. So because what\’s really going on here,
there\’s something called the polyvagal theory, which is a really wonderful area – if you
haven\’t looked at it. Or your readers or listeners – check out Steven Porges has talked
about it – our nervous system really tries to deal with threat – it\’s an evolutionary
thing….how to deal with threat, safety, danger…. like serious life threat. We go through
these different stages…everyone knows about fight or flight. There\’s also freezing, and
freezing is like the reptilian response – I\’m going to be eaten by this creature, so I\’m just
gonna play dead. Those things are actually wired into our system. And the other one
that\’s most evolved, that we\’re going to talk about is called the social nervous system.
And that is the one where you can really play and you can connect and you can be
creative and involves people looking at people\’s faces. And the face-heart connection,
which the vegas nerve is involved in – that is really the place you want to be when you\’re
trying to heal, grow, restore, not in fight or flight or extreme life threat. So what we\’re
trying to do is create that safe environment so people can feel comfortable to tap into
those other autonomic response systems – those are neuroceptions of safety or danger.
When you do that, if you give people an opportunity to dissolve the default mode, those
defenses do go down, and you might be able to send that all-clear signal in really deep.
That\’s sort of the psychology of it – I would try to put it in a kind of contemporary
psychology of the threat, because the cancer, these illnesses, they represent this deep
existential threat.

Diva Nagula 36:59
It\’s essentially a chronic history of having your nervous system maxed out, and that\’s one
of the contributing factors of developing cancer and in my opinion, and it\’s essential to
have the client or patient learn to calm their nervous system, so that any type of
intervention can work. So it\’s interesting – you\’re using the ketamine for that purpose, is to
really calm that nervous system, reset that default mode network. And then I\’m assuming
that in addition to that, you\’re really trying to plant seeds in the patient\’s brain – of
nourishment, positive thinking, mindfulness, and those types of things kick in. And I guess,
in essence with conventional Western medicine, and then what you\’re doing with the
spiritual medicine, and then in addition to the naturopathic, it\’s just hitting it from all
different angles to see if the patient can heal.

Dr. Sunil Aggarwal 37:57
Beautifully put absolutely. You\’re exactly hitting it. There\’s so many things, that once you
do that, the experience can be quite frightening and can be quite beautiful. You know, like
I said, it\’s short lived with ketamine. With psilocybin, it\’s many more hours and others,
even more hours. But the whole idea is that once you\’re in this state….we don\’t know
everything that\’s happening. There\’s like all kinds of research about the entropic brain
hypothesis or states of order and disorder – it\’s a very complex thing happening. But
whatever is happening, people describe visions, they describe, traveling or really
dissolving into nothingness and becoming a point. But you do come back, and you come
back different. And there\’s also research like neuroscience, from the hard-nosed data
people. NIH has funded studies with animals where they, you know, we\’ll stress rats out for
like, 30 days. And then they give them ketamine and some groups they don\’t, and they
dissect their brains after this. It\’s quite a lot of animal loss here, but the studies show that
you have new neurons being generated that next day. The neurons are actually
connecting – it\’s neurogenesis. It\’s post-ketamine, post-psychedelics. Isn\’t that great? It\’s a
term – neuroplasticity. Here\’s an example – I like to use the glass example, heating up
glass, and it becomes more moldable. Some people use metal annealing, re-annealing. So
that\’s what\’s happened, that\’s what you\’re doing, and then you can lay down new
pathways. And I think that\’s why the integration piece is so critical. Is that after care, and
that\’s what what we hope to see happen. And then, you know, the psychology, positive
psychology you were mentioning, I think that\’s wonderful. There\’s a lot of really good
research now in the psychology of awe. You know, what does aw give people? When you
have a serious sense of awe. You don\’t have to, like, see the Grand Canyon – you can have
awe in everyday life – simple things. You know, it\’s not just like this great grand view from
the top of the Eiffel Tower or something, which is wonderful, don\’t get me wrong. But awe
can be done, can be created with the help of these medicines, I call them awesome,
awesome medicin – this is kind of an awe experience. But what happens in we and even
they do awe research in the lab, psychology labs, it really depends on what happens just
before and what happens just after. You can use awe and get people to suicide bomb, or
you can do terrible acts of violence – awe is a tool to hypnotize people in some ways, I
should say. We have to be very careful with this type of medicine because it can, people
are really open to suggestion. And that\’s where the doctoring, the health care they can
give unconditional, abiding presence and really letting patients sort of guide the path.
This is a really powerful thing. And that\’s what I think is happening.

Diva Nagula 41:03
It\’s very fascinating. It\’s very fascinating what you\’re doing and what I wanted to find out
is two things. One, with the dosing of ketamine, are you are you able to share what you\’re dosing? Are you doing an escalatde dose? You\’re doing a one time experience?

Dr. Sunil Aggarwal 41:21
I\’ve learned this from other people who\’ve written about this and published this. So the
standard approach that I\’ve learned, – not everything is standard for people. But, you
know, ketamine is an interesting drug – there\’s low dose, microdose, all the way to these
macrodoses of anesthesia. There\’s different regimes and not everybody is right for
everybody, you know, in terms of one size fits all, but in general, the rule of thumb we\’ve
used is 1.5 milligrams per kilogram.

Diva Nagula 41:49
Wow, you\’re going that high? That\’s amazing.

Dr. Sunil Aggarwal 41:51
Yeah, that\’s an intramuscular injection, you want to get that psychedelic effect, the
dissociative anesthetic psychedelic effect, you\’ve got to go into that realm. The lower
dose…so the NIMH – National Institute of Mental Health. I did some of my training at
NIMH – they were using the 0.5 miligrams per kilogram.

Diva Nagula 42:11
Yeah that\’s pretty much the standard, for even the Ketamine Papers, you can read about
their discussions of how they use ketamine, for your clients. And it always started at 0.5
mgs per kgs.

Dr. Sunil Aggarwal 42:21
Yeah, and I actually and we have another ketamine treatment we do with an IV with
magnesium and that we\’re doing 0.3 mgs per kgs. And that\’s an IV dose…the absorption is
a little bit less when you do intramuscular versus IV. So those are the factors but, and
those have purposes and roles for sure. But that\’s not a psychedelic therapeutic model, it\’s
a more of a what we call a psycholytic or pharmacological model, which can be really
effective and helpful. But sometimes, if you really want to tap in and get into some of
those deeper issues around existential distress, and I think some of the major potentially
more powerful antidepressant and neurogenic effects. I think tapping into those more
mystical experiences, potentially. And this has also been borne out in the psilocybin research that Hopkins and others are doing now, there seems to be some value in having
an experience that sometimes can be quite awesome. But at the same time, I\’m not like
everyone needs a high dose. And more is better, I think it really depends. And sometimes
people need to work up to that, or it\’s a process. And because this is not a one time thing,
this is you do this, you go through a cycle, and then you go through another cycle and you
go through another cycle, maybe we say three or four cycles like this, because it takes
time to rewind, rewire. And, you know, things like you say are constant- are going on over
lifetimes or decades, especially, we take care of serious PTSD in our clinic as well, people
with developmental trauma, different forms of abuse growing up or, or other traumas that
have happened to them in their lives, a serious depression. And, of course, these illnesses,
these life threatening illnesses. So it\’s, it\’s, it\’s certainly something that takes a little time.
But I think that dosing regime is where you can get more reliable.

Diva Nagula 44:14
I know – there\’s so much to converse about, and we\’re running out of time. But the last
thing I really wanted to chat about – actually two things if we have time for this, but one is
success rates, you know, using this approach, versus the conventional approach, which we
talked about earlier is just a combination of chemo-immunotherapy or you know, even
radiation and excluding all these other modalities that you\’re doing. What you\’re offering,
it\’s the best of the best of what Western medicine has to offer and then you\’re infusing
and peppering it with some Eastern medicine and spirituality – I\’m just curious about the
success rate.

Dr. Sunil Aggarwal 44:51
You\’re asking the right question and I don\’t know yet. I have an outcome study Dr.
Stanage my partner has started the AIMS Cancer Outcome Study – they\’ve enrolled some
80 or 100 patients at this point. And we\’re going to find out, looking at disease free
survival, overall survival, that\’s those are our heart. She has these hard endpoints. She\’s
done previous work before, when we weren\’t incorporating ketamine, but doing
naturopathic care. Some areas I believe advanced. I think it was some lung cancer, she\’s
published – I have to look up the data, but her responses in her small cluster were above
or beyond what randomized control trials and those types of lung cancer had found. She\’s
published that. But I think we really still, we want to check ourselves on that. And that\’s all
we have an IRB approved outcome study, through Seattle University, and we\’re trying to
enroll people and say, hey some of these things are experimental, many things that we\’re
doing, but we want to see, we want to get your permission, we want to track your data
down the road, and record on that. So it\’s still remains to be seen, I think. The cancer
especially – one of my resident doctors is going to be presenting at the ONC-ANP meeting, which is the Oncology Naturopathic Association in the United States. And there\’s
several of the cancer patients who have gone through ketamine therapy – she\’s going to
be showing some of their data. At least what we do know in terms of their mood score
changes, PHQ-9 for depression, anxiety, and then if there\’s any data on their cancer
course. But we\’ve only been around like I said, really since October 2018.

Diva Nagula 46:36
I mean, with all the things that you\’re doing, I mean, you\’re implementing strategies, that\’s
going to starve the cancer with with your intermittent fasting and fasting technique, right?
And then you\’re doing a high dose vitamin C, then you\’re infusing spirituality with this, I
mean, how can it not get better? And then the whole idea is, well, it may not get better,
because you\’re not taking into consideration the patient\’s mindset. But that\’s the whole
process – that\’s what you\’re doing with with the psychological counseling and the planting
of the seeds so that you\’re actually allowing and teaching the client and patient to have a
positive mindset. And that in and of itself, can be the biggest predictor of success.

Dr. Sunil Aggarwal 47:18
That would be cool. Spoken like a rehab doctor right there. That truly is something that
we talk about – just like people say, self-rated, like how well are you? Like there\’s all these
fancy psychometrics and quality of life metrics, but it\’s like the self-rated health actually
ends up being one of the best predictors of survival. And, you know, and so it\’s, I think
you\’re onto something there. And certainly I\’m not like a – there\’s no such thing as a
panacea, I think, you know, with the complex illnesses like cancer, multifactorial solution,
you know, and you really want to bring the best of what we what we have, what research
has. That\’s I my hope, you know, hit me back in like a year, and maybe we\’ll have some
preliminary data to share.

Diva Nagula 48:10
I would ove to, love to hear more about what you\’re doing. And some of these outcome
studies – I really can\’t wait for that to come out. And for our listeners – I\’d love to
understand what\’s the best mode for people to find more information about you, the clinic
that you work at, and the amazing things that you\’re doing there.

Dr. Sunil Aggarwal 48:29
Oh, thank you. I think anyone can reach us on Google -AIMS Institute. And your first hit is our website, AIMSInstitute.net. We\’re also on Facebook and Instagram – once you get to
that website, you can see the news section. And we have a blog of different articles we\’ve
been publishing or talks we\’ve given or information – there\’s a lot. And then if patients are
interested, unfortunately, we\’re only licensed in Washington State – maybe that\’ll change
in the future. But we do do tele-education opportunities. So we can give people some
information wherever they are in different states, educate them and maybe try to give
them some guidance from from afar. We do telemedicine regularly. And then you know,
in-patient coming to our offices, certainly, then we can practice and we take many major
forms of insurance for the areas that we can cover, including Medicare, which I\’m really
excited about because Medicare covers a lot of patients with cancer are over 65. And very
few of them get access to naturopathic medicine. And so through incidental services
billing, which means that Medicare allows me as a Medicare credential doctor to have
other providers who aren\’t credentialed and take care of the patients – I\’m supervising.
That\’s what I wanted to let your readers know that we can try to work with them.

Diva Nagula 50:00
For my own reference, and it might be applicable to some people who are listening. But if
I want to refer someone to you who doesn\’t live in Seattle, is there a program that\’s
available where they can stay a duration of time? And go? Like a, I don\’t know, like a
package, like a five week package? I don\’t know if that\’s what you offer?

Dr. Sunil Aggarwal 50:18
Yes, we have developed those for patients. I\’ve had patients who come come from the
east coast, housing, you know, oftentimes people will find their own airbnbs, we do have a
discounted rate with one of the Marriott\’s hotels, it\’s in the area, it\’s on our website. And
they actually have a shuttle bus where they did pre-COVID. I don\’t know if it\’s up and
running again, but they made it easier to come back and forth. And, you know, really, if
people wanted to do that, we would pre-cook that, you know, try to do some remote
visits, and really understand what the need and sequence that they would want in terms
of, you know, what, and making sure we have space – we are a smaller practice, but we\’re
hoping to have more spaces. A cancer patient would need to see our naturopathic
oncologist and get a full assessment. And then you know, maybe get also a medical
screening if he wants to do the drug assisted psychotherapy. And then we would say okay,
this is kind of how, what course you could follow here, here\’s the bloodwork we will need,
here\’s the vitamin C\’s or other types of high dose interventional therapies we would do.
Here\’s the course of ketamine therapy, maybe cannabis education as well. And we could
we could space that out over a month or four to six weeks, depending on on what the
need is.

Diva Nagula 51:34
Yeah, I was talking about that specific patient that I had that had the recurrence of the
same primary appendiceal cancer. So this might be something where I can refer him to
you. And we can talk off line about this. But that\’s good that you have that available for
people who don\’t live in that vicinity. So thank you for that. And thank you so much for
being on the show today. I appreciate all the insights and I look forward to keeping in
touch with you to see what other things that you have in the pipeline that you\’re going to
be able to offer and also these outcome studies. So it\’s been really an honor and pleasure
to have you on the show.

Dr. Sunil Aggarwal 52:08
Dr. Nagula, I feel the same way. Thank you for sharing your platform, for creating this
platform, and giving me a chance to come and meet you and talk to your listeners – up to
do it again in the future. Thank you.