Cancer ND

Magnesium and Hot Flashes

2011-09-26T11:28:00.000-07:00

by Jake Psenka, ND

Hot flashes are one of the most common and irritating conditions experienced by women. They are often experienced by women going through menopause and also frequently encountered as an unpleasant side effect of breast cancer therapy. Anti-estrogen drugs such as Arimidex and Tamoxifen are notable promoters of hot flashes.

The ideal treatment for hot flashes would be one that:

a) Was effective at decreasing both the frequency and intensity of the hot flash

b) Didn’t interfere with other drugs

c) Was safe and didn’t cause more problems that it was fixing.

Unfortunately, very few effective treatments are available which decrease both the frequency and severity of hot flashes. Occasionally SSRI drugs (selective serotonin reuptake inhibitors) are used to control hot flashes. However, concerns exist about these medications interfering with the metabolism and effectiveness of anti-estrogen drugs including Tamoxifen. The SSRI drugs, which are mostly used to treat depression, also come with some less than exciting side effects of their own. Botanical medicines such as black cohosh (cimicifuga racemosa) are frequently used however there are some doctors have voiced concerns about the use of this plant in cancer patients. While botanical medicines are much less likely to have unpleasant side effect than drug therapy, they do not seem to provide relief from hot flashes reliably in all patients.

A study published recently in Supportive Cancer Care described magnesium oxide as a potentially effective treatment for hot flashes. Magnesium seems to be an ideal candidate, it’s very safe, doesn’t interfere with anti-estrogen therapies (i.e.. it's safe for women with a history of breast cancer), and according to the study is relatively effective. This study used magnesium oxide at either 400mg or 800mg doses per day for 4-weeks in breast cancer patients. Both the frequency and severity of hot flashes were measured. Severity was assessed using a “hot flash score,” which was defined as frequency x severity.

The frequency of hot flashes decreased by 41%. There was also a 50% reduction in the hot flash score compared to baseline. Study participants reported improvements in sweating, distress, and fatigue. Two women reported experiencing headaches, and another two reported grade-1 diarrhea (diarrhea is graded 1-4 with 4 being the worst). Considering the effectiveness and excellent safety profile of magnesium, the authors concluded that this treatment was worthy of additional study.

A magnesium dosage of 800mg is considered to be an optimal intake by many healthcare professionals. It is also interesting to note that magnesium levels have been found to be decreasing rapidly over the past 100 years. Inadequate intake of foods containing magnesium is likely to be responsible for this. It is also important to point out that many drugs can induce a magnesium deficiency including antibiotics, chemotherapy drugs, corticosteroids, and laxatives. Alcohol is another potent promoter of magnesium deficiency.

Magnesium is a very safe mineral, with diarrhea being the most frequently encountered side effect. Dosages of 800mg may produce loose stool in some people, with others being able to tolerate much higher dosages. This potential side effect can also make magnesium effective in some cases of constipation. Starting with a lower dose is generally the best way to start any supplementation.

It is important to remember that when taking magnesium is it important to supplement with calcium as well. This is especially true for those who are post-menopausal, and those who have previously been treated with chemotherapy or radiation and are thus at increased risk for osteoporosis.

Reference: Support Cancer Care, 2011, 19:859-863.

Mayo Clinic Researchers Report That Vitamin D Deficiency Can Double The Risk of Death in Chronic Lymphocytic Leukemia

2010-12-06T10:17:00.000-08:00

It’s pretty amazing that a deficiency of a single vitamin can double a person’s risk of dying from a particular disease. This is exactly what a group of researchers from the Mayo Clinic in Rochester, NY found out when studying the effects of vitamin D in a population of patients with chronic lymphocytic leukemia (CLL).

During this study researchers determined that out of 390 patients with known CLL 119 of them (30.5%) were found to be deficient in vitamin D. Thirty percent is a fairly large number, and is most likely indicative of the chronic vitamin D deficiency that exists throughout society. In fact, the authors of this research study cited reports of both vitamin D’s anti-cancer properties, and it’s widespread deficiency as reasons why they felt this research was important to perform. Another goal of this study was to investigate the relationship that vitamin D may play in CLL, as past research had not fully investigated this relationship.

Vitamin D is unique in that our bodies have the ability to synthesize this vitamin when our skin is exposed to the sun’s ultraviolet rays. It has been estimated that 400 IU can be achieved with the exposure of 30% of a person’s skin surface for 30 minutes at moderate latitudes (Recommended Daily Allowance is 400-800IU/day). However, most people don’t receive this kind of exposure. Vitamin D can also be obtained by eating foods that contain vitamin D such as fish liver oil, morel mushrooms, and egg yolks. Additionally vitamin D can also be obtained by eating foods that have been fortified with this vitamin: milk (cow, soy, and rice), Cherrios, and some cheeses. Vitamin D is also often frequently taken in supplement form.

It is important to understand that excessive dosages of vitamin D can produce toxic side effects. The National Academy of Sciences has determined that dosages up to 2000 IU per day are safe, although some studies have found that higher dosages can also be used without toxicity. However, as with most vitamins it is not wise to assume that “natural means safe,” and it is a good idea seek the guidance of a qualified health practitioner when considering the use of higher dose vitamins.

It’s quite easy to determine if you are one of the people who would benefit from taking some additional vitamin D, as vitamin D levels can be obtained via a blood test. It is a good idea to ask your physician to include vitamin D testing when having your blood drawn. If you have CLL, or any other kind of cancer, you should insist on checking your vitamin D level. If found to be deficient then returning it to a normal level may be a very important part of your overall treatment.

Vitamin D for cancer prevention: global perspective

"It is projected that raising the minimum year-round serum 25(OH)D level to 40 to60 ng/mL would prevent approximately 58,000 new cases of breast cancer and 49,000 new cases of colorectal cancer each year..."

Vitamin D and prevention of breast cancer: pooled analysis

"According to the pooled analysis, individuals with serum 25(OH)D of approximately 52 ng/mL had 50% lower risk of breast cancer than those with serum levels less than 13 ng/mL."

Vitamin D and prevention of colorectal cancer

"Intake of 1000IU/day of vitamin D, half the safe upper intake established by the National Academy of Sciences, was associated with 50% lower risk."

Serum vitamin D concentrations are related to depression in young adult US population: the Third National Health and Nutrition Examination Survey

"In this large population based study, likelihood of having depression in persons with vitamin D deficiency is significantly higher compared to those with vitamin D sufficiency."

Environmental and Occupational Causes of Cancer

2010-11-15T16:16:00.000-08:00

At a recent lecture I gave for the Wellness Community's Cancer Transitions Program I referenced this 2005 paper which discusses environmental chemical exposure and cancer risk. Several people asked for a copy, so here it is.

Click HERE for the paper.

High-Dose Vitamin C IV's on 60 Minutes

2010-10-29T22:24:00.000-07:00

High-dose vitamin C therapy has been something that hasn't received too much attention outside of the complementary and alternative medical field- until now. Recently the New Zealand version of the television show 60 Minutes published an investigative report concerning vitamin C being used in hospitals, sometimes despite the hospital's best efforts to not do so. After watching this video you may find yourself asking why there is such resistance to this therapy. After prescribing 1000's of these IV's over the years I find myself asking the same question. It's inexpensive, safe, and provides many benefits. The video is really worth watching.

To watch the video choose the link below:
Show #1

A follow-up report was aired which detailed the response of New Zealanders. Also a video worth watching:
Follow up show

Lastly, here is a link to a study published in the Proceeding of the National Academy of Sciences regarding the action of high-dose vitamin C therapy. Click HERE.

Vitamin D, Hydrogen Peroxide, and Breast Cancer

2010-07-28T18:14:00.000-07:00

Vitamin D has received quite a bit of attention over the past two years. It has shown the ability to prevent disease, keep the immune system functioning, and help people keep mentally sound. It has also been shown to help fight off cancer. One of the ways that it may do this is by increasing the action of hydrogen peroxide inside cancer cells.

You might be asking yourself "how does hydrogen peroxide get into cancer cells, and why is this important?" It's a good question. The answer has to do with free radicals. It is a fact that many conventional and alternative treatments for cancer work by producing free radicals inside of the cancer cells. These free radicals react with other substances within the cell which can ultimately lead to that cell's death. Placing free radicals specifically into cancer cells is a very good therapeutic target, as often these cells don't have the ability to protect themselves from this sort of insult. Hydrogen peroxide is an intermediary-type molecule in the production of free radicals. Some treatments, like high dose vitamin C IV's, work by generating high levels of hydrogen peroxide inside cancer cells. In turn this hydrogen peroxide then is changed into free radicals which destroy the cancer cell from the inside out. It has been found that cancer cells are particularly sensitive to the actions of hydrogen peroxide due to their lacking of an enzyme known as catalase. Don't make my word for though. The Proceedings of the National Academy of Sciences has a bit to say about this too.

Interestingly, vitamin D has been found to increase sensitivity of breast cancer cells to the action of hydrogen peroxide. That means vitamin D has the potential to make many anti-cancer therapies work better. Vitamin D is sometimes called the sunshine vitamin, because your body can synthesize it using sunlight. Well, yes, it can make vitamin D, but not always in sufficient quantities. I routinely analyze patients blood to assess their vitamin D3 (the most active form of vitamin D) levels, and even though I'm in AZ, a real sunshine state, I often find low levels of vitamin D.

It is easy to take a vitamin D supplement, and it's probably a good idea. I think that adding a vitamin D analysis to your annual checkup would be a smart move. I think that an even smarter move would be to get a vitamin D3 test prior to starting an anti-cancer treatment. Also, it is important to point out that vitamin D can be problematic to the liver when taken at high doses for a prolonged period of time. Therefore it's a good idea to let your physician know that you are taking it.

Exercise, Acidosis, and Cancer

2010-07-26T09:52:00.000-07:00

Nearly everyone should have heard by now that exercise is beneficial for people with cancer. It is also fairly well known that regular exercise has been proven to prevent the development of many cancers, such as breast cancer. There are many theories which try to explain how exercise is beneficial, but not a lot of scientific data proving these hypotheses. In our increasingly toxic world, where the majority of cancers are thought to arise from some sort of environmental exposure, the need to identify prevention strategies has never been more important.

Recently researches decided to try and uncover the mechanisms by which exercise may help to prevent cancer. It is an established fact that the transition from a pre-cancerous cell to an invasive malignant, or cancerous, type of cell is a prolonged multistep process. This process is regulated by changes which occur in the body in response to different exposures or events. Diet, exercise, stress, and environmental exposures are all things that can influence the change from a non-cancerous cell into a cancerous one.

These researchers, who published their work in the April edition of Biology Direct, used cell cultures in which they subjected those cells to exposures similar to what happens in the body during exercise. The researchers found that the transient acidosis that occurs with exercise interrupted the evolution to the invasive cancer phenotype.

If you have ever had a vigorous day at the gym and then paid for it the next day with sore muscles, you have experienced the acidosis that accompanies exercise. The culprit is lactic acid, and it is a byproduct of energy metabolism. It is interesting to note that acidosis is often trumpeted as a causative agent for cancer development. This study demonstrates that in reality things might not be so cut and dry. Indeed a healthy balance of acidity, alkalinity, exercise, diet, and mental well being are all necessary for health.

Here's a link to the study: Episodic, transient systemic acidosis delays evolution of the malignant phenotype: Possible mechanism for cancer prevention by increased physical activity.

Iodine Helps Prevent and Treat Breast Cancer

2009-01-06T11:12:00.000-08:00

Hello Everyone and Happy New Year

So, after way too long I’ve finally found the time to add some more information to this site. It’s not that there haven’t been any newsworthy topics in the cancer field in the past six months, I just need an 8th day in the week. However, for 2009 I’m going to try and post something useful every month.

Many of you may have heard about the relationship between iodine and breast disease. It has been known for a while that women with fibrocystic breasts, and women who suffer from cyclic mastalgia (aka. tender breasts during menstruation), can find substantial relief by taking molecular iodine. What you may not be aware of is that an iodine deficiency can lead to structural changes in breast tissue, and has even been shown to lead to an increase in breast malignancy in animal models. On the flip side iodine has been shown to reverse the development of cancer cells in chemically-induced animal cancers. Researchers have also suggested that iodine decreases early cancer progression through an inhibitory effect on cancer initiating cells.

Wow, iodine, how about that? But the question is how the iodine is protecting the breast tissue. When doctors talk about iodine they are usually doing so in reference to the thyroid gland, as 75% of the iodine in the body is found in there. Interestingly, women with breast cancer have larger thyroid glands than women without cancer. Could iodine be decreasing breast cancer risk through the action of the thyroid gland?

That is one of the questions that researchers from Drexel University College of Medicine in Philly, PA set out to answer. These people attempted to determine how the iodine was working by examining the genetic profiles of breast cancer cells which were exposed to iodine. In their study, which was performed in vitro (in a Petri dish), they used the estrogen responsive MCF-7 breast cancer cell lines. Breast cancer cells that are estrogen responsive (aka “estrogen positive”) have estrogen receptors on their cell surface, and are stimulated to grow and divide in the presence of estrogen (one reason that HRT post-menopause can lead to increased risk of breast cancer). Breast cancer cells can also be estrogen receptor “negative,” which implies that the cells are not as sensitive to estrogen. The classification of negative vs. positive is determined by testing done on tissue that has been removed from the body, such as in a biopsy.

Anyway, in this study they used estrogen responsive breast cancer cells and treated them with Lugol’s iodine solution. Lugol’s is 5% iodine and 10% potassium iodide. Iodine is the term used to describe “free” iodine, and iodide is used to describe iodine that is molecularly bound to something else, like potassium. What these researchers found was that 29 genes were up regulated, and 14 genes were down regulated in response to the iodine/iodide treatment. Genes are the biological entity responsible for defining traits. Remember Gregor Mendel, the priest with the peas? These genes cannot only determine which peas will be wrinkled and which will be round, but other things like eye color, or even the number and type of estrogen receptors on a breast cancer cell. This evidence, along with other data, does not suggest that the beneficial effects of iodine are mediated by the thyroid gland, and for the most part are independent of the thyroid gland.

Of the 43 genes that were effected by the iodine/iodide treatment several were involved in hormone metabolism; more were involved in the regulation of cell cycle progression, growth and differentiation. Importantly, this study found that treated cells expressed genes which regulate estrogen metabolism. One of the mechanisms that was influenced by the iodie/iodide treatment is the Cytochrome P450 system. This system, often referred to as just the “P450” system, is made up of a family of enzymes which are responsible for processing, modifying, and eliminating things from the body. The P450 system is responsible for eliminating drugs (like some types of chemotherapy), dietary chemicals (like caffeine), and substances produced within our own bodies like hormones. In the iodine study, it was discovered that there was an increase in the enzymes of the P450 system which are responsible for metabolizing estrogen into a form which inhibits cellular proliferation. This means that iodine/iodide can change the body's estrogen into a form which inhibits abnormal cellular reproduction.

It was also found that treatment with iodine/iodide diminished the effect that estrogen had in estrogen-receptor positive cells. Specifically, treated cells showed evidence of having an activated BRCA1 gene. The BRCA1 gene, often called the “Breast Cancer Gene,” seems to be widely misunderstood. This gene is not something that promotes cancer, but something that helps to prevent it. The BRCA1 gene is a tumor suppressor gene, and as such is used by the body to repair damaged DNA. Cancer develops from damaged DNA. BRCA1 can also influence the effectiveness of other systems throughout the body, like the P450 system. When women undergo genetic testing and are told that they have “the BRCA1 gene,” that means that they have a mutation of that gene. So, by increasing BRCA1 the iodine/iodide treatment helps to protect your DNA and thus offers some protection from the development of cancer.

Additionally, this study found that many genes which influence growth, cellular reproduction, and differentiation (a measure of a cell’s maturity or specialization- typically the lesser the degree of differentiation, the more aggressive the cancer) were impacted by the addition of iodine/iodide. Iodine/iodide treatment up-regulated genes which are responsible for preventing uncontrolled cellular division (aka cancer).

Lastly, and I have to say that besides the cancer preventative effects of iodine. This is the coolest action. Iodine/iodide treatment showed some ability to inhibit breast cancer cell’s ability to become resistant to treatments such as Tamoxifen. Tamoxifen, a SERM (selective estrogen response modifier), is an estrogen blocking drug used to treat estrogen-positive breast cancers. Unfortunately, like most cancer therapies Tamoxifen can loose it’s effectiveness over time. This occurs because cancer cells can change their genetics in response to their environment. Like most chemotherapy, chances are that it will work initially, but that it may become less effective over time. So, now it seems that it might be a good idea for women taking Tamoxifen to take some iodine as well.

For those who are interested the whole article “Iodine Alters Gene Expression in the MCF7 Breast Cancer Cell Line: Evidence for an Anti-Estrogen Effect of Iodine” article can do so by clicking here.

So, if you want to prevent breast cancer, or if you already have breast cancer is then you might be asking yourself “How much, and what kind, of iodine should I take?” The RDA for iodine is 150 micrograms per day for adults. For most people this is probably a good dosage to take on a daily basis. Those with thyroid disease or who have a history of breast cancer should consider having their iodine levels checked. This can be done easily using a urine collection. Doctor’s Data is a lab which I have used which can provide this testing. For more info on Doctor's Data and how to obtain this testing please contact my office here.

Iodine can cause things like rashes, nausea, headaches, or allergic reactions. However, most of these side effects are seen when people take very high doses (greater than 30 milligrams per day) over a long period of time. Some physicians believe that it takes much higher doses to cause any significant side effects. One thing I have learned in practice is that we are all physiologically unique, and what is good for one person isn’t necessarily good for another. If you would like to start taking iodine I would suggest eating foods that contain it before taking a pill. Many people will undoubtedly think that they are getting enough iodine because they eat iodized salt. The truth of the matter is that maybe they are, maybe they're not. A study published in 2008 found that 53% of iodized salt products contained less then the FDA recommended level. You can see this article here.

If you like seaweed salad you’ll love this: kombu, arame, and kelp all contain lots of iodine. Certain types of fish also contain higher amounts of iodine. Haddock, cod, herring, halibut, and sardines are all good sources. My favorite seafood, shrimp, also contains a fair amount of iodine. Shrimp are some tasty little bugs aren’t they?

Healthy Regards,
Jake Psenka, ND

PS-If anyone has any ideas for future topics please let me know via email.

Cancer Related Fatigue

2008-04-28T10:27:00.000-07:00

Fatigue is the most common symptom associated with cancer and cancer treatment. Current estimates suggest that between 60 and 90% of people with cancer suffer with at least some degree of fatigue. Fatigue associated with cancer manifests in many forms, some people find that they only need to take a short nap during the day to relieve their fatigue. Others find themselves feeling exhausted all of the time, yet unable to have a restful sleep. For these people even the simplest of tasks, such as walking to the mailbox, can become physically overwhelming. Fatigue resulting from cancer and cancer therapy has been termed “Cancer Related Fatigue” (CRF). Although there are not yet any definite answers about the causes of CRF, it is very clear that steps need to be taken to reduce it’s impact on people fighting cancer.

There are currently several hypothesis which try to explain the mechanisms of CRF. Some of the hypothesis suggest that this fatigue is the result of treatment side effects. For instance many people who undergo conventional cancer treatment like chemo or radiation develop a condition called anemia. The term anemia refers to a group of conditions in which the body has a decreased ability to utilize oxygen. This condition arises when the amount of hemoglobin, a blood protein which carries oxygen, is decreased. When there is less of an ability to carry oxygen, the tissues must do without, and this manifests as tiredness and fatigue. Another cause of CRF that may be brought on by treatment is poor nutritional status. Simply put, when the body doesn’t have the raw materials it needs to carry out day-to-day operations, then one of the frequent results is fatigue. Conventional cancer treatments, as well as the disease itself, are notorious for diminishing people’s appetites.

The non-treatment related causes of CRF are slightly more ambiguous. An interesting paper published in the December 2007 issue of the journal The Oncologist provided a good summary about the mechanisms of CRF well. Click here to access the full article.

The current thoughts about the cause of CRF include: serotonin dysregulation, hippocampus-pituitary- adrenal Axis (HPA-Axis) dysfunction, circadian rhythm disruption, altered muscle metabolism, afferent vagal nerve activation, and cytokine dysregulation. All of these multi-syllabic fancy sounding phrases have one thing in common, inflammation.

Inflammation is developing into one of the primary causes for many of the chronic conditions affecting people’s health today. Research about the health implications of inflammation is exploding, with new information becoming available everyday. Much of the inflammation that people experience today is lifestyle induced- bad diets, bad habits, no exercise, prolonged stress, etc. In CRF, inflammation is produced through the action of several substances called cytokines. Cytokines are a type of cellular communication device used by cells when they want to relay information to each other. When one cell wants to talk to another, it can’t simply yell out “hey you over there, listen to this.” In order for a cell to send a message it has to use communication chemicals, like cytokines. Cytokines deliver their chemical message by leaving one cell, floating through the body, and then attaching to a target cells. In the case of CRF, many of the cytokines are delivering a pro-inflammatory message. Inflammatory cytokines associated with cancer and its treatment (chemo, radiation, surgery, biologic therapies) include Tumor Necrosis Factor Alpha (TNF-a), Interleukin 1 Beta (IL-1B), and Interleukin-6 (IL-6). These chemical messengers instruct their target cells to respond in an inflammatory manner. This can manifest in many different ways, including how the cell reacts to other stimulus in it’s environment.

As an example of how inflammatory cytokines can cause cancer-related fatigue, consider the following explanation of serotonin dysregulation. Tumor Necrosis Factor Alpha (TNF-a) has been shown to be associated with problems in central nervous system functions, which can lead to a state of lethargy and weight loss. Specifically, cancer (or cancer treatment) induced TNF-a increases influence brain chemistry. Raised TNF-a levels cause the body to increase the amount of serotonin that is released into the synaptic cleft. Serotonin is an inhibitory neurotransmitter, which means that serotonin promotes relaxation. The synaptic cleft is where one nerve “plugs in” to another. The quality of the connection between the two nerves depends on the level of neurotransmitters present at this junction.

High levels of TNF-a send a signal to the nerve tissue instructing it to put more serotonin into the synaptic cleft. This causes the inhibitory signal to be amplified. Too much serotonin is like too much of a sedative, it can cause exaggerated tiredness or fatigue.

Not only can TNF-a cause elevated levels of serotonin, it can also increase the body’s ability recognize more serotonin in the synaptic cleft. In a way, this doubles the effect that serotonin has on the brain- not only does the TNF-a signal the body to make more serotonin, it tells the body to respond more drastically to serotonin’s message.

Hopefully, this brief example of how an inflammatory cytokine influences neurochemistry and promotes fatigue makes sense. Remember that this is just one example of how inflammation can contribute to fatigue.

Knowing the mechanism can help to find a cure. There are a number of natural medicines that have the ability to reduce inflammatory signals. These natural agents not only have good research supporting their use and safety, but many are also compatible with conventional therapies. Some of these natural agents have even been shown to make conventional treatments work better with less side effects. Others have demonstrated the ability to kill cancer cells on their own.

Remember, it’s very important to check with your doctor before taking any new medication or supplement. This is especially true for people fighting cancer.
Here are a couple of examples of natural medicines that may help with CRF.

Curcumin
A derivative of the indian spice tumeric, this supplement has amazing anti-inflammatory and anti-cancer actions. Pubmed lists over 800 references when searching for curcumin and cancer. An recent study analyzed the effect that curcumin had on chemotherapy induced increases in TNF-a levels. The study authors found that a single dose of the chemotherapy drug cisplatin increased TNF-a levels by 486%. When curcumin was administered in an oral dose 2 days before, and three days after chemotherapy treatment, the TNF-a levels decreased significantly. TNF-a is not the only pro-inflammatory signal that curcumin modulates, it also has an inhibitory action against several other mediators of inflammation. It is this ability to affect several systems in the body that allows curcumin to work synergistically with several chemotherapy drugs. A study published in Molecular Cancer Therapies summarizes this action well- click here for the study.

Other natural medicines which may be beneficial in CRF include vitamin E, the herb boswellia, omega-3 fatty acids, certain amino acids, and activated vitamin B3.

Acupuncture
According to a recent investigation, acupuncture led to a 36% improvement in CRF symptoms. Symptoms such as motivation, activity levels, and general fatigue were all measured. To read the abstract of the study click here.
Acupuncture is gaining favor as a great therapy for many cancer related side effects. Many women have used acupuncture to successfully treat the side effects of radiation therapy. More than one treatment is usually needed, and weekly visits may be the best way to get good results. Acupuncture is very relaxing and no, the needles don’t hurt!

Exercise
Several studies have been published regarding the use of exercise during and after cancer therapy. Nearly all of these studies have suggested that exercise is beneficial for alleviating symptoms of cancer-related fatigue. Thirty minutes of light exercise three times a week is a good place to begin. Start with easy, non-impact activities like walking, yoga, or Tai Chi. In addition to being a powerful way to combat fatigue, exercise is great for enhancing the immune system, detoxification, and relieving stress.

Diet
It seems like every post on CancerND mentions the importance of a good diet. Well, this post is no different. Many people fighting cancer are malnourished, at least to some degree. This may arise because of many reasons such as lack of appetite, compromised digestion, or just eating the wrong things. It is very important to consume the right amounts and types of protein, fats, and carbohydrates everyday. For more info on diet and cancer see the CancerND post about Acid/Base Balance.

If you’ve tried the therapies listed above and still find that you are feeling fatigued, certain lab tests may shed light on the situation. As many of the symptoms of CRF seem to be related, at least in some ways, to serotonin, measuring serotonin levels in the body may be beneficial. Such testing is easy and relatively inexpensive, and usually doesn’t even require a blood sample. To find out more about this type of testing use the contact information above.

Cancer related fatigue is a complex, multi-factorial problem that effects millions of people worldwide. Only recently has research been directed towards figuring out how CRF develops. Hopefully, a better understanding of CRF will lead to successful ways in which it can be treated.

It's Official- Green Tea is OK for People with Cancer

2008-03-31T22:24:00.000-07:00

Over the past few years a great deal of research has supported the use of green tea extract in cancer medicine. However, as with any natural supplement, there has been concern about potential interactions with conventional therapies such as chemotherapy. Most of this concern centers around the possibility that green tea, and the green tea extract EGCG, may interfere with the body’s metabolism of drugs. Most substances, including drugs and supplements, are processed in the liver via a system known as the cytochrome P450 system (CYP450). The CYP450 system consists of many separate sets of enzymatic pathways- each responsible for the metabolism of certain types of drugs and natural substances. For instance, one of the most commonly used pathways is the CYP3A4 pathway.

Some substances, both synthetic and natural, have the ability to speed up or slow down pathways like CYP3A4. Something that slows down the action of a P450 pathway can cause substances that are metabolized through that pathway to remain the body for an extended time. Conversely, something that accelerates the action of a P450 pathway can decrease the time a substance is in the body.

Most conventional physicians are concerned that a natural agent could decrease the amount of time a chemotherapy drug spends in the body, which would potentially decrease that drug’s effectiveness. Concern also arises from the idea that a natural agent could inhibit the P450 system, which could result in the chemo drug remaining in the body longer and potentially result in more toxicity. Additionally, when two substances, which are both metabolized via the same pathway, are put in the body at the same time a sort of competitive inhibition can occur. This is similar to two people trying to sit in the same seat on an airplane- both people push each other out of the way, and consequently, neither actually gets into the seat.

Unfortunately, this concern for accelerating or inhibiting CYP450 systems often seems to be biased towards natural therapies. Oncologists often get agitated when a person takes any supplement along with their chemo treatment, but never seem to mind when a patient is taking several prescription agents. It’s curious to me why this bias occurs, and the only reason for it that I can deduce is that conventional docs don’t know anything about natural therapies, and therefore shun them all.

So, what does all this talk about CYP450 systems have to do with green tea? Fortunately not much. In the December, 2006 issue of Cancer Epidemiology Biomarkers & Preview research was published which showed that repeated green tea administration did not have an effect on the metabolism of drugs processed through the CYP enzyme systems. This research was done at the Arizona Cancer Center at the University of Arizona, and the Division of Cancer Prevention at the National Cancer Institute. These are not small poorly run labs, these are the creme de’ la creme of research facilities. To see the whole article click here.

So, it seems that green tea extracts are safe to take along with chemo drugs, as least as far as CPY interactions are concerned. Of course there is still the debate about whether or not anti-oxidants, like green tea, can interfere with chemotherapy. Stay tuned for a CancerND blog on that topic in the near future. We’ve already covered the similar debate on anti-oxidants and radiation therapy- the research suggests that anti-oxidants actually make radiation therapy better. I think that they’ll do the same for chemo.

Here’s the good news on green tea and the green tea extract EGCG:

1. Is cytotoxic to some cancer cell lines like prostate, colon, and breast cancer.
2. Has an anti-proliferative on cancer cells.
3. Inhibits angiogenesis/neovascularization.
4. Is an anti-oxidant.
5. Promotes fat loss.
6. Increases insulin sensitivity.
7. Prevents many cancers- liver, head and neck.
8. Essentially free from side effects and virtually no toxicity.

There doesn’t seem to be a downside to green tea/EGCG. It prevents cancer, it helps treat cancer, and it doesn’t seem to have any side effects. The best green tea supplements will be standardized to contain a specific amount of EGCG. Supplements of this variety helps to ensure that an adequate amount is taken. Be aware that all supplements are not created equal, and you get what you pay for. Also, don’t forget to drink green tea too! I especially like the high-quality green tea that can be found at a Japanese grocer. If the grassy taste turn you off try the blueberry green tea from Celestial Seasonings, it’s great either hot or iced.

Remember- Check with your Naturopathic physician before starting any new supplement.

Until next time,

Jake Psenka, ND

Johns Hopkins "Cancer Update"

2008-03-07T07:54:00.000-08:00

Over the past couple of weeks I have received several emails from several people regarding a “cancer update” from Johns Hopkins Hospital. This cancer update contained all sorts of information about what most people would call alternative cancer treatments and advice. However, I was curious why Johns Hopkins would suddenly be publicly embracing alternative medicine. They are known for being a very good conventional hospital, and not really known for alternative treatments. So,to find out more about the update I visited the Johns Hopkins Newsletter website. There was no mention of the cancer update on that site.

While searching the web for a way to validate the cancer update I found several “urban legend” website that were discounting the truthfulness of the email. For the most part these sites were not saying that the information contained in the email was bogus, but that it did not originate with Johns Hopkins.

As I read through the email I thought that some of the topics mentioned were interesting but need more clarification to be useful. Below you will see a copy of the infamous email, along with some of my opinions added.

Feel free to pass this on to anyone you think may find it useful, or if you have a question use the comment link at the end of the post.

Enjoy!

Jake Psenka, ND

1. Every person has cancer cells in the body. These cancer cells do not show up in the standard tests until they have multiplied to a few billion. When doctors tell cancer patients that there are no more cancer cells in their bodies after treatment, it just means the tests are unable to detect the cancer cells because they have not reached the detectable size.

It is true that even our most sophisticated detection devices such as PET scans, mammograms, ultrasounds, MRIs and CT scans cannot detect abnormalities at a cellular level. Most cells in the human body are very small, like red blood cells which are about 5 microns in diameter (0.005 millimeters). For an idea of how small this is consider that a human hair averages between 5 and 181 microns in diameter. One micron is one thousandth of a millimeter. While the aforementioned detection devices can detect changes at the millimeter level, smaller changes may go un-noticed. New technology is now able to detect the presence of cancer cells in a person’s blood. It is thought that everyone with cancer has circulating cancer cells in their bloodstream. I’ve heard, although never found out for sure, that a 1-cm tumor can shed up to a billion cells per day. The idea is that if the circulating tumor cells can be isolated from the blood then cancer is present. If no cells are able to be isolated then a person could be considered cancer free. This test is available today, although rarely utilized by conventional oncologists.

2. Cancer cells occur between 6 to more than 10 times in a person's lifetime.

Undoubtedly true, however the frequency with which mutant cells arise in the human body is probably closer to 6-10 times per day. Consider that conservative estimates suggest that there are roughly 50 trillion cells in a human body. Most of these cells need to be replaced from time to time, which occurs via a process known as mitosis. In mitosis a single cell splits into two identical daughter cells. The genetic information contained in each cell, known as DNA, is like a blueprint for building the two new daughter cells. Each of the 50 trillion cells in the human body has about nine feet of DNA inside of it. Each time one of the 50 trillion cells enters mitosis then all nine feet of DNA within that cell needs to have an exact copy built. It is inconceivable that an occasional error in building the DNA wouldn’t occur. Luckily, our bodies have an innate ability to detect and destroy the mutant cells that arise from mis-copied DNA.

3. When the person's immune system is strong the cancer cells will be destroyed and prevented from multiplying and forming tumors.

It is true that an impaired immune system can lead to the development of cancer. This is most commonly seen in Kaposi’s sarcoma which is seen in people with HIV/AIDS. The hallmark of HIV/AIDS is an impaired immune system. When the immune system is functioning well, and there are more competent immune cells in the body, there is a higher likelihood that abnormal cells will be detected and destroyed. The immune cells are like policemen guarding a bank. When there are many cops around it is less likely that a robber will be allowed to slip in undetected. If there’s only one sleepy rent-a-cop watching the bank then being ripped off is more likely. The immune system is not the only way that our bodies protect themselves from mutant cells. For instance, our cells contain enzymes which oversee mitosis and, should an error occur, they destroy or repair error. The take home message is that it is a good idea to avoid things which can damage your immune system. This includes many things such as radiation, certain drugs, and a many environmental toxins.

4. When a person has cancer it indicates the person has multiple nutritional deficiencies. These could be due to genetic, environmental, food and lifestyle factors.

The guy who sits on his couch all day eating Hostess cakes and alternating between diet Big Gulps and Virginia Slims is going to have a higher probability of a nutritional deficiency that someone who takes care of themselves. Nutritional deficiencies can contribute to the development of chronic disease, including cancer, but are rarely the cause on their own. There are two interesting points from #4: genetics and lifestyle. It is estimated that around 85% of cancer are due to environmental factors, which leaves only about 15% due to inheritance. If someone wants to minimize their risk of getting cancer they need to pay attention to their lifestyle. I often tell people that the most important things that they can do to prevent caner are to eat a good diet, exercise daily, and foster mental well-being. Eating a healthy diet prevents the body from developing deficiencies, allows the body to detoxify itself, and keeps of all our little functions humming along smoothly. Exercise too promotes detoxification and promotes health, and it also decreases stress. Eliminating mental stress is also important as it is well established that higher stress levels are associated with a weakening of the immune system.

5. To overcome the multiple nutritional deficiencies, changing diet and including supplements will strengthen the immune system.

Yes, eating a healthy diet will promote health. It will help to keep your immune system charged and also give your body what it needs for day-to-day operations. Good diet with or without supplementation is not enough. Exercise and stress reduction are essential as well.

6. Chemotherapy involves poisoning the rapidly-growing cancer cells and also destroys rapidly-growing healthy cells in the bone marrow, gastro-intestinal tract etc, and can cause organ damage, like liver, kidneys, heart, lungs etc.

True. One common side effect is a weakening of the immune system. A weak immune system makes it easier for infection to occur. Most people with cancer don’t die from cancer, they die from infection. I strongly feel that people need nutritional and immune support when they elect to use chemotherapy or radiation therapy. However newer classes of drugs, like those known as monoclonal antibodies, are becoming more available. These types of drugs try to selectively attack cancer cells, while leaving normal cells alone. While these drugs are far from being perfect, I think that they are a step in the right direction.

7. Radiation while destroying cancer cells also burns, scars and damages healthy cells, tissues and organs.

True. It also impairs immune function. Emu oil can help prevent radiation burns.

8. Initial treatment with chemotherapy and radiation will often reduce tumor size. However prolonged use of chemotherapy and radiation do not result in more tumor destruction.

Sometimes it does, sometimes it doesn't. When a person first elects to use chemo or radiation they stand to benefit the most from it. This is because at first the cancer cells are naive to the treatments. As time goes on cancer cells some cancer cells will be destroyed, yet some will have the ability to live despite the treatments being used to exterminate them. Inevitably, those cells that are not effected by the chemotherapy or radiation become resistant to these therapies, and therefore the drugs have less and less effect on the cancer. There tests used now which can predict which types of chemotherapy will be most effective for a particular person. This tests use the circulating tumor cells described above in #1. These cells are isolated from the blood and them tested to determine their particular physiology. When this information is known it becomes possible to choose drugs with the highest likelihood of success. This type of testing known as tumor sensitivity testing is gaining acceptance and will hopefully become more mainstream in the future. Additionally, there are several natural substances which have ben shown to decrease a tumor’s ability to become resistant to chemotherapy. Examples include curcumin, graviola, ginseng, and green tea extract. Before adding these things to your anti-cancer regime please consult with a qualified physician. This is typically NOT your average oncologist.

9. When the body has too much toxic burden from chemotherapy and radiation the immune system is either compromised or destroyed, hence the person can succumb to various kinds of infections and complications.

True.

10. Chemotherapy and radiation can cause cancer cells to mutate and become resistant and difficult to destroy. Surgery can also cause cancer cells to spread to other sites.

Resistance, yes. As for surgery increasing the ability of the cancer cells to spread, referred to as metastasis or metastatic potential, I have not been able to find any conclusive evidence supporting or refuting this hypothesis. Both sides of the debate have research to support their views. The potentially negative impact of surgery varies among individuals. Things such as the condition of the patient, the extent of the surgery, the recovery time, and any additional health problems that a person has must be weighed against the potential benefit of the surgery. Surgery, like chemo or radiation, can cause a weakening of the immune system. When this occurs it is more likely that a cancer can progress.

11. An effective way to battle cancer is to starve the cancer cells by not feeding it with the foods it needs to multiply.

“Starving” cancer cells is an interesting concept. Depending on the type of cancer being treated, decreasing simple carbohydrates (ie. sugar, like glucose) may be helpful. No one can dispute the fact that diet plays a major role in cancer therapy. It is very important to provide the body the nutrients during periods of stress, such as when undergoing therapy. However, starving the cancer by eliminating sugar from the diet can only accomplish so much. This is because some normal tissue in our bodies are dependent on glucose as an energy source, i.e. the brain. As a result of our brain needing an adequate amount of glucose to maintain function, our bodies have developed a way to make their own glucose. This process of making glucose is called gluconeogenesis, and it occurs mainly in the liver. I often use an analogy of going to an all you can eat buffet when talking about maintaining healthy glucose levels. When a person eats a healthy diet with adequate fiber, protein, and fats, and they also minimize their intake of refined foods and simple carbohydrates, they can balance their blood sugar. If a person ate lots of junk food that contained high levels of glucose their blood sugars would be elevated for long periods of time. When someone has high blood sugar levels and they also have cancer it is like the all you can eat buffet for the cancer cells. All they have to do is finish off one serving and then turn around to get another. By adopting a healthy diet it is possible to make it a little more difficult for the cancer cells to get the glucose they need. Some theories have been proposed which blame the higher calories we as a society consume as the reason for the increased cancer rates experienced today.

New Opinions About Prostate Cancer Screening

2008-03-04T21:20:00.000-08:00

Last month the American College of Preventative Medicine (APCM) stated that they no longer recommend prostate cancer screening with DRE (digital rectal exam) or PSA (prostate specific antigen). This new position statement was published in the February issue of the American Journal of Preventative Medicine.

Currently, a DRE and the PSA blood test are the principal screening tests for detection of asymptomatic prostate cancer. When the results of either of these tests are outside of the normal limits, additional testing is then used to determine the cause of the abnormal test results. With the high quality imaging used today, very little escapes medical surveillance. It is possible to detect even the smallest tissue abnormalities or cancerous growths. Therefore early screening with PSA and DRE can help to diagnose prostate cancer early, thereby potentially decreasing the mortality and morbidity associated with the disease. However, there is currently no conclusive data which demonstrates that early screening, detection, and treatment of prostate cancer actually reduces mortality. Here's a link to the research.

Not all aspects of early screening are positive. There are potentially adverse effects of early screening including increased anxiety, significant discomfort and possible complications from biopsy including pain, bleeding, and infection. Additionally, prostate cancer can be a slow growing disease which may never progress to cause significant disease or death. It is known that more men die with prostate cancer than of prostate cancer.

Additionally, men with slower growing cancers who receive conventional treatment may experience serious short-term and long-term adverse side effects such as pain, incontinence, and impotence. Treatment side effects are sometimes more damaging, and cause a significantly decreased quality of life, than the disease would have caused had it been left untreated by conventional methods.

It is because of these facts that the American College of Preventative Medicine concluded that there was insufficient evidence to recommend routine screening with DRE or PSA.

Instead of routine screening, clinicians should focus on educating patients about screening options. Doctors should provide information about the potential benefits and the risks of prostate cancer screening, and the limitations of current evidence for screening, in order to maximize informed decision making. This is especially true for African-American men and those with a family history of prostate cancer.

Both the ACPM and the American College of Physicians advocate that informed discussion about screening should take place annually, during the routine periodic examination, or in response to a request by a patient.

I often meet patients with many unanswered questions even their appointment with their physician. This seems to occur because of lack of appropriate time, or their doctor simply not answering all the patient's questions in an easily understood manner. It is essential that everyone with cancer gets all the information that they need to make the right treatment decisions. Decisions about cancer treatments should be made based on education, and not on fear- which is often the case.

It's a good idea to write down any questions you may have for your doctor before your appointment. Take this list with you, along with a pen and paper so you can write down the answers. Also, ask your doctor if they mind if you record your appointment so that you can review it later. I've never met a doctor who was opposed to this idea. Discuss your options with your support group, whether family or friends, and choose the path which makes the most sense to you. If you can't get the answers you need from your doctor, find another one.

Lastly, investigate your alternative and complementary treatment options. Most of the time treatments of this nature promote health, have no adverse treatment side effects, and, in the case of prostate cancer, can be very effective at halting and reversing the disease. It is also important to investigate your cancer promoting risk factors. Fighting cancer and ignoring any potential risk factors is like trying to stop your car while your foot is on the gas. Identifying, and then eliminating any risk factors is like stepping on the brake.

Until next time,

Jake Psenka, ND

Finally! Acid and Base Balance Part Deux

2008-02-12T12:25:00.000-08:00

Well, it’s been a little over a month since my first post on acid and alkaline diets. Despite my intention to try and post the follow-up in a week, it just didn’t turn out that way.

Anyway, in the first post I reviewed the body’s mechanisms that work to keep the internal pH at a relatively constant level. These mechanisms include the phosphate buffer system, the carbonic acid/bicarbonate system, and the protein buffer system. The previous post also discussed the possibility of the micro-environment that immediately surrounds a tumor having a lower (more acidic) pH than the rest of the body. Several hypothesis have been put forth to explain why the lowered pH occurs near a tumor. Lactic acid is often implicated in causing the decreased pH; however, newer research suggests that the pH shift is not the result of a lactic acid accumulation; rather it is due to the accelerated ATP (adenosine tri-phosphate) production that results from the cancer’s dependance on anaerobic metabolism.

Whether or not diet can have a significant impact on cancer development and growth is a hotly debated subject among doctors and researchers. Many have stated that it would be nearly impossible to cause a significant shift in pH via dietary influences. This often seems to be the opinion that most people with cancer hear when they consult with their conventional physicians.

Changes in pH occur through the action of different substances, such as carbond dioxide. When more of a particular substance is put into the body the result is a change in body chemistry. This change can either be a shift towards a more acidic state or a more alkaline state, depending on both the type and quantity of the substance being assimilated. The body's ability to excrete acid or base substances also has an impact on pH.

Diet certainly can influence the body’s pH. It is a well established eating a highly acidic diet is detrimental to bone health. A study in 2001 reported the following:

The urine-acidifying properties of food constituents depend on their content of non-oxidizable acids or precursors. Acidifying constituents such as animal proteins may negatively affect calcium metabolism and accelerate bone resorption, thus representing an aggravating factor for osteoporosis. This four-period, double-crossover study investigated whether a diet intervention specifically focused on acid load could modify calcium metabolism in humans. Eight healthy volunteers underwent a four-day metabolic preparation with two types of diets, one rich in acid ash-forming nutrients, and one providing base-forming nutrients (including bicarbonate-rich mineral water), both having similar contents of calcium, phosphate, sodium, proteins and calories. On the fourth day, a single oral dose of 1 g calcium was given, either as carbonate or as gluconolactate. Serial blood and urine samples revealed that the diet affected blood pH (average difference 0.014, p=0.002) and urine pH (average difference 1.02, p<0.0001) in the expected direction, but had no influence on the absorption of the calcium supplement. The acid-forming diet increased urinary calcium excretion by 74% when compared with the base-forming diet (p<0.0001), both at baseline and after the oral calcium load, and C-telopeptide excretion by 19% (p=0.01), suggesting a skeletal origin for the excess calcium output. This observation confirms that renally excreted acids derived from food influence calcium metabolism, and that alkalizing nutrients inhibit bone resorption. Further studies are needed to determine the clinical impact of dietary counseling for avoiding diet acids as a preventive measure against osteoporosis.

For those interested, here’s the citation: “Diet Acids and Alkali's Influence Calcium Retention in Bone” by Buclin, et. al published in Osteoporosis International in 2001.

When I read studies like this it seems pretty obvious that dietary influences most certainly affect blood/body pH. This study is particularly useful information for those people who have bone metastasis. In this case, the bones are being actively attacked by cancer and, by eating a alkaline-rich diet, a person may be able to help preserve the integrity of their bones.

So, now we know that diet affects pH. The next question is what is the best way to measure pH, saliva, blood, or urine?

Consider the following:
In November of 2007 there was an interesting article on urinary PH published in the British Journal of Nutrition. The title of the article is “Urine pH is an indicator of dietary acid-base load, fruit and vegetables and meat intakes: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk population study,” by Welch et.al. This study investigated the relationship between urine pH and dietary acid-base load and it’s contributory food groups. The data for the study was collected from over 22,000 men and women aged 39-78 years old. The study concluded that a more alkaline diet (high fruit and vegetable intake and lower consumption of meat) was significantly associated with a more alkaline urine pH. Furthermore, the finding that diet influenced urinary pH held true even after the study investigators adjusted for potentially confounding factors such as age, body mass index, physical activity, glucose, ketones, high blood pressure, smoking, and diuretic medication.

From this study is seems clear that urinary pH does in fact relate to dietary acid-base load. This study also suggests that urinary pH can be used to monitor change in consumption of fruits and vegetables. So, if someone is just starting on a more vegetable-based diet they may be able to watch their pH change as the new foods begin to have an effect. For therapies such as diet it’s good to have a way to monitor progress, as the positive effects can be very subtle at first.

Now we have evidence that cancer does promote a acidic environment within the body. We also have research that shows that diet can change our internal pH, and we know that urine is an acceptable way to measure pH changes.

The only question that we haven’t addressed is whether or not cancer cells actually prefer an acidic environment in which to live. However, we know that our bodies prefer not to have an overly acidic pH, and therefore, if a condition exists which promotes acidity then we should make every attempt to correct it.

So, do I suggest that people fighting cancer eat a alkaline diet? Yes, I do, but it doesn’t end there- I feel that everyone should make an attempt to eat a more alkaline-based diet if they want to be healthy. An alkaline-rich diet is full of fresh fruits and vegetables, and therefore vitamins, minerals, fiber, antioxidants, bioflavinoids, etc., etc. All of these things are essential to living a healthy life and providing the body what it needs in times of disease and stress.

Healthy regards,

Jake Psenka, ND

Physiological Realities of Acid/Alkaline Diets

2007-12-31T14:23:00.000-08:00

Happy New Year!!

For the New Year I’ve decided to spend some time writing about the popular diets that are often used for fighting cancer. I imagine that we’ll discuss three or four of the most popular diets, trying to determine the positives and negatives of each. So, without further mumblings, let’s get to it.

One of the topics that I am asked about the most in practice is that of the acid and alkaline diet for people fighting cancer. The idea behind this diet is that cancer cannot survive in an alkaline environment and therefore, cancer promotes an acidic environment inside the body. Some have put forth the notion that it is an acidic condition within the body that causes a cancer to grow in the first place. In order to understand both the benefits and drawbacks to this type of diet it is important to understand a few things about acid and alkaline regulation within the body.

In most physiology texts acid and alkaline regulation in referred to as the acid/base balance. In this context “acid” refers to a chemical compound that, when dissolved in water, gives a solution with a hydrogen ion (proton) activity greater than pure water. An alternative definition of an acid is a compound that donates a hydrogen ion (H+) to another compound called a base. In either definition the acidic compound would promote a pH of less than 7.0. A base, on the other hand, is a compound or substance that can accept protons (H+). Bases can be thought of as the opposite of acids, and a reaction between the two is known as a neutralization. The pH of a solution is a measure of the acidity or the alkalinity, with <7 being acidic, and >7 being alkaline. A pH of 7.0 is thought of as neutral.

In a human body the acid/base balance is regulated at an extreme level. Tight regulation is imperative to our survival, as many of the chemical reactions that happen in the body can only occur at a specific pH. If the pH of the body were outside of the normal range then these chemical reactions would be greatly impaired, and disease may ensue. There are many reasons why the pH may become unfavorable to health- from outside influences such as toxins and poisons, to problems within the body such as kidney failure or pulmonary (lung) problems. To make sure that pH changes do not occur, the human body has three main mechanisms designed to keep the pH balanced: The carbonic acid/bicarbonate system, the phosphate buffer system, and the protein buffer system. Each of these systems are designed to operate either inside or outside of the cells, and within a particular part of the body.

If something were introduced to the body that caused the internal environment to become more acidic, then one of the buffering systems would kick into gear- usually by acting as a base and accepting or quenching the excessive protons and then eventually eliminating them. This is why it is thought to be very difficult to achieve anything but a transient change in pH with diet changes.

However, it is a known fact that the local environment around a rapidly growing cancer is acidic compared to the rest of the body. This is why many have postulated that it’s the acidic micro-environment that causes the cancer in the first place. Intuitively, I think that the idea of the internal environment becoming unbalanced and this then leading to disease makes sense. Toxins and environmental pollutants have the ability to cause cancer, and it’s not because they are inherently evil substances. These substances cause chemical malfunctions within the body that ultimately change the internal environment. Additionally, these chemical malfunctions and the impaired function they cause lead to some sort of cellular damage. Consider this example:

Chronic gastro-esophageal reflux, aka heart burn, is common problem in smokers. In this condition acidic stomach secretions are erroneously allowed to back-flow through the sphincter which connects the stomach to the esophagus. When that acidic solution comes into contact with the cells of the esophagus it causes a chemical burn. Over time this repeated burning damages the esophagus, leading to a condition called Barrett’s Esophagus which is a risk factor for esophageal cancer. The damaged esophageal tissue is constantly trying to heal itself from the repeated chemical burns, and because of this there is increased cell replication. The burned and damaged cells need to be replaced by healthy new cells. Whenever there is increased cellular proliferation, there is a heightened chance of a mutation. In some respects that is all cancer is, a genetic mistake.

So, back to the micro-environment of a cancer being acidic. Is this the cause, or an effect? One of the hallmarks of cancer, and in fact the definition the term is uncontrolled cellular division. Cancerous cells divide and reproduce at an accelerated rate; they do not “hear” the signals the body sends to stop reproducing. As a result of this accelerated growth, tumors can easily outgrow their vascular supply. All tissue, whether cancerous or normal, require adequate blood flow. The vascular system usually delivers the nutrients needed for tissue maintenance and growth. So, if a tumor’s growth exceeds the delivery capacity of its vascular system the tumor has to make due with less resources. This is often causes a change from oxidative metabolism to anaerobic metabolism. Biochemically speaking, oxidative metabolism is a “clean” energy production system, whereas anaerobic metabolic is “dirty.” Think solar power vs. coal. One of the most abundant by-products of anaerobic metabolism is lactic acid. Lactic acid, when in solution- like in a human body, is found in as lactate. As a cancer grows it produces lactate faster than it’s meager blood supply can remove it. It is thought that the abnormal accumulation of lactate is the cause of the decreased pH around growing tumors.

However, lactate may not be as big of a player as first thought. Research has indicated that lactate does not directly cause acidosis. This is because lactate isn’t capable of releasing a proton (H+), and secondly, the acidic form of lactate, lactic acid, cannot be formed under normal circumstances in human tissues. The acidosis must therefore have another cause. This alternative cause is most likely ATP production. ATP, or adenosine tri-phosphate, is the gasoline for the human engine. ATP is our fuel of choice; it is what powers all of our functions, from blinking our eyes to the beating of our hearts. When ATP is broken down a proton is released, and it is thought that these ATP-derived protons are the primary cause of the acidosis.

Now, imagine the growing tumor- it is undergoing rapid cellular division, something that requires a substantial amount of energy (ATP). I’ve often likened a tumor’s need for energy as being similar to an automobile. Tumor tissue can “burn gas” like a Hummer, where normal tissue is more like a Prius. The tumor needs lots and lots of energy input to keep going. Now, remember, this tumor is also suffering from a resource shortage due to the lack of adequate blood flow, and therefore has had to convert to anaerobic metabolism as it’s dominant energy producing pathway. Anaerobic metabolism produces ATP faster than aerobic metabolism. With lots of ATP being produced and broken down rapidly there will be a large release of protons. This rapid release of protons (H+) will quickly overwhelm the buffering systems in the tissues and cause the pH to drop. This is how the acidic state around a growing tumor develops.

With the acidosis being the result of accelerated ATP production, and not from an accumulation of lactic acid or lactate, nor from an acid-rich diet, how effective can an alkaline-based diet be at changing the situation? That’s an interesting question, and there is no simple answer, but tune in to CancerND next week to find out what answers the science supports.

Have a great New Year!

Jake Psenka
Naturopathic Physician

What Happened to Dr. Forsythe, MD

2007-12-13T07:15:00.000-08:00

A friend emailed me an article this week that made me think of a question I often am asked in the office. Actually, there are several variations of this question, but they all ask basically the same thing: "Why didn't my oncologist tell me about this?" Frequently, this question arises during conversations about chemotherapy sensitivity testing, or about supplements that may accentuate the effects of the conventional treatments. I often answer by pointing out the fact that very few traditional oncologists have any training or exposure to alternative medicine. Another reason why many traditional oncologists don't know much about alternative treatments may simply be from lack of time. Then, of course, they simply may not care to learn about anything other than what they do.

The article that I received discussed another reason oncologists rarely delve into alternative treatments: fear of legal action. There are very strict rules about what therapies oncologists can offer and which they cannot. If a doctor were to venture they may find themselves in a situation similar to Dr. Forsythe, MD.

So, here's the link:

Alternative Medicine on Trial

Coming Next Week: The Acid/Alkaline Connection

Antioxidants and Radiation Therapy

2007-12-03T10:26:00.000-08:00

For many years now I have been of the opinion that people actively engaged in fighting cancer should be taking vitamins, minerals, and antioxidants. Not only are the nutritional needs of cancer patients more intense simply because they are fighting cancer, but also because they are receiving treatment. As anyone who has ever been through chemotherapy or radiation can tell you, it's no picnic. I have often been told that it is the worst a person can possibly feel; I have even been told by a number of people that the treatment is worse than the disease. Putting the body under that sort of stress increases the body's nutritional and defensive needs.

Frequently, patients are told to stop taking all of their nutritional supplements before starting chemo or radiation. This is often the advice of traditional oncologists despite their lack of understanding about what certain supplements are or how they work. There seems to be a "knee -jerk" reaction that happens when some doctors hear the word "supplement." This word somehow triggers a totally involuntary spasm of the throat causing the words "stop now" to be uttered by some physicians.

This negative blanket-type approach to nutritional supplements is really sad. There are numerous studies indicating that vitamins, minerals, and antioxidants can be beneficial for people with cancer, AND also those for people currently receiving cancer treatments. There was a time when a traditional doctor could say "Well, there aren't any studies to support the use of this or that." Those days are long gone. Don't take my word for it, do your own research, go to www.pubmed.gov and see for yourself. Pubmed is a great place to check the cancer research. Pubmed is a service of the National Library of Medicine and the National Institute of Health. By they way, when you're looking at Pubmed, make sure you research the mechanism of action of chemotherapy drugs. You'll find that many aren't known....

So, when articles become available on this topic I like to pass them on. A new article was just published by Ralph Moss, a well known cancer researcher, in Integrative Cancer Therapies. The article was in the September 2007 edition, pages 281-92. This review article looked at all the available research on the use of antioxidants and radiation therapy. The article found that, "with few exceptions, most of the studies draw positive conclusions about the interaction of antioxidants and radiotherapy." It goes on to state that "although more studies are needed, the preponderance of evidence supports a provisional conclusion that dietary antioxidants do not conflict with the use of radiotherapy in the treatment of a wide variety of cancers and may significantly mitigate the adverse effects of the treatment."

Here are the options the way I see it:

1. Undergo the therapy without taking care of your body and feel terrible.

2. Undergo therapy while taking care of your body, possibly minimize side effects, and feel better.

I'd choose #2 as well.

Here's the original abstract:

Despite recent comprehensive review articles concluding that supplemental antioxidants do not undermine the effectiveness of cytotoxic therapies, the use of antioxidants during cancer treatment remains controversial. Many oncologists take the position that antioxidants by their nature undermine the free radical mechanism of chemotherapy and radiotherapy and should therefore generally be avoided during treatment. For their part, many integrative practitioners believe that antioxidants taken during cancer treatment not only alleviate some of the adverse effects of that treatment but also enhance the efficacy of cancer therapy. Until recently, research attention has focused primarily on the interaction of antioxidants with chemotherapy; relatively little attention has been paid to the interaction of antioxidants with radiotherapy. This article reviews the clinical literature that has addressed whether antioxidants do in fact interfere with radiation therapy. Studies have variously investigated the use of alpha-tocopherol for the amelioration of radiation-induced mucositis; pentoxifylline and vitamin E to correct the adverse effects of radiotherapy; melatonin alongside radiotherapy in the treatment of brain cancer; retinol palmitate as a treatment for radiation-induced proctopathy; a combination of antioxidants (and other naturopathic treatments) and external beam radiation therapy as definitive treatment for prostate cancer; and the use of synthetic antioxidants, amifostine, dexrazoxane, and mesna as radioprotectants. With few exceptions, most of the studies draw positive conclusions about the interaction of antioxidants and radiotherapy. Although further studies are needed, the preponderance of evidence supports a provisional conclusion that dietary antioxidants do not conflict with the use of radiotherapy in the treatment of a wide variety of cancers and may significantly mitigate the adverse effects of that treatment.

New Study on the Effects of Lifestlye and Cancer

2007-11-28T09:50:00.000-08:00

Research published in the October, 2007 edition of Clinical Oncology supports the use of healthy lifestyle choices both in people trying to prevent cancer, AND those people currently fighting cancer. This article goes on to say:

"The evaluated evidence was utilized to show potential lifestyle interventions to facilitate well-being and quality-of-life initiatives. There is now persuasive evidence that dietary choice and exercise can improve teh physical and psychological function of patients with cancer. There is also persuasive evidence that lifestyle choice can prevent cancer or the reoccurrence in susceptible individuals, and possibly improve survival."

It is unfortunate how many people with cancer are told by their oncologists that they should eat whatever they want. This sort of poor advice can only set the patient up for malnutrition, and at best provide excess calories and sugars that cancer cells need to survive and grow.

If you know someone fighting cancer please make sure that they seek out the help of a physician well-versed in dietary and lifestyle strategies for fighting cancer.

Cancer Studies Wasted Millions

2007-11-26T10:43:00.000-08:00

It's a sad state of affairs when information like this becomes available.

I was recently forwarded an article from a patient that I thought I had to pass on. The BBC News reported that millions worth of charity and taxpayers' money has been wasted on worthless cancer studies. It seems that one of the most prevalent cancer cell lines used, a strain called TE7, turned out to be the wrong cancer cell line. Apparently, researchers using the cells thought that they were using a human cancer cell line, when in fact the cells that they were using came from mice and rats.

The article goes on to state that few scientists admit such problems when they are discovered. As a result many of the studies done using flawed material will appear in reputable scientific journals and become part of the accepted literature. This is the same literature that physicians use to make decisions about people's health. What kind of unscrupulous researcher would knowingly withhold this type of information. If they were testing toilet paper it would be no big deal, but this is cancer- it's the leading cause of death in the United States!

I'm not saying that data obtained in animals cannot ever be extrapolated to justify use in people. What I am saying is that this sort of mistake should never be able to happen. Who's the person in charge of quality control? Are there safeguards in place to make sure this sort of thing doesn't happen? Doesn't seem like it. Hopefully this finding will help make researchers and cell culture distributors more diligent in checking their materials. It makes me wonder though, if this sort of mistake is being made, what else is being overlooked, suppressed, or ignored?

The unfortunate truth is that there's lots of money to be made in cancer research, and it remains to be seen how many people will sacrifice their potential earnings by being honest. One doctor suggested researchers be denied access to publication unless they can offer a certificate of authenticity on their cell lines. This seems like a good idea to me.

If you want to read the article follow the link:
http://news.bbc.co.uk/go/em/fr/-/1/hi/programmes/file_on_4/7098882.stm

Chemosensitivity Testing

2007-08-22T15:03:00.000-07:00

How many people out there who are undergoing chemotherapy know if they are taking a drug which won't kill their cancer? In my estimation it's way too many people. Most of the patients that I see are being treated with what everyone else with their particular type of cancer takes. Well, the truth is that works for one person, doesn't always work for another. I recently heard of a study which claimed that only 2% of people received a cure using chemotherapy. For example, two women, named Nancy and Rebecca, who are both 45 years old with infiltrating carcinoma may end up on identical chemotherapy regimes. Nancy's cancer has a genetic predisposition which causes multiple proteins to dot the surface of her tumor cells. These proteins are known as P-glycoprotein, or PGP. PGP is a transmembrane efflux pump- it pumps harmful things from the inside of the cell to the outside of the cell. In many cases, PGP is at least partially responsible for a patient's decreased sensitivity to taxane-based chemotherapy (taxol, taxotere, paclitaxel). As soon as the drugs enter the cancer cells, the PGP pumps start pumping the drugs out. So, while Rebecca is receiving benefit from taking the chemotherapy, all Nancy is getting is the side effect. This is just one example of how tumors can become resistant to therapy, there are many other similar ways used by many types of tumors.

Wouldn't be nice if a person's tumor could be tested on a molecular level to determine which drugs show promise as a therapy, and which don't. Well, this type of testing is available, but for some unknown reason it's not being routinely used. The potential reasons for the lack of testing are many, with unfamiliar doctors and no insurance coverage being the most likely. Tumor sensitivity testing can be accomplished by either having a biopsy sample submitted to a lab, or by simply sending a sample of the patient's blood to the lab. Everyone with cancer has circulating tumor cells in their blood, and if these cells are isolated they can be used for the sensitivity testing.

While this type of testing can be ultra valuable to people fighting cancer, especially those people who have already failed a chemo regime, getting the testing done is not the biggest obstacle. Even though the testing suggests only proven chemotherapy drugs, many oncologists are not willing to prescribe the therapy because often the drugs recommended are not the "standard" drugs used for that type of cancer. It is truly a shame that more people can't take advantage of this type of testing, because it would undoubtedly improve their odds of winning their fight with cancer.

If you would like more information about chemotherapy sensitivity testing or about CancerND call 602.493.2273.

For more information about the research on chemosensitivity testing check out Pubmed at www.pubmed.gov

Labs that do chemotherapy testing include Biofocus (www.biofocus.de) and Oncotech (www.oncotech.com).

Increasing Your Chances Of Beating Cancer

2007-08-12T06:39:00.000-07:00

A study was just published (August 2, 2007) in the journal Clinical Oncology (Royal College of Radiologists) that confirms that cancer patients have the ability to take steps to control their disease. The study's author concludes that lifestyle interventions can dramatically effect the course of disease AND help to prevent cancer reoccurrence. Lifestyle choices associated with increasing health include a nutritionally sound diet, some type of exercise, and promoting mental wellbeing by reducing stress. This isn't new information- this topic has a large body of research supporting it, and some people are living it.

The question is, why don't most cancer patients know about this?

Unfortunately, most people diagnosed with cancer will never hear about this information. If you know someone with cancer, do them a favor and pass on the information. The article is copied below.

Healthy Regards,
-J. Psenka

Lifestyle During and After Cancer Treatment.
Thomas R, Davies N.

The aim of this overview was to examine the evidence for links between lifestyle during and after cancer treatment and quality of life, risk of treatment side-effects, rate of progression and prevention of relapse. The reviewed studies were divided into categories according to the role lifestyle plays in progression, during treatment, and in relapse prevention. The evaluated evidence was utilised to show potential lifestyle interventions to facilitate well-being and quality-of-life initiatives. There is now persuasive evidence that dietary choice and exercise can improve the physical and psychological function of patients with cancer. There is also persuasive evidence that lifestyle choice can prevent cancer or the reoccurrence of cancer in susceptible individuals, and possibly improve survival.

Blog Intentions

2007-03-01T20:10:00.000-08:00

In the past four years I have dedicated my medical practice to providing options for people fighting cancer. During this time I have learned that many people who have been diagnosed with cancer often don't know what choices they have about their care. Today, unbiased researched-based information is available for every person with cancer. This information can be used to make educated decisions about what the best treatment options are. Furthermore, this information can be applied on a personal level. Creating a treatment plan based on an individual's unique medical needs is a plan for success. Unfortunately, finding the information needed can be difficult. Patients are often not given the resources to find it, or they do not have the medical background necessary to interpret the information.

On this blog I hope to present information in an easily understood format that will help people win their fight against cancer.

-J. Psenka
March 1, 2007