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Nutritional Support of Cancer PatientsPamela W. Smith, M.D., MPH

The following potential conflict of interest relationships are germane to my presentation.

Equipment: NoneSpeakers Bureau: PCCA, Spectracell, ZRT & Orthomolecular

Stock Shareholder: NoneGrant/Research Support: None

Consultant: CustomVite, Pathway & Thorne

Status of FDA devices used for the material being presented NA/Non-Clinical

Status of off-label use of devices, drugs or other materials that constitute the subject of this presentation

NA/Non-Clinical

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Nutritional Support of Cancer Patients

Pamela W. Smith, M.D., MPHCopyright 2012

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Goals Of Therapy

Support the whole person Take away any factors that support cancer

development Stress Toxins—household cleaners, cosmetics, pesticides Sugar—feeds cancer cells

High insulin increases the risk of cancer recurrence—The recurrence rate for colon cancer is one-tenth as high in women who had low levels of insulin that it was in those with high insulin Argiles, J., et al., “Insulin and cancer (review),” Int J. Oncol 2001;

18:683-87.

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Goals Of Therapy (Continued)

Utilize functional medicine to treat cancer and prevent recurrence. Inhabit tumor growth Boost the immune system Promote natural death of cancer cells Boost the effects of traditional therapies Reduce the side effects of conventional treatments

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Standard Approaches To Cancer

Produce a cure only about 50 percent of the time.

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Strategies Natural Medicine

Work of Drs. Michael Murray, Joseph Pizzorno, Tim Birdsall, and Paul Reilly

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Strategies Of A Functional Approach To Cancer Treatment

Support immune function Inhibit tumor growth Support normal cell differentiation Promote programmed cell death (apoptosis) Inhibit metastasis Inhibit formation of new blood vessels Reduce the likelihood of recurrence or future

mutations

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Diet Half of all people with cancer will eventually die of their

disease. One-half of cancer patients die of malnutrition. The cancer patient’s body may be so ravaged with disease that

they cannot properly absorb nutrients. Cytokines act on the body by increasing metabolism,

accelerating tissue breakdown and speeding up the wasting process of cachexia.

Cancer patients who have higher nutritional status are more likely to fight off infections.

Patients with good nutritional status are able to better tolerate therapy and its side effects.

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High Protein Smoothies

Cancer patients usually need to increase their intake of protein.

It helps maintain muscle mass, nourishes the lining of the gastrointestinal tract, boosts blood counts, heals tissue, and boosts the immune system.

Inadequate protein intake slows recovery from illness and decreases resistance to infection.

Undergoing chemo and radiation may require as much as 50% more protein than usual.

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Whey Protein

The highest-quality protein powder comes from whey. It is a natural by-product of cheese.

Whey is a complete protein because it contains all essential and nonessential amino acids.

Whey protein has the highest concentration of glutamine and branched-chained amino acids found in nature.

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Glutamine

Is the most abundant amino acid in the body Is involved in more metabolic processes than

any other amino acid Important as a source of fuel for WBC Important as a source of fuel for the intestinal

lining Increases survival in critically ill patients Prevents stomatitis

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Glutamine (Continued)

Prevents suppression of the immune system in patients on chemotherapy

Heals peptic ulcers Enhances energy levels Boots immune functions Fights infections

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Whey Protein

It is preferred to get glutamine through whey protein by taking daily doses of 20-30 grams of whey-protein BID

Whey is more beneficial because it contains other compounds that improve immune function and boost glutathione concentrations Bounous, G., et al., “Whey protein concentrate

(WPC) and glutathione modulation in cancer treatment,” Anticancer Res 2000; 20:4785-92.

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Allergy To Whey

Take glutamine supplements, 3-10 grams daily.

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Whey Protein/Glutamine

Either can be taken to support recovery from surgery, radiation, and chemotherapy.

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Reducing Tumor Cell Glutathione Levels With Whey Protein

Some studies show that the concentration of glutathione is higher in tumor cells than in neighboring normal cells. This may be why some cells are resistant to chemotherapy.

Whey protein is the answer. It selectively depletes cancer cells of their glutathione, inhibiting cancer cell growth and making treatment more successful. At the same time, whey increases glutathione in normal cells and increases their growth

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Hydration

Electrolyte drink for severe dehydration 1 quart water 4 tablespoons honey 1 teaspoon salt 1 teaspoon baking soda

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Use A Juicer

Have the patient drink 18 to 24 ounces of fresh fruit or vegetable juice daily. Drink throughout the day.

Juicing four carrots along with one apple can mask the stronger vegetables such as broccoli or kale.

Pineapple juice also makes a good base for kale, spinach, or other greens.

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Ginger

Ginger acts directly on the GI tract and the brain to control nausea.

Tummy Tonic: Juice the following: ¼ slice ginger ½ handful fresh peppermint or spearmint ½ small fennel 2 apples, cut into wedges

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Ginger (Continued)

Ginger tea can be made by adding slices of fresh ginger to hot water and steeping for 6-8 minutes.

Ginger rice can also be eaten to try to decrease nausea. Cook rice as usual and add 1 piece peeled fresh ginger (l inch long by 1 inch in diameter) and cut into thin slices for each 1 cup serving of rice.

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Ginger (Continued)

Homemade ginger ale Juice a ¼ slice of an average size root 1 lemon wedge 1 green apple Add it to 4 ounces sparkling mineral water Stevia for sweetening

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Soy

Many cancers benefit from soy intake. Soy isoflavonoids prevent the formation of

new blood vessels. Thy also prevent tumor cells from dividing and growing by inhibiting enzymes involved in replication.

Breast cancer do not use soy. Studies show that isoflavone genistein stimulates the growth of estrogen-receptor positive tumors.

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Supplementation For Cancer Patients

Pharmaceutical grade MVI Extra vitamin C: 1,000 mg TID Vitamin E: 400-800 IU Take green tea extract: 300-400 mg of

polyphenols Drink green tea BID Probiotics EPA/DHA: 1,000-2,000 mg qd

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Green Tea Polyphenols

Studies show that green tea polyphenols are protective against cancer

They also have therapeutic effects as well and can be used with chemotherapy. Sadzuka, Y., et al., “Modulation of cancer

chemotherapy by green tea,” Clin Cancer Res 1998; 4:153-56.

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Breast Or Prostate Cancer

Indole-3-carbinol: 500 mg qd Lycopene: 30 mg qd Calcium d-glucarate: 400 mg qd

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Indole-3-Carbinol

Has also been used successfully in precancerous lesions of the cervix and for recurrent respiratory papillomas.

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Antioxidants When cancerous cells are exposed to antioxidants

they increase the rate at which they are destroyed and become less able to switch on the gene that tells them to grow. Prasad, D., et al.,. “Scientific rationale for using high-dose

multiple micronutrients as an adjunct to standard and experimental cancer therapies,:” J. Am Coll Nur 2001; 20(suppl 5):450S-63S.

Conklin, K., et al., “Dietary antioxidants during cancer chemotherapy: impact on chemotherapeutic effectiveness and development of side effects,” Nutr Cancer 2000; 37:1-18.

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EPA/DHA

Address many of the underlying biochemical features of cancer

Also help with cachexia Fish oil supplementation along with vitamin E has

been shown to produce favorable effects on the immune status and survival of cancer patients. Barber, M., et. al., “Metabolic response to feeding in

weight-losing pancreatic cancer patients and its modulation by fish-oil-enriched nutritional supplement,” Clin Sci 2000; 98:389-99.

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EPA/DHA (Continued)

Fish oil is a must in patients receiving chemotherapy—especially doxorubicin.

Fish oil not only increases survival time, but is increases the effectiveness of the drug (test tube studies). Rudra, P., et al., “Cell-specific enhancement of

doxorubicin toxicity in human tumour cells by docosahexaenoic acid,” Anticancer Res 2001; 21:29-38.

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Eight Natural Medicines For Cancer Treatment

Proteolytic enzymes Curcumin Quercetin Maitake D- or MD-fraction PSK/PSP Polyerga Modified citrus pectin Ip6 (inositol hexaphophate)

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Proteolytic Enzymes

Proteolytic enzymes (or proteases) digest protein.

Pancreatic proteases: chymotrypsin and trypsin Bromelain (pineapple enzyme) Papain (papaya enzyme) Fungal proteases Serratia peptidase

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Proteolytic Enzymes

Increase the manufacture of cancer-blocking antiproteases

Inhibit angiogenesis and metastasis Enhance the immune response Promote differentiation of cancer cells

Leipner, J., et. al., “Systemic enzyme therapy in oncology: effect and mode of action,” Drugs 2000; 59:769-80.

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Proteolytic Enzymes (Cont.) Proteolytic enzymes have been used in the treatment

of cancers of the breast, lung, stomach, head and neck, ovaries, cervix, and colon, and lymphomas and multiple myeloma.

Treatment improves quality of lie and produces a slight to moderate increase in life expectancy.

They help fight viral infections as a result of chemotherapy suppression of the immune system.

Has been used as an adjunctive therapy to both radiation and chemotherapy.

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Proteolytic Enzymes (Cont.)

Use a mixture of enzymes such as Wobenzyme (Naturally Vitamins) or Zymactive (Natural Factors).

Have an excellent safety profile Should not be used two to three days before or

after surgery because they can increase bleeding risk

May be helpful against lymphedma

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Proteolytic Enzymes (Cont.)

Pancreatic enzymes should not be used if patient is allergic to pork.

Bromelain should not be used by anyone allergic to pineapple.

Papain should not be used by anyone sensitive to papaya.

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Pancreatin

Is an enzyme made from hog pancreas Contains chymotrypsin and trypsin Only use full-strength product Low potency products are diluted with salt,

lactose, or galactose

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Bromelain

Sulfur-containing proteases from the pineapple plant

Augments standard chemotherapy treatment May activate immune functions Dosage: 1,200-1,888 mcu or gdu

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Fungal Proteases

Aspergillus oryzae Active at pH levels ranging from 2 to 12

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Papain

Is a mixture of protein-digesting enzymes derived from the green, unripe papaya

Used commercially in meat tenderizers Dosage: 30,000 USP per mg

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Serratia Peptidase Is an enzyme naturally present I the intestine of the

silkworm Produced commercially by a bacterium called

Serratia species E15. Is the most powerful of the proteolytic enzymes Use also to ease pain from sprains, torn ligaments,

and other traumatic injuries Relieves postoperative inflammation Improves sinusitis, upper respiratory tract infections,

asthma, and COPD Dosage: 200,000 Serratia peptidase units per gram

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Curcumin

Is the yellow pigment of turmeric the chief ingredient in curry

Is an anti-inflammatory Has anti-cancer effects Affects all stages of cancer formation May cause cancer to regress Inhibits the formation of cancer-causing

nitrosamines

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Curcumin (Cont.)

Enhances the production of glutathione Promotes the liver’s detoxification of cancer-causing

compounds Prevents overproduction of cyclooxygenase 2 (cox-2) Inhibits epidermal growth factor (EGF) receptor sites

(decreases the cell’s ability to proliferate) Inhibits angiogenesis by inhibiting production of

fibroblast growth factor

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Curcumin (Cont.)

Inhibits nuclear factor kappa beta (this protein blocks the signals commanding it to stop proliferating)

Increases the expression of the nuclear p53 protein (needed for apoptosis)

Inhibits growth-promoting enzymes

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Use Of Curcumin Preliminary studies suggest that curcumin is likely to

inhibit prostate, breast, skin, stomach, colon, and liver cancers

Can be used with chemotherapy Dosage: 200-400 qd to TID The body does not absorb curcumin well therefore

take with proteolytic enzymes Take on an empty stomach 15 to 20 minutes before

meals or between meals Excellent safety profile

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Quercetin Is the most common flavonoid in the diet. The estimated average daily intake is 25 mg. Is the most active of the flavonoids. The most effective flavonoid to inhibit tumor

formation. It works by keeping cancer cells from dividing by

suppressing the production of mutant p53 protein . Quercetin also works by inhibiting a family of

enzymes known as tyrosine kinases which also decreases cell division.

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Quercetin (Continued)

For breast cancer, quercetin works in a unique way. I causes cancer cells to produce type II estrogen receptors (ER II), and then it attaches to the receptors. This blocks the receptors and stops growth signals from being generated. The more ER II the cell produces in response to quercetin, the more sites there are for quercetin to attach to and the greater the suppression of the tumor.

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Querectin (Continued) Quercetin has been used experimentally to treat

breast, lung, skin, ovarian, colon, rectum, and brain cancer.

It enhances the effects of chemotherapy while reducing its side effects. Xing, N., et al., “Quercetin inhibits the expression and

function of the androgen receptor in LNCaP prostate cancer cells,” Carcinogenesis 2001; 22:409-14.

Scambia, G., et al., “Quercetin potentiates the effect of adriamycin in a multidrug-resistant MCFG-7 human breast-cancer cell line: glycoprotein as a possible target,” Cancer Chemother Pharmacol 1994; 34:459-64.

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Quercetin (Continued)

ER II sites are found in normal tissue and on many tumors, including leukemias and melanomas. Quercetin may be helpful against these cancers also.

Dosage: 200-400 mg qd-TID. Take with proteolytic enzymes to increase

absorption. No adverse side effects

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Maitake D-fraction and MD-fraction

The active components are beta-glucans. It is effective taken by mouth. Other

mushroom extracts need to be injected. The MD-fraction is more potent. It is 30%

more active than the D-fraction. Stimulates macrophages

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Maitake D-fraction and MD-fraction

Four mechanisms of action to fight cancer: Protects healthy cells from becoming cancerous By enhancing the immune system’s ability to seek

out and destroy cancer cells By helping the cell regain control of cell division

and apoptosis By stopping metastasis

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Maitake Fractions

In animal studies maitake fractions inhibit the growth of tumors in the colon, lungs, stomach, liver, prostate cervix, bladder, and brain. Also inhibits leukemia.

Dosage: per body weight: 0.5 to 1 mg for every 1 kg of body weight qd.

Tale 20 minutes before meals or on an empty stomach.

No side effects

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PSK/PSP

Are related protein-bound polysaccharides from the cloud fungus mushroom.

The active components are beta-glucans that enhance immune function.

It is not necessary to take both PSK/PSP and maitake.

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Study on PSK/PSP

Colon cancer patients treated with placebo or PSK. Compared to placebo group, the people in remission

were twice as high as in the PSK group. The survival rate was twice as high after 10 years in the PSK treated group. Torisu, M., et al., “Significant prolongation of disease-free

period gained by oral polysaccharide K (PSK) administration after curative surgical operation of colon cancer,” Cancer Immunol Immunotherapy 1990; 31:261-68.

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PSK/PSP

PSK/PSP can inhibit the growth of every type of tumor.

It also enhances the positive effects of chemotherapy and reduces side effects of chemotherapy. Ooi, V., et al., “Immunomodulation and anti-

cancer activity of polysaccharide-protein complexes,” Curr Med Chem 2000; 7:715:29.

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PSK/PSP (Continued)

Dosage: for PSK and PSP is 1-3 grams qd. No known side effects.

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Polyerga

Polyerga is a purified extract of peptides obtained from the spleen of pigs.

Polyerga contains substances that bind to receptors on WBC which then release chemical messengers that stimulate other immune responses.

Increases the output of gamma-interferon which increases the immune system

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Polyerga (Continued)

Other effects of polyerga: Prevents some of the side effects of chemotherapy Enhances the effectiveness of chemotherapy and

radiation Prevents metastasis Enhances the general sense of well-being,

improves energy levels and prevents weight loss Increases both the quality of life and survival time

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Polyerga (Continued) Used to treat breast cancer and colon cancer. No known side effects. Take on an empty stomach before meals. Do not take with digestive enzymes. Can use during chemotherapy and radiation. Dosage: Each polyerga tablet contains 100 mg of

polypeptides Under 140 pounds: one TID For every additional 40 pounds of body weight, add

another tablet.

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Modified Citrus Pectin

Is a complex sugar obtained from the peel and pulp of citrus fruits

Is a short, nonbranched, galactose-rich carbohydrate chain

Reduces the risk of metastasis Binds to galectins which blocks the cancer

cell’s ability to clump and spread.

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Modified Citrus Pectin (Continued)

Used to help prevent metastasis of breast cancer, prostate cancer, lung cancer, and melanoma.

Still needs more studies on Dosage: 6-30 grams a day in divided doses. Is

a powder dissolved in water or juice. Extremely safe.

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Ip6 (Inositol Hexaphosphate) Ip6 is a component of fiber from whole grains and

legumes. Studies have shown that supplemental Ip6 is more

bioavilable than Ip6 found in food. The Ip6 found in food binds to calcium and other minerals and is hard to absorb.

Take Ip6 with additional inositol. If there are too many inositol molecules the phosphates will leave the Ip6 molecule and attach to inositol, yielding two molecules of Ip3.

Ip3 is better able to get into cancer cells. Ratio of 4:1 of Ip6 to inositol is best.

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Ip6 (Continued)

Ip6 and inositol is an effective antioxidant and immune booster.

Stimulates the activity of natural killer cells.

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Ip3

When Ip3 levels are low (as in cancer cells), the cells replicate out of control.

When the cancer cells are treated with Ip3, the cancer cells turn themselves off.

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Ip6 Lab studies show that the combination of Ip6 and

inositol has anti-cancer affects against all cancer, including breast, prostate, lung, skin, brain and lymphomas and leukemia.

Now awaiting human studies. Dosage: 4,800-7,200 mg of Ip6 with 1,200 to 1,800

mg of inositol Should be taken on an empty stomach No side effects even when given to humans IV Animal studies show it can be given with radiation

and chemotherapy.

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Discontinue Prior To Surgery May cause bleeding, discontinue 7 days before

surgery Garlic Ginkgo Ginseng Vitamin E

May interfere or increase effects of anesthesia, discontinue 5 days before surgery Kava St. John’s wort Valerian

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Prior To Surgery/Surgery

For breast cancer have surgery during leuteal phase of still cycling has shown a better outcome.

High levels of MCP in the blood stream at surgery can reduce the risk of cancer being spread by the procedure.

MCP may interfere with chemotherapy. It should be taken midway between doses of chemotherapy

Probiotics

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Prior To Surgery/Surgery

Gotu kola is an herb that promotes wound healing by stimulating the manufacture of collagen.

Gotu kola also helps prevent adhesions Dosage: 50 -100 mg qd in capsules or tablets

Crude dried plant leaves:1-2 grams BID Tincture (1:5): 5 to 10 ml BID Fluid extract (1:1): 1-2 ml BID

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Proteolytic Enzymes

Can help recovery from surgery but should not be used prior to surgery since they can increase bleeding.

Reduces inflammation and swelling Can prevent lymphedema

Adamek, J., et al., “Enzyme therapy in the treatment of lymphedema in the arm after breast carcinoma surgery,” Rozhl Chir 1997; 76:203-4.

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Lymphedema

The best results occur when proteolytic enzymes are combined with complex decongestive therapy. This includes massage, compression wraps, exercises, weight loss, and skin care.

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Support For Radiation

Hodgkin’s disease, lymphomas and prostate, and maybe breast cancer respond to radiation.

Use aloe vera gel on areas of radiation. Vitamin A and beta-carotene benefit people

undergoing radiation therapy—reduces inflammation Lamson, D., et al., “Antioxidants in cancer therapy; their

actions and interactions with oncologic therapies,” Altern Med Rev 1999; 4:304-29.

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Support For Radiation (Continued)

Vitamin A can increase the effectiveness of radiation. Tannock, I., et al., “Vitamin A and the radiation

response of experimental tumors: an immune mediated effect,” J. Natl Cancer Inst 1972; 48:731-41.

Dosage: 75 mg of beta-carotene and 10,000 IU of vitamin A at least one week prior to radiation. Then use 15 mg of beta-carotene and 5,000 IU of vitamin A as a maintenance dosage.

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Support For Radiation (Continued)

Vitamin C is helpful during radiation. Side effects are fewer in patients given vitamin

C. Dosage: 1,000 mg TID

Hanck, A., et al., “Vitamin C and cancer,” Prog Clinc Cancer Res 1988; 259:307-20.

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Vitamin E

Vitamin E during and after radiation in animals enhances the killing power of the beam and reduces cancer cell division. Kagreud, A., et al., “Tocopherol in irradiation of

experimental neoplasms,” Acta Radiol Oncol 1981; 20:97-100.

Dosage: 400-800 IU

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Vitamins E And C

Studies have shown that vitamins E and C relieve chronic radiation proctitis including rectal bleeding, rectal pain, diarrhea, and fecal urgency. The treatment improved all of the symptoms except rectal pain.

Dosages: Vitamin E: 400 IU TID Vitamin C: 500 mg TID Kennedy, M., et. al., “Successful and sustained treatment of

chronic radiation procitis with antioxidant vitamins E and C,” Am J. Gastroenterol 2001; 96:1080-84.

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Curcumin And Quercetin

Curcumin and quercetin protect healthy cells against the harmful effects of radiation without decreasing its effectiveness. Decreases skin damage.

You do not need both. For head and neck cancer use: quercettin 200-400 mg For all other cancer use curcumin 200-400 mg. Continue for at least a month after the last radiation

treatment.

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Curcumin And Quercetin (Continued)

After this time, use the following: Curcumin: breast, colon, liver, prostate, skin,

stomach Quercetin: brain, leukemia, lung, lymphoma,

ovarian Castillo, M., et al., “The effects of the bio-flavonoid

quercetin on squamous cell carcinoma of head and neck origin,”

Am J. Surg 1989; 158:351-55.

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Maitake MD Fraction Or PSK/PSP

Use either maitake MD-fraction or PSK/PSP Dosage: Maitake: 1 mg per 2.2 pounds qd

PSK/PSP: 3000 mg Continue at this dosage until the cancer is in

remission, then cut the dosage in half

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Study With PSK

In radiation for non-small-cell lung cancer increased the five-year survival up to 39 % in stages I and II disease and 22% in stage III disease compared with 16% and 5%, respectively in groups that did not get PSK. Hayaka, D., et al., “Effect of Krestin (PSK) as

adjuvant treatment on the prognosis after radical radiotherapy in patients with non-small cell lung cancer,” Anticancer Res 1993; 13:1815-20.

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Melatonin Human trial: used 20 mg a day of melatonin with

radiation compared to radiation alone for glioblastoma.

At the end of one year, 6 of the 14 patients receiving melatonin were alive, compared with only one of the 16 undergoing radiation alone.

Also fewer side effects from radiation in patients taking melatonin.

Use 20 mg qd at bedtime one week prior to radiation and continue until cancer is in remission. Neri, B., et. al., “Melatonin as biological response modifier

in cancer patients,” Anticancer Res 1998; 18:1329-32.

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Alkylglycerols Alkylglycerols are compounds found in shark oil. Effects of alkylglycerols in the treatment of radiation-

induced leukopenia—helps prevent severe reduction of WBC and increases WBC production

Dosage: 1,200 mg a day for at least one week before and after treatment. 600 mg a day until normal WBC.

Alkylglycerols increase cancer survival rates. Bohult, A., et al., “Effect of alkyoxyglycerols in uterine

cervix,” Acta Obstet Bynecol Scan 1979; 58:203-7. Brohult, A., et al., “Reduced mortality in cancer patients

after administration of alkoxyglycerols,” Acta Obstet Gynecol Scand 1986; 65:779-85.

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Chemotherapy

Work of Kedar Prasad at the Center for Vitamins and Cancer Research at the University of Colorado Health Science Center’s Department of Radiology.

Cancer Centers of America

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Fish Oil Fish oil boosts immune function and prevents

cachexia Fish oil benefits anyone taking chemotherapy,

especially anyone receiving doxorubicin. Increases survival time and increases the

effectiveness. Dosage: 700-1,200 mg of EPA and 400-700 mg of

DHA Lamson, D., et. al., “Antioxidants in cancer therapy; their

actions and interactions wit oncologic therapies,” Altern Med Rev 1999; 4:304-29.

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Maitake MD-Fraction and PSK/PSP

PSK increased the survival rate in women with breast cancer undergoing surgery and chemotherapy, compared with control group.

Dosage: MD-fraction: 1 mg per every two pounds of body weight PSK/PSP: 3,000 mg qd.

Both should be taken on an empty stomach. Continue at this dosage until the cancer is in remission, then

cut dosage in half. Ilino, Y., et al., “Immunochemotherapies versus chemotherapy as

adjuvant treatment after curative resection of operable breast cancer,” Anticancer Res 1995; 15:2907-12.

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Curcumin or Quercetin?

Curcumin has been shown to increase the action of cisplatin.

Quercetin increases the therapeutic efficacy of busulphan, Adriamycin (doxorubicin), cyclophosphamide, gemcitabine, topotecan, and cisplatin Call me for refernces—are numerous

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Curcumin or Quercetin?

Use curcumin: breast, colon, liver, prostate, skin, stomach cancers. Also if using alkylating agents and platinum compounds for chemotherapy.

Use quercetin: brain, leukemia, lung, lymphoma, ovarian. Also use if antimetabolites, antitumor antibiotics, or microtubule and chromatin inhibitors are used for chemotherapy.

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Melatonin

Preliminary work: melatonin increases the expression of the p53 gene which signals apoptosis.

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Melatonin

Preliminary work: increases the expression of the p53 gene which acts to reduce cell proliferation by signaling apoptosis.

May regulate interleukins and gamma-interferon

May reduce the toxicity and enhance effectiveness of chemotherapy

Do not use in acute leukemias, children, or people taking anti-depressants.

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Melatonin (Continued) Studies in patients with solid tumors, melatonin has

been shown to enhance the effects of: cisplatin, etoposide, interleukin-2, interferon, tamoxifen, and lupron.

May reduce cachexia Increases survival in patients with brain metastases. Patients with stage IV cancers used with

chemotherapy had double the response and survival rates.

Dosage: 20 mg qd

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References

Lissoni, P., et. al., “A radomized study of immunotherpay with low-dose subcutaneous interleukin-2 plus melatonin vs. chemotherapy with cisplatin and etoposide as first-line therapy for advanced non-small cell lung,” Tumori 1994; 80:464-67.

Lissoni, P., et al., “Is there a role for melatonin in the treatment of neoplastic cachexia,” Eur J. Cancer 1996; 32A:1340-43.

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Shingles

Orally administered pancreatic enzyme preparations are helpful.

Studies show it helps as much as acyclovir.

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Hand-Foot Syndrome Is an adverse reaction to chemotherpay characterized

by reddening of the skin. Doxorubicin, cytarabine, docetaxel, and fluorouracil

are the most frequent agents causing this side effect. Can affect any area that is subjected to heat or

pressure. Redness may be accompanied by blistering, pain and

swelling. Skin peels Usually appears after two or three cycles of

chemotherapy.

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Hand Foot Syndrome (Continued)

Avoid not baths, saunas and heated whirlpools. No tight clothing Reduce exposure to sun Do above for one day prior to chemotherapy

and three to five days afterward. To help with symptoms—cool baths or

showers. Take vitamin B6 50 mg BID. Use aloe vera gel topically.

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NAC

Do not use during chemotherapy. May use after chemotherapy.

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Use of Alkylating Agents

Hydrotherapy, acupuncture and polyerga are helpful.

Use selenium—increases WBC and patients needed less transfusions

Use soy foods. Genistein increases the uptake of cisplatin into cancer cells.

Avoid dosages of vitamin B6 over 200 mg. It can interfere with platinum-containing compounds.

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Antitumor Antibiotics

Use coenzyme Q-10 100 mg BID. Improves heart function. Doxorubicin depletes the heart of Q-10. Q-10 prevents the cardiac toxicity associated

with antitumor antibiotics like doxorubicin. DGL helps mouth ulcers. Dosage: 400 mg to

800 mg between meals or 20 minutes before meals. Can dissolve in mouth, or crush and dissolve in water if needed.

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Antitumor Antibiotics (Continued)

Melatonin 20 mg qhs has been shown to normalized platelet counts. May also decrease size of tumor. Increases tumor-killing action of doxorubicin and decreases side effects.

Vitamin E may also reduce the toxicity of doxorubicin and enhance effectiveness.

Vitamin C may also reduce the toxicity of doxorubicin.

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Antitumor Antibiotics (Continued)

Quercetin has been shown to increase the concentration of doxorubicin in breast cancer cells. It reduces the concentrations in colon cancer. So use quercetin with breast cancer and use curcumin with colon cancer.

The use of green tea in animals has been shown to increase antitumor affect of doxorubicin.

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Antimetabolites

Avoid large dosages of folic acid if using methotrexate-not more than 800 micrograms.

If using methotrexate have patient use whey protein. The glutamine in whey protein increases the intratumor levels of methotrexate. Two servings of whey-protein smoothie, each containing 20-30 grams of whey.

Aspirin and other NSAID interfere with methotrexate. So does penicillin.

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Biological Response Modifiers

Patients who take interleukin-2 should supplement with melatonin. Dosage: 40 mg qd.

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Hormones and Antihormones

For breast cancer: If using tamoxifen avoid soy. For hot flashes: Clonidine patch or cream compounded.

Antidepressants like Effexor also work. For women using tamoxifen use melatonin—20 mg qhs.

Increases survival and decreases anxiety and depression. Tamoxifen can elevate triglycerides and cholesterol—use

vitamins C (500 mg) and E (400 IU). Use lycopene, I-3-C, calcium D-glucarate, and ground

flaxseed.

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Hormones and Antihormones

For prostate cancer: Use lycopene, calcium D-glucarate, I-3-C, and

ground flaxseed.

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Microtubule Inhibitors and Chromatin Function Inhibitors

Use polyerga. Use 40 to 60 mg of whey protein or 3-10

grams of glutamine qd.

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Hair Loss

Deficiencies of zinc, vitamin A, EPA/DHA, and iron can cause hair loss.

Watch with replacement of iron. Too much iron in the blood can promote tumor growth and worsen the side effects of chemotherapy.

Hypothyroidism can be the reason for hair loss.

Cortisol abnormalities can cause hair loss. Chemotherapy can cause hair loss.

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Coumadin The vitamin K in green leafy vegetables and green tea

can interfere with coumadin. Use a consistent amount.

Coenzyme Q-10, St. John’s wort, proteolytic enzymes, panax ginseng, devil’s claw and dong quai can increase coumadin’s effectiveness. May use but do not change the dosage.

Garlic and ginkgo may reduce the ability of platelets to stick together. Avoid higher dosages of both.

Iron, magnesium, and zinc can bind coumadin. Take coumadin and these nutrients at least 2 hours apart.

105

Case History

45- year-old women with stage IIA breast cancer.

What is work-up? How would you treat?

106

Case History

60-year-old male with prostate cancer. What is work-up? How would you treat?