Order Matters

By Jacob Schor, ND

Photo by Kanko* via Flickr, used under the Creative Commons License.

If order matters, what comes first?

The implications of a study published way back in February in Clinical Cancer Research have been stewing around in the back of my mind. It’s one of a growing cascade of studies in which researchers at fairly mainstream medical institutions reveal that they’ve been playing with stuff that’s standard fare on a naturopathic doctor’s dispensary shelves.

In this instance we are talking about researchers from the Mayo Clinic in Minnesota playing with various combinations of curcumin, an extract of turmeric and green tea, and seeing how they affect lymphocytic leukemia cells.

As much as we still occasionally hear and read the myopic criticisms of our profession that claim our therapies are not backed by research, this study is just one of many. A PubMed search just now of the National Library of Medicine’s published scientific literature on curcumin and cancer yields a list of 1,265 articles. A search on green tea and cancer yields 1,338 published papers in the peer reviewed journals.

This particular study was similar to many others; cancer cells were grown in a laboratory, exposed to the ‘natural’ ingredient, and the degree to which growth was slowed down or that cancer cells were inspired to drop dead was measured. In this particular experiment, chronic lymphocytic leukemia B cells were the targets. Nothing unique about this setup.

And no surprise that the curcumin was found potentially useful. Here let me quote from the results in the abstract and then translate the interesting parts:

“Curcumin induced apoptosis in CLL B cells in a dose-dependent (5-20 micromol/L) manner ...”

‘Apoptosis’ is when a cell decides life isn’t worth living and self-destructs. Curcumin convinces these leukemia cells to commit suicide. The more curcumin added to the cells, the more died.

“Coculture of CLL B cells with stromal cells … decreased sensitivity to curcumin.”

Adding some other cells, stromal cells, into the mix decreased the curcumin effect; fewer cancer cells died.

“When curcumin was administered simultaneously with EGCG [green tea], antagonism was observed for most patient samples.”

Adding green tea extracts along with curcumin to the mix of leukemia and stromal cells caused, what these scientists called ‘antagonism.’ That’s an odd term and you need to view the full text article to get an idea of what they mean by antagonism. Put simply, the combination of the two natural substances, green tea and curcumin, didn’t work as well as predicted: “… simultaneous culture had a less than additive effect.” That is if you measure the anti-cancer effect of each substance separately, you can add the two ‘effects’ together to predict what should happen when both are used simultaneously. It turns out they don’t work as well as predicted; they antagonize each other.

“In contrast, sequential administration of these agents led to substantial increases in CLL B-cell death ...”

When instead of adding both curcumin and green tea to the culture at the same time, the cells are instead exposed to one agent and then the other, the story changes completely. They tried treating the cells first with curcumin followed by green tea, and vice versa. To quote the authors, “… sequential administration led to dramatically more leukemic cell death than simultaneous administration.”

Not only did exposing the cancer cells to these substances one at a time matter, but order mattered as well. Green tea first, followed by curcumin, worked much better than if the cells were exposed to curcumin first.

Think about the implications this brings to our practices. Sequential administration of treatments may work better than simultaneous treatments. Order matters. In this case green tea works better first.

Typically in practice we pile a bunch of different substances into a patient’s blood stream on the assumption that each has a specific action and these effects will add together. This reminds me of those combination locks that have four or five parallel numbered rings and to open the lock. You line up a number on each ring, get all the right numbers in a row at the same time, and the lock opens.

This leukemia study makes that image obsolete. If sequence matters, just knowing the combination is no longer enough. This is more like the dial lock on a safe. Sequence is essential. Three turns to the left and stop on the right number, then turn the dial to the right past your first number and stop on another specific number. And so on…

Think about this: our cancer patients often take a long list of supplements. This study suggests that, at least in chronic lymphocytic leukemia, we should start them on green tea for a period of time and then switch to curcumin. What if it is a similar story with quercetin, resveratrol, sulforaphane, vitamin D, melatonin and so on? What if there is a ‘best sequence’ for all of these? What if that combination were to vary by cancer? By patient? Or even by dose?

This is worth stewing about. It makes me think of certain patients who tell me they vary what supplements they take day-to-day based the way a pendulum held in their hand swings. Though this sounds less than ideal, it can’t work any worse than flipping a coin to decide on a sequence, which for the time being may still be of some utility.

Now that this study has been published, we shouldn’t be surprised to see other studies up asking this question: “If order matters, what comes first?”

Ghosh AK, Kay NE, Secreto CR, Shanafelt TD. Curcumin inhibits prosurvival pathways in chronic lymphocytic leukemia B cells and may overcome their stromal protection in combination with EGCG. Clin Cancer Res. 2009 Feb 15;15(4):1250-8.

Will Asparagus Cure Cancer?

By Jacob Schor ND, FABNO

Photo by La Grande Farmers' Market via Flickr, used under the Creative Commons License.

If you have cancer, you have likely read that asparagus will cure it. A letter gone viral online claims this. If you haven’t seen it yet, it’s only a matter of time until a copy is forwarded to you by some well-meaning friend or relative.

Those of us who specialize in naturopathic oncology hear about this asparagus business often from our patients, many of who assume the information is true. It’s not.

There is no reason to believe that asparagus will cure cancer. It may actually make a few cancers worse.

Here is what we do know about these claims:

The “Asparagus Cure for Cancer” first appeared in print in the February 1974 issue of Prevention magazine. A second, similar article was printed in the December 1979 issue of Cancer News Journal, a magazine once distributed in health food stores. Both articles claim that a dentist named Richard R. Vensal discovered that eating asparagus could cure cancer.

According to the letter, a cure can be achieved by consuming four tablespoons of pureed cooked asparagus twice a day. Improvement is supposedly seen in two to four weeks.

Unfortunately there is little reason why we should believe this information. Richard Vensal never had anything published to substantiate this claim.

There is one study from 2009 that suggests asparagus has an anti-cancer effect. Chinese researchers reported that a chemical, which they named asparanen A, showed an anticancer effect when added to liver cancer cells.ⁱ

No studies describe the results of feeding asparagus to animals with cancer. Nor are there any published clinical trials on giving asparagus to human cancer patients.

It is certainly widely understood that diets high in vegetables are anticancer. Yet no evidence singles out asparagus in particular, suggesting it has an anticancer effect. There may be some health benefits from eating asparagus because it is a vegetable, but there is little reason to think that asparaguses are special.

In contrast there is substantial information on the anticancer effect of other vegetables. For example, a current search of the National Institute of Health’s National Library of Medicine, lists 597 published articles related to the anticancer effect of broccoli.ⁱⁱ A search for published papers on garlic and cancer yields 648 references.ⁱⁱⁱ

There are only two clinical trials involving asparagus and humans. One paper published in 2009 describes a study in which patients with high blood pressure took a combination of parsley and asparagus extracts in the hope that their blood pressure would go down. Unfortunately, no effect was seen.^iv An earlier study published in 2008, reported that a combination of asparagus and elderberry extracts helped patients lose weight.^v Losing weight is not curing cancer.

While there is little reason to think that asparagus will cure cancer, there is good reason to think that asparagus may make some cancers, in particular acute lymphoblastic leukemia (ALL), worse.

There is a long established link between asparagus and leukemia. In 1953, John Kidd discovered that blood serum taken from healthy guinea pigs, if injected into mice, killed leukemia cancer cells.^vi It wasn’t until ten years later that John Broome explained why. Guinea pig blood contains an enzyme called l-asparaginase, which breaks down the amino acid l-asparagine. Healthy cells make l-asparagine, but certain leukemia cells do not. These leukemia cells must rely on nearby healthy cells to supply them with l-asparagine. The enzyme in the guinea pig blood breaks down the needed l-asparagine depriving the cancer cells of this chemical that they need to grow.^vii

L-asparaginase enzyme is sold as a drug (Elspar) and is now part of the standard protocol used to treat acute lymphoblastic leukemia (ALL). Taking the drug decreases l-asparagine and starves the cancer cells. Most types of cancer do make l-asparagine, so Elspar is only useful in treating a few specific cancer types.

As the names hints, asparagus contain l-asparagine. Eating asparagus would seem ill advised for people who have cancers that respond to l-asparaginase. This enzyme may be useful in treating lymphoma and multiple myeloma.^{viii ix} Eating asparagus may make all of these cancers grow faster, most especially ALL.

People diagnosed with cancer are often desperate to do everything in their power to fight the disease. They grasp onto every story and rumor about anything that might possibly help them. The myth that asparagus cures cancer is a good example. Eating daily doses of asparagus will not cure anyone. Some of these people may actually worsen their situation.

A wiser course of action than believing everything you read online would be to consult a medical practitioner who specializes in naturopathic oncology. There is ample knowledge and evidence that dietary changes and specific foods and supplements may be useful in fighting cancer. It makes sense to base these diet and food choices on evidence and knowledge rather than web-based ‘urban myths.’ When you need specialized knowledge go to a specialist.

The Oncology Association of Naturopathic Physicians (OncANP), an affiliate of the American Association of Naturopathic Physicians, lists naturopathic doctors who specialize in caring for cancer patients on their website: www.oncanp.org

This group tests and provides board certification in naturopathic oncology to those members who meet specified standards of education and experience.

If naturopathic physicians are specialists in natural medicine then OncANP members are specialists in using natural medicine in an oncology setting.

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ⁱ Liu W, Huang XF, Qi Q, Dai QS, Yang L, Nie FF, Lu N, et al. Asparanin A induces G(2)/M cell cycle arrest and apoptosis in human hepatocellular carcinoma HepG2 cells. Biochem Biophys Res Commun. 2009 Apr 17;381(4):700-5.


ⁱⁱ To search yourself, go to: http://www.ncbi.nlm.nih.gov/pubmed?term=broccoli%20and%20cancer


ⁱⁱⁱ To search yourself, go to: http://www.ncbi.nlm.nih.gov/pubmed?term=garlic%20and%20cancer


^iv Chrubasik S, Droste C, Black A. Asparagus P(R) cannot compete with first-line diuretics in lowering the blood pressure in treatment-requiring antihypertensives. Phytother Res. 2009 Sep;23(9):1345-6.


^v Chrubasik C, Maier T, Dawid C, Torda T, Schieber A, Hofmann T, Chrubasik S. An observational study and quantification of the actives in a supplement with Sambucus nigra and Asparagus officinalis used for weight reduction. Phytother Res. 2008 Jul;22(7):913-8.


^vi H. D. Moon Presentation of the Gold Headed Cane to John G. Kidd. February 24, 1973. Am J Pathol. 1973 October; 73(1): 1–6. PMCID: PMC1904051
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1904051/pdf/amjpathol00248-0005.pdf


^vii Broome JD. Evidence that the L-asparaginase of guinea pig serum is responsible for its antilymphoma effects. I. Properties of the L-asparaginase of guinea pig serum in relation to those of the antilymphoma substance. J Exp Med. 1963 Jul;118:99-120.


^vii Jaccard A, Gachard N, Marin B, Rogez S, Audrain M, Suarez F, et al. Efficacy of L-asparaginase with methotrexate and dexamethasone (AspaMetDex regimen) in patients with refractory or relapsing extranodal NK/T-cell lymphoma, a phase 2 study. Blood. 2011 Feb 10;117(6):1834-9. Epub 2010 Dec 1.


^ix Taylor CW, Dorr RT, Fanta P, Hersh EM, Salmon SE. A phase I and pharmacodynamic evaluation of polyethylene glycol-conjugated L-asparaginase in patients with advanced solid tumors. Cancer Chemother Pharmacol. 2001;47(1):83-8.

What I Learned From My Nursing Colleagues

By Marica Prenguber, ND, FABNO


Photo by *Sally M*, via Flickr, used under the Creative Commons License.

As the year end rapidly comes upon us, I am assessing the work I have done toward achieving both personal and professional goals that I set out for 2009. One of the goals that I had established was to better understand what the day to day experiences are of the nursing colleagues in the infusion room of the cancer center in which I work. So I spent a few hours with them in the past couple of weeks (and yes, although the goal was made for this year, I still managed to put it off until December 2009). I am so glad to have spent that time with the infusion room nurses, and been able to better understand what their perspectives are in working in that environment with folks who are undergoing chemotherapy as part of their treatment program for their cancer diagnosis.

Although I work with this same group of patients, my work brings me somewhat different experiences with these patients. So, during part of the time that I spent with these remarkably dedicated nurses, I asked them many questions, including why they do this work – in oncology. Universally they shared very similar reasons. Each of the nurses with whom I spoke told me that they chose oncology because they felt that they could make a difference in someone’s life – in the lives of patients who are going through very difficult situations. And that is helps them to keep their own lives in perspective – to keep a measuring stick against their own trials and tribulations.

I asked about their fears – working in this environment. (It’s very common among folks who work in oncology, at some point, to be very concerned about a symptom that we experience that makes each of us wonder if we have just found the first symptom of a cancer within us.) The vast majority of these nurses are of child bearing years – and the vast majority of them have either been pregnant or their partner has been pregnant at some point during their years working in the infusion room. They all shared that they have feared a specific cancer diagnosis at one time or another, and even now ponder what type of cancer it may be, if not today - then one day. Yet it has never caused them to consider switching to another department. Despite their newborns, their toddlers, their growing children waiting at home for them everyday. Their work with these patients is too much a part of who they are to allow their fears to take over. And still they take the emotional disappointments and triumphs home with them.

What about the frustrations? The loss that comes with the territory – getting close to patients that come in regularly for their treatment, and the family members that come with them, and the battles that are lost. Many shared that come to know the families well – often spending 6-8 hours caring for a patient (and family members!) each time they come in- you get to know them pretty well. Suffering and loss with a relationship that has developed through difficult times over weeks and months can be very painful.

And they still say the good outweighs the difficulties. They have learned to personally be “more spontaneous, to appreciate health (their own) more, and to live on a day to day basis rather than living for the future – appreciating family and friends, and not to live in fear.” They are inspired by these patients – patients who face such challenging situations and yet have such great attitudes – how they get up every day and face the challenge. It seems to me that these nurses do the same - and for this I admire them. I am certain that we all have challenges that make us better, but I am in awe of these RNs who look those issues square in the face every day, and although they drop some tears along the way, they never turn their back on the challenge.

I am fortunate to be able to work alongside an impressive and inspiring group of people. And am happy to be able to have accomplished this goal for 2009, and hope I am better for it. Hoping not to sound too philosophical, I do think it’s important to set goals, personal and professional, and evaluate them at year’s end. Maybe it is just the former school teacher in me, but there is so much to learn and to allow ourselves to be inspired by - with every experience. So my advice for 2010 - set some goals – the research tells us that those of you who do, achieve more, and are happier! Goals provide a focus and enable you to measure your progress. I have read that goals are motivating, and I would agree – it may have taken me until December – but I got it done! And am so glad that I did.

Happy New Year.

Here's An Easy Tip For Curing Cancer

By Shiva Barton, ND, LAc
2011 AANP Physician of the Year

Photo by esmtll via Flickr, used
under the Creative Commons License.

So now that I have your attention, you hopefully know that there are no natural cures that have been researched well enough to state that they can cure cancer of any kind. Yes, isn't it interesting that there are no known natural cures for ANY TYPE OF CANCER! Is this because there is nothing out there that works or because the scientific/medical community hasn't put the resources into finding the cure? I don't know the answer to that. Time will tell.

However, there are definitely things that you can do to improve the outcomes and help the survival of cancer patients. I am focusing on one of those treatments, below. If you are like me, you probably see many patients who have cancer. Some of you choose to treat people with cancer and some of you don't. I encourage all of you to treat these patients because there is so much that we can do to help these patients have better outcomes. Sometimes EXTREMELY better outcomes. That is what I want to share with you now.

As you may know, (if you have attended any recent Clinical Anecdotes sessions that I have moderated at either the AANP or NHAND conferences) I am very interested in periodic fasting for health improvement. I am particularly interested in periodic fasting to improve outcomes of patients who are undergoing cancer treatments, specifically chemotherapy. There is emerging research that doing alternate day fasting or a pre-fast before chemo enhances the effectiveness of the chemo while protecting the normal cells and reducing the side effects. This is what I have been doing with my last few cancer patients with great success. Here's an example with my latest case:

A 50 year old man came to see me 2 weeks after being diagnosed with stage 4 duodenal carcinoma that had spread to the liver. Prognosis for survival was 2 months (Christmas 2011). He was scheduled for 4 rounds of chemo (once every 2 weeks) which would have taken him to his drop dead date. Clearly, his oncologist didn't have much hope but thought something should be done. The patient had one chemo treatment before seeing me. After learning what chemo he was getting I suggested some of the supplements recommended in Lise Alshuler's book, The Definitive Guide to Cancer. (This is an indispensable book and I strongly urge you to get a copy.) In addition, I recommended that he fast for 24 hours, starting from 24 hours before the end of his chemo the following day. To clarify, his chemo infusion ends on Friday at 2pm. I recommended that he fast from Thursday at 2pm until Friday at 2pm. In addition, I recommended that he fast daily from after dinner until noon the next day.

So, here is what happened. A PET scan was taken at the 6 week mark. The tumors had shrunk "significantly" (30 -50%). The oncologist was stunned (said they never see that kind of result), the patient was happy (doh!), and I was inspired to write about it in this blog. Now, I can't say for certain that it was the fasting that had the biggest part in the response. But it is a potentially powerful tool that is non-toxic, inexpensive, "easy" to do and mimics our natural prehistoric seasonal cycle of times of plenty (building cells) and times of famine (breaking down cells). Sounds uniquely naturopathic to me and it could save many lives. That’s why I am encouraging all of you to treat patients with cancer and to use this treatment to improve their outcomes of their chemotherapy. It could help to change lives.